News not related to hospitals, even though it is malaria season

Millet growing in my concession

Part of the winnowing process

The millet, stored on its stalks. This is in Narba's concession, with millet from the family's fields.

Other news that isn't related to hospitals! Let's see. Harvest is in full swing. Beans beans beans, everywhere. And millet. Yesterday a woman gave me an entire bucket of green beans which were sooo good and fresh. It's hot again, and we have fewer rains to cool us off, so I spend a lot of time looking for shade.

Malaria season is upon us--started a few weeks ago and will continue for several more. Malaria season sucks, and if I could think of a more powerful word than "sucks" I would use it. Every home I visit has someone down with malaria. Lots of kids have it; in my close family circle, which includes 12 kids under the age of 12, 4 have malaria this week. Two of them got meds from the clinic a couple miles away; the other two haven't gone yet. I realize that all of my messages to you guys for the last month have been semi-bummers. It is a fitting tale...this time of year is tough, and there's no way around it. Sick people, hot weather, mosquitoes.

But we're all hanging in there, treasuring the lighter moments--such as:

Two days ago I walked around (verrrry slowly) with Abarta, an old lady and former women's leader. She's awesome--even-tempered, candid, and logical, a good leveler for my sustained mild sense of panic of the last few weeks. She also doesn't see well, but she knows my voice, and we've become friends. Anyway, we shuffled around Foloa, and she told me why she chews tobacco. She made a convincing argument and I did not counter it. Her gums hurt from where her teeth fell out, and tobacco is the only thing that soothes them. So there.

An unplanned trip to Illela (Part 2)

9/17/09

So. This morning was the longest time I've spent at the infant malnutrition ward. There are five women staying there right now: Habi (in her 3rd week!) with daughter Samsiya, Salamu with son Abu Zaidi, and three women with their babies from other bush villages. One of the women has eight month old twins; one is a normal weight and well developed. The other, a little boy, has bright eyes and seems alert but weighs less that 2 kilograms. While these women stay at the hospital, they are under the stern but compassionate eye of Nurse Hajara. Hajara administers medicines, weighs the babies every day, tells the mothers when and what to feed them. Depending on the age and ability of the babes, they are fed fortified milk, or a peanut-butter like paste, or a combination of the two. Babies who won't drink are force fed; babies who will eat eventually get fed bits of fish and egg. When they reach a weight and health that Hajara approves, they are allowed to go home. Everything is paid for by the government.

When Habi came with 5-month old Samsiya 2 weeks ago, the top of Samsiya's skull was so sunken in you could have filled it with a half cup of water. She weighed 3.8 kilograms (sorry guys, how much is that in pounds? 8?). Today I got to watch Hajara weigh her again- she is now a whopping 4.0 kilos and will be released when she makes it to 4.3. Hajara said that Habi is the best of all of the mothers at making sure Samsiya is getting better. I was really, really happy to hear that. Salamu was smiling this morning; Abu Zaidi already looks better. She told me today that he had passed out three times yesterday, and she thought he had died. But now he's drinking canned milk and getting a whole smorgasbord of medicines and vitamins. It is too soon so guess at how he will do, but I sure do trust Hajara, and I think she'll know what to do for this babe. Habi and Samsiya will probably be home within the week, and hopefully Salamu and Abu Zaidi won't be far behind.

Some of you who read this blog last year may remember that September, October, and November were hard months for mothers and babies. One difference this year is that women seem more aware of where they can get help. It could be my imagination, but I think that perhaps some of the negative stigma- associated with revealing that your child is malnourished- is fading in my village. I hope so. I'll probably write about this again; I sure think about it a lot.

Toothbrushes!

Here is the headmaster, Shaibou, giving a lecture on dental hygiene to a primary school class. We handed out toothbrushes, courtesy of my generous dentist in Corvallis, to over 200 village students.

Shaibou insisted that the students raise their new brushes into the air for the photo-hence the salute. We salute you, Dr. Kendall Wood! Thank you!

Last days with the docs

Here are Tuni, Fatima, and Zeinaba. Zeinaba and Tuni came with me all the way from Foloa to see if the doctors could do some work for Zeinaba. The woman in the middle is a friend of theirs who lives in Niamey and came to visit them in the courtyard.

In the last two days of the mission I translated for Ramatou, Hamsa, Rachida, Halima, and Miyeba. Ramatou is a forty year old Beriberi woman, from a village way out east. I didn't have Hwanta to translate the Beriberi into Hausa for me, so this was another very mime-y surgery. She had a fistula repaired, and was looking good in recovery this morning! Hamsa is a Zarma woman in her twenties, and again, this was a multi-lingual event! Zarma, Hausa, English, Doctortalk.

Rachida, one of my 8 year old charges, was put under anesthesia as well yesterday, but only for an exam. I dressed both her and her mother up in scrubs, so they could be together before the drugs were administered. Long story short, the doctors determined they can't operate on her here; she may be another candidate for an over-seas operation. Maybe one day. We can dream.

Halima is a twelve year old girl from Zinder (a 13-16 hour bus ride east), who came here all by herself. She is a bright and intelligent child; you can see it in her eyes. She listens. Her history is violent, and when combined with her complicated anatomical issues the doctors decided surgery was too risky this time around. Halima has a Peace Corps Volunteer in her village out east who'll keep an eye out for her.

Last but not least, Miyeba! Miyeba is the only woman who speaks her language in the entire hospital. She's Gourmance, an ethnic group from the Nigerien border with Burkina Faso. The Gourmance are known for their distinct language, filing their teeth into points, having short unbraided hair, and for not conforming to Islam. Miyeba is dark-skinned and observant, and she must be awfully brave and independent to have made it here without any common language. She'd had her urethra cut by a traditional doctor who was trying to increase the size of her vagina; we've had a few cases like this. (It is not the same as genital mutilation, in which the clitoris is cut.) This being my fourth or fifth time translating for a patient whose language I don't speak, I was a lot better at communicating stuff to her. Her surgery was quick- about 2 hours- and hopefully successful.

And that's the end of that. The doctors leave tonight at midnight, two days ahead of schedule. I really enjoyed working with most of them, and am proud that they're Americans! They did a lot of incredible work here, and changed the lives of many a girl and woman. I'll continue to go to the hospital to check on the post-operative women for a few days, but the translating is all over. Thanks for checking in.

We're tired today

I'm a zombie today. I need to get more sleep! Will work on that. In other news: today was slow for me, because most of the patients were Zarma speakers. I translated for one woman this morning, Maimuna. She's a 26 year old Tuareg from Agadez, and she only speaks Tamachek. So, I did alot of miming and smiling, nodding and holding of hands. One of the male nurses in the room is Tuareg, so I could call him over for help when something significant was going on. Otherwise we were pretty quiet.

Maimuna is a gorgeous woman- smooth, golden skin, straight black hair, big black eyes. She was pregnant with her first baby last year; after a 6 day labor the baby was removed, stillborn. She is a small person, very slight, and impossible not to notice. She's here with a few other Tuareg women; they are captivating and warm, and always greet me even though we share few words in common. The surgeons said her fistula is the worst that they have seen yet, but they also said they were able to do a lot of good work on her. I visited her in recovery this evening; she was surrounded by three Tuareg women and two Tuareg men. The men spoke Hausa, so I was able to talk directly with them, which was great. They wanted to know if they could give her yogurt (what is it with men giving women yogurt? Or is this a coincidence?). I like Maimuna's family.

I've continued to have some interesting conversations with the anesthetist. He's been observing some pretty fascinating differences in the ways Nigerien women react to surgery, anesthesia, and pain medication, relative to the way American women react. He says the Nigerien women, hands down, require fewer meds of lower strength, and do not seem to suffer many of the side effects that Americans have. Examples: American women get itchy and scratch alot when they get spinals. Nigeriens do not. Americans get more headaches and neckaches from spinals. Nigeriens don't get very many. Americans feel pain sooner and request sedatives, Nigeriens tend to bear it all. The anesthesiologist showed me all of these pain meds he expected to be running out of; he hasn't even opened most of them! Also, when we do rounds to visit the women in recovery, we keep finding women who haven't even started taking their pain meds yet (there is no nurse to dispense meds, and so the women have to keep track of all of their antibiotics, Percoset, Advil etc. ) They are in pain, but they wait until we come by to start taking them-- these are women who just had all sorts of crazy surgery, and they're not even taking Tylenol! Take that, pain! It's very humbling. I have vowed never to complain about an annual exam, ever again. That's small beans, ladies. Very small beans.

There's more. I was told this afternoon to go tell Bichara (one of my 8 year old girls) and her mother that she'd be getting surgery tomorrow. I went, I told them, I gave them the whole pre-op shpeel. And then, not a half hour later, I was told that no, never mind, she will not be getting surgery. I.was.so.pissed. I won't go too much into the details of all of this, but I will say that if the doctors had put their heads together and been honest from the beginning, they could've told this girl last week that surgery wouldn't happen this time around. Instead, they made promises they couldn't keep, and as a result this girl and her family have spent a week living at the hospital expecting surgery. I insisted that the surgeon come with me to break the news, because she is his patient, and she deserves to be told by him. It really sucked. But, Bichara's mom Eki is a tough and composed lady, and she was as gracious as you could expect. Bichara, by the way, has gotten less shy around me and now holds my hand when I'm nearby. I got their phone number, and will try to get Bichara's name on the list for the next round of surgeries, in October. There is some talk of trying to fly her to the US for surgery, because she needs some very specialized work, but I don't know if that will go beyond just talk.

And now, this zombie needs some rest. More news to come. Thanks again, to everyone who reads this blog! It means alot to me to know you're out there.

Another day in surgery

When we finished today, after 11 hours in the chilly, sterile, beige-and-seagreen world of the operating room, the other translators and I crammed into a taxi and realized we look realllly ragged. We had many laughs at each others' expenses. (expenses? sure) But we sure clean up well. Yep, we clean up well, and then we go to bed and sleep like rocks. It feels good to do good work.

So, today: I translated for Rabi, Fatima, and Joumare. Rabi is 20, a stoic, composed young woman who stayed calm through her whole surgery, which took all morning. She barely said a word, and managed to sleep for awhile (with no extra meds). Her biggest (and best) reaction was the giant grin she flashed us when I told her that the surgery went perfectly. Yay!

Rabi was similar- she's 18, and has been through 3 previous surgeries. She knows the drill, and hardly flinched when they gave her the spinal. I was very impressed. She slept (again, no extra meds, just the spinal), so I chatted with the anesthetist about all of the different types of doctors. Rabi's surgery went very well!

Joumare is Fulani, and she speaks both Hausa and Fulfulde. She's one of the most amiable people that I know-- so easy to be around, and interested in the world, and one of those people you look forward to seeing. I met her at the beginning, when I was going around meeting all of the women; she stood out partially because of her ethnicity and appearence, but also because of how warm she was to me. I mentioned her earlier, after doing her interview. Joumare is probably in her 40s, and lives in Agadez. She has one grown son who's a tailor and jewelry maker; she's selling some of his stuff iin the hospital courtyard (it's very pretty!) Joumare's fistula started 3 months ago, after she had a hysterectomy performed. During her surgery today, we found out that the reason she was leaking urine was because whoever did her hysterectomy stapled her bladder (by accident? on purpose, stupidly?), leaving it with a bunch of holes. After a whopping 5 hours in surgery, Joumare's bladder is as good as new. Awesome! Next on the list for her: nutrition. She needs to put on a few pounds.

All of you Wisconsin family folks will appreciate the conversation Joumare and I had during her surgery-- she told me how to make cheese, Fulani style. The Fulani's are herders, milk sellers, cheese makers: she knows her cheese. Joumare rules.

Happily, all of my translations today were happy stories. I was a busy bee for awhile there; there were about two hours when both Rabi and Fatima were getting worked on, so I kept going back and forth to sit with each one. There was one rough moment this morning; when the surgeons opened up a Zarma woman on the table next to ours, they found a lot of cancer in her abdomen. They cut some of it out, but not all of it, and they weren't able to operate on her fistula. It is hard to know something like that before the person herself knows. I don't know how I would tell her that news.

What else. We had some unfortunate news this morning- the doctors may be leaving a few days early to avoid a strike that's about to happen at the airport. They're worried that if they don't leave early they'll get stuck here. I know I am biased, but I wish they would just stay...I know it would screw up their plans and schedules at home if they weren't able to leave right away, but just think of all of everything they could do here! I am dreading telling dozens of women that, in fact, they won't be getting that surgery that they were told they'd get. Not a cool situation.

Further bulletins as events warrant. In the meantime-- thank you for reading! Celebrate your health!

What Sahara went through

Today was alright. I translated for my first surgery. The doctors are doing all of the most complicated surgeries first, so the women have more time to heal while the doctors are still here. So I got in at 8 and right away jumped into surgery clothes (scrubs, plus funny hairnet and boot covers and face mask and goggles), and brought Sahara in for surgery. Her story, the more I think about it, brings up red hot anger from the pit of my belly, and I despise whoever did this to her. She's probably about 15 years old. She was married at age 10. She was pregnant and had her baby at age 12. Her labor lasted five days; her child didn't survive childbirth. And she was left with a gaping hole from which she leaked feces and urine, as well as damaged nerves in her left leg. I hate thinking about what she went through.

So that is the worst part. The best part is that three months ago, she came to Niamey (all by herself, no family with her, not to mention her husband. Where is he? Does he even know what happened to her? Does he care? I'm sorry to lash out like this, but not sorry enough to not do it. Where is her family?). And today, three surgeons performed surgery on her for five hours-- they took some muscle from her leg and used it form a 'sling' that will hold her urethra up so she won't leak (which they accessed through the vagina and a hole they cut in her abdomen), and then they cut out a bunch of scar tissue and reconstructed her rectum. They said that everything went as well as they could have hoped, and are confident that she will see a major improvement. They gave her an epidural, so she was only numb from the waist down. For the first hour she was really anxious (so was I), and it didn't help that we had no sheet to keep us from seeing what the doctors were doing. She started to get more panicky, so I asked her if she'd like to be more sedated, which she did. The anesthesiologist gave her some meds to keep her drowsy. I stayed with her, anyway, because every once in awhile she would be more lucid and I didn't want her to feel alone. Now she's in the recovery room, on lots of pain meds, with an ice-pack I made out of three bags of frozen juice. Please send Sahara some comfort and some love.

After surgery I went back to our little meeting room and laid down for a long time. Eventually I went back out to talk with some of the women awaiting surgery, many of whom are making stacks upon stacks of beaded bracelets while they wait. I will buy tons and tons of them, to bring home and give to you all, who are helping by just thinking of us over here.

And that is what I did today.

Fistula Days 2-3: Exams

Today and yesterday were full days. We did, I think, at least forty exams each day. An exam is like an annual exam but waaaay worse in every possible way. The women are poked and stretched and prodded, in order to determine why and where they're leaking. For anyone who wants more details on this, I can tell you about it later.

Yesterday I translated for Bachira, Mariama, Sakina, Joumare, and Tawra. Our responsibilities as translators are to help the women change into hospital gowns, bring them into the examination rooms, be with them throughout the exam (takes 30-60 minutes, sometimes longer), and translate for them the whole time. It requires some new Hausa vocab, to say the least.

Today, I had Fachima, Habsatou, Bintou, Fatima, Sa'a, Habi, Nana Hanatou, Rachida, and Djaliatou. My mind is full of their stories and I'm finding it hard to concentrate on writing about anything-- I want you to know everything, but there's just so much. I will start, I guess, and see how it goes.

Habi is seventeen years old. She's beautiful, with dark eyes and a large, careful smile. She knows 'hello', 'how are you', and 'i'm fine'. She limps, because her nerves in one leg got damaged during labor. Habi was pregnant at age 13, and had one son, stillborn. She has had several surgeries to correct the leaking of urine and feces; she no longer leaks feces but continues leaking urine. She has lived at the hospital for a few years. During her exam today, the doctors decided that they will not operate on her, because she has too much internal scarring, and the surgery is unlikely to succeed.

Bintou is twenty years old. She is serious and direct, and came from a village from way out east. She has never been pregnant or had a child. She leaks urine because her urethra was cut in order to enlarge her vagina. Her clitoris is intact. The doctors will perform surgery next week.

Nana Hanatou is in her early forties. She talks a lot! I ask her one question and her answer deviates all over the place, ultimately being about her grandchildren. She leaks urine, but it turns out it's not because of a fistula. After doing a bunch of tests (and putting an IV of indigo into her hand, which was pretty fascinating for me and her to watch), the doctors determined that she has an easily reparable condition in which one of her ureters (sp?) runs to her uterus instead of wherever it's supposed to go. Anatomy. She'll get surgery in a week.

Joumare is older, maybe in her fifties. She has one grown son who is a tailor. I don't remember the details of her fistula, but I do know that she's going to get surgery next week. The doctors said they won't perform it until she beefs up a little; she's very slight and malnourished. They're going to give her power bars! She was pretty excited about that. She also said she's going to bring me some new clothes.

Fachima is twenty years old. She is petite, not even 5 feet tall, and is quick to smile. She shouts my name every time she sees me. She had one daughter last year, stillborn, after three days of labor. Her bladder has a large hole in it, so the doctors aren't sure surgery will work; they estimated 60% chance of success. They'll try tomorrow.

Some other women are here who don't have fistula, exactly, but other gynecological/pelvic/obstetrical/rectal issues. Today I translated for a woman with stress incontinence, one with a fallen uterus, and another with a large hernia.

Fistula Day 1: All personal

Today we gathered medical histories on all of the women and girls. The term 'medical history' used to sound so impersonal to me-- it seemed like a neutral term, the simple compilation of facts. But now I see that it's all personal, and it requires you (the translator) to ask a lot of sensitive questions.

Such as: When did you start leaking urine? Do you also leak feces? Is it constant, or only when you're walking? What caused your fistula? Was it after childbirth? How many children have you had? How many are living? How many were stillborn? Are you married? How old were you when you got married? How old were you when you had your first baby? Do you still sleep with your husband? Have you had surgery before? Did it work?

Depending on what the answers are, a person can feel really, really shitty after telling them to a total stranger.

And this first day I definitely felt like a total stranger. A real jerk, for coming in and asking too many questions about things that I perceived as upsetting. How does a person learn, in question #26, that a woman has given birth 4 times and lost all 4 babies, and then move on to question #27 and ask whether they were boys or girls? And then on and on.

I talked with some of the women about this. Well, I wasn't 'talking' about it- I apologized for it. And without exception, they all said "We're here to get better, we'll tell you everything, don't worry about it". So. I did my best to be private and gentle with these sharp questions.

Fistula Mission

Yesterday I started doing translations for obstetric fistula patients at the National Hospital in Niamey. I'll be here for this work for two weeks, so you'll hopefully hear from me much more frequently (daily internet access! holler!).

Obstetric fistula is a condition most often caused by prolonged childbirth. Simply put, fistula is a hole between the bladder and the vagina or the rectum and the vagina, which leads to the leaking of urine and/or feces. Women develop obstetric fistula when, after being in labor for a very long time, their internal tissues begin to die because of lack of oxygen. My understanding is that the weight and pressure of the fetus essentially crushes the woman's organs, which begin to disintegrate. Prolonged labor is more often seen in young girls; their bodies aren't fully developed and are not ready for childbirth. When I say prolonged labor, I mean 2 to 5 days. Other causes of obstetric fistula that I have encountered are genital mutilation and botched hysterectomies.

Women and girls with obstetric fistula are able to function in 'normal' society to varying degrees, depending on the severity of their case. Some women leak urine constantly, while others only leak when standing, working, or walking. Depending on the community in which the woman lives, and the age at which she gave birth/developed fistula, she may or may not be ostracized for her condition. Because perpetual leaking, the women often smell strongly of urine. Those who also leak feces have it harder. In the short time that I've been working with these women, it seems like most of them move out of their husband's house and back to their own family's home. They may remain married, but do not have much contact with their husbands. Many of them are divorced. In the vast majority of cases, the babies do not survive childbirth.

So there are some of the basics about fistula. At the National Hospital in Niamey, there's a wing for women with fistula to live while they await surgery. Currently there are over 80 women waiting here. One of the surgeons on staff knows how to repair a fistula, and groups of American doctors come through 3 times a year for two weeks to do what they can for as many women as possible. The latest group just got in on Sunday night, and I'll be translating for them during their stay.

We just started yesterday, and there's already so much to tell. I think maybe the easiest way for you to know about what's going on here is for me to just give you a play by play-- to tell you about what we're doing, how the women are, the ups and the downs.

Where Narba was

11/30/08
You might have noticed that Narba's name wasn't on the list of the women who came to the training, although she is one of the grain bank committee's presidents. The reason she couldn't be there was because her granddaughter died that week. And the reason that her granddaughter died was, to my eyes and my understanding, because of severe dehydration and starvation. It's difficult for me to write about this, and so I haven't written about it to anyone. I haven't written a single letter to anyone for this whole month, because I'm unsure of what words to use to describe what is going on in Faloa and Niger right now. I hate not telling you about it, because it's been part of every day of my life for weeks now. But I also hate telling you about it, because I don't think you will understand. That's not fair of me, so I'm going to try.

The big picture, which is easy to explain: By this time of year, people-- farmers, meaning villagers, meaning my people-- have been working their bodies, hard, for six months straight. They have used their bodies and nothing more than a few handmade hand tools to turn sand into fields of millet, sorghum, and beans; they have battled acres of weeds with their backs bent over in 120° heat, they have spent weeks harvesting giant bundles of heavy stalks of grain, they have clocked hundreds of miles on their feet that are either barefoot or in crappy flipflops, and for a month of this- all September- they did it without food or water, for Ramadan. As the doctors at four of the clinics and hospitals that I have visited in the last month have explained to me, by this time of year, nursing mothers' bodies are exhausted and broken, and they stop producing milk. Babies who weren't weaned yet get weaned abruptly, and babies who weren't ready to be weaned yet get weaned anyway. They are given more water than they would normally drink, which results in higher incidences of diarrhea. And that, for a baby, or a kid even, in this country, is close to a death sentence. I wouldn't have, couldn't have, believed it before coming here. But it's real, and it's been happening all around me this month, and I have never felt more helpless, devastated, or furious.

Narba's granddaughter, Foziya, was about 16 months old. When I left the village in early October to help with Peace Corps training, she had a fever and I put a damp cloth on her hot little body. When I returned at the end of the month, I didn't recognize her, except as a child that I could've seen on the news in a report about famine or war. By then I think she was not entirely conscious. She was just bones in a small, rigid shape on her mother's lap. I sat with her mom, Dela, and Narba, and the other women in the family in their hut- I knew they were there because that's what you do when you are waiting for a person to die. It was confusing and shocking and upsetting, and I didn't know what to do, or if I should do something, or if I could. I told Narba, please let me take her to the doctor, but Narba said that it was in God's hands. Foziya died in the evening, and the wake lasted for the next three days.

So that is why Narba couldn't come to the training. I sat at the wake in the mornings and all evening after the training was over each day. I am a part of this family, and I felt like it, and my presence was never questioned.

I'm not sure what else to tell you about, because Foziya's story is the first in what has become way too many children who have died in this village. I can't just list off these names like that's all they are, names. I don't want to do that. They're a lot more than names, they're babies that I am used to holding and carrying around when their moms are pulling water, they're babies that were learning to sit and walk and talk. It's so messed up, it's not fair, it's the cruelest thing in the world that this is true. My friend Mariama, who is lovely and clever and whose daughter Harira was born the week I moved here, is now walking around without her baby on her back, with her breasts leaking milk. Mariama is healthy- she wasn't weaning Harira and didn't have to, she had plenty of milk- but Harira got diarrhea, and even though Mariama took her to the clinic-- three different clinics, all hours of walking away- they couldn't help her. They didn't help her, and her beautiful baby, whose picture I've taken a hundred times, died in less than a week.

As this has all been happening, I've been struggling to understand it and working to find out what the options are for mothers- where can they take their babies, and what help can they expect to get? The two closest clinics have one person on staff at best, who's not usually there, and who just hands out oral rehydration salts like that's going to fix everything. The clinic in Tajae is better, but gets absolutely flooded with people. I've been there a lot lately-- I've started going with women, because they like it when I come, and I think it makes it easier for them to go. I started going a few days after Foziya died, because one of the kids who is closest to my heart started really going downhill. I know I've told you about him before-- Rahman, Zuera and Salla's son, another grandson of Narba's. He's the kid who always toddles up to me yelling 'habba!' and who squeals when I lift him high in the air.

Rahman is 18 months old, and was still nursing until October, when Zuera's milk dried up. Rahman started getting diarrhea, and throwing up, and he started to refuse to eat or drink. He'd been like this before I got back, and was losing weight and acting listless, limp. Zuera and I went to Tajae, where they gave him antibiotics, but he didn't get better. He lost his baby cheeks, his eyes started sinking farther and farther in his head, and the skin on his legs hung like paper. He just got worse and worse, so we went back. We went on a Wednesday, which is when an Irish NGO called Concern sets up at the clinic and administers a whole lot of help- all for malnourished kids. I'd never seen them in action before, and I was overwhelmed and grateful to the point of tears. I mean, you walk into this big cement building and it's full of hundreds of women holding on to their skinny babies, waiting in lines to have them weighed and measured, and then to get a week's supply of high calorie super-nutrient life-saving food. It takes courage to take your kid, you know? They want, like every mother, their child to be healthy. But it's still hard to get the guts to take them, because everyone sees you and sees your sick baby.

Zuera and I were told that Rahman was "broken", and that if he refused to eat the special food at that instant, they would write him a referral to the Concern Hospital in Tahoua. He wouldn't eat anything, and so Zuera and I returned home with him to ask for Salla's permission to take him to Tahoua that afternoon. And you know, this was really strange and disorienting for me, because I don't have authority over this child, or his parents, and if Salla didn't agree, Rahman wouldn't be going to the hospital. It was painful for Salla to decide- he was surrounded by all of the women in his family, yelling and watching, and there I am, terrified he's going to say no, and then he does, he says no. He said no, because he heard that if your child dies there, the hospital doesn't give you your child's body back. I was devastated, and Zuera started crying (people don't cry here), and the women went crazy...I told him, okay, let me call them and ask them if that is true, because if it is true, I understand. But he really didn't want me to call them, and he excused himself and consulted with some other men, and then he gave us permission.

Relief.

Zuera, Rahman, and Narba ended up spending nine days at the Concern Hospital in Tahoua. The doctors showed them how to force feed him highly nutrified milk, and they were kept on a strict feeding schedule every hour. I visited them there twice, and got to see Rahman get better and better. Everyone in Foloa knew he was there, and constantly asked me if I had any news. When they finally got released, Rahman had his chubby cheeks back and even started smiling every once in a while. He'd been back for four days before I left to come in to Konni for Thanksgiving, and he seemed better each day. He still qualifies for the supplements given out in Tajae every Wednesday, so he and Zuera and I will keep going, along with the other five or so women from Foloa who have started going. Last week, a new mom joined us, Tahira, with her son Aziz. Going with them, and helping to connect them with doctors who can and will help them, makes me feel less helpless. I feel like I finally know where to go, and I'm getting to know the doctors. Best of all, women who felt helpless can see Rahman and how much better he is. And that is what really matters.

Mornings

I sleep outside, underneath a yellow mosquito net, on top of a foam mattress, on top of a bed made out of millet stalks, on top of clay bricks made from the bottom of a nearby seasonal lake. I wake up around 6 most mornings—I think it’s often a combination of the light and the morning sounds that start around that time (women pounding millet or talking at the well). Other, earlier morning sounds—the 5am prayer call, roosters, cows, goats, sheep, donkeys, etc.—wake me up too, but not as decisively as sunlight.
I usually spend about thirty minutes lying there, coming alive, reminding myself where I am, and thanking God/Allah/Goddess/Whoever Invented Water Filters for getting me through another night without sickness. Seriously, every morning that I wake up healthy, I feel extremely grateful. That is one thing—health—that is on my mind much more often than ever before. This is no place to be sick, not for anyone.

The heat is creeping in

2/10/08
The heat is creeping in! It started a week ago exactly. At first we all just thought "oh today is a hot day, " with the expectation that the next day would be cool again. Alas, that is not how it works. The heat comes on a little more each day. This week it was 82 in the shade at 10:00 AM. Soon it will be too warm in my hut at night and I'll move back outside, where surely sleep will evade me (noise+heat=recipe for insomnia!) Or, maybe not. Maybe the next two years will be Niger's most temperate!
I am delighted to report that at this junction in time, I am healthy, and even though the heat is tiring, I have returned to myself again. It took awhile to recover from my double-whammy sicknesses. It hit me yesterday that I finally understand why so much emphasis is placed on health and wellness in the daily greetings of this country. The long string of greetings that we run through with everyone is mostly an oratory on one's health and the health of one's family. I understand now that it's not at all a coincidence, but that people here ask about health because it's really IMPORTANT. And it's much harder to recover from anything.

1/29/08

Jessica and all of the other trainees went on a "demystification weekend," spending a few nights with a volunteer at their home site. The volunteer kindly loaned Jessica the use of her phone. This letter was written a few days after that conversation:

Hello again!
Can you believe that this is the 1st real chance I've had to write to you in days?They keep us busy here--it's a bit much, really. But it's okay. I'm learning a lot, most of the time, until I get too full of new words that my brain drops everything. The big news is= I got to talk to you! That was SO cool-- I was exhilarated for hours. I'm so glad you were home! It surprised me that I didn't cry the minute I heard your voices--it was just so wonderful that I could just smile. Interestingly enough, 21/2 hours after our conversation, at 11:30 PM I was visited by my second bout of bacteria, which was much worse in terms of volume than my 1st time. After 9 hours on the squat latrine, a Peace Corps "ambulance" picked me up & took me to the regional hostel where I got more meds. And now I'm fine! Peachy. Did you know that Niger has the highest rate of diarrhea among PCVs in the world? Shiiiit...they should tell you these things before you sign up...
Also: after demyst I returned to Hamdallye to find that the skinny guard dog that my family owns was PREGNANT!! She had 3 puppies over the weekend. There is just one now--I didn't ask too many questions, but I since learned that the other two were killed by my host dad, presumably because they're too expensive to feed . There is no extra food around here--I'm amazed they even let the pup live. If my language gets good enough soon, I'll try to find out what their plan is--because it's all so serendipitous that I should overlap with a puppy. Really. Alright it's bedtime. (p.s. Please tell Grandpa HAPPY BIRTHDAY when you get this, even though it'll be weeks late. 90!!)