The good, the bad, and not always pretty..

Surprise! We have photos!

I hope I won’t bore you! Again, Wendi has very thoroughly explained some of the things we have been seeing and doing recently and I really don’t want to be redundant. But, if you read her blog(s), you’ll realize that we now have the ability to upload some pictures from here! I have so wanted to, before this point, share them with you, because in some cases, I do think they represent many (maybe not 1000) words. And I know some friends (ahem, EVB, who may or may not ever even read this) aren’t that keen on reading. So take a peek at some of these! Please visit Wendi’s blog for more.

I am amazed at how “at home” I currently feel here. I think it took a few days (well, about a week) to really get our bearings and for things, people, our surroundings, and routines to stop feeling “new.” I can truthfully say that now it feels like we have been here much longer than a week and a half! It kind of feels like “home.” We are used to the bucket showers, the square meals of meat and starch (here, beef is much cheaper than chicken so we’ve been having a lot of stew!), the early morning sounds, the heat, the lack of power and consistent internet access, the loose adherence to start times. When Dr. Chris says “I will come and pick you at 7:45” or whatever (he leaves out the “up,” as in “pick you up,” which cracks me up but which no one else has seemed to notice), we know that that can mean anything from 7:45 to 9 or so. Even when we went to the wedding last weekend (which was supposed to start at 10), Dr. Chris said that they can start late, i.e. up to 11 or so. We have all sort of accepted this lack of punctuality or strict time schedules. We are living on “Nigerian time.” It is actually really liberating. We just wait and relax (I usually pull out a book). I am totally unstressed. Life seems so simple here.

I think feeling was driven home by our reactions when our luggage finally arrived yesterday, a week and a half after we arrived. Ajit had somehow made out with nothing missing and Wendi and John had, from the beginning, had their clothes, although were missing their medications, toiletries (that TSA rule is SO ANNOYING), and some shoes. However, prior to yesterday, Kelsey and I had nothing of our own except things we had in our carried-on backpacks when we left Denver and Rochester (respectively) on March 25th. While it was great to finally have clothes and shoes that fit, underwear, razors, and things of our own, Wendi, JB, and Ajit had been soooo generous to loan some essentials to us in the meantime), we realized how little we really needed to live on. It had been so long, that I had even forgotten what I had packed!

However, this is Ajit and Kelsey with a necessity-- mid afternoon coffee

It’s nice to have medications (I call John and Wendi’s bag “the pharmacy.”). It would have been helpful for me to have some Immodium the previous night. Papa, our cook, has taken to calling me “Mrs. Fruit” because I’m always raving about how much I love the fresh oranges and watermelon he’s added to our lunch and dinner meals. It has become a joke that everyone better take what they want before I get my hand on the fruit bowl. However, I think I overdid the watermelon the other day. I’ll spare you details, but I was up for most of the night with stuff coming out of both ends… not feeling so hot. I got over it relatively quickly and now am kind of scared of watermelon (John, who had only a moderate amount of watermelon did okay but did say he’d felt a little sick), but think that it should be okay in moderation. I think some of us have allergies acting up because of all the dust (better, I think, since it rained briefly and got MUCH cooler), but everyone’s stayed healthy for the most part!

Okay. I guess I should probably write about “real stuff,” or the medical stuff that is the reason we’re here. Wendi alluded to the fact (which I just found out today!) that Ajit, John, and I were all recruited to give a “lecture” in a clinical pathology class to students at JUTH (Jos University Teaching Hospital) because the teachers were on strike again (I knew I was to teach but I didn’t know the reason!)! I did a chalk talk on parathyroids and calcium homeostasis. It went really well—I realize how much I like teaching (and am more comfortable when the audience doesn’t know me!). Ajit (thyroid) and JB (who, today gave his second talk on clinical enzymology) also did great! The students had a ton of questions on the American medical system. They were interested in learning about our training program, just as we have been enlightened about theirs. Here, they enter medical school for 6 years, right out of high school. Afterwards, they each do an in-house “internship,” after which they are a licensed medical doctor. Everyone in Nigeria, if they at any point want to work for a public organization, has to do a year of “service” at a rural location. So most of these doctors do that; then, they may (if they want to become a consultant) do a residency program in a specific field. Dr. Aquaras said that it is 6 years for surgery. Not sure what it is for other specialties.

Some pictures of the patients we saw in Kafanchan:

Huge multinodular goiter

This baby's eyes are sooo big!!

The OR (sandals or bare feet = proper footwear)

John, Ajit, and I have been seeing a lot of patients at Faith Alive in both the mornings and in Dr. Chris’ evening clinic. It is still amazing to how HIV or AIDS, such a devastating (although low prevalent) disease back home, almost becomes “routine” here, after seeing hundreds and hundreds of people who are “positive.” After seeing patients walking around with CD4 counts of 24 or 16 (Dr. Chris has seen as low as 8!!), I start to think that levels of 150 cells/mm3 are “high,” although, in the U.S., the threshold for treatment with antiretroviral drugs (ARVs) is around 350. Here, just because of limited resources, it is 200. And CD4 counts and viral loads are not even routinely checked here because there is just not the money. Only if a patient starts losing weight is the CD4 count rechecked.

This morning, John and I worked with a doctor at the clinic who works on the team that treats HIV patients with second-line therapy (i.e. if they fail the first line and have resistance issues), who are pregnant, or who are kids. It was interesting to see Dr. Chukuma’s perspective (that of a young, optimistic physician much like we are probably going to be) compared to that of seasoned veterans like Dr. Chris. While, optimally, women should be started on antiretroviral drugs during their first trimester of pregnancy (even if their CD4 count is “okay,”), to reduce the risk of intrapartum transmission of the virus to the baby, it is just not practical. Waiting until the third trimester to treat one woman with an “okay” count may “give someone else 6 more months of treatment.” While shocking, this is how we need to think while over here. This is not the land of milk and honey. At Mayo, most people don’t give a second thought to ordering daily cbcs (complete blood counts) and electrolyte panels on hospitalized patients, or other lab tests and studies from the office. Here, they don’t even have certain tests available, such as lipase (very specific for pancreatitis), or troponins (the best early detector of a heart attack). While John tells me that Mayo has more CT scanners than the whole country of Canada, there is not even one in Jos (including the teaching hospital). The closest one is in Abuja, about 3 hours away. And you have to call ahead of time to see if it’s functioning (we saw a man who was waiting for a CT scan for his 2-year old daughter, with abnormal motor control and development, who traveled all the way to Abuja only to find out that it was not working). Shocking. The harsh realities of medicine and allocation of resources are strikingly apparent practicing medicine here. While Dr. Chris is one of the most tender-hearted and compassionate people I have ever met, he gets angry and bitter when talking about some of the disparities in health care. I can certainly see why. See some photos for illustration.

Street beggar

HIV positive patient being carried to Faith Alive satellite site

Kaposi's sarcoma (scroll fast if this makes you queasy)

We are here for another 2 weeks before we head to South Africa. It has already been eye-opening and life-changing. I will continue to, all my life, support this fantastic organization, Faith Alive, and Dr. Chris’ dream of having a health facility of a high quality, a “mini-Mayo” in Africa. I urge all of you to do the same, with any resources you have.

So I don't end this on a downer, let me mention the glorious rain we had this afternoon. It was like a monsoon! Ajit, Kelsey, and John all went out and bathed in it while Wendi and I (semi-wimps) watched and took photos (not yet compressed into an uploadable size). They said it was one of the most exhilarating things of their lifetime. It definitely cooled things off. Stay tuned for pictures!