Ok so this ended up taking 3 posts. I finally figured out, a certain link was oddly causeing the screen to go blank!
So, this is the last if it I promise.
All in all, things started to go along pretty well. We were busy, and hot, tired and dusty…
but we worked on. Soon, it became yhe day to do the children selected. Mostly again hernias which can become emergencies, if not repaired.
The Student Nurses were doing well, they had learned to do the monitoring and charting, and could pretty well manage the adults with little help. So I could concentrate on the kiddos.
As I mentioned before, children are in general, pretty well loved in Nigeria. Many parents sacrifice a great deal so their children can go to school.
As in many African countries, school
costs money. Students need to
buy texts and uniforms, in addition to pencils, pens and lesson books. So, children who do not go to school, work. As seen in the pictur to the right, where the little boy is hawking bread.
Kids, of course, could not handle just a regional nerve block, so they got Ketamine. Ketamine works well, but because it sedates the patient, there are increased risks of respiratory depression or prolonged Apnea. Because of this, I wanted all the kids to have pulse oximetry, for about 40 mins in recovery. It will not surprise anyone that these little items were in short supply. I had to insist very stubbornly about this to several people, surgeons, anesthetists…. Ketamine is less sedating than other sedatives, so these people believed it was 100% safe. At the time when I was insisting, I felt petulant. But later that day, one child had a terrible time coming out of the Ketamine and had to be carried, not breathing, back to the Operating Theatre for oxygen. He ended up doing fine fine, but the experience was both frightening and validating. It's important as a foreigner not to have patients die! After that, it seemed the entire team had a new respect for me…much help was offerred in getting patients readied for the nights and when I wanted monitoring, I generally got it.
Of course, I wasn't right all the time. I learned more than my Nigerian counterparts. This young physician
taught me how to recognize measles! I had never seen it, and if he had not
helped me, I might have considered it a simple rash.
Measles is a fairly common occurrance in Nigeria, though it is gradually being reduced by vaccination campaigns, advertised in awesome pidgen English below.
He also taught me about listening to Fetal Heart Tones with a fetoscope (see below). I had never seen such an item. It was really an experience to put one ear up to one end and the other end on the Mothers abdomen! I felt like I was perhaps a bit TOO close to the whole situation. They work remarkably well. I really was glad to learn these things.
I also learned to stand up for what I knew was necessary and right. At the end of my time in Akwa Ibom, the surgeon who had previously complained about my time suck of post op now told me she had seen value in having a post operative area and that they were going to include one on each project. I felt very proud, but I still know it was I who learned more about being assertive in this culture. When I got on the plane to go back to Europe, This enormously tall Nigerian man looked at me (with my aisle seat in the plane) and insisted quite rudely that I was in his seat. If he had asked nicely I would have moved as I'm pretty short, but since he was actually pushy, and intimidating, I whipped out my seat check and said, "gee you'll have to sit in the middle" and indeed the poor man had to. Midway through the flight, I did offer to change, which he then very politely accepted.
It's hard to understand Nigeria. The entire time I was there, I felt like I was confronted with requests for money, water, food, pens, my automatic BP cuff, my stethoscope etc…I had brought tons of stuff, including dresses that I had hardly worn, pens, inexpensive stethoscopes, but none of it seemed to be enough. I think it's simply that these people really never had anything, and I appeared as someone who could give them something. They often said, "Sister, you can get another in America!" So, I knew they didn't understand that I actually had to budget and save to afford certain things that they were requesting…This photo sums it up.
But even though this behavior seems really odd to Americans (to ask for more even after having been given what might seem like alot…), I found it to be very authentic. In Nigeria, you always know what people are thinking of you, or of a situation. and I thought I'd share a few of my favorite photos of town that didn't quite fit in the story.
Children, freshly "barbed"!
The local Wal-Mart:
and one that actually turned out fairly good:
Thats all for Nigeria!!! I'd love to go back and considered a project there, but instead, I went to Liberia.