Dear Friends and Family:
So good to be home! It was a good trip and much was accomplished, but I am glad that during the rest of the year, our family will be separated only two more weeks in late April. Thank you for your prayers for us while we were apart.
When I finished last week’s SteffeScope, it was unclear whether I could get to Niger or not. The civil unrest in Mali to the northwest and a recent agreement between the US and Niger, allowing the placement of US drones in Niger, security pretty uncertain. However, leaving it all in God’s hand, I started out. It would take me days to get to my destination.
The vagaries of African air travel stranded me for a night in Lomé, Togo. Ethiopian Air changed its schedule at the last minute and flew to Accra, Ghana first rather than Lomé, Togo. This caused me miss the connecting flight. As we taxied in, they were revving up the propellers on “my” Asky plane to taxi out. I watched my ride fly away. Ethiopian Air did right by us putting us up in a fairly nice hotel. It met my two chief requirements – free internet and air-conditioning – and I was very pleased with the best mattress I have had to date on this trip. The next day, the incoming flight was late in arriving in Lomé, but we finally left and I made it to the guesthouse in Niamey after flying to Abidjan, Ivory Coast first. Originally, I was to arrive on Friday night and fly to Galmi Hospital on Saturday, but because I landed in Niamey on Saturday, I wasn’t able to leave until Tuesday. The missionaries don’t fly on Sunday and they had some maintenance on the plane already scheduled for Monday. I was able to worship at the international church on Sunday and again enjoyed the good Internet access at the guesthouse. It was a forced two days of rest that probably did me some good.
The heightened security due to the conflict in neighboring Mali made travel by missionary plane the only option. The Europeans have all pulled their citizens back to Niamey (must to the disgust of two Germans working at Galmi who I met in Niamey) but the US embassy is on a lower level of alert, so we could still travel. However, road travel by expatriates was forbidden by the Nigerien government unless you went with a police escort. Fortunately, travel by SIM Air, the missionary agency plane service, was still unrestricted. I was in the back seat of the six-passenger plane (see right).
Galmi Hospital is undergoing a major renovation and has recently opened a new surgical wing. The old surgical wards have been demolished. There are plans in hand to literally rebuild almost the entire hospital one building at a time. Money is, not surprisingly, an issue.
There are presently two PAACS residents assigned to Galmi, both in their first year of training: Dr. Jean Lenga and Dr. Yves Mpongo. Both are natives of the Democratic Republic of Congo. In an effort to give some upper level guidance and help, Dr. Ruffin Loua and Dr. Philadelphie Dembele have been sent from Bongolo Hospital for rotations. For those two senior level surgeons, this is a great place to gain experience in surgery of the gastrointestinal tract as well. Dembele, with whom I worked on the Mercy Ship, was still here and it was very good to see him. A request has been sent to COSECSA to consider accreditation of this site for training and to arrange a visit by their inspection team in late summer of 2013. I was here with another general surgeon, Dr. Steve Weber. My first goal was just to see the place; I have never been there before. I also came to help with any issues that have arisen since the program began last August as well as helping them focus further attention in those areas which will receive attention from the COSECSA inspectors. I worked with Starke and Sanoussi as well as the hospital administration team to establish a plan of action. We should have no trouble getting the first level of accreditation (the MCS level – Member of the College of Surgeons) but I would like to get as many of the remaining 3 years with this upcoming visit as we can. It will require that the ICU, recovery room and emergency room be improved and that somehow we develop some more expertise in the clinical lab (and develop some expertise in pathology!).
Galmi is a hard place to serve, for both short-termers and career surgeons. The remote location, the limited travel, the weather, the lack of available amenities (including a limited variety in food choices) and the Islamic culture make it clear that we are aliens in a strange land. The heat during certain times of the years can be over 110o and during rainy season, the humidity can be very high. This was the perfect time to come – the temperature in the evenings was in the 60s and in the low 90s during the day but with very low humidity. The Harmattan (dust from the Sahara carried by a cool north wind) is almost done blowing and so the dust which bedevils me at times was not a problem during this visit. It was critical to stay hydrated.
The hospital is very busy on the surgery wards although the pediatric and medicine wards are very seasonal. On rounds earlier this week, there were at least ten case of typhoid fever that had perforated. Since they come late and malnutrition is so severe, they have a high mortality and very advanced peritonitis when they come.
 The Sahel is a strip of land south of the actual Saharan desert and north of the more usual African savannah. It goes across the continent. It might get rain or it might not. In a 7 year cycle, two years have good crops, two are disasters and the remaining three are spent on the edge of malnutrition. Only brush and the occasional stunted tree survive away from the rivers or reservoirs.
We flew from Galmi back to Niamey by SIM Air on Friday. The trip home was marked with concern about how the NYC blizzard would affect things. It would ultimately have no effect on my flights – thank God. At 1:00 AM Saturday morning, I went to the airport at Niamey to catch the Royal Air Maroc flight to Casablanca. After a long layover there, I flew on to New York where I went through customs and then had to schlepp my suitcase to another terminal and check in at the Delta. It was a short flight to RDU and I was very glad to see Micky there but it was nearly midnight before we got home. Long day!
Micky, Sean and I will leave for Thailand on Thursday, February 14. In crossing the international dateline as we fly to Seoul and on to Chiang Mai, we will not land until Saturday the 16th. We are going to help serve during the biannual Continuing Medical and Dental Education conference in Chiang Mai Thailand. After two weeks there, we will fly to Australia for only a week (a little sight-seeing combined with visiting some friends from our hometown and meeting with four different people about PAACS-related business) and then on to Ghana and Togo for a few weeks of service. We will be back in the US in early April in time for the PAACS business meeting in Chicago.
Praise and Prayer:
- Praise for the traveling safety and a request for more safety for this trip around the world.
- Effectiveness in all that we will be doing in the next six weeks.
Pleased to be home – if only for a few days,
Bruce for Micky and Sean