We are leaving Jos for the flight from Abuja because of it being Good Friday, a holiday and their is a slight chance of riots by Muslims on a Christian holiday. Despite ups and downs of trying to work in a 3rd world hospital it has been a worthwhile experience for me and makes me want to do more of this kind of work. One does get used to the cold bathes and lack of electricity and even seeing the garbage all over land the goats eating it. The dust , the heat and inability to get work done in an efficient way are the main frustrations. One appreciates the accountability we have in our health system. Of course this takes personnel and money to do that, which they don't have----but it also takes a different mindset.
The AIDS epidemic is overwhelming and so slow to control it, but unless we are willing to let a generation die, we have no choice. There are still so many questons as to why the prevalence rate isn't decreasing faster. It is multifactorial.
Anxious to see all of you. Hopefully I will have some time to add to this blog when I get back Thanks for sharing it with me and post your comments
Will
Friday, April 10, 2009
Tuesday, April 7, 2009
Soon I will be home
After treating a young man with diabetic acidosis, I would say that Evangel
hospital's main problem is getting lab tests done accurately and promptly, having a chart that one can follow and having less patients for each nurse. We tried to get him in their ICU but it was full. I find if I talk to each nurse about my orders they get done more accurately. The chart is the old metal folding ones that we stopped using about 1972, because the sheets are loose and get lost and out of order. The doctors work hard to improve their standard of care but they can't or don't have time to correct these problems. The medical director told me he thought their lab has improved alot , so I didn't want to insult him with my assessment of the problems. It is so much more difficult to run an efficient hospital when , you don't have good phones, computers, records and ways to reach patients. I needed to make copies of medical information handouts for a presentation I gave. Both copiers were not working and they never know when the repairman will actually come, so I got a driver to drive back to Faith Alive , about a ten minuted drive to get these copied.
I will have given 6 of these lectures and the nurse's seem to appreciate them more than the doctors. Some are at 4pm in a hot stuffy room, so I'm not surprised to see eyes half open. I must always make the information pertinent to their situation---which means they don't use alot of our meds and tests and so telling them how we treat hypertension, diabetes and heart failure isn't as helpful as how they might use their resources as efficiently as possible.
As when I worked in Madagascar, I feel frustrated in not being able to do more. Working here again reaffirms that they need financial help and partners in their struggle , more than medical knowledge. But for us westerners to want to help, we almost have to be here to see their struggle. Hopefully, more of us will come , see and help.
It is getting dark so I must go
Will
hospital's main problem is getting lab tests done accurately and promptly, having a chart that one can follow and having less patients for each nurse. We tried to get him in their ICU but it was full. I find if I talk to each nurse about my orders they get done more accurately. The chart is the old metal folding ones that we stopped using about 1972, because the sheets are loose and get lost and out of order. The doctors work hard to improve their standard of care but they can't or don't have time to correct these problems. The medical director told me he thought their lab has improved alot , so I didn't want to insult him with my assessment of the problems. It is so much more difficult to run an efficient hospital when , you don't have good phones, computers, records and ways to reach patients. I needed to make copies of medical information handouts for a presentation I gave. Both copiers were not working and they never know when the repairman will actually come, so I got a driver to drive back to Faith Alive , about a ten minuted drive to get these copied.
I will have given 6 of these lectures and the nurse's seem to appreciate them more than the doctors. Some are at 4pm in a hot stuffy room, so I'm not surprised to see eyes half open. I must always make the information pertinent to their situation---which means they don't use alot of our meds and tests and so telling them how we treat hypertension, diabetes and heart failure isn't as helpful as how they might use their resources as efficiently as possible.
As when I worked in Madagascar, I feel frustrated in not being able to do more. Working here again reaffirms that they need financial help and partners in their struggle , more than medical knowledge. But for us westerners to want to help, we almost have to be here to see their struggle. Hopefully, more of us will come , see and help.
It is getting dark so I must go
Will
Saturday, April 4, 2009
Too Busy to Blog
Time is going fast and even though I live alone I have been invited for supper a few times,which helps. I was excited this Sat am bec I had electricity and didn't have to bathe by candlelight---so I also washed my clothes in the bathtub----what did people do before soap? IT is very rewarding to see all that dirt and dust come out of my clothes.
Soon electricity went off and I was reading by candlelight at noon bec this house has so little natural light.
Exciting News!! It just started raining ----haven't had any since Nov. A driver said he has to drive 30 min each am to get water from his pastor bec his well had dried up. Hope this settles the dust---locals say one rain is worse than none bec it isn't enough to get rid of the dust---just makes it humid.
Looking for a good investment? A doctor I work with needs a capital partner to expand his hospital which he owns. The banks don't make those loans so he asked if I knew of any organization or person who would like to partner with him. This will offer state of the art medical care and testing. He only needs $500,000. Give me your name before I leave so you don't miss out on this opportunity !!
I was invited to go with a group of Americans on an outreach. A Christian group here in Jos reaches out to street people, blind people and the poor. Instead of going to the Blind Town as planned the men went to "Bad Boys" which is a slum area where alot of alcoholics and drug dealers hang out and make their brew---Goscola. The plan was to minister to them and the Jos Christian leader of the outreach group then had us hand out Christian tracts, tell them about Jesus and pray for and with them. I had a hard time not laughing at these events----most of the people I approached wanted the pretty blue tracts and were quite enebriated sp? with slurred speech and rambled on and on about the fact they knew Jesus but what they said didn't make much sense. One wanted me to pray that he would pass his secondary school exam. He had his alcohol problem for many years. The image of these tin shacks, the brewing of the goskola , all the smoke from the charcoal fires, the dirt and the drunks will not be forgotten.
Who knows? Maybe people are more receptive to the gospel when they are a little "tipsy"?With that in mind Jim Linden will be having a revival meeting April 24 when I get back with his goskola!!
Actually this outreach group does sponsor an Alcoholics Anononymous group for these people which is prob the most effective way to approach their problems.
Last Sat, 1 week ago, I sponsored a trip where 6 of us went to Yankari Game Reserve. I mean't pay for part of it ,but ended up with 90% of the bill through some miscommunication and assumption by them of me "sponsoring " which means paying for it. We were to leave at 6:30 am No one was there then so I had to go wake up the driver and then heard alot of excuses from the older staff docs from Evangel Hosp that they couldn't go. Then I was told that housestaff docs wanted to go but they had to tidy up or finish rounds, but they would be there soon. By Nigerian time this meant that we didn't leave till 8:20 and the driver then felt he had to go 140km or 90 mph in this old peugot. We saw some Wildebeest, baboons which are relentless pests, warthogs and distant elephants. The hot springs were the best. Thankfully we made it home safely. Sorry if I already reported this.
All for now,
Will
Soon electricity went off and I was reading by candlelight at noon bec this house has so little natural light.
Exciting News!! It just started raining ----haven't had any since Nov. A driver said he has to drive 30 min each am to get water from his pastor bec his well had dried up. Hope this settles the dust---locals say one rain is worse than none bec it isn't enough to get rid of the dust---just makes it humid.
Looking for a good investment? A doctor I work with needs a capital partner to expand his hospital which he owns. The banks don't make those loans so he asked if I knew of any organization or person who would like to partner with him. This will offer state of the art medical care and testing. He only needs $500,000. Give me your name before I leave so you don't miss out on this opportunity !!
I was invited to go with a group of Americans on an outreach. A Christian group here in Jos reaches out to street people, blind people and the poor. Instead of going to the Blind Town as planned the men went to "Bad Boys" which is a slum area where alot of alcoholics and drug dealers hang out and make their brew---Goscola. The plan was to minister to them and the Jos Christian leader of the outreach group then had us hand out Christian tracts, tell them about Jesus and pray for and with them. I had a hard time not laughing at these events----most of the people I approached wanted the pretty blue tracts and were quite enebriated sp? with slurred speech and rambled on and on about the fact they knew Jesus but what they said didn't make much sense. One wanted me to pray that he would pass his secondary school exam. He had his alcohol problem for many years. The image of these tin shacks, the brewing of the goskola , all the smoke from the charcoal fires, the dirt and the drunks will not be forgotten.
Who knows? Maybe people are more receptive to the gospel when they are a little "tipsy"?With that in mind Jim Linden will be having a revival meeting April 24 when I get back with his goskola!!
Actually this outreach group does sponsor an Alcoholics Anononymous group for these people which is prob the most effective way to approach their problems.
Last Sat, 1 week ago, I sponsored a trip where 6 of us went to Yankari Game Reserve. I mean't pay for part of it ,but ended up with 90% of the bill through some miscommunication and assumption by them of me "sponsoring " which means paying for it. We were to leave at 6:30 am No one was there then so I had to go wake up the driver and then heard alot of excuses from the older staff docs from Evangel Hosp that they couldn't go. Then I was told that housestaff docs wanted to go but they had to tidy up or finish rounds, but they would be there soon. By Nigerian time this meant that we didn't leave till 8:20 and the driver then felt he had to go 140km or 90 mph in this old peugot. We saw some Wildebeest, baboons which are relentless pests, warthogs and distant elephants. The hot springs were the best. Thankfully we made it home safely. Sorry if I already reported this.
All for now,
Will
Tuesday, March 31, 2009
The man with the femur fx and blood clot has and xray that shows he definitely needs a red placed inside the fx to get it to heal as the bones are not in contact, but he still wants the traditional healer to take care of it.
Be sure to check this blog: www.marybeth0.blogspot.com It tells alot about what I experienced lately at Mashiah and Yankari. Fatima is really sick, but getting better and I met Peter the economics major and he told me his story-----shows alot of courage on his part. I worshipped Sun in the burned church.They will need to build a new church and it will be expensive, but they are such people of hope. I found that Lutheran Nigerians (women) can strut down the aisle to give their offering just as classy and rock with the beat just as good as the Baptist Nigerian women. Somehow I can't picture Zion's women doing that!
About 50 Christian churches were burned in Jos and 20 small house-type mosques were burned in the riot last Nov. Christian and Muslim leaders are talking frequently about trying to live in peace , but some don't agree to it. One Christian leader feels it just isn't Alkaida-sp? who advocates war on the infidels, but that many Muslims feel they gain a reward in heaven by killing or harming Christians. Northern Nigeria , a Muslim stronghold, is known for persecuting any Christian who prosetylizes there. Sharia law is the standard there, but not often enforced.
I'm sure there are 2 sides to the issue. Unfortunately, it won't be easy to resolve the conflict easily.
Mary Beth's blog has nice pictures of Yankari. I went Sat. with 4 interns from Evangel Hosp. I thought older docs were going but they couldn't make it at the last minute. I sponsored or paid for 90% of the cost as it turned out as there was some miscommunication----not unusual in a foreign country even though they speak English. I also got an introduction to "Nigerian time", as we were to leave at 6:30 am, but no one was there at that time. I had to wake up the driver and then all the excuses came in grad. that so and so wasn't coming. Then one by one another intern wanted to go but "had to tidy up" first. We didn't leave till 8:20. The driver drove at 140 km or 90 mph in a somewhat dilapidated peugot with the windows wide open bec of the intense heat. It was too noisy to talk. We had a 1.5 hr safari and 1 hr at the Wikki hot springs and then had to leave. The Wikki springs are really an oasis in the desert and were as beautiful as in Mary Beth's blog. Quite the adventure!
My days are varied. Yesterday I was just exhausted at 2pm when we finally finished seeing the inpts. I think it is the heat and the struggle to understand their English. They talk very softly also. The most frustrating aspect thought is just getting orders followed and tests done and getting all the information from the pts to make a dx. Since most of the pts speak Hausa and are not educated and can't read and write , you don't get clear answers to your questions. One intern just laughed at me as I repeatedly kept trying to get just a simple answer ie. yes or no to a question. She said they will never give a yes or no answer, but tell much other non impt. information----OH how nice it would be to be a veterinarin?
Take care,
Will
Be sure to check this blog: www.marybeth0.blogspot.com It tells alot about what I experienced lately at Mashiah and Yankari. Fatima is really sick, but getting better and I met Peter the economics major and he told me his story-----shows alot of courage on his part. I worshipped Sun in the burned church.They will need to build a new church and it will be expensive, but they are such people of hope. I found that Lutheran Nigerians (women) can strut down the aisle to give their offering just as classy and rock with the beat just as good as the Baptist Nigerian women. Somehow I can't picture Zion's women doing that!
About 50 Christian churches were burned in Jos and 20 small house-type mosques were burned in the riot last Nov. Christian and Muslim leaders are talking frequently about trying to live in peace , but some don't agree to it. One Christian leader feels it just isn't Alkaida-sp? who advocates war on the infidels, but that many Muslims feel they gain a reward in heaven by killing or harming Christians. Northern Nigeria , a Muslim stronghold, is known for persecuting any Christian who prosetylizes there. Sharia law is the standard there, but not often enforced.
I'm sure there are 2 sides to the issue. Unfortunately, it won't be easy to resolve the conflict easily.
Mary Beth's blog has nice pictures of Yankari. I went Sat. with 4 interns from Evangel Hosp. I thought older docs were going but they couldn't make it at the last minute. I sponsored or paid for 90% of the cost as it turned out as there was some miscommunication----not unusual in a foreign country even though they speak English. I also got an introduction to "Nigerian time", as we were to leave at 6:30 am, but no one was there at that time. I had to wake up the driver and then all the excuses came in grad. that so and so wasn't coming. Then one by one another intern wanted to go but "had to tidy up" first. We didn't leave till 8:20. The driver drove at 140 km or 90 mph in a somewhat dilapidated peugot with the windows wide open bec of the intense heat. It was too noisy to talk. We had a 1.5 hr safari and 1 hr at the Wikki hot springs and then had to leave. The Wikki springs are really an oasis in the desert and were as beautiful as in Mary Beth's blog. Quite the adventure!
My days are varied. Yesterday I was just exhausted at 2pm when we finally finished seeing the inpts. I think it is the heat and the struggle to understand their English. They talk very softly also. The most frustrating aspect thought is just getting orders followed and tests done and getting all the information from the pts to make a dx. Since most of the pts speak Hausa and are not educated and can't read and write , you don't get clear answers to your questions. One intern just laughed at me as I repeatedly kept trying to get just a simple answer ie. yes or no to a question. She said they will never give a yes or no answer, but tell much other non impt. information----OH how nice it would be to be a veterinarin?
Take care,
Will
Friday, March 27, 2009
TGIF
I gave a talk on treatment of hypertension to day at Faith Alive. I had an illuminating dialogue on which meds to use. They still use Aldomet alot which we stopped using about 1973 bec of side effects. Pts can't afford even the one a day meds we have so have to take captopril 3xs a day instead of one a day lisinopril. The pharmacist was there and he verified that some of the meds I were advocating weren't as expensive as they thought , so I think I gave them some useful knowledge. They thanked me profusely.
Saw a 37 yr old man who broke his femur 5 wks ago and was seeing the traditional healer but got SOB suddenly and came to the hospital. Prob. has a fat embolism or a pulmonary emolism. He had a dressing and a 4" splint on his thigh and didn't want us to treat his fx bec we would put a long cast on his leg and never take it off---so he will let the trad. healer treat his fx. He came to the hospital bec he knows the white man has the best medicine for SOB and chest pain.
Evangel Hospital where I see inpts. requires pts to pay for tests first, so we often order tests that don't get done bec of poverty. Today a lady with Stage IV AIDS, prob TB and very weak and cha chetic--sp? finally told us after the 3rd day that the reason she couldn't pay for the chest X-ray was that her family who were standing there, couldn't help her and she would have to go to the bank to get money, and she can't stand up----which is the truth. So I paid for the X-ray, as it was only $5.00. Interestingly . an abd US is only $4.50.
The main problem is that many pts have a combination of HIV, hepatitis B, TB, malaria and chronic liver disease. So which sx are due to what and what can you treat. They make alot of home brew called Goskola which leads to liver disease .Typhoids always a possibility and tests don't reliably rule it out ---same for malaria and TB. So you treat based on experience without alot of evidence and if you have any treatment for it. Is no treatment here for hepatitis B or C.
Tomorrow I am paying for 7 other docs and myself to go to one of only 2 wild game parks in Nigeria. We will do it in one day. Should see alot of pesky baboons and warthogs. It is pretty expensive for Nigerians so the docs were excited to have the chance ---it is 3 hr away.
More later.
Will
Saw a 37 yr old man who broke his femur 5 wks ago and was seeing the traditional healer but got SOB suddenly and came to the hospital. Prob. has a fat embolism or a pulmonary emolism. He had a dressing and a 4" splint on his thigh and didn't want us to treat his fx bec we would put a long cast on his leg and never take it off---so he will let the trad. healer treat his fx. He came to the hospital bec he knows the white man has the best medicine for SOB and chest pain.
Evangel Hospital where I see inpts. requires pts to pay for tests first, so we often order tests that don't get done bec of poverty. Today a lady with Stage IV AIDS, prob TB and very weak and cha chetic--sp? finally told us after the 3rd day that the reason she couldn't pay for the chest X-ray was that her family who were standing there, couldn't help her and she would have to go to the bank to get money, and she can't stand up----which is the truth. So I paid for the X-ray, as it was only $5.00. Interestingly . an abd US is only $4.50.
The main problem is that many pts have a combination of HIV, hepatitis B, TB, malaria and chronic liver disease. So which sx are due to what and what can you treat. They make alot of home brew called Goskola which leads to liver disease .Typhoids always a possibility and tests don't reliably rule it out ---same for malaria and TB. So you treat based on experience without alot of evidence and if you have any treatment for it. Is no treatment here for hepatitis B or C.
Tomorrow I am paying for 7 other docs and myself to go to one of only 2 wild game parks in Nigeria. We will do it in one day. Should see alot of pesky baboons and warthogs. It is pretty expensive for Nigerians so the docs were excited to have the chance ---it is 3 hr away.
More later.
Will
Wednesday, March 25, 2009
Sensory overload
Today I was overwhelmed with too many very sick patients. We don't have enough time and resources to be very sure of their diagnosis. Two patients died of strokes, which you can't treat. One boy died of sickle cell disease--ie crisis. New pt with Stage IV AIDS with meningitis and a lady in renal failure from probable but certainly not definite disseminated TB who won't live long.
The hot dry winds don't help. This is the worst time of the year I'm told to live in Jos----when the rains come, it is much nicer.
I went to Mashiah Foundation today this pm and found alot of hope and joy in the women who sew and make quilts, place mats, dolls etc. They all have HIV and didn't have a place to stay nor any skills to earn food, so Mary Beth and Baye Oyebade started this home for them and taught them to sew. They now are self supporting and have a new life. They laugh alot and some of them were as sick as the patients I described above. They now have 54 people on staff and are reaching out to teach and help more patients each year. I will show you some of their products as I bought a doll, table runner , purses etc.
Must get home before dark
Will
The hot dry winds don't help. This is the worst time of the year I'm told to live in Jos----when the rains come, it is much nicer.
I went to Mashiah Foundation today this pm and found alot of hope and joy in the women who sew and make quilts, place mats, dolls etc. They all have HIV and didn't have a place to stay nor any skills to earn food, so Mary Beth and Baye Oyebade started this home for them and taught them to sew. They now are self supporting and have a new life. They laugh alot and some of them were as sick as the patients I described above. They now have 54 people on staff and are reaching out to teach and help more patients each year. I will show you some of their products as I bought a doll, table runner , purses etc.
Must get home before dark
Will
Tuesday, March 24, 2009
Last Sat. I went to a village 2 hr away where we dedicated a new clinic paid for by Fresno First Baptist of whom 8 of them were at the event. It cost $40,000 and will house a doc and clinic on the other side. They haven't had any medical care in this village----ever!!! We met with the chief in his 3 layer wool robes and hat with a feather in the hot sun. The kids swarm you and rub your lilly white skin to see if it will come off. They rarely see whites. In fact, I think I saw my first white couple since I have been here except for a missionary couple. We ate some goat meat and intestine with the chief----good I didn't know it was goat bec we have goats feeding on the garbage near our guest house all the time.
Some sayings: often an educated man will first of all say How is the family? and if you cough or stumble, they say "sorry" ----every time you cough ie sorry for you. The Nigerians are rated one of the most happy people in the world I was told,,, yet other surveys list the Danes. They do love to laugh and tease each other, which helps.
Why do Nigerians keep getting AIDS ----the prevalence rate by some is 10% some say 5%. It hasn't gone down much. Good data is very hard to get since most don't have a birth certificate if born in rural areas. Many don't know their real age. One lady told me she was 100 when she didn't look over 55. they don't celebrate birthdays. Condoms aren't used nearly enough partly bec of lack of knowledge, many men are willing to risk it, and women are too scared to make their lover use a condom. Women need to be empowered. Having children is their greatest goal, so they will try to get pregnant so the man will marry her and also prove her fertility. I'm sure there are many more complex reasons. In Uganda and Botswanna they have decreased the prevalence bec the govt is more involved than in Nigeria. Locals say Nigeria has the most corrupt govt in the world.
They don't allow you to take pictures of public buildings so I couldn't take pics of the adobe mosque or wall----since their crisis in Dec.
I shouldn't mind the dust bec in the rainy season our roads must be all mud.
I'm working at Evangel hospital more. I think I can help them improve their care bec the patients are so sick, it is easy to miss impt. history bec they just aren't careful enough. Of course they don't have many of the tests we have , but they jump to conclusions about the diagnosis out of habit without much evidence of having the disease. They can't trust the lab either. Besides AIDS, there is a ton of liver disease and TB. Meningitis is not rare and strokes in young people from hypertension surprised me. NO heart attacks yet. The pt. rooms often reak of a smell of sweaty people in a small room with no ventilation----which is the case.
More later,
Will
Some sayings: often an educated man will first of all say How is the family? and if you cough or stumble, they say "sorry" ----every time you cough ie sorry for you. The Nigerians are rated one of the most happy people in the world I was told,,, yet other surveys list the Danes. They do love to laugh and tease each other, which helps.
Why do Nigerians keep getting AIDS ----the prevalence rate by some is 10% some say 5%. It hasn't gone down much. Good data is very hard to get since most don't have a birth certificate if born in rural areas. Many don't know their real age. One lady told me she was 100 when she didn't look over 55. they don't celebrate birthdays. Condoms aren't used nearly enough partly bec of lack of knowledge, many men are willing to risk it, and women are too scared to make their lover use a condom. Women need to be empowered. Having children is their greatest goal, so they will try to get pregnant so the man will marry her and also prove her fertility. I'm sure there are many more complex reasons. In Uganda and Botswanna they have decreased the prevalence bec the govt is more involved than in Nigeria. Locals say Nigeria has the most corrupt govt in the world.
They don't allow you to take pictures of public buildings so I couldn't take pics of the adobe mosque or wall----since their crisis in Dec.
I shouldn't mind the dust bec in the rainy season our roads must be all mud.
I'm working at Evangel hospital more. I think I can help them improve their care bec the patients are so sick, it is easy to miss impt. history bec they just aren't careful enough. Of course they don't have many of the tests we have , but they jump to conclusions about the diagnosis out of habit without much evidence of having the disease. They can't trust the lab either. Besides AIDS, there is a ton of liver disease and TB. Meningitis is not rare and strokes in young people from hypertension surprised me. NO heart attacks yet. The pt. rooms often reak of a smell of sweaty people in a small room with no ventilation----which is the case.
More later,
Will
Subscribe to:
Posts (Atom)