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

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

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

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

My day---March 23

My day starts at 6am when I jog for 30 min while it is still cool. Then when I take my bath with buckets of cool water it feels so refreshing. Worst part of living here is the dust and dryness as it is the end of the long dry season. My bath tub was lined with sand when I filled it with water.
Breakfast is hot oatmeal and hard boiled egg and nescafe instant coffee. We have a cook who makes very tasty rice with veggies and fresh pineapple. I do miss my sweets. Electricity is available for about 3 hr a day via Neppa and we have a generator we can use for night time bec Neppa often doesn't come on till 9 or 10 pm----when you really need it. No running water but I am used to getting water out of the large oil drum type plastic container with a bucket.
Fresno Baptist Church is here and leaves in 2 days. I will be alone in the guest house the rest of my 2.5 weeks. I have to run bec it is dark out and not so safe to be on the streets. The whole city has a curfew at 9pm since the crisis in Dec 08
Will

March16, 5:15pm Nigeria

This is my first attempt to post on my blog so bear with me.
First day in clinic started at 8am with a black pastor speaking for 30 minutes with alot of emotion and gestures and amens. and walking all over the meeting area. They call this devotions!!! I have never heard someone speak so fast and for so long extemporanously and yet say the same thing over and over with different words. The ending prayer was also spontaneous and went on for over 7 minutes , with his voice rising higher and louder, esp the last 2 minutes.
Patients are encouraged to come to this, but they also are seen an a first come basis so that gets them there. Even Muslim women come to this ,but are the least interested.
The 2nd pt. was in early shock with a BP of 80/40 and a pulse of 140. Her HIV test was +. Her husband left her in Jan. and just before he left he told her to get an HIV test. She also is breast feeding her 8 mo old , so the baby prob is also + for HIV. We wanted to send her to a hospital but she had no money and they wouldn't accept her. So we sent her home to return tom . to start ART for AIDS. IV fluids do wonders .
In a 12X12 room 3 diffent doctors with 3 diferent pts would all be working together with no privacy. No wonder they don't do much for physical exams. Nurses and other admin. people are coming in and out of the room, cell phones are going off and Christian music is played in the background. Total chaos. They have alot of doctors here at FA, but not near enough examining rooms. Can you imagine an American being told he has HIV with many other people in the room that the pt. doesn't know? Where is HIPPA when you need her?
That is all for now.
Will

Nigeria, here I come!

I'm leaving for Jos, Nigeria on Weds., March 11th. I'll be returning on Saturday, April, 11th.

I will be working with Dr. Chris Isichei, who is the director of Faith Alive. The website is www.faithalivenigeria.org

I will be posting for the next month. Talk to you soon.

Love,

Will