Motherhood in Niger

A post from Marc...

Just over 2 weeks ago we celebrated Mother’s Day. Eli, Hailey and I thanked Stephanie for being such a blessing to our family. We could not have survived this journey without her. In fact, we didn’t just survive. We enjoyed gourmet meals several times a week, ate homemade banana bread, granola, yogurt, and sliced bread, and had a very warm home thanks to her labor for 10-12 hours a day without modern conveniences. Thanks Stephanie. We love you!

I’ve been thinking a lot about mothers lately. I have spent the last 2 months providing primarily obstetric and gynecologic care here at Galmi. You may have heard the call by Christy Turlington to celebrate “No Mothers Day” this year to raise awareness about the obscenely high maternal mortality rate (aka death from childbirth) in many countries - particularly in Sub-Saharan Africa and Southeast Asia - which leaves many children with no mother at all. Niger is no exception to this grim statistic. In fact, it may be the epicenter of the problem. A colleague from Australia recently sent me an article which said Niger was rated the worst place in the world to be a mother. The triple whammy of extremely high maternal mortality, infant mortality, and famine makes it the worst place in the world to be pregnant, deliver a baby, and try to raise a young child.

My experience here has been like nothing I had ever seen or imagined while doing residency training in the United States. I remember having one mother who died shortly after delivering twins while I was in residency. She was 48 years old and had a rare condition called acute fatty liver of pregnancy. I talked with people about that case for weeks. I did a teaching presentation on it. I talked with specialists about it. We poured over the details. This seldom happens, and when it does everyone stops and thinks intently about the case and about what went wrong. Sometimes I feel like there is no time to stop and reflect here. The pace is so fast, and bad outcomes so frequent, that I often have little time to grieve over a patient before I have to move on to the next one. I wonder if when I get home all the suffering and death will crash over me like a tsunami when I finally have time to stop and think…

 We lost 6 mothers this week. Three were pregnant and three had just delivered. One patient had malaria, pneumonia, and severe preeclampsia, another had peripartum cardiomyopathy, a third had a ruptured uterus and developed an abdominal infection, the forth had a perforated gastric ulcer, and two died for reasons that are still a mystery, possibly a blood clot or aspiration. Unthinkable. Unimaginable. Truly, in this part of the world, it is No Mothers Day.

 Galmi hospital suffers from what is known in medicine as “referral bias”. Because Galmi is the largest and most well equipped hospital in the area, all of the most difficult cases get sent here. As a result, my perception of the problem may be worse that it really is. Most women in Niger are too poor to deliver in a hospital, so they deliver at home with a traditional birth attendant after no prenatal care. I'm sure that every day there are numerous normal home deliveries and even hospital deliveries in Niger. But at Galmi it is a pleasant surprise to have a healthy mom come in for a normal delivery. Most of the patients we deliver present with no prenatal care and an acute problem with their pregnancy or delivery… pre-eclampsia, eclampsia, peripartum cardiomyopathy, 2 days of labor without delivery, a baby's head that is stuck in the pelvis, post-partum hemorrhage, fetal demise, and on and on and on.

 Here’s a glimpse… Two weeks ago I was covering the OB ward on a Saturday, which meant that I was the only one on call so I rounded on every patient. I saw 42 mothers that morning and 29 newborns before I went home for lunch. Of the 5 patients who were still pregnant, 2 were in for pre-term labor, 2 for pre-eclampsia, and 1 who was bleeding from placenta previa. Of the 37 post-partum patients, 19 had C-sections, 5 had ruptured their uterus, 2 had cesarean hysterectomies because the rupture was so severe it could not be repaired, and one had also ruptured her bladder. We had 1 wound infection, 1 post-partum hemorrhage, 1 wound dehiscence, 1 uterine prolapse, and 1 patient who had a very difficult delivery because she had a female circumcision when she was a young child. We also had 2 sets of twins. And of the 37 post-partum patients, 10 did not have a baby in their bed because their child had died - either before they came to the hospital, during labor, or shortly after birth. In my 3 year residency, I delivered 225 babies. I remember 1 who died during a C-section, and I probably delivered 5 that had died before the mom came to the hospital. Six in 3 years in the United States… 10 in 1 day in Niger.

 But mixed with the heartache and pain that I have seen over these 2 months, there have also been many joys. The twinkle in a mother’s eye when I tell her she has twins and show her the picture on ultrasound, the many preterm babies who I thought would not survive, but by God’s grace pulled through and went home with their family, several late night C-sections for fetal distress where I doubted that the child would live, but to my surprise they came out crying and vigorous. Every day I am greeted by mothers and grandmothers who smile at me and thank me when I do my morning rounds. I love this job. It is painful at times, but it is also deeply rewarding and satisfying. I think that when I come home I will miss the difficult cases that I encounter here every day, and the constant challenge of doing the best we can with what we have. These women and their children are precious. They are so tough and resilient. They are a joy to serve and I will miss them terribly.

 Here’s a glimpse of the maternity ward at Galmi…



Delivery room

An OB nurse and my translator, Mamane

Presenting at 36 weeks with no prenatal care, I had to inform this woman she was having twins and needed a C-section because they were both breech.

A premature baby in our nursery

Here are some of the moms with their babies. This one is enjoying her twins!

Not enough beds so this newborn was parked on the floor

Before...

And after. So thankful this one survived.

Brand new dress for this little one

Welcome to the world baby! Getting a first bath in muddy water.

Thank you to the women and children of Galmi Hospital. It has been an honor to care for you over these months. My heart is with you on this "No Mothers Day".

Gracie's Birthday!

This past weekend we celebrated Gracie's second birthday with a Noah's ark theme party. It was SO much fun and our tummies were filled with delicious treats that we haven't seen much of since our time here in Galmi.

Hailey was very excited to carry Gracie's present to the party even though the box was nearly as big as she is.

Dianna made some multi-colored tissue balls to form a rainbow which looked really cute.

The treat table had an assortment of yummy things like animal crackers, Laffy Taffy, Starburst jelly beans, Teddy Grahams, Goldfish, and more! Marc said we never would have made it to the end of May trying to stash away all those goodies in our house. :)

 Dianna made an adorable cake with an ark made out of graham crackers and some animal cupcakes that were marching two-by-two to get on the boat.

 Happy Birthday Gracie!

It didn't take Gracie long before she had her entire cupcake licked clean. Good job on the icing mommy!

There were a few extra families in town that joined in on the celebration. I think we had around 24 kids in all!

Eli was a little too helpful when it came time to open presents. I had to stuff a few presents back in their gift bags so that the birthday girl could actually open them herself. :)

I still remember holding Gracie for the first time in the hospital two years ago. It is hard to believe how quickly time passes. We have gotten pretty used to seeing this precious face nearly every day for the past five months. It is going to be hard when we finally part ways with the Kubaczs in a few short weeks.

Sneaky Bites

I am making granola this afternoon and had a flash back to a few weeks ago when I last baked granola. I briefly had looked over to my "cooling station" just in time to see Hailey sneaking a few morsels. This girl loves to climb. I try to keep my eye on her but I was obviously distracted this day because she had already made her way onto the table and was helping herself. I wonder who taught her to climb on anything and everything???

Winding Down

In just three short weeks we will begin our trek back to the States. Can that really be possible? It seems like just yesterday I was writing a post about me learning how to make yogurt and knead bread for the first time. We still have some things to catch you up on (mostly on the medical stuff that Marc wants to share with you) before we leave and we hope to finish those posts in the next few weeks. We have had an amazing experience here and God has given us plenty of food for thought in the coming months and even years. I'm not sure I will ever be able to put words around all that we have seen and learned, but it has been good. Hard at times, but good.

Here's a quick catch-up on the home front...

This past weekend we decided to take a family trip to the reservoir. You might remember that Marc mentioned biking a few months ago to this man-made body of water. He really wanted us to see it before we left, so on Saturday morning we, along with the Kubaczs and our friend David, all piled into a car. We drove just a couple minutes outside Galmi and were dropped off for an hour at the reservoir. I should probably mention that Marc had been telling Eli all morning that he was going to get to throw lots of rocks into the lake. It is a good thing our little man can make an adventure out of almost anything because I wouldn't exactly say that what we found was a lake.

Not the most award winning scenery for a photo, but this is what you get in the dry season of Niger. :)

Ok, so maybe you need a reminder of what the reservoir looked like a few months ago...



and now (see the same tree)...

Crazy! I guess they decided the crops needed some watering because the water had all been let out on the other side. It will probably be some time before the lake begins to fill up again. The people have taken full advantage of the rich soil that was under that body of water and it is now covered with crops.

We still managed to enjoy our hour of climbing rocks, seeing a few camels, and taking a break for a snack.

 

There was a group of boys with an older man who were fishing the whole time we were there. We saw a big bucket near these boys on the water's edge with some tiny minnows in it. We initially thought they were using the minnows for bait to catch fish... and then we realized that those teeny, tiny minnows were the fish they were working so hard to catch. Just when I thought I was getting used to seeing the poverty here, I was again humbled.

This man was fishing knee deep in the water with a net.

Yes, that is a live fish in that boy's mouth...yuck. :)

Even the fish they caught that were a little bigger than minnow size would still have been thrown back into the water at home because they would not be worth the effort to clean. Not in Niger though.

We are SO blessed. I thought I understood what that meant before, but I didn't . I had absolutely no idea how wide the gap is between "us" and the majority of the world. I mean it is like a Grand Canyon sized gap. Please don't take that lightly. Let it sink in deep, deep, and deeper still. It does hurt us a little to go there, but I promise God will use it for good if you let him work.

On Sunday, we celebrated Mother's Day with an nice relaxing morning. I didn't think there would be any Mother's Day brunches here in Galmi at all of the many restaurants we have to chose from, so I made my first batch of cinnamon rolls that I refrigerated the night before and then baked up on Sunday morning. Marc took charge of the kids all day and really let me have a day of rest. It was a perfect day.

I love being a mommy to these two.

Well, now that I caught you up a little I am going to go start PACKING! We are sending some of our luggage by car early next week so I better get moving. :)

Thankfulness

Yesterday, I wasn't sure I could endure another single day here in this climate. It seemed much hotter and stickier than previous days, which I was trying to attribute to the busy work I was doing in the kitchen while the kids were napping. I was really beginning to sweat while baking up the breads and muffins we will eat for the next two weeks. Baking in this heat quickly raises the temperature in the front part of our house. As I was pouring some batter into a loaf pan, I felt something quickly run down my leg. I frantically whipped up my skirt expecting to find an ant or a spider crawling, but there was nothing. Then, I felt it again. This time I saw it. It was sweat trickling down my leg. As I sat there pondering how much perspiration is actually needed in order for a sweat droplet to make the distance down my leg, Marc walked in the door.

Marc had been in surgery all morning and was well overdue for lunch. Since the kids were thankfully already fed and asleep, I was able to express to Marc some of the weariness I was feeling in regards to the heat. After we talked for awhile, the kids woke up, and we decided that a trip to the pool would be the best way to refresh ourselves, both physically and mentally. We got the kids in their suits and lathered on some sunscreen. Just as we were about to head out the door, I heard a very loud noise outside. We live right next to the main road in Galmi and hear lots of loud noises, day and night, from the big trucks that travel up and down the road. But, this noise sounded different, almost like a clash of thunder. I excitedly asked Marc if he heard any thunder, but he did not hear it. I looked outside and saw the wind was blowing like crazy, and I started to hear a "clink," "clink," "clink" on the metal roof.

“Marc, do you hear that? Is it raining???
    “No, it’s not raining.”

“No, Marc, I really think it is raining.”

We opened the door wide, and then we saw it..... the first precipitation since we arrived at Galmi.
Look closely.

 See it?

 We were all a little excited. :)

With our kids in tears when we told them we couldn't go to the pool, we decided to let them splash around in the rain and mud. We got a great video of them jumping into this mud puddle. They probably had more fun playing in the rain than if we had gone to the pool.

 After the rain was over, the clouds parted and it was glorious. I kept thinking of the Chris Tomlin song "Kindness" when I looked at this.... "Open up, the skies of mercy, and rain down the cleansing flood..."

It was unreal how quickly the temperatures fell. The cool breeze was the most refreshing thing I have felt in months. I'm not sure that I have ever been nearly brought to tears by the sight of rain, until that moment.

There are probably plenty of reasons God had it rain yesterday (a few weeks ahead of what is normally considered the rainy season). However, it felt like a personal gift that God hand wrapped and delivered on my doorstep. In the midst of my frustration and despair, it was a reminder to me that God has made promises to me and he is faithful to see me through everything he calls me to go and do.  He will not leave me or forsake me. He will be with me wherever I go.

So, today I am thankful…

Thankful for God’s unconditional love and faithfulness.

Thankful for the first rain of the season.

Thankful that the Nigerien people who don’t have air coolers and ceiling fans were able to enjoy a cool night’s rest.

Thankful to know what rain on a tin roof sounds like.

Thankful for another month here in Niger for God to teach me beautiful lessons like this.

And, thankful that after the most incredible rain, someone brought MAIL to our door! We are thankful for everyone who reads this blog and sends us encouraging emails, prays for us, or sends us a package. Thank you!!! These goodies will certainly carry us all the way home. :)

"Have I not commanded you? Be strong and courageous. Do not be terrified; do not be discouraged, for the Lord your God will be with you wherever you go." Joshua 1:9