Busy Days

Well, we hit the ground running when we arrived home on June 9th and we haven't stopped since. Hence the reason for a lack of the blogging these days. :) We have bounced around between Kansas, Arkansas, and Illinois for the past two weeks and won't stop moving until we relocate our family the beginning of July to our new home in Peoria, Illinois. The kids have readjusted really well, and I think Marc and I have just been so busy that we really haven't had much time to process all that is different about our lives these days. I have moments where it hits me hard and the tears come out of no where. Sometime they are tears of gratitude for the many blessings we have that we previously overlooked, and sometimes they are tears of sadness when I think of all the despair we left behind. Maybe when the pace slows a bit I will write out some more about all that I have learned.

We certainly have found some new appreciations in our day to day life here. The best part by far has been soaking in the beauty of the green landscape everywhere we go. We have spent so much time outside these past few weeks. We have gone for walks, frequently visited parks, and let the cool grass rub between our toes. Everyone around us seems to think it is too hot to sit outside for very long in the heat of the day, but we are simply loving it.

Here are some recent pics since we have been home...

Marc was working on Father's Day so we celebrated a few days early with a dinner to Abuelo's. With all the eating out we have done in the past two weeks we shouldn't have any problem regaining the weight that we lost. Between eating out and visiting family, I haven't cooked a meal yet since we have been home. :)

 Pool time in Arkansas!

Papa D protecting Eli from Uncle Brandon :)

Nana made snow cones

 Feeling grass beneath their toes was so exciting to them

 Some fun in the sprinkler

 Enjoying some time with the cousins in Illinois

Eli is a good big brother on most days ;)

 Where did Eli go???

 Hailey found him!

Oh, these two keep life fun. Never a dull moment.

So, tomorrow we leave Illinois to briefly head back to Arkansas to meet our new niece. Then, we head to Wichita for Marc's graduation and to pack up our apartment. After that, we are driving back to Arkansas to see family for a few days before we head up to Illinois for Marc's sister's wedding. Then, a few days after the wedding we are moving to Peoria which will become our new home. Marc starts the second week of July with his new job. Whew! It is going to be a whirlwind. I will post a few updates when I'm not napping. ;)

Sweet Friendships

As we are starting to pack and mentally prepare ourselves to leave this place, we are also forced to begin thinking about some of the friendships that we have made over the past five months that we will soon be leaving behind. There are many missionary women and moms here that I have grown quite fond of over the past few months. Not only have they helped me survive what has undoubtedly been the most challenging thing I have ever undertaken as a wife and mom, but they have also continually inspired me by the way they live their lives here year after year. I know we will stay connected to these families and their stories, so I am refusing to say any permanent goodbyes when our plane arrives in a few days. :)

Marc is also starting to process leaving behind some of the sweet friendships he has made with the other physicians he works with as well as with the nurses and translators that he has spent so much time with over the past few months. From the beginning, Marc formed a really special bond with one of his translators, Mamane. We have had Mamane in our house more than anyone else who works with Marc. He coaches the little kids on the soccer field which is in close proximity to us so he occasionally stops in to say hello or eat a meal with us. His English is very good so our conversations are always enjoyable. Our kids really like Mamane and Hailey has even learned how to call him by name. He is very kind, humble, and has a bold desire to share his faith with those around him. Marc is really going to miss this friend.

We hosted one of the nurses from the hospital and his family a few weeks ago. Rufai is from a different people group in Niger called the Tuareg. The Tuareg live mostly in northern Niger and have a lighter skin color than the local Hausa people here in Galmi. There has been some violence among his people in recent years so he left and came here for some temporary refuge and discipleship. He does hope to return at some point to share more with his people about the love God has for them.

Rufai, his wife, and his seven year old daughter from his first marriage, came to eat pizza with us. He told Marc that he really wanted to try pizza since he had heard so much about it. I don't think they were too crazy about it when it was all said and done. :) His daughter was really enthralled with our nicely painted concrete walls. They are painted with a very slick and shiny white paint and she was running her hand over the surface during dinner. Her dad apologized and said that she had never been in a house like ours before. I forget that our humble house with concrete floors and walls is still so very nice compared to what most people here live in. 

We really enjoyed getting to know this family. Their daughter was very sweet. I thought she would make the perfect new mommy to one of Hailey's baby dolls that we had brought with us from home. She was beyond excited to take this doll home with her after dinner.

Rufai is only 34 but his first wife passed away shortly after giving birth to his youngest son (he has two children, ages 7 and 3). He has been married to his new wife for two years now. They are of different religions which is not out of the ordinary for this culture where one religion is so dominant. They were married when she was 17. Rufai told us at dinner that she suffered a miscarriage last year and is still very sad about losing that child. They are hoping to have another child soon.

There is a social pressure placed on women here to be able to have many children for their husbands. Sadly, some husbands will divorce their wives for someone new if their wife becomes infertile or goes through menopause. What is really heartbreaking to me is that when the husband leaves her, he can take any of their children with him. The woman is then left with nothing. I can only imagine that many women feel devalued and without worth if they struggle to have children.

Have I mentioned anything yet about the sweet woman who has been helping me keep house over the past five months? Hasira comes in the mornings on Monday, Wednesday, and Friday to wash our clothes and help clean the house. Even though we don't speak the same language, she has been such a wonderful presence in our home during our time here. She loves on our children and has really eased the burden of the housework here for me. I could not have done it without her. 

I really wanted to show how much I have appreciated her by having her whole family over for a meal. I didn't know when I extended the invitation how many were actually in her family, but she was so grateful when I told her she could bring everyone that lives in her house (which I found out would be 4 children, 1 grandchild, and a husband). We also invited a translator from the hospital to come and help navigate us through our conversations. We did not know before our meal that Hasira's husband is actually one of the anesthetists who works at the hospital. He and Marc have been in surgery together nearly every day for the past month! Her husband speaks some English as well so we had a great time. They have 9 children together, and 4 of them plus a grandson still live at home. I think the ages of the children who ate with us were 15, 13,11, and 8 though all of the kids looked smaller than a typical eight year old from home. Their grandson was two. The kids had so much fun playing with Eli and Hailey's toys. And for the most part, our kids did a good job with sharing. I think they were just excited to have so many new kids to play with.

I put all the kids (minus Hailey who sat with us) at a table together. They giggled through the entire meal! I served black beans and rice with cornbread and we had an assortment of fresh fruit for dessert. I think it went over a little better than some of the other things I have served people here. :)

At the end of the night Eli put several cars in a bucket for his new friends to take home. It was really sweet.

This picture below really gets me tickled. All the kids were busy playing with Eli's Thomas the Train toys when Eli ran into the kitchen to get one of our empty powdered milk tins and a plastic spoon. He put it on our table and started beating on it like a toy drum. Hasira and her husband were laughing so hard at him. I'm sure they thought his choice of a toy was quite funny when he had many fancier things to play with.

Sweet, sweet, friends. Thank you Lord for bringing these people into our lives.

An Hour Away

One of the moms here graciously offered to watch Eli and Hailey for me one morning last week so that I could take a few last pictures to document our time here. I have really enjoyed my new opportunity to stay home all day with our kids, but I have also learned that I am a better mom when I get some kid free time periodically. It has been hard to work that time in here, so it was refreshing to have an hour away from the kids with Marc (we are due for a few date nights when we get home!) and to see all that he has been doing here at Galmi Hospital. I had a great time as he took me around and introduced me to all the nurses, translators, and surgery techs that he has worked with since January.

A group of midwives and nurses

We peeked in on these newborns that were just born.

One of the midwives and her 6 month baby girl

Another group of nurses

Checking in on a few kids while we visited the peds ward

We stopped in to check on Dianna in the peds clinic...

And then our last stop was to the malnutrition unit, the CREN. This little boy is 4 years old and only weighs around 17 pounds. He is severely malnoursished. He has a blue plastic bag in his ear that the nurse told us would help with his otitis externa??? I think both of our kids weighed around 17 pounds at 6-8 months of age.

He was so weak he couldn't stand very well. I am left without words.

This mom was busy preparing food and her baby was really ready to get down. :)

These little twins were so cute.

Thank you Tara for watching the kids so I could spend this time with Marc. It was really special for me to see it all one last time and a wonderful way for us to remember Galmi Hospital after we leave. 

A few thoughts....

If any of you who have followed our journey over the past few months are curious about coming to Galmi or somewhere else in Niger to serve, please email us and we can give you more information about SIM Niger. There are people serving here in Niger in so many capacities: teachers, construction workers, electricians, farmers/agriculturists, pharmacists, nurses, doctors, occupational therapists, IT or administration people, and so on and so on. If you have a gift and a desire to use it for God's glory in this place then we would love to help assist you in that process. 

God does powerful things in our lives when we respond to Him and His calling... and it does not mean you have to get on a plane to travel across the world. :) Just ask God to show you what He is calling you to do wherever you are right now. Maybe He is asking you to intentionally read the bible for the first time, maybe He is asking you to take a widow or an orphan into your home, maybe He is asking you to mend a very broken relationship, maybe He is asking you to live off less and give away more, maybe He is asking you to repent and fall on your knees before him, or maybe He is asking you to come here and serve. I don't know what it is for you, but I really believe that when we are willing to respond, He will show us what it is He would have us do with our lives. The invitation to be a part of God's plan is there.... read Isaiah 55. Will you respond?

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".