Week 4: Can't Think of a Catchy Title

Dear Friends,

I have had a fun week!

On Sunday morning I attended the Family Worship Center, an evangelical, fundamentalist Christian church in the southern part of Abuja. I accompanied Do-pe(do pay), a Nigerian woman trained as a dentist here, who now lives in Baltimore. She does research for IHV in both Baliomore and Nigeria.

The church is a mega church with at least 3000 people but probably more, per service. The singing was breathtaking and at times I just closed my eyes and let the sounds surround me. Pastor Sara gave a good old Bible thumping sermon with lots of Amens and Alleluias; ending the service with a brief Altar Call because 3000 more people were waiting outside for the next service. I really wanted more singing and dancing! And again, I was the only non-African in the sanctuary. Great fun!

Friday afternoons and Sunday mornings are sacred mosque/church times here. Many local businesses close on Friday afternoons so all Muslims can go to the mosque to pray between 1:30-3pm. Traffic is horrendous around all mosques; but most especially around the central mosque that seats thousands. Cars are parked everywhere and traffic is at a virtual stand still.

Sunday mornings, apparently all non-Muslims attend some kind of church service and the city is quiet. No honking horns signaling a lane change or turn, no men with really big guns, no nothing. It is quite lovely. Not even the drivers are available until 1pm.

Sunday afternoon I escaped! Woo Hoo!!! IHV-N is starting and funding 7 comprehensive labs in Nigeria with the goal of being certified by the World Health Organization (WHO). The labs will be focusing on advanced HIV and TB testing if the labs can get up and running. A lot depends on the availability of some type of 24 hour electricity to maintain consistent refrigerator temperature for cultures, etc. Even with generators, it is still impossible. An engineer arrived the other day to fix/replace cords on the machine that calculates the HIV Viral Load. Reason: the rats chewed thru the cords of this gazillion dollar machine! Because of these projects, many people come and go from the Guest House at all hours of the day and night and then they are gone to outer towns for days at a time.

Sunday afternoon, Valentina, a Russian woman who lives and works in Botswana as a Microbiologist, needed to be driven to Kaduna, about 3 hours away. There was an apparent mix-up between Valentina and some engineers who thought everyone was driving on Monday, blah, blah, blah. Words were spoken, blah, blah, blah and Valentina said that she needed to go NOW. OK.

Chinduc, the driver, agreed to take her, knowing that this was a 6 hour trip that would have to be repeated with the engineers the next day. I was sitting outside, listening and watching this little sidewalk soap opera, when I spontaneously said, "Can I go with you?" Chinduc said ,"Yes" and I was outta here! Du-pe did know that I was going but nobody else did. So clandestine!

One of my frustrations has been the inability to really "get out" and see this place. The drivers take us everywhere, which is wonderful of course; and the guards must accompany us after dark, even if it is to walk down the street to a little shop. I was not allowed to stay in the home of the matron, in Keffi, because of security. I understand all of this and would not do anything to compromise this but I really wanted to see a sunset and not its reflection on the Guest House wall.

So off we went and I felt like I was running away from home!!! It was wonderful! The landscape wasn't much different than the one I see daily driving to the clinic but I was excited to see life after dark. What were the villages like? The markets? Did everything shut down at sunset?

What I did see was a lot of truck stops. Now, the 2 lane road (in each direction) that we were on, is about 3 cars wide. The trucks, oil tankers and semi's, park right on the shoulders, on both sides. Itisreallyclose!

Several years ago, I read about truck stops and the charting of HIV infection in the country. The infection transmission paralleled the truck routes and we were driving thru one of these stops. There were about 50 trucks all stopped; some being washed or fixed and all idling with thick black exhaust smoke. I asked Chinduc what was going on and he said that they were "all resting with their concubines."

The ride was uneventful except for having to dodge non stop potholes which means cars, motorcycles and trucks are all over the road, all of the time. Driving is like participating in a 3-D movie and not for the faint hearted.

We arrived in Kaduna, staying long enough to drop off Valentina, get some bottled water and use the facilities. And do you know what the facilities had? Hold on now: a door on the stall, a lock on the door of the stall that worked, a toilet seat, a flusher that was attached to the inside, thingy and DID flush, toilet paper, a sink for hand washing, running water, SOAP and paper towel. Can you imagine? What will they think of next?

We headed back to Abuja and Chinduc immediately said, "Why don't white men want to have a lot of kids? Can white men have more than 1 wife?" Color: if you are not black, than you are white. Poor Treeny hasn't adjusted to that one yet and is hoping that her Chinese ancestors don't put a pox on her house.

I briefly explained that there are many colors in America but for someone who has never been on a plane or out of Nigeria, demographics are an abstract concept. Except for Rap videos and President Obama, white is all many people know. I told him that family size was a mutual decision; and 1 wife at a time was the legal limit. In Nigeria, Muslim men can have 4 concurrent wives, non-Muslim men 2 wives but only 1 marriage can be in the church. I did ask if women could have more than 1 husband and he laughing, emphatically saying, "NO, that is taboo!" I said that that was discrimination. He laughed at that too! Homosexuality is taboo here and is appalling to anyone that I have asked.

Dusk was settling in and the steel gray, puffy clouded sky looked so close and so beautiful. But...no one turned on their headlights! I had heard about this and the explanation given was to "save gas???" I asked Chinduc about this and he said, "no need, everyone can still see." OK. He also said that the switch on new cars that automatically turns on headlights is usually disconnected when the car is bought because, "we can see.”

A few minutes later, I again asked about the headlights because it was more dark than dusk and he laughingly put on his lights "just for you." Now, just because there are headlights does not mean that there are taillights. I had this realization as we came really close to crawling up some semis’ tail pipe.

As we passed the villages, mainly round mud huts with thatched roofs, it was apparent that most huts did not have electricity and any light that was seen, was coming from small kerosene lamps. Bigger villages that had small houses or "apartments" had a few lights but that was it. The markets were open, lit with single lights bulbs strung from cords going to generators, and were busy. They will stay open until about 10pm. The only people that were walking along the road sides were women who sell their goods from small "lean-to's" or mats along the roads. There are no street lights and with poor use of headlights until it is pitch black, I would see people "just appear" out of the dark. A bit spooky.

All headlights came on when it was totally dark and because we were on a main road, the traffic looked like any other stream of highway traffic. Great fun!

Mid-week, Treeny and I ventured to the market by ourselves and we felt like "such big girls." Wuse (woo say) Market is a massive flea market/ outdoor shopping mall, comprised of very small stalls selling everything. It is the main shopping center for all of Abuja. Chickens in wheelbarrows, live fish, clothes, cell phones, etc. We had shopped there twice before but always with a small group and a native Nigerian. This time, the driver dropped us off and we ventured in to buy some fruits and vegetables. And of course, we were the only non-Africans.

Some people stared but most were about the business of shopping. Only the kids and babies stare and sometimes scream. I always feel so bad about that. Any time I did not get the price that I wanted I would say that I was "returning to America, you know, Obama." "Obama?" they would smile and ask. "Absolutely" I would say and then usually get the more reasonable price. I am shameless!

Next to the food portion of the market, is a small mosque that is always busy with people praying or just lounging about. Today, there were "barbers" sitting in chairs on the mosque "porch", shaving men’s heads and beards. We both wanted to take pictures but that is really taboo.

I also had the opportunity to visit the matron’s house this week. Ladi has so wanted me to visit and stay with her but due to security, it is not possible. So on Friday she said, "we must go to my place so I can get you a book" and off we went driven by the IHV-N driver. I love breaking the rules, especially in the light of day when there is little risk. I am not that brave to do this after dark.

Ladi lives in a 2 bedroom apartment walking distance from the clinic. The complex looks like single story row houses. All doors are maroon colored and iron "to keep out the robbers." The small living room had a nice couch and love seat, TV, etc. There was a large freezer and a small buffet style cupboard in a dining area of sorts. We then walked out a door opposite from the front door, into a small concrete courtyard. There was a large Satellite dish on the block wall, separating Ladi from her neighbors, clothes drying on a the line and 3 small rooms, all with the small maroon, metal doors. One small room was the toilet with a shower wall nozzle 'when there is water", one room was for storage(I saw Ladi's 10 year old son's bike) and the biggest room was the kitchen.

There were no appliances in the kitchen. The walls were charred black from smoke with a small open window for ventilation. There were 2 small 2 burner each, cooking stoves on the floor with pots of boiling "soupy white material". I have seen this same boiling material in large kettles outside the huts in the villages. There were piles of foot long yams on the ground which is another food staple here.

She showed me her small back yard, accessible thru another maroon, metal door, with plants of peppers that are used to make pepper soup. I have had the soup and it is delicious!

Ladi then said, 'wrap this cloth around your waist and sit and eat." OK. The cloth was a common African print, that was a long skirt really, and I guess is worn for eating. I sat on a small stool and was handed a plastic mug of a cool rice pudding like substance that was wonderful! With honey, which she scooped out of a large barrel, it was to die for. She said that I was not a typical oyibo (white person) and should move to Nigeria. After a few minutes, we left and returned to the hospital. As we were getting in the car at the apartment, kids emerged from several apartments to see the oyibo. Most have never seen a white person. Amazing!

My clinic activities have included cleaning and organizing some of the clinical areas that are crazy messy and make me nuts; speaking on appropriate chart documentation, HIV 101, etc. and problem solving clinic issues with Ladi. for some reason, I just love this clinic. It's a hellhole, but I love it!

Miscellaneous:

- Every person seems to have a cell phone with some pretty entertaining ring tones: ABBA-Dancing Queen, Mexican Hat Dance, Prayers to Jesus. And my personal favorite, "The First Noel" on the phone of a veiled clothed Muslim woman. Her phone rang and 2 nurses and myself started to sing and sway. The woman laughed not understanding a thing that we were saying!

- There is no graffiti here, at least as we know it. There is "Caveat Emptor" "Love Jesus" Think Positive"(this is about life and not HIV) and "Don't urinate here." It is culturally acceptable and necessary at times, for people to pee and poop on the side of the road. And not unusual to see men relieving themselves every few feet in populated areas; so signs are necessary. I never see any women though, I wonder where they go?

- Every major intersection has traffic lights BUT NONE OF THEM WORK!!!! Instead, there is a police officer standing inside a teeny, tiny shack, somewhat directing traffic or usually just watching all of the vehicles try not to hit each other! Crazy, and pretty funny.

- All engaged couples are strongly encouraged/required by their churches and mosques, to have HIV testing. Many clergy will also send a church representative with the couple when they are tested and will be given the results along with the couples. Some churches will refuse to marry a couple that is discordant (1 positive, 1 negative) because the clergy do not feel that the couple "can have a satisfying married life." Those couples usually go to the courts to be married.

Well folks, I think that is it for this week. The water has been off more than on and the electricity. . . . .you know the rest. The generator keeps overheating and the poor guards furiously try to fix it. And life goes on.

Kathleen

Week 3: This and That

Hello Folks,

This is the beginning of Week 3 and life has taken on a quiet routine in our little corner of heaven. It continues to rain at least every other day and the nights are starting to feel a bit cooler and dryer. The clinic staffs are feeling more comfortable with our presence so we are starting to be able to see "the real stuff" in clinic functioning.

The pace of life is much slower here, I'm sure that the heat and humidity influence this, and most people seem to move at that slow pace. Only vehicles with wheels move quickly here. Treeny and I are constantly slowing our pace when we are walking with people because we feel the urgency of time with places to go and things to do. But in order for there to be change, we can't be the only ones moving quickly.

We daily observe situations that are maddening, unfair, inhumane, defy logic and are just plain stupid. Examples: the lab tech spilled some reagent on the floor but wouldn't allow the porter to come in and clean it up until he finished his phone call. The porter waited 15 minutes and was called to another ward. The lab tech finished his call, came out looking for the porter, she wasn't there, so he waited for 60 minutes until she returned, refusing to draw any blood until the reagent was cleaned up. Twenty (20) patients stood in line in a non-ventilated hall, waiting to have their blood drawn for 90 minutes.

All people wanting to be HIV tested must report to the clinic by 7 a.m. to receive a number to stand in line. They then wait 6 to 7 hours because the lab tech will not allow the nurse, who is educating the people on the test, and knows how to do the test, to draw the blood. So the people wait, all 30-40 of them.
And it goes on.

This is the time during my mentorship that I look at all of the issues affecting life here and functioning in that life, and I see why this country and continent are sinking. A work ethic that is not always the best; leadership, or the lack thereof, that seems to have blinders on; constant complaining about too much work and can't "my country" do something. Malaria is endemic to this country, yet hospital windows into the patient wards are missing screens, or have screens that are partially pulled away from their frames. Boggles the mind.

Hospitalized patients can get oxygen ONLY if they can afford it! Can't afford it? So sorry. Patients can't be discharged from the hospital until they pay their bills so many patients sit there for weeks while their families beg, borrow, sell and steal, to get money. This also includes the morgue!

So...Who sent me here and what am I doing?

I am associated with Global Medic Force, an organization started by a physician in New York, that focuses on sending doctors and nurses who are HIV knowledgable, into areas with high HIV rates, to mentor staff in caring for people with HIV. Organizations in high HIV incidence countries, contact Global Medic Force and request mentors to come into their countries for 6 to 12 weeks to do a "rapid skill transfer" with their staffs. We do not care for any of the patients, just train and mentor the current staff so they can carry on after we leave. When I arrive in the country, I work with the requesting agency, ie: The Clinton Foundation in Lesotho; Family Health International in Viet Nam; and now The Institute of Human Virology in Nigeria (IHV-N).

IHV is through the University of Maryland in Baltimore. They have been in Nigeria for 5 years, in an effort to support the Ministry of Health in the HIV epidemic. The Clinton Foundation is here focusing on procuring Pediatric HIV medications; and Baylor, Tufts, the CDC and Morehouse College are also here
in various capacities, to assist in the HIV fight.

IHV receives their money through PEPFAR: Presidential Emergency Program For AIDS Relief which was created by George W. Bush and now continues with Obama. The US is frequently mnetioned as a partner with the Nigerian government and is routinely thanked by the Nigerian people. It is very easy to be an American here.

The four of us are the first set of clinical mentors that Global Medic Force has sent to Nigeria; and the first set that IHV-N has put into clinics. There have been numerous IT and Research folks who have come here through IHV-N but we are the first folks to be sent into clinical sites. We receive a daily stipend and our airfare is paid but we are volunteers.

Each of us evaluates our clinical sites and staffs on HIV knowledge and practice, clinic efficiency and flow and then mentor's the staff based on what we see and don't see. We are not expected to accomplish all of our goals in 6 weeks, that is impossible; but we are expected to direct them on the path forward and make recommendations for future mentoring groups if we feel that they are needed and it would be beneficial.

We are usually well received by the clinical staff and they say that they want our feedback but having strangers from white Western countries can be uncomfortable for both sides. We are very delicate and gentle in our speech and presence, spending the first week or so just being around and gaining the staff's trust. The Keffi staff has openly and warmly received me and Treeny and welcomed us into their working lives.

Today I visited a pharmacy aka the Chemist. I have continued to cough and my voice sounds like a cross between Marlena Deitrich and Typhoid Mary, and I have been forbidden to go to the clinic until I sound healthier than the patients!

Obtaining legitimate medications here can be difficult; counterfeit medications are the norm. I brought every conceivable medication with me except cough syrup because I was afraid that it would leak, so off to the chemist I went in search of Nigerian Robitussin.

I was expecting some dark, dank, "lotions and potions" type of place but this place, albeit quite tiny, looked legit. I described my symptoms to the chemist assistant, answered all of his very appropriate questions and he reached up and handed me a bottle that looked like something Mary Poppins would dispense. In fact, it is from the United Kingdom. It is called Covonia Original Bronchial Balsom and it tastes like liquid black licorice mixed with bitters. BLECH!!! Taste so bad, its gotta be good. I am feeling better already!

I have been asked to give weekly presentations to the entire hospital nursing staff on nursing assessment, wound healing, etc. I am also starting to give some type of a daily presentation on HIV related issues. The staffs are very open and enthusiastic about learning and hearing new information.

Miscellaneous items:

-Along with ubiquitous churches and mosques, there is the constant insertion of God's name into everyday speech. 'Praise god, you are better." "Thank you Jesus for my medications." "God is good..." This is spoken by all people of all faiths and it sounds normal and genuine.

-God is also spoken of in other parts of life: God is Able Pharmacy, Alleluia Aluminum Company, Devotion Hotels, just to name a few. Gotta love it.

-Nigerian food consists of predominantly carbs and deep fried whatever. One of the staples is a ball of dough think baseball size, possibly mixed with yams, that is baked and then eaten whole. It is an acquired taste and I am not quite there. There are also meat pies that look like a half pot pie, that is filled with some kind of meat(I don't ask) or some curry flavored vegetable (no peas! I hate peas!) and deep fried. They're pretty good actually. There is some type of green vegetable dish, looks like spinach but tastes like fish, that is boiled or something. Still working on that one too! There is also something called Moi-Moi. Rust colored, solid something, in a small container. It's OK but I don't really know what it is! My favorite is Garden Eggs. They are the same size, shape and color of eggs but we saute them in some olive oil with some garlic and thyme and they are outstanding.

-There are NO western brand restaurants here. No Starbucks, McDonalds, KFC, etc. There is Mr. Biggs that is a hamburger joint; and Chicken Republic that is similar to KFC. There is also the Mama Cass Cafeteria, Killimanjaro Restaurant, Berkeley's Fine Food, La Luna Mexican Restaurant and Nigerian Niblets.

Current “this and that’s”:

Last night, 9 of us went to the one and only Korean restaurant in town that opened last month. Big news in these parts! There was a Thai restaurant but that closed 6 months ago. A travesty of justice according to some people. And there is Chopsticks Chinese/Italian/Hamburger restaurant.

The common denominator for all of these restaurants, is that they are either Nigerian or Lebanese owned, and entirely Nigerian staffed. I did see one lone Korean man who I think was the owner but that was it.

The food was excellent but expensive, about $30/person, which is the norm for any basic meal. There was also karaoke which made it a legitimate Korean joint!

Picture this: 3 middle-aged white women, 2 women in their mid-20's, 1 from Nigeria, the other from Boston; 1 Chinese/Australian woman, 1 man of Thai descent, 1 man, a self-described "New York Jew", and 1 very tall man from Ghana, all singing "Macho Man" by the Village People! Mainly well educated physicians in their daily lives but at night with some wine and Kim Chee and Karaoke...a thing of beauty. We even had the waiting staff dancing with us (I started that, I will admit) and cell phones in the air instead of lighters. There are pictures!

Well, today is Friday and I am feeling less poopy and negative about the clinic; it must be the Mary Poppins cough medicine! My goal for next week is to investigate a water cooler for the clinic. There is NO drinkable water in the clinic!!!!!!!!!!! People wait for hours with no food or water and only the grass as a toilet. The staff does have 2 toilets which are fairly decent, all things considered. At least they are inside.

Take care friends. Talk with you next week. And Happy Birthday to Lee, my favorite nieces' sweetheart!

Kathleen

Week 2: FAQs & Keffi

Dear Friends,

A few clarifications: I am not allowed to blog or use Facebook per IHV-N policies and because I am connected to their wireless system, I cannot access the blog. So I am sending all of this in e-mail segments to Veronica who then posts it on the blog. That is the main reason for last weeks delay. I also cannot access any comments or questions but if there are any, Veronica will write them to me.

Some leftovers from Week 1:

1) Independence Day evening, 7 of us walked down to a local restaurant for some pizza and drinks. The restaurant was packed with embassy folks and ex-pats who had to work the next day, Friday. A local TV station came into the restaurant and interviewed several of us about our thoughts and feelings about Nigerian independence and apparently, I was on the local TV station for a few seconds!!!!

2) Last week I experienced my first roadblock. Apparently, a man had gone into the police station to complain about being mistreated by the police. He was roughed up a bit by the police, and when he walked out of the station, he found that they had slashed the tires on his car. And then the police came out and shot him dead. Several of his friends were outside the police station, observed all of this and started to riot. The rioting spilled into a major intersection and traffic was stopped for hours. We sat in non-moving traffic for 1hour as we returned from Keffi clinic. As we passed the site of the shooting, we could see police investigating the scene and large numbers of young men standing around waiting.

3) Anybody can get a driver's license here. There is no DMV, no driver's test, no experience needed, nonothing. Send in a check and the license is sent to you in the mail.

FAQ'S:

1) Most of our food shopping is done at local, outdoor food stalls. There are 2 regular food stores that have a decent selection of goods but all fruits and vegetables are purchased at the stalls. And that means that all transactions are bargained and haggled over. I hate doing it but am starting to understand the "principles" of it. As a white non-African, I am assumed to have money so am quoted the top price. I then divide that number by 3 and quote the lowest number. The merchant says, "Madam, no." I say "yes" and we go back and forth with numbers until I agree to pay his bottom number. It’s a tiring process, but the norm. The fruit and vegetables are big and fresh. Avocados the size of softballs for one dollar but grapes are nine dollars for a small tub. Prices are generally high here comparable to US prices, but the wages are obviously not at US levels.

2) What do I eat, you ask? Breakfast: cereal with yogurt or toast with peanut butter and bananas; maybe some orange juice and tea. Lunch: fruit, avocado, cheese. Dinner: omelets, sautéed veggies, chicken wrap. We are still working on this meal. Our goal is something on a plate that doesn’t cause disease!

3) Saturday, we all went to an HIV support group meeting at one of the hospitals and it was one of the most joyous ones I have ever attended! There were about 25 men and women in all stages of the disease. They meet once a month to share concerns and support each other. Their concerns are the same concerns as in the US and we told them that. We talked about advocacy for themselves and living a long life with the disease. We are finding that people assume that WE/the US/Canada/Australia have no issues in caring for those with HIV and are stunned to hear that we have the exact same problems, concerns and issues as they do. They had drinks for us and requested a group picture with us! Amazing!

4) Utilities: Water is plentiful and hot if it is running. Twice it has gone out in the middle of a shower and I was not quite done. At least the soap was out of my hair. Electricity – I was told and the guide book said, that there are frequent power outages but my first 3 days there were none, so I assumed wrongly obviously. The daily average is 5-10/day. The electric company is called NEPA/Nigerian Electric Power something but it seems to stand for NEVER EXPECT POWER AGAIN! Even the guide book says this so it must be so. People seem to be quite used to it; they don't like it but they do go on. During a Power Point presentation last week, the power stopped 5x and the presenter never flinched.Just normal business! That obviously means the A/C goes off but we do have a generator that kicks in fairly rapidly and things carry on. Except for Treeny's A/C, that works on its own time and not for her convenience. Off for 10 hours, on for 24, off 3, etc. She says that she has made peace with it and hascome to accept life's limitations. I did tell you how well an aussie swears, right? Believe it.

5) Weather: Abuja is approximately 4 degrees above the equator so it is always hot and humid. There are two distinct seasons here: wet and dry and we are at the end of the wet, rainy season. Every few days, the sky darkens and the city is pelted with torrential type rain. Everything gets muddy and streets become rivers. The crops are growing and are being harvested before the dry, windy season begins in November when sand blows in from the Sahara.

6) All God's Creatures Great and Small: I have only seen a few medium sized, mangy dogs and one very skinny cat. There are many goats about; and hordes of cream colored bony cattle which wonder everywhere, including thru construction sites! There are really big bugs and mosquitoes everywhere. I leave the bugs alone but do spray and squish the mosquitoes. For those of you of the Buddhist persuasion, I am aware that the mosquitoes might be the reincarnation of the Buddha BUT HE IS FULL OF MALARIA. Sorry. I have seen monkeys, baboons and hyenas walking down the street on leashes which seemed strange for a city but this is Africa!

Now onto Week 2:

Today, Sunday, Treeny and I went to the nearby Catholic church for Mass, accompanied by one of thefemale employees of IHV-N, along with her husband, Justice, and daughter. What a glorious, joyful, sacred event.

The church holds about 1000 people, give or take a hundred or so. The sanctuary is round so most people can see fairly well. There are 5 Sunday masses, lasting at least 2 hours each. Ours was 2.5 hours which I had been warned about. There were 7 priests on the altar with lots of incense and bell ringing. There is no a/c but the windows were open and several large fans were positioned on the congregation. We sat in the 3rd row behind a group of Church Ladies who had matching white blouses, long, bluepatterned skirts with that same material wrapped around their heads.

The mass started on time, more or less, with 6 couples standing at the steps of the altar holdingtheir newborn babies. The priest took each baby and turned and raised the baby to the altar to be blessed. Beautiful and touching!

As you can imagine, the singing was beautiful and hypnotizing. Two hymns were sung in Latin; the rest in English but with a cadence that is different from what I am used to. The priest preached on the importance and sanctity of marriage and sinfulness of divorce, which prompted Treeny to ask me if there would be a question and answer period after the sermon. I said "No' and that she was not allowed to ask how a celibate man could be preaching on the merits of marriage!

After communion which was done pretty quickly given the numbers, 11 people were commissioned to be missionaries to the poor in the surrounding Abuja areas. They had just completed a 2 year formation and training program but I did not understand what exactly they would be doing now. It somehow felt appropriate and prophetic that we were there for that event.

THEN...Each service group in the parish walked up the aisle, 2 by 2, dancing and singing with theirofferings. They marched up to the altar and the priest would bless them with holy water. People carried in sacks of rice, eggs, canned goods, and held money. I truly expected live animals to bring up the rear! There were at least 10 groups that processed in, each time more rocking than the next. The priests were swaying and moving in place, the nuns were dancing in the aisle. So...I also got up and joined the line and danced down the aisle! The priest looked very surprised but was laughing. Did I mention that Treeny and I were the only non-Africans in the church? What a joyful, joyful noise was made!

Justice said that he had attended a service in his village last weekend that lasted 4 hours, and thereason for such long services is that the people are so poor and life is so hard, that they turn to the churches for support. Longer services help the people to feel better. There were large statues of Jesus and Mary in the church and they both had white faces. I was outraged, full of moral indignation, assuming that the parish could not afford statues with black faces or that they were left over from British colonial days. I asked Justice about them and he said, "You think that they should be black?" Uh, yeah. He said that Jesus wasn't African, he was Jewish so considered white by the Africans so white faced statues were "right." "We also don't get into the politics of the Church onthis one. We have more important things to worry about." So true!

Next Sunday, Treeny and I are attending some Evangelical church with Mike, the driver how fetched me at the airport. The service will last at least 3 hours.

This week, Treeny and I started our formal mentoring at Keffi Clinic. We are picked up by the driver and driven 1 hour south to the clinic. We pass hundreds of merchant stalls along the dusty roadside; wide and crazy traffic, multiple construction site that haven't been worked on for years and children in one room school buildings, without screens or doors, walking home from school. Every vehicle seems to belch smoke.

Keffi is a regional hospital with 131 beds. Large wards with 10 patients, no privacy dividers or screens on the windows. They look like the American wards of 75 years ago.

The HIV clinic was opened in 2005 because of the thousands of people getting sick and dying. There are presently 7000 patients receiving care in the clinic with about half on medication. Approximately 40 people per day are HIV tested with 5-8% positive results. This sounds like a small number but that is 5% of 1.4 million. Boggles the mind!

The building is terrible and needs to be torn down, pure and simple. The waiting room has 5 benches that can seat 20-25 comfortably but usually has 40-50 people sitting there. And then there are the other 50-100 people sitting outside in a covered patio area, waiting for testing or to see the doctor.

There are about 30 staff members and 3 physicians. There is no room for a real exam room so 2 doctors share a room while seeing patients. The doctors sit at desks with patients sitting in chairs at right angles to the desks. the patients are "examined" sitting in chairs, fully clothed. If a full exam truly needs to be done, the door is locked, charts removed from a long table and the patient lies on the table. The other doctor sits in a smaller room which he shares with an Adherence Counselor who is also seeing patients. Incredible!

Four nurses sit in a 12'x12' room and triage 4 patients at a time. They attempt to speak softly to maintain some dignity and confidentiality but it is nearly impossible. Ideally, each patient school be seen in a private room.

The Medical Records room is 6'x6' and 5 people work in it. It is an inside room so there is no outside ventilation or even wall space for a fan. Files are everywhere! It is truly miserable in there.

The Matron or Clinic Manager, is Ladi Musa and she is a hoot! She knows and sees all and runs a tight ship. We are a lot alike in many ways and a good relationship is forming. I am also called Matron by the staff; and, Madam, Aunty or Mommy by the patients, only if they can close their mouths and stop staring at a white woman. I just smile and say “Good Morning.”

The clinic also house's the TB clinic for all patients, HIV positive or negative. There is no special room for them, just an open window. 350 people have been diagnosed with TB since January.

My "job" so to speak, is to assess clinic flow and functioning, staff competency and education needs and then make suggestions as needed. My first recommendation will be to bomb the place but I will be a bit more tactful than that. I will also suggest greater accessibility to supplies, such as pens; the staff is allotted ONE PER MONTH. I brought a few hundred with me and gave them to Ladi who ceremoniously handed them out to the staff the next day. To a person, they came to me, curtsied and said “Thank You.” I will also suggest, that the nurses be allowed to assess patients more completely, as in taking a temperature when someone appears ill. Of course, they do need thermometers for that and I am told they are "somewhere" but I gave them 2 digital ones just in case "somewhere" is not found.

The place is a hell hole, but for some reason, I am really loving it! It is hot and sweaty and dusty and smelly with people everywhere but it's OK. Treeny and I look at each other and marvel that "we are doing HIV in Africa." It feels like we are in some parallel universe or some National Geographic program.

Ladi invited me to spend a few nights at her house in Keffi to experience life in a village but IHV-N cannot guarantee my safety and even Ladi admitted that it was a risk. One night would probably be OK because there wouldn't be enough time for people to realize that I was there but more than one night and there is the very real risk of kidnapping because I am a white woman, assumed to be American and rich. I am very disappointed but I understand.

Both Treeny and I have been "sickish" this week. She had some GI-ick and I have some upper respiratory "crawling crud." Those are medical terms just in case you were wondering. Tea, cough drops and Benadryl are doing the trick.

That's all for this week folks. Life is good.

Kathleen

Week 1: The Road to Abuja

Dear Friends,

I left my home at 5am Thursday, Sept. 24th and walked into the Guest House in Abuja, Nigeria at 1pm Friday the 25th, exactly 24 hours later. Nigeria is 8 hours ahead of Phoenix.

My flight was due to leave at 6:20am but due to President Obama and other world leaders, flying in and out of JFK for the G-20 conference, all air traffic was halted for 90 minutes including our flight that hadn't even left and was 4 hours away. When we finally took off, we still circled twice for "Presidential Movement" and once to be directed to another runway due to a wind change. As the pilot said, "I couldn't make this stuff up folks." We landed 90 minutes late and my connecting flight to Dakar, Senegal was due to depart in 15 minutes. I was told that the flight had left and I would need to make alternative arrangements but fortunately, the flight was also running 90 minutes late due to "Presidential Movement" so I was fine.

I sat at the boarding gate in the midst of two groups: Senegalese and Nigerian's returning home, all dressed in suits or their best African finery, little girls in pink ruffley dresses and beads in their hair; and a group of older, stout, polyester clad, caucasian ladies on a tour with several Roman Catholic priests, headed to Lyon, France. I just sat in the middle and watched all of them eye each other. All things being equal, I was glad to be with the African group.

When we finally boarded, I was one of only two non-African people on the plane and was promptly told that my carry-one would not fit under my seat. Oh great I thought, African men already telling me what to do. I said that it would fit fine and promptly put it under my seat. So there!

We sat for one hour on the taxi-way and heard multiple announcements from the Flight Attendants concerning the H1N1 flu and ways to protect ourselves. They spoke of the importance of washing our hands whenever we used the toilet, coughed, sneezed or blew our nose; and how to dispose of tissues after blowing our nose. We were also instructed to always wear our shoes on the plane!!!!!!!!!

We flew 7 hours overnight, landing at 5am in Dakar, Senegal, in the dark, on a not so well lighted runway. Our flight was only partially full, so with my jammies, U of Washington hooded sweatshirt, eye shades, unplugged headphones and pharmaceuticals; I stretched out on 3 seats, and slept like a baby for 3 hours.

Because I was flying on to Abuja, as were 40 others, we were not allowed to leave the plane or change seats. Airport personnel came onto the plane and asked each one of us to identify all of our carry on luggage and then to step away from our seats. Each seat was pulled up and inspected, I am assuming for anything suspicious. We then sat down and the plane was sprayed with a World Health Organization approved "mild insecticide" to kill any mosquitos. Malaria is endemic to Nigeria.

We flew 5 hours to Abuja, landing at 11:30am. From the plane, the land looked green and lush and I wondered what I was doing here. I have no great affinity or passion for Africa, did not particularly enjoy Lesotho, loved Viet Nam and wondered just how committed I still was to the HIV cause. But here I was.

Abuja is a city of 1.5 million in the center of Nigeria. Nigeria is a West African country with a population of 140 million; the most populous of all African countries and ranked with China and India as most populated in the world. It is the political capitol of Nigeria; Lagos was the previous capitol and is still considered the commercial center of the country. Abuja was built "from scratch" in 1989 to put the capitol in an area that was populated by both Christians and Muslims, unlike Lagos that is primarily Christian.

The air was steamy but less so than Singapore. I breezed thru Customs, not knowing that the Protocol Officer for IHV Nigeria, who was at a training and not able to collect me, had spoken to Immigration about just looking at my documents and not hassling me. Excellent I say!

For those of you who have traveled internationally, you know that there is that period of time when you walk into Baggage Claim and are approached/surrounded by baggage handlers, all wanting to help. You do not speak the language, have no country currency, were told that "someone" would meet you but no one is holding a sign with your name on it, you don't know who to trust and you have only a phone number with many more digits than you are accustomed to but no phone. That was me.

I put off 2 handlers but finally consented to one man who spoke enough English to understand that someone was waiting for me. He whisked me through all of the other stops and we walked into the waiting room and a large man stood up with my name on a sheet of paper and I said, "That's him!" Mike extended his hand and said, "Welcome, how is my Brother Obama?" Swear to God.

Mike than escorted me, with our baggage handler in tow, into a small room, a closet really, that had 2 men who are the Money Changers for the terminal. There is a great deal of money changing that occurs here and none of it is done in banks. The Central Bank of Nigeria has licensed men, all of whom are Muslim, to stand on street corners or sit in small rooms in airports, to change currency. Both the men were in traditional dress of a long tunic with pants and a small hat. One man was reclining on a mat, the other at a small desk. He and Mike haggled about the exchange rate which fluctuates daily and apparently was low today and then I received my first handful of Nari. 100 Nari equals about $1.50 US. The larger the bills, like 100 dollars with the "big heads" ? Ben Franklin gets the best rate.

We then drove 45 minutes into Abuja. There are mainly cars here, lots of new Honda's, Toyota's, VW's, Mercedes Benz, Peugeot and some Ford's. Driving is CRAZY. There is the Right lane, the Left lane and the imaginary Third lane that straddles the dividing line for the Right and Left lanes. Cars just weave in and out, dodging potholes that could swallow a small car, or drive on the shoulder either way, it doesn’t seem to matter. Most cars have so many dents from being hit that they look like Rent-a-Wrecks. If the accident is really bad, the cars are just abandoned on the side of the road to be used for parts and possibly torched.

The Guest House is in the center of Abuja that houses several Embassies and major family or company compounds. The Mexican Embassy is right across the street; the Indonesian and Belgian embassies around the block. As are the Japanese and Canadian ones. The US Embassy is several miles away, all by itself. I will speak of them later; just think "Poor Customer Service."

All of the buildings have high walls with barbed wire, some electrified and guards, and some with really big guns. It is not uncommon to see and hear police cars, sirens blaring, soldiers sticking their guns out of the windows, escorting some very important person, to their office.

Our Guest House is a 3 story building with 6 Flats, each with 3 bedrooms and bathrooms. There is a living room, dining room and kitchen in each Flat. There is a TV with several stations including CNN, A Prayer Station, a station in English with Arabic subtitles and a whole lot of soccer. I showered, slept for an hour and decided to go looking for dinner.

I was advised not to go out by myself until I had been shown the neighborhood during the day, by one of the driver's. IHV-N provides driver's to take us wherever we want to go, especially after dark when we are not allowed to go out by ourselves, unless we are in a large group and we are close by. Of course, when I ask the driver's if there are any kidnappings or special issues, they all say, "very safe, no problems." Uh huh. Estavinus, the main Housekeeping man, drove me to a restaurant that he thought "I would really like." Southern Fried Chicken, "Lip Licking Flavour" "All the Flavours of the South." Their logo is a paddle boat on the Mississippi! For this I flew half way around the world. It was OK but KFC is better.

I went to bed and slept 13 hours, waking up at 4:50 am with the Call to Prayer from the Mosque and the sounds of the next door neighbors having sex.

Saturday morning, still alone in the Guest House until the other mentor's arrived that evening, I decided to walk outside for some fresh air. Hot, humid air but fresh, none the less. The door squeeked as I opened it and IMMEDIATELY a guard appeared. "Did I need something?" "The driver will provide everything." As I tried to explain that I just wanted to get some air and say Hi, 2 other guards casually walked up to the first guard. "Was I OK?" Yes, I said and walked back into the house. I am not accustomed to having someone do everything for me, including accompanying me around the neighborhood. This will take some adjustment. I had no phone, phone card or internet access and felt very isolated. But God knows, I was safe!

A few hours later, one of the driver's drove me to a street near the Hilton, haggled with the money changers and got me a great exchange rate! It was probably Ben Franklin’s big head that did it! We drove thru a small park and saw birthday parties and a wedding reception. There was music and dancing; kids playing in one of those big blow-up things; people arriving with food in covered dishes; and the wedding party posing for pictures. What in the world am I doing here? This looks like any other big city.

That evening, I drove with Mike, the driver, to pick up Brenda and Janet, the doctor and nurse arriving from Canada. They also wanted to change money but the men on the corners were gone so we down some dark streets into another neighborhood, down a hill, into a gravel covered courtyard of a 3 story ghetto building. Out of the darkness comes 3 men in Muslim dress, to change our money. Swear to God.

Sunday afternoon we finally got to go out. Estavinus said that we must have an escort the first time we are out because we are not known. If he walks with us, the people will see that we are OK to be in the neighborhood and not to be bothered. OK.

The streets are very tropical looking: large green, lush trees and bushes. Many tropical flowers; fruit trees; birds singing. and piles of rubbish everywhere. Piles large enough that you have to walk into the street to get around them. And several large McMansions in various stages of construction; but many more abandoned McMansions with vines and weeds growing into the abandoned buildings. Bizarre.

Around the corner from us is the Indonesian Embassy and on the street corner in front of the Embassy, are several spread out mats for Muslim people, all men it seems, to kneel and pray when the Mosque calls. There are several small, pastel colored, plastic tea kettle shaped containers on the curb that the men use to wash their hands and feet before they pray. There were about 20 men kneeling and bowing and we quietly walked by. As we walked by, I turned to look at the back of the group, thinking about taking a picture of the beauty of the scene, when a LARGE man started to walk towards me. I took a picture of a street sign instead, Salt Lake Ave, turned and looked at him and he walked away.

A block away, we walked past a small building that I realized was a Mosque, based on the shoes and pastel colored tea kettles in front of the door. No sooner had we walked by the building, a soldier came out with an AK-47 (I am told) and just casually stood there, indirectly looking at us. Alrighty then.

We later "escaped" from Estavinus for pizza and beer at a restaurant down the block, but he found us! Busted!

Monday, the 28th, the 3 of us, Treeny had not arrived from Australis yet, drove with our mentor Sara, to the University of Abuja Teaching Hospital in Gwagwalada, about 1 hour north of here. This was the Africa I was expecting: people walking everywhere, cars, motorcyles and buses, cheek by jowl. Open air stalls selling everything and then women carrying everything on their heads. One woman curtsied to us with a large cardboard box full of cleaning products on her head. HOW!!!!

We spent the morning at the HIV clinic, touring and being introduced to everyone it seemed. Non-African faces are rarely seen so we created quite a stir wherever we went. We planned on arriving at the hospital by 10am but the bridge that would take us the final mile to the hospital, had been washed out in the last few weeks so we had to take an HOUR detour. No one has any idea when it will be fixed. Maybe not even this year! This is sooo Africa!

We arrived in time for the question and answer period after Grand Rounds, the physician's weekly presentation of an interesting case. 50-60 people all in one room and 4 Westerner's walk in the door. Quite uncomfortable for them, I am assuming, but they graciously carried on.

Nigeria is a formal society. The men all wear suits or minimally, shirts and ties. The women wear African dress: bright, long skirt with matching material wrapped around their head; or casual business wear. But use of deodorant is not a cultural practice here so any gathering of people can be "fragrant" in 90 degree heat with corresponding humidity.

Most people speak English very well but with a British/African accent with several words that I am not familiar with but I am understanding most of what is being said.

Sara, our coordinator, wanted to stop at a neighboring orphanage to give the nun's some needed medicines for one of their women so off we went. The 4 of us plus 3 physician's that we were taking back to Abuja. For those of you who have read my previous Viet Nam tomes, you may remember that I visited several convents and met with many nuns and priests. So here I was again, going to a convent to see the nuns.

The "Poorest of The Poor" orphanage was started by a nun from Africa who wanted to minister to the prostitutes in Gwagwalada. These women, numbering about 25, are not necessarily HIV infected but are obviously at risk for any disease transmission. They can stay at the convent to get off the streets and if they become pregnant, they can stay to deliver and then move back to their homes. There was one 13 year old girl with a baby that can only go home to her aunt's house if she relinquishes the baby, which she will not agree to do, so she and the baby are living at the orphanage.

The grounds are dirt packed with several brightly colored, one story buildings. There were a few chickens, one rooster and a tired looking dog milling about. Several women ran to Sara and then us, to give us the universal welcome here: "You Are Welcome." It always sounds like I have said "Thank You" and they are corresponding with "You Are Welcome" and I work to not quizzically look at them when they speak. Many of the women were sitting on walkways, using old heavy, manually operated Singer sewing machines to sew clothes. I have seen these same sewing machines carried on men's heads to make "house calls" for mending. The orphanage was a bright, joyful place.

We returned to Abuja and the 3 of us decided that we should visit our respective Embassies to register our presence in the country. Yes, it can be done on-line but with spotty internet and 10-12 power outages/day, a trip to the Embassies seemed more practical.

Ah yes, the US Embassy. I am assuming that pre-911, it was fairly easy to get into the compound. But now...there are barricades guarding the barricades on either sides of the sidewalk and a guard stading at the end of the sidewalk. Unlike other Embassies, there are no identifying signs and no US flag visible from the street. I was disappointed and not impressed though it is the largest, most modern building around.

I had to tell the guard what I wanted so he could check inside if that was OK. He then let me into a seemingly bullet proof glass door. I immediately walked thru a metal detector and put my bag thru screening. Then one on the guards came over, opened my bag(no asking) and took out my phone, camera, make-up, dental floss, calculator, gum, half bottle of water and Tylenol. Obviously ALL WEAPONS OF MASS DESTRUCTION. I was left with my money, glasses, Tic Tacs and a pen. They let me out through another bullet proof glass door and I walked up a long, hilly concrete path, to the back of the main building. I rang the bell and was buzzed in to immediately walk thru another metal detector. The surly guard mumbled something about why I was there and pointed to a chair in a small, empty waiting area behind him. In the other larger waiting room far across from me, were many Nigerian nationals sitting in chairs, gazing at...

We all sat there silently for 10 minutes until I said to the guard's back, "Excuse me but do they know..." "Yes, they are coming." Another 10 minutes and he said, "they are here." A woman appeared in the window and said, not pleasantly, "Yes". You should know that I am silently screaming, "THIS IS MY EMBASSY, WHY ARE YOU TREATING ME LIKE THIS?

I walked up to the counter that came to my shoulders so I was able to rest my hands on my chin and gaze appreciatively up at this woman. She gave me the paper that I needed; I filled it out and returned to the window to again gaze and wait for her presence. Two personal phone calls later she returned to the window, examined my paper and said that she needed my phone number. "I don't know my phone number." "I need your number." "I don't know my number, it is written on the phone." "I need your number. Where is your phone?" "You have my phone in Security." "Why don't you know your number, I need your number." "I have been here for 3 days, I don't know my number." Might I add, that I continued to rest my hands on my chin and gaze appreciatively at this employee of the US Embassy. To her credit, she wrote down her name, Mary Ann, and her number and asked me to phone her in Security. I walked past the surly guard on his cell phone who just pointed me to the door and I reversed my trek to the guards. they said, "Welcome Back!" and returned my contraband. I offered them a piece of my confiscated gum and walked out the door. If I didn't already belong, I don't know if I would want to join.

Our 4th mentor, Treeny, arrived today from Australia. She is a physician, born in London, England, raised in New Castle, Australia and swears as only an Aussie can.

Tuesday was our orientation day to the Institue of Human Virolog thru the U of Maryland. In the interest of time and power outages, I will elaborate later. Suffice it to say, the US is loved here and Brother Obama is beyone words. Several times a day, I am asked "How is My Brother?" And have heard more stories about how people stayed up all night to view the election results and cried when he won and was inaugurated.

Two days this week we have visited the 2 clinics where the four of us will be mentoring. Janet and Brenda will be at Gwagwalada clinic that has 12,000 patients enrolled. They see 150 people/day and have managed to decrease the waiting time in the clinic from 10 hours to 6 hours. A guard with a really big gun stands outside the open air waiting room that seats 100+ very weary, sad looking people.

Treeny and I are assigned to the clinic in Keffi, about 1 hour south of Abuja. Keffi is in the state of Kasawara and has a population of 1.4 million. We are their first clinical mentoring team and they have NEVER had non-Africans in their area let alone their neighborhood. We do not blend but people will smile if we say hello first.

The clinic has 6000 people enrolled and also sees about 100 people/day with 2 doctors. It is beyond words to say that the clinic is small, dark and dirty. The Emergency Room aka the Casualty Unit, is a dark room with 4 beds. At least that is what I saw during our tour of the complex. I have asked to spend a day there. Many offices were dark with people working in them but no one can afford the light bulbs. This is the Africa that you see on TV.

Thursday was Independence Day, the 49th anniversary of freedom from British rule. We celebrated by going to the Hilton for some "real" coffee and later an Arts and Crafts Fair.

I apologize for any grammar, spelling and any other mistakes that you see in reading this. I cannot tell you how many hours this has taken to compose, save, loose power, loose internet, loose sentences supposedly already saved. This is sooo Africa and I am liking it!

Talk with you next week.

Kathleen