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