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