Tuesday, February 17, 2009


From James:

I'm calmly chatting with Doug in the air-conditioned OR in Bere. We are just finishing up a routine hernia operation. The external oblique is closed and we are preparing to close the skin. Before starting the surgery, I'd passed by the charge nurses, Augustin, deep in conversation with the midwife, Hortence. I briefly caught the words "breech presentation". I almost stopped to ask what was going on, but ignoring that still small voice I continued on to surgery rationalizing to myself that it must just be a prenatal visit or something or they'd come and tell me for sure.

So Doug and I take our time on the iguinal hernia repair which I do with mosquito net mesh as usual. Suddenly, Hortence's head pops into the OR through the swinging doors.

"There's a woman...the legs and body're out...the head's stuck...been that way for awhile...we can't..."

"I'm coming! Doug, close up the skin." I cry as I strip off my surgical gown and bloody gloves and race out through two sets of swinging doors, a screen door, around the corner, under the veranda, through another screen door and right into the tiny delivery room where I see a floppy set of legs and arms with no head plopped on the delivery table between a woman's bloody spread legs. The room is packed with Augustin, Hortence, a mid-wife student, another nurse, Dr. Jacques, a family member and now myself.

I start to shout out orders.

"Augustin, get me the symphysiotomy kit!"

"Hortence, bring me some gloves."

"Prudence, I need a syringe and some lidocaine."

"Jacques, a 20 blade scalpel."

As everyone goes off running I slip my hand in and with a few futile tugs confirm that the baby's head, extended on it's neck, is stuck.

Everyone back in a matter of seconds. I slip on the gloves, draw up the lidocaine, open the instruments, inject quickly over the pubis, put the scalpel on the scalpel handle and speak directly to the woman.

"Don't move whatever you do if you want this to work! Augustin, Jacques, grab her legs and pull them up and out!"

I slice through the skin and cartilage and feel the pelvis pop open. The baby slithers out. I clamp and cut the cord. I whisk him off to the exam table. He has no heartbeat, tone, movement, cry, respiration, color, nothing. I try and clear out the gunk in his mouth and nose and do chest compressions for a couple minutes before silently covering him with a rag.

I turn my attentions to the mother. I start to examine the position of the placenta and notice two things at once.

First of all, her belly's still really big. Secondly, there's a bulging bag of water in her vagina. Twins!

I break the back of water and out pop's a full head of hair. Within seconds the second twin is delivered, pulling up his arms and legs, grimacing and screaming his little lungs out. He's alive!

Monday, February 16, 2009


From James:

I am back in Africa but this welcome is far different than the one I'm used to. Sarah, Gary and I have just flown 8 hours across the desert from N'Djamena to Niamey, the capital of Niger. We cross dry grasslands, rocky outcroppings and fingers of the Sahara itching ever southward. Arriving over Niamey, we circle the Niger river and the new bridge being built by the Chinese before making a smooth landing at the airport. As we taxi up we see large men in black suits and dark glasses walking over to meet us. Dick, Kari, Scott and Mindi are huddled together with Bill and Barbara Kirker in front of the VIP welcome center. Are bags are taken over on carts and the men in black whisk us through immigration and customs and out the front where black mercedes and land cruisers wait with chauffeurs leaning casually against the front fenders.

Hazard lights flashing we make our way through the city ignoring lights and stop signs as other cars pull over to the side to let us pass. We arrive at the President's guest house overlooking the Niger and the irrigated fields crowning its banks. A sumptuous, yet simple supper awaits us. Air conditioned rooms, white table cloths, sodas and cold water on the side and comfortable couches welcome us in style. Conversation flows easily as we are from time to time interrupted to meet more important people in dark suits.

The next morning starts with a tour by Jason Brooks of the ADRA office and school where bright kids in sharp uniforms smile and shout out English phrases they have learned. The school is an impressive combination of underprivileged kids sponsored to go where they'd never have the opportunity to go otherwise, and rich kids who pay big to get a good education. All have become equals in their matching uniforms.

Then we're off to see the big wigs starting with President Mamadou Tandja himself. Circling around the winding, well-guarded roads up the the governmental palace is a little surreal. We climp up the massive steps and enter through a metal detector into an inner courtyard with high ceilings, traditional carved horses on stands, pictures and maps on the walls and a 10 foot giraffe carved out of the twisted root system of a tree.

We are finally ushered into the President's office where we are presented by Bill Kirker as the group possibly willing to take on the management of the Maine-Soroa Hospital, which just happens to be in the President's home town. I translate for Dick as he presents the President with a gift from Loma Linda University. The President is very gracious, poses for photos with us all at the end and decides on the spur of the moment to give Dick on of the carved horses in his lobby.

Whirlwind tours with more Mercedes and Land Cruisers and flashing hazards take us through the turbaned Tuareg Minister of Health, the distinguished, glasses-on-the-nose Minister of Education, and the plump, take-no-prisoners US Ambassador.

The next day we fly 800 km across the desert, east towards Chad with a quick stop at the only Christian hospital in Niger. A quick, chicken dinner probably providing the source of our later diarrheal illnesses and a too short crash on floor mattresses inspected by a mouse and many mosquitos and we take off again the next morning for the last 600 km to Maine-Soroa. Two flat tires and mostly good roads later and we are stopped at the side of the road in the middle of a desert with widely spaced scrub trees, and goats, sheep, donkeys, horses and camels wandering through.

As we get out of the cars, a crowd gathers around as we are welcomed by the governor, the mayor, the prefect and a host of other dignitaries from the region who then escort us into town in front of the king's quarters, in front of the central mosque and next to the market. A crowd has gathered. Brightly decorated horses mounted by robed, spear-and-sword-toting cavaliers prance on the sidelines. School kids in uniforms wave and chant. Turbaned, shirtless boys twist and contort in front of drum-pounding musicians beating out a fast rhythm accompanied by a bulging cheeked flute player. We push through the crowds to where chairs and couches have been arranged. The toothless, ninety-year old king nods and shakes hands as his eyes bulge out from behind coke-bottom glasses.

Speeches are made, kids dance and sing and recite and shout poems and slogans, horse-men dress out and shake their weapons, traditional dancers move and shake, and Dick is crowned "Wokil". He is brought crosslegged onto a mat in front of the king while his side-kicks circle around dressing Dick in a traditional, blue robe with elaborate embroidery, a red, felt skull cap and crowned with a turban. The "Wokil" is the king's new ambassador to the world, and in the absence of the king, his word is law. The ceremonies ended we end up at Bill and Barbara's for a feast of goat with couscous cooked in it's belly.

The next morning is another whirlwind tour of Barbara's Second Chance School for kids who have never been to school and are passed the country's maximum age (9 years old) for entering elementary school, the king's court, the Prefect's office, on to Diffa to see the governor and back to Mainé to check out the ancient air strip. Friday morning we finally get to see the hospital newly named the Kirker Hospital in honor of Bill and Barbara's efforts as first Peace Corps volunteers and then as the only doctor for years in this extreme eastern city of Niger founding a hospital where before there was none. Now, the hospital is being revived after years of neglect with some new hospital wards and the hope of a new management team, nursing school and maybe even specialty services to serve the underserved populations of Eastern Niger, Western Chad and Northern Nigeria.

We all crash Friday evening and Saturday with staggered episodes of vomiting and diarrhea. Another feast of splayed roasted sheep and couscous goat on Saturday night with the hospital staff finishes off our stay in Niger. Sunday morning, Sarah, Dick, Kari and I head off in Bill's Land Cruiser across the desert, up north and around the top of Lake Chad. 13 hours of desert, many camels, much sand, a few Lake Chad thick-horned cows, one gazelle, one desert fox, a large bird whose name I forget, clusters of white brick mud huts with flat, horned corner roofs, one half-hour stuck in the sand barely getting out episode, one border crossing where we are the only car to have passed in two days and we arrive in Chad at Bol.

I am welcomed back to my host country by a couple of moto taxi-men trying to scam us into believing that the airport is a long ways away and only they can show us. We ignore them and continue through the one road town to the hospital where the charge nurse who happens to be on duty informs us that Gary and the Bere Hospital chaplain, Noel, have just arrived and are over at the regional medical officers home.

The regional medical officer is a friend of Noel's and he welcomes us with a big smile and a feast of macaroni and tomato goat sauce which we partake together on a mat on the floor with the tray of noodles in the middle. Everyone digs in with his own spoon and washes it down with bananas and cold water. The next day, we fly off with Gary over the vast expanse interconnected lakes which is what remains of the great Lake Chad. Massive herds of cattle wander in long lines like ants across the green fields watered by what is still one of Africa's largest lakes only to end abrubtly in the sands of the Sahel. After landing in Moundou and showing Dick and Kari the progress on our Surgery Center project there, we finally arrive back in Bere.

Sunday, February 15, 2009

Not much sewing happening at my house these days. I did sign up to participate in the SWAP on Stitchers Guild, found patterns to sew, made a story board, looked over material from my stash and haven't gotten any further. It's the middle of February and I am still at point 0! We have a store in another part of the country and trying to figure out how to make it stay afloat in this economy has taken much time, energy, thoughtful consideration and prayer. If all goes as planned, I should be able to start the sewing next week.

During this down time I have been hand knitting a little sweater for the granddaughter. It has been some time since knitting anything by hand and so I have had to rip out many, many rows. I am now trying to decide if it will look like a used garment by the time I have it finished.

As you know, there are all sorts of questionnaires that go around on Facebook, and for the most part I just press "Ignore" and go on. For some reason while I was reading Ann's post this morning I decided to do her little High School Questionnaire - my answers are boring but I had fun doing it. Here goes:

1. Did you date someone from your school? No

2. Did you marry someone from your high school? No

3. Did you car pool to school? The first two years I rode with my father and the last two years I was at boarding school.

4. What kind of car did you have? You've got to be kidding

5. What kind of car do you have now? Chevy Tahoe - I haul everything and when a semi hit me from behind going 70 mph while I was driving it in Tennessee, I was spared serious injury so I just can't part with it yet.

6. It's Friday night...where are you then? Home with the family.

7. It's Friday night...where are you now? Home with the family.

8. What kind of job did you have in high school? Babysat, worked in the library. The library sound boring but we had so many fun people working there that everyone wanted to work there.

9. What kind of job do you do now? Own a health food store, manage rental properties, one that we rent every nine weeks specifically for patients with cancer coming for Proton treatment.

10. Were you a party animal? No

11. Were you considered a flirt? If you don't tell my kids - yes

12. Were you in the band, orchestra, or choir? Of course!

13. Were you a nerd? Oh, no.

14. Did you get suspended or expelled? With my dad as principal for two years - he always took care of "things" when we got home.

15. Can you sing the fight song? We didn't have one

16. Who was/were your favorite teacher(s)? Mr. Mayhew

17. Where did you sit during lunch? The first two years wherever we chose, the last two we sat where the hostess placed us at each meal. So we tried to place ourselves in line to make sure we could sit with our fun friends.

17a. Who did you usually sit with? Tried to sit with Sue, Laura, Judy, Kerry, Sharon, Roy, Jeff, Ron, Derick

18. What was your school's full name? Kansas City Junior Academy, Sunnydale Academy

19. When did you graduate? Oh, please.

20. What was your school mascot? We had none

21. If you could go back and do it again, would you? We had a great time, but I would never want to repeat it.

22. Did you have fun at the Prom? We had banquets and I always had a good time

22a. What was the prom song? None

23. Do you still talk to the person you went to the Prom with? Nope

24. Are you planning on going to your next reunion? I only go when my good friends go as it is a long trip

25. Did you play any sports? I could barely pass P.E.

26. Did you have a senior class trip? That's what they called the bus ride to St. Louis and a visit to the planetarium. The bus broke down and we spent hours on the hot bus waiting. Sound like fun?

28. What were you voted Most Likely? Nothing official that I can remember.