We have now been seeing patients for a little more than three weeks. We usually start our hospital rounds at about 8 AM. Bill visits the surgical and obstetrical patients and Orietta and I check the pediatric and internal medicine patients. At 10 AM we start with the outpatients. We divide the outpatients along the same lines, with Bill doing surgery and obstetrics and Orietta and I handling pediatric, internal medicine and gynecology patients.
There is a wide gulf between hospital care in the western world and Niger. A major factor of course is the lack of money available for health care here. Hospital beds have mattresses covered with a rubberized plastic – often worn through to the foam inside. There are no bed sheets. Patients who are better off will bring a mat with a blanket or other cover from home. Others may have only a straw mat and some have nothing. Most patients prefer to be outside. After our hospital rounds are finished, most of the patients take their mats outside and spend the day on the sand in the shade of the few trees on the hospital grounds. Family members bring food and small charcoal burners and prepare tea or warm food for the patients. The hospital provides two meals a day, prepared over an open fire in the kitchen, . Many patients spend the night outdoors as well. In the dry season it is not a major problem, but when the rains come the risk of catching malaria at the hospital will become much higher.
A handful of drugs for things such as tuberculosis, HIV disease and leprosy are available free of charge to the patients through government programs. Recently we received a container load of medications from Atlanta – based MAP International (Medical Assistance Programs) and these medications are provided free of charge to the patients, but otherwise everything must be purchased by the patient before it can be used. For example, if one of us orders an intravenous antibiotic, the patient’s family must go to the pharmacy and purchase the antibiotic, the fluid used to dilute the drug, the administration set and even the needle, gauze and tape needed to set up the infusion. If there is no money, there is no antibiotic. If someone has to go home to get the money, then treatment is delayed. X-rays are a special problem. The x-ray here doesn’t work, so patients needing x-rays must be transported 35 miles to neighboring Diffa. There is an ambulance available but gas money must be paid in advance by the patient in addition to the charge for the x-ray. It’s the same story here – no money, no study. You might say, “Well, in the States patients have to pay for everything as well.” That’s true, but in the States accounts are settled after the fact. Treatment comes first and we figure out how to pay for it later using a mélange of private insurance, Medicare and Medicaid, cash and funds from other governmental or charitable organizations, or the hospital just absorbs the loss. Here the realities are much harsher.
Nursing care is provided almost entirely by the family. The hospital has a handful of nurses, but no nurses’ aides or other technical help. The nurses transcribe the doctors’ orders for medications or other treatments then communicate this to family members. Family members do all nursing care such as bathing, turning and feeding the patient. The nurses administer intravenous or intramuscular injections, draw blood for laboratory studies, help with bandage changes and check vital signs daily. All oral medications are administered by the patient’s family. The risk of medication administration errors is very high. We speak with the nurses in French and they then communicate the instructions to the patients in their native languages such as Hausa or Fulani. Not only do most of the patients not speak French, but most do not read or write so patients have to remember pills by shape or color. Then they must remember the schedule of administration as well. The nurses maintain that they don’t have enough time to give out the medications. They also point out that it is better for the patients to learn how to take their medications while we are supervising them. They may be right – we will have to give this some thought.
Teaching hygiene is a continuous problem. Many of the patients are from the bush and have had little or no exposure to showers, sinks, toilettes, etc. Showers and toilettes are located in an outbuilding. This is fine for ambulatory patients, but it poses a major problem for sicker patients or small children whose families have to figure out how to cope with bedpans. One enterprising family hit on the idea of putting sand in the bedpan – at least spills were easier to avoid. Again a major problem is personnel – there’s just not the money to have the personnel to help teach the patients.
None of these problems will be solved quickly or easily. It is hard to know where to begin. The four of us along with a local citizen have chipped in the salaries for four custodians so at least we can begin the process of cleaning and hopefully reduce the risk of hospital acquired infection. The shipment of medications from MAP International has been a major help to many patients but the supplies are being used rapidly. We hope that MAP will continue to send us medications but they have many requests from other deserving sites well. Funding, manpower, medications and hospital equipment will be ongoing issues requiring patience, persistence and innovation.
All of us here enjoy hearing from you. Please send a comment from time-to-time.
Steve Humphrey
Maine-Soroa, Niger
17 June 2007
Tuesday, June 19, 2007
Friday, June 8, 2007
First Visit to the Hospital
Today was our first look at the hospital we are to help resuscitate. There are four of us…three doctors and a nurse nutritionist.
Dr. Bill Kirker, a Michigan native, and his wife Barbara, the team’s nurse and nutritionist are heading up our team. I first met Bill and Barbara two decades ago in Columbia, SC. After leaving Niger and the Peace Corps in 1975, Bill built a large practice in urgent care. I was an internist and cardiologist in Columbia, so our paths crossed frequently. From time to time we talked about his work in Niger. When Bill talked about it I could sense that he had never wanted to leave Niger and that circumstances surrounding the coup d’etat in 1975 had taken him and Barbara away from their work before they considered it finished. Those conversations always reminded me that when I decided to go into medicine my thought had been that I would work in the third world.
Dr. Orietta Barquero is a native of Costa Rica and a tropical medicine specialist. We became acquainted with her through medical missions in Nicaragua two years ago. She teaches at the medical school of the University of Costa Rica. Since specializing in tropical medicine at the University of Barcelona some years ago, she had always wanted to work in Africa. The more we talked, the more all of us realized we shared a sense of unfinished business and the decision to come to Niger was made.
In the mid 1980’s, about 10 years after the Kirker’s departure, the Ministry of Health of Niger decided to reopen a hospital in Maine-Soroa. With the assistance of the French government a fifty bed hospital was built adjacent to the site of the old hospital. The hospital was equipped with two operating rooms, a delivery room, systems for equipment sterilization, a laboratory, x-ray, and separate buildings connected by covered walkways for maternity, surgery, and medical and pediatric patients. Unfortunately there were inadequate funds to fully staff the hospital with physicians and nurses and to provide for regular maintenance and upkeep. It became what is known as a “resource dump”, that is lots of money and labor poured into something which never functioned. Now it houses only a few patients and sees a handful of outpatients daily. Two physicians have been trying to keep things going here under very difficult conditions. One is a young general practitioner recently out of training at the medical school in Niamey and the other is a surgeon temporarily posted here by the U.N.
None of us were quite prepared for what we found on our first visit. The hospital with its multiple buildings is situated within a walled compound about four acres in size. The grounds are sand with the driveways marked by stones. There are a few scattered trees which provide some shade and part of one drive is bordered by mangos. Goats and guinea hens belonging to the guard who lives on the premises roam the grounds freely. Patients’family members are scattered around the grounds seated on mats in the shade, many preparing food or tea over small charcoal fires. Paper and plastic litter the grounds as do pieces of discarded hospital furniture and the carcasses of two trucks leftover from a previous aid program from Japan. A shed houses four vehicles – two old Land Rovers and two battered Toyota pickup trucks, all without tires and partially “parted out”.
The building which houses radiology and the lab is our first stop. It was designed to be air-conditioned but only one unit has any refrigerant in it, so the entire building is roasting. We get a look at the x-ray machine. It’s a nice French built unit like you might find in an urgent care or small emergency room in the US. It would be fine for taking x-rays of chests, abdomens, heads and broken bones. Incredibly we learn that it has never taken a single x-ray. At the time the hospital was built there was no physician staff, so a hospital in nearby Diffa appropriated all the film and the darkroom system used to develop the films. Later when physicians arrived here, there were no funds to re-purchase the darkroom system, so no x-rays were taken. Now after a decade and a half in the heat, the unit will not even turn on. We look into an adjacent room. There is a portable x-ray machine which could be used to take x-rays at the patient’s bedside – same story.
Down the hall there is a machine covered with a blanket. I pull the cover off and to my amazement I find myself looking at an echocardiogram – a device which allows a cardiologist to make an ultrasound picture of the heart. When I decided to come here I thought I would be doing primarily internal medicine and that all the cardiology would be done with a stethoscope alone. Now the possibility of doing something a little more sophisticated tantalizes me. It’s not a bad machine either – maybe 10 or 12 years old. I worked with machines like this in the States some years ago and they do just fine. I inquire if it works. No one seems to know so I plug it in and turn it on. Smoke immediately curls up from the underside of the machine - back to the stethoscope.
The laboratory is small. It can do simple blood counts, an analysis of the urine and microscopic examinations for parasites and malaria. Blood chemistries such as you might use to check kidney and liver function are out of the question although blood glucose can be checked. When the budget allows, quick-tests for HIV (the AIDS virus) can be performed. There is a small blood bank and when reagents are available the blood can be screened for HIV and hepatitis viruses. If reagents are not available, unscreened blood is sometimes used in emergencies.
There is a small emergency room. It contains two rusted stretchers which are coated in dust. Used bandages are on the floor and small surgical instruments, uncleaned after the last case, lie in the dust on a counter top. A basket containing used surgical gloves and old syringes and needles is near the open door through which family members and children wander.
Only one of the two operating rooms is functional. The electrical system in one doesn’t work and hasn’t for several years. The other room does work but is in need of a thorough cleaning. The sterilization equipment works and a couple of sets of old surgical instruments are available. There is an anesthetist on the staff, and basic anesthesia equipment is available. A few cases such as emergency appendectomies, caesarian sections, and some minor procedures are performed each week. Infection rates are high. Electrical power in Maine-Soroa comes from nearby Nigeria and is unreliable. There are numerous outages ranging from a few minutes to an hour or more each day, so surgery is frequently performed without lights. The hospital has an emergency generator which is said to work but often there is no diesel fuel available.
Next we tour the buildings which house maternity, medical, and pediatric cases. The hospital rooms are relatively small and contain anywhere from three to six beds. There is a skeleton crew of nurses. There are no nurses’ aides or janitors on a regular basis. There were no funds available to pay them, so most quit. A few still come around on a volunteer basis. Day to day patient care and cleaning are the job of each patient’s family. The rooms and beds are dusty and sandy. There are no sheets or towels, most patients lying on mats on bare mattresses with family members sleeping on the floor or on the ground outside the building. The rooms have no sinks or water and the bathrooms and showers are in an open building behind the hospital. Hand washing by the staff requires a trip to the nurses’ station. One meal a day is prepared for patients in the hospital kitchen where cooking is over an open fire. Meals are not delivered but must be picked up by family members. Special diets are out of the question. The feeding of infants is a special problem, especially if the mother is unable to nurse them.
As we walked back to our truck I think all of us shared a sense of being overwhelmed. There is so much to be done that it’s hard to know where to start. The problems are numerous and none will be solved easily. If ever any of us thought this hospital could be turned around quickly, today’s visit put that out of our minds forever. Tomorrow we will start to see patients.
Steve Humphrey
Maine-Soroa, Niger
May 20, 2007
Dr. Bill Kirker, a Michigan native, and his wife Barbara, the team’s nurse and nutritionist are heading up our team. I first met Bill and Barbara two decades ago in Columbia, SC. After leaving Niger and the Peace Corps in 1975, Bill built a large practice in urgent care. I was an internist and cardiologist in Columbia, so our paths crossed frequently. From time to time we talked about his work in Niger. When Bill talked about it I could sense that he had never wanted to leave Niger and that circumstances surrounding the coup d’etat in 1975 had taken him and Barbara away from their work before they considered it finished. Those conversations always reminded me that when I decided to go into medicine my thought had been that I would work in the third world.
Dr. Orietta Barquero is a native of Costa Rica and a tropical medicine specialist. We became acquainted with her through medical missions in Nicaragua two years ago. She teaches at the medical school of the University of Costa Rica. Since specializing in tropical medicine at the University of Barcelona some years ago, she had always wanted to work in Africa. The more we talked, the more all of us realized we shared a sense of unfinished business and the decision to come to Niger was made.
In the mid 1980’s, about 10 years after the Kirker’s departure, the Ministry of Health of Niger decided to reopen a hospital in Maine-Soroa. With the assistance of the French government a fifty bed hospital was built adjacent to the site of the old hospital. The hospital was equipped with two operating rooms, a delivery room, systems for equipment sterilization, a laboratory, x-ray, and separate buildings connected by covered walkways for maternity, surgery, and medical and pediatric patients. Unfortunately there were inadequate funds to fully staff the hospital with physicians and nurses and to provide for regular maintenance and upkeep. It became what is known as a “resource dump”, that is lots of money and labor poured into something which never functioned. Now it houses only a few patients and sees a handful of outpatients daily. Two physicians have been trying to keep things going here under very difficult conditions. One is a young general practitioner recently out of training at the medical school in Niamey and the other is a surgeon temporarily posted here by the U.N.
None of us were quite prepared for what we found on our first visit. The hospital with its multiple buildings is situated within a walled compound about four acres in size. The grounds are sand with the driveways marked by stones. There are a few scattered trees which provide some shade and part of one drive is bordered by mangos. Goats and guinea hens belonging to the guard who lives on the premises roam the grounds freely. Patients’family members are scattered around the grounds seated on mats in the shade, many preparing food or tea over small charcoal fires. Paper and plastic litter the grounds as do pieces of discarded hospital furniture and the carcasses of two trucks leftover from a previous aid program from Japan. A shed houses four vehicles – two old Land Rovers and two battered Toyota pickup trucks, all without tires and partially “parted out”.
The building which houses radiology and the lab is our first stop. It was designed to be air-conditioned but only one unit has any refrigerant in it, so the entire building is roasting. We get a look at the x-ray machine. It’s a nice French built unit like you might find in an urgent care or small emergency room in the US. It would be fine for taking x-rays of chests, abdomens, heads and broken bones. Incredibly we learn that it has never taken a single x-ray. At the time the hospital was built there was no physician staff, so a hospital in nearby Diffa appropriated all the film and the darkroom system used to develop the films. Later when physicians arrived here, there were no funds to re-purchase the darkroom system, so no x-rays were taken. Now after a decade and a half in the heat, the unit will not even turn on. We look into an adjacent room. There is a portable x-ray machine which could be used to take x-rays at the patient’s bedside – same story.
Down the hall there is a machine covered with a blanket. I pull the cover off and to my amazement I find myself looking at an echocardiogram – a device which allows a cardiologist to make an ultrasound picture of the heart. When I decided to come here I thought I would be doing primarily internal medicine and that all the cardiology would be done with a stethoscope alone. Now the possibility of doing something a little more sophisticated tantalizes me. It’s not a bad machine either – maybe 10 or 12 years old. I worked with machines like this in the States some years ago and they do just fine. I inquire if it works. No one seems to know so I plug it in and turn it on. Smoke immediately curls up from the underside of the machine - back to the stethoscope.
The laboratory is small. It can do simple blood counts, an analysis of the urine and microscopic examinations for parasites and malaria. Blood chemistries such as you might use to check kidney and liver function are out of the question although blood glucose can be checked. When the budget allows, quick-tests for HIV (the AIDS virus) can be performed. There is a small blood bank and when reagents are available the blood can be screened for HIV and hepatitis viruses. If reagents are not available, unscreened blood is sometimes used in emergencies.
There is a small emergency room. It contains two rusted stretchers which are coated in dust. Used bandages are on the floor and small surgical instruments, uncleaned after the last case, lie in the dust on a counter top. A basket containing used surgical gloves and old syringes and needles is near the open door through which family members and children wander.
Only one of the two operating rooms is functional. The electrical system in one doesn’t work and hasn’t for several years. The other room does work but is in need of a thorough cleaning. The sterilization equipment works and a couple of sets of old surgical instruments are available. There is an anesthetist on the staff, and basic anesthesia equipment is available. A few cases such as emergency appendectomies, caesarian sections, and some minor procedures are performed each week. Infection rates are high. Electrical power in Maine-Soroa comes from nearby Nigeria and is unreliable. There are numerous outages ranging from a few minutes to an hour or more each day, so surgery is frequently performed without lights. The hospital has an emergency generator which is said to work but often there is no diesel fuel available.
Next we tour the buildings which house maternity, medical, and pediatric cases. The hospital rooms are relatively small and contain anywhere from three to six beds. There is a skeleton crew of nurses. There are no nurses’ aides or janitors on a regular basis. There were no funds available to pay them, so most quit. A few still come around on a volunteer basis. Day to day patient care and cleaning are the job of each patient’s family. The rooms and beds are dusty and sandy. There are no sheets or towels, most patients lying on mats on bare mattresses with family members sleeping on the floor or on the ground outside the building. The rooms have no sinks or water and the bathrooms and showers are in an open building behind the hospital. Hand washing by the staff requires a trip to the nurses’ station. One meal a day is prepared for patients in the hospital kitchen where cooking is over an open fire. Meals are not delivered but must be picked up by family members. Special diets are out of the question. The feeding of infants is a special problem, especially if the mother is unable to nurse them.
As we walked back to our truck I think all of us shared a sense of being overwhelmed. There is so much to be done that it’s hard to know where to start. The problems are numerous and none will be solved easily. If ever any of us thought this hospital could be turned around quickly, today’s visit put that out of our minds forever. Tomorrow we will start to see patients.
Steve Humphrey
Maine-Soroa, Niger
May 20, 2007
Monday, June 4, 2007
Beyond the End of the World
For two days we pushed overland, eastward from Niamey, finally arriving in Maine-Soroa late in the afternoon of May 11th. Our route followed the main east-west road which parallels Niger’s southern frontier with Burkina Faso, Bénin and Nigeria.
About 60 miles out of Niamey the way passes through the village of Kouré where West Africa’s last wild giraffe herd, numbering about 150 animals, can be found. Often they are close to the road. We were lucky enough to catch sight of several and a few minutes of off-road driving and walking brought us very close to these elegant creatures. They have been protected for several decades. Although cautious, they will let you draw within 30 to 40 yards before they amble off.
From Kouré the route passes southeast towards Maradi. As we approach Maradi the terrain changes. The rocky orange hardpan of the Sahel gives way to sandy soil which supports larger stands of trees and sparse pasture resembling the savannahs usually found further south.
Leaving Maradi we reenter the Sahel and by the time we reach the city of Zinder we are really in the desert, seeing the first of large sand dunes. Zinder brings to mind all the history, romance, adventure, and cruelty of the Sahara. Originally a resting place for camels on the trans-Sahara route it later became the capital of the Damagaram state which profited from agriculture and the slave trade. Near the end of the 19th century the French arrived with their Foreign Legion. Zinder was at the center of bloody fighting for many years but eventually fell to the French. For the early part of the 20th century it served as the capital of Niger. If you remember the novel Beau Geste reread it for the flavor of Zinder in those days.
We stayed the night in Zinder at a government guest house. Our rooms were air conditioned but the rest of the house was not. The heat was stifling. Ceiling fans stirred hot air and fine dust over the dining table where couscous and mutton were served along with fresh mangoes. The bathroom was nicely tiled and fully equipped but there was no water because of low pressure in city mains – a common problem in the dry season. A five gallon bucket of water was provided for washing and flushing and there was bottled water for drinking and tooth brushing. Breakfast was yogurt, tea, and excellent local bread.
We continued on good quality paved road east to the village of Gouré.
Here the Sahel loses its battle with the Sahara and is no longer able to hold it at bay. Despite attempts to stabilize the dunes with plantings of hardy grasses, the sand has marched steadily southward. The desertification of this area has ruined the road which in many areas is non-existent. Our trucks grind slowly in 4 wheel low through sometimes deep sand. We pass two or three of the big ten-wheel Algerian desert haulers being dug out of the sand. Vegetation is sparse to non-existent and the temperature reaches 120 degrees. We drive around the base of a large dune and downward into a depression in the desert. Suddenly the road reappears and everything is a deep cool green. It seems like a hallucination. Date palms are everywhere. Through the trees we can see blue water – a lake maybe 3-4 acres in size surrounded by fields planted with vegetables and fruit trees. It is an oasis produced by a spring fed lake which has created a small island of life in the midst of apparent desolation. We endure about 60 miles of poor to non-existent road and at last good hard surfaced highway reappears. By late afternoon we are approaching our destination, the village of Maine-Soroa. In the distance we catch sight of something obstructing the road and cars and trucks are on the side of the road. As we draw closer we see that a group of twenty or thirty people is in the middle of the road. We are waved to a stop and as we get out we hear applause and cheering. In the distance drumming can be heard. The chief of the village and a large delegation have driven about a mile out of town to greet us and escort us to the village center. The men approach first with smiles, handshakes and fists held in the air. The fist in the air is not an invitation to leave town but rather the equivalent of a salute – it takes a little getting used to. The women stood to one side while we were greeted by the men, then we were introduced to the women.
As our entourage entered the village everyone stopped and waved or shook a friendly fist. The town center near the mosque and prefecture was completely filled. Our trucks stop and everyone crowds around. As we open the doors we are literally pulled out by friendly hands. Everyone thrusts a hand to be shaken. The sound and movement are almost disorienting…drums, the griot’s horn,
clapping, cheering and dancing. We are pressed toward the center of the square by the crowd. The senator from the region along with the village chief offer us a traditional welcoming drink of cool goat’s milk laced with ginger. Introductions to the traditional and now largely ceremonial king and princes of the region and other local dignitaries are made and we are offered seats alongside the king. There are a few speeches of welcome and then a traditional dance. Bill and Barbara Kirker join in to great cheering from the crowd. The reception we receive is very gratifying. It is a welcome to all of us, but more than that it is a great tribute to the work Bill and Barbara did here more than thirty years ago. From nothing, over a period of ten years, they built a hospital and dispensary system which eventually served thousands of patients in the region around Maine-Soroa. They trained nurses, midwives and technicians, organized vaccination and public health programs, and treated epidemic diseases such as cholera and meningitis. Bill performed hundreds of surgeries and handled complicated obstetrical cases. Almost everyone we talked to was either cared for by Bill and Barbara or had a close family member whom they had treated. In 1974 a coup d’etat in Niger forced the Kirker’s to leave the country. The military government decided to move hospital operations to nearby Diffa and a decade of work was rapidly dismantled. Bill and Barbara returned to the U.S. and Bill entered private practice. In addition he founded and still serves on the board of Africare, a Washington, D.C. based NGO providing assistance to Niger and other African nations. Bill retired from his medical practice in the late 90’s. While inspecting Africare projects in Niger last year he was invited by the Nigerien Ministry of Health to return with a team of physicians to reopen the hospital in Maine-Soroa. Now after months of planning we are here.
The reception ends and we are driven to our quarters at the government guest house. This will be home for the next two months while our housing in completed. All of us on the team are volunteering our time and paying our own living and travel expenses. In return the Ministry of Health is providing us with housing and two vehicles with a monthly fuel allowance. Tomorrow will be a day of rest. Then we will pay our first visit to the hospital.
Photos:
#1 The village of Gouré
#2 The Griot and his horn
Steve Humphrey
Maine-Soroa, Niger 13 may 2007
Sunday, June 3, 2007
The World Ends at Gouré
Africa begins in terminal 2C at Paris’ Charles DeGaulle airport. Walk into this terminal and you leave behind the sleek, carpeted, calmly efficient world of modern Europe. Here the floors are concrete and the ceiling is best described as industrial. Noise, crowds, jostling, and an agreeable energy are abundant.
We four Americans form a pale island in an ocean of darker faces. At first it seems that finding our flight and checking in will be an impossibility. Surprisingly, the long lines move quickly and soon enough we are aboard our flight for Niamey, the capital of Niger.
Clouds cover southern France and the Mediterranean as we fly south. Over the Algerian coastline the clouds break up and we get our first view of the Sahara stretching below us. Except for the bright sand it could be an ocean. The stark blue Air Mountains, rich in uranium and other exotic elements, signal our passage over the northern border of Niger. During the descent into Niamey heat rising from the desert floor produces severe turbulence and as our plane turns west on final approach we are buffeted by heavy winds.
Descending from the door of the aircraft the view and the sensation are otherworldly. The afternoon temperature has reached 115 degrees with a relative humidity of 9 percent. We have arrived at the peak of dry season. The hot west wind has stirred a haze of fine dust which has reduced visibility to about a mile. As we step onto the tarmac our eyes sting from the grit and dust and the walk to the terminal is withering in the hot wind. We are in the Sahel, the flat, stony edge of the Sahara where orange soil, scattered trees, sparse grass and scrub vegetation defend the savannahs to the south from the desert
.
The four of us make our way into the terminal where air conditioning has mercifully reduced the temperature to a bearable 90 degrees. The thump of an immigration officer’s passport stamp finally signals our arrival in Niger.
We have come here on a two year medical mission at the invitation of the Republic of Niger. We will be working as volunteers to help reopen and expand the services of the hospital in Maine-Soroa, a village which lies in the southeastern corner of the country, near Lake Chad. Our team is made up of three doctors, Bill Kirker, Orietta Barquero and I as well as Bill’s wife Barbara who is a nurse and nutritionist. In the early 1970’s Bill and Barbara headed the Peace Corps effort which originally built the hospital. Hard economic times in Niger later forced the near-closure of the facility. Now it is our job is to try to get it running again.
So, after months of planning we find ourselves walking from the Niamey terminal with a delegation from the Maine-Soroa hospital, to waiting Land Rovers. Driving from the airport into town we share the road with camels, donkeys, motorbikes, container trucks, old cars and a few shiny Mercedes and BMW’s, most bearing either diplomatic tags or plates from neighboring oil-rich Nigeria.
Although downtown Niamey has broad boulevards and several handsome government buildings courtesy of the previously high price of uranium, it is clear that Niger is struggling. The markets are full and food and an array of consumer goods are available, but the desperately poor and sick are everywhere. Beggars congregate at the edge of the marketplace. Most of them are blind, crippled or disfigured by leprosy. Even before the drought and severe food shortage of 2005 the country ranked last on the UN’s Human Poverty Index. Life expectancy here is about 44 years. Before reaching the age of five, almost one of every five children will die, usually of malnutrition, diarrhea and dehydration, or malaria.
There is also cause for optimism here. In 1999 the country underwent peaceful transition from military to stable democratic rule. President Mamadou Tandja was reelected in 2004 with 65% of the vote. There is ongoing decentralization of government. Main roads are good quality, information technology and communication are progressing rapidly and public health is receiving new emphasis. In addition, there may be large oil reserves here and uranium is plentiful. There is interest in investment in Niger, especially by the Chinese, who along with the Americans, Cubans and European Union are also providing medical and other assistance to the country.
We have had much to do here in Niamey before heading 650 miles east to Maine-Soroa. Supplies have been purchased and equipment and medications shipped from the States have been cleared through customs and transported east to the hospital. We have visited the US Embassy and the Ministry of Health. We were also nicely received by President Mamadou Tandja who has taken a significant interest in the work we’ll be doing.
One of our final visits was to the Peace Corps headquarters here in Niamey. We hoped to interest the Peace Corps once again in the hospital at Maine-Soroa. The director was sympathetic to our request. Walking to a large map of Niger he traced out our overland route from Niamey east to Maine-Soroa. “You’ll be going this way… through Dosso, Tessaoua, Maradi, Zinder and Gouré,” he said, his finger coming to rest on the map over the village of Gouré. “The paved road stops here in Gouré, a hundred miles west of Maine-Soroa. We have volunteers working all the way out to this point, but as far as we’re concerned the world ends at Gouré. Not even the Cubans or the Chinese go out this far. I wish I could help you, but right now I can’t.”
The rains and cooler weather should arrive in a few weeks. Tomorrow morning we will leave for Maine-Soroa.
Photos top to bottom:
1. Niamey, sunset over the River Niger
2. Niamey market scene
Steve Humphrey, M.D.
Niamey, Republic of Niger
May 4, 2007
We four Americans form a pale island in an ocean of darker faces. At first it seems that finding our flight and checking in will be an impossibility. Surprisingly, the long lines move quickly and soon enough we are aboard our flight for Niamey, the capital of Niger.
Clouds cover southern France and the Mediterranean as we fly south. Over the Algerian coastline the clouds break up and we get our first view of the Sahara stretching below us. Except for the bright sand it could be an ocean. The stark blue Air Mountains, rich in uranium and other exotic elements, signal our passage over the northern border of Niger. During the descent into Niamey heat rising from the desert floor produces severe turbulence and as our plane turns west on final approach we are buffeted by heavy winds.
Descending from the door of the aircraft the view and the sensation are otherworldly. The afternoon temperature has reached 115 degrees with a relative humidity of 9 percent. We have arrived at the peak of dry season. The hot west wind has stirred a haze of fine dust which has reduced visibility to about a mile. As we step onto the tarmac our eyes sting from the grit and dust and the walk to the terminal is withering in the hot wind. We are in the Sahel, the flat, stony edge of the Sahara where orange soil, scattered trees, sparse grass and scrub vegetation defend the savannahs to the south from the desert
.The four of us make our way into the terminal where air conditioning has mercifully reduced the temperature to a bearable 90 degrees. The thump of an immigration officer’s passport stamp finally signals our arrival in Niger.
We have come here on a two year medical mission at the invitation of the Republic of Niger. We will be working as volunteers to help reopen and expand the services of the hospital in Maine-Soroa, a village which lies in the southeastern corner of the country, near Lake Chad. Our team is made up of three doctors, Bill Kirker, Orietta Barquero and I as well as Bill’s wife Barbara who is a nurse and nutritionist. In the early 1970’s Bill and Barbara headed the Peace Corps effort which originally built the hospital. Hard economic times in Niger later forced the near-closure of the facility. Now it is our job is to try to get it running again.
So, after months of planning we find ourselves walking from the Niamey terminal with a delegation from the Maine-Soroa hospital, to waiting Land Rovers. Driving from the airport into town we share the road with camels, donkeys, motorbikes, container trucks, old cars and a few shiny Mercedes and BMW’s, most bearing either diplomatic tags or plates from neighboring oil-rich Nigeria.
Although downtown Niamey has broad boulevards and several handsome government buildings courtesy of the previously high price of uranium, it is clear that Niger is struggling. The markets are full and food and an array of consumer goods are available, but the desperately poor and sick are everywhere. Beggars congregate at the edge of the marketplace. Most of them are blind, crippled or disfigured by leprosy. Even before the drought and severe food shortage of 2005 the country ranked last on the UN’s Human Poverty Index. Life expectancy here is about 44 years. Before reaching the age of five, almost one of every five children will die, usually of malnutrition, diarrhea and dehydration, or malaria.There is also cause for optimism here. In 1999 the country underwent peaceful transition from military to stable democratic rule. President Mamadou Tandja was reelected in 2004 with 65% of the vote. There is ongoing decentralization of government. Main roads are good quality, information technology and communication are progressing rapidly and public health is receiving new emphasis. In addition, there may be large oil reserves here and uranium is plentiful. There is interest in investment in Niger, especially by the Chinese, who along with the Americans, Cubans and European Union are also providing medical and other assistance to the country.
We have had much to do here in Niamey before heading 650 miles east to Maine-Soroa. Supplies have been purchased and equipment and medications shipped from the States have been cleared through customs and transported east to the hospital. We have visited the US Embassy and the Ministry of Health. We were also nicely received by President Mamadou Tandja who has taken a significant interest in the work we’ll be doing.
One of our final visits was to the Peace Corps headquarters here in Niamey. We hoped to interest the Peace Corps once again in the hospital at Maine-Soroa. The director was sympathetic to our request. Walking to a large map of Niger he traced out our overland route from Niamey east to Maine-Soroa. “You’ll be going this way… through Dosso, Tessaoua, Maradi, Zinder and Gouré,” he said, his finger coming to rest on the map over the village of Gouré. “The paved road stops here in Gouré, a hundred miles west of Maine-Soroa. We have volunteers working all the way out to this point, but as far as we’re concerned the world ends at Gouré. Not even the Cubans or the Chinese go out this far. I wish I could help you, but right now I can’t.”
The rains and cooler weather should arrive in a few weeks. Tomorrow morning we will leave for Maine-Soroa.
Photos top to bottom:
1. Niamey, sunset over the River Niger
2. Niamey market scene
Steve Humphrey, M.D.
Niamey, Republic of Niger
May 4, 2007
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