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