La belle vie in cafes

Well kids, definitely one of the perks of being out here is that we're only 1 1/2 hours from Montreal. Yes, my hard life in Psychiatry is running me down; I think each of us who went to Montreal plunked down several hundred dollars apiece on Rue St-Catherine (manic symptomatology?), as well as going tete-a-tete with various musiciens quebecois till 2 in the morning... sigh... walking through the streets of Vieux Montreal is -really- stressful :) , especially trying to break the stereotype of the Torontonian who Never goes to Montreal unless they absolutely HAVE to...
But really, I think psychiatry is filled with weirdos (sorry Steph), with the most likely candidate being the guy who was my staff last week. The poor OCD man is also psychotic, thinking it's a good thing to come into work (and his residents too!) at 7:30 am and not leaving the psych ward till about 7 or 8 at night... I would never have imagined actually having to be on Psych service twelve hours a day! That's nutso! Anyways, so the trainees have been busy psycho-analyzing the staff, while learning about psychiatry... I think the poor man derives personal satisfaction from his work alone, to the detriment of every other facet of life... He's an INCREDIBLY great psychiatrist, and even over the four days I was working with him, I could totally see the benefit he imparts to patients, but twelve+ hours a day?!?!?
I think this has taught me that we need to work hard to be excellent, in fact, I think if we don't put in the time, we actually cannot be as excellent as our other colleagues who do work hard. On the other hand, if you put in tons of work, and are an excellent excellent excellent doctor, then who is really the sick one? It makes me wonder...

Greetings from Parliament II

OK, I dunno about you guys, but I had my first medical student encounter where I actually was responsible for one, instead of just working with them. I think he thinks I'm retarded. So here I was in the emerg, minding my own business, about to do call, when I get paged, "Uh, are you the resident on? I'm so-and-so, I'm the medical student on with you this evening." I hang up, and think, GEEZ LOUISE, what am I going to do with him? What on earth did my senior do on team? Am I supposed to see a patient briefly beforehand and triage them to determine if they're stable/simple/educational enough for the student? Am I supposed to let the student report to the staff, or am I supposed to do that? Oh crap, that means I have to teach them something educational... in French... right....
So this lady comes in with a fib and a TIA. I figure, geez, that's probably educational. Go off, young student, go learn on a patient! Page me when you're done... figuring, of course, that maybe he'd finish taking the history and physical and also have written the orders in about an hour. Meanwhile, I find a computer and desperately read up on a fib and TIAs so I'll
have something intelligent to say besides, "Well, what's the target INR?". Meanwhile, the student takes 2 hours and 45 minutes to see the patient, and then comes with half done orders, after which, having reviewed his history and physical (now that was a total laugh, if you were watching me, trying to look all intelligent and asking what else he may have forgotten to ask about or what physical signs he should be looking for...), I had to intelligently explain what else had to be put in there and then CO-SIGN them! After teaching a bit about a fib (which really just came down to telling him what the target INR was
anyways...) and getting that all in order, and making sure that her CT head and CxR were OK, that case took, from when I sent him in to when I was finally free to go see my next consult: 4 1/2 hours. Unbelievable. I don't understand how on
earth our senior residents did it.

Greetings from Parliament I

I didn't realize that this would turn into such a huge chronicle of the many adventures of medical alumni.... :)
Anyways, I'm busy speaking franglais to everyone... and either confusing the francophones or amusing the bilingual patients... Still haven't actually made it to Parliament Hill (figures with all the Canada Day celebrations, Tragically
Hip in town, etc etc and I'm busy admitting non-Q MIs...)
On a more serious note, one of the interns in Ottawa made a very serious suicide attempt over the weekend and is currently in ICU. It's kind of cast a pall on residency as a whole. So, PLEASE guys, take care of yourselves, it's not the first one that I've been kind of connected to, but I would hate for it to get anymore personal than that...

Niger letter

Dear Friends, I have been quite tardy in distributing thanks to many of you for your support and prayers while I was in Niger in April. As you know, I've been out of Toronto, and even Canada, for most of the time that I have returned from Niger, and am now in the midst of a move to Ottawa. It has been quite hectic, and I have yet to have been given the chance to sit and reflect with my Nigerien journal and think back on my experiences properly!
I went to Niger, a culturally Islamic country, from April 3 to April 26, 2002 to work at Galmi Hospital. It is a 100-bed hospital about 500 km east of the capital of Niamey, 17 km north of the Nigerian border, and just south of the Sahara Desert. It was established by SIM Niger in 1950, after lobbying long and hard with the (then) French government to build a mission hospital. After humble beginnings (the hospital was given land in what was, essentially, the middle of nowhere, lacking water, power lines and the like; in fact, Galmi Hospital still lacks a functional, dependent phone line out of the hospital), it now serves about 600 out-patients a day, offers surgical and obstetrical services and runs an emergency department. Most of the staff at the hospital are nationals (163 nationals at last count); only seven to eight missionaries remain full-time, mainly in the form of administrative and physician/surgeon roles.
My role as a medical student was to learn and do, as much as I could and as much as I felt comfortable with. I helped in the out-patient clinics, did some (very) minor surgeries and helped the mid-wives in the obstetrical ward. Overall, it was a whirlwind experience for me, as my limited amount of time at the hospital was dispersed amongst many different medical serivces. I feel like I saw and did much that wouldn't be seen in our 'first-class' medical system here in Canada. It was humbling to see patients with disease that we would never see or deal with in Canada, and even more frustrating when there was very limited therapy that we could offer.
The Nigeriens struck me with their bravery and stoicism. People would travel for days, from miles around, hoping that perhaps Galmi could help them with their problems. How some of them adapted with their symptoms and their pain for months, or even years, before seeing a doctor, astounded me. I realized that I would have gone crying for some medication long before many of them would have even acknowledged that there was something amiss. Nonetheless, people would come from far and wide, even from neighbouring countries, because they knew "sai Galmi (only at Galmi)" could they find an answer.
Galmi Hospital's witness throughout the years is manifest in how it has changes its pocket of the world. When it first begun, it really was in the middle of nowhere. Today, Galmi is a village of about 5000-6000 people. Two churches are present here, with several more within a ten to fifteen minute drive of the hospital. A kindergarten and primary school have been built and are running, while a secondary school is getting off the ground. All have been built and are being taught by the local Christians. Galmi Hospital's reputation is far-reaching and is recognized as one of the best hospitals in the entire country. God is even working amongst the employees of the hospital. The majority of the employees are Christian, but some are not. In particular, a mid-wife named Fatima had been asking about Christianity and wanted to know more over the past year. The hospital director had give her a copy of the Bible, and she was in the midst of reading it while I was at Galmi. Please remember her as she tries to figureout who Jesus is. For a long time, the mid-wives of the hospital have all been Muslim, or at least non-Christian. This will change as some new Christian mid-wife graduates are coming to join the staff at Galmi Hospital within the next few months. Please pray for them that they might be able to make an impact amongst their colleagues in the obstetrical department.
Please remember the missionaries who are at Galmi, particularly Allan Quinn, the hospital director, as well as Drs. Maja Graber, Nick Palmer and Ibrahim Barre. Two other physicians are returning from furlough within the next few months and will help make the work a bit easier when they arrive. Please continue to remember the church in Niger; it is in the minority, but it is there!
Thanks again for all your support and your interest in me! I would love to tell you more, if you'd like, Please don't hesitate to get in contact with me at...

Postcards from the Edge of the Sahara VII

Language lesson time!!! Not that I've learned a ton of Hausa since I've been here, but I'll share some of the interesting words that I've learned (not -that- kind of interesting!!!!). Hausa is actually one of the dominant tribal languages in West Africa. It would be a very handy language to learn if you were in this part of the world, although, as one of the missionaries told me, it's not like people are oooooooh impressed with your mastery of Hausa like they would be if you spoke, say, French. Or Arabic.
Sannu (hello; there are some other forms, like when you're speaking to males or females and things, but as I never get the gender pronounciation right, I just keep things simple and just say the gender and age neutral hello)
Lahiya (I'm fine, I'm well, I'm doing OK; this is the right answer to all questions you are asked. For those of you who know that I HATE being asked "How are you?" this takes a bit of teeth-gritting to get through)
kululu (lump, bump, mass. Try saying it fast; it's fun!)
Akwai kululu (there's a bump... in the middle of the log... ha ha ha...)
Ubangiji Allah (LORD God; we usually say this, that way it clearly differentiates Him from the islamic Allah, so none of the patients can be confused as to which God we are referring to)
Aduu'a (prayer - very important word to know on medicine rounds, in the operating room, as well as in church, cause then I know when I'm supposed to bow my head and close my eyes)
That's enough learning for now!
julia
jlee@galmi.sim.ne

Postcards from the Edge of the Sahara VI

Bonus two for one in one day! Dear Gina reminded me of this... about how I never pack anything when I go anywhere, so I must be bringing back the equivalent of a fanny pack back... that will likely be true, as I realized that I don't have any 'souvenirs' per se (not that I don't encourage anyone from attempting to pick me up from the airport with allllll my heavy luggage, as my parents told me to take the TTC home from Pearson.... actually, forget it. My parents live closer to Pearson than most of you anyways... ). So, I'm apologizing in advance for lack of gifts. Not that it's not for trying. But it's been kind of hard to buy tourist trap souvenirs, cause, um, tourists don't go to Niger. They mine uranium. That's their big draw. (Whoo, you can see the line-ups now; I went to the uranium mines in Niger and all I got was this lousy T-shirt...). Hyon and Peter warned me that there was a dearth of culture here... no elephant jewellery, no velvet-painted Elvises, no snowman paperweights, no "Niger at night" postcards, no stuffed lions and giraffes at the local Disney Co., no keychains saying "I love Niger", etc. There's even NO McDonalds here in the country (whoo hoo!!! At least one place in the world multinationals have yet to besmirch by getting their tentacles in!)! Admittedly, Nigeriens have a little bit more to worry about than other tourist draws like Kenya or South Africa.... Typical markets offer, um, food. Soap. Unidentifiable animal parts (but I guess that's food too). Flip-flops. Batteries. Razor blades. Basic clothing. Tin cookware. Plastic washbasins. Yup. That's about it. Oh wait, I've also seen books, but that was in the capital. Even though Galmi has a higher proportion of people with literacy and some education (thanks to the schools and the hospital that SIM runs here), I still didn't see anything in the way of written material being sold here. So, as you can see, I'm kind of limited... well, at least they won't have to stop me at customs and ask me if I have anything to declare... ""why yes, in fact, I have a beaten tin pot that I was hoping to smuggle in, I believe it's worth about three dollars... actually, what about this stick? I picked it off the ground...")
julia

Postcards from the Edge of the Sahara V

I got lali-ed yesterday. That's a traditional foot-colouring procedure/ceremony/thing. They use henna, along with cinder ash and ammonia salts to produce this burning sensation on your feet to paint them black. It looks neat on African women, but it's kind of dramatic (like in the scary way) on my pale pale pale skin (did you get the sense that I'm rather pale? I thought I had gotten a bit of a tan, but I still look like I'm incredibly anemic and I'm going to die. I can understand why they think I'm a white person. I am :) ). Now my feet are black and orange, and where the dye didn't hold so well, kind of bluey-green. I'm not sure how long its supposed to last, and I keep on forgetting that I had it done, so I glance down at my feet and wonder why the heck they're so filthy. Makes me think of the engineering tradition with the purple dye (although I only stuck in my arms at that point!)
In other news (although maybe only interesting to Nancy :) )... I haven't eaten so much ice cream in such a short period of time before! I guess there needn't of been any worries about ice cream shortages in the desert... :)
julia

Postcards from the Edge of the Sahara IV

A few male-female observations:
1. Women always follow behind men when they walk, never (OK, that's a bit strong; maybe rarely is a better word) side by side. I think it may take me a while to get used to that again (yes, Peter, I'm learning how not to be an unruly woman, aren't you proud of me?)
2. Grown men hold hands while walking down the street. That's normal. I suspect some of you might feel a bit queasy about doing that with your friends... :) I must admit, even to me, that looks a bit odd...
3. Women do not shake hands with men. That's considered being easy. That's a bit difficult when everyone wants to 'touch the white lady' (which has only caused me problems once). The only exception I've found to that rule is in the church amongst Christians, where I am allowed to shake brothers' hands. Although men and women sit on opposite sides of the church, so I still haven't quite gotten my head around who's doing what where.
julia

Postcards from the Edge of the Sahara III

I was offered a baby today. I've been offered a couple of husbands, but this is my first baby. Mom got excited when she heard I was from Canada. (Sorry, a bit of medical jargon coming up). It's about two weeks old, 2.6 kg, and it hasn't cried at all since it was born. No Moro, no grasp reflex anywhere, no rooting, barely a sucking reflex. Just breathing. Contracted limbs. Labour was apparently prolonged, about a day or so. We assumed cerebral hypoxia. Baby didn't even react when we were pinching it on the limbs. (OK, medical jargon over).
I mean, my reasoning that 'pas de mari' (no husband) was accepted as a pretty good reason for not taking it, but it was still hard... especially as she had hoped... I think I need to think a little bit more...
Sorry about the downer...
julia

Postcards from the Edge of the Sahara II

Well, if you could possibly believe it, it's actually gotten hotter out here today. I don't understand how that is rationally possible. My air-cooler is now blowing out air, cause it can't sustain the temperature gradient necessary to blow cool air. (Here's a funny story, just for Swong, although I'm sure my family will appreciate it too, and likely agree ;) ...)
This morning, I went out to a village while some nurses were doing vaccinations. Unfortunately, it was the first time quite a lot of the little ones had seen someone as pale as me in their lives. I think they must've thought I was some sort of mutant African or something, because they just kept staring and staring. Some babies and toddlers even started crying (I didn't know I was -that- hideous!) and wouldn't stop until they were taken away from my view (after which they got their vaccination and started crying again. Oh well. At least I didn't give any needles; could you imagine the trauma to the children... this pale white mutant monster with slanty eyes comes and bites children with needles, and even your mother can't protect you from it!!!) It was quite strange. I felt like an animal in a zoo or something. Or maybe a movie star... no wait.... zoo animal is probably more likely... I can't believe I made children cry.... maybe it's a good thing I didn't end up going into paediatrics... :)
julia

Postcards from the Edge of the Sahara I

For those of you who have never been introduced to the PFTE series, mainly I just make observations about the culture that I'm visiting, and try to provide some sort of education of the various countries that I'm visiting... hopefully it will be illuminating, and occasionally funny (particularly when I talk about stupid things that I do)...
As I mentioned before, it's quite hot in the desert. This actually affects when Nigeriens eat during the day. (Aside: Differing between people from Niger and people from Nigeria is quite easy. Nigeriens (pronounced with a French accent) are from Niger, while Nigerians are from Nigeria. Interesting.)
The 'strengthening' meal of the day is at 10am. In fact, that's the equivalent of the 'lunch break'. We also have siesta time from 1-3 pm, mainly cause it's too hot to do anything useful at all, except for maybe pass out from heat stroke. Nigeriens will tend to have a small snack at that point, while all us foreigners will be eating lunch at that point. Finally, they'll tend to eat dinner much later, around 8 or 9pm, because it's too hot to try and cook earlier than that (all of us silly foreigners who eat around 6 or 7pm are clearly just being silly; 'slaving over a hot stove' takes on a WHOLE new meaning here).
julia