by Angela Jackson, MD
Today's Christian Doctor - Fall 2002
Angela Jackson, M.D. (OB/GYN PGY-3) at Saginaw Cooperative Hospitals, Inc, in Saginaw, Michigan, spent February 2002 at Galmi Hospital in Niger, West Africa. This is her account of a very .... Busy, Wonderful, Sad, Amazing, Difficult, Yet Fulfilling Adventure
As a medical student, I had spent eight wonderful weeks at Galmi in 1999, so when I applied for residency in 2000, I made it clear that I was interested in returning to Galmi for one of my rotations. Through God's providence, one of my faculty members turned out to be Dr. Jim Hines. "I spend two months on medical mission trips to Africa every year," he told me. "I'll be glad to lead a team to Galmi."
Before my trip even began, God faithfully supplied everything-including a $1,000 Christian Medical Association SM scholarship, $1,500 from another private scholarship, and the rest from family and friends. He even supplied the medical equipment requested by Galmi, including trunks full of supplies-gloves, suture, needles, a fetal doppler, two fetoscopes, forceps, an obstetric vacuum, a set of dilators for surgery and some free glucometers from the diabetic educators!
Our days were full from the start. Every morning we made rounds on all the OB and GYN patients. Then we would perform, on average, four to five hours of surgery. During our 24 days actually at Galmi, we performed 14 C-sections, six vesico-vaginal fistula repairs, seven USO's (ovarian cysts), seven D&C's, two cerclage placements, one (ingrown) pessary removal, 11 vacuum deliveries, one myomectomy, one vaginal hysterectomy and four abdominal hysterectomies.
One day while we were removing an ovarian cyst the size of a melon (in a woman who thought she was seven months pregnant) the electricity went off. Complete darkness. We froze. This being a routine occurrence at Galmi, the anesthesia staff simply turned on their flashlights and all three surgery tables proceeded with their operations.
After lunch and short siestas at our homes on the compound, Dr. Hines and I gave organized lectures to the five African midwives who so aptly run the entire obstetrics unit at Galmi. We taught on many topics, including neonatal resuscitation, dystocia, postpartum hemorrhage, vacuum deliveries, fibroids and ovarian cysts. They were very attentive and grateful for our input.
Our afternoons also included time in the outpatient department doing consultations on a range of ailments including infertility, uterine prolapse, pelvic masses and abnormal uterine bleeding. The surgeons, who usually handle all these cases, were glad for our assistance and expertise. They also appreciated us doing all the C-sections during the daytime, since these represent quite a burden on them.
As evidenced from edited excerpts from my e-mails home, some days were very difficult. "We had four C-sections and only one baby survived," I wrote. "The first was an abruption and the baby's hand was hanging out the vagina. That baby was dead but we had to do a C-section to get it out. So sad! Then we had a normal C-section for cephalopelvic disproportion. That baby also had meconium and a tough time of it. I scrubbed out and went to resuscitate him. I had to run to the other side of the hospital to get the only oxygen tank because he was grunting and retracting. The midwives said 'No problem.' They don't understand resuscitation or evaluation of a newborn at all. He is doing OK now. Then we had a girl come in after three days of labor in the bush. At C-section, the head was SO stuck in the pelvis, it was nearly impossible to get out, and there was also meconium. I again tried to resuscitate him, but this time without success. I even intubated, suctioned, did CPR, everything for about 15 minutes. It was so heartbreaking. I cried and prayed. I asked the Lord to just take him quickly.
"Meanwhile, Dr. Hines was struggling to repair the lacerations of her uterus and vagina from the difficult extraction. He said that these are the most difficult C-sections he has ever performed, or will ever perform. So just keep praying for us. God is in control. I know He is good and there are reasons for everything. I'm thankful we can be here to assist but He is the great physician. My heart aches, though my head knows these truths.
"Then as I was about to go home, I stopped by OB. And in rolled a lady in labor with a huge belly. I said in Hausa, 'Are there two?,' She said no. But then I did an ultrasound and indeed, there were two babies. Vertex, breech. She was eight centimeters dilated so I stayed with her for a few hours. She made little progress. Then with poor visualization on the old ultrasound, we found that the first baby had no heartbeat. Dr. Hines couldn't find it either. I was horrified. We had to get the healthy baby out before it died also.
"So I called in the OR team. It took them over 30 minutes to get here from town because we had to send a guard walking into town to find them. No phones. They set up the operating room and gave the spinal anesthesia. All that time, there was no fetal monitoring and I was getting very antsy to get that healthy baby out. Finally we got in, and as we delivered the first baby, it cried! Praise the Lord, both babies were OK. The ancient ultrasound with its tiny screen isn't very reliable, I guess. So now it's 6 p.m. and I've had no rest or lunch but it's worth it to have two good healthy girls."
There were other moments of joy as well. One day a 25-year-old first-time mom came to Galmi from neighboring Nigeria. Her water had been broken 36 hours earlier, yet she was only six centimeters dilated. We started Pitocin and she progressed well. It was nice because they actually spoke English! I was called to do a vacuum delivery for her later that night. She was exhausted. It went well and after a few tense moments and a bit of oxygen, the baby boy perked up and started screaming. The grandmother went down on her knees and joyfully praised the Lord. I agreed heartily with her. It was wonderful to see Africans with happy faces and joy at a birth. It's very rare there. I'm told it's because they've become accustomed to the death of infants. They don't emote nor do they bond with their newborn easily, until they are sure it will live.
There were also moments of sheer terror (but in retrospect, hilarity). One day Dr. Hines arranged for a man to bring his six camels for us to ride. I had declined, stating I would just take pictures for them, since I had ridden a camel in Israel once. But Dr. Hines soon convinced me. I informed Aaron (Dr. Hines' son) that camels are difficult to get up on because they lean way forward and back to get up and they can toss you off easily. When they came, I was the first to get on. They picked the tallest and biggest camel for me. I climbed on, but before I was settled, the camel suddenly stood its back legs completely up. I was catapulted forward, and found myself upside down and screaming my head off. My hands were pinned under me, on the "saddle" of wood/straw they had created. There were no stirrups so my legs were desperately trying to grasp the side of the horrid beast. Everyone started pushing and pulling on me. Finally, the camel's front legs went up. I was right side up, and scared to death! My heels were about at the height of a man's shoulders. "GET ME DOWN NOW!" I insisted. But they convinced me to try about five steps, after which even they were scared for me and suggested I get down. I readily agreed. So after about five minutes of discussion, instruction, and me concentrating on just breathing (while imagining falling off, breaking a leg and having to be airlifted out of Africa, all because I wanted to ride on a STUPID CAMEL!) I leaned back, the camel put its back legs down first, then it's front and no problem, I was OFF and thanking the LORD to be alive and in one piece!
Our last day at Galmi was wonderful. At 7 a.m., the midwife informed me that we needed to do a C-section for hand presentation (hand sticking out of the vagina). Fortunately, the baby was still alive. So Dr. Hines finished rounds quickly while I tried to coax the OR staff to hurry with the prep for the section. Many of these babies with malpresentations die. I grabbed the ultrasound, and quickly found the heartbeat. The hand was out almost to the shoulder and there seemed to be a butt sticking partially out too. But when I scanned, the heart was higher up in the abdomen. HMM, weird, I thought.
Once the mother had her spinal anesthesia, I asked Dr. Hines if we could possibly push the hand up and try to deliver the baby breech, vaginally. "Well, you know it's dangerous," he said, "but OK." He moved the arm, and suddenly the bottom came down. A breech delivery! I was so excited! The baby came out coughing and crying. Praise the LORD! I was SOOO pleased. I carried the baby out to the recovery room to give it some oxygen. Dr. Hines leaned out a few minutes later and asked how she was doing. "Fine!" I replied. "So do you want to come back in and deliver the second one or do you just want me to do it?" he asked.
"WHAT?" I answered. Amazingly, there was a second baby and no one knew! Then I understood why the heart rate was up higher in the abdomen-it was the twin's! I ran back in and delivered the second girl, also breech! Both babies were small but doing OK so far. I'm so thankful.
Dr. Hines said he was praying that I would get two more breech deliveries before we left and sure enough, God answered in one fell swoop.
Prior to the trip, a friend gave me a copy of Ruth Myers' book 31 Days of Praise. In each daily devotion she paraphrases Scripture as she leads you in praise. At Galmi, this book blessed my heart as it expressed my feelings in a time when I was overwhelmed with the death and disease all around me. "I choose to thank You Lord for my weaknesses, my inadequacies, my feelings of helplessness, and inferiority; even for my pain and distresses," I read. "What a comfort to know that You understand the feeling of my weakness and that in Your infinite wisdom You have allowed these in my life so they may contribute to Your high purposes for me. Thank You that many a time my weaknesses cut through my pride and help me walk humbly with You. Then as You promised, You give me more grace....[and] Your grace is sufficient for me, for Your strength is made perfect in my weaknesses."
What truth! I am grateful for my time at Galmi and for its trials, pain and tears. Each time I return to Africa, it is a litmus test of my reliance on my Heavenly Father for strength, grace and wisdom. And He supplies abundantly!?
The 200 Camel Proposal
During our month serving at Galmi, our team took a weekend excursion to Agadez, Niger-a crossroads for camel trade and an acclaimed "tourist" town on the edge of the Sahara desert. As the only six white people in town, we created quite a stir, riding into town in the back of a pickup.
The Hotel De L'Air could have used some air as well as paint, clean sheets, and toilet seats for the holes in the ground. But we brought our own bug spray to remedy the huge cockroaches and other beasts scurrying around under the beds. After bombing our rooms, we began our exploration of Agadez, accompanied by "friends" who had shown up at the hotel and in their broken English announced themselves as our tour guides-for a small fee of course. Their full-length Muslim dress revealed only mysterious eyes, calloused hands and sandaled feet, but the sword tied around each waist proclaimed them as our protectors in this city of many thieves. Our entourage grew as peddlers shoved their wares at us, "I make good price for you... last price... last price ... you like? What last price for you?" Holding tightly to my purse, my anxiety level slowly rose.
Dr. Hines led the way as our crew, now numbering nearly 20, walked on. The marketplace was buzzing with people peddling used clothing and shoes, spices, handmade jewelry, buckets, fresh fruit and vegetables. The hanging "fresh" meat, dripping blood, buzzed with flies. The mass of people, ruckus of noise and disgusting smells were a bit overwhelming.
Suddenly, to my surprise, one of the guards leaned over to me and whispered in halting English, "You married?"
"No," I answered.
"You getting married?"
"I don't know." I nervously replied.
"I pay good money for you... I give 200 camels... You take home, come back, marry me. OK?"
I was in shock. Seeing my face, he decided I must not understand the question. He repeated again, "I give 200 camels for you. You marry me, OK?"
A sheepish "No" was all I could manage, having never expected my marriage proposal to come in this manner nor in this place. But obviously this wasn't the answer he desired, so he kept following me, thinking that if he repeated the offer often enough, I might finally understand and accept.
Mortified, I finally called to Dr. Hines, informing him of what was happening. He turned to me and said, "You got a proposal for 200 camels?"
"Yes!" I responded, thinking he would come to my aid, and chase this guy away.
"Well, do you want me to see if I can get a better deal?"