Couple of Things

First, I love holding babies. This is true of any baby, but I've just recently found I'm particularly fond of African babies. I could do it for hours, seriously. Especially this one little girl, she's two months old. One of the sewing students babies, ah, so cute, you don't even know. Second, I've made some head way with the kids who call at me everyday from the street, Ouybo! (white person) Now they say, "Nikki". Well not all of them, but some, and let me tell you, it makes me feel warm fuzz on the inside. It's like now, I'm more than just the random tall white girl they see every day, I have a name, and it's personal . I'm trying, although not very successfully, to learn their names. Of course they're all traditional which makes it ten times more difficult to pronounce let alone remember. Lastly, the girls in the sewing shop have been helping learn Hausa. It's a slow grueling process, but they've been so patient and persistent with me. Every once and a while I'll say something that makes sense. The rest of the time it just mumbo jumbo. They tend to have a good laugh, either way.
Sunday a group of peeps from my church arrive, really excited about it, needless to say. Time is flying, hard to believe it's the end of January already. Which by the way means I've been here for a total of four months! Woo hoo!

Holy Dust Batman

I was aware of the dust factor when I first arrived, but seriously? I swear it's a thousand times worse. As in, I wiped down the dust yesterday, tables, chairs, headboard, etc. And this morning it looked like a sandstorm came through over night. And it's not just the furnishings, it's my clothes, my sheets, my bedspread, the curtains, everything! It's doing a number on my allergies, that's for sure. And on another note, I've suddenly become aware of the unwelcome changes in my skin. "Dry" does not even begin to describe, it's sort of like, rhino meets reptile. It's not cute folks. I've given up on trying to keep my feet clean. One trip to the clinic and back and my feet look like they've been doused with dirt and mashed with mud. Then add to that just a thin thin layer of dust that coats everything else, legs, feet, arms, etc. Not exactly glamorous. I think I took a bucket bath three days ago. Yeah, something like that. I attempted it yesterday, but the air was so cold I only got as far as washing my feet. Think of it like this: a fall morning in Colorado, except that's the temperature inside the bathroom. Cut to, bucket of steaming water staring up at your from a cold porclin tub. It's not exactly inviting. I had goosebumps from head to toe just from soaking my feet. The thought of pouring water over my body in such crisp conditions was more than I could bear. Mornings have become quite chilly, at first a welcome change to the swealtering heat. But now, sort of a nuisance with the whole bath factor in mind. Having said all that, I'm still greatful to be able to bathe indoors, many don't have such a luxury. I'm thankful that I have water to bathe with, and a stove to boil water on. There's been a strike at some level of the government which has somehow caused a water shortage in and around Jos. I haven't been affected to badly, but I know many others that have. Count your blessings, right?

Food for Thought

Last week I was observing in VTC (voluntary testing and counseling), essentially the place where they test for HIV. The process looks a little something like this: person X sits down with one of three counselors, they collect some basic info and ask them why they’re there. Most people respond with “to do a test”, to which the counselor says, “what kind of test?” Once it’s clear they’re there for an HIV test the process continues. The counselor explains very briefly what HIV is, in that it’s a virus, not a disease, and it attacks the body’s defense system. They use this analogy: We have soldiers in our body that fight infections; HIV attacks and kills our soldiers. When the body doesn’t have it’s soldiers, it has a hard time fighting diseases and infection. They explain how HIV is contracted, through human fluid or blood. They further explain what that means; HIV can be passed from a positive mother to her child during pregnancy, through unprotected sex, blood transfusions that have not been properly screened and sharps that have not been properly sterilized such as blades and scissors from barber shops. Side bar on that, it’s very common for men to go to a barber to have a shave. And when I say shave, I mean old school, single blade shave. There are many cultural misconceptions about what HIV is and how you get it. For instance, some people believe it’s a curse caused by evil spirits and spells, while others believe it’s a disease that can be contracted like the common cold. There are so many people who are shunned from their families and communities when they become aware of their status. It’s for this reason, some people would rather not know than live in potential isolation and shame. Some who do learn of their status will go so far as to keep it from their marital partner, afraid they will leave them if they find out. So anywho, they go through this informational session and then are sent around the corner to do a rapid test. About fifteen minutes later the results are out and they return to the counselor, who then delivers the news, positive or negative. If it’s positive they’re sent to the clinic’s main building to do a second confirmation test. Sometimes the rapid test will show a positive result when it is actually negative; these cases are pretty rare, but it can happen. If it’s negative they will tell them to return in six months to take a second test, allowing for the “window period” in which HIV can develop.
So anyways, there was this one woman who had her baby with her, still breastfeeding. Actually she was feeding her while was being counseled. Also really common, women will fully whip out their breast in the middle of a conversation, a doctor consultation, in the waiting room, on the street, in the market, just about anywhere. They were speaking in Hausa so I was catching the translation in bits, but basically her daughter is a year and a half, the mother didn’t know her status when she was pregnant and has been breastfeeding since birth. Cut to the diddy about HIV, what it is, how you can get it and she was off to do the test. When she came back to the room, she handed him the folded piece of paper that had a big black stamp that read “HIV positive”. The counselor then advised her to have the baby tested. Again, she came back with a folded slip of paper, and it read “HIV positive”. I could have cried right then and there. I was looking at a beautiful baby girl, not even two years old, and HIV positive. It was totally surreal. How could this be? It’s just not fair! I wasn’t quite sure how to sift through the relentless waves of emotion, one right after the next. It was inconceivable. Later that day I did an inquiry and found out that at Faith Alive alone, there are over 200 children receiving ARV drugs. Children with HIV. The words ‘cruel’ and ‘unjust’ come to mind, but even that doesn’t seem to capture the gravity of how I feel about this said reality.
MTCT (Mother To Child Transmission) can happen at several different stages.
It’s possible transmission can occur in the womb, during delivery and/or through breast milk. If no precautions are taken, there is a 45% chance the baby will be infected with HIV. If a mother is aware of her HIV status and is taking ARV drugs during her pregnancy, the baby’s chances of contracting HIV are significantly reduced. There are special birth attendants, trained in a particular delivery procedure that can then reduce the chance of transmission during birth. Just by eliminating breastfeeding and substituting strictly with formula, the chances of the child contracting HIV is reduced to 30%. If all the above precautions are taken there is only a 2% chance the baby will contract HIV from her mother. So, what are the challenges? Well, number one, the mother must know her status. If a mother is pregnant and knows her status she is automatically placed on ARV drugs. Okay, so let’s say a mother knows her status, now she needs to be receiving pre-natal care and counseling on the advantages of using a trained birth attendant. This in and of it’s self is a huge battle. Many women don’t go to the hospital to have their child let alone get pre-natal care. Cost of medical care and transport to and from the hospital are just a few of the obstacles. But let’s just say for the sake of example, she knows about Faith Alive and gets hooked up with pre-natal are and a trained birth attendant. Now we move into the issues associated with formula feeding. Number one, it’s not widely accepted, and by that I mean culturally. Many husbands and extended family members will pressure a woman to breast feed, because it’s just what you do. There’s ‘no reason’ not to. Then add to that the cultural sigma of HIV and you have pressures coming at you from every direction. Okay, so let’s say she can get beyond that, her family is aware of her status, and is supportive of her formula feeding. Now we’re looking at cost. One tin of formula is about 700 Naira. That’s approximately six dollars. If exclusively breastfeeding, she will need to buy about 8 tins a month. That’s 5,600 Naira. Minimum wage in Nigeria is 5,000 Naira, and most people don’t even get that. The challenge here is obvious. The problem has no easy solution. And the children suffer.

Medical Records

It occurred to me recently that I haven’t talked much about the work I’ve been doing at the clinic. For those who have been curious (thanks for the reminder grams) here’s the 411:
The last, oh, three or four weeks, I’ve adopted a project of sorts in medical records. To understand what I’ve been doing you’ll need to know a little bit about the place and how it works. Every patient that comes through Faith Alive, either receiving ARV’s (Anti-Retro-Viral’s) for HIV or those coming for treatment of the common cold (malaria, typhoid, etc.) has is file with their name and hospital number. Every morning when patients line up outside the clinic, their name goes on a list (first come first serve) to be seen by the doctors. If they’ve been here before they have a hand card that has their name and corresponding hospital number for the medical record staff to locate retrieve their file.
Now, if a patient loses their hand card medical records has essentially lost their ability to locate their file. Or have they?
There was/is a system in place to curtail such a predicament, however it hasn’t exactly been maintained. With each file there is supposed to be a small index card with the patient name and hospital number. These cards are to be filed in drawers alphabetically, so that, in the event a hand card is lost, medical records staff can easily look up their name and thereby locate their hospital number. Sounds logical, right?
Well here’s the thing, these cards that are supposed to be neatly alphabetized and organized in their little card catalog like drawers have, to date, been living in one of two places: a box on the floor or in rubber banded stacks inside the drawers. The work, no doubt, of volunteers before me.
And just so ya know, there’s about 8,000 files in medical records. Which means if staff have been following due process and creating a little blue card for every file, there should be something like 8,000 cards to alphabetize and organize. And it doesn’t stop there. Turns out the cards are too big to fit into drawers, so after I’m finished with the alphabetizing, I’ll be cutting, 8,000 little cards. How jealous are you? Seriously…
Right, so with that said, here’s where I’m at in the process:
Step one: Gather up all blue cards and start sorting by first letter. Check.
Step two: Alphabetize by letter. Nineteen down, seven to go.
Step three: Cut cards to size. Pending completion of step two.
Step four: Pray someone maintains the system after I’m done.
When I’m not working on step two, I’m usually in medical records either pulling files for the morning clinic or helping the staff post files back in the afternoon. So that’s work in a nutshell. Any questions?

What Would Jesus Do?

A child, his face sunken and emciated, teeth missing from his smile. His body, a pile of small mangled, deformed bones, birth defect or disability, difficult to know.

A woman, late 60's, crawling on her hands and knees. Old t-shirts wrapped around her knees to somehow protect her knees from scraping agains the gravel streets. Her skirt tattered and torn. Her feet bare, caked and crusted with dirt.

A man, mid 40's, paralyzed from the waist down. He moves around in a seated tricycle powered by his upper body. His face is sullen, his eyes filled with sorrow. A begging bowl sits beneath him, empty.

We've seen the bracelets, the necklaces and the bumper stickers. But what would Jesus do? I don't remember any accounts of Jesus dashing the leapor his spare change. Or dropping a few coins in the blind man's bucket. What did Jesus do? He healed them. He made the blind to see and the crippled to walk. Amazing.

And I understand why like I've never before. Have you seen a crippled boy laying on the street corner? Have you watched a grown woman crawl in the dirt scrounging for scraps? I never had. If I had the ability to heal, believe me I would, in an instant. But since I don't, it begs the question, what do I do? Sure, I can give money, but it dosen't seem like it's enough. I feel so helpless. It's not fair. It's not right. Why him or her and not me? These are questions that cannot fully be answered, but they are questions nonetheless.

The poor. It's easy to forget about them, because we're not. It was easy for me to spend my time on My Space, Facebook and e-mail. It took no effort at all to watch a season (or two) of Friends or Grey's Anatomy in a weekend. When I had nothing better to do I'd wander the aisles of Target, cruise the sale rack at Gap or grab a Starbucks just because. Never giving a thought to what a luxury, no what a privilege, it is to know how to drive much less, own a car. To have the access to constant electricity, to own a tv, to afford cable or to have a job that allows me the great gift of two days off in a week.

It's humbling friends. It's kick you in the stomach, break your heart in a million pieces, cry your eyes out, humbling.

Nelson Mandela

"Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that frightens us most. We ask ourselves, 'Who am I to be brilliant, gorgeous, talented, and famous?' Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that people won't feel insecure around you. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in all of us. And when we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others."

--Nelson Mandela in his inauguration speech in 1994

Hello?

So last weekend my friend Krysty left her room to go fetch some water. She was gone maybe five minutes. When she got back to her room she noticed her phone was missing. She searched all around but couldn't locate it. She borrowed her neighbors phone to call her number, and a man answered. She asked, "Who are you? Where did you get this phone?" The man said the phone was left in his shop. When she asked where the shop was he hung up. She tried dialing the number again but he had switched it off. What's interesting is no one saw anyone enter into her room, and what's even more fascinating is the fact that there was 600 Naira on the table next to where her phone was, but he only took her phone, not the money.
Later that day she went to the phone shop to block the phone line and salvage her number for when she's able to get a new handset. When she arrived there were over 150 people waiting in line for the same thing! All of whom had their phones stolen recently. The woman at the counter told her this was "light" compared to what it usually is.
The appeal for stealing handsets (cell phones) is for re-sale value. "Used" (which may often turn out to be stolen) handsets are re-sold for more than half what a new phone would cost. You can find handsets such as these in the markets all around Jos. Just another little snippet of life in Nigeria.

Clown Car

A couple weeks ago I went to church with Blessing. I've told you about the bike situation (the motorbikes) and how I wouldn't touch one with a ten foot pole. Right, so with that said, Blessing said we could take a cab to church. A cab I thought, now that seems reasonable, I can get behind that. Okay, so where do we find such a thing? We just look for one she says. Hm. Okay, let's go look for one. So there we are standing on the side of the road in our Sunday best 'looking' for a cab. What exactly are we looking for, I asked her. She looked at me and smiled, um, I don't know, one will just stop. Finding all this very interesting, I stood faithfully at her side waiting for one to "just stop". Every once and a while she would stick her hand out at her side, a signal of sorts to cab passing by? After about five or so minutes of this clunker of a car pulls over. She negotiates the price of the drop through the window and motions for me to get in. Now, I don't quite know how to describe this said 'vehicle' that we entered, but I'm going to give it my best. First of all of the paneling on the inside of the door was missing, the inside wreaked of gasoline, and the area where the controls would normally be for radio, heat, air etc. was totally gone. Just a big hole showing straight through to metal. There were noises coming from places I'm sure they shouldn't be and other smells that were unidentifiable. I seriously didn't think this thing was going to make it three blocks, let alone three miles. But sure enough, old Bessy got us there, all in one piece. Hallelujah.
After church we went through the same process: standing on the side of the road waving down cars that look like they may be a cab. The best I can tell, you look for the oldest, junkiest, most beat up thing on the road and wave it down. So again, after about 5-10 minutes a car pulls over. Now mind you, the car is full, three in the back, one in the front, and Blessing is negotiating with him as if we're actually going be be getting in. Standing beside her I said, "Um, Blessing, there's no room in this car." She laughed and said, yes, we can fit. Are you serious? Where?! I didn't say that, but that's what I was thinking. So Blessing got in the front, half sitting on a random man's lap and I got in the back, one cheek half wedged between the seat and the door, the other riding up the side of the window, bracing myself for dear life. We went on like that for a mile or so, hit some traffic, which was awesome, and then arrived at our dropping point. I'm guessing most, if not all of the people ridding in the car were estranged to one another, but let me tell you, by the end of it they might as well have been family. Heaven knows I've never been that close to complete strangers before.

Death and Dying

The first week I was here I visited two women, home bound and dying of AIDS. The images of them will forever be engraved in my mind. To say they were emaciated would be an understatement. They were so weak (and frail) they could barely walk. I'm not at all exaggerating when I say skin on bones. One of the two women died about a month after our visit. The other, Habbibat, I just found out passed away yesterday. Her husband died long ago, he was the one who infected her. Extramarital relationships are very common especially with the Muslim population. She had three children, two of which are currently in school courtesy of Faith Alive scholarships. The oldest, a teenager, is still in the village, uneducated. The worry now is what will happen to the two that are in school. Will they be able to stay with her sister here in Jos? Or will they be sent back to the village? Faith Alive of course is pushing for them to stay here and continue their education. I guess only time will tell.
I've seen and heard about more deaths in these last three months than I have in the last 24 years. Death due to bike accidents, car accidents, AIDS and other illnesses. Makes me realize how much I take for granted.