What's it Like at the Clinic?

People often ask us what the medical care/system is like here, so we thought we'd take a few minutes to tell you about Mary Michelle's treatment over the past few days...

Earlier in the week, we'd made an appointment and taken her in to see the doctor. She had croup, and being as young as she was, we were a little worried. To make the appointment, we called the doctor on her cell phone and arranged a time that worked with both our schedule and hers, and so we met with her at 7:30 in the evening. Our doctor is originally from Iran. Her family fled the country over 30 years ago, ended up landing here in Niger and have since rebuilt their lives here. The clinic is a small building with a reception room, 2 examination offices, a lab and one room for hospitalization. Then, behind the clinic is another house that they are slowly developing into additional hopitalization facilities. I always find the clinic by looking for the little red picket fence along the front... it might be the only picket fence in the entire country. There are a few large trees right out in front and underneath those are the preferred parking places - otherwise your vehicle cooks in the sun.

When you walk into the clinic, there is a reception area, lined with 12-15 chairs and a TV in the corner that is either playing music videos, a soccer game or extremely melodramatic arabic soap operas that have been dubbed into French. There are always several people sitting there, watching the TV. Sometimes you find the waiting room filled with patients, but at 7:30 in the evening, the only ones still there were staff. When we arrived, the receptionist, janitor, nurse, lab technician and the doctor were all there. As soon as you take your seat, the janitor hops up to sweep away the sand you've inevitably tracked into the clinic. They know us pretty well at the clinic, so usually, I'll be greeted.... "Bonsoir, Madame Tim..."

We were immediately ushered back into the doctor's examination room/office, where the doctor had to call one of her staff to come and change the dirty sheet left lying on the bed. While we were waiting, she began asking as questions, taking a history and took Mary's temperature. The temp is always taken under the arm and is in Celsius - which I'm just now starting to figure out. When the body temp goes up over 38', then it is time to begin getting concerned. After the clean sheet was on the examination table, we laid the baby up there and the doctor began her exam. This doctor typically does a fairly thorough exam, quite similar to what would happen in a doctor's office in the States, except it all takes place in French. Many doctors (including some of the other doctors who help to staff this clinic) do not do a physical exam other than taking a temperature, listening to a description of symptomsm and then prescribing a treatment.

At this initial exam, the doctor confirmed that the baby was indeed sick with croup, but did not appear to be in any distress, gave us a prescription for more saline drops and an expectorant and an antibiotic (in case it continued on for 4-5 more days, at which point she wanted us to start the antibiotic), and sent us off to the pharmacy.

Unfortunately, she did not improve - be it the dust or just the change of environment, and by Friday night she was still coughing, the congestion was thick and she was also becoming dehydrated. We had called once and the doctor had added a prescription for a steroid, which Mary I'd begun giving her that morning, but it wasn't seeming to make a difference. We called the doctor again and asked if we could bring her back into the clinic.

After examining Mary Michelle, the doctor was quite concerned because although they could hear nothing in her lungs, her respiration was fast, shallow and she was obviously working very hard to breathe, grunting from the exertion of each breath. They had called a physical therapist to perform something that here they call "clapping" - massaging and gently tapping all around the chest, back and rib cage to stimulate coughing, soften and loosen congestion which then helps the child to expel it. Therapy consisted of 3-4 10 minute session with a 10-15 minute pause in between. Mary was not impressed... by the end of her therapy 3 days later, she started to cry as soon as she heard his voice.

Once the therapist had finished, they'd wait for her to fall asleep, check her breathing respiration rate, and determine if she needed to be put on oxygen. That first night, she was on oxygen for nearly 1.5 hours, until they felt like she was breathing slower and with minimal effort. For the oxygen treatment, they moved us into a different room where an old, rusty oxygen tank hangs from the wall beside one of two beds in the room. they searched for and sterilized (where I could see what they were doing - we've learned it is best that way) an older adult-sized mask that covers the mouth and nose and I had to sit and hold her and the mask in the correct position during that time. Once they were pleased with her breathing rate and the amount of effort it she appeared to be making, they sent us home for the night with instructions to return the next morning at 8 a.m. for another session.

In the meantime, I had been talking with her therapist, and had found out that he is a legally blind man who lives in our neighborhood and who had previously attended the school run by our mission; now, he is sending his son to our school. He was taught to read braille by a now retired EBM missionary and was asking questions about several other former Niger EBM-ers. In the course of our conversation, I ended up asking him if he'd like a ride to the therapy session in the morning. He hemmed and hawed for a few culturally appropriate moments, and then we agreed to meet right outside our school a few minutes before 8. And, in Niger, it isn't such a bad idea to volunteer to pick your doctor up and bring them to the appointment... that way you'll be sure they actually arrive at the clinic.

So the next morning, I picked up M. Oumarou, we went to the clinic, and after reminding them again to put a fresh, clean sheet on the therapy table, began treatment. We were there for a few hours, as she needed oxygen for less time the second time around - which was very encouraging. One of my friends showed up a the clinic to keep me company, and brought me breakfast - they are very relaxed and anyone you'd like to have at an appointment with you, you are welcome to have. The three of us - therapist, my friend and myself - visited and talked while he worked and the baby fussed through her treatments. After he'd finished, I was told to return at 5 for a third treatment. Mary and I were at the clinic for a total of 5 treatments - fortunately each treatment was of a little shorter duration than the previous one. After her last treatment, the current doctor on call gave parting instructions - durations for each of the medications, a suggestion to continue using steam/humidity to help keep the congestion soft, and to only bring the child back if things didn't continue to improve.

We saw a different on-call doctor each day, although they were consulting with "our" doctor by phone each time we were there. She would also usually pop her head in for a minute just to ask me how I felt things were going, which is a fact I appreciate very much. One thing we've found to be very true with the medical system here is that once you've developed a relationship with a particular practicionner, it is a good idea to continue with that person, even when sometimes, you wonder... Doctors and medical practicionners here don't tend to always ask your permission or explain what they are doing before they go ahead and do what they feel is best, and if you do ask questions, it is easily perceived as disrespect and a lack of confidence instead of a simple desire to know what is going on. And there is always the language issue. We speak understand French, but when more than one person is speaking at a time, when someone is speaking very fast, when we are already exhausted from having been caring for a sick child several nights in a row, or when someone is using a whole lot of medical terms, it is easy to make incorrect assumptions or mistakes.

I find it scarier for my kids to be sick here than when they are sick in the States. Every fever (and Elsie Mae just wandered into the bedroom, looking sick and feeling hot, so I took her temp - and she is...) I wonder... "Could it be malaria?" "How long do we wait before we take him/her in for a blood test?" "If she's really sick, will we be able to get her the treatment she needs?" This issue or our children's health is the single biggest issue that Satan uses to discourage me and to tempt me to pack it all in and head home. At the same time, it is probably the one that grows my faith in the biggest leaps and bounds as I see God providing and taking care of us, even when He's done so in ways I wouldn't have chosen and don't understand. I've heard it said so often that the safest place to be is right in the center of God's will, but I've decided I don't like that statement: I've learned that in my finite mind, I don't define safety the same way God does. But while I may not necessarily feel safe in the way that I'd like to feel safe, He's slowly teaching me that I can trust Him and that He is with me.