Niger January 2012
- Posted Feb 5, 2012
A Cloud of Dust and a Call to Prayer
Niger FAME Medical Clinics
Dwain C. Illman, M.D.
Not far north of Niamey, Niger the Sahara Desert sand begins. The Southern 15% of Niger is mostly red dirt and rocks with occasional desert thorn tree or bush. Driving to the clinics we conducted, our twelve-member FAME team created huge dust clouds. The unfortunate donkey cart or camel rider was soon covered with our dust. Many of these people were our patients on their way to or from the clinics.
Our clinics were held in small rural classrooms, under some shade of a tree or in a church building. No matter where, all of our items became dusty. Cameras and computers beware! Stethoscopes and otoscopes were not spared.
No wonder most all of our patients were very dirty. I commented many times that half of the patient problems could be overcome with soap and water.
I didn’t really see the extreme filth until close to the end of our second day of clinics when members of the Taureg Tribe arrived after walking many miles. My interpreter Brahma said, “these people bathe once a year.” He did not make it clear what morning they work up and decided to bathe!
The influence of Islam is pervasive as over 95 % of the country is at least nominal Muslim. We saw this by the large number of mosques and the dress of the women and men. But how we really knew was hearing the 5 AM call to prayer over very amplified speakers. In the town of Ouallum where we stayed that is made up of 50,000 people the calls seemed to start beginning at 5 AM with one Muezzin singing out the call followed by many others about 30 seconds apart for ten minutes. There was one Muezzin who had a very beautiful voice but most created an unpleasant cacophony of noise. This was either preceded or followed by the roosters. The worst rooster was one morning after our driver Godfrey tied his new rooster to a bush right next to our outdoor sleeping area in Ouallum. Finally, I heart Emmanuel Mantey yell: “shut up.” Trust me, that didn’t work.
Jeff and Tyler slept on the roof of Kwame and Suzie’s home in Niamey. Jeff came down and remarked: “I didn’t know there so many dogs.”
Under this Islamic background I found many desperate to know God and many disciples sold out to Jesus. If you leave the Muslim system and accept Christ, it is a full and complete enthusiastic and expressive faith.
My interpreter Johan Brahma told me he went to a Muslim village called Karma to build a church. The village leaders took his bag and threw it out of the village and instructed him never to return. As he was leaving he recognized an old man walking to the village and greeted him. The man invited him to his home and served him food. Brahma had first met this man in the capital Niamey. The old man in the city seemed to need help so Brahma helped him around the city. This was repeated with other visits by the old man. Now on the “chance” encounter seeing him in this village, the old man told Brahma to stay. “I am the chief. I will feed you and house you while you work here as much as you want.” In the following 6 months, 16 new believers became the nucleus for a new church. The town Karma is a strategic location 18 miles East of Niamey on the main paved road. The local group led by Kwame Yeboah-Mantey has chosen this place as a site for a new clinic to be built with the assistance of First Christian Church, Burlington, Kentucky with some possible contribution by FAME in Indianapolis.
The people are desperate for medical care. I had a mother walk 4 days covering 60 miles with her twin girls 5 months of age. One is well nourished and reasonably healthy; the other is malnourished and has a poor outlook for survival.
Another mother walked 12 miles to clinic with her two girls. The mom said: “I left early.” Well, I guess! Her 10-year-old daughter is thought to have an evil spirit. Pastor Brahma said he would go there next week to pray with her.
Hundreds would wait from 4 to 8 hours every day in the hot sun often for a small bag of vitamins and a few ibuprofen. The Muslim dads typically would bring the boys over 5 years of age to clinic. One of our team who had come to Niger before said after observing people in Laba last year and again this year how amazing the vitamins, teachings and worm medicines seem to make the kids healthier.
Grandmothers in every culture are a critical link to a bright and fuller life. One grandmother I treated is 45 and is caring for her 18 month old granddaughter. The child’s mother died in childbirth. Often in African culture that is a death warrant for the child. But the loving grandmother kept a goat to provide milk. The child appears much more healthy than most other children I saw.
A parallel story is not so happy about a grandmother raising her grandchild. Last month another grandmother’s goat died. Now the 9-month-old child is wasting. We gave her all the powdered formula we had.
There was a huge variety of medical conditions and skin diseases. One lady came in with purpura, which is not easy to discern on black skin. A 60-year-old man said he had a “snake in his side causing stomach pain.” So is this a bad gall bladder or a new form of worms?
Speaking of worms, the condition is omnipresent. All the kids were dewormed with Albendazole. Perhaps I should take one?
The Taureg people marry young. Girls marry beginning at age 8. I had a 10-year-old girl who looked 10 in her face, but she had a 4-month-old baby. No matter, she still looked like a child. Her tribal dress was impressive. There were beads and buttons in interesting patterns on a heavy fabric. These people are very distinctive. They are a nomadic people who probably started in Ethiopia.
So many skin disorders would not have started or not advanced if the people had been using soap and water regularly to bathe. This population had so many abscesses, infected wounds from minimal trauma, poor healing burns and scalps with multiple pinpoint infections. Gloves and hand washing were critical for us as we served these people.
In my previous visit to this area in 2010 I did not see much hypertension. This year we had scores of serious high blood pressures. There were more in Ouallum and Niamey than in rural Laba and Donoumoro. Some people had previously been diagnosed with hypertension and had a written prescription but couldn’t afford to purchase the meds. I saw some patients on the very old hypertensive medicine called Aldomet.
Niger is at, or close to, the bottom of the rankings of the United Nations and other surveys in health statistics in most categories, including life expectancy, infant mortality and nutrition standards. Income and living standards are the poorest in the world. Libya was a major contributor to the nation’s budget, but this aid stopped with the rebellion and change in government March 2011. The main export of Niger is Uranium from mines in the far north of this country, twice the land area of two states of Texas.
Political and security issues are both stable and insecure. The new president partnered with a Taureg vice president to ensure some modicum of stability. The Tauregs are nomads and align with convenience. Some are aligning with groups of al Qaeda. We hired a platoon of Niger Army to oversee and protect us. A jeep of soldiers preceded and another followed our three vehicles to our remote clinics.
Each night as I lay down on my cot with the stars as my roof and the waning moon to highlight my surroundings, I slept under the shadow of a 20 mm gun mounted on a nearby jeep. In the small town of Ouallum the platoon would scout the clinic area and set up a perimeter before we could leave the military compound where we stayed. Further remote in the desert the lead jeep would send soldiers on our arrival to the small hills and strategic locations around the clinic. The locals told us that in convoys going way north, the Sahara dust clouds from the vehicles became a blackout curtain. Al Qaeda has been known to take out a middle vehicle that would not be noted until the convoy later stopped. I avoided the middle in our convoy of five!
But let me assure you, we felt very safe. I also noted we had the best crowd control than in any previous clinics. It helps to have a big soldier with an AK47 standing by the door.
Our ministry was effective at many levels. In our nine clinics we treated 2156 patients. Both the American team and the locals prayed for the patients. I am confident many lives were saved with injections of antibiotics and with the malaria treatments. Children should develop better for the time they have no worms and are taking the vitamins.
There was a young woman who came in with a leather necklace holding an old leather pouch. She said that it was a fetish given to her by her grandfather. It was protecting her from “evil spirits.” Our nurse Shirley along with Pastor Augustine led her to Jesus and the change from fear to peace as she gave up the pouch, which was later destroyed and buried. Warning: do not mess with true evil as manifested by the pouch.
Pastor Brahma said many of the people live in fear from evil spirits and incantations given by a spirit man (witch doctor or shaman). They will still take a chicken before planting crops and along with the witch doctor sacrifice the chicken and pour the blood over the field. He said that even today some rarely follow the old way of actually sacrificing a virgin girl and burying her in the field. This allegedly promoted good harvests for 50 years.
I write to tell you that the seed of the gospel was sown. Three times I went along with Jean Bertrin and others to visit the chief, headmen and in town the area commissioner. This was done as a courtesy and to thank them for assisting us. After each time of greetings the leader would express gratitude to us for what we are doing and encourage us to return. I told Pastor Jean and others later that I wonder what these men will say in 7-10 years when they look around and see 100,000 Christians in their areas!
Sunday out in the desert was an inspiring time. Our FAME team and about a dozen interpreters met in one of the schoolrooms to sing and pray. Let me tell you, the Nigerians pray with power. After that Pastor Jean formed the crowd outside consisting of well over 600 people into a large circle 2-4 people deep. He started preaching in French. Two other pastors stood apart from him nearer to the people and interpreted into the local language Zarma. They all three seemed to speak in unison and with power. The people hardly stirred as Jean told the story of Jesus. In my mind I visualized Pentecost as described in Acts 2. We didn’t have 3000 decisions but I am convinced the word of our Lord that was sown will take root and prosper. That was the day we treated over 500 patients.
Further Thoughts and Experiences
We landed in Niamey, Niger on Air Maroc having come from Casablanca and Ouagadougou (have you been there?). We landed at 2:30 AM. That’s right, 2:30 AM. After immigration, baggage claim and customs we were loading into 3 vehicles by 3:30 AM. In the truck I was in as we backed out I said to our host Kwame: “is that a fresh puddle of oil from us?” He said “no” but stopped and looked. It was our mess. Under the hood, oil was spurting out from defective tubing going to the manifold. Duct tape would not work. We waited for another vehicle and were finally at Kwame’s house by 4:30 AM. Yes, the roosters and call to prayer began promptly at 5 AM.
Food and meals during our days in the desert were a challenge. I brought most all of our food for these days in my 2 suitcases. We ate Kraft macaroni dinners highlighted with bacon strips now packaged for room temperature storage. We cooked on a small propane burner. There was a meal of spaghetti and meatless sauce. I created a meal using cream of chicken soup with minimal added water mixed into a large pan of minute rice. It was simple but tasty. The lunches were peanut butter and jelly on local bread. By the third day the bread had turned to rock. Instant oatmeal worked well for breakfast.
Each day we were in Niamey we went to a Lebanese French restaurant for a meal. The place is called Amandine. The first night I ordered 6 pizzas of different types for us to share. We enjoyed them. The fresh croissants and homemade ice cream there were delicious. Suzie Yeboah-Mantey fixed 3 meals for us as well and some scrambled eggs for breakfast the days in Niamey.
Kwame and Suzie Yeboah-Mantey came to Niamey in 2004. Kwame graduated from Ghana Christian University College (sic) and came to Niger to build the church. Since then they have seen the First Church of Niamey grow to a 100 in attendance with satellite groups in Ouallum, Laba and Karma. His ministry is in leadership training and discipleship. The new Christians there have a real zeal and passion that inspires.
First Christian Church in Burlington, Kentucky has been a leader in financing the work. They were the main contributor to the lovely new church building in Niamey. They are giving $50,000.00 this year towards construction of a rural medical clinic in the Karma plateau area. This area is not where we worked. This area is 18 miles east of Niamey on the major highway.
Medical supplies in country are limited. To illustrate, I went with Jean in Ouallum one evening to get some more medicines for our clinics at the local pharmacy. The shelves were nearly bare. The main in stock medicine was to treat malaria. Fortunately, that is one of the key items we needed.
Most adults don’t know their ages. I guess this has its advantages. I noted that the registration team only used round numbers for ages. People were 30, 40, 50, etc. but few were 35, 42, etc.
The women were Muslim and mostly totally covered except for their faces. They would more willingly take their tops off than they would remove their head coverings.
The clinics were in the town of Ouallum and the villages of Donoumora and Laba. When I visited the village chief at Donoumora, the dung scattered through out the village area was a prevalent as cobblestones on a cobblestone street.
By the time of the 6th clinic day we had surpassed my estimated number of patients and planned formulary. I told the team on the 6th day “this is a loaves and fishes day” in reference to Jesus taking the 2 loaves and 5 fishes to feed the 5000 people. Sure enough, we had lots of “leftovers”.
In Ouallum we had a local policeman that seemed to be bypassing the line of men (men and women were separated). Jean told him to wait. There was a loud argument. The local Pastor Issa went to the man and led him to a provider. The policeman continued to be angry. When two of our soldiers came and stood over him he shut up. As he left, the man turned to everyone saying: “I’m sorry.” Let me say again, we had excellent security.
One of our vehicles had not one, but 2 flat tires on our return to Niamey. The driver of the truck I was in had had a flat the day before and told me: “my spare is dead.” The rural roads are a disaster and most tires are old retreads.
We took a tourist day to the Giraffe Park of Niger. It was so much fun. We truly did see a “journey of giraffes”. We could walk among them. One mother had two small calves.