Sorry for the delay in writing. I have had limited access to the internet. I am going to start going to the internet cafe most days so I will be more available via email or wordpress.
I have been in Kaduna for the past week and a half. Kaduna is a relatively modern city and is much smaller than Kano. It is also considered northern Nigeria’s political center and there are a number of training colleges and two universities (hence, why I am here).
I am staying at Dr. Mairo Mandara’s house with her niece, Khadija. Dr. Mandara is based in Abuja but she visits here some weekends. I actually finally got to meet her this weekend and she is a very intelligent and wonderful person. Khadija is 19 and a student here and also ridiculously nice.
I am working with the Shehu Idris College of Health Sciences and Technology Makarfi. They have a main campus in Makarfi (about 1.5 hours north of here) and a School of Midwifery here in Kaduna. The school has a demonstration clinic in the center of Kaduna for mothers and children. They provide free health care in the form of antenatal, labour, immunization, diagnosis, and pharmaceutical work. The clinic is run by some of the most amazing women I have ever met. They are all incredibly welcoming, willing to explain anything to me, and love to try and teach me Hausa. (I am getting better but they still all laugh at me whenever I say anything in Hausa).
I have just been observing since I arrived to see how the clinic works and to determine the best way to help out. My project was initially supposed to be about using cell phones in health care, but since I have been here, I have realized that it is not the best option here and probably would not work. One of the reason’s it wouldn’t work is that it is just too expensive. In order to use a cell phone, you have to buy prepaid cards which credit your account. It is a bit unclear as to how much it costs to text or call, although I know voice calls are very expensive (I spend about $15 a week for maybe 40 texts and 10 short calls). The other reason cell phones are not ideal is because not enough people have them. The clinic serves very poor people and most of them do not use cell phones. Also, the staff does not make much money either so they would not be able to afford using their cell phones in their work.
However, one of the other things I had done research on is an electronic medical records system called openMRS. It was developed by a bunch of NGO’s and the World Health Organization. We think that this would be much more useful for the students at the school in Makarfi (who study health information management), the clinic, and the community. Currently, the clinic keeps all of their data in paper log books and client health cards. They are not able to easily keep track of the amount of medication they give out, the diseases they encounter or the number of woman who use their services. Access to this information is absolutely crucial to improving the care given by this clinic and in understanding the health care in the country. Just to name a few things that could be done with this information; they would be able to show the government how much medication they need each week (now, they usually run out and have to tell the poor mothers to go buy medication, which they can’t afford), they could track disease patterns or locations of specific diseases, they could also track maternal and child mortality rates. We have spoken to both the provost of the school and the woman in charge of the clinic and both have been wanting something like this and are very excited to get started, and so am I!
Being in the clinic, I have done a lot of work….. but I also got to see some really amazing things. The first day I watched as about 100 babies got vaccinated for polio, Hep B, and yellow fever. It was great to see so many babies getting vaccinated considering only something ridiculous like 30% actually get vaccinated, but it was also heartbreaking to have to watch babies cry for two hours. Another day, I sat with the woman who does the antenatal care. It was amazing to see how many pregnancies woman have here. The highest number I saw that day was 12. She was a 36 year old woman who started having babies when she was only 15. Her first 4 babies all died during birth, her next 5 survived, then she had 2 abortions. She said that any more pregnancies were a gift from god and that she would keep them. Another woman told me (through translation) that the reason she wanted to have so many children (she had 6 and was on her 7th) was so that they could take care of her when she gets old and the more she has, the less of a burden she will be on them. Women who come in for their first time for antenatal care all have to be tested for HIV. If a mother is HIV positive, she is given free medication, counseling, and is encouraged to try and persuade her husband to come and get tested as well. Also, when she has her baby, she is given medicine to separate her from the baby and after the baby is born, he is given other medication which is usually successful in keeping the child from contracting the virus. While I was talking to the counselor, she showed me one of the HIV tests which was positive. She called for a woman who arrived with her small daughter and took her into the other room to give her the medication and counseling. Fortunately, her daughter was negative but it was interesting how the woman reacted to the news that she was positive. She did not cry or anything. They were speaking in Hausa so I could not understand exactly what was being said but it is pretty clear that she did not know the effects of HIV or the severity of it.
Thursday was the most amazing and horrible day. I spent the day in the labour room with a 14 year old and a 21 year old who had both already been in labour for a few hours when I arrived. I have never seen anybody in so much pain before. They were in the “1st stage” room, which consisted of 2 beds with no sheets or pillows. For two hours I watched them cry, walk around the room, bend over, and do anything they could think of to lessen the pain. Their family members waited outside and came in every so often to give them tea or food. I don’t think I have ever been so uncomfortable in my life. All I wanted to do was go and try and do something, anything to make them feel better, but none of the other nurses paid any attention to them and they could only speak Hausa. I ended up just walking back and forth between them kinda putting my hand on a shoulder or rubbing their back. I was desperately trying not to cry with them and I really don’t know if I made them feel better by being there or if I just made them feel uncomfortable. After about two hours, another woman came in who was literally giving birth. They rushed her to the “2nd stage “ room, which has 3 metal tables with small plastic cushions on them. The doctor sprayed antibacterial on the floor around the bed and put a bit on the bed as well. The girl was very tired and very skinny. After only about 10 minutes, the baby’s head was already out of her and the doctor just grabbed its neck and pulled it the rest of the way out. It was a healthy 3.4 kg baby boy. One of the nurses took the baby, cleaned it off, and clothed it. The doctor cleaned the mother and cleaned the bed and instruments that she used (and I use the word “clean” very hesitantly because it was only a processes of soaking instruments in antibacterial soap for 20 min, rinsing them off, and then doing it again). Then the director came in to talk to the mother because she was HIV positive. The director offered her anti viral medication and the woman took them with the stipulation that she removed the label (there is still a huge stigma against HIV). She also explained that it is best to not breast feed her baby because it increases the chances of the baby getting the virus. The woman said that she was still going to breast feed because she was too poor to buy formula and because if she didn’t, people would question her on why she wasn’t. The director accepted this answer and told the mother it was OK, but that she needed to stop after 3 months, 6 months tops. The director and myself were the only two left in the room with the mother and baby, and when we left, the director left the baby on a table across the room from the mother. The mother had yet to hold her child or to feed him. She was only 18 and she was left in the labour room, all alone, 5 minutes after giving birth, watching her baby boy lay on a table. I know that it is a different culture and that they have different practices, but this is one that I don’t think I will ever understand.
On a lighter note, I have started to get my bearings in Kaduna. Adam came down for a few days and we were able to explore the city and find some good places to eat. One thing that I am still getting used to are the storms. To say it is pouring outside is such an understatement. Not only is the rain coming down in buckets (I finally understand that saying) but lightening is lighting up the whole sky every minute and the thunder is so loud! I have woken up multiple nights because the rain on the tin roof is deafeningly loud in my room. I know I am 20 years old, but I would be lieing if I said I wasn’t scared at times. When I told some of the woman that I work with how the storms were scary, they just laughed and told me that they are going to get even worse as the rainy season continues.
Mairo’s husband has two wives and his second wife lives next door with her two girls who are 8 and 11. They are pretty fun to hang out with and the little one has more energy than any kid I have ever met. They also like to use Adam as a jungle gym which is pretty entertaining to watch.
I realize this note is ridiculously long, but a lot has happened in the past week. I think it would be impossible to explain everything that I have done or experienced. I am really enjoying working here and I think that I will really be able to make a difference in the clinic. I am also thinking of a million other projects that I want to do here in the future.
Tomorrow I am going to visit the general hospital which is next to the School of Midwifery. My visits there are mostly just to observe and learn but I am really excited to see how a government hospital is run. I am going to Abuja on Tuesday for a conference with Adam and Ian which is for a bunch of NGO’s in Nigeria that use technology. I am really excited to visit Abuja and hopefully I will meet some very interesting people at the conference.
That’s it for now. Thanks for all the comments. I really appreciate all your support and I miss you all so much!!!
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