Category: From Peter

A three day holiday turned into four days off with the passing of Gerald Ford. To my amazment, I didn’t receive any work related phone calls throughout Christmas and New Years!

For the most part, it was calm. We had leisurely breakfasts and gatherings with friends. On the morning of the 31st, the kids remembered Toulouse with Nina one and a half years ago, given it’s her birthday. Stefan recalled her stories of the Juneau garbage bears rummaging through town, eating trash. He received his very own "garbage bear" from her as a gift for Christmas. Dina and Camille made Aunt Valerie’s famous carmel corn and fruit on a toothpick in preparation for the kids’ New Year’s Eve party. It also happened to be Tobaski, the Muslim holiday. Goats were slaughtered in the early morning after being taken to the mosque. We didn’t actual observe the slaughtering but it was imjpossible not to see all the slaughtered goats being butchered in the street and then cooked on the open fire pits.

Dina and I were invited to our neighbor’s house. She is originally from Argentina and her husband was a chef before he joined the Foreign Service (and according to him, "took a pay cut."). They had a very nice sit down dinner with lots of food and at midnight, we popped open a bottle of Moet to toast the New Year.

On New Year’s day, our friends came over with Stefan’s favorite playmate for the afternoon. The weather has been increasingly dusty and seems like a high overcast. We sat outside and ate Nims and yummy crepes Dina made filled with broccoli in a cheese sauce seved with a green salad and garlic vinegrette dressing. A glass of wine. a glass of water. A glass of wine…

I had no plans for Tuesday given the short notice day of remembrance for the former president. Our DCM called and invited me to a game of golf. I was apprehensive, not knowing how skilled he was at the game, and myself not having swung a club in about 2 years. I thought of Bob (my brother-in-law) who taught me the game. I have enjoyed several rounds with him but am never really certain where that ball is going to end up; in front or behind me after the swing.  My friend Gary was also invited so I joined them to make it a threesome.

The drive out to the course is about 20 minutes from Niamey. It’s situated along the Niger river. It actually has a club house and driving range. You tee off of these platforms. The fairway is marked by green painted rocks and the imaginary water is outlined with yellow painted rocks. The greens are smooth hard packed sand. Most of the terrain is rocky with compact dirt and scattered shrubs, some low lying dunes and trees. With the hazy dust, it resembles the moon. Plenty of sand traps! As long as your ball is on the fairway, your caddie places a piece of astro-turf under it with each stroke. If your ball is out of bounds, it’s best to have an old club (or a weedwacker!). Unlike the golf courses at home, these fairways are forgiving in that the ball really rolls a great distance if you top end it. We had a lot of fun playing and socializing. It turned out my colleagues were only a little bit better at it than I was. Or maybe they were having an off day.

The holidays have been very pleasant. The temperatures were in the mid 80S to low 90S. Not a snowball in sight. I never received a single work related call.

We spent Christmas Eve afternoon out on the sand dunes of the Sahara dessert with some embassy friends. We had a picnic with Dina’s homemade biscuits, German ham, French cheeses and wines, Nims, and sodas for the kids. Our Land Cruiser performed superiorly to most of the other 4WD vehicles who got stuck in the sand and we helped push out. 

As dusk approached, we watched the ever changing shadows form from the dunes and saw a beautiful orange sunset out on the plateaus of the horizon. The kids rolled down the steep sandy slopes and we sang some Christmas carols to a group of Nigerian natives who came out of no where and shared in our festivities.

We each opened a few gifts from my family and Dina and I watched a movie (Meet the Fockers) and wrapped gifts late into the night. The kids woke us up early with excitement. Santa came and left presents! I drank some strong coffee and we had breakfast while opening gifts and listening to Christmas music. Stefan played with his wooden track for cars and trains. Camille got horseback riding gear and lots of good books.

Our friends came over around 2PM and we started cooking and baking while the kids played and we sipped Lillet, wine, and snacked on hor-d’oeuvres. Dinner was great. Dina roasted a turkey (or perhaps a peacock) with stuffing, green beans, mashed potatoes, and gravy. Sirianna made a Finish raspberry linzer tort served with homemade ginger snaps and lace cookies. Zuri stayed to clean and help serve. A very relaxed evening.

It’s been quiet at work. Many folks took vacation for the holidays. The kids are on their two week break. Camille is riding horses with a group of kids her age. Stefan got his dream come true remote car from Grammie and Grandpa and they got other great gifts that preoccupy their time.

Next comes New Years!

We took the "Denver spruce" tree out of the box and assembled it. We played Christmas music and the kids helped decorate the tree. It looks pretty good! Especially after a few glasses of wine and a full meal. The only thing that’s missing that could make it better is one of those tree shaped, pine scented, air freshners people hang from their rear view mirrors to use as an ornament.

I got a little nastalgic thinking about those smells from the kitchen my mother always created, fogged up windows, and sneeking a peak at the gift tags to see which presents where for me when I thought nobody would notice. On Christmas Eve, my grandfather would sit by the tree and put on his reading glasses. Each one of us would take turns going up and choosing a present for him to read the label out loud and then take it to that person. We would have to sit and wait until the gift was opened before the next person could go and get another one. It would take half the night but we loved it.

I miss our families and friends. It may be in the mid 80’s outside without all the fanfare here but friends are still calling "you who!" and inviting us over for holiday cheer. It’s great to see the traditions that everyone tries to maintain wherever we go. We celebrate Christmas and try to bring all those traditions that we were raised with to our home. And the kids are excited that Santa WILL come to Niamey; snow or shine! And that’s what Christmas is all about.

We’ve pretty much gotten most of our boxes unpacked. Read some. Our chef came on Saturday and made these delicious chicken buns with shitaki mushrooms.

There was a going away party for a couple and it feels sad since they are both good people who I have become fond of as well as had private personal consultation with their medical issues. I am privy to more information than most people (so I know more about them than the average Joe).

Dina went to parent teacher conference and the kids are doing well. We expected the usual somber mood that the French teachers usually give at the first conference, like; "we hope your child improves or they will have to stay back a year." But this time, both were very positive. Stefan is speaking French at his level and well liked by his teacher. Camille’s teacher recognizes her maturity and he is impressed with her French considering it is her second language. "Bravo Camille!" he wrote on her report. This makes parents very happy.

Yesterday, my friend Gary came over to search for bugs! Dina and I have been getting bit by varmints in the night. The bite itches beyond belief but we cannot find the parasite. We suspect bed bugs but there are no tell tail signs of blood smears etc. Gary happens to be a pest control specialist. He could not make any definite conclusions but we have a plan to control and eradicate now.

I got a phone call from a friend here who I found out is pregnant with triplets.  I am excited for her and her husband. Triplets! Wow!

We went to Stefan’s playmate’s 7th Birthday party. She is Stefan’s favorite friend and it’s really cute to watch them play together. The theme was ladybugs and her mom, made a delicious Finnish cake, decorated with a ladybug and later, a ladybug pinata bashing!

Back at work now and wondering where the weekend went.

I back and I’m trying to deal with the usual administrative things, catching up on patients charts, seeing patients, and the call at 7AM on Saturday morning from someone who has "a bit of a  tummy ache" and do I think they need to take something for it?

Uh? "Who is this and what time is it?"

And a regional psychiatrist is visiting so I have to act "normal" which is challenging. I don’t think that they know that I think they don’t know sort of thing.

So I’m trying to get breakfast ready and get everyone up to send the kids off to school, get to work in time for a meeting and prepare for a "community assessment" with the shrink when Stefan wanders into the kitchen in his planet underwear and asks, "who made God?" He drew me a martini glass with a smirk face on it on a bookmark he made me and described it as "a very happy Mr. Martini." I’m still not sure what it means or what gave him that idea. He scarres me.

Next week; my regional medical officer comes for a visit…

As you already know, I had to urgently take a patient to Paris. Foretunately, it all turned out fine and the patient continues to do well.

I knew I had left Niamey the minute we got onto the plane. We had just left the airport and were loaded onto a bus to take us 100 feet onto the tarmack to board the plane. Rediculous! As soon as we entered business class, we were being offered champagne and/or orange juice before we could get our seatbelts on.

The flight was uneventful and the patient remained stable. We arrived in Paris at 6AM and were taken to the hospital by ambulance. We spent most of the day doing exams and procedures. She is a star patient and handled the crisis very well. My hotel was only a 10 minute walk from the hospital and a 15 minute walk from the #1 metro line.

Surely you didn’t expect me to go to Paris and not get Dina something! Did you?! I only wish I had more time. But I did manage to eat the worst meal I’ve ever had (shocking for France!) and also had the smoothest cafe creme with a pear pastry and pan au chocolate for breakfast the next day to make up for it , shopped and walked the rue Rivoli from the Concord to the Bastille, and took in the sites and smells of that decadent city! You just never know where to look it’s so visually stimulating.

I left on Wednesday night and returned Friday late afternoon. The final shipment of things we sent from Oregon, our vehicle, and the mail (which hadn’t come in over a week) all arrived in my absence. Even the bike that we found in DC and snuck into the car made it all the way to Niamey (Thank you Tyotya Lana)!

Now I’m back and trying to catch up. It was stressful because of the circumstances but all told, it was great to be in Paris; even if only for a Medevac stint! It’s not the same without you love.

We have experienced one of the greatest luxuries! Leopold cooks for us 1.5 days a week. Prior to his arrival, we have been planning all meals and grocery shopping, which is incredibly time consumering, since many things cannot be found in the stores and even in the very best situations, we have to go to more than one to find all the ingredients. This has been especially trying for Dina since she has to arrange for a duty driver to pick her up and drive her around.

Leopold is originally from Togo. He has cooked for a high-ranking French embassy employee in the past. A Canadian meteorologist then hired him until he left and our neighbors who moved in to that house didn’t need him full time so we decided to try him and see if we wanted to share his services.

His first day with us, he made baked fish in a herb cream sauce, served with a salad in which he cut the carrots and cucumbers into flower shapes and concocted a tangy mustard vinegrette dressing. Both were delicious! For dessert, he made homemade chocolate ice cream. Tell me you wouldn’t want him to cook for you! He also made three pizzas and chicken enchiladas, plus a fruit salad with melon, pineapple, and grapefruit. He also shopped for all the ingredients and bought extra fruit and vegetables, milk, and eggs for us to last the week.

Last night, we had a soupy beef stew with vegetables and garbanzo beans to pour over couscous. He also made delicious Capitan (fish) brochettes in a salty lime marinade served with homemade french fries and salad. Anorexics beware!

The other important point to make is that he’s nice. All of our hired help are. The way he smiles when we talk about food. The dishes he describes that he’d like to make. His suggestions and ideas for meals and presentation really show his artistry. There are other cooks here. We are fortunate in that we found a great one.

We hit a major obstacle with our internet at home. As you know, we had spurratic connection most of the time. Then for four days, we had awsome internet use. There must have been a stalled satellite overhead! Then, as if someone pulled the plug (and we believe someone did), NOTHING! Dina called our local mafia and they reported that THEY had a problem. They came out a few days later and told us we couldn’t use our router. Appearently, we were sucking up all the available broad band so they cut us off. We have a different router which the guy has spent several days (2 hours at a time when he came) trying to set it up. Bottom line; we’re looking for another service provider.

While we were out, work has been busier than a bee hive. I think the flu season is upon us. I keep forgetting that it’s winter here at the 13th parallel  where it’s 87 degrees out.

Just as the Veteran’s Day long weekend was about to start, I got called in regarding a bus accident about 5 hours out of Niamey. It was an archeological expedition with Americans and Italians on board. I was able to make phone contact at the crash site and help a paramedic with the tour triag patients. Only two were more seriously injured and I was able to locate a good hospital run by Missionaries in Galmi about 100 kilometers back from where they came. The following day, I made radio contact and spoke with the attending physician. Both patients were stable and very lucky. I researched air transport for them but they declined and made their own arrangements to come by ground transportation. I wiped my hands clean at that point.

Last Tuesday, I was invited by the Ambassador to travel with her to Dosso (about 1 1/2 hours from Niamey) to assess the healthcare of the natives. The military is setting up some training there and they already had their medical unit set up. They had 3 doctors, several medics, and 2 nurses. They offered to see the local Africans there and I was invited to help. Over 1000 people showed up. I saw a lot of malaria, infections, and malnutrition. One woman came in with her 8 children. Those beautiful little mushroom kids were all sick with Malaria and mom is expecting twins. I also saw a woman with HIV. The team saw over 400 patients that first day.

Camille is loving her horseback riding lessons. She just glows when she’s out at the stables. Stefan plays in a sandbox there under the bird nest tree and runs around more than most of the horses there. It’s a healthy playground for the kids and we are lucky to be able to belong to the Equestrian center. Anywhere else, I’m sure we could not afford it.

Our weekend is about to start. No doubt there will be more to report on Monday.

Ouaga was very very interesting and had many different contrasts to Niamey. It is more “city,” more developed, and more western in terms of shops and restaurants and clothing attire. The health care standards are higher with newer clinics and greater application of modern resources.

I felt I had accomplished a lot for just a 5 day visit. I had seen quite a number of patients, visited multiple clinics including a radiology center, two clinics which provide full services including basic surgeries (I observed part of a hip replacement), and an AIDS infirmary that not only gives care to patients and their families but also is working on an experimental HIV vaccine. I had also met with many of the Embassy community as well as the local health community. I gave a 30 minute lecture “Health and Well Being.” 53 embassy employees attended.

On Friday night after we had eaten out at a fine restaurant, I awoke in the night and vomited. I was assuming the worst and wasn’t going to be fooled by the instant relief and momentary good feeling one gets right after. But the blahs never returned. I guess I was just lucky. The following day we went to the artisan festival. It was hot but I mostly viewed the art work of venders inside air conditioned buildings. We had a very nice evening at the Ambassador’s residence. Early the next morning I was half awake because of the booming music coming from the discoteque across the street when all of a sudden, “Bang!” I developed an acute onset of pain on my left lower side. Such a sensation I’ve never felt before. The usual medical possibilities ran through my brain; bad food or water, parasites, bladder infections, gunshot wounds, ovarian cysts (not likely)… The pain stayed localized and intense but no nausea or diarrhea. Unable to find a position of comfort or use the bathroom, I got up and paced. Dina heard me and I told her what was going on. We called Paulina, the embassy nurse, who came and took me to the clinic. I didn’t have to tell her what tests to run, she skillfully took the initiative. All of my lab work was normal except for my urine which was concentrated and revealed 3+ blood. I drank lots of water and got a liter of IV fluid. The pain subsided and then went away. My suspicion is that I probably passed a miniscual kidney stone complicated by some dehydration. Now, a week later, I’m recovered (deep sigh).

The drive home to Niamey was uneventful and I came back to a very busy week of work. I had several meetings to attend and had to write several reports including a travel report on Ouaga. Too many phone calls. Most of the patients presented complicated issues including some psychosocial problems that can go way beyond my scope of practice. I’m not a therapist. “Don’t go selling crazy here. I’m all booked up” says Jack Nickelson. I have some limitations but I’m always willing to listen and try to help. I spent a few hours, after work on Friday afternoon, catching up.

Now it’s Saturday morning. Stefan is playing with his cars, making all those engine noises. Camille is rubbing her sleepy eyes and Dina is waiting for the computer.

We are in Ouagadoughou (pronounced – O-waga-doo-goo), the capitol city of Burkina Fosa. This is my regional medical travel post. There are only about 30 Americans here but it has so much more of a city feel to it. Niamey seems like a small village in Mexico in comparison. There is a far less Muslim influence and it is noticeable. For example, we see many more women running and conducting businesses and they are uncovered! More are driving cars and motorcycles independently. There are less visible mosques and call to prayer. There is definitely more pollution as well. But the people are just as friendly and sincere.

The car ride here took 6 hours but was surprisingly beautiful. Lots of greenery. We did not expct to see so many watering holes and springs. We often would see a group of men or women (always separately) wade in up to their necks and playfully splash each other. The road is well paved and safe with the exception of goat and cow crossings. The landscape changed dramatically with plateaues, shrub covered dunes, and bolderous hills.

My first day at work, I had a briefing with the Ambassador. She was very warm and receptive. She is now inviting us to come to her residence for drinks and a viewing of her art collection on Saturday.

The clinic here is in many ways is better than the one in Niamey. It seems more inviting and less cluttered. The nurse here, from Chile, is very well organized as is my nurse in Niamey. But the building is it’s own edifice where in Niamey it’s part of a building which doesn’t seem like it was intended to be used for medical examinations. I feel as though I’m seeing a lot more patients here in Ouaga but I think that is because I’m new (they’re checking me out!) and I only come here every 12 weeks so they schedule more appointments when I’m here. A lot of interesting cases; from a new foreign national hire as a security guard, a pregnant women about to take medical leave, and a poorly controlled hypertensive. I must say, I’m not missing the stress of the ER and I love the new patient-provider relationships I’m building. It really is rewarding.

Ouaga hosts an artisan festival once every two years. It so happens that it starts tomorrow. It should be interesting. It will be fun to see the local art and possibly buy some jewelry, crafts, and art work. When I come back in February, they will have their annual film festival as well.

Tonight is a reception for me at the hotel (Ricardo – her husband runs it) where they are having a Chilean dinner with French wines! There will be many local health practitioners there. My friend Cliff says, “first impressions are lasting.” Let’s hope I’m a good one!

Dina’s big idea to join the FS has proven to be exciting. I never dreamed I’d be living and working a job in Africa where there are so many interesting people, cultures, and things to see.

Oh! A patient! Gotta go play doorman!