Thursday, July 5, 2007

Everybody who speaks English asks if I'm married

I've been on this computer a few times today without managing to get a connection so if you're reading this it means the power didn't go out and I didn't give up for the night.
The staff here have been really patient with my lack of French but they're very young and we have conversations like this:
Me: I need to send an email and the computer isn't working and I don't know what the error message says.Nice Hotel Staffer: Why not?Me: Because it's in French. NHS: Oh, right.Me: That's ok, I can call. Does the paper in my room say that the room phones don't work?NHS: No, you can call.Me: From my room?NHS: No, not from the room. The room hones don't work.
Ghaichatou: Is Deni Robey in the hotel?NHS: Yes, she's here. Ghai: Can you call her room?NHS: She is not answering, she's probably coming. Ghai: Are you sure she didn't leave for the Grand Hotel?NHS: Ah, yes, she took a taxi.
Eight years ago Friday (July 6th) I watched my nephew, Charlie, come into the world. He's been on my mind because this is the first year that I won't be with him on his birthday but he's also my only experience with childbirth. And I'm sure I don't have to go through the litany of differences between my step-sister's delivery and that of most of the women I've met here. I'll just say this one thing because it's pretty interesting. West African women are expected to give birth without crying or screaming. Literally, they are supposed to "suffer in silence." That's a cultural thing, not a poverty thing. (Imagine a whole country of Tom Cruises.)
I'm here to see women's health programs but education comes up again and again. School is free here (through university) though students have to buy their uniforms and pay small fees that are not exactly tuition. But very few children are in school. The Nigeriens I meet keep telling me that the country won't get any better until the kids go to school.
On Monday as we were leaving the Dimol offices a very young girl was waiting outside with her husband. She gave birth two weeks ago and has been leeking urine ever since. Madame Traore was telling her that she could go to the Dimol Center and that they would help arrange the repair surgery. Then, a little like there was an audience, she loudly praised her husband for coming with her and ranted a little about how most husbands don't care. Then the husband told Madam Traore that he had gone to university with her son and, even louder, she went into a small tirade about how the educated men are the good ones and that if more men went to school we wouldn't have so many problems.
(By the way, I asked Madam Traore if she went to the university in Niamey and she laughed and said she only finished secondary school but she just kept working her way up. Three of Madam Traore's children went into medicine - one son is a gynecologist and the Assistant Director of Dimol.)
Niger is a hard place. It's hard for me to explain but the landscape is so bleak, it makes you feel that bleak is all it's ever going to be here. BUT, the Nigerien health workers and teachers and businessmen aren't flocking out of the country. This is definately one of those cases where the work is already happening - just on less than a shoestring.
Back to fistula. And by the way, after four days I realize that I'm not necessarily getting the facts straight - either because these are casual conversations I'm having or because of the language issues or whatever. For example, there are five doctors who do fistula repair in Niamey - but not all at the National Hospital. So, if you're really interested in this stuff, check out the rest of the website or email me if you can't find what you're looking for.
UNFPA donates the equivalent of $100 to the hospitals for each fistula patient who undergos surgery (the government is supposed to provide additional money but I'm not clear whether it does or not). And UNFPA funds Dimol's reintegration strategy - which includes the cost of each patient's recovery at the Dimol Center, the gas to drive her home and the $100 she gets to start an "income-generating activity."
Another UNFPA-funded intiative is the the contraceptive program at the Reproductive Health Center - which is a large, very nice but underfunded clinic in Niamey. The clinic is a project of the Ministry of Health and offers prenatal care, basic gynecology and contraception. The staff seems large, there are supplies and even a sonogram machine but the equipment is old and the written materials haven't been reprinted since the clinic opened in 1984.
(The midwives I've met are all like Madam Traore. They're smart and dedicated and they mean business. I guess years of helping women push babies out and they tell it like it is and don't care who you are. Madam Traore told me tonight that she doesn't want to retire until the Dimol Center has surgical capabilities but she said that she's tired from the stress of 40 years of delivery and the constant stress about the woman and the baby.)
Apparently, USAID funded a lot of family planning in Niger until they closed that particular program in 1998. There was a break in service while the Ministry and other NGOs tried to fill the void but, according to the midwife who showed me around, the use of contraception never returned to rate it had been. But UNFPA funds the women who do come.
The fistula trifectorate: prevention, treatment, reintegration.
I got to sit-in on a weekly group counselling session with the fistula patients at the National Hospital. Women with fistula who make their way to a hospital generally camp out in one of the courtyards until they get surgery (and there are always the stories of women who live in the courtyard for years). At one point, the fistula program at the National Hospital stopped but the women didn't leave. So they had to find a way to start it again.
Dr. Abdulai runs it now and it addition to being really dedicated, he's hilarious. In addition to talking to them about their own worth, he makes them laugh frequently. (I started to explain a couple of times when he had the whole room laughing but it sounded maudlin in the telling. Women who constantly leak urine have a different outlook on life.)
Every 15 minutes or so the computer screen is taken over by scantily clad women and I just don't want to know what the ad is for. The owner of the hotel introduced himself to me in the dining room and asked if everything was ok and I felt like saying, if you could just change the ads so they're for Dimol or the Reproductive Clinic or the Youth Center that would be great. But tonight I'm taking it as my que to turn off the computer.

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