The OR

In my "free time" when I wasn't trying to build water filters, I would pop into the OR to see what was happening, sometimes I ended up doing some sort of assisting and always documenting...



An essential in any Nigerian hospital is some sort of insect killer. You just never know when a stream of ants is going to march through your surgical field or try to get into your sterilized instruments...









Here I don a super extra large set of scrubs donated by some Canadian hospital. I know I have lost weight recently but this makes me look like a poster child for Weight Watchers! I am with some of the visiting staff at Peace House hospital. They have volunteers that come on their days off from other jobs to help. The hospital is run completely by volunteers - no one gets paid a salary. I learned a lesson about living by faith...




To get into the OR, you have to change into sandals - yes, sandals. They do have a couple of pairs of rubber boots but those are reserved for those actually doing the surgery, and often they don't wear boots. A couple of patients had some major blood loss and I had to make sure nothing dripped onto my feet!







I'm sorry if surgical pictures make you sick to your stomach - this one isn't too bloody. It is a uterine fibroid. It was attached to the top of the uterus and several times the size of a uterus. In this case the uterus was saved, and hopefully the woman will be able to have children in the future.


I also watched a leg amputation (yakubu's), an appendectomy, and the most disturbing was a goiter removal. They don't have intubation at Peace House, so they use something called Ketamine which is a sedative. But not all people are completely sedated during surgery. One woman in particular did not "take well" to the ketamine and kept waking up and struggling during surgery. I had just stopped by to see how it was going and ended up coming into surgery to hold the woman's arms and legs down and trying to suction her mouth with a bulb syringe (no suction either) under a sterile field (I was in my everyday clothes), during the surgery. The woman was fine post-operatively despite her struggle and major blood loss.
I learned I never want surgery under minor sedation!
But I love watching surgery and seeing all the "parts" I only seen drawn in books. God was pretty imaginative when it came to designing the human body!

Soul food

People have often asked me what kind of food I eat in Nigeria. I will offer you a little smorgasborg of photos. Be careful not to drool on your keyboards!!

Below are yams for sale at the Adoka market. These are a staple food in southern Nigeria. They are quite large, not like the yams you buy at Safeway. You can eat the yams fried on the fire, or "pounded". With the latter you peel them, boil them, then pound them in a large mortar with a pestle. It is pretty bland, but you eat it with a soup...


Above you see "pounded yam" on the left and a soup to accompany it on the right. You pick a piece of pounded yam off your ball, roll it in a small ball, make a divot with your thumb and dip it in the soup. This particular soup was served to us at a hospital we visited. I thought it was fish inside at first, then noticed the skin was a little too thick for that. I ate it anyway and it tasted like chicken. It was "bush lizard", which I later saw for sale at the market....

mmmmmmm..... lizards-on-a-stick or shishkabob-lizards.... whatever your pleasure:-)


Another soup is "draw soup" which can be made from various vegetables. This particular one is made from a bush/tree that has white stalks. It is also made from okra. It is not my favourite as it reminds me of secretions that I suck out of people's tracheostomies at work...

And then we have "bean cakes" (below) which are made from mashed up beans which are then rolled into a banana leaf and baked. Sometimes they put a boiled egg in the middle of it. To spice it up, they mix in salt and pepper and HOT red peppers which clean out my sinuses and make it look like I am weeping about how good my lunch is.




Leanne, Jenny & I nicknamed this snack (above) "peanut poo sticks" for obvious reasons. They are actually quite good. They are made from the left over peanut oil and residue and pressed into these stick formations. They are very hard and crunchy, and taste, well, like peanuts:-)

Speaking of another nut, did you know where cashews come from? Being a city girl, I thought they came out of the bulk bin at Safeway... but they grow on the top of this fruit. Perhaps there is an african name for this fruit, but we called it "cashew fruit" (geniuses i tell you...)
The fruit has kind of a smoky flavour, and I guess you can just pluck off the cashew and roast it.

The fruit in Nigeria (and every other developing country I have been too) is OUTSTANDING because it is fresh off the tree and not covered in pesticides. I love mangos and bananas and oranges and pineapples. I probably eat at least 10 servings of fruit a day while in Nigeria (where it is available). below is my somewhat pathetic attempt at creatively peeling a mango.



Nigerians can peel an orange top to bottom in one piece. Normally, they suck the juice out of the top and discard the rest of the orange. It is affectionately referred to as "sucking an orange"

My last week in Adoka, Nelvia and I learned how to bake without an oven. She brought dry brownie mix from Canada, we mixed it up with some eggs and oil and put it in this ingenious little oven. All you do is take a large pot, fill the bottom with about an inch of sand, put your smaller pot inside, cover it and put it on the stove. 30 minutes later we had delicious fresh brownies! It was a little piece of heaven:-)

That is just a little taste of what I have sampled of the wonderful African cuisine (i say wonderful with a mischevious smile).

(background music: corrine baily rae and moby)

the biosand water filter in the making

How is a biosand filter made?

With dust and sweat in 37 degrees celcius, here is a small look at what goes into making a filter.

On the right, I am sieving rocks and sand so that we have the proper size of gravel and sand to make the filter itself and also the "media" inside of the filter.
We had three different sieves made - to sort out gravel into 1/2 inch stones, 1/4 inch stones, and sand.
Although this is the "easiest" and most straight forward part - my nigerian counterparts made comments about how doing things "the canadian way" took much longer than a typical "nigerian way." They joked that "their way" is to find the shortest and fastest way possible to finish a job (whether or not it is done "the right way"), then go home as soon as possible. Joking aside, I told them we were going to do it "the right way", no matter how long it took:-)


Next, you pour a filter.
We mixed small stones, sand, and portland cement and filled our steel mold.

A steel mold can be used thousands of times if taken care of and used properly.

We let each filter set for 18-24 hours, then removed the mold, filled it with water, and let it set for another 5-7 days.

At the right, we are pouring cement in our first filter.


I demonstrated then how to work the cement into all the crevices of the filter and how to "bang out" the air that gets trapped in the cement. Air pockets will weaken the strength of the filter, so you do your best to remove them.

We banged the sides of the mold with rubber mallets until we saw fewer and fewer air bubbles coming up to the top of the fresh cement.

It often sounded like a drumming party, and I would throw a little dance in here and there to get a laugh.


Here is a "snap" (nigerian word for photo) of our very first filter! It was probably also the best one as people were diligent in their work and excited about the outcome.

The work got a bit sloppier as time went on as I tried to supervise less, and the "nigerian way" started to take over. I had to repeatedly reinforce that each step of the filter making had to be followed exactly, not what steps they felt like doing.

A particularily frustrating day was when for some reason we could not get the mold off the filter. I demanded that the guys stop trying to remove the mold as they were on the verge of breaking it. A mold costs about $400 to have made and the cement inside is worth only about $3. They finally consented and started the process of removing the mold a different way in order to break the cement off. But as soon as I left for the market, they put the mold back on and started again trying to force it. They ended up breaking a piece of the mold, stripping the nut and part of the metal plate. Thank goodness it was a smaller piece of the mold and not the large part. It cost a few dollars to fix, but I was very upset and disappointed. The hired mason (cement worker) apologized the next day, even getting on his knees, and I told him I hope he would take this as a learning experience and not make that potentially costly mistake again.

After allowing the filter to cure, you fill it with specific levels of washed gravel and sand, place a diffuser plate on a ledge to properly difuse water into the sand, and start pouring contaminated water into it. It does not require a pump as it works by siphoning effect. The tube coming out of the nose is fed through the cement, down to the bottom of the filter. When the water level is above the curve of the tube at the top, the water is automatically pushed out. When the water level equalizes again, the water stops running.

All the parts and equipment are made from locally available supplies (although not always easy to find as home depot does not exist there) and therefore can be built anywhere in the world.

Through a simple, yet complicated process, it removes up to 98% of bacteria, 99.9% of viruses, and 100% of protozoa and worms. It requires simple maintenance that requires the user to drag their fingers through the top layer of sand. If maintained properly it can last for decades.
All for about $20. The families are required to pay for it, but the cost of the filter is a fraction of what it would cost them to treat one bout of typhoid.

It has the potential to revolutionize drinking water and eradicate water-bourne illnesses in the area. If successful in Adoka, the program can be implemented in new villages and towns.

That is the filter in a nutshell....

the water in adoka

The first day in town, while looking for filter supplies,

Dr. Aba stopped some girls who were walking by and
had them put their bowls down on the ground.
The young girls had just gone to the stream to collect
drinking water. This is what it looks like to the naked eye.

Can you imagine what it looks like under a microscope?

Above is a photo taken less than 50 metres from a river/water source. Nigerians seem to think they should dump their garbage right beside streams and rivers. The garbage ranges from plastic bottles to batteries, to paper, to rusty buckets to car parts. The children are walking through the garbage to get down to the river. In the top third of the photo, the river is inbetween the garbage and the bushes. Then, not 50 feet from the garbage dump and the river, we saw children relieving themselves...After relieving themselves, the children run down to the river to bathe and do their laundry. Many people also relieve themselves in the stream when no one is looking, or their "gifts" left on the banks are later washed into the river during the wet season. After bathing, washing laundry, and relieving themselves, the women and children load up their buckets full of water to take home to drink....

There are several places in town that have large tanks with "Buy your clean water here" painted on the sides. I don't know where they procure their clean water or how they ensure it is clean. But I certainly was not comforted when I saw this tanker trunk on the other side of the stream. The men dumped one end of the hose in the stream, hooked it up to the truck and started pumping water into the truck. Who knows what the destination is... I would probably just get more angry...

Below is me beside one of the rivers where people get their drinking water from. January to March is dry season, so the level of the river will only go down and the water will become more and more disgusting... but people have no other options due to the complexities of poverty (i.e. no money, no education, no understanding of hygiene)

how diarrhea and dehydration kept me motivated...

There were many times during my time in Adoka that I wondered why I was there, was I really doing anything worthwhile, was it really worth the frustration?

My last weekend in Adoka kept me motivated and reminded me of the reason that I was sent to start the water filter program.

Nelvia (at right) came from Mkar for a week to work at the hospital in Adoka. She is a GP resident in training and was doing an international placement with the medical team. We were "on call" one weekend to try to give Dr. Aba a break. We spent most of saturday night at the hospital trying to revive babies. This first picture is of Monica, who came in with severe diarrhea and even more severe dehydration. During the evening a nurse had attempted a "cut-down" IV with no success. Nelvia tried an intra-osseus IV as a last resort. This is done by driving a large bore needle into the leg bone. You can rehydrate for 24 hours until you can get a regular IV. Hers went into the tissue, so we had to teach the parents how to feed her 20mL of IV fluid every hour and hoped that it would keep her a bit hydrated until the morning when we could try a scalp IV.

Then it was onto Joseph. He is 9 months old, but not much bigger than a 4 month old. It was at that time that his mother introduced some baby food to him - mixed with stream water. When you see the photos of the stream water, it will be no surprise why he started getting sick.
He stopped growing and became consistently ill for the following 5 months. As you can see, he is severely malnourished, not much more than a skeleton. He had been doing well during the day; eating and playing with the balloon. But sometime late in the night, he took a turn for the worse. The night nurse came to get Nelvia and I to try to intervene.

Joseph's whole body had started shutting down. He was so dehydrated that his eyeballs were dry and they rolled in his head like a doll. His limbs were flaccid - they just flopped around, and he was not responding to touch. Nelvia started a successful IV into the bone and we started to rehydrate. We had the generator turned on so that we could give him some oxygen and had his mother come and hold him.

After a couple of hours he started to perk up just a little, enough to make some eye contact with Nelvia and his mother. We started some blood donated by his mother (after I had to practically beat off his abusive grandmother who was screaming that he was no longer human).

It was during this time of trying to resusitate Joseph, that I looked down at his tiny body struggling to stay alive - and realized HE is the reason I was there to clean the water. Throw the frustrations of working on "african time" and the obstacles of getting the program off the ground... and focus on the real reason I was there. The helpless babes being fed stream water, getting diarrhea and dying by the thousands. I had to keep going for Joseph, whether he lived or died.
Unfortunately, Joseph lost his struggle only a few hours later. His body was too weak to keep going. Monica, on the other hand, recovered and was smiling and laughing the day I left Adoka.
Although I deeply grieve Joseph's death, it was the motivation to keep me going. I don't write this to try to depress people, but to give some hope - clean water will save the future Joseph's from ever knowing dehydration, malnutrition or death.

yakubu

Although I went to Nigeria to start a water filter project, I could not stay away from the wards for too long...
I had seen Yakubu sitting outside many days - his left leg wrapped in a huge piece of guaze, his face a picture of pain when he tried to move, stand or walk. But his shy smile and quiet nature intrigued me and i asked more about him.
He had been abandoned by his parents for reasons unknown to me, and was discovered by a good samaritan woman who brought him to the hospital when she saw the state of his leg. He was being cared for by an aunt who came after he was admitted.

His lower leg, tissue and bone, was completely ravaged by a horrific infection with no hope of healing. The only option was amputation, which was done when Dr. Verbrugge, an American doctor on the team, came to visit adoka for a day. We knew he could do well if he had access to rehabilitation and a prosethic leg, but considering he was abandoned, there were no financial resources to pay for such things.

Dr. Verbrugge told him that within one year he could have a new leg and be playing football (soccer) with friends. This didn't sink in for Yakubu until the next day when he motioned for me to come to his bedside. Through an interpreter he asked if it was really true that he could get a new "rubber" leg and be walking without crutches. When I affirmed this, the look on Yakubu's face was one of astonished enlightenment.

I had been trusted with funds from various sources to help pay for treatment for needy people, and Yakubu continued to tug at my heart. I knew that without financial help, Yakubu would be on crutches for the rest of his life, with no chance of running and playing like a 13 year old boy should.

I am happy to report that a fund was set up at a Rehabilitation hospital in Mkar for Yakubu to receive physiotherapy and treatment for two months, and he will receive a prosethetic leg once his therapy is completed. His aunt agreed to accompany him so that someone is caring for his daily needs while in hospital (in Nigeria, the family must provide all food, bathing and personal care). Yakubu will be in Mkar by Feb. 10 to start treatment!

Yakubu and his aunt were deeply humbled and greatly appreciative of this help and encouragement, and he promises to work hard in physiotherapy so that he may soon be running and playing.

The seemingly small gifts of several people in Canada have contributed to an enormous change in a young man's life. A boy abandoned by his own parents is being cared for by an "international family" who has never even had the pleasure of meeting him. Yakubu's life is renewed not only because he will be receiving a new leg, but because he has received a new heart and hope where he thought there was none.

the power of prayer

besides completing the basics of a water filter project in 2 1/2 weeks, not getting killed on the roads in nigeria, and arriving safely back home, i witnessed quite an answer to prayer that i have neve seen so readily and quickly before!
while i was still in mkar in mid-january, waiting to go to adoka, i spent some time going on rounds with the doctors in mkar hospital. the first patient we saw on ward six (male medical ward) was an unconcious man who had apparently suffered a stroke. with a history of hyptertension and consistent blood pressures of about 210/110, the three canadian doctors and i thought he must have suffered from a devastating intracerebral hemmorhage. on exam, he did not repsond to speaking or pain stimulus, had zero movement or pain reponse to to any limbs. the nurse and the wife said he had been like this for over a week. one of the doctors had the nurse tell the wife that we would treat him aggresively for a couple of more days, but that his prognosis was poor and he would likely die very quickly. another doctor suggested we pray for him and the family, so we offered an open-ended prayer up to God, then moved on to the next patients.
about 20 minutes later the wife came and tugged on my arm. "he's talking, please come and see" she said. i highly doubted this. i figured he was probably moaning and she misinterpreted it as speaking. but to appease her and settle my curiosity, i went with her to the patient's beside.
"good morning, how are you?" I asked in his native language of Tiv.
"nothings going on" he replied in Tiv.
my mouth agape, i asked if he had any pain and he quickly replied "no".
i went over and informed the other doctors that we need to pray for ALL the patients!!
i left for adoka the next day but learned that within a week he was talking and walking around the ward and was slated to go home within a week or two.
never doubt the power of prayer!