seeking to balance cultural tradition...with economic opportunity
Through the generosity of Eyes on Africa many more nomads this trip have been given the ability to see more clearly. Until this program of Eyes on Africa through the Tamesna clinique they have never had access to glasses. Along with eyeglasses for close work, we distributed sun glasses to help prevent cataracts. Here Linda Lamb with her usual flourish lets this nomad know how cool he looks in his new glasses.
The treating of patients has taken a back stage to the training program–I have not been too present to take photos as I am always involved in the training program. We have also noticed that our patient load is lighter than past missions. We were puzzling over this until we started getting reports from the bush that because of the presence of the clinic all the time, we have improved the general health in the region and the need for care during the missions has gone down–I guess the ultimate goal is to make ourselves unnecessary. I think we have taken a step in this direction. Even though we have a higher level of experience when we bring in American doctors, we know that the clinic can operate on its own and can take big strides in improving general health in the region. We are pretty proud of that.
Louine runs the pharmacy with the help of Linda–both have worked really hard, not only filling perscriptions and fitting glasses, but preparing the medicine to replenish the matrone’s supplies to take back to the camp.
Ali checking in patients with the medicine chest and pharmacy in the background.
Sidi with our friend Tambola’s mother who is being treated for malaria. Her son travels alot in the modern sense, runs a travel agency and lives mostly in Niamey. Yesterday we treated the mother of another Tuareg friend who lives in Tucson and Mexico. No matter where a Tuareg ends up he usually has family here in the homeland in the bush where the true nomads live: the pasturelands of the Cure Saleé: Tamesna.
The next problem is the most complicated to teach. It is important to understand if high blood pressure is present in a patient it indicates pre-eclampsia. This can lead to eclampsia which means seizures and possible death. But how does a woman who cannot read numbers learn to take blood pressure? When Dr. Skankey met with Dr. Zeidou of HDI, in the south who runs this kind of training program in 500 southern communities he was very skeptical about the ability of the women to understand and use this important tool. Dr. Bob decided to try anyway. They have shown how smart they are already and how well they retain information. There is nothing to lose by trying. So we marked the dials with red nail polish to show high or low levels. By listening to when the pulsing starts and ends and noting the red lines, even without reading the numbers they could at least tell if there was any danger from a reading above the red line at 140 on the high side and below the red line at 90 on the low. They were issued their own blood pressure cuffs and practiced for two days, taking everybody’s blood pressure many times. They seem to understand it. They know that if the patients levels are above the red line to contact Ali as a dangerous condition could exist. We will see if this tool will be able to save some more lives.
We decided it was important for the women to keep records of the pregnancies, births and problems in their communities. Without statistical evidence it is impossible to know what the most prevalent problems are and to know if our solutions are having any success. So we borrowed from the program of HDI (Health and Development International) in Niamey after a very fruitful meeting between Dr. Zeidou and Dr. Skankey. (Thank you for all your good advice Dr. Zeidou). We created a report form with drawings which the women can fill out by making a mark. I gave each of them a copy and Ali, our nurse, when he makes his monthly rounds will collect them and replace with new ones.
The categories drawn are: New pregnancies, Women who visit a clinic, Women who give birth at home, Evacuations to a hospital, Post-partem hemorrhage, Infection, Maternal death, Infant death.
When I left them alone they practiced until they got it right.
Bob brought a really great gadget which measures temperature by holding it on your forehead. If there is a fever a red line lights up next to the reading , if it is normal it lights green and if it is below normal a blue line. Fevers can certainly be dangerous for pregnant women and now the women can determine easily the danger range.
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After being reassured that they retained the initial training for a normal birth and the use of medicine for post-partem hemorrhage, Dr. Skankey decided to tackle other problems that could arise from different positions of the baby. Breech birth was the first. Two of the women had experienced this and so Bob had them go through the process with the pelvic mannequin. Then he addressed Face up birth and feet first–the last being virtually impossible for them to deal with. They each demonstrated dealing with the different problems to Dr. Bob’s satisfaction. He is demanding and exacting and they are very smart, hardworking and willing–a good combination.
Since the Tuareg and Wodaabe deliver in different positions we used the appropriate position to demonstrate. Here, Fatima, a Tuareg, uses their on the side style, while below Azarra uses the kneeling position favored by the Wodaabe.
The governor after promising for three months to give us security, decided there was none available so Sidi negotiated for three days and finally we got a crew to come out from Ingall and only one vehicle instead of two. Although we are happy to have security and I want everybody safe–there is no evidence of any bad guys in the region and everything is quite calm. So Sidi who is ultraconservative in security matters felt that we could cut down on our security and save some money–I have yet to believe that they will not demand some kind of bribe at the end of all of this, but so far we have saved almost $1,500 from the last trip’s cost for the same number of days. This is really good news because it means we can do something worthwhile with the money.
Each of the women was asked to go over what she had learned and repeat the process she used with each patient. They were almost perfect in their retention of the training. They explained how they do prenatal consultations, then prepare the birth site, wash their hands, administer antibiotics to prevent infection in baby and mother, under Ali’s direction. Their weakest point was putting on the sterile gloves, without contaminating them. Their failed attempts provoked gales of laughter and so I was singled out to demonstrate–I think so they could laugh at me too. They tried to help show me how and after blundering through–not doing a very good job I at least got my hands in the gloves–kind of–but I DID NOT CONTAMINATE THEM! They laughed at me anyway.
The “matrones” arrived today. We have a reduced training session since one of our original trainees was ill herself and another was absent to visit a sick aunt. But we went ahead and try to catch the others up as we visit their camps later in the week.
We were anxious to find out how the ladies have done since their first training and asked them each to tell us about their work.
Mariam’s story
Mariam with her bag of equipment supplied by Rotary
When Miriam arrived from the very isolated Wodaabe community of Tedbouk she was the only one of the trainees who had never delivered a baby. The woman who had been chosen from her community had travelled and she did not want her community to miss the training. Although her husband is officially chief of the community it is she who is the dynamic one and in most situations acts as chief. So although she had not been known as a midwife in her community she is highly respected and decided to take on the role. She is bright and seemed to understand the training well. Here is her story:
The first baby she delivered was her own first grandson. There was a problem with the umbilical cord wrapped around his neck, but she solved it and the baby and mother came through healthy. She described her other deliveries. In the last two months she helped 11 women deliver babies. As the word spread that she had training people came from long distances. She helped not only Wodaabe, but Tuareg women who have different birthing traditions –the Wodaabe kneel, the Tuareg lay on their side.) but she adapted as necessary Of the eleven patients two had post-partem hemorrhaging and she administered the misoprostil that Dr. Skankey had trained her to use and the women came through fine. Her only problem was a set of triplets. The mother had come to her well into labor having never seen her before, but word of her success had spread and they called on her for help. The woman was in labor for three days, each day delivering one baby dead. Since Mariam lives so far away she was unable to call the clinic and had no vehicle to evacuate her. Apart from the triplets who died, not totally unexpected here with premature babies and triplets, she delivered 10 healthy babies from 11 healthy mothers.
Azzara’s story
Azzara, a Wodaabe from Foudouk had delivered several children before the training. When she went back to her community there were four women in the last two months who delivered, two of these had hemorrhaging but were administered the misoprostil and came through healthy and with healthy babies. There was another problem with infection which was solved with antibiotics.
Fatima’s story
Fatima is a Tuareg from Aboye. This community is one of the reasons that provoked this program because they have lost so many young mothers in childbirth. They never knew why. We started trying to get them prenatal vitamins and iron, but until this program there was no regular distribution of prenatal vitamins and NO distribution of other lifesaving medications. In the two months since the training she delivered three healthy babies to three healthy mothers, one with a hemorrhage which she solved with the proper medication.
Fatima kept a record of the women she helped and their husbands in Tifinagh, the writing system of the Tuareg. We have been calling them illiterate, they are not, but their writing system has few publications and its own alphabet, so they do not read French or the latin alphabet.
We will never know how many women’s lives were saved by the practices of cleanliness, the use of sterile gloves, birthing pads, sterile blades and sterile string to tie the cords, by drinking plenty of water and better prenatal care, or by prophylactly administering antibiotics in late labor, but we can assume at least the five who had severe post-partem hemorrhaging.
What we do know is surprising. The women were totally accepting of the suggestions we made, to drink more water, to use sterile technique and even those to improve nutrition. Their communities saw improvements in health almost immediately with the moringa powder we gave them so they started buying it and planted the seeds we gave them so they could harvest their own. Many of these things we expected to take some time to be accepted. We were ready to accept any progress as a success, but this was beyond our expectations. The intelligence and hard work of the women is a large part of this successs, but above all the thorough preparation by Dr. Skankey who managed to figure out how to get complex theory across to uneducated women. Now people from other regions are seeing how effective this training has been and are asking us to expand.
The bags finally arrived and everybody got to work installing the meds and seeing patients. 
Aboli with the somewhat bedraggled lost bags.
Fortunately the patient load was not too heavy so we had time to get organized with all the donated medicines from Direct Relief International, Amani at Medicine Shoppe, Dr. Bob Skankey, Globus Relief, Eye glasses from Eyes on Africa, and sunglasses and soaps and shampoos from rotarians of the Rotary Club of Ojai.
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