On social media, new mothers can bake bread in their skinny jeans whilst blissfully nursing their newborns, who also sleep through the night. Volunteers on medical missions can miraculously save lives on shoestring budgets staffed by highly skilled, selfless providers in dangerous environments. As a mother and obstetrician on many missions, I see these boast-posts and ponder their unintended harm. Doubtless the goal is to share success, not to brag in a way that trivializes struggle and failure. However, glossing over the hurdles encountered in accomplishing any important goal serves to diminish rather than enhance understanding and appreciation of the endeavor.
Every mission I have participated in has been plagued by supply shortages, communication errors, treatment failures, and disappointments that exist right alongside of the triumphs and successes. Needless to say, our most recent mission to Niger is no exception. For good reason we frequently heard Leslie say that you must suffer to get to paradise.
Planning and running a mission is hard work. That work is magnified when conducted in a foreign language, in the desert heat, and in a place where last-minute changes are the rule rather than the exception. Our entry to the country was complicated by new customs rules; our travel was disrupted by missed and changed flights and lost luggage. Out on the “roads” we were plagued by any number of tire issues and mechanical problems. Our training session at Tamesna was limited by family and personal illness among our selected leaders and late arrival of many of the matrones. Our supplies were delayed in arrival thanks to Air France and our own difficulties in communicating from our remote location. We all suffered from various ailments: heat rash, heat exhaustion, bug bites, cough, digestive problems, and jackal attack. I mention all of this not to paint a grim picture of the mission but to provide a balanced perspective. It isn’t easy. (Just kidding about the jackal attack though.)
We have two medical projects in Niger – the Tamesna Clinic and the matrone training program. Both are successful in ways we could never have dreamed they would be. The clinic is capably staffed by Rabi Abdrahmane, RN and the number of patients she sees continues to grow. This year we will be providing her with assistance during the rainy season when she simply cannot keep up with the volume of ill patients. Thanks to Direct Relief and Amani Hismeh of the Ojai Medicine Shoppe, we were able to supply Rabi with large quantities of quality medications for the conditions she most frequently treats: infection, hypertension, and skin and digestive disorders. For the first time we were also able to bring pediatric antibiotics and analgesics/fever reducers. She is helping restore health and relieve suffering among nomads who normally would not receive any medical care whatsoever.
The matrone program started with focused training for women who will become trainers themselves. We produced pictorial guides to antenatal care and childbirth to assist them – the language and literacy issues are big but not completely insurmountable. The remainder of training was a refresher course for experienced matrones. We included more physiology to enhance their ability to grasp pathology. The matrones report that their understanding increases with each training session and I hope they are not just humoring us. The data suggest that their outcomes are much improved compared to the situation before Dr. Skankey started the training program: there still have been no maternal mortalities at home. There have been mortalities after transfer to the hospital. In addition, there is a distressing rate of fresh stillbirths, a problem that cannot be addressed without monitored labor and skilled birth attendants.
This year we initiated a new matrone program in Iferouane with 17 participants. We were unsure how we would be received and how well we could work with the local interpreter provided for us. The large welcoming committee of singers and dancers and the ice-cold beverages were the first sign that things would go well and they most certainly did. The women were eager and clever learners and the interpreter was spot on. The only thing that could have made it better would be if I could speak French. (Peut-etre un jour…) Although Iferouane has a birthing unit, nearly half of all births in the region are home births attended by matrones. The doctor and midwife who staff the birthing unit were welcoming and appreciative to us and appear to have a good relationship with the matrones. Both are critical for our program’s success.
Taking a longer view, our goal is for these projects to be managed completely by nomads themselves. There are barriers to this goal which we are addressing starting with teacher training. Of course it is more than a bit challenging for a woman who has never been to school to suddenly become a teacher! The usual education tools – books and notes – do not work with non-literate learners. Our pictorial guides are a start. Many challenges remain.
While I would love to be able to say our mission was without difficulties and that the health of the nomads and new mother-infant pairs is perfect, it would not be honest. Much work remains to be done. We are far from the time when nomads can approach childbirth with joy and confidence. We will continue to work until they can.
Thanks to the many magnanimous donors who made this trip possible starting with my family and friends who gave so generously. My travel is supported by Ventura Global Health in honor of Dr. Skankey and I am grateful for their continued support. Medications for the clinic were donated by Direct Relief and Amani Hismeh. Medications for the matrones were generously supported by Eric Esterbrook of Esterbrook Pharmacy (Reading, PA) and his mother, Pat’s and my friend, Maria Phillips. Thank you.