Gradual recovery and slow change in season

After one month in Zinder, Niger, the heat is finally beginning to abate somewhat and sand storms are coming in. The locusts came by and created their own storms, covering the windshields of our vehicles, walls of the houses and our entire patio, especially attracted by light sources at night time. Having come through the city also means that they ravaged crops in the countryside, and are now on their way further south into Nigeria. Smaller locusts or “crickets” as they are called here, are a popular snack after they are dried and mixed with spices and onions. People collect them in little plastic bags or cups, including mothers of patients at the hospital, in order to be able to prepare them at home and often sell them. I have to admit that crickets are actually quite a tasty snack which I have come to appreciate and which has improved my evolving phobia of locust storms.

A little girl enjoying her Plump'y Nut The hospital is just as busy as always, especially on market day which is Thursday, when people come in from the surrounding countryside to sell their wares and take the occasion to make a trip to the hospital for themselves, relatives, or to bring in their sick child. On the way to the hospital in the morning, I pass the “marche de betail”, or the livestock market, where camels, goats, cattle and other animals are sold in a large open area. The streets are full of oxen pulling small wooden carts filled with various items on their way to the market. There is much excitement in the air on market day, which tends to be transmitted even through the gates of the hospital as people carry various food items to relatives on the ward.

The therapeutic feeding centre is full to capacity this week and the phase 2 or recovery phase has been moved to the tented area near the end of town, which used to house the entire feeding program. My weekly visits to this area are among some of my favourite moments so far, as this is where I see children who came through the ICU, who are now seated on woven mats with their mothers on the sand some already smiling and playing with sticks or utensils, eagerly awaiting their supplementary food package. This is where I played with little Charifa this week, a 13 month old little girl with Down’s Syndrome whom I have become attached to, as she for some reason had been smiling already in the ICU, while we tried to manage her heart failure. She is always smiling and very little seems threatening to her. Her mother has a very strong bond with her and is entirely oblivious to her special needs, yet fully aware of what a special child she is in every other way. This seems more important at this time in this context and has pushed Charifa to progress quickly through the phases. She achieved her goal in weight at the end of the week and was discharged home.

The focus in phase 2 is especially on the mother child relationship as it relates to patience and nurturing while feeding. Many mothers struggle with wanting to force feed their children, hoping that they will put on weight more quickly so that they can go home. The nurses and nutritional assistants in this phase ensure that mothers remain patient with feeding, as many children at this stage relapse quickly into refusing milk and need much encouragement in order to avoid regressing back to feeding tubes and phase one.

After the peak of hunger season has passed, a part of the project here in conjunction with acute medical care, will be to set up a play area in the centre, in order to help stimulate those children in phase 2 to help their recovery. Psychological recovery in malnutrition is included as a section in the MSF protocol for treatment of acute malnutrition with a focus on physical and emotional stimulation. I think that we often forget what an important part of healing, play is for children, especially for malnourished children whose entire energy for weeks has been focused just on basic functions, such as keeping body temperature stable and whose experience of touch has been distorted by the state of their body and the pain associated with touch.

A memorable moment for me earlier this week, was the discharge of a 4 year old girl in whom we placed a chest tube to drain an infection in her lungs. She came into hospital weighing 6 kilos and after 3 weeks of treatment for TB, she has made a rapid recovery. We were unable to approach her during rounds and she would scream incessantly when we examined her. She made absolutely no eye contact with anyone for weeks. The day of her discharge, she stood giggling, holding her package of therapeutic food and when I finally picked her up, she hugged me and clung to me for several minutes laughing and laughing. After many difficult moments over the last month, Amira’s laughter, Charifa’s smiles and the privilege of witnessing my patients’ first smiles after weeks of illness as they show signs of recovery, has been significant in helping me remain positive in such an urgent environment.

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17 Responses to Gradual recovery and slow change in season

  1. Anne says:

    Dear Elisabeth,
    Thank you for sharing Amira’s laughter and Charifa’s smiles. I felt your care and healing for them and so many others. It resonated for us all!.
    So looking forward to hearing and seeing more when you’re back. You’re an inspiration to so many. Stay well and safe travels.
    Anne

  2. Hodan says:

    Elisabeth you make us believe in a better world. God bless you and the people of Niger. We miss you lots..Much love.
    Hodan

  3. Mohanad says:

    Hello Liz
    Good for you Liz, your contribution to these great people is amazing. I felt the warmth in your words. Keep us posted. See you soon in Burlington and Hamilton as your patients are missing you.
    Mohanad

  4. Arinder Malik says:

    Every time I read your stories, makes me appreciate all the more, what we have. May you have the strength and courage to do this . All that you do is amazingly inspiring for everyone who sees it.
    My best wishes.
    Arinder

  5. Cecile says:

    This is both incredibly moving and educational! I look forward to reading more.

  6. Kelsie H says:

    Thank you for sharing this!! I thoroughly enjoyed reading your story, and it made my heart smile. I hope to one day do as you do with my life; I graduate with my acute care pediatric Nurse Practitioner degree in May ’12 and can’t wait to help change the world one day at a time!

  7. Daire Winston says:

    Well done to you all and thank you for sharing this.

  8. Nikita Lopoukhine says:

    Your strength in facing the daily hardships and ability to feel rewarded in helping those that are helpless is a gift and for me and many others a real inspiration. It is special to be able to share your experinces. I know your mother is very proud of you and I am sure your father would be as well as is all of the Labelle Community.

  9. Cecilia Godoi says:

    Inspiring , beautiful work! Thanks to people like you at MSF we can still believe in a better world

  10. ailbhe says:

    Such an inspiration to us all, not just the incredible work, patience and dedication but the strength to face each day such heartbreaking and difficult scenarios. We should be ashamed of our own pitiful complaints.
    Sending you warm hugs and tons of strength to continue your great work Lizinka.

  11. Ignacio says:

    Dr. Canisius, people like you “make a difference” in this world. Congratulations for that!

  12. Solomon says:

    What an amazing work that is and thank you for posting it.Keep up with the great job and God will pay you back in heaps.Smile when even it hurts you will be comforted by God’s Amazing grace!

  13. Becca Fasciano says:

    I applaud your work. I worked for the Peace Corps in the late 80′s in Niger. I lived in a little village south of Aguie called Gangara. I worked with Abdou Alka and his wife Hawa. Abdou was the nurse in Gangara and was moved to Aguie. I wonder if you have run into him – and could give him my best. I also wonder if the supplies in the dispensieres have gotten any better. Hard to work with minimal supplies and funding. So glad that you are finding the joy and success in reaching those smaller goals. Thank you!

  14. Michael Mira says:

    Dr. Canisius, if you don’t mind, I posted an excerpt of your blog post on my own blog with a link to this web page. MSF is still one of my favorite non-profit organization. Keep up the great work.

  15. Michael Lardner says:

    Dr Canisius, God bless you and your colleagues for helping people under these harsh conditions. Your efforts make my contribution to MSF seem paltry. Stay well and safe.

    Best regards,

    Michael Lardner

  16. Katherine Kidnie says:

    It really is posts like this that make me want to get through my undergrad and then through med school and to never give up. In the end I just want to help people. These kinds of posts are so inspiring and I think its amazing what an individual person can do to make a difference in the world. Thankyou for your amazing work!!! Keep smiling :)

  17. Barefootmeds says:

    It’s blogsmlike these that get me through my exams. I hate studying. All i want is to get through medschool in one piece so I can do things like this, too.