Kids’ Doc in Jos

I hate spam–who doesn’t?–and I hate the “prosperity gospel” preached in Nigeria. As I started thinking about the reasons why I hate spam, it is not really because of the clutter or bandwidth or wasted time. I get a fair amount of semi-junk mail from organizations, journals, non-profits, businesses, and so on, and that doesn’t bother nearly as much as real spam. Why is that?

I think the real reasons I hate spam are that it’s invasive and toxic, like the stench of garbage heaps and pit latrines seeping into my home. It’s clearly hostile and invasive, since people go to incredible lengths to bypass all the boundaries and barriers we establish against it.

Richard Foster wrote a very good book, Money, Sex, and Power (a much better title than its new one, The Challenge of the Disciplined Life: Christian Reflections on Money, Sex, and Power). In it, he reflects on the power of these three things for good and for evil. It seems that most spam is a constant, foul stream of these three in their raw, worldly form.

I realize as I write that, though, that spam is just the unvarnished, non-sugar coated version of the same messages that bombard us from every direction. In fact, the glossy ads and funny commercials (not even to mention much of popular culture) are probably even more dangerous in their seductiveness.

I really didn’t set out to complain about spam, and complaining wouldn’t do much good anyway. Rather, what is grieving me is that all around me in Nigeria Christians are turning their desires to becoming rich. I’m not talking about people who want to work hard, build a business, and get a fair or even abundant reward in return for their contribution. I’m talking about people who are lured into economic scavenging: get-rich-quick schemes, pyramid plans, foreign exchange speculation, and so on. Also, in the cases I’m thinking of, the drive is not to escape poverty but to reach the top, to be literally rich.

Many Nigerians, of course, are getting rich or are already rich. It’s hideous to hear about such cases as the recent governor of our state, Joshua Dariye, a “good, church-going Christian:”

In all, Mr Dariye faces charges of stealing some $128m from Plateau State during his tenure as governor from 1997-2007.

His official earnings were only $80,000 a year, yet police in London say he accumulated property and assets worth millions, much of it from state funds which were intended to provide drinking water to villages.
(UK targets Nigeria’s stolen loot, BBC 27 September 2007, emphasis added)

Stealing life-giving, clean water from poor villagers, so he could buy more houses in London? Of course, these are only accusations and I don’t think the man has been tried yet. Still, the British did return a quarter of a million dollars to Nigeria, just Dariye’s pocket change, “just the cash seized from Dariye on his arrest.” Perhaps it was really his own money after all.

At the same time so many have been become wealthy, whether honestly or not, we’re a country where most people really are dirt poor, many on the edge of existence and with virtually no social services to assist them. Some of the wealthy and middle class do contribute to the needs of the poor, but it is ironic that we have to seek for aid and expertise from overseas at the same time as our (Nigeria’s) economic and human wealth is being accumulated overseas.

Yes, all this is nothing new, just the age-old story of rich and poor, class divisions, and so on, but it’s hard to see happening around you, especially when there is so much “religion” but so little visible “true religion.” (Jesus’ brother the apostle James wrote, “Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world. [James 1:27, NIV]). It’s hard to swallow especially seeing all the shiny new cars boasting “I’m a winner” or “This is the year of my prosperity,” which are supposed to be proclamations of one’s godliness and faith.

What brought on this diatribe? Just that today I had two requests, from a friend’s son and from a doctor acquaintance, to purchase materials online for them. It’s really hard to buy online from Nigeria (not surprisingly) and I get asked to buy with my credit card or PayPal, while being re-paid in Naira. I agreed to both requests, but discovered that both of the “products” were get-rich-quick schemes: buy our material and learn how you can make a zillion dollars a week. Both people probably need the money (especially for school fees) and not necessarily seeking riches, but I just want to shout to all us Christ-followers, “can’t you see where this is leading?”

“You snapped me,” the young man sternly told me, after he and his three colleagues had pulled us over to the side of the road and slapped a nail-studded plank in front of our tires. I did have a camera in my hand and at that point was very glad that I had not “snapped” them. I opened the window and said no, I hadn’t taken their picture, then I started to open the camera to let them see for themselves on the digital screen. The boss grabbed the camera from my hand and I made the mistake of trying to wrest it back, which just made matters worse.

These are the “revenue boys” or, a name I just heard and like better, the “nail boys” after the home-made nail barriers they use to stop cars. They’re one of the regular interesting features of travel on Nigeria roads, identified by their smocks labeled “Local Government Task Force” (conveniently pronounced “tax force”). Though generally disclaimed by local governments and other authorities, they continue to ply their trade with some impunity. The ones stopping us yesterday were operating a scant 100 meters from a (probably) legitimate police checkpoint, not on some barren stretch of road.

Finally, after some tense discussion, I convinced them that I had not photographed them (hmm, why would taking their picture have been so terrible, I wonder?), but rather the sights and people along the way, and they let me have the camera back. Now the real business began, that we needed to pay “taxes” for our car. They pulled out a form and couple of stickers and showed it to me. How much do we need to pay, I asked? “This is just a private car, not a commercial one, and we’re just on a private journey.”

“OK, see, ordinarily you would have to pay ten thousand naira ($75) but because you’re a private car, and a doctor working at the hospital, and doing good things for children, and we like you, you only have to buy this stamp for 2,500 naira.”

The plain, black-and-white sticker was labeled “Akwanga West Local Government Vehicle T.V/Radio [sic] Permit 2006″. It looks pretty home-made (see scanned image), but not knowing the graphics capabilities of the Akwanga West local government, I couldn’t be sure. Still, it’s common knowledge that these nail boys are out skimming money all over the country and whenever the authorities are questionned, they say that the taxes and roadblocks are in fact illegal. In some cases they’ve actually arrested the perpetrators. In fact, I had just received an email notice three days earlier addressing the problem, and saying that a state revenue service chairman had “expressed regret at the incidents we documented, admitted that he has no jurisdiction over other states, and encouraged us to present all our complaints to the Chairman of the Joint Tax Board for all of Nigeria. He and all the other Executive Chairmen of state internal revenue services are members of this joint board, and they meet regularly to discuss complaints such as ours and see what action can be taken.”

None of that, however, is of any use on the scene when confronted by four guys who have nails under your tires. After all, if they’re operating illegally then it is probably useless to argue with them about the law. Appealing to the police wouldn’t help, either, at least not the ones operating right there in full view of the scene. In the end we paid the 2,500 naira and are now fully licensed to have a radio in our car while in West Akwanga Local Government. However, since according to the Nigerian government there are 773 other local government authorities, who knows what will be next.

On the bright side, we had no worse experiences on the road home and were delayed only briefly at four or five other checkpoints, not counting ones where we were just waved through, including the one by the vehicle inspection officers, who said that if I had been a pastor they wouldn’t have stopped us (?). When we set out yesterday morning from Abuja, our driver told us that earlier in the week there had been armed robbers stopping cars along the route we planned to take, the new shortcut route to Jos. I said we’d better take the usual road instead (which, though it has its share of armed robbers, is better traveled) but he said not to worry, that it’s all in God’s hands anyway. True, but I still opted for the slightly longer route, and if we encountered any robbers, at least they were armed only with nails. We were in fact thankful for our safe journey and heartily affirm that our safety (and money and time) are in God’s hands.

[You can see some of the photos I did take on the trip yesterday at http://www.flickr.com/photos/blyth/ ]
[For a short, interesting article mentioning this sort of roadblock as a symptom of more serious problems in Africa, see "Africa's Development Challenge: From Predatory to Accountable Government" by Robert Guest (Economic Development Bulletin No. 1 June 30, 2005).]

I just got back from Gada Biyu Market. Eight-thirty wasn’t early enough to go — I still got hot and tired walking there and back. It would have been much more stressful to take Luke, though it would have been good for him to get out of the house during this week of Easter break.

We were nearly out of flour and sugar. I used to buy 100-pound sacks from Vincent, but the last few years I’ve been buying flour and sugar by the mudu [measure] at Gada Biyu. They don’t sell it in the “supermarkets” where I usually do my weekly shopping.

Sometimes I have Magit the driver drive me because 5 mudu of flour and sugar is quite heavy to carry, 14 1/2 pounds to be exact. By walking, I had a chance to look around, notice the changes, and greet people.

There is a new metal walk-over bridge now so that I can safely cross the street in front of the hospital. I chose not to use it today, preferring to cross at the Polo roundabout. There are many more taxis and motorbikes clustered there than there used to be, and there are more new tiny shops hugging the road between the roundabout and the market, selling charcoal, used clothes and shoes, sacks of grain, linoleum, luggage, and prepared food.

The river had rushing muddy water in it since it poured rain last night, our second rain this year. The bridge railing is skimpy and barely exists, and the pedestrian sidewalk is barely wide enough to pass — quite scary.

The steep banks of that river are encrusted with garbage as ever. As I walked across the bridge I had to step into the heavily trafficked roadway to pass a teenage boy who was dumping yet another wheelbarrow of garbage into the river. I felt so sad; I hate seeing that. Of course the boy couldn’t see upstream or downstream where others were using that same water to bathe, wash clothes, urinate, and even drink.

The market was very busy at 8:30 this morning, teeming with even more people than usual because all school children are on Easter break, some for two weeks, others for a whole month. It still amazes me how these ladies can make a living, each sitting on the ground with her little piles of tomatoes, onions, red peppers, and “spinach” in front of her, next to other ladies selling exactly the same items.

I walked past dozens of such vendors to get to the tin shacks where provisions are sold. Actually, I never entered the market itself; I’ll do that another day.

The 100-pound sacks of rice, flour, beans, sugar, acha and gari are all open and outside the shack in the open air. The flour and sugar are not sold by weight but by volume, a little more subjective I would say. Sometimes they heap the mudu measure quite high, and sometimes they don’t. The guy dips the flour and sugar out with his hands, the same hands that handle the money and who knows what else. My bill was 490 naira ($3.63).

Can you imagine attending a ribbon cutting ceremony for new latrines? That’s what I did May 25. I traveled out to the Kogum River Bible school, two hours from Jos, to help celebrate the completion of the new well and latrines (how exciting) that our supporters the Sailors had funded. The students had provided all the labor themselves, and were so excited about having a good supply of water available. At this time last year, they had to take turns even in the middle of the night, just to get single bucket of muddy water from the old well.

Our little team snaked through the narrow alleyway between mud brick houses, carefully stepping over the small gutter where a trickle of dirty water ran. We were just entering a large, poor neighborhood of Kano, a neighborhood where many of the blind beggars live. Nearly 100% are Muslim. A hundred yards further along we came to a bend in the alley, and the entrance to a hut. I wondered where our team would set up to see patients. In a public building, or the chief’s living room? We waited a few minutes while someone went in and talked to the people inside. Children gathered around and smiled, stared, or tried to greet us in English. This was the first day of our two-day medical outreach to the “blind towns” of Kano.

After a bit our leader emerged and said we should pass on through what turned out to be the entrance hut for the community. Inside the hut two old, blind men greeted us. Out the other side, we entered another alley, with small, dilapidated huts on either side. Just fifty feet inside the entrance, we milled around, and then were told that this is where we would stay to see patients. Right here, in the middle of the dirt alley, in the sun? Yes, that seemed to be what was available.

see more, with photos, on our website.

Joshua Gidado’s mother came to visit and to deliver two messages. First, there was to be a special service at the Kabong church on Sunday with Joshua preaching, and he hoped we could come. The other thing was that the roof of Joshua’s room had been damaged in a storm, and could we help with the cost of fixing it. We agreed to do that, but the first request was a little harder. The Hillcrest Living Stones praise team, including Sara, was to lead the entire service at another school, and we were planning to go. Not until Saturday night did we decide what we would do: I would go to Kabong, and Barb would go to the praise service.

We first met Joshua only days after we arrived in Nigeria. A missionary neighbor, Janne Andrew, whisked us off to Joshua’s 18th birthday party. She had made popcorn, a beautiful birthday cake, and was bringing two cases of “minerals,” or soda. We drove about a mile up the road to Miango, then turned off onto a bumpy, muddy road in a little neighborhood of mud houses. Hordes of children surrounded the car when we arrived, all anxious for the party to begin. We adults and “official guests” crowded into Joshua’s tiny house and greeted him, congratulating him on his birthday. While Cokes, popcorn, and rice with meat were passed out, we got to know Joshua.

He was born at Evangel hospital, and because of frequent illness was in touch with our doctors ever since. We noticed that though obviously not well, he had a good sense of humor, sincere faith, and the will to do whatever he could despite his problems. He was coaching a soccer team of neighborhood boys, though he himself couldn’t play. He loved reading though he couldn’t hold a book by himself.

You see, Joshua was born with a severe case of brittle bones, or osteogenesis imperfecta. Very early in life he started suffering fractures of his arms and legs. Even with all possible precautions and medical attention, the bones broke again and again, causing pain each time, and soon Joshua’s limbs were shrunken and nearly useless. He couldn’t walk or crawl. Someone made a wagon for him, like the kind American kids like to ride in–maybe three feed long. Since then, for many years, he has lived in that wagon. He coaches football, reads with someone helping him hold a book, visits friends, and shares the gospel, all in his wagon. And that first day we saw him, his mother held the birthday cake down low, near enough that he could blow out the candles.

Amazingly, his mother and brothers had been able to keep him alive all these 18 years, through many cases of pneumonia, malaria, and other serious illness. His mother works as a cleaner in the government veterinary center, but cares for Joshua whenever she is home. A few years ago some Hillcrest students made it a project to build an extra room onto the family’s tiny mud brick house. It was the roof of that room that the storm had damaged.

I think God spoke to many people Sunday through Joshua’s message, as he preached from his little wagon on the platform. The electricity had gone off, so we were afraid the people might not hear him, but he spoke loudly and clearly. He talked of the need for the church to be more involved in ministry to people with disabilities. He described the loneliness and isolation all too common among people whom the church does not fully include. He called on God’s people to be more caring of each other, as brothers and sisters should be. [Photo: Joshua preaching from wagon]

At the beginning of the sermon time the pastor had announced, in typical African spontaneity, that I would be bringing a short message in response after Joshua spoke. That caught me off guard, but it sure did help me concentrate on Joshua’s message! So at the end, in the few minutes remaining while the early arrivals for the next service crowded around the door, I spoke from II Corinthians 1 and 4 about the God who understands our suffering, our opportunity to comfort others after we have been through suffering, and about the way Joshua’s life has portrayed the truth that “though outwardly we are wasting away, yet inwardly we are being renewed day by day.” I also took the opportunity to remind the church of the importance of ministering to those with HIV/AIDS, who are often cast aside.

The old, two-room building stands just beyond the edge of town, among fields of cotton, beans, and guinea corn. Reddish-brown mud bricks peek through where the plaster has fallen away. Faded blue lettering on the streaked whitewash identifies the building as the ECWA Community Health Clinic. The district supervisor and I have driven three hours from the district health headquarters to one of the northernmost outposts.

Getting out of the car, I look for a shady place to stand while we wait for the local health worker, Mallam Gambo, to bring the key to open the clinic. To the south are men and women working their fields with hand-ploughs, and beyond them are the low mud walls of the town’s compounds. To the north there are more fields, then the wide stretches of scrub. As we’ve moved farther north the trees have become smaller and more sparse, and I know that not so many miles beyond, across the border into Niger Republic, savannah finally gives way to the lower reaches of the Sahara desert.

The old man returns, key in hand, from his compound fifty yards away. He wears a brightly-colored, cylindrical Hausa cap on his head. The wrinkles on his face meld with the tribal marking scars worn by most men. As he unlocks the door he tells us, “I’ve worked here in Wagini for thirty years.” Thirty years out here in the bush. I wonder what has changed in that time. Not much, probably, at least not much for the better.

A lizard scampers across the floor as we enter. It’s 2:00 PM, and no patients are anywhere to be seen. Gambo opens another side door to let a little more light in, and shows me the record cards for the three patients seen in the morning, two with malaria and one with malnutrition. The 4 x 8 inch pink cards have been used ten years earlier for other patients; those names are now scratched out, and the new names written over them or on the reverse side.

I’m disturbed by the record of the malnourished child. Actually the card does not even list malnutrition as the diagnosis, rather says that the child has rashes in the mouth, sores on the skin, and swollen arms and legs. What is disturbing is the long list of medicines prescribed, and the bill at the bottom of the list, enough to buy a good amount of peanuts, beans, or other good food. Gambo can understand this, but feels the pressure of his position to give out drugs rather than advice, both because people expect it, and because he needs to make enough money to pay his salary and keep the clinic going.

As I review other case records with Gambo, it becomes apparent that his years of isolation in the bush, and limited education, have conspired against him. Not all antibiotics are the same. Malaria grown more resistant can no longer be treated by two or three injections of chloroquine. Vitamin C syrup probably won’t help that wound to heal any faster. “Do you have a treatment manual, or standing orders, that you can refer to?” I ask.

Gambo tries to open one of the old wooden cabinets. The bent nail holding it shut proves too difficult to move by hand, though. “We had thieves,” Gambo explains, “so we had to take precautions.” A tooth extraction instrument proves to be just what is needed to pry the nail loose, and Gambo searches inside and brings out some dusty log books.

“No, not those,” the supervisor says, “a treatment manual, that tells you how to treat patients.”

There is no such book after all. A look at the empty wooden shelves for medicine is even more discouraging. Two dubious vials of penicillin bought in the market, some iron pills, a few antacid tablets, some pain reliever, and little else. The thermometer just broke yesterday, a surprisingly common coincidence in the clinics I visit, and the blood pressure cuff “spoiled” long ago. There is no examination bed, but by ingeniously moving a short bench against an open storage shelf, Gambo can make a long enough space for a patient to lie down.

The problems are all to evident, but the solutions are not. It seems most villagers now prefer going to the new government clinic where the cost is lower and there are sometimes more medicines available. The ECWA clinic is far from the district headquarters, and transportation is expensive. The district as a whole has very few drugs. The supervisor doesn’t seem to know much more than the health worker, despite his professional training.

“Why not just shut this place down?” I ask the supervisor, “what good is it really doing?” I don’t buy the predictable answers, that really the people do appreciate the clinic despite the problems, that they trust the good quality medicine in our clinics, that they are really loyal to this place. Yet perhaps with improvements the clinic would still fill a real need.

After locking up, we walk down the dusty trail to Gambo’s small compound, passing the crumbling remains of another house built by the missionaries long ago. “We wanted to use that place for another worker to help here,” the supervisor tells me, “but no one wanted to come and stay all the way out here.”

Grain, peanuts, pounded lotus-bean pods and other food stuffs are drying on the ground outside the stick walls of the compound. Inside several women are sitting on mats in the shade of a tree, nursing small babies, pounding yams, and talking. Gambo introduces us to his wife who greets us warmly and agrees to have her picture taken. As we talk I learn that there is no church in the whole area, and no Christian believers until recently when two of the villagers, through Gambo’s visits and friendship, have come to faith in Christ. Gambo says that now there is talk in the village of killing him because of his Christian witness in this community.

Old men in flowing gowns raise their fists high in greeting as we pass back through the town. We bounce over the rutted dirt road, honking to warn children, chickens, and goats out of our path. Young men chewing sugar cane gaze impassively at us. Is this the time to close the clinic, leaving no Christian presence here at all? If not, how do we begin rebuilding what has been falling down for so long? How do we overcome the problems of distance and lack of communication, of limited abilities? How do we begin to re-orient workers who may have been with our program for 30 years, to new ways of thinking about health in a society with far less econically than it had decades ago?

21 Dec 95; events began 11 Dec

When I arrived, the only patient in the clinic was Dimas, the baby of Rhoda, the junior health worker. He had a slight fever and some diarrhea, and had already been treated by the senior worker. Otherwise the place was empty. Like most clinics, we have been struggling with poor attendance. The economy, time of year, shabby condition of the clinic, and presence of other clinics in the community all contribute to the problem.

Since there were no patients to see, it was time to review those who had come during the week, few as they were. “Did you see any interesting patients, or anyone to see me, or ones you have questions about?” I asked.

“No, there weren’t many problem patients. But yes, one baby was supposed to come back today to see you. His mother brought him here yesterday because of a swollen scrotum, and crying.”

“That sounds like a hernia, right? Could you reduce it?”

“No, but I told them to bring him today so you could take a look.”

I reminded her that a case like that was a surgical emergency, and she replied that she had tried unsuccessfully to talk the mother into taking the child to a hospital. Too often that is true, as the mothers know they can’t afford the hospital bills.

The baby didn’t come in during the time I was there, but before I left I thought of him again and asked Rhoda whether she knew where he lived. “Yes, I can take you there if you want.” Being basically lazy, I don’t like starting out on a house visit when it’s time to go home, but then this case certainly sounded like a serious one, and it would be good to see another home in the community.

“Let’s go,” I said, motioning toward the car. Rhoda was surprised at the idea of driving such a short distance, protesting that it wasn’t far at all, but got in anyway. The road was quite congested as we passed through the market in the center of the small town. Taxi vans, large panel trucks, trailers, motorcycles, and pickups all competed for parking, loading, unloading, or just getting through. Dozens of stalls offering everything from peppers to plastic shoes lined the sides of the street, and recently-harvested grain was piled in 50 kilo bags waiting to be loaded. Not far beyond the market we came to the school, where we turned off the road and drove about 1/3 mile on a dirt track.

“Here it is,” Rhoda pointed to the mud-walled compound. People don’t knock on a door and wait to enter. For one thing there is often no door to the compound, just an open entryway. For another, the compound may be too large for anyone to hear knocking. So we just called out the entry greeting, “salama aleykom,” as we entered, staying in the public, open area. “Aleyka salamu,” a woman replied from one of the huts. Two or three women and some children came out to greet us and make us sit down comfortably. When Rhoda asked about the baby, it turned out that this was not quite the right compound. His was next door, so one of the women took us there and called the mother.

The home was poorer than the first. There were two huts and a small shed, all covered with grass thatching. A bamboo fence ran between them, giving the effect of a small compound, with a cooking fire near the middle. Chickens wandered in and out. The only evidences of modern life were some metal cooking pots on the dirt floor and some magazine pages pasted on a wall. The young mother emerged from the dark sleeping hut with the baby in her arms. I examined him briefly just enough to see that he looked emaciated, that he indeed seemed to have a trapped hernia, and that he looked sick but not yet extremely sick. A few questions brought out the main facts.

He was three weeks old. He had been taking the mom’s breast well, but she didn’t seem to have any milk, and was feeding him artificial formula mixed at home. He seemed to be getting thinner though. The swelling had started two days earlier and hadn’t changed. It had never been noticed before. He was crying a lot now, and not sleeping. He hadn’t passed any stools in over 24 hours, but wasn’t vomiting.

The next problem was convincing the mother to take the baby to the hospital. She was a village woman from a more remote area and very reluctant. She herself looked quite thin and not well. “Have you been coughing?” I asked. Yes, she had been coughing for several months, beginning during her pregnancy. Yes, she also had fevers, and was losing weight, but was receiving no medical care. It seemed quite likely she had tuberculosis and possibly HIV infection, and her general ill health could explain the lack of breast milk.

“Mama, we have to take the baby to the hospital now. We don’t have time to wait for your husband to come back. The baby is very sick and could die. He needs an operation right away. Her main concern was the cost, as she simply didn’t have any money even for an initial deposit. Since Evangel hospital depends nearly entirely on patient fees for its operating expenses, it has to be strict about collecting them. Still, critically ill patients are never turned away. The government hospital might be accept the baby without a “bed” fee, but would almost certainly do nothing for him until the mother had bought all the needed medicines, IV fluid and needles, bandages and other supplies. Plus I knew Evangel had the skilled staff this baby’s condition required.

“Mama, don’t worry about the cost now. If you wait to get money, you may have the money and a dead baby.” The woman’s sister, neighbor, and Rhoda all helped me convince the hesitant mother. I’m always hesitant to promise to waive or underwrite the cost of hospital care, because I don’t want to be swamped with patients wanting free treatment. But there is nothing else I know to do in this situation. Between the cultural fatalism so often present, the skepticism about the effectiveness of modern medicine, and the realistic appraisal of the huge cost of hospital treatment relative to their tiny resources, parents very often decide rationally to try only traditional remedies. They simply expect that some will die, that’s just the way children are, This woman, probably not much older than 20 years, had already had two other children, and one had died.

Finally the mother agreed. The neighbor offered to tell the husband the situation when he returned from the city, and to take care of the other child when he came from school. The rest of us got into the van. I held the tiny boy while Rhoda tried to get the seat belts onto the mother and her sister, with no luck. The idea of seat belts was new to them. I managed to snap them in and we were off.

We left Rhoda back at the clinic and went on to Evangel, half an hour away. Dr. Bill Ardill was just between cases in the operating room took a quick look at the boy, and confirmed my diagnosis. We agreed that the overall outlook was quite poor. Such a malnourished patient would be at considerable risk in any case, but with a sick mother, unable to breast-feed, and needing surgery …. Still, there was a reasonable chance of a good outcome.

On the pediatric ward the house officer placed an IV and began the rehydration process. Later in the afternoon Bill operated. The bowel was still alive in though trapped in the hernia sac, but it had perforated in one place, which Bill repaired.

From the operating room the infant went to the ICU, kept in an incubator. He seemed to improve for a time, and even started taking some fluids orally. Then one morning on rounds Dr. Orosz asked about him and was simply told that he had died. That’s the way it is so often. With few labs, little or no monitoring equipment, sometimes sketchy records, and never any autopsies, the cause of death often remains a mystery. For the newly arrived Western doctor it is very distressing. How will we learn to improve if we can’t even find out what went wrong? The prevailing medical tradition here, though, is more ready to accept deaths as givens, and is more anxious to move on to the next living patient than to try to find out what happened in the one who died. To some extent most of us missionaries who have been here a while have moved in the same direction; it is hard to continue functioning otherwise.

I’m sitting on the porch of some friends, the Patkes, in Kano late in the afternoon. It’s probaby about 80 degrees now and dry, though there are some filmy clouds high up that filtered the sun a bit today. I’m looking across the back yard to the Cedar Tree “Best Quality Refined Vegetable Oil” factory. I can smell the oil, and there is a constant sound of 50 gallon drums being pounded. Somehow the factory gives me a comfortable sense … it’s more like my own world, machinery running, looks fairly clean from the outside, and I know something is happening I understand. Not like our usual world in Jos and the villages. Though there are some factories in Jos, too.

I came here yesterday for a meeting involving getting American aid for our community health program. They’re actually looking for programs to help, though it’s mostly giving training and helping our people get out to reach the community rather than material support (such as drugs). But that’s a great step anyway. The community health director and I set out from Jos at 6:15 yesterday morning, planning on making the 11 AM meeting, but the car broke down at about 9. One of the engine bearings burned out, they thought.

I came the rest of the way, 2 hours, in a commercial van. There were 9 seats including the jump seat over the engine, and 15 passengers. A couple of men had to push it to get it started whenever we stopped. I had my suitcase wedged between my legs and laptop computer on my lap, but it wasn’t all that uncomfortable. I had expected as much and anyway I was only having to pay about $0.75 for more than 100 miles. Then we stopped, and 5 more people got on! Two women and three small children. They sat on the metal ledge behind the front seat, directly in front of me. I was sitting half on the main middle seat, and half on the fold-down seat. From there on it was not much fun! I couldn’t move in any direction, and had to hold the suitcase as well as the computer on my lap. The fold-down seat fell into the step by the door, leaving me sitting on a gap. The front roof strut kept falling off and being put back on, though I couldn’t see what the point was when it wasn’t connected. Finally people got tired of replacing it, and just passed it to the back of the van. The condition of the rest of the vehicle was about the same, but it was running.

After about an hour we made a brief stop, and some people bought food, slices of sugar cane, a long yellow vegetable, and a pastry like doughnut-holes. The little boy across from me, almost on my lap, was probably almost 2 years old, thin but happy. He kept playing with his pastry, then took to rubbing it on my suitcase. A little 3 or 4 year-old girl in the back started singing a little song whenever we passed herds of cows being driven along the road.

“Well,” I thought, “God really does have a good sense of humor.” I had just been thinking in the car on the way up that one of the things I was really not willing to do was travel by public transport … not comfortable or safe. Another was fasting, but this week was announced to be a week of fasting for our church … just morning to night, people still eat supper … and here I was doing both! And I had thought I was cramped before the extra people got on board.

I did get to the meeting only an hour late, and it continued on until 5 PM so I didn’t miss much. I was supposed to go home today but decided to wait until tomorrow so I can return with a friend who is coming and going (bringing travellers), instead of going all the way back on a bus or taxi. And it has been a great day, just for reading, contemplating, praying, and now writing you.

BSF (Bible Study Fellowship) was frightening this week. Part of our passage in Deuteronomy listed the things that are detestable to God, including human sacrifice, sorcery and divination, witchcraft, and consulting the dead.

At the end of our discussion time, Frieda told us how she was frightened by a pregnant woman who turned into a black goat at night to eat her flowers and bother her. The black pregnant goat would knock on Frieda’s door in the middle of the night. Frieda would go to the door, see the goat and try to chase it away but didn’t want to venture too far from her house in the dark. One night the goat got its head caught in the fence wire and was strangling, with its tongue hanging out and foam at its mouth. Frieda didn’t know what to do. She wanted to kill the pesky goat but she didn’t. The next morning she found that the pregnant lady was in the hospital with foam on her mouth and her tongue hanging out. She concluded that the goat was actually the woman.

Another lady in my group warned us to be careful because there are agents attending BSF classes and they look like all the other ladies. I asked naively, “Agents of what?” She replied, “Agents of Satan.”

An hour after I got home from BSF, the hospital chaplain Justina visited me with her co-worker. I told them what I heard and asked what they thought about “agents.” They had a lot to say, including that such agents could indeed penetrate Bible studies, chasing weaker members of the class, making them feel sleepy or dizzy or distracted.

Justina told me what she said was a true story about a boy who was given a piece of candy. He didn’t want to eat it right away so put it into his pocket and forgot it. When the boy’s mother washed his pants, she discovered the end of a human finger in the pocket — wiggling! She asked her son about it but he said he had only been given the candy. Justina said that if the boy had eaten the “candy,” he would have unwittingly eaten human flesh, making him an agent of satan and obligating him to participate in meetings of the spirit.

I determined then and there that I would pray each day for the protection of the BSF leaders, that any satanic power at BSF would be broken, and that God’s power in the shed blood of Jesus would be in control.