Friday, July 31, 2009

Dog Dossier: Stone

Aliases: Stoney, Stoner, Big Boy, Brown Dog, Old Man, Handsome Boy, Stank Breath, Shit Eater, Snuggle Bug, Lovey Dovey, Little Yorkie, Tiny Boy

Back Story: Stone is the other brother that I adopted from my ex. He moved in when she moved in to join Daisy, Duke & I. Stone is a little older than Duke, by maybe a year or two (which makes him about 13 I think). Although they aren't blood brothers Duke and Stone have been together since Duke was born and they get along just like brothers. Sometimes I catch them licking each other's faces and nuzzling each cute! And sometimes they get crabby with each other, but usually not too much. Mostly because Stone is a push-over. He is the lovey-dovey-iest dog you've ever met. He just wants to be petted and snuggled and sometimes to get crazy and play with his two little sisters. He is so wonderful with other dogs. Sometimes I'll look over and Daisy will be pulling on one of his front legs and Caramel will be pulling on one of his bag legs (with their teeth of course) and he just has a goofy look on his face and will let them play until he's had enough. Then he lets out the most ginormous WOOF you've ever heard and then he'll chase them down the hallway. The girls absolutely love that game.

We like to joke that Stone is actually a Yorkie. He was just somehow born into the wrong body. Kind of like being transgendered. In his mind he is a little, teeny lap dog. In body he is a giant 80 pound German Shepard that squishes all the air out of you when he lands on you. He can't understand why he can't fit in little bitty places that are not meant for his big body...but he tries like hell to fit anyway. He just wants to be loved and snuggled all the time, and we are (almost) always happy to oblige. The only time we hesitate is when he's just eaten a big old pile of poop and his breath stinks like WHOA. Yeah, that's one of his less charming qualities. I've asked the vet about strategies to stop that habit, but it just seems like he really, really likes poop so there's not much we can do about it.

Stone is the oldest of the dogs, but you'd hardly know it. Maybe it's because he's young at heart. Maybe it's because he's really good at projecting a little dog persona. Whatever it is, it's working for him. Sadly this year has been a rough year for him. He has some kind of mass-like tumor growing in his belly. It was causing some issues earlier this year but after several vet trips the side effects seem to mostly have resolved themselves. The only "treatment" would be to have surgery and open him up, but since there are no guarantees that anything can be done I figure it would do more harm than good to put him through all of that at his age. So we monitor him closely to see any signs of distress, and brace ourselves for the day we will have to say goodbye. I know it's sooner rather than later (he's lost 10 pounds since last year) so we're just trying to enjoy the time we have left with our sweet, sweet boy.

Likes: Hugs and kisses, his ears scratched, to lay on people, to sit on your lap, to pretend he is a tiny little Yorkie, to lay on things no matter how small, to sleep with his feet on the wall or just generally up in the air, to play with his little sisters, to pretend like he is so tough, chew on empty water bottles, eat poop, howling, squishing himself into places that are too small for him

Dislikes: getting his feet wet, having his feet touched, being outside for longer than 5 minutes, car rides, being alone

No he doesn't have rainbow junk...he's just been airbrushed for modesty!

Thursday, July 30, 2009

Dog Dossier: Duke

Aliases: Dukey, Duker, Big Boy, Gray Dog, Grumpy, Old Man, Handsome Boy, Pig Nose

Back Story: Duke is the first of the 2 brothers I adopted when my ex abandoned her dogs and left them with me. He actually came to live with me first, a few months before his brother. See, I don't know much about Duke's first 6 years in the world but I do know that he got hit by a car and beaten by my ex's ex so bad that he couldn't walk for a few days and now that he is older had been suffering from some pretty bad hip problems. He's used to be in pain every once and a while but now that he's approaching 12 he is in daily pain. The vet thinks it's some pretty heavy duty arthritis and he's on a daily NSAID to help manage pain. Understandably Duke is very, very sensitive about his hind quarters and doesn't like anyone getting near them, much less touching them.

Shortly after I moved into my house, but before my ex had moved in, she was living in a duplex with one of her friends in one half and her friend's sister who had like 5 kids. They had a big backyard and because of the plethora of kids her friend's sister had there were always a crap ton of neighborhood kids around. Well apparently there was one little girl who just loved to bother Duke. She wasn't necessarily mean, but she was always touching, poking, messing with him, even after repeated warnings to just leave him alone. Well one day, no one is quite sure what happened, they heard a scream in the backyard and came out and realized that Duke had snapped at the little girl and caught her just hard enough to break the skin on her butt. She ended up getting 2 stiches, and the parent's weren't really mad but my ex thought it would be a good idea to get him out of the situation. We were already moving in the direction of probably moving in together so she asked if Duke could come live with me and Daisy. I loved Duke already and knew that he'd just been given a raw deal in life so I said yes. He's never bitten anyone before this incident and never has since living with me. I think that the kid just messed with him too many times and he was over it. But also, being a good dog owner, I have never left Duke alone with a small child (or any visitor really) because I want to make sure that both his and any potential child's safety and security are assured.

So my ex came and went and decided that when she left she couldn't take her dogs. Which frankly, was fine by me. They had already been living with me for 4 years and I knew that she could barely take care of herself much less these two dogs. They'd been through enough in their lives and I knew that my house was home to them and that they had a big backyard that they could roam around and lots of dog beds inside to rest their big bodies and I knew that I would have a much better capacity to care for their needs (vet wise as well as TLC) as their ages progressed and their health waned.

Although Duke has a rough exterior...he tends to growl and gripe a's just a front. He's actually one of the most sensitive and loving dogs I've ever met. He hates when people yell, he gets upset very easily, he's actually scared of just about everything, and he just wants to snuggle in bed with you and be babied. He'll always be my grumpy little boy that I just love to pieces!

Likes: To be left alone, to be brushed, treats, sleeping on dog beds, sleeping on mommy's bed when she isn't looking, barking loud in people's faces

Dislikes: Flies, grills, vacuums, most other dogs, strangers, cats, birds, having anyone in his personal space, being touched anywhere near his hind quarters, leaving the house, baths, being wet in general, when people yell, when someone looks like they are going to hurt me

Wednesday, July 29, 2009

Dog Dossier: Daisy

Aliases: Black & Tan, Baby Dog, Daisy Mae, Daisy Maisy, Maisy, Maisy Mouse, Little Brute, Brat Dog, Crazy Daisy, Naughty Dog, Daze, Mary Jane Rotten Crotch

Back Story: Daisy was the first dog fully owned by me. When I was looking for a house I knew I wanted a house with a yard so I could have a dog. Little did I realize that I would one day end up with 5. After finding the perfect house with a very large fenced in yard I started thinking about a dog. I have a soft-spot for mutts, having grew up with the greatest little mutt that every walked the planet, so I knew that at the very least I needed some kind of rescued dog. I started seeing Miniature Pinschers (also known as Min Pins) everywhere and began to fall in love with them. They were just so cute. At the time I also belonged to Indy Freecycle which is an internet group that strives to recycle things for free to avoid throwing crap into landfills. They used to allow animals though I'm not sure about that now. I had been eyeing the animal posts that came out and one day there was an ad not only for a free Min Pin but it also came with a sad story about how she was at the end of her days at the shelter she was at in Terre Haute and if someone didn't take her ASAP she would be put to sleep. I was sold. The lady had to bring her that day, but I was at work at the time. I told her my (now ex) girlfriend was home and the dog could be dropped off with her. Eagerly anticipating my new dog I waited and waited for Shelly to call with news. When she finally called she said "Uh, the dog's here. But I don't think she's a Min Pin." As soon as I got off work I raced home to check her out. Ok, so maybe she wasn't a full-blooded Min Pin but she was black and tan and awfully cute. I loved her anyway. So the lady said that her name was Winnie which I thought was the dumbest name ever so I decided to re-name her. She was as pretty as a flower so she was then called Daisy. Little did I know that my sweet little flower would turn out to be a royal pain in the ass (but still cute!)

Quickly she realized how to get out of her collar, how to fling herself off the deck and run like a maniac through the neighborhood, and how to squeeze past you and bolt out the door if you weren't watching vigilantly. I quickly realized that she actually liked to be spanked (the harder the better...she's truly into S&M), had some screws loose, would forever have to wear a harness and be chained up when in the backyard even with a 6 foot tall privacy fence, my yard would always look like crap, and the house had to be thoroughly doggie proofed forever or she'd chew me down to the crawl space.

After only a few short months I experienced a sad loss. Daisy bolted out the door and could not be found anywhere. I looked and looked and looked but no Daisy. I hung up signs, I checked the Pound and Humane Society, but no trace. After being sad for a few weeks I tried to move on. Then one day out of the blue, my mom and sister were leaving my house when Daisy bolted in front of their car in the middle of the busy street in front of my house. They screeched on their brakes, looked at each other and said "Wasn't that Daisy?" They opened the door to the car and she jumped right in. They drove back to my house and said "Look what I found!" I was in disbelief! It had been well over a month since she was last seen! Where the heck was she? Apparently she wandered into someone's house and they'd been taking care of her for a month. I saw that she was wearing a new collar and some vet tags. I called the vet, told them the situation and they gave me the number to the people who had been taking care of her. Now the next part might sound mean, but hear me out. It was an older couple she had been living with. The man had Parkinson's and the wife had Alzheimer's. Of course I was like, oh geez. How can I possibly take her away from a little old couple? Well two things made it easier. One, she was mine. Sorry, but it's true. I had posted signs EVERYWHERE...sorry they didn't see them, but whatever. Secondly the vet said that they had experienced the loss of two pets that year. Apparently they had been mauled by the next door neighbor's dogs. If they were incapacitated to the point that they couldn't prevent their dogs from dying then Daisy didn't have much hope. I called them up and we settled the issue.

Now I'd like to say that she's never gotten out since then, but that would be a lie. This is one rascally dog we're talking about. There are some days I wish she would runaway...but not really. She may be one of the naughtiest dogs to ever grace this planet, but truly, she is very sweet, silly and cute and you just can't help falling in love with her. She makes me laugh most of the time and no matter what, she'll always be my first solo "adoption." And come on...she's a good story to tell!

Likes: Rolling around on the floor itching her back, digging up the yard, chewing up things, running away, rolling in smelly things, being spanked, her belly rubbed, wrestling with her sister, being chased, riding in the car, sleeping in bed with mommies

Dislikes: Being told "no, no," being woken up suddenly, being touched by Sam, sharing food, being clean

Tuesday, July 28, 2009

She loves me! She really loves me!

So I meant to write about this before I left for Nigeria, but I didn't get around to it, so I'm writing about it now.

I love granola bars, snack bars, energy bars, meal replacement bars...pretty much any kind of "bar." On last year's mission I totally fell in love with a bar called the Clif Mojo Dipped Peanut Butter & Jelly Bar. It's almost like a PB&J sandwich in a snack bar. Which to me, is like heaven. In case you didn't know...peanut butter and jelly sandwiches are my absolute favorite food in the world. You know that game where someone says "If you were stuck on a deserted island and could only bring one food with you what would it be?" My answer is always PB&J. So when one of the volunteers last year introduced me to the Mojo PB&J bar I was hooked.

I'd been happily buying them for about 6 months when all of a sudden they could be found NO WHERE. I usually bought them at Target or Walmart, but occasionally found them in other places. However, about 6 months ago they just disappeared! I was, of course, devastated. They were great snacks when I was running between classes, meetings, and other days where I'm so busy my head spins. What was I going to do???

I fell deeper into my Mojo depression, but never gave up hope. Every time we hit the store I'd look hopefully for my little purple packages. Ange would stand faithfully by warning me not to get my hopes up. It was sad.

One day I came home and there was a mystery package on my doorstep. I hadn't ordered anything so I wondered what it was. It had my name on it, but I didn't inspect it much closer. Ange played innocent and interested also wondering what it could be.

I opened the box and started shrieking! IT WAS A WHOLE BOX OF MOJO BARS!!! OOOOOOMMMMMMGGGGGGGG! She knew I was going to be traveling to Nigeria and that I don't eat a lot of local food there (many reasons) and that I survive on my snack bars. And that I was super sad that I would be without Mojo PBJ's.

So that sneaky little girl surfed the net and found out that you could order them directly from Clif! So she ordered me an entire box of them for my trip! How wonderful is she??? Just one more reason I love her and know that she is perfect for me :)

*I did not take a picture before I opened the box. I pretended to close it so I could do a re-enactment cause I knew I wanted to blog about it.

**Since the initial shipment, Mojo has rolled the bars back out in the store. They are shaped a little differently and have a slightly different package. They must have been pulled off the market during the redesign process.

Monday, July 27, 2009

A Random Text Conversation

An excerpt from a conversation with my very sweet, p.c. girlfriend...

Me: Are you mad at (Name)? He texted me and asked. I said I didn't think so.

Ange: What? No. He's so gay.

Me: Haha. Ok.

Ange: He really texted you that? God he's such a girl...

Saturday, July 25, 2009

Farmer's Market, Part 2

Ange & I did some more Farmer's Marketing yesterday evening and this morning. She did a smash up job of describing what we bought and the run down of where we went. Check it out here:

On a side note, I will say this: shopping farmer's markets is a learning curve. Last week we tentatively went into the project and bought a few things, but definitely ran out before the week was over. This week I think we went a little wacko-y-wacko and will have to have some major cooking days and freeze some items. We also spent a crap load of money this weekend. But that's ok, but it is stuff that is good for our body and we will make sure it won't go to waste! (I hate waste)

And just an FYI...not everything at Farmer's Markets is great. We learned our lesson the hard way. We're pretty much shying away from most dairy products. Cheeses are ok, but today we spent $5 on a tub of sour cream that was H I D E O U S. It smelled like rotten intestines. Seriously. Ange was brave enough to try it. Sadly I didn't have the camera ready to get a picture of her gagging over the garbage can and scrapping her tongue like a crazy person. Milk is hit or miss as well. We got some whole milk (ick) at Trader's Point. Ange likes it, but I think it looks disgusting. It has some chunks in it that she tried convincing me were delicious, but since I'm not a huge milk fan anyway I couldn't be swayed. We figure as long as we scout out organic dairy products at Trader Joe's or Whole Foods that's a step in the right direction.

So hopefully we'll find a happy medium next week. And for sour cream. Yick.

Friday, July 24, 2009

Farmer's Market!

So Ange & I recently read a book called Animal, Vegetable, Miracle by Barbara Kingsolver. I had received the book for Christmas last year (I always get TONS of books and it usually keeps me busy over the course of the year) and had dedicated it as one of my summer reads, so it was prominently displayed on my bookshelf. I am a reading fanatic and I've been trying to encourage Ange to become more of a reader. So one day Ange was checking out my books and saw it and thought it sounded pretty cool. She read it while I was in Senegal & The Gambia and absolutely loved it. So as soon as I returned home she urged me to move it to next on the list. So I started it slowly between my two trips and brought it with me to Nigeria where I whipped through it. Besides the fact that it was a fantastic book, it was also fun to read it together so we could both learn from it and share the experience.

Basically the book is about eating locally produced food. The Kingsolver-Hopp family moved back to their family farm and decided to embark on a family mission to only eat locally produced food for a year. They grew a lot of their own, but also participated in the local economy of farmer's markets and local dairy farms, etc. Barbara (a highly acclaimed writer of several popular American novels) wrote the main narrative, but her husband, who is a professor of biology, added small snippets throughout that reflected on some facts of the global business of food and its impact on the environment, economy and other things, and her daughter, a college student interested in dietetics and biology, wrote about her perspective as a teenager embarking on the journey as well as including menus and recipes. It was a great book that we both loved, and it also inspired us both. We are both into healthy food and the book brought up a lot of good points about why local is better. To summarize, the food is healthier, it's better for the environment (in several ways), and it's better for communities (by way of supporting farmers directly rather than big agro-business).

While the Kingsolver-Hopp family did the "extreme" end of things, she makes it a point to say that not everyone needs to have their own farm and go as in-depth as them (and acknowledges not everyone could even if they wanted to) but even small changes can be good for all of the above summary points. Ange and I both support this point so we have decided to undertake a small project of our own. As much as we can we are trying to buy our food at local farmer's markets. We certainly aren't going totally nutso, but we are trying to build our menus around the food that is in-season and available at the market.

Last weekend was our initial weekend and we visited the Zionsville Farmer's Market. We had so much fun visiting all the booths and seeing what was available. We spent about $40 and bought enough food for about half of what we ate that week. Plus some items that will last for longer than a week. Take a look at the spread (click to zoom in):

We were a little timid this first week, not knowing what we'd need and not really having a plan of action. We just browsed around and grabbed whatever we thought might be good. Based on this experience we were able to start thinking about it a little more and have come up with a better plan for this weekend.

The added bonus is that we got to spend time together and we were so excited about the whole thing it was better than going out on a fancy date!

Thursday, July 23, 2009

Act like you know what you are doing...

And people will believe you do.

I've written about this in several previous posts, and I firmly, firmly believe it. I think it is one of the best tips I can ever give students and burgeoning professionals.

I am generally not perceived as a timid person. I'm downright sassy and give off a "know-it-all" attitude. Most of the time it is a ruse. I'm actually just a pretty good actress. I know that if my public persona is strong, most people are unwilling to test me. This comes in handy in a variety of situations:
  • When you want something you technically shouldn't have access to. See "breaking into hotel rooms" and "making people give you information that they shouldn't be releasing."
  • When you are trying to b.s. your way out of situation that could cause you trouble. See "forgetting an important assignment's due date" and "making up stories to get you out doing something you don't want to do."
  • When you want to be in some place and you shouldn't be. See "busting into conferences where you weren't invited (or paid for)" and "hob-nobbing with people who wouldn't normally give you the time of day."
These are just a few of the scenarios that have come up in my life where the old adage "Attitude is Everything" have come in handy.

Tips for pulling it off:
First, give yourself a good pep talk before embarking. "I am awesome, and I can pull this off!" is my usual mantra.
Have a serious and determined face. If you look timid and unsure you will be busted.
Walk with purpose. Rarely will people stop you if you look like you are hauling ass because of some important, yet unknown reason. Don't run though...then you look criminal.
Speak with purpose. If you stutter and stammer you look like a liar and fake. Even if what you are saying is complete horse crap so long as it's said with force and passion most people will believe it.
Strike up a conversation with someone important. If you are walking with someone and looking engaged then people assume you're supposed to be there.
Strike up a conversation with whomever you are trying to sway. Flirtations and small talk often work wonders. Charm can get you farther than you believe.

Now I can't offer any hard and fast success rates, but I can tell you it works more often than not for me. Practice makes perfect. If you've done all of the above well and you still can't get your way, I guess it wasn't meant to be. But keep trying. Remember...persistence pays off!

Wednesday, July 22, 2009

Life Lesson: Be Persistent

So as I mentioned previously, the conference that we stayed an extra week for was a total bust. Very unorganized and chaotic. And definitely not worth the expense (both time and real dollars) to stay in Abuja. Our cameraman (who is working on a documentary for us...yeah we're that cool) was heading home Thursday night to go to his nephew's wedding. So I had the brilliant idea that maybe I could change my flight from Sunday to Thursday for a nominal fee. After running this stroke of brilliance past Mercy I called home and asked Ange to call Delta thinking it might be easier to change the ticket from the US. Sadly no.

Ange called me back a few hours later and said that Delta gave her some b.s. explanation about seats or something and that they could get me a guaranteed seat for the low price of $1287. Say what? My original round-trip ticket cost $1218. Why would I pay MORE to change it? In the meantime Ange looked up the phone number for Delta in Nigeria and suggested I give it a try. So I did, and they said there were no seats available. BOO. I told her to try again later, which she did, but still no avail. I resigned myself to being stuck for several more days.

Trying to be a good sport I decided to see if the conference organizer could use my skills...or at least an extra set of hands, even though she lost my reservation and I was staying at an off-site hotel. I was trying to be the bigger person. So I went to find her at the Hilton and asked how I could help. She said she'd need my help...but probably later because everything was so chaotic she couldn't think straight to give me something to do. Okkkkk. So I asked if I could have a name badge (that they had also lost my registration for) so I could at least get into the conference and see what was going on. Oh, sorry, we don't have anymore. Ok, so I can't help and I can't go in. Super.

Mercy was going to a Rotary meeting at another hotel so I was stuck. Suddenly I remembered that I had both of her passports (because she hands them over as soon as we arrive or she may very well lose them) so I meandered over to the front desk to see if I could finagle a room key from them. I told them I was her assistant (true) and I needed to get a key to her room because she was in a meeting and couldn't find her key (first part true, second part very likely true), and I needed to put something in her room (half true, I needed to put ME in her room). I showed her passports to the man and I was very quickly given a key. Genius.

I went up to the room to chill. When she called to check in I told her the story and she just cracked up. She's used to my shenanigans by now. She was also glad that I was able to get in because that meant she didn't have to come back to the Hilton to take care of me and could go on with her biz. On a lark, I decided that since I was really, really wasting time in Abuja I would try and call Delta again, just on the off chance they could come up with a seat home for me.

And wouldn't you know...they did. I had to switch planes in Dakar and fly to Atlanta but bottom line was that I was still getting home 3 and a half days early. And for only the $250 ticket change fee plus some taxes. Ecstatic over the developments I called our camera man to let him know I'd be joining him (he was excited too!) and Mercy to let her know I was abandoning her. The first thing she asked was "Are there any other flights before Sunday???" Sadly, there wasn't. But at least I got home! Saved the foundation some money, and I had a wonderful weekend at home. Worth every last naira of the $319 I paid.

Morale(s) of the story: Never take no for an answer. Always keep asking until you get what you want.

Side Morale: Act like you know what you are doing. Rarely do people question you if you act with confidence.

Tuesday, July 21, 2009

Life Cycle of Our Medical Mission

So anyone who knows me well enough knows that I have been going on a medical mission to Nigeria every summer for the past 4 years. What I realized is that I've never sat down to really explain what this entails. I know some people think we just go and magically provide some medical care and there you go. I also know that even some of the people we work with who've come on a medical mission think that Mercy and I just jump into a mission and hope for the best. What a lot of people don't realize is how Mercy and I have worked on this process for the past 4 years with the goal of constantly improving the ways things work, from both a public health and a clinical perspective, and that the process is highly routinized, even if it looks like chaos when it is going on. This is how we can say we are ecstatic about how a mission turned out, while some people who volunteered and some community members can have their doubts about how effective the mission was. I think if I can get people to understand the bigger picture, then they may be able to look at the mission more objectively. So I thought that the first step is to walk you through the clinic process station by station so you can understand how things ideally work from our viewpoint.

Before I launch into the clinic process I should say that over the past 4 years we've evolved our goal of the mission from general healthcare to screening and treatment of cardiac risk factors. In particular we are targeting hypertension and diabetes. Why the switch you ask? The simple and short explanation is two-fold. First, it is very expensive to treat every condition that comes up, we can't always fix everything (lots of rare diseases show up when they hear Americans are giving away free medical care), and the local community of physicians were becoming upset because we were impacting their practices, particularly economically. Yes, that is a strange complaint, but the reality is, it is true and it is not something we wanted to continue doing. Whether we like it or not, the healthcare workers in the area have to make a living. It isn't like here where they can work at a large hospital system and they'll still make their salary. Bottom line, the less patients they see, the less money they make. And physicians in Nigeria don't make money like physicians in the US do. They are barely making it as it is, so if we destroy their livelihood it is a serious issue. If they leave their practices then who will be there to care for patients the 51 weeks a year we aren't there? So we had to address that issue. We decided that the best use of our money (we have a very limited budget, we are a completely volunteer non-profit) and the best care for patients would be to target health conditions that don't not get treated and managed well. When you think of Africa you likely think of HIV, maybe Malaria, and maybe TB. No one thinks of hypertension and diabetes. And yet, these two conditions can kill you almost as quickly if left untreated. But they aren't "sexy" diseases. No one gets up in arms about them. But they are very prevalent and vastly under treated. Even if they are identified most people do not have the access to medicines that can save their lives. So we decided that screening for these conditions and treating them year-round would be the best use of our funds and make the most impact on lives. This is why Mercy and I work so well together. She can focus on the clinical aspects and I can work on the public health & planning side. Together I think we make a great team.

Early each morning our crowd control workers arrive at the clinic site. We've used different sites over the years but the past 2 years we've used the town hall in Uromi for the main site. It has worked very well, and we like that it is a community site that is not under control of any shady characters that would try and extort things from us. It belongs to the community and we have support to use it. When the crowd control workers get there (between 6 and 7 am) there is usually a crowd already. They distribute numbers that will be used to enter the patients into the clinic. I don't have any pictures because I don't like getting up that early. So just imagine it.

After a patient receives their number they can either go inside and sit in the "waiting area" that has been set up. If they have a higher number they can go about their business and come back in a few hours. This rarely happens. Most people just hang out all day until they are called.

Once their number has been called they come up to the registration desk. Here they are asked basic demographic questions such as their name, their phone number (we switched from addresses because we realized more people had a phone number than an actual address we could find them at), their occupation, and their age or date of birth (not everyone knows either, sometimes they just guess). These are filled out in triplicate using carbon paper. Very old school, but it works. They are then given two copies of their form and enter the "clinic" area. The original copy stays in a bound book so we have proof of their attendance and can keep track of how many patients we've seen. We merge their info later.

When they enter the clinic they first have their height measured. This is important for figuring out their BMI, which is an indicator for cardiac risk (hypertension & diabetes) which is our main goal of this medical mission.

Next, the patient is weighed. Like height, weight is need for BMI.

Another measurement we take is abdominal circumference. This is a very effective, but somewhat under-utilized measure that can tell you a lot about a person's risk for diabetes and hypertension. We are not able to do cholesterol screenings or hemoglobin A1C levels (both are very expensive lab tests--not only do we not have the money for them, but no labs around are able to do the tests) so we want to get as many markers as possible during the screening.

After their measurements are taken they then go to get their blood pressure taken. This will tell us whether or not they have or are at risk for hypertension.

After their blood pressure they get their blood sugar checked by a glucometer. Without going very in-depth about fasting vs. random blood sugar tests, we look at the blood sugar test as a random test and therefore treat diabetes risk more carefully then we would in an actual clinical setting. We set the bar higher because we don't want to treat someone who is borderline when we aren't sure what their long-term sugar levels are.

After all of the screening procedures are completed the patient goes to the nurse triage station. The nurses will look at the patient's numbers and compare them to the cut off points we've determined and they will either discharge them or send them on to the physicians. The nurses have a very important job, because they often do a lot of education and counseling at this station. Patients want to be treated for everything and do not feel any consolation that they are not at risk for diabetes or hypertension. We give out vitamins to make them feel like they haven't completely wasted their day (which WE know, but it's harder to explain that to them). Medicine dependence is a big issue in Nigeria which we are trying to combat in Uromi, but we have a long road ahead of us. Bottom line, if they don't get any meds, they don't think they've been "treated" regardless if they need it or not.

If the patient is at risk for diabetes or hypertension then they need to see the doctors. But before that we want to take their picture, in case they don't show up later and we need to track them down. This also ensures that when they go for their monthly medicine dispersal we are treating the right person. Again, the importance of medicine comes into play. People will "sell" their information to people who just want to get meds. This has lead to some sticky situations and again why we are trying to explain you don't just take medicine. Taking hypertension or diabetes drugs when you don't need them can cause serious harm (passing out, etc.) and even death.

After their picture they then go to the physician. Like the nurse triage station, the doctors have to listen to a lot of complaints unrelated to diabetes and hypertension. They do a lot of education and then tell the patients that they have to go to a formal education station at a pre-determined time (we usually held education sessions at 9am, 1pm, and 4pm). Sometimes the patients would be irritated that they wouldn't be getting meds RIGHT THEN, and they'd give up, but most of the patients would go to the education session.

The patients would then go to St. Anthony's Church to one of the outside pavilions. This is where we held the education sessions. We used to do them at the hospital but we had some issues with the Chief Medical Director and decided to look for other venues. We have a good relationship with the Catholic Church in Uromi so we were given access to the pavilion for free and with community support. At the pavilion the patients sit through a 20 minute presentation about diabetes and hypertension which covers the basics, e.g. what is the disease & how it works in the body, what lifestyle changes you should make (diet & exercise), education about medicine and why you may or may not need it. They then have a question and answer period where they can ask lots of questions about the diseases. This typically last about 30 minutes and they have lots of good questions.

After the education session they are asked to select a primary health care clinic where they will go for their monthly check-ups and medicine dispersal. Again, some are irritated that they aren't getting their meds right then, but it is still part of our grand scheme. If we give them their meds there, they may not follow up with their health clinic, and if they don't, there was no reason we should have treated them for 30 days and not again til the next year. We are trying to educate as well as treat so this is an important part of the process.

At the end of the week we worked with the health clinics about how the process should go. It didn't go as smoothly as we'd like, but it was step in the right direction. This is the first time we've been able to accomplish this part, so we knew there would be some bumps and bruises but Mercy and I are used to that, and we can see when progress is made, no matter how little or insignificant it looks to outsiders. The patients showed up on Friday as instructed and waited patiently for us to work with the local workers to train them on the process.

After collecting the forms from the patients who showed up, Mercy would work with the healthcare staff (mostly nurses) to work out a management plan for each patient. For those on borderline we told them to do the things they learned in the education session (eat better, more cardio exercise), and to come back for a check up in 1-3 months. If they needed treatment (past borderline) Mercy and our other doctors would decide what prescriptions were appropriate and wrote it out on their management form.

After all the prescriptions were written, either the doctors or the pharmacists we had working with us would call the patients in, explain their management program and given instructions about their next steps (take meds, when to come for check ups, etc.). After that, they were all done with us.

So that is the long and the short of it. We hope that the process will stay in place and that next month we will get a report from our data collection agent that the clinics are all working and that they will continue to work until we come back next year! We're hopeful, but we also know that we may have more kinks that we may need to deal with in the interim.

Hopefully this gave you a better overview of the process. Leave a comment if you have any questions.

Monday, July 20, 2009

Nigeria Trip: Summarized with Pictures!

So the long and the short of the trip.

The medical mission was good; we accomplished what we wanted. We've made progress over year's past. Mercy and I were very satisfied.

The volunteer management aspect of the trip pretty much sucked. It was hard to meet their needs, and we had some moody ones this year. Overall the group was ok, but you know the saying...a few bad apples spoil the bunch.

The conference we stayed the extra week for also blew. It was disorganized and after we did our session we realized it was a waste of time and planned for something else. Mercy went to visit family and I stalked Delta until they let me come home early at a reasonable price (more on this later).

Taryn & Pat (2 of our American volunteers) working hard during the screening

Me with one of our guards Abiye. Everyday I told them that I did NOT want to be kidnapped so they better do a good job. And every day they would say "Oh Lindsay. No one will kidnap you. They don't want to be chased by the US Embassy." Good to know.

Random shot of a ceiling fan in the Town Hall. If it's not labeled it may be stolen.

Gotta love abbreviations in other countries. Comm Ass. Lovely.

Homemade birth control chart in one of the satellite clinics. Very cool.

Want to know how you move large panels of wood in Nigeria? Hop on a motorbike and drag along behind you. I cracked up over this one.

NY Diva worked on a Jump Kids Jump project for her culminating MPH project. Her preceptor was a jerk and has seriously exploited the fruits of her labor. So of course JKJ is now one of our sworn enemies. So when I saw these in the pile of children's toys I had a good laugh to myself.

It rained like crazy the entire time we were there. It literally rained every single day. Not all day, but every day. It rained so hard that there were some serious flash floods. This was just a random street.

This little man was so cute. I saw him everywhere I went. He was soooo old and walked with a cane. He just shuffled, shuffled, shuffled everywhere. So naturally I had to get a pic with him.

These were termites.Mercy said when they were little they would catch them and eat them (fried). Sick ass.

Mercy in the middle of the lecture at the conference. She did a great job.

There was some important meeting going on at the Hilton. All these Emirs from the Northern states were there. The first day we were there they came blowing through security like nobody's business. I was so flabbergasted I didn't take a picture or video. But the next day I caught one of them and snapped a picture.

This was in the hotel room at the Hilton. It's so Muslims know which direction to pray. Neat, huh?

I know that wasn't a great summary, but hopefully you got a minimal overview and saw some cool pics. When you've done the same things for 4 years it's hard to be inspired to write much more. If you have specific questions, hit me up. There will be some random stories here and there soon.

Sunday, July 19, 2009

Home sweet home

Well I am home. Yes I'm early. Three whole glorious days early. Nothing catastrophic happened to send me home early. We stayed the extra week for a conference. The conference turned out to be bunk so I stalked Delta until they found me a seat for a reasonable price and I was out! Many blogs about random shenanigans to follow. For now I am relaxing and enjoying the weekend with my love, my new bathroom, and our brood of dogs. You'll hear from me shortly. Until then, enjoy this random picture:

Yes as a matter of fact that is a dead animal in that bag. She was trying to sell it to the restaurant we were at. I pretended I wanted a picture of her child. I know, shameless.

Thursday, July 2, 2009

I'm Outta Here (again)!

Taking off for Nigeria today. I'll be gone for 3 weeks. Off to do another medical mission. Hopefully all goes well and I'll have fun stories to tell when I get back in later July!

Wednesday, July 1, 2009

Sam's Club

I saw this picture on LOLDogs and it made me think about Ange and myself. Cause neither of us has hot abs. But we love each other anyway. And then I remembered that I had a blog in the queue that needed finishing. Trains of thought are fantastic.

So Ange and I have a love affair with Sam's Club. I used to belong to Costco, but sadly there are only two in Indianapolis and they are both on the North side of town. Sam's Club is around the corner from my house. Secretly I love Costco more, but I'm not driving all the way up there for it.

So Ange and I frequent the Sam's Club frequently. We like to go and look at the cool stuff. But mostly, we like to eat free samples. I mean, I don't know many people who don't like free samples, but I also don't know people who like free samples as much as us. One of the saddest things about being a vegetarian is that many of the free samples are meat products and that means I can't eat them.

Now the reason I really thought about this blog when I saw the chubby dogs was because on one of our recent trips I was striking out in the non-meat department side of things while Ange was eating high on the horse. BUT, they were serving cream puffs. Have you ever had the frozen cream puffs that Sam's sells? If not, you should totally go get a membership and get some. They are soooo delicious. So I was basking in cream puff heaven for a bit and then I was sad again because I was back to meat hell.

Now, for some reason Ange and I can't pull it together when we're at Sam's and we end up wandering the aisles like drunken hobos frequently re-tracing our steps to get stuff. It works out well most of the time because, if you didn't know, the sample ladies are not always manning their stations. So sometimes you miss some samples. But if you are bobbing and weaving through the aisles sometimes you get lucky and hit a station you missed before.

So as we were walking past the cream puff station and I was looking longingly at them I see Ange hiding behind the stack of bulk whatever and see her arm snake around the corner and snatch up a cream puff while the lady was busy schmoozing someone up to buy them. Yeah, that's right, Ange double dipped a cream puff for me. Now that my friends, is love. I don't think I've ever tasted anything so delicious in my whole life. That is why we are perfect for each other, abs or no abs.