For me, last week has been quite amazing. A one month old baby was brought in a seriously emaciated state. He had been having treatment at another centre for an infection in one testicle, but clearly had a strangulated hernia. The nurses at the other centre had persisted with antibiotic treatment for about 3 weeks before referring the baby to us in Zidim. The only chance for survival would be surgery, but his condition was so poor that the chances of surviving surgery seemed slim. The family decided they couldn’t afford the operation (£30, which is a huge sum in local terms) even on “credit”, so left the hospital. I found this really difficult: for us £30 is not a huge sum and I found myself wondering if I should have offered to pay. I was warned against that as it would only open flood gates. I suspect the family’s decision was right – I don’t think there was any hope for this baby.

Wednesday, I was assigned to “assist” Abdou with a laparotomy (operation to explore the abdomen). When he handed me the scalpel to start the incision, I felt instant panic, but had no option other than to proceed. In fact, he is an excellent tutor and guided me safely, taking over when I was clearly out of my depth. After that I was sitting in on consultations with Sylvia when we were called to see a casualty with a gunshot wound. There he was, sitting with a bandage wrapped round his left hand. He proceeded very calmly to remove it, revealing a charred fragment of bone which was all that remained of his left thumb! When asked what had happened, he explained he had been shooting birds with a “fusil Africain”. This _expression_ explained all as no one seemed at all surprised. Having seen the thinness of African metal work, I can easily understand that the gun must just have blown apart in his hands. There was no option other than to amputate what was left of his thumb. I expected this would be arranged later in the day in theatre, but in fact one of the nurses dealt with it in the “minor surgery” room!

That same night another casualty turned up, the victim of a brawl. His assailant had finished up stabbing him in the face just in front of his right ear. Sylvia and her nurses had great difficulty stopping the bleeding from a severed artery (for those of you who are technical, I think it must have been his temporal artery), but managed it eventually. He is left deaf in his right ear and with the lower half of his face paralysed. At present, he is also having to cope with a postoperative infection. Just hope he makes it. His assailant has been carted off to jail in Maroua, I think.

I have been doing a bit more consulting with the help of nurses to translate and keep me right on procedures. They’re very patient and helpful, but it will be some time yet before I feel at all confident.

I have now started formal French lessons, daily for an hour starting at 4pm. My tutor is Oomarou, a brother of the Lamido. I’m not sure how useful they’re going to be, but I am enjoying them and Oomarou is very encouraging. Later, he will be my tutor for Fulfude.