Reflections with one week to go...

Bon soir,

We've come to the end of our second week in Niger.  We had pizza cooked with veggies we purchased from the market and in the other room I can hear Toy Story 3 playing to make our pizza and a movie night complete. At times, life here feels so real and normal.  We have a morning routine, spend some time in the clinic working with patients or teaching and then can usually count on soccer in the afternoons in the yard. I sometimes forget than I am half way across the world in a country and culture very different from what I am used to. I am learning to read pepole and communicate without words, because my french and hausa are minimal at best. Even though I don't speak the same language as the kids in the yard (or pronouce half of their names correctly), I feel like I know them, who is most competitve and likely to get upset when a goal is scored against us, who has the tricky feet and will school their opponent every time, who will pass to the younger kids to make sure everyone feels included in the game, and who will take time to patiently correct my poor pronounciation after five failed attempts. The people here are so welcoming and sincere and fun to be around, depsite the environment in which they live.

There are other times when I am keenly aware of the disparities between what I am experiencing here and the life I am used to at home.  The conditions in which people live, the trash that lines the roads, and the beggars that roam the streets are heart breaking.  The whole picture can be overwhelming, what can I do to make difference? Is it worth traveling half way around the world and not even make a dent in the problems the face this country? We've had a few conversations as a team about this very idea. What's the point of a trip like this? What it comes down to for me is I know that we am not going to change the world, but we can make a difference in someone's world.  As Greg told us before we left, we are bringing the people not only physical therapy skills and education, but also hope. It's about the individuals we encounter, the difference we make in their lives, and the difference they make in ours. God has created us to be dependent on each other, learning and growing from the fellowship we share with one another, whether it is our neighbors down the street or a kid with a soccer ball half way across the world.  

I truly believe that God has orchastrated every aspect of this trip so that we are able to meet the people and visit the places that are instrumental for impacting the health care environment of Niger. It is obvious that physical therapy can make a huge impact on the lives of the people living here.  Many people live with pain or disability because they don't know what physical therapy is or where to go to find one.  The physical therapists here are desparate for continuing education, promotion of the profession among the people, and a school for locally trained therapists because they recognize the needs of those around them and how they could make a difference with the right training and resources.  Their passion for learning and desire to create a better life for the hurting and disabled in this country is inspiring to me and makes me excited to begin my career and use the skills I've been taught to make a difference in people's lives.

I've not only been inspired in my professional life, but in my personal life as well. God continues to reveal different aspects of his character throughout the duration of our trip.  I've realized that I try to fit God in a neat little box, small enough for me to understand who he is and what he is capable of doing.  A box that isn't too scary or intimidating, but comfortable.  The more I see how he is working in the lives of pepole here and even some of the events of our trip, I'm beginning to understand that God is beyond my comprehension and bigger than any box I can imagine.  It's both exciting and terrifying to see what he has in store for us next. Whatever it is, I know it will be better than anything I could plan or even imagine.

Au revior!

Michelle

The Work We are Doing

It's probably time for us to share more about the things we are doing outside of camel rides and hippo chasing. The clinics we've spent the most time with are Hope House and CURE.  They compliment each other well and have allowed us to see and experience a variety of diagnoses and treatment techniques. To start we'll talk about some of the most common diagnoses we've seen, which clinic/hospital is best suited for that diagnoses, and what they do to treat each one.

Hope House is a Nigerien run clinic that typically sees club foot, leg deformities from Rickets, contractures from burns or spasticity, brachial plexus injuries, and cerebral palsy. The main form of treatment is serial casting.  Jeanne will be happy to know that Kristina is now Nigerien trained in the Ponsetti method since she was unable to learn during the serial casting lab mishap with the cast saw.

CURE is an international organization that has hospital locations in 11 different countries.  This campus was opened in October and run by an anastethesiaologist from Pennsylvania, a surgeon from France, and a host of expatriate and Nigerien nurses, doctors, and staff.  Their main focus is children with cleft palate, club foot, limb deformity, post stroke rehabilitation, and trauma following burns or fractures.  They also use some serial casting, but primarily work with severe cases where surgical fixation is necessary.

Here are some pictures of selected patients:

This little boy has rickets.  They surgically corrected his left leg at CURE and he is receiving inpatient rehbilitative care at Hope House.  He will have the other leg surgically fixed once the left leg has healed.

This little girl has a brachial plexus injury and presented for therapy at Hope House.  She cried for the first hour, didn't speak French or English, and was terrified of Dr. Carey, Michelle, and Kristina.  We eventually found a way to communicate (showing her how to play with toys), gave her animal crackers, got her to use her injured arm, and got some really great stuff for a home program that we showed her mom.  She also warmed up to Kristina and Michelle.  Not Dr. Carey though.  When he was around, she hid behind her mom.



Here is Kristina being trained in the Nigerien ways of serial casting at CURE.  This was for a young man who had what we think was cerebral malaria, resulting in a paretic left arm and associated wrist and elbow flexion contractures from disuse.  He, unlike the last patient we had with a wrist flexion contracture, did not try to bite anyone.

This little boy is actually 14 years old.  Before coming to CURE, he walked on his hands and knees resulting in the unusually large patellae (knee caps) seen above.  He also had knee flexion contractures, which were the reason for the serial casting.  He hated Michelle.  And the PT.  Mainly because Michelle wouldn't let him scratch AND painfully extended his knee while the cast dried.  Kristina consoled him.  And he loved her.  However, Kristina later betrayed him by recreating the pain Michelle had previously inflicted on the other leg.  He yelled, in Hausa, "For the love of God, leave me alone!" throughout the entire session.  Thank goodness for translators.

This little girl actually liked all of us.  I think it was because we had nothing to do with her treatment and gave her a necklace, a ring, and a princess sticker.  She was from an orphanage and came into CURE with a fractured elbow that healed with a 70 degree flexion contracture (her elbow was bent at a 70 degree angle and she could not straighten it from there).  She currently is at 38 degrees with weight-assisted and manual stretching.  I think she even liked Dr. Carey.

 

In addition to these two clinics, we particpate in consultations at the guesthouse where we are staying.  Those types of patients range from local missionaries with shoulder pain to 12 y/o kids with knee pain to the brother of one of our students who had back pain. Sometimes the consultations occur when Susan's clinic is open for business, other's occur whenever we have time. Kristina was even able to use her wound care skills to bandage a toe nail (or lack thereof).

We are now off to teach English to one of the guys that works for our hosts while he teaches us Hausa.  Should be interesting. 

Sai wani lokaci ("until another time" in Hausa),

Michelle and Kristina 

 

Our Weekend in Pictures

Sannu (Hausa for hello)!

So, the waiting is over.  This is our picture-focused blog to describe our first full weekend in Niger.  A weekend which also marked the loosening of previously applied rules given to us by the US embassy.  Originally, we had to be in our house from 8 PM - 6 AM and could not travel outside of Niamey (which pretty much eliminated all fun outings such as the wildlife park, giraffes, hippos, and sand dunes).  But now...we can stay out to the late late hour of 9 PM and we can travel anywhere in Niger (the real bonus to the deal).  In addition to our rules, the representative at the embassy led us to believe that any Nigerien would pick-pocket us before we knew what was happening, that we were practically the only targets for the Taliban since all other volunteers had left the country, and that if we took a picture of a governement building (or anything really), we would be "staring down the barrel of an AK-47".  I think he exaggerated as we all still have the money we did not spend, have not yet been kidnapped, and the only weapon we've seen was a sword sticking out of someone's backpack (which according to the embassy is completely normal for everyone to do).  Our hosts, who have lived here for 4 years, also seemed to think our embassy representative was a tad dramatic.  However, we have gleaned what we needed from the embassy meeting, have talked with our hosts and other locals, and have taken the necessary precautions to ensure we are safe during our stay.  Now, we are excited for our new found freedom.

So, without further ado...OUR WEEKEND!

Friday:

Friday started out with the last lecture of the 5th year medical students at the University.  The lecture itself went well, but the real excitement was the papparazzi (?) scene we encountered upon leaving the classroom.  You see, white people are famous here.  Literally all of the 50+ students wanted a photo with the "beautiful white girls" who are "very smart".  Direct quotes, I promise.

This is the one with the majority of our biggest fans.  We also took a picture or 2...or 3 with each individual person as well as groups of friends... this picture session lasted at least 20 minutes.

Unfortunately, Friday night was also when we said goodbye to Betsy, but you already know that story.

Saturday:

We started out with a trip to the Musee (zoo) with 3 members of the Medical English Club. 



Note the rules, such as "Do not jump on hippos".  Also, hippos apparently will eat you, as will crocodiles (keep this information in mind when it comes to Sunday).  Of course, our French is minimal at best, so we're not sure if this is what the captions said, but we all agreed this is what the pictures meant. 

 Turns out there was a special exhibit at the zoo this day.  US!  We were followed around the entire time by a group of children that thought we were, by far, the coolest animals there.  Above is Dr. Carey with about 1/3 of our followers. 

And here is the group with the Medical English club.  They bought all of the girls (Michelle, Kristina, and our new friend, Lori) a bracelet.  This may or may not mean that we are married to them according to our host, Susan. 

After the Musee, we had a goobye dinner for Dr. Steve (so, if anyone gets sick now, we are in trouble) and stopped by our friend Chako's house (he's kind of a big deal in Niger) for a final goodbye.  The problem with this, however, is that Chako likes to talk.  A lot.  He also likes to learn about everyone in the room.  And their families.  And their dreams.  And their three favorites things.  He also apparently likes photo shoots.  Here is a sample:

Steve, Chako, Madame Chako (this is how they refer to wives in Niger), Dr. Carey, Michelle, and Kristina.

And here is Chako's photo genius.  He insisted on taking pictures in which the subjects were looking at each other.  Quote from Steve: "I feel like I am at my wedding".  Chako has since proceeded to tell many people about this night, but not without emphasizing that it "was not a gay wedding".

In all seriousness, Chako and his wife are wonderful people and have done a great job making sure we feel at home here. 

Sunday:

Sunday started at our hosts' church.  Church here lasts three hours.  Saying goodbye after church takes another hour.  At least.  The church we went to had beautiful music, which was good since this composed the first hour.  We were lucky enough to have a translator as well since the whole service was in Hausa and French, given to us precisely when we started to zone out entirely.

After church, we went to an area outside of Niamey for a variety of fun activities. 

Activity 1: riding camels.

The ride up in scary.  The ride down is terrifying.  The ride straight, sort of like a horse, but less comfortable, especially when your saddle is shifted to the left like Michelle's.  This shift left her terrified that she would fall off the camel into the thorn trees, which caused Dr. Carey to pour blood from his head all over the back windshield just last year (but that's not our story to tell).  Also, for the PT students reading, note Kristina's SCM's and scalenes.  Dr. Carey plans to use this picture for his next anatomy exam.

Activity #2: Searching for hippos.

Here is the canoe used for such a task.  On the shore, pituresque, but on the Niger River, slightly leaky.  As we entered the hippo's territory, we saw a baby hippo jump into water!  Cute, until the 3 adults it was with got angry and chased us.  Suddenly the canoe, not so pituresque, was more of a death trap.  However, our gondoliers were speedy and saved us from certain doom.  From the looks on their faces, we think it was close.

(can you find the hippos...they're stalking us and making angry sounds...)

Activity #3 (after narrowly escaping): Touring the village of Kanazi.

Kanazi is a very small village where we got a whole tour by all the kids that lived there.  We got to see the crops, the houses, the school, the hospital, and hundreds of bats.

At the school we got serenaded with a welcoming song and the national anthem of Niger by part of the crowd of children guiding us.

 Here is outside of the school with all of our little tour guides.  Most were excited to see us, but some were terrified as we were the first white people they had ever seen. 

All in all, this weekend was a great experience.  We got to see camels and hippos and bats up close and learned that in Africa, white people are apparently the most exciting exhibit for locals.  We made lots of friends.  And possibly husbands.  We're not really sure of all of the cultural customs here yet, but we're learning.

Sai an jima (Hausa for "until next time"),

Kristina and Michelle

Au revoir, Betsy!

So, as you all saw, we bid farewell to Betsy Friday night so she could go back to the US and get the medical care she needed in an American hospital (as opposed to the make-shift clinic/guest house here) and sleep in her own bed without goats bleating at her all day long.  Though we will miss her, we were glad to hear that she made it home safely and is starting to feel better!  Continue to keep her in your thoughts and prayers as she heals. 

Here is a picture of our last few minutes together with the whole team: Dr. Carey, Kristina, Michelle, Betsy, Dr. Troy, and Dr. Steve (our personal physicians who fearlessly saved Betsy's life):

 The three students together for the last time in Niger:

We love you, Betsy, and hope you get better soon.  Hope you are enjoying your Jamba Juice, Sprite, and lack of calls to prayer at all hours of the night!

And now for a preview of our weekend adventures in celebration of our ungrounding by the embassy...

Stay tuned; coming to a blog near you!

-Michelle and Kristina

One for the Books

How many people do you know who have had a spinal tap in Africa?  Probably just one.

Yesterday stared off as a bizarre day and became one that we (at least I) will remember.  We all woke up about 3 hours before our alarms went off due to an especially obnoxious dog barking outside the window for at least a half hour, followed by the Muslim Call to Prayer that last about 57 times longer than usual.  When it was time to actually start the day, we left for the University to continue our lectures, and we learned that the taxis in Niamey had gone on strike, leaving citizens who depend highly upon the taxi system standing around the streets aimlessly wondering what to do next.  While Michelle and I got the lectures started, Dr. Carey and Kristina attended a support group for women and children with cerebral palsy.  However, due to the taxi strike, none of the group members showed up. 

Before I begin with the main story of the day, let me back track and explain why I've been MIA from the previous posts.  Since Day 1 of the trip I've been sick with a fever and neck stiffness, which did not change despite treatment and contant care from the American physicans (Troy and Steve) on the trip.  I've been bedridden most of the week, and in fact I think I've learned more about the shapes of the paint chips on the ceiling and cracks in the walls than I have about Niamey.  Granted, I was able to participate in a couple things each day, and make it through my lecture on Fistula today, but most of the week I've been forced to be a complete party pooper. 

So back to yesterday...  After returning home for lunch, my neck stiffness and headache were much worse, so the American doctors and Susan did an exam, concluding that it is likely that I have meningitis.  They all agreed that I would need an LP to rule out the bacterial form, which is much more severe.  When I heard "LP," I thought they meant some kind of lab procedure, like a blood draw, and there was no way in heck I was letting anyone touch my blood in Africa.  The words "needle" and "Africa" did not belong in the same sentence in my book.  So, when I discovered that LP actually meant lumbar puncture, or spinal tap, you can imagine my enthusiasm (that was sarcasm).  Bigger needle, and not just into my arm, but my spinal column to test my cerebrospinal fluid.  This is necessary to differentiate between viral and bacterial meningitis. 

So I packed my bag (unsure exactly what one should pack to go to an African hospital, but figuring that my Nook e-reader and Dora the Explorer fruit snacks were probably necessary) and we all jumped in the vehicle to head to the best hospital in Niamey.  Every single person in the group sacrificed their afternoon to come with me without even thinking twice.  We got to the hospital (and who knew that Clinique means clinic?  Is that why they wear lab coats at the makeup counters?) and waited in the waiting room drinking sodas from glass bottles (coolest thing about Africa thus far), then it was my turn.  Terrified, I went in with Susan and Troy.  The African doctor did the exam, then wanted to admit me overnight in order to do the spinal tap.  Since I have yet to see an African hospital room, I'm picturing a mix between a military hopsital from WWII with amputee patients side by side and an orphanage.  But since I've never even spent the night in an American hospital before, any orphanage-like room where they only speak French, unless you're reading from the book Madeline, is not my cup of tea.  So on to Plan B...

We left the clinic and drove around to just about every Pharmacie (pharmacy) in town to get all the supplies we needed for Do-It-Yourself lumbar puncture.  After we had everything, we came back to the guest house and the American doctors prepped.  Seven-year-old Lydia gave me an Ariel sticker, my second favorite Disney princess (I already had a Belle sticker from Michelle) for good luck.  Still terrified, but a little more relieved that it would be Troy performing the procedure, I went in the room.  In fetal position, I talked myself into being as brave as Troy's bone marrow transplant patients, who are probably 1/5 my age.  Surpringly, it was not that bad.  And I'm probably the only person I know who has had a spinal tap in Africa.

They started me on an IV as we wait 48 hours for the lab results.  Unfortunately, I will be going home tonight, 2 weeks earlier than planned.  I need to make sure I get the medical attention I need at an American hospital.  Although this week in many ways was miserable and I felt like I wasn't able to contribute as much as I wanted to our learn as much as I had hoped, I did learn a few things through this whole ordeal.  I have so much appreciation for Dr. Carey, Kristina, and Michelle for being there for me every second, and for Troy, Steve, and Susan for taking such good care of me.  I was able to experience African healthcare from a patient's perspective and gain insight into its problems and downfalls.  And by driving to the hospital and then to every pharmacy in town, I was able to see more of Niamey than I probably would have otherwise. 

I wish Dr. Carey, Greg, Michelle, Kristina, and Kate the best of luck on the remainder of their trip!  I will be thinking about them and I hope they have many amazing experiences. 

Au Revoir!

Betsy

Telephone Translation

When I (Michelle) first woke up this morning, I decided I liked waking to the gentle crow of a rooster.  It's a more pleasant sound than the constant beeping or ringtone that I am used to.  However, I quickly realized that roosters don't come with snooze or off buttons and after a half an hour of constant crowing, I changed my mind.  Once I was fully awake thanks to the rooster/barking dogs/goats outside our window, we got up and headed to the university to teach the medical students about electrical stimulation and soft tissue mobilization (aka massage). They seemed to enjoy the leacture and practice time and really got a kick out of making each other involuntarily contract their muscles through the stim machines. After our lecture and lab time was complete, Kristina and I each saw a patient and demonstrated how to complete physical exams.  Kristina lead the students through a low back pain exam, letting a different volunteer complete a different part of the exam they were taught yesterday during lecture.  I taught them how to complete a neurological exam on a woman with stroke.  This was an interesting experience.  She only spoke Hausa, the nearest tribal language, the hausa interpreter didn't speak english, so I gave directions to the French interpreter, who gave instructions to the Hausa interpreter, who then gave directions to our patient.  Needless to say some things got lost in translation.  While conducting a peripheral vision test, I asked the patient to look at my nose and point to which hand was wiggling.  When all was passed through our telephone of translators, she reached up to grab my nose.  Later I asked permission to touch her hips to facilitate weight shifting, when the message reached her she reached over to grab my hips.  She was a very sweet older women and everyone had a good laugh over our antics.

We spent the afternoon at "the mall" (aka market) to see what different artisans were selling.  It was a cool experience and maybe before we leave I'll have enough courage/language skills to negotiate prices for souveneirs I would like to bring home (so get your orders in now).  I ended up getting a wallet to keep my Nigerien money in and a leather map of Niger which artistic decorations.

We ended the day with a rousing game of volleyball.  A visiting friend of the missionaries we are working with is a PE teacher in the states and brought a volleyball net and volleyballs to teach the local kids a new game.  We never were able to communicate the point system so it was actually more like hit the ball over the net and keep it in the air as long as you can. Our team did get down how to rotate positions by the end of it though.  The kids then proceeded to try to teach me words in French, Hausa, and Jarmin another local tribal language.  I don't think I retained any of it, but i promised to bring a pen and paper tomorrow so they can teach me their languages while I teach them English.  It's been a blast to play and hang out with the kids everyday, especially since they love playing soccer as much as I do. Although I've discovered that playing in  skirt adds a whole new challenge to the game.

Tomorrow Betsy and I will be teaching at the university, Kristina and Dr. Carey will spend some time at Hope House, and that's about all I know for the plan tomorrow!  There really isn't a schedule, we're on Africa time, which is one thing that doesn't get lost in translation.

Bon nuit!

First day at Hope House

This morning, Michelle and I (Kristina) spent our first day at Hope House observing and helping with patients.  Hope House is a children's hospital on the border of Niamey that caters to children with neurological disorders, particularly those that require casts and bracing.  Especially children born with club feet who require casting to correct them.

We started the morning with a 6 month old who had damage to his brachial plexus during childbirth and was left without any movement in his right arm so that it remained stuck behind him.  With PT at Hope House, the child was able to move his arm around, though he did prefer his non-affected arm, and had strength to reach for and hold onto toys.  Michelle got to spend a lot of time evaluating and treating him.

In the meantime, I was able to watch a young boy who suffered a stroke at 13 so that he had flexion contractures in his right arm at the elbow and wrist (both of these joints were stuck in flexion and were essentially unusable).  He was getting new cast in a series of casts to bring his wrist into extension so he could utilize it.  He had a lot of pain with placement of the cast where he attempted to bite and kick his therapists, but he also seemed to understand why he had to endure so much pain and left without actually having bitten anyone.

We also saw a girl and a boy get fitted for AFO's (a brace) because they could not dorsiflex their foot so that their foot dragged on the ground when walking and they have to bend their knee and lift their leg to keep it off the ground.  This disorder was due to anti-malarial injections, which are often placed in detrimental spots in Niger so that the medicine destroys the nerves in the leg (in these cases, the sciatic nerve from placing the injection in the buttock).  In addition to not being able to walk well, they had no sensation in their affected foot, thus both had histories of severe injuries to the feet because they could not tell when they were burning them or stepping on something sharp.  So, when they get their AFO's later this week, they will be protected from injuring their foot and they will be able to walk with a normal heel to toe gait pattern.

Finally, Michelle and I got to help remove bilateral leg casts from a little child who was getting casted for club feet.  She had originally been casted and then received a surgery to finish the process, but her shoes meant to be worn to protect the feet while they healed broke and her mother did not know to return to PT to get new ones, so by the time the therapist saw her again, her feet had begun to return to their "clubbed" posture, so she had to get more casts.  It was really nice to be hands on, but we unfortunately had to leave in order to make it to our next place before we had a chance to attempt the actual casts.

Overall, the experience was a great one!  We saw a lot and got to be very hands on.  Our therapist spoke English well enough to discuss what was happening with us and our host came along to help translate as she was available.  At least one of us will be returning there Thursday to help with a support group for kids and parents with Cerebral Palsy.   We'll be sure to keep in touch!

-Kristina & Michelle

No elephants, but at least there are goats...

We arrived in Niamey, Niger, on Sunday evening after about 30 hours of travel through NYC, Paris, and finally to Niamey...three continents in one day!  Our trip was relatively smooth and uneventful, the highlights being Greg Santema, group leader of the trip, being offered a wheelchair at the airport (does he really look THAT old?!), and Dr. Carey, unbeknowst (I think I spelled that wrong) to him, singing excessively loud to his Queen music on his iPod on the trip from NYC to Paris.  Michelle, Kristina and I were in tears from laughter before he realized we were laughing at him.  I mean laughing with him, of course.  In Niamey we are staying at the Evangelical Reform Church guest house.  We have hot meals, real beds, running water (but don't drink it or you may pull a Charlotte from Sex and the City: The Movie), and screens in the windows, luxuries many Nigeriens do not have.

After settling in on Sunday evening, we set our alarms for 7 am (which was seriously unnecessary considering considering the sounds of barking dogs, bleating goats, and the Muslim Call to Prayer at dawn) for our first day of teaching at the University.  Today's events included 4 hours of teaching to medical students about musculoskeletal exam, a trip to the U.S. Embassy (where we learned many insightful facts about Nigerien culture and current events), and seeing patients at the guest house using French (and Hausa) interpreters.  Our patients appreciate our compassion and the special attention we give them.  Another highlight of the day included playing soccer and baseball (which then evolved into hitting the ball, then playing tag, since the concept of bases was ultimately confusing) with neighborhood Nigerien kiddos in the yard (aka sandpit).

Despite the jet lag, cold showers, tummy aches from Malaria pills, and stuffy noses from the dryness and dust, we're learning to be flexible and we anxiously await many (more) adventures to come.  Look for more details and photos in the near future (but photography is limited, according to the U.S. Embassy, unless we want an AK47 in our faces).

Peace, love, and Malaria pills,

Betsy

One week and counting...

Bonjour!

Today begins the one week countdown as we anxiously await our departure on our great adventure to Niger, Africa!  As we sit in Nokomis Beach Coffee Cafe discussing details of the trip, revising our packing lists, and planning our lecture topics for our education of health care providers in Niamey, Niger, we experience a mixture of excitement and anxiety.  We look forward to many amazing and rewarding experiences including educating medical students on human anatomy and musculoskeletal examination; treating children with birth defects and developmental abnormalities; treating wounds due to leprosy, burns, and trauma; experiencing African culture and way of life; using interpreters to communicate in French and Hausa, and hopefully learning some of the language ourselves; going on a real African safari and seeing animals we've only seen in zoos up until this point; and many other adventures that will expand our perspectives and allow us to grow and learn.  We are excited to provide high-quality healthcare to a population in need, to develop our physical therapy skills as we practice and problem solve with diverse patient populations, and gain an appreciation for our own culture and lifestyle as we experience life in an impoverished nation.  Thank you to all our friends and family who are supporting us on our journey.  We can't wait to tell you all about our experiences.

Au revoir!

Betsy, Michelle and Kristina