August 18th, 2011

I can not believe I leave tomorrow. I’m not real happy about it.  There are plenty of things I am looking forward to when I get home, but the idea of finding a job and moving sounds like too much of a hassle- especially after getting used to the easy and relaxed way of life around here.  I’m definitely excited for this next chapter of my life, but I think vacationing and traveling the world for the rest of my life sounds much better haha.  I don’t think my parents would be too thrilled if I ditched my plane so I will be back in the states on Saturday. J

I went on an awesome adventure the other day.  Samuel, Josiah (just graduated form high school, spending 6 months out here with one of the families), and I hiked to the top of the highest mountain right near the compound.  There are a few families living up there, and a few young boys were our tour guides for a while.  The kids absolutely loved hanging out with us!  We ran across a man that spoke some English and he led us to the river where they get their water and to a church.  I’d say this is one of the coolest churches in Togo because it has an incredible view, overlooking Tsiko and Adeta.  Instead of taking the trail back down we (well, mostly I… it took a little convincing them) went straight down the side of the mountain.  We met a farmer working in his corn field and eventually (he really tried convincing us to go back to the trail) he pointed us to a goat trail of sorts.  It was pretty strenuous and we got plenty cut up and attacked by ants, but it was a ton of fun.

Aug. 14th, 2011

We have started a NICU. A 32-weeker, and three 30-weekers (one set of twins). We lost two preemies in the last few weeks I have been here, but these four kids are going strong so far. We just have to go day by day and tell the nurses to pray every time they give a feed that the baby’s stomach will tolerate it.  One of the long term missionary doctors, Dr. Gayle, is back from furlough so that has been nice for everyone, especially Dr. Briggs who has had the lead role around here for several months now.  The pediatric ward has continued to stay pretty full this last week, and yesterday was a particularly bad day.  A few of the kids have come in having received malaria treatment elsewhere, but it just wasn’t quite long enough so they get anemic and come to us.  It still surprises me how many of the patients have gone to several other places or tried all different types of treatments before showing up here.  It’s astonishing how many people do not have access to decent health care in this country and continent.

I watched two of the most disgusting surgeries yet: drainage of an abscess in a thigh and drainage of an abdominal abscess. I won’t get into the lovely details for you all, but it was sure a smelly, puss-filled, nasty task for the surgeon.  Most things here are a good ten times bigger or worse than anything ever see back in the states.  People don’t have money to spend on healthcare so they just wait until they can’t function any longer.  I have seen several leg fractures (open and closed) that didn’t seek treatment for months so there isn’t a whole lot we can do for them, and infections that have gone untreated so long that there is no way to save their foot or leg.

Last week Tsiko church had prayer meetings every morning from 5 to 6am.  A few of us would meet at 4:30 and take the 20-minute walk there.  It was a time of singing, prayer, and a short message.  Usually someone would translate into English.  There were about 75 people every morning.  It was really neat to be surrounded by people fervently and passionately praying around me in some remote little Togo village.  The pastors and church leaders are on fire for the Lord, the people have such a strong faith in God, and He is sure being glorified here!  The other day Samuel asked a couple of us what was the biggest thing that has impacted us so far.  I thought about it for a few minutes, and decided that the strength of a lot of the Togolese Christian’s faith is what has been most significant to me.  Most of these people do not have an easy life: There is not a lot of money to go around, many people don’t have enough food, they work hard to make it by another day, and there is so much sickness and death. There are always some pretty significant prayer requests.  Family members of patients in the hospital pray fervently, and somehow a lot of them manage to praise God despite their world falling down around them.  A lot of times the response of the parents when a child dies is that it was God’s will, it is what He wanted, and now the child is with Him.  I have had the opportunity to meet some incredible pastors who are on fire for the Lord.  There are some medical and evangelical staff members that never seem to get weary of sharing the Gospel.  The Togolese don’t have much, but they give glory to God for everything that they do have. On the other hand, there are still so many people in Togo that are not Christian and have not even had the opportunity to hear the Gospel before.  There is also a lot of Muslim and still a lot of fetishism and animism.  But it is evident that God is at work in so many different ways here! I have met some amazing people who have mission-centered hearts.  Although I have been made much more aware of how much evil is in this world through their experiences as missionaries, it has been quite an inspiration to learn their testimonies and hear some of their stories and adventures.

August 7th, 2011

For 6 days we only had two doctors here. I bet Dr. Briggs prayed really hard every day for an ‘easy’ hospital/clinic load and no major accidents with lots of trauma.  He is the only long-term doctor here, so he runs the whole place on his own right now.  Maternity, surgery, everything.  We have not had a surgeon here for a week, and a few that were supposed to be coming canceled. So the hospital is paying for a surgeon to come- Sam Williams. He was here for a couple weeks right before I came and I guess he’s a pretty fun, great guy.  A young doctor came a couple of days ago, so that will reduce the patient load for the other two doctors.

I got to witness Dr. Wicker to an excellent job of telling a family member that her sister did not have very many days to live.  She had cancer starting in her knee six years ago and it went untreated and was now spread throughout her whole body and into her lungs- there is nothing the hospital can do for them.  The sister began to ask if they had treated the knee years ago if she would be healthy now, but Dr. Wicker cut her off and said that we can not live in the past and should not dwell on regrets, but we have to live in the present and enjoy the last days that they have together.  He explained that God rejoices in our death, because it means that one of his children is coming home to be with Him in heaven.

Friday and Saturday were two of my favorite days in Togo! Samuel was going to Atakpame to show films at a youth conference (the woman Becky who does this ministry is in the states so he has filled in for her) and he invited Ben, Peter, and I to join.  We played with children for a few hours that night.  Biggest duck-duck-goose circle yet, haha there were a lot of kids.  Some members of the church prepared a meal for us.  I have eaten village food a couple of times now, but this was the first time I had half of a nasty, dried, fish staring up at me.  I have been really good about just getting tough and eating things even if I don’t like it much, but there was no way I was going to pick up a fish and gnaw on the crunchy bones.  When it got dark Samuel played about 2 hours of film with speaking and praying in between each movie.  There were close to 300 people by the end of the night crowded on the church benches outside, it was awesome! It was also the first time I have worn a light jacket since I’ve been here.  We slept in one room of the church, and the volunteers from other churches around the area slept in the main part of the church.  Things quieted down around 11pm, and got going again at 2am.  At first I couldn’t figure out why on earth people were up at 2 in the morning and wasn’t real thrilled about it, but around 3 they started praying and worshiping together, then at 4 the horrible stereo system starting blasting praise music… I thought it was pretty neat to be in the middle of nowhere Africa with people that are too excited about glorifying God to sleep. I taught a lesson to 60 young women (didn’t know I would be doing that until the night I got there, but God managed to make it work out great). My translator was awesome and there was some really good discussion with the girls.

I think this is the rest of the interesting cultural facts I can come up with:

-A lot of people’s names are the day of the week that they were born on.  Some of them have that as just part of their name, some have a different first name but still get called by the day of the week, some are named a day of the week but get called a different name. Either way, there are lots of Koffis, Affis, Kodjis, and Kossis. It’s funny- when we go to pray for a new baby we ask the mother if they have a name yet and most of the time there is a small pause in the reply as the mother/nurses think of what day of the week the baby was born on.

-Almost every girl/woman and a lot of the boys have beads that they wear around their waist. I have asked a few people what the purpose of them is, and the clearest answer I have gotten is that it is meant to ensure that the woman or child will not leave their village.  But most people seem to do it simply because it’s tradition.

-Women wear skirts or wraps that go just past their knees (or to their ankles if they are muslim).  But above the waist? Well let’s just say it doesn’t seem to matter too much what is or isn’t covered.  You see babies (well sometimes they are 3 or 4 years old- milk is free and nutritious so they nurse as long as they can here) nursing everywhere.  I still laugh whenever I see a kid nursing even though they are tightly wrapped on their mom’s back (haha bet that’s a good mental picture for ya… there isn’t much use for push-up bras around here).  It is beginning to become more common to see women wearing jeans and pants in the bigger cities- definitely not in the villages though.

July 29, 2011

Yesterday I went with mobile clinic to the city of Badou to do a blood pressure clinic. It was a 3.5 hour drive and we traveled a tiny tiny distance on the map.  Most of the drive was on a dirt road like the ones on our farm that go alongside the ditch between two fields.  It was a beautiful drive through the mountains! Saw quite a bit of farmland: coffee, cocoa, rice, corn, bananas… There didn’t seem to be a lot of people or villages along the way, and I think the people that own those farms are pretty well off (well by Togo economy standards, at least).  The clinic started with a 30 minute teaching session on blood pressure to about 50 patients and then Pastor Jeremy (Togolese- he is a really cool guy, I enjoyed visiting with him on the drive there and back!) gave a message.  Before the patients saw a doctor their blood pressure was taken, a bit of their medical history was jotted down (that is never a simple thing to do here!), and we asked them what their religion was.  Mostly muslim, catholic, and ‘global’ church (which is similar doctrine to a baptist church) but every now and then a fetish or animist. Most of the patients visited with someone from the team about Christianity and taught them about this pretty cool guy called Jesus Christ. Last time they came to this village there were 33 decisions (to accept Christ as their savior) made! I don’t know how yesterday went, but they gave out a lot of Bibles.  We saw a total of 190 patients and were turning people away towards the end of the day because we ran out of medications.  My hand is sore from doing manual blood pressures all day.  Some of the patients were repeats from the last clinic they did there (pretty big deal for someone to actually make a follow-up so we can adjust and keep them on their medication!), a lot of new ones with symptoms of high blood pressure, and a lot of people came for other problems.  Unfortunately there is no way we can serve as a real clinic 3.5 hours away without the proper equipment or medications, so a lot of people weren’t able to be helped much more than giving Tylenol.  Everywhere I go, I see such a huge need for healthcare in this country.  I can’t imagine not having access to a dentist, eye doctor, chiropractor, family doctor, etc. 

After the clinic we drove to the property that ABWE has purchased to build a church and met with the man that will be the pastor. Pretty neat stuff happening in Togo J

This morning I watched Dr. Briggs do a pretty cool procedure on a little girl.  About a month ago she had surgery at a different hospital on both of her legs, and they had become infected and very painful.  So they opened everything up and hopefully got the bones cleaned out properly.  This case was unique in that the parents were outwardly affectionate and worried for their daughter.  The dad even teared up as they gave her the sleeping meds and took her back to the OR.  This is the first, and probably the only, time I have seen someone cry tears in my time here.  Because of this outward behavior of love between family members it was much easier for me to be emotionally invested in this case.  I feel like a horrible person (let alone a good nurse) for this because so many other cases have been so much worse.  It was good for me to be made aware of this because I want to have as much compassion for every child that comes in the door and not just the ones whose family shows their sorrow in a way I can relate with. 

Some more Togolese tidbits:

-The people here love Obama.  About 50% of the time I introduce myself as an American the first response back has something to do with our president being African.  Most of the OR staff has brought up Obama and it’s evident they are proud that someone from Kenya is America’s President.  It’s pretty interesting to listen to the way they almost idolize him.  In Tsiko church the other day the message was about children being gifts from God (it was a special baby dedication service for one of the hospital employees, and lately they have been translating the message into English which I have been very thankful for!) and President Obama was brought up as an example, saying you never know what your child is going to become or do in their life- maybe President of the United States someday.  Obama’s face is on shirts, duffel bags, flashlights, crackers, even underwear.

-Hardly anyone has a toothbrush here. Instead they chew on these twigs (no idea if it’s from a certain kind of tree or just any regular old twig) for awhile in the morning. It’s pretty distracting to talk to someone who has one of these in their mouth with little bits of wood all over their lips haha. The participants in a competition during soccer halftime got a toothbrush and travel size of toothpaste for their prize.

-Fabric. There are some pretty crazy prints on fabric: Cell phones, planets, trees, robots, fans.  Some materials and super bright and colorful, some fairly simple and plain.  It seems like it’s all or none with fabric: Either every article of clothing matches (skirt, top, baby wrap, and hat) or every one is different.

-There is no public display of affection (and for all I know, no private display of affection either). Between husband and wife, parent and child, anyone.  I have not seen anyone kiss or hold hands in the 6 weeks that I’ve been here except in the movie The Notebook that a few of us watched a while back.  I have not even seen two Togolese hug.  It is still a strange observation to me that mothers do not cuddle their newborn babies, husbands do not touch their wives (if they even come into the hospital at all), parents do not comfort their children through touch, etc.  The other night Dr. Petersen said it was refreshing for him to see a husband move across the room to his wife and make a small embrace when they saw the ultrasound of their unborn baby.

-You are putting your life in danger by going on a road here- whether you are a passenger in a moving vehicle, the driver, or a pedestrian.  Enough said.

-Despite the beautiful mountains and vegetation here, it is almost always overcast and I have only seen one good sunrise since I’ve been here.  It is dark from 7:30pm to 5:30am, and it’s about like that all year long. I miss my long summer days and big blue skies!

July 28th, 2011

The hospital is filling back up. But with 7,700 new patients to the clinic/hospital so far this year (they had over 10,000 new patients last year) that’s no surprise!  People come from everywhere, including all the surrounding countries.  I have no doubt that Mango hospital will be busy the minute they open their doors for the first time.  

Here are a couple of random culture/environmental things…

-Everyone carries everything on their head.  The most interesting things I have seen on people’s heads so far include: a crate of chickens, a sewing machine, a huge platter of bras.  It’s cute to watch the toddlers carry around their little buckets, balancing it with one hand.  These kids get really good at it at a young age (hence the reason it seems like 25% of the kids have umbilical hernias and the hospital does lots of inguinal hernia repairs!): I have seen lots of 7 or 8 year olds carrying huge bowls of bananas or bundles of branches through the jungle trails. Guaranteed I am not that strong or that tough! To fill up their huge water bowls (they’ve got to hold a good 12 gallons of water or more) they put it on the ground until it’s about half way full, then with the help of another person they lift it onto their head and then stand under the high faucet until they feel it reach the top of the bowl with their fingertips.  I have yet to see anyone dump all their water. (Amanda, can you imagine how wet we would be with all the laughing that would occur during this endeavor?!)

-All babies and most toddlers are carried around on someone’s back.  A lot of times it’s an older sister carrying a sibling that isn’t much smaller than them- the couple of days I have spent in villages there is at least one girl trying to keep up with the rest of the kids and play games with a baby bouncing around on her back asleep for hours.  It’s neat to watch the process of how they get the kid properly wrapped on their back, and then back off again. Even the kids that come into the clinic too sick to keep their head up somehow manage to make the moves that get themselves from their mom’s back to lap and then back up again. I’m sure these babies are born with an additional reflex that allows them to hold onto their mom with their legs and arms until they are tightly secured. 

-Greetings are very important.  Everyone says hello (bonjour) and asks how you are (como se va), and everyone replies, usually just by repeating the exact same words.  Even when a doctor on call gets an emergency phone call, they take the time to do the proper greeting before they get on with the subject of the crisis.  Do you know how difficult it can be to sincerely say hello and ask how someone is doing before they give you details on the kid seizing on the stretcher next to you?! Haha

-Being here is kind of like going back to the 1700’s.  They dig up all their farmland by hand, and cut everything with machetes.  They haven’t discovered using a scythe (spelling?) yet to make work more efficient.

-The wildlife here is pretty neat.  There are some awesome butterflies- so many different colors, shapes, sizes.  Plenty of other interesting bugs as well, but the abundant supply of ants have seemed to ruin my short-lived fascination in African insects.  Lots of interesting birds.  No big safari animals where I’m at, but there are supposedly some monkeys if I find the time to hike up a nearby mountain.  There is always buzzing and chirping, it sounds really cool at night.

-The climate changes within a two hour drive (about 30 miles) of any direction. Mountainous rainforest to flat grasslands and everything in between.  Because of this, the people and villages are very different wherever you go.

Monday, July 25th

Pediatric ward was full of extremely difficult cases last week and into the weekend. More cerebral malaria than ever, and the kids are coming in worse than Dr. Miller has ever seen in all his years of tropical medicine- seizing and/or unresponsive.  The kids have done amazingly well though! We only lost one little boy.  Two earned themselves the nickname Lazarus. One boy was resuscitated four times and went home healthy.  The other one came in seizing, low oxygen saturation, had to start an intraosseous for emergency medicine, after over 20 pokes eventually got a head vein to give blood.  Two days later he is climbing around in bed crying when mom doesn’t feed him boey (this starchy broth stuff) fast enough haha.  I have learned to never underestimate the healing power of God!  We have also gotten quite a few newborns with sepsis sent from a dispensary in a town 2 miles from here.  The treatment is long but the babies have all done well so far.  This morning (Monday) we sent home everyone but two kids. The entire hospital is feeling really empty! Especially after Saturday when 13 patients came in at once from two car accidents.  There have been close to 50 patients sometimes, but right now there are only14.  But it’s a Monday and the clinic usually sends quite a few people for hospital admission because they get really sick as they wait over the weekend.

Even though I’ve been here for five weeks and have gotten used to a lot of the differences at this hospital, it seems like every day there is still something that comes up (nursing friends I will share some good stories with you later) when I can’t do anything but shake my head, remind myself that I’m in an underdeveloped country, and continue to function in a calm and productive manner. Gentleness, patience, kindness…. those are some good characteristics that I have been made aware of how little I have. God knows the change of attitude I need and He is sure trying hard to make those adjustments in me!

July 18th

I can’t really remember what I wrote about last- the internet is down again so I can’t see my last blog.

A couple of days ago we discharged Clementine- she is the little girl that had Hirshbrung’s disease, super malnourished, complicated surgeries. It was really neat to see her looking so good compared to my first day in the hospital when she looked so fragile and we were all really worried about her.  She has a colostomy now and in a couple of years when she is much bigger and stronger she will get a final surgery.  That’s the plan anyways, hopefully it’s God’s too!! She is supposed to come to the clinic for a follow up on Friday; hope I get to see her. It has been a wonderful experience to be so close to the family and watch them grow stronger in the Lord despite all their hardships.

Last night we lost a little boy that was pretty special to me.  He has been in the hospital for almost two weeks. It’s been a roller coaster with him, and we never really figured out what exactly was wrong.  He had 3 good days in a row and they discharged him to Infection (it’s not really infection, it’s part of the hospital where the patients can stay for free but still get checked by a doctor and get dressing changes, etc.). His first night there he passed away.  Even though it is still really hard to accept, I am pretty positive he went to be with God.  I got to pray with him, sing praises with him, and even got a few smiles out of him in the last couple of days. I just feel so sad for the family.

A new pediatric doctor came, and two new surgeons.  It is good for me to see the hospital and everything from their ‘new’ eyes.  It took me a solid two weeks to adjust to things here, and I’m just a newly graduated nurse- I can only imagine how much more difficult it must be for highly skilled doctors who come from really good hospitals.  We have had several hard cases since the new peds doctor, Dr. Ken, has come. It’s really hard for everyone involved to send a patient home to die, and to get new admits that are too far for our medicine to fix.  The pediatric ward could use some prayers this week please. But we are sending lots of healthy, happy kids home too J