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

July 12th

Yesterday a group of us went to the waterfall. About 30 minutes in, it started to rain. Half the group turned back, but the rest of us proceeded on. It was pretty much a torrential downpoor off and on for the next 3 hours. Peter, our mighty leader who was very certain he knew the way, totally had us wandering around in the mountainous rainforest for a while. But it was a lot of fun! We finally got on the right track thanks to a really nice village guy taking us to the right path.  I can only imagine what all the people we passed huddled under their huts were thinking of us crazy Yovos going to look for a waterfall in this weather.  But it was totally worth it!! The path was a bit treacherous (like to the point if you took a wrong step you would most likely die- and as often as I do exaggerate, I’m quite serious about this). The waterfall was really big and gushing tons of water from all the rain we’ve been having. We climbed up part of it and made it a waterslide down. Our clothes were soaked through by that point anyways.  3 of us ruined our cameras L I have yet to ask my parents to mail me another small camera haha they won’t be too thrilled.

This morning we delivered a 28-weeker (preeclamptic mother). He took a while to get going but he did great most of the morning. Started to fade a little this afternoon and I’m sure he will be making his trip to heaven sometime tonight.  Two weeks ago I would have been throwing a fit out of frustration because in the U.S. this wouldn’t happen, but I have gotten a lot more used to not having the equipment/technology and just accepting this way of life the Togolese live.  There are 5 other tough cases this week that will not have a positive outlook.

Oh, something gross: I watched them remove a uterine fibroid that weighed 11 pounds.  It was pretty disgusting.  Andy (a new OB doctor here for a couple of weeks) and I were discussing how it’s going to be difficult to listen to the complaints of patients back home… compared to just about every single patient at this hospital they have absolutely no reason to be whining haha.

I am tired of my feet being muddy, I am tired of finding new bites on me, and I am tired of my hair being pulled back in a ponytail every day. And I really miss shorts.  Hope you are all enjoying some good summer fun!

July 10th

So… the big surgery that I mentioned above was on a premie that had an esophageal-tracheal fistula.  In the U.S. this wouldn’t be such a big deal, but here even figuring out a diagnosis was a dilemma.  We also found that she had a popped lung during that surgery. So she came out with a stomach tube for eating and a chest tube for her lung.  The parents are from Ghana and speak English, and seem very literate and involved in the baby’s plan of care (unfortunately, not something that happens very often around here). So I really enjoyed working with and teaching them.  That night I left the baby with who seemed to be a very competent nurse (perhaps I’m being biased but I like a lot of the male nurses and PA’s more than the women staff) and I knew the baby was in good hands.  The nurse was worried about her and asked me to pray for her that night, so I knew he’d be watching her closely haha. To make a long sob story shorter, the baby had to have a second surgery the next night, was more difficult to breathe on her own after (I spent some pretty late hours into the night serving as a human ventilator and making sure she was stable enough to leave with the staff… they don’t have any sort of ICU and some of the staff don’t really understand the difference in the criticalness of one patient’s care versus another’s), was still doing well the next morning, and then she died late that afternoon.  I guess this can be considered the first patient that I lost.  Dr. Bryce’s (he just graduated from med school as a surgeon, and he has done an incredible job jumping in and running the OR!!) first patient to die here too.  Part of me was disappointed in myself because I can say that maybe if I had just stayed and given her 24-hr care this wouldn’t have happened- we are assuming she aspirated and nobody noticed for a while, it didn’t matter if I told someone to check her oxygen every 30 mins or to suction her every hour (which by the way nursing friends they don’t ever use a suction tube down the nose or throat, and some of them thought I was crazy for using the suction bulb syringe in her mouth they thought it could only go in the nose… you can imagine how frustrated I am here)., this is their hospital, they have an established staff that has been hand-chosen and trained by ABWE, and it’s just the way things are here.  It’s easy to say TIA (this is Africa) in regards to something funny I come across, but it’s not so easy to just say TIA and brush off a baby dying that really would have been just fine and healthy back home.  So every day in the hospital I just do what I can.  Obviously it would be wrong to push my way in and want to run things a new way, give my own care to every patient.  But if you know how hard-headed and abstinent I can be it’s really hard not to!

Hopefully in another few days I will be completely over my whining so you don’t have to endure any more of my sob stories.  It was really funny- yesterday two of the boys were absolutely terrified of the Yovo doctors.  Their eyes would get huge as the doctor got closer, and then once the doctor actually touched them they would just start screaming.  The entire room full of family and staff was just laughing at the boys, who were plenty old enough to rationalize with but they were just too scared.  It’s a good sign when the kids start crying as a Yovo goes to touch them- means they are getting stronger J 

July 7th

So that was what I wrote last night.  On my way back to my house, Samuel was just pulling in next door so I went to say hi and when he asked me how my Mango trip I was I was happy for the invitation to talk to him.  It was really helpful - he let me be mad, agreed with some of the things I thought and gave similar examples of things that bothered him with the systems here, gave me some really great advice (we talked about Habakkuk and God’s timing), and then he prayed with me.  I didn’t go home perfectly satisfied, but at least I knew I’d be able to fall asleep.  This morning everyone was asking me how my trip to Mango was, that Dr. Miller had already told some of them about the hospital we went into.  Last night when that question was asked I had a hard time answering and not crying, and this morning at breakfast I was still pretty upset about it.  The majority of the people had remarks like ‘I know, so sad… too bad there’s nothing you can do’, or ‘ABWE would never allow you to do that- work in a public hospital under their name’ and it wasn’t what I wanted to hear.  Then Dr. Peterson (a short term OB doctor) told me that God doesn’t place things in your heart like that very often, that it is important to listen, and that I am a ‘better’ person (can’t remember how we actually worded it) than to just forget about it and continue on like I had never seen it.  Between what he had to say next and remembering what Sam had said the night before and on our run this morning as he walked into breakfast, I understand that God is a little bigger than me, His hand is over these people and the work that ABWE is doing there, and that it is in His timing.  Right now Tsiko is where God has placed me, and there is a lot of serving to do here.  Sure enough, when I walked into the hospital this morning there were ten really sick kids to take care of, lots of patients and their families being witnessed to, and I helped in a big surgery all morning.  It’s hard seeing all of this need for the first time, and I think I have some lessons on God’s sovereignty to learn.  So I will pray for the people in Mango, ask for God’s mercy on those children that have not been shown the Truth yet, and I will be looking forward to when God sends me to Mango to be part of what will be a huge, amazing ministry.  Until I get to return there, I hope that I can still see those beautiful faces clearly and be just as passionate about them as I was the day I walked out of those hospital doors.

July 6th

I had a pretty emotional 12 hours. Haha- Me? Emotional? No way… ;)  Last night when I got back from Mango I just wanted to vent to a couple of close friends, but as God’s timing would have it of course the internet connection was down (first time it’s been down since I’ve been here, and I don’t know how many days til we get it back) so no skype to make a phone call through, no Facebook to chat or send a message, not even an email to send.  So I went to see if Samuel (pretty sure I have mentioned him in my blog- he’s a CPA helping out with some of the financial stuff here, pretty funny and adventurous, can hold a decent conversation now and again if he’s not being real A.D.D. haha, he’s one of the good friends I have made and I’m happy we are serving here at the same time) was home but nope, he wasn’t.  (I think God was protecting my friends from yet another episode of my going on and on ranting nonsense until I feel a little better and have some of my thoughts sorted out.)  So I wrote all my feelings out instead, and here they are for all of you to see. I thought about editing what I wrote last night since I knew I was pretty upset then, but I decided that maybe it would mean a little more to each of you if I left it as is:

I had been thinking of the children of Mango off and on during the drive home. The statistics that 1 in 5 kids don’t live past the age of five was a little unnerving, and I was thinking of the kids that we saw in the hospital.  It wasn’t until about two hours before we got back to Tsiko compound when Dr. Miller mentioned something that it all really hit me: We- Dr. Miller and I- had walked into the pediatric building of the government public hospital, saw a dozen sick children on beds with their families receiving minimal to no medical care (I don’t think that even one of them had a running IV, no vital signs being taken, no patient charts, etc.), met one man in a white coat who was not a doctor or nurse just some sort of tech guy in charge of all of those patients trying his hardest to do what he could, were introduced to the people as a doctor and a nurse ‘visiting’, and then we turned around and walked out and headed back here.  Not to mention the countless women and men we walked by in the main hospital building and didn’t see a single health care professional.  When the government heard ABWE was coming to build a hospital here, they asked ABWE to just take over their building at no cost because that is how bad these people need health care.  Dr. Miller has traveled around the world doing medical missions for 11 years and he said this is the worst hospital he has ever been to (and several of his hospitals you could only get to by plane or were in makeshift tent buildings).  I did not want to come back here; I do not want to be here right now.  I want to be in Mango helping those children and their families.  It would have been easier if this was one of those hospitals where people just go to die. But it wasn’t- those parents still had hope in their faces, and when Dr. Miller was introduced as a doctor they got up again and took his hand in both of theirs and bowed as they shook hands.  I am only one new grad, but I know how to start IV’s and give drugs.  Dr. Miller said the same thing as I was thinking- what are we coming back here for when there is so much more need there? Then he said that even if we spent one or two weeks there it wouldn’t solve the big problem. Well it would sure solve a lot of little ones if you ask me. It would save lives.  I feel so small and helpless right now, I don’t know what to do.  Part of me is furious with ABWE.  How can they see such a need for so many completely helpless people, yet make sure that they have a super nice pool in the first 3 things being built at the new compound when they haven’t even started building the new hospital?  How can they wait 3 years to open when there are so many people here that could go up there to help? They don’t even need a real building to be serving the health needs of these beautiful people.  Ok I am being completely unfair- ABWE is doing lots of great things around the world, including Mango. And maybe the hospital there hasn’t always been quite this bad (although even at it’s best I’m sure it’s still terrible, the entire country of Togo needs some real help). But still.  So that’s the mad part of me.  Then another part of me is ready to head right back up there and just live at the hospital for three years until the ABWE hospital is done, eat the food that will surely make me sick, find the means to diagnose my own patients without a doctor, and treat as many kids as I can and find a way to send the more severe cases down to the hospital here.  Or hitch a ride to the U.S. embassy and find out what the deal is with hardly any employees at the government hospital, start my own non-profit organization, send a million emails to every health care professional in the states asking for help.  Or convince Dr. Miller to really head back up there with me for the remaining month of his stay and convince everyone important here with ABWE that we can stay at the guesthouse up there and volunteer at the government hospital.  And lastly, a big part of me is wondering if I’m somehow supposed to just accept that this is a much bigger issue than one person can handle and that I just need to pray for a miracle in each one of those kids’ hands until the new hospital opens 3 years from now.  But I’m not too happy with that idea.  (If you know me well, you know that I’m more of a go-getter than one to just sit around and see a need and ignore it. And I’m also way too impulsive haha.) I think if people saw and realized the need they would want to help.  The other night during our 4^th of July celebration there was some important person from the Togo government or something here- at the end he got up and gave a long thank you speech for the work we were doing here for his people.  Everywhere we go, the people smile at us and wave- they truly are thankful for what is being done here. Now it just needs to be taken up north. And a little quicker than 3 years from now when the hospital building is finished.

Oh my goodness, please please pray for the people in the ‘forgotten’ city of Mango, especially the sick children in the hospital. I have never been so emotionally torn before. God has placed the passion in my heart, shown me a need, and now I need some serious guidance. And I haven’t even gone to see the ‘poor’ orphanage yet. Oh geeze.

On a lighter note…

The traveling to Mango was quite interesting.  The car was plenty tight and the majority of the road was horrible.  Lots of big potholes- I don’t know how we didn’t break an axle or pop a tire- and our driver did his best to stay out of them which meant plenty of swerving, speeding up then slamming on breaks, driving on the side of the road, etc.  So thankful that I don’t get carsick easily! We played chicken with plenty of vehicles, passed big trucks that were barely crawling up hills without really being able to see who might be coming the other way, passed plenty of broken down trucks and two trucks that were tipped over.  The trip was 10 hours with a couple short stops to stretch our legs.  About 3 hours north of Tsiko the climate got much different- drier, hotter.  A lot less mountains and trees and a lot more flat grassland.  Lots of little farms and even quite a few cows being herded across the land.  It seemed like there were more kids out working.  The cement buildings and tin roofs became more sparse and the round mud huts with grass roofs more plentiful.  The biggest city near Mango that we drove through is Kara, about a 5 hour drive from Mango.

Mango is a lot different than all the other cities I have been to so far.  Most of the structures are made out of mud bricks.  There are very few bigger homes (I think ABWE missionaries are in the only ‘real’ houses aside from the muslim leaders with their mini palaces).  A lot more muslim culture- I was awaken at 3:45am and 4:45am by their prayer call (or something like that, not sure exactly what all the noise was about haha).  Not a lot of fresh fruit for sale or even people selling things along the road in general.  Most of the kids shout out when they see white people, and just about every person waves back at you.

I stayed at Tim and Esther Neufelds’ house. They are really a fantastic missionary couple. Lots of stories of how they have seen God at work, and adventures from their travels.  It is quite an inspiration how hard they have worked to glorify God and spread the gospel.  But it is evident that after so many years they are both finally getting ‘tired’ and retire in one year.  They have lived quite the story I’d say!

The new compound is going to be amazing. It is absolutely enormous.  They have started two houses, the guesthouse, swimming pool, and maintenance shop.  About 25 Togolese work every day and short term teams rotate through every two weeks.  It is quite the project.  Kevin is overseeing all the construction- he and his wife Emily who runs the guesthouse are wonderful people with a pretty huge task.  I am excited to be a part of the new hospital (hopefully things will work out with ABWE- it can be quite an intense endeavor to work with them).

4th of July!

The compound is FULL of people! Teachers, medical team, maintenance, etc.  There have been families with kids coming and going, which I have enjoyed (except it is much harder to run around with them here- this heat and humidity slows me down! Either that or I’m just turning old way too fast haha). At the compound church service the other night there were almost 50 people. It’s pretty neat to be surrounded by so many people who have such a love for the Lord!

Yesterday for 4^th of July we had quite the celebration. Games, volleyball, softball, great dinner with all-American food (my favorite was the blue jello with frosting lol), beautiful singing, campfire with smores (Jessica I have completely outdone you with my first experience of making a perfectly toasted GIANT ‘mallow’… we will have to let you give it a try when I’m home), and just some really great fellowship!

Today I am going to Mango. I have been hearing all about this new compound/hospital (well the hospital isn’t actually being built quite yet) and I have the opportunity to go check it out. It’s about a 9 hour drive- Togo style, my sister Jessy would probably opt to walk or she’d be very carsick- but at least I will have some good scenery to look at. Dr. Miller (the pediatrician) is coming as well. I am sad to leave a couple of the kids at the hospital, but the world will continue to revolve without him there. We have a really good medical team right now. I really enjoy working with the visiting surgeons and doctors here- it’s different than how it is in the hospitals at home. We do most of the rounds together, have a really fun time with lots of stories in the operating room, pray for the patients together, stuff like that.

July 1

So… I am going to become a pediatric nurse practitioner and then come back to this place over and over and over!!! And maybe check out a few other hospitals around the world!  Someday. I’m in no rush.  I had an incredible day today.  There were plenty of frustrations, tough cases, and sad situations, but the amazing things that the hospital/clinic is doing for the people in this area somehow still manages to shine through and make everything alright.

This morning there were 6 pediatric patients and by the end of the day there were about 15. It is extremely busy right now, the hospital is absolutely packed.  Some easy cases, but a few pretty complex ones too.  The staff and missionaries are all working really hard.  The missionary doctors/surgeons are quite an inspiration- they pay quite a bit of money (one of the lovely quirks about ABWE haha) to come over here and work long, hard hours in terrible conditions.  Dr. Miller is the pediatrician right now and I really enjoy my time with him.

3 recurring things that I have found most difficult in medical care here:

1) Lack of general health education in the population.  A lot of the patients end up in the hospital in bad condition due to complications from herb treatments or other home remedies.  The other day in the OR (I wasn’t present for this one) the surgeon went to fix a bowel perforation and when he cut into the child’s abdomen he described as being filled with a black grease that was caused from stuffing nasty herbs and stuff down the child’s throat.  Today in clinic we had a boy who looked like he was 9 months pregnant but with tiny arms and legs from malnutrition… he has hepatitis and is in liver failure caused by herb poisoning.  I could go on and on, but I’ll save more stories for later.

2) They wait way, way, way too long to seek health care.  These are some of the sickest people I have ever seen. One guy was in a coma for 4 days before they brought him in, and I watched him die about 3 hours after admission.  Today a child was admitted with a hematocrit of 6%. The population here in general runs on low hematocrit (nursing friends, all the lab values go out the window in Togo!! Divide- or multiply- everything by about 2 and the docs are happy enough) but this was the second lowest that Dr. Miller has seen in all his world travels without the child dying in minutes.  They started this girls’ blood transfusion before they got the lab values back, but about half way into it she started seizing and went into respiratory failure, but they resuscitated her. Nobody thinks she will make it through the night though.  A lot of the children aren’t brought in for malaria treatment until after they have had a few seizures and have had high fever for days.

3) The hospital facilities.  I have no idea what the other hospitals in this country are like, so I have nothing to compare this one too.  But it’s terrible here.  Aside from the general lack of equipment, most of the stuff that is here stinks.  I have a list of small things that I will be purchasing and sending back here, just simple things that will make everyone’s work much smoother.  For crying out loud they hardly even have reliable pulse oximeters and they reuse the peds oximeter sensors (I cannot think of the real term for them… they are like a bandaid with a sensor that wraps around fingers/toes to take an oxygen reading… NOT very high tech or expensive and not meant to be used more than a few times for one patient let alone shared with the entire hospital for a week long) until there is nothing left to them.  They don’t even have reliable suction in there “ICU” ward. That’s in quotations because it’s not even a fraction as good as a regular medical floor in the states.

I’ll end with a good note.  The beautiful little girl, Clementine, that I mentioned in a previous blog… well she is doing extremely well and should be able to go home soon (back for more surgeries eventually).  Every time I look at or touch her my heart is very happy and it reminds me that there are really good things happening here and I feel extremely blessed to have gotten to play such an important part in her life.

I do apologize for my sloppy writing and lack of grammar for those of you who haven’t experienced reading it yet. When I’m tired and/or in a hurry- or just telling stories I guess- it all goes out the window.