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.