Bonjour!

I made it safely to the hospital.  It is so nice to be settling in.  The 2.5 hour drive from Lome to the hospital where I am working was uneventful, however, I am beginning to think that abiding by traffic laws is entirely optional.  The only rule that seems to apply is whoever avoids the pothole first wins. 

When I arrived I was shown my new room which will be home for the next month.  It is probably one of the nicest places I have stayed in Africa.  This just might be my first trip to this continent that will be bed bug free!  I am pretty excited about that.  I am, however, sharing my room with a resident gecko who greeted me on the wall above my bed when I first walked in.  Some things just have to make you smile.  I have my own bathroom and shower along with a king sized bed that has way more room than I know what to do with. I tried to attach some pictures, but for some reason it won't let me do that.  I will keep working on it to figure out a way to post pictures on this blog with this computer system.

After getting settled in all of us staying at the guest house had dinner together in the dining room.  Someone along the way trained some Togolese women to make American food.  Dinner last night consisted of ham and cheese sandwiches as well as mac-n-cheese.  I guess you could say we were going for comfort food J

Yesterday was my first full day at the hospital.  This morning I helped with two hysterectomies and then spent the rest of my time getting to know my way around and figuring out how things work at the hospital.  I have never seen an ultrasound machine that was so…..um, antique? It is going to take a little getting used to in order to figure out all the buttons, especially when half of them have their labels worn off.  I just can’t help but laugh a little. 

So far I have been very impressed with the organization and capabilities that this facility has.  They are able to do some pretty big OR cases for their limited amount of resources.  Today they are going to operate on a 3 month old girl with Wilm’s tumor.  This is a tumor that grows often in children out of one of their kidneys.  This tumor has gotten so big that this poor little girl is having trouble breathing.  I am praying that they will be successful in getting the tumor out without much bleeding.

Tonight and tomorrow will be my first call shifts.  I have been a little nervous about this.  I could definitely use some prayer.  The way obstetrics is done here is very different than how I have been trained.  I know I will learn a lot.  I am just praying for wisdom and insight whenever a new patient crosses my path.  I hope to write more soon.  The internet here is what one would expect for third world country dial up J

First Morning in Togo

I slept super well last night.  Probably making up for my lack of sleep over the last 4 days.  It was wonderful.  They also had air conditioning in the room for free which was a huge blessing.  The moment I stepped off the plane last night I started dripping from the heat.  That is something I am going to have to get used to.  I just learned that the ORs in the hospital have airconditioning.  What a huge blessing!  Being in the city however, I did get woken up by the 4am Muslim call to prayer.  Always an interesting reminder of what dedication to prayer can look like.  Gives me something to think about. Alright, off and running!

Made it!

I am officially in Lome!  I landed in the capital city of Togo about 2 hours ago.  What a blessing.  I was able to sleep on both flights and navigate the Paris airport with a little help :-)  I ended up having two seats to myself on the flight from the States to Paris.  At 5'2" that was just enough room to curl up and take a nap.  I woke up singing 10,000 Reasons....."Bless the Lord oh my soul, oh my soul, worship His holy name."  Perfect.  When I made it to Lome I stepped off the plane and everyone around me was speaking French and all I could do was laugh at myself.  Here I am, traveling by myself, in a foreign country without an ounce of understanding of what is being spoken around me.  What was I thinking!?!  Thankfully, very little thinking was required. I am so thankful that World Medical Mission had me apply for my visa in advance which greatly sped up the process of going through customs, both of my bags made it all the way from the States without issue AND they sent a female American nurse to meet me at the airport with my driver!  Praise the Lord.  I don't know why I worry sometimes.  God has the details all under control.  What more could I ask for? 

Tomorrow we will be waking up early to run some errands around the city before making the 2.5 hour drive out to the hospital.  Right now it sounds like there is one surgical PA and one general surgeon taking all of the surgery call including cesarean sections.  They are switching off and taking call every other night without a post-call day.  I really hope that I can help with some of that burden and take some of the c-sections off their hands.  I am so excited to get started!  Tomorrow is going to be a big day. 

The Skirts

The fact that I have to wear a skirt at all times while in Togo has been an object of fascination for lots of people at work.  This skirt wearing includes when I am in the hospital and operating in the OR.  In the States this would be unheard of.  Our hospital uniforms of scrub shirts and pants are the expected attire and I don't think I have ever heard of anyone wearing anything else while operating. 



This is my typical look when working at the hospital in the States. Yes- I look like a smurf.

 

Because scrub skirts/dresses are not so commonly worn in the US it took a little searching to find someone who makes them.  I finally found some and ordered three to bring with me.  I wasn't sure how they would fit so I ordered three different ones hoping that at least a couple of them would work.  Well, given my short legs I learned years ago that ordering clothes online without trying them on first can be a risky deal.  Sure enough one of my skirts came and I promptly realize that it was going to be much more efficient as a floor mop than a functional piece of clothing.  This was definitely not going to work.  I talked with one of our wonderful L&D nurses and she graciously agreed to help me with this problem.

 

One of our wonderful L&D nurses volunteered to hem this skirt.

 

This is how I ended up modeling my scrub skirt in front of everyone in our L&D report room.  I am not sure that I am ever going to live that one down.  

Psalm 91

I am sitting here in the hospital in the lull of the early morning hours watching as the clock ticks away the minutes for my last night shift before I leave for Togo.  It is coming up so quickly.  I have been preparing for months and can hardly believe that I will be actually getting on a plane to fly over there in less than three days!

Over the last week several of the staff that I work with here in the hospital have come up to me independent of each other and given me verses out of Psalm 91. Such an encouragement, and such a wonder that the same verses are being given to me over and over again. 

Psalm 91

1."He who dwells in the shelter of the Most High will abide in the shadow of the Almighty. 2 I will say to the Lord, "My refuge and my fortress, my God, in whom I trust."...

4 He will cover you with his feathers, and under his wings you will find refuge; his faithfulness is a shield and buckler...

11 For he will command his angels concerning you to guard you in all your ways."


I have been marinating in this Scripture all week. As I was taking time this last weekend to think over this next month my heart started to just swell with joy. I am so excited to do this. It is really easy to get bogged down in the details of a big international trip and I have to constantly remind myself to take a step back and remember the 'why' behind all of those details.  Someone asked me this last summer "If you could do anything with your life what would it be?" I honestly could not come up with an answer different from what I am doing right now.  There are moments when a wave of nervousness and fear sweeps over me.  I am so very aware of my own limits, but am thankful that I serve a God that has none. 

Togo Culture

Different cultures and customs has always been very interesting to me.  What offends one person may be completely commonplace and acceptable to another by happenstance of geography and the setting in which one was raised.  As I have been preparing to leave for Togo in less than three weeks I have been reading up on some of the cultural norms that I should be aware of before I arrive.  Here are a few that I thought were most interesting.

Clothing: Women must wear skirts that cover their knees.  This is starting to change, however, for a long time only prostitutes wore pants and there still is an underlying association.

Handedness: The left hand is considered unclean and should not be used to give or take anything unless there is no other option.  I wonder how that works in the OR when I am standing on the left side of the table and having the scrub tech pass instruments to me?

Posture: Women crossing their legs is a sign of arrogance.  She is essentially saying she thinks she is important.  This shows authority and independence equal to that of a man. Standing with your hands in your pockets or on your hips is a sign of disrespect when talking to another individual.  This one is going to be a challenge for me.

In public: Sneezing and coughing, especially loudly is not polite.

Entertaining: When a Togolese person invites you over to their house they will offer for you to sit in the best seat in their home.  This invitation should be accepted.  When it is time for you to go, you must ask permission to leave before standing up. 

Just some interesting thoughts to keep in mind as I am preparing myself to go.

Kidney stones - not recommended.

I just had my follow up appointment last week and it has had me reflecting on the events of the last several months.  I just thought I would share a little bit about my thoughts...

The summer of 2012 was one that was marked by kidney stones.  I have never experienced them previous to this and I pray that I never have to again.  Wow....for those of you who have had the pleasure of such an experience you know what I am talking about.  In total I had them for about 7 weeks.  Some of my patients say that kidney stone pain is about the same as being in labor...I believe it.  Though I definitely wouldn't recommend kidney stones to anyone, it was pretty incredible to see how God provided for each and every need that arose during that time. 

For a couple of days before I sort of knew something was up.  I talked to my chief resident at the time and told her I didn't know what was going on, but I was pretty sure that at some point that week I was going to end up in the ER.  3am that morning was that point.  I have two roommates and one of them was out of town - the other one was going to be going out of town in two days.  I woke up in the worst pain I have ever experienced (worse than when I broke my foot, and definitely worse than when I blew out my ankle x4).  It didn't take long to realize that this wasn't something I was going to be able to handle on my own.  Thankfully, one of my roommates was still home.  I crawled down the hallway, pounded on her door and it took all of 10 seconds before she realized that I was going to be needing a ride.  Praise #1: my roommate was home, I don't know what I would have done without her. 

On my way to the ER I called one of my good friends and fellow resident who had graduated from residency a few weeks earlier, Dayna, to meet me in the ER.  At 3am, I have to say she responded pretty quickly Praise #2.  I thought I was going to have to go to surgery and I knew that if there were going to be any big medical decisions made that I would want Dayna there with me.  What a blessing.  She advocated for me in the ER and helped me to get admitted more quickly.  She stayed with me all day and walked me through each and every test and consultant.  Once it was decided that I didn't have an appendicitis or a torsed ovary and that I wasn't going to have surgery right away I got admitted to the GYN team - Praise #3. It was ironic because it was the GYN service that I was technically helping to manage at the time and then I ended up as a patient on their list.  So much better to be taken care of peers that you trust though, and I am so thankful for all of their help. 

The amount of pain medication that I was on necessitated that when I was released from the hospital that I have someone with me for 24 hours.  My roommate was going out of town, and I really didn't want to burden her with this.  Dayna graciously volunteered and took me home with her. She was in between graduation and starting her new job which is Praise #4 because she was able to be with me and make sure I had the things I needed without feeling the pressure of needing to be at work.

Praise #5 was that I had previously been scheduled to be on vacation the next week and had bought plane tickets to go home.  It is so much nicer to be home with your family when you are not feeling well than here where would I put pressure on myself to get back to work as fast as possible.  The pain and stones were rough that week, but I am so thankful that I already had the time off.  I came back and on week number three of this and realized I couldn't go on much longer.  Pain was only able to be controlled with narcotics and of course, I couldn't work and be on such strong pain medication.  Praise #6 - I talked to a couple of my attendings who convinced me to contact a really wonderful urologist we work with.  I called him and he graciously agreed to take me to the OR that night Praise #7.  I had surgery that night and had a stent placed.  If anyone says that stents will make you feel better, don't believe them.  I can't decide what was worse - the stent or the stones. The stent was necessary, however, and I knew I needed it.  Two days later I was on call for 24 hours.  I wasn't sure how I was going to make it.  Stent still in place, I felt like I could barely walk.  I woke up that morning and just prayed for strength.  I knew that I was facing more than I could handle.  When I got to work I realized that it was a special call day.  Instead of having just one junior resident on call with me to share the load, I had two! Praise #8.  God had given me extra help when I needed it the most.  The L&D staff was amazing that night and I survived.  Pain control was an interesting dilema and I guess I resorted to digging my fingers into my thighs.  The multiple bruises that showed up the next day were a testimony to that...I didn't wear shorts for a long time.  I don't know that I could have carried the work load without the extra help from my juniors.  Praise #9 two wonderful L&D nurses offered to help me pull my stent out after I was done with call.  I had talked to my urologist and he said that would be fine.  This saved me from taking more time off for another doctor's appointment and helped to get rid of a lot of the pain I was feeling.

I still continued to have pain for many weeks after that, but it was nothing compared to those first three weeks.  After this experience I definitely wouldn't wish kidney stones on anyone, but it is incredible looking back on the whole thing and seeing step by step God's provision.  What was required of me was beyond what I could handle.  Everytime I really needed something though, He provided.  What an incredible thing to be apart of.