Back from Mango!

We have all officially made it back to the hospital from Mango!  What a great trip!  I am so glad that I got the chance to see this piece of Togo.  It was a 16 hour road trip for Rhonda and me on Wednesday, but we finally made it to the town of Mango dusty, tired and very sunburned.  It was so great to see so much of the country.  We ended up driving through almost every major town in the country.  It gets progressively more dry and grassland like as well as progressively more poor as you travel north.  When we got to Mango we stayed with a long term missionary named Anna.  What an incredible person she is!  She is about my age and has moved to this far northern city by herself.  She lives in a compound with the people and has really settled in making it home. She has learned the language and has reached out particularly to the Falani people (the tribe that I sort of described gypsies in a previous blog).  The Falani are looked down upon and discriminated against by just about everyone else.  They can’t even shop in the markets in town without getting cheated just because of the tribe that they are from. It is so sad.  Anna, however, has made friends with many of the women and has been welcomed into their lives.  She freely visits them in their homes and they often come to hers to talk and spend time together.

 

Anna, Kristen, Rhonda

We stayed with Anna while in Mango and had a wonderful time.  What a great hostess.  When we got there she had dinner waiting and then gave us a tour of the place. As soon as I stepped inside the house I could feel the temperature difference.  The outside air temperature had begun to cool down, but her home was still very warm.  I took my shoes off and walked inside and noticed that the cement floors felt like they were heated.  Back in the States people pay a lot of money for heated floors….here it come for free!  She showed us our room that Rhonda and I would be staying which had two mattresses on the floor each with a pillow and covered with a fitted sheet.  There were no other sheets or blankets to put over us at night, but honestly I was thankful because it was pushing 100 degrees in her house.  She showed us the bathroom which had a modern sink, toilet and shower.  I just had to laugh because along with giving us the tour she informed us that she was having a little bit of a frog problem particularly in the bathroom.  These little orange frogs like to sit on her toilet.  We were instructed to just push them into the bowl and flush them down.   Haha, wow.  Yep, I am definitely in Africa!  We were also told not to touch them with our hands because they have some sort of toxin in their skin that stings.  Looking at the frog currently sitting on the toilet seat I wondered if that toxin gets left behind on anything they have touched.  I decided at that point not to test it out and I would just avoid sitting on the seat.  I was so thankful for a shower that night to wash away all of the grit from the day.  I don’t think I have ever had such a bad farmer’s tan.  When I stepped into the shower I just had to laugh.  There was only one knob to turn, which in Africa means that the water only comes in one temperature.  Great!  Who would want to take a warm shower in this weather anyway?  It was perfect.  We finally went to bed after visiting with Anna for a while and when I laid down I could feel the heat from the floor coming up through the mattress.  How in the world was I ever going to sleep?  Heat was coming at me from all sides.  I was trying to lay as perfectly still as possible without letting any limbs touch or any joints bend to avoid trapping any unnecessary heat.  I just prayed that the Lord would allow me to sleep.  I was so tired that I drifted in and out for about an hour or so before I fell into the best, deepest night’s sleep I have had in over a week.  Praise God!  The temperatures outside continued to cool and eventually permeated the inside of the house.  So wonderful.

 

We were woken up around 4am the next morning by the Muslim call to prayer.  In many towns this is conducted over a loud speaker system that can be heard throughout the whole place.  However, in Mango this was replaced by a man that got up every morning between 330 and 430 and ran up and down the streets yelling in a raspy voice to wake everyone up.  I just had to smile.  What a job this man had! 

 

We got up hours later, had breakfast and started to make our way towards the compound where the new hospital is being built.  It takes a long time to get anywhere in Mango with Anna because when she is walking down the streets all of the women come up and greet here.  It was so wonderful to meet all of her friends.  We made it to the compound and took a tour of the construction site.  I was so impressed!  This is going to be an extremely well done hospital. 

There are a few homes and other structures already completed on the compound which include a guest house, homes for some of the missionaries, a work shop and a pool.  The quality for all of these buildings would rival anything we have back in the US.  After visiting with some of the missionaries and seeing the construction site we wandered back into town to go to market.  Like most African markets it was an open air event with different stalls set up selling various things.  What made this market different though was that it was nestled under a canopy of trees.  This is so key to help keep the temperature down.  We bought little snacks along the way and made this lunch.  We also stopped by the home of Anna’s friends who is a Falani lady and she had the most wonderful fried chicken prepared for us when we arrived.  What a treat!  After visiting for a while we then stepped out to walk around and see more of the town.  We visited with more people and then walked down towards the old section of Mango.  It was at this time that I started to really notice the heat and felt like I should probably start thinking about doing something to get to a place that was somewhere cooler.  Some of the missionaries from the hospital drove by and offered to pick us up and take us back to the hospital for a meeting.  I gladly took them up on it.  When we got back to the hospital we were told it had reached 122 degrees!  No wonder the heat was starting to bother me.  I don’t think I have ever been in weather that hot.  Thankfully, there was no humidity which did make it much better.  After taking a rest inside and out of the direct sunlight Anna, Rhonda and I wandered over to the water tower on the hospital compound.  What a view you can get from the top! 

Enjoying the view from the water tower

 

Very few things can beat the beauty of the sun setting over the African grasslands.

 

The African grasslands of northern Togo are totally the description everyone thinks about when they think of Africa.  Simply beautiful.  The waves of golden grass extended for miles in every direction and just reminded me of how incredibly great and vast my God is.  We watched the sunset over the horizon and then headed back to the guest house for dinner.  This would be the last dinner for the construction team of short term missionaries currently working on the hospital before they head back to the US.  After dinner we all decided to go for a night swim in the pool.  What a perfect evening!  The water was so refreshing and the African stars so incredibly bright.  I absolutely cannot believe that I have had the honor and privilege to spend the last month here.  We got a ride back to Anna’s house in town and no sooner had we stepped foot inside her home than there was visitor after visitor of African women coming to say hello.  People were just wanting to talk, play games and many brought meals.  What an incredible example of how to fully integrate into another culture and love people who are so different than you as truly part of your family.  It was such a good, tangible example for me to see.  I learned so much by just spending that little bit of time with this incredible and dedicated missionary.  It was getting late so we finally just had to close the door to keep more people from coming.  Bedtime followed the same routine as the night before and again we were woken up at 4am by a raspy voice shouting down the street.  The van with the short term construction team that we were going to be getting a ride back to the hospital down south would be here soon.  The time in Mango just flew by.  I am so glad we were able to see it.  The ride back was uneventful and comfortable!  The van actually had air conditioning.  I don’t think I will ever take such a luxury for granted again.  We made it back here to the hospital just as the sun was setting.  My last night in Togo.  Wow.  It is bittersweet.  After checking in at the hospital Rhonda and I spent some time dipping our feet in the pool and just watching the African sky. One shooting star after another danced in front of us.  So peaceful.  I will definitely miss this place. I know there is much reflection and processing of the events of this last month yet to happen, but I cannot describe the contentment and joy that I have had in the opportunity to serve here.  I have had the privilege of working with some incredible people and the honor of loving the people of this little known country.   I just praise God for His incredible grace in allowing me the chance to do this.  Where I will serve in the future long term is still being heavily prayed over. I know His guidance will come at just the right moment and not a second sooner.  I just thank the Lord for the work He is doing now and for whatever may lay ahead.  Tomorrow I leave to fly back to the US.  I am so thankful that I will get the chance to spend Thanksgiving with my family this year.  Oh how He has so sweetly provided.  Thank you for your continued prayers and encouragement.  I cannot tell you enough how much it means to me.  Blessings to you all, goodnight.

Going to Mango

The internet here has been a little touch and go over the last few days making it hard for me to post.  Sorry for the delay.  The weekend call went fairly well.  I ended up being awake most of Sunday night with a pt that came in term with bad malaria.  That was a little beyond what I am used to taking care of back in the States.  She had a high fever and baby wasn’t liking that too much.  I asked several people the next day how to proceed with caring for this pt and every time I asked someone new I got a new answer.   Haha, well sometimes things just are not very cut and dry.  Thankfully, both mom and baby are doing well and mom is well on her way to recovery. 

The hospital here is currently constructing a sister hospital up in the northern part of Togo in a city called Mango (pronounced Mongo).  This is a city that has no medical care at all.  The closest hospital to them is over 2 hours away.  If ever there is a medical emergency there is very little the people can do.  If a mother needs a c-section it often ends in death for both mom and baby.  There is not a single surgeon in the area and there is tremendous need.  An opportunity over the last couple of days has come up for me to go there and see the building of the new hospital and compound as well as the surrounding city.  I am very excited to get to do this!  We will be traveling by car which means I will get to see most of the country of Togo while I am at it.  It is going to be a quick trip, leaving early tomorrow and then getting back on Friday.  I am scheduled to fly out of Lome on Saturday.  I cannot believe it is coming up so quickly! I would love prayer for the trip up there and back that the roads would be ok and that the vehicles will not have any problems.  Rhonda will be going too which will be wonderful to get the chance to spend some time together outside of the hospital context.  I don’t believe that I will have internet access up there, but hopefully I will be able to post again when I get back here Friday night.  Thank you to everyone for your prayers, support and encouragement for my time here.  It has meant everything.  I am on call for one last night here in Togo and praying for God’s sustaining hand.  I cannot believe that my duties here at the hospital are coming to an end.  I have learned so much and been stretched in so many ways.  There have been a lot of moments filled with laughter and joy as well as those that threatened to rip my heart out, but I cannot say enough how much I have enjoyed my time here.  I am thankful for the opportunity to be here and serve alongside some incredible individuals to a people who truly are in need.  One of my medical school mentors had a saying that I think has been very true of my time here in Togo, “God loves you just the way you are, but He also loves you too much to leave you there.”  That is how I feel about much of the growth that has occurred over the last several weeks.  Many of the experiences, challenges and lessons learned will not be forgotten for a very long time.  Praise God for allowing this time to happen. 

Simply Beautiful

Today is the one week mark.  I only have one more week here in Togo.  Where did the time go?!? I have gotten to learn and see so much that the time has passed by very quickly.  I haven’t had the chance to blog about half of it.  Last night I was on call, but got a full 8.5 hours of sleep!  I think that is the most sleep I have gotten since coming to Togo….and for those that know me well know that I really like to sleep J  I think the fact that it was much cooler last night after the rain we got helped a lot. 

I woke up this morning and rounded on the pts and then did a c-section for twins!  Multiples are so fun! One boy and one girl.  Everything went really well.  Mom and both babies are doing great.  This pt brought extra family with her to help with both little ones.  The babies here are so cute.  They are all born with the most adorable fro.  It would be the envy of many back home who put a lot of effort into getting their hair to look this way. 

So refreshing!

 

Having fun, clothes and all!

 

 

This afternoon a bunch of us got to take a hike out through the local mountains to a waterfall.  What a great way to see Togo!  Hiking along this dirt path we got to see many people out harvesting things from the surrounding jungle, small villages and family compounds, people doing laundry in the local river and  hauling their goods back to their homes hoisted upon their heads. A lot of the hospital staff lives back in the jungle behind the hospital where we were walking.  It just gave me a much better sense of where the nurses and pts live and how they do life.

When we finally reached the top we got to this really beautiful waterfall and swimming hole.  Yes, I jumped in clothes and all!  So refreshing. I don’t think I have been that cool since arriving in Togo.  God sure has created some incredible stuff.  Africa is so beautiful. 

View from the trail

The views from the mountains we were hiking up just spoke of His greatness and vastness.  I am sure that the pictures I took do not even capture half of the wonder of it all.  Everything is green.  The tall jungle trees grow all sorts of nuts and fruit that can be eaten. The wild flowers come in some of the brightest colors of reds, yellows and lavenders.  The dirt we walk on is a rust color that contrasts with the green jungle surroundings.  There were also a fair number of chickens, goats and pigs we saw roaming around eating whatever they could find.  I am sure that they all belong to someone, but I have no idea how anyone keeps track of them all.  The children seem to be working just as hard as the adults carrying fire wood, flour or water on their heads back to their compounds.  As we were walking back it was getting closer to dinner time and many of the families were cooking in the open air in the middle of their compounds with big pots set on top of open fires.  Families and extended families all seem to live together in the same compound and so they share meals together as well as communal chores.  Their homes range from mud huts with thatched roofs to small square cement buildings with tin roofs.

One of the compounds where they were drying food

 All of them appear to have dirt floors.  A compound usually consists of several such homes arranged in a square or circle with all of their doors facing inward to a central open area where most of the day’s activities take place.  Each compound also has a communal meeting area which consists of an open air shelter with a thatched roof and a few wooden benches underneath.  The dry season is coming when there will no longer be fresh fruits and vegetables.  As we were walking through the different compounds I saw many people laying out their goods to dry in the sun so that they could store them for the coming months without any rain.  I am so thankful to have had the opportunity to step away from the hospital for a bit and see a little bit more of this country.  I can’t believe that I have been so blessed to spend the last month in such a place as this. 

No Such Thing As Bad Hospital Food

Back home one of the common complaints across hospitals is that the food is terrible.  Having experienced patient life first hand I can attest to the fact that the rumors are indeed true.  When you have a hard time deciding if what is in the mug is supposed to be coffee or vegetable soup you know you should look elsewhere for your next meal.  The hospitals here in Togo have it figured out pretty well….they just don’t serve food at all.  They have then completely avoided all of the usual complaints.  J Actually, being in the hospital is an entire family affair.  No one can be admitted to the hospital by themselves because they need to bring family members to come and help care for them.  It is the members of the pt’s family that do the cooking and provide all of their meals.  They also do the laundry, bathe the pt and supply them with blankets and clothing.  Such a different way of doing things than back home.  Consequently it is important for the hospital to have some extensive grounds so that members of the family can cook and do wash (all of which is done outside).  At night, the family members sleep on the tile floor next to the pt’s bed.  Each ward consists of one big room with beds lined up next to each other on either side.  Privacy isn’t something many seem really all that concerned about.  Between the pts and their families you can pack a lot of sleeping people into one ward.  It is always interesting as the practitioner when I get called to see a pt in the middle of the night and have to step over a bunch of sleeping bodies to even reach the pt’s bedside. 

Sometimes back home we joke about the hospital being more like a hotel.  The laundry is done every day, the pts get room service with their meals set right next to their bed and they even have a menu to choose from.  It is not completely unheard of for a pt to request to stay much longer than medically necessary because they feel well cared for and are lacking nothing.  I guess that speaks highly of our medical care, but it can be frustrating on the practitioner side of things to have pts in the hospital who don’t really need to be there.  Funny, this is never an issue in Togo.  With the family being burdened to care for the pt’s needs and thus having to be away from home as well as with the lack of health insurance and the personal responsibility of having to pay for the hospital bill, pts are more than willing to leave when the time is right.  We did have one father offer to bribe us to release his premature son from the hospital early due to the mounting inconvenience of the things I have just mentioned.  No, we did not accept the bribe or discharge the baby, but it is such a different attitude than what we sometimes struggle with back home.

It has been raining all afternoon!  The thunder rolled over the mountains behind us just after lunch and it has been steadily coming down ever since.  I never thought I would be so excited for rain, but what a refreshing break from the heat.  I am on call tonight and might be sloshing my way to the hospital on the muddy dirt path between the guest house and L&D, but I am not sure that I even care!  Oh so nice to be excited about the simple things in life!

Broader Shoulders Than I

Yesterday afternoon was relatively quiet.  There is no clinic on Wednesdays which means there aren’t the normal lines of pts to see.  No elective surgeries are scheduled on Wednesdays giving the hospital and its employees time to catch up and focus on just the emergencies and the pts already admitted to the hospital.  The need here is seemingly endless and having a day in the middle of the week that is designed to be slower so as not to spread people too thin was a wonderful idea.  During the lull of the afternoon I was back in my room reading a passage in Phillipians 4.  I knew that the words were hitting home with me, filled with meaning, but I had no idea that they were really preparing me for the night to come.  This passage talks about letting go of your anxiety, letting the Lord of all creation take that anxiety for you.  He promises to cover you with peace when you fully hand over all of your fears.  What an incredible promise!  It is a truth that I have to constantly remind myself of and am not very good at practicing.  When am I ever going to learn?

I knew my break from the hospital had come to an end when the phone rang in my room and I heard that all too familiar voice on the other end, “Please! Come to maternity.” (Maternity is what they call L&D here)  I was on my way.  A pt had arrived in labor that needed a repeat c- section.  Gladly.  I was so thankful this happened late in the afternoon instead of the early morning hours.  The c-section went very well.  The proud mother gave me a huge smile and grabbed my hand in the recovery room after the surgery was over.  I just praise God for another wonderful life born.  I made my way back to the guest house for dinner and was just finishing up when I got called to the hospital again.  Another laboring pt had gotten sent to us from an outside facility.  It was back in the OR for another c-section for us.  Beautiful delivery number two!  Before we had left the OR we received word that there was another pt that needed our attention immediately.  Ed and I quickly went to see what we could do to help.  A young lady had come in with complaints of abdominal pain, bleeding and a positive pregnancy test.  The flags went up in my head.  Something wasn’t right.  Back home these pts come to the ER and often have an ultrasound completed before I even receive a phone call, but here the ultrasound was going to have to be done by me.  There were two things I was looking for, a miscarriage or an ectopic pregnancy ( a pregnancy outside of the uterus which is not compatible with life for the baby and can be life threatening to the mother).  I have never done the ultrasound myself to diagnose an ectopic, but as with many things on this trip, there is a first time for everything.  I placed the ultrasound and didn’t see anything remarkable inside the uterus.  I was praying that if there was something that I needed to see somewhere else in the pelvis that God would show it to me.  I knew this was critical and if I missed something it could catastrophic for this pt.  As I scanned to the left the diagnosis jumped out at me.  There was an ectopic pregnancy in the fallopian tube.  There was evidence of fluid in her abdomen and I knew at this point we needed to move and move quickly.  This pregnancy was already starting to hemorrhage and as we waited to place the IV I watched as this pt’s blood pressure started to drop.  Ed and I brought her back to the OR and opened her abdomen quickly clearing the blood out as we went.  Sure enough, the dilated tube stared back at us as we placed our clamps and removed the left side.  I am so thankful this pt came in when she did and that we were already at the hospital when she arrived so that no time was wasted.  It is amazing how fast these pts can go from stable to unstable.  Praise God that she survived and was doing well this morning!

Nothing else was pressing so I went back to try to get a few hours of sleep.  That was not going to be my last phone call of the night.  My phone rang again in the early morning hours.  A pt of ours had arrived, in labor, with a history of 2 prior c-sections and the nurse was now not able to find the baby’s heart beat.  My heart sunk as I pulled out my flashlight and hurried toward the hospital.  What was I going to find when I got there?  I immediately turned on the ultrasound and took a look.  The pt’s belly was so tender and hard.  What I saw on the ultrasound left a pit in my stomach.  This was something I had never seen before, but only read about – uterine rupture.  From the grainy quality of the ultrasound it looked as if the scar from this pt’s previous c-sections had burst open and the head of the baby was now in the pt’s abdomen. Scanning some more I confirmed that indeed there was no heart beat. It was too late to save the child, but we still had a chance at saving the mother if we could get her to the OR quickly enough.  I made the necessary phone calls and prepared for surgery.  One swipe with the scalpel through the pt’s skin was all that was needed to see the infant’s curly hair poking out at me.  I groaned out loud as we opened further and I realized that the entire body of the baby and the placenta was outside the uterus floating in the abdomen.  I don’t think I will ever forget the overwhelming sadness of scooping that lifeless body up and handing it to the waiting nurse.  If only this pt had come in sooner, if only she hadn’t waited at home while she was contracting, if only, if only, if only…..but it is not my place to play the if only game.  I am not the one that holds the power to correct the past and change the future nor do I want to be.  I am not the one to question the events that were, I simply must be ready to help in the events that are.  Only God has the answers to the whys and the what ifs and He is certainly not obligated to give me an explanation.  I am so humbled.  We stopped the bleeding and repaired the damage.  In all of the suffering and pain that I have seen here thus far I have never once seen a Togolese woman cry until last night.  This would be her last pregnancy.  Her physical and emotional pain is more than I can fathom as I watched her silent tears drip down her face.  Lord, I know there is redemption in even this though I don’t see it in the moment.  He loves this Togolese woman more than I do and feels her pain even more acutely than what is piercing my heart.  I am so thankful that two lives were not lost last night and that the Lord was able to guide us through the necessary surgery to save this mother.  Why one woman made it to the hospital in time and one did not I will never have the answer, but I do know that the outcome does not change the Sovereignty of our God.  Nothing surprises Him and nothing is too big for Him to handle.  God has broad shoulders, much broader than mine and I have to rest in that. 

Ups and Downs

I was able to send home the mother with the breech twins this morning!  Both babies weigh about 4.5 lbs and are probably some of the cutest things I have ever seen.  Everyone is doing well.  Praise God!  When I was talking to this mom yesterday she said that she had no idea she was having twins until she delivered.  What a surprise!  I have asked them to come back in a couple of weeks to monitor how these two little ones are growing.  I so hope I get to see them again before I leave. 

Today was a slower day at the hospital for me which was nice as it has provided some much needed rest.  There have been a couple of hard cases over the last few days which have been sort of draining.  Abortions are fairly common in Togo and I seem to see a lot of people coming to the hospital a week or so after having an abortion performed by some medicine man infected and in need of treatment.  Two nights ago I got called to the hospital to help with just such a case.  I am not sure that we ever really get the complete story, but this pt had an abortion about a week prior and was now complaining of pain and fevers.  Ultrasound showed that tissue was still remaining inside her uterus and needed to come out.  Whoever had performed the original procedure had left some of the tissue inside and then to add injury to insult poked a hole in the uterus so that infection from their dirty instruments seeped into her abdomen.  Very few things make my blood boil like this.  I have seen many pts come to clinic with a history similar to this one who years later are married and desire to get pregnant, but are no longer able to.  It is both frustrating and sad.  They often beg me to do this test or that surgery in hopes that they will be able to conceive, but in reality there is very little I can do to help them.  Both of our hearts end up broken. 

Yesterday, we had several successful deliveries which are always wonderful.  There is no sound quite like that first cry of a newborn child.  It makes me smile every time.  Rhonda and I got to work together with several of the mothers. It is always so much more fun to do things as a team.  We did have one difficult case though of a mother who came in at term, in labor, with a stillbirth.  No matter how many times I have done this my stomach still drops when I place the ultrasound on the mother and see that lifeless body staring back at me.  The delivery was hard and it took almost 20 minutes to deliver the body of this baby.  I cannot imagine the torment of that poor mother.  There are no epidurals here in Togo, there is nothing we can do to dull the pain.  Like many of these cases there was no obvious reason for the death of this little one which just serves to make the situation harder by leaving a lot of unanswered questions.  Rhonda and I both prayed for this mother, there was nothing more we could do.

I have been so blessed to have Rhonda here.  When I was coming to Togo no one told me that I would be working with an American trained midwife.  I was under the impression that I would be working on L&D alone.  I realized this morning that I was praying for Rhonda even before I left the States.  I prayed that the Lord would send someone to help me, someone that I could talk with, discuss cases with and share my joys and sorrows with.  I prayed that this person would also be female and here by herself.  I really was just praying for a friend.  I love the work that I am doing, but I knew that if I was here and felt truly isolated the work here would become much more difficult.  I love that He provided long before I even asked.  Rhonda has been here for months!  We have made such a great team, both learning from each other, wanting to explore the country and understand the Togolese people as well as having a deep desire to serve the Lord.  God is so faithful.  He has provided for my every need even before I knew I had one.

Quick Update

I am on call tonight and just have a few minutes to write.  I wanted to give an update on Bernadette, the 4 year old girl I asked for prayer for.  She made it as far as Ethiopia where it was decided that she was too sick to travel all the way to the United States.  She ended up having surgery in Ethiopia and to the glory of God it went well!  She spent 36 hours in the ICU and is now on the regular floor recovering with what appears to be full function.  She has a shunt in place to help drain the fluid from around her brain.  We are praying that they will be able to remove it because living with a shunt like this in Togo is not really compatible with life because of the infection risk and the care it requires.  If all goes as planned she may be able to come back to us as soon as next week.  This is such an incredible outcome for this little girl.  Thank you to everyone who has been praying.  I so love the comments and emails I have been receiving from people back home.  It is so wonderful to still feel connected even though I am half a world away.  Alight time to try to get some shut eye before being called back to the hospital.  From Togo - good night!