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Kid’s Club

May 12, 2010

This afternoon I (Ginnie) had the opportunity to participate in Kids club.  One of the missionaries devotes every Wednesday night to children’s ministry.  The word has spread and about 100 children “appear” on Wednesday afternoon for singing, games, teaching of the Gospel and Kool-Aid.  It was crazy to see all the children cram into one of the missionary’s living room for singing.  The group then split up by age for teaching.  They all came back together for Kool-Aid and snack.  Then it was off to “pick up” games of basketball, hockey and soccer.

Last night during hospital rounds Aaron and I had a long discussion with one of the patients regarding healthcare in Africa.  As you could imagine, the government hospitals have limited resources and many doctors are corrupt.  This patient was nearly pleading with Aaron to go start a hospital in a nearby country.  It is amazing to think of how God has blessed this hospital in Togo.  The hospital is going to celebrate its 25th anniversary in a few weeks.  The hospital has grown tremendously over this quarter of a decade.  The new OB ward is testimony to this growth.  The OB ward opened just a few months ago and the number of deliveries at the hospital has grown exponentially.  “If you build it, they will come.”  The pediatric unit has been full and overflowing into the other wards since I have been here.  Unfortunately, several of the pediatric admissions are for severe malaria.  But thankfully with God’s grace most of these children survive. Many of these children if they were brought in to the hospital a day later would have died at home.

Togolese Kitchen

We may think we are “toughing it” in the humid heat here at Togo.  But in comparison to how the Togolese people live we are living like royalty.  Many of the people here  live in compounds with no electricity.  Their “kitchen” is outdoors with a campfire.  In many of the villages the houses are made of mud with dirt floors and unclean water.  The hospital has safe drinking water which they have available for the locals for free.  Many people make trips to the hospital for water everyday.

Village house

Our time here is quickly coming to an end.  We have both very much enjoyed our visit here and are thankful we came.  I have enjoying getting to know the other missionaries and hearing all the amazing stories of how God provides.  Right now the ABWE (American Baptist World Evangelism) is fundraising and has started building a hospital in the northern region (sub-Saharan) of Togo.  This new hospital project is very exciting since the area of northern Togo has very limited resources and many people die needlessly secondary to lack of healthcare.  It is fantastic to see God at work all around us.

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Sunday–a nice rest day

May 9, 2010

The waterfall about an hour hike behind the hospital

I have to admit the past week of operating was tyring. On Friday we had another baby with an intussusception that went to the OR, a hernia repair, an exploratory surgery for a suspected pelvic mass, a very difficult chest surgery for a likely severe tuberculosis infection of the lung that had spread into the lung space, neck and back, and finally at 130 on Saturday we had baby that needed to be delivered by c-section. So it was great that no emergent cases came on the weekend.  Ginnie had time to go to the waterfall.

Nothing beats the pool!

We also celebrated Mother’s Day a little early but going into the market to buy some fabrics to have made into dresses and to buy some gifts for the kids and a few others at home. We ended the day with a nice meal at a local restaurant thanks to Michael and Cheryl Gayle who drove us around. It’s great to work with the American and Togolese staff again. I jokingly say that Michael’s twin brother is Russ (on the left in the picture). Russ is the pediatrician at the hospital. Ginnie is helping teach him cardiac echo.

Russ and Michael

The Togolese staff remain amazing. After having been to other mission hospitals, I can safely say that the Togolese are some of the hardest working and attentive nurses/aides I have worked with. To be a nurse here you will have graduated from the nursing school run by the missionaries. I’m sure that’s a big part in why they are so good. They share the gospel with the patients at every opportunity. Some may think this is coercive in nature, but the reality is the patients receive the same care irregardless. And frankly, knowing there is hope is something everyone needs to hear about.

David sharing the gospel with a patient

Today, Sunday was also a nice day to rest and attend the local church near the hospital. We also had a raucous game of waterpolo/basketball with the Cedarville nursing team that just arrived. The above picture of the pool was from a few days before. I wish I had some shots of today’s game it was a great time. Have to finish my preparation for tomorrow’s devotions for the staff now. Thanks for reading and praying for us!

“Gas”

May 8, 2010

As with all tropical countries there seems to be a collection of lizards.  Here on the hospital compound I have seen several small brown lizards.  I just saw one in our bathroom tonight. There is a bigger lizard, which hangs out in front of the guesthouse that is black and yellow.

Every time I see one of these lizards I can’t help but think of Noah.  He has two small toy lizards.  The first toy lizard I found in the parking lot at Costco and Noah loved that little green lizard. He decided to name the lizard “Gas”.  Why “Gas” who knows?  He just got a second toy lizard, which is brown and called “Big Gas”. So here are some pictures of the lizards that remind me of Noah.

 The other local wildlife here on the compound include a monkey.  The monkey is not so friendly, even when I tried to bribe her with peanuts.  There is a baby pet deer, which plays with the dogs.  All of these belong to one of the missionary families.  They also have a Civet, which looks like a weasel with leopard markings.  Other wildlife sightings have included Aaron almost stepping on a bullfrog.  I spotted a 3 inch or so millipede yesterday.  This morning near the hospital the staff killed a Green Moomba snake.  So as a rule, always walk with a flashlight in the dark and look where you put your feet.

It is mango season here.  There are mangos hanging off several trees.  We have has some of the sweetest mangos.  We even had a mango pie, which was one of the best pies ever.  The downside to all these mangos is that there are so many they can’t all be picked and are rotting on the ground, which can be a little stinky.

I (Ginnie) have really enjoyed interacting with the Togolese.  They seem like such grateful people.  I have been fascinated by their colorful clothing and interesting hairstyles.  The new style here, is wrapping small braids in wire, which can look rather interesting. 

 Tomorrow, I am going to a local waterfall and then in the afternoon Aaron and I are going into town with our missionary friends to the market.  I am looking forward to seeing some of the local sites.  Thank you for all your prayers.  It has been very busy for Aaron in the hospital with some very sick patients.  We pray that the patients during their stay in hospital hear and respond to the Gospel for spiritual healing.

Long days…

May 7, 2010

This will be a very short post. We finally got done last night at 11pm. Three big cases and another room running with Todd the PA doing the other cases. I don’t think I’ll be posting pictures of the cases since they might make people squeamish. In my room we did a large abdominal mass resection, a pediatric intussusception and bowel resection, a hernia and draining a large abscess on someone’s back–the last patient will go back to the OR today for a chest surgery and drainage.

Sorry this is so short today, I’m hoping I’ll have time later today to post more.

Day 3–the rest day

May 6, 2010

Well let’s say that it’s supposed to be a rest day. One of the things that I love about Togo is the hospital talks Wednesday’s off (usually the afternoon) to allow the staff to participate in ministries out in town. The challenge with anything medical in Africa in my opinion is the burden of disease. Yes–certainly missionaries that have been here for decades have made a huge impact into to people’s lives. But if you read their biographies (eg Jesus, MD by David Stevens–an FP/surgeon at Tenwek), you see how overwhelming the burden of disease is. You could operate 24/7, and you wouldn’t beat the problem. So I’m grateful when there is deliberate downtime to allow for time to plug-in to other aspect of the ministry.

However, not unsurprisingly, we performed two operations on men who had incarcerated hernias for several days. In the US, a hernia that is trapped in the groin goes to the OR immediately. This time unlike yesterday, the bowel was partially dead in on case. While attempting to put this flimsy inflamed tissue layers back together to repair the hernia, a young woman arrived in extremis. Ginnie had to do an emergency pericardiocentesis and removed about 200 ml of fluid but that didn’t help and the poor woman continued to decline without an identified etiology. Unfortunately her family left her near the end, and she died within hours of arriving at the hospital. Indeed the fragility of life is evident here.

On a brighter note, I did have the chance to talk with a man dieing from HIV about the gospel. Hopefully, he will decide to accept the Lord before he dies in the next few days/weeks.

Off to round…blesings to you all.

Pray for surgery–

May 5, 2010

And you get surgery. From a surgery standpoint, it’s been a busy two days. I have a trauma patient with an expanding retroperitoneal hematoma. He was hit by a “moto” (moped/small motorcyle) in the left flank and had blood in his urine. On u/s he has a growing fluid collection around his left kidney. His hematocrit has dropped 50% in the past 36 hours, I’m hoping he’ll stop soon as the retroperitoneum tamponades off the bleeing. Otherwise, this could be a very tricky problem to manage out here.

I had the privilege to do several hernias yesterday including a pediatric case which can always be challenging. We also did a hysterectomy for a woman with abnormal bleeding and pain. I was thinking there was actually a shortage compared to normal of emergencies—and lo and behold we had to perform two exploratory laparotomies. One in a very ill appearing gentleman who had bowel trapped in his scrotum for 7 days, and the other for a young woman with an extremely distended abdomen due to a large mass (turned out to be a large cystic adenoma that had ruptured from the right ovary). Fortunately both patients are doing well.

Ginnie and I continue to pick up whatever we need to do as the missionaries from all over Togo meet here for two days. It’s a blessing to be able to help where we can. Yesterday John who came in 2005 with me arrived in Togo to help. It’s great seem him again after almost 4 years. He’s a tremendously talented surgeon.

Today is Wednesday and the hospital usually takes a mid-week breather for ministry. We’re praying that we would be open to do what God would have us today. Certainly those one-on-one conversations with patients and hospital staff are unique moments that are important to pay attention to.

Our kids continue to do well with Yvonne and Cico. We’re so thankful for them and for your prayers and support.

Will try to post pics later today.

First full day in Togo

May 3, 2010

A little bit of medical detail for today…nothing to make your squeamish though.

Crazy Monday OR Day

Drinking from the fire hose today for both of us. It’s fun being back at Togo as a surgery resident compared to when I was a medical student. Now I get to operate all the time, but each time I operate it’s always something new. Today we did five cases in about 4 and ½ hours. It’s great when the room turnover after an operation is less than 10 minutes. Some were simple obstetrics procedures, others were more complicated such as delivering a near term baby in transverse lay (baby’s head is pointing to the side instead of pointing down into the pelvis) via cesarean section in less then 2 minutes because the mother was a paraplegic, and couldn’t risk general anesthesia or spinal anesthesia. Even the hernias we did were extremely challenging in terms of chronically inflamed hernia sacs that were difficult to dissect off the cord. We also do not use mesh to close hernias in Togo for various reasons (in America the usual standard of care is a tension free mesh repair). Probably the most poignant case though was an elderly gentleman in a poor state of health who had an incarcerated ventral hernia (the bowel is trapped in hole in the abdominal wall and eventually dies if not put back into the abdomen). When I saw him on rounds in the AM, I knew we were in trouble. True to form likely elderly patients in the states, it was difficult to obtain a reliable physical exam on him. But my previous experiences in Africa have taught me that if I think someone needs an urgent operation, don’t hesitate. Nevertheless, he died before we could the operating room. (Cultural tidbit—in French we say this as “aller au bloc” pronounced alley-oh-block”). At least this time I didn’t make the same mistake I did in Tenwek. I talked with the man and his family on rounds about the potential for death during the operation and prayed with them. What a joy to know that he was saved before he came to the hospital. Indeed the family was so grateful for all that we had tried to do for him and that he was in heaven. It’s rare to experience what some call the purity of medicine—where you care for the patient and their family without the overwhelming worry about the overwhelming spectrum of reduced reimbursements, malpractice costs etc. While we can’t always provide the highest standard of care as in the developed world, we can practice medicine with far greater intimacy than in the states. This is an incredible experience that I think no doctor would regret.

Ginnie was equally overwhelmed…well probably more overwhelmed since she can’t speak French

Tough living watching satellite TV in the Ghana Guest House

and pediatric residency didn’t cover cereberal malaria and all its complications (and man there are a lot—low blood counts, seizures etc). She did a bunch of adult and pediatrics echos today as well. But she’s still pretty nervous about being the on-call doc tomorrow. I can’t say I blame her. I’m on call for the reminder of my time here as well for surgery. So your prayers would be appreciated! We heard from the kids’ adopted grandparents. It sounds like they are doing well and loving to spend time with Yvonne and Cico. What a blessing to know that God knew that we would need help from the great body of Christ, and he provided these two wonderful folks at just the right time. It’s late so I’m off to prepare a devotion in French for the OR guys in the bloc in the morning. More to come!

Ghana Guest House Porch--tough African living--ok it's a little hot!

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