Saturday, September 12, 2015

My adventure in Togo

As I sit and reflect on my amazing time in Togo it is hard to not think of a few things I am truly grateful for. 

1. My amazing family and boyfriend who have always supported me no matter what. Family here in Togo is everything and they are so dedicated to getting their loved ones heathy. It would be so amazing to see everyone this invested in their family like the Togolese. No one is ever in the hospital unattended and most family members sleep on the floor at night. I got to experience this first hand because I spent the night (slept on a gurney mattress on the floor) in the hospital with my roommate. She is better and feeling more like herself now. It was just amazing to experience what these people do on a daily basis. 

2. I am very thankful for my job, my team, and modern medicine. Anyone in America would be shocked to learn what these nurses do day in and day out to provide for these people. They have hand-me-down supplies that no one wants or cannot use and makes the best of it. They put their heart and soul into their jobs and really put in a 100% effort all the time. It has deifniey put in perspective for me how much we have at home and how much of a servants heart we need to have for those less fortunate. 



3. This one is silly but I am thankful for Arizona. The general sticky feeling you get here because it's so humid is something I don't think I could forever 😳 I am sorry for those who live in humid weather. 



I head home on Monday and it is going to be even longer than coming here. Pray for safe travels and stamina to get through the drive and three long flights. 

I will depart with one of my favorite memories of my trip. I was able to witness three deliveries and was able to do all the baby stuff once they came out. The babies were healthy, crying, and frankly making my job easier, which I was in turn very grateful for. I was in maternity the last three days I worked and it was amazing to see the moms slowly progress all day and then, more often then not, all of a sudden we would be getting ready to catch a baby! 




Obviously more pictures to follow on Facebook! 





Thursday, September 10, 2015

The Power of Prayer and Coartem


I just want to thank everyone who has been praying for me to feel better! I woke up yesterday with no fever but still achey and was taking Motrin very regularly. Today I woke up and felt like 100% myself with no fever and no aches! I just have a hoarse voice which can be a side affect from the coartem. 

Today I am in maternity with Jess and Amanda and we only have 1 baby and no moms 😁


A huge container was unpacked with all sorts of medical supplies and we got foot printers for the babies! We decided to print Neo 4 which is the only preemie here :) 



One of the nurses aides son came to play while she was at work and we got to play and cuddle with him which was very fun! 




I'm going to try and post two more posts before I leave on Monday morning! 








Monday, September 7, 2015

Meet Patient 9,516

Unfortunately I'm patient 9,516... Since I haven't been feeling the greatest and have been running a fever for two days with no success of breaking it the PAs decided to treat me prophylacticly for malaria :( I had to go to registration and get a "carnet" which is like a mini patient chart they bring to every hospital visit. 
After that Caitlyn, my lovely PA roommate, wrote me a prescription for coartem. 

After getting the prescription I had to go to pharmacy and get it filled. Luckily since I work at the hospital and am a short term missionary we were able to wait inside in the AC which was nice :) After the pharmacy filled it then you have to go to the cashier and pay. Surprisingly the coartem cost 11,050 CFAs which translates to about $21.29. We were definitely surprised it cost that much in CFAs even though it is in high demand all the time. The amazing thing about the coartem is that once you've taken about 3 doses you should start feeling better. Even if I don't have malaria I'm going to finish the prescription anyways. Yes, just so all of you know I was and still am faithfully taking my anti-malaria meds as well. 



A busy three days of work!

Sorry for not posting in the last three days work was busy and I had no time to write!

The past few days I’ve been busy working in the hospital. I have been very fortunate to stay in the peds unit so far. I unfortunately can’t work with the babies unless the nurse I am paired with is assigned maternity. They have four babies in maternity and I cannot wait to love on them when I work there next week! The kiddos we have had the past few days have mostly been malaria with severe anemia but we did get a few snakebite patients. When the hospital first opened they had a ton of snakebite victims but their mortality rate was around 50% and they were using the same anti-venom as the other hospital down south. After a few weeks of research by the pharmacist and the director they found out the snakes who live in north Togo were more similar to those found in India. They were able to get the anti-venom from a pharmacy in India and now they very rarely have patients die unless they were not brought to the hospital right away. I obviously don’t see ANY snakebite patients back at home so these few patients I was sure to ask lots of questions. When the patient is bit the venom can cause the clotting factors in the patients to be increased thus decreasing the patient ability to clot. If a patient cannot clot they can start bleeding internal and externally and then die from blood loss. We draw labs and the guys who work in the lab start a timer as soon as the blood is drawn and then watches the blood for the next 45 minutes waiting for the specimen to clot. In a normal sample the blood would clot (I think but I’m just going off what I learned today) in 10-15 minutes, but in these patients their clotting time was over 45 minutes! We gave them two doses of anti-venom and then will recheck in 6 and 24 hours.



On Friday I got to help out a first time mom give birth. I have been told there is a stigma in this culture; if the women show any kind of emotion in public it is definitely frowned upon. In Mango it is primarily Muslim, which is a shame/honor culture, which means the people want to honor their families and if they are shamed for something they have done wrong it beings dishonor to their family. I would just want to remind you these moms DO NOT receive epidurals or any kind of pain medicine unless they are going for a C-section. The mom was extremely composed throughout labor and was breathing through contractions like a champ! It took a little while for the mom to push the baby out so the baby ended up with a big cone head but was still super cute! It was awesome to be able to help this mom get her baby out and welcome a healthy child into the world! Just so everyone knows I did not catch the baby I was just there to help the baby take its first breath and make sure it did okay once it was delivered.

I tried to take some pictures of the “station” which is the central hub for the nurses but it’s hard when I’m trying not to take pictures of the patients. We are told not to take pictures of the patients unless we ask and they say its okay.



Sunday was my last day of work for my three-day stretch and it was definitely the busiest I’ve been here! We started out the day with 2 peds patients and 1 in observation for post transfusion due to malaria. Soon as the day progress we kept getting more and more and more peds patients. My most favorite patient of the whole day was a 32 weeker born at another hospital. The baby was 1.2kg, which is roughly 2lbs 6oz. So she was a tiny little thing but mighty feisty. Her unfortunately had a twin sister that died at the other hospital and so the parents took their other baby to use. One thing I’ve heard about the local hospital is that it is trying to make its services sound more appealing by offering services for less money. As I’ve said the Togolese people are extremely poor and sometimes cannot pay for the services they provide at Hospital of Hope. So back to my little peanut; she came in and we started an IV, which was the only IV I’ve felt comfortable starting while I’ve been here! She needed a little boost for oxygen so we started her a little flow of oxygen and then started her on phototherapy (the blue light to help get rid of bilirubin). She was definitely active and feisty, which is always good for the little babies. The nurse I was paired with told me that if I didn’t mind taking care of her she would do more with our other patients. After we admitted the 32-weeker we got another child with severe anemia and malaria, a child who had diarrhea x 4days, and a little baby who had been severely burned. According to the nurses they have had numerous children come in with burns to at least 50% of their bodies in the past month. Luckily we had a surgeon right there when she came in and he was able to assess what needed to be done and give the child the pain relief she needed.




On another note, I have been getting progressively sick over the past few days so any prayers would be appreciated. I do not think it is malaria but just the flu and the PAs I am staying with told me they would give me the malaria medication in a heartbeat. Once again thank you all for reading my blog while I am here and I hope to post a couple more times for my trip ends!

Thursday, September 3, 2015

The Hospital of Hope

Today I am going to talk a little bit about the hospital itself, but first a little background. There is another hospital in the southern part of the country and it has been there since the 70’s. It was founded by ABWE a Christian organization who wanted to reach the people in Togo. They were approached several years ago by the government about building a hospital in Mango (pronounced Mon-go). Since Togo is primarily Muslim ABWE told the government it would be a Christian hospital and they would be talking about the bible there. The government said it was okay because Christians took better care of their patients. So the plan was set and the wheels begun turning on how they were going to build a hospital almost 8 hours away in the city of Mango. It took many years for the hospital to be built but once it was finished it has now seen over 9000 patients in 6 months. I learned many of the Togolese people who helped built the hospital were then trained and hired on to work on staff at the hospital. Since these people helped build the hospital and watched it come together they in turn take great care of the hospital itself.

A typical morning at the Hospital of Hope goes something like this-

Allan Niells is the director of HOH and does triage with over 400 people every morning! Allan has lived in Togo for seven years with his family and is fluent in French one of the main languages here in Togo. Unfortunately French is not the only language spoke in Mango, there are 10 different tribal languages and sometimes it is hard to find the right person to speak the language you need. All children, pregnant women, and those with obvious wounds and illness are immediately sent to clinic. Allan then has to weed out all the people or give them rendezvous to come back at a later time. Triage is “complaint based” and there are no vital signs taken until they get to clinic. Once they get to clinic they are sent to get their vitals taken and to then wait for a doctor or PA to see them. Sometimes patients wait all day to be seen because of the amount of people allowed to go to clinic that day. Clinic usually sees about 100 patients per day, which is divided up by I believe 5 doctors and PAs. Once assessed by the medical team they will either be admitted or scheduled to come back to do follow up clinic appointments. Once they are admitted they come to Rea (the ED) and then either observed for worsening conditions or admitted into a bed. I haven't quite been able to get pictures on the inside because we don't want the patients thinking we are making a spectacle of them by taking pictures. 
(sorry for it being so far away but this is the front of the clinic)
(This is the security shack that patients are triaged at) 

The hospital is then divided up into 10 sections: men’s general, isolation, and ICU, women’s general, isolation, and ICU, general peds, PICU, NICU, and maternity. There are usually four to five nurses on per shift to take care of all these patients. Many patients stay for a couple of days or up to 2-3 weeks before they can go home. Many of these people are sacrificing a lot to stay in the hospital because of how much it costs. As you could imagine the people of Togo are extremely poor and a hospital could be many months of salary for a family. One thing the hospital does that I found to extremely cool is they will accept goats, sheep, and cow as payment if the family does not have any more money. They have around 12-15 animals, which have been received for payment, and in turn will be sold to benefit the hospital. Since the family members have to provide care and food for their loved ones the hospital has provided them a place to stay on the compound. It is called cuisine and it is just a tall building with an open area where they can sleep and then return to the hospital the next morning. Next to cuisine is another building where patients can stay if they do not need a hospital bed but still need medical attention regularly. These patients can have long term IVs or wounds which need to be redressed frequently but do not need to be admitted.

Something that the hospital does that I found extremely interesting is that patient’s families can give blood onsite that will go to their family members. One doctor was saying there are some religions in Togo that believe if they give blood they will also get the illness of their family member. So the nurses talked to me into donating some of my blood since I am O negative. I walked to the lab and the nurse told them I was O negative and the lab guys cheered and told me they wanted to take all my blood.

After you give blood you get a coke! 

Wednesday, September 2, 2015

A day to explore!

Day two of work was much like day one very busy with patients of all kinds. We had the pediatric patients again which was nice. Four of our patients had malaria and anemia and one was the little girl that had the head injury from the day before. I definitely got in the groove of how things work in the hopsital and was able to function a little bit on my own which was awesome! Since we are seeing many malaria patients I am learning quickly the signs and symptoms and how to notice changes within the disease. I asked the nurse I was paired with how they direct the plan of care with the patients who have malaria and she said they go in one direction or the other. In other words the patients will either pull out of the disease so to say with the assistance of Coartem (an anti-malarial drug) and many blood transfusions or they die. Unfortunately many of the patients die because the parents take them to witch doctors or the local "physian" to get looked at and then come to the hospital too late. Many times the patients end up with cerebral malaria when they come too late which can cause serious brain damage. On a high note I was able to play peek-a-boo with a little lady which made my day after all the sadness with my patients. 

Caitlyn and I were able to sit in on a bowel perforation repair surgery. The child was three yours old and had contracted typhoid. For an unknown reason typhoid causes a perforation in the bowel at the terminal ileum (sorry for the medical jargo). So we sat in on the surgery and she did great! She was awake and alert about 20 minutes after surgery and the Dr. said she looked great the next day in recovery. 

Caitlyn and I were very excited!


On Wednesday Caitlyn and I had a chance to explore Mango! Bill and Melonie the pseudo house mom and dad for the short term missionaries took us to see the beautiful sites of Mango. 

They took is to the future Christian radio tower which looked out into a huge valley and a river down below. The valley stretched for miles and miles and was luscious and green! They said it was a stark contrast to the dry season when everything is brown ... Those of us from Arizona can relate :) 



(This bird picture is for my dad) 

After we stopped at the radio tower we took a drive and went to market. Market is the main way for people to by food, goods, and fabric. It was a little overwhelming because everyone was telling us to buy something and we just kept say "no merci." We were able to buy fabric for skirts to be made before we come home! 


Thanks to everyone to us sent me words of encouragement along the way! I so do appreciate it! I am going to be sitting in on two surgerys today (Thursday)! I hope everyone is enjoying my posting and really getting a little taste of what it's like here in Mango, Togo! 


Monday, August 31, 2015

First day on the job!

Today is my first day on the job and I'm pretty nervous but mostly excited to help the people of Mango, Togo ! 
Nurses have to wear long skirts and white scrub tops and I'm wearing keens for shows because it rains quite a bit. For the first part of my morning we were assigned four pediatric patients. 3 of which are in their PICU type room and 1 in the regular peds area. Two of our patients had been hit by cars and the other two have malaria with anemia. Obviously it is extremely different assessing a kid but it's also pretty straight forward. The nurse I'm following is Jess and she is here for two years serving in the hospital. The Togolese believe in a very long lunch break (siesta is what they call it) so I was able to eat and lay down for a nap from 12-2!!! 

In the afternoon work slowed down and we just had medications, our final assessments and then report. The two hour brake really speeds your day along :) 

Around 530 we had three patients came in who were all pretty sick. The first patient had malaria who was seizing, the second had a head wound and bled all over the floor before we got him settled in bed, and the third another patient with malaria who needed blood. Near the end of the day I definitely felt much more confident and I am sort of figuring out how to get the equipment and meds I needed. 

(This is my little lady who had a head wound. )

Hopefully doing pediatrics tomorrow and two days off to tour Mango before working Friday, Saturday, and Sunday! 

So grateful for all of you who read my first two posts and those who are praying for me!