Ambassadors

Today was a full-blown African celebration - the opening ceremony of the Hospital of Hope. This represents the culmination of more sweat and tears and money invested than I could ever convey here. This was clearly a big deal and I was just an outside observer, arriving in this town only four days earlier. 

I was struck by many contrasts that I am still trying to process. It was a once in a lifetime experience for sure.

I met the American Ambassador, a nice man who showed up in a steel-plated white LandCruiser with small American and Presidential flags on the hood. When it was his turn to speak with the “Vive La Cooperation Entre Les Etats Unis D’Amerique Et Le Togo” sign backdrop blowing in the wind, I picked up that he was speaking in general terms regarding Ebola and AIDS.

Because the President of Togo attended, security was tight. A soldier with an AK-47 dangling from his shoulder inspected our bag at an entry checkpoint. I pulled out my daughter’s sippy cup, her favorite doll, her Doctor Dan book. He moved a few other items about, peering into the bag.  Then, he formed a small smile, looked up at her blonde pigtails, raised his finger up toward her cute cheeks and waved us through. I think she was a good ambassador today too.

The doors open for business on Monday, then I get my chance to be an ambassador in this place. I am looking forward to it.

Burns

Burns are dreaded in a developing world hospital. Frequent, preventable, resource exhausting, poor outcomes are terms that all come to mind.

For example, my first experience with this plague in Togo back in 2004 - I nicknamed her Ms. Feisty b/c of her spitfire personality and loud protest of our painful care of her wounds. As a naive medical student I became very attached to this girl and actually thought she would survive until one day I noticed that a pseudomonas infection rapidly turned her skin grafts into mush. Late that same night she died. I helped her mom but a pink dress on her burned dead body. I walked past her burial spot near the hospital the other day. That girl took a piece out of me.

A nearly identical experience at Tenwek in Kenya in 2008 left me more pessimistic. Others wanted to write off a badly burned girl who needed a tracheotomy. I plowed ahead and perseverated over her post-op care. One night while I was sleeping her tracheostomy plugged from dried secretions (no moisturized air in the primitive ventilator circuit there). Her ICU bed was empty the following morning - proving me wrong again.

So, you might imagine the sensation in my chest when I stumbled across this boy on rounds on my first day here. He was burned over the face from a hot liquid at a funeral ceremony - that was all of the story that I could understand. I would describe it as choking down tears trying to well up all the way from my heart.

Duplicate that sensation when I saw this mother (blue shirt) in this same position (hours apart) praying over her burnt son in the pediatrics ward. He had carried fuel for a generator, spilled some on his clothes and then ignited in a clothes distribution when he started the generator. 

Over the course of my work here he turned septic with high fevers - consuming much of our limited supply and most powerful antibiotics. I just asked God to please honor the prayers of this pleading mother. Because she is from Ghana and speaks English, I developed a special relationship with her. That boy is indebted to his mother.

Well - prayer was mercifully answered and meticulous burn care was rewarded.

See the boy with the face burns at time of discharge (he required no skin grafts!). His pigment should come back with ongoing healing.

And the boy the mother was praying over playing cards with my son. He had additional skin grafts this week and they are taking well. I am hopeful he will run and jump again someday. 

I am losing track of all the prayers for mercy and healing I have seen answered around here. 

Hike

We took advantage of a free Saturday to do a jungle mountain hike to a nearby waterfall. 

Our preferred guide was occupied in the morning with a funeral. His niece just died from SIDA as they call it here (AIDS), but he was kind enough to lead us out in the afternoon. 

Thankfully much of the trail was shaded by dense forrest but still plenty hot. He pointed out interesting sites along the way including banana and coffee trees. We saw scattered huts, a small church or school, stacks of charcoal and assorted livestock grazing along the way. 

My fear of schistosomes kept the sweaty boys from doing cannon balls in the pool beneath the falls. An intense tropical thunderstorm broke loose just as we made it back the guesthouse for dinner. After carrying a sizable 5-year-old on my shoulders part of the way down the mountain, the rain felt good.

Culture / Cats

There are so many cultural differences to process. I just finished a long conversation about what informed consent means here. It turns out that this is a very Western ethical idea designed to promote individual autonomy. This is hardly a highly valued ideal in a society where the community good and other priorities supersede the rights of the individual. It’s hard to comprehend what consent even means to a woman who may not have consented to her own marriage and must sign with a fingerprint (without ability to write her name). 

I try to keep a nonjudgmental tone in all this. Especially after the story our driver Kofi told me regarding the delicacy of cats in Southern Togo.

On my second day here, I sat in a Lome cafe eating a hamburger with Kofi. I just had to know, so I asked “Kofi, do you eat cat?” 

“Yes!” he replied enthusiastically.

Perhaps seeing my eyebrows raise, he was more measured in his response to my follow up question, “What does it taste like?” 

“I mean…I don’t know yet” he answered. Then he laughed loudly and launched into what I suspect is now a well rehearsed story. This is my best recollection of it:

“One time I was picking up a missionary at the airport and while I was loading her bags she asked me if I eat cat. I said ‘yes’…. this is normal in Togo, this is accepted.  But she becomes very upset…”

Now his arm motions get into the story. 

“I mean she becomes very very angry… she says, “Kofi, I don’t want you touch my suitcase,” the whole way to the hospital she will not talk to me. She tells Madam at the hospital that she doesn’t want her to send Kofi to pick her up anymore. The missionary never comes back to Togo!”

So madam tells me ‘Kofi, when someone asks you what cat tastes like, say “I don’t know yet.”

By then I was just shaking my head, smiling and reassuring him I wasn’t a big deal to me.

The next day, before going to the hospital I was putting on khakis when my son asked “Dad, why are you wearing pants?"

“It’s not appropriate for men to wear shorts in this culture” I replied.

“WHAT?!” he shot back, “They want you to be even hotter?” followed quickly by “What do kids have to wear??”

Oh culture.… It is interesting isn’t it?

Back to the cats for a minute. Last evening over dinner - rice with unidentified meat in a red sauce - Finley said “Dad you know is this cat meat don’t you?” through his ornery grin. Actually, cat is “VIP meat” as Kofi called it, reserved for your boss or the chief for example. He went on with details about the cat trade and how meat preparation works, showing big claw scars on his wrist to verify his claims. I have noticed there aren’t many cats around here. In fact I haven’t seen one. One of the full timers here had a cat that became so unruly and uncorrectable around the house that it was “given to one of the Togolese who could use it.” 

A Post from Sara - The Ugly-Beautiful

A few things I've been thinking about the past few days...

One thing I have learned about myself in our trips to various parts of Africa is that I am impacted more than I would have guessed by what I see in the environment around me.  Years ago, we stayed a couple days in a hotel in Nairobi before catching our flight out of the country.  Although the hotel was nice by Kenyan standards (running water and even a pool!), the furnishings were tattered, the walls were cracked and crumbly and the 1950s television appeared to not have worked for years.  And as I looked around that worn hotel room, my attitude deteriorated incredibly quickly so that I was not much fun to be around until we bolted the country.  In hindsight, my lack of gratefulness is embarrassing, but this fight for my attitude is ongoing whenever I leave the comforts of the US.

There is so much natural beauty in parts of Africa--the picturesque printed in National Geographic.  We will see a little of that beauty, but the reality is that the majority of my time will be spent inside our home (right now one large dorm-style room with an attached bathroom where Fiona sleeps in a pack-n-play in the shower).  The homes are practical for the most part and we have commented how life works just fine with only one large room, but there isn’t much to my indoor surroundings that is pleasant to look at.  And it didn’t take me long after our arrival to start feeling like this little home was a depressing place to be for a few weeks, let alone make the choice to live long-term in a place like this.  But thankfully, what God sees here is so different from what I see, and He is so gracious to shift my perspective.  From my Ann Voskamp devotional:

“The impressionist painter Paul Gauguin encapsulated it as, “Le laid peut etre beau”—the ugly can be beautiful.  The ugly-beautiful….In Christian circles, we elevate what we deem beautiful, endeavor to create spheres of pristine beauty, and perhaps rightly so, for “whatever is good, pure, lovely, think on these things.” But I wonder if maybe in the upside-down kingdom of God, what we regard as unlovely is, in Jesus, lovely.  Because somewhere, underneath the grime of this broken world, everything has the radiant fingerprints of God on it.  Seeing the world with Jesus’ eyes, we have the astonishing opportunity to daily love the unlovely into loveliness.”

So today, instead of the rusted lamps with ripped lampshades, I see electricity and am thankful it works reliably.  Instead of a lumpy mattress, I see the fun elephant-print coverlet that reminds me of the rich culture here.  Instead of the ripped sofa chairs, I see missionaries who are willing to live with less for life so others can know hope in Jesus.  That is beautiful and it inspires me to thankfulness to God and His upside-down kingdom.

Starting in the South

Our first stop in Togo has been in the Southern part of the country where we came initially in 2004. This hospital was started 30 years ago and has established a good reputation based on the wide variety of patients cared for in a wide catchment area.  The people and facility seem timeless - virtually unchanged from how I recall them over a decade ago.

We’ll be here of most of February and this is a great place to start our stay in Togo because we are among old friends, it gives us all a chance to adjust to the temperature change (not near as hot as it will be in the North) and allows me to get a refresher course on what general surgery means on this continent. 

There is a relatively big surgery team here currently -  a full time general surgeon, a professor of trauma surgery from New York who serves 6 months each year here, a pediatric surgeon and third year general surgery resident from Cleveland here for a month and a gastroenterologist who has cut back to a 3/4 position in the US so he can work hear each year. So, I have plenty of back up when I am not sure how to handle things like machete hacks to the hand, redo C-sections and neglected tooth abscesses that turn into life threatening face/neck abscesses. Thankfully there is plenty of what I do back home too. When we move to the new hospital opening next month in the North, the surgery team will be much smaller.

I’ll include a cute picture again. This girl was hit by a car and suffered a femur fracture. She became popular because she looks like the person in traction in a well used surgery text here called Primary Surgery. She sat in this position in a crude traction apparatus (sand bag) for 6 weeks! Her X-ray shows callus formation of a healing fracture. The overlap is okay because her growth plate remains open and with time the fractured leg will lengthen. I snapped a picture the day the traction came off and she was cleared to return to her home. I liked her little  baby doll and showed her a photo of my daughter with a similar matching doll which made her flash her big smile.

Example Cases

My first surgical case Friday demonstrated much of the adjustment to realities of medical care here.

What a cute and stoic boy with an inguinal hernia. In the picture, a bright OR light shines on the spot of planned surgery on this small boy. The marks on his abdomen are scars from a witch doctor’s treatment of his fever earlier in life. 

Thankfully he sought care early for this common problem and the case was a straightforward start to operating here on Friday morning. I found him alone in his bed on Saturday morning rounds, but his grateful mother soon stopped by to ask a Ca va bien? I nodded that all was well and he was discharged. I complimented him to his mother through a translator, knowing that my own son about his size wouldn’t have been near as tough. 

The boy with his mom (younger child on back) before discharge.

Later the mother was trying to tell me something so I flagged down his nurse to explain. 

She says “When you go, you can take the boy with you” he said, half laughing. I laughed along with the mother - choosing to believe / hoping that she was only joking. 

At the same time, a 38-year-old man lay in the triage area in grave condition with the same problem. Only his hernia had been long neglected, and was now the size of a football and containing strangulated intestines. There was much discussion about his poor prognosis and the reality of running up a hospital bill that might not change his outcome. Being relatively young and otherwise apparently healthy,  it was hard to just do nothing. After much discussion with the family, the decision was made to attempt operative intervention.

After  lunch I took my youngest son back to the hospital to check on the on-call team operating on the ill man. We ran into the family of the boy I had discharged earlier. I explained to my son that this was a boy I had operated on and tried to introduce them. The two boys just stared at each other. The father seemed upset about the bill. He showed me, in their patient booklet, where they had paid 80,000 cfa in advance for the surgery (roughly $160) but questioned (in French) additional charges entered upon discharge. I explained (embarrassingly) that I only speak English and thankfully another helpful nurse walked past. I could pick up that she was telling the family I had nothing to do with their bill and she quickly dismissed me and my son from the discussion.

I stopped by the OR and made my son wait outside. I peeked in and saw that our suspicions where confirmed - the intestines trapped in the man’s hernia were dead. I told the operating team I would pray and left. 

When I explained that the patient might die from his problem to my son, he said “Oh” and looked like he wanted to cry. As we walked back to our guest house I tried to tell him how much I like working at this place. He was pretty quiet. Despite an aggressive operative effort and our prayers, the man with the strangulated hernia didn't live past this morning.

Point A to Point B

Point A to Point B

After about 14 hours of flight time with a 4 hour layover into an EST +5 hr time zone, we are settling in and getting adjusted. Amazingly, there were no travel glitches and our bags all made it through unscathed. 

The culture is as different as the climate. Photo A shows us packed up in the snow with most of our 15 bags requiring a separate pickup. Photo B shows the kids heading off to the pool (after the first day of homeschool if their teachers are wondering) :).  A termite mound and the guest house where we eat our meals are shown in the background.

It feels good to be back here and whole family is adjusting well. Our accommodations are nice and we all remain healthy for the most part.

The cultural adjustment is going well. Avery asked if it was okay to eat the salad on the Delta flight out of Chicago. He is vigilant about food borne illnesses. Finley was pretty shocked to see a couple of boys peeing in the street and a baby with no clothes on. He thought it was pretty funny that a lady at market was walking around holding a big platter above her head filled with bras for sale.  I had a shocking and hilarious conversation with our driver about eating cats (a delicacy in South Togo) that deserves its own blog post.

The patients at the hospital are many and varied. The smells and sights are the same and bring back memories and emotions. The cases I see quickly soften my heart and the realities they represent make my head spin. I am getting back into the groove here and have a lot to learn again.

Praise God for merciful answers to all the prays for our safe travel and a good start here.

Point A

Point B

Our Team

Well our big experiment is about to begin…

After doing a lot of talking / praying / planning / saving - today our family is headed to Togo, West Africa for three-month term split between two hospital compounds there. 

Our overarching goal is to be good ambassadors as I join a surgical team and our family comes alongside of others trying to demonstrate the love of Christ to the wonderful people who call Togo home.

As we try to navigate in a very different culture, our appearance and our accents are not going to blend in easily, but we go in love and hope to rejoice in the diversity of all God’s creation.

I am excited to be apart of this team. And I think we have some of the best supporters in the world. Many thanks to our families, church, co-workers, school teachers, neighbors and friends around the world who have wished us well, committed to pray and shown love in sending us off. 

This blog will be our attempt to journal and keep in touch while we are away. We are going to miss all of you back home and we hope you will keep in touch with us too.