Love in Togo in the time of COVID

Lament is, “a prayer in pain that leads to trusting God” Mark Vroegop

I have been thinking and praying through this idea a lot lately. It is hard to be here in Togo; watching the news online and reading the stories of healthcare workers, death, stress, lockdowns, quarantines, and social distancing that is happening in the US and around the world. I watch it unfold from my corner of the world of Togo, West Africa. The inconvenience that it all seemed to cause at first to now the total disruption of life that has happened.

For a long while, I have only watched, read, and looked on from a far while all of this unfolded around me. I remained relatively untouched and unaffected from it all. But none of us are unaffected and what is happening and will continue to transpire has and will continue to disrupt all of our lives. 

The way our system works here is that we have a core group of missionary physicians that live and work here all of the time but that group really cannot sustain the work at the hospital for long periods of time and so we rely on short term providers to come and help. Many of the physicians here were slated to take a much needed and long awaited vacation at the end of March. We were all going to a conference and then taking some vacation time afterward. We had called, emailed, and asked volunteers to come and cover the hospital to make it happen so that we could all go. Well, as March went on and COVID ramped up, worry set in that the conference would not happen. Then the news came, no conference. Many of us were like, “ok, no problem, at least we will still get to leave for a vacation.” Then one by one our volunteers decided not to come. Finally, we all decided given what was then happening in Europe and the US that it was smart for no one to come to our still untouched area of the world with the possibility to bring COVID here. So just like that, no vacation and no volunteers coming in. 

I was devastated because I really needed a break even though I knew from every aspect of life and public health that no one coming in and no one leaving was the right answer. After this sunk in, instead of a vacation and a break, we went into prep mode for COVID. 

There was a sense of eeriness for sure, because we have all been here before. We are not new to prepping and preparing for an epidemic here. With the prep, came a weird anticipation that “it” is coming. With all of this, comes all of the emotions of 2016 with Lassa Fever and now every year that follows as we continue to be vigilant for Lassa fever every spring. Now, with COVID, there is a new, invisible enemy that will attack us. But this time, it’s not only us, it is everyone. The whole world is battling this new enemy and affected by it daily. For so many weeks, we just read about all of this and did not truly understand all that was happening. It is strange to be sitting in Africa and only reading about an epidemic that is affecting the entire world when so often we are the ones being read about from afar. 

Being an ER physician, it feels weird to be here and not “there” where I would be in the middle of the fire every day. Instead though, I am here, preparing and waiting, and weathering this in my own way. 

Epidemiologically, we are at least 3-4 weeks behind Europe and the US. The cases for Togo are slowly starting to climb and a week ago, we had a case in our town. Since then, we have went into high gear with vigilance, screening, and preparing an area to treat possible and confirmed patients here despite our overall lack of resources. How COVID will end up in Togo is yet to be written but we at the Hospital of Hope are making every effort to be in the fight to the best of our ability. We may not have ventilators but we are prepping to give the very best level and quality of care possible despite this. 

1 Corinthians 1 27-28 says, “But God chose what is foolish in the world to shame the wise, God chose what is low and despised in the world even things that are not, to bring to nothing things that are, so that no human being might boast in the presence of God.” 

My prayer is that God will use our hospital, our workers, us, to bring glory to Himself. There is no boasting in a time of an epidemic but there is a lot of lowness and “things that are not.” May I be used by the Lord in this…in this time of COVID….in this time of uncertainty and inadequacy….in this place….to bring Him glory. 

Please pray, because despite COVID being here, our hospital carries on. Preemies keep coming, cerebral malaria continues, cancer, and heart failure continues. Borders closing are good steps to control the spread. But with that means, no short-term help is coming any time soon. So hunkering down for now is wrapping our minds around that and all the implications that brings to future breaks, furloughs, vacations all of which are giant question marks for all of us. Pray for resilience…pray for strength…pray for peace in this time of uncertainty. As I continue to lament to the Lord during this time I pray that it could be something that turns me even more to total dependence on Him. 

Know that prayers from here continue for the US and the world as we face this thing together….try to laugh a little more….be creative with your time…wash your hands…and don’t touch your face. 

Pick me.....pick me!!!

These past two weeks have been extremely busy at the hospital. For a few days we had over 35 patients on our service which is just insane. Two doctors a day, split 12 hours each trying to care for all of those people and all of the emergencies that come in is, well, a lot. Things were probably not done as effectively as they should have been and some things probably got missed or overlooked. 

It was a rough few days and it took its toll on me. But then this week the census was much more manageable and it was like the Lord was saying, see….sometimes really good things happen….

Almost every conversation here with a patient or family member goes through a translator. Because even though I speak French, many of the families here do not. They speak one of about 15 tribal languages. So normally, it goes French through a translator to the patient and/or family. Because this is how it works, I will typically go and examine kids and then go back with a translator to explain the plan for the day, what we are doing, etc.

Almost every bed here is located in an open ward with beds beside each other.  That can vary from 3 beds in a room to some big wards that hold 9-10 beds. So when you are talking with a  family everyone hears what you are saying. 

It is malaria season and I have written often of the tragedy that comes with malaria. But I do think it’s worth sharing some of the successes we have too. It is true that we see a lot of kids succumb to malaria but there are even more that get to leave, recovering or cured and do well. 

I do these “are they ready to go?” rounds every morning and every afternoon. Sitting up, awake, eating, these are things I look for to see if they can go home. Sometimes I walk through and kids have a plate of traditional pate and sauce and they are shoveling it in. Well, that’s an easy one….discharge home. More often though it becomes this almost a game. I see a kid with his eyes open and tell the family, “ok if he can eat something and sit up maybe he can go home later.” That’s all it takes and next thing you know they have propped up the kid and are giving him bouille, which is like a porridge. Sometimes the family will call me over and show me kind of like, “see…see he is doing it.” It becomes funny at times because parents seem to be like, “ok there she is, this is our shot to go….”

This past weekend I walked through the ward and told one family their child would be discharged and the Dad of the kid in the next bed tapped me on the arm and pointed at his child. So I sat him up, awake but pretty weak and the Dad kept calling his name. The kid would just cut his eyes over to look at his dad every time and then look forward again. Almost like, really dad, I hear you, why do keep calling my name. It was so funny. Needless to say, that child also got to go home that day. 

It can be rough here, not going to lie, but there are times when it is very sweet as well. Please pray for the hospital, the nurses, the aids, the doctors as we continue to walk through very difficult days of malaria. However, rejoice with us as well as we see many kids go back home with their families, recovered. 

If you would ever feel like contributing to the work here at the Hospital of Hope, you can do so at this link: www.abwe.org/give 

click give now, then search for HOH Togo pediatric care. This fund allows us to help families pay for their bills when they are not able to do so.

Reality

I get asked from time to time, “so what’s life like there?” So this blog is going to be my reality. The good and the bad of it. This is where I live: 

It is pretty nice. However, that roof is metal and on hot days, which is most of them, it’s like an oven inside. We do have A/C in one room so I stay in there most of the time. 

This is my transportation: 

Always a lot of fun and really the most practical way to get around on dirt roads. Most of my days are spent at work but on my days off its laundry, cooking, cleaning, all the same stuff that occupy days off in the US. 

Working at the hospital here is my ministry and why I am here. We do shifts, either days or nights and when I am on I am responsible for all of the medicine patients. We are extremely pediatrics heavy and on most days, 80-90% of the admitted patients are pediatrics. We also have a very busy NICU and usually at least have 3-4 preemie infants admitted as well.  During a normal day, I will round in the morning and then take care of any urgent or ER type patients that may come in. There are some days when I am like, “yep I got this, no worries.” But there are many when I plead with the Lord for help because I don’t have the right answer or know exactly what the right thing is to do. The Psalmist says it plainly, “I lift up my eyes to the hills, from where does my help come? My help comes from the Lord who made heaven and earth.” Psalm 121: 1-2. I find myself praying this prayer often. 

It is hard to be here at times. There is so much poverty, illness, death, and disease. We try fiercely, as a medical staff, to stand in the gap and to intervene when we can but death still comes. It comes like a thief in the night. We are in malaria season now and every year this disease breaks my heart as I see it steal kids from this life so quickly or it devastates them to the point of needing full time care and a feeding tube. 1 – 3 million people …..that is a big number. That is roughly the population of cities like Houston or Chicago. That is also the number of people that die every year from Malaria. Of those 1-3 million deaths, 80-90% are children under the age of 5.

A limp child is brought in to the ER area. He is unresponsive. His breathing is not good. Glucose check and its normal. We start bagging. Heart rate is ok. As we work, the family gives the story, 2 days of vomiting and fever at home. They took him to a clinic today, had a malaria test that was positive and he got a shot and told to come here for anemia. We continue to bag him while an IV is placed and IVF given. Labs are drawn and he starts breathing better. He’s placed on oxygen and I walk away for a few minutes. I am then called back over shortly and he is again not breathing. I check his pupils and they are now both fully dilated and fixed. He has no respirations at all. And just like that malaria has taken another one. I talk with the family through and translator and tell them how sorry I am but their child is dead. The nurses go about taking out the IV and cleaning everything up and I go back to another chart, another patient. All women here carry their children on their backs, held there by a piece of material. It is like a better but different baby bjorn. I happen to look over a few minutes later and the family is helping to put the child on the mom’s back so they can take him home for burial. This was not a new site for me, I have seen families carry out dead kids on their backs before but every time, including this one, I just stopped and my heart ached for them….They came for healing and with hope and it was too late….there was nothing to do….the thief of malaria had taken another one. 

Twins are prevalent here….we see them no uncommonly. However recently we had 6 sets of premature twins admitted in our hospital. I am pretty sure that is a record for us.  They are super cute but given their prematurity and all of the potential complications that come with that they are a ton of work. And, it’s very confusing trying to keep them all straight J. Are these the boy twins, the girl twins, are they one boy and one girl. Are you sure this is baby “A” and that’s baby “B”? So, for a long time now, even when our numbers of twins have not been this high, we started wrapping tape around one leg of each to “label” them as “A” or “B.” 

This is one set here that is close to being discharged.

                            Photo used with permission

Sometimes, after they are discharged and come back for follow up appointments, they still have the tape markers on. These kids are usually in the hospital for a month or two so it allows us to easily make relationships with the mom. She is a captive audience so to speak of all that is happening and going on. Please pray for us that we can display the love of Christ to her in how we care for her and for her babies. As we walk through this very up and down course that is preemie care, may these moms see Christ in us. Often, we don’t have the words to comfort or to console but may our actions display His love to them. So, as cute as they are, I am ready for all the twins to stop for a while. JThese kids rack up quite a bill for their stay, especially with twins. We have a fund that helps these families subsidize their hospital bill and if you ever feel like contributing you may do so through www.abwe.org then go to support….missionaries & projects….HOH Togo Pediatric Care. 

Sacrifice to prayer…..

Many of you know and follow my story of Tama and how his family have become Christians since his death. This tribe is GanGam and very spiritually dark. They do sacrifices, have witch doctors, and have some of the darkest practices that I have ever heard about. I remember the first few times I met Tama’s dad and how I could just feel the oppression in him. He was a witch doctor in this tribe before becoming a Christian. There is now a church in their village where the two Bible studies have merged to form this body of believers. I attend when I can and I am not working. So, not often but I try. Here are a couple pictures of the church. 

The service is conducted in a tribal language of which I only know the greeting, so for most of it, I just sit and smile. There is always singing and even without the language, you can hear the joy. This past week, a woman got up at the end and gave a report about how she used to do sacrifices, according to tribal custom, when she needed something or had an affliction in hopes that the sacrifice would appease whomever or whatever and the thing she was asking for or needed would happen. But now, she says that since she has Jesus, she no longer needs to find a sacrifice or to do those rituals anymore because she can just pray about it and bring it before the Lord. From darkness to light is happening here and it is an amazing thing to see the Lord bring these people to Himself first-hand. 

Far from the Shallow....

I know that it has been WAY too long since my last blog post. I apologize for the absence and please know that I do recognize that many of you count on these to connect to what I am doing in Togo. The absence has been a long one and frankly I just was not in a place to impart anything. It has been a time of introspection that has been unbridled and raw. It has also been a time of physical thorns in the flesh given to me and forced me to cry out to the Lord in a new and uninhibited way. One thing that I have learned is that nothing will force your dependence on God quite like physical pain that you are powerless to combat. 

Even though the Lord has been taking me through a season that has left me raw, battered, and bruised (physically and emotionally) I am at a place where I can say that at least now I am in the fight and not merely just a bystander. 

I have come back to where I love the Psalms. I think they display a realness in David especially. He was called, “a man after God’s own heart” and yet he struggled and lamented with the Lord so often. Psalms 42 says, “Why are you cast down, O my soul, and why are you in turmoil within me? Hope in God; for I shall again praise Him….” V. 5

I find it comforting knowing that someone so highly esteemed by the Lord struggled as I do at times. 

It is easy, well easier, to go about life half engaged, half-hearted, and lackadaisical. It is especially easy in Togo, because so often the things pressing in are hard things. Hard cases in the hospital that despite efforts just don’t turn out as you hoped and prayed. Patients that show up just too late to save for reasons as trivial to us as they couldn’t find a moto to bring them. Trying to reconcile my mind and heart around these things day in and day out can easily overwhelm.  

We were created to feel, to experience, to savor this life. Why then do I fight that tendency? Because to feel, experience and savor here is most times trying, sad, and just hard. 

So to play off of a very popular song right now, I am far from the shallow….I am way out in the deep end, floating at times but mostly frantically treading to keep my head above water. Even though, at times, I want to stop and sink I know that what I need to do, what the Lord has for me,  is to stay out here….far out here…….

I hope these songs can maybe meet you where you are. There are moments and days when all I have been able to do to connect with God is to turn on a song. These have become those songs for me. 

God of all comfort….Iron Bell

http://youtu.be/gnfvrkz-7Jc

When I fall apart…. You sustain my heart….You rush in…. and begin …..to comfort me

“Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction...” 2 Corinthians 1:3

You Say….Lauren Daigle

http://youtu.be/oZvKJl1kK8g

You say I am loved….when I can’t feel a thing….You say I am strong when I think I am weak….You say I am held when I have fallen short…..and when I don’t belong you say I am yours….and I believe… what you say of me….I believe

"Normal"

A “normal” work day here is never normal as I would think of it in the US. On a “normal” shift in the US I may see 2-3 patients an hour, admit a few and discharge most. 

Here when I am “on shift” I round on all of the patients and then take care of any urgent medical patients that may come in. That includes NICU, peds, peds ICU, medical and medical ICU. It is definitely nothing like my days at work in the states. 

Our hospital is so very heavy towards Peds that on any given day 90% of the patients I see in the hospital will be pediatric. 

With that and it being malaria season, the hospital has been pretty full lately.  Malaria is one of those things that I think we take for granted living in the US. We don’t have it so it probably just doesn’t register in our minds. Malaria is contracted by mosquitos. You get bitten and then the malaria parasite attacks your red blood cells. The malaria parasites lyse the red blood cells that they attack causing, at times, dramatic anemia. It can also get into the brain causing cerebral malaria which is severe. Many kids with malaria develop seizures so one thing I know very well is dosing of all the seizure medications that we have. 

I think the best description I can think of is malaria is a thief of life. A healthy 2 year old playing one day, has cerebral malaria 3 days later and is either dead or now has cerebral palsy because he seized for so long and for so hard that his brain just cannot recover. I have seen kids come is so pale with anemia that they need multiple transfusions just to get their blood counts up to a number that doesn’t make my US medical mind cringe because it is so low. 

How do I walk in there every day and know that today I may have a child arrive at reception without a heartbeat but still so warm that she had to have just died on the way. 

I do because there are also so many stories of cases where God intervened though me or the rest of the medical team and they turned around. Kids with Hct of 5 that went home the next day after a transfusion and are fine. A woman in her 30s with a new baby that when she came was so swollen that when starting an IV, water came out. After beating our heads against a wall for a few days we starting down a plan of antibiotics and steroids and she was discharged with a smile and back to normal. 

The only way I can do it is knowing that whatever part I play, in restoring life or watching it leave, the Lord is also painting a story in the life of that family. A testimony that I will most likely never know of hopefully how they saw their loved one cared for with excellence and dignity regardless of the outcome. The Lord has used cases here of death and restoration of life to impact many. We have many village Bible studies that have been established solely as a link to a patient or family member of a patient at this hospital. Those are the truths that keep me going. Please pray that the Lord continues to use me and everyone on the medical team to impact the lives of our patients and families. 

I love music. I don’t sing well but I love it anyway.
I will leave you with the lyrics to a song that has become a go to song for me lately. Such good words. I encourage you to listen to it. https://youtu.be/FP003C5dP3k

Defender by Rita Springer
You go before I know
That You've gone to win my war
You come back with the head of my enemy
You come back and You call it my victory
You go before I know
That You've gone to win my war
Your love becomes my greatest defense
It leads me from the dry wilderness

All I did was praise
All I did was worship
All I did was bow down
All I did was stay still

Hallelujah, you have saved me
So much better Your way
Hallelujah, great Defender
So much better Your way

When I thought I lost me
You knew where I left me
You reintroduced me to your love
You picked up all my pieces
Put me back together
You are the defender of my heart
When I thought I lost me
You knew where I left me
You reintroduced me to your love
You picked up all my pieces
Put me back together
You are the defender of my heart

Goat, sheep, or child?

We play this game in Togo. We will be sitting in our house and you hear a sound and you have to decide if it’s a sheep, a goat, or a child. Sounds pretty easy but actually they can all sound pretty similar. 

I have been back in Togo for a little over a week now….there are so many familiar things here that are just so foreign to the things that happen in the States. I was asked so many times when I was Stateside about day to day life and about living here that I thought I would try to explain as much as I can as since I just returned all of the “shocking” things are still fresh in my mind. 

It is the rainy season in Mango, which means it rains almost every day.  This gives cooler temperatures but turns the dirt roads into ever-changing rivers and gullys. I ride a moto here everywhere I go so the drives are never boring. There have already been quite a few times of sliding or slipping trying to navigate these roads but so far I have managed to remain upright.  Oh I haven’t even mentioned the constant worry of goats, chickens, or sheep that are always in the roads and threaten to dart in front at any given time. It’s always entertaining to say the least. 

I also moved into a new place this time around and so this past week has been filled with unpacking, washing, and rearranging. I started back to work to this week too,  so no rest for the weary. One of the doctor’s said, “Oh it’s like riding a bike.” To which I quickly replied except the bike has a flat tire J. So here I am, attending C sections, doing exchange transfusions, treating seizing children. All just a touch out of my norm of ER medicine at home. It keeps me humble that’s for sure. I wouldn’t trade it because by caring for patients in the hospital gives me the opportunity every day to show a patient, a family member, someone who Jesus is. 

But really the sweetest times since my return have been the reunions.

As I am sure most of you remember, there was a sweet, sweet child (nicknamed “puddles”) here that died that me and another doctor had cared for for many months. Just before I left for the States, a Bible study was started in the village where this child’s family lives.  Also, “puddles” mom found out she was pregnant again just before I left as well. I prayed so fervently for her to have a good pregnancy and to have a healthy child. Well, I received a photo in June that she had another boy and had named him Soloman. Needless to say, I was excited to get back and to visit. 

Well a picture is worth a thousand words so…….

That smile is his brother’s smile for sure…..

I asked the chaplain that has been doing the Bible study in this village if he knew why she chose the name Soloman. This is definitely not a traditional name in their tribe. He said they chose it because in the Bible, when David lost a son and God gave him another one he called him Soloman. 

The Lord is moving in Togo folks…..this family had a great loss when “puddles” died and they are also a very dark and really demonic tribe so for Soloman to receive that name and for that reason is truly astounding. Deuteronomy 30:6 says, “And the Lord your God will circumcise your heart and the heart of your offspring, so that you will love the Lord your God with all your heart and with all your soul, that you may live.”

So please join me in praying that the Lord would do just that so this family can truly love the Lord with all of their hearts. This study happens every Wednesday morning so please join me in praying for this sweet family and this sweet new boy. 

Stepping through the wardrobe…..

I have been back in the US now for about 2 weeks and I am continually struck by all things ‘merica. Don’t get me wrong, I have enjoyed the endless coffee, cheese, and chick-fil-a but the stark juxtaposition of setting is so ever close to the surface all the time.

I have and continue to have sweet reunions with family and friends but the friends I left are ever on my heart and mind as well. It is truly a process to return just as it is a process to go.

As the adjustment continues, I find myself so many times thinking and praying for the ones there. I was able to see the beginning of something so encouraging before I left….

It is a Wednesday morning and I am waiting in a parking lot for a friend of mine who is a chaplain. We are heading out to a village to visit a family that has become very dear to me. After about a 30 minute moto ride, we come to a fork in the road and my friend has stopped. I catch up to him and he asks me which is the right direction and we continue to our destination. He goes on to remind me that the last time he was in this village it was the middle of the night. He was coming to tell this family we are visiting today, that their 1 year old child has died and they need to come to the hospital. You see this family’s child “lived” at our hospital for many months and at times the family could not stay because of the other demands at home. We would care for their child so that they could return home. But, on that night, my friend had to go and retrieve them and tell them that the worst had happened and they needed to come.

I had been out to this village several times since then but I had forgotten that my friend had not and all of that emotion just flooded back in that moment.

However, today was the day that a Bible study would start in this village. The death of their child had cut a wound in a couple of us that was very deep, but through that loss and pain, we began a journey with this family that led to this day. To the day when the Bible and the truth of Jesus could be told among them, in their heart language, in their own village. I was so encouraged to be able to see the beginning of that study before I left. I told my friend, who will continue this study weekly, that my heart was full when we left that day. As I am here, in the US, it is comforting to know that this study continues. I pray for the walls to fall and the veil to be lifted from around the hearts and minds of this family, this village.

Below are the lyrics to a song that cannot play without my mind and heart being reminded by times in Togo that were so hard and more questions remain than answers. One of those times is that night with this family’s child. But, there is a hope that even when my human mind and heart cannot and do not understand that I can rest that there is one that is sovereign over me.

https://www.youtube.com/watch?v=4x8TZiwPGaO&sns=em

Sovereign Over Us

“There is strength within the sorrow, there is beauty in our tears

And you meet us in our mourning, with a love that casts out fear

You are working in our waiting, you are sanctifying us

When beyond our understanding, you are teaching us to trust

Your plans are still to prosper, you have not forgotten us

Your with us in the fire and the flood

You’re faithful forever, perfect in love, you are sovereign over us

You are wisdom unimagined, who could understand your ways

Reigning high above the heavens, reaching down in endless grace

You’re the lifter of the lowly, compassionate and kind

You surround and you uphold me, and your promises are my delight.

Even what the enemy means for evil, you turn it for our good.

You turn it for our good, and for your glory

Even in the valley, you are faithful

You’re working for our good, you’re working for our good, for your glory

You’re faithful forever, perfect in love, you are sovereign over us. “

This study happens at 7:30am every Wednesday. Consider spending your Wednesday mornings praying for this study, this village, this family.