Togo Pics

Here's a link to pictures of our time in Togo...Hope you enjoy.

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Home!

We are home, for those of you who haven't heard. We had a few minor delays but arrived home this morning safe and sound, just tired. Evelyn did really well over all. Thank you for your prayers everyone! We'll post pictures when we can.

A little planting, a little watering

  Well, this will be my last post from Togo. Once again, the time is drawing to a close… hard to believe! But I am ready to come home, in the sense that I feel like our time here (for this trip, I mean) is wrapping up and coming to an appropriate closure. We accomplished what we were hoping to, learned a lot, and have much to think and pray about for our future. And let’s be honest… there’s nothing like being in your own bed, and having your own home to “homemake” in! Not to mention having your toddler in her own room…

  This post will probably be a little random and disconnected, as I just wanted to write about a few experiences that stick out to me that haven’t fit into any other blog posts. Some of the ABWE churches here (or former ABWE churches I should say, they are actually independent now) have started a network of Christian schools in Togo. The issues with the school system here in Togo could take up a whole post in itself… suffice it to say that it is a very needed area of ministry (though the Christian schools struggle in many ways too). There is a young missionary here named Christy who helps these schools – there are 14 – by training the teachers and helping with curriculum development. One of the schools in a village (Bodje) about an hour from here is particularly struggling, and the teachers there decided to have a Bible club every Wed. afternoon in order to reach out to the community (the teachers, by the way, are Togolese – not missionaries). I went along with Christy and one of the other short term ladies (Donna) to help teach the club. We had about 80 kids, all eventually packed in to an itty bitty (maybe 25’ by 25’?) concrete structure. But that was after the most disorganized, rule-breaking, hilarious Awana games I had ever seen, all around a faintly chalky circle scrawled in the schoolyard dirt =-) Now, I know that plenty of those kids were there out of curiosity to see the “yovos” (white people), or out of hope to get a craft, bouncy ball, or lollipop (which they got!). But they heard the gospel, and that contains the power of God for salvation! Who knows where and when and how God will later bring that to mind and use it in their life? And really, it was also just plain fun to hang out with so many eager, enthusiastic kids! Especially when they sing =-)

  Another favorite thing I’ve been able to do is give some of the nursing students here (they have a nursing school to train Togolese nurses) some “conversational English” practice. I was asked to do this but honestly wasn’t super excited, because when you speak almost no French and the person you are talking to speaks very little English and you are supposed to sit down and have a conversation… things can get a little, well, awkward. But I loved it! I talked to two nursing students for over an hour, about all kinds of things – family, nursing, etc. They asked me about nursing in the US and various other things, and wrote down the funniest English words to remember on their little notepads. When we had been talking for awhile and I was about to say something like “Well, we should wrap up”, one girl (Filomen) then asked me to tell her how I came to know Christ. After 10 minutes of me stammeringly trying to share my story in the simplest English words possible, I was then able to hear from them in their sweet halting English how they had come to know Christ as well. And seriously, I had the best, deepest conversation with these two students. Due to language barriers, I don’t often get to have “real” conversations with the people here – it was such a blessing to me to be able to do so! And to see them truly overflow with joy as they talked about how they came to know Jesus and how He has changed them! And you know what? Both of their stories started with something like “My family did not go to church or know about Christ, but when I was a child two men from the church came to my house and talked to me…” I could not help but think of the kids in Bodje. One day, will they also have a similar story to tell?

  Finally, I will close with one brief thing I have been thinking about and learning. To quote a corny phrase (because apparently I love corny phrases) – “There is no ‘I’ in team”. If I view my time here merely about what “I” have done and accomplished, I will be discouraged. I didn’t really share the gospel much, personally. I didn’t have too many “quality” conversations. I didn’t save any lives, and I’m pretty sure there won’t be any Togolese talking about how eternally grateful they are that I was here. In general, if I view ministry as about me – I will either be falsely inflated and proud, or full of discouragement and self-pity. But if I see my time here as just part of what the entire team here in Togo is doing – and even more importantly, as just a little part of what God is doing in the world – then I find its meaning. The smallest acts of love – whether kisses blown from an enthusiastic toddler, giggles shared among children, friendly greetings from one mom to another, or even an encouraging arm squeeze – have meaning in light of the gospel. God uses many things to open up closed hearts. Some plant seeds, some water, some even get to reap, but God causes the growth. And not only am I ok with that, I rejoice in it. My little bit of planting and watering have meaning, because God is at work here causing growth.

  Please pray for our traveling on Friday/Saturday. We will leave here about 10am Friday (5am EST) and arrive home (hopefully!) at 11-something on Saturday morning. I think that is about 31 hours. That is a looooong time with a toddler. Evelyn was quite sick over the weekend, but is ok now. Please pray for all of us to stay healthy, be well rested before we leave, and of course – for Evelyn to SLEEP on the flight! Thanks so much for all of your prayers and encouragement, everyone. Looking forward to seeing many of you soon!

P.S. – For those requesting pictures, don’t worry – we have many! We will post them as an album soon after we get home.

A Doctor’s Life in Togo

  Greetings are important in Togo.  They are a sign of the priority that the culture places upon relationships.  When I walk into the hospital, I go around to many of the nurses and staff saying, “Hello.  How are you?  And your family?” They reply, “Hello.  Very Good.  Good,” and then ask me the same questions.  It first struck me as formulaic, but as time has gone by I realize there is a warmth in these greetings and that the Togolese really do appreciate these relationships.

  Apparently, the one place greetings are not required is in a medical encounter.  Sometimes I can squeeze in a, “Hello, I’m Dr. Wreesman,” before my translator asks why the patient is here and the patient subsequently goes on a several minute monologue that I’m convinced contains every symptoms they’ve experienced in the past two months.  Sometimes I don’t get in any greeting, not that the patient seems to be the least bit concerned about that.  Maybe it’s just me, but wouldn’t you want to know the name of the person who could be doing a rectal exam on you?

  Another humorous challenge is trying to discern what a patient’s medical problem is through a translator, when your patient has almost no medical knowledge.  Sometimes you’re going through multiple translators (you -> translator -> son -> father -> son -> translator -> you).  It’s like playing a game of telephone, except people’s lives are at stake.  Then there are complaints that you have no about what to do.   For example, “I have total body pain!”  I guess that might be useful a complaint, if the four previous patient’s hadn’t also complained about the same thing.  At that point, I get the hint that there’s something cultural in the meaning of this complaint, and I have no idea what it is. 

  Next, I have to figure out what the patient is expecting me to do about their complaints.  Some refuse an indicated test, saying they don’t have enough money (understandable for people who make only a few dollars a day).  Others demand the test, even when you try to explain that the treatment is the exact same one no matter the results and are just trying to save them a little money.  They (or their family member or friend) usually tell you this after you just wrote their prescription. 

  Finally, people like to convey their medical concerns in dramatic terms.  For example, “I have belly pain.  It hurts very, very much,” as if having moderate belly pain would be grounds for dismissal of the entire complaint.  And this comes from men and women whose ability to endure hard labor, heat, pain, and hunger has my utmost respect for, knowing I could not have lived so well under the same conditions.   I guess no one has explained that hurting “very, very much” may be an indication for surgery.

  (Please note, none of the above is meant to convey a since of superiority.  I just share the humor of approaching medicine from one cultural perspective among a people from another culture.)

  Perhaps the best way to convey the variety of what I’ve been able to do would be to give a brief account of my last call stretching from yesterday to this morning.  Though it was an especially busy time, it shows the variety of medical needs that exist in a place like Togo and the fun of being a family physican in this setting.  Days typically begin with hospital rounds.  We started on seeing our handful of medical patients: an ulcerative colitis case with incidental BPH and urinary retention, a man recovering from tetanus (saved by administration of intrathecal tetanus toxoid a few days previously), and girl with persistent abdominal pain.  After medicine rounds, I went stopped by maternity to say hi to the mother whose twins I had delivered on Saturday (my first breech and first twin delivery).  Then I went to the pediatric ward – which could be better called the malaria and premature baby service.  One young boy had recovered from a case of cerebral malaria (20% mortality).  We also currently have 5 premature babies ranging from 26-29 weeks when they were born.  Our set of 26 week twins started at just 640 grams, but have now reached a kilogram and are doing well 5 weeks into their stay.  There is a 29 week baby that I delivered at the beginning of the month (see previous post) who is growing well and probably will go home in the next week.  One 28 week baby is a month old; thankfully she is still at the hospital because we had to fight with her parent to keep the baby.  Sadly, our 27 week baby is looking pretty sick only 4 days into life and may not make it.

  After rounds, I head up to clinic.  I admit the first patient I see, a 12 year old boy with sickle cell, fever and anemia (likely sepsis or malaria).  I also see his mother who has a 12 year tooth infection that drains from a tract on the bottom of her jaw; the xray she brought in shows an impacted molar with osteomyelitis and extensive erosion of the bone.  Though she isn’t acutely sick, we’ll probably operate on her before the end of the week.  I see a couple more patients, then go back to the hospital to check on our DKA patient that I admitted during rounds (glucose 1540, potassium 7.9, calculated osmolality 419 for those of you medical people).  Forturnately, I get a moment to break for lunch.  After lunch I head back to the clinic and see a few more cases including back pain, infertility, and breast cancer (she had a mastectomy, but unfortunately the cancer has spread and we send her home with pain medications knowing that death may come soon).   Meanwhile, the hospital has been filling up with new admissions.  I go down to check on them.  New cases include the following: a lady with HIV with likely pneumocysitis pneumonia; a man swollen neck and pleural effusion after being “stoned” a month earlier; a lady with generalized lymphadenopathy, giant splenomegaly, abdominal pain, fever, and treated HIV/tuberculosis; a child with an 8 cm eye/cheek tumor vs infection, plus a smattering of gastritis and malaria.  Before dinner, I get called to OB clinic to give some input on a 26 week pregnant lady with nephrotic syndrome.  Apparently being a third year family medicine resident makes you the local expert for this case.  Later, I get called back down to the hospital because my sickle-cell patient had a transfusion reaction.  Then I end up of L&D to see a new patient.  I call the surgeon to come do a C-section because the baby is breech and she is likely preeclamptic.  I go into the OR and actually do the C-Section and tubal ligation with the surgeon assisting and teaching me.  By this time its 1230 am.  Fortunately, there are no more calls.

  Next morning, we’re back rounding in the hospital on the 9 patients we admitted yesterday, plus those already there.  During rounds we admit a stroke patient and a man with cerebral malaria vs meningitis.  On ultrasound, we find that the man who has been “stoned” actually has a giant empyema.  The surgeon lets me place the chest tube with his assistance, and we drain a liter of pus.  By this time, it’s lunch time and I’m more than happy to take off the rest of the day. 

  It has been a blessing to serve here.  I’m thankful to see how much I have learned in the past 3 years and what I can contribute.  Being a family physician, it is exciting to practice such a broad spectrum of medicine.  Additionally, I’ve been thankful to serve at a hospital that doesn’t just treat physical needs but talks with people about their spiritual needs in Christ.  As we sat around dinner last night, one of the doctors shared how a patient he saw in clinic accepted Christ as his Savoir.  After praying, the man told him, “God is good; this is why I had to come here today.”  What a blessing to see this, knowing that in Christ alone is eternal life.  I am grateful to be a part of that process by serving here in Togo.

These are a few of my favorite things… about ‘Toto’ (by: Evelyn)

  It’s just not fair that Mama and Da-eee have been taking up all the blog posts, so in honor of my 18month birthday I decided it was time to write one myself and tell you about all the truly interesting things in Togo (or, as I like to say, Toto)!

  First off, I really like it here. Mama says I fit right in! I guess if you are Togolese, greetings and goodbyes are really important and extensive. Well, I’m a Togolese in disguise I guess because they are really important to me too! For instance, in the morning while I eat my breakfast I often say “hi!!!” (in a loud shriek) to the guest house staff ladies (Miss Amavi, Mrs. Florence, Mrs. Elizabeth, or Mrs. Enyonam – some of my new best friends) at least 60 times or so. And the best part is, they answer me back every time! But I have to say I don’t really like being grabbed… and here the grown-ups do like to grab my hands in greeting. But no worries, I just get even by attacking their kids – usually with hugs and kisses, uninvited. Oh, and I never met a baby or kid I could walk by without stopping to talk and play. I usually have one of two effects – I either make them really excited, or really scared. My favorite thing to do every morning now is to go to the hospital, and when Mama tells me we’re going to go see Daddy and the babies I get really excited. The first thing I do is walk right in the door and shriek “Daa-eeee!”. This usually gets everyone’s attention, just the way I like it. I usually bounce from doctor to doctor for a few minutes while they say hello, and then the Togolese nurses come up and say hi to me. After that I have a few favorites I go and visit. There are a few preemie (I’ve learned that means itty bitty baby) babies and their mommies around who are always there, so I kind of know them now and will let them hold me and everything while I point at their babies and shout “Beebee!!”, just in case someone missed the obvious. Mama tries her best to keep me from doing such things as licking the floor and swiping a baby’s bottle (which I did!). After blowing a few kisses we move on to see the kids. I have two friends named Delphi and Sarah that I play with every day. Their little brother is one of the itty-bitty’s so they are always there. We really like to blow bubbles, play with stickers, and color together. I think their favorite is bubbles, because it just makes them giggle and giggle. After that we go to the peds ward. The little kids there are pretty sick, so we usually just greet them and give them a few goodies (coloring books, or little beanie babies). We then go visit the women’s ward, which actually has some pretty young girls in it too. We greet everybody and then spend some time playing with the younger ones. Today we taught one girl how to play tic tac toe! At least, we think we did… but it’s kinda hard to say when we can’t exactly understand each other. Sometimes we share some lotion and stuff too. Then we move into the maternity ward, my favorite! We go from bed to bed to say hi to the babies. For some reason all the babies here are always asleep? And I find it necessary every time to declare each one “Night-night!”. I blow them kisses of course, because that always makes their mommies laugh. Sometimes the moms try to hand their babies to me, at which point Mama insists on rushing to my side and helping me “hold” them. I mean, what does she think I’m going to do, drop them?!?! Squish them? Poke their eyes out? Sit on them? I digress… Anyways, I always talk to the nurses here, and if there are older siblings around sometimes I play with them too. By this time I’m pretty exhausted and ready to head back to read a book, cuddle with my Quack-Quack, and take my pre-lunch nap (not to be confused with my pre-dinner nap – life here is tiring!). Though I always have to stop to talk to the pet monkey that belongs to my friends on the way back…

  Don’t tell anyone I said this, but the doctors here aren’t very smart. They are always asking me where my trachea, xyphoid, liver, and spleen are. I keep having to tell them over and over again! Sheesh, what would they do if I wasn’t around? I’ve noticed around here mealtime talk is usually about something medical or gross, so I just join in by pointing out everyone’s body parts – you know, I’m trying to help them out with their medical education. My current favorite is pointing out everyone’s “Belbows” – especially when they lean them on the table. I’m the only toddler around here, but there are some other MK’s (missionary kids) around. I really like hanging out with them and they like me too. What in the world am I going to do when I go back to boring ol’ home and it’s just me and Mama all day? Oh, and another cool thing about this place is the basketball court and swimming pool! I was afraid of swimming at first, but now I’m pretty much over that. And everytime we leave our room I point to the basketball court and talk about balls and kicking them. Of course, when we go down there to play – I still just want to talk about playing with the balls, rather than actually doing it.

  Well, those are a few of my favorite things about Togo. In conclusion, and in honor of my 1 ½ yr birthday, I will give you a list of “firsts” that I have experienced here in Togo:

·           1. Skinned knees (and 2^nd, 3^rd, 4^th … all “Oweeeees”)

·         2. Riding in the car without a carseat! (don’t worry though, that’s only for short, squished trips)

·         3. Cooo-keees, Ca-ca (chocolate), and cu-cakes at almost every meal! I now ask for them all by name     =-)

·         4.  Mangos! Mmmmm…

·         5. Soda (ok, this one has a story – the Fulani shopkeeper we met gave me one, and Mama thought it would be rude to refuse so I got to try my first Pepsi =-)

·         6. I have consumed part of a stick. Strangely, that wasn’t quite as good as the previously mentioned items.

·         7. Money… for some reason this one lady in the hospital keeps giving me coins to keep! I’m rich…

·         8. Bugs – I now recognize them and talk about them!

·         9. Fufu, Gawu, and various other African dishes

·         10. Medicine every morning! Mommy says I’m weird that I actually like my anti-malaria medicine that is supposed to be so bitter and awful

·         11. I now say Amen! I especially like to say it right in the middle of prayers, loudly =-)

·         12. Saying I love you (I wuh-woo), and singing along with the song in the “Love You Forever” book too!

·         13. Dancing in church – I’m a huge fan! =-)

·         14. Going to work with daddy…I think I help his patients feel better!

·         15. Antibiotics – yay…

P.S from Evelyn’s mommy… Sadly, the little stinker got quite sick yesterday with a very high fever. She likely has typhoid or something similar, but she is being treated for it and seems to be improving. Please keep her in your prayers!

"Wawa" II

  Please pardon the double use of the corny title, but I think I have a good reason. As I was thinking about it, I really thought it was a perfect description of Mango. A place where West Africa has been “winning” for… who knows? Centuries? Millennia? The town is beaten town, one of the poorest and most undesirable in Togo. It is a dustbowl this time of year – the most immediately striking thing about the town is the dirt and trash everywhere. It seems like no one really wants to be there. There are 5 main tribal groups in town, and traditionally they all hate each other. Even now, most people walk around with a stony expression on their face. I guess there isn’t much to smile about living in Mango. As one of the missionaries here said, “Living in Mango is like living in hell; it’s incredibly hot and the people hate each other.”

  But things are changing. ABWE has been present building this hospital (which the town leaders begged for) for about 5 years now. Church planters are already at work learning languages, building relationships, and building the hospital. They are also building trust. Now, when you stop and greet someone you are normally met with a warm smile. Children excitedly wave and call out “Batture!” (white person) when they see you. A handful of people in this Muslim dominated town have already come to know Christ as their Savior. The church here is beginning to sprout. It is a young fragile sprout, and does not yet have roots. Nonetheless, for the first time in Mango – there is life, and hope.

  The hospital being built here is called “Hospital of Hope”, and for good reason! In a town with no resources, it offers hope to the sick and hurting where none exists. But more than that, the opportunity to be a beacon for the gospel in this whole region (the hospital will be attracting those from surrounding countries as well, as there will not be anything like this anywhere nearby) will be unparalleled, here at least. During our trip up here, Stephen and I really had the opportunity to pick a lot of people’s brains. We are super excited about the team’s vision and philosophy of ministry. The medical work here is only a part of something much, much bigger. It is a part of the unreached ends of the earth, but it appears God is doing something. He is beginning to make His name known, and He is planting His church. And from Mango, who knows the influence that church could have? The opportunity for evangelism and then discipleship through medicine here is huge!

  We spent some time with Anna, an incredible young missionary lady working here who took us around town to meet her friends. She is focusing on the Fulani people group (she is the only one working with them, and this is the people we are very interested in too!), and so we were able to meet and “talk” with several of them. We reeeaaallly enjoyed that! We also were able to have a lot of meals with the other missionaries, pick their brains about the plans for the hospital and ministry up here. We got to hang out in their incredibly cool pool. We went to market and met some amazing people. We got to help the DeKryger’s unpack, and we got to attend the little church here. In all, it was a privilege. Yes, there are a lot of inconvenient things about the place. The water is not clean (the hospital is working on digging its own well, but has so far come up dry). The dust is unlike anything I have ever experienced. The bugs are annoying. The heat is, well… “uncomfortable”. It’s more isolated and not really as pretty as down south. But I hardly think those things should really be a consideration in deciding whether to move to a place, do you? ;-)

  Pray for Mango. Pray for the missionaries in Mango, that they would not grow weary because life there can be hard! Pray for the people there, that the Holy Spirit would soften their hearts and they would be receptive to the message of Hope. Pray for real discipleship and true strong churches to grow. And pray for us, as we consider whether this place and work is where God is calling us to be. There is a unique opportunity here to combine our two loves – medicine and discipleship. You see, “Wawa” has been true in Mango for a long time. But by God’s grace, West Africa WILL NOT Win Again – God will, through the power of His gospel. 

"Wawa"

  The missionaries have a phrase they like to use here. When things go wrong in a uniquely frustrating but almost humorous way, when you get the run around instead of straight answers, when the horrible roads beat up both you and your cars… they will have often shrug their shoulders, give a little laugh, and say “Wawa” – West Africa Wins Again. Because sometimes it is better to laugh than to cry ;-)

  Such as yesterday. A driver from the hospital in Tsiko came up to get us on Sunday, and the plan was for him to drive down one of the missionary’s cars to try to sell in Lome (the capital), dropping us off in Tsiko on his way. Why did the missionary want to sell his car, you ask? Well, ‘cause it was a dump (and why was it a dump, you ask? Probably ‘cause they have car-eating and man-eating roads here). By the time we pulled out of Mango at 8:45am yesterday (much later than planned), the car had already been to the mechanic because it wouldn’t start, had its battery changed, and had a flat tire changed. Oh yeah, and then it still wouldn’t start at first. And when we got gas on our way out of town, it wouldn’t start again. I joked with Pericot, our driver, that we would have to pray the car to Tsiko. Well, I guess someone wasn’t praying hard enough (kidding!) because less than an hour out of town the car started pouring out black smoke. For a second we all thought the car was on fire as Pericot started pulling us out. Well, it wasn’t. But it definitely wasn’t going any further. Wawa.

  By the way, we were stuck on the side of a little two lane road (I say little, but it’s the main highway in Togo!) that’s riddled with enormous potholes out in the middle of nowhere. It’s 100+ degrees (glad it wasn’t their “hot” season yet, or it would have been 130+!). Thankfully, our driver had a cell phone and could call for help. Also thankfully, we had plenty of water. But we spent the next couple hours toasting by the side of the road. I spread out my “pagne” skirt (the traditional African cloth) under a shrimpy little tree and Evelyn and I sat and read books and sang our ABC’s, as we waited for an unknown amount of time and had no real idea of what was happening and what the plan was. And you can imagine the stares we got from the occasional truckers passing by. What, you don’t normally see a white woman and baby camping out in the African bush by the side of the road? Have you ever been in one of those weird situations when there is absolutely nothing you can do to fix it and you can only sit and wait? Yeah, it was one of those. Wawa.

  Well, eventually help arrived in the form of a mechanic to try to get the car to Mango and a driver +taxi to take us the rest of the way. This guy drives crazy fast so we actually make pretty good time, until we get to the mountain pass. It’s blocked by a traffic jam, caused by a semi towing another broken down semi up the mountain at a rate off approximately 0.25mph. Once we finally start moving again, on our way down we pass truck after truck that is turned over, burned out, or just plain not working. I’m telling you – they have car-eating, man-eating roads here. Wawa.

  The rest of our trip was uneventful. We made it back in record time, exhausted and covered in red dirt (no a/c so the windows were down the whole time). Evelyn did amazingly well, a little whiny at times but that was the worst of it. Our only injury was the thorns I stuck my bare foot on while we were sitting on our pagne under our tree (oops). So that was our trip back, and we learned a few lessons. Such as: if/when we move here, a reliable car is a must! Cell phones are pretty useful too…

  On a more serious note though, we are so thankful for God’s protection in an uncertain situation that could have been much worse than it was. Without that, “Wawa” would be more than just a little joke you say when you are trying to roll with the punches! So that is the story of our adventurous trip back – tomorrow I will write more about our actual time in Mango, which was just what we were hoping it would be.