Hey everyone! It’s been just over 5 weeks since Josh and I have arrived in Togo. Each week has brought its unique challenges, but with each challenge, we’ve experienced God’s hand at work. We hope to share some of these stories with you over the coming days. First, I want to share more about our daily lives on the compound.
Each day begins with morning rounds where all the providers gather to discuss the hospitalized patients under our care. We start each session praying as a team for guidance and healing. From there we make our way to the nurses’ station where the hunt for patient charts begins. On average, we spend at least 15 to 20 minutes looking for charts each day. But, on some not-so-rare occasions, it can take up to an hour before you can get your hands on the chart. After reviewing the necessary paperwork, we track down a nurse/translator and round on our patients.
The hospital consists of multiple wards: The men’s, women’s, ICU, maternity, infection, and pediatric wards. The men’s and women’s wards are large open rooms with 6 beds on each side. Every bed is close in proximity, roughly 5 feet apart, separated only by a small curtain for privacy. The ICU is similar in its set-up but has a maximum capacity of four beds with access to oxygen and “continuous monitoring” of vitals.
When walking through the wards you will notice some key differences in how the hospital operates. Here in Togo, the nursing staff’s primary job is to obtain vitals, administer medications, place IVs, and translate for career and short-term missionaries. The patient’s family is responsible for the more intimate part of patient care including bathing, toileting, feeding, and providing food for the patient. Normally, each patient has 1-2 family members at the bedside helping care for them.
Over the last several years the hospital has expanded its lab and radiology department. We have access to basic and essential labs needed for the day-to-day operation. For radiology, we have X-ray and ultrasound available which play a critical role in formulating our diagnosis. Even with the updated imaging and labs, there are still a few hurdles the team must overcome. Unfortunately, lab machines can break or become inaccurate without warning which can take several days to repair or recalibrate. Lab inaccuracy can go unnoticed for several days which leads to improper treatment for the patient.
Our first few days were spent in men’s and women’s wards to acclimate to tropical medicine. We quickly learned most diagnoses and treatments were made based on clinical suspicion rather than test results since lab error is common. After a couple of weeks, it was our turn for weekend call. So, for the next few days Josh and I worked in conjunction with the nationalist provider to manage all new and current admissions including the pediatric and ICU wards.
Initially, we were overwhelmed by the complexity of our patients. Most of our experience is in outpatient family medicine clinic which is drastically different from ICU and neonatal care. We had to re-learn basic procedures, physical exams on comatose patients, neonatal reflexes, and pediatric dosing. We spent hours reading through resources to formulate treatment plans and assisted in multiple codes on adults and children. We were exhausted and overwhelmed. It wasn’t until a few days later we were able to reflect on how God’s hand was at work.
While working in family medicine, I had become overly confident in managing most diagnoses, but I would find myself praying for certain patients I was struggling to diagnose and treat. I relied on my own strength and knowledge for 95% of cases and I would rely on God’s wisdom and guidance for the other 5% of cases. Here in Togo, my inadequacy was magnified. It was clearly visible to my eyes. But every time I felt like I was drowning in my incompetency the Lord provided. During one of the many codes that weekend there was a question about neonatal dosing of a potentially lifesaving medication. Unfortunately, Josh and I have minimal experience in emergency medicine, especially with neonates, and we could not recall the exact dose of the medication needed. Josh raced to the provider room to look up the information in hospital’s library hoping to find the answer quickly. I stayed behind and in the middle of the chaos began to pray. I confessed my inadequacies to the Lord and asked Him for wisdom and healing. A few moments later I picked up a book nearby in the nursing station and found the dosing information for the medication. God provided, just like He promised.
“I can do all things through Christ who strengthens me”
Philippians 4:13 (ESV)
I realized I have always been inadequate, and God has always been the source of my strength. But I needed to experience this to realize how much I relied on him. Now I start each day praying for God to use our hands of inadequacy to treat these patients appropriately.
The story didn’t end there. Even with God’s provision of the medication dose the patient passed a few hours later. This would be one of many patients we would lose over the next weeks and one of the many hard lessons we had to learn. We have experienced a substantial amount of loss here more than I ever could have imagined. Our patients are battling against cerebral malaria, meningitis, tuberculosis, typhoid fever, and various non-communicable diseases with limited resources. It’s not uncommon to lose multiple patients in a day.
The losses can become burdensome when accumulated over time. You begin to question God’s sovereignty and how this much suffering plays a role in his plan (a blog post coming soon on this topic!). But amidst the heartache, we are blessed with the opportunity to come alongside our patients and their families to provide compassionate care. We share the hope and comfort that can be found in Christ Jesus. As much as we see God working to heal physical ailments, it’s these intimate moments where His love truly shines.
We still have so many more stories and experiences to share with you and plan to post more often, so stay tuned!
Several photos have been added to our instagram which are not viewable from our website. Click the first image below to see more!
