Death. A term the Togolese are all too familiar with. Death is natural. Inevitable. Regardless of the cause, our time here on Earth is limited and we are guaranteed that our last breath will one day come. Because nobody lives forever. Before coming to Africa, I had minimal exposure to death. Most of my experience came from clinical rotations, witnessing a handful of patients pass in the ER and the ICU. I was taught to separate my emotions and approach the situation logically. As a bystander in these cases of the past, I was never involved in formulating the treatment plans, attempting resuscitation, or having those hard discussions with family. When I arrived in Togo, I was not sure what I expected to see in terms of death and dying. I knew I would witness some death, but I never expected the large quantities I would witness day after day and the spiritual toll it would have on me.
It was our 3rd week in Togo when it happened. Josh and I felt more comfortable and confident with treating tropical diseases. We had conquered our fear of helping care for the pediatric ward and by the grace of God successfully treated cerebral malaria in a handful of children. This week however would be different. Josh and I would have to cover the ICU and pediatric ward while part of the team returned to the United States to speak at a medical mission conference.
The week started off busy with a packed ICU and pediatric ward. One of the cases that landed on our list was a 3-day-old baby boy named Komi. He was brought in the day prior for acute respiratory distress with intermittent episodes of seizures. His medical history was limited. From what information we could gather Baby Komi was born full term to a young mother 3 days prior at an outside hospital. Based on his lab work and presentation we suspected he had meningitis vs neonatal sepsis which is all too common among the Togolese neonates. Unfortunately, there was an additional concern for brain damage given his prolonged seizures and lack of oxygen to his brain. Upon hearing the case at morning rounds I had already decided the national provider would be the one to round on the patient.
But God had other plans.
We were asked to take the case and Josh accepted on our behalf. At that moment my heart dropped. This 3-day-old baby boy was now under our care. Initially, I was scared and angry. Partly because of our lack of knowledge in neonatal ICU medicine but mainly because I knew I would fall in love with Baby Komi, and I knew there was a chance he would not make it. I did not know if I could handle that. As I approached Baby Komi’s incubator all I could see was the CPAP machine. His face and body were hidden in the vibrant baby blanket his mom had him wrapped in. He was small only weighing 6 pounds. He had dark brown eyes and black hair, and his skin was light brown with a tinge of yellow likely from jaundice. He was beautiful. A true gift from our amazing and loving God.
Josh and I spoke with the family and shared our concerns. Right now, he was working way too hard to breathe and he desperately needed antibiotics. Back in the US he likely would have been intubated and mechanically ventilated. But here, the CPAP was the best we could do. As we did with all our patients, Josh and I spent time in prayer with the family. For the next week, Josh and I oversaw Baby Komi’s care. We checked on him multiple times throughout the day. We spent hours at his incubator trying to obtain accurate vitals with a pediatric pulse ox machine that was not meant for infants. We celebrated small victories like weaning him off the CPAP and starting NG tube feeds. His jaundice began to fade, and his dark brown hair began to curl. He seemed to be doing well.
Over the weekend things took a turn. He developed a fever, and his abdomen became severely distended. Now we were concerned for possible necrotizing enterocolitis or NEC. Essentially, the disease causes severe inflammation in the intestines which causes the bowel to become necrotic and die. In the United States NEC has a 50% mortality rate even with early intervention and treatment. In West Africa, the chance of survival is almost none. Josh and I spent several hours researching possible treatments to help Baby Komi. We prayed several times throughout the day asking God for healing. But as the days continued Baby Komi’s condition continued to decline. His extremities became cold, and his body began to stiffen. His cries turned into a whimper. Baby Komi was dying and there was nothing we could do to save him. We were utterly helpless. I cried every night leaving the hospital. I felt like we were failing him in every way. Our knowledge of neonatal care was limited, but any further treatment would not be possible due to limited hospital resources. Josh and I felt defeated. All we could do was pray.
In a last-ditch effort to save him the surgical team agreed to perform an exploratory surgery with the faint hope his abdominal distention could be corrected surgically. However, the likelihood that Baby Komi would survive the surgery was low, and the possibility that his illness would be resolved with surgery was even lower. We discussed the risks vs benefits with his mother, who wanted time to think it over and discuss it with her family. Josh decided to go back to the hospital later that night and check on Baby Komi. Right after Josh left, I felt this wave of sadness and heartbreak hit me Then a sudden urge of the need to pray. Then I did something I never do. I got down on my knees and began to pray. Through the tears, I begged the Lord to heal Baby Komi. I knew we had done everything we could medically for him and his healing could only come from God. Then it hit me. Baby Komi’s family was going to decline the surgery.
Josh arrived at the hospital only to find the family packing their things. They declined the surgery and wanted to take him home. His family could not afford the surgery and since his chances for survival were low, they did not want to risk it. I cried for almost an hour after hearing the news. I was heartbroken. Angry. Confused. I felt like a failure. Josh returned to the hospital, hoping to share the gospel with the family and say goodbye to Baby Komi. He asked me to come with him, but I couldn’t. It is not appropriate in the Togolese culture to show any emotion even after a loss. I knew this young mom would have to cry silently for her son and I was not strong enough to watch her.
After my tears had run dry, I began to pray. I prayed for God’s will to be done whether it was healing or calling Baby Komi home. I prayed for God to take away his suffering and pain. I prayed for his family to hear the gospel and lean on Christ for strength during this difficult time. Finally, I prayed for strength so I could say goodbye. Then a sense of peace washed over me in these moments.
After Josh returned to the hospital, he was informed about an issue with the hospital bill. The family only had enough money to pay for part of the bill and the hospital policy states the patient is not allowed to leave the facility until the bill is paid in full. Unfortunately, we would have to wait until morning to discuss using the benevolence with the staff missionaries. With the severity of Komi’s condition, waiting until morning was not an option. Josh and I discussed the situation and agreed to pay the remaining balance for the family. We wanted Baby Komi to pass away in peace, surrounded by loved ones and in his mother’s arms.
Josh recruited two Togolese staff members to assist in our conversation with the family. It was beautiful to see the local staff passionately share the gospel with the family. In these tragic moments, comfort could be found in the arms of God. Amidst the pain, we still have hope in Jesus. Surrounded by darkness, we experienced God’s light shining through. At the end of the conversation, we informed the family their hospital debt was paid, but there was a debt we could never pay, a debt paid by Christ on the cross. Baby Komi went home with his family that night. I know in my heart he was called back to his eternal home shortly after. Unfortunately, we don’t know if Baby Komi’s family accepted Christ into their life. But I hope they do.
We learned some hard truths after caring for Baby Komi. During the chaos, we questioned. We questioned God’s sovereignty. We questioned the power of prayer. And we questioned where God was amidst all the pain and suffering. As the days went on the Lord answered. While at the airport waiting for our departure to Africa, we received a $250 donation from a family member who wanted to help fund our trip. We were surprised by the donation since we had decided to self-fund, nonetheless, we were extremely thankful! The morning after we discharged Baby Komi home, we were informed of the amount of his hospital bill. The bill came out to a grand total of $250. The Lord provided.
Later that week we stumbled across a speech given by the medical director of HBB. During his speech, he shared a story similar to Baby Komi’s and his own grappling with God’s sovereignty. He was able to empathize and pass on wisdom he had learned in his walk with Christ. God placed him in our lives to walk us through a difficult time and remind us of God’s character. As we reflected on the situation, we could clearly see God was with us every step of the way. He was working all things for His good and His glory.
It is the LORD who goes before you. He will be with you; he will not leave you or forsake you. Do not fear or be dismayed.”
Deuteronomy 31:8 (ESV)
The truth is death is guaranteed and unavoidable in a fallen and broken world. But God is still in control of all things, and His love is far greater than we could ever imagine. If you need proof of His unending love, then turn your eyes to the cross. Through this experience, Josh and I were reminded of the true purpose of the Hôpital Baptiste Biblique. Our primary job is not to heal the sick. We praise God for the patients who are healed, but if our ultimate goal was physical healing, we would walk away devastated. Our job is to walk alongside the patients and their families amidst tragedy to provide comforting compassionate care while sharing the eternal hope we have in Christ Jesus.