Give us this day, our daily bread.

Bonjour!

I’ve been in Togo for a week and am just getting around to posting.  Take note of the map that I made below with annotations for each leg of the journey:

(I could not find out how to make the map of airplane travel; I did not drive to Togo from Kenya, although it would have been quite the adventure.)

1: Bomet, Kenya -> Nairobi, Kenya: 5 hours

(Stayed in airport overnight due to runway construction.)

2. Nairobi, Kenya -> Addis Ababa, Ethiopia: 3 hours + 3 hour layover

3. Addis Ababa, Ethiopia -> Lome, Togo: 6 hours

(Slept in a gueshouse in Lome.)

4. Lome, Togo ->  Mango, Togo: 10 hours

Needless to say that I was (and am still) tired from the journey.  Wait until you hear about the journey back.

And now, my first photo essay from West Africa:  Bon voyage!  (Abbreviated from my initial conception as it takes ~7 minutes to upload one photo.)

The lunch stop en route to Mango from Lome, on the 10 hour van ride.  (Note the tree protruding from the restaurant.)  I enjoyed a hearty plate of spicy spaghetti while watching soccer from the English Premiere League.  And this may be too much information, but I do not yet have diarrhea.

From the drive.  On the 10 hour trek north the towns thinned out, we went through a stretch of mountainous land covered by forest, and then we hit desert.  Not the sand-dune desert you think of when you think of the desert, but just a  dry and barren land with scattered trees.

L'hopital d'Esperance, or the Hospital of Hope.  It was built by American Baptist World Evangelism at the request of the Togolese government and has been in the works for more than 7 years.  I have the upmost admiration for all of the people who worked so hard to build the hospital to serve the people here.  Coming in for just a month almost feels like taking advantage of their hard work.

Give us this day, our daily bread.

It is a rare opportunity these days to hear a true lecturer.  Not someone who just prattles from a powerpoint reading projected slides word-for-word – a lecturer: someone whose knowledge of a material is so deep and broad that brilliant thoughts skip off of their mind like stones skipping off a still lake.  The lecturer and thinker who comes immediately to my mind is Dr. John Patrick, the speaker at the Michigan CMDA retreat in February. One topic that he mentioned was the Lord’s Prayer.  He’s been praying it once in the morning through, and then once again, stopping on a particular word or phrase to try to delve into the depths of its inner meaning. Over the past two months I have been trying this practice to begin the day.

           

A phrase from the last week: “Give us this day, our daily bread.”

           

Here at the hospital there has been a water shortage.  It has to do with something to do with the pumps that put water up in the hospital’s water tower.  The regular faucets were shut off and people are having to use hand sanitizer (expensive) to wash hands in between seeing patients instead of regular soap and water. 

Another shortage is antivenom.  In the area there are a species of viper that is quite poisonous.  At this point there have been a number of mortalities from the bites  - the antivenom isn’t effective – and we the hospital has given most of its supply to people who have come in.  Currently there are 2 units left in the entire hospital, the amount that is given to a person upon admission.  Supplies just arrived Saturday, right when our stocks were completely depleted.

Earlier this week we performed a biopsy on a young boy who had a parotid mass, enlarged submandibular lympy nodes, and a soft-ball sized abdominal mass.  All of these findings point towards cancer.

Burkett’s lymphoma is very common in West Africa and he was started on chemotherapy.  The therapy worked – the tumors started shrinking instantaneously – but it worked almost too well:  he currently has a massive GI bleed from tumor surrounding some vessel in his abdomen shrinking at an incredible rate which caused it to bleed into his intestines.  Blood is coming out of his mouth as vomit and out of his rectum.  We do not have the normal tools (tagged red blood cell scans, therapeutic options with upper endoscopy, angiography+interventional radiology to localize and possibly stop the bleeding) like we would in the States.  

He received 3 units of whole blood and was in hemorrhagic shock.  The surgery team had been following closely along with the pediatrics team but we did not feel that there was a role for operative intervention in a malnourished boy who is on chemotherapy.  The decision was difficult, but the potential for operative mortality was exceedingly high. Underlying surgery is the premise of success, even when there is potential harm, and in the judgment of the staff the chances of successfully identifying an obscure source of intraluminal GI bleeding is low.  To compound matters there are not ventilators at the hospital, making postoperative care for the patient difficult, if not impossible.  As I walked home from the hospital one thought was going through my head: “Not every patient needs an operation before they die.”  The next morning when I went in his bed was empty.

Give us this day, our daily bread

Here at Hospital of Hope there are so many luxuries:  working OR lights, a working X-ray machine, general anesthesia delivered by trained anesthetists, suture selection, sharp scissors in the OR, excellent nursing care, and brand-new facilities.  Many places in the world do not even have these things that are the bare minimum in the US. The care that is being delivered here in this setting is nothing short of exceptional.  I am blessed to be able to work the people who are serving here.

Give.

On days that I halt on this line, often the word that I stop at winds up being Give. Plumbing to the depths of give alters perspective and brings back up gratitude. There are so many things to be thankful for in life aside from what I listed above: food, water, shelter from the sun, the ability to communicate with friends and family and loved ones, health, the ability to serve. Give causes one to realize that what one has is not his own, but provided from someone Else.  Not only this, it implies reliance on someone Else to provide.

So, here at the Hospital of Hope, we do what we can for people with the skills and tools we have been provided to the very best of our limited ability, pray, and let God do the rest.  And, oddly enough, there is a comfort to practicing medicine (and living) in this.

Au revoir,

John