Saturday, March 14, 2020

Togo.....a few hospital scenes at HBB.

The docs and PAs meet each morning in the doctor's lounge for "morning report" where all of the non-surgical cases are reviewed and treatment plans discussed. Then, rounds on the inpatients takes anywhere from 1 to 2 hours. After rounds are done, we go to the outpatient clinic until noon, when there is a nice break for lunch. Clinic resumes in the afternoon and usually lasts until 5 or so.





A teaching session with the PAs - everyone huddled around a Powerpoint presentation on a laptop!




The nursing station is the center of activity. The nurses at HBB are very good and always interested in helping and learning. They all speak excellent English !!





Susie with a malnourished 3 month old baby ready for discharge. African babies are adorable!!!




Justine is a 72 year old lady with lymphoma. Dave gave her 2 cycles of chemotherapy and left instructions for her followup care.





Essene is a 32 year old lady who came in with pancytopenia (all blood counts dangerously low) and a huge liver and spleen.  Her abdominal ultrasound showed numerous nodules in the liver of unclear cause (?malignant, ? infection, etc). Her peripheral blood slide was not diagnostic of anything. We suggested a CT scan in the capital city but the cost was prohibitive. Dave did a bone marrow aspiration and biopsy with assistance from Nurse Mawunyo.  We will carry the specimen to the US where it will be prepared and read by a pathologist. 




Each day several young boys greet us at the hospital. This is Jeremy with one of the hospital guards. Jeremy has an orthopedic problem and is staying near while he recovers.






OPD - Outpatient Department

The outpatient clinic at HBB is busy!! People start coming before 7 AM, are given a number, and patiently wait their turn to be seen by one of the  PAs or a visiting physician.   Patients drive up from the capital city of Lome and down from northern Togo. We have seen a few patients from Ghana as well as Burkina Faso.
                                                                                                                                                                   


Patients arrive early, sometimes even coming the previous evening and sleeping on the ground!  Most come by small motorcycles ("motos").




The outpatient clinic was named in honor of Dr. David Clutts, an early surgeon here. He trained in Grand Rapids a few years before us and is now in Illinois. Another surgeon who served here for many years is Dr. Bob Cropsey, who is from Ann Arbor.




This is the scene at 7 AM in the waiting room - already packed!! While they are waiting, one of the hospital chaplains shares the Gospel with them.



Everyone who works on the base, from the guesthouse ladies to the pharmacy staff to the PAs and docs all have name tags -  we were happy to see that the Medical Director, our old friend Dr. Michael Gayle, labelled us as "Dr. Susie and Dr. Dave" !!

Pastor Komla Gaglo is an amazing man!! When the hospital was being built 35 years ago, he was a mason who practiced animism/spirit worship. He became a Christian, was identified as being very bright and was taught by Dr. Cropsey to function as a PA - completely by "on the job" training! He later became a pastor at one of the local churches. Gaglo is very wise and thoughtful - on our first trip here in 2007, Dave spent some time with him to "learn the ropes".



Susie has spent some time in the clinic working with Kodjo, one of the new PAs. She loves to teach and this has been a good experience for her.



Dave has enjoyed working with his translator, FoFo. He is very proficient in English, French, and the tribal language Ewe. He enjoys sharing the Gospel with patients while I am writing my clinic visit notes.










Welcome to Togo -HBB!

We arrived in the capital city of Lome on February 18.
After a night at a guesthouse, we were driven the 2 hour trip to HBB,  l'Hopital Baptiste Biblique, a ministry of ABWE (Association of Baptists for World Evangelism).  This was the first place that we served together after we left our American practices in 2006 and it has been great to get reacquainted with some old friends and meet some of the new folks. For the first 2 weeks, we were able to stay at an unoccupied home; for the last 2 weeks, we have been at the guesthouse where we have stayed on earlier trips.



This is the sign that greets patients at the entry gate to the hospital complex.










                                                                                   


The guesthouse has 6 rooms for visitors.
Each room has a small but adequate bathroom, comfortable bed, and a couple easy chairs. Most importantly, there are ceiling fans, a floor fan, and a wall AC unit which we use sparingly since electricity is expensive. Behind this building is another guesthouse which is set up to house groups that come for construction or electrical projects.
                                                                               
This is the main gathering room at the guesthouse. We have our meals here and our Sunday evening church service is held here. Food is served buffet style and is more than adequate. 
                                                                               

Amavi and Yawa are 2 of the ladies who prepare our meals. They have taken good care of us and usually have a vegetarian option for us. Everyone's favorite is Friday dinner which is "pizza night"!



Susie at the door to our guesthouse room.

Sunday, December 29, 2019

...a few more Tenwek scenes


It was great to be with our very good friends, Dr. Greg and Marilyn Hondorp,
for our first 3 weeks here! They are from Grand Rapids and we attend Calvary Church together.
Greg was very busy in the Anesthesia department!!

Gladys is a nurse in the outpatient clinic where Susie works. Her husband Steve
and their two adorable sons, Liam and Emmanuel, joined us for dinner.

Tenwek is a vegetarian's paradise - there are numerous nearby kiosks that kept
us in good supply. Prices were unbelievably low - each banana was 10 cents and
a cabbage as big as your head was just 50 cents!!

Clean water is taken for granted in the US.
Here, we purified rain water with
this ceramic filter.

Just down the hill from the hospital is a
waterfall and hydroelectric plant.


Enjoying a walk to the waterfall.....

Tenwek Hospital

   Our time at Tenwek has gone by quickly - we have been here nearly a month and have just a week to go before returning to Michigan!! Here are a few pictures..... not as many "people" or "hospital" pictures as usual because the hospital requires written permission from any patients being photographed and we are not supposed to take pictures of the hospital wards!
   Tenwek is a 300+ bed hospital located in rural western Kenya about 250 kilometers from Nairobi. The service area is 400,000. There are 120,000 outpatient visits and 15,000 inpatient admissions per year along with 8000 surgeries and 2500 deliveries....a very busy place!!! There are residents training in General Surgery, Cardiac Surgery, and Family Medicine as well as Clinical Officers (like our PAs) and Rotating Interns.


...just outside the main entrance


Map with Tenwek's location in western Kenya
Large central courtyard - CT scan and Radiology are shown; the inpatient
wards, emergency room, surgery, administration, and lab modules are nearby.
Susie in the outpatient clinic area.
Teaching rounds.


The medicine ward team that Dave worked with. Common diagnoses
include heart failure (often related to rheumatic fever), hypertension,
diabetes, and HIV sometimes complicated by TB or cryptococcal infection.

Christmas caroling in the hospital!


Thursday, December 26, 2019

Safari!!

Several weeks ago, we enjoyed a 2 day trip to the Masai Mara - this was our third safari and we loved seeing this wonderful expanse of God's creation again!!!

Susie visiting with two Masai men at the lodge.























We were able to get very close to many of the animals.

Mama cheetah with her cubs.

Mama cheetah looking for lunch!




The cape horn buffalo has an aggressive nature and is very dangerous.


We were fortunate to catch a glimpse of a hippo!!

3 jackal brothers enjoying a lunch of fresh-caught baby impala.

There are only a few black rhino left. They roam in an area that is patrolled 24/7 by guards to keep poachers away.


We were amazed at how close we were able to get to the rhino!!!!

Our eagle-eyed safari driver/guide was an animal magnet!



We had to get out of the Land Cruiser when we had a flat - thankfully, no nearby animals were hungry!

Dave, Susie, Marilyn and Greg Hondorp, and Rachel, an Obstetrics resident from Virginia.

The scariest moment of the trip was not in the park with the animals but on the ride back to Tenwek. A large truck had gotten stuck on a road that was partially washed out. Our driver surveyed the situation, motioned the people to get out of the way and said "let's dance!!". He then gunned the engine of the 4-wheel van and went to the left side where all of the people were trying to fill in dirt and stones.  We made it!!!!!! (Praise God!!!)