Today marks the halfway point of my rotation here in Togo. Appropriately, Dr. Gayle (a long-term family doc here) and his wife Cheryl took several of us on an outing to the largest town in this region of Togo, Kpalime. We toured the local school for the blind ("The Village of Light"), checked out their nifty aquaponics set-up, shopped at their artisan boutique and the larger local artisanal market, dined at a nice local restaurant, and shopped in the town's outdoor market. All of the experiences-- as well as the drives there and back-- were eye-opening and enjoyable. I continue to derive pleasure from spending time with all the folks here, and am coming to appreciate more how truly wonderful most of the Togolese people are.
Yes, that is a goat on top of the van and two pigs on the back of a motorcycle. Not all that surprising when you think about it (how else are poor people going to transport their livestock?), but entertaining nonetheless given the novelty.
The workweek was also varied and productive. Since my last post, I have performed two more Caesarian deliveries (both of which went well from a surgical perspective, although one was on a known fetal demise), gotten pretty comfortable in both inpatient and outpatient OB and Medicine, and seen a lot of neat cases. There are too many stories to tell and cases to review. In rough order of frequency, on inpatient medicine we see malaria, typhoid, new HIV, anemia, schistosomiasis, acute kidney injury, osteomyelitis, and pneumonia most commonly. Common outpatient issues include dyspepsia, parasites, other infections, back and hip pain, infertility, diabetes, hypertension, orthopedic issues, HIV, and new TB. Yesterday, I was finishing up clinic when I heard a commotion in the waiting room, and a support staff person burst in the room, grabbed a fistful of gloves, and rushed out. Shortly later, I followed him out and discovered two motorcycle accident victims being rushed in on stretchers. I also discovered I was the only doc around. I instructed a nurse to get me some help from one of the local PA's, and began to run through the ABCDE's for each patient. Turns out both had head injuries (hopefully superficial only) and one had an open tib-fib fracture. Fortunately, both were protecting their airway and didn't show any obvious signs of imminent shock. After I got them exposed, I had them moved over to the hospital triage area, where we got IV's started and I was able to promptly obtain a surgery consult. That was fairly exciting.
In regards to surgery, I have not pursued getting in the OR (aside from C sections) because of my workload on Medicine and OB and the presence of five surgeons here for the past two weeks. I do still hope to get a few intubations, as well as a few spinals and some General Surgery cases if I can find time.
Tomorrow, I'm back on OB call, then on Medicine call Monday. We have some people leaving so it will be busy, but hopefully in a good way. I also hope Brett, Felisha, and I can find some time in the afternoon to repeat our Sunday Swim!
Though it's been a busy week, I've been encouraged by reading Celebration of Discipline by Richard J. Foster and following via group text the experiences of my house church brothers and sisters as they have sought to make meditation (the topic of this week's chapter) a meaningful part of their lives. Being a part of a group of people committed to strengthening and encouraging each other is a key to making spiritual progress, and I've come to appreciate that more this week.
I also had an African feast on Wednesday, which was the first time I had knowingly eaten cassava. It was super bland. The rest of the food was ok. Though I knew cassava wasn't paleo, after reading the Wikipedia article on it, I realized it ranks somewhere near Little Debbie Cakes in its un-paleoness, consisting of almost 100% carbohydrates and requiring extensive processing to remove toxic levels of cyanide. And it's not even native to Africa, having been transplanted here from Brazil by the Portuguese in the 16th Century. Next time, I think I'll pass.
I also had my second French session with Professor Tupo yesterday, and have made some good progress in vocabulary and verb conjugations this week. I'm hoping to practice more each day as I become able to articulate a few things and understand more. Brett has studied with me a couple times, which has been good. I have one more lesson to finish learning the rest of the language!
Though it's been a good two weeks and I'm looking forward to another couple good ones, I'll get to see my girls when I get home! And other people too, I guess. I miss you!