Welcome 2024!

New years often ring in changes. Change is hard. But isn't it incredible how change helps you remember to value what is important to you? How change can lead to improvements and to new and exciting opportunities? How quickly we adapt to change? 

 If you saw a woman walking down the street while balancing a tub of water on her head, you'd probably think that was both abnormal and impressive. I thought so too at first, but that lasted for about two weeks. Now it is normal- along with geckos living behind my fridge, bucket baths, stepping over people sleeping on the floor of the hospital, employing guards at my house, children chanting at me as I drive by on my motorcycle, teaching in a foreign language, and using MacGyver-like skills to keep hospital equipment functioning, all while it is 100 degrees and wearing a full-length skirt. 

When I first moved to Togo, I remember thinking there were way too many subjects to talk about in a blog or newsletter. Everything was new and weird and unfamiliar. Now I can identify my African coworkers by their laughs. Now I automatically reach for the gear stick and clutch when I'm driving. Now the sight of a massive cockroach in my bathroom doesn't result in screeching and standing on the toilet. Now I am the reference, translator, and resource in the hospital instead of the greenie with infantile French. Now I've performed more CPR than most AHA instructors. Now no matter what changes, Togo is part of me. From the motorcycle burn scars to the family I've gained to the seemingly permanent dirty feet to the friendships to the memories, Togo has left its' mark. 

Prayer Requests

-I am teaching my last course for the nursing program on trauma in February. Please pray as I prepare all the material.

-Please pray for the nursing students as they are in their last trimester. Pray for motivation, continued learning, and for Jesus to work in their hearts

-Pray for my Bible study and relationship with the girls at the sewing school as there have been some different beliefs

-The water situation continues to be pretty awful. The hospital has to truck in water multiple times a week to meet the needs of the hospital and compound. Pray for a solution. 

-C-

Not an accident

Hundreds of people pass through Mango on short-term missions trips for a lot of different reasons (a majority are hospital workers). It is incredible to meet and serve alongside people from all over the world. I feel like I could legitimately travel to almost every state in America (and several countries as well) and have a Togo reunion. As I talk to new volunteers, there are a few Frequently Asked Questions that come up in almost every conversation: Where are you from? What do you do here? How long have you been in Mango? Then it moves to questions like, How did you become a missionary? My recent answer- mostly just to get a good reaction- has been a tongue-in-cheek "by accident". 

Obviously, it was no accident that the Lord brought me to Mango. These past 5 (!) years have shown me that God did this whole thing very much on purpose. Nevertheless, when this all started, I had really no idea of what I was getting myself into, or that I would fall in love with the ministry and people of Mango, or how God would move my heart to keep coming back for the next 5 years. (I do explain all of this to short-termers!)

This past spring brought several challenges. There were some rough moments. I wish I could say that I handled it all by always trusting and surrendering it all to God; but in reality, it led to quite a bit of grumbling and doubting on my part. Despite the challenges and despite my response, God was still moving and working. Now that we're a couple of months out, it's easier to get some perspective and see that none of it was an accident. 

There are actually a lot of accidents at our hospital...moto accidents. We offer the best ortho care in the region, and we have patients traveling hours and hours following a vehicle/moto accident to get quality care. When they're discharged and have frequent follow-up care/wound dressing changes/IV medications, these patients often stay on hospital property in our 'cuisine'. Sometimes the patients stay for months, and some of the most incredible testimonies come from our chaplains and missionaries who go to the cuisine to visit, encourage, and share the Good News. 

A few weeks ago, there was a baptism and a new church building dedication in a village near Mango. Just 10 years ago, there were no believers, but a man heard about Jesus at the Hospital of Hope and accepted Jesus. Through him and his connections with the hospital ministries, there is now a growing church. 

A colleague told me a story this week about a woman who shared how before our hospital opened, one of her children had gotten sick. She took him to the local hospital, but when her child had a seizure, she couldn't find anyone to care for him. She knocked on every door of the hospital, but no one answered, and her child died. She compared that experience to what she observed at the Hospital of Hope and shared her gratefulness for our hospital. She thanked us for prioritizing taking care of the sick and the poor. 

Back in April, 8 missionary kids were baptized. I gotta tell you, the kids on my team are simply the best. Investing in their lives is a privilege and one of my favorite things. Their testimonies brought me to tears as they sincerely shared of how God moved their hearts to love Him. 

The nursing students have entered their third and final year of the nursing school program. They have come so far and have learned so much. Having them working in the hospital has become truly helpful as they can take a load off of the staff nurses.  Recently, we got to experiment with our Sim (simulation) man for the first time. I will be teaching the critical care course later this fall. 

Even if it was by 'accident', I love being part of medical missions. Seeing people come to Christ and grow in their faith as a result of the work at the hospital is what keeps me going in hard times. Because of the hospital, we can reach people who may otherwise be closed off to the Gospel. This is what medical missions is all about. It takes a significant amount of people, resources, time, and prayer to keep things running, but through it all, there is a Healer who works despite our failings. With Him, there are no accidents. 

Signing off,

-C-

100,000 Reasons

For all Your goodness, I will keep on singing
Ten thousand reasons for my heart to find

                                                   So bless the Lord, O my soul, O my soul
                                                                Worship His holy name
                                                          Sing like never before, O my soul
                                                            I'll worship Your holy name 

The Hospital of Hope has been open for 8 years and will probably see its' 100,000th patient this month. 100,000 Reasons to bless the Lord. 100,000 is a big number. I can't possibly begin to share all of their stories, but maybe I can share a few. 

A man was in an accident and had an open fracture. He went to surgery and was staying at our cuisine (where patients can stay on hospital grounds) to get dressing changes and antibiotics. A few weeks into his treatment, he started to experience some complications, so he returned to the hospital. At that point, he was already in critical condition with acute heart and kidney failure. The next day, he was my patient. He was fighting for every breath on maximum oxygen. He was so swollen, but his kidneys weren't working at all. The worst part of it was that he was still so awake. He was totally alert while suffering. All day long, I was next to this guy. The doctor came in at one point and talked about the gravity of the situation with the family. He explained that we were doing everything possible, but the patient was still in critical condition. Afterward, the family asked me if they could take him home. This happens regularly at our hospital with dying patients who aren't showing improvement- it gives the patient the dignity of dying at home, and it saves the family money and the difficulty of transporting a body. Normally, I would support the family's decision, but this man was still so awake. He was still fighting. I couldn't feel right about it, so I prayed for wisdom and for God's healing. I talked with the family and convinced them to stay. I also asked our chaplains to come in and pray with the family. When I left that night, there were still no signs of improvement. However, I went into the ward one more time to say goodbye, and this man, while fighting for each breath, he looked me in the eye and gave me the thumbs-up sign. I fought back tears as I sent the thumbs-up back and left for the night. I knew the odds were against him, but I just felt like he was going to make it. The next day, he was still there and was still fighting. It still seemed like his body could give out at any moment, but yet, he was still fighting. The next day, they were able to start weaning down his oxygen, and his kidneys started to work again. Over the next few days, he kept improving and was eventually discharged. I saw him and his family several times afterward, and every time, we praised God for answering prayer and for the miracle He had done. One more reason to bless the Lord. 

"This is the confidence we have in approaching God: that if we ask anything according to his will, he hears us. And if we know that he hears us—whatever we ask—we know that we have what we asked of him." 1 John 5: 14-15

A baby was brought in after a traumatic birth at an outside hospital during which she didn't get enough oxygen. We see these cases fairly often, and sometimes the babies have irreversible brain damage due to the lack of oxygen. This baby came in with no suck reflex, so we had to give all her feeds through a tube. The mom was so attentive and sweet, but she was obviously discouraged. One of my friends prayed with this mom that God would help her sweet baby. The next day, I was in that ward. I was doing my assessments, and put my gloved hand into the baby's mouth to see if there was a suck. After a couple of seconds, the baby started to suck! Quickly, I gave her a bottle to see if she would take any by mouth, and she did! I looked at mom who started to laugh, and we celebrated together. The baby was discharged from the hospital yesterday and is taking all of her food by mouth. One more reason to bless the Lord. 

Back in December, a 12-year-old malnourished boy came in with a large mass in his abdomen. As the point person for our cancer program, I sat with him and his mom and explained cancer, chemo, and what we could offer them. Several weeks later, he came in for his treatment and was already looking better. He had gained weight and the tumor was already smaller. One of our providers talked to the family, and both the boy and his mom decided to accept Christ as their savior! Two more reasons to bless the Lord. 

In the fall of 2018, the 40,200-something patient arrived at the Hospital of Hope for the first time. Like many patients, she had no idea what to expect. She had no idea how she would witness and experience the power of prayer, the changing of hearts, the overwhelming grief consoled only by the Sovereign Father, the bonds of teammates forged through shared struggles, the incredible joys, and the unimagined experiences that would define the next 4.5 years. For all of His goodness, I will keep on singing. Cause I have 100,000 and more reasons to bless the Lord. 

Fall

 Dear friends,

It's been a while since I've written. The main reason is that the last few months have looked like submitting doctorate assignments at midnight after working a 12-hour shift, printing nursing school exams mere minutes before it starts, squeezing hospital beds into new corners of the hospital, and researching the lifecycle of a malaria parasite for hours at a time (it's fascinating!). Since I haven't posted in 4 months, there's a lot to catch up on. 

Big theme:
I listened to a sermon recently wherein the pastor said something to the effect of "worry is atheism" (Pastor DeWitt, Bethel Church). Turns out, I'm prone to fits of atheism while I look at nursing staffing or the length of my to-do list. I forget the omnipotence of God while I'm failing to solve complex issues or feeling like I'm barely keeping my head above water. That whole "worry is atheism" thingamajig has been the needed reminder that neither my personal worries, the hospital worries, nor the problems of the world are out of God's control. 

Nursing school:
This fall I taught courses in the nursing school on the cardiac system, the hematology system, and IV insertion/medication administration. Prepping for the courses teaches me so much as I try to anticipate the dozens of questions my students will ask (my Togolese students are like toddlers asking college level questions..."why? but why? then how? why?". It's a good thing...mostly). The students have been working so hard, and our program is not at all easy. They're also fearless and willingly let another student put in multiple IVs I've come a long way from where I started as a teacher. I'm better at writing test questions and engaging and interacting with students. I've found that a lot of my best ideas appear while standing in front of my students. Despite all efforts, cultural differences still can cause conflicts and misunderstandings. I'm still learning. 

Drawing the anatomy and blood flow of the heart

First IV insertions

Hospital: 
Malaria season is just now starting to wane. Every year, the hospital has seen more patients as well as more patients with a higher acuity level. This malaria season, every department was stretched thin, and our staff is tired. Often, once a child was discharged from a bed, they were moved to the floor to make room for the next. There were days of heavy losses and disappointments. Our emergency room area was regularly overflowing, and so growing lines of stretchers lined our hallways as we tried to find more room. For months now, there have been some difficulties with obtaining enough blood. Malaria causes severe anemia (Hematocrits as low as 6 or 7%), and the blood shortage has been a challenge.  

Despite everything, God has provided. A lot of our long-term providers returned this fall and were able to staff the hospital. Some amazing short-term nurses have come and made staffing possible. We're hiring more personnel to relieve the burden on some of the departments. And even on the overwhelming and heavy days, God helped us make it through.  

Starting an exchange transfusion

Doctorate program:

School. Sigh. Who let me sign up for this? I'm getting there though. I'll start my doctorate project this summer and hopefully, potentially, possibly, prayerfully, maybely, return to the States in 2024 with my doctorate degree. 

Friends:

Can I just say that I have the best team? Sometimes it is really really hard to be away from family. I miss the good moments and the hard moments. But since I live across an ocean, I cannot be thankful enough for my community.  I have my Christmas stocking right next to my Togo familys' stockings, ukulele lessons with 4 (and counting!) teammates, standing meal invitations, prayer times, daily ping-pong matches, and incredible support. 

One recent highlight of my time with Togolese friends was my roommate's birthday party. We got together with our Togolese friends to eat a meal. And, as it often happens, somebody put on music, and we started dancing. Even my African grandmother with her old, arthritic knees danced and waddled and shimmied.  

Duck duck goose during a team outing

God sightings: 

Yesterday, I had a young patient who seized non-stop for over 3 hours despite every medication and intervention. She stopped breathing, so we gave rescue breaths for about an hour. When I thought the situation was nearly hopeless, the doctor ordered one more med as a last resort, and it worked. She stopped seizing and started breathing on her own. She is still very sick, but we hold on to those encouraging moments and thank God. 

The picture above is my little friend A who had severe congenital heart issues. My teammates worked fervently to get him to the States for corrective surgery, but when he arrived, they were not able to do the surgery. Sadly, he passed away while in the States. We might not yet understand what God is doing, but so many people were touched by this little guy's life. Pray for his parents who have heard the Good News so many times but don't yet know Jesus.

What's Coming: 

The nursing students will be taking a Bible course next week on the life of Jesus. They've taken multiple other Bible courses that have led up to this. They will be challenged to think about their beliefs, so please pray for their hearts next week. After that is their exam week, so please pray for them to be able to demonstrate all that they've learned. In January, I will be training a group of new nursing aides and more teammates will be coming and going. Life is full and fast-paced and never boring. A personal prayer request would be for perseverance and continued energy to try to accomplish all that is on my plate. Thank you so much for your continued prayers and support. Y'all are amazing.

In Him,

Caroline

Summer

Hey friends, 

It's been a while, and I have so many stories to tell, but not a lot of time. Ergo, I'm going to let some of my photos from this past summer do most of the talking. 

1. My work continues to stretch and challenge me in new ways all the time. This is the dream job. 

My team working together during a code. In the foreground is one of our chaplains comforting the mother of the child. This is a common occurrence during malaria season. 

I had the opportunity this summer to write my own course on the gastrointestinal system and then teach it over 3 weeks. Pictured is our dissection of a freshly butchered cow's digestive system.

Small intestines all stretched out (!!!) 

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Nursing students working in the classroom 

Dancing with the girls in my Bible study

Clinical instruction with nursing students

2. I had the privilege to go on a fantastic 3 week vacation and spend some time with family and friends.  

 

2 weeks at home in May

3. Last December/January, we weren't sure how the hospital would be able to function this spring/summer. We were looking at severe staffing shortages and were praying that volunteers would come to help. God answered prayers in many and unexpected ways. We've had a succession of wonderful, helpful people come out and serve at HoH who've brought energy and enthusiasm for the work in Mango.  

4.  When you're living away from family on a different continent, it can be hard to be so far away. I couldn't do this without my teammates and friends who are more like family. 

 

Please keep praying for the minstries of the hospital and the team. We see clearly that God is working, but there are always challenges and trials as well. We strive to be more like Him, and we covet your prayers. Thank you!

-C

Going Home

A few weeks ago, I said that I was 'going back home' to the United States where I  was able to spend a delightful and restful 3 weeks with my family. But then, I said I was 'going back home' to Togo and that's also true- the place where I'm living with my Togo family and my work. For me, the hardest part of missionary life is the fact that I will always be missing something. 'Going back home' means goodbye to something else. The parts of life that matter to me most, which used to be nearly exclusively contained to Northwest Indiana, are spread out over thousands of miles. 

While I am in Togo, I miss doing whatever ridiculous tricks are necessary to illicit my niece's nose-crinkly, four-toothed smile. And gathering with my family to watch our favorite TV show but being the only one still awake 20 minutes later. And learning the latest family joke that's incessantly repeated but never overdone. And simply being present with and for my people in everyday moments.  

Whilst in America, I miss the daily challenges, emotional roller-coaster experiences, and fulfillment of my dream job(s). And weekly lunches with kids squirming on my lap. And doing life with my teammates: the Togolese and Americans, the old and new, the young and old, who have changed my life. 

I started trying to compare the feeling to a Harry Potter horcrux... that my heart is being split into multiple pieces/places. But it's not that because if you're nerdy enough to know what I'm talking about, that implies that I'm less than whole. But it isn't perfect either because, even while I can be fully content in both places, I am always missing something. What I hope for is that this points me towards thinking of heaven. I hope the longing I feel leads me to realize that, while life is incredible, this is all temporary. I'm not home yet. But once there, I won't be missing anything. 

P.S. (actual missions update) Heading back into Year 2 in full force! Pray for the influx of short-term volunteers and their training, the course I am teaching at the nursing school in August, the upcoming malaria season, shifts in leadership, ongoing Bible studies, and the wisdom and strength to do it all that only God provides! 

Moments: Episode 8

The last time I wrote a Moments post was three and a half years ago. I had been in Togo for around 2 months, and everything seemed new and different and unfamiliar, but God was faithful, and there were a lot of people who supported and encouraged me. My mantra at the time was it's nothing I can't do, it's just something I've never done before.

Now, even more seems new and different and unfamiliar, God is still faithful, and there are so many people who support and encourage me. I am more established at the hospital and am an elected member of the hospital management committee. Different responsibilities pile up like continuing nursing education, implementing policies, making the nursing schedule, helping coordinate short term nurses, and being oddly involved in a lot of biomed/technology stuff on top of working in the hospital and teaching in the nursing school. This presents new challenges and the now familiar feelings of grateful, humble, inadequacy on a nearly daily basis. My mantra stays the same.

I like posting about little moments that attempt to give a glimpse into life in Mango. A lot of these Moments stand out to me because they don't fit into one category. Maybe it's not just sad, but it's hopeful too; not just funny, but also poignant. Sometimes, cultural differences hit me like a slap in the face. But in everything, there are moments of seeing God's faithfulness and goodness in a broken world. 

-There was a little boy in the hospital who was incredibly malnourished. He would just lie in bed all day and had multiple wounds. Keeping him clean was really difficult, and he was so weak. One day, I sat on his bed, blew up a glove into a balloon, and drew a face on it. I handed it to him, and I saw him smile for the first time. He died later that week. 

-A man with a bad leg fracture requiring 7 weeks of traction came to know Christ in the hospital through interactions with our chaplains and watching the Jesus film and other media. While teaching the nursing school on getting a subjective patient history, we sent some of our students to talk to different patients and ask them questions. The students who talked to this young man were struck by his joy despite his tough situation and noted how he had put his faith in Jesus. 

- I was assigned to one of my cancer patients nearly every shift. Her nursing care was very involved and took a lot of time. I spent a lot of time in her room with her family and grew to love them- especially her adorable baby sister who would toddle into my arms. One day, I was finishing up all of my tasks and started to walk away, but my patient reached up and grabbed me by the pocket so that I couldn't leave. Her mama thought it was hilarious, but I was so glad that I had a little time to sit on her bed and spend a little more time with her. 

-A different cancer patient told me how much she liked school and how sad she was that she'd be missing school for her chemo treatments. Her sweet dad told me that she was going to study and grow up to be a nurse- just like me. Both of these girls have passed away. 

-A patient came in completely comatose with very unstable vital signs. Without the ability to get a CT scan or MRI, we have very limited ability to know a real diagnosis or prognosis. An hour or two later, the patient started moving his right side, but was completely flaccid on the left. A while later, I was with some of my students and we talked about the possibility of a stroke vs. other diagnoses. As we were in the room, the patient moved his left leg for the first time and then his left arm. Then he tried to sit up. It felt like we were witnessing a miracle. 

-I co-taught the physical assessment course at the nursing school. We introduced the different techniques at the beginning to introduce them to the concepts. To have them practice, we started percussing (tapping on the body in different places as part of the assessment) on their schoolbooks. We then moved to practicing on other students. We walked around correcting technique, but I had to stifle laughter as I witnessed one student intently, rapidly, repeatedly, and forcefully percussing the abdomen of his poor fellow student who probably had no idea that he would be experiencing that particular woodpecker effect when he walked into class that day. 

-I talked to one of my Togolese colleagues about some hard topics (leadership positions don't always garner friends y'all...).  At the end of a tough, but open and honest conversation, I thanked him and concluded by saying that I hoped he knew how much I cared about all of the nurses. He smiled and said, "yes, we know that very well." 

-I say something to one my patients in their tribal language, and he started giggling and clapping. 

-A patient comes in after an accident that resulted in his foot being cut off. He's prepping to go to surgery, and I see his family bringing him what looks like a sack of food. I motion for him to stop because the patient can't eat before going to surgery. He hands me the bag, and I realize it is not, in fact, food, but I am holding in my hands the severed foot. 

-Remember my twin that I posted about in 2019? She's almost 3 and loves to sing. Remember my coloring party cancer friends from 2020? They're both doing really well and still come to their appointments together. 

My twin H

Another healthy appointment!

-We spent a week of nursing school in January practicing dressing changes on Mr. Cucumber and Mrs. Papaya (pictured below)

Thanks for reading and for praying. I really appreciate when I get messages from people back home who are faithfully praying. 

Finally, if you are a healthcare worker, we are anticipating a shortage of both medical providers and nurses this year. Let me know if you are interested in learning more about serving in Togo. I gotta say, it may be hot, but it's a pretty great place to be. 

In Him,

Caroline