2018

Hello my friends!

   At the end of the year, I like to try to reflect and remember and review and recall and reminisce about everything that occurred. Now that sounds deep and thoughtful, but I'm not really a deep and thoughtful person. I'm a list person. So what it really entails is looking through lists of things that happened this year, thinking, 'this was a great year!', and then calling it a day.

   In my review, 2018 really was a pretty fantastic year. I crossed a number of items off my bucket list (appearing as an extra on Chicago Med, completing my Master's degree, giving a commencement address, winning a LipSync battle, embarking on a medical missions trip, and owning a motorcycle among others). I got to travel to new places (including 4 new countries), learn a bunch, read 38 books, and do so many fun things. I've met and gotten to know so many incredible people that I've made a list so I wouldn't forget anyone. I reviewed the list of my financial and prayer supporters that brought me to Togo, and I am once again so thankful. The list of things that I'm thankful and the list of people I'm praying for keep growing.  I'm also counting my phone's photo gallery as a visual list of things that have happened, and I am reminded of so many joy-filled days. I am blessed beyond measure.

This was a great year!

   And now, in an effort to reflect for a moment beyond my normal, I'll try to write a brief reflection.  In the past few weeks, I've been reading the Valley of Vision (collection of Puritan prayers), gone through a couple tough days at the hospital, and have had a few conversations with different people, and have been reminded of a few things. Here's another list cause I can't resist. 1. True joy is found only in Jesus. 2. Whether I am checking something off my bucket list, having just a normal day, or performing CPR on yet another infant, the Source for hope and joy and peace is Jesus. 3. It's easy to be distracted by both the happy things and/or the hard things, but it's really all about Jesus. 4. Everything that happened this year- big or small, all the growth, all the blessings, all the fun, and all the hurt is so small compared to the majesty and power of Jesus.

See ya in 2019!

In Him,
Caroline

A Collection

Hello my friends!

It's been a while. Two reasons. 1. My schedule is filled up. 2. All of the things I want to share don't really require their own blog post. I'm just collecting all sorts of stuff and now I'm going to share them in this little collection. I haven't written the rest of this yet, but you may expect some sagas, vignettes, anecdotes, updates, lists, and whatever else comes out of this.

Let's start off with a fun one.

Caroline vs. Critters. 
Chapter 1. The Gecko Saga
    It all started my first week in Mango. The morning of my birthday, I was getting ready for work and saw a critter run right past me into the laundry room. I started and gave a little shriek. Thinking it was a mouse, I informed people who knew what to do, and was given a sticky mouse trap. For months, it just sat there collecting dust. The occasional spider or cockroach climbed on, but there were no further mouse sightings. Fast forward 3 months. I walk by and notice a large gecko on the trap. 
    Now I think it's necessary to describe the relationship I have with geckos. They range in size, but are generally smallish and are generally smoother than lizards. They live in houses and help eat insects. They run around on the walls and don't bother anybody- there's an occasional jump scare when you open your cabinet and see one scurrying away, but we just leave them alone and agree to co-exist. 
    The gecko on the mousetrap is there for about a day until one of my roommates got a glove and scooped the gecko off the trap and let it go outside. Unfortunately, it was too weak or injured from the trap, couldn't move, and died.
    But that was just the beginning. (Dun dun dun)

    Within the next couple of days, two more geckos apparently went on a suicide mission to revenge their leader and got themselves stuck on the trap! (At this point, I have something to confess. I was not in the mood to deal with this. I was working night shift and was tired and grossed out. I ignored the problem and avoided responsibility for too long.)
     Another day passes. Another gecko had made a valiant attempt to rescue the other two, but had gotten stuck.
     The next day. Two more joined the party. There were FIVE geckos trapped on the mousetrap.
     Finally. While I was at work, two of my roommates went in and witnessed a SIXTH gecko jump on! Enough was enough and the two of them were brave enough to scoop up the trap and take it outside to our guard. 
    The rest of the story is hearsay, but was apparently traumatic. The guard took the other 5 geckos into the back, and the rest is simply a mystery- but allegedly you could hear some thudding. 
     We did not put the trap back out.

The End.

Chapter 2. Caroline the Spider-Slayer

    Once upon a time, the hospital was nearly void of patients, and Caroline was bored. After doing her normal work, playing with her pediatric patient, scrubbing, wiping down, organizing, and cleaning for most of the morning, she had the bright idea to get rid of all the cobwebs in the corners of the wards.
    Armed with a rag atop a broom, she went to work. Quickly, she realized that there was the added challenge of nearly all the cobwebs still being occupied. What could've been perceived of as disgusting turned into a quest to defeat all of the spiders inhabiting the hospital.  The prey would sometimes leap to the ground and try to hide, but would not get far before being crushed by broom or foot. She started out counting her slaughtered foes, but lost count.
    The final tally was somewhere around 200ish. The enemy was defeated. The quest was fulfilled. And much fun was had. 

The End.

Even when it Hurts

If you've talked to me about this, you know that I care a lot about dying. After working on oncology for 3 years, I care a lot about how people experience the end of life.

I've watched a lot of kids die here. During a code, I usually jump into CPR and there have been a number of times where I have been the one to give the last breath or the last compression before we stop. And that hurts.

In a limited resource setting, there are a number of different illnesses or conditions where there is no way of treating a patient. There are currently no resources for a patient having a stroke or 3rd degree heart block or advanced liver cancer. And that hurts.

There are so many heartbreaking situations.

In the midst of this, the doctors that I work with here are so filled with the love of God for the people in their care, that even when it hurts, they still decide to care. Even when it hurts and they have to have hard conversations, they speak to the patients and their families with honesty and dignity. Even when it hurts to say that there's nothing we can do, there are chaplains there who deliver the Good News because they want to share the hope they have. It breaks my heart when we take all of the lines off of a dying baby and hand him to his mama so she can hold him as he passes away. It breaks a little further as we gather around her and the doctor prays, but we praise Him for His goodness and His faithfulness even when it hurts.

Behold Our God
   Today I had the incredible opportunity to go to a baptism. We piled in cars and drove out to a village where there has been a Bible study led by some of the hospital employees and chaplains. When we arrived, there were a whole bunch of people under a tree singing and dancing. We prayed together, and then started walking towards the river. The line of people in a single file line stretched way down the road. As they walked, the people being baptized kept on singing. At the riverbank, a pastor gave a message which was translated into the local language and then those being baptized started lining up. 

   Baptisms can make me cry nearly any day, but today I found it extra powerful. Before I left the house this morning, I got a video from my mom from the Christmas concert at my home church with the whole choir and orchestra singing the song Behold Our God. We sing it frequently here, and it's become my theme song for this year. 
   As 30ish people publicly declared their love for the Lord, that song was running through my head. Then that thing happened when all your thoughts mix together and I thought about the people back home singing, 'come let us adore Him', and the people in the hot sun on the riverbank singing praises in a language I can't understand, and the choir in heaven celebrating each life that comes to Him, and how even our most majestic forms of worship can't begin to do Him justice. I heard the story of how the Bible study started in this village which started with the tragedy of a little boy dying in our hospital. During his time there, his relative heard about Jesus and brought Him back with her. And then when the line was finished, I looked back up the riverbank, and saw most of the newly baptized wearing a new yellow cloth. As we walked back, they were still singing and I heard them chanting a familiar word: Alleluia. God be praised. Come let us adore Him. 

I'd love to make a full post about this next topic sometime, but I haven't found the thoughts or the words or the conclusions yet.

Sharing

There are up to 10 patients in a ward with nothing separating the beds. The patients are cared for by their family members, and I never thought I'd have to work so hard to identify which family member belongs to who. They sleep on mats on the floor and bring their meals inside and eat on the floor too. Kids run or crawl around the ward- at least halfway naked more often than not. 

And they share.

Water out of the same bowl. A meal including the whole ward. Village languages translated into French. Discharge instructions given through a complete stranger. Turns giving food the the woman there alone. Help and caring regardless of relation. Gifts given that are immediately shared with a neighbor. 

And now I'm asking, what is my role in this? Does giving ever become too much? When does sharing hurt? If I do share what I have, where do I draw the line? Should there be a line? Why don't they save? Why do I save so much? What would this level of sharing look like in America? 

I don't know a single answer. 

A List.
Of completely unrelated things that I still have left to say. 

1. This is my 14 year old friend S who was electrocuted and lost his right hand. His other arm might need amputation as well. He is in the process of getting a prosthetic. Most importantly, he's open to hearing about Jesus. Pray for him. 


2. I saw a cockroach in my bathroom today and calmly picked up the closest heavy item and smashed it without hesitation. Contrast this with the first time that happened and it took a 10 minute standoff with much shrieking and flinching while standing on top of the tub. Progress.

3. Here's a video of my newest project/hobby. These are kids who are staying in our cuisine. The cuisine is basically a building that has divided areas where people can sleep. There is running water and some places where people can build a fire for food. It's mostly there for patients who have been discharged but still need wound care or medications, patient families, or patients who come from a long ways away. They can be there for anywhere from a couple days to 8 months. A couple of people have ministries in the cuisine, but one of them is leaving this week, and I get to help continue her ministry with the kids. Basically, I get to play games with them whenever I can. It's a pretty sweet deal. 

4. Riding a unicycle in a skirt is nearly impossible.

5. I realized recently that I haven't given a single update about my work with the students. Whoops.  For about 7 weeks now, I've gotten to work with students in the clinical setting in addition to working as a nurse. I love working and teaching in that setting, and I love the students. They are so smart and have such great hearts for nursing and their patients. It's been encouraging for me, and I've learned a lot from them. Also, it really helps my French. Please pray because there are seeds that have been sown and tended and watered and are growing. These students are part of the future of the hospital, and they have so much potential.

6. I love and miss y'all. Have a Merry Christmas!

Because they haven't heard,

Caroline

Day in the Life: HoH Edition

Heya Peeps!

As a new nurse a few years ago, I wrote some blog posts about a night in the life and a day in the life of my job. I'd go find them for you, but I got up at 5:30 to run a Turkey Trot this morning and already used up all of my overachieving energy for the day.

However, working as a nurse in Togo is maybe just sliiiightly different, so I thought I'd try to give you a taste/glimpse/whiff/feel/drift of what a day looks like for me here at the Hospital of Hope.

6:00am: Alarm goes off. Get dressed, eat breakfast, take my malaria prophylaxis, head out the door.

6:30ish: Drive my moto just over a mile to the hospital while braving the sand dunes that are forming on the road and the 'traffic' consisting of turkeys, mules, goats, school children, and many other motos. Cars are rare and don't cause traffic here.

6:36: Park at the guesthouse and drink a cup of coffee before the day begins.

6:56: Walk over to the hospital, greet everyone, look up which wards I am assigned (could be 1-13 patients), get my med sheets, get report (mostly in Frenglish), start to assess my patients.

That's where the schedule ends and the madness begins. I think at this point it's easier to make some lists to help catalog the day.

Types of patients I could work with on any given day
-Adults
-Adults intensive care
-Pediatrics
-Pediatric intensive care
-Overflow maternity patients
-Neonates
-Post surgical patients
-Patients in REA which is the ER area
-Outpatient injections and infusions

Things I do nearly everyday
-Give meds. This includes mixing most medications and doing all of the dosing calculations myself
-Calculate drip rates
-Measure feeds for some of the babies
-Crush one of a thousand bugs that made its way into the hospital
-Assessments
-Paper charting. I chart 1 main assessment, an update assessment, and anything notable that happens This takes maybe 20 minutes if I have a bunch of patients
-Respond to emergency patients in REA
-Put in my own IVs, give my own neb treatments, respond to codes, restock medications and supplies, clean, do EKGs, or any number of other things that I might have delegated back in the States
-Take a real 2 hour long break to eat lunch and rest and have energy to finish the day without having to carry a phone on me or eat on the unit
-Make a fool of myself mispronouncing French words and trying to act out various bodily functions or procedures
-Wash med cups so that we can reuse them
-Search around for equipment I need that is currently working
-Sweat
-Learn or experience something new

Notable things I DON'T do every day
-Tons of charting
-Take people to the bathroom. Families do this 95% of the time.
-Fetch water/coffee/snacks. Families are responsible for this.
-Answer half a million phone calls
-Ask dozens of questions to admit someone. A lot of patients don't even know their birthday, so most of the admission questions I'd ask would be kinda pointless.
-Do a lot of discharge teaching. I'm bummed by this cause I love teaching patients, and I am very limited by language and health literacy.
-Have everything double checked by a computer and scan everything to double/triple check the identity of a patient
-Answer call lights. I do however answer to family members who come and get my attention.

Common illnesses/issues
-Malaria. Often accompanied by seizures, severe anemia, and/or hypoglycemia
-Snakebites
-Fractures and injuries from accidents
-Meningitis
-Typhoid fever
-Respiratory distress from pneumonia or tuberculosis
-Premature infants
-Hernia repairs
-Cancers

Things that make my day
-All the siblings/children who hang out in the wards and stare at me but then smile when they learn how to fist bump. I also love the moms and grandmas who are so amused by the interaction.
-The way family members care for their loved one but will also step in to help someone else in the ward. They'll empty the bedpan or share food or help translate for someone they've never met.
-Getting an IV on a baby. Actually just getting IVs in general.
-Saying something in French and having the person actually understand it.
-Listening to the doctors or chaplains pray with patients.
-Seeing a child turn the corner, wake up, and start to eat and interact with you.

7-7:30pm: Give report. Say a prayer of thankfulness for getting through the day. Head home. Raid the fridge.

That's about all I got for now. Thanks for reading!
Prayer Requests:
1. Pray for the students I get to work with in clinicals.
2. Pray for the many wonderful ministries going on here. It's exciting.
3. Pray for my relationships with my Togolese neighbors.

Praises:
1-10,000. Where to start? Let's just say everything.

Peace out,
-C-

Every Tongue

Before I came to Togo, I tried to learn a little bit of French. I diligently spent 10 minutes a day on Duolingo and spent some time reading Harry Potter in French on my Kindle. But it turns out that 10 minutes a day doesn't make you fluent or teach great pronunciation, and knowing the French word for magic wand or cauldron doesn't do you a lot of good in Togo....  It would have been so helpful to go to a language school and take some intensive courses, but it cost a lot, and the timing didn't really work out with my time table.

Since I've been here, I've picked up more and more, but still can only track 30-60% of a conversation and can speak much less. Turns out, there are many people who come through the hospital who don't speak French at all. They come from remote villages or even other countries in order to get better care. Even if I were a fluent French speaker, I wouldn't be able to communicate with them. You have to find a hospital employee who speaks that language (or in some cases, two people to do a four way translation), and hope that at least a portion of your message gets across.

Something else I've discovered is that gestures are not universal. Not everyone rocks a baby like I do. Not everyone physically expresses pain, so acting out pain doesn't always translate. Drinking from a cup is something I take for granted, but might be a foreign concept to someone from a remote village. Even things like telling time or counting seem like simple concepts but can still cause more confusion than clarity.

To further complicate things, there may be next to nothing in terms of health literacy.  I've heard doctors have to explain that if a person is not breathing, it means they have died. There's a big misconception that malaria is caused from too much sun because the person may feel hot (with fever). Teaching patients sometimes feels futile.

If you can't tell, language is a huge barrier to communication. It can be so frustrating- especially in an urgent situation where there isn't time to figure out the proper communication. If I can't even tell someone that they are going to have surgery in an hour, how can I possibly have a meaningful conversation? How can there be any sort of relationship?

Some of the best and most relational things in life transcend language.

Celebrating a good save in volleyball doesn't require words. Turns out that even trash talking can cross that barrier. Team bonding occurs even if you can't pronounce the names of your teammates.

No one gets confused if you admire their baby. Cuddling and cooing over tiny fingers and toes is something everyone understands.

Everyone laughs.

This morning, my roommate invited some of our Togolese neighbors over for a late breakfast. We sat on the floor for our meal. We drank coffee with ridiculous amounts of sugar and ate breakfast sandwiches made from bread that was baked this morning. One of them started playing music, and we got up and danced. We ate and we laughed and we communicated both our words and our actions.

So. I'm going to keep studying French. I'm going to keep attempting to communicate and educate as much as I can. I'm going to figure out alternative gestures. I'm not giving up.

But even more so, I am going to play games and cuddle babies and laugh and open my home and eat with my neighbors and sing and dance and love these people whenever I can. I have 6-7 more months here. There are so many more things connecting us than barriers separating us. My relationships are not dependent on my fluency in French.

And then, when I come home and can relax into my own culture and language, I'm not going to change a thing.

"God exalted him to the highest place
    and gave him the name that is above every name,
 that at the name of Jesus every knee should bow,
    in heaven and on earth and under the earth,
 and every tongue acknowledge that Jesus Christ is Lord,
    to the glory of God the Father."

Philippians 2: 9-11

Moments: Episode 7

"Storytellers, by the very act of telling, communicate a radical learning that changes lives and the world: telling stories is a universally accessible means through which people make meaning."

Chris Cavanaugh

I've been told that it's a trait of my generation to connect and communicate by telling stories. I'm not an expert, but I know that it's true for me.

It's been almost 3 years since my last Moments post. If you haven't been following the blog for long, I find it easier to share a moments than to tell a story.  (See here or here for a couple previous Moments posts). Since I've been here for nearly 2 months, it felt like a good time for another one. Here we go.

-I look up from the desk and see the kids sitting on the bench. I don't know a thing about them except that they are cute. I smile at them, and they hide their face in mama's skirt. I start to walk towards them, and they do a little half laugh/half shriek. I hide behind the counter and play peek-a-boo. They don't know whether to play with me or to be scared of me. The mamas are laughing. I slowly work my way closer and eventually end up squatting next to the bench. The little one toddles over and falls onto my knees. He tangles his fingers into my hair and pulls. Hard. Then he reaches up and grabs my nose with tiny, grimy hands. Mama pushes the bigger one over, and she reluctantly lets me teach her how to give a fist bump. They find my phone and are fascinated when I turn the camera around to show them their own faces. I get 2 little hugs as I stand up to leave.

-After 3 years of disuse, I am expected to put in IVs again and had to relearn that skill. After a few speedbumps, there was a day when I got 4 on the first try-including 2 kids.

-I use the full extent of my broken French and get a blank glassy stare from the mom in return. I do some creative miming to communicate that the kid still needs the feeding tube, but this time only get a little shake of the head. I do some intense pointing with exaggerated facial expressions, and this time I get some pointing in return. Only now I have no idea what she means. Finally, a woman across the room sighs exasperatedly and starts quickly and loudly speaking in a language I don't understand. The mom turns back to me and nods. I thank the other woman in French, and she responds. It took a long time, but we found a (not very private) way to understand each other.

-I'm sure this happens everywhere, but kids do not want to take their medicine. One of a few common solutions is that the parents take their kids, lie them down, hold their arms, and pinch their nose while I empty the syringe into the back of their mouth and pinch their cheeks shut so they can't spit it out (sometimes they still manage it). I feel like a jerk and a villain, but if it's a decision between being a villain or having the kid die of malaria, I'll choose being a villain any day.

-The doctor rounds on his patients, changes dressings, writes orders, and then prays out loud with each of his patients every morning.

-Families staying in the same ward share food, get each other water, translate for each other, and sometimes share babies. It gets harder to decipher who belongs to who...

-It's an emergency, and everyone is rushing around in a frenzy around him, but the nurse takes a few seconds to bow his head and pray over the tiny arm he holds in his hand. Then he gets the IV that no one else could.

-The nurse brings in a coloring book and crayons into the pediatric ward. The kids have to be taught how to color, but once they get it, they sit all together and are busy for hours coloring every inch of the page. They are so proud and show off their creations.

-We perform CPR on yet another baby who doesn't make it while mama holds the twin.

-A group of 4 men come in to get tetanus injections. I get all of the shots ready and then perform an efficient tetanus assembly line as one gets a shot, stands up, and the others scoot down the bench for their turn.

-The little girl who had lain still for days, barely breathing, plagued by seizures, with fevers of 104 sat up in bed. Her mama fed her a little bit of food, and she smiled at me.

-Countless conversations occur where pronunciation is overlooked, each word is said individually, verb tenses are misused, pointing is essential, kind corrections are given, misunderstanding is overcome, and communication is achieved by caring about the other person more than clarity. 

That's all for today folks. I love ya. Miss ya. Send me a message sometime. I love hearing from you peeps back home.

Teaching and Learning

Hello to all of my biggest supporters and cheerleaders! The fact that you’re reading this means that you’ve taken time out of your day to listen to me monologue. I appreciate that. Thanks for praying and for checking up on me and caring.

So I finished up teaching the oncology course last Friday. The week went by so quickly, and I can’t believe it’s already over. Overall, it was so good! I’m going to tell you a bit about it.

In the south, there are 16 students, and all of them are believers. It’s split about 50/50 men and women. They sing together every morning. (For comparison, in the north, there are 15 students and only 1 or 2 women. Most of them are not believers). These students are bright. They really want to learn and put forth a lot of effort.

In the States, nursing students go through nursing school and then search for a job. Once they’re hired, they get a couple of months of on-the-job training. Here, this is all of the training. They come out of school ready to go. This implies that I gave them education and material that I didn’t get until I was working on the oncology floor. Going from the basics of cancer to administering chemotherapy in 4 days is a lot, but they handled it like champs.

The class schedule started at 8 with devotions, then I taught for a while, then we took a little break, then I taught until lunch. Lunch lasted for 2 hours (normally a siesta time), and then teaching again until 4ish. It was quite a schedule. One of the things I was most nervous about was how much material I would get through and if it was enough or too much. I had a couple moments of panic when I made it through my major first powerpoint in an hour and a half when I planned on it lasting 3 hours. During the break, I came up with some exercises and questions, and that was a good to determine if they were understanding anything of what I was saying. That’s the first major thing I learned: how to adjust on the fly. Some things took much longer than I thought, while others went way too quickly.

Possibly the hardest thing for me to learn has been how to ask good questions. The school system in Togo pushes for memorization, so the students were so quick to pick up on facts. However, it’s a lot harder to ask questions that really test comprehension. In addition, writing quiz or test questions is a skill that I completely underestimated.

How hard can it be to write a multiple choice question? (select all that apply)
a. hard
b. harder than you expected
c. very hard
d. all of the above

Answer: d. all of the above

I am really bad at coming up with wrong answers. I am not good at making my questions clear. I have a hard time turning a concept into a question. In my free time, I need to take up a course in question writing because that is a major deficiency.

Another difficulty was explaining the same concept in a different way (complicated by translating it into another language). I’ve precepted and taught enough in other situations that I do have some experience with this. It can take some time, and I honestly felt like I was caught in quicksand a few times, but when they give you a little nod and lean back in their chair cause they get it now, that’s a very rewarding feeling.

A big lesson was that I am terrible at correction. If I could find a way to acknowledge a wrong answer without ever telling them that they’re just plain wrong, I would be very happy. I’m sure this is something you can gain over time, but I am terribly guilty of trying to twist a wrong answer into a right one. I’m still on the learning curve.

I love teaching. I loved developing rapport with the students, and I will continue to pray for them as they finish school this spring and start their careers. They are amazing. On the first day, I tried making a few funny remarks and got blank stares in return. As the week went on, it got more comfortable and they’d actually laugh a little (not too much though- I’m not actually that funny).

Lastly, I just want to acknowledge how incredible this opportunity was. The nursing school director has never seen me teach (mostly cause I never have in this setting), and she took a chance on me. (I sincerely hope she isn’t regretting that decision) She gave me some great advice- especially on the first day when I was struggling. I got to develop my own materials, and it was translated for me into French. It was a big leap for me, but I gained so much. I hope the students gained something too.

Heading back up to Mango tomorrow! I’ll be there for the next 7ish months as far as I know. I’m looking forward to being back. Even though it’s hot.

Have a great day!
Because they haven’t heard,

Caroline

Bless the Rains Down in Africa

Have you ever experienced a rainstorm in Togo?

Let me paint you a picture.

The sun is out, and it is blisteringly (not sure if that's a word, but it is now) hot. Your entire body is glistening with a thin layer of sweat. And that's when you're not doing anything strenuous. As soon as you start to exert yourself, the glistening becomes sticky. Clothes and hair stick to you, and you automatically try to avoid touching anything that could make you hotter. The fans going at full power don't really help bring you cool air, but at least the air is moving.

You look out the window and see a cloud in the distance. After only a couple weeks in Togo, you can guess how long it'll take to reach you. Maybe you have some time to finish your errands or maybe you should hurry home a little early to avoid being caught in the rain.

Soon you will notice a change in the wind. Trash starts to fly down the street. If you happen to be on your bike, you need to take care to make sure your skirt doesn't fly up (definitely not speaking from experience...) If you're sitting inside, papers that have been sitting still all day suddenly flap and then fall to the floor. The temperature drops at least 10 degrees in a matter of minutes.

Even when you're in your house, you are much more exposed to the elements than in the States. The windows are open 99% of the time to keep the air moving. While there are screens on the windows, you still feel the changes outside.

Then the rain comes. Sometimes it starts lightly, but more often it comes pouring down all at once. Many of the roofs are made of tin and the sound of the rain through the open windows and on the roof is incredibly loud. You have to yell in order to be heard across the room. People who are responsible (i.e. not me) unplug their devices to avoid a power surge.  If there is thunder, it means business. People don't usually keep dogs as pets here, but these are the kind of storms that would make your Spot or Fido freak out.  I had to traverse through a rain storm in order to get dinner one evening (food is a priority people!). I had a rain jacket on, but I still came in soaked through and dripping water off of my nose.

Then it stops. Often as suddenly as it started. The sun comes back, and the air smells fresh. It is cool for a few more blissful hours until the heat creeps back in.

The rains are getting more and more spaced out. They'll stop pretty soon, and it might not rain for another 4-6 months. Everything green is going to turn to brown, and I am told it's only going to get hotter. I'm going to miss the rain.

This is the part where I talk about something I've learned or that is meaningful. I spent a good 10 minutes trying to think of a nice analogy that would tie in experiencing a rainstorm to something profound. I got nothing. The only thing that came to mind was that catchy song called Africa by Toto. Hence the title of this post. There's also a lovely song called Healing Rain by Michael W. Smith, but I have to admit that I don't really know what the lyrics mean....

Anyway. I like rain storms here.

In the next order of business, I am halfway through teaching the oncology course! Here are the halfway takeaways: 1. I am probably learning more than the students are. 2. Teaching is a whole new level of exhausting. 3. Do not say something if you're not prepared to answer the question, 'why?'. 4. I am so blessed to have this opportunity.

I'll update you more on the class soon, but I just spent all of my writing energy talking about rain... Hope you have a good day!

Because they haven't heard,
-C-

A Real Update

Bonjour! I’m writing from the nursing instructor office back in Tsiko! I realized a couple days ago that I haven’t given many of you a very good picture of what is going on or what I’m doing or what life is like…. My bad. It’s the same with my family- I think I’ve told a story or explained something, but I actually only told one person.  I could start writing and just keep writing and never stop writing about everything that is going on, but I’ll try to make this so you can have a clear picture of my life but also read it in the 5-10 minutes before you have to go do your next thing.

So. Where in the world is Caroline SanDiego?

For most of the 8 months that I am here, I will be spending my time in Mango. Mango is a town of anywhere to 10,000-40,000 people in the northern part of Togo. (that number fluctuates because the size of house does not account for the number of people living in it… there are huts with 8-10 people, so it is difficult to count.) The Hospital of Hope or Hopital de l’Esperance is just outside of town. The hospital is in the front of a large compound. Behind the hospital are many buildings that include the guesthouse, missionary houses, the pool, maintenance, the missionary kid school, etc.

 I live a mile away from the hospital right on the edge of town. I live in a house called Maybury with 2 other nurses, and there should be another roomie arriving very soon. My house is very nice with a kitchen, a fully functioning bathroom, and my own bedroom. Last year, a doctor took pity on the nurses trying to sleep after a night shift in the 115 degree heat. He did a fundraiser and was able to install an air conditioning unit in one of the rooms. We call it the AC room (very original), and any short term nurse is welcome to use it. Apparently 90 degree days aren’t even considered hot, so I am truly grateful for that option. There is a guard in our yard 24/7, and I feel very safe even though I live in town.

Last Saturday, I headed back down to the southern hospital in Tsiko. I am teaching a weeklong course in oncology at the nursing school down here next week. This week, I am doing a lot of preparation and studying. In order to make the most efficient use of my time, the nursing school is not doing clinicals the week that I am teaching. This means that I will have 4 full days of class to teach everything I can about oncology. While there are breaks during the day, they are still 8-9 hour days. Also, everything I say will be translated into French. While I am comprehending more and more French, I have a very hard time forming real sentences. Also, I’ve never taught a course like this before.  Yay for breaking out of comfort zones!

When I head back up to Mango, I will be working two 12 hour shifts per week. I will also be doing at least 2 days of clinical shifts in the hospital with the nursing students. They are in their final year of school.  I have the privilege of working with these students very closely as they continue to learn nursing skills, critical thinking, and take care of a full patient load. Towards the end of October, I will be teaching the same oncology course up in Mango to the students up there. I’ve been told that once I finish, there is a large list of projects that have been put off for a while. Hopefully, I’ll have the opportunity to tackle some of those.

Working in the hospital is so very different from the States. Because labs and tests are expensive, we rely a lot more on physical assessments. There is only an ultrasound and xray machine. No CT or MRI.  I get assigned a ward or two or three and take whatever patients are in there. One day, I started the day with no patients! An average is 5-7, but I’ve had up to 9. There are a lot of pediatric patients, so even the adult wards will have children in them. My first day on my own, I had two women who had delivered babies that day as well as their newborns! I was looking up newborn and maternal assessments during my lunch break because I have never taken care of that population before. One huge difference is that the patient’s families do so much of the work for the patient. They are responsible for feeding them, cleaning them, and taking them to the bathroom. I couldn’t imagine it being like this back home… it would change nursing drastically!

The Togolese nurses we work with are wonderful and so smart and helpful. One thing that surprised me is that many of our patients speak absolutely no French. There are many tribal languages, and I think that all of them are spoken by someone on the staff. There have been times where I greet a patient in French and they respond appropriately. I assume they actually speak French. Then, I try to use broken French and gestures to communicate something, and I get the idea that they are not comprehending anything I say. After a while, I discovered that they don’t really speak French either, and gestures are not a universal thing. This makes communicating and teaching very tricky.

The patients we see often come in very sick. They wait too long or it takes too long to get to the hospital. This means that something simple becomes something complicated or impossible to treat. I arrived in the middle of malaria season. It is a devastating disease, and I have seen far too many children die. Anemia is a complication of malaria… I worked oncology back home, so I thought I had seen a lot of anemia. I have seen hemoglobins of 3 multiple times here. Hematocrits of 6. I didn’t even know your body could function with it that low…

I bought a moto! It’s basically a glorified mo-ped, but it’s purple and pretty  and I love it. It took me a bit to figure out the whole shifting gears thing, but I got it now J. I also can get around on my bike. It’s not a mountain bike by any means…it’s the kind you’d ride around Mackinac Island with a basket and a bell, but it does its’ job.

Before I came, I thought I would lose a lot of weight because of the limited food options…. That is not true. Whenever I don’t have food or don’t feel like cooking or packing a lunch, I have the option of eating in the guesthouse which provides delicious food. It’s food I’d get back at home with just slightly more limited options (no berries in Togo). It’s delicious. Also, there’s a wonderful woman that comes to my house once a week and cooks different dishes for me and my roommates. She makes some mean chicken pot pie. I’ve started getting braver in the kitchen and actually used the oven last week! It doesn’t have numbers on it… you literally light the fire in the oven, stick something in there, and then you wait and hope it doesn’t burn… So far I haven’t burned anything! If you know me and my cooking history (cooking a pizza upside-down), that’s actually pretty impressive.

It’s hot. It’s ridiculously hot. I keep saying it’s hot, and the people who have been here a long time tell me it’s not even close to hot yet… I might sweat all of the salt out of my body.

I am getting more comfortable interacting with the Togolese. I can manage to get out the normal greetings and can understand more and more French. I am slowly making friends with some of the women who live close to me. Market is still a little overwhelming, but I am getting better.

There isn’t a movie theater, a mall, a gym, or much else nearby, but I am so impressed with what people come up with to do. Between sports on Sunday afternoons, Bible studies on Thursdays, waffle breakfast on Saturday mornings, movie nights, and many more activities, the social butterfly in me is quite satisfied.

I am making more friends. I am getting more and more comfortable. I helped deliver a baby. I am having great devotional times. I am learning and growing. I am still being stretched.

Thank you for all of your prayers. Thank you for asking about me. Thanks for making it to the end of this post.

Prayer requests:

1. Pray for my class next week. I want to do a good job for the students.

2. Pray for my relationships with the nursing students and the people in my ‘neighborhood’.

3. Pray for the many ministries in Mango and Tsiko. God is at work. And when God is at work, the devil finds ways to attack.

Praises: 

1. I felt a little sad when I left Mango to come down to Tsiko. I think that is a good sign that I am settling in! 

2. There are wonderful people here who have been so nice and encouraging. Making new friends is hard, but they are making it easier.

3. Internet and AC are conveniences they didn't always have here. Hallelujah for modern conveniences! 

4. So many more, but this post is too long already and you are probably skimming at this point cause you got to go to work or something.  

I love ya and miss ya. 

-C-

Clever thousand words cliche

So. It's getting late here. I'm really tired today, but it's time for a blog post. I'm going to post most of the pictures on my phone and explain what they are and why I took them. Please be advised that I'm terrible at documenting things in real time. I don't even think of getting a picture until someone else gets their camera out. Most of the time I am lucky to get by without making a fool of myself... I don't have pictures of a lot of important things, but this might just give you a little glimpse.....



A picture of the grocery store in Lome. This is as American as it gets. Seeing this while being slightly jetlagged and overwhelmed was oddly comforting. We don't have stores like this in Mango. There's an open market and 'boutiques'. These boutiques are made of one small room with three walls. I'll take more pictures sometime.



A termite mound. These are very common- especially in the South.


 
A dragonfly. In retrospect, this isn't that exciting, but I took this in the first few days. There are so many huge bugs here. Moths and dragonflies and flies that don't just buzz around you but decide to kamikaze into your face. Or mosquitoes that have a numbing agent along with their bite so you don't feel them. Or the ants that decide to have a parade around your house every night. Or cockroaches the size of that perfect skipping rock. Ew.



This is from the wedding I got to attend. It was totally different and truly beautiful. This is a picture of all the pastors from the area gathering around the couple and praying for them. I promise I don't normally take pictures while people are praying.



A view from the drive on the way up to Mango.
It's green, so you know it is rainy season. This will look very different later in the year.



I made a friend. Actually, that is false. He tolerated me.



This is a baobab tree. It isn't a very good picture, but it was HUUUGE!!!The trunk was so thick... if it was hollow, I could live in it.



Me. In a custom tunic. At the nurses station.



Our omnicell/med cabinet.



Nurse central. It's in the middle of all of the wards, so all of the nurses use this for nearly everything. The colorful notebooks on the counter contain our med sheets. There are chairs around the outside and drawers with miscellaneous medical equipment.



This is Rea or basically the ER/post operative area. It can get pretty busy right there.



The current short term nurses enjoying brownies together. They're wonderful. They're teaching me how to adjust, how to love more, and how to share better. A couple of them are leaving soon, and I will miss them even though I've only known them for a short period of time. Two of these girls are my roommates, and they have been so awesome and welcoming to me. I'm grateful for this group.



This might be my favorite picture on my camera roll. I sport this flattering style nearly every day in the hospital. From the long skirt, to the socks with sandals fiasco, to the filthy shoes that squeak when I walk.... You can tell that I am definitely aiming for comfort over anything remotely resembling a fashion statement.

That's all folks! I'll try to take more pictures. I've been here a month already!!!
Miss ya.
-C-

Convenience

An adventure is only an inconvenience rightly considered. An inconvenience is only an adventure wrongly considered. - Gilbert K. Chesterton

Hey! While I really miss all of y’all, it feels like I’m settling in here and am doing really well! I think it’s amazing how quickly new habits can form and foreign things start to feel familiar. I’m not saying I could pull this off without the help of the 60 other missionaries or that I’m good at it by any means, but getting through a day in Togo is definitely in my wheelhouse.

So I’ve been here for about 3 weeks. That means that I still have very clear memories of what I was used to in the States. When I’m talking to my friends, a lot of our discussion is how much things are different here. DIFFERENT is the key word. Not better or worse. Different. Admittedly, a lot of things are much less convenient.  From the standpoint of living in the States, here is a list of some inconveniences or things I gave up to come here.

-The power goes off in my house frequently. Sometimes for 15 minutes, but sometimes it is for hours at a time.

-There is only one room in my house that has air conditioning. The hospital has no air conditioning.

-I have to use bottled water to brush my teeth cause the water in our house needs to be filtered before ingesting.

-All of the produce that we buy needs to be soaked in bleach water before eating.

-The produce options are basically limited to what can grow here. No berries.

-There are bugs everywhere, and I need to sleep under a mosquito net.

-I have to wear full length skirts everywhere.

-I don’t know the language.

-The hospital has limited resources and 1^st world healthcare is very far away.

-I gave up my nice job with good pay and hours.

-I left behind everything except for 71 pounds of luggage to last for 8 months.

Those are facts of my life, but here is another list of facts that carry more truth:

-I have power in my house. It’s a nice house. There is internet. I have my own room. The kitchen is stocked.  The toilet flushes. There is hot water for showers. In this town, that is rare. Even among the missionaries who live off compound, our internet has a better connection and is more reliable.

-I have access to air conditioning. And fans. If I had come last year, there wouldn’t have been air conditioning. There’s also a wonderful pool on the compound that is the absolute best on a hot day.

-I have access to a water filter. The water on the compound is all safe. If worse comes to worse, I can afford to buy bottled water. A new well was opened last Friday in a village not too far away. Some of the other nurses were there at the time and got to see a huge crowd of people come and celebrate a new water source. They were lining up for water and singing because they didn’t have to walk as far to get safe water.

-I can afford produce. I have a freezer and refrigerator to keep my food safe. If I don’t want to cook, I can eat a balanced meal at the Guesthouse any day of the week.

-I have so many options for food. People bring things from home. There’s a store 2 hours away that sells many American items. We have a garden that is growing green beans and tomatoes. I had a fresh butternut squash today. I tried a fresh guava for the first time and can’t wait for mango season.

-I have a mosquito net. And bugspray. I can’t speak for the general public, but there are patients and families who sleep on the ground outside the hospital and on the hospital floors on a simple mat with no bug protection.

-I have more than one skirt. And a washer. Also, the skirt thing is to be appropriate within the culture. However, even though I am a woman, I can speak with men, play sports, and have a job that is very respected.

-Why don’t I know more languages? I’m working on it. I can understand and read much more than I can currently communicate.

-I live a mile away from the best healthcare in the area. And if necessary, I have the means to get the necessary treatment.

-When I go home, I have a degree and enough experience that I am not worried about finding employment that will provide more than enough.

-I own more than I could ever need.

So yeah. That’s it for today. Love y’all!

-C-

New Depths

Two tiny girls lay there, nearly comatose, the first day I walked through the hospital. Yesterday, one of them got off oxygen and took out her IV and feeding tube. She got to eat for the first time and was sitting up and smiling at her mama. The other one didn't make it.

The sound of weeping and of crying
will be heard in it no more.
"Never again will thee be in it an infant 
who lives but  few days,
or an old man who does not live out his years;
the one who dies at a hundred
    will be thought a mere child"

Isaiah 65:19b-20a

I missed Tabaski by about a week. It is an Islamic holy day remembering Abraham's willingness to sacrifice Isaac. It is commemorated by killing animals and there are streams of blood that flow down the streets.
Every day I hear the call to prayer from the mosques.

All day long I have held out my hands
    to an obstinate people,
who walk in ways not good,
    pursuing their own imaginations—
 a people who continually provoke me
    to my very face,
offering sacrifices in gardens
    and burning incense on altars of brick

Isaiah 65:2-3

The chaplains pray in languages I don't understand. Jesus and Peter and John speak French on the videos playing in the different wards. I watch as another nurse teaches children how to color for the first time. One missionary hasn't had time to get ready for her trip to the States because people keep coming to her and asking for help. She gives them food and clothes and prays for all of them. On Wednesdays, the chaplains go to villages and spread the Gospel to people hearing it for the first time. The Christian radio station has its' grand opening next month and so many more Togolese will have a chance to hear the Good News. The maintenance crew meets together every morning before work and nonbelievers are mentored and discipled every day. People come to know Christ on a regular basis.

The Lord has anointed me to preach good news to the poor.

 He has sent me to bind up the brokenhearted, 

to proclaim freedom for the captives, 

and release from darkness the prisoners

Isaiah 61:1

I fell a few days behind on my Bible reading plan, so today I got all caught up. I ended up reading the last 6 chapters of Isaiah. I gotta say, it struck me in an entirely new way. The language used in Isaiah seemed more alive and applicable. It was much more powerful to me than ever before.  I was hoping to find a verse about bugs or critters because  roaches and elephant beetles and mice and spiders and mosquitoes and termites and ants and frogs and geckos and praying mantises and grasshoppers and snakes are much more alive and applicable in Togo than in the States. Oh well. 

I've been here for two weeks. 1/16 of my time here. So much has happened and there has been so much to get used to. It feels like an odd time warp when talking to people back home. As you can imagine, living in a third world country is different. However, God is still the same and is still at work. There are so many lives being changed and influenced. It's a privilege to be here and witness it. Even though I do miss the privilege of air conditioning and grocery stores. 

"And I, because of what they have planned and done,

am about to come and gather the people

of all nations and languages, 

and they will come and see my glory."

Isaiah 66:18

Specific prayer ideas if you're the praying type: 

-Preparation for my class is coming along, but I still have a ways to go

-Pray for me developing relationships in order to encourage others but also for myself

-Pray for the many ministries around Mango

-Health and safety

Praises:

Basically everything so far. I'm here and doing well. People are very kind to me and the Togolese are very patient with my poor French. I got to blow bubbles with a little boy. I'm being stretched but not beyond what I can handle so far. And God is good.

Love you all! 

-C-