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-