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

Because the Lord heard...

What makes a good story? 

The Hook: A dead, premature baby was rushed into the hospital but was miraculously brought back to life.

The Context:  Despite a grim outlook, she not only survived, but seemed to thrive. Her mother was mentally unable to care for her and, in a situation that is rare in Togo, she had no family that was able to care for her. Read the beginning of Baby Leah's story here:  https://lettucetomatoandmayo.blogspot.com/2021/10/and-when-lord-saw.html. 

The Challenge: Help Baby Leah grow, stay healthy, and find a family.

The Conflict: After copious prayer and a leap of faith, an amazing Christian family from Lomé agreed to start the adoption process. The adoptive mother came to meet with government officials and take Leah home, but the meeting did not go well, and she was sent back home without Leah. Missionary families fostered Leah with abundant, selfless love, but we all prayed that she would soon join her forever family. 

The Resolution: On December 8th, the judge approved the adoption of Leah, and she was sent home with her legal, loving family and multiple bags filled with diapers, formula, and clothes. Tipping the scales at just over 8 pounds (4 times her birth weight!), she doesn't yet understand the weight of what God has done through her. 

Adoption day <3

I hope that someday Leah gets to hear her story. How hard we worked to save her life. How far she came from that first night when she fit in the top of my tunic. How we decided what we would call her. How an entire town somehow knew her story and cared. How complete strangers would ask me how the little baby was doing and if she had found a family. How despite the possible social stigma of having a mentally ill mother, multiple Togolese families were willing to step up and adopt her if things didn't work out with the family from Lomé.  How she went on a goodbye tour on the day before her adoption to be hugged and kissed and adored by all of people who had grown to love her. How much she was prayed for. How through the testimony of her adoptive family, other Christians were more willing to step out in faith and how her story may continue to have an impact in the life of another baby who needs a home. How her adoption portrays the heart of the Gospel and how God has adopted us as His sons and daughters. How her story renewed hope in me during a really hard season and how that continues to influence my attitudes in the hospital. And finally, how we've seen God at work. He cares for orphans and provided Leah with not just a family, but an entire community that loves her. And that's just an amazing story. 

She (Leah) said, "Because the Lord heard that I am not loved, He gave me this one too".  

Genesis 29:33. 

Fit to Burst

Currently, life is like my favorite tunic- which is currently with my seamstress being repaired- again. Every couple of months, I have to take it back because another seam has ripped. This time, I split a seam in the armpit while playing ping pong. Last time, it was the slit at the bottom that tore while getting on my moto. Before that, it was my pocket seam from the weight of all my supplies while working at the hospital. Life in Togo is not for the fragile of cloth nor for the fragile of heart. God's placed me where I'm being used often, in different directions, and to the point of bursting at each seam. 

My time, energy, and brain power are all split in between teaching 19 enthusiastic nursing students, working at the hospital, scheduling the nurses and nursing aides, grading piles of tests and papers, tracking cancer patients, coordinating and recruiting short-term nurses, repairing or replacing hospital equipment, doing my own homework, preparing Bible studies and ukulele lessons, leading youth group, and spending time with my friends, and man, I love it all. 

Honestly, there have been times in recent weeks when I feel like I'm about to bust a seam. I've felt overwhelmed and exhausted and frustrated and like I just can't. And I'm right- I can't. I can fill my calendar down to the hour with lots of meaningful things, but it's all meaningless unless I remember Who it's all for. As I overestimate the number of hours in the day, I aspire to be Wonder Woman, say yes to everyone and everything, and do it all well without breaking a sweat (ha. haha. hahahahahahaha. I live in Togo...). But I'm not. Below are some lyrics to a song that I've been listening to a lot recently. 

Oh, to be empty and lowly
Meek and unnoticed and unknown
And to God, a vessel Holy
Filled with Christ, and Christ alone

How great is God?
His grandeur endless
How frail I come before His throne
I am lost in love relentless
That Christ be all, and I his own

May Christ be all, and I be nothing
His glory shines in the vessels weak
May Christ be all, and I be nothing
This is my hope
Not I, but Christ in me

-May Christ Be All by Grace Worship

These lyrics have helped remind me that I am here simply to serve Jesus- though I bring so little to the table. Whether that's in Togo or wherever else He leads. Whether it's by accomplishing lots of tasks that seem important or by washing the dishes. Whether I'm frazzled or bored (I can't seem to find a happy medium). Whether I spend time among others or spend time alone with Him, may Christ be all, and I be nothing.

First week of nursing clinicals

Still cancer free!

Prayer requests:

-Please pray for short nurses who can come out from February-April. We are anticipating a critical shortage and desperately need volunteer nurses

-Please pray that the busyness and pace of the hospital doesn't get in the way of sharing the Gospel with our patients and their families

-Please pray for the nursing faculty as we make decisions this week for the upcoming trimester

- Please pray that my team can spread the hope of the Word of God despite language and cultural barriers

Praises:

-After having to jump several hurdles, we believe that Baby Leah will get to join her forever family next week! 

-God has answered specific prayers by providing short termers who have filled critical staffing gaps

-Two of my cancer patients are still cancer free and are doing well!

Thank you all.

Because they haven't heard,

-C

And when the Lord saw...

    In my last post I shared about a day where we saw four children die. Earlier this week, 6 people passed away in a single shift. It is impossible not to be affected by this brokenness- and this manifests itself in a myriad of conflicting, constantly changing ways. My faith solidifies while my heart aches while my hope wavers while my comradery deepens while cynicism creeps in while I'm being emptied out while I'm filled only by Him. 

But in the midst of all this mess, the Lord allowed us to witness a miracle. 

    The door slammed and a woman rushed into the hospital carrying a bundle of African cloth. We rushed her to the ER area. I unfolded the cloth and saw a freshly born, cold, lifeless, premature baby. We started CPR, but in the darkest part of my heart, I was cynical. We see this too often with too many poor results. I thought it was pointless and wondered why we should even try. 

    After a little while, we got a heart rate back and she started breathing. With a lot of trepidation, we moved her into my ward. She was alive for the moment, but would it last? With an obviously traumatic birth, what brain damage had been done? At the end of the day, I just could not get her to warm up, and our incubator wasn't working well. No one was there with her, so with much awkward maneuvering of breathing tubes, IV lines, and monitor cables, I lifted the 3 pound baby and put her in the top of my tunic to try skin to skin care. We sat there for a while as I finished my charting. 

     The next day she was still there. And she had purposeful movements.

     The next day she was still there and her oxygen needs were decreasing. We did skin to skin care again as there was still nobody with her at the bedside. 

     The next day, I found out that the woman who had given birth to her was unable to care for her, and she was essentially an orphan. 

     The next day, I was at her bedside with the doctor who had revived her (who also happens to be my roommate), and we talked about how she was a miracle. She was estimated to be around 32 weeks gestation, and had come to us lifeless. This baby had been dead dead, but she was now opening her eyes, moving around, tolerating formula, and weaning off oxygen with no apparent brain damage. We prayed for her together, and my roomie suggested that we give her a name. Off the top of my head, I suggested Leah. It's one of my favorite names. My roommate said, "Yes. Because the Lord saw the Leah of Scripture even when she was unloved, and He cared for her."  

Leah around 5 days old

    The name stuck. And Leah kept doing well. Team members came during their free time to hold her and feed her. As the hospital employees learned about her situation, they started to call her Leah as well. Slowly, she got off oxygen and took feeds on her own. Over time, she started to amass a collection of baby clothes and hats...She even has a pair of tights- which are incredibly impractical but ridiculously cute.

I can't even with the tights...

    

    Fast forward to now. Leah is about 38 weeks and weighs just about 5 pounds. She is the queen of the hospital and boy, does she know it. Her crib sits at the nurses station where she is doted on by nearly every hospital employee. She now believes this is her right, and is incredibly spoiled. Sometimes she disappears for hours on end as the maternity nurses steal her for a couple of hours. It's a common occurrence for someone to chart with one hand and feed her a bottle with the other. An employee bathes her almost every night, and I truly believe she is the most photographed baby in Togo. 

     Here's my favorite part. The Togolese government gave my roommate permission to search for people who would be willing to adopt Leah. A couple weeks ago, a man from a Christian family came to meet Leah and talk to government officials about adoption. I got to be there as he met his future daughter. At the moment, he was a little afraid to hold her because she was so small, but he asked if we could pray for her. Together, we prayed for Leah and thanked the Lord for her life and for the blessing that she has been. Please pray for Leah's adoption process and the potential hurdles that must be jumped before she can go home. 

     I am profoundly thankful for the possibility that Leah will grow up in a Christian family that will love her. I am profoundly thankful for the joy that she has brought me and everyone in the hospital over the last several weeks. I am profoundly grateful that she came along to humble me and teach me a lesson about not losing hope- because God can perform miracles. 

My miracle