Miriam Tillman

Protests in Togo

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Since early September, there have been demonstrations and protests across Togo, demanding that the current president step down for power. President Faure Gnassingbe has already been in office for 12 years, and he became president following the death of his father who had ruled the country for many years, meaning the Gnassingbe family have been in power for 50 years. Protesters want to see the Togolese constitution limit presidents to two terms in office.

In response to the protests, the Togolese authorities have intermittently blocked internet access, seemingly in an effort to hinder protesters from gathering. The scale of recent protests, which the opposition said were attended by hundreds of thousands of people, represented the biggest challenge to Gnassingbe’s rule since the aftermath of his ascension to power in 2005.

Earlier this week the Togolese parliament sought to pass a bill limiting presidents to two terms in office, but it failed to win approval due to a boycott by opposition lawmakers. Though the opposition are hoping for the two term limit, under the terms of the bill, the current president would be eligible for two further five-year terms that could leave him in power until 2030.

The above video which was released on September 7, gives you a clearer picture of the situation. For more information you can see the articles on the situation at Al Jazeera or Reuters

Nationwide protests are planned again for this Wednesday and Thursday starting at 8am (8pm NZ time). Both the pro-presidential group and the opposition party are planning on protesting at the same time. Miriam Tillman’s team at the Hospital of Hope are taking every precaution to keep safe, and there has been no reported danger for expatriates. But please keep them, and the whole country, in your prayers.

Snake-o-clock

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It is the time of year for snakes!

I was off to babysit some friends’ boys for the morning. As I pulled up to their house I was greeted with cries of “Do ya wanna see our snake?” Well I knew they used to have a pet snake but this was a whole different kind… The poisonous kind… Luckily it was already dead, ‘cos that was one long snake and I was glad it had already been given the death blow before I was in charge! But of course once the danger was gone I was happy to pose for a photo as if I was the brave dispatcher.

Last week David, one of my pharmacy technicians was leaving the pharmacy on his way to lunch and saw something slithering across the concrete and went to investigate. In the corner of the stones that surround the garden area was an Echis (the deadly snake that we had trouble getting anti-venom for when the hospital opened). There were a whole row of patients waiting for their medicines outside the Pharmacy only a meter away, totally unaware that this deadly creature had crept up behind them. David poked his head in the Pharmacy window and asked for something to kill a snake and we gave him the only thing that we thought would work, a short square stick of wood that holds the window shut at night. With a few deft blows the snake was mortally wounded and writhing on the ground and David was on his way to lunch again (after I made him bleach the “Snake Killer” stick).

 

Here’s the complete image from above:

21 Days

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A few weeks ago Miriam Tillman shared that the Hospital of Hope was once again facing Lassa Fever season in northern Togo. They were going to remain on high alert until they hadn’t seen any new cases for 21 days. She wrote the following update last Thursday.

We finally reached day 21 but are holding our breath… Lassa Fever is an acute viral haemorrhagic illness that is endemic in many countries around West Africa but was not believed to be in Togo until last year. One of our Missionaries became sick and died from an undiagnosed disease but it was not until a second Missionary got sick that we found out they both had Lassa Fever. Last year these were the only two cases that were discovered in Togo.

In February this year, as I was preparing to return back from furlough in New Zealand, I found out that our hospital was treating a patient with Lassa who had arrived from a neighbouring country. Since then the Hospital of Hope has treated five Lassa Fever patients from Togo and the surrounding countries. We are taking precautions to limit the risk of exposure to our team and medical staff. Until further notice we are limiting our clinic services to follow-up and urgent cases. We are also washing our hands with bleach water when we return from market or visiting and not meeting in large groups (which restricts playing sports and going to church). We will remain on high alert until we have not seen or heard of any new cases for 21 days.

Which brings us to today… day 21… Unfortunately we had a patient die over the weekend who is a potential Lassa Fever patient and so we must wait until the blood test results come back from Lomé tomorrow before we can know if we are at day 2 or 22.

 

Unfortunately the tests confirmed that the patient had Lassa, meaning they were at day 2. Please pray that no further cases will occur so that the hospital can resume it’s normal functioning as soon as possible.

The dog hunt

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A while back I went on an impromptu dog hunt. Don’t worry no dogs were harmed in the making of this update!

I was leaving ‘Waffle Breakfast’ (an important weekly ritual on the social calendar here in Mango which is hosted each week by the Molsee family who live on the hospital compound) when I spotted a dog. Normally the guards manage to stop them from slinking though the entry gates but this one must have been extra sneaky.

In Togo a dog bite can be fatal if it has rabies so we definitely want them as far away from the kids as possible. I turned back to the house to call Ethan Molsee as he always enjoys being called to fight off any predator who has invaded our homes or compound, whether it is a camel spider, snake or dog.

We took off on our motos to hunt down our enemy and herd him off the compound. Of course he didn’t stay on our roads but took to the cornfields and zipped around houses and through bushes to try and avoid us. So we followed and enjoyed off-roading from one end of the compound to the other.

Eventually we trapped him in a corner and then carefully guided him past the guesthouse, through a grove of baby trees and out the main gates. While it wasn’t exactly a form of exercise as we rode our motos, it was definitely a great way to let off some steam at the end of a rough week.

The Visa Saga

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In August my latest three month visa expired and when it was issued I was told that I would not be allowed any more but would have to apply for a Carte de Sejour. This would allow me to stay for another year but involved a lot more paper work, including a Police Report from New Zealand and Togo, opening a Togolese bank account, letters from the Hospital and the mission organisation ABWE and turning up in person in Lomé to be photographed, finger printed, fill out 3 more forms and pay 100 000CFA.

In an effort to cut down the number of days I would have to take off work (and because the Post Bus decided that it would not run on Monday) I decided to take the 10 hour “Night Taxi” down to Lomé one Monday night after work, spend all day on Tuesday in Lomé at the Togolese Embassy and then catch the same “Night Taxi” back on Tuesday night to arrive in time to start work on Wednesday. Well let’s just say I survived the ordeal! But not with the desired outcome as I now need some previously unrequested paperwork to prove that I don’t earn any money in Togo (harder to prove than you would think!). So Pasteur Laurent (our extremely helpful Togolese Pastor who lives in Lomé) asked for a one month visa so that I can stay until I can find this mythical proof.

The Saga continues

I thought I was going to be able to pick up my Carte de Sejour on Monday last week… But a week prior I got told that the paperwork I sent down to Lome three weeks earlier to be processed could actually not be processed at all in Lome but had to be done by me in Kara. So off to Kara I went armed with a Soduku book, snacks and water … I then found out that this wasn’t actually the correct place either – next time I promised to go to Dapaong as required.

As far as I could gather I was trying to find the mythical proof that I did not earn any money in Togo. Apparently this could be proven by going to the Tax place closest to me and applying (with four different forms) for proof that I did not pay any income tax for the last two years. This seemed reasonable at the time … To receive the official paperwork I had to declare where I was living, and since there are no street names or numbers in Mango I had to draw a pretty little map.

Then came the trap. I have to pay what best I can describe as “I live in Togo Tax” which is 30 000CFA per year – which was somehow dependent on how many rooms in my house and whether I had a metal or thatch roof. Then came the second trap. They would not be able to process my “I live in Togo Tax” until my landlord had paid tax on the income he had received from renting the house to us.

To make a long story short, to prove that I do not earn any money in Togo by proving that I DO NOT pay tax, I PAID tax for this year AND last year AND the tax that my landlord owes.

I have until the October 18 to get all my “now completed” paperwork approved before my “extended” one month extension visa expires.

Carnets of hope

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When patients arrive at the Hospital of Hope they buy a small booklet called a “carnet” where our prescribers write lab tests and order medicines for the patient to buy. Throughout each day these carnets end up in the pharmacy. Sometimes in neat little stacks as information is entered into the computer system and sometimes in rows across the bench, stuffed full with medicines that need to be checked before being handed out to the patients.

In the seven months since the Hospital of Hope opened its doors 10 000 of these carnets have been given out to patients. So you can imagine why one of the catch phrases we have in the pharmacy is “Sooooo many carnets!” Apparently it was something I inadvertently said one day, but the technicians now have great pride in informing me of this fact when I return from an errand around the hospital and see 20 carnets neatly lined up waiting for me to check. Somehow I have also ended up with the nickname of “Check Master”?!?

Unfortunately we’re not able to see all the patients that arrive at the hospital gate each day. One day last week we had 600 people more than we could treat. Non-urgent patients are given an appointment for up to two months later. Apparently word is getting out that we are the place to go if you are looking for doctors who accurately diagnose medical conditions and for high quality medicines at a reasonable price (yah for the Pharmacy!). Actually we’ve discovered that the pricing of our medicines may actually be a little too competitive as people are willing to travel past perfectly good medical centres in the capital cities of Togo, Ghana and Burkina Faso just to get a deal from our hospital. We even ran out of the 400 000 paracetamol tablets that we expected to last six months. Fortunately this is a medicine we can buy more of locally to last us until our next order from Holland arrives.

Cyclical Malaria

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No malaria prophylaxis is 100% and now I know that first hand. It all started when my friend Elizabeth and I decided we needed to get out of Mango for the weekend. We didn’t go far – 20 minutes down the road was enough to get away from work schedules and 2am call-outs to the hospital.

In the tiny village of Sadori there’s a Nunnery where guests can stay and where we invented the game of Ultimate Frisbee-Soccer. After a few rounds we decided it really would be a game better played with more than one player on each team: it’s quite difficult to kick a soccer ball and throw a Frisbee to ones-self at the same time!

Then came the dreaded mistake of trying to read peacefully outside. I believe that is when that nasty little malarious mosquito bit me. By the Monday I felt headachy and tired but didn’t think much of it. By Tuesday my joints had started to ache but only sometimes. First it was my knees, then my elbows, then my shoulders, and I felt unwell enough to go to bed at 7:30pm halfway through a movie. On Wednesday I ran 9 miles (somehow I now think in miles). By Thursday night I was so tired and achy I couldn’t leave the house to go to a birthday party. When I turn down the opportunity to eat cake it is a sure sign of illness! On Friday morning I felt way better but when I discovered I had goosebumps on a 40˚C day I knew it was time to take a malaria test even if they had to extract two whole drops of blood! (If I haven’t told you before, I am a pharmacist because tablets don’t bleed.)

After taking my treatment it took two weeks before the waves of exhaustion interspersed with feeling perfectly fine began to fade away. I’m glad I was taking my prophylaxis otherwise it could have been a whole lot worse.

Kɔtɔkari cɛsse

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Here in Northern Togo not everyone speaks the national language French and the major local language of the village we live in is Anufɔ. So while I am continuing to have French lessons each week, I have also been having Anufɔ lessons and have found that there are a few phrases in the pharmacy that I get to use multiple times every day. While the phrase “Entana biɛsou” (“Please sit down”) is highly useful, the phrase I have become known for is “Kɔtɔkari cɛsse” (“Go and pay at the cashier”). While it can be at times frustrating to master the correct pronunciation of some of the words, seeing the patient’s faces light up when they realise that I am speaking their language always brings a smile to my face.

Now when I enter the market in the middle of Mango I am often greeted by cries of “Kɔtɔkari cɛsse” from the grinning faces of ladies who recognise me from the Pharmacy. So I guess that is my new nick name.

Miriam’s Journal

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Day 1. I finally arrived in Mango and it has been a long journey. Months of planning and working and saving, a Bible Collage paper, a million emails back and forth to Togo and NZCMS, learning to ride a motorcycle and a few rugby games – you have been caught up on what I have been up to for the last year.

A quick flight to Auckland then the not so quick flights to Hong Kong, Bangkok, Addis Ababa and finally Lomé left me all ready for the eleven and a half hour bus ride up to Mango. I was mentally prepared for it to take up to 18 hours so the shortened time and the air conditioning came as a pleasant surprise.

Day 2. A quick tour of the hospital to see where I will be working for the next two years. The most exciting part for me was to finally see the Pharmacy that I had designed while on a 36 hour whirlwind trip to Mango one and a half years ago. I am impressed how much it looks like the diagram I drew and could not wait for the shelves to be full of medicine. The rest of the Hospital looks pretty amazing too! We have a 40 bed hospital with separate Men’s and Women’s wards, a Maternity ward, NICU, Operating Rooms, Radiology, Laboratory, Sterilising Unit and a Clinic which sees about 100 patients a day.

Next was a quick tour of Mango to see the local market where I will be buying my rice, tomatoes and cucumbers. I have since learnt that it is worth paying extra for the bagged rice in one of the boutiques as this means you don’t need to pick out the rocks yourself and saves on potential dentist bills. Also you can not always buy Mangos in Mango!

Day 28. I had just got back from prayer meeting and was excitedly going through a box of donated kitchen supplies – it is amazing what becomes exciting when there is no Briscoes down the road! – when I received a Pharmacy call out. A little surprising as the Hospital was not open for another 18 days… I quickly pull my long skirt on over my shorts and borrowed a flash light to put in the basket of my bicycle so I can see as I cycle back to the Hospital. I entered the Pharmacy, picked up my jandal to squash a spider (I never know which spiders are dangerous so my current theory is to kill them all!), retrieved the meds then cycled off through the night to deliver Morphine to the poor nurse with kidney stones.

While dropping off the meds I had a conversation with the Chief Medical Officer about how the machine that gets water ready for making the IV solutions (we make them from “scratch” around here) needs a part that is coming from the USA. He asks me to order some IV fluids from Lomé. I cycle back off into the night with my IV fluids order scrawled across a scrap of cardboard, knowing that this is exactly where I am supposed to be and that tomorrow will bring more exciting adventures and challenges.

Day 30. Elizabeth, a Paediatrician from Texas, and I moved into our brand new cottage. It wasn’t until four weeks later that I got my bed and I still haven’t unpacked my suitcase yet but it is starting to feel like home.

Day 42. The Grand Opening! I was woken up at 6:30am by Hotel California blaring out of the sound system over the other side of the hospital compound. Four hours later, with the same song on repeat, I was well and truly ready for the President of Togo to arrive in the hope that this may cause the sound man to choose a new song! There was a lot of excitement and all the Hospital workers were dressed in the blue Hospital of Hope fabric, while many of the people from Mango were dressed in a green version in celebration of the day. It was fun to see some of the local dances preformed for the opening ceremony and while the speeches seemed long (it is always difficult to concentrate in a different language) I was rewarded for my attention by hearing ‘Nouvelle Zealande’ mentioned once.

Once the excitement of the cutting of the ribbon and the feast of roast beef and rice was over it was time to head back to work for the afternoon before collapsing into bed at 6pm and sleeping solidly until the next morning. Apparently opening a hospital is exhausting work!

You can watch clips from our opening day by clicking here.

Day 46. Monday March 2 saw our first patients arriving at the Hospital gates long before I woke up. By the time I got to work at 7am there was a well-controlled line of patients stretching out of the Hospital entry and down the dirt road that leads back towards Mango. We had a tent set up just inside the Hospital walls where the Doctors, Nurse Practioner, Midwives and Surgeons were screening people to decide if they were going to be our first patients or if they were not urgent and could come back later in the week. It was a slow start in the morning for the Pharmacy as it took a while for the patients to get through the system but we made up for it in the afternoon and we ended up having crowds of people waiting at the Pharmacy until 8pm.

Thank you for your continued support and prayers during this start-up phase.

Prayer for Miriam

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Here’s a quick item for prayer. I’m now in Togo with the Hospital of Hope, working to set up the pharmacy department before the hospital opens. We have items that are needed for the operation of the pharmacy that were shipped from America but no one can find them at the Hospital. The most important is a scale that we use to weigh the NaCl and dextrose used to make our own IV fluids. Please pray that they will be found.

We are trying to order the last of the medicines needed for the pharmacy. Pray that this goes smoothly and quickly and for safe travel next week as we go down to Lome to pick them up.