Togo

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.

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.

God’s Grace in Togo

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By Kelly (colleague of Miriam Tillman in Togo). Reposted from her blog. This God–his way is perfect; the word of the Lord proves true; he is a shield for all those who take refuge in him.– Psalm 18:30 Merely ten days ago I wrote a blog about the grieving of a friend where I said, “the Lord had other plans.” Little did I understand the extent of that statement and that we were actually in the middle, and not the end, of a story that continues to unfold today.  As many of you know already, Todd Dekryger was the Medical Director for this hospital as well as a talented surgical physican assistant who ran our surgery department here at the Hospital of Hope. He was the visionary, the motivator, and main recruitor for the team. But in the middle of Febuary, he became ill with symptoms consistent with malaria and rested at home over several days. He continued to struggle despite the treatment and was admitted to the hospital 1 week after he became ill. His testing for malaria was still significantly positive which spoke to us about the severity of the illness. His labs were also suspicious for Typhoid fever, which we began to treat as well. As many know the story, Todd continued to worsen and the decision was made to try and medivac him out-of-country to seek further supportive care and recovery. And although Todd was extremely ill when he boarded that small plane headed for Germany, I had no doubt in my mind that I would see him soon on Togo soil. But this was not to be. Less than 24 hours after landing in Germany, Todd went to be with the Lord. The story was over.  Complications from severe malaria would not be overcome, but none of us were doubting that the Lord would somehow use Todd’s death to still bring a message of Hope to the Togolese people–the message of how Christ had overcome death to save the world, to save the Togolese people.  But one week after boarding Todd onto that plane, Andrés, a volunteer nurse with Samaritan’s Purse who had cared for Todd, developed a fever. As common diseases are common, Andrés treated his illness with malaria medications and tried to rest. Three days later, he came into the clinic because his fever never went away. By God’s miraculous plan, Andres came into the hospital to get some IV fluids. The doctor who had cared for Todd happened to be passing off patient care to another doctor for the day, but happened to look up at the computer screen and saw Andres’ lab results. Nothing short of dread came over her as the lab results that stared back at her were mirror images as those Todd had presented with.  What if Todd had something more? That something more came to be diagnosed as Lassa fever–a viral hemorrhagic fever normally not found in Togo but instead endemic to Sierra Leone and Nigeria–countries that don’t even touch Togo!  By this time the suspicsion for Lassa fever was confirmed, Andres had already been isolated and infection prevention measures were taken. Samaritan’s Purse was able to evacuate Andres to the United States where he remains hospitalized in order to recover. As it turns out, Nigeria was and is experiencing a large outbreak of Lassa fever that was able to reach our town, likely through a patient who wanted to seek care at the Hospital of Hope.  Many of you may be thinking, “This is still a horrible, tragic story.” And in many ways it is.  No one can deny the pain and void we feel every day because Todd is not here with us, leading the charge towards compassionate healthcare in the name of Christ. But there may be something more.   If the inital patient, of whom we’ll never be able to identify, had come into Togo and even our Hospital, and died here, we would’ve never known his true diagnosis. As sophisticated testing, such as Lassa testing, doesn’t exisit here, the death would have tried to be assumed as liver failure, yellow fever, or just a severe bacterial infection. We would have continued to see patients and never associated that death with any other illness that may have developed in our healthcare workers here, or the community. Because we try to do as few labs as possible here, in order to keep things affordable for the Togolese, we wouldn’t have seen daily labs each morning as we could with Todd. We would have never linked any labs results with each other.  What if the doctor that took care of Todd wasn’t seated at that computer at that moment to see Andres’ test results? Andres may have continued to get sicker and not had enough time to start treatment or get evacuated to the US.  Todd’s illness and subsequent death made it possible for us, for Togo and for the world to be notified of a potential outbreak of a viral hemorrhagic fever in a country that was not felt to be at risk. Although many of us are on surveillance and verifying that we are not at risk, the story as it is unfolding, saved lives….many lives. Lives that this hospital was built to reach with the message of Christ.  The story seems like it should end there. But 3 days after Andrés left for the United States, and when we had already put an alert system in place due to the diganosis of Todd, a woman showed up to the hospital with a fever. Because she told us that she had come from Nigeria 3 days before, we put her in isolation immediately under surveillance for Lassa fever. Two days later, 2 of her children ,who we had been following daily, became symptomatic with fevers and were placed in isolation.  As I stood in that mother’s room trying to explain to her the significance of Lassa fever and the tears were silently falling from here face, I said to her, “Did you know that the fact that you are here at he Hospital of Hope in Mango is a miracle?! I am so happy you are here with us.”  I explained to her that it was only God’s hand of mercy that after Todd’s illness and death, Andrés visits to clinic and evacuation, along with her travel from Nigeria to our small town of Mango, we were able to identify her as a likely case of Lassa. If we never tested Todd’s blood in Germany, if Andrés had not gotten ill, we would’ve never known or investigated  further. Had this woman gone to any other clinc or hospital in Togo, they would have never placed her in isolation and she could have continued to spread the virus, unknowingly, to others. Because of each step, in God’s perfect timing, this woman and her two children are at the only hospital in Togo that currently has the potential life saving medicine to work against Lassa fever. What are the chances that this family left Nigeria to come to Togo and ended up here…at this time.  Zero. That is, zero without a God whose hand of mercy stretches to the skies! I am confident that no other death could have sparked the response and timeline of discovering that Lassa fever was here in Togo. I am confident, that in no uncertain terms, Todd’s death did make it possible for many others to keep theirs; others who have not yet heard the message of the Gospel; others who were either prevented from getting Lassa because of measures taken, or others who will now get a chance to be identified, cared for and treated.  No one who knew Todd has any doubt that he is face to face with The Savior Jesus Christ, the Son of Man who “did not come to be served, but to serve, and to give his life as a ransom for many” Matthew 20:28  And what further testimony can one give to show the love of Christ? “By this we may know that we are in him; whoever says he abides in Him must walk in the same way in which he walked.” 1 John 2:5-6 But the final word cannot be about Todd or Andres.  Nor can it be about Togo or the Hospital of Hope.  “For by grace you have been saved, through faith. And this is not your own doing, it is the gift of God, not a result of works so that no one may boast.” Ephesians 2:8-9 The story is the Story of Hope. And it continues on. It is the reason we are all here and we can’t wait to see how Christ will use our weak, broken, mourning selves to carry on His message of joy, strength, and peace as we press forward.  Please continue to pray for Togo and that Lassa fever will not spread any further.  Please continue to pray for hope and healing our HOH team and the Dekryger family.  Please pray for the Morales family as they continue their journey of healing in the US.  

Tragedy in Togo

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Todd Dekryger, who was the chief of staff at the Hospital of Hope in Togo where Miriam Tillman works, died on Sunday from complications from malaria and typhoid. He was a key figure at the hospital and indeed in the initial setting up of the hospital. He, his wife Jennifer and their four boys had been in Togo since 2005, initially at another hospital near Lome and since 2013 have been involved in setting up the hospital in Mango.

Todd was initially treated for malaria and typhoid. When his condition didn’t improve, he was moved to a hospital in Cologne, Germany where he died Friday, February 26, with his wife, Jennifer by his side. It is still unclear what precisely caused his deadly infection.

Todd, a surgical physician assistant from Michigan in the United States, was the chief of staff at Hospital of Hope in the Togo’s northern city of Mango. The hospital’s opening in early 2015 was such a big deal that the nation’s president came to the grand opening and met with Todd. Since it’s opening, the hospital has treated more than 10 000 patients, many coming from the surrounding countries of Ghana, Benin and Burkina Faso.

The opening of the hospital had been a goal of Todd for years, after he moved his family to the West African country in 2005 to do mission work. He and his wife, Jennifer, who had done mission work in Hong Kong, wanted to share their faith while providing healthcare to those in need. “They served the physical needs of the Togolese people,” said Jeffrey Burr, pastor of Forest Hills Baptist Church. “But their goal was to compassionately communicate the good news of God’s salvation through Jesus Christ.” The family was overdue to take a furlough back to Michigan because they were so committed to serving the Togolese people, he added.

In a message to the church, Jennifer wrote about her grief and her husband’s sacrifice:

My heart is overwhelmed with unspeakable grief – for myself, our boys, our extended family, our spiritual family and the Hospital of Hope team. I cling only to the gospel and the certain hope of our salvation through Jesus Christ. I long for the men, women and children of Togo to know the Savior that Todd served so faithfully. Even in my pain, I am confident that our sacrifice – that Todd’s sacrifice – was worth it. I believe that the great commission is a cause worth dying for. And in the midst of my grief, I fix my eyes on Jesus, the author and finisher of my faith.

Please pray for Jennifer and the boys as well as Miriam and the rest of the team as they come to terms with this huge loss. Todd was a vital part of the community at Hospital of Hope. May they know God’s love and comfort in these days of deep grief.

Further details including a video of Todd from 2014 can be found by clicking here.

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.

Our Latest Mission Partner

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We’re delighted to welcome Miriam Tillman to the NZCMS family.

In her 30 some years Miriam has visited over 30 countries. Between the ages of 5 and 17 she, with her family, was part of numerous cross-cultural Kings Kids (YWAM) trips that took her as far afield as Venezuela. At 21 she lived in a small Tanzanian village for three months where she served at the local dispensary. And she’s spent three years working for Mercy Ships on the African Mercy as a pharmacist, visiting various African nations including Togo, West Africa.

Miriam is returning to Togo to join a team starting a new hospital – the Hospital of Hope – in the town of Mango, about 12 -16 hours north of Togo’s capital, Lomé. The Hospital of Hope, due to open in March 2015 is run by the Association of Baptists for World Evangelism (ABWE), an organisation that has served in Togo since 1974. Miriam will be tasked with setting up and running the hospital’s pharmacy along with training local pharmacy technicians. She aims to arrive by mid-January in order to commence training before the hospital opens.

Christians are a minority in Mango which means Miriam will not just be able to serve the people through her pharmaceutical expertise, but will also be able to shine Christ’s light to some who have perhaps never seen it.