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.


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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.

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.