Clinical Shadowing and other adventures in Lomé, Togo Audrey Coventry
“Le Togolais chante quand il est content, alors il chante toujours ” - The Togolese sings when he is happy, so he is always singing Fast facts: Capital: Lomé Population: 7,756,937 (40% urban) Languages: • French (official) • Ewe and Mina (in the south) • Kabye/Kabiye and Dagomba (in the north) Religions: Christian 29%, Muslim 20%, indigenous beliefs 51% Physician density: 0.05 physicians/1,000 population Fertility rate : 4.43 children born/woman Median age: 19.7 years https://www.africaguide.com/afmap.htm Literacy (age 15+): 66.5% (male 78.3%, female 55.3%) http://www.operationworld.org/country/to go/owtext.html
Recent government history in brief • Gen. Gnassingbe EYADEMA ruled Togo as a military dictator for ~40yrs • After his death in 2005, his son took his place • In 2007, democratic progress led to the first relatively fair election • Faure Gnassingbe remains president of the presidential republic today Togo is a developing nation, and is a safe and stable country compared to many of its neighbors in sub-Saharan Africa https://commons.wikimedia.org/wiki/File:Flag_of_Togo.svg
Polyclinique Saint-Joseph The nicest (and most expensive) hospital in Togo ~100 beds (KU has 713) Medical services: • 3 stories, 7000 m 2 Surgery • Pediatrics Laboratory services: • Emergency medicine • Biology • OB-GYN • Hematology • Ophthalmology • Parasitology • Internal Medicine • Pathology • Dermatology • Bacteriology • Neurology • Nephrology • Medical Imaging • Kinesiotherapy
Why Lomé? • Personal interest in international medicine • Personal desire to travel somewhere new • Family connections in Lomé • My uncle Franck teaches at the French high school in Lomé Why Polyclnique Saint Joseph? “Ce n’est pas la réalité ” (It’s not reality ) • Closer to American hospital standards • The doctors didn’t want to scar me by going straight to the CHU
My 2-week experience 1 week of shadowing • Surgeries • Laminectomy • Hematoma resection • Hospital rounds • Pediatric office • Neurosurgery office Tour of the CHU Sylvanus Olympio • Largest public hospital in Togo • The teaching hospital of Togo 1 week of Togo tourism
Unexpected clinical realizations • Everything is BYO at Polyclinique Provided at Provided at Saint Joseph KUMC PSJ • IV bags, vaccines, etc. are Hand sanitizer bought at the pharmacy, then IV bags and tubes taken to clinic/hospital • The doctors administer shots, Drinking water IVs, etc due to insufficient Food and patient nursing staff meals • Families of patients provide all Blankets food, water, and other essentials Procedure gloves • Patients are billed for everything, including gloves and wipes
Double-take moments • “I’ve had the same IV for 5 days, can I get a new one?” • “We’re out of mosquito nets, why didn’t you order more?” “People steal them” • The doctor called to a random guy on the street from the balcony to fetch me a bottle of water • One of the rooms with 4 beds: No curtains, one topless female patient, one male patient on dialysis getting fed by a nurse using her fingers for silverware • No hand-washing between rooms on rounds
Touring the CHU (public and teaching hospital) “If you learn here, the rest is easy” “we have every specialty and good doctors, we just don’t have enough equipment” • Largest and arguably best public hospital in Togo • The teaching hospital for Togolese medical students • All medical specialties represented • Extremely dirty and run-down by our standards • Dozens of beds per room in the pediatric ward • Doors to the OR didn’t shut properly • Trash everywhere between buildings • Not enough linens • Most window screens broken • Much of the equipment old and rusted and/or malfunctioning https://maximedomegni.wordpress.com/tag/chu-sylvanus-olympio/
The CHU Pregnant women sleeping on the floor in the maternity ward Representative of the state of much of the equipment and infrastructure http://renaudossavi.mondoblog.org/2015/02/16/greve-au-chu-sylvanus-olympio-la-determination-des- grevistes-le-desespoir-des-familles/ http://www.freiwilligendienste-afrika.de/big_photo_gallery/ http://www.27avril.com/blog/culture-societe/sante/chu-sylvanus-olympio-maternite-les-femmes-obligees- Crowded beds daccoucher-a-meme-le-sol-faute-de-lits
Cool cultural things: Tamberma village • UNESCO World Heritage site • They have kept the same style of hut and village complex for thousands of years • The first ancestor of the village Presumably lived in a hollow Baobab tree Top: Children of the Tamberma village with 2 of the many huts Left: Me inside of a hollow Baobab tree
Cool cultural things: Peuls nomads • Nomadic people that live throughout sub-Saharan Africa • Ethnically, linguistically, culturally unique distinct from the Togolese and other tribal groups • The Togolese believe they can do magic
Cool cultural things: Lots of villages Young boy helping sift his flour at the village mill
Cool cultural things: artisans, Obama, and terrifying road adventures
Cool cultural things: Religious diversity in harmony Christianity, Islam, and the world’s largest Fetish market http://www.flyingfourchette.com/2013/12/23/lome-togo/
References • https://www.cia.gov/library/publications/the-world- factbook/geos/to.html • http://www.countryreports.org/country/Togo.htm • http://mtn-togo.org/?p=1438 My sincere thanks to my aunt and uncle for hosting me, to Dr. Jacques Amegnito and the medical staff at Saint Joseph for their kindness and unparalleled hospitality, to Dr. Theo for giving me a tour of the CHU, and to Anatole and Corrine for providing the opportunity for this once- in-a-lifetime cultural adventure
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