In June 2021 I accompanied Dr Craig Kline MD, a Spectrum Health Lakeland General Surgeon, to Hôpital Baptiste Biblique (HBB) in Togo, West Africa. Measuring only 71 miles wide, Togo is one of the narrowest countries in the world. Its neighbors include Ghana to the west, Benin to the east, Burkina Faso to the north and the Gulf of Guinea to the south. Approximately eight million people composed of 40 ethnic groups speaking 39 languages call Togo home. In the south where HBB resides Ewe is the predominant group and language spoken. HBB opened in 1985 and serves over 2,400 medical inpatients and ~1,200 surgical cases each year. Patients come from the surrounding communities as well as countries to seek care and counseling from the well-trained team of missionary physicians, physician assistants, nurses and support staff.
While there I assisted with a variety of cases including hernia repairs, hysterectomies, I&Ds and lye ingestions. I also split my time with the medicine team rounding on pediatric and adult patients with malaria, typhoid, intestinal bacterial infections, HIV and TB. The lye ingestions, not often seen in the US, posed a particular set of challenges and opportunities for public health. Lye is an odorless, tasteless alkalotic ingredient in soap making that is unfortunately stored in pop bottles which children and adolescents accidentally consume. Shortly after arriving we heard about two recent cases and on our first day rounding encountered another one which required placing a gastrostomy tube for feeding and close airway monitoring given his inability to swallow his own secretions. Unfortunately for him there will be more challenges down the road including adequate nutrition and the risks of repeated esophageal dilation procedures. In the future it would be beneficial to provide education and appropriate storage containers labeled with pictures to prevent further incidents.
On the medicine team I enjoyed working with the local PAs to round on patients and learn more about what they commonly treat. In particular, I enjoyed applying my ultrasound skills to evaluate ascites, hypoxic patients and GYN complaints including retained products of conception and tubo-ovarian abscesses. Ephraim, one of the PAs, taught himself how to do ultrasound so we discussed various techniques and resources that we use to keep learning. Encouraging local healthcare workers to continue their education and skill set not only improves the health of the community but helps build sustainability, a large hurdle to maintaining care in a low resource environment.
When not at the hospital we hiked to surrounding waterfalls, explored local markets and attended church services conducted in French and Ewe. Our guide, Kokou, kept us on the trails and away from snakes while traversing the tropical countryside and Kofi graciously drove us to and from Lome for Covid tests and provided stories from the road about daily life in Togo.
International medicine challenges residents to adapt to low resource settings, language barriers and cultural expectations that differ from your own. I am incredibly grateful to the SWMC Foundation for the generous scholarship, the Lakeland EM program for this opportunity (given only a month's notice) and to Dr Kline for inspiring residents to continue providing compassionate medical care worldwide.