Togolese Health Care, or, A Very Long Post

I spent a lot of time this week in the Togolese healthcare system.  Most of this was intentional. 

Like Ive said ad nauseum, one of the things I like about Peace Corps is the fact that I don’t know whats going on happen on any given day.  Last Monday was no exception . . .

I think I mentioned that N’tido is pregnant.  I took her into the Kouka hospital last Monday to get her blood work done.  To get there, I called my friend Richard, he’s a zedman, to come get us.

We got to Kouka, and I realized that I actually had no clue what was going on in the hospital, luckily Richard did.  He parked his moto and led the way in like he owned the place.  This was kind of funny given his penchant for wearing big floppy hats.  Richard knew the sage femme (midwife—actually the title of the nurse who runs the maternal care ward).  She got N’tido set up with all the tests that she needed right away.  Richard took us to the laboratory, helped me pay, etc.  It occurred to me that while he was helping us in the hospital, he wasn’t taking clients anywhere.

Since we had to wait until after repos for the results, I took N’tido out to lunch at Kouka’s only cafeteria.  I’m pretty sure it might have been the first time she’d been somewhere where you sit down and people bring you food.  I discovered that I can definitely use a fork better than her.  And I can drink pop out of a bottle. These, plus typing, are probably the only things I can do better than she can.  Anyway, it was interesting.  N’tido spent most of the day being overwhelmed by everything I think. 

We went back to the hospital after repos. And had to wait for the lab to finish N’tido’s blood work.  When it was done, we took her health booklet with the results to the sage femme.  Turns out N’tido is B neg.  Until Monday, I had no idea that this is a problem for women who want to have babies.  

Anyway, N’tido had to go back to the hospital on Tuesday for more tests.  I went home.  Richard met her the next morning and walked her through the rest of the tests.  No HIV.  2 parasites/infections.  Bag full of medication and vitamins.  

We had to go back to the hospital Friday with the dad to see the sage femme again.  The sage femme sat N’tido down and was like ‘you need to thank daniel for making you come in here because if he hadnt you wouldn’t have known that you are B neg and you would have had your baby at home and it might have died and people would have said it was sorcery.’  

This was after she asked N’tido if the baby was moving yet and N’tido was like “I don’t know.”  D does a lot with family planning and pregnant women in Bina and she often tells me that she’s amazed by how much women here don’t know about their bodies.  I didn’t know what she meant until I watched the sage femme explain to N’tido how it feels when one’s baby is kicking.  

I thanked Richard profusely on several occasions for his help.  Seriously, US hospitals are bad enough.  Imagine one that’s dimly lit and doesn’t have huge signs over everything.  Or helpful maps for guys whose only experience with pregnant women was about 20 years ago.  Richard was like “you came to help Togolese, and you are doing more for N’tido than her ‘boyfriend’ is, so it’s the least I can do.”  

Actually, the boyfriend is kind of in trouble.  My host dad told me that the guy came by several months ago wanting to “marry” N’tido.  Petit was like ‘no, she’s a student. Don’t touch her.’  Oops.  Getting a female student pregnant is apparently not good.  The guy has to pay for all of her medical bills and stuff now.  I can’t really muster up any sympathy for him.  

Richard and I had another hospital experience yesterday.  He was taking me to Bassar.  We were on the nice Kabou-Bassar road when a moto directly in front of us stopped in the middle of the lane with a flat tire.  Many people don’t get the concept of pulling off on the side of the road when their vehicle breaks down, probably because shoulders are rare, or are part of the road.  Anyway, there was an old woman on the back of the moto.  Her son told her to get off.  Without looking behind them.  I was spaced out looking at the landscape. Richard didn’t notice that they’d stopped dead.  Then we flashed by and something caught the toe of my chaco and wrenched my foot.  

We turned around to see what happened.  The woman had climbed down off the moto and was hopping around on the road, trying to walk it off.  Drizzling blood everywhere.  The skin on her calf had torn.  It was crumpled up like when you push a tablecloth on a hardwood table.  In this case, the table was her calf muscle. 3-4 inch tear. The woman was going into mild shock as we tied my handkerchief around her leg to slow down the bleeding.  Then we went to the hospital in Bassar.  

I hope Im never bleeding to death and need urgent care in Togo cause Richard had to buy all the surgical supplies and medicine before anything happened apart from a doctor looking at the injury.  D was in Bassar and came to hang out with me while we waited for the woman to get stitched up.  In Togo, if you cause an accident, you pay the medical bills.  Richard was out like 8 mille before the afternoon was over.  His profit margin for the trip would have been about 1.5 mille, depending on gas prices.  I felt bad for him.  He was really upset about the accident, which wasn’t entirely his fault.  I asked him about that, and he was like “yeah the guy stopped in the middle of the road and told his mother to get off.  It was stupid.  But if I’d brought it up we would have spent a lot of time arguing about it.  Me paying for it all was much faster.”  

Personal profile: Richard

Richard is a zedman; he makes his living driving people around on his moto.  He’s really good at it too.  Zedding here takes a degree of nerve (or stupidity in some cases), good depth perception, excellent reflexes, a large degree of skill, and luck.  Richard is the president of one of the two zedmen syndicates in Kouka, a fact I use to my advantage when I negotiate prices (“over charge me? Let’s call your president . . .”).  He’s one of the more, um, stocky togolese that I know.  I rarely see him without his big, gap-toothed smile.  He’s the kind of guy who has friends everywhere because that’s just the way he is; he’s happy to see everyone.  Richard knows everyone from the Catholic nuns, to the doctors in the hospital to the gendarmes. It helps that he speaks at least 5 different languages.  Once, a Fulani herdsman pushed his cattle across the road in front of us when we were going back to Nampoch.  Richard got mad, which he usually only does when someone blocks the road and about causes an accident.  He flipped out, stopped after we dodged the cattle, and cycled through a repertoire of languages until he found one the guy understood. 

 

Richard calls me “ton-ton Daniel” – uncle Daniel—half out of respect, half out of affection.  I’m not sure when we became friends.  He’d been one of the regular drivers for other Volunteers in the area until I, according to Karen once, “appropriated” him. Now, when he comes to my house on Fridays, my mama gives him a calabash of tchakpa.  He helps me when I do sensibilizations, especially the ones on gender equality; he’s really into that, especially since his daughter was born.  Today is actually her first birthday.  He’s planning a big party for her.  This is interesting because, 1, parties are expensive, and 2, Togolese usually don’t keep track of the exact day when their kids are born.  Richard is also probably one of the few strictly monogamous Togolese men that I know. Watching him and his wife interact is really funny because they are a lot alike—same build, same sense of humor, same iridescent smile.  They are devout Catholics.  Sometimes, Richard has to hurry to get back to Kouka to make it to choir practice at the church.  He responds to the universal “comment ca va?” with “good, thanks to God.”  He’s one of those people you can trust implicitly.  He’s one of those genuinely good people who you occasionally meet in life.  

Last time I was in Lome, I found a bottle of barbeque sauce for 1,750 cfa.  Best. Buy. Ever.  It makes everything taste better.  Barbeque sauce and rice?  Lunch of champions.  I think I even put it on pate once.  Of course, I might just have missed the sultry taste of high fructose corn syrup. . .

Last Sunday I was in the Kouka marche when a Togolese ‘hissed’ me down.  My usual reaction to this when Im having a less than good day, like last Sunday, is somewhat assholish.  However, before I could say much, the guy was like “are you Peace Corps?” In English. Brain reset.  

Turns out, he is the ‘brother’ of a RPVC who was in Bassar 25ish years ago.  Greg was at the Kouka marche with his friend Andy, another Bassar RPVC, and Andy’s Bassari-American wife, their son, and other Togolese relatives.  After running their son back to Bry’s for a pit stop, his stomach wasn’t acclimated to Togolese food yet, I spent a very pleasant afternoon swapping stories with a pair of 50 something RPCVs who love Togo so much that they come back every couple of years to visit and do projects.  

D and I had actually run into Anna, Andy’s Bassari wife, in Bassar the week before.  It was interesting to be in the marche with someone who could yell at people in Bassar then joke about it in English.  Andy went back to the States after completing 3 years of service and took her, and her young son, with him.  It was a refreshing experience because many PCVs get worn down and disillusioned with Togo by the end of 2 years—“I need to get out of here.  This country is stealing my soul.” That isn’t how I feel about Togo; its good to be around Americans who share my love for this place. 

I kick a kitten at least twice a day. Unintentionally. Whenever I walk through my house I have a furry escort running around my feet.

Nighan has started to bring stuff in for them to eat.  The following scenario happens probably once a day—Daniel is laying on his bed reading.  Becomes aware of ferocious growling under his bed.  Becomes inquisitive.  Investigates with flashlight.  See’s lone kitten straddling a lizard twice its size, chewing on its head, and growling at the world.  Kitten is too little to actually do more than tear pieces off, but that doesn’t stop it.  Repeat 4 times until Nighan finishes the thing off. 

I am craving Sprite right now

When I got back from Kouka on Monday I left my phone and my Nook out on my little table while I went to garden.  When I came back, I discovered that David decided that my phone and a bucket of water needed to be united.  I took it to a repair guy in Kouka, but its still messed up.  David has almost signal handedly cured me of ever wanting to procreate.

I don’t know what it is about the landscape here, but I am always noticing new stuff.  Like the other day I was biking into Kouka on the back road, and I realized that, from this one hill, I could see the mountains of Kabou, and, barely, of Bassar.  Then, a couple days later, I realized I could see the Kabou mountains from just outside of Nampoch.  Which makes sense cause they are the biggest thing in like 30 miles, but its still weird that I never noticed them before.  

Ive been watching the TV series the Walking Dead this past week, and I feel compelled to comment on it.  First of all, the people in it are stupid.  If the world was overrun by zombies, and there were abandon tanks everywhere, well . . .  I'd be learning how to drive a tank.  Secondly, one of the driving "apocalyptic" factors in the show seems to be the collapse of Western civilization, epitomized by the lack of hot showers.  Oh, the humanity.  The apocalypse is characterized by a lack of creature comforts.  Ugh.  Third, this reinforces the general lack of hope in the show.  D and I were talking about it today and she made a comment about zombies embodying "mindless evil."  This was my missing link, so to speak.  Civilization collapses, you can die any given day from something mindless and horrible, and you dont have hot showers.  This paradigm doesnt really resonate with me in Africa.  Look up Buruli ulcers (seriously, I just saw a poster about them in the Bassar hospital, i dont know what they are) and tell me about mindless and terrible.  Lack of western civilization has nothing to do with lack of hope in humanity or the world.  Finally, a zombie apocalypse is a stupid concept-- they will all die of starvation anyway. stop whining.  

that being said, i'll probably keep watching the show because apocalypse is interesting.

Thunderstorms are roiling across the horizon, gotta run.

Kittens Tombu too

My two great accomplishments for today are:

1. taking Ntido to the dispansaire for pre-natal counseling and

2. popping a big tombu maggot out of the tail of one of my kittens.

There is something satisfying about popping tombu maggots out of dogs/cats.  its almost as satisfying as watching them squirm around on cold concrete people you step on them. 

The other morning I walked out of my house to see papa scooping the brains out of a goat skull with his finger and eating them.  his response to the apparently incredulous look on my face? "C'est doux!"

So yeah, Ntido is pregnant.  I thought she was about 2-3 months ago.  then village rumor picked it up about 3 weeks ago. i hate being right sometimes.  Anyway, I tried talking to Ntido about it.  No good. D came out last week though, and had a good talk with her about about stuff.  So I feel better. It sucks being a guy Volunteer sometimes because half the population is too shy or doesn't speak french well enough to talk me.

The dispansaires, e.g. local/village/rural health clinics, have decent pre-natal counseling and infant health programs.  this is especially true with the dispansaire in Nampoch because it is run by Sisters from the Catholic Mission in Guerin-Kouka. 

I have a lot of respect for the Catholics here.  they do a lot of good work in Togo, especially in the arenas of health and education.  i'd never be a monastic, but you have to have a Lot of respect for people who dedicate their lives to making their corner of the world a better place.

D and I went in to talk to the Sister who comes out to the Nampoch dispansaire to find out when their CPN is, well D did all the talking cause she works with dispansaires, I just went along cause I knew the way. Anyway, the Sister was really nice and professional.  Unwed, pregnant teen mothers are sort of a fact of life here.

On my way into town today, I biked past an army ant mound, one of like 50.  This one was different cause it had a 15-ish centimeter long dead viper on it.  Poetic justice.

I refuse to say anything about the recent elections in the US, especially since it could get me fired.

I've reached this weird point in my service. Its time to start handing off national projects that Ive been working on.  Most national projects, like committees, publications, etc, have a year-long term.  Last month we finished up our last issue of Farm to Market and passed that off to the new editing team.  Then, last weekend, I went up to Dapaong to take part in the transition meeting for the new Food Security Committee.  I was one of the founding members of the committee; its kind of weird passing it on to new people, but in a good way.  Normally, I guess, it wouldnt be that big of a deal because I'd be getting reading to COS.  Since I am planning on being here for another year or so this feels like my mid-service point instead of the beginning of the end. 

i like the feel of real books, but i like trees and being able to have 100+ books with me on my nook.  conflicted.