I wake up but keep my eyes closed because my eyelids are so heavy with sleep still. I know the power has gone off because my ceiling fan directly above my bed has stopped, causing me to wake feeling overheated and sticky. With the white noise off I can hear people laughing and talking in a different language outside my window across the sandy, red dirt road. The air in my room is still. Too still to be comfortable. I guess it’s about 32C in here. The dependance I live in is just two rooms and sits across a small courtyard from the house my friend Miriam lives in. We are in Mango, Togo, 475km (295 miles) north of Lomé.
The power comes back on and my fan restarts but now I’m fully awake so I wrench myself out of bed and dress with my shoulders covered and a skirt that reaches my ankles in respect of the Muslims who populate this area of northern Togo. I unlock my door from the inside and head across the dirt courtyard to the house. The sun is blazing and a warm breeze rustles the pink bougainvillea on the wall surrounding our house block and the mango tree in our yard. The house is simple inside and a very fine layer of red dust coats everything. The Harmattan winds that blow from the end of November to the middle of March create most of the dust but also the red dust is kicked up from the village streets as only the main road is paved.
I head to the kitchen to get a drink of water as I wake thirsty every day. The tap water is dirty so we have a big water filter and keep clean water in bottles for when the town water is switched off, which is frequently.
The next step of the day is making coffee. The power is back on but I need to switch off the kitchen fan to light the gas stove to boil water in a saucepan as we have no kettle. I mix up the powdered milk while I wait for the water to boil. There’s seems to be an extra step for everything here.
Coffee cup in hand I sit on the couch and check messages on my phone. At least Miriam’s house internet is reliable when the power is on. It’s nice to still feel somewhat connected despite being miles away from anywhere. I start replying to messages people have sent asking me how it’s going over here.
I’ve worked a few shifts in the hospital now and have an idea of what each day might look like. The hospital is run differently from other hospitals. Patients must come between 0700-0800 and wait at the front gate to be triaged and sent to the clinic for outpatient appointments, surgery appointments and new presentations. Not everyone will be seen each day as there are limited staff members and hours in a day to work. Patients are sent to the laboratory, pharmacy, radiology or up to the hospital from the clinic. The hospital has areas for emergency, men’s ICU, men’s ward, men’s infectious, women’s ICU, women’s ward, women’s infectious, isolation rooms, paediatric ICU, paeds ward, maternity/labour and delivery and neonatal ICU. The nurse’s station to all these areas (except maternity/labour and delivery) is central so it’s set up in a cross shape. There is also an operating room wing with a recovery room area, although if we are under staffed the emergency nurse will recover the patient.
The hospital is run by expatriate Baptist missionaries but employs many Togolese who work in all areas and are the team leaders and nurses each shift. There is a nursing school on the compound and the 15 nursing students work in the hospital 3 times a week putting into practise what they are learning. Each registered nurse is assigned a Nurse-aid who takes the patients’ observations, helps with tasks, restocks and also helps translate for the expat nurses like me. A patient’s relative stays with each patient. They are responsible for providing all meals for themselves and the patient. There is a place on the hospital compound where they can go out and cook their meals (cuisine). They must bring all pots and pans and essentials for cooking. They normally bring a mat or piece of fabric and sleep on this flat on the tile floor near the patient’s bed. When a patient is ready for discharge the family member goes to the caisse to pay the bill and if they don’t have enough money they must stay until they can pay. For one more night they can sleep in the hospital but after this, there is a place on compound for families to stay until they can pay their bill.
The patient population here is mostly different to Australia. So far I have seen or cared for patients with eclampsia, HIV sepsis, chronic osteomyelitis, fractures, malaria, abscesses needing incision and drainage, Burkitt’s Lymphoma, infantile fibrous sarcoma, snake bite, CHF, nephrotic syndrome and premature birth (33 weeks gestation). Most of these conditions I’ve never cared for so I have a lot to learn.
The nursing shifts are from 0700-1930 or 1900-0730 with a 2 hour lunch break, 4 shifts per week. Miriam had the bike man put new tyres on her bicycle and this is now my transport to and from work and around town.
One night last week I barely slept as the power was off and it was unbearably hot and then at 0430 the wind picked up and a storm blew over, battering my little home. The sky opened up and dumped down rain. I was fully awake despite minimal sleep and prepared to ride to work on my bike in the downpour through sandy unpaved roads. I put my work uniform and gear in plastic bags but by the time I left the house the rain had stopped, much to my relief. The cycle to the hospital required quite the effort through sludgy red mud, avoiding goats wandering in the streets, kids walking to school and motorbikes zipping past, all keeping an ankle length skirt out of the wheels and covering at the very least my knees.
As I drink my coffee Miriam hands me the Mango + 1 recipe book. All recipes are ingredients that can be found in the small market in Mango plus 1 ingredient from a big city such as Kara (2 hours drive south) or Lomé (9 hours south). I page through the book deciding which recipes I could try this week according to the food already in the house, thankful for the recent 18 months I had in Australia cooking each night and knowing those skills will come in handy for the weeks to come.