Although I spent my childhood in West Africa (Cote d’Ivoire and Ghana), this fall I had the opportunity to see this beautiful region in a new light as a medical professional.
Medically there was some aspect of the familiar but also much that was so different, reminding me of the humbling and very steep learning curve of intern year. Possibly the best example of this dichotomy occurred on my first day. After travelling for over 24hrs, I was offered an afternoon tour of the hospital before starting the next day. While sitting at the nurses’ station in the 100-bed hospital reviewing the flow of patient care, a trauma patient in the ICU (a room with nasal cannula O2 and continuous monitoring) began coding. There was no overhead code blue, no rush of a multi-disciplinary team, just an urgent call to the long-term missionary physicians and Togolaise PAs and nurses that were sitting at the station. We walked the 10 steps to the ICU and a familiar algorithm unfolded with chest compressions and epinephrine interrupted by rhythm checks. The patient regained a rhythm several times but one key ACLS step was missing, definitive airway, as the hospital had no ventilators available outside the OR. Nearly an hour later, the code was called and my hands aching from holding the airway open, I looked around in the empty space that occurs as your mind breaks free from the pre-set steps of a code to see the familiar devastating scene of a family beginning to grieve for a life lost too soon.
This was the only code I experience in my month in Togo. During the remainder of the time, I worked alongside the providers on daily inpatient rounds, outpatient clinic and every 3-4 day medicine/ER call. Though less dramatic in their unfolding, similar lessons to the one experienced in the first day continued. Lessons of learning new maladies and management but also adapting what I knew of disease and treatment to an algorithm without CT scanners, ventilators or medications I have come to appreciate as ‘standard’. Lessons of practicing in a system where medication choices are often limited by availability of stocks that may not be replenished for months. I was also reminded of lessons that are present here but I sometimes overlook beneath the mountain of EMR charting – of the foundational knowledge of biology and pathophysiology that is not bound by culture or language and more importantly the impact of health care providers who are passionately dedicated to their calling and compassionately committed to their patients and their families. It was a privilege to learn and relearn these lessons from the providers at Hosptial Baptiste Biblique and I am grateful for the FMed funding for making this experience possible.