Joyeux Noel!

Merry Christmas everyone!
We hope you all had a great Christmas.  Because it is hot like summer here all the time, Christmas sort of snuck up on us this year.  We didn't let the eternal summer stop us from celebrating though!  Tim found a five-foot-tall fake Christmas tree, a bag of ornaments, and a string of lights in our storage shed which must have been put there by previous volunteers.  After a little assembly and arranging, the tree was looking good, but the ornaments were showing their age (and dust!) and needed a facelift.  We re-covered the ornaments in bits of colored and patterned fabrics and then created some more ornaments of our own with things we found around the house.   Our tree was our only decoration for Christmas, but we were very happy with the way it looked. Even with the weather feeling nothing like we are used to for Christmas, the palm trees, the red earth, and most of the area around us not really being decorated for Christmas, a decorated Christmas tree just has a special way of making you feel a lot more like it is Christmas all on its own.
For all of us, Christmas has always been a holiday that is very family-focused.  None of us have ever spent an entire Christmas season apart from our families before, so we wanted to try to celebrate in a similar way as we do at home.  In that spirit, we invited two families and one of our friends from the hospital who was on his own for Christmas to join us for a Christmas Eve dinner that was very similar to our Thanksgiving dinner (turkey, mashed potatoes and gravy, green beans, corn cakes, mixed veggies, and Leah's "sweet potato" casserole). We ate in the dining room with music playing and our Christmas tree lit,  creating a wonderful holiday atmosphere.  Ream and Leah made cookies as gifts for everyone.  Before each person left, they received a bag of cookies tied with a gold ribbon and a handmade card.
Christmas day, we had been invited to eat lunch with the sisters. Their dining room was decorated with large bows made of ribbon, brightly patterned table cloths, our Christmas card placed at the top of their tree, and every plate on the table had cookies and candy.  They served roasted goat, mixed veggies, and fufu (a local food made from large roots called ignams - pronounced in-yam - and served with many different sauces), and, as always, fresh fruit.  Like all the celebratory meals before, they also provided sodas, beer, and wine.  After lunch they served ice cream and cake, both of which are a bit of a rare treat here.  When everyone was finished eating, we helped wash the dishes and clean the dining room, and the sisters sent us home with candy, cookies, and a present for each of us (we must have been good this year; it wasn't coal!).
The rest  of the afternoon was very relaxed as we all spent time lounging, reading, writing blog posts, and Skype-ing with family.  That evening we went to Michele and Salyne's house for dinner.  Salyne prepared a couple of Togolese dishes and even taught us how to make them.  One was fufu, which we already knew how to make, but the sauce was peanut-based and we had never tried it before.  Since we all really liked it, we will try to make that one ourselves. The other dish was made from rice flour and mixed with curry and a few other spices and had a texture similar to polenta.  It was really very good, and has been one of our favorite Togolese dishes so far.  The tomato sauce that went along with the rice-polenta-dish was made with sauteed onions and peppers and a little bit of chicken, and it was also quite delectable.  After we had all toasted, eaten, drank, and were thoroughly full and happy,  Michele and Ream went to make  bananas flambe for dessert.  The bananas were very ripe and soft, so it turned out to be a little soupy, but the flavor was  excellent.  Next time, we will try to use greener bananas and maybe a little bit less butter.  After dinner and dessert were through, we sat, played cards, chatted, and generally just enjoyed each others' company for a little while before heading home for a very welcome night of sleep.
In many ways, Christmas here was nothing like what we are used to seeing and doing for Christmas at home.  However, in the most important ways, it was exactly the same.  We were fortunate to have the opportunity to celebrate this most important of holidays with people that we care about.  It was bittersweet, seeing as we were all away from family and friends, but being able to celebrate here with newfound friends was a joyous blessing in and of itself!

La Laboratoire...and Leah's other experiences working in Togo

Nothing about working in the lab at the dispensary is anything like the work I was doing at UGA.  The only knowledge I had that was useful in the beginning was my basic bench top skills.  This started out a a big challenge, but I am having a lot of fun learning new things.  Although the guys in the lab all speak at least a bit of English, the language barrier is still there when it comes to technical terminology.  When I first arrived, I was very surprised by the level of technology in this third world village.  The dispensary was started and funded by Italians so most of the lab equipment is Italian.  Just another thing to add to the language barrier.  On the bright side, I'm learning A LOT of French and Italian!
All of our work in the lab is body fluid analysis.  It is mostly blood work, but we do tests on urine and other things as well.  In regards to blood, we do basic counts and levels, but also we do blood typing, tests for HIV/AIDS, typhoid, malaria, and Hep A, B, and C.   I learned how to do blood draws on patients.  Most of the adults are pretty easy.  I have only drawn blood on one child, and he was 10 years old.  Watching the children scream, cry, and flail when we are trying to draw blood breaks my heart and is not confidence inspiring.  I still don't feel comfortable drawing blood on children yet.
We also do bacterial and yeast cultures in the lab.  I haven't done much with that since most of my responsibility is in the blood area.  We do fecal tests looking for worms and other parasites under the microscope.  Pregnancy tests are a daily occurrence.  One of the difficult parts for me is doing a pregnancy test and HIV test at the same time for some of these women.  Some of the girls are young and already have one or more children.  I've had pregnancy and HIV tests come back positive together.  It always puts a damper on the rest of my day.  Positive HIV tests are always a heavy emotional hit for me.  Even though I see it every day, I know it will always be difficult for me to the positive test results, especially for the babies and children.
I am reminded every day how different things are in the medical field here.  Almost NOTHING is sterile and it makes me cringe sometimes.  The only sterility is found in the surgical area.  Needles, syringes, and others things that come in processed packaging are fine but when the medical personnel don't use them properly it becomes a mute point.  Taking a needle out of a patient, placing it on the hospital bed (which is a thick plastic mat, no sheet, and not usually cleaned between patients) and then picking the needle up and using it again is not exactly clean.  Blood typing is also a little sketchy. We have reagents in the lab to do blood group testing, and although I've never seen it done in a first world setting, I can imagine it's a bit different.  The sketchiest part though is when they are about to do a transfusion.  They take a little of the patients blood and mix it in a small plastic tray with a little bit of blood from the transfusion bag.  If it doesn't agglutinate they start the transfusion.  Yikes!
One of the biggest challenges for all three of us working in this type of hospital setting is their lack of urgency.  We have been told many times that this isn't America and we need to learn that these people don't feel the urgency of some situations like we do.  These people don't really understand urgency because everything in life here is so slow.  It is difficult for us to see a patient who needs urgent care and they sit and wait or we just don't have the ability to care for them.  Patients who are beyond our medical capabilities must be told to go to Tokoin, the big hospital in Lome.  But most of them don't have transportation and can't afford the medical care, let alone the moto-taxi fee to get there.  So most of them just go home when we've done all we can do.  The reason these things are so difficult for us is because we always have that sense of urgency in certain situations...it's hard not to.  But we keep hearing from the dispensary staff, you can't come into a world you don't understand and try to change things so they fit your ideas of the way things "should be."  Even after months of being here we are still adjusting to that.
Sometimes I glad that I work in the lab and don't have as much direct contact with patients.  But sometimes when I'm running blood work on a patient in a critical situation, especially children, it's hard to not go look around to put a face to the name.  I have also been helping with the malnutrition program that we offer every Friday morning.  This is a free program, and we work with malnourished children over 6 months of age.  Every Friday we take the child's temperature, weight, and length/height.  We have a calculation system to determine their percentile and depending on their severity we give them a follow up appointment for further evaluation.  We distribute enriched flour and sometimes milk and supplements depending on the status of the child.  The most severely malnourished children must come every Friday, but when they start getting healthier we can have them come every two or three weeks.  Some children don't return, and you assume the worst.  Most of the time the other mothers can give us information about that child.  Sometimes it's only that the mother didn't have the money for transportation to the dispensary that day, but occasionally it's that the child passed away.  That is always heartbreaking.  When a child reaches 100% of weight to height ratio we release them from the program.  This has happened many times, and it is so satisfying to think you played a roll in helping these children become healthy.  We have become very fond of one of the little girls from the program, Marie, and her mother, Christine.  Marie is at 100% and has been released from the program, but Christine still comes by our house to visit and we are so grateful for her friendship.
Back to the lab for a couple of interesting stories.
Blood group testing...
About a month ago I was doing blood group testing and I noticed a strange pattern.  I had 5 patients, and they were all A+.  To run 5 tests and not get an O is a little odd, but also having no B's or AB's made me wonder if our anti-B reagent was working properly.   So I mentioned something to our chief of the lab and he was also concerned.  We tested one of our lab techs who is AB+ and the anti-B reagent worked fine.  Just a crazy coincidence that all 5 of my samples were A+.  But in any case, I received a huge pat on the back from the chief for my observation of a potentially hazardous situation.
Lab equipment hiccup...
Monday our machine that runs blood samples (it calculates basic levels of blood components) started giving VERY inaccurate readings.  This is the only machine we have to do these readings.  It's very important since we use it every day, and doctors need results to make a diagnosis and treat their patients.  Our chief called the technician who usually does maintenance, and he was not available until next week.  Not good enough, so other technicians were called, the director of the dispensary was notified, and more frantic phone calls were made.  In the meantime, doctors were coming in asking for test results we couldn't give them and patients were waiting for doctors to treat them.  While we were waiting for someone to come to our aid, we did everything we could to try to get it working again.  We kept flushing all the internal tubing but the readings were still bad.  Our chief finally decided to open it up and look at the inside for himself.  After 30 minutes of looking at all the components (he doesn't know what most of them are) he found a large red ant stuck in one of the tubes.  That's it...just an ant. This is so funny for us because the joke around here is that you can NEVER escape the ants.  They effect a lot of the way you do things around here.  In the kitchen you must store food in a certain way, and cook in a certain way.  You set a pan down and 3 seconds later there are ants in it.  We don't have a dryer, only a clothes line, and the ants love to crawl on drying clothes.  There are so many different species of ants here, and they are EVERYWHERE!  They range from the almost invisible and harmless to the inch-long, aggressive, attacking, and biting.  The fact that our little ant friend was the big red aggressive one made it that much more thrilling when we found the cause of the machinery hiccup.  All that stress over an ant.  When we first arrived, I said that these ants were big enough to kill someone.  Well, I didn't realize in what way that would actually happen until the incident in the lab today.  In the end, we were able to remove the ant and get the machine running smoothly again.  

Hello again! We're still alive!

Hi all,
Time is flying!  Halloween and Thanksgiving passed so quickly and Christmas is rapidly approaching.  We are in a perpetual state of summer here, so it's hard to believe it's December.  We haven't posted anything in a long while, so we'll try to tell you about the important things.  Let's start with Halloween...
Adam told us his mom really loves to decorate for Halloween and that he was sad that he wouldn't be able to see his housewith all the decorations this year .  So, Ream and Leah made signs and banners and put them up to surprise him.  He was so happy and surprised when he came down in the morning and the kitchen and dining room looked like Halloween!  We also wanted to carve Jack-o-lanterns, but there aren't any pumpkins here in Togo.  However,  we did find something that looks like small round watermelons growing near the garden and thought that they might work.  Turns out, they worked just fine for carving but they taste so terrible!  They may have been oddly green, but we had Jack-o-lanterns for Halloween.  Leah even made popcorn that we tossed with cinnamon and sugar to help make it feel more like Halloween.  In the end, it may not have been just like at home, but it was really enjoyable for all of us to celebrate together.  Halloween isn't celebrated here, so people looked at us a little bit strangely when they saw our green watermelon-o-lanterns.  We attempted to explain the whole concept of Halloween and how and why it is celebrated the way it is at home, but we don't think anyone really understood much past the fact that it's a tradition for us.  It must be one of those things you have to experience to understand! And now, gli Italiani...
Two Italian surgeons, Antonio and Gabriele, arrived the first week of November.  Also, for two weeks in November, a couple from Italy, Paulo and Eva, came to teach Italian at the school.  At first, we weren't sure what it would be like to have four more people living with us, but it has turned out to be so wonderful, like having a big family!  As for our surgeon friends, Antonio is in his 70's and Gabriele is 36, and both are general surgeons.  Antonio has been coming here for one month at a time twice yearly for the last 3 years to perform surgeries for the people here.    Most of the surgeries done here are for hernias, but occasionally they will remove tumors and perform other soft tissue procedures.  All the surgeries for this year are finished and Antonio has just returned to Italy, but Gabriele has decided to stay here until the end of January to perform minor procedures that can be done with only local anesthesia.  We are very excited he is staying!  When Eva and Paulo were here,  Ream and Leah were happy to have another girl in the house, and the guys had Paulo to help them do manly things like causing mischief (ed. note: no actual "mischief" or any other trouble has been shown to have been caused.  Any mention of said mischief is solely conjecture and hearsay.  Comments or inquiries can be directed to the proper authorities.  Thank you for your time and understanding).  Thanks to Paulo's amazing cooking skills, we now know how to make gnocchi from scratch.  It has been so nice having other people living with us and sharing this experience, even if it is only temporary.  Now, on toThanksgiving...
Because it's not a holiday here and we all had to work, we decided to postpone Thanksgiving  until the following Sunday, and then because we hadn't had a chance to go shopping for the foods we needed, we postponed it again until December 1st.  When we had finally made all of the necessary preparations, we invited all of our Togolese friends and began to do the actual cooking.  We had turkey, mashed potatoes, macaroni and cheese, green bean casserole, gravy, dressing  (AKA stuffing), mixed vegetables, and "sweet potato" souffle.  Since there are no actual sweet potatoes here, we thought we would have to go without (alas, also there are no cranberries, so we didn't have the traditional cranberry relish).  However, on one of our trips to the big open market, we found a large squash that, while we had no idea what it would actually taste like, we thought we'd buy one of and just give it a try.  As it turns out, it tastes a lot like acorn or butternut squash and it made a beautiful substitute for sweet potatoes!  It was hard for all of us to be away from our families on what, for each of us, is usually a very family-centered day, but it was really fulfilling and joyous to be able to spend it with friends we have made here.  Also, we all had a chance to talk to our families on the telephone, so that made it a little easier as well.  Onwards with this narrative, toDecember...
December has been already and will continue to be a month of celebrations for our little family.  Besides the big one (Christmas), Leah's second annual 29th birthday was the 14th, Gabriele's 36th birthday was the 15th, and Ream's 24th birthday is the 31st. Of course there is also New Year's, but we'll be celebrating for Ream already.   There is not much in the way of entertainment here, at least not the types we have become accustomed to at home, but we seem to find great ways to celebrate special occassions nonetheless.  Sometimes "entertainment" can also equatae to distraction from the true reason for celebration.  The most important part of celebrating any of these holidays is to spend quality time with people that we love.  As such, we have celebrated each holiday quite well!
We are taking pictures all the time and hope to be able to post some.  Our Christmas present  to everyone, such as it is, will hopefuly be multiple blog posts (with pictures?!?) over the next few weeks.  For now, enjoy some photos that Gabriele (and also Tim) has taken over the last month.

https://www.dropbox.com/sh/nz6voi8iyu9aqzg/FQKCZ2bK9U

Look forward to posts about:
Leah's work at the dispensary
Our gardening project
Beer in Togo
Cooking and eating local food
The roof/lounge/thingamajigger of our house
Funny quotes from Africa
People we have met
And of course, photos (we hope)

As always, we love and miss you all, and your support and encouragement has been and still is so important to all of us.  Thank you for making it possible for us to be here!  God bless you all.

-Tim and Leah