She assured me she would return for any subsequent appointments as necessary. The 8-12 hour journey (pending traffic) was not too far if only we could help her.
She had come all the way up from Lome to seek treatment at Hospital of Hope. She's not alone, nor has she traveled the farthest. Mango, Togo is at an international crossroads and has a catchment area extending beyond Ghana through Cote d'Ivoire to the East, beyond Benin through Nigeria to the West, to the coast in the South and through Burkina Faso to the North. For some, the journey just to arrive at our gates has taken days. This is then followed by days of waiting at the gates to be granted their turn for rendevous. The process is painful for everyone involved, some more than others.
There is an occasional ambulance, but used only for transport of a patient from one hospital to another, and to be honest, that is only just what I've been told. I have yet to see an ambulance in action. In general, to get to the hospital one is reliant on personal assistance and transport
Remember Memouna? After being run over by the moto, she had been transported to HoH, broken bones and all, on the back of a moto.
To respect the lengthy distances that so many of our patients have traveled, there is an area within the hospital gates that is referred to as the cuisine. It is a congregational area of living for discharged patients that still require treatment and follow up. Instead of making the long journey to return to their village, to then turn around and make the same long journey to keep their follow up, they can stay on site until released from care completely. From a surgical perspective it also allows us to discharge patients that still require daily IV treatments and/or daily dressing changes. They are able to stay in the cuisine and have family wheel them or carry them up to the hospital or clinic for their daily medical needs.
I had scheduled a patient for a procedure the other week, but when I could not give him a sooner slotted time, he changed his mind, not wanting to wait or accept the cost of staying in Mango for the extra week. Acknowledging his right to refuse treatment, I instructed the accountants to return the depot he had paid. It wasn't but a few hours later, he had returned. He had called home to let family know he would be returning, and discovered it was no longer safe for him to make the journey. Therefore realizing he was needing to extend his stay in Mango anyways, he had reconsidered the procedure.
Along the same lines, when a patient did not present for his electively scheduled procedure the other day, we called to investigate. He apologized but explained his village was currently surrounded, making any sort of exterior travel not safe.
Back in Indiana, though never questioning a patient directly, if anyone had traveled more than an hour, I internally pondered why they hadn't sought medical attention closer to home. With clinics and/or urgent cares in nearly every other small town, and multiple hospital options sometimes within a radius as small as 20 miles, Americans have the ability, blessing, and/or privilege (pending your perspective) to essentially shop for their medical care. I hold that in contrast to my patient from Nigeria that traveled for a week to get to our hospital for care. A trauma that may have been effectively managed if treated immediately, now a long drawn-out slow prayerful process of healing due to the delay in treatment. Furthermore, I don't even blink an eye when I triage a patient to rendevous during the following week, and the tech/translator gently points out that they came from Ghana, and could we possibly squeeze them in sooner.
I tend to get comfortable and settle into the world around me. What is commonly acceptable and normal determined by the status quo at that moment in time in that particular environment and culture. Perhaps nothing is wrong with that. But I find, it makes change and the willingness to speak up for change difficult. The world is bigger and more diverse than any status quo, and Jesus' love infinitely bigger than that. An occasional reminder to continually work to expand my perspective is healthy.
Even if that reminder comes in a physical sense of climbing a tree to give me a literal new perspective.
May we forever respect the beauty and value in each human life and the incredible world that the Savior has created for each one of us.
Appreciating the difference in perspective held even by the small villages that dot the horizon along the edge of the cliffs versus the villages that dot the floor of the valley.
Much Love.
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