Nurse anesthetist Elisa Oetting gives shots in Dtoudjena, Togo.

It’s day one of the first ever Mercy Medical Team serving in Togo. Walk through the day with us to see what it’s like to serve in a medical clinic on a Mercy Medical Team.

7 a.m. — Breakfast & Devotions

The team trickles in to breakfast around seven. On the table for us is French bread, butter, and jam. The server comes around and asks if we want coffee or eggs. Many people get fried eggs or an omelet with their breakfast. After breakfast, the team chaplain leads us in a short devotion and the missionary hosts explain a little more about clinic set up for the day.

8:30 a.m. — Arrive at Clinic

On arrival, the host missionary checks in with the local chief. Even though we have government permission to do the clinic, we need to maintain good local relationships. He indicates that he wants the team to do the clinic in a different building than the school building. The team looks at the new building and hearts sink. This new building is completely closed in with no air flow, and it’s already 75 degrees out.

The host missionaries keep discussing the situation, and suddenly clinic is back on in the original location at the school house. To get there, the vehicles follow a small path, almost a bike track, and wind up in someone’s field. The team totes the clinic supplies to the school building. The building has three classrooms in a row, with a fourth sheltered space at the end under a thatched roof. There are already people waiting for us.

The open-air school house where the MMT clinic was held.

The classrooms are full of desks, so the team gets to work re-arranging them for clinic. Some desks stay to provide space to work on, while others get moved out into the yard to make additional space. Two small lightweight plastic tables are also set up in one of the classrooms to provide additional table space for the pharmacy.

10 a.m. — Local Providers Arrive

Molly Christensen, missionary nurse serving in Togo, gets to know a local provider.

The local medical providers arrive at clinic later than originally agreed because they had to go to their regular jobs first to check in on patients. Our main local medical contact and the host missionaries negotiate which providers will serve where. This is our first MMT in Togo, so the concept of the intake station takes a while to explain. MMT members are introduced to their translators and local provider team members.

10:30 a.m. — Clinic Opening

The clinic is opened with a reading from God’s Word and a short message & prayer in the local language.

The clinic is able to be opened. President Lambon of the Togo Lutheran Church has one of the area pastors begin with a devotion and prayer for the waiting crowd. Then, introductions. The team is introduced personally and only then can the clinic start.

First stop for patients — Registration

Patients wait in line for registration.

This station is staffed by local pastors & church members who hand out registration forms and help people fill them out as many people aren’t literate.  The form asks for seemingly simple things like name and age, which turn out to not be so simple.  Many people have multiple names (one French name, one Moba name, etc.) so it can turn into quite a string of names.  Also, for people from the villages, their age may be a guess as birth dates and ages aren’t tracked very rigorously.

Second stop — Vitals

Missionary Ryan McDermott takes vitals.

Two team members and a missionary take patients’ vitals at three stations. The process of taking blood pressure, weight, oxygen saturation, and temperature is unfamiliar to many people, but they watch the people before them and understand what they need to do.

Third stop — Intake

At this station, a team member, typically a nurse, determines the patient’s chief complaint. Due to the language barrier, this station takes a little while. The patient’s answers must be translated from Moba to French by one translator and then from French to English by a second translator (typically a missionary). By the end of the week, some of the missionaries have learned enough through the translation process that they can take the health histories independently. Also, the people have a tendency to list EVERY complaint and getting to the main problem can take a while. If the health history indicates the possibility of malaria, that person will be sent for a malaria blood test before seeing a primary care provider.

A local medical provider performs a malaria test.

Fourth stop — Primary Care Provider

A local physician assistant meets with a patient for a diagnosis.

Since our team doesn’t have any primary care providers on it, all the primary care providers in the next room are local medical providers. The primary care providers look at the chief complaint as well as the patient’s vitals and make a diagnosis. They write down any treatments or prescriptions needed. If, by chance, the person is completely healthy, they will prescribe multi-vitamins so that the person feels like they received value from spending the time to come to the clinic.

Fifth stop — Pharmacy

Patients go to the third room of the school and turn in their registration sheets to one of the two team members serving as pharmacy assistants. On the first day, the pace in the pharmacy is steady but not overwhelming. There is a learning curve at the beginning of the day as the non-medically trained assistants learn about the various medications and learn to interpret the primary care providers’ handwriting. But we soon settle into a rhythm with the local pharmacy technician who does the dispensing. It’s fascinating to observe the system of tally marks that he uses to show illiterate people when and how to take the medication.

Sixth stop (if needed) — Treatment and injections

One of the nurses from our team is in charge of the treatment and injection station. On the first day, it’s set up in the same room as the primary care providers, requiring people who need injections to double back to the second room of the school. The next day, this station moves into the same room as the pharmacy, increasing congestion in that room but increasing efficiency. Common treatments include wound care and ear cleaning. Many of the injections are for malaria, as 65% of patients are diagnosed with malaria. More severe cases of malaria start with an injection of the medication followed by pills for malaria treatment.

Last stop — Prayer 

Under the small thatched roof at the end of the school, each patient is prayed for by a local pastor in their own language. The local pastors provide Christian care for patients in addition to the physical help they have just received.

A local Pastor prays for a family after they received treatment.

2 p.m. — Lunch

A traditional Togolese lunch: Rice, Sauce, a little meat, and the addition of non-traditional spaghetti.

Word trickles down the line that lunch is ready, so people at each station find a place to pause their work in order to break for lunch. Lunch is set up in the first school room. Each team member receives a bowl of local food: rice, slightly spicy sauce, and a couple of small pieces of guinea fowl. We eat traditionally: with our fingers. Each of us also gets a 1 liter soda: Coca-cola, Fanta, or a local fruit-flavored soda. We have to finish the sodas before the end of the day so that they can take the glass bottles back for the deposit.

After lunch, we resume our work stations and continue to serve the people.

4:30 p.m. — End of Clinic Day

By the end of the first day, we have served almost 200 people. We pack up the medication and supplies and put them back in the vehicles. Unfortunately, there’s no place at this location that can be secured overnight, so we’ll have to repeat the pharmacy set up in the morning, but the desks can remain in place so that set up will take less time tomorrow.

After clinic, we head back to Dapoang over rough dirt roads. It’s a relief when we get closer to the city and get on to the paved road. When we get back to the hotel, there is a little time for a break. We scatter to our rooms to get cleaned up, cool down, and rest. Some team members also contact home over the Wi-Fi and WhatsApp. As dinner approaches, many team members gather back in the open air restaurant to socialize and enjoy a cold drink.

7 p.m. — Dinner & Devotions

The host missionaries made special arrangements to get dinner served so early by Togolese standards. We are the only ones in the restaurant, but as our dinner wraps up, more people come in to get dinner. We enjoy our spaghetti and salad before moving into debriefing of the day and evening devotions. Then it’s time for bed … tomorrow will be another day filled with hard work!