Trip to Togo and Ghana

Lo que aparece a continuación sucedió cuando trabajaba para ADRA. ADRA es el acrónimo de Adventist Development and Relief Agency [www.adra.org], organización de la Iglesia Adventista para la que trabajé a partir de 1988. Esto es parte de uno de mis informes de viaje. Después de tantos años, no me he tomado tiempo para traducirlo al español. Ya veremos un día . . .

I flew out of Baltimore on British Airways on Tuesday, June 25. I arrived in London on Wednesday, June 26. I waited for about 5 hours (7:30-11:45) to take another British Airways flight to Ghana with a stop in Nigeria.

Mostly white Europeans and Americans on both flights. A Ghanaian family of mother, son, and daughter sat next to me. The daughter, 8 to 10 years old, cried all the way to Ghana (6 hours!).

I arrived in Accra at 6 PM and waited for about 1 hour to get my luggage. Tete, one of the ADRA drivers picked me up and took me to the hotel (Penta), close to the airport. By 9 PM I was asleep. I got up at 5:30 to go to Togo (nice rhyme). Teté picked me up at 6:15.

The drive was very interesting. I didn’t talk much. Tete was listening to gospel music first and then to Ghanaian music. I spent my time observing the people and the countryside. I noticed that they mostly grow corn and cassava. The terrain is flat, savanna like. Everything looked very green but I couldn’t see very many trees. I only saw banana trees in populated areas. A fine rain was falling and it felt a little on the cool side. Tete had the aircon on at full blast and I was cold for the three hours of our trip.

At the border I had to fill papers to get out of Ghana and to get into Togo. At the border crossing I discovered we had been driving along the coast. Lome is right on the Atlantic, as well as Accra. Dr. D’Oliveira’s driver picked me up at the border and took me to the hotel Le Benin. Syme and D’Oliveira joined my while I was having breakfast. After Dr. D’Oliveira made a few calls to some government officers we left for Glei (120 km to the north).

The natives in this part of the country speak Ewe (same tribe name) and I don’t know how far into Ghana and Benin. In the northern part of Togo they speak another language. The scenery is very similar to what I saw coming from Ghana. The main difference is that the European language they speak is French and their food has French influence. The road we took to Glei is the only paved road running south/north and goes all the way to Burkina Fasso.

Both in Togo and Ghana they travel in very crowded mini vans (mostly Toyota), whey they carry all kinds of things: furniture, goats, cassava, bananas, etc. People use this road to get from one place to another on foot. The driver has to honk almost continually to warm them of our passage. From makeshift stalls they sell all kinds of things: furniture, oranges, boiled peanuts, sugar cane, etc. Everybody seems to be selling something. I don’t see anybody buying. Women and children carry great bundles over their head. Frequently I see them carrying dry sticks for firewood.

About 50 km outside of Lome we begin to see teak trees. I find it interesting that the young trees have rather large leaves that make them look like a totally different species. Corn and cassava grow on both sides of the road. At every village we cross, women sell cooked food, soap and bread, along with the boiled peanuts and tomatoes.

The only cows I see belong to Mali herders on their way to the markets in Ghana. Evidently it takes them weeks and months to take their cattle to market and weeks and moths to get back home. I learn later that Togoans (Togolaises) do not raise any cattle. Their diet consists of corn, cassava (they boil the leaves and eat it as well), goat, fish, chicken and grass cutter, a kind of ground hog. I also learn that they are quite fond of dogs and cats. I don’t get to see many dogs and not a single cat all the time I’m here.

Several “outdoor” schools caught my eye and we stopped to see them the following morning. Though classes were over for the year, children had gone back to the school to help with this year’s corn harvest. They were terribly happy to see me and to get their pictures taken. At their headmaster’s request they began to sing in Ewe and didn’t stop singing until I left. It’s too bad I didn’t capture it in video. In broken English the headmaster told me they have 120 students and they need economic help for notebooks, chalk boards, etc. The school consisted of four structures with thatched roofs and no walls. The students sat on benches that were nothing more than tree trunks on the floor. Only one of the classrooms had a chalkboard. There were other schools along the road to Glei but at least they had “walls,” sticks covered with mud.

During grades 1-3 children are taught in Ewe and from then on in French. All educated togoans speak French as well as Ewe or whatever other language they happen to speak in the north.

Compared to its surroundings the hospital at Glei is Disney’s Cinderella’s castle. The hospital was built with funding from ADRA Sweden and had to be closed for lack of patients and funding. Dr. Edgard D’Oliveira and his wife Cristina began working at the facility four years ago and turned it into an ophthalmologic facility specializing in cataract surgery. Word of mouth has made it a success. Edgard studied medicine in Montemorelos, Mexico, and at the Universidad de Campina, in Brazil. Cristina studied in Brazil. Both of them specialized in ophthalmology and cataract surgery in Brazil. They have three children Juliana, Andrea and Edgard. The D’Oliveira began working in Glei in September 1992. Originally they had gone to Togo to learn French. They had accepted a call to go as missionaries to Malamulo Hospital in Rwanda. Through a providential encounter with David Syme, then the Division ADRA Director, in Togo and with the approval of the Union and the Division, they were reassigned to Togo. The Togoan government was about to take the building in Glei and have the Catholic church run it as a hospital but with the help of Christophel Blindenmission (CBM), a German NGO dedicated to the eradication of blindness in the world, ADRA was able to turn it into a much needed ophthalmological unit. Its actual name is Centro Hospitalier Adventiste D’Ophtalmologie (CHAO). ADRA Germany donated a microscope for surgery. This is a special electronic microscope that uses cold light.

The D’Oliveiras lived on the hospital grounds for about a year and a half and then they moved to Lome so their children could go to school. For this they have to travel 120 km every day. They leave their home at 6 AM and return after 7 PM. They see an average of 25 new patients and 40 “controls” every day. The “controls” are people that are under treatment or have had surgery at Glei. On the Friday we were there they had over 100 patients. According to Edgard, “With every successful surgery two people get liberated: the blind and the person that had to take care of him…”

Dr. D’Oliveira showed us around the hospital and told us about some of the patients that were there either waiting to be operated on or waiting for a follow up exam. Later we observed as he performed cataract surgery on a 70 year old woman.
“We really don’t know their age,” he said to me. “They don’t register their children until they know they have survived. I’ve had old men come to me and tell me they are 35 years old. I doubt they know their own age.”

The old woman had been totally blind for four years. By the end of the surgery (40-50 minutes) she could see the doctor’s fingers in front of her face. She was taken our of the room in a stretcher. “It’s the funniest thing,” the doctor told us, “they can walk out of here but they want the full treatment and want to be taken out in a stretcher…”

We spent the rest of that day and the next one talking to some of the employees. One of their best nurses was found by the D’Oliveiras selling bags of rice by the side of the road. Later we took her to the same spot and took pictures of her in her nurses uniform right next to the table where she used to sit by the side of the road. The pharmacist, who has turned the pharmacy into a total financial success used to wash cars for a missionary. “They lack the degree,” doctor D’Oliveira told us, “but they could work in any hospital anywhere in the world.”

What the D’Oliveiras would like to see is the hospital expanded. They need more patient wards. They need to finish work in their kitchen and they need an Agiograph (a special devise for measuring the eye pressure). Their dream is to have a mobile ophthalmologic clinic that could go throughout the country. They have two projects they would like to launch later this year: the first one is a preventive medicine program that will start around Glei and expand to the rest of the country. They would go to all the school and test all children for glaucoma and vitamin A deficiency. They figure this would cost about US$80,000.00 and would test from 15 to 20 thousand students. The entire project would take about 90 days. The second one is to perform 200 free of charge cataract surgeries for totally blind people with ADRA and CBM funding. With the help of another doctor or two, to do this it would cost about US$35,000.

Togo has a population of about 4 million. According to the World Health Organization there are 40 thousand blind people in Togo as a result of cataracts. 2000 people go totally or partially blind every year. The causes are normally high exposition to UV light and decease. In some cases is genetic.

The D’Oliveiras have seen more than 13,800 patients since the hospital open its doors. Some of the maladies include rive blindness, glaucoma (50% of the Togo population suffer from glaucoma), and reginoblastoma (tumor). Edgard and Cristina have done more than 100 surgeries outside of cataract removal. About 20% of their patients are children who develop congenital cataract by the time they reach puberty.

The hospital has 27 full time employees. The medical personnel include: 2 doctors, 7 nurses, 3 nurses aids, 2 nurse apprentices, 1 visual field technician, 1 medical technician and 1 pharmacist. What they need badly is another doctor to cover for them while they are on holiday.

“We belong to the ophthalmological society in Lome,” Edgard tells me. “They are very happy we are working in their country. They are very happy we are working in Glei. They want us to stay there.”

So effective is their work that people come from all the countries around Togo to see them. While there are five ophthalmologists in Lome, people go all the way to Glei to have eye surgery with Edgard or Cristina. “There have been days when we’ve operated on ten people. Cristina operated on five while I operated on the other five. But that doesn’t happen very often…”

The technique Edgard and Cristina have brought to Togo is called Extra Capsular Cataract Extraction (ECCE) with Intra Ocular Lens (IOL) implant. This is the procedure we saw (and video taped) Edgard do on the old woman. Using very fine instruments (and a very fine pulse) he slit a cut on the eye and removed the cataract and implanted a lens. This technique costs about US$5,000 in the US. The Glei hospital charges 50,000 francs (about US$100). The hospital at Glei is the only one using this, more advance technique, in all of West Africa. The ophthalmologists in Lome use an older technique, that requires the patient to use glasses, and charge from 180 to 250 thousand francs (US$360-500).

The following morning we watched as the doctor removed the old lady’s bandages.

“Do you see the light lamps?” Dr. D’Oliveira asked her.

“No,” she said, “but I can see the big man in front of me.” That was me taking a picture of her. “He must be very rich because he is very fat.” Which caused the entire group to laugh. After that she began to sing and dance for all of us. She was totally happy. She couldn’t keep it to herself.

Later that same day we went to visit two of the three chiefs of Glei. They were both very proud of the doctor and pleased that we had stopped to visit them. We went to visit the main chief when we saw that the flag was up in front of his house. He thanked us for the miracles the doctors were performing at the hospital. When the D’Oliveiras had initially arrived at Glei they received an ultimatum from this chief. “The previous hospital,” he said, “promised a lot of things and nothing was delivered. Now you’ve come and promise to make miracles. Because it takes a miracle to make a blind person to see.” This was right before they were about to perform their first surgery. “If that woman doesn’t see after your surgery,” the chief told them very serious, “pack up your things and leave. We won’t want you in Glei.”

After close to 1,000 surgeries all the chiefs are happy to have the hospital operating. A year later, the chief brought his brother to be operated of cataracts by the doctors.

“When we went to a convention in the States not long ago I met some ophthalmologists friends of mine. They wanted to know what we were doing in Africa. ‘Brazil is where the action is in ophthalmology,’ they told me. ‘Serious?’ I asked them. ‘Serious,’ they said. ‘How many surgeries have you done?’ I asked. ‘About nine,’ was the reply. ‘A month?’ I asked, incredulous. ‘No, not a month, a year.’ I didn’t want to tell them how many surgeries Cristina and I do a week. They wouldn’t have believed me.” Edgard told us as we drove towards Glei one day. “We could be making a lot of money in Brazil… But there’s nothing like knowing you are really needed. There’s nothing like knowing God wants you there. God wants us here.”

As we moved among the local population of Glei, a crowd gathered around us. In the middle of almost every group of “rooms” belonging to the same family, a cone shaped altar was stained with blood and ashes. I was told to be very respectful of such altars, nothing more than mortar or cement in the shape of the bucket it once contained it.

The last day I was at Glei there were 125 patients waiting for the doctors. Before we went to the hospital, Edgard took me to a textile manufacturing plant not far from the hospital. The manager was very happy to see us and showed us the entire process, from the bales of cotton to the imprinting on the fabric to the making of shirts. Built by the Germans some 40 years ago, the factory is now run by the Chinese with local workers and administrators. The doctor informed me that an employee of the factory was operated on recently and that the manager often made donations in kind and in cash. Before we left they gave us a packet with fabric for our wives. I was very impressed by the entire operation. The manager told me they could help us create a special ADRA design and manufactures T-Shirts, or shirts for us.

Arriving at the hospital the doctor took me to see a 9 month old girl that was born blind due to cataracts. Her name is Monique Bakkah. She will be operated later in the week and will be able to see for the first time. She is going to have to learn to see since at that age she should be able to have almost complete vision. “She will have to wear glasses and be operated again when she is 15 or 16, but she will be able to see just fine,” Edgard told me.

On the several trips we made to and from the hospital it was interesting to notice the number of trucks that had suffered from some malfunction. There was usually a “crew” of men doing nothing around the truck. Often they seemed to be just napping in front or under the truck. A couple of them were there every time we went by. The “crew” never looked worried or concerned. Just one of those things…

While we visited around Glei I had the opportunity to observe some of their eating habits. Everything is either boiled or roasted. Corn and cassava are turned into a mush they eat from a bowl with their fingers. No utensils were ever used. On the side of the road they sold fried fish and some other fried meats—I was told later they were rats, but I didn’t see them eat that at their homes. Everybody seemed to always be eating boiled peanuts. Their equivalent to sunflower seeds, I guess. They also roast peanuts but they like to put them in a used liquor bottle to sell. Boiled and roasted corn is also very popular.

All the cooking is done outdoors in small makeshift clay “stoves” right on the ground and some 12 to 20 inches high. Some families did all their cooking right next to their altars in more than one of these “stoves.”

Everybody was always very friendly and they loved to say “ADRA” to us, as if it was a magic word or counter sign. Children loved to have their pictures taken. That wasn’t always the case with the women. But most of them didn’t mind. Only at the clinic people looked somber and serious, I guess they thought it was expected of them to behave that way or it was the proper thing to do.

During my last day at Glei, Edgard operated on a young looking cattle herder that had come all the way from Burkina Fasso. He had been blind for two years. His brother came with him and was taking care of him while in the hospital. The hospital has room for about 20 patients but some relative has to take care of them while they are hospitalized. While the kitchen is under construction, so they can have a place to prepare the patient’s meals, the back side of the hospital has a row of little “volcanoes” where meals are prepared. By the end of the surgery, though he doesn’t speak the local language or French, he indicated that he could see the doctor’s fingers in front of his face. When his brother was brought in to translate, he confirmed that he had been able to see the doctor’s fingers. I could see in the brother’s expression that he was delighted.
On Friday Syme went back to the States through Accra.

Saturday I was picked up by Siegfried Mayer and his wife Ellen. Siegfried and Ellen are from Chile and have been in Togo for a few years. He is the Sahel Union president and Ellen is the ADRA director. We went to a newly formed church that meets in what used to be a warehouse. I’m told all they did to turn it into a church was build a platform and the baptistery.
I felt relieved when I found out they were from Chile. They could translate from Spanish into French for me. My relief turned into dismay when I realized that everything was being translated from French to Ewe.

“Are we going to have two translators?” I asked, quite concerned.

“No,” Siegfried told me. “You will preach in English and someone will translate into Ewe.” That’s precisely the way it was done.
The D’Oliveira family went to the same church and we were invited to the Mayer’s home for lunch after church. We spent a lovely afternoon speaking “portuñol” because Cristina doesn’t speak English and I’m as fluent in French as in Klingon.

That afternoon I learned how much the Church is behind the efforts of Edgard and Cristina in Glei. Siegfried told me in no uncertain terms that the work of the Church has been enriched by the ministry of these two dedicated doctors. There are only about 3,300 Adventists in Togo, about 60 in Glei. But these numbers keep growing. The light of Glei shines through every successful surgical procedure. The light of Glei shines through the ministry of Edgard and Cristina. “We don’t know how long we are going to stay in Togo,” Cristina told me. “We need to think about the future of our children. But we don’t want to think about it now. There’s a lot to do in Glei. There’s a lot to do in Togo.”

On Tuesday I was taken to the border by Dr. D’Oliveira’s driver. I had to show my passport and fill up papers at the Togo side and do the same thing at the Ghana side. After a few minutes the ADRA driver showed up. “ADRA” everybody around me began to say.