Report 2

Reporter: Mireille Captieux

Contact at destination: Le Directeur, Yorouba Sémenou, CHU, Lomé, Tokoin.

Year of visit: 2011

Country: Togo

Region: Lomé

Institution: CHU Hôpital Lomé, Togo.

This is the largest hospital in Togo. It is in the centre of town, Tokoin. It is also the teaching hospital for Togolese medical students.

Department Neurologie for 1 week, Pédiatrie for 1 week, Urgences for 1 week and Les maladies infectieuses.

Work / Study undertaken:

I went on the ward rounds and could attend any clinics I wanted. Where I was taught to write out discharge slips in French, wrote prescriptions under supervision and did histories and examinations. There was not a lot of opportunity for practical skills such as putting in IV lines as these was all done by nurses and nursing students. There were a lot of opportunities to learn how to do lumbar punctures though. You can sometimes feel pressured to do more than you are qualified to do, as the hospital is under-resourced and the medical students have a much more active role in Togo, so you have to remember you are not qualified!

 Description of the destination:

Were the local people friendly?

Yes, as a Western foreigner I attracted a lot of attention. However, it was never threatening and people are genuinely friendly and will strike up a conversation at any opportunity. Although, I did get asked about whether I could get them a Visa to UK many times. So, unfortunately, it is sometimes hard to know if people like you for yourself or because they believe you are a link to a job in UK.

Did you feel safe and if not why not?

I did feel very safe and had no problems during my month there. Like most countries I would not have felt comfortable going out late at night, mostly because street lighting is poor. My flatmate did have her rucksack stolen when she put it in the boot of a taxi, however the police and tax driver did track down the thief and she got all of her belongings back and an apology from the thief! Transport is mostly by taxis and motorcycles. Most accidents happened on motorcycle, as helmets are not provided and the streets are very chaotic. If possible, try and avoid the motorcycles and if you do take them then make sure you cannot smell any alcohol on your driver’s breath, as drink driving can be a problem.

 What did you do in your spare time? Togo is a small country so a month is plenty of time to explore the beautiful rural north. I went on weekend trips to Kpalime, Kara, Togoville and even Ghana. During the week I visited the marché which is an Aladin’s cave of trinkets, clothes and jewelry. There is also the public beach which is beautiful but I did not swim in it as you can often spot someone using it as an outdoor toilet! There is a private beach called Crystal beach about 20 minutes away by taxi where you can swim in the water and enjoy cocktails or food on the beach. Every Tuesday night, Greenfields a restaurant/bar on the road next to the hospital shows films in its outdoor terrace. The films are either French or English dubbed over in French. Every alternate Tuesday they do a deal where your entry fee includes a Margherita pizza and drink. As an aside, the pizzas are wonderful- stone baked in the outdoor ovens. There is also the Centre Culturel Francais in town which show French films and host various events throughout the week.The town is very hectic so when I wanted some time out and a break from the heat I went to use the Hotel Ibis’ outdoor swimming pool, which you can use for the equivalent of £5. Church is a big deal in Togo, so even if you are not religious any friends you make in Togo will insist that you come to church and even make you a traditional Togolese dress for the occasion! Church is very different there and just walking down the street on a Sunday is an experience with everyone dressed in traditional Togolese clothes and the sound of enthusiastic singing and dancing emanating from the many outdoor churches!

Is there anything that you would particularly recommend others to do?

I would make sure to take time to explore the north of the country. Lomé is the only real city in Togo, so it is not really representative of the whole of Togo.

What time of the year were you there? What was the climate like?

January. Sunshine everyday and temp 20-25c. There were occasional days of rain but this was refreshing! Depending on when you go there are dry, wet and windy seasons.

What was your accommodation like?

I stayed with a local family, a baker in Attikoumé. I had my own room which had a double bed with a mosquito net. I also had a small desk and sofa. The only downside I would say is that the bakery came to life with a bang at 3am so earplugs were essential!

Was it provided? No

If not who arranged it?

I arranged through an African-based charity that arranged medical placements and home-stays. The charity was recommended through a friend that had used then when she had gone to Togo on elective.

How much did it cost?

$375 for the month, it included meals and I had my own room. The price was also meant to include them setting up my placement, but this fell through and was very disorganized. So I would contact the hospital yourself and maybe see if you could organize a homestay for a cheaper price.

Did you enjoy your visit?

Yes – but 4 weeks in Togo was enough. Working in a hospital where you are constantly confronted by the reality of an under-resourced health service and frequent deaths is really frustrating as there is little you can do as a medical student.

Did you find the visit useful medically? – in what way?

The medicine was extremely different to what I would have seen in the UK. I saw much more florid signs, symptoms and pathology. However, you also see the management of diseases relying much more on the clinical history and examination. There is also an absence of clinical protocols so the ways a patient is treated depends on the individual doctor, and you will often be called upon for your own opinion and so you can sometimes contribute to a patient’s management. Some treatments are just not viable for certain patients due to financial reasons, which can be very hard. Apart from anything else, it was really valuable for me to observe the reality of health care in a developing country.

Has it improved your French?

Yes, immeasurably. The standard of spoken and written French is very high. Not only did I improve my medical French, but the doctors are so patient and kind that you never feel embarrassed or awkward if you ask them to repeat something again. It is also very easy to get individual French lessons for up to 4 hours where a teacher comes round to your house, this is much cheaper that you could get in UK so no excuse not to improve your French!

How has it increased your knowledge of French culture?

Yes, although, the Togolese do not generally like the French. I suppose you hear a lot about the grievances of a former colony. The presence of the colonization is still very evident, croissants, baguettes are all a staple food in Togo. You also see many grand hotels and monuments but they have mostly fallen into disrepair.

If you went back would you do anything differently?

I would organize my elective directly with the director of the hospital and only use the charity for the accommodation. The charity is not bogus, but they are very disorganized which is not what you want when you are organizing an elective.

How did you get there?

Air Travel: Brussels Air (Heathrow-Brussels-Lomé)

What was the approximate total cost?

£400 on flights, £335 on food, accommodation, transport costs are negligible. Living costs are really very little once you are there. I took out £200 when I was there and still had money when I came back and I spent a lot on travelling and a visa to Ghana.

Is there any other information that you think may be useful?

There is very little about Togo in the Lonely Planet and it’s not really a tourist destination, so Togo is really very exciting to visit. I would use online travel guides from former travelers to Togo to help inform your trip! Other little things, they use French adapters, don’t drink the tap water, internet connection is slow and usually does not support Skype. So buy a cheap phone and Togo sim card while you are there and give friend’s and family your number (however it is very expensive so they will probably need to buy an international call card)