Off to Sierra Leone soon…

Many of you are likely to know that I’m off to Africa again in February.

Mercy Ships, the NGO I worked for in Togo last year have asked to take me on again for 8-10 weeks in Freetown, Sierra Leone this year. However this time, instead of photographing a variety of requests from the many offices across the globe I will be photographing with the aim of producing a book and exhibition for them to use for fundraising across the USA and the UK. That creative process will start after my third field service with them at some point towards the end of 2012. I will of course not be profiting off of this.

Meanwhile, despite this privileged position I am still a volunteer and am fundraising for Sierra Leone to pay for my flights and basic board and lodgings. This total is $3000 and I’m just over half way there. If you would like to hep in any way do please donate here. If you are not sure about donating to this direct link online then get in touch with me for another way: info@tom-bradley.com.

To remind you of some of the work that Mercy Ships did in Togo here are a small selection of pictures that I took there.

Gafar, an 11 year old boy with a large benign tumour. As Dr Gary Parker the chief surgeon points out this is almost worse than malignant tumours because it is a much slower, painful death that leads to all sorts of stigmas and social exclusion. Some tumours on the neck and mouth are even worse because they result in very slow starvation. Gafar was practically a mute before his surgery. His eyebrows didn’t so much furrow from worry as weigh heavy at the sides from the past few years of misery.

Gafar lies under anaesthetic, post-operation. His tumour has been removed, and he now has two weeks of recovery in the ships’ wards to look forward to.

Gafar and Tani play in the hallway of the hospital floor. Gafar is a strikingly different human being, mischievous and fun. Tani, a young patient who is undergoing several long-term operations suffered severe burns to her face. Neither show any sign of concern of the physical changes they’ve gone through, but are simply basking in the wake of the slow deaths they escaped.

In 2010 the Africa Mercy was docked in the Lome, the capital of Togo. The ship has a number of 4x4s for getting around the city which are regularly used by medical staff during the day to ferry patients to and from the ship and the hospitality centre in town.

The hospitality centre in town was a building that Mercy Ships used to let patients stay in care and recover a bit longer without crowding up wards on the ship. It also served for most of the eye patients that needed tests and correctional treatment.

Many of the Africa Mercy’s 450 crew don’t get to meet patients of help with Mercy Ships’ prime mission on a regular basis (they are busy in the keeping of the ship). So day trips are organised for them to spend time with the locals that Mercy Ships sets out to help. Here a young boy from a special needs school for the mentally disabled plays with a carpenter and a shop assistant from the ship.

The orthopaedics team often deal with the younger patients, whose deformed legs or feet are usually easier to mend than older ones. A child born with club foot is caught early and the large remainder of their physical development continues like any normal person. Here a particularly young boy does not like his correctional shoes put on to ensure the correct growth of his bones after the club foot operation.

Vision trips are made up of a team of people from developed countries, often generous donors that wish to see the cause they are supporting from afar. One such team from a church in Texas brought bags of cuddly toys for the patients. This lucky recipient being held by a nurse doesn’t seem to be quite as pleased as her mother on the ward bed behind her.

Sassou was born with a growth behind his right eye. As it grew, pushing against and slowly killing his eye, his father spent most of the families money on doctors to cure him, but to no avail. His teacher suggested Mercy Ships when they arrived, who quickly agreed to operate. To Sassou life is no different now to how it was before. He still can’t see out his left eye, but he no longer has a time limit of a few years on his life.

Mercy Ships cannot operate on everyone that comes to them. There are so many patients wanting care that priority must be given to those that are sure to recover successfully. So cancerous patients are not offered operations. However for a few nearby terminal patients they provide a palliative care team. In this case Ayabavi, an old lady with very late stages of cancer that started with the enormous tumour on the side of her head receives a wound change from Harriet. The team also provide painkillers, social care and advice on how to look after themselves once Mercy Ships have gone.

Lucie Amedji is also a palliative care patient, with a malignant tumour on her right eye that has spread through her body. It has been extremely painful and the painkillers that Mercy Ships provided have alone made her life bearable once again. The supply of drugs that the palliative care team provides will run out a couple of months after their last visit (which was the beginning of August 2010). The cocktail of painkillers she requires costs in the region of $60 a month. Her church community who provided much support throughout Mercy Ships’ Togo field service cannot help her financially. She earns an average of about $1 a day.

Kossi was a patient near the start of the Togo field service. Surgeons removed a large benign tumour from the side of his mouth, which was slowly suffocating him to death. His father was so grateful that he invited us to one of his services, where he is the Pastor (front figure). It was outdoors in the evening, and at just an hour very short for an African Christian service. He breathed fire and brimstone in the sermon, and the congregation, all seated in a circle got very animated towards the end of it. Kossi is the boy seated on the right in the light blue and white shirt.

Mercy Ships teamed with Bethesda of Benin, a fellow NGO, to create the Food for Life Agriculture Program. This photo is of the second graduating class so far celebrating the end of the course with traditional song and dance. They underwent a 16 week course where they learnt about biological agriculture and how to manage and market a farm. Now they not only have agricultural knowledge, tools and skills, but they can pass on their knowledge to fellow Africans to improve farming practice in their local areas.

Three stories of palliative care

In June I posted about Ayabavi, one of the terminally ill cancer patients that Mercy Ships was looking after. In August myself and Claire visited her along with Harriet and Alex on their last visit. The two weeks previous I also tagged along with the palliative care team visiting two other patients; Lucie and Eklou. The following are very briefs accounts of the effects that the cancer and Mercy Ships has had on their lives, followed by a series of portraits and stills showing where and how they live.

Lucie Amedji

When she first noticed the lump in March earlier this year she felt fine, she was selling second hand clothes on the roadside. It soon got very painful, and she realised her sight was diminishing. As it grew larger her sight went completely. The doctor gave her some eyedrops, but didn’t even mention removing it. She carried on working.

On a visit to Aneho to pick up more of the eyedrops they had another look and told her they couldn’t do anything, sending her to the general hospital in Lomé. They informed her they could do surgery, but the cost was far more than she could afford.

Lucie lives at the Auberge du Lac, a backpackers on the beach of Lake Togo, owned by her Uncle who lives in Germany. He came back to see her and got in touch with Mercy Ships, arranging for her to go to one of their screenings.

She learned about the cancerous nature of the tumour from the doctor on board the ship.

Each week Harriet and Alex bring her painkillers, bandage dressings and fruit. They counsel her, and try to help her cope with her short future. I’ve mentioned before that they often read through the bible with their patients, suggesting areas that may provide comfort. The three patients I’ve photographed in this post are all Christian, and all expressed to me their appreciation for the palliative care team for reading through the bible with them and the prayers they share.

Lucie gets visits from her pastor and members of her church each week. She is grateful for the moral support and friendship they’ve shown. The pain relief the drugs have provided have made an enormous difference in her life. It is this that concerns her most about the Africa Mercy’s Togo field service ending. Without them she is in constant agony, totally immobile and would surely not live long. While she can carry on taking them she has been able to resume her job selling clothes. Without the pain she has been out and about more of recent, and has a certain joy she hasn’t felt in a while.

The supply of drugs that the palliative care team provides will run out a couple of months after their last visit (which was the beginning of August). The cocktail of painkillers she requires costs in the region of $60 a month. Her church community cannot help her financially. She earns an average of about $1 a day.

Lucie.

Lucie and her father.

Looking through Lucie’s front door.

Lucie’s house.

Lucie talks to her cousin.

Lucie and her niece.

Lucie waits for her father.

Electricity cables above the TV.

A bar stool keeps the tap closed.

Fisherman fold their netting after their morning catch outside Lucie’s house.

Eklou Gnakou

He’s had a tumour on the right side of his face for many years now. It’s been operated on twice, both times by Dr. Amaglo, a local surgeon that has worked on the Africa Mercy before.

He owns a plot of land which he used to farm and sell the produce. He carried on working after the first operation, but after the tumour grew back and was removed a second time he was too weak, and had to stop farming.

He heard about Mercy Ships and went to a screening where he was told that he couldn’t be operated on again – it was malignant. He still asked to be operated on even then, but after talking with Harriet he understood, and realised it was futile.

He is extremely grateful to Mercy Ships for a number of obvious reasons, but partly because he would have paid for a third operation which he now knows wouldn’t have got rid of the cancer. He’d like to take the hospital he was operated on to court, partly because they should have told him the operation wasn’t enough, partly because they waited a year before he got the results of the operation.

Money has been an issue for him since he stopped working on his plot of land. He has seven children, four of which live at home. At the moment he is able to feed them all and send them to school, but his eldest son Kofa, 14 works constantly in their garden to make sure food is growing. Kofa tries not to think about his father’s illness. He says that he feels sad when he does, and he doesn’t want to think about who might provide for the family after his Dad has gone. At the moment he can see that his father’s in much less pain than he used to be, and they’re managing at the present.

Though Eklou is more able to work with the drugs that the palliative care team provides, he does not have the money to start up the plot of land he farmed on before. He owns it still, but cannot afford to use it. He needs help from a microfinance organisation, but because of his cancer will almost certainly get turned down.

In an understandable attempt to get rid of the cancer a rich Uncle is paying for him to have radiotherapy in Ghana. Radiotherapy usually shrinks the tumour quite quickly, but if there’s any trace left it will grow back rapidly. There is little chance that the radiotherapy will work, but Eklou is hopeful. – the doctors there have told him that after treatment his cancer will be gone forever.

Eklou talks to the palliative care team.

Eklou’s children leave their toys in the yard.

Eklou explains his concerns for his families welfare after he’s gone.

Alex listens with concern.

Eklou with some of his children.

Kofa and his younger sister.

Harriet’s medical kit.

A blackboard that Eklou’s children use at home.

A stopped clock in Eklou’s bedroom. Despite being Christian, his wife is obsessed with voodoo.

The patch of land in Eklou’s yard that he and his son Kofa maintain.

Ayabavi Fiodegbekou

Before she attended a Mercy Ships screening Ayabavi was pushed around various health clinics, having tests and examinations delayed. Her tumour was very painful, and it was bleeding to the point where she was feinting. Eating was getting harder and the situation was clearly getting desperate. Her daughter heard about Mercy Ships screenings taking place in Aneho; they examined her, taking her to the Africa Mercy to get her tumour scanned. She was told that it was inoperable, but they could provide a palliative care team to help here deal with the pain and help her live the end of her life with dignity.

Before they started visiting she was treated as somewhat of an outcast due to the smell that the tumour was causing. She was weak, barely strong enough to walk 20 metres. She had needed a lot of help just to make it up the gangway on the ship.

The drugs, painkillers and dressings have helped enormously, stopping the smell, and giving her strength and her appetite back. Harriet, Alex and their translator (for the first few months) Sylvie have all become good friends of hers.

Her daughters are grown up and help look after her, changing her dressings when needed, and making sure she’s happy. She spends lots of time with her grandchildren, and will sit down and chat to other people in her village now that the tumour doesn’t smell. She’s taken Harriet’s advice about the best diet to have, but making sure your diet has plenty of vitamins is no comparison to the drugs and painkillers the palliative care team provides. Like Lucie and Eklou, these will run out a few months after the Africa Mercy has left, and she doesn’t know where she will be able to acquire more.

Ayabavi.

Ayabavi’s daughter Tante dries her eyes behind her mother, as the palliative care team talk about life after the Africa Mercy leaves Togo.

Harriet and Ayabavi’s daughters change the dressing on her tumour.

Alex plays with Ayabvai’s granddaughter.

Below three: Stalls at Ayabavi’s daughter’s shop where the palliative care team meet her each week.

Ayabavi prays with Harriet, Alex and Sylvie.

Ayabavi in her house.

Ayabavi’s room.

Ayabavi with a photo I took of her on my previous visit.

Ayabavi leaves the complex of houses where her home is.

The palliative care team in Togo was Harriet Molyneux, Alex Williams, and their translator Sylvie, then Komlan. They provide counselling and advice on how to live the remainder of their life, and are willing to pray and read the bible if the patient wishes. They can provide drugs and painkillers for as long as the ship is in dock and a few months more. The ship’s primary function is to provide surgical care in the areas of Africa where it is needed most. It left Togo to undergo five months of repairs and maintenance in South Africa, extending its service for another 30 years. Mercy Ships can’t help everyone, and leaving an area like Togo where they could clearly carry on working around the clock for many years will always be painful. However Togo is not the only country in need of their services, and once the ship is finished (hopefully in February), it will be going up to Sierra Leone to start a 10 month field service. I’m hoping to join them for a month or two out there.

One can only hope that Lucie, Eklou and Ayabavi leave this world without pain and with dignity.

(L-R): Komlan, Claire, a grandson, Harriet, Ayabavi, a grandson, Sylvie, Alex, Tante and a granddaughter.

Leprosy Eliminated? Togo

MAHAMADOU KEFAS

Mahamadou was 20 when he got leprosy. I spoke to him at Koloware’s Centre de Sante, formally Centre de Lepreserie, a Catholic Mission near Sokode in Togo, West Africa. He was born in neighbouring Benin, and was working on a farm in Anie with his father when he noticed a cut on his arm that he hadn’t felt. He realised that his entire body was going numb. I spoke to him as he sat in his wheelchair outside the wound care room where Tchedre the nurse was doing dressing changes for several patients at 7.30am on a Friday morning. Most of the patients who were due to have their wounds looked at had not turned up due to heavy rains that morning. This is not uncommon, but unchecked wounds do get worse. Stones often turn up in foot wounds and infection sets in very quickly. It is these infections that result in rotting flesh that drops off or requires amputation, leading to loss of digits and limbs.

Mahamadou told his father about the symptoms and was taken to a hospital where a doctor correctly diagnosed it as leprosy. He was due to go into the local clinic near where he lived in southern Togo three times a week for injections. However continuing to work on the farm he suffered more cuts which started to get infected. Word spread that he had leprosy. No-one would hang around with him anymore. If he went out people would shy away from him. He told me that his friends would see him then simply turn around and run away. He lived with his father who stuck by him, but the rest of his relatives did not visit or speak to him. Eventually he stopped going out completely. The only people he spoke to for several years were his father and the doctor. His Uncle heard about Koloware and his father brought him up to the Leprosy Centre. His father visited him every Saturday for 4 years before he died.

He now lives in a small room in a compound with a total of five rooms, each housing a patient. He is the only one of them that does not have family. The leprosy bacterium (Mycobacterium leprae – closely related to tuberculosis) that causes the numbness is no longer active in him. He has no right foot, no digits on his left hand, cannot feel any part of his body, is blind and according to the World Health Organisation does not have leprosy. He has lived in Koloware like this, relying on food and support from the sisters of the Catholic Mission since the 1960’s.

Above and below: Mahamadou eats alone in his room. He is blind and can’t feel what he’s touching, so makes sure his food bowl is always in the same place between his legs so he knows he’s picking up food. He has no fingers on his left hand, mainly from burning his fingers while cooking during early years at Koloware.

Above: Mahamadou gets a check up every few days at the health post about 40 metres from his house. Missed appointments in the past have lead to the types of infections that took his right leg away from him.

Above: Mahamadou is numb over almost his entire body.

TCHEDRE WALLAKASONA AND THE KOLOWARE LEPROSY CENTRE

Tchedre’s Uncle was a nurse at the Leprosy Centre and encouraged him at 17 to come and work here. He soon learned that despite much help being needed for the 300 ‘lepers’ (at the time) at Koloware there were very few doctors who would even go near them for fear of contracting the disease. The sister who was in charge of the mission at the time saw potential in him and with the private funding that the centre gets from European (primarily German these days) individuals sent him to the nearest town, Sokode to get trained as a nurse.

Despite retiring 5 years ago, he still comes in three times a week to check and clean the wounds on many of the patients. He described the attitude of many of his patients as like that of children: “Every day you must bring them in to take their medicine, or get dressing changes. But they can’t feel the pain, and I see them handle red hot pans with their hands. If they have work to be doing at home (such as cooking, or even farming for the few that are able) they choose that over coming in for their check-up. When they do come in I sometimes see stones lodged in their wounds (causing infections) because they haven’t been checked in several days. I even tell them not to go into the field to work after I’ve changed their dressings, yet they do and get dirt all over them”.

He is dealing for the most part with the very poorest people that have received no education. Sometimes it is hard to have sympathy for those that don’t seem to want to help themselves, but in the cases of these men and women their priorities are always going to be food, water and whatever family is still around them above a cut that does not affect them at present and that does not feel painful. Such is their way of life. Tchedre obviously cares enough to carry on having retired.

He told me that in the central region (where Koloware is located) about 50 people get diagnosed with leprosy each year. It’s not exactly a ground breaking figure, but such a feared disease also means that many will be hiding their symptoms – like almost all of those that attend Koloware Health Centre once did. Women especially suffer from this – if the husband doesn’t throw them out outright they’ll almost certainly be hidden away for fear of bringing shame on the family. Leprosy is not a fast acting disease, developing over many years. But with most of the people that get it ignoring the patches and numbness out of ignorance or fear, the later stages are often reached even in these current days when the Multi-Drug Therapy (MDT) cure is readily available worldwide.

They are able to take the drugs at home, only coming in to Sokode (where the central region’s leprosy advisor is) to pick them up and for the occasional check up. But too many times have professional, trained nurses in Sokode hospital refused to touch those with the disease, helping fuel the stigma. Many patients are sent to Koloware for these dressing changes. With the exception of the foreign missionaries (like the director – Sister Antonietta from Italy), all the staff in the health post have been born in Koloware and grown up around those with leprosy. However even in Koloware there’s fear about the disease, despite being educated in how easy it is to cure if caught early.

Just a few weeks before I arrived some farm-hands had seen patches on a sixteen year old co-worker. They suggested it was leprosy, but the boy covered them up with his shirt insisting it was from a voodoo curse that was put on him – the more bearable burden. Fortunately they confronted him later and he agreed to go for a diagnosis at the health post, where they confirmed it was leprosy. Within two weeks he was no longer contagious; however he will need to make sure he continues taking the MDT for at least a year before the bacteria has completely been eliminated. His colleagues had caught the disease before any nerves had been killed, but if they hadn’t the numbness would remain for the rest of his life, and he would have to be extremely careful as a farmer that those areas of anaesthetised skin don’t get damaged.

There are only a couple of the ‘lepers’ that attend the markets – when people from all around the village come to sell, buy and trade in Koloware. They fear being shunned and rejected. Those that have small businesses rarely attend their own stalls, knowing people will not buy from them. They instead get family to sell for them. Others have little choice, hoping the busyness of the market will pull attention away from them they go about buying the food they must have to survive. Since the leprosy post was founded here 63 years ago there has been only one marriage between a ‘leper’ and a ‘non-leper’. Social mixing is relatively uncommon.

Above: Patients wait outside the Health Centre for dressing changes and check-ups.

Above: Assistants from Koloware help patients clean out infected wounds under the tap before they are looked at by the nurse.

Above: When you can’t feel your feet you can’t tell when your feet get too big for your shoes or when they are crushed. Permanent disfigurement can make walking extremely difficult.

Above: Tchedre Wallakasona, who has worked at Koloware since 1967 and despite retiring five years ago still comes in three times a week.

Above: Tchedre examines a regular patient while a child looks through the curtain from the room next door. The Health Centre now attends other diseases and injuries as well as leprosy, it’s main purpose when it was founded over 60 years ago.

Above: A ‘leper’ makes twine to sell to bind straw onto roofs. I saw a few patients doing this job even though few have fingers, and some are entirely blind.

Above: A patient passes the time with a rolled up cigarette.

Above: This man has been blind for over thirty years. He also spends much of his time making twine for roofs.

Above: Leprosy affects the eyes in a number of ways that can result in blindness. In this case it has prevented the eyelids from closing and protecting her eyes from dust and dirt. Tchedre is reaching out to her and berating her for missing her dressing change the previous morning due to the rain.

Above: A ‘leper’ buys vegetables from the Saturday market.

Above: Outside the Mosque at lunchtime on market day, a faithful patient must remove his prosthesis as well as his footwear before entering.

AISSATOU ASSOUMANOU

Aissa was brought up in Sokode, red patches started appearing on her face and she was diagnosed with leprosy. She was 12 at the time. She started the treatment, but stopped going when she was married at 13. Her husband told her it brought shame to the family, so she pretended she had never had it. In the next few years she gave birth to a boy and girl by him, but patches started to appear again in her late teens and her husband left her. “I was sad” she recounted wistfully, “but not because he left me, because the leprosy had come back again”.

Her parents took her to Koloware where treatment began. After four years of living in Koloware and taking the treatment she got married again, to a fellow ‘leper’.

“While I was with my second husband, my first one came to visit me. He saw I had built a life around me and was happy. He was jealous and angry. But I wasn’t going to go back to him, even after my second husband died from leprosy.” Her second husband had built a home for her and their two new children, but after his death a storm destroyed it while they were sleeping. She managed to get her children out before the roof collapsed in on them. The director at the time helped rebuild her house with the funds from private donors. Of her four children three are living in Cotonou in Benin, and one in Sokode. She sees them once a year after the Islamic festival of Tabasci.

She is lucky in that her leprosy injuries are easier to hide than others, and she sells a few things on market day; ground nuts, cigarettes etc. “I used to sell much more, biscuits and sweet snacks. However over the years my custom has got worse. If the director didn’t provide me with ingredients to cook with I wouldn’t have enough to feed myself”. Last week the patient living in the room next to her died. She will use the room to house her chickens until somebody comes to fill it up.

Above: Aissa thinks back through her life as my questions brought up past memories.

Above: The courtyard where Aissa lives. Her room is one of those on the block on the right.

Above: Aissa cooks in the light of her doorway, away from the spitting rain outside.

Above: Aissa emerges from the doorway of the room next to hers. It was vacated last week by its owner who died of infections from leprosy. She keeps chickens in it now.

Above: The infection on the bottom of Aissa’s foot. She is glad that it is easily concealable.

Above: Aissa sells groundnuts and other snacks at her stall outside the yard where her room is. She used to sell much more, but business has not been good in recent years.

I only had two days to photograph in this small village. I wish I had been able to spend more time and properly got to know the lives of these social outcasts. I am trying to document leprosy in several different countries worldwide, to show that such an ancient, well-known and easily curable disease has not been eradicated because of the vastly disproportionate wealth distribution across the globe. It can only survive in people with poorest immune systems where poverty is rife, and will continue to destroy the lives of those it inhabits due to the lack of education and stigma that surrounds it. The project is entirely self-funded, and I plan to fund my own exhibition to raise awareness. If you can help in any way, with finance or advice, then please do not hesitate to contact me – info@tom-bradley.com. My leprosy work from Nepal and Nigeria is on my website – www.tom-bradley.com.

Central Togo: The Koloware Health Post

The trip up to Sokode went as far as I was concerned pretty smoothly. Dodji and I left the house at 6 in the morning and went straight to the bus station where I bought us tickets up north to Sokode. I’d travelled on plenty of local buses in various part of Africa before, so wasn’t surprised that we had to wait for over an hour for the bus to leave at 7.30am. I also wasn’t surprised that it didn’t in fact leave until 8.30am. In fact I was pretty happy it was only delayed an hour. In Zambia I once had to wait 8 hours for a bus to leave after its scheduled departure. Naturally we were crammed into the bus, 20 in a 14-seater bus. Raymond (having lived in Sokode for three years) had promised the journey would be about three hours. I remember smiling to him as he said this and suggesting that perhaps it would be therefore more like five or six hours. I received a hurt look in return and bit my tongue from explaining the western take on time in Africa.

Regretting my smugness we arrived in Sokode at 4pm. There weren’t even long delays, we stopped every now and then for travellers to answer nature’s call and satisfy their snack cravings as well as allowing a poor young mother on the bench behind me to clean her vomit from her and her baby’s clothes. Malaria apparently.

After directions from a pastor-friend of Raymond’s to Koloware, where the Catholic Mission Leprosy Centre-turned Health Centre is located, we hopped on zimis for the pleasant journey through beautiful lush-green Togolese countryside. The villages were beautiful, with noticeably less rubbish than near the cities and stop-off points on the journey up. The wind blowing in my face was warm but not to humid, the clouds ranging from bright white to thick black, divided with crackled lines, a sky that had Ride of the Valkyries as its soundtrack. Raindrops fell lightly and sporadically bringing the temperature down perfectly.

Koloware Catholic Mission

A cyclist scoots through Koloware village among houses for the 'lepers'

Approaching Koloware

We arrived at a Health Centre that looked luxurious – spacious, clean simple buildings that were not nearly as old as I had expected from a leprosy mission that had no ties with NGO or government funding.

We briefly saw the director, Sister Antonietta, who was extremely busy, but greeted us with a beaming, surprised smile. It was through a friend of Raymond’s who worked in Health that I had heard about Koloware. When I asked for the number to call ahead and ask if we could stay, he said it was not a problem – it was run by Catholic sisters and they had a dormitory. We could turn up, explain my project and stay there with no problem at all. I’m not sure the frightfully busy Sister Antonietta quite appreciated his casual attitude. Explaining that she’d been given no warning, she informed us of the lack of beds they had at Koloware – even all the hospital ones were full. We’d have to put ourselves up in hotel in Sokode. Well I was not able to afford the daily commute to Koloware for the next couple of days let alone accommodation at a hotel – even basic accommodation was not within my budget for the trip.

With nowhere to stay, Dodji and I stood crestfallen at the side of the road – the formerly pleasant light rain now soaking through our clothes and spirits. He explained our situation to two passing elderly gentlemen. They sympathised and led us two minutes walk away into a little hamlet of huts. There we were introduced to Reda, who immediately with the fussiness of a grandmother who had just had the Queen turn up on her doorstep took my extremely heavy camera bag and sped across a courtyard over to a room while excitedly beckoning us to follow. In less than five minutes, with barely a word from Dodji or I she had cleared the room, put in a hefty mattress made with rice bags for myself, a mat for Dodji (he insisted on sleeping on that rather than the mattress), clean sheets and a table for all our things. We thanked her constantly, but she just said ‘non non non non non’ waving it away.

This is Reda's courtyard. Our room is the centre one with the door open. The man on the right is brewing beer.

Mine and Dodji's room.

Reda cooks our Akume and Soup by torchlight. Electricty went down 3 months ago in this area from a lightning strike. It hasn't been fixed since. Only the hospital has it's own generator.

Half an hour later, we were clean (I’m surprised at how I’m now so used to washing with cold water from a bucket) and sitting down in the dark to akume (a mashed pulp of cassava and flour) and kodoro (a northern Togolese soup made with leaves from baobab trees). I really couldn’t have asked for more.

Sister Antonietta in her office. She has lived in Koloware as a missionary for eight years.

A patient waits for dressing changes at 7.30 in the morning.

A 6.40am rise and we went straight to the health centre where Sister Antonietta pointed us in the direction of the leprosy clinic. There were already 15 gathered together, ready and waiting for wound care and dressing changes by the nurse Tchedre Wallakosona. It took a little while to find someone who spoke French well enough to translate into the local language of Kotokoli.

Kufou, the thirteen year old pharmacists son and our translator form French to Kotokoli.

Eventually it was Kufou, the pharmacist’s son who was shyly pushed forward. With two translators, especially when one is 13 and only speaks the French he’s learned from school, it’s not always easy to get the answers to the questions you asked originally. Still, I managed to talk to a couple of patients for a while, gathering their stories.

Dodji speaks to Mahammoud, a blind Beninoise leprosy patient that has lived here for over forty years.

The rain was thick in the morning, getting to torrential-standard for the UK, but simply averagely-heavy rain for here.

Patients crowd under the porch away from the heavy rains at Koloware Health Centre.

Rain in Koloware.

A decent rest at lunch time and a quick charge of my laptop at Tchedre’s house made for a relaxing afternoon before more photography. I got a chance to chat with the spritely, enthusiatic Tchedre, who proved to be extremely helpful and informative about the health centre and the area. He’s worked here since 1967, and despite the fact that he officially stopped working 5 years ago, still works with the leprosy patients in the hospital three days a week. I’ll follow up more on this in my next blog, specifically about the leprosy work being done here.

A leprosy patient sitting in his doorway in Koloware village.

The Togolese people further north in the country are, like many western African countries, predominantly Muslim, and I attended my first ever Islamic event in the evening. The Imam allowed me to go into the Mosque and photograph. Embarrassingly I know very little about the religion, so I was cautious and hovered at the back, photographing in the spacious, well-used room, the light blues and drab browns lit by just a couple of bulbs. It lasted just a few intense minutes, with the Imam praying out loud at the front. Each time they bowed in silent worship I’d take a photo, aware of the echo of my near silent shutter in the holy temple.

Muslim men pray in the Mosque.

Muslim women pray in a separate section at the back of the Mosque.

I nipped round the back to photograph the women’s entrance. They have a separate area at the back where they pray. I’ve always wanted to find out more about Islam, preferably not from reading the Daily Mail, so if anyone has any recommendations for a book about it I’m all ears.

Koloware Mosque.

Dodji and I got back to our room in the dark to find a mouse in my mosquito net and droppings all over my bed. I’m not particularly bothered about such things, but Dodji had a little fit trying to stamp on the mouse which promptly disappeared into the corner of the concrete room without a trace. A half kalabasse bowl was posted outside Reda’s, informing passers-by her homebrew was for sale. I tried a bit with my Akume, it smelt like rotten vegetables, but tasted more like very yeasty liquid bread dowsed in something strong and tesco-value. I declined a second bowl.

The half-kalabasse outside Reda's indicating her home brew is ready for consumption.

Reda and her daughter make her homebrew.

My wash in the square walled drainage area across from the little courtyard was shared with a spider the size of my palm, pulling itself up into the tree above on its slivery thread, glinting in the light of my headtorch, and unwavering in the warm still air. The yellow markings on its back glared at me, just daring me to have a reaction. I’ve barely seen the stars since being in Togo, a result of spending most of my time among city lights, but they are clear up here deeper into the country, peaking through the branches above my head. Venus shone out like a pearl among salt granules, with the dim orange hue of mars not too far. I saw several shooting stars, and not a single satellite. For the first time in three weeks, I wished I could stay here a bit longer. This is the Africa I’d like to live in. We went to bed early, to the laughs of men outside drinking Reda’s homemade beer.

Tchedre shows us the numerous leprosy patients in the village, translating from Kotokoli to French.

A leprosy patient relaxes in the afternoon out of the sun.

Tchedre introduced us to the chief and his two wives. He did have three, but one died recently.

Saturday was market day. The market only started to get under way at about midday so Tchedre showed us around several houses in the morning, asking many of the leprosy patients if I could photograph them. I spent two hours with them, as well as photographing a few around the market. I’d already established from Tchedre that despite Koloware having a large concentration of leprosy since the late forties, and the town also being educated in the fact that none of them can pass on the disease (as none of them are carrying the bacterium) there was still a large stigma attached to having leprosy. Almost all the ‘lepers’ get children or relatives to sell their produce in the market to avoid being seen; it is only a few that venture out to brave shuns and revilement.

Vendors outside the Mosque.

Selling pork at the market.

I had the idea in the afternoon of photographing Mahammoud, one of the patients I had spoken to the previous morning. He agreed to stand without his sunglasses or prosthetic limb wearing just his shorts. I photographed different parts of his body in sections. I’ve exhibited my leprosy work before, and am always looking for new exhibition ideas, and a montage of close ups of this man’s frail, weathered body, numb from leprosy, still healing from wounds well over a decade after he went blind I’m sure will provoke a response from the audience.

Myself and Mahammoud in his room.

He was more than compliant about posing, and I helped him put his prosthetic limb back on afterwards. He’d mentioned the day before that of the five people living in the housing block, he was the only one who had no relatives or friends to visit him. Usually I don’t give money to those I photograph, especially just one person, but since it was beer season, I gave him 200CFA (40 cents) to get a bowl from where everyone else was on this swelteringly hot market day. A big grin broke out on his face, one that you might expect from an old man at the end of his years who’s just been given the opportunity to spend a hot afternoon with a kalabasse of strong yeasty-red beer. Who can blame him? Being blind, disabled, very forgetful, going deaf and with no relatives to visit him, there’s little else left in this world for him.

On my last night there it rained. This time the rain was torrential. It started around midnight and carried on through the morning. For about half an hour it was truly deafening. I was awake anyway when it started, and heard the first few dull thuds like small balls of putty falling from a great height. This developed in a matter of seconds into a barrage of paintballs fired from the heavens targeting Dodji and myself. Within ten minutes it seemed like waves were hitting the house, the Atlantic Ocean emptying itself onto our doorstep. The corrugated iron roof amplifies the sound five-fold and I spoke just to see if Dodji could hear me. I could barely hear me. With the exception of slight cracks around the wooden door and window shutter, the room was sealed, yet I could feel the spray through my mosquito net. I’ve always loved storms, but this one never subsided, and when my alarm went off seven hours later I realised it may be a wet journey to Sokode.

Tchedre with his wife and granddaughter. Tchedre has worked in Koloware since he was 17.

I’d planned to say goodbye to Tchedre, but with the rain like it was I’m sure he’d understand that we’d have got drenched going to his house. Luckily there was a car by the bar down the road that said it had two spaces. It’s not so much hitch-hiking, as anyone can be a taxi, so we agreed about $2 for the both of us to Sokode and hopped in a car that was in poor condition even by African standards. The windscreen resembling a crazy-paved patio is a norm and not something to write home about (he says writing home about it). The front seats looked like they had been attacked by a starved Rottweiler on crack and the back of the rear bench looked half melted. Dodji’s door had to be tied and untied in order to get in and out of it, and mine kept swinging open. Luckily this wasn’t too dangerous as we couldn’t go much faster than 20 mph, partly due to the 100kg of charcoal propping up the back seats, and partly to do with the ancient engine that had a break to smoke every 20 minutes (the driver kept pouring something into the bonnet to put out whatever fires lurked underneath). It had taken us 25 minutes to get to Koloware, but over an hour to get back to Sokode.

The trip home was lengthy (we had to wait 4 hours for the bus to show up this time), but being on a large (prebooked) coach, it was much more comfortable. I got home at 8.30pm to Raymond welcoming me with open arms, like I was the prodigal son. After Koloware, Raymond’s house seems very modern and comfortable. Just goes to show everything in this life is relative.

This year’s adventures in Africa have come to a close now. Raymond, his family and Dodji and the other people who have introduced me to life in Togo have been extremely kind to me and I will make every effort to stay in touch with them in years to come. The last three weeks will stay with me for the rest of my life as very strange but essential time in getting to understand a bit more about how most of the world lives. Yet I don’t consider the wildly poor (compared to back in England) houses I’ve stayed at as places of poverty in terms of the other things I’ve seen here. Perhaps next time I’ll have a go sleeping on the streets.

The barber in Koloware asked if he could shave off my beard. I allowed a quick trim.

Markets, Sleeping on Streets and African Dancing

Well it’s been another varied week or so here in Lomé. Like I finished in my last post, I’ve continued rolling with the punches and taking the daily frustrations as part of life and so learned to accept them. That doesn’t mean they’re not there though, and I don’t feel I’ve got coherent photo essay, let alone a complete set of photos for Raymond’s street children organisation. I’ve been photographing around the area in part, but I haven’t yet accomplished anything special image-wise – something that is naturally very important to me in progressing as a photographer.

Raymond still feels peaky from the malaria – we just had a sprite together at “Obama Bar” at the end of his road, which he promptly filled with salt to help with his fever. Having tasted salt water before, I had no real inclining to ruin the cool sweetness on my panting tongue, surprisingly dry in the humidity. It sounded like a useful hangover cure or something to down just before you go to bed after a night out – a hangover preventative by purging the system perhaps? But when in Africa… it tasted like sprite with a strong aftertaste of salt. Don’t bother.

Raymond has been disappearing every now and then, trying to organise anything from UNICODES meetings to baby Robin’s naming ceremony. Meanwhile when I’ve not been out photographing I’ve been passing my time reading the last few books I brought with me (I must admit, I never actually thought I’d be reading ‘Ships of Mercy’ by Don Stephens), watching Prison Break in French over Vivienne’s shoulder, and answering emails from home and friends; some bringing upsetting news, some asking for photographic services on my return, even some wanting advice about belief in God (God help them if they’re asking me).

I’ve found that in keeping those western elements in my life I sadly haven’t been able to truly get to know Lomé. I can’t seem to let go of them for more than a day at a time. But it’s those times when they’re not present – visiting Raymond’s sister for lunch, playing goalvi football (4-a-side teams using miniature goals) with Dodzi (one of the day volunteers, currently a law student), popping out to the woman on the corner to get water sachets (because of my yovo stomach) while chatting with Raymond about his childhood on the streets, eating fresh pineapple skilfully diced up into a black plastic bag by a woman ambling along the street with them on her head, walking along the beach and through Adidogome and various market places, chatting to Dodzi’s brother before realising he’s deaf and the other elements of life here where I don’t feel the need to compensate with American TV programmes, or facebook, or even this blog. Here’s a few of those moments taken with my western camera…

Fisherman preparing to fold their nets.

A baby clings on to his mother who as a single parent is the bread winner, bringing in 500CFA a day ($1.00).

A young mechanic takes the seats out of a car.

Kids in Adidogome

A roadside butchers in Adidogome

If anyone wants to move to Togo...

A graveyard near the Ghana border

Brother and sister at Adidogome coal market

Mother and child at Adidogome coal market

Dodzi's deaf brother (far right) at his cobblers workshop

So these last few days have been a last ditch attempt to get photographs for Raymond’s street children project. Part of the problem has been getting natural shots. People are very suspicious of cameras – perhaps more so than back home – and I found out yesterday that in Togo you are in fact not allowed to photograph anyone in public without their permission. Oops. I’m still not sure how I can verify this. Anyone know? This is very different from UK laws; which is how the paparazzi get away with everything. It’s always helpful to find this out at the end of a project about the life on the city streets…

Monday night was an odd one. Plenty of times in the past three or so months I have been to the big market that stretches towards the port from the Palm Beach hotel. However I have never been there after dark, and the transformation from the bright, bustling bodies and businesses of the day time is a stark contrast to the eerie (yet unempty) shadows, filled by the occasional argument, sleeping bodies in doorways, young girls crouching in the nearest puddle to relieve themselves etc.

The plan was to photograph some street children at 5pm that a journalist friend of Raymond’s had agreed to take us too, but his phone ran out of battery, so at 6.15 so to cut a long story short we found ourselves wandering back through the market, as dusk began to steal away the beautiful golden African sun. A short, mama selling fresh, silver foot-long fish called out to me: “Yovo, o fon yureah?” (excuse the spelling if you speak Ewe). “Eee, mefon dadanye. Ocho o fon yureah?” I replied, widening the beaming smile underneath the childhood-etched voodoo scores on her cheeks. She shouted out to the other women in the stalls next to her, revelling in this white man that responded in her native tongue. I stopped. “Donna vegbe vidividi” – “I speak a little Ewe”.

Raymond immediately saw this as an opportunity, taking over from my limited lingual abilities to explain who I was, that I had worked for Mercy Ships, and that I was now working for/with him to photograph children that live on the streets. I have met very few people in Lomé that don’t know of the Africa Mercy, and one of the women’s sister-in-law had had both of her eyes successfully operated on a few months ago.

Raymond talked excitedly with them. They were very helpful, explaining the problem of children sleeping on the streets in the evening. Of course it’s not just the children; many of the adult street vendors come to the city on Sunday night, sell their produce throughout the week until Friday, then go back home at the weekend. Unable to afford the daily commute, they sleep on the streets, occasionally under mosquito nets if they have one. Their children help during the holidays, and some are too valuable on the stall to afford school after holidays are over… mainly the girls.

We were told to come back around 9ish that evening, when people would start settling down to sleep. Raymond arranged for a policeman friend of his to meet us in town, for a bit of extra security, and we munched on spicy bean, tomato, avocado, onion and potato salad sandwiches made freshly (trying not to look at everything been stuffed in the baguette by bare hands) to order on the street.

So at around 8pm I stood on the same street looking at a very different scene. Rubbish was strewn everywhere, the last few vendors packing up under the orange cast from the concrete lamps parked sparsely at long intervals. Raymond went round the corner to ‘prepare the field’. By this time I had given up questioning his method, it only prolonged the inevitable. So I waited with Martin the policeman, attempting to try out my French and Ewe. In trying to search for the word ‘flag’ he showed me a photo on his phone of a flag – I noticed with amusement that he had to skip past about 10 photos of naked white women and a photo of Christ on the cross to get to it.

I was very much aware of the eyes of those passing being planted on this yovo with a £3000 camera in the bag he gripped tightly to his chest. A nearby boy was cleaning out the dust from a pile of handbags. “Madeo photoa?” I asked. He stared at me, unresponsive (so much for my vegbe pronunciation). A group of passing youths stopped at the sight of my camera. They asked me something in French I could only guess at. Then “you take his photo, you dash him something” they said. “Ah no, I don’t give money” I tried to explain. Five minutes of poor communication ensued where I learned that they were in fact Nigerian. Mentioning that I travelled through Niger, Kwara and Kogi state there for 5 weeks last year did the world of good, and suddenly I was their best friend. For the next half hour or so we talked about Nigeria, football (well we listed clubs) and taking them back to England with me. It’s never entirely a joke when they mention the latter to you.

The market streets late in the evening

Myself and the Nigerian guys

Meanwhile Raymond had come back and was chatting to a security guard who was looking after the surrounding area. At first he wasn’t too pleased at me photographing so I stopped, but Raymond once again turned the situation round to his favour, and he was soon showing us the areas where people slept. It wasn’t hard to find. Walking down the street perpendicular to ours for about 100 metres I must have passed 50 or so people sleeping outdoors. Maybe 5 or so were lucky enough to have mosquito nets.

Vendors sleeping on Lomé's streets

Vendors sleeping on Lomé's streets

Vendors sleeping on Lomé's streets

'Vendors sleeping on Lomé's streets

Walking around the block I was glad for the protection of Jules the security guard and Martin the policeman. Without them I would almost have certainly got mugged, quite possibly worse. When you walk through the market during the day you don’t really look at the buildings behind the stalls, but now they rose out of the loom, creating darkness below the faint glow of the clouds.

Lomé at night

Lomé at night

Lomé at night

The woozy whiff of weed ran in ribbons across the air, creeping out of some dark corner. We approached the distant glow of a meth lamp lighting up a street vendor’s delicacy of meats. The night ended nibbling on a bit of slow-cooked pepper-dusted beef. I declined (unusually for me and food) the stuffed large intestines.

A vendor slow cooking beef and intestines

Yesterday was not quite so surreal. We had planned to photograph at a street children’s charity at 9am, at 2pm meet up with Jules again to photograph the same places we saw last night in day time, and at 4pm meet with the girls from the beach.

Not one of those things actually happened.

Well we went to the charity – Terre des Hommes – run by a helpful Frenchman called Gerôme, who did point out that as well not knowing we were coming, there are of course many child-protection policies in place, so photographing the children – only a few of whom stay at their facility – at a moment’s notice is not really possible, and they weren’t in fact street children anyway, but abused children in need of mental healthcare. So that didn’t quite go to plan. However he did put us in contact with a man called Souleman who works with former street kids, and is running a rehearsal (of some sort) at 5pm that we could go to.

Jules wasn’t at the home number he’d given Raymond, and when we went to meet the beach girls by the independence building, they weren’t there. So a good few more hours of the day were taken up migrating through the streets with Raymond.

Children playing by the Independence building with the largest hotel in Lomé in the background

Luckily Gerôme had come up trumps and at Nyekonakpoe, I gave my index finger a good exercise photographing (mainly former) street children rehearsing their traditional African drumming and dancing performance set. The breakneck rhythm and sheer volume of the percussive sounds was enough to energise even the weariest of souls. The exhilarating dancing was gone about with certain menace and fierce pride in what they were doing, every part of their bodies streaming with sweat and throats hardened to the hoarseness from years of experience.

The Amagan drumming crew

Amagan dancers

Amagan dancers and their founder Souleman (far left)

Souleman, who is now 28 started living on the streets at the age of 10 after his father died. He befriended mainly wood carvers, his father having been one, who helped him find money by giving wood carvings to him to sell. He soon became skilled himself, and over 10 years the money he earned from selling these crafts helped him get off the streets. With the money he’d saved up he wanted to go travelling to Europe, but was swindled by men claiming to sell visas. So he moved in with his grandmother. Feeling empathy for many of the street children, he employed a few at his workshop and let them eat at his grandmothers, soon letting them sleep on the floor there as well. Soon 15 children were staying there.

The children were allowed to come and go as they pleased. Unfortunately this meant that often they would stay out all night and sleep at work the next morning. Souleman decided to encourage drumming sessions in the evening. This way they would be tired, sleep all night and be awake for work the next morning. Except many of the children turned out to be very talented at drumming and dancing, so Souleman sent them to get properly trained by a professional. Soon they were performing at events and functions all over Lomé allowing Souleman to build up various shops and workshops in different places. The money collated from them and the performances was shared with all the kids and youths involved.

Amagan dancers

Amagan dancers

Amagan Dancers

About 100 people have been through his organisation Amagan, and about 30 youths are currently employed by him. They no longer have a place to shelter, but many of them can afford to rent, and the few that can’t sleep in the workshop/bar/training area where these photos were taken. Amagan has never had any financial sponsorship. In all honesty I’m quite in awe of Souleman, having built up his organisation pretty much from scratch without outside help in a city where he found himself living on the streets at the age of 10. It’s a dog-eat-dog world on the streets, and it is only the smartest that survive.

A group of street children in Lomé

I’ve got less than a week until I leave now. I’m off to Sokode tomorrow morning – a town up towards northern Togo where there’s a leprosy settlement run by catholic sisters. I haven’t been able to contact them, but hopefully I’ll have two days there to continue my ongoing leprosy project. No doubt I’ll see; it will be nice to be able to get out of the city at least.

Living in Lomé

On Sunday 15^th the Africa Mercy left port for the sail to South Africa where it will spend the rest of the year in dock suffering ship repairs of one sort or another. I had originally planned on going to Liberia or Niger to photograph more leprosy in these next three weeks. However, I wasn’t able to get a response from the contacts I had in Liberia, and the TLM (Leprosy Mission) reps I knew of in Niger were all going on leave from the 16^th. Naturally.

So I had a choice – pay an extra $500 plus £300 for three weeks additional ship fees and a flight home from Durban which lets me spend extra time to work on various photo projects in the office I’ve called home while crossing the equator on a Danish ferry-turned-hospital ship designed for journeys of no more than a few hours. Or stay in Lomé as a guest at the house of one of the day volunteers who I’d only just met, but who runs a charity that aims to help the street children of Lomé which I could photograph for. As much as I was burning to sail for three weeks and spend that little extra time with friends I know I may not see for a long time, I decided the opportunity to get to know Lomé as well as photograph for a local charity was too much to pass up.

One of the Mercy Ships longest serving volunteers waves goodbye for the last time.

The gangway is lifted up – the point of no return (for me at least).

So I waved goodbye to the Africa Mercy. It was a strange moment waving goodbye to 100 beaming, colourful, familiar faces, some of whom it was very painful to say goodbye to.  The port seemed bleak and empty without the blue and white branded hulk. I didn’t feel as though I was saying hello to a new adventure, just saying goodbye to the last one. It was like a huge vacuum had just been created in my life, ripping away all sense of comfort and routine that I had settled into over the past three months.

However I told myself I’d soon be experiencing what it is really like to live in an African capital city, away from luxuries like air conditioning and a dining hall with boiling water on tap. It would do me good.

There were about 12 or so of us left behind, many of whom were staying at the Team House (a rented complex where inland MS volunteers had been staying), one staying at a hotel for a week and myself who was meeting up with Raymond the day volunteer to go and stay with him, his wife, his puppy, and as it turned out his baby girl who was born the night before. I couldn’t help but wonder if I’d come at the wrong time. As I write this I unfortunately still have that feeling…

However, Raymond had insisted I stay with him. I believe it’s quite a nice house for this area of Lomé. Raymond has a spare room and his wife had already made my bed the week before the boat left by all accounts. He’s provided a mosquito net and curtain-come-sheet, but it’s so hot and humid that I need no more. The bathroom is two tiny cubicles – one with a toilet (I’ll spare details of cleanliness), and the other a tap with a bucket. It’s very cramped, and I don’t even mind that I’m washing out of a bucket. Trouble is I’m the only that uses toilet paper, the soap smells dodgy (I foolishly left my shower gel on the ship) and it doesn’t let in light, or have a working bulb.

My room.

For the first two nights his wife Vivienne and the baby stayed in hospital. His puppy, Joli was a month and old and very cute. It was nice to have a timid and totally clueless ball of dusty African fur to scratch and pay a bit of attention to for the first day. It stopped after that because the dog disappeared right before a day of solid rain. I’m guessing there’s 10 inches of lifeless pup-meat lying somewhere in the sewer ditch that runs past the back of the house, right outside my bedroom window. On top of this, calls from the hospital kept coming through that Raymond had to go and buy drugs for his wife and the baby, who had a fever for the first few days – a worrying time for any child in the developing world.

I made friends with quite a few day volunteers in my time with Mercy Ships. These are men and women from Togo who are paid expenses and a small (but not bad for Togo) wage to work on board the Africa Mercy in various positions in various departments, mainly as translators, but also as deck hands, cleaners, galley crew etc.

I will eventually post a blog about the day volunteers leaving party. It was a sombre time for most of them, who are going back to a life with no jobs. The same is for Raymond. He has his charity, UNICODES which was set up in 1999, but got all the official paperwork done in 2007. I’ll explain more about it in a few weeks, hopefully after I’ve taken some photos that describe what they do – essentially they are aiming to combat the problem of youth on the streets, many of whom have no home and are forced to resort to illegal activities like stealing and prostitution. He is hoping that UNICEF will fund the work the charity is doing and will allow him, as president, a small wage. He has a program written up, along with a number of staff that are willing to be trained and a comprehensive (apparently) budget. This will start next year if he gets funding.

Meanwhile, I went to and fro on Monday, Tuesday and Wednesday trying to get a visa extension sorted (successfully thank goodness), having to get a new charger for my laptop to replace the one that didn’t work except for the occasions when it sent off sparks, and trying to figure out what it is that Raymond actually wants me to do for the charity.

I’d already offered to cover expenses for my stay, Raymond asked for some money up front to cover the next two weeks at least. This would cover all travel by zimi-jean (motorbike) as well as my portion of the food that I’d be eating with the family.

On the first night when it was just myself and Raymond, he showed me how to cook a gumbo (okra) and fish soup with Akumé (the pap similar in consistency to fufu, but with flour added as well). That lasted a few days until his wife and mother-in-law returned. The mother-in-law (which she was introduced to me as – I call her grandma) is a very sweet old lady, and between her and Vivienne, the food has been absolutely delicious. They haven’t so far cooked me anything that I haven’t loved. No ‘problems’ yet either (famous last words).

Looking out of my room one evening.

 

Grandma.

The baby under her mosquito net.

The baby, who has been named Robin (after Robin Harper if you’re reading this!) has hardly made a sound, except for when grandma was throwing her up in the air and catching her. Upside down.

Raymond at a UNICODES meeting in his house.

Those first few days were incredibly frustrating, but that gets easier once you realise Africa requires endless patience (I thought I’d vaguely learned this over the past three months when going off ship with Mercy Ships). I can safely say now that Mercy Ships perform miracles with what they are able to coordinate and achieve with the countries they work in. It’s still frustrating, but I’ve since learned just to roll with it.

I have been out on only two trips to photograph around town since I’ve been here, which has been disheartening, I must admit. I’d got the impression from Raymond on the ship that he’d already organised all the different places and people to photograph. However, this is Africa, and it’s never that simple. It seems that in these next few weeks we should work to build up a relationship with children to gain their trust before photographing them. I couldn’t agree more – I’d just assumed that Raymond had already done that with some of the children. In all fairness, it’s been hard to gauge all the facts about what the charity has done without appearing to be an interrogator. Raymond seems to have a lot of last minute meetings (political, church, family, anything…) that either overrun, or don’t start on time (usually both), that coincide with when we were supposed to go out and photograph, so I’ve been out twice to photograph street children. Once with Joseph, a friend of Raymond’s who is quite timid, and submissive (as Raymond put it), but who owns a zimi. Unfortunately, he didn’t seem to understand at all what I was supposed to be photographing (a general mystery it seems…) so I did my old bit of street photography through the market.

A naked mad man who some Mercy Shippers maybe recognize from the streets.

Selling pepper’s.

Muslim’s wash their feet before worship.

I went out the next day with Raymond, and got talking to a few street kids on the beach, finally getting one or two decent photos that could possible relevant to this project (whatever it turns out to be!). I won’t post them now, but here’s a few along the beach…

I was hoping to meet them again today to get to know them a bit better and gather some information as to the sort of lives they lead. They were for the most part very friendly and eager to be photographed. I will say one thing for Raymond, as I’m sure anyone who knew him on the Africa Mercy could vouch for: he is an excellent talker and gets along extremely well with children. If I knew that we could go out for 5 hours a day to meet and photograph children (as I had naively thought it might be) each day for two weeks, I’d be confident of creating a coherent and interesting photo essay about the street life of a child in Lomé. Maybe coming events will surprise me. I’m sure I will get an interesting series of photos that show life in Lomé, but it would be nice to make sure I go beyond that and actually get photos that a struggling local charity like UNICODES could use to improve its image – make it look that little bit more professional.

In all honesty, I do love it when we hop on a zimi and zip through town; the wind dusting my beard and blowing my hair into a jedwardesque hairstyle. I’ve travelled on zimi’s quite a lot in Lomé and I’ve only ever come across one that had working dials on the dashboard. It was also spotlessly clean. However that same guy had also angled both of his mirrors so he could see his face from both sides, and not behind him. Maybe that doesn’t matter too much, as most of the others didn’t seem to have mirrors on their zimis anyway. There’s something very liberating about hopping on the back of a motorbike and zipping in and out of traffic, experiencing the sights and smells of Togo. It is one thing I know I’ll miss about Togo.

It is exciting going out when the African rain hits. You wade through miniature street rapids and after the downfall the mud roads have changed; the meandering grooves that plague the taxi drivers and make life more fun for the zimi drivers deepen and form little ox-bows in the street. And in some areas the stench of human waste thickens in your nostrils until you simply accept that you can’t do anything about it. It helps squeeze the squeamish out of you.

I’m ashamed to say I have not made nearly as much effort with getting to grips with French as I should have. Having translators around has spoilt me. However I’m trying to learn as much Ewe (the local language) as I can – Raymond’s teaching me but I’m not the best learner. Bizarrely though he’s been taking me to a free Chinese language course in town for two hours day. I asked why we are going, to which Raymond grinned ‘because it is what I want very much to learn!’. Obviously.

So myself, Raymond, and two others can count (extremely slowly) to nine hundred and ninety nine million, nine hundred and ninety nine thousand, nine hundred and ninety nine in Chinese, as well as say the basics; how are you, I’m fine/have a body with no health etc.

Vivienne speaks a little bit of English, but Raymond is really the only person around that can translate for me and I can have a decent discussion with. He has a lot of energy and a good heart. Unfortunately on Saturday, when he was supposed to be at a political party meeting we got a call from him saying that the mild malaria he thought he’d had for the past two days had got much worse and he was in hospital.

Vivienne and I left straight away, leaving grandma and the baby behind. When we got there, Raymond was on a dirty table-bed, with no doctor in sight. He had tears in his eyes and was no longer able to talk or even open his mouth, and he kept pointing at his heart. What really makes me angry, and is the icing on the cake of why I’ve written this post is that his wife was given a prescription and told to go and buy the prescribed drugs for him, as well as glass slides and a tube to take a blood sample. If his wife had not been around, or if they didn’t live in Lomé there would be no one who could have got him any pain killers, or medication or anything.

Everything here is just so bloody inefficient.

I have given my last bit of cash on me (about $20 worth of CFA) to his wife that will hopefully cover the drugs. I did not hesitate in lending/giving money for his medication (as I’m sure any person in my position would have), but at the same time part of me didn’t want to – because what would happen if I wasn’t in Togo staying with Raymond? Would his wife have stood and watched him suffer pain until it went away, or perhaps it is not worth thinking about. I am thankful that I’m privileged to be in the tiny top percentile of the world that has as much money as I do, even if it does not seem that much to me. I am a white westerner. And the fact is that I am in Togo, I am staying with Raymond and I will do what I can to help without being too foolish.

Even speaking to those from the states on board the Africa Mercy I realise how lucky the UK is to have the NHS. I’ve had a number of operations in my time, and I’m sure if my parents had had to pay for them life wouldn’t have quite been the same. I don’t think I’m being overdramatic.

It turned out that it was malaria, and the IV medication, thankfully did help. He’s still resting, but feeling much better. I’m sure if it was me that got malaria I would not have recovered so quickly.

I’m experiencing the real Togo, and in this past week family life has been as colourful and chaotic as i could have imagined it. I am learning that the life of a local in Lomé is about enduring constant frustration, pain and crises, while learning that the best way is to just roll with it, trying to enjoy the occasional carefree feelings of freedom, and balance a careful mix of not planning ahead with planning too many things at the same time (not planning ahead seems to work better I think). And I am extremely thankful for where I come from, and where I will be returning to in 17 days. I am glad though that I chose to stay in Lomé and not sail. I’m sure I would be enjoying the sail thoroughly, but my desire is to live Africa, not the 51^st state of America.

Meanwhile I can only hope things improve while I’m here, for Raymond, his family, myself and this slowly evolving project.

If you could spare any thoughts or prayers for Raymond and his family it would be greatly appreciated by them. Thanks, Tom

A Mental Health Workshop

Unfortunately towards the end of the field service you discover that there are aspects of the work that Mercy Ships does that are seldom reported and that you haven’t had time to cover properly. I was asked to photograph the last day of a Mental Health Workshop and in researching what the Mental Health Program was about found the summary of the objectives of the team from 6 months ago.

I think it’s a very interesting aspect of healthcare contrasting with the very obvious removals of benign tumours and other physical operations that Mercy Ships is primarily there for.

Here is the executive summary:

“Togo is listed among the world’s poorest countries, but continues to improve developmentally.The country of six million people currently ranks 159 out of 182 countries, according to the 2009 UN Human Development Index. Poverty remains a problem as almost 70% of the population lives on less than $2 a day. Access to quality health care is still limited for most citizens. There are only 225 physicians in the country, or less than one per 10,000 people. Comparatively, in the U.S., there are 26 doctors for every 10,000 people. Specialty care, such as mental health, is even more limited.

Togo is currently striving to improve the mental health care capacity. Mercy Ships intends to assist in this improvement through partnerships with the National Mental Health Coordinator and two Togolese neuropsychiatrists. The mental health team plans to utilize existing primary health care services and community organizations to increase capacity to assist the mental health needs of adults, children, and families.

In collaboration with Professor Grunitzky, Dr. Gaba, and Dr. Dassa, Mercy Ships will provide a mental health nurse/trainer and an interpreter during its service in Togo from February through August 2010. The Mercy Ships trainer will train 30 health care workers during the six-month field service. The primary training will occur over ten days of training, one day a week for ten weeks. Mercy Ships will also train a total of 60 health care professionals from hospitals and clinics in Lome and the surrounding provinces in two separate three-day seminars. The goal is to increase awareness of mental health diseases, and improve diagnosis and treatment of mental illness and counselling skills. Additional activities will include patient assessment and referrals for severe cases.

These cases include those patients requiring more than basic counselling, changes in life skills or social support, and/or medication. Training for a total of 60 church leaders will take place in two separate workshops (30 participants each). The sessions will take place two days a week over a period of two months (18 days) to increase proficiency at recognition, support, and proper patient referral. The sessions also include instruction in training of trainers so that the indigenous leaders can multiply the model.

Additionally, the mental health team will offer two distinct workshops for 50 teachers and 50 social workers. During each three-day event, the goal will be to improve awareness and identification of, and counselling/treatment for mental health diseases and problems. These participants will also learn how to refer severe cases to appropriate medical facilities. Counselling and training for 50 corrections officers and prison workers and 50 military leaders will take place during two three-day workshops.

The goal is to increase awareness of mental health and illness, and anger and stress management training. The workshops will help participants better understand, identify, and be sensitive towards mental health sufferers. In addition, due to high levels of stress accompanying these positions, the mental health team is prepared to provide training for prison workers and corrections officers in partnership with Pastor Martin Anani, the President of Prison Fellowship, Togo.

The training for military leaders is being developed at the request of Dr. Dassa, a well-qualified, critical incident stress management provider, and in collaboration with Colonel Baton Bineh. Many children can benefit from trauma healing; not just children impacted by war.

Mercy Ships mental health team will offer a five-day children’s camp to provide counselling for 50 children and training for childcare workers. This camp lays the groundwork for children to know how to express and heal their emotions in a safe environment, and to educate them on basic abuse and neglect.”

These photographs are the children on the last day of the camp. Many come from broken homes and have suffered abuse in one form or another.

If I ever come back to work with Mercy Ships in the future, then I think this is something I’d like to explore more. I have no doubt many of these children have interesting and probably disturbing stories to tell…

CMS Adidogome – a Togolese hospital.

I got the chance to visit a local hospital – CMS Adidogome. A couple of nurses went to meet the Director there and we got a tour of the facilities. I don’t have a huge amount of information about it – Mercy Ships did a screening there at the start of the field service, but as to how many people it deals with I have no idea. Unlike the UK, but like most of the rest of the world health care in Togo is not free. That could explain why there were only a few patients there.

Coming in through the entrance.

A patient waiting to be seen.

This is a poster that informs of the different ways HIV/Aids can and cannot be transmitted. Click on it to view the details – some of the captions may amuse you – bluntness is a key to the poster. Some of the captions are questionable in their reliability too; I am not an expert in Aids, but I know that some of the ”nul risque’ captions aren’t entirely accurate.

The hospital director gave us a tour.

The above price list refers to the cost of different echographs and examinations. The price is in CFA – of which there are 513 to the US dollar. The average wage is just over 1000CFA per day.

A young girl is examined in a room also used for minor surgery and wound care.

A boy stands under the checkout where patients pay for the medical services and supplies they’ve received.

The Maternity ward notice board.

A mother with her newly-born child.

The hospital director and two nurses.

Blackout day and teaching an African how to swim…

Well I do have some more serious and informative posts coming up, but since I’m still gathering information on these things here’s a few more snaps taken on the blackout day. A few times a year the ship needs to cut the electricity in order to perform maintenance checks and repairs. So this time they got everybody off ship to a local sports facility.

We brought along a few of the day volunteers – one of whom didn’t know how to swim. This piece of information accounts for perhaps one of the dodgy photos of nurses holding up Togolese men in the water.

As for the rest – you’ll have to take my word for it that it is innocent fun.

After a good afternoon burning under the West African sun in the pool, four of us decided to head out with the day volunteers for some local grub on the Boulevard.

Black and white photos of life on the Africa Mercy

This is a rather general blog; I thought I’d share some of the individual photos that don’t usually get made into stories. These were taken at a variety of times, usually when reporting on another story, or while I’m down on the wards taking medical photos. However the first photo is of myself and Claire (Bufe – the writer who pretty much gets all the information that I put in these posts) in our little office.

(Left to right) Missie, Dick and Marina inside the admissions tent (on the dock by the ship).

A toddler wandering around one of the wards where their mother’s bed is.

A cargo ship from Thailand on the dock next to us.

Painting the bow of the Africa Mercy.

A mother sits with her child while day volunteers and nurses sing and dance in ward devotions.

Mary, a ward nurse, takes stitches out of a patient post-operation.

Day volunteers singing during a VVF dress ceremony.

This is Kossi, a 5 day old baby sleeping next to his mother. He was born with a large tongue lesion that almost prevented him from breathing, and became one of Mercy Ships’ quickest admission patients (most are screened many months in advance).

Members of the fire team put on their gear at the start of a fire drill. There are two alarms, a first for the fire team, and a second for everyone else to assemble at the their muster stations on the dock. This ensures that the fire team aren’t blacked from getting to the fire by crowds of staff trying to get off the ship.

Having already been the first group in to fight the (simulated) fire Elliot (centre) and the rest of his fire team changes their oxygen supplies while another team goes in to continue fighting it.

Deck hands help secure a new tyre to the side of the dock. These help cushion the ship when hitting the dock as it sways in the water. New tyres creek very noisily, keeping many of the people in the cabins next to it awake during the following few nights.

Christina, a charge nurse, cheerily looking after an infant (that’s not so cheery).

Day volunteers and staff spontaneously form a band in the corner of Starbucks, keeping everyone entertained after the church meeting on Sunday evening.

(Centre to right) Theo, James and Cael entertain in the corner of the Strabucks cafe in Midship.

In the orthopaedics tent a mother breastfeeds her child while a day volunteer takes off the babies correcting shoes (for club foot) ready for a post-op photograph. Nick, the physical therapist makes notes in the background.

Anama (left), Nick (out of sight) and another day volunteer put the babies correcting shoes back on. They’re not particularly comfortable.

Eye patients sit outside the admissions tent on the dock.

Tracy (Ship Security Officer – centre) and the Gurkhas, who guard the ship: (left to right) Lok, Pradip, Tek, (Tracy,) Ganesh (head of security), Chitra and Min.

A VVF lady listens to a speech during her dress ceremony.

A day volunteer drums during a VVF dress ceremony.

Americans celebrate their independence on the fouth of July with a barbecue on the dock.

Amanda and Anouchka enjoy the dock barbecue on the fourth of July.

Above and below: Crew and members of the Academy throw an American football around on the dock.

Maaike, a charge nurse, tickles Irene, a patient, on a bed in a recently emptied ward.

Josee (centre) plays a card game with Claire and a couple of visitors.

Dr. Leo Cheng explains to Kakou the details of the operation he will perform on him later that day.

Dr. Cheng operating on Kakou later that day.

The port of Lomé from the Bridge.

A member of a vision trip from Texas pulls along a patient on a buggy.

Patients resting in the ward.

Deck workers take a moment to look out over the port of Lomé.

A nurse pushes a patient along on a tricycle.