2026 Fall Newsletter

Random stories and thoughts as the year comes to an end.

Managing Needs

I am trying to spend time outside of the compound seeing Togo while exploring the back roads. I have made 3 trips so far. On one of the trips, an HBB (Hôpital Baptiste Biblique) nurse took me to his small farm where he grows food for his family. On that piece of land, I was introduced to a widow and her 4 kids. She works a small piece of the land, growing and selling produce. Outside of a cooking area, she and her kids live in a 10 square foot home. She used to have a larger addition to the home but it collapsed. In returning home and discussing with Lydia what I saw, we could not help but remember a past conversation where we were considering building roots and buying a house in Indiana. At that time, Lydia and I figured out what we thought would be the ideal house size for our family of 6. We came up with 2,000 square feet. Today, at HBB in Togo West Africa, we live in a 2,000 square foot house and we are comfortable; I cannot imagine living in 10 square feet.

A tough part of life is connecting. Life is easier when there is no connection, when a distance is maintained. The Gospel of John speaks to me about the importance of connections and relationships; I don’t do these well. As we travel down this road of “connecting,” we are seeing “the needs” –a pair of lower limb prosthesis for a double amputee, a 240 square foot home for a widow family of 5, a water tower and filter system for a family of 5, a medical bill, school fees. etc., –and we are “struggling” on how to respond. In this we recognized we could give everything we have to help, and yet this would not be enough. We are praying in how to respond.

One more day

She, Mrs. G, is in her late 30’s. We saw her for the first time in clinic at about 25 weeks pregnant. This was not her first pregnancy. Her BP (blood pressure) was 180’s/120’s (normal: 120/80). The OB clinic did a solid history and physical exam, along with some labs and started her on nifedipine (a BP medication). We asked her to come back that afternoon for a BP recheck. The recheck was still high, but acceptable. So, we gave her return precautions, sent her home, and asked to see her again in 2 days.  The next time we saw her, she was 27 weeks and 2 days (2 weeks later!), her BP, was again, dangerously high (180’s/100’s), and I was frustrated. Why didn’t she follow up as scheduled?

We admitted her, did some labs, increased her medications, started her on steroids (for baby’s lungs), and placed her on a monitor for baby’s heartbeat. Within a short time, we started to see drops in the baby’s heart rate, which responded to fluids, oxygen and position changes. After this, I sat with her and her husband and explained the gravity of the situation. There was no easy decision. She could not go home while still being pregnant; however, to deliver the baby now would be too early and I could not say with certainty that the baby would live. To leave the baby in mom, however, could harm mom. The only good news at this time was mom’s blood pressure and baby’s heart rate were responding to the interventions. Our goal at this time was to buy as much time as we could to help the baby while trying not to harm mom. We got her to 28 weeks and 0 days.

Mom’s recovery was horrible and lasted 3 weeks. After the C-section, we treated her for pre-eclampsia, worried about a stroke as she was unable to move her right side for days, wondered if she would die of starvation as she would not eat and kept pulling her NGT (nasogastric tube) out, saw her blood pressure tank to below normal, diagnosed her with urosepsis (a systemic infection), and worried about the fact that she did not get out of bed or move much for 2 weeks. And then things changed, and by the end of 3 weeks we were able to discharge her home.

The baby’s recovery has been long and continues to be on going with an end in sight. Born at 870 grams, that baby is now 1,910 grams and 79 days old! We struggled with sepsis 3 times, feeding issues, connecting mom and baby, weight gain and jaundice, never really confident, until recently, that she may leave the hospital alive and well.

We have sweated over her and her baby, praying, laughing and crying. To those who ask, these are the toughest cases, the ones that last for days and weeks and the ones that make us question our decision making. It is hard not to become connected to the patients in these cases, as we see them every day. In the beginning, I was one of her doctors, frustrated and trying to manage a bad situation. Now, as I go on to the OB floor, I hug her, pray with her, call her “chef”, and express my amazement at what she and her baby have gone through and where they are today. It is only by God’s grace.   

HBB (Hôpital Baptiste Biblique) – “More Than Just a Hospital”

Moral Injury: For 10 days in September, we were blessed to have Dr. R and his wife here at HBB. During that time, they gave six 2-hour lectures on the concept of moral injury, with the goal of helping us to process our experiences. Moral injury is “a chronic emotional and psychological wound that happens when your actions or experiences go against your moral beliefs and cause inner conflict and distress that don’t go away” (What is Moral Injury? – Utah Moral Injury Project, Oct 13, 2026). It is a concept we had never heard before, but it explains both our present and past experiences here at HBB as medical missionaries. Recently I referred out a 35-year-old male with hypoxia (low oxygen). His work up showed renal failure (BUN: 400, Cr: 31; normal:10 & 1). We tried medical treatment with high doses of medication and could not make him urinate. What he needed was dialysis. This service, which a lot of our patients cannot afford is available in Lomé. In referring him to Lome, I was making an effort, yet I knew that not only would he not be going, but that he would most likely be dead by the morning. This shouldn’t happen and he should have access to this. This is hard and it really hurt us. This is an example of moral injury.

Benevolence fund: HBB has different types of benevolence funds that cover the hospital bills from patients that are adults, pediatrics, palliative, and surgical.  In addition, there is a “cash box” that helps patients with meals in time of need. These funds are directed by hospital “commis” (Togolese who are responsible for finalizing the bills of the patients on discharge) and signed off by the doctors. For the adult medical benevolence fund, we have helped 77 people this year with bills ranging from $3 – 1,036 USD each. If you would feel lead to contribute to any of these funds, please click here (look under “Financial Support”).

TST Meeting: Every four months or so, the Togo South Team (TST), which HBB is under, gets together for a day. During this time, ministry updates are given on the work of the different TST ministries. TST which has planted over 100 churches, has over 17 different ministries: a MK (missionary kid) school, which 3 of our kids are enrolled in; a blind school with 47 students; a deaf school; 25 Christians schools throughout Togo; a literature and print shop; a visual audio studio; a prison ministry; a program that teaches pastors in Biblical counseling; a pastor school; a child evangelism program that focus on teaching teachers and church leaders how to create and carry out children programs, and more. In all the presentations there is not only the common thread of a focus on God, but also of connecting, building relationship and helping others. From a purely business point of view, this should not work, but it does, and it is a testimony to not only God’s work, but the faithfulness of God’s people.  God is having an impact.   

Soccer / Sports Ministry: We are pleased to announce that we have been able to raise enough support to maintain the status quo for the hangar and the airfield for the next two years. This will allow the Saturday morning soccer ministry, the use of the airfield for soccer practice during the week, and the Awana program, to continue for the next two years, while the TST/sport ministry committee investigates further the feasibility and needs of a future sports ministry. We would like to thank all of you who have contributed with finances and prayers!  (If you would like to contribute to the Sports/Soccer Ministry, please email us.)

OB / Medicine: Our OB meetings continue every two weeks. During our last meeting, which lasted about 1½ hours, we spent half the time talking about patients currently admitted and recent deliveries. In doing this, we reviewed premature baby care (including feeding protocols), and shoulder dystocia.  We will be following up this discussion with a video in two weeks, reviewing “visually” what needs to be done during shoulder dystocia. The second half of the time was spent reviewing how to do a history and physical on patients either presenting to clinic for a routine visit and/or to the hospital in labor. It was a solid conversation. Their questions and responses are showing not only an interest in doing more, but that they are picking up and retaining information through the discussions. Our medicine meetings are not occurring regularly; however, we are having good conversations when they do occur. Please pray for the opportunity to have regular medicine meetings with our fellow Togolese clinicians (hospital trained mid-level providers) as this not only provides for an important opportunity to guide medical discussions, but also build relationships.

Family Update

Fred and Lydia: Between job sharing, home schooling, fixing stuff (shoes, a trampoline, a sink, a motorcycle, etc.), making trips to Lome (shopping, orthodontist, dentist), Bible study, and sports (Saturday morning soccer, just finishing cross country as a family and will start swimming this week), life is busy. We kind of thought by now we would be hitting a stride, and although we are not overwhelmed, we are feeling the weight of the constant go and demands. We are grateful for the other missionary families, ministries, and resources that help us manage this schedule easier.  For work, we have “iPhone applications” (UpToDate, WikiER and OpenEvidence) that are amazing, allowing us to search medical information in a timely fashion; for school we have the MK school on the compound, on-line schools such as Potters, Veritas and Liberty and a missionary mom who has include Noah in one of the courses she teaches her kids; for traveling to Lome we have the Guest House and other missionary families who are flexible in their schedules, allowing us to tag along as needed and for fixing things, a solid maintenance department that will repair things I cannot and/or that I made worse in trying to fix.

Noah, Nathanael, Noémi, and Noll: The kids started the 2026-27 school year at the end of August. They seem to be managing the work well at this point, for which we are grateful. We still spend time with them every day going through their homework and memorizing Bible verses. If there is a challenge in what they currently do, it is the individuality of it all. At Blackhawk Christian School (in the US), they were among a larger group of friends which helps to motivate them and provided opportunity, whereas here in Togo they are not. We continue to keep these lines of communication open with them, recognizing that the path they are on is not easy and is different. And regardless of path taken, no path guarantees success.

An early Happy Thanksgiving, Merry Christmas and Happy New year!

God bless,

The Pfenniger’s

website: www.fredandlydia.com ….. email: mail@fredandlydia.com

Pfenniger Family Prayers:

• Each day we will choose to follow Christ in what we say and do
• Wisdom in how to respond to the numerous needs that surround us -which ones God would have us invest in and how and in what way to invest 
• Ability for us (individually and as a family) to form relationships with the Togolese -both in and out of work environments
• Wisdom in how we invest our time outside of the hospital, whether studies or ministries or in one-on-one relations
• Fred and Lydia • marriage (finding time for each other), • parenting (wisdom to know how to help the kids in processing life, how to overcome challenges, how to relate to others, how to look to God for their help/strength), and • work (wisdom and insight needed in medical work, in relations with others –both Togolese & fellow missionaries –and in looking for how to plan for the future).   
• Noah -navigating his on-line classes and the intensity that comes with high-school level classes; working through exercising/doing sports without “his team” –this at times feels very lonely to him.  Please pray that he will sense God in a very real way “walking beside him” in this.

Praises:

• Support that we have had through family and friends stateside (texts, phone calls & emails) and through fellow Togolese and Togo South Team missionaries (both at work and at home)
• Moments of laughter and fun that we’ve had together as a family

Togo, Hôpital Baptiste Biblique Prayers:

• Patients, and their families, that come to HBB –that they may feel the love and compassion of Jesus in their time of need
• Mrs. G’s baby –that she will be able to go home soon and will be able to thrive and do well at home.  And that Mrs. G and her family will grow in their relationship with God  
• Wisdom for the medical providers, nurses and doctors caring for the patients
• OB meetings ‒continued wisdom in discussions in managing difficult cases and working through how to be able to do more; also, in developing deeper relationships with the OB nurses and becoming a true team atmosphere
• Medical Clinician meetings –wisdom on finding a time that works to meet
• Proposed sports ministry –wisdom in the next steps as TST and the sports committee look into the feasibility of a sports ministry
• Soccer ministry -to find ways to develop relationships with the kids and encourage their spiritual walk (biggest challenge: language –French is their 2^nd language too and they speak one of several local tribal languages)
• Wisdom and vision needed by the HBB team in the construction of the expansion project.

Praises: 

• Dr. R & his wife who came and helped in talking through and processing “moral injury” and what we do with it (Please also pray that what was discussed will carry forward and have a positive impact on our team.)
• Adequate money raised to maintain the Hangar and airfield for 2 years.
• Encouraging cases where patients shouldn’t have survived but they did, and thus “open doors” with patients (as some stay a short-time and others stay a long time).
• Opportunities in tough patient situations and the discussions with staff that are happening afterwards
• Different short-termers who have come and are coming out to help in the hospital and in other ways (construction, sports, etc.)