When you approved the order, did the service become a "Pending" service? Has the invoice been paid? If the invoice is paid, and the service is a pending service, it should be activated by cron. If it isn't check the module log under Tools > Logs > Module.
USD must be in use by another merchant gateway. A currency can only be assigned to one merchant gateway at a time, you should be able to check it if you disable the other merchant gateway that is using USD.
Yup, we don't have an importer for the other direction.. not much demand for that. Your best bet is to contact them directly. We are planning a TCAdmin module, but have been pretty slammed, so it's just a matter of time.