S: 26 y.o. WF s/p travel to Ghana. She reports that she is doing well. Good PO intake. Tolerating exercise. Condition is stable
In all seriousness, we literally have hit the ground running since our arrival in Accra. We finally came into the airport around 9:45pm Ghana time and made it to the guest house close to 10:30. Then, it was back to the airport by 6:00 to leave again for Tamale and drive to Nalerigu. I’m sitting in my room at the mission house thinking back on the last week trying to decide how to relay my experiences. I will try and do a quick day by day account. If you get bored, you can skip to the end, I’ll add some jokes to the last paragraph.
MONDAY: Arrival at BMC. After unpacking, we met the team of physicians that is working here with us. I’ll take a quick moment to introduce the team. First is Greg Mitchell; he is an Ob-Gyn from Mississippi. Michael and Greg Blake are both family physicians from Knoxville, and they arrived on the same flight as me from Tamale. George Aiken is a surgeon from Knoxville (who I have previously worked with on a surgery rotation), Megali is a family medicine resident from Canada and Candice is a fourth year med student from Arizona. Of course, you know Beth, who is my trusty travel companion for this trip. We quickly went over to clinic and began working alongside Dr. Hewitt (a long time physician at the BMC.) This was by far the most overwhelming moment of the trip. The entire waiting room is a patio on the side of the hospital. Each “exam room” gets 2 physicians and a translator. The patients will come in and sit on a stool next to the doctor. Dr. Hewitt is an amazing man, and he was able to quickly recognize spinal TB, malaria and the like. Then dinner and we were back again to the hospital around 8:00 pm for evening rounds on the hospital wards (pictured below).
Hospital wards in Ghana are massively different from anything you would encounter in the states. There are 3 male wards, 2 female wards, a pediatric ward, isolation, TB and maternity ward. Each ward is literally an open room with 10-12 beds around the room (aside from peds with 36 beds). The family is responsible for the care of the patient aside from medicines and procedures. As a result, there will not only be a room full of patients, there will always be at least one family member constantly by their side. The nurse will round with me to translate and give charts for new patients. I saw patients on medicine ward…feeling completely lost and overwhelmed. Finally, back home by 9:30, shower and to bed. I would like to mention that we have not slept more than 5 hours at a time since leaving Memphis (which was our one night in Accra). You can imagine the fatigue and jetlag at this point.
TUESDAY: Needless to say that I slept through my alarm, so morning rounds on an empty stomach in isolation/wound ward was nearly enough to make me hit the floor. Tuesday/Thursday are not clinic days and are predominately reserved for procedures. This can range from debridements to D&C or lipoma removals. Greg did several TVHs and let me come scrub and hold retractors on those. Have I mentioned that it’s hot here? So, the OR does not have any air conditioning nor fans, and the sterile gowns are not paper, they are cloth nylon…Add the OR lights, and it’s a recipe for sweaty scrubs!
We finished early today and I was able to go for a trail run with some of the guys. Joel, Greg, Greg and Michael were all going for a little trot and I decided to tag along. Yep, keeping in shape here y’all! I’ll leave it to say, we go back to round after dinner every night at 8:00….so I won’t write about that again.
WEDNESDAY: Another day, more am rounds. I realized my stomach may be too weak to deal with wound ward and I stuck to medicine with Michael. We see a lot of things like malaria and typhoid, but we also see things just like we do in the states like asthma exacerbation or pneumonia. Clinic was again busy. I did see a patient today that really pulled at the ol’ heartstrings. This was an elderly gentleman who was complaining of a groin mass as well as a lesion on his toe. I had not removed the toe bandage to try and save our “office” from a pool of blood before I took him to a back room. Melanoma. He had a massive lesion that had begun on the toe and now metastasized to form this grapefruit sized lesion in the groin. Nothing we can do. It was one of the most painful moments of the trip thus far to write him for some pain medication and send him home (Tylenol 1gm PO TID). This is not only frustrating but truely a struggle for me. I want to be here to help medically, and there is so much we cannot do. Additionally, I want to share the love of Jesus, but I can't speak their language....and I don't know about the faith of my translators. This is a huge point of struggle for several of us that have come to serve.
Lunch was cut short today by a frantic call telling of a Lorrie (sp?) accident. I believe that a lorrie is a bus- type vehicle that can accommodate additional passengers by putting them on the roof. Our team hustled over from the guest house back to the hospital to find the theatre (aka operating/ procedure rooms) full of patients: lying on stretchers, in wheel chairs or already being sutured in the back. There was blood all over the floor, IV bags hanging and people moaning. I was really impressed how everyone snapped into action. Not only our team, but the group of Ghanian medical assistants did a considerably good job of triaging patients. Of course, the hospital was full the next day, but our patients really did quite well.
All the while, our clinic filled with patients who needed to be seen. I might add we had to return again to round at night…which I may have said before.
THURSDAY: Procedure day number 2. This day was primarily interesting because there was only one anesthesiologist present. I might point out that anesthesia here is not inhalational anesthetics. Everything must be done with local, spinal or ketamine. Greg was kind enough to allow me to follow him back into his OR for a few TVHs. We worked right through lunch…I might have gotten a bit overheated in the first case…Greg laughed and told me if I fall in there, no one will pick me up. He’s right. The cases all went well and the patients did fine.
Following dinner, there was yet another pregnant woman who was not progressing. Back to the OR for another c-section. Greg took them back and baby and mom both did well.
FRIDAY: Sick patients on rounds today. There were two gentlemen admitted to the male ward with hepatic encephalopathy. The nursing staff found me in clinic later in the day to ask me to sign a death certificate. That was the first time I had seen that patient, and there was not much that could be done for him. It becomes really frustrating that death almost seems so common. Patients die during the day, and the physician responsible for them hardly gets a call.
We had several c-sections today, and more patients to be seen in clinic. Our translators, Perpetua and David, are so funny. I want to finish my patient and head to the OR, but Perpetua says, “please, Doctor. This patient, Please, Doctor.” More sections, more babies. They went well, and Greg was very kind to let me participate and do a good bit of a section myself.
I am really starting to enjoy running here. Greg figured out several routes from Joel (the perminant OB here) and he is the perfect pace running buddy. Let’s hope he doesn’t get tired of me always tagging along. The climate is so hot and dry, and when the wind blows, there is red dust everywhere. I do believe everything I own is now covered in red dust.
SATURDAY: Finally a weekend!!! Or so I thought. Rounds, debridement, D&C, Lunch. Called back. Lorrie accident #2. Luckily, this accident turned out to be rather minor. Unluckily, there was a seizing ecclamptic that arrived at the same time. The nurses could not get an IV as the patient continually tensed every muscle in her arms. Finally, she got enough meds to get her to the back, an ER doc (Jim) placed a spinal and the baby was out. The baby was very small, and the ability to resuscitate an infant here is next to none. We were all very concerned, but the baby continues to do well.
Paragraph of jokes. In case the rest was boring, I hope that you skipped to this paragraph. I don’t actually have any funny jokes, but I have learned a few interesting facts. The best response to anything anyone says here is “Nah.” I have no idea what it actually means, but you can almost always say it and seem right. Second, French fries at our guest house are made out of yams. Third, salad has no lettuce, only cabbage. Fourth, the human body is apparently designed to carry at least 35lbs on your head. Fifth, if you can’t tell the difference between a goat and sheep (as they look the same here) look at the tail: down=sheep, up=goat.
The next post will be shorter…less boring… and hopefully soonerJ