From Stateside

I realized I should have posted a final blog, as I have already been back home for a little over a week now. The first few days back were quite a change. The first time I went to drive my car I almost hit the car next to me because it was so easy to turn. I spent over 2 hours in the grocery store...it was so strange to have everything so available to me; I had no idea what to buy. In church, I almost turned to Beth, all excited, to comment that the service is in English!

I think the greatest difficulty we have had so far is relating our trip experience. People will ask, "how was it?" What do I say? "Great...but terrible. Awesome...but really sad. I LOVED it...but I wanted to cry all the time the first week I was there." Long story short, we appreciate your prayers and you following us along the way. I hope that our stories have served to inspire or touch you in some way. Finally, I won't keep posting, but please do continue to pray for the missionaries and hospital. It didn't really occur to me until the last week, but the clinic sees 500-600 patients every monday, wednesday and friday. So every clinic day that the chaplain's office gives their morning devotion, they have a huge opportunity to reach a lot of people.

Here are a few of the trip highlights in photo form. Love you all, and thank you for your support.

 Thes are the chiefs of a village where we did a dental clinic with the Clarksville team.

 This little miracle was Dr. James Dunn's first c-section, done in Ghana under local anesthesia

 Little child with significant burn injury that spent time on peds ward. He is now doing well.

 The children from the orphange, mentioned in a previous blog posting.

 The Corams, new to Nalerigu and committed to stay for the next year (Noah not pictured)

The Dickens, another one of the amazing missionary families in Nalerigu (Colt not pictured)

The Hewitts and Gibbs are the remaining families that would appreciate your prayers.

Not yet week 6: photos of the croc.

So this isn't a real post yet... week 6 to come. I fly back this evening and will finish the last post after I land in the states. Long story short, I have loved my time here and am so thankful to have had the opportunity to come. Thanks for reading along and praying along the way.

For now... here are the promised crocodile photos. He is 93 years old!

Week 5: Small World (aka small Nalerigu)

Week 5-ish

So this was written on Sunday, but internet has been down all week. Here it is late, but still just as goodJ

It’s hard to believe I only have a few days left at the BMC before heading back to Accra and back to the states. It has been such a whirlwind of an experience…and there are so many things that I miss about home, but I am going to be really sad to leave.

I believe in a previous post that I mentioned a woman that came in with what we believe to be cerebral malaria. She has been at the BMC in woman’s ward for the past 2 weeks in a coma with an NG tube for feeding. The first week she was in the hospital her husband came into my clinic; he told me who he was and how much time he has spent at the hospital, worried about his wife. Since his visit, I wave and smile every time I go by, and every time it breaks my heart. At this point, she seems to have significant brain damage. It is that she was likely having a prolonged seizure leading to her present state. Friday night on rounds, I smiled and waved at the husband like always, but he pulled me aside, full of questions. I hadn’t been the physician caring for his wife, so I didn’t know what had been going on with her. He showed me how her arm was stiff and she had urinary incontinence. Through a series of translators, Beth and I began to wonder how much the family really understands about her condition. We tried to explain that her brain has been hurt and we can’t do any tests to see how much damage there is. We ended our visit with a prayer and went away. Walking away I was glad for the opportunity to have prayed with them, but I wondered if I should have said more about her prognosis…that she may not be normal ever again. Interestingly, the story does not end there. I am not entirely sure their religious status, but at church sunday (Filane church) the pastor said that one of their people was in the hospital…in woman’s ward with a tube feeding her. The Filane (not sure of spelling) people are nomadic and are often outcasts in whatever village they settle near. They are often forced to live on the outskirts of town and are not even accepted by local churches. It seems that she may be of the Filane people but not necessarily Christian. I write all of this because I think it is interesting how small Nalerigu can be when you have been here for as long as we have. I prayed so long for this woman unable to speak to her family. I then discovered that we are working with missionaries supporting the church and people that are supporting and praying for her. I also share this story because I pray that these relationships can help lead to healing and salvation for the family.

I posted previously about several admissions of some sick folks on Thursday. We had several abdomens we were a bit concerned about…always on the lookout for a typhoid perforation. There were two women with tender bellies that looked pretty sick, but they are both doing well now and did not need surgery. We did have another woman the same afternoon that appeared to have suffered some brain injury. The source of her problems was not clear, but it almost seemed like any moment she would take her last breath. She did not make it to rounds that evening. It is very hard to see, but the longer we are here, I think we are better able to recognize the things that we can help and those that we cannot. We could do some small things, but her case was already pretty much out of our hands.

I believe I also may have previously posted about a small boy that came into my clinic with the history of having swallowed a coin 6 months prior. In disbelief, I did a chest x-ray. To my own surprise, we found a coin in his esophagus. The family came back to clinic on Friday, and reported that they had been to the medical center in Tamale where the coin was successfully removed. Big answer to prayer.

The hospital has seemed less busy with Joel and Earl back…. We seem much less busy than we had been before. Saturday, Earl took call and the Corams took the volunteer crew to Paga to the crocodile pond. There are apparently over 200 crocodiles in the pond, but there is one that is 93 years old and is rather friendly. They pull him out for the visitors to see…. And sit on. J pics of that one to come. We had a great time and really enjoyed the afternoon off. I even had a chance to get out on a bike this past weekend!!! Big thanks to Bart and Jane Ann for loaning us their own bikes.

Love you and miss you all…more to come.

Orphanage

What? A Mid-week post? I bet you are wondering if I am even working over here!

We had a busy day today…several new admissions with some really sick people. I have seen more typhoid here than I ever anticipated, and I have seen the consequences of a late detection of a typhoid perforation. I will write more about those patients in posts to come.

My heart today really goes out to the children at the local orphanage. Most of the children there are missing their father but do have a mother. The mothers really can’t care for them, so they will go to the orphanage during the day where they will be fed. They then go home for the night time. The children were so sweet. When they saw our car arrive, they all came running over and were hugging us and holding our hands. We played games and had a little Bible story time. Some of the girls wanted to sing some songs for us, and they sang the most precious Christian songs I’ve ever seen.

We did discover that somehow the orphanage does not have any more money. I don’t know much about the situation…who is in charge or how such a thing happens. Long story short, the kids were about to be sent home with no supper at all and with no prospect of a meal tomorrow. With nothing else to buy or cook, we rushed back to town to buy loaves of bread to break and feed them. It is just not something that we think about. Even working in the hospital here, I have seen even very poor people with things to eat for meals…even if it is mushed corn porridge (Tizet).

Please pray for these sweet little children, that their tummies will feel full and we can help the orphanage to ensure they will have a means to eat in the months to come. 

Week 4: Committment

Week 4: Commitment 

It is an incredibly hot day here in Nalerigu. Perhaps the hottest we have had, and as I sit on my bed typing this post, I am sweating despite the lack of exertion. We were hoping for a little stroll on Bart’s bikes later, but the heat may deter us.

Towards the end of this week, I began to wonder how anyone can do this for more than a month at a time. My respect for the long term missionaries increases each day that I am here and the more tired that I feel.  They are such Godly and wonderful people who have given up so much to serve God. Writing about the missionary families feels very fitting this week, as a new family arrived on Wednesday to work in Nalerigu. It sounds so daunting to hear them talk about getting on a plane with two suitcases…not to return to the states for at least one year.

The patient that is really on my mind is a little girl that came in yesterday afternoon. She was having a difficult time breathing, already on oxygen and receiving a blood transfusion. Basically, her heart is not working well. I would guess she is no more than 8 years old, and she can’t breathe because her heart is failing. What can we do in a center like this? Even the oxygen is not pressurized, it is only an oxygen concentrator. For the medical readers, she is started on Lasix and digoxin. As of this morning, she had stopped peeing as of yesterday and her abdomen has gotten more distended. Joel used the ultrasound to look at her heart only to see the ejection fraction is very low (it does not pump blood very well). Joel put down the ultrasound and says, “I think it would be a good idea to pray for her now.” I have seen Joel in the OR doing some impressive procedures: he saved a child with a typhoid perforation just the other day. But, I was more impressed by his prayer and his faith than anything else I have seen him do.

There are four American families here: the Gibbs, Hewitts, Dickens and now the Corims. Bart Gibbs is a nonmedical missionary who does a lot of ministerial work through the hospital and in Nalerigu. He has three daughters, and one lives with them here in Ghana. Earl Hewitt has three children and he has been in and out of Ghana over the last 25 years. He speaks the language and has amazing dedication and wisdom. Joel Dickens is the Ob-Gyn (and in Ghana general surgeon) at the BMC, which means he is “on call” nearly every night. He also has three little children. The new family will be in charge of organizing volunteers in the guest houses and will connect with the schools and orphanage. They have 2 children and are already committed to stay here for one year.

I am very pleased to report back on the uterine rupture patient that I have mentioned before. She had a prolonged hospital course with sepsis and infection of her incision site. To make matters worse, she does not have insurance and her family had no money to pay her hospital bill. Arrangements have been made from previous volunteers to take care of her bill and get her back home.

Prayers for strength for us and healing for our patients. Sometimes the medical is so busy it becomes easy to forget the mission side of what we need to be doing.

More to comeJ

Week 3: Local Celebrity

Week 3: Local Celebrity.

It’s an interesting phenomenon to walk down the streets of Nalerigu, through the market, or even in the hospital. There is clearly no means of looking natural. At the door leading to the inpatient wards of the hospital, there is a guard that will open the door and decide who is allowed to pass. Rushing down from clinic yesterday, I hurried passed a group of people, knowing the door would automatically open for me. Then the patients outside maternity all stop what they are doing to watch me pass and greet me.

I stop and think. I am automatically respected because I am white. At first I thought, no, it seems that way in the hospital because people respect us for taking care of their families. But, even in the village, children will run up to us to hold our hand, touch our hand (or ask us to buy them something). This is an interesting situation for a person who specifically came to a country to serve others: I am respected and elevated in their eyes when I am trying to be humble and serve.

What do I do? How does one make each patient feel as if they are important and worthy of my time and effort? How do I take care not to expect such respect when it is so common?

A few interesting events from the past week:

Pic of myself with the baby delivered from the ecclamptic mother (mentioned in previous post)- both came into my clinic and are doing well.

-Beth and I took call. We were called by maternity around midnight for a patient that was a VBAC, not progressing and now had decreased fetal heart tones. We rushed over in the old BMC truck (that’s right, I learned to drive a standard!) and ended up calling the surgeon in to do a c-section in the middle of the night. Interestingly, anesthesia will not come in at night, so Joel had to do both the spinal in addition to the section. Both mother and baby are now doing well.

-I had a patient in clinic with a congenitally shortened femur so that one of her legs is un-useable and much shorter than the other. She is a really sweet girl with a strong spirit. We are working to get her a hand powered tricycle type chair so that she will not have to continue to hobble around  on crutches.

-the Ghana police came by our house with two men that had been shot. The story was not entirely clear, but they were evidently idol worshipers and were out somewhere. Both had been shot and killed. For some reason, a physician had to examine them and pronounce them, so Jim went out and examined both bodies for number of bullets and causes of death.

- Beth had to little babies that we were able get money to send to Accra this week who needed surgery. One was a little boy with Hirchsprung's Disease (basically part of the bowl does not have nerves and doesn't move things along). He had a big belly and kept getting worse. The second was a little girl with a heart murmur (likely a hole between her ventricles). She was in heart failure and would likely not live without surgery. The family came into clinic before getting on the bus to say thank you to us for helping them. 

Again. Thanks for reading. I miss you and love you all. 

Please pray for the patients I have mentioned, especially the two little children who went to Accra for surgery. Pray for us to continue to have strength as we are both getting rather tired and for humble hearts to serve.

Week 2: Frustration

Week 2:

Monday: today was a good day… just kidding. I will save you the day to day details of the past week. Let’s suffice it to say, it was a similar play with a new cast of characters. There was a huge team here from Clarksville, TN doing dental, eyeglass and school visits, and our MVP is Dr. Jim Howard, an ER doc from TX.

Frustration. Jim is on his seventh visit to the BMC. Walking back from clinic on Monday he says, “we just have to focus on what we can do.” It sounds so simple yet so impossible. It is extremely easy to become frustrated here. I often feel like half the patients I don’t really need to do anything to help. They complain of headache; I determine they carry heavy items on their head and send them away with Tylenol. Even worse are the patients that come in and I can’t do anything to help: a young woman with ascites and likely liver disease, melanoma and the like. I would like to share a few stories of patients with you. There are patients everyday that will break your heart. Everyday kids die that wouldn’t die in America.

Burns. First, was a man who came in a few weeks ago. He had a seizure and fell into a fire. Third degree burns extended all the way up his legs. After fluids, fasciotomies, and debriding, the man was stabilized. Over the coming days, his legs were full of contractures and lacking any form of blood supply. What next? We are here to help and serve, but taking both his legs would be death for someone in Africa. If he cannot walk, he cannot eat. Any of our efforts to prolong his life here may only cause him more pain. He has gone home early this week to pass. I asked myself if we did him any good. What if we had never stepped in and brought him back with fluids and care? What if bringing him back gave him the opportunity to pray with the chaplin? Was it worth it?

Rupture. Greg, James and I were out on a nice morning run…until we arrived home. Maternity ward had been looking for Greg to come see a patient who presented with a hand out of the uterus. There were no heart tones, and mom’s uterus was ruptured. Medicine is difficult when ‘interesting case” often also means “bad outcome.” When the baby came out, they say, “put it in the bucket.” The mom’s life was saved that day. She is still on maternity and we have been very concerned about her. Following her section, her hematocrit was very low and there was no family to give her blood. (I can’t remember if I have written about that before, but the lack of blood bank means that blood must come directly from the patient’s own family). She finally did get blood, but has been spiking fevers every day since her operation. Today, another woman on the ward was translating for her. A nurse finally translated something back to me, and said that the lady was telling our young patient that she is lucky to be alive. God saved her life and she needs to go to church. My patient looked down and had tears on her face. I pray for this patient. I pray that she knows Jesus or that good will soon come from her sad situation.

 

Pus. Last one. There is a 8 year old girl that presented septic a week or so ago. We were certain she would die during the night and her extremities were already cold. She did not. In the coming week, her right leg appeared swollen despite a normal x-ray. She was taken for debridement…I have never seen so much pus in my life. I’ll spare the non medical crowd any further wound description, but the infection is now in her knee and she has already been drained twice. We clean, drain and pack, but it breaks my heart to see this beautiful young girl with such a big problem. In the states this infection would have been caught by CT long before it got this far. In the States, we treat people for 6-8 weeks with IV antibiotics for osteomyelitis…not in Ghana. This poor girl may not walk normally ever again. Her knee might be frozen and she very well could lose her leg. We saved her from sepsis, but she is not healed.

This post is not supposed to be depressing, but I wanted to share my heart. This is a sampling of what we see. It is hard. It can be frustrating. Nonetheless, we have to focus on what we can do because there is an ultimate healer, and we are not Him.

Photo of boy with burkitt lymphoma. Our team raised funds to send him to Accra for chemo (a very chemo-sensitive tumor).

Thanks for following. I love you all and miss you!

Week 1. Hit the ground running!

WEEK 1

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

Preparation-Intro

"Are you ready?" I sit and look at my calender, where "TO GHANA!" dominates any other tiny notation I have made. Yes, I have gotten all immunizations, malaria prophylaxis, DEET bug spray, and skirts to wear. Yes, all travel arrangements are set. I am indeed physically prepared to gather my things and translocate from here to Ghana. Am I, however, intellectually, emotionally and spiritually prepared?....unsure.

I won't go on anymore; I am truely not a blogger. After the time I have spent in the hospital writing notes, I wonder why I am incapable of typing a paragraph with any regard for grammar: Patient in no acute distress. Not tolerating PO intake. Will discuss with team. Are those sentences? Unsure. I decided to put myself through the misery of challenging my typing abilities so that I can have a means to share how God is working in Africa. Please tolerate my attempts to "blog" so that I can tell of God's greatness in Ghana. In John Piper's Let The Nations be Glad, he opens with these lines 

      "Missions is not the ultimate goal of the church. Worship is. Missions exists because worship doesn't. Worship is the ultimate, not missions, because God is ultimate not man.When this age is over and the countless millions of the redeemed fall on their faces before the the throneof God, missions will be no more. It is a temporary necessity. But worship abides forever."

I have to admit, I have not yet finished the book, but Piper demonstrates that worship is the driving force of missions. I say this because I do not want the following posts to bring any light to myself nor the physical work that we are doing. Let us use them to praise God for the work he is using us to accomplish in Ghana.

Finally, please pray for us. We set out on Saturday, fly to Amsterdam then Accra. We stay in a guest house there overnight, then a local flight to Tamale and a bus to Nalerigu. We ask for prayers for safety along the way as well as prayer for the hearts of the people we will encounter.