Sunday, February 26, 2012

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

Thursday, February 23, 2012

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.

Wednesday, February 15, 2012

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!

Tuesday, February 7, 2012

Week 1. Hit the ground running!


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