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
