Asdis’ Blog

Back to Accra

Yesterday was our last day in the rounding in the hospital and seeing patients in the clinic. Sheila and I talked Jaquelyn and Lena into helping out with triaging the patients in the clinic and it went pretty well. Usually everyone just has to wait their turn regardless of how sick they are but this way the girls identified those patients that really needed to be seen and sent them in first.

We said our goodbyes to all the nurses and patients and took some pictures of everyone. Leaving Nalerigu was a little bitter sweet experience because I have really enjoyed my time here but at the same time it will be nice to go home and see my friends and family again, and of course to finally find out where I’m headed for residency. I will definitely miss all the people that I have met and all the patients that I have taken care of here.

It is strange to think of all the interesting patients and cases that I have seen here, much of which I would never see in the States. Just some of those include severe malnutrition, dealing with acute respiratory distress without supportive equipment, breech deliveries gone horribly bad, 14 year old girl with renal failure and no dialysis available, never ending nose bleeds in a severly anemic woman, endless amount of snake bites, severe inguinal hernias and hydrocoeles (men walking around with a basketball between their legs), malaria, acute typhoid abdomen, tuberculosis, and deliveries on the floor. There are so many interesting things to see and do here at the BMC!   

We had to leave Nalerigu at 4 am in order to catch our flight from Tamale to Accra. The first 90 minutes of that drive are pretty brutal, driving on a dirt road trying to avoid rocks, pot holes and of course the goats that are all over the place. Therefore, when we finally arrived in Accra this morning I was pretty tired and took a quick nap. After lounging around for a while we went back to Osu Street, where we walked around for a while. Our flight tomorrow doesn’t leave until 9pm so we are planning on going to the beach which should be nice. By Monday morning we will be back in the States and to our usual routine, but I’m ready to start planning my next international medical experience already!

Last week in Nalerigu!

Our last week here has really flown by fast! It doesn’t really feel like I’ve been here for almost a month but when I look back at all the things that I’ve seen and done it all starts adding up.

Monday was a holiday because of Ghana’s independence day so I was very glad to have an extra day off from clinic. Of course we still rounded in the hospital as always but it was a nice break none the less. Monday was also the last day that Kim and Jess were here because they left for Accra very early on Tuesday.

Since there are just three of us left (Rich, Sheila and I) we have been dividing up the hospital for rounds in the morning and so far we have been able to finish everything on time for clinic and/or procedures. I usually start in peds and then work my way into the adult wards where I find Sheila and Rich and then we all go to the isolation ward and finish rounds there. That is where they have the meningitis patients and the TB (berkla)patients.

I am enjoying the independence and confidence that I gain by seeing patients on my own and I feel like I am learning a lot every day. Inspired by two of my patients on the ward right now, I am writing my Inmed presentation on malnutrition. These two kids are tough to look at because they are so malnurished. The girl is 3 years old and weighs 5.4 kg and the little boy is 31/2 and weighs 6.1 kg. I am trying to get them well enough so that they can go back to the nutrition clinic and continue to get fed there, but they are nowhere near ready for that yet.

Today, Thursday, Sheila and I spent finishing up all the things we wanted to do in Nalerigu before we left. We visited the Happy Child school, where kids from 3 years old up to teenagers go to school. The kids were on break when we got there which was good because they went crazy when they saw us coming. Sheila and I had to break free in order to finish our tour of the classrooms. We also went to the orphanage here in town. Lena and Jaquelyn work there every afternoon so we went with them. There are 18 kids that live in a housing compound with one woman cooking for them during the day, and one caretaker staying with them at night. These kids are starved for attention so they were very excited to play with the jump ropes, frisbees, and crayons that we brought for them.

Tonight we had dinner with Greg, Wendy, their kids, Rich, Lena and Jaquelyn. We gave them all a couple of gifts as well as some of the things that we are not taking back with us, like granola bars and candy. We are also leaving a whole bag full of clothes to donate to either the orphanage or one of the local churces in town.

Tomorrow will be the last day working in the hospital and we will have clinic in the afternoon. We fly to Accra from Tamale early morning on Saturday, so we leave Nalerigu around 4 am. Our flight back to the States is on Sunday night so maybe we will have some time to explore Accra a little better this weekend.  

Just a quick update….

So, let’s see… Thursday we got some rain for about 30-45 minutes or so which brought a nice relief from the scorching heat. All the procedures went well on Thursday. The little boy (4 years old) with the swollen thigh and buttock we think he may have rhabdomyosarcoma (a long word for cancer). We took a biopsy of his thigh and it will be sent to the States to be evaluated but the results won’t come back for another three months so we discharged him from the hospital.

Friday was a long day in the clinic and I was ready to go to sleep early that night. I did see one 12 year old boy who had been playing with a gun and had managed to shoot him self in the hand. Rich and I took a look at what was left of it and unfortunately his thumb is completely gone and we are not sure if he’ll keep his index finger.

Shortly after coming home and eating dinner we all got called back to the hospital around 10 that night due to a big bus accident. When we got to the hospital the lobby was crowded with bystanders and patients and it was difficult to figure out who was actually injured. We tried to get people that weren’t hurt to move out of the way but it was challenging at best. I admitted three guys with femur (lærlegg) fractures, a guy with a collapsed lung, and a two year old that was unconscious (he walked out of the hospital today and was doing great). One young man was brought in dead but fortunately there were no other casualties.

Saturday, Sheila and I, along with Lena and Jaquelyn (the two German girls) all went up to Paga to see the crocodiles and to do some shopping at a souvenier market. It took us over two hours to get there and most of it on a very bumpy gravel road so we were all grateful when we finally arrived. After buying two chickens to feed to the crocodiles, the guides loured them out of the water. There were probably 5 smaller crocs (2 meters long) on the shore of the lake and one huge one (almost 3 meters long). The guides whistled and waived the chickens around and they all came out of the water. Then one of them shows us how we can sit on the back of the big one, lift the tail up, and pet it. I thought it was crazy and I was freaking out the whole time but I did it while Sheila quickly snapped some pictures so I have proof of my bravery! Then Sheila, Lena, and Jaquelyn all took there turns and the crocodile was perfectly still through everything. The quide waived a little stick around a couple of times when the crock started walking and it stopped right away. After the crocodile adventure we shopped for a little while and then headed home.

Today was our last Sunday here in Nalerigu and it is Ghana’s Independence Day. It’s kind of strange to think that I only have one more week here! The time has really flown by. We rounded a little late this morning and it was nice to get an extra hours of sleep. There wasn’t much celebration going on here in Nalerigu as most of it is held in Accra.

 Greg and Wendy invited everyone over for dinner tonight so that was fun. We hung out and chatted with them for a while afterward. Their kids are a lot of fun and just so full of energy all the time.

This weekend Sheila and I have been trying to figure out all the things we still want to see and do here before we leave. There are quite a few things on our list on top of working so hopefully we will get it all done. Also, since Jess and Kim are leaving tomorrow, Sheila and I will be on call every day until we leave so we should have plenty of things to do. 

Las Vegas, Ghana

Sheila and I went out to dinner last night with Rich and Samson (a nurse from the hospital). We walked all the way across town, or at least it felt like forever, until we got to this restaurant named Las Vegas. We all had some chicken and rice with a spicy sauce, and we had to use our flashlights to see what we were eating since it was getting pretty dark! But the food was delicious so I think we may go back there before we leave Nalerigu. Walking back to the BMC was also pretty interesting because there are motorcycles everywhere and they don’t really slow down for those who are walking!

 Today was a crazy day at the clinic. We stopped at 6pm without getting through all the patients that had been checked in for that day. We just couldn’t get through them all. Afternoon rounds were pretty busy as we had filled the hospital again and we had a few procedures to do. By the time I got home a little after 8pm I was starving and I was grateful for the pizza and Coke that was waiting for us. Sheila and I are on call for the next few nights so I’m hoping they will nice and calm without too many calls. We’ll see what happens.

 Quote of the day goes to Sheila for saying “what is that coming out of this boy’s testes?” Answer: “Sheila, it’s a girl” (talking about a new born baby girl we were doing a lumbar puncture on).

 It’s been really hot here lately and I am definitely feeling it. Also, the mosquitoes seem to like me so I’m getting eaten up despite using mosquito sprays and everything else. I’m hoping the doxycycline works

Tomorrow is a procedure day and we already have several lined up to do. I have a debridement of a foot injury, I&D on a child’s thigh, hydrocele, and congenital tooth extraction so we’ll see how those go.

Another few days…

Last week didn’t really end on the best of terms as towards the end of clinic a mother brought her 2 year old boy in to be seen. He was already dead and the mother was crying for us to do something for him. After that I didn’t really feel like doing much that night but since Jake was leaving we had a little goodbye party for him. Sheila and I were on call and it seemed like the trend continued through the night because we got called in to look at a three week old baby in respiratory distress. The baby looked premature and was not breathing well so we put it in the incubator and used the mask to ventilate her. However, as there is not much that we can do for these children so the baby died shortly there after.

The weekend was a welcome break from the hospital as after rounds we went to Nakpunduri which is a cliff/rock formation that overlooks Ghana’s borders with Togo and Burkina Faso. It was a really beautiful area and the view was fantastic. We hiked up there, took some pictures and I just enjoyed being outside for a little while. Sunday Sheila and I went with Bruno (one of the peds nurses) to church. It was interesting to see and different from any mass that I have attended before. They did a lot of singing and dancing and lasted over two hours. The kids were all very interested in us while we were there and both Sheila and I, as well as the German girls that were there, had at least one child in our arms at all times.

Sunday night we were on call again, and again we got called in on another 3 week old baby in respiratory distress. We tried everything that we could here but in the end the parents chose to take the baby home to die. Monday also didn’t start well since a new child was brought to my attention as he was gasping for air. The nurses had been unable to get IV access and the baby (three months old) was pretty sick. He died before I had a chance to do anything but ventilate him for a couple of minutes. I am frustrated with seeing all these kids die before I even have a chance to do something for them and we don’t even have the tools to do everything that we would like to.

 All of this probably sounds pretty morbid, but overall I am enjoying this experience. However, I am getting to see and do a lot of things that I would never be able to do in the States. I did another lumbar puncture (mænustungu) the other day, as well as a D&C (for women who have had miscarriages) with Sheila on Friday. Also, I’ve done a few I&Ds (draining pus out of joints or skin) and managed all of the peds ward on my own for the most part. Despite those four kids dying in the last few days, most of the kids do pretty well and recover so that is always fun to see. I am getting more and more comfortable in managing patients on my own which is a nice preparation for residency.

Sheila and I had last night as well as tonight off which has allowed us to catch up on some reading and more importantly, sleep. My time here has really passed fast and I can’t believe it is already more than half way done!  

Mango Tree Clinics

Both yesterday and today I went with Dr. Prine and his group to a couple of villages to have a make-shift pediatric clinic there. We went there along with the dentist and his assistants.

When we arrived at the villages we were introduced to the Chief of each village to ask if it was okay with him if we set up their. In both villages the Chief sat on a little coushin-throne in a clay hut and someone from our group offered them a small gift of flashlights. They allowed us to work their and see their villagers so we set up a couple of benches and a table and went to work.

 It must have been like the circus was in town because everyone swarmed around us and every once in a while we had to ask people to step away from us just so that we could see the patients. Shortly there after though, we were just as crowded and we just had to work through it. We saw a lot of healthy kids with some minor issues but we did bring one 3 year old boy back with us to the hospital today so that we can treat his typhoid adequately.

The clinic was pretty rough and we didn’t have all the medicine that we might have needed but for the most part we were able to treat most of the kids. Most of them really didn’t need anything but it was like every mom was bringing all of her 5 children to us to be seen, regardless of whether they were sick or not. I guess they just wanted us to make sure they were okay so we handed out a lot of multivitamins.

The village we went to yesterday wasn’t too far away but today we drove for about an hour and a half to get there and the road was challenging to say the least! On the way there we pretty much had to climb up a cliff and move rock from the road to get there and then on the way back we almost got stuck in the sand after crossing a small stream. We all got out to help push the vehicle but the whole thing was pretty funny. The scenery was beautiful though and I was hoping to see a giraffe or elephant strolling around to perfect the image but aparantly the don’t live around here.

 Dr. Prine is leaving tomorrow afternoon along with the dentist, the surgeon, the anesthesiologist, and the rest of their crew so tomorrow I’m gonna try to soak up as much knowledge as I can on rounds in order to be able to see most of the peds patients on my own. We still have Dr. Etuh who is a Nigerian general surgeon working here for the year, so we will still be able to treat surgical cases. Other than that it will just be Sheila and I, two residents from Missouri, Rich (our attending), and Jake (a student who is leaving on Sunday).

Anyways, being outside all day yesterday and today took a toll on my shoulders, even with plenty of sunscreen and trying to be in the shade while working, but hopefully it will fade soon ;)

Sheila and I were on call the last two nights. The first one was pretty uneventful but yesterday morning Sheila gave blood again to the little boy. Unfortunately he was too far gone and he died yesterday afternoon. Last night was a little busier as we got called on a lady in labor around midnight and a boy in respiratory distress around 3 am. So, not much sleep but they both did well so it was worth it.

Tomorrow is another clinic day but I am definitely looking forward to the weekend. Just to get to relax for a little bit will be nice.

Days #7,8 and 9

I apologize for the delay but I have just been too busy/tired to write anything for the last few days so I guess I have a few days to tell you guys about. Well, my call night on Saturday wasn’t too busy. I got two calls to go to the hospital at around 2300 and then again at 5 in morning, but nothing serious was going on. Sunday was nice and relaxed. We rounded on the hospital patients in the morning and in the afternoon, but in between I was able to catch up on my laundry, do some reading and go over to Greg & Wendy’s house for a movie with everyone.

After rounds were done that afternoon, Sheila and I went with Jess and Kim (family medicine residents from Springfield Missouri) to a funeral celebration in the town. We didn’t find it at first but after a while we just followed the music and saw a big crowd gathered. The were celebrating a one year anniversary of an elder’s death and everyone was dressed up in their best clothes, dancing, drumming, and slaughtering goats. It was pretty interesting and I was allowed to take some pictures that I will try to put online. Sheila was on call that night but she didn’t get any calls.

Yesterday was another busy day in the clinic and after work. Over the last few days I have become more and more comfortable with diagnosing and treating the disease spectrum that we see here but I still have a lot to learn. It is great to have Rich, Dr. Prine, and the other docs around to help. Today I helped the dentist extract a tooth from the lady with the swollen jaw. He thought that one of her molars might be infected so hopefully she will continue to improve. I also scrubbed in with the surgeons to help fix a an inguinal hernia (kviðslit), and then I removed sometype of calcified growth from a woman’s hip.

It always seems that as we are about to leave something happens. We were done with the afternoon rounds when we got two admissions. Both patients had been bitten by snakes. One patient was doing fine and had received the snake antivenom in time, but the boy (about 12 years old) had been bitten about 5 days ago so the venom has had plenty of time to bind and the antivenom won’t help much. The venom causes problems with coagulation so these patients are at increased risk of bleeding. The boy was having nose bleeds and we were unable to get him to stop. Sheila and I probably spent about 30-45 minutes holding, stuffing or squeezing his nose without any improvements. Rich and Jake were around so they came in to help us. About 2-3 hours later, with sedation, nasal tampons, blood everywhere, and plenty of gauze we were able to slow down the nose bleeds. (by the way, we don’t have cautery or any other means of stopping nose bleeds). That poor kid did not like us by the end of that wrestling match. Unfortunately he still hasn’t stopped bleeding so we are kinda running out of options as far as what we can do other than wait for his body to deal with the venom.

Since I am on call tonight again, Sheila and I decided to go check on new admissions after we were done dealing with the kid. Things were pretty managable on the men’s and women’s ward but the peds area had exploded throughout the day. We were told about one patient who had just been admitted for malaria. He is 10 months old and in severe distress, uncounscious when we first saw him, struggling to breath and severely anemic (hematocrit of 8%). It was kinda reassuring that we didn’t freak out at the sight of a kid that sick, there have been so many like that, and Sheila and I were able to work through what we needed to do for him. Sheila donated blood since his family wasn’t able to find anyone to do so for him (there is no blood bank here, family members have to donate blood to the patients). By the time we left he was breathing much better, crying a little, we were treating him appropriately, and Dr. Prine was offering us a letter of recommendation so we felt pretty good about what we have learned here so far.

It was about 10pm when we finally finished rounds and made it home for dinner. I was starving, tired, sweaty and warm. I was told that the temperature reached 122 degrees F today!! (50 degrees Celcius). No wonder I couldn’t sleep last night! Air conditioners are few and far between, the OR has two, but other than that we only have fans and open windows to create some breeze. Our room gets a pretty warm during the day in particular so I can’t stay inside for long. The only problem with being outside is all the mosquito bites I keep accumulating.

Tomorrow I am going with Dr. Prine and his group to some village to set up a clinic there (under a Mango tree). I don’t really know what to expect but if I enjoy it I may go back with him on Thursday. I am hoping that I won’t get too many calls tonight as I am pretty tired and ready to sleep, but who knows. It seems to be pretty random as far as when we are busy at night or not.

Well, I think that’s about all that has happened here in Nalerigu for the last few days. I’m glad you guys are reading this and enjoying it!

Days #5 and 6 at BMC

Our little girl that Sheila and I stayed up with died yesterday. We knew she was getting pretty bad and there wasn’t much we could do for her, so I was glad that we had said our goodbyes to her the night before.

We were pretty busy yesterday, with rounds in the morning and then clinic in the afternoon. I did a couple of paracentesis (draining fluid of a patients abdomen) which was a little different from what I’ve seen done in the States. Usually we numb the patient up, use this fancy apparatus to put a catheter into the abdomen and then hook it up to vacuum containers to assist with the whole process… Well here there is no such thing. So I grabbed an IV catheter, a used tubing, and a blue tub… that was it! No numbing meds,  so I just stuck the needle through as the patient gritted his teeth and then just taped the tubing to the tub which was on the floor to use gravity to assist with the draining process. It took about 2 hours to drain completely but it worked.

 After work yesterday, Isaah (the cook) came and picked Sheila and I up on his motorbike. All three of us rode over to his house where his wife had prepared dinner for us. We had Fufu, which is made from ground up yams so that it becomes a white ball of somewhat gummy like stuff. Pretty interesting texture but it was good. This was served with a spicy pine oil sauce and meat from a pig’s head. Isaah has a little bar that he wanted to show us so he and Kaleb (another chef) drove us over there and we had a couple of drinks. His place was much nicer than the first one we went to, with a fenced of area and music.

Since today was Saturday, we slept in a little bit and then rounded in the hospital this morning. After lunch we went over to Greg and Wendy’s house for a magic show held by their son Aiden and a movie. Greg is a missionary here, and his wife Wendy is here with him along with their thee children, Carter 9, Aiden  7 and Sukonya 7. Unfortunately we weren’t able to finish the movie since we had to go back to the hospital and round again. I did and I&D (draining pus and cleaning and infection) of a ladie’s jaw. Her infection was so bad that the whole right side of her face was swollen up, from her forehead to her neck and behind her nose. She could hardly open up her mouth to eat of speak. I might have to do it again a couple of times but she looked a lot better after the procedure.

 I’m on call tonight so hopefully I won’t have a crazy night like the other day. I have a phone that they call if they need me so I don’t have to sleep at the hospital or stay up all night if nothing happens. Tomorrow should be a fairly light day so I am thinking about exploring the town a little bit although I do have to catch up on some laundry and e-mails.

On a completely unrelated note, I think it will take me weeks to clean my feet after this stay here. I walk around in flip flops all day and there is red sand all around here so by the time I come home at night my feet are stained red up to my ankles. The first thing Sheila and I do when we come home for dinner is to wash our feet but I just can’t get it all off! This red sand also is everywhere, both in the hospital, OR area, and at the house. It’s impossible to keep things clean. Anyways, I’ll keep trying but just don’t laugh when I won’t go barefoot for a few weeks after I return. 

Day #3 and 4 at BMC

The last few days are kind of a blur as a lot of things have happened. It has been incredibly hot here and although I am trying to drink several liters of water or gatorade each day, I am barely keeping up with the amount I am sweating.

Yesterday (Wed) had a rough start. I started to round with Dr. Prine, a pediatrician that is here, and we started in the Peds Ward. We had just finished examining a 6 mo old boy and we walked across the room to check on another baby when all of a sudden the mom says something and the nurse calls us back to the bedside. The child had died! No more than a minute after we had been there checking on him. He had been rushed to the OR the night before due to an acute abdomen and had been found to have severe intussusception. We thought he was on the road to recovery but things change pretty quickly here. Also, we don’t do CPR here since there are no ventilators here and the staff is not trained. Death is pretty much an every day occurance here at the hospital, usually a few each day, but this was the first child we lost since I’ve been here.

 When we recovered from the shock we finished our rounds in the peds ward. We have a lot of malaria patients, typhoid with or without GI perforations, meningitis, TB, and malnutrition. I did my first lumbar puncture on a two year old girl that we suspect may have meningitis.

Clinic on Wednesday was busy and I admitted four new patients to the hospital, and once again the hospital was overflowing as all the other docs admitted several patients as well. After clinic I checked up on some of my patients and then proceded to round again with Dr. Prine in the Peds ward. As we were finishing up, someone brought a tiny little girl to us. She was a twin that had just been born at home that day, and the mother had died due to some complications during the delivery. She is probably a little premature, about 35 weeks, and was struggling to breath. We were able to give her some oxygen and put her in an incubator but she needed constant stimulation and occasional ventilatory support to keep her oxygen level up. Sheila and I volunteered to stay overnight in the hospital to take care of her… and we were in for a crazy night! Only in Nalerigu could all this happen at once!

The night started a few deliveries that the midwives handled, but the little girl kept us busy as we took turns bagging her every once in a while. Then we got a call about a woman whose labor was not progressing properly and we decided that she needed a C-section so we woke Rich up and he took care of that. Things calmed down for a while but then I was called to a patient’s bedside and all I was told was that “her condition has changed”. When I got there the patient was gasped a couple of times but then died. Unfortunately there is nothing we can do in these situations when the meds don’t work, since we don’t have all the necessary equipment. I haven’t had to pronounce someone dead before but it was a 70 year old lady with severe pneumonia. Sheila was up for the next call so I stayed with the baby girl. Again, all we are told that we needed to check on a patient in the women’s ward since “her condition has changed”. She gets there through the interpreter figures out that the lady is having contractions. As she hears that, the lady gets up, squats on the floor and delivers a baby girl!! Everyone was just standing and watching her so Sheila came running back to the maternity ward where I was and grabbed what she needed to cut the cord, suction the baby, etc., but both mother and child did well. 

Our night wasn’t over yet, and we did have to call Dr. Prine to come help us because we couldn’t keep the little girl oxygenated well. Her O2 sats kept dropping, but he was able to stabilize her and she was fine for the rest of the night. However, the worst was yet to come. Around 6 in the morning I took the next call and I was told that a woman was being brought to the hospital due to prolonged labor. We went outside and a few men were moving a young woman from a van to a stretcher so that she can be moved inside. She was obviously in pain but she had all these sheets and plastic wrapped around her waist so I couldn’t really see what was going on as far as the delivery went. We took her inside to look her over and unfortunately I don’t think I will ever be able to forget this sight! The baby had been delivered breech (feet or butt first), she was unable to complete the delivery and the baby was stuck. The baby had been that way for several hours was dead. I called Rich in since neither I, Sheila or the midwives were able to get it out. The poor woman was in so much pain but luckily Rich was able to help us and the woman was actually doing really well today.

 Dr. Prine came that morning to take over watching the baby girl and Sheila and I decided that after a night like that we needed to rest for a little bit so we slept until about 1pm. Luckily the afternoon and this evening were pretty uneventful… Admitted a crazy lady, Sheila did some sutures on a guy that fell of his motorcycle and we rounded on our patients. Dr. Prine and his wife were able to rig the equipment that we have so that be little girl is getting constant oxygen and CPAP and they taught the maternity nurses how to check on her and make sure she’s ok. We are not sure what’s going to happen to her, but if she had been born anywhere else she would have had about 95% chance of survival but she needs to be on a ventilator, which we don’t have. It is frustrating that we don’t have all the equipment, technology, or trained staff to treat patients properly.

Well, my sleep schedule is all off since my call night so I need to try to get to bed before too long. Hope all is well with everyone back in Iceland and US!

Day #2 at BMC

The day started with a special treat as the cooks made us pancakes for breakfast (they usually only make lunch and dinner). This was really nice as lunch is not always a sure thing here as things tend to come up throughout the day. Today was a procedure day so we started as always at 7:30 but instead of having clinic at 10 we did some of the procedures that had been scheduled. I took out a cyst from a ladie’s arm and watched a few other procedures as well. We were able to take a long lunch since we had a pretty light load today as far as the procedures goes and a lot of people around to help. However, there were a lot of patients in the hospital and many of them have to sleep on the floor since we don’t have any more beds. Sheila and I decided to round on our own today and we started in ward 5 which is where the older children are. It went pretty well and and I think I’ll do the same tomorrow. I am learning a lot that way and Rich and the other attendings are always available to answer any questions that I may have.

 Late this afternoon after we had finished our 2nd rounds we were called to see a lady in the maternity ward. We were in the room discussing the case and what to do when all of a sudden a RAT came running across the floor right by where Sheila and I were standing. I just about freaked out, as most of you know I am not much for any type of animal that is smaller than a cat The midwives just couldn’t stop laughing at us as they are used to them roaming around the hospital. As far as other creatures around here goes, I tried to take some pictures of bats that were hanging in a tree outside the hospital but I quickly gave up after they all woke up and swarmed around us.

 Since we got done pretty early Sheila, Rich, Jake and I decided to go walk around town for a while. We stopped at a local restaurant which was more like a shed and we sat outside in plasting chairs around a crate but the weather was nice and the sunset was beautiful. The kids in that neighbourhood as well as some of the adults were really interested in us and my camera in particular, and all of them wanted to pose for a picture. In the end I had to hide the camera in order to get some space.

I am trying to pick up some of Mampruli, which is the language that is spoken here. It is difficult though as it is nothing like anything that I have tried before. Greetings such as dahsuba (good morning), neewuntahngah (good afternoon) and good evening (neezanoree) are pretty important, but I’m also trying to pick up some helpful words around the hospital. So far my vocabulary is limited to a handful of words and some gestures. It is also challenging since there are so many dialects here that often times the interpreters need to have someone else to translate since they can’t understand the patient’s language. All we can do then is to hope that there is another patient or family member around that speaks Mampruli.

The hospital system here is pretty different than what we are used to. Each patient needs to have some friend or family member around to help take care of them because otherwise the patient does not get food (which they bring from home or buy), bathed, or anything else. The nurses here really only make sure that our orders are processed, get the meds/labs/etc, and things like that, but as far as actual patient care they don’t do much.

Tomorrow will probably be pretty busy since we have clinic again and we had to turn many people away on Monday. I’m still pretty much exhausted from all the traveling, time change, and work so I am going to bed early tonight. I hope you guys are enjoying this, I’ll try my best to keep it up!