Come to Ghana!

November 7th, 2014 by Dennis Salter
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You will fall in love with these people!  I guarantee it!  They have a kindness and a love like you have rarely seen before.  It is a joy and a privilege to be here to help and to learn!


Today I went on outreach with a team of four.  It was great to get into the public health piece directly into the communities.  We went to two villages and did primary care, vaccinations (including dpt, polio, rotavirus, pneumococcal, mmr, and even yellow fever) and weight checks for children under 2 years of age.  Vitamin A is given age specific at 6 months.  Many of the children were either not gaining or actually losing weight.  We also distributed mosquito nets for families as needed.  The goal is to reduce childhood mortality (mostly from malaria and child hood diseases) and to reduce maternal mortality by doing more prenatal care.  We didn’t have any mothers to be that I could tell (although, it is not always easy to keep up with the language barrier!).


Our journey began with a fairly long drive on challenging roads (no roads in some places, I swear we drove through at least 3 small lakes and some moon craters!).  It reminded me a bit of the drive up to Loi Tai Leng in Burma!  It always amazes me how we make it through and don’t get vehicle breakdown!  God is good and roads like this are the reality here, so, get used to it!


One thing that surprised me is that they don’t routinely give deworming medicine to these kids when they do outreach.  Worms are common from contaminated water and food.  You can see some huge bellies on some kids and that is quite often worms.  No wonder kids don’t gain weight, they are sharing their food with “friends”!    Perhaps I can speak with leadership at some point and suggest this need.  Albendezole and mebedizole is relatively inexpensive.


Back at the “ER ranch” and I hit the ground running, about 12 noon.  We had student nurses today (every Friday and again on Saturday mornings).  They are eager to learn and I get to spend alot of time precepting and teaching.  I love it!  We had a hodgepodge of patients (as usual).  One patient had a reaction to the blood she was getting, stopped it and gave her hydrocortisone (they don’t have benadryl).  She was fine and the good news she didn’t react till the unit was almost all transfused so she still got the benefit.  Lots of kids and then at 2:30 we had a baby rushed in who was seizing.  He had a temp of almost 104 and was likely malaria.  It was tough going and I gave valium and a tylenol suppository.  Seizure continued for what seemed like forever!  God intervened and the child stopped seizing briefly.  This gave me time to get an IV in his sweet little hand and blood sent to lab.  He seized briefly again but soon he was somewhat better with fever reduced.  I went back tonight after dinner and he was much much better, positive for malaria and being treated.  He cried when I touched his forehead but at least he was feisty and focusing and responding!


Tonight we had a road traffic accident and patients everywhere!  (even laying on the floor, not enough beds).  I tell you, this is a great place to practice!  Innovation is key and flexibility is everything!


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What really matters

November 6th, 2014 by Dennis Salter
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Let me just share from my heart.  I was walking through the Wenchi Thursday market after work today.  To see the reality of these people and their poverty was an epiphany of sorts.  I started to think about American politics and the center stage that it took for many in the USA a couple of days ago.  Here I am, halfway around the world in a different reality.  A reality that doesn’t even acknowledge that American political scene and a reality that isn’t even impacted directly by that scene.  You see, America is not the center of the universe, well, that is except for Americans!  Have I really missed anything significant on the American news scene.  I doubt it, because, you see, this is the true reality.  People living in a world of poverty, a world of lack, a world of sickness at times, and a world that, for many, will never be much beyond these municipal borders.  This is the true reality because most of the world lives in conditions very unlike the American culture that we are encouraged to achieve.  Unfortunately, this reality will never make the front page news.  The news needs to be something that will sell.


Yes, that is about it.  In this reality, we had a 9 year old girl expire from cholera complications.  In this reality, I had a 7 year old boy come in with enteric fever.  And, in this reality, we saved two people from the clutches of cholera because this hospital exists.  We are currently transfusing packed red blood cells into three infants suffering from malaria, with hemoglobins less than 6.0.  I love these people.  I can’t think of anything more rewarding than living my life to serve in this way.  It is awesome!  Welcome to my reality!


November 4th, 2014 by Dennis Salter
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I am sorry to say that we lost the battle with cholera today on one of our patients.  He was 24 years old and otherwise healthy.  He was weak yesterday but doing well with rapid fluid rehydration and doxycycline.  He took a turn for the worst over night and sadly, he passed away this morning shortly after I went in.  This was a tough one.  Cholera is nasty and comes from contaminated food and water.  There are limited human resources in a place like this and limited ability to handle the acute phase of something like cholera.  Infection control is also a challenge due to the lack of facilities and supplies.  All in all, healthcare can be a success in a low resource setting but today, we had a casualty.


How about a mining accident.  There is alot of mining in the reaches of this hospital and with mining comes accidents.  This particular accident was from a gold mine (yes, this is the gold coast!).  On one of the blasts there was a partial collapse and we had the four victims come in the ER.  I think all will be okay.  There is a pretty nasty head injury on one of the patients but the x-ray looks okay (no CT scan here).  The other patients had multiple lacerations and a broken femur but we made progress.  I sutured one of the smaller lacerations and some other care was done in the theatre.


I am definitely getting the experience that I came here for, and in the process, I am falling in love with Ghana!

Week Three

November 3rd, 2014 by Dennis Salter
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The beginning of week three is off to a great start.  You have to experience the hospitality and genuineness of the Ghana Christian churches to understand how embraced I feel.  These people have a commitment to the Lord and each other like I have rarely seen before.  I attended Emmanuel Presbyterian Church on Sunday and was warmly welcomed and introduced to the congregation.  It was good to be part of the cultural experience and also to worship alongside these wonderful people.


It was cholera clinic again today.  I had two patients in isolation as they were more acutely ill than the other two suspected cholera patients in the ER.  Stool cultures confirm cholera and they have to be sent to Sunyani for analysis so they take a while.  In the meantime the two in isolation has the classic cholera diarrhea and we are treating them as positive.  Isolation is a huge challenge here in a developing country hospital.  There are very limited resources and it is virtually impossible to follow all recommended infection control practices.  But we do our best and leave the rest to God to help us.  What I notice most is the strict entry and exit of the cholera ward with the bleach soaked foot mats and the bleach water hand wash.


I am enjoying the developing relationships with the doctors and the nursing staff.  They are a pleasure to work with.  They teach me so much and I am able to share also with them.


I have been able to expand these relationships somewhat outside of work.  I spent part of Sunday in the home of one of the ER nurses and we watched football.  Also, I am making plans to take two of the ER staff out for Fufu very soon.  I have not had it yet but it is all the rage in Ghana!  I am looking forward to trying it.  I must admit my culinary skills are lacking in this culture.  Normally I am a very good cook but I am unfamiliar with the ingredients needed to make some of the featured items of Ghana.  I am hoping to learn more!


November 3rd, 2014 by Dennis Salter
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October 31st, 2014 by Dennis Salter
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I was able to put my suturing skills to use. We had a sweet boy, around 7 years old, come in. He had a one inch laceration on his left upper scalp. He had been running and fell down. Ouch! I prayed for the peace of the Lord and then I proceeded to gather the suturing supplies. My sisters love to sew so I guess this is my contribution to sewing, haha! He will get the sutures out in 7 days or so. In the USA a wound like this would likely have been stapled. I mentioned this to the workers here and clearly this was not something that they have to offer. But the sutures will do nicely.


Public health is the second component of my diploma that I am here to complete. Clearly, it is a huge undertaking considering the lack of resources available to the people of Ghana. We have had some very severely ill children.  These little ones are very sick and starting an IV on a sick, dehydrated, (often malaria) child is no easy task and today it was one after the other. We had some successes and some failures. The option of a central line isn’t available here and scalp IVs are not the norm either so we just have to let the children rest and try again but time is of the essence.  Please pray for these little ones that we will succeed and get the treatment that they need.


Another public health issue is the complications from untreated typhoid/enteric fever. They do not have vaccination programs to prevent typhoid.  The worst complication has happened twice in the last few days….that of typhoid bacteria caused intestinal perforations. This is very serious and we took this second guy to surgery today. He had five separate perforations.  I was so thankful for my critical care background at a time like this.  Currently there is no critical care unit here in Wenchi and this man was critical.  In my short time here I have been part of three laparotomies. Wenchi Methodist hospital is the only hospital available for a very large area.


I am impressed with these surgeons! Almost all doctors in Ghana do surgery like this, that is amazing to me. Quite different than the western medical system.


So back to the public health piece I am referring to. We need to do community education regarding the use of permethrin permeated mosquito nets for people. If these could be distributed to families in Ghana, we could prevent mosquito borne illness like malaria and protect little children (who sometimes die from this disease). We need to do community education regarding typhoid fever and how to prevent it (not cross contaminating food and water with feces that have the typhoid bacteria in it). Same goes for cholera and other diseases of poverty here and in other developing nations. Public health is huge and that is the bigger nut to crack. Sorry to go on and on about this but that is why I am here, Diploma in International Medicine (treatment) and Public Health (prevention).


Pray please for these dear people! That is ultimately what they need. Only God can step into this huge challenge and bring hope and healing. If Ebola came to Ghana it would be extremely serious. Praying that it would not come. I do get to do my presentation to these people on Ebola and it will be good for them to have and it will be very good for me to “imprint it on my mind” by teaching it to others.


Oh, one more thing, the nursing students were back today and again tomorrow. It is so great to get to be here and teach them.


October 29th, 2014 by Dennis Salter
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Have I said recently that I am humbled and honored to be here!  It has been an amazing day.  To begin with, I walked in at 7:30 to find two gun shot wound victims.  One was in severe pain and needed an NG tube and a foley for starters.  Check!  I was able to decompress his stomach and help him empty his bladder. But his problems were evident on the xray results which showed just one bullet (shot really), but it was in the abdomen on the opposite side of entry.  Not good. This man had most certain bowel perforation.  We took him to the theatre for exploratory abdominal surgery.  He had 8 perforations.  All 8 were repaired by Dr. Benjamin and our patient was moved to the male ward (remember, no ICU here).

I have reached a new level and have become part Ghanaian!  Today I was asked to do many more things by the regular staff.  Prior to this I was treated very respectfully but I had to be very proactive with my rotation.  I still need to be, but it is great to be bossed around!



October 28th, 2014 by Dennis Salter
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I continue to have some great experiences here in Ghana.  Diseases of poverty are what I want some experience with and there is no substitute for seeing what is in the textbooks played out before your eyes.  During rounds this morning there was a middle aged gentleman status post surgery from a perforated bowel as a result of complications from typhoid (enteric) fever.  One source estimates that perforation happens in less than 10% of known typhoid fever cases.  Our gentleman was status post surgery and doing okay in the male ward.


There is no ICU at this hospital at the present.  So open abdominal surgeries have to go to the male or the female wards.  This is obviously not ideal.  I was asked to help setup the ICU (there is dedicated space), if I had time available.  My schedule is jam packed so I don’t know if i will have time.  I would love to be able to do that though because of my critical care background.  I do have that administrative side!

Catching up

October 27th, 2014 by Dennis Salter
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I highly recommend Calvary Methodist Church, right here in Wenchi near the hospital.  I went there yesterday and it was an awesome experience.  The rest of Sunday was a day to relax and to contemplate my experience so far and what lies ahead.  It has been great and I am so thankful that I get to do this.


We started out with a mini cholera clinic today.  In developing countries, cholera is a serious problem, especially in rainy seasons and times of flooding.  We are in the tail end of Ghanas rainy season.  As you know, one of the primary reasons that I am here is to get my Diploma in International Medicine and Public Health.   I am here to see and to understand by experience what I learned in theory in the hybrid course through INMED.  Cholera is one of those diseases/problems.  Treatment is crucial within the first 24 hours, keeping someone hemodynamically stable with more fluid in than is coming out.  It has a unique diarrhea, vomiting and sometimes fever.  We sent stool culture to lab on all patients.  We give antibotics but the primary treatment is fluid replacement…!  In this case it was two large IVs on all three patients.  Ideally you should isolate these patients quickly since cholera can spread.  We did what we could but a third world hospital has few options.   Well the good news, we succeeded with God’s help on all three patients.  As I left today, all three were through the acute stage in the isolation unit that we setup.


We also had a serious laceration with lots of blood loss.  The man was brought by foot 8 miles so you can imagine what condition he was in and losing blood from the cut.  He was cutting with a machete and cut his hand with a 2 inch deep laceration.  Praise God he missed his tendons so it was stop the bleeding, suture him up (inner layer of tissue and then the skin surface), followed by antibiotics and some fluids, including D50 (50% dextrose solution).


Needless to say, we had a very exciting morning and into the early afternoon.  Above all, we know that God was with these patients and He was the one who brought them through, we just got to help!  (At the morning devotions we prayed for all patients and staff that would be involved today, clearly God was with us).


In the midst of all of this we had more malaria and more motor vehicle accidents.  We also had two ENT cases with tonsillar involvement.


Now for the cultural.  You would love these people.  I learned much today once things settled down a bit.  Did you know that in Ghana it is very important to know the day of the week that you were born?  That is your name!  They say that before you are named you already come with a name….the day of the week.  I looked up my birthdate and it was a Tuesday, therefore my name is Kwabena!  Cool huh!  So I have two names in Ghana, Kwabena and Dennis.  There are people that actually have just the day of the week name because the family used that name.


Now for a Ghanian economy lesson.  These nurses make less than a dollar an hour.  You heard me right.  They are professionals to the nth degree.  They know so much and they practice in very austere conditions.  They are very smart and I have never seen a skill set for many things that nurses do in America, any better than I see in these professionals.  Wow!  less than a dollar an hour!  A motorcycle here costs upwards of $7000 and a Toyota Corolla is upwards of $80000.  Yup, you heard that right!  So you can imagine how few cars are being driven in this country.


I guess the lesson is, be thankful for the affluence that you have in America.  Even America’s poor are rich in the eyes of these people.  Oh what we could do if we lived more simply and gave to the poor of the earth.  America is less than 5% of the worlds population.  If you throw in the rest of the affluent western countries, it is still a fraction of the total.  Most of this total lives in conditions like I mentioned above.  Oh my!  We need to get our values straight.  We need to get a heart for the poor.  We need to help!

Fresh Faces

October 25th, 2014 by Dennis Salter
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I spent yesterday and part of today training new nursing students.  These were first year (out of three years) students and their first clinical experience.  It was so fun to see the enthusiasm they have for what they are embarking on.  It was a great opportunity for me to share theory on different disease processes and to explain what vital signs are really indicating rather than being just a number.  I talked with students about how the circulatory and respiratory systems function and complement each other.  It really is a great experience practicing in the emergency setting here.  I am expanding my experience by making my number available to hospital staff so that they can call me when interesting cases come in.