Jessica Van Bibber’s Blog

Nakpanduri

Today was our first day rounding without the huge team of adults around. Really just lost an internist and pediatrician. But that is two whole wards we weren’t rounding on before. We started about 8:30 and took us until after 11:00. Not too bad but we had plans today! We went to Nakpanduri, the escarpment in the very northern part of Ghana. It is the highest point in the Northern Region. It was about a 40 minute drive from Nalerigu to the northeast. Our crew was: Greg, Carter, Aiden, Sukanya, Sheila, Disa, Jake, the 2 German girls (Nina and Jacqualine?), Kim, Mom, and I. Really nive riding through the countryside waving at all the kids. They run out and run after us. Pretty cute actually. A quick picnic when we got there and we were off. Thankfully it was a little overcast so not so terribly hot today. It wasn’t a bad hike actually, just huge rocks. Similar to Elephant Rocks in MO. The view from the top was pretty amazing. We could see Ivory Coast to the north and Togo to the east. Hard to describe really, but of course I’ll add pics when I get home. We hiked around to different parts of the escarpment, climbed some trees, then headed back to the van. We drove to the opposite side to take pics of where we were. There was a huge landslide that stopped just short of the road. Very impressive. Will see how those pics turn out. Very narrow road with steep drop offs! We got home and had evening rounds followed by spaghetti for dinner. Not a bad Saturday in Africa…

Sad Day

Another day of clinic. I was busy in a different way today. My first order of business is always rounds which went by quickly and uneventfully. However, prior to starting clinic we were called to peds to see a 10 month old boy who was admitted the night before with malaria and severe anemia. For the docs, his hematocrit was 8%. Sheila & Disa did a great job taking care of him but he was in respiratory distress. He had improved somewhat by morning rounds but was now gasping for breath and requiring oxygen. We reviewed his chart and examined him. Nothing more we could do at the time. We all scattered to tackle clinic. I was asked to come back to see him in the afternoon. I was told, “his condition has worsened.” The nurses don’t specify what that means. Either you push them to tell you or you go see yourself. I went to see myself. He was gasping and fighting the mask. They were having difficulty getting the pulse ox to read (measure of the baby’s oxygenation.)  I know very little about tiny humans and oxygen masks so I went hunting for Jeanette. She is a NICU nurse from the states (Bill the pediatrician’s wife). She helped by sitting with the baby and watching the sats. After awhile though we just let mom hold the baby to calm him while she held his oxygen mask. I went back to check on him after rounds. He was lying completely still. The nurse was still holding the oxygen mask over his tiny face. I asked if he was better or worse, knowing that he was much to still. The nurse said worse. I listened to his chest 3 different times and check every pulse I know of. Nothing. “23/2/11 1700 hours. Pt expired.” That is what I wrote in his chart. With tears in my eyes I covered him with a cloth. I moved on the the next patient…

When people ask me why I help people in Africa when there are so many in the states that need help. He is why. Because if we didn’t come they would all die.

Catching Up

Saturday 19/2/11

I found out that rounds start a little later on Saturday mornings. The fellow likes to sleep in! He deserves the extra hour of sleep for all the hard work he does. We did discuss a game plan since there are so many working here right now. I’m writing this on Tuesday and we haven’t really stuck to it at all! As best I can remember we just rested after rounds. Oh! I had banged my foot jumping in the back of the truck yesterday and thought I had broken it! I woke up from my nap and could hardly walk. But with a little ibuprofen and ice it was better by the evening.

Sunday 20/2/11

Rounds again this AM. We round everyday just the same. I think you all get that by now. After rounds we went to First Baptist Church. It is similar in a lot of ways to a baptist church in the states. You have your back row baptist (where we sat) and your front row baptist (where the evangelical team sat). They introduce guests, sing songs, and take an offering. The differences are that is was 2.25 hours long in a packed church without air conditioning. The entire service was done in English and Mamprusi. To give the offering every person goes to the front to a collection box and then back to their seat. Lots of dancing. The music doesn’t quit match the singing. But overall it is a fun experience. They have at least two other churces: Second Baptist and a Presbyterian church. We have been to part of a Second Baptist service on our last trip. We may go to the other churches during our other 2 weekends here. My favorite part is seeing the woman dressed up and all the cute kids! On call tonight for the first time. We have 3 medical students so we decided to have them actually be on call with a resident/fellow backup. Just like at home! Sheila was on with me. No calls of course!

Monday 22/2/11

Clinic day! I had two admissions today. Typhoid and intractable abdominal pain. Nothing to out of the ordinary. Didn’t see as many as the previous clinic, only 28 pts. I can see a lot more I think, but I was sharing a translator with another doc. That’s quite a problem here. Too many doctors, not enough translators. Also, they get bored after a few questions, so you must choose wisely. Everyone here has headache, fever, and waist pain (back pain, usually lower back). Everyone also gets treated for malaria, sometimes if they have it or not. Very prevalent here, year round. We finished relatively early. Had evening rounds then off to bed.

Tuesday 22/2/11

Finally to today! Procedure day without many procedures! We have 6 wards here: men’s, surgical, 2 woman’s, older children, and peds. Duey takes the men, surgeons take surgical, Bill takes peds. Everyone else takes what’s left plus maternity and isolation (bad infections, tetanus, tuberculosis). Kim and Sheila weren’t feeling well, so I took most of the hospital. Rounds were still done before 10 am. Much better than in the states!                                                                       After lunch I went with mom to Happy Child to watch them pull the tree down. No luck! They broke a cable yesterday and arope today trying to pull it down with a wench. They had already dug up most of the roots. I think Musa decided to hire someone to cut it down. He will still be able to use the tree or lumber. After he got all that sorted out he took us to see his land. We (Musa, Grace, Theo, Mom, and I) drove to the edge of town then walked among his 16 acre plot for the new school. He had a well dug in May 08. He thinks he will start building sometime this year. After that he showed us another part of land he owns. Beautiful views! Theo, their 13 mo old son, got carried back down on mom’s back in the traditional way. Really cute! Pics soon. He sat on my lap in the car on the way home. After dinner we were invited to Greg & Wendy’s house for s’mores! Around a real campfire. Cooler tonight than most days, so not as miserable as it sounds. It was great to finally spend some time getting to know them. They are a great family! They have 3 kids: Carter 9, Aiden 7, and Sukanya 7. They kids love it here. Aiden does magic tricks, Carter rocked a chicken to sleep, and Sukanya is tiny and adorable and sweet. It was a nice day! Off to bed though as tomorrow is a clinic day…                                                                       

Dental Clinic

Whew! It was a long, dusty day today. We went out with the dental team to the villiages today. Our crew was Jerry, the actual dentist, his wife Sandra, Alasan, the Ghanian dentist, Davis, our driver, his wife, Carol, our interpretors, Johnson and Micah, Kim, Mom, and I. Kim and I were dentists in trainning. We took a truck to get the the 2 villiages we went to. Kim road in the back with us. Her first time riding in the back of a truck! When we arrived in each village we had to get the chief and meet with him. We asked for permission to take care of his people. We prayed with him and gave him a gift- a flashlight! It was a neat experience to meet him and his council of elders.

We learned how to do mandibular blocks, long buccal blocks, and palatine blocks. We then learned to extract teeth! I took out two and Kim did more than that! It was fun but a long day! I got a little too hot in the afternoon and had to sit awhile. All the more time to hold babies and take pictures. The kids loved us, well most did. Some still get scared. The women and children would bring babies for us to see and hold. Mom and I have a picture holding twins!

One of the best parts was riding in the back of the truck! Sounds silly but we got such a great view of Ghana. Even saw the sunset. The pictures from today are really the best way to describe the day. All in good time…

Martin and Brynn leave in the morning. But that still leaves all the adult couples, plus the three of us, and 3 medical students. Think we’ll make it! We only have two full weeks left in Nalerigu before making our way home. Goes by fast!

Happy Child Learning Centre

Hello! Today was pretty great! We had rounds this morning. Brynn, 4th yr from Omaha, and I took care of peds today. Bill, the pediatrician, went to sit with a 35 wk twin who was born last night. The babies mother died at home in childbirth and her little girl had respiratory trouble. She is in an incubator with oxygen and doing ok. I sat with her after rounds. I have a picture that I will try and post at some point. You can see the 78% O2 sat in the pic. Mid-eighties was the best we could get with what we have until a NICU nurse that is here figured out a way to rig a CPAP! Sats are now in the low 90s! I do think I have the hang of rounding on peds. Just a few procedural questions, but otherwise I actually feel useful.

After rounds we gathered up about half the school supplies to take to Happy Child Learning Centre, the Christian school mom taught at last time we were here (October 2007). After lunch we (Kim, Mom, Martin, Brynn, and I) headed out, all with a backpack full of supplies. We arrived and we shocked to find that the old school was no longer! Musa, the headmaster, had torn it completely down and rebuilt it! It looked amazing! Again, pics later. We were so excited to learn that Musa was there!!! He was so surprised and happy to see us! Said he had just been thinking about mom. He took us to see the “Toddler’s Palace,” the building mom illistrated last time. It was so fun to see it all painted! Mom drew all the pictures last time and I helped outline with marker. Then Musa painted it after we left. Looked amazing! Musa then showed us around to all the classes. 400+ students now! They loved us! Many students remembered mom and cheered when Musa reminded them of her name. The little ones also cheered after each picture flash. Pretty cute. The students got to go home for lunch so Musa took us to his home to meet his wife Grace and their 13 mo old son Theophilous. So amazing to be invited into their home and learn about their courtship, wedding, and honeymoon. Musa also told of his plans for his second school, complete with a house named after mom!!! She is going to start helping with the building next week. She is thrilled. Me, I think I’ll stay in the shade of the hospital.

We had station meeting tonight as well. Where we all gather together for dinner and fellowship. By all I mean all the volunteers here now and Greg’s family. They are the coordinators for all the volunteers. His wife, Wendy, sons, Carter and Aidan, and daughter Sukanya. Wendy told an amazing story of a 2 year old boy with Tetralogy of Fallot. She worked it out to get him to Florida for open heart surgery. We may get to meet him next week at station meeting.

 One of my favorite moments from today was while walking through the theatre (where we operate, aka OR) on my way to consult with Bill on a patient, a little girl about 3 or 4 touched my very white arm, looked at me smiled shyly, and ran off! It was so cute that she just wanted to touch my white skin!

Tomorrow is clinic day but mom and I are skipping to spend the day with the dental team out in the village. No idea what we will encounter but I’m sure it wil be an adventure!

First Clinic Day

Today began at 7:30 am with rounds. I ran into Bill, the pediatrician, first today so I did rounds with him on the peds ward. We started with a 6 month old little boy who was s/p intussception repair, ileocecectomy, and ileostomy placement. He looked ok this am so we moved on to the next child across the room. A few moments later we were summoned back over. He had just died. It is a difficult thing to swallow that this is just part of life here. You feel it in the pit of your stomach for a moment then move on to try and save the next one. Our next one was a sick looking child who needed an LP. Desa, on of the medical students from Kirksville, did a great job getting clear CSF. The other child that stands out is a little 4 week old who has had projectile vomiting. In the states we would immediately check his electolytes with a BMP. Here, we recognize his hypokalemia with seizures. We stopped them with valium but he is now too unstable for surgery. We think we felt on olive, so the surgeons will look for pyloric stenosis if he improves enough. This was all before lunch! After lunch I went back to clinic. I saw 32 total patients today but helped with quite a few others. The best was a sweet young girl who said she was 6 months along but looked 9+ months. I offered to do her US. I quickly found her baby, but was way too small for 9 months. I moved around a bit and found baby number 2. There was still room in there! Perfect for baby #3! I found triplets!!! That explained her huge belly at only 25 weeks! We had someone drive her home with strict instructions to take it easy! Hopefully she can carry them a bit longer.

One nice change from my last visit is that typically Tuesday and Thursday afternoons are free. We have plans to go to Happy Child tomorrow. It is the school mom taught at last trip. It is a blast to play with the kids. We brought toys this time: jump ropes, football, soccer balls, etc. Looking forward to it. I hope we find Musa as well. He will be thrilled to see mom again. We are hoping he has a child now that he is married. I’m sure we would have heard by now, but fingers crossed anyway! I am also looking forward to seeing mom’s artwork painted in person.

 Good night!

Nalerigu

Hello! We made it! We got up at 4 am to catch our 6am flight from Accra to Tamale. From Tamale we drove 2.5 hrs by van to Nalerigu in the Northern Region. If you are from the country you are familiar with dirt roads. Dirt road does not even begin to describe the “wash board” that was our path today. No complaints, we made it safely with all our luggage!

I hear that MO weather is beautiful! It was 93 degrees in our room last night while we attempted sleep. My nap this afternoon was in 96 degrees. I’m a warm-weather lover but this will take some acclimating!

 So far I have met 4 medical students- a married couple in their 4th yr of med school from Omaha and 2 girls in their 4th year from Kirksville. There are at least 5 adult couples from TN. An orthodontist and his wife, a pediatrician and his wife, a maintenance guy and his wife, an IM/GI doc and his wife, and another couple that I haven’t officially met yet. I haven’t spoken with the International Medicine fellow yet, but we ave plenty of time to get aquainted in the little over 3 weeks that we will be here.

 Clinic is tomorrow. Usually makes for a long day. However, it seems easier than 3 years ago when we were here. Could be that I know a little more this time! Usually clinic days are Monday, Wednesday, Friday. Tuesday and Thursday had been surgery days in the past, but are now reserved for clinic procedures. Will see what the day brings…

3 days…

Hello!  My mom, Kathy, my fellow resident, Kim, and I depart on Sunday for Ghana, West Africa. A valiant effort will be made to keep you all updated as to our adventures. Keep us in your thoughts and prayers as we travel and work.