April 21st, 2008 Posted in Uncategorized | No Comments »
Week 3- If there are grammar errors I am sorry- I try to get my thoughts across but the time is limited for computer/internet access. Please forgive me. Thanks for reading.
Last Friday was a difficult day for me. There has been a lot of changes going on at the hospital with insurance coverage. There is a national insurance plan and this week new patient booklets were being implemented. The supplies of booklets did not show up, so it put the day behind from the very beginning. I did the usual rounding and then went to spend time in casualty.
There was a child who was about 3 years old and had been admitted for severe malaria. The use the term severe malaria very loosely here and many probably do not really have severe malaria. The history from the time the child was first seen until I saw him is not really clear. But, apparently when he first was seen he was not in any apparent distress. He had been given the standard regimine of IVF and malaria treatment. My attending noticed when we arrived the child was not breathing well. It was clear this child needed immediate attention. I had a million different thoughts running through my head as to what I wanted to provide this child. All of the emergency interventions this child required were not accessible. The oxygen was not working, the ventimask was not the correct size, we did not have the means for intubation, and the list just goes on. We finally got an oxygen tank that we could use for the child. He was not responding and I kept a very close eye on him. He would stop breathing and I would shake him in hope of keeping him alive. They finally called an ambulance to send this child off to another center that has more options for emergent medical care. But, just before he left they tapped his bladder, because the child was anuric and noticed brown and thick urine. It was quite apparent this child was not going to make it. I was absolutely heart broken.
On a lighter note, we headed out for Mole at the end of the day. We had to go first to Kumasi to catch a STC bus to Tamale. The STC buses are the nicest buses here in Ghana. They have air conditioning, plenty of room, and even some have working TV’s. Unfortunately, they only go to the major cities.
We ran into a major rain storm while we were in a taxi on the way to the station. It was crazy and the rain was about 1 foot deep in the road. We actually left on time, but did not get into Tamale until 2am.
The next morning was spent in Tamale. We really enjoyed this city. It is a larger urban city but very manageable. We met a young boy named Kofi who helped us to the Metro station and with other various odds and ends throughout the day. Kids approach abruni’s (foreigners) everywhere you go in Ghana. For the most part they want your address/email and help to pay for “school.” However, this boy was just looking for friendship and did not want anything more.
It was market day in Tamale, so we spent some time exploring the market. We both had some further plans for cloth- and fortunately found some great patterns. We also were able to locate an internet café. We did have to wait some time in the peak of the sun for our bus to arrive. The bus to Mole National Park is a Metro bus. This bus does not have air. It was a pretty hot and bumpy but a wonderful adventure.
The architecture in this region of Ghana is very different. The houses are made out of mud and they engrave very unique but simple designs. The roofs are made from straw. I asked how long the roofs would last and I was told 5 years! As you get further from Tamale it becomes very rural, so it was such a peaceful and refreshing experience.
Mole National Park
We arrived at Mole around 7 pm, so it was already dark. Apparently the status of the motel area changes quite frequently, but it was in good condition for our visit. We met a lot of really great people the first evening. One of the gals we met brought a guitar all the way from Holland and she sure had a beautiful voice. We all sat around the pool and sang for most of the evening. We met people from Holland, England, and the US. It was really neat to hear about everyone else’s experiences and what they were volunteering for while being in Ghana.
We woke up the next morning bright and early. We were headed for the walking safari when one of the park rangers pointed out two elephants walking through the motel grounds. We made our way over to them and were able to get very close!!! We took many pictures and followed them for a bit. Eventually we had to meet everyone for the safari.
It is not allowed to walk around the park without a ranger. Our first stop was the staff living quarters. Here the children wash and play right along side the warthogs that run freely through all of Mole. We continued through the park and were first encountered by antelope. The antelope are supposed to be the most prevalent animal throughout the entire park. We saw about 3 different species. We then saw the red monkey. It was quite fun to watch them run about in the tree tops and the poses they took when chillin’.
We did not see any roaming elephants during our walk, but we did make it to the “watering hole” where the elephants were plenty. It was absolutely amazing to be in such close and uncontained quarters with these elephants. They were all bathing and keeping cool in the intense heat of the sun. We did see three elephants who were also on their way to the watering hole. They paraded in single file- drinking water and spraying their backs on the way in. There were also alligators living in the watering hole. It was fun to watch the other animals who were trying to drink the water. They were scared of the alligators and would sit for quite along time before attempting a quick sip.
We decided to order a traditional dish for lunch. We had giant rice balls and African nut stew. The lady came to serve us our food and she gave us a bowl of water to wash our hands, but first she had to wash the dirty serving utensils in our water. Then Paul asked for silverware and she said “no, you eat with your hand.” The left hand is considered “dirty” in Ghana, so they use their right hand as a scooper and shovel the food into their mouths. That was quite an experience.
We met a guy from Canada who had been volunteering for different random projects while being in Ghana. He told us of this villiage called Mognori, which was about 14km from the park. He explained they had set up an ecotourism village and we should use the remainder of our day exploring this villiage. It was quite a predicament to figure out how we were going to get there- but in the end we rented bikes and headed out on an adventure.
First of all as I said above no one is to go around in the park without a guide. By the time .we decided to take the bikes a guide was not available and the children renting the bikes told us to just go. The temperature outside is at least 100 degrees daily. We bought 10 “sachets,” which are 500cc bags of water, and tried to keep ourselves hydrated. The bike ride was absolutely invigorating. We were off all by ourselves in this massive park- surrounded by nature and serenity. We felt as if we were on the world’s best bike trail.
I must admit I was getting nervous because there were not any signs to ensure us we were headed in the right direction- but with patients we finally reached the most wonderful village. As I mentioned the architecture here was all mud huts. The village is very rural so the people appeared much more traditional and made us feel like we were truly in Africa.
The ecotourism of this village offered a village tour, a canoe safari, and a traditional drumming/dance ceremony. We first went on the canoe safari. It was still the dry season here so the water was quite low. However, it was still really fun. We had to wear life jackets and the water was only 1 foot deep. We saw a spitting cobra and another large lizard. There were also many birds and butterflies along the way.
Upon returning to the village the locals had put together a welcoming drum and dance ceremony. The children had taken branches from the bushes and were all dancing their hearts out to the beat of the drum. Eventually the dance performers came out and the children had to move over. They continued to mimic the adults and dance with Paul and I. They were so cute! The adults did three different traditional dances- I don’t remember the names. At the end they thanked us for visiting and assured us of the great honor it was to perform for us. This was one of the most memorable points of out trip!
We made our journey back to the park. On our way back in the roads were flooded with baboons. All weekend long the visitors in the park were talking about whether the baboons even existed. We had to laugh and ensure everyone that plenty indeed exist. It was so fun to ride our bikes along side them and some even took off running with us. There were also a few female baboons with babies hanging on to them. Paul captured a quick movie of this which is really neat.
Back in Ankaase….
Tuesday- I spent in surgery with a Ghanain doctor. We did about 8 surgeries by the end of the day and it was quite the day. I saw inguinal, umbilical, and epigastric hernia repairs. I must also say that these are considered minor surgical procedures. They moved them in and out like I have never seen before- as soon as one was out the next one was already on the table.
We did a very interesting uterine fibroid case as well. The lady was 40 years old, unmarried, and has never been able to bear a child. She had a very lumpy mass visible from the surface of her abdomen. I was told the surgeon was going to do a myomectomy for this women. When he opened her abdomen and I saw the uterus I thought to myself how is this possible. The surgeon proceeded to cut the uterus in many different locations and in many different directions. He would just cut down to the fibroid and tear it right out. The surgeon made the comment, “if this lady ever gets pregnant she can not deliver here.” I was thinking to myself- how is he going to even put her uterus back together. He sure enough repaired the entire uterus and all of the incisions. I am sorry if this is too much detail, but what an interesting experience.
The other thing that amazes me is they do not use general anesthesia on patients here. The patients are all awake. The lady above hummed the entire length of her surgery which was about 3 hours.
Thursday- I spent the day with Dora, who is incharge of family planning/HIV counseling and testing. I have a real interest in HIV and was really hoping to get good exposure to this disease and how they manage and care for patients in Africa. Fortunately, there is a low prevalence in the area I am working. Unfortunately, I am not getting the exposure I was hoping for. Also, there are few centers here in Ghana that are actually able to do more then the initial HIV screening. After this they do not have the funding for CD4 or viral load testing. They also do not have antiretroviral therapy available to the patients. Our site does offer some prophylactic antibiotic treatment and Niveripine for pregnant mothers who have HIV. They are working towards getting HIV training and government funding to get better care for their patients, so I hope for the best in the future!
We have an inpatient in the male ward who is very chachectic, has oral candidiasis, and appears ill. He complains of diarrhea, dyspnea, and weakness. His labs did confirm the diagnoses of HIV as well as Typhoid. On review of his CXR it appears he could possibly have PCP but there is no way to confirm this diagnosis here. He also could have other opportunistic infections but once again there is not really any way to diagnosis this. This is an example of a man who could really benefit from advanced HIV care. We will continue to care for him the best we can.
Friday- We had the mortality conference this day- with the amount of resources available to these patients compared to the US it is sure minimal. It is really great to watch the physicians continue to try and understand the course of patient care and how it could possibly be different in the future.
Saturday- We started the day with a field trip to pond Otrubu. Paul took the Gongwer family down to show them what he has been studying for the duration of this trip. It was really great. There are also a ton of bird life down at this pond. There are birds called weavers which are so busy and amazing to watch build their nests. The nests hang down from the tree limbs and they are building them with grass. Then there are birds with really long and skinny legs that walk all over the tops of the lilly pads. The last birds I really loved are big, beautiful, and graceful white birds. These ones were also seen at Mole following the elephants around. I am not sure of their name- so sorry.
Paul and I also brought supplies to do an art project with the children here in Ankaase. We were able to join with a reading group in the afternoon and we all made lion faces on paper plates. We also had them make a mane for the lion out of yarn. It was great fun working with these kids- they were so diligent and very proud of their work in the end!
We took a quick trip to Kumasi to pick up some supplies for “Kelly Welly.” The ingredients include plantains, ginger, and lemon. We have a lady who comes and helps us cook local dishes once and awhile. We will see how it turns out and let you know.
We are heading out for Cape Coast as it is time to go home. We are sad to leave and feel our time here has gone way too fast!