Kristi’s Blog

Bittersweet endings

Hello from San Antone! What a bittersweet return to America! In less than a week I will graduate from medical school, move away from San Antonio and leave the wonderful friends I have made while in school.

Well, the rest of my trip went ok….but I certainly learned a few things, such as, 1)I’m not well equipped to travel in a developing country by myself, 2) I really like owning a cell phone, 3) Instant coffee can be quite good, one might even use the word ‘delightful.’

Saturday afternoon, I walked over to the Elmina Castle, a structure built in the 15th century and later used for a slave encampent where slaves were kept before being transported back to America. It was just horrifying to hear the torture these men and women were put through. We walked through rooms where hundreds were kept for months at a time, rooms without a toilet! It’s amazing that anyone survived the castle, let alone the ship ride over to Carribean and States, and then the entire ordeal of slavery!!! The castle even had a church! Can you imagine the house of God was just above the slaves’ living quarters! There is a small pathway in the Castle that led from the slave chambers to the very narrow door that leads to where the slaves were loaded on the the slave ships. The door is referred to the Door of No Return, because when they left, there would be no return to their homeland-ever. At the Cape Coast castle, a similar door had been renamed ”The door of Return” and serves as a place for African Americans to return through and seek to reclaim their African Heritage and the dignity that was lost the horrible system of slavery. The phrase the (wonderful) guide left us with was “Never Again.” And we should strive to never again let this happen! Sadly, it reminded me that slavery does exist in the form of human trafficking, which also sadly, happens even in America!

Anyways, my last day of travel was a bit of a nightmare and a lesson in patience. I showed up a the STC bus station around 12:30 hoping to cath the 1pm bus, which I guess was cancelled and was then infomed there would be a 3pm bus. I should have just gone to another bus station, but I knew STC was semi-reliable so I stayed and waited…Oh, and the best part was I could not even by a ticket until 2:30 when the attendant would let me know if there were seats available. But she assured me there would be…Aghhhh….At 2:20 I secured my ticket and then waited some more. Actually I waited until the bus to Accra arrived at 3:50.

The bus rolls on, we pass through several cities. At one point I was pretty sure we were in Accra. We even stopped several times. Naively, I assumed that the bus to Accra ended in Accra and that’s where everyone would get off. Well, after passing through the city and ending up on the other side I realized I might not have had all the info. So I go up to the bus driver and ask what the last stop is, and he tells me Tema (which I had no idea where that was, and was hoping/praying it was not in Togo, the neighboring country!) Then he yelled at me (in a totally paternalistic) way for not telling him I needed to stop in Accra! He then said once we got to Tema he would find a taxi for me to take me back to Accra…oh and just for time reference it was dark outside and a little after 7pm.

Once arriving in the town of Tema, “the industrial capital of Ghana” a nice man (maybe a Angel?) named Richard offered to find a legit cabi for me and then bargained down a good price for me. Finally around 8pm, I arrived at the Accra airport for my 11pm flight. I checked my bags and treated myself to some french fries and coffee. After such a crazy day of travel, I was glad to be on my way home to America. Despite the bad travel experiences, I still would have stayed in Ghana if I could have. And ‘bad’ is probably a relative term, because it could have been much worse. My bus driver could have not spoken any english, but he spoke English perfectly. The bus could have just never showed up…but it did. It could have been so much worse!!!

Thank you again for following along with my journey abroad. It really was an amazing experience and I know that God has put on my heart to return, if not to Ghana, somewhere else to do health missions in poor, developing countries. The need to have caring, healthcare workers in the setting of immense poverty and disease is so great! Before I left, I remember thinking “How could people just give up their life and family in America to move permanently to a foregin country?” I’m now certain that life abroad is not for everyone, but it can be so rich and full of genuine experiences that are stripped of the need to be the best and own the most stuff and make gazillions of dollars.

Thanks again!

In Christ,

Kristi

Friday the 13th

I’m writing today from the Coast! Yes, I made it. I’m actually at this hotel/restaurant/crocodile pond called Hans Botel Cottage. My driver (and many guidebooks) suggested it, so I said ok, sure I’d love to see some crocodiles. And then I was lured away by the internet cafe sign! Actually the pond is just out the window I am sitting near and I have already managed to see one crocodile surface.

I left Nalerigu early early on Wednesday morning. Our drive was very bumpy- a combination of unpaved roads and my super fast driver. But we survived and made it safely to the bus station in Tamale. Our bus was scheduled to leave at 7am….which came and went. We finally loaded the bus at 10:30 am. Luckily, Dan another volunteer was travelling with me to Kumasi, so I was not totally bored. But it was a pretty long wait. The drive was very nice and also about 7 hours.

We finally arrived in Kumasi about an hour before sunset and then made our way to the hotel across town. The city was incredible…and a huge contrast compared to the small city of Nalerigu. There were concrete buildings, many 3-4 stories high, many half painted, some not. The roads were paved…and the traffic was unimaginable. Think a cross between Mexico and Houston. Cars, mostly taxi’s and Lorry buses lined the streets. Someone told me walking is faster in this city and it was absolutely true. There were so many people- everywhere, walking to the next destination or selling everything from fruit to sandals to underwear to rope and batteries on the sidewalk.

Thursday we spent seeing the touristy parts of Kumasi, capital of the Ashanti region. We started our day with coffee (don’t get excited, it was just instant nescafe) and then a walk over to the Fort. The fort was so- so, contructed around 1897, but the tour was awesome. Basically, we had a 2 hour tour with a spectacular guide who knew so much about Ghanaian history, history of the fort and the Ashanti people. He was also really funny and nice, just like nearly every Ghanaian I have met.

After the full morning we went over to the market…a huge version of the Nalerigu market! It was ridiculous! When I show you the pictures you will be amazed. It seemed to stretch throuhout the city- just crazy! As we entered the market I saw a pedicure station and was tempted to stop, but that would have been just ridiculous! The market sold all the usual junk, plus some foods. We stopped to have lunch- 1.50 for rice and beans and lettuce- much like a taco salad without the taco shell. Delicious and we did not get sick, which was an added bonus! After all the fun of being the “bruni’s” (Ashanti for white person) eating in the market we left and headed to the cultural center.

At the cultural center, there is a collection of artists that gather and display their works and their craft. The crafts are all part of the Ghana culture- tie and dye cloth, Kente cloth- a woven clot made from a loom, wood sculpting, and painting- a special kind of painting called Batik, referring to paint on cloth. It was neat to walk through and talk with the local artists. It seemed like many of the artists were either trained in university or learned the craft from their father.

For dinner we went to a “fancy” hotel in Kumasi and ate at the poolside restaurant. It was a nice atmosphere and it was a bit of contrast to the inner city which was pretty dirty and poor. The other people dining appeared to be buisiness people from around the world- a bit of a higher end clientele.

Then came Friday the 13th…i’m not one to subscribe to this superstition or superstitions at all, but I may be a believer now. After my breakfast of coffee and a large mango I packed up my stuff to prepare for the day and my departure which was much later. Around8:30, I fished around for my bus ticket and could not find it anywhere! Despite having placed it in my small bag, it was not there, and I checked about 5 x! So I caught a taxi around 9 to go back to the STC bus station in hopes they had a seat available, otherwise I might be stuck in Kumasi another day. The driver was a little lost at first, but eventually around 9:45 we showed up at the bus station. Keep in mind it might have been a 20 minute walk! Upon arriving, Dan informed me that they could re-issue my ticket for 1 cedis! Hallelujah! But, his own bus to Tamale had been cancelled for the day So he was off to try to find a different route to tamale. I hope/am sure he found something.

Now I’m at the coast, actually Elmina a small fishing town. Tomorrow I will leave and venture back to Accra then back to the states. I’m looking forward to using my starbucks giftcard the minute I arrive at the DC airport! Mmm….Hope everyone in Texas is doing well! Thanks again for the continued prayers and well wishes!

Oh, and happy early 22nd birthday to my sister!

Babies, Babies, Babies

It’s been a little crazy around here. But sometimes we are granted a little grace to help us through the hectic times. This weekend was very busy at the BMC and the craziness continued on through Monday clinic and today’s busy list of procedures. Luckily, distractions in the form of the internet were not readily available, so I was able to focus on work while at work and rest while at home…and not on responding to emails, etc. But now the internet is back up and just in time because I’m leaving the BMC tomorrow, very early to go on Safari.

Yes, Safari! Will there be animals? Maybe, but not like what you are imagining. I’ve been told West Africa is not exactly the place to explore for lions and elephant herds and free roaming monkeys….but maybe I’ll see a few animals during my days abroad. Tomorrow I will take a bus to Kumasi, the capital of the Ashanti Region in Ghana, then on Friday head to the coast. And then Sunday I will head back to Accra and then home.

Can you believe it? I can’t! I would love to stay….despite the chaos of the past few days, I would still love to be here for at the very minimum a few more weeks. I wish residency were going to be this fun ( and who knows? maybe it will be!)

If I happen to find an internet cafe along the way I will try to post again. Can’t wait to see everyone again! And Congrats to Anna and Gabe who will be getting married this week at Big Bend National Park! Wish I could be there! Anna, I know you will be a beautiful bride. Blessings from Ghana!

M is for mmm…and mangos

We had another busy procedure day yesterday! We got started around 7:30, finished rounding about 9am, then began the long list of procedures lined up on the board. Most of them were debridements for infected abscesses on various body parts on various patients. We’ve seen a boom lately in anaerobic skin infections, and the only reason I’m aware of that is because the smell is soooo bad! I did a couple of the procedures by myself because others were busy. Let me clarify…I decided I was going to do them by myself, and then I ran to Zawto for help. I’m not sure what his exact title is, but he is the authority in the theatre. He does everything from cleaning the procedure room floor to gathering supplies to teaching assisting on major surgeries, and more importantly helping 4^th year medical students remember how to suture. He’s a super intelligent guy with a dynamic personality and he really keeps the surgical aspect of the BMC running as smoothly as possible. It’s amazing how people like him find themselves in the situations where they are most needed.Half way through the morning one of the visiting docs came in and said the midwives were saying a lady might be in need of a c-section. I knew there were two women laboring and I did not want to see either one of them have an unnecessary surgery. So, I walked down to the laboring room and found a lady fully dilated and having contractions. I said, “What is the problem?” and the midwives said, “Oh, she does not want to push.” ( If you can, you should imagine this said with a thick accent.) I rolled my eyes and thought that was the worst reason for a c/s. So one of the docs happened to come in and do an exam and after a little bit of coaching and me shouting a very poor interpretation of the word for “push” in Mampulli the baby was delivered. There is a little bit of triumph in delivering a live baby by regular delivery and preventing a woman from having a c/s. It’s always nice to start the morning off with a successful delivery of a healthy baby! Yesterday was also one of the doc’s birthday so we celebrated with a Mango Cobbler! The guy who cooks at house 6, Bowa, was off yesterday so he actually prepared it the day before so that we could still have a special dessert to celebrate with. The people here really are so thoughtful! We also marked the occasion of Melinda’s last night. She is another 4^th year volunteer from the states. So, now there are only 2 med students left- the 2 Texans! Today was a very busy day on the wards and in clinic! We started the day with a near c/s…which luckily ended in a successful normal delivery. Then there were a few procedures. I assisted with a debridement of an abscess in a young man’s cheek and then helped clean out an abscess on another guys hand! I am plus/ minus about taking pictures of such grotesque wounds. This man’s hand had an obvious sore on the palm of his hand, draining pus and also draining pus from the back of his hand. The entire hand was very swollen and painful. I went to see him this evening and he was very grateful…he must have forgotten about all the pain I caused him before he received a touch of ketamine Clinic was typical, in the sense that if you don’t have a good sense of humor then you might go crazy. It’s a little like being at the theatre, like the real theatre, not the operating room. I’m not sure if I’ve given adequate description to a clinic day. Today I sat in the main office with Richard, the doc who is here all year. The room we share is small, maybe the size of a dining room, has one desk, one exam table and a bookshelf full of medical text published at some point in the 70’s. There are two interpreters, one for him and one for me, and 2 patients, one for him and one for me. Today I came in, Rich was sitting at his desk and the two interpreters were near him. They called in a patient and he begins to ask the typical questions. Then, who knows what the interpreters say but it almost looks like they are arguing with each other, then arguing with the patient (all in Mampulli) and then they both turn to Dr. Rich and say “He has general body pain.” The entire scenario is both frustrating, exhausting and hilarious. Eventually, after I watched about 10 minutes of this, the other translator came over and brought me a chart so we could start seeing patients. Later in clinic I saw a young man in his 30’s with a subacute onset of swelling of legs and abdomen with discomfort with breathing…here that nearly always means portal hypertension and end stage liver disease. So I tell the nurse what my plan is for the patient and the importance of telling him that we will give him some meds and drain some fluid that is collecting in his abdomen, but the fluid would quickly recollect and he would continue to have swelling and pain due to his cirrhotic liver. He will eventually and soon succumb to the disease. She looks at me and says, “ok.” Then nothing. I tell her again to please relay the message, to which she replies, “What did you want me to tell him.” Argh! It’s no wonder the people here have a difficult time grasping the concept of chronic illness. The idea that no medicine will be able to heal the disease and any medicine given will be used to comfort the person  is kind of a difficult concept, even without the educational and language boundaries, then throw in the unwillingness to even share information! Sheesh! There were a couple of procedures after clinic ended (at 7pm!) and then another c/s that ended up being a regular delivery (the theatre staff is going think we are crying wolf everytime we call for c/s.) I hung around and did a couple ultrasounds some pregnant ladies. It’s so wonderful to be able to give these women a little glimpse at the baby growing and tumbling inside. I know they are just as reassured as I am to see the beating heart of the tiny infant. It really is so wonderful being here. Despite the daily frustrations, the sadness of not being able to find a cure (or even a diagnosis), there is an abundance of joy here that is remarkable! I find myself smiling throughout the day. I hope you all find little blessings to smile out throughout the day and ways to share that joy! Blessings from Africa

A curious case of food poisoning

Sorry, the internet has been up and down all week. Over dinner I mentioned the option of going to a local internet cafe in town and the physician who is here year round laughed and said “Is that place open? I was told it’s been closed for the last 3 years and might be up 6 months from now.” Well, I guess that is what one sould expect in a small town in rural Ghana!

 Friday was a fun/interesting day. We had our normal clinic, but before that was a very special wedding! After morning rounds, I went back to the maternity ward and sat and watched the beginning of the royal wedding. I should probably let go of fairytales, but watching that wedding made it a little difficult! What extravagance! And beauty, her dress was so simple and beautiful! And the clothes of the attendee’s- it left me wondering what I would have worn to the royal wedding.

After that, clinic was really busy and we started with difficult cases from the beginning. I’ll try to mention some of the interesting ones:

- Late in the afternoon, but before lunch, I was informed that there were 11 people needing to be seen for food poisoning from the same source of food. I was hoping it was some kind of joke, but that was just wishful thinking. The ‘victims’ were exclusively women and children. We quickly grabbed some other volunteers and worked through the patients quickly, admitting those who were pretty dehydrated and weak and sending the others home with an oral rehydration solution. Their food poisoning source was never determined; orignially the story was that everyone ate bad Tizette- some kind of grain that is eaten with ones hands…and then someone mentioned that it could have been the dog they ate before…and then the story escalated to the dog being bitten by another rabid animal before it was killed/died. I think that the story may have been embellished, but who knows.

- I saw the case of a woman with secondary infertility, meaning she had children before and was having difficulty getting pregnant again. Reading through here history, I saw that they had done a work up before and not found any fixable problems for infertility- like uterine fibroids, blocked fallopian tubes(although we can’t check), male partner factor (hers was the same who fathered her previous children…. The problem that she had had in the past continued to be a problem for her…the other wife took up too much of the husbands time! I had heard of these cases from the other volunteers, but had yet to encounter this myself.

Saturday was a fun day…for me at least. It was much like my typical/ideal saturday. I woke up and enjoyed my coffee on the porch in the setting of a very cool, breezy morning. Some children gathered to play soccer outside of our house…I took one glance and decided their skill level exceded mine and that I was no where near as in shape as those kids! Then we had rounds at the hospital- I stayed and watched a couple procedures, then left when I decided to go to lunch. I came back and saw a couple more patients, saw a few more procedures and hung out with the nurses.

In the afternoon I went over to the home of the mission family that lives here and visited with Sukanya (sp?), their adorable 7 y/o daughter whom they adopted from India when she was 3. She is a very thin lanky girl who is as sweet as can be and so very curious! I told her earlier in the week that I would bring some cards by and teach her the game “Old Maid” as long as I could paint my nails. What actually happened is that she thought it would be fun to paint my toes and I couldn’t say no….so now I have a pedicure that rivals the time I painted my toenails on a road trip to Houston.

That night we went out as a group of volunteers to the Icehouse/Iceberg (i’m so bad with names) for a few drinks. I had a local favorite- Alvaro juice a sweet beverage that tastes like sparkling white grape juice. On our way back to the hospital I got a phone call saying a doctor was needed in the maternity ward, which pretty much means a lady needs a c-section. So I dropped by maternity and found a young woman in labor with a hand presentation, meaning the hand instead of the baby’s head was the presenting feature. Next thing I knew, I was scrubbing into an 11pm c/s. I know at some point in my career I’ll probably be jaded by c/s in the middle of the night, but for now I still enjoy them!

Sunday was pretty routine from what I remember. A couple of the med students, a married couple, left this morning. Our large group of medical students has dwindled from 9 to 3. Melinda leaves in a couple of days, then Rania, and then I will leave sometime next week. I can’t believe my time here has passed by so quickly. I’m certainly not ready to leave yet and some of me wishes I could stay longer, but I am so looking forward to the events leading up to graduation when I arrive back home in 2 weeks. People always say the end is bittersweet.

 Oh and I was most surprised by the news this morning!!! Osama bin Laden has been killed. I was not sure if I could believe the news or not, but it seems pretty real. It seems rather crazy that this year marks the 1oth Anniversary of 9/11.

Thank you again for all the prayers & well wishes!

Highs and Lows

Sorry, the internet has been down this week!

Thursday nights we meet at house 6 (my current home and the place where all meals are served) and have a Bible reading/devotional. I suppose this is a tradition that the BMC has had for many years and the mission family who currently live here have carried on the tradition. Tonight Greg talked about the story of Abraham, and focused in on the moment when God asked Abraham to make Issac, his only son a sacrifice. Greg related the story to our own struggles with highs and lows in life, which is an eternal theme in life, but maybe more so this year and at this present time for myself.

The hospital here definitely offers highs and lows throughout any given day. Last week I saw a sick patient in the hospital who continued to feel ill despite being treated for her presumed diagnosis of malaria with CHF. So I ordered a urinalysis with only a vague suspicion that her lower abdominal pain was a result of a urinary tract infection. When the results came back, she indeed had a UTI, so we treated her appropriately and she began to show improvement. Confirming a diagnosis and being able to treat appropriately carries such a satisfying feeling, especially when it’s an easy fix like a UTI. It’s also nice when you are able to take a good history from a patient then piece together the diagnosis with physical exam findings and then confirm with a lab test and find a simple treatment.

However, that is so rarely the case in medicine, especially in the developing world or any poor area of the developed world. As I’ve mentioned in the past, a good history is hard to obtain because it’s rare to get a good translation/translator. Then the physical exam findings, well I suppose that is limited by my own lack of experience. And the lab tests, well, to say the least, we are limited here. We can run a CBC (complete blood count), but not an electrolyte panel. Obtaining a urinalysis is not exactly a proper UA, it’s actually just a urine dip which is not nearly as accurate. There is no imaging beyond ultrasound and xray, which are both extremely useful and I’m very grateful for those tools. And then meds are limited. We do have a number of medications, but medications do not always heal and for chronic illness like emphysema or hepatitis B, there is no cure, just symptom management.

But the social situations are probably the most challenging part of tropical medicine…and probably the most challenging part of practicing medicine in general. How can I convince my mother with a 5week old infant with severe malnutrition that she should stay in the hospital, when 1) she has run out of money to feed herself and 2) there are children to feed and care for in their home village (an easy 2 hour walk away)? How do I help heal an open sore on a woman’s foot when she only has flip flops to wear, must walk everywhere she goes and lives in a home with a dirt floor? These are not the simplest of problems and there are no easy solutions or fixes to the problems.

Part of what makes medicine fun is the ability to find the problem and find an instant or quick cure. I think we as doctors feel like we have failed when we cannot instantly or easily cure the problem (or maybe our patients think that?), but some problems have no answer or the solution is just out of the means of the situation.
It’s certainly humbling to contemplate on the things we cannot control; intervene when we can and let God take control when we cannot.

K.Pogue…on call

What a crazy past two days! Yesterday was Easter Monday so we had the day free from clinic, but still had our normal responsibilities at the hospital and any procedures that would come in. It was also my day to hold the call phone. We don’t get a ton of calls, but occasionally the nurses will call about a patient. Actually, it’s a rather bizarre system that nobody really understands. Here are a few things I’ve gleamed about the call phone: 1) Nurses call any time anyone is admitted for vaginal bleeding, 2) Any other patient, whether they are in severe respiratory distress, actively seizing, or here for plain old malaria will have “Admit to hospital, have M.O. (medical officer) see on evening/morning rounds.” It’s so crazy. And for inpatients, we rarely ever get called. Like people die overnight and we are not called. Last night I actually received a phone call at 12:45 am about an inpatient child who had been seizing since before shift change at 8pm and they wanted to know what the next step was. First of all, nobody knew the child was seizing, because I guess it started after evening rounds and second, the MO on call (ie. Me) wasn’t notified until the child had been in status epilepticus for an extended period of time and probably severe acidemic. It’s very frustrating, but I guess it’s our responsibility to let the nurses know when we want to be called. But trust me, the mentality is that if the patient looks really sick, they are probably going to die and we should just let them, ie. not call the on-call doc and have them intervene. Anyways, yesterday was also interesting for me because I felt like I was going to pass out for the majority of the afternoon. Lesson learned: do not take mefloquine on an empty stomach…the day after giving blood! I also saw probably the worst thing I’ve ever seen in my 4 years of medical school. I would mention it here, but it’s actually really too horrible to write on a post that will be published for any curious mind to read, so maybe I will tell you when I get back to the states. I also saw a really interesting case of a newborn infant with Scalded Skin Syndrome affecting the feet and ankles- really weird for a newborn. Essentially, his feet looked like they had been burned and were oozing blood. We wrapped them and applied some cream to help them heal and prevent secondary infection. We also had a couple docs leave yesterday, but 2 new docs came in the morning from UCLA. One guy had been here before and they were both very eager to participate, in fact I met them on the wards mid day as they were examining a patient. It’s always great to have good teachers around to help make clinical diagnosis/plans for the really sick patients. This morning we had a couple of gynecologist arrive from Accra (woohoo!) I’m super excited to be able to see how they perform fistula repairs in the developing world. Or at least I was…and then I scrubbed in (for my first time since October) for a 5 hour case that went through lunch. The case was really interesting and something I had never seen before, so that part was really awesome. But the retracting for 3+ hours was not…but I suppose I am still a medical student, even in Ghana. They have a couple of interesting cases lined up for the week, so hopefully I will see some cool stuff. Well, I know I was going to write more, but now I cannot recall what I wanted to write about. Oh well. Thanks for all the posts and Easter well wishes! I love hearing from you guys! And Anna, I cannot wait for girls’ night! I spent part of Easter eating M&M’s and reading a magazine, but I really could have used a girly movie, pizza, Jacky’s couch and my girls! Soon!   

Life giving blood

Easter is here! Christ has risen, let us rejoice and be glad! This weekend has been such a blessing. I will try to recount the weekend’s events as best as I can. Friday was a relaxing day, with a few procedures in the morning. There was sad news in the hospital that the young woman with endometritis vs. pid had passed away during the night. Morning rounds went by quickly and there were only a few procedures to do, which left me with plenty of time to rest and reflect on the meaning of suffering…I mean it is Good Friday and that seems like an appropriate topic for the day. Being in Ghana, a developing nation in Africa, and being in a relatively small and poor village within Ghana, I figured it would be easy enough to focus on the topic of human suffering. But, I actually had a difficult time because people here are so joyous and so thankful that it’s almost easy to forget that they are all living at baseline poverty, and many go without food, clean water, education, and anything beyond baseline healthcare. Looking around the hospital, I’ve seen death from curable infections and young children suffering from malnutrition, things that rarely occur in the US, but here they are common and accepted as part of life, so the amount of suffering by the individuals is expressed differently. In the US, the suffering I saw was that of loneliness- one patient that comes to mind is a gentleman who eventually died from hepatocellular carcinoma 2/2 chronic alcoholism. He was in physical pain near the end of his life, but much of his pain stemmed from being alone and facing death by himself. In his last days he made a phone call to his stepmom, but that was it! There was nobody else for him to call or reach out to in his last days. I suppose here it is more frustrating, because there are preventable illnesses, but death is so accepted that if another child dies of malnutrition no one is horrified (except the volunteers.) I think people are sad, but it’s just accepted so no one is looking for ways to prevent the next child or person from dying. There must be a balance between accepting human mortality and valuing each life as unique and precious and worth fighting for. Anyways…yesterday morning I was surprised on morning rounds to find that the PPROM lady who has been living in the maternity ward went into labor overnight and delivered a healthy baby boy! She was so happy and since there was no need for us to keep her at the hospital, she was able to go home and enjoy the Easter weekend with her family. Of course we took pictures with her before she left! I sincerely hope her baby will do well and thrive over the next few weeks! Yesterday afternoon we went to Napanduri (sp?) for the Expat Easter celebration. I believe 18 of us gathered into 2 trucks and drove about an hour to the home of a missionary couple that lives in Napanduri. This was their 25^th year of hosting the expat Easter at their home in Ghana!!! Amazing! On our way to their home we ran into an abrupt rain/hail storm, which was unfortunate for the guys riding in the back of the truck! It was the coolest it’s been since any of us have been in Ghana! Once arriving at the home, the rain stopped and we were able to enjoy the evening. I must tell you that this house has a view that anyone would envy! It overlooks a valley and over the horizon you can see the Togo border! Stunning! It’s really the ideal space for morning coffee/afternoon lemonade/ and evening beer! The kids hunted for easter eggs, we ate a pot luck dinner (including guacamole and chips!!!) and then returned to the BMC. This morning I was woken up early from some crazy winds that brought a ton of rain! Luckily by the time I actually needed to wake up the rain had stopped…which is lucky because I just realized I don’t have a poncho, rain coat or umbrella (so typical!) On rounds we had a young woman in maternity who had come in yesterday with a retained placenta. After she arrived, one of the physicians here was able to extract the placenta from her uterus, but she had already lost a lot of blood. This morning the lab test showed that her hematocrit had dropped down to 15% (very low) and she was symptomatic so it was necessary for her to receive a blood transfusion. Blood transfusions here are a little tricky. First, if you don’t have insurance, then you have to pay for it, and I think you also have to find a donor! This may be true for the insured patients as well, but I cannot remember at the moment. Nonetheless, my patient did not have insurance, and her husband had left to find money and there was no way of knowing when he would return and how much money he would have. It’ not uncommon for the volunteers to donate blood while they are here, so I figured what better day to donate than on Easter Sunday! I would hardly say that my blood is life giving, but hopefully it will prevent this lady from passing out or going into heart failure from her acute anemia. Hope you all have a very blessed Easter! It’s a wonderful day to reflect on the many blessings in our life, especially family and friends!

Lazy days in Ghana

Today was a wonderful contrast to yesterday. When I woke up I may have laid in bed an extra 10 minutes just thinking of ways to avoid going to the hospital, but I’m not very good at making up excuses so I eventually had to get up and begin my day. I was obviously still worried about those kids plus we had 3 med student volunteers leave this morning, so I knew there would be more work than usual. But alas, that is why I am here!

But, after arriving at the hospital, things seemed to go fairly well. The patients were sick, but had problems we could manage. I saved the pediatric ward for last, and by the time I made my way there all of the patients had been seen and more importantly all of the children we had worried so much about yesterday were drastically improved! I’m pretty convinced there was more than just fluid and medication that kept those children alive overnight!!! The poor child who was malnourished and had diarrhea is still pretty ill, but we are treating him appropriately so hopefully his condition will improve steadily. After rounds, there were a few procedures and I hung around to watch/help in a couple of them. After that, we had the afternoon off! Despite the 100+ temp outside, I managed to take an incredible nap and wake up just in time for evening rounds, which were also not bad. In maternity we had a lady who was in early labor and required a repeat c-section…which meant I was finally able to see my first c-section since having been over here. It really was the same as in the states. The lady had a healthy baby girl, which rounded out her family so that she now has 2 boys and 2 girls! I’m told that c/s here do not always have such a wonderful outcome, because usually the indication for c/s is 2 + days of labor and the lady is either infected, or her uterus is near perforation, or the baby has died. So, I was glad this one turned out so well for the mom!    And just for Anna (and whoever else is interested) I will give you some patient updates:-          The lady who had endometritis, turning into sepsis is still pretty sick. Maybe 2 days ago we had a team discussion about the patient and everyone threw out ideas. We decided PID (pelvic inflammatory disease) could a potential alternated diagnosis. Upon further exam, it turned out her uterus was full of pus, and quite possibly her belly as well. We started appropriate antibiotics 2 days ago, and did a D&C to remove pus and potential retained tissue from her uterus. We all thought she would drastically improve, but she has not. She is moving around more, but continues to have fever and is pretty loopy. She provides some comic relief for her mother who is with her in the hospital. We are hoping to transfer her to the teaching hospital in Tamale where she may be able to have further imaging and lab studies (like an electrolyte panel, which we do not have here) and hopefully find a source for her current delirium.-          The PPROM lady is still hanging out in maternity, and she has not developed chorio yet, which is a very very good thing! The standard of care is to deliver at 34 weeks and tomorrow she will be at 33 weeks!!! Yesterday, Amy made a countdown for her that she posted next to her bed. This woman has such a wonderful spirit. A week ago, she was very upset and really looking to go home, but I think the midwives and other patients in the ward have rallied around her and given her the support she needs to stay sane while just lying around the maternity ward. I sincerely hope that her baby is healthy when she delivers next week, but only time will tell!-          I’m not sure about the twins. They are being kept in the warmer in maternity, but honestly, I’m not sure if they have been able to feed or not. Tomorrow is Good Friday so our normal clinic is cancelled. Hopefully I will make it over to church at some point. On Saturday I’m told we are going to a pot luck/ easter egg hunt for ex pats living in Ghana…should be interesting and hopefully a lot of fun!  

When it rains…

Today was an especially difficult and challenging day at the hospital. My morning began with typical rounds in Maternity and to my surprise the lady I mentioned yesterday was not pregnant anymore! YES! That means she delivered her 28 wk gestation twins last night! I am sure you are just as surprised as I was this morning. The twins are young and I’m not sure what their chances of survival are here, especially because we don’t have means of supportive care, other than keeping them warm and wrapped in a blanket. Being this young, even if everything goes well and they do not acquire an infection, they still have very immature lungs and an immature sucking reflex that will make it a challenge to breath and eat…both which are pretty important for sustaining life. After that, I went over to women’s and saw some sick patients and performed a procedure. To my surprise, I was asked to help out on the wards today which was a huge blessing, because I was secretly dreading another day of our outpatient clinic. It’s not terrible, but Monday had been such a bad day of hunting down translators that I was not sure I was up for another full day of that! So Melinda, another student and I hung out on the wards, waiting for new admissions and dealing with acute issues with current inpatients as they arose. Before 11am, there was an unexpected death of a child and that pretty much set the tone for the rest of the afternoon.Most of my afternoon was spent taking care of new patients in the pediatrics ward. There were 2 cases of pretty severe respiratory distress and a couple more children with severe malnutrition. The cases were challenging in themselves because 1) we are in a resource limited setting, and 2) quite honestly, I’m not sure how to accurately diagnose and treat a lot of things, especially in kids! Luckily, Melinda and I were able to talk the patients together, and then when we were at a loss of things to do, we looked to our more experience attendings to help us make sure our plans were as good as they could be for the kids. We eventually left the hospital with plans for all the new patients, but I still have a pretty uneasy feeling about all of them. I feel a little like our peds ward has become a pedi ICU!Enough about sad things! One of the fun things I did today was consult the KoKoDu (our outpatient nutrition center.) On it looks like a small pavilion where women lounge around while breastfeeding all day and occasionally rise to bathe their children, but really it’s a place where mothers can go and get help to take their children from a malnourished state to a healthy weight! They teach the women about proper nutrition and also provide instruction and guidance on breastfeeding. Today I consulted on the mother of a child who at 1 month was already very malnourished, despite mom breastfeeding. So the mom and I walked over to the KoKoDu, we talked to one of the nurses, did a short little exam, got some advice and then walked back to the peds ward! I had a tiny sense of triumph in placing my consult! And more importantly, I felt reassured that the mom was able to feed the baby and she got a little bit of instruction that will hopefully help her child gain weight! Not that I’m in danger of malnutrition, but I am hungry and in danger of not getting any dinner. Hope you all are well! I love the emails and comments! My mom told me yesterday that there is a 2^nd grade class in Burleson who discusses my blog nearly everyday! (Yes, it might be my aunt’s class…) Greetings and hopefully I will meet you before the end of your school year!