Silvestri’s Blog

Life is Beautiful

Hey Folks!                                                                                                                                                                                                                                I have a couple hours off and Darryl is around… thats awesome!  Sorry the video didn’t load… the internet is slow.  They pay over 300 a month here for internet .. crazy.  Anyways, update on how things are going.  We are both still healthy and doing well.                                                                                                                                                                                                                                                Yesterday was the hardest day so far for me (and thus probably the hardest for Darryl too haha).  We have patients who don’t make it quite often because they present usually at the critical point in their illness or with severe trauma but Tuesday night I had a girl come in that just broke my heart.  This was a healthy looking 10 year old girl who fell from a tree on her head and fractured her skull.  We have had two other kids who fell from trees before this girl; one who lived and one who didn’t.  This beautiful girl came in with her dad and she couldn’t even protect her airway by the time she got here.  The patients that come often travel from far away so I am sure her neck got jarred around in the car - not to mention all the brain damage from the skull injury.  She had no reflexes and was just mentally gone.  The dad could speak some english and he just so badly wanted me to say there was something we could offer but there just wasn’t.  She actually survived overnight which surprised me but I just couldn’t swallow the pain in her dad’s eyes.  Heartbreaking.  I had to do clinic yesterday after we rounded and I saw more than 60 patients on my own.  Its great to have the chance to make clinical decisions and learn so much and have an overwhelming amount of responsibility but emotionally I was just so empty yesterday.  Today is better though.  Just please pray for strength. I can’t believe we aren’t even halfway through!  I love it here and I feel very useful but it is definitely a time when I really need to reach outside of myself to give to these people.                    Monday was a holiday and Vince took us all to greet the chief of the Nieree (I am probably botching that spelling).  It was so neat and you always have to bring gifts to the chiefs.  I found it hillarious that Vince was bringing trailmix so I thought I might as well offer the Werthers since they are in gold wrapping and look nice (dad I have a pic for you!).  It is always a neat experience to go greet these important pillars of the community here, we just always wish we knew what they were saying!  Vince gives us a rundown when we are through.                                                                                                                                                                                                                                                                                                                                                                                                                                                              Tuesday was surgery day and of course taking care of the wards (my favourite part).  I made myself go in on surgeries because there are some pretty rare things we do.  I do some procedures that I want to do and that the residents don’t jump at but for the most part I have just been making sure I see all the cool stuff.  I am trying to remember what we did that day surgery-wise.  I remember there was a horrible car crash guy who needed lots of lacs sewn and had a skull fracture.  Lots of babies and c-sections.Wed was the hardest day as I have said.  Clinic is awesome and horrible all at the same time.  Its so fun to try and use sign language and learn some of the Mamprulli language - Darryl and I both know all the greetings and I know some common words I need to use.. diarrhea, pain, vomiting and fever ALL the time are used.  I have also learned how to say “sorry” before I am going to poke someone or whatever I have to do for a procedure.  We were in clinic till 630pm because monday there was no clinic and wed is market day so everyone is in town I guess it just all accumulated.  All together I bet we saw 500 patients… crazy.  After clinic we powered through a ton of proceedures (lots of people need wound debridements.. ultrasounds… and most are important and have waited since early in the AM so we feel bad eating and making them wait.. but man dinner is so good at 9pm or whenever we are done).                                                                                                                                                                                                                                                                                        I think one of the most valuable skills I have learned is to tell if a patient is very sick and needs to be admitted (most are sick to start off with).  John, one of the FP residents and I share a clinic room with likes to play his ipod and the patients love the music… you definitely have to have a sense of humor and enjoy yourself or clinic would be torture.  I am so blessed to work with great people.. I don’t know how I would do it without them and all the fun we have.  We can just start laughing at something and the patients will have no idea but they will start laughing.. its infectious… I love it.                                                                                                                                                                                                                                                                                                                                                                                                             The most common things we see are malaria malaria and more malaria, typhoid (which can get really bad and perforate the bowel and need surgery), osteomyelitis, infected wounds (saw one with maggots yesterday.. I videoed it.. amazing), pregnant women with miscarriages, kwoshiorkor (protein malnutrition), HUGE ginormous hernias (amazing how big testicles can get.. no kidding.. grapefruit or bigger), snake bites (carpet viper… thats why we use a flashlight at night) and trauma.                                                                                                                                                                                                                                                                            Anyways, little update on Darryls side of things.  He has been asked to speak quite a few times (not surprising).  The first day he spoke he talked about the good smaritan and loving your neighbour which is really good for the Mamprusi here because there are lots of tribal disputes (thus a lot of the gunshot wounds).  Hes such a good speaker and today he rode on the back of Pastor Kofi’s “moto” (a dirtbike.. freaks me out) to the TB (tuberculosis) village where all the TB patients live and get their meds till they are better.  While he was there he got asked to give an ad-lib devotion… he was a little flustered but of course came up with something.  I think its good for him to just do it on the spot.. he agrees : ).  Hes becoming friends with some guys who are around a lot and getting to know people pretty well.  Its nice he has time to really get to know some of the locals.. I know that its something I am missing out on so I listen to all he learns about people.  He really cares about people and I think hes doing a lot of good here.  He is speaking this sunday somewhere else but sadly I can’t go because hes going on the back of a moto again…. boo  But I want to go to the dancing church  so I will probably do that.  Oh and he also helps in pharmacy counting pills and putting them in church offering envelopes (ha yes they use anything you send them).                                                                                                                                                                                                                                                                                                                                                                                                                                    Well, this sporadic updating is kinda like binging and purging so sorry about the verbal diarrhea.  I am writing some of this stuff so I remember it too.  Hope all is well with you out there.  I love hearing from you.  Thanks for the emails so far. Its encouraging just to hear from you.  Its only been less than two weeks but it feels like forever… Darryl says its because the days are so long.. hes pobably right.  Ok, going to try to post some pictures.. I will spare you the gross ones and try to put up some cute kids!  Until next time! Don’t climb trees.

Sweet music

I am going to try to post a video from church today.  The song was awesome and the little girl dancing at the end is so worth the watch. Next week we are going to hit up the Ghanian version of a pentecostal church because there is more dancing.  I love listening to them sing.. so beautiful.  They have so much joy and love for life and it overflows into everything they do.  enjoy.

Update

dahsubah! (good morning)

Wow, I am so sorry there has been zero time for us to write but here it goes!  We are loving it here.  Its hardwork so far but so fulfilling.  Its been an adventure!  Im not feeling super creative so Im gonna just list days and say what we did and hopefully that will capture the gist of it.  We flew out of Accra Monday at 5am and landed in Tamale which is about a 2 hr drive from where we are now.. Nalerigu.  We are lucky enough to be travelling with Vince a doc who used to practice here full time for about 14 yrs I think and his friend who has been here many times and two family practice residents.  Vince knows so many neat things about the region so he took us to a “natural healing” orthopedic place on the way here.  It was so neat to see and definitely a good intro to the spirit of the people here.  This one guy who had been there for 11 months because he fell and was paralyzed we asked him “so can you move your legs at all” and he says “not yet”.  It is something that stuck with me.  They have such hope and strength.  It amazes me constantly.  I have such admiration for what they go through and still have faith and so much strength to go on.  We have some pictures of this ortho place so we can post some when our battery charges.  (yes dad we have been using the camera.. kinda proud of us.. its annoying but i know we are seeing somethings I want to show people).  We went to greet a chief as well which is a formal process.. the women and men do different actions and its kinda cool to know (we used that again this A.M. when some chief came to breakfast… I definitely am still learning all the rules.. it was funny, I came out with my cup of coffee and sat down and said goodmorning to him not knowing it was someone important.. oops…  status is a big deal here, I love how rich the culture is that way)  After the ride to Nalerigu we arrived at the hospital .. ate a quick lunch and started clinic.  Darryl came to clinic to see how things worked.. he left after this girls leg had a chronic osteo with the bone just sticking out…  he has seen a lot and been so good with it.  Hes kinda amazing me : ) Clinic lasted till 8pm and we ate dinner then did rounds on the wards till about 1am.  Long first day!  The good news is all the other days have been only till 11pm.There is so much need here that the work doesn’t seem as tiresome.  I am exhausted but its really not hard to motivate myself to work all day and night because the people come with such acute illnesses and they really need attention or they will not survive.  I have seen a lot of death.  The first night I was there this young girl died and that was hard because we actually coded her (did CPR)… which they never do here but we thought there was hope for her.  So many patients have died but many have gotten or are getting better.                                                                                     Clinic is crazy.  The first day I hung out with Vince and Sheila (pediatrician…  and probably one of the coolest people I have ever met).  The illnesses here are things I havent seen so it was good to get a clinical picture of what a “sick” patient looks like here.  A LOT different than my previous experience.  I am now doing clinic on my own and seeing my own patients because the volume is SO SO big.. we see around 400 patients on clinic day.  The best part is that they are all interesting and I have seen so much pathology in clinic.We have clinic mon wed fri and tues thurs are just surgery.  A typical day now is rounding at 730am and then either clinic or surgery all day and then rounding at night…. usually home by 11pm.  We all eat meals together so Darryl and I get to see one another throughout the day.. its awesome.                                                                                                             So Tuesday was a surgery day… anyone who knows me Im a thinker not a doer… surgery is boring but I went in on a few cases. I prefer to keep an eye on the wards and see what new patients come in.  We always have things happening so always things to be done.  Darryl went out with the dentist tuesday and learned how to pull teeth.  Dr Robinson is this super old guy (80s) and he comes every year with his granddaughters and they go to these remote villages and do teeth cleaning and pull teeth.  Ha, it was so funny that Darryl ended up doing that but he was a big help.               Wednesday - the most exciting thing was that this girl had a placental abruption and needed a stat C-section .. I was in on the case and the girl ended up having a uterine perforation when we went in so she needed blood.  I volunteered to find some blood.  After some running around it turned out Darryl was the only universal donor I could find… he kindly volunteered and after giving his unit he passed out.  It was kinda hillarious I must admit but we took care of him… he sat up to quickly.  Hes ok now : ) and the girl lived so that was awesome… he saved a life after only 3 days here!!! Thursday - Darryl and I went out with the dentist… another resident arrived so they had enough help at the hospital.  It was a fun day… very tiring but the kids in the villages we went to had so much energy it was amazing.  It continually amazes me that despite all of the disease, hunger, heat and poverty there is so much life… and the life is so full too…  definitely just reinforces that there is something bigger than all of us keeping this going.  Darryl pulled teeth as did I… Darryl had a hard time making people have pain.  I took pictures of him.. haha.  Its crazy that people line up for this painful procedure.  We do use some local anesthetic.  It was fun to do that together.                Thursday night D gave the devotional at this group they have every week.  He was very good.  Im glad hes getting a chance to share things… hes got a gift forsure.                                                         Friday - Clinic again… it was fun but I don’t remember a lot.  I did some OMM (the manipulation I learned in med school) and people loved it.  Its kinda hard to find time but I try to go it when I know it will be helpful.Today we had a field trip!  We went to visit this hippie couple who just live here and plant trees… it was awesome.  Hes been here since 1961 and shes been here since 1978 (D just told me that haa.. why he knows that I don’t know haha).  They had pets .. antelope.. monkeys etc.  Then we went to an escarpment.. very beautiful.  ITs the dry season here so its not as lush as usual but still so cool.Anyways… I have tried to finish this post a few times today… I finally got up the motivation to come write after evening rounds.  Hope its not too wordy… just somethings I don’t want to forget!                                                                                                                                              The team I am working with is the best.  Vince is a genius…. he knows everything I think… but hes so easy to work with at the same time.  He practiced here for awhile so he knows the language.  He also did surgery along with his FP residency so he does lots of surgery and its just amazing.  Sheila is a pediatrician who is a fun amazing spirit who just makes everyday enjoyable.  I am learning lots from her.  Dorothy and John are FP residents who are so great.  ITs nice to work well as a team.. it makes the long long hours go by fast and work seem really productive.                                                      The people here are so welcoming.  Its been fun learning some of the language.  They are always telling us we are welcome and  constantly smiling and thankful.  I think one of the things that makes caring for people so easy is that they trust you.  They just want to be well.  When one family member is sick many other family members sleep around the bed and care for the patient.  They do all of the feeding and bathing and they nurses just do the clinic things. It works really well.  Life here is so communal.  We are learning a lot just observing that aspect of life here.Ok, time to sleep.  Darryl might upload pictures soon.. he will do the next update I think.  Sorry if its one big paragraph… I can’t figure out how to fix that.Until next time!!

We have arrived!! well, at least partway

Hello!!

Darryl and I are at the guest house in Accra and wanted to let you know we arrived here safely.  Our luggage is on African time already and isn’t here so we are thankful we packed some extras in our carry on.  Long story but someone expired on the plane on our flight to Germany and so our connection involved running and apparently our luggage was too slow.  We are hoping we will get it Wednesday when another resident comes.We arrived and met up with some others who are going to be heading to Nalerigu tomorrow with us.  Pretty much just had dinner and enjoyed sweating a lot for the first time in a long time.  Its in the 90s… nice!  A local surgeon and his wife who works for the Ghanian ministry of health had dinner with us and it was interesting to hear her talk about their healthcare system here.  I am sure we will learn lots more about that.  Well we fly out early tomorrow AM so thats all for now!  We will keep you posted. Thanks for all of your prayers!

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