January 9th, 2008 Posted in INMED | No Comments »
June 25, 2007
It has been a long while since my last post; so long, that I doubt I will be able to contain all that has happened over the past couple of weeks within a post that doesn’t morph into a small novel. I am still keeping my notebook updated with happenings and things that I see in the hospital, so I will flip through and pick out the stories that have had the most impact on my stay in Nalerigu so far.
First I will bore you with the educational component of my stay, though it is anything but boring to me. Clinic has been a gigantic learning experience, and at first it was a bit daunting. There are multiple factors that add the the challenge of clinic, the biggest of which are the language barrier and the difference of 3rd world medicine.
At a certain point, Elisabeth was kind enough to think of giving me a list of the mediations that were available at the hospital pharmacy. This became a foundation for learning how different diseases were treated at BMC. Every time I learn of a new disease, I write down prescribing information next to the drug. After a few clinic days, I was allowed to see a few patients of my own; simple ones with HTN, or sometimes some seizure disorders. Eventually, I ended up working in Dr. Faile’s office as a student team with David. We get some pretty interesting patients, and Dr. Faile is always right there for us to ask questions if we are completely lost (this happens embarrassingly often, as we often get people with strange lumps in strange places). We also see a lot of Dr. Faile’s post-op patients, making sure their incisions are healing well. I have also done more pelvic exams in the past couple of weeks than many students do in a year’s worth of outpatient clinic. Also, I have done more rectal exams than many avoidant students will do in their entire schooling!
It hasn’t been all work, though. A big group of people from Georgia, who went to the same college as Peter Faile, came out to Nalerigu to see Peter’s home town. They were really a fun group, fully equipped with bubbles, frisbees, balls, nail polish, string, beads, and pipe cleaners! They really had fun with the kids in the schools, and with all of the inpatients. A lot of the smaller children are very scared of the white people, and will cry when we get to close. So, it was probably good that this group came in with pleasant things like bubbles and stickers, instead of sharp needles like the rest of the white people these kids know! There are twin girls at the nutrition center every day, and on our way to and from lunch, David and I often stop to coo at them. They are malnourished, but adorable, with these HUGE eyes. They put eyeliner on their babies here, and that only makes them look even more doll-like. They aren’t too enamoured of us, though. In fact, when we get within a few feet, they start fussing and reaching for their grandmother. Today, though, I got very close, and decided to just go ahead and pick one up…she cried. And I thought “what a selfish mistake”. But they are adorable even when crying! So, on my way back to the hospital from lunch, I stopped again, and guess what! It was the first time one of them actually smiled at me! I was so excited, but I stayed a ways away, so I wouldn’t discourage this new habit.
The group from Georgia, Elisabeth, David, Peter (a doctor working in a village past Nalerigu), Brittany (a nursing student), Peter, Emily, Katie and I headed out one day for a hike to the escarpment at Nakpanduri. The hike ended with a pretty good rock climb up to the edge of the escarpment. Dad…you would not have liked this. The drop to the valley below was pretty dramatic, especially considering the otherwise flat landscape that I have seen since being in Ghana. We all sat on the rocks for quite some time, looking over this African plain, and thinking “hey, I’m living my dream…I’m in Africa”.
On the 9th, David, Dr. Hewitt and I attended a funeral for one of the men that used to work as a watchman for BMC. It was surprisingly similar to Baptist-style funerals in the States, with hymns, and some scipture, and some words about the man’s life. But…it was all in Mampruli, and they buried the guys right in front of his hut. The men in the community had dug the hole themselves, and buried him in a small coffin, right there during the ceremony. Another difference was that they collected an offering before nailing the coffin lid shut. Everyone, even the family, went around the coffin, dropping money in a bucket.
Church wasn’t an entirely shocking experience. It was a little bit frustrating to have most of the service in Mampruli, especially the music. The music they have is very lively, and VERY loud. I wanted to join in, but without knowing the words or their meaning, I was at a lost. I did join in on the dancing, a little bit at first. David has become quite popular for dancing at churches. He picked up on the native way of dancing, and people stick money to the sweat on his forehead. We found out later that the money always goes into the offering, and is way people can show appreciation for the worship. It is kind of strange, but a different way of worshiping. They also held a blessing for a newborn child. Every child goes through this ceremony, and an offering is taken up, and the congregation is asked to give he child their Christian name. At this particular service, a young man in the band raised his hand and named the child.
I completed my first human sutures on 6/13! I was SO EXCITED. My hands shook, but it didn’t matter. This woman had undergone a lipomectomy, which is basically a procedure to remove a big, benign fat tumor. I will post a picture of it on this blog later on. Since that first one, I have also closed a coule of surgeries, including a hernia repair, and a c-section. My hands have stopped shaking as much. I don’t know why, but suturing is one of my favorite things to do! It just feels so satisfying to actually be DOING something that absolutely needs doing. I have also had a lot more experience in the OR. I will post stats in a different post, but I am learning more and more every surgery day. In a fix, I could probably manage a C-section, but hopefully that will never happen!
There have been some challenging times as well. Slowly, over the past few weeks, I have been face to face with a lot of physical suffering. I don’t think I was really processing it so much, I have been so busy, but it all came tumbling out of me when I met a man on 6/20. This man came into outpatient clinic with his family. While waiting to be seen, he had been moved a ways away from the seating area because other patients were complaining of his smell. When he came in, he had a cloth draped over his head, like a shawl. And he did smell, but it wasn’t unbearable. When he took off the cover, it was obvious where the smell was coming from. He had a gigantic mass on his left jaw line that was basically festering and rotting. It was a parotid tumor that had gotten out of control, then become infected. I sat in the room with him and his family as Dr. Faile told them that there was nothing he could do. Operating was too dangerous with its location, and chemotherapy isn’t much of an option in Nalerigu. The family cried. In Nalerigu, you do not see many adults cry, and the impact was deep in me. Beyond the family crying, was the silence of the man; the look in his eye that seemed to by void of any hope. This man was already dead. The emotions became overwhelming as I recalled seeing a man slowly dying from massive infection in the isolation ward, and the extremely malnourished skeleton of a child with HIV, whose cry was no more than a weak whimper. I found myself needing to pray and cry. I know God is just, and that He is sovereign, but I couldn’t get those images out of my mind. I spent some time trying to remember my purpose on earth, and reconciling the ideas of healing, and of the shortness of life. After I was done, I went back to clinic, but I have continued to see things that are absolutely heart breaking every day, and I wonder if I will ever be hardened to it all. Today I saw a child from the infection isolation ward getting yet another abscess drained. This boy is just covered with bandages. He has some mysterious infection where he is getting abscesses all over his body, almost a new one every day. Unlike the man with the parotid tumor, he is still trying, but barely. David and I held his hands and stroked the skin on his back that was peeking through the bandages while he had an abscess on his chest cut open. At least a cup and a half of pus poured out of him, and it was horrifying. So, every day is a new challenge, and a new joy. It is such a mix of emotions.
This past Saturday Brittany, David and I decided we would hike up into the hills at a quarter past 4 to watch the sunrise. It would have been beautiful…if we had known the way…and if it hadn’t started a downpour half way through. We turned around when it started raining, but we were still about 30 minutes out. We were soaked and, surprisingliy, COLD! We all went back to bed for a while (I actually slept for a looong while). When I got up, we decided to try again, and we ended up making it to the top of the hill nearby by picking our way through some of the farm country of the valley. We were greeted by many farmers on our journey, which lasted four hours. It felt good to actually get out into the countryside and explore a bit. We met a man out in a field who didn’t speak an English word except “bye, bye!”. I have a picture of him, which I will post later.
I made a pineapple upside down cake after dinner, and it tasted deep fried! I ran out of margarine part way through, and I had to use oil, so I guess it kind of was deep fried. It was rich, but good, and it is all gone!
Sunday was quite an eventful day, and I know if I don’t write about it now, I will be completely unable to catch up later. David and I went to the Assemblies of God Church because David was giving an abstinence/HIV talk later that night there. It was by far my favorite church to go to in Ghana so far. They sang some hymns in English, and there was such a sense of worship there. It was Children’s Day in the church, and they did a short play about obedient versus disobedient children that was very adorable.
After church we wandered into the market (it was a market day). We were looking for foo foo when we ran into Immanuel. He actually approached us and introduced himself to us. He said he worked as a messenger at the city council building, and he would like to show us his office. We told him we were looking for foo foo, and he showed us where we could get some. He sat across from us as we ate soup and mashed yams with our fingers (David brought hand sanitizer this time!). When we were finished, he absolutely devoured what was left, practically fitting his entire hand in his mouth. When he was done, we were lead to an “office building” in town, and shown inside to his office. The building looked more like one you would see at the Sedalia State Fair, maybe with a swine contest or something. But his office was enclosed, had a desk, complete with piles and piles of documents. There wasn’t a light, but he left the door ajar, and helped us into some plastic lawn chairs. He was about to explain more about his job there, when he was inerrrupted by a couple of men yelling outside. He went back outside and was arguing with them for a while, and when he came back he apollogetically explained that we were being required to approach the local chief, to be questioned about our interest in the city affairs.
The chief was sitting under a protective awning in a back street of the market. We approached bowing low, and clapping. I was told “woman do not clap, they do this” and shown how to do the challenging snap greeting that women use. I tried it, and I guess it was accepted. There was quite a bit of discussion back and forth between the chief, Immanuel, and the accusers. Immanuel mentioned our work at BMC, and it was like he had said the magic words. The Chief chief, the Nijiri, hold the BMC and all those who work there in high regaurd, so this Chief would not be the first one to punish volunteers from there. He apologized for the mistake, reprimanded the accusers, calling them drunkards, and insisted that we be taken to greet the junior brother of the Nijiri. The Chief’s name was “Dan” and he lived in a good house just off the market. He was very welcoming, telling us that his house was our house and we were welcome any time. He told us how he grew up with Dr. Faile, and how he was so facinated with George’s bicycle and white skin back in their shared childhood.
When we finally returned to BMC from our 5 hour trip to town, it was time for dinner, and I had promised to help Emily (Dr. Hewitt’s eldest daughter) make cookies. I headed over there, and found out that Abby also wanted to make some kind of fancy chocolate-mint concoction. So, we stayed up past their bedtime baking, and Mona was kind enough to offer me a drive home. We were greeted at my house by a couple of the night gaurds. They were beconing us to get out of the truck and had some news. They had killed a snake! This wasn’t surprising to me really. Tons of people come in, bleeding from everywhere due to carpet vipor bites, and a cobra was killed near the schoolhouse the other night. So, I wasn’t expecting to see this gigantic monster of a snake! It looked like a boa to me at first, but apparently it was a python…a six foot python. I convinced the gaurd to let me have it, though he seemed confused as to why I would want it. I quickly woke up David, and he and I posed for pictures that Mona took for us.
Then I got an idea…and it involved the snake, and Dr. Peter. Now, Dr. Peter works (worked) at a hospital in a village a ways from Nalerigu. Unfortunately, his hospital was recently shut down by the government, and Peter had come that day to stay with us at BMC and help out. My idea involved a morning wake up surprise in the form of a six foot python on his doorstep!
He took it very well, and actually enjoyed the joke. When he left it there though, the woman coming to clean his house was not so entertained. She dropped the bananas she was carrying and ran the opposite direction! David brought the snake back to the house, and we decided to give it to Yisah to cook up for us. Peter informed us that the word for snake is Waifu…so we had boiled waifu for lunch, and it really did feel like fish, but taste like chicken. I ate a couple of segments, but David and Peter chowed down on it, consuming at least a foot of snake a peice. And, (this is really gross) David ate the snake liver. I couldn’t watch because I thought I might vomit. But it was good, and we felt better about the snake’s untimely death after eating some.
And that is a big part of what has been going on. I will try to be more prompt in posting my adventures in the remaining weeks. I love you all, and miss you tons! I hope all is well, and I look forward to seeing you again.