Nathan & Rebekah’s Blog

Heading Home

Rebekah here with some concluding thoughts…

Nathan and I just completed our last week of service at the BMC for this trip. We have safely landed in Accra, and we will spend just a few nights exploring the coast before we head back to “the real world” Friday. This will be an important time for us to discuss our trip—the experience and all of the emotions. Really, we were encouraged to use this time to debrief between each other. Please continue to keep us in your prayers as we travel.

A new team arrived this week with three EM physicians from UCLA. They brought new energy and enthusiasm to the work. Although we were sad to say goodbye to the previous attendings who were here from WVU, we have enjoyed the way our experiences changed based on the personalities of each group of people as many have come and gone through the four weeks. We are feeling bittersweet about our own departure. Emotionally and physically we are feeling empty and tired. On the other hand, there is still so much work to be done and such a need here that it is difficult to just walk away and out of the lives we have met this month. One of my new girlfriend here said it best, “It just feels unfinished.”

This last week has been similar to those before it.

We had some catching up to do after the Easter holiday. Out patient clinic was actually closed for Good Friday and Easter Monday, so Wednesday we were slammed in clinic. I never heard a final count but I have to guess something like 400 patients may have come through the clinic that day. I felt buried under the mountain of charts that kept re-accumulating after we would make a small dent in it. At some point I almost put my head down—feeling defeated—but then a thought crossed my mind. Many of these patients had traveled for many miles and perhaps even days. They were traveling to see ME —the white woman from America who they call doctor even though I am technically still a student—the same young women who so many of my patients at home call nurse and become frustrated with when I am the one has to ask the same questions of them as the real doctor and repeat the exam and who often doesn’t have the answers to their difficult questions…these patients at the BMC that day that were represented by the mountain of charts, they were spending their day to come see ME. They believed I could help. They trusted the advice I gave. They accepted the diagnosis. And then, they lowered their eyes and thanked me.

One more story and then I will try to make some good point.

I admitted a woman with a traumatic brain injury. She was an older woman who was hit in the head by a piece of corrugated metal roofing. She lost consciousness immediately and had not woken up when I evaluated her about 5 hours later. TBI is something I have been really interested in from a research standpoint, but it is not something one wants to encounter in the developing world. First, there is no effective imaging modality to evaluate the injury. Second, there is really no effective intervention available—actually even at home treatment options are limited. So I had to have yet another difficult discussion with her family. At this point in the month I had become somewhat accustomed to a statement that goes something like, “You family member has a very serious injury. There is no way we can estimate the extent of the injury other than to evaluate her clinically and as you can see she is in critical condition. We cannot predict what the outcome will be, but we have done everything that we can here. We will try to make her comfortable. Even as doctors, we can provide some medicine or some treatment, but we have to trust that it is still God who heals. At this point we can pray for her.” I frequently reevaluated this patient, and one day her son confided in me, “Doctor, we are praying for my mother. We are also praying for you that God would give you success in treating her. We know you taking care of her. Thank you.”

I was not prepared for that.

I have actually said similar prayers for the doctors taking care of my friends and family. “Lord, please guide their hands, give them wisdom, help them not to make an error.” Now I was the doctor being prayed for? And thanked, although I had done very little for this woman. About five days later, she went home—oriented, following commands, and moving all four extremities. I can honestly say that felt like witnessing a miracle. I did not expect that outcome either.

So, what’s my point that you’ve been waiting for? I guess it’s just that I feel like a little, tiny, under skilled, semi-equipped, not-smart-enough-make-a-big-difference girl from a humble home in a tiny town in the Midwest of America. But this month, for these people, I was different. I am just this little lump of brown clay and God made it something beautiful this month that I could have never imaged or done on my own. And I can say for certain that I will never be the same because of it.

I’ve told some of you before, that I often feel as though the journey to become a physician was out of my control. Over the past nine years, I feel that I have just been holding on (with all my strength and might) along for a difficult ride that I don’t remember consciously choosing. My mom says that she believes God gives us dreams—and that she thinks God gave me this dream to become a doctor. And while I often feel inadequate, she reminds me of that as we have prayed before every exam, important challenge, or after a difficult day. Nathan and I have been reading this book called, The Hole in Our Gospel. On one page there was a quote, “God doesn’t call the equipped; He equips the called.” So back to my point, at the end of four weeks and too many stories to relay, I think we may have an answer the question of why this simple country girl is about to graduate from medical school. I think we have answer to the question—how was your trip to Africa? I hope you can read those answers between the lines of our stories here.

My good friend Jane says, “Medical school changes you.” I’ve always known that she is correct. These past four years for us have taught us so much about life, death, and health. We’ve learned about physiology, anatomy, and pathology. But, I propose more importantly, we have delivered new fresh little babies into the world, we have sat and watched as lives have ended just as quickly. We have witnessed the effects of physical abuse, substance abuse, poverty, and racism. We have taken care of VIPs and people who think they should be considered VIPs. We have taken care of the marginalized in our society and abroad. We are about to complete this step in our journey and graduate from medical school. Nathan and I want to thank you for reading and sharing this month with us. We know that some of the stories and some of our emotions are difficult to hear and may be difficult to try to understand or relate to. Specifically, Aliu’s story really touched us. It was one such experience that will have a lasting impression on our life as physicians and as people. We hoped it touched you too. Thank you for the words of encouragement. Thank you for listening to our adventure and sharing in our heart ache.

The question we cannot yet answer…what will the future hold for us after this experience? I don’t think that Nathan or I are ready to answer that. Will we come back to Ghana? Will we come back to Africa? What more can we do, and what can we now from our home during residency? Will there be another place to serve? Would there be a better way to support this hospital, the workers, and the patients here? Will we travel for a shorter or longer time period? Would some of you be willing to come along next time? These are questions on our mind now as we prepare to head back home. We will try to keep you updated as the answers become more clear.

Thank you again for your love and support!

Signing off from Ghana,

Nathan and Rebekah 

Aliu

Although there are countless stories to share from the last three weeks we have spent at the BMC here in Northern Ghana, I want to take a few moments to tell you about one specific patient that has touched my life in a great way. Aliu was a very quiet yet kind twenty-seven year old man who I met just three days ago. He came to the hospital with complaints of fatigue, shortness of breath, and generalized aches and pains. I have seen numerous patients present this way during our time here and nine out of ten times they have anemia secondary to malaria. So when we got his blood counts and saw that his hemoglobin was very low, we were not surprised. Typically these patients also have evidence of malaria on their blood smears. Subsequently, they receive a blood transfusion, anti-malarials, and multivitamins, and they do well. Aliu’s case was not as straight forward, though. As we looked through the rest of his blood counts we were shocked by what we found. In addition to his hemoglobin being low (indicating anemia), his white blood cell count was 133 and his platelets were only 38. Typically, the white cell count should be less than about 10 and the platelets should be more than 150. My heart sank as I saw these numbers knowing that they indicated a serious diagnosis – leukemia.

Leukemia is a terrible diagnosis to receive regardless of the country you are in. Even in the States where we have the most advanced cancer treatments available, many still end up dying from their illness. But to receive this diagnosis in a place like Northern Ghana is most certainly a death sentence. There are only a couple of places in all of Ghana that can even offer chemotherapy (none that offer advanced treatments like bone marrow transplant), and chemotherapy is not subsidized at all by the national health insurance. Thus, unless your family is very wealthy, you have no options.

Unfortunately, Aliu’s family was one that did not have funds available to pay for treatment which would likely cost several thousand US dollars and require travel to Accra, which takes half a day by bus from Nalerigu. Knowing this, several of the volunteers here began to discuss the possibility of raising support for him. Actually, two of the doctors here thought they would be able to pay the entire hospital bill, and even many of you at home who were praying for Aliu offered to help. For a moment there was a glimpse of hope that maybe we would be able to get Aliu to the right place and potentially get him treatment. The window of opportunity was just to narrow, though. Over just one or two days Aliu’s condition deteriorated rather quickly. He was becoming more symptomatic from severe anemia and his platelets were so dangerously low that risk of an internal bleed was very high. The only treatment we had to offer here at the BMC was blood transfusion which could temporarily raise his hemoglobin and platelets to a safer level. The hope was that these temporizing measures would allow for an opportunity to arrange transfer to Accra.

I wish this story had a happy ending but it does not. Aliu received a transfusion yesterday evening but had a terrible reaction to it, likely because of antibodies he had developed from receiving so many previous transfusions. At the BMC we are able to match the main blood groups (ABO), but patients like this ideally need more advanced transfusion options. About an hour after the transfusion, Aliu became increasingly febrile, his heart was racing, and he was in severe respiratory distress. Over the following three to four hours we did everything we could think to do to try to save him, but our efforts were unsuccessful. We were helpless and could do nothing more than to try to make him as comfortable as possible. We gave him pain medications, took turns sponging him down with cold water, and tried to comfort the family as best as we could. We watched as his heart and lungs slowly began to tire out and his oxygen saturation numbers fall lower and lower. We all waited anxiously as he took his last few gasps of air and then all movement ceased. He had died.

I am sure this story is not easy to read as I am even crying while I write it, remembering everything that I witnessed yesterday evening. I do not write it just for the sake of writing it, though. I am writing because I feel that Aliu’s story deserves to be told as it represents one of millions of tragedies that occur every year around the world. One of the things from the hours leading up to Aliu’s death that struck me the most was something his uncle said. As we were working diligently to do all we could for Aliu, his uncle looked at one of the doctors and said two simple words. “Poor Africa.” That was all that needed to be said because it summed up all of the frustrations and tragedies of this family’s situation. Although this man probably had never seen an ICU and did not fully understand what could have been done for his nephew in a wealthier nation, he had a firm grasp of the reality that there was certainly much more that could have been done had we not been in rural Africa. Aliu would have likely been diagnosed much earlier, would have probably received treatment, and would have had a real shot at cure from his illness. It is even more heart breaking when you learn the rest of Aliu’s story. He was actually well known by many of the nurses at the hospital because he was previously an employee here. He spoke very good English and has been a translator for past medical volunteers. Aliu also was currently a student at the nursing school here in Nalerigu. He had planned to continue work at the BMC once his nursing training was completed, were he would serve the people of his hometown. He was likely one of the first people in his family to receive any form of higher education and was probably the family’s “pride and joy.” This family lost a very important part of themselves when Aliu passed last night, and as I ponder his story more and more I keep coming back to those two words. Poor Africa.

As I write to you today it is Easter, the day we celebrate the resurrection of our Lord and his conquering of sin and death. We lift up his name and worship him for He has brought healing and redemption to a broken world. But here in Africa it is easy to look around and wonder where God is. Even in the States when we are faced with pain and suffering, we question God’s love and concern for humanity. So often you hear people asking questions like, “If God loved the world, why is there so much death? Why is there so much pain? And why does he not intervene?” Honestly, it is sometimes easy for me to feel those same feelings and ask those same questions. It is also easy for me to be blind to the world, comfortable in my own health and wealth. Short of even beginning to think about places like Nalerigu, Ghana, I forget to even consider the sufferings of those living in the inner city in Columbus, Ohio. I forget about the millions living all around us that go without food, water, shelter, and clothing. When faced head on with tragedy here in Ghana, though, I now hear God asking me the same questions we ask him – “Nathan – If I have loved the church and redeemed her with the blood of Jesus, why is pain, suffering, and death so tolerated by you? Nathan – with everything I have blessed you with why do you not intervene?” The truth is that God has blessed the American church with incredible resources and has called us to be his voice, and hands, and feet to reach the broken hearted. We ask why he has not intervened but fail to realize that he has made a way through us! The Church is his intervention for the tragedies of the world. The Church is his answer to poverty, lack of clean water, hunger, and sickness. We must realize this quickly if we are to affect change both in our own cities and across the world. We must see that all we have from God – our time, abilities, and money – has been given as a blessing to bless others.

I challenge you to begin praying for the world. There are needs beyond what we can even imagine, but there are also solutions to these needs. Pray that God would show you how to best be a steward of the blessings he has given you to reach people in need. I would challenge you also to deliberately remember the poor in your daily decisions. The next time you feel you “need” a new shirt, consider the many children in Nalerigu who wear the same tattered t-shirt every single day because it is the only one they have. The next time you are going to a nice dinner, think about the mother that has to choose which child will get to eat and which one will starve because she can not feed them both. When you open up a fresh bottle of water despite the fact that you also have the option to drink clean tap water, imagine the thousands children who die daily from water-borne illnesses. Simply put we are rich beyond what most people in the world can even fathom and it’s time to use our wealth to reach the world.

I hope that what I am writing does not come across as judgmental. My hope is that you hear it only as an urgent call to action. Please know that it is a message Rebekah and I are listening to as well. I do know that there are many of you who already give much to the poor, but even so I challenge you as well to think of how you can give more. I pray that God would use all of us as we think about those in need all around, people like Aliu who have great needs that we can meet. I know that he can use us mightily if we will respond to his call.

We love you all so much and we are thankful for each one of you in our lives.

Love,

Nathan & Rebekah

Health Care in Ghana and a Growing Perspective

It has been almost a week now since we have had time to post something on the blog, so we are putting a two part post up this week. First, we’d like to share just a little bit about health care here in Ghana, and, second, we’d like to share more about the things we have been learning the last week here at the BMC.

Health Care in Ghana

It has been very interesting to learn all about the health care system here in Ghana over the last couple of weeks. We have experienced much of it first hand but have also had the opportunity to talk much about the system with two Ghanaian doctors from Accra that have been working up here at the BMC for the last week or so.

One of the most striking things is how much cheaper health care is here as compared to the States. Granted, access to advanced care is very limited, but it is still just so interesting to hear about health care expenses here. For example, there is a nationwide insurance program that families are able to sign up for. The cost for an adult is fifteen Ghana Cedis (about nine or ten US dollars), and the cost for a child is five Ghana Cedis (about three US dollars). That is for the whole year and there are no additional co-pays to go with it. But even if patients do not have insurance, the costs are still very low. We had one particular patient without insurance admitted for about ten days of IV antibiotics and the total hospital bill was eighty-five Ghana Cedis (about fifty dollars). The cost alone for even one night of admission to an American hospital would cost thousands of dollars! Another interesting part of the issue of payment is that patients must remain in the hospital until they are able to pay their bills. It has not been uncommon for a patient without insurance who has completed their treatment to stay at the hospital an extra two or three days until the family can come up with the money. In the States we usually rush people out of the hospital as quickly as we can because of the high expense of each day of hospitalization.

We have also learned that there are a total of four medical schools in the country and around five or six teaching hospitals. Medical education works a little bit different here than in the States. Students attend only two years of undergraduate type work learning basic sciences – biology, chemistry, physics, etc – before going on to medical school which is five years instead of four as it is in the States. They still do two years of more basic science in medical school, but they have an extra year of clinical work. After graduation every student spends two years in general practice where they learn primary care, obstetrics and gynecology, surgery, and so on. It is what the “intern year” in the States used to resemble. Most of the intern years now are spent only in the specialty the person has chosen. The goal of the two year general practice is to equip these doctors to be able to function autonomously almost anywhere in the country. This really seems to be a great way to train physicians here in Ghana as there are many remote areas where specialists are very, very difficult to come by. At the BMC, for example, one of these generally trained physicians would be able to see any medicine patients, both adult and pediatric, provide OB/GYN services including c-sections, and perform basic surgeries. It’s really much different than most parts of the States where specialists, and sub-specialists, and even single disease specialists are relative easy to access. Many here do, however, go on to specialties, but most of the specialists them do not practice in the remote areas of Ghana.

Another pretty astonishing aspect of health care here is the absolute lack of privacy, something that we value greatly in the States. All healthcare workers go through yearly training regarding privacy, we have many laws concerning privacy issues which if broken can result in serious litigation, and, most importantly, we generally feel that it is a moral obligation to keep patient information private. None of this exists here, and it would be nearly impossible to enact any policy regarding privacy given that up to twenty patients are packed into one ward at any given time. Questions about bodily functions, sexual history, and drug or alcohol use are asked with everyone listening. Sometimes other patients or family members even get involved in your discussion with a patient because of language barriers. This may be because the interpreter is having a difficult time getting your question across or because the patient speaks a different tribal language. If the latter is the case another patient or random person from across the room becomes an extra link in the translation chain. A simple question about whether or not the patient is having diarrhea then goes from you to the interpreter, who yells across the room to the next person, who yells across the room to the patient. The sequence is then reversed to get the information back to you. All of this for a simple yes or no! And everyone in the room now knows what your bowel movements are like. There is also little privacy for patients to perform bodily functions. There are restrooms that can be accessed, but if a patient is not able to get to the restroom, they must use the bedpan in the middle of a crowded room. It really is just very different than what we are used to, but it is normal life for the Ghanaians. Part of it is that community is embraced much more here than in the States. People are incredibly open with one another and view strangers as family almost. They band together very readily in times of distress and just do not seem to be embarrassed or ashamed by illness or weakness. It has been quite an experience to observe this part of their culture.

A Growing Perspective

God is faithful. That is a hard and fast truth that we are able to cling to at all times, and He has certainly proved this to be true during our time thus far in Ghana. As you know from our previous blogs our first several days here at the BMC were very difficult. We were quite discouraged at times and very saddened to see many deaths that we felt could have been prevented in other more resourced parts of the world. God has been faithful, though, to grow our perspective very much.

When you first step into a situation like we have at the BMC, it is very easy and tempting to compare it to what you know, and despite the current issues with our own healthcare system, it is still a system that provides pretty amazing care. At first it was so shocking to see how high some of the mortality rates are here, especially for neonates and young children. There was one twenty four hour period where we had five children die, and this is not uncommon. It is easy to look at those numbers and be so discouraged. However, God has been faithful to show us that despite the fact that many patients die, probably all of them would die if this hospital did not exist. Simple things like being able to rehydrate a child with an acute diarrheal illness, providing anti-malarials to a patient with malaria, or treating a patient for pneumonia or meningitis with antibiotics all have saved many lives in the short time we have been here. What an impact it is even if it were only fifty percent of the patients who were saved. This would never be acceptable in the States, but here it is a significant difference.

God has also been showing us how strong and present the gospel is here in Ghana. Despite hardship the people here are so quick to thank God for the things that He has provided. They do not blame him or become angry with him for their sufferings, but instead depend on him for perseverance. And for this they are made stronger. We actually sang a song in church today that had the lyrics “What else can I say, but thank you, Lord.” They realize that we as sinful humans are deserving of nothing and that each day is given as a gift only by the grace and goodness of God. It is an attitude that we are very humbled by and one that I pray we can learn.

We have really been very encouraged the last week, and although the work is still challenging at times, our growing perspective has helped us to view our work the way it must be viewed. God has been teaching us much and we know that he will continue to do so over the following two weeks. We still think of all of you often and pray you are doing well. Today actually marks the halfway point for us in our work here at the BMC! Thank you for all of your prayers. We ask that you would continue to pray for safety and perseverance and that we could continue to grow in the Lord.

Love,

Nathan and Rebekah

Life away from the hospital

We thought you all might like to know what things are like in Nalerigu when we are not working at the BMC. We are currently living in one of about twelve or thirteen houses that are on the same property as the hospital. It takes us about two or three minutes to walk to the hospital in the mornings. The houses are actually very nice, and we were pleasantly surprised to be living in one by ourselves with our own bathroom and shower and filtered water. There is no air conditioning but things cool down enough at night to be pretty comfortable. We’ve also got a little spray bottle next to the bed for misting when it does get a little warm! The houses are fully equipped with electricity, a washer, a refrigerator, and a gas stove. We have done much cooking for ourselves at the house yet, but it’s great to have the option.

We are also really blessed by the fact that lunch and dinner are prepared for us. The hospital has a couple of cooks hired to have meals ready for the volunteers. Typically, they cook a lot of American-style food, things like spaghetti, lasagna, fried rice, grilled cheese, and even hot dogs! All of this is usually washed down with several glasses of water. It is great to be provided for here so well.

We have had several opportunities to get off of the hospital compound which has been very rejuvenating. Our first weekend here we took a day trip to Paga which is a border town near Burkina Faso to visit the Zenga crocodile pond. When we got there, the workers informed us that there were over two hundred “trained” crocodiles in the pond that could be lured out with fowl so that visitors could sit on them and take pictures. We were a little nervous at first but figured this might be our only opportunity to do this in our lives. So we bought a couple of fowl, walked down to the pond, and the workers lured the crocs out. It was actually a little creepy to see little eyes pop up out from under the water swimming straight towards us. Once the crocs were up onto the shore, the workers would use long sticks to smack them on the head into submission. The animals were apparently very used to this routine because they stood there very still knowing that if they played along, they would get to eat. Somewhat hesitantly we then began to take our turns walking up behind the croc to sit on its back and hold up its tail for pictures. Even our driver’s twelve year old daughter did it! It was all very surreal. After we were all finished, the croc got its reward of a live fowl that was swallowed in one big gulp.

This weekend we got to take a short hiking trip to an escarpment near the town of Nakpanduri. It really reminded us a lot of “pride rock” from the Lion King. It was a short hike up to a huge cluster of rocks, and when you climbed to the top, you were immediately greeted by an incredible 180 degree view of the land below. The point is actually high enough up that you can see some small mountains and the border of Togo on the horizon. It was absolutely beautiful.

If you remember from our first blog, we told you about a man named Aaron who is the health information officer here at the BMC. He has actually been a great friend to us during our stay thus far. The other day he took us out in the afternoon to the market which is held here in town every three days. He walked us through and showed us all of the local goods that are sold and bought some local foods for us to try. We had cola nuts, which were one of the most bitter and difficult to swallow things I’ve ever eaten, but apparently they have some sort of stimulant in them to help you stay awake. They seem to be the Ghanaian version of coffee in the States. We then tried some sort of green fruit that was also quite bitter. We began to wonder if the people’s palates are just a little different here. Lastly, we had a food called cosi (not sure if this is the proper spelling) which is a bean cake of some kind that is deep fried and then coated in some different spices. It was really tasty. The market was a blast, and it was just so neat to see all of the people bustling around and all of the goods that were for sale. It was also interesting to think about the fact that this is how people buy their food and their clothing. There’s no grocery store or mall that they can go to anytime they want. They show up on market day or have to wait three days until the next market day to get the goods they need.

After we were finished at the market, Aaron took us out to eat lunch. We pulled into this random lot where some stalls had been built to host markets. You would have never known this was a restaurant as it was not marked in any way, but as soon as we pulled up some people popped out of a small doorway in the adjacent building and set up some chairs and tables for us. We shared some cokes and had jalaf rice (again, not sure if this is the correct spelling). I forgot to mention also that our mode of transportation was motos to and from the market. Aaron insisted that I drive one of them with him on the back despite the fact that I told him it had been about ten years since I had driven a motorcycle. It was pretty hilarious as all of the local people were pointing and laughing and shouting “solminga” (white person) as we drove through the streets. We stood out just a little bit.

Lastly, we had the wonderful opportunity to go over to the house of one of the hospital workers for dinner. She cooked tizet for us which is corn meal mixed with hot water. It sort of resembled some kind of grits or cream of wheat. Over the top of this she poured a vegetable soup with some chicken. She offered spoons for anyone who wanted to eat the American way, but I figured why not get the full experience and eat with my hands like the Ghanaians do. It was messy but totally worth it. After dinner, some of the girls from our team wanted to be taught to carry things on their head. Everyone took turns trying it out, and our host thought it was absolutely hilarious. It was fun to see her laugh so hard and to enjoy us struggle with something that is so simple for them.

It has really been wonderful here in so many ways despite the difficult work that we are doing, and we are glad to be able to share with you how we have enjoyed the people and culture of Ghana thus far. We continue to work diligently at the hospital, though, and ask for your continued prayer for what we are doing there. Specifically, we would ask that you be praying over the next several weeks for a young child we have who is severely malnourished. It’s hard to believe but he is twenty months old and weighs only thirteen pounds. His mother is nowhere to be found, and his only family is a grandmother who sits and sleeps at his bedside twenty-four hours a day. He is very, very sick and we are working hard to feed him and get him to grow. Despite anything we can do, though, we know that God is bigger and more powerful than any efforts we can make. So we ask that you would bring this particular little boy before the Lord in your prayers. If it is God’s will, pray for healing for this young child.

Thank you all so much for your continued love and support. We miss you all lots and can’t wait to see you when we return.

Love,

Nathan & Rebekah

Week one pictures

The pediatrics ward.

A view from the men’s ward. You can see patients on the floor and the technique for elevating a patient’s feet when you don’t have electric powered beds.

Us at the Zenga crocodile pond in Paga (on the border of Burkina Faso). Believe it or not we both actually sat on top one of them!

Rebekah in front of the hospital. The patients are beginning to gather underneath the shade to be seen in clinic.

A view from inside of patient’s waiting to be seen in clinic.

Weighing kids at clinic.

Learning to carry things the African way.

This woman has obviously had a few more years experience than I have.

Week one at the BMC

Hello family and friends!

We have survived our first week! There were moments that we were not sure we would, but we are now so excited to be able to share more with you all about what life in Ghana has been like since we arrived in Nalerigu and have begun work at the Baptist Medical Center.

Our days typically start at 7:30am with rounds on all of the patients at the hospital. The hospital is broken down into several wards – men’s, women’s, pediatrics, maternity, and isolation (for wound care, meningitis, and tuberculosis patients). When we arrive to the hospital, we split up and go to our designated ward to begin seeing patients. Rebekah and I have mostly been working in the women’s and pediatric wards. However, if we finish quickly, we go to the other wards to help. After rounds are completed around 10:30, we begin either clinic (Mondays, Wednesdays, and Fridays) or procedures (Tuesdays and Thursdays). Clinic days are incredibly busy here, and I think we both felt a little overwhelmed at first by the volume of patients we see. Procedures days are a little bit lighter which is certainly a nice break from the craziness of the clinic. Later in the day the team meets back up at the hospital around 5 or 6pm to do evening rounds. This typically lasts an hour or two, but there have been nights when we have stayed at the hospital until 8 or 9pm. It really just depends on the day and how many new patients are admitted. After evening rounds, we eat a quick dinner and we are usually wiped out and ready for bed right after that!

To be completely honest, the first couple of days here were somewhat difficult for Rebekah and I. Although we were prepared for some amount of culture shock, I don’t know if there was any way to fully prepare for what we would be seeing at the hospital. Although the BMC is a well-respected hospital in Ghana that strives to give excellent care to its patients, there are still many limitations in resources that make the practice of medicine here difficult. There are some diseases that we are capable of treating well, but there are many others that we can do nothing for. Because of these limitations, there is great pain and suffering all over the hospital. It is really quite emotional to witness first hand as your senses are flooded by sights, sounds, and even smells that are difficult to stomach. If you stepped into one of the wards, you would see a large open room packed full of patients, many of which are lying on the hard floor for lack of beds. Many are in pain and many have no hope for healing in this life. There is no air conditioning, no privacy, and no meals that the hospital is able to provide. It was actually interesting to learn that the patients’ families bring food to their loved ones from outside of the hospital when they are admitted. In just a few days here you would also see that death is a very apparent reality in Ghana. We were initially discouraged to see some of our patients die who might have been saved in the States – children with meningitis, neonates with sepsis, trauma patients. I actually pronounced a patient deceased for the first time in my life. Rebekah and I were called to a patient’s bedside by the nurse because the patient’s “condition had changed.” At first I didn’t know what he was implying, but when I put my stethoscope to the man’s chest and heard nothing, I quickly learned what this euphemism meant. It really was a strange thing to experience. Seeing so many patients, you fully expect to hear a heart beating and lungs moving air when you listen to one of them. But this was the first time I listened and heard no signs of life. I was responsible for officially declaring that this patient had died. As soon as I stated that this was the case the family broke into tears. Rebekah and I both nearly did as well and left the hospital to talk with each other and share our emotion over what we had just seen and done. A couple of days later I was called to another patient because “the condition had changed” but was a little more prepared for what to expect this time. This was actually a tuberculosis patient of mine who came back to the isolation ward from the nearby TB treatment village for acutely worsened respiratory distress. Again, it was strange to be the one to have the responsibility of declaring that a life had ended.

I apologize if this account paints a somewhat grim picture of what is happening here in Ghana, but these were our emotions during our first few days here. However, by the grace of God we have come to see that there are also many patients that we are saving that would have otherwise died had they not received care here at the BMC. It was recognition of some of these “wins” that have begun to help us tremendously. I had one patient in particular who was a young girl. She had had several weeks of fevers, headaches, stomach aches, and decreased appetite – symptoms here in Ghana that indicate malaria. She had actually been admitted for several days to another hospital but did not receive treatment for this illness. Her father requested referral to the BMC because the hospital has such a strong reputation and he believed they would receive better care. When she arrived, we started treatment for malaria and her blood smear came back the following day indicating that she did, in fact, have this disease. She improved markedly over the following couple of days, and I actually was able to discharge her home today. As they were leaving the father shook my hand warmly and said “I am so grateful.” He actually asked if I had a phone number he could have so that he could call me to talk. I told him I didn’t have one here in Ghana, so he wrote his number down for me instead. I was incredibly touched by this family and so encouraged to see their child get better.

We have also begun to see how incredibly joyful the Ghanaian people are despite hardship. There is joy in everything they do and it is expressed freely to one another in daily interactions. They make sure to greet everyone they pass with different statements depending on the time of day, and the response is always Naaaa to say “it’s fine” or “it’s good.” There is something about the way they hold out their a’s when they say it that communicates that they are so pleased to be greeted. It’s really very fun. You can also just see their joy in their smiles. They really have some of the best smiles you will find. When we are out walking around the streets in town, almost all the local people wave and smile at us. We can’t help but smile right back.

Even more importantly than all of this, though, is what God is revealing to Rebekah and I about himself and ourselves as future physicians. Namely, that doctors may treat, but it is God who heals. He has been revealing much of this through one of the residents who arrived earlier this week. Rachel is a second year pediatrics resident from Texas Children’s in Houston. She actually grew up in Bangladesh as a missionary kid, and previously worked here at the BMC in her fourth year of medical school like we are doing. She is a strong believer in Jesus and has an amazing perspective about the work we are doing here. She taught us much through one particular patient we cared for together over the last two days. A completely healthy seven or eight year old girl came to us with seizures after falling and hitting her head very hard. We suspected that these seizures were secondary to brain swelling and worked diligently to try to stop them. We gave all the medications we knew to give, but could not stop this child’s seizures. After some time, it became apparent that this child had a severe brain injury and was going to die. We called the chaplain to the patient’s bedside to help us talk and pray with the family. It was during this conversation that Rachel said “doctors treat, but it is God who heals.” This really struck Rebekah and I and we have been thinking about it a lot. It is easy to sometimes believe as physicians (or really in any role in life) that we are in control. But God is sovereign. His will is so much bigger than us or our decisions and it is simply humbling to begin to realize this. With this child we did everything we knew to do, and afterwards, we could only pray and wait. God chose to take this child and there is maybe no way to begin to understand why. But we continue to trust that it is He who is the great healer – physically and spiritually.

Overall, this week has been a roller coaster of emotions. There have been moments we have wanted to just get on a plane and return to the home we are used to. But God has been faithful to us here in Ghana. He is teaching us so much, not only about medicine but also about who He is. We feel encouraged by this and despite the difficulty in working here, we look forward to all he will do through us over the following three weeks. We continue to be thankful for all of your prayers and love you all deeply. You are in our thoughts and prayers as well and we would love to hear how you are doing!

Love,

Nathan & Rebekah

PS Many thanks to all of you who have written us. We apologize if we are not able to respond to you individually as our internet connection here is a bit slow. We are reading emails you send, though, and appreciate all you have to say very much.

Greetings from Nalerigu!

It’s hard to believe that Rebekah and I are in our final year of medical school and are going to be graduating in just two months. It’s even harder to believe that that means we will officially be doctors! It is certainly a strange feeling. Honestly, it feels like yesterday that we just started medical school and were gearing up to learn basic anatomy and physiology. Since then we have been through two years of basic science, we have rotated through all of the various specialties, and are now ready to move onto residency, the next phase of our medical training. We actually just matched about two weeks ago and found out that we will be staying at Ohio State. Rebekah will be doing a residency in emergency medicine and I will be doing mine in combined internal medicine and pediatrics. We are very eager to be moving onto the next step.

During this last year of medical school we have had a lot of freedom to choose month long electives that we have interest in. For example, I rotated through pediatric cardiology and an internal medicine elective. Rebekah did an elective called advanced topics in emergency medicine. In addition to electives done at the University hospital, students are also given the opportunity to do a global health elective in any developing country around the world. When Rebekah and I heard about this, we knew that we wanted to do it. So, in the fall we started looking at some of the different locations and found out about an opportunity in Nalerigu, Ghana to work at a mission hospital called the Baptist Medical Center (BMC). After reading about the opportunity we would have working at this hospital, we felt that it was the right place for our global health elective. We spent the next several months planning and learning about the diseases we would be treating, and now we are finally here! We will be here for a little more than four weeks and consider it such a blessing to be here to work with the doctors and serve the people of Ghana.

We left our home Columbus two nights ago on March 31^st, had a short layover in Washington, D.C., flew through the night, and woke up the following day in Accra, Ghana. We were met at the airport by Jimmy and Sylvia Huey. They are missionaries who manage a guest house in Accra that is owned and operated by the same mission group that runs the BMC. We had originally been under the assumption that the guest house in Accra would be a small place we would be staying at alone. We were pleasantly surprised, however, to find that the guesthouse is a very large facility that serves missionaries from all over West Africa who are passing through. We actually got to eat dinner with a large group of doctors and residents from Massachusettes who had just been at the BMC for three weeks and were heading back to the States. This was such a blessing as they filled us in extensively on the logistics of the hospital and the resources we would have at our disposal. We also met two missionary families serving in Togo. One was a Mennonite family from Alberta, Canada who was involved with church planting in the south central region. The other was a family from Tennessee working at an HIV clinic. It was incredible to hear about their work and all that God is doing through them in Togo.

This morning we continued our travel by taking another flight from Accra to Tamale (pronounced tama-LE), which is the regional capital in the Northern part of the country. We were met at the airport by two of the hospital workers, Aaron and Deacon, who kindly drove us to Nalerigu which is an additional two and a half hours by car (half of which is dirt roads). The people of Ghana are by reputation very inviting and warm, and these two men were no exception. They immediately took us in and we actually stopped about half way through our drive in the town of Walewale to share some drinks and try the local food. We pulled into a little place that set a table up for us right under a huge mango tree. They ordered me a beer brewed here Ghana called STAR (sit together and relax), a name that is very reflective of their friendly culture. We also had some plantane chips and tried a local dish called tubani, which was some sort of spicy plant and bean mixture that you eat with your hands out of a bowl shared by everyone. It was certainly a new way of eating for us but fun to just jump right into the culture. We spent most of the time with Aaron and Deacon learning more about the Ghanaian culture, their work at the hospital, and their families. Aaron is actually the health information officer here. He collects statistics about that patients and diseases the hospital sees such that the hospital is better able to understand the patient population they work with. Deacon does a lot of the driving for the hospital and told us he has driven the rough road to Tamale six times this week! They were also kind enough to help us learn some basic Mampruli (the language spoken in this part of the country). They and the other Ghanaians sitting nearby got a kick out of the solamingas (white people) trying to speak their language. It was a wonderful afternoon.

After this, we finished our trip to Nalerigu. Upon our arrival we met Greg and Wendy Nyhus, the missionary family who work here to coordinate all of the volunteers. They showed us the house that will be our home for the next month and all around the hospital campus. In addition to the hospital facility, there are about twelve houses that are used for volunteers as well as a school house. We also got to meet some of the other people we will be working with this month. There is a full time physician named Dr. Rich Ambler, a team of one physician and two other fourth year med students from West Virginia University, three other fourth year med students (one from the University of Wisconsin, one from an osteopathic school in Arizona, and one from St. Louis University), and a friend of Dr. Ambler’s who is planning on going to med school in the next couple of years. We had dinner with everyone tonight and got to learn a ton about what we will be doing for the next month. Honestly, it was a little overwhelming to hear about how many patients we will be seeing and how much autonomy we will have. I think it will be an amazing learning opportunity, though, and by the grace of God we will hopefully be able to serve the people here well.

That is probably enough writing for now! There will certainly be much more to tell in the following weeks as we see patients and learn about practicing medicine in a new environment. We appreciate your prayer, though, and ask that you would pray for safety, for the adjustment to a new culture and environment, and for the patients we will be treating. We love and miss you all lots and would love to hear how you are doing this month as well!

Nathan and Rebekah