Nina’s Blog

bread

the day started off with rounds and then clinic.

i know that most of my stories talk about death, but that is very real out here. Today a mother delivered twins on her way to the hospital. There must have been some type of twin transfusion syndrome going on where one gets all the blood and the other doesn’t get any. One arrived blue and was resuscitated, but died a few hours later. The other one is still hanging on but probably has polycythemia vera..which means too much blood and can lead to stroke. They are also premature, only about 28wks. I know that I couldn’t do anything about it, but it’s still hard. I feel that my job as an ob/gyn is to make sure that my moms and babies live. So it is hard when there is nothing you can do.I love my staff. The death still affects them hard too. They worked so hard to bring back the baby that died….

And if I haven’t mentioned it already. the women out here totally style. They have booths in the market with buckets of water to do hair. They have relaxers, hair creams and braid hair, etc. And the clothes have to match. (you get called out if you don’t match, I did, lol). One day I wore scrubs that didn’t match and they were all laughing. But they love the dresses I have had made out here, esp with the matching purses. the fabric is awesome. I just get drawn in and want to buy all the fabric!!

Tonight we had dinner over at one of the doctor’s house. It was an awesome dinner and then we played flashlight tag outside. It gets so dark out here that you don’t see anything unless you have a flashlight.

And everyone knows I love bread. I thought I would have to go to Italy to find the best bread but I think Africa has the best bread ever!!! There is sweet bread, cinnamon roll bread, sandwich bread, hamburger buns, hotdog buns, and pizza bread….just so many different kinds of homemade breads. I am in bread heaven!!!

Tomorrow we are going to take a field trip to another village.  So I will write about those details later.

and I can’t believe time is going by. I have two more weeks out here before I head back to the states.

my first c-sxn

so as you all know, i have done plenty of c-sxns, but usually I am first assist. Today I did my first c-sxn on my own!!! It was awesome!!!! I love surgery and I love ob/gyn. The surgery went great!!!!. Today we sectioned a lady because she was in arrest of labor at 4cm and there was a fetal hand and head presenting. It was kind of funny. I go to do a sterile vaginal exam and I feel something funny and then I’m like oh my gosh that is a hand! I had a hard time getting heart tones so they use this old fashion fetal scope that I swear I have only seen in the museum. i have to take a picture of that too. So the baby came out fine. a cute baby boy.

so that lady with the abdominal pain that I was worried about…turns out she had a typhoid fever perforation. I scrubbed in on the surgery and she had so many ulcers along her intestine, any of them possible perforating at any moment. So you get salmoneli typhi from water or food that is contaminated and also through the fecal oral route. I am wondering if there is a small outbreak or contamination somewhere because we have a lot of people presenting with typhoid perforations. It usually takes about 4wks from innoculation to get the perforation. We just sutured up the hole, reinforced the ulcers, decompressed the bowel, put in an Nasal gastric tube and put her on antibiotics and pray. We might take her back for surgery in a few days. I am glad that I admitted her to the hospital. It just didn’t seem like a gyn problem even though she had lower abdominal pain.

today was market. I picked up some fabric for my mom to wrap some of her preschool babies in. I also brought a pillow. Today I mostly walked around with jen and kim and showed them the market. Jen brought some fabric to put her baby in. It is so cool that all of the moms and even the little kids, carry the babies on their back held up by fabric.

still having camera difficulties….sorry guys.

new people

A surgeon from Kansas city came today. Both he and his wife are awesome and really fun people. So it looks like the next two weeks will be good times ahead.  So I was on call last night. They knocked at my door and I didn’t hear it so they had to go to my partner. I felt so bad. We had this bell rigged up but it didn’t work. Today started off with a gastric perforation that we operated on. I did a D&C on one my ladies that came in last night bleeding. (side note: I am getting better with the u/s machine) Then we had clinic. It wasn’t too bad. We finished early today. Probably because market day is tomorrow and we always have more people on clinic days that fall in with market day. Clinic consisted of malaria cases, a 5 yr old girl with a dog bite on her pudendaI area, arthritis, hernias, hydroceles, incomplete abortions, infertility, ear infections, typhoid fever. I had a lady who has abdominal pain and a distended abdomen with a UTI/yeast infection. It is very difficult trying to figure out what antibiotics to use and which ones we have in stock. One thing for sure is that my physical exam skills have really increased in precision. You have to rely on your physical exam and trust your instinct since we don’t have many test. I have to say that even though it is difficult, I have learned so much. You end up being hard on yourself because you realize that it really is life or death. If you are wrong, your patient could die because most of them are already so close to death. Jen is so cute, she named our hospital basically the ICU ward because everyone is so sick. So in my maternity ward we have the NICU, because a lot of my newborn babies end up on antibiotics. We also have the SICU, MICU, PICU and I think you get the point. But again you can see the dedication everyone has in the midst of the frustration of not having enough. The hospital is in need of more long term doctors and everyone is worried right now that this center might shut down if the main doctor leaves on furlow.  I don’t know what would happen to the people. This place is so amazing but it can’t be run by one doctor alone. That is top on the prayer list for everyone out here. Kind of like the unspeakable elephant in the closet.

  I picked up my new dresses today and they have matching purses too!!!

today is saturday

Today is actually Tuesday but it feels like Saturday. We had surgeries this morning and no clinic. Today has been a great day. For one, I feel much better!!! Back to my talkative self. I did a hernia repair, a hysterectomy , a D&C and a c-section. The c-section was on the lady who had a high temp. her temp came down with the antibiotic treatment and she delivered a baby boy. She was praying throughout the whole section for a boy. This is her second boy….i joked that girls get the short end of the stick. My other lady was the one who had a stillborn previously and came in with premature rupture of membranes and they couldn’t find a fetal heart. I had found it on u/s. she delivered today and has a beautiful baby girl that looks just like her.  I was so happy I was jumping up and down and the whole maternity ward starting laughing and clamping. And the mom was so happy. And I was so happy. I almost cried I was so happy that she had a successful pregnancy. Also one of my babies and mom with malaria went home. Baby and mom were doing great. It was so amazing to see one of my malaria babies go home!!! I love it when my ladies have good deliveries.  So today was good. It was really really good.

I came home and took a nap.i could sleep forever but I wake up from thirst. Today is a big soccer game In which Ghana is playing. They won!!!

So I learned why there is so much trash around. People usually sweep up the trash into piles and then they bury it or burn it. But once the wind blows it away, no one bothers to pick it up again. Ahhh. So I am on call again tonight. I am sharing call with one of the doctors Jen. She is awesome!!! I am so glad she lets me do call with her because I am learning so much. And she is from Kansas city so I have a new friend and more good times ahead in Kansas city. We have an awesome team because she is med peds and I am ob/gyn. I take care of the moms and she takes care of my babies…we are called fashiatana and asana, which means twins in Ghana, because we are the twin American female doctors. She is here with her husband and their daughter….we have sooo much fun.

And with learning there is just so much to learn here. The staff at the hospital are really great. They are excited every time I walk in the door, and I can’t wait to get to work because they are so much fun. They have a lot of experience they share with me. There are also ghanians who are at the house I am staying at and cook my meals. They are good cooks. And we have fun joking around and talking about the different cultures.

Today, the kid I helped pay to go to school, left to go to school today in tamale. He is so excited and said he will keep in touch with emails. Oh and I saw the cutest scrubs someone was wearing today. I am going to have some made for myself!

p.s. i am having techincal difficulties getting pictures to transfer from my camera to computer. Once I do there will be tons more pics.

p.p.s also I give a shot out to all my fans…i feel so famous with people reading my blog, lol

meanings

so i forgot to mention that yesterday I learned what the ghanian flag stands for.  The green stands for the greenery of ghana, like the coco trees, the yellow stands for the material resources of the land like the gold, the red stands for the blood that the forefathers shed in world war 2. the black star resembles the black skin of the people.

I also learned that there was a wall that was built in ghana that was to prevent the white people from getting to the african people and taking them away. From that wall the africans fired cannons to try to protect their people.

There is also a place in ghana that I am going to try to visit near the end of my trip that obama visited. it is called the slave castle. It is where they took the africans to be shipped across to the u.s. There is a point called the gate of no return. Once you were pass this point, you never came back. Before you reached that gate, the only way you might go back is if you were really really sick and therefore no good.  wow. the history here is really deep. my friend ben explained it to me. People are really good with their hx.

also out here when they see you are an american, they call you a semina. semina means white man. It is also kind of their term that you are an american. Everyone is really nice and loves for you to explain what it is like in america. it is everyone’s dream to one day make it to america where the opportunities are great.

Today was clinic day….long lines. I saw a 3mo old with puffy hands….probably a lymphatic problem. A lot of infertility, but unfortunately we don’t have any medicines or tools for that.

better

so  today I feel a lot better. I missed going to work and seeing my ladies and babies!!! Today I went to church to hear one of the traveling ministers preach and one of the guys play guitar. I dressed up in my ghanian outfit. everyone loved it. I still have to pick up the dresses that were being made for me. I will post those new pictures tomorrow.

today I had a 9mo pregnant lady come in with a temp of 40.1….that is around 104 degrees and baby heart rate around 190s…i was worried but she is doing better now. we gave her tx for malaria, and infections. now her temp is 38.1 and baby HR is 140s. i can sleep soundly tonight. I am worried about one of my mothers, this is her second preg. the first was a still birth for unknown reasons. when she came in they couldn’t find a HR. I di an u/s and found the heart rate. I am going to continue monitoring her. I don’t want anything to happen to the baby. I am not on call tonight but I was going around the wards and saw a mother who delivered her baby at home and probably had a retained placenta. The baby isn’t admitted but he was breathing pretty heavy with wheezes. I’m going to have jen…our med peds doctor check him out.

so funny stories. I found out the kind of squeaking i heard throughout the night and thought were birds are actually bats!!! I can live with the thought of bats outside my door but the bird idea was a lot nicer.  We have a new doctor who arrived today. he is an er doctor from texas and has been here a few times before.

ok well that is all for now. Talk to you guys later

sick

First off I am feeling better so don’t worry. I got sick on Friday. I think something has been going around. A few of the missionaries and one of the other doctors and her family also got sick. It is hard having diarrhea and vomiting out here. I just slept and took medicine because I was too nauseas and sick to go see my patients. Everyone looks out for you. All of the missionaries here are awesome and kept making sure I was alright, and brought me some sprite from in town.  One of my friends waited for me to wake up to see how I was doing so she could report back to the hospital staff. News travels fast here and everyone was worried.  And I don’t know if the cause of me being sick was from everyone else being sick or from some tofu I ate. I brought some tofu (soybean)from a bin that someone was carrying one their head in the heat. I know it probably wasn’t smart but curiosity of the vegetarian won.  P.s …it was good

So what happened before I was  sick. I wore one of the dresses I had made into town. Everyone loved it and said I looked beautiful and like a real ghanian woman. I will be picking up some other outfits I had made later on this week.  The lady, Rachel, who sewed my outfit got married this weekend. I missed her wedding because I was sick. They say there is a muslim wedding one day where there are a lot of clothes and veils, and lots of food and dancing. Then 2 days later there is a second ceremony where she gets to go to her husband afterward. A lot of funerals, weddings and naming ceremonies are happening now because of the good weather.

I have had some sangria out here. It is really really good!!! I never could master making that.  So when my luggage arrived, everyone asked what it was that I missed most. I would have to say it was my pink dove soap. I love the way it smells, and the soap out here smells weird to me. I also missed my vasaline because it gets really dry out here. Otherwise I pretty much had everything I needed because everyone shared their supplies with me.

Another thing is that your feet get really dirty. Everyone knows how much I love flip flops but I don’t wear it so much because of my feet getting really dirty. One of the missionaries pointed out that she now knows why they  washed feet back in the bible days. I agree!!!! My shoes are gross. There is blood and red dirt on them. In surgery we don’t have booties to wear so all the blood just runs off the bed onto the floor… and your shoes.

Patients…so I had twins born at 28wga. Only one survived. Then he ended up dying. It was really frusturating because I think the reason he died is because he didn’t get his fluids fast enough. I had a med peds doctor helping me with my newborns and she ordered IV fluids for the baby…they weren’t put in until 8hrs later and not until after I told them this was very important and more important than the paperwork. Again, it goes to show not much importance is placed on the baby. I found out why the naming ceremony for the baby is 1wk later. They believe that if the baby is meant for them, then they will stay after one week. If the baby is not meant for them then God will take the baby away before I week.  This shows how the concept of so much death is worked into customs.  As opposed to the u.s. where we have names before the baby is born.

One girl I admitted was about 7 years old and had this crepitus and we thought that she had a liver abscess by u/s so we operated on her, and couldn’t find it. She died not long after the surgery.

Today we had a communial dinner since some of the missionaries are leaving tomorrow.  One of the ob/gyn doctors I worked with already left. It is so sad when people leave because you become like a family here.  Some of the missionaries went to visit the king of the village, and he gave them some guinea fowl that were plucked and cooked for dinner one night.  I didn’t eat it and I swear there was a heart and a ribcage in the soup.  I didn’t get a picture of it but I know some of the other people did so I will have to borrow their picture.  Oh and I found out they eat beetles, termites and rats. Ugg. The beetles are fried. The beetles land on the light bulb and they take a cup of water to it until it falls in and then fry it and eat it…wow.

So that is it for now since I have mostly been sleeping and recuperating. I will try to go to work in the morning….

I leave you with….the stars are so beautiful…it looks so close like u can touch them. There are plumeria trees which have the flowers that are used for leis and it smells so beautiful.

p.s.

my luggage came last night. YEA!!!!

surgery, market and death

sorry I’m late on this blog but I was on call last night. So call was okay. It was kind of sad. We had 3 deaths yesterday and one died right in front of me. I had admitted her for congestive heart failure and we were giving her lasix because she had fluid in the abdomen. She started to look better and then declined shortly. By the time we got to her she was already taking agonal breaths. Which are the breaths someone takes seconds to minutes before they die. Then she just stopped breathing. and the sister was there and started crying and moaning. all i could say was ga fa ra…which means I’m sorry, and then I just gave her a hug. One thing that is true is that comforting someone is the same in about every language.  Since I am on the subject of death, I will just continue and then move on to happier times. So again, there is a LOT of death. I am worried about two of babies that I delieverd 2days ago. Both spiked fevers and one of them’s mother is being treated for malaria. Malaria is just killing my babies. i have made the decision that I will do my presentation on malaria and pregnancy. I look forward to researching it more, but know that there isn’t much to do. Malaria is just so prevalant. Today was clinic and again…very long lines. I will have to take a picture of that to show you the never ending amount of patients we seen. Most people come in with fever, headache, bodyaches, vomiting….and those are signs of malaria, so we just treat. One of the Ghanian school teachers died yesterday also, so some of the kids didn’t have school today. I also had a lady I admitted for asthma exacerbation. She had a 2mo old at home. She also passed away in the night. So everyday we go in to see our patients and hope that we don’t see an empty bed where there was a patient lying in yesterday or that a new patient is in place of the old patient. Both happen pretty often, but every once in a while we have a patient get discharged home who is well.

The patients that are getting better. One is a lady I diagnosed with pyelonephritis and possible hemorrhagic cystis with malaria. I treated her and she gradually got better and I discharged her home today…exciting. There is also a little boy with teatnus. Usually the teatnus patients don’t survive but he is getting better. These patients get very rigid, but he is starting to loosen up.

ok now other things:

first off, I have had a lot of questions about the animals in Ghana. I asked the same question myself. I was like where are all the lions and elephants? Their answer…in the zoo. I guess that most of the animals were killed off with hunting. Iheard there are some elephants in kenya…so hmm. the only animals I have seen out here are goats, donkeys, chickens, roosters and rats. And yes there is a pet monkey in the backyard. She doesn’t like other women and jumps at people who come by. She is tied to a tree by a rope. But she does love bananas.

The goats are also very interesting. One thing is sad is that there is no trash truck that comes around so everyone throws their trash on the ground. The goats are thriving though!!!! But it looks like a landfill outside of the homes. Inside the homes and in the courtyards, the houses are kept very clean.

guess what yesterday was….market day!!!!! yes i went shopping again. I have so much fun in the market place. Today I picked up one of my skirts that I had made. Tomorrow I will pick up the rest of my outfits. I also brought a new scarf. Funny thing is that i have the rumor of being rich becauseI gave some money to two kids. One girl I brought shoes for school and paid $20 for her school fee. Another boy needed 50 ghana cds for his school fee…he had already paid a 100 ghana cds for it but was missing class because he didn’t have the rest of the balance. He is so excited he gets to go to school now. And just to explain. 1 us dollar is about 1.45 ghana cds. so 1 ghana dollar is like 60 us cents.  I also brought a radio for 2 of the boys, which was 5 ghana cds for 2 radios. so today a kid asked for 800 ghana cds for school. Ummm, I’m not that rich, lol. It was funny because all the other kids were shocked and were like don’t give them money because now they are just asking because they heard I gave money. and they couldn’t believe someone had asked for so much. well, i don’t mind the asking, I give what i can give because I came to help…to help through medicine and if i can spare 5 dollars for someone to have shoes than so be it. I play with the kids also. Today we played tic tac toe and found some cool seeds that are shaped and sound like rain sticks.

Yesterday was surgery day and I took out an ovarian cyst, watched a hysterectomy for a uterus that had a prolapsed fibroid in it, and took out a testicular cystocele.

so time for sleep now. those were the adventures of the past two days.

more pictures

oh yea and sorry to those I tried calling last night. I tried using skype to make calls but my microphone for some reason wasn’t working. It worked on the test call but not the actual calls. so i will try to get a phonecard in the market tomorrow.

oh yea…and a huge huge HUGE rat ran in front of me at the hospital tonight when I was doing rounds…I screamed…everyone laughed at me and said it was just a mouse…NO IT WAS A RAT!!! A MONSTER RAT. I have NEVER seen one so big in my life!!!! p.s. and people were sleeping on the floor of the hospital!!!!