Ryan’s Blog

Back in the US of A!!! I’ll try to do a couple more posts before I leave for Phoenix for medical school graduation. For now, after 3 flights in 24hrs., I need some rest.

Culture, part 2

Culture Shock- a state of bewilderment and distress experienced by an individual who is suddenly exposed to a new, strange, or foreign social and cultural environment.

Culture shock can often be overwhelming. For some who travel the first time to a third world country, it can even be paralyzing. I remember my first missions trip to Bolivia, the poorest country in South America. Though I expected the dirt roads and dilapidated huts, I didn’t expect to see both men and women urinating on the side of major roads. Then there were the “toilets,” which were outhouses with a hole in the ground. Going number 2 the first time was interesting… Then the other things we found out over the course of several days. Many children couldn’t afford school fees (a paltry $3 per month), so they would attend for a month, then take the next month off to help their parents raise money so that they could hopefully make it the following month. The amount of orphans was astounding, and some of the orphans who could not find food would sniff glue and other chemicals to forget about the hunger. There were more stories even more heartbreaking than the ones mentioned here.

When confronted with such abject poverty and the accompanying problems, there are several ways to react. One reaction is fear. This is one of the more common defense mechanisms, and the one most think of when talking about culture shock. You stay at your 4-star hotel, watch TV or movies on your laptop, and don’t venture into the real world. Another reaction is the desire to do whatever you can at that moment to help- so, you give away your money, buy food for the hungry, etc. Obviously, unless you’re a billionaire, that can’t last too long. (Nor is it a good idea, for a multitude of reasons).

Another cultural reaction is one which seems to occur more often on medical missions like the one I’m on now. You want to control outcomes- so, if you give clothes to someone, you’d like them to wear the clothes (your expected outcome), as opposed to selling them at the market, as what happened with another medical student who was here before me. In medicine, this is far more pronounced even before coming to a place like Ghana. I’ve been taught in medical school and by my mentors that what happens under your watch (i.e. your patients) is your responsibility. So, in the ED, this means that I watch for complications which are not even caused by my action- if a nurse tech incorrectly places an IV, or if an incorrect medication or dosage is given, I’m still responsible to help fix the situation. To some degree, I can control the outcome (even against devastating disease, we have many ways to artificially keep blood pumping and people breathing). Here in Ghana, this desire for control (which I believe every physician inherently has) can make things very difficult. Due to the severity of disease here and the lack of supplies, we are often fighting a losing fight, and patients will die. For the first couple of days, this was a difficult challenge for me. I could tell certain patients needed special attention and to be monitored closely, but this is not something the nurses do here. They follow specific orders to give medications and to check vital signs up to 4-5 times/day, but they don’t really watch patients closely for complications. Thus, it came to be that a patient of mine, a 25 year old man, died last week of a snakebite (I believe I mentioned the carpet vipers here, whose venom can cause a person to bleed out internally- unfortunately, snake bites are common). I had implored the nursing staff to keep an eye on him, to little avail. As I rounded in the evening, I noticed he was very warm, but not breathing. One of the nurses says at this point, “I noticed that man breathing funny 30min. ago, but he seems fine now, huh?” Well, no, he was dead, but not by much. I begin CPR alone, pointing at 3 nurses individually, telling them specific things I needed. 2-3 minutes later, the nurses are still watching me give compressions, while I still had no help. Realizing this was a losing battle, especially without readily available blood (there are no blood banks here- to get blood for a transfusion, a relative must be cross-matched with the patient, and you must wait til the family member gives blood to give it to the patient), I relented my control, to Death’s.

What does the above situation have to do with culture? Well, the best reaction (from me) to a situation like the one above is this- you must be able to separate what you can control from what you can’t control. I cannot control the disease. Many people will come in with end-stage diseases, and have never been seen by a medical doctor. It’s difficult enough to diagnose some things, much less cure them with limited resources. I cannot control the nurses and the way they are taught to think. They are taught to think linearly or in algorithms, not as individuals. So, they give the meds on time, but won’t recognize other issues. As I mentioned before, many times nurses will nap for several hours on a shift (sometimes 7-8hrs. on night shift) or listen to music in the nurses’ lounge. As far as they are concerned, giving close attention to patients here isn’t helpful, since if a patient is that badly off, there’s not much they can do to help (and often they are correct in this assumption). The times where we can intervene to help, they are not trained in how to react. For example, we often use quinine here to treat malaria in the hospital. Quinine is an old drug which is notorious for causing hypoglycemia (low blood sugar). Yesterday, a patient on quinine had a morning glucose level of 25 (normal is 70-100 while fasting)- the man was in a hypoglycemic coma. Though the nurse saw the lab, nothing had been done- luckily, we were able to find some D50 in storage to save the man’s life from what would have basically been a death caused by our use of quinine. I cannot control the patient. Today, a patient’s family wanted to take the patient home so he could die. Though we still had a (admittedly) small chance to beat his infection, and I explained this to the family, their decision is theirs, and not mine to make. Here, just as at home, it is difficult for people to understand why controlling blood pressure or diabetes is important. So people will pick up their BP meds a couple times a year, but will not take it for months, not realizing the damage to their cardiovascular system. In the US, we call these non-compliant patients, one of the more frustrating things a physician will deal with. Here, the factors contributing to non-compliance makes it much more of a cultural issue than a compliance one. People here have so little knowledge of Western medicine that they can’t comprehend hardly anything we try to explain. The belief that disease is more spiritual than physical is the predominant thought, and does not appear to be changing anytime soon.

I believe I may have mentioned this before also, but Ghanaian culture teaches that death comes when it is supposed to, and people accept that. It is such a foreign idea to us as Westerners. Somehow, I’ve learned to accept what they believe, though I still do my best not to accept failure on things which can be treated or prevented.  Past that, we must accept that their culture is ok with death. Yes, it’s still sad for families, for mothers and fathers, for siblings. Still, to them, the greater purpose has something to do with unearthly things.  

In what will be my final post on culture, I want to delve into the advantages and disadvantages of the culture here as compared to ours. More to come…

Culture, part 1

Culture-  the sum of attitudes, customs, and beliefs that distinguishes one group of people from another.

As an American, many things are difficult to understand when one first steps into a third world nation. Such as: how do so many people have cell phones but so few have toilets? How do people live without TVs and internet? What happened to all of the paved roads? Why, oh why, are people never on time for anything??? And, on a deeper level: How do so few people have access to clean water? How do 2 billion people in this world live without medical care? Why do some people here seem so lazy- is that why Africans never can seem to advance?

Culture is a tricky thing, much too difficult to delve into without easily writing a book. Yet, a rudimentary knowledge is important to understand when traveling to a place like Ghana. In fact, I would argue not just knowledge of the culture, but comprehension of that culture is vital. I spent six months in Rwanda prior to this trip, and thankfully I was able to begin to not only comprehend certain African behaviors, but also to accept them.

Acceptance of the culture is exceedingly difficult for Americans. Why do people here go to local “witch doctors” with their herbal treatments before going to the Western physician/hospital? Why are people never on time? Why do the nurses sleep during their shifts? Do people here really not understand that untreated high blood pressure can cause strokes and heart attacks? Do people have any idea why I give them medicine? Why does my interpreter literally walk away while I’m talking with a patient? Don’t people understand that condoms and birth control are available? How can men here have 5 wives, or have girlfriends on the side with their wives full knowledge? Why are women so unimportant? The questions are many, the answer both simple and complex- culture.

As Westerners, we are raised to think a certain way. There is a correct way to do things. Science teaches us certain things about the world, and we figure out ways to manipulate that science in order to live fuller, longer lives (see: medicine). Knowledge is power. Efficiency is key. Hard work means not stopping until you get what you want. And so on.

In medicine, we also have Western cultural standards. We must evaluate the best course of action for every malady, and failure is not an option. Side effects are rarely acceptable. Doctors are expected to explain what the problem is in understandable terms, and a patient must give informed consent to treatment. A complication means someone made an error, and must be accountable. Patients must be monitored closely in hospitals. There is an evidence-based way to address all medical problems.

Of course, here in Ghana, the medical standard is a little different. In a remote hospital like Baptist Medical Centre, where many drugs, technology, and other things are not available, the standard is even lower. For example, though Cipro is the best drug here for typhoid, chloramphenicol, with its serious side effects (see last post), is the standard of care because Cipro is expensive and in short supply. Probably more difficult to acclimate to, though, is how Ghanaians view medicine from their cultural standpoint.

A majority of Ghanaians, when afflicted with a medical condition, will first seek care from a village elder, or a witch doctor from the village. Various herbal and other treatments are attempted, including herbal injections into subcutaneous skins (which often cause bad abscesses or local reactions) and different potions. If these are not working, the person treating the patient decides whether or not to send the patient to be seen by a hospital such as BMC. So, even as Ghana is the most advanced country in most of West and East Africa, many tribal remedies are tried before “real,” Western medicine. Sometimes the patient is so sick from the delay that there is little to do but watch him/her die. Where I’m from, that’s malpractice. Here, it’s accepted culture.

When explaining medical conditions to patients, there are several difficulties. First, at our location, few people speak English, so we must use translators. The translators here are not exactly ideal. You may ask a patient a question, and the translator may have a 2min. conversation with him, while you wait for an answer. Which you sometimes still don’t get. Then there’s the problem of the translators walking out in the middle of a conversation with little reason. Efficiency here isn’t quite the same. Then there’s the problem of explaining medical conditions to uneducated people. They don’t quite understand that there are unseen organisms called bacteria and viruses which cause major problems in our body. Though most people here will get malaria several times in their life, and often even be treated for it, they have no concept of this parasite transmitted by mosquitoes which causes the disease. So, even though public health officials campaign to have people buy bed nets, most won’t, because they don’t understand why they need to.

Cultural differences make medicine very difficult here. The examples above are just a small portion of the cultural problems encountered here on a daily basis. In part 2, I will talk about culture shock, and how it often handcuffs Americans in their aid efforts in the third world.

Miracle drugs

Chloramphenicol. Hailed as the new miracle antibiotic at its inception in 1949, it is now a rarely used relic in the war on bacteria. Its spectrum of activity is impressive- it covers the majority of typical and atypical bacteria. Yet, at some point in the past, several unacceptable side effects were discovered. The most serious SE is aplastic anemia, a condition which causes the bone marrow to stop producing red blood cells. This occurs in about 1 in 25,000 patients treated with the drug, and is usually fatal. Another alarming SE is gray baby syndrome, a serious condition which can cause low blood pressure, cyanosis (blue color due to inadequate oxygen to tissues), and death in newborn infants. Other serious side effects include bone marrow suppression and an increased risk of leukemia in children. Obviously, in 1^st world countries, we have newer antibiotics with much less serious and fewer side effects. It is now very rarely used in the US except for a couple of very specific uses.

In third world countries, chloramphenicol is still a miracle drug. The 1 in 10,000 serious SE which may occur are much less important than a very serious bacterial infection- typhoid. In nations such as Ghana, where typhoid is endemic and thousands die from this very treatable illness each year, chloramphenicol is a life-saver. It is exceedingly cheap, and at least in Ghana, very effective. Since I’ve been here, I had to relearn the other uses of the drug, as I gave it very little mind in medical school. It was understood that we would likely never prescribe the drug in the US, so there was little use wasting precious brain space. Now, I’m seeing many people saved by this drug. Still, years later, a miracle.

Thoughts

Random thoughts on medicine, missions, Africa, Ghana, and more…

I was first assist on a C-section last night. I have never had a desire to be a surgeon. Some people are meant to live in the OR, and some aren’t. So it’s strange to find myself in the position I was last night. Rewarding, to see life begin, and to be part of it. Would I want to do obstetrics? Or surgery? Oh Lord no. Cool experience nonetheless.

The stars here are absolutely stunning. No ambient light. Beautiful.

It’s amazing that kids here somehow seem to enjoy life without games, toys, books, soccer balls, and Legos, not to mention the internet, Playstation, Wii, and Xbox. Fascinating.

The disparity between here and home still astounds me. Africa is essentially 200-300 years behind the West in nearly every area, with a few exceptions: cell phones are common, though most people can rarely afford to talk on them. There’s also Coca-Cola here. There are enough trucks and buses that people can get from place to place, though it can be pricey.

Ghana has a national health insurance program, which is difficult to explain. Somehow it’s paid for with partial government and private funds, from what I understand. It’s 10 Ghanaian Cedis (approx $7.00) for 1 policy for someone, and that policy covers nearly all outpatient and inpatient expenses, including most medications. Even though healthcare is laughably cheap here, the insurance program appears to be going bankrupt- the company which oversees the program stopped paying hospitals and doctors last month.

Being a medical student today vs. 20 years ago is a completely different experience. When my uncle, who graduated med school 20 yrs ago, was a medical student, he was often in control of treating the patient with little oversight by attending physicians. These days, medical students can rarely write progress notes on patients, as Medicare has made it illegal for students to do so. Because of fear of being sued, medical students rarely perform any procedures or assist in surgery. I’m not sure how people think we learn to become doctors… but I digress… So, most medical students are never in a position to have your own patient die. I was. This week. Several times. A lack of diagnostic tests, monitors, oxygen, blood products, and other things makes one feel helpless. Frustrated. Sad. Angry. Discouraged. Hopeful.

HIV is, by standard of American medical care today, extremely treatable. Infectious disease docs have told me that it is no longer a death sentence, and that compliant patients can expect to die from some other cause. Here, even with drugs costing literally pennies per day, which are subsidized fully by the government, it is still considered a death sentence. Partially, this is due to lack of education. More importantly though, are the social implications. In most African societies, being HIV positive essentially means you are an outcast. Often from your own family. Your own friends. Your husband, your wife. So I was strongly hoping the 21yr girl yesterday, with all the classic signs of infection, with a fiancé, with a long life ahead, was negative. HIV positive. Ugh.

Back to disparity. People in rural Ghana live in huts made of mud, often with floors of dirt. The temperature 9mon of the year here is a constant 90 degrees plus (as it is right now). The other 3 months are the rainy season, where it gets down to the 70s at night. Often, the rains are so heavy that the roofs of the huts either collapse or are blown away. Every 5 years or so, the hut will have to be rebuilt due to wear and tear. Many people will never travel more than 10 miles from their village during their entire lifetime. There is really no such thing as government aid (except for HIV treatment, as above). People die of malaria on a daily basis. Mothers and children die during childbirth on a daily basis. People die of snake bites on a daily basis. And Ghana is probably one of the best places to live in sub-Saharan Africa.

Irony. Average Ghanaians are far happier than nearly all Americans. Even without air conditioning. Perspective.

Snake bites. There are several types of poisonous snakes here, but the worst are the carpet vipers. These snakes are apparently very aggressive and will bite people sleeping on the ground. Every day, we have at least 1 admission for a snake bite. The venom of the viper causes coagulation defects, making a person literally bleed to death, usually internally. A few days ago, I saw a strong 25 year old man die of this. Sad.

There are also cobras here, though much less common and less aggressive. These snakes can spit poisonous venom several feet. A few years ago, one got a surgeon in the eye. He was ok, but I’m guessing that was a bit scary.

This is simply my own principle, and I don’t judge others by it. If I, as someone who has been lucky/blessed to have nearly everything this world has to offer, can’t give a little back to the poor, what meaning does my life have?

More to come…

Still going!

So, it’s been a few days since I’ve updated. While we’ve been pretty busy, that’s not the only reason. I did my first call shift here on Monday, and well… I’m not sure how much worse it could have been. I’m still trying to process what happened, how I feel about it, how I should feel about it, etc. I may or may not write a post on it. I definitely need more time to process.

Today was pretty cool. I saw about 60 patients by myself in clinic today in about 6 hours, and I feel pretty confident about many of the diagnoses, treatments, etc. We were talking at dinner about the most common diagnoses made here, and here’s some of what we came up with- malaria, typhoid, GERD (acid reflux), gastritis, OB patients, dysmenorrhea, hernias, gastroenteritis, fungal skin infections, abscesses, arthritis (extremely common here due to hard labor that most do, in addition to women carrying heavy loads on their heads), snake bites, congestive heart failure, high blood pressure.

Time to go get some sleep tonight. Peace.

Takin’ it easy…

Tomorrow is a national holiday called May Day. I actually don’t know what the reason for occasion is, but either way, we don’t have clinic tomorrow. I’ll be on call, which means I do rounds 3 times- once with the other physicians/med students, then twice alone. Clinic, therefore, will be horrendous on Wednesday, since patients haven’t been seen in clinic since Friday. For now though, I’m just enjoying the weekend, and catching up on some rest. The following post is not meant to be morbid or depressing, although it may sound that way. I wanted to highlight the ways death occurs and is seen culturally here vs. in the US.

One thing you often don’t notice in medicine is how many people die in hospitals. In the states, unless you are directly caring for a patient, you don’t often notice people passing away, and since most places have a special elevator which goes to the morgue, you won’t often see the body being moved either. Here, death is an everyday occurrence, and unfortunately, we don’t have the resources to ward it off like we do in America. So, while we can often keep patients with bad infections, or post-heart attack or post-stroke victims, alive for a long time on a ventilator with the most sophisticated antibiotics in the states, we simply don’t have those things here. (Side note- intubation is not an option, so patients are not intubated here for major surgery- they are simply anesthetized with ketamine or given a spinal block, but nothing to protect the airway).  Add into the equation just a few issues - that we cannot check electrolytes, troponins (for heart attacks), do cultures for most infections (although we can culture spinal fluid, suspected malaria, and tuberculosis), and imaging is very sparse (we can only do ultrasound and x-ray, no CT’s or MRI’s) - there is a good amount of guesswork going into the diagnosis of very sick patients.  Over the last 2 days, I’ve seen deaths result from things which may have been treatable, if only we had the resources.

A 16-year old boy was admitted to the hospital for mental status changes Friday. I saw him first, and he was only responsive to pain with a GCS of 4 (apologies for not explaining all medical terms to everyone, but we’ll just say a GCS of 5 is bad news). The boy had a history of head trauma 2 weeks prior, at which time he fell >10 ft from a tree and landed on his head. At the time, he was unconscious and vomited several times, but appeared to improve over the next day. An outside medical clinic (with less resources than us) evaluated him the next day, at which point the boy was acting normally. 10 days later, he begins acting strangely, starts vomiting, then progresses to being unresponsive and unable to control his urine. It’s an almost textbook case of a subdural hematoma- a brain bleed which can progress very slowly after trauma. In the states, he would have initially had a head CT, which would have shown a small bleed, and then he would have been monitored in an ICU while receiving multiple CT scans to check the status of the bleed. If it worsened, as it obviously did, a neurosurgeon could evacuate the blood and hopefully save his life and brain function. By the time we saw him 2 wks after the trauma, it’s too late. He has already lost most brain function. The family was going to try to take him 12hrs to Accra, the capital city, to see a neurosurgeon yesterday, but I doubt they made it. The boy will likely die before they make it.

I saw an older man in clinic Friday, who had a very large inguinal hernia (the intestines slip through a hole in fascia, allowing the some intestine to actually move into the scrotal sac). The hernia did not appear to be an emergency, as it was reducible, so we decided to wait until the next day for possible surgery to repair it. He also had a skin infection over the scrotum, so we started antibiotics. He was in extreme pain, but did not appear ill, so we treated his pain. He died the next morning, cause unknown.

The vast majority of people here accept death as a normal part of life, in stark contrast to Americans. They accept that a certain percent of babies will not survive birth, and not a small percentage of babies that live will die before they turn 5 (see the WHO website for actual statistics).  People die of trauma and infections here on a daily basis that could often be treated fairly easily in the states. They view death as normal- at any age, of any reason- it simply is that person’s time to go. In fact, funerals here are treated as a party of sorts- a celebration of that person’s life (more on that later- hopefully I will be able to attend one). As those of you in medicine know, no matter what the age, medical problem, or circumstances, people in the US are not supposed to die in a hospital. We often try to figure out what someone did wrong for our relatives to have passed while under the care of the best medical care in the world. Perhaps sometimes, it is simply that person’s time.

Rounds in the morning, then…

We had the afternoon off, so obviously we had to do something fun! Luckily, I came back with all of my limbs, fingers, and toes. I was actually more scared of the smaller, more aggressive croc behind me, since he was really fast!

TGIF! Wait, I have to work all weekend??

I wrote the following blog post yesterday, Thursday the 29th. Just didn’t get on the internet. It’s a long one!

The last couple of days have been pretty awesome.

Best stories:

1) One of the family practice residents did a tendon repair on a teenager’s hand today. I wish I would’ve taken a picture. He was literally going step by step as he read the procedure from a textbook! It looked good when it was finished, but needless to say, you can only do something like that in bush medicine, not in the States!

2) At dinner tonight, one of the residents’ wives screamed, pointed at the ground, and jumped into her chair. I’m thinking there’s a snake on the ground, but we see something scurry out and into the kitchen. She swears she saw a scorpion. We finally get the critter out from under the freezer, and it ends up being a huge spider, probably 3 inches across, that indeed looked like a scorpion. I think my heart is still racing from that episode!

3) I watched the delivery of a G9P8 mother today (she has been pregnant 9 times and had 8 babies already). The baby was breech, which we knew, but they often do vaginal deliveries of breech babies here (in the states, it would usually be a C-section). The mother had been bleeding, signally a placental rupture( very serious), so the midwife wanted to deliver quickly. She punctured the membrane, and simultaneously, a wave of water came out with the baby, who may have gone from placental sac to the outside world in about 3 seconds flat. Definitely the fastest delivery I’ve ever seen. The resident and I were laughing, til we realized the baby was in trouble, so we helped the baby, and thankfully, she appears to be healthy.

After a couple days mostly watching, I started to feel comfortable seeing patients alone, so yesterday I saw quite a few patients by myself in clinic. The complaints ranged across the board, as you would see in any family practice clinic. The most common diagnoses seen though, were two diseases you rarely see in the US, and then usually only in travelers.  About half of the patients we saw had either malaria or typhoid fever. Malaria is like the common cold here- it seems that everyone gets it now and then. Luckily, it is usually easily treatable, if caught early. A 3 day course of medicine often does the trick. I’m not sure how expensive the drugs are for patients here, but they cost pennies in US dollars (1 US dollar = about 1.40 Ghanaian Cedi, although 1 Cedi here seems to be a lot of money). The symptoms of malaria are fairly simple- fever, headache, malaise, body aches, and often complaints of rib pain. We have few lab tests we can perform here , but a blood film is one of them. If unsure of the diagnosis, a blood film will catch more than 50% of malaria. Since it doesn’t have a high sensitivity though, sometimes it’s more cost effective to treat empirically. I probably prescribed antimalarial medicine to more than 15 patients yesterday. Worldwide, millions of people will get malaria each year, and an estimated 500,000-1 million will die from it, the vast majority of them in sub-Saharan Africa. It is estimated that simple measures such as mosquito nets and other mosquito control could reduce the number of cases significantly.

The other disease we see very often is typhoid fever, a gastrointestinal disease caused by a type of Salmonella. It is contracted from contaminated food or water, or being in close proximity to someone with typhoid. The symptoms are nonspecific, and usually include fever, abdominal pain, and other constitutional symptoms. Malaria and typhoid often seem to have similar presentations here. Typhoid usually has a slower course than malaria, so sometimes we treat for malaria first and have the patient return for follow-up to make certain the treatment worked. Untreated typhoid can be very bad- the most common complication is intestinal bleeding and perforation, which can easily kill a patient if a surgeon is not available. Studies in third world countries are not great, but conservative estimates show that typhoid can have 15% mortality or greater. I saw several cases of typhoid yesterday.

Today, Thursday, was procedure day. I did 2 lumbar punctures, 2 incision and drainages, and a lipoma (a small mass, similar to a cyst, but made of fat cells) removal. Procedures are very interesting here. For most minor procedures on adults, you do not use any local anesthesia at all. So, we do the incision and drainage of abscesses with no anesthesia. We also do lumbar punctures without any anesthesia. I couldn’t believe I did 2 of them today without giving the patients anything! We do anesthetize if we are doing any suturing (stitching).  Also, I drained an abscess of a 4year old girl today, so we gave her ketamine as a general anesthetic.

Also today, I saw one of the saddest cases ever. A young girl, maybe 8 years old, came in a few weeks ago with a Buruli ulcer (spelling?). Apparently this bacteria gets under the skin and causes the fascia to necrose. The ulcer grows rapidly. I’m not sure if I should post pictures of this girl, as it’s fairly gross for anyone who’s not in medicine. Basically, the girl looked like one of the cadavers we cut up in med school. She was missing about a 12in. circumferential area of skin and fascia around her abdomen, chest, and back. You can see her abdominal and back musculature, just as if you were slicing a cadaver. She will likely die from infection in the near future.

A couple of medical residents who have been rotating here left today, and the rest leave tomorrow, so there will only be the 2 attending physicians, myself, and a couple other med students here for the next few weeks. We’ll be getting lots more procedures, and be expected to do much more by ourselves. It should be interesting!

A conference with the king!

So today was pretty interesting! On Tuesdays and Thursdays here, we round first in the morning (like every other day), and the rest of the day is set up to do procedures. Today, there were the usual cyst and lipoma removals, in addition to basic incision and drainage procedures. We also did a C-section for a woman having twins, since one of the babies was breech, which could mean trouble during delivery. Usually C-sections here are done with a poor prognosis, meaning that something is very wrong for the procedure to be done at all. Fortunately, today’s was a controlled setting, and went perfectly, with both babies and mom doing well. We were supposed to do an amputation on the girl I mentioned yesterday with the osteosarcoma, but that was pushed til Thursday since today was so busy. (When I say we, right now the people doing most of the procedures are family medicine and pediatric residents. They will be leaving Thursday, leaving myself and 3 other medical students in addition to the two full-time physicians here.)

In the afternoon, we had a meeting with the king of Nalerigu! Although Ghana is technically a democracy with elected officials, there are still kings of different areas of Ghana. It’s hard to tell how influential they are today, but it seems they still have a good amount of local power and prestige. The king talked about how much he appreciated our work at the hospital, and how the hospital has really been a savior for the local population to other nearby nations, such as Togo and The Ivory Coast. It was a very interesting conversation culturally- one of the village elders was translating, and he definitely did not understand our American English as well as some of the other translators.  We brought him a small gift, and when we left, he gave us 2 chickens as a gift, since he did not have dinner prepared for us. I’ve tried uploading a picture of the king, but unfortunately the internet connection is too slow here to do so. I’ll definitely post some pictures when I get home!