Sarah Cooper’s Blog

Warm again

So I know that many of you will be surprised considering my previous love of winter and snow, but I have definitely grown to love the dry heat here.  In a previous post, I made fun of the locals for being cold when the temps are in the 70’s, but now I am bundled up along with them.  Thankfully the weather is back into the 90’s today:-) I am sorry that I have not been able to keep everyone updated better, but the satellite has been down on the compound.  I continue to see many interesting things: leprosy, rabies, lots of snake bites, and fractured jaw, pelvis, and patella.  I also saw an extremely advanced case of breast cancer.  The breast was black and hard with lots of nodules.  The skin changes wrapped around to her back and her arm was swollen about three times larger from the lymphatic fluid that was blocked.  Because of the blocking, it had created an opening and was draining out.  I also have seen a softball sized skin cancer (squamous cell) and protein-calorie malnutrition known as Kwashiorkors.  These are only a small fraction of the wild cases that are here, and unfortunately I have seen a lot of death coupled with them.  Praise God that He brings healing to some.

My time at the mission is drawing to a close and I will soon be traveling to a couple of national parks for a few days afterward.  I am very tired from the physical and emotional drain of working at the hospital, but I am not ready to leave.  I feel like I have just begun to get used to the culture and the people.  I am able to take a history in the native language.  I am told that my pronunciation is pretty good too!  The locals get a big kick out of hearing me speak their language.  They often ignore me and just stare at the translator.  Apparently this is because they would never expect a white person to be speaking their language.  It is a very expressive language and you have to speak it very forcefully and loud.  There is no room for the soft-spoken in Mampruli!

 Thank you again for all of your thoughts, words,  and prayers of support.  I am healthy and very happy here.  As you think of me, please pray for my adjustment back into the States.  I know that it will be very difficult.  I hope to keep everyone posted on the rest of my experiences.

Crocodiles

Hello everyone!  Thank you for your kind words and emails.  They pick up my spirits.  The satelite went down on the compound and it is very difficult to find time to walk the mile plus to the dial-up internet cafe.  We have been very busy at work, but it is rewarding.  I apologize that my posts will be much less frequent.

Kristin and I took our first call on Thursday.  This was the first time that we had ever been on call by ourselves (even in the States).  It was a very challenging day both intellectually and emotionally.  It definitely pushed me out of my comfort zone with the care I provided to the patients.  We are also working on our own in clinic now.  I know that this will be very good training for residency next summer. 

I spent a lot of the day and night taking care of a little boy with meningitis.  I tried several progressive steps over the course of the day to improve his respiratory status.  I got to the end of my knowledge at about 10pm and I went to Dr. Hewitt’s house for direction.  He gave me advice, but by the time that I walked back, the little boy was dead.  I don’t think that I will ever forget the sight of that mother grieving her little boy that night.  Later that evening, we had another boy who had fallen off of a donkey cart a few days proir.  His abdomen was very distended and he needed surgery.  The surgery was uneventful, but Dr. Faile couldn’t find the reason for all of his pain and poor status.  He also died later that night. 

Ysterday was a fun day yesterday.  I sat on a crocodile and picked up its tail.  We went into Burkina Faso for just a little bit and we saw this really pretty cathedral with lots of cool African art. The walls were made of crushed herbs and they looked like concrete but weren’t.  We had local food which was good and went to a slave camp.  We also hit a basket shop really quick.  It is the basket headquarters in Ghana. 

The people here are so funny.  They are freezing because it is their winter, although it is still in the high 80’s to 90’s everyday.  They layer on the clothes and some have coats and put crochet hats on their babies!

Thanks again for all of your prayers and support.  They are definitely needed.  I am doing much better since the day we took call and I am healthy as well.

TB Clinic

I saw several interesting things today. There is one young boy admitted right now who the doctors suspect has polio. Polio was once almost eradicated from Ghana, but Nigeria decided to quit vaccinating because it was thought that the vaccinations were leading to sterility. Now there has been a growing incidence of polio over the last few years.

There is a man who suffered a stroke in the hospital now. Unfortunately, there is not a whole lot that we can do for these types of cases. Many of the necessary medications are not available here and the care is mainly supportive. This man does not have a good prognosis. I also saw a couple of cases of severe liver failure too.

I assisted in some interesting procedures too. One of them was a finger amputation. A young man had lost much of his finger in some kind of traumatic accident last night. I assisted Dr. Hewitt in breaking off portions of his exposed bone and then he stitched it up. I scrubbed into another c-section and was able to close again. Dr. Dickens let me try to pull the baby out (my first attempt at this), but I was unsuccessful. Not to worry though, he quickly pulled him out!

I also had the opportunity to observe at the TB clinic. I saw a couple of very unusual presentations (for the U.S.) which was good. I also learned a lot about the logistics of treating TB in Ghana. The government pays for all of the treatments, but the Baptist Medical Centre requires a deposit since they house the TB patients and provide food, etc. This helps to ensure that the patients will stay for the full duration of the treatment, or six months. There is one tribe in the area, the Felani, that are particularly susceptible to tuberculosis because they are cattle herders and more nomadic.

I also watched another skin grafting and a hernia surgery. I gave the spinal anesthetic for the skin grafting. The procedure is very similar to doing a lumbar puncture, you just inject the anesthetic into the spinal canal. I scrubbed into a lipectomy (removal of a benign, fatty mass) and was able to close the incision then too. I am grateful for the exposure in suturing and being able to observe and perform many ultrasounds too. These things take lots and lots of practice!

Meet Nayiri Abdulai Mahani Siriga, king of the Mampruli!

Pet antelope in Nakpanduri.

Suturing during a cesarean section

Escarpment

Another clinic day

Today was another day of rounding and clinic followed with procedures. I had some interesting cases in clinic. I diagnosed a woman with HIV and admitted a man with cellulitis. He was in a motorbike accident two weeks ago with a couple of superficial skin lacerations. These openings caused infection to spread inside his leg and today he was unable to walk. I also saw many cases of malaria and a man with a patellar (knee cap) fracture. The treatment for this is to surgically wire the patella back together, but he chose to go for “local treatment” instead. It is very common for Ghanaians to choose the local methods of treatment, especially for bone deformities. In this case, local treatment is basically a form of splinting and wrapping. There isn’t anyone at the hospital that is able to perform the necessary surgery in this case.

I was also able to scrub into a cesarean section and I got to suture the incision closed at the end of the case. I also drained a hydrocele (collection of fluid in the scrotum). There was about 1400 mLs that I pulled off! The day ended on a low note when we did several ultrasounds. We had three Intrauterine Fetal Demises (miscarriages) and one woman that will likely miscarry soon. Three of them are admitted now to monitor them for bleeding and see if they need a D & C tomorrow.

The dust from the Harmattan was much less today and we were able to see lots of stars on our walk home from the hospital. Usually we are lucky if we can spot even a couple because of the dust.

countryside

Here is another link of pictures to view:

http://www.facebook.com/album.php?aid=2015742&l=4404b&id=162801085

Second Baptist and more pics!

We went to the Second Baptist Church this morning after rounds. It was similar to the other service and also a mixture of Mampruli and English. There was a lady walking around with a stick to poke adults who fell asleep and kids who were being to rowdy!

After lunch, Kristin and I went on a walk to the TB Village. It is located about 1/2 mile from the hospital to help quarantine the patients. It is basically just a small village of houses. The patients come into the hospital once a week for the TB clinic with Dr. Hewitt.

Enjoy the photographs!

Kristin successfully performing a lumbar puncture.

countryside and moon

cows and countryside

local seamstresses

local women

pet baboon

TB Village

Flag of Ghana

Rock formation at the escarpment that we hiked to last Sunday.

Selling watermelon at the market. It is watermelon season now in Ghana.

to view more pictures, copy and paste this link into your browser: http://www.facebook.com/album.php?aid=2084357&l=890c7&id=36102348

Surgery

Today was a little slower.  After rounding this morning, I scrubbed into a surgery of an ovarian torsion.  The patient had a benign growth of her ovary and the mass that we took out was nearly the size of a football.  This mass had caused the ovary and fallopian tube to twist on itself.  These cases are known to be associated with a significant amount of pain.  I also watched a skin grafting for the first time.  This was pretty fun to watch too.  After that there was a young woman with osteosarcoma (bone cancer) in her femur.  Dr. Faille did an amputation pretty high up on her thigh.  We had a slow afternoon so we watched Horton Hears a Who at Dr. Dicken’s house with his wife and kids.  They used a laptop and projector.  It had been nice to have a slow afternoon.  Tomorrow we will go to a different church and maybe hit the market up depending on how busy things are at the hospital.

Lots and lots of malaria

 Today was another clinic day.  I was working with Dr. Faille, who is a career missionary in Nalerigu.  He grew up in Nalerigu and went to the states for medical training.  His father founded the hospital 50 years ago.  Dr. Faille is trained in family practice, but he has worked alongside surgeons from time to time here and has picked up different techniques from other visiting surgeons.  When visiting surgeons are not here, he acts as the surgeon performing a wide array of operations.  This makes his clinic population a much different variety than a true “family practice” clinic (which does not exist here, but I’m trying to get at the difference in working with two of the career physicians here.  The other family practice doc’s name is Dr. Hewitt and the OB/GYN is Dr. Dickens.)  I admitted one patient for malaria vs. appendicitis vs. typhoid fever and another patient for meningitis vs. malaria.  I was able to perform her lumbar puncture! 

 I had another patient that was emaciated.  He was an adult that weighed only 40 kilos and complained of fevers and pains for 6 months.  He also had a cough, but for only one week.  I sent him for an HIV test, which was negative.  This patient came late in the afternoon and I was unable to do a blood film and check for malaria.  (This is impossible after noon because the volume is so high in the lab.)  I ended up treating him for malaria and typhoid fever.  It seems that it is almost a waste of resources to check for malaria here because it is as common as high blood pressure in the states.  He will be coming back next week for us to check a Chest XR (rule out tuberculosis) and stool sample.

 After clinic we went down to the Theatre for some minor procedures.  A little girl was seen in clinic who was breathing very quickly.  Fortunately she did not have a fever.  Dr. Hewitt extracted about 3 ccs of pus from her chest during clinic and decided that she needed a chest tube.  Dr. Faille put in the chest tube and tons of pus came out of this empyema (pus collection).  I think that it was close to 500 ccs or half a liter.

 Tomorrow morning, I am looking forward to scrubbing into an ovarian torsion surgery.  I haven’t watched one of these before.  Dr. Dickens (OB/GYN) recently moved here with his family to complete a two year committment to the hospital.  He was busy moving in last week, although we were able to get to know him and his family at dinner each night.  I am looking forward to gaining more perspective of women’s healthcare in this third world region as he returns to work.

 I would like to take some time to describe the facility.  The hospital is broken up into several wards, which are basically just a large room with many beds in it.  The patients are responsible for their own food and most of them has a family member assisting in their care.  There are at least 30 babies in the pediatric ward and about 20 women and 20 men in their respective wards.  There is an isolation wards with three sections.  The first is for severe skin infections, many which require frequent debridement or possible skin grafting (Dr. Faille performs).  There are about 12 patients in this room now.  The second section is for meningitis.  Nalerigu is in the West Africa “Meninigitis Belt”.  Right now, this room is housing about 6-8 patients.  Apparently during outbreaks there will be a couple hundred cases.  The last outbreak was in 1997.  The third section is for tuberculosis.  There is no one requiring that service right now.  There is a tuberculosis clinic which is held once a week, but I did not help with that this week and I don’t have much knowledge of it.  There is also a maternity ward.  The routine cases are handled by midwives.

 The possible tests that we can order are very limited.  We can get a blood film (malaria), stool sample (parasites, etc.), white blood cell count, and a urinalysis.  We are also able to do a gram stain to look for bacteria in the lumbar puncture specimen (meningitis) and check it for white cells too.  As I talked about before, it is tricky to get the information out of the patients that we need.  I have access to translators, but they have a limited medical understanding and it’s difficult to convey the appropriate information to the patients.  When you consider these hindrances, in addition to the fact that I’ve never seen hardly any of these tropical diseases before, I feel like it is my first day of medical school again!  The physicians here are understanding and I’m sure used to other Americans going through a similar transition.

Market

We went to the local market this morning after finishing up with our duties at the hospital.  There were people selling produce, material, nonperishable foods, cell phones, etc.  One man was blasting American music from a speaker at his table.  When I took out my camera to snap some pictures, I gathered a train of about ten kids that wanted their photo taken too.  I picked out some material for a woman to sew me a skirt.  Bright patterns are popular here.  There is lots of tie dye and some batik.

 This afternoon there was a large vehicle crash, similar to a truck with many people piled in it.  We had 10-20 people come in with abrasions and lacerations.  Some required stitches.  One woman’s hand wound was so deep that the tendons were exposed, but thankfully intact.

 Last night was the annual fire festival.  The history is somewhat unclear, but people all across Northern Ghana celebrate when the Chief’s son was lost and then found.  They throw around fire and dance in the streets to celebrate.  I was not feeling up to going, but the pharmacy student that is here went and was invited into the Chief’s house to take photographs.  Apparently his quarters are very similar to our housing.

 Tonight we will have our weekly Bible study.  There will be about 30 people that come from all over.  They will stay the night on campus. 

Translating woes

Today was the first day of clinic for Kristin and I.  We started off rounding as usual in the hospital.  There is one kid with Burkitt’s Lymphoma and they will never regain vision of one of their eyes again.  We started off the day debating whether it was time to surgically remove the eye.  Then I observed one of the doctors in clinic this morning.  I just met him and his wife.  They returned last night from a vacation in Burkina Faso where they were riding camels.  It was very interesting to observe him.  He is a very capable speaker in Mampruli and is able to converse with minimal use of the translators.  When he speaks to a patient or staff person that knows English, he converts into speaking in their broken, accented English.  Then a few seconds later he will teach me and turn his southern drawl back on.  It is really quite humorous and impressive. 

The fun decreased quite a bit when I started seeing patients in the clinic by myself after lunch.  It was stressful to work with a translator even though this was certainly not my first time being somewhere that I did not speak the language.  The most frustrating part of the day was when I was working with a patient and trying to explain something to her.  The translator began yelling at her for minutes.  I kept trying to ask if the patient had questions and she would yell at her some more.  In the end the translator said that she had explained everything, but the patient still did not understand and she kicked her out of the room.  I know that this is a cultural difference not a specific indication of how patients are treated because I have seen similar interactions earlier in my stay.  It is still frustrating to not be able to make a patient understand what I am trying to get across. 

I did see a lot of interesting cases today.  We diagnosed a man with syphilis and HIV and a young girl with meningitis.  We also saw a woman with breast cancer metastases to the skin on her chest and lots of cases of high blood pressure.  I watched several ultrasounds after we were finished with clinic.  One patient had an enlarged liver and spleen that was all the way into the lower quadrants several centimeters below the umbilicus.  Then I watched a D & C. 

I am looking forward to when I will have adjusted to the very different brand of medicine and after I get used to some of the cultural differences. 

We had dinner with the rest of the short-term volunteers, as usual.  The OB/GYN (Joel) and his family joined us for dinner.  We had fu-fu for dinner that the nurse made for us.  It is a doughy substance made of mashed yams.  You are supposed to grab a ball with your fingers and dip it in a spicy, soupy mixture.  It was interesting and fun to try some native food.  All of the other food we have eaten has been “American” food prepared by the guesthouse cook.  It is very good though.  We also had this Ghanaian beverage that tasted like a syrup coffee nastiness.  I did not finish mine.

Below are some pics from our adventures yesterday.  If you want to see more pictures, click on Scott Miller’s blog.  He is a pharmacy student that is volunteering here now too.

http://www.facebook.com/album.php?aid=2015643&l=c93a2&id=162801085
The facebook link above should be accessible by anyone and contains 5 more pictures. You may have to copy paste it.

another view from the top. notice the hamatan.dscn1343.JPGkristin at rock formationdscn1343.JPG

Rounding, church, hiking

We started off the day rounding at the hospital. I am feeling somewhat more confident with being thrown into it on my own tomorrow. There weren’t a whole lot of changes in the types of patients that we saw with the exception of three who had second or third degree burns. They will require skin grafting which can be done at this hospital.

We went to the First Baptist Church in Nalerigu after that. I don’t know how large this village is, but there are about three protestant churches, one catholic, and a mosque under construction. There was lots of singing and dancing and the people were very welcoming. Kristin and I stood up in front of everyone to introduce ourselves. I think there were about 150 people there. The children recited some of their memory verses and were really excited. The service was a mishmash of the native tongue and English.

After lunch we drove for about 45 mins further north and west. Apparently both Togo and Burkina Faso were visible except for the haziness caused by the Saharan dust (Harmattan). We hiked for about a mile and then climbed to the top of a rock formation. There was a large cliff that we looked over. It was a little challenging to climb up the rocks. They reminded me of Elephant Rock near Johnson’s Shut-ins in MO. We climbed down and visited a couple that live near there. They had a pet baboon, monkey, a baby antelope, and some turkeys. They are involved in ministering to people who are in need of amputation and hook them up with the necessary contacts and resources.