March 12th, 2011 by INMED
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Yesterday was our last day in the rounding in the hospital and seeing patients in the clinic. Sheila and I talked Jaquelyn and Lena into helping out with triaging the patients in the clinic and it went pretty well. Usually everyone just has to wait their turn regardless of how sick they are but this way the girls identified those patients that really needed to be seen and sent them in first.

We said our goodbyes to all the nurses and patients and took some pictures of everyone. Leaving Nalerigu was a little bitter sweet experience because I have really enjoyed my time here but at the same time it will be nice to go home and see my friends and family again, and of course to finally find out where I’m headed for residency. I will definitely miss all the people that I have met and all the patients that I have taken care of here.

It is strange to think of all the interesting patients and cases that I have seen here, much of which I would never see in the States. Just some of those include severe malnutrition, dealing with acute respiratory distress without supportive equipment, breech deliveries gone horribly bad, 14 year old girl with renal failure and no dialysis available, never ending nose bleeds in a severly anemic woman, endless amount of snake bites, severe inguinal hernias and hydrocoeles (men walking around with a basketball between their legs), malaria, acute typhoid abdomen, tuberculosis, and deliveries on the floor. There are so many interesting things to see and do here at the BMC!

We had to leave Nalerigu at 4 am in order to catch our flight from Tamale to Accra. The first 90 minutes of that drive are pretty brutal, driving on a dirt road trying to avoid rocks, pot holes and of course the goats that are all over the place. Therefore, when we finally arrived in Accra this morning I was pretty tired and took a quick nap. After lounging around for a while we went back to Osu Street, where we walked around for a while. Our flight tomorrow doesn’t leave until 9pm so we are planning on going to the beach which should be nice. By Monday morning we will be back in the States and to our usual routine, but I’m ready to start planning my next international medical experience already!

March 10th, 2011 by INMED
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Our last week here has really flown by fast! It doesn’t really feel like I’ve been here for almost a month but when I look back at all the things that I’ve seen and done it all starts adding up. Monday was a holiday because of Ghana’s independence day so I was very glad to have an extra day off from clinic. Of course we still rounded in the hospital as always but it was a nice break none the less. Monday was also the last day that Kim and Jess were here because they left for Accra very early on Tuesday.

Since there are just three of us left (Rich, Sheila and I) we have been dividing up the hospital for rounds in the morning and so far we have been able to finish everything on time for clinic and/or procedures. I usually start in peds and then work my way into the adult wards where I find Sheila and Rich and then we all go to the isolation ward and finish rounds there. That is where they have the meningitis patients and the TB (berkla) patients.

I am enjoying the independence and confidence that I gain by seeing patients on my own and I feel like I am learning a lot every day. Inspired by two of my patients on the ward right now, I am writing my Inmed presentation on malnutrition. These two kids are tough to look at because they are so malnurished. The girl is 3 years old and weighs 5.4 kg and the little boy is 31/2 and weighs 6.1 kg. I am trying to get them well enough so that they can go back to the nutrition clinic and continue to get fed there, but they are nowhere near ready for that yet.

Today, Thursday, Sheila and I spent finishing up all the things we wanted to do in Nalerigu before we left. We visited the Happy Child school, where kids from 3 years old up to teenagers go to school. The kids were on break when we got there which was good because they went crazy when they saw us coming. Sheila and I had to break free in order to finish our tour of the classrooms. We also went to the orphanage here in town. Lena and Jaquelyn work there every afternoon so we went with them. There are 18 kids that live in a housing compound with one woman cooking for them during the day, and one caretaker staying with them at night. These kids are starved for attention so they were very excited to play with the jump ropes, frisbees, and crayons that we brought for them.

Tonight we had dinner with Greg, Wendy, their kids, Rich, Lena and Jaquelyn. We gave them all a couple of gifts as well as some of the things that we are not taking back with us, like granola bars and candy. We are also leaving a whole bag full of clothes to donate to either the orphanage or one of the local churces in town. Tomorrow will be the last day working in the hospital and we will have clinic in the afternoon. We fly to Accra from Tamale early morning on Saturday, so we leave Nalerigu around 4 am. Our flight back to the States is on Sunday night so maybe we will have some time to explore Accra a little better this weekend.

March 2nd, 2011 by INMED
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Sheila and I went out to dinner last night with Rich and Samson (a nurse from the hospital). We walked all the way across town, or at least it felt like forever, until we got to this restaurant named Las Vegas. We all had some chicken and rice with a spicy sauce, and we had to use our flashlights to see what we were eating since it was getting pretty dark! But the food was delicious so I think we may go back there before we leave Nalerigu. Walking back to the BMC was also pretty interesting because there are motorcycles everywhere and they don’t really slow down for those who are walking!

Today was a crazy day at the clinic. We stopped at 6pm without getting through all the patients that had been checked in for that day. We just couldn’t get through them all. Afternoon rounds were pretty busy as we had filled the hospital again and we had a few procedures to do. By the time I got home a little after 8pm I was starving and I was grateful for the pizza and Coke that was waiting for us. Sheila and I are on call for the next few nights so I’m hoping they will nice and calm without too many calls. We’ll see what happens.

Quote of the day goes to Sheila for saying “what is that coming out of this boy’s testes?” Answer: “Sheila, it’s a girl” (talking about a new born baby girl we were doing a lumbar puncture on). It’s been really hot here lately and I am definitely feeling it. Tomorrow is a procedure day and we already have several lined up to do. I have a debridement of a foot injury, I&D on a child’s thigh, hydrocele, and congenital tooth extraction so we’ll see how those go.

February 24th, 2011 by INMED
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Both yesterday and today I went with Dr. Prine and his group to a couple of villages to have a make-shift pediatric clinic there. We went there along with the dentist and his assistants. When we arrived at the villages we were introduced to the Chief of each village to ask if it was okay with him if we set up their. In both villages the Chief sat on a little coushin-throne in a clay hut and someone from our group offered them a small gift of flashlights. They allowed us to work their and see their villagers so we set up a couple of benches and a table and went to work.

It must have been like the circus was in town because everyone swarmed around us and every once in a while we had to ask people to step away from us just so that we could see the patients. Shortly there after though, we were just as crowded and we just had to work through it. We saw a lot of healthy kids with some minor issues but we did bring one 3 year old boy back with us to the hospital today so that we can treat his typhoid adequately.

The clinic was pretty rough and we didn’t have all the medicine that we might have needed but for the most part we were able to treat most of the kids. Most of them really didn’t need anything but it was like every mom was bringing all of her 5 children to us to be seen, regardless of whether they were sick or not. I guess they just wanted us to make sure they were okay so we handed out a lot of multivitamins.

The village we went to yesterday wasn’t too far away but today we drove for about an hour and a half to get there and the road was challenging to say the least! On the way there we pretty much had to climb up a cliff and move rock from the road to get there and then on the way back we almost got stuck in the sand after crossing a small stream. We all got out to help push the vehicle but the whole thing was pretty funny. The scenery was beautiful though and I was hoping to see a giraffe or elephant strolling around to perfect the image but aparantly the don’t live around here.

Dr. Prine is leaving tomorrow afternoon along with the dentist, the surgeon, the anesthesiologist, and the rest of their crew so tomorrow I’m gonna try to soak up as much knowledge as I can on rounds in order to be able to see most of the peds patients on my own. We still have Dr. Etuh who is a Nigerian general surgeon working here for the year, so we will still be able to treat surgical cases. Other than that it will just be Sheila and I, two residents from Missouri, Rich (our attending), and Jake (a student who is leaving on Sunday).

Anyways, being outside all day yesterday and today took a toll on my shoulders, even with plenty of sunscreen and trying to be in the shade while working, but hopefully it will fade soon 😉 Sheila and I were on call the last two nights. The first one was pretty uneventful but yesterday morning Sheila gave blood again to the little boy. Unfortunately he was too far gone and he died yesterday afternoon. Last night was a little busier as we got called on a lady in labor around midnight and a boy in respiratory distress around 3 am. So, not much sleep but they both did well so it was worth it. Tomorrow is another clinic day but I am definitely looking forward to the weekend. Just to get to relax for a little bit will be nice.

February 19th, 2011 by INMED
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Our little girl that Sheila and I stayed up with died yesterday. We knew she was getting pretty bad and there wasn’t much we could do for her, so I was glad that we had said our goodbyes to her the night before. We were pretty busy yesterday, with rounds in the morning and then clinic in the afternoon. I did a couple of paracentesis (draining fluid of a patients abdomen) which was a little different from what I’ve seen done in the States. Usually we numb the patient up, use this fancy apparatus to put a catheter into the abdomen and then hook it up to vacuum containers to assist with the whole process… Well here there is no such thing. So I grabbed an IV catheter, a used tubing, and a blue tub… that was it! No numbing meds,  so I just stuck the needle through as the patient gritted his teeth and then just taped the tubing to the tub which was on the floor to use gravity to assist with the draining process. It took about 2 hours to drain completely but it worked.

After work yesterday, Isaah (the cook) came and picked Sheila and I up on his motorbike. All three of us rode over to his house where his wife had prepared dinner for us. We had Fufu, which is made from ground up yams so that it becomes a white ball of somewhat gummy like stuff. Pretty interesting texture but it was good. This was served with a spicy pine oil sauce and meat from a pig’s head. Isaah has a little bar that he wanted to show us so he and Kaleb (another chef) drove us over there and we had a couple of drinks. His place was much nicer than the first one we went to, with a fenced of area and music.

Since today was Saturday, we slept in a little bit and then rounded in the hospital this morning. After lunch we went over to Greg and Wendy’s house for a magic show held by their son Aiden and a movie. Greg is a missionary here, and his wife Wendy is here with him along with their thee children, Carter 9, Aiden  7 and Sukonya 7. Unfortunately we weren’t able to finish the movie since we had to go back to the hospital and round again. I did and I&D (draining pus and cleaning and infection) of a ladie’s jaw. Her infection was so bad that the whole right side of her face was swollen up, from her forehead to her neck and behind her nose. She could hardly open up her mouth to eat of speak. I might have to do it again a couple of times but she looked a lot better after the procedure.

I’m on call tonight so hopefully I won’t have a crazy night like the other day. I have a phone that they call if they need me so I don’t have to sleep at the hospital or stay up all night if nothing happens. Tomorrow should be a fairly light day so I am thinking about exploring the town a little bit although I do have to catch up on some laundry and e-mails.

February 17th, 2011 by INMED
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The last few days are kind of a blur as a lot of things have happened. It has been incredibly hot here and although I am trying to drink several liters of water or gatorade each day, I am barely keeping up with the amount I am sweating.

Yesterday (Wed) had a rough start. I started to round with Dr. Prine, a pediatrician that is here, and we started in the Peds Ward. We had just finished examining a 6 mo old boy and we walked across the room to check on another baby when all of a sudden the mom says something and the nurse calls us back to the bedside. The child had died! No more than a minute after we had been there checking on him. He had been rushed to the OR the night before due to an acute abdomen and had been found to have severe intussusception. We thought he was on the road to recovery but things change pretty quickly here. Also, we don’t do CPR here since there are no ventilators here and the staff is not trained. Death is pretty much an every day occurance here at the hospital, usually a few each day, but this was the first child we lost since I’ve been here.

When we recovered from the shock we finished our rounds in the peds ward. We have a lot of malaria patients, typhoid with or without GI perforations, meningitis, TB, and malnutrition. I did my first lumbar puncture on a two year old girl that we suspect may have meningitis.

Clinic on Wednesday was busy and I admitted four new patients to the hospital, and once again the hospital was overflowing as all the other docs admitted several patients as well. After clinic I checked up on some of my patients and then proceded to round again with Dr. Prine in the Peds ward. As we were finishing up, someone brought a tiny little girl to us. She was a twin that had just been born at home that day, and the mother had died due to some complications during the delivery. She is probably a little premature, about 35 weeks, and was struggling to breath. We were able to give her some oxygen and put her in an incubator but she needed constant stimulation and occasional ventilatory support to keep her oxygen level up. Sheila and I volunteered to stay overnight in the hospital to take care of her… and we were in for a crazy night! Only in Nalerigu could all this happen at once!

The night started a few deliveries that the midwives handled, but the little girl kept us busy as we took turns bagging her every once in a while. Then we got a call about a woman whose labor was not progressing properly and we decided that she needed a C-section so we woke Rich up and he took care of that. Things calmed down for a while but then I was called to a patient’s bedside and all I was told was that “her condition has changed”. When I got there the patient was gasped a couple of times but then died. Unfortunately there is nothing we can do in these situations when the meds don’t work, since we don’t have all the necessary equipment. I haven’t had to pronounce someone dead before but it was a 70 year old lady with severe pneumonia. Sheila was up for the next call so I stayed with the baby girl. Again, all we are told that we needed to check on a patient in the women’s ward since “her condition has changed”. She gets there through the interpreter figures out that the lady is having contractions. As she hears that, the lady gets up, squats on the floor and delivers a baby girl!! Everyone was just standing and watching her so Sheila came running back to the maternity ward where I was and grabbed what she needed to cut the cord, suction the baby, etc., but both mother and child did well.

Our night wasn’t over yet, and we did have to call Dr. Prine to come help us because we couldn’t keep the little girl oxygenated well. Her O2 sats kept dropping, but he was able to stabilize her and she was fine for the rest of the night. However, the worst was yet to come. Around 6 in the morning I took the next call and I was told that a woman was being brought to the hospital due to prolonged labor. We went outside and a few men were moving a young woman from a van to a stretcher so that she can be moved inside. She was obviously in pain but she had all these sheets and plastic wrapped around her waist so I couldn’t really see what was going on as far as the delivery went. We took her inside to look her over and unfortunately I don’t think I will ever be able to forget this sight! The baby had been delivered breech (feet or butt first), she was unable to complete the delivery and the baby was stuck. The baby had been that way for several hours was dead. I called Rich in since neither I, Sheila or the midwives were able to get it out. The poor woman was in so much pain but luckily Rich was able to help us and the woman was actually doing really well today.

Dr. Prine came that morning to take over watching the baby girl and Sheila and I decided that after a night like that we needed to rest for a little bit so we slept until about 1pm. Luckily the afternoon and this evening were pretty uneventful… Admitted a crazy lady, Sheila did some sutures on a guy that fell of his motorcycle and we rounded on our patients. Dr. Prine and his wife were able to rig the equipment that we have so that be little girl is getting constant oxygen and CPAP and they taught the maternity nurses how to check on her and make sure she’s ok. We are not sure what’s going to happen to her, but if she had been born anywhere else she would have had about 95% chance of survival but she needs to be on a ventilator, which we don’t have. It is frustrating that we don’t have all the equipment, technology, or trained staff to treat patients properly. Well, my sleep schedule is all off since my call night so I need to try to get to bed before too long. Hope all is well with everyone back in Iceland and US!

February 15th, 2011 by INMED
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The day started with a special treat as the cooks made us pancakes for breakfast (they usually only make lunch and dinner). This was really nice as lunch is not always a sure thing here as things tend to come up throughout the day. Today was a procedure day so we started as always at 7:30 but instead of having clinic at 10 we did some of the procedures that had been scheduled. I took out a cyst from a ladie’s arm and watched a few other procedures as well. We were able to take a long lunch since we had a pretty light load today as far as the procedures goes and a lot of people around to help. However, there were a lot of patients in the hospital and many of them have to sleep on the floor since we don’t have any more beds. Sheila and I decided to round on our own today and we started in ward 5 which is where the older children are. It went pretty well and and I think I’ll do the same tomorrow. I am learning a lot that way and Rich and the other attendings are always available to answer any questions that I may have.

Since we got done pretty early Sheila, Rich, Jake and I decided to go walk around town for a while. We stopped at a local restaurant which was more like a shed and we sat outside in plasting chairs around a crate but the weather was nice and the sunset was beautiful. The kids in that neighbourhood as well as some of the adults were really interested in us and my camera in particular, and all of them wanted to pose for a picture. In the end I had to hide the camera in order to get some space.

I am trying to pick up some of Mampruli, which is the language that is spoken here. It is difficult though as it is nothing like anything that I have tried before. Greetings such as dahsuba (good morning), neewuntahngah (good afternoon) and good evening (neezanoree) are pretty important, but I’m also trying to pick up some helpful words around the hospital. So far my vocabulary is limited to a handful of words and some gestures. It is also challenging since there are so many dialects here that often times the interpreters need to have someone else to translate since they can’t understand the patient’s language. All we can do then is to hope that there is another patient or family member around that speaks Mampruli.

The hospital system here is pretty different than what we are used to. Each patient needs to have some friend or family member around to help take care of them because otherwise the patient does not get food (which they bring from home or buy), bathed, or anything else. The nurses here really only make sure that our orders are processed, get the meds/labs/etc, and things like that, but as far as actual patient care they don’t do much. Tomorrow will probably be pretty busy since we have clinic again and we had to turn many people away on Monday. I’m still pretty much exhausted from all the traveling, time change, and work so I am going to bed early tonight. I hope you guys are enjoying this, I’ll try my best to keep it up!

February 14th, 2011 by INMED
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We worked hard today, that’s to say the least! We started this morning around 7:30 and rounded at the hospital. I started in the pediatrics ward by observing the other students to get familiar with the system here and to figure out how they handle certain issues. There are 3 other US med students here. Two of them, Bryn and Martin will leave this weekend but Jake has another two weeks left. Rich is the attending physician here and he has been here for about 5-6 months. We also got 13 new volunteers today which includes a pediatrician, dentist, optometrist and an few of other docs and their wives.

I did get to assist on a breech delivery early this morning also. Rich was preparing to do a C-section on her but we stepped away for just a few minutes to get ready and the midwives came running to tell us that a foot was sticking out as the woman had started pushing. We quickly returned and I assisted Rich with the delivery. No such thing as epidurals here by the way, these ladies are tough! It took a little while but a tiny little girl was born. I was on the receiving end for the baby and handled the recusitation as she needed a little assistance with breathing and stimulation. Luckily she did fine so I will check on her again tomorrow to see how she is doing.

We had clinic today and saw patients until about 8pm. We saw a lot of patient with malaria, typhoid, GI parasites, and pregnancy complications. The patients just keep coming and some have to return Wednesday to be seen. We had to force the nurse to give us a little break around 2:30 for lunch and by that time I was starving. The food here has been really good so far and Wendy (missionary’s wife) made cupcakes to celebrate Valentine’s day which was really nice. Her son Carter also distributed little gifts to everyone.

Since Sheila and I missed the Chiefs’ Celebration last night we decided to go tonight after work at 10. We walked to town following the beat of the drums and observed the women as they were dancing and singing. It was really interesting and worth seeing but it probably wasn’t too smart of us to be walking around by ourselves that late at night.

Tomorrow is procedure day so hopefully I will see some interesting things… I will try to keep you posted.

February 10th, 2011 by INMED
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Wow, it feels like we have done and seen so many things already that it is unbelievable that we have only been here for two days! Sheila and I arrived safe and sound in Accra yesterday morning and after a quick nap we decided to go out and explore the city. We walked around Osu which is a busy shopping street and practiced our bargaining skills. They had a lot of nice things to offer and I, of course, couldn’t resist the temptation so I bought a few things that I liked. I also tried my first coconut and coconut juice which was interesting… really sweet and almost salty at the same time which was kinda strange.

We flew to Tamale early this morning and then drove the two and a half hours to Nalerigu. A little bit of a bumpy ride as we navigated between potholes on the dirt road. Nalerigu is a town of about 10,000 and pretty rural. We wanted to explore it a little so we decided to take a walk around the BMC and the town. Pretty quickly some cute little girls ran up to us and wanted us to take pictures of them. They were obviously used to having volunteers around. They called us Zaminga which is the mampruli word for white person.

Tomorrow I start working in the hospital. Sounds like they stay pretty busy as work days have been lasting from about 7:30 am to 11pm. I am very excited yet a little nervous at the same time. I was introduced to many of the MAs and nurses today on our tour today but it’s a lot of new names, faces and customs to absorb so it will probably take me a few days to adjust.

The food has been good so far and I haven’t been bit by mosquitoes yet so I am pretty happy with everything so far. Everyone has been very nice and helpful and people here are pretty friendly in general. I have taken a lot of pictures already and I will try to upload them soon. I will definitely take some more tonight as we are going to a festival that is being held to honor the chief of the region.  Well, I think that will be it for now… Big HI to everyone at home!

February 5th, 2011 by INMED
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My name is Asdis Wagner. I am a medical student at AT Still University, and I’m starting my INMED service-learning experience at Baptist Medical Center in Ghana, beginning in February 2011.