November 17th, 2019 by Burton Adrian
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After two weeks in Nalerigu, northern Ghana, at the Baptist Medical Center, there are somethings that are at least somewhat familiar. I am feeling less a “foreigner” as I have traveled through unbelievable terrain requiring a Land Rover to get to church. The constant smell of dust, body odor, bed side commodes and infected wounds weeping pus from Staph and pseudomonas bacterial infection is the new normal. Unconscious young adults screaming out from the pain of the inflammation around their spinal cords from meningitis and cerebral malaria has lost its “shock and awe” value even when they go into a grand mal seizure until I given them diazepam intravenously to put them at rest. This occurred twice this morning before I went to church.
Due to malaria, there are a lot of intrauterine fetal deaths. Miscarriages for the same reason are common. The verses in Matthew 9:36 and 37 come to mind. “When he saw the crowd, he had compassion on them, because they were harassed and helpless, like sheep without a shepherd. Then he said to his disciples “the harvest is plentiful but the workers are few”. Such words cause me to catch my breath and want to weep. All the physicians and nurses here are so tired and over worked, and tomorrow two doctors from Burkina Faso leave, leaving even fewer for this week until re-enforcements from America arrive.
I think there is a psychological metamorphosis that happens after 2-3 weeks of being somewhere where you are the only one, or one of a limited few, who looks and acts like you. For hours on end, day after day, I see no one who is Caucasian. Only my wife Vonna and I and a surgeon from the Ukraine are white, among hundreds of Africans that visit the medical center each day. I think after this amount of time you start to see yourself as African, because everyone is, even if you are not. I am confident this is an extremely good thing. When you no longer can identify the “me” and the “them”, the “them” disappears and the only thing left is “us”. I think the stress Vonna and I are under helps this too. To see the profound suffering and naturally experiencing the empathy that is drawn out of you as you care for them puts you in their place and station in life even more.
This is perhaps part of the reason Christ commands us to GO and proclaim the gospel to make Him known. He could have said, “just sit tight and do the evangelism over the internet, it will come in about 2,000 years and it will be much easier.” Or He could have suggested spreading the gospel only through radio and TV. But he didn’t. The command was specifically to GO. Maybe Christ knew about the “me” and the “them” yielding to the “us” factor. And maybe he knew just how much joy the GOING would be to heal and fill your soul.

November 17th, 2019 by Burton Adrian
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On May 31^st, 2018 I walked away from the medical clinic in which I had spent the past 20 years, left the town in which I had spent the last 28 years of my career  practicing Internal Medicine without a trace of apprehension, only a benign dose of “been there, done that”.   I had no thoughts about what medicine I would or would not practice in the future.  I was not burnt out, not upset nor anxious. I had only the feeling of just “been there, done that”.

If you had asked me “are you passionate about practicing medicine?”  I would have answered “probably not”.  If you had asked “were you once?”  I would have thought back to the first ten years of my career in private practice in 1990 and said “yes, I was once”.  But again, I would not have felt a need to ask the question to begin with so why answer it?  I did spend some time wondering if the choice to be a physician had been a good one. There were various conclusions to varying degrees of certainty.

But at the age of 63, I have also learned “God made the world round so that we could not see too far down the path”.  That path, the details of which are of no particular importance, lead me to pursue the curriculum through INMED for the DIMPH.  The path led me to Baptist Medical Center in Nalerigu, Ghana.  When it comes to what I thought was a medical career, I could have said “been there, done that”.  But I have never done anything like this.  This is medicine, and this kind of medicine requires passion.

“We are not in Kansas anymore”, are the famous word of Dorothy to her dog Toto in the movie “The Wizard of Oz”.  Much were my thoughts in the first few days at BMC.  The demand for medical care in both volume and severity are profound.  The resources for lab and diagnostic technology extremely limited, close to non-existent.   You cannot cover up a lack of diagnostic and therapeutic skill by ordering a bunch of lab and x-ray test to “make sure you did not miss anything”.  The only thing standing between you and a bad patient outcome is you the clinician, in that regard quite naked and alone.  The volume is huge.  Not only do you have to be good, he have to fast and efficient.  No AC to keep you refreshed.  No breaks for a coke and a doughnut. Just dim light bulb in a room large enough to be my bedroom closet and a noisy ceiling fan against the heat and humidity.  Bottled water against dehydration.  And hunger, I have already lost 5 pounds in two weeks. Typical day – 7 cases of malaria two of which two were severe.  One intrauterine demise, to an internist, that is an unusual day. One critical aortic stenosis in an 8 year old, previously undiagnosed and multi-lobar pneumonia presenting in shock.   Then you can drop by maternity and help with three vaginal births and start treatment for two with pre-eclampsia.    Remember, I am an internist, so this is really challenging.

At the end of each day I am either exhausted or nearly so, but my wife is here, beautiful and loving.  The local cook is great.  My emotions are recharged. My body refueled and ready to be rested. And I have passion again.  It is required.

November 17th, 2019 by Burton Adrian
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I had been caring for him for almost a week. I first came across this 14 year old boy during morning rounds on the Sunday morning of the third week at Baptist Medical Clinic in northern Ghana. He was admitted the day before by the doctor on call for “gastritis”.The chart indicated he had been vomiting the day before admission but it also stated he had complained of being blind, an unlikely combination of symptoms in addition to the rarity of complaining of blindness at age 14. He was only ordered medicine to reduce stomach acid.
When I first saw him, he was unconscious, completely unresponsive. His eyes were partly open revealing what is called dysconjugate gaze. This means one eye was looking to the left, the other to the right. I was able to look into the back of his eyes, the optic nerves were normal. His neck was stiff. He was febrile. In Africa this is meningitis or malaria or both. You always treat for both. They do not do spinal taps here. Yes, I know they should. I order the tests for malaria and order the antibiotics for meningitis and treatment for cerebral malaria. Before any treatment could be given he seized. Fortunately I was right there to help protect his airway, a dose of diazepam 5mg was available on the floor and quickly given. This is my first case of either disease in Africa. The patient is young. I can only hope for recovery.
Over the next days, his consciousness returned and the large forty bed open ward was filled with his screaming and crying out. Was it from the pain of his inflamed meningeal membrane around his brain and spinal cord or fear of the world of darkness in which he found himself? I presented the case at the staff meeting with the African doctors. I felt it was cerebral malaria. They were more in favor of bacterial meningitis or even viral meningitis. In either case I asked, in their experience, would he see again. All the African doctors shook their heads no, their eyes cast down to the floor. Somethings you learn from experience as a doctor are not nice to know, not good to know, even if what you know is true.
After a few days he was speaking words in Manpruli. I asked the nurse if the words were meaningful or was he confused. She said he was calling out for the doctor so the words were meaningful. It was clinically a good sign. The next day he must have heard me talking in English as I was seeing the patients in the beds for before him. I greed him with “Dahsubah”, good morning in Manpruli. He replied in the voice of the innocent pre-pubertal child in perfect English,“Doctor, open my eyes.”
I am still not beyond those words, like a man who has just stopped suddenly after running up to the edge of a cliff, not yet knowing if he have stopped in time to avoid falling beyond the edge to who knows what fate or has he stopped in time to remain with his feet on solid ground. The physician and the patient both not knowing what the world will be beyond the grim reality of the present. Christ healed the blind. That is the only thought there is for now for either one of us, the patient and his physician.
After just three weeks in this resource limited environment I had known the following experiences. A father would not consent to the amputation of his son’s gangrenous arm because, as he said, “I have five other children, I don’t need one with just one arm.” Even if the arm was amputated as would be necessary to save the boy’s life, the father would not accept him on anything close to equal status with the other children. He would be relegated to the status of being less than a “complete person”. Without amputation of the arm, the son will die. Families request they be allowed to take their critically ill alcoholic family member home, with the obvious expectation he will die. They don’t want to pay for the oxygen he is using that they will be billed for. What then is the fate of a blind fourteen year old boy? I asked this question to my African colleagues. Again they just shook their heads. Again, their eyes were looking at the floor. This is the truth you know as true and wish it were not.
We are blind to the world around us if we are unable to see, we are unknowing of what is there. We are also, equally unknowing of what we have never seen even if we have full vision. My father died this summer at the age of 95. After two years of profound dementia and poor quality of life I let sepsis end his life on this earth in the comfort of the nursing home on clean sheets and a soft mattress. A Ghanaian man took his father home to die today. I saw the father lying on the concrete in the small motorcycle parking lot, the cement curb was literally his pillow. A group of flies crawled around his eyes and mouth in anticipation of what is to come. The different worlds we live in is profound. Lab tests that are vital to the best medical care as it is found in the USA and done routinely are rarely obtained in Ghana. The referral hospital I work at in Ghana would be shut down in an instant in the USA due to lack of resources. The burden of disease from malaria, tuberculosis and typhoid is immense. The disparity between what is available for health care in USA vs Ghana is unimaginable until you have seen it and worked in it. It constantly brings the question “why”, “how can this be”, “what can or should be done”? Am I blind to the answer?
Dasubah.
Lord Jesus, open my eyes.

August 21st, 2019 by INMED
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Hello! My name is Burton Adrian. I am a practicing physician and I’m starting my INMED service-learning experience at Baptist Medical Center in Ghana beginning in September, 2019.