February 25th, 2008 by INMED
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Well, today was the day of tourism fun! We got up early, so we could be at Kakum National Forest right when it opened at 8am.  We figured we’d get a taxi, it’d cost us like 10 Ghana Cedi, and that would be that. Well, turns out, since the taxis know that they have the tourists cornered out here, they charge 30 ghana cedi for the trip!! Highway robbery.  We make a deal with the driver to take us to Kakum, wait for us, and then take us to Elmina after that, all for 35 ghana cedi.  If for nothing else than convenience and ease of mind, it was mostly worth it….

Kakum was awesome! It is this national forest, which is obviously all rainforest. The canopy walk was built in 1994 by some people from Vancouver BC as a tourist attraction.  It stands about 20meters above the forest floor, and is a series of planks of wood connected between wood platforms built around tree trunks, all suspended with cables and ropes. Not for the faint of heart, that’s for sure! We ended up doing it with our own guide and a couple from Holland, which was a ton of fun. Encountered another Ghanian who wanted to know if we were married…par for the course! We got some excellent pictures too.

We then headed south to the coast, where we visited the Elmina castle. It was built by the Portugese, then captured by the Dutch, then captured by the British, then given over to the Ghanians in 1957, the year they got their independence from the British.  The history is absoutely flooring, and the conditions these people were made to live in were totally inhumane to say the least.  We got a tour of the castle, and got to learn about the history, which made the experience even better.  Plus, being on the coast, it’s just totally different here.  There’s a breeze (praise the Lord!), and it smells like salt water, and there are fishing boats (hand-carved) everywhere.  Again, we have some great pictures.

Then we caught a taxi over to the Cape Coast castle, which was more of the same (not that it lessens the experience, I just don’ t have much additional to say about it), situated in a little bit different of a setting.  We got to see the famous “Door of No Return” in that castle, and go through it and back into the castle again, which is pretty symbolic. Again, more great pictures, and more tales of just absolute torture that these people endured.  We learned today that the Ghanians that have more european last names are named thus because they are descendents of babies born to slaves who were raped by the colonists.  Those mulattos think of themselves as superior to the purely African people, and there’s a little bit of a hierarchy because of it.  So interesting, I never knew that.  We learned a bunch more about women in slavery, and different destinies for different women, depending on the mercy of the men, but I won’t write about it, for those of you who don’t want to read about it. Maybe you.

We found out our next STC bus (oh the adventure) to Accra leaves at 1pm tomorrow.  We have to be at the airport by 930pm for our 1130pm flight to London.  You would think that was plenty of time, but as our experiences have gone thus far, we’re not so sure. It was either 1pm or 4am, and we figured it’d be better on our general senses of well being not to have pulled essentially an all-nighter before embarking on our London adventure! Seeing as we’re both people who don’t do well emotionally on little sleep, I’m thinking we were right! So you all can cross your fingers and pray that we don’t get delayed enough tomorrow that we miss our flight!! I’m sure that missing a flight out of Africa would be an adventure, but it’s not one that either of us is excited about embarking upon at this point… 🙂

Here’s to a relaxing evening (we’re going to eat at the restaurant at our botel, and there’s supposed to be this massive bird arrival to a tree right outside the open air restaurant), and a successful trip to Accra tomorrow.  Love to all of you!!!

February 25th, 2008 by INMED
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The kindness and generosity of the people here was shown to us tenfold today.  We had been talking to Phillip (the hospital administrator) yesterday, and told him that this was our last week.  Well, we are sitting in devotionals this morning and time comes for the announcements. Phillip begins to talk about how this is our last week, and how much they will miss us, etc. After he’s done saying what he wants to say, he looks at us and says “now you will say something to us.”  Kind of like, give a speech, and you don’t have the option of saying now.  It just made me laugh! So I said a couple sentences of thanks.  Then he looked to Cam and told him to tell everyone how much he appreciated us and how he’ll miss us.  Get that! Cam was told to give a speech, and exactly what to say! Again, hilarious!  Phillip then presents us each with a wooden statue of San Kofa (a bird symbol that means “back to your roots”, roughly), a necklace with the same figure, and a bracelet with the colors of the Ghanian flag on it. We were so shocked! I’m going to miss those devotionals.  They have a special place in my heart, especially since it was there that I led my first devotional.

The other thing we were asked to do, on the spot, is to recite three Twi words or phrases we had learned.  Luckily, we both passed the test with flying colors, and the whole room erupted into laughter and applause after each of us finished.  Who knew there would be a test at the end of the time? I would have studied harder. 😉  As the weeks have gone on, it has become apparent that the people, especially the older women, are not merely greeting us in Twi, but rather are testing our abilities to learn new phrases.  It’s hilarious! For example, it will be the middle of the day, we will have greeted any given person a couple of times by then, and had been at the hospital for hours. All of a sudden, out of the blue, they will say “Akwaaba” to us (welcome).  Well, the appropriate response is “Yeasong” (phonetically spelled, I’m sure), which roughly means “received.”  All they’re doing is seeing if we know what to say! Such sneaky old Ghanian ladies….  It’ll be interesting to see how much I retain.  Here’s what I’ve learned:

Maa Kye– Good morning;  Maa Ha–Good afternoon;  Maa Kyo–Good evening; Me daase–thank you; Wo ho te sen–how are you?;  E te sen–how are you?; Me hoye–I am good; Eye–I am good; Debe–no; Akwaaba–welcome; yea song–received. I think that’s about it. 🙂

I’m going to miss this place. I’ll miss the peculiarities of the delivery of medical care here (well, SOME of the peculiarities anyway), but moreso I’ll miss the people. Lisa and I have both said to each other that if we get sick and need medical care, we want to be flown to Europe or the States!! And if we need to go to the OR, we want the other person to be present, overseeing everything. 🙂

My man with the huge belly and high potassium is doing much better. Turns out he has massive cardiomegaly, for all of you dying to know.  What probably happened is that he was admitted (NOT by me, thank you very much!), begun on diuretics before lab data came back, got the crap diuresed out of him, which produced some electrolyte problems, that we identified and fixed by stopping the diuresis.  Electrolyte problems being caused by over-diuresis in the setting of failure to check laboratory data before starting the medication…..imagine that…. 🙂

February 23rd, 2008 by INMED
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My patients are all still alive, praise the Lord! I’m rounding on the adults now, so I don’t feel so much like a fish out of water when it comes to my own knowledge base. There was a group here from California today, doing dental and auditory checks on some people.  They are spending 2 weeks travelling through Ghana, doing the same in other small villages throughout the country.  They are all very nice people, and I was able to have lunch with them at the team house today (which I didn’t even know existed until today!).  I came away from the day with them, however, almost ashamed of being an obruni and being associated with them.  That sounds harsh, I know, so let me explain myself a little.  There is probably (Ok, I KNOW there is) a large portion of my own pride issues in that feeling, thinking that after 2 weeks, I’ve mastered how to interact and fit into the Ghanian culture and they have not.  And maybe there’s a little bit of feelings of ownership, like I want to be one of the only obrunis around. How selfish am I?!? But, on the other side of the coin, I definitely had the distinct impression at one point in the day, that we were on this African safari, and the little African children were the animals. We were driving by a couple of the schools, and the children were all crowded around the van screaming “obruni!” like they always do, and here are a group of women, all hanging their cameras out the windows, taking pictures of them. As I type that, I realize that it doesn’t sound like something totally insensitive to do, but at the time, all I wanted to do was to jump out of the van and run from the situation. It just felt so wrong.

Maybe another reason for my reaction to the people from CA was the fact that a few of them were pretty stinking dolled up for being in Africa. One of the women had her hair perfectly done, her makeup perfectly applied, her fingernails and toenails perfectly french-tipped, and her bracelets and necklaces and earrings and diamond rings all sparkling and matching.  Now, there’s nothing wrong with looking nice, but I just think that when you’re coming to work in the midst of a poverty-striken village, wearing all of that is kind of like flaunting what you’ve got in front of them. It just struck me as highly inappropriate.

Then I was talking to a couple of them, and saying something about how friendly everyone in Ghana is, and how impressed I’ve been about that overall. She proceeded to say how her experience has been that people are very pushy and rude about getting people into their shops, and force them to buy things, and yell at them when they don’t.  It just shocked me, because all of that was such a misinterpretation of intentions! They talk loudly, they even talk loudly to each other; they’re never yelling like we interpret yelling. And yes, they are very excited to see people who are going to buy something, so they to what they can to get you to go in their shops.  But if you politely refuse, they won’t get upset.  And if you don’t buy something from them, they are almost always still exceedingly nice to you.  So, what a sad experience for them if they’re interpreting everything so negatively!! We’ve had the advantage of having Cam and Anne to process through things with, so maybe that’s where we have been blessed to understand motives and intentions a little better these past few weeks.

And then, at lunch, a couple of the Ghanians (that I’ve come to know) served us the whole time, while we just sat around.  It felt so wrong that I was completely anxious for lunch to be over, so there wouldn’t be this difference of roles anymore. I tried to get up and help them serve at one point, but they had already got everything ready, so there wasn’t anything for me to do. I just feel like we’re supposed to be coming in the name of Christ to these people, and befriending them, and livinng in their culture, and that having them cook,clean, and serve us propagates thsi master/servant relationship.  We’re these rich obrunis that they’re waiting on.  Now, I’ll be the first to say that it’s nice to have the woman who cleans clean our apartment, and to have them make us meals sometimes, don’t get me wrong.  I’m just curious as to what that does for the relationship or the view of the Obrunis by the Ghanians. Maybe nothing, who knows. I’ve thought similar things when I watch the watchmen at the house open the gate for us to drive in with Cam, or the women at the house doing the ironing and cooking.  But maybe it’s never hit me like that before because I’ve never been put in a direct situation of being physically waited on.  Again, it just doesn’t feel right.

Went into the surrounding villages again this afternoon to do more of the health survey that the community health program is conducting, and again was just struck with the level of poverty these people live in.  Words just can’t do the situation justice, so I won’t even try. I now understand how diseases are transmitted fecal-orally, and how people get diseases from flies, and how animal to person disease transmission happens, let’s just leave it at that.  I had this thought, though, later in the afternoon, that it would be so awesome to be able to come back and do clinics in some of the more remote villages.  Maybe I could be based out of the hospital here, and utilize some of the staff for translation and nursing, but then do week-long clinics in 4 or 5 different villages throughout the region.  How totally rewarding would that be!!! Something I’m tucking away, for a time when I have more freedom with my schedule than residency will allow…..!

February 18th, 2008 by INMED
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So today’s Saturday, and we got up early so we could go into the cultural center in Kumasi with Erica, to do some perusal and general souviners-type shopping.  We got a LOT of great stuff, and I finally got my cloth for an outfit! It’s absolutely gorgeous cloth, and I can’t wait to take it to the seamstress tomorrow in Ankaase to get it made.  So, now seems like a good time to talk a little bit more about general Ghanian culture, since it’s fresh on my mind from our trip today…

We rode a tro-tro into Kumasi, that we caught in Ankaase right by the hospital. It only cost us about 45 cents each, amazing.  Tro-tro’s are everywhere, and in a lot of ways, the easiest way to travel.  They’re these white, VW-type van things, originally designed as 16 passenger vans, but converted to seat about 25-30 people, depending on the day.  Kids sit on their parent’s laps, there is no idea of pesonal space, sometimes there are chickens and such riding alongside you. It’s quite the experience! They kind of look like clown-cars when they’re totally full, people bursting from the seams. Same idea, for those of you who have been to Honduras, as the collectivo there.  There’s this guy who sits at the door, who seems to dictate who gets on an doff by these hand signals and certain taps on the bare metal interior of the tro-tro.  I’ve tried to watch, to see how this guy knows what one of the people (in the midst of the sea of people standing around) on the side of the road wants a ride, but it’s an absolute mystery to me.  It can get pretty claustrophobic, smelly, and hot inside one of those, especially considering that there is no such thing as air conditioning in them, but my two experiences thus far haven’t been too bad.   Maybe I’m being lulled into this false sense of security, about to be awakened by the worst tro-tro ride of my life. Bring it on! 🙂

The idea of retail and stores are definitely different hear (shocker, I know).  With the weather being so hot, most everything is open-air style.  Even the houses in the villages, as run-down and sad as they are, have these open air spaces in the middle of them around which the rooms are organized. The stores consist of these small rooms, with almost ALL their merchandise sitting on the dirt or street in front of the room.  I’m talking rows of tires, old TVs, car radios, fridges, car engines, mufflers, the works.  And each store is dedicated to one type of retail. There are stores, like in this village that is wholly devoted to wood-carving products, where you do go inside the small room to look at their goods.  Those places are especially interesting for an obruni (I’ve been spelling that wrong, by the way. It’s not albruni, it’s obruni).  They immediately surround you, even in each other’s shops, and start asking what you will pay for what they’re holding.  IF you show the slightest interest in something on a shelf, they will grab it, dust it off, and start asking what you will pay for it.  If you say you’ll come back later, they will follow you, and ask if you still want whatever it was you were interested in before.  You’ve got to have a pretty strong resolve to be in a situation like that, or you end up buying much more than you intended, and spending a ton more money! I really like bartering with them, so I have fun with it. It can be pretty exhauting though, if you’re there long enough.

In Kumasi (big city about an hour’s drive away), people like the streets with their goods they want to sell.  They will sit side by side in the dirt by the road, or on the pavement if the sidewalk is big enough, lay out a tarp or two, and have all their goods arranged on top if it.  All varieties of veggies, clothes, shoes, sunglasses, cloth, you name it.  The sidewalks are absolutely packed.  A lot of places will also have peeled oranges and friend plantains for sale.  I stay away from those….I’d rather not feel the ill effects of eating them, if you know what I mean….!  There are also women and men walking aorund with amazingly heavy loads on their heads, perfectly balanced.  They do that all over, and it never ceases to amaze me.  We saw a little boy the other day with a huge bag of charcoal balanced on his head, walking to the next town over.  When I say bag of charcoal, think large bag, previously used as a flour bag, probably containing 15-20 kg, filled with the charred remains of something they use to burn fires.  Young women with bowls of water bags, plantain chips, etc. will stand on the roads and go up to the cars, tro-tro’s, busses, etc to try and sell their stuff.

Something else fascinating to me is what happens if you refuse to buy something from someone.  They are still as nice to you as they were before you said no!  I refused to buy something from someone today, and he wished me a good day and said God Bless.  Even in rejection, Ghanians are the nicest people ever! Now granted, we have had plenty of over-friendly people talk to us too! I had one guy come up to me in the tro-tro station in Kumasi (utter chaos, through and through), and ask me if I loved him. Before I could reply, he said “I love you, do you want to love me?” and repeated this over and over until I just smiled and walked away.  How endearing….!  And another guy who I bought a little figuring from asked me if I was married. I must admit, I told the smallest of white lies and told him that I was. It was just easier than dealing with the consequences!

I’m almost done with my 600 page book (Woman in White, for those of you who care….an amazing, suspensful book!), if that gives you any indication of the laid-back atmosphere of life here.

I can’t believe that we leave a week from tomorrow!  It’s way too soon.  We actually looked into changing our plane tickets, so that we would be in Ghana longer and London for less time, but turns out that it would have cost us about $650 each in order to do that. Hardly worth it.  I guess we really do have to leave.  I wish we were here for a few more weeks at least.  I also have this not-so-fleeting wish that I could change my ticket from London to Seattle to something more exciting like London to somewhere-else-in-Africa.  I’d totally look into it, except getting a visa this last minute would be a headache, especially living in a remote village like Ankaase. More adventures will just have to wait I guess…

February 17th, 2008 by INMED
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I don’t know if I wrote previously about a little baby with a raging infection, but Lisa is watching this little newborn girl born to an 18 year old with HIV, unknown whether or not she took her HIV medications during pregnancy or not.  The baby was running a fever and had an elevated white count, both things that Lisa discovered through being assertive, things that would otherwise never have been found, as newborn care is one of the areas that is in need of improvement here (it’s currently almost nonexistent).  Well, the baby obvioulsy has an infection of some kind, but we have no method of finding out where.  We cannot do blood cultures to find out what bug is the culprit.  Lisa and I decided to start ampicillin and gentamycin to cover everything, and we write the orders.  Come to find out, the next day, the orders had not been done, because the midwife “didn’t like” putting IVs in newborns, and she said the mom couldn’t pay for the medications.  In talking with Cam later, it was probably mor eaccurate to say that the midwife didn’t know how to put an IV in newborns, and was covering over her lack of knowledge, and that it wasn’t the standard of care to withold antibiotics on the basis of ability to pay.  So the baby is in the hospital, probably infected, and is getting no treatment.  Once we alerted Cam to the situation, he talked to one of the Ghanian docs, who went and saw the little girl the next day and put her on antibiotics, and she’s doing better now.  Such a broken system, yet so much better than what was available before this hospital existed (ie, nothing).

I wonder why I’m not getting more worked up about the sub-standard care here.   Does that reveal apathy on my part? Should I get angry about my diabetic patient, or about the septic newborn? Sometimes I wonder if my lack of outrage is representative of a failure on my part to totally emotionally involve myself here.  But then the other side of me things that getting outraged about those things, first of all, is going to accomplish nothing for anyone.  This is the system that is in place, like it or not, and we need to be able to function within it as best we can and deliver the best care possible while we’re here.  These patients are still better off getting care that we Americans view as substandard, than having no care at all.  So maybe my unemotional response to things is just my rationalization of the situation.  Maybe I’m just intellectualizing the situation. I don’t think of myself as a callous person, but am I being callous? I think I would argue that I’m not being callous, that I’m choosing to focus on the good in the situation while doing my part to remove the bad with the best healthcare that I, as a 4th year medical student, can provide.

Just a peek into the inner workings of Crystal’s mind.  Run scared, I know I would 🙂

I still think about whether I could do something like this full time.  I know that a big part of why everything is so fun for me is because it’s all so new and exciting.  When the newness wears off, would it still be fun?  Could I function long-term in a hospital setting like this, where there would be so much change that needed to take place, and I would have to pick and choose what was most important for now? Sitting in church today, I was struck by how hard it would be for me not to have my “traditional”, “American” church services, with the sermons in English and delivered in a style that spoke to me, with the worship music of a kind that I was familiar.  Also, to not have a community of belivers with whom I shared a common culture and similar way of life, selfishly, would be excruciating.  Maybe all of that means that I would need to be somewhere not quite as isolated as this.  Maybe it means that I’m not meant for long-term mission work–I don’t really know.  Maybe my interest in critical care means I’m bound for the ICUs of the states! I’m sure that all of this will become more clear as the years go on….God tends to be good like that!

February 14th, 2008 by INMED
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Today, we saw our first baby with SEVERE dehydration.  It was heartbreaking.  The baby was 2 months old, his mother had died in childbirth, and he had been admitted yesterday afternoon and promptly (it seems) forgotten.  The nurse overnight seemed to be fairly good, as far as Ghanian nurses are concerned. At least he wrote down the baby’s temperature, and incredibly quick heart rate and respiratory rate, even if he didn’t actually call a doctor.  They hadn’t even drawn any labs or started basic fluids on him by the time we saw him in the morning, even though both were ordered yesterday afternoon.  He had an impressively sunken fontanelle, pronounced skin turgor, respiratory rate in the 60s-70s, hear rate in the 150s.  Obviously sicker than stink. They just let him lay there overnight, and did almost nothing.  Long story short, we all got involved this morning and the baby ended up getting transferred to Okomfo Anokye hospital in Kumasi (the huge teaching hospital about an hour’s drive from here), praise the Lord. We didn’t even have any oxygen to administer to him.  He should have been intubated hours ago, but if he suddenly stopped breathing, we had no way of intubating him or recusitating him at all.

It was just so frustrating to know that the baby had been laying there all night, with no real therapeutic interventions made, and that if he dies, it will be because he didn’t get adequate care.  THIS  is how kids die of dehydration so regularly in developing countries.  There is just this cultural inability or unwillingness to react to emergent situations, and it can be infuriating sometimes.  Cam handled the situation with amazing calm, staying true to his ideals of preserving relationships at all costs. He was obviously distressed about the situation, but never once yelled at anyone or got angry at any specific person.  I truly wonder if I could function in an atmosphere like that, I think I might go nuts, simply for the knowledge of everything the patient’s WEREN’T getting. It would be hard to remember everything they ARE getting by being in the hospital at all.

Other firsts: first clinical conference at Mampongteng (Cam talked about bacterial meningitis, and the standard of treatment here), first experience with African drug reps (yes, they exist over here as well!), first experience with fish balls (well, Lisa’s first experience, and then she strongly urged me NOT to try them…), first trial of Malta (malt beverage). People have been right; Malta tastes like a mixture between straight molasses and liquid rasin bran. Needless to say, we did not finish them. In fact, they were mostly full when we handed the bottles back. 9

The drug rep talk was actually pretty exciting, even I have to admit that. There is this new pharma company called LeGray whose entire focus is creating pharmeceuticals that are entirely produced and distributed within Africa. Currently, there are tons of drug companies, but all of them import the ingredients for their pharmeceuticals from other countries, and so rely on the markets of those countries. This company, whose parent company and therefore source of funding is based out of Illinios, would be entirely independent in that regard.  They are currently working on artesunate (an antimalarial we have become quite familiar with), and are trying to get approval from the WHO to begin manufacturing antiretrovirals for HIV.  The exciting thing, among many, about producing these pharmeceuticals in Africa is that the costs would probably be incredibly reduced.  Currently, 70% of drugs in Africa are imported, and 25% of drugs in Africa are sub-standard (including completely fake).  So companies like this would do so much to improve the state of pharmeceuticals in Africa. How exciting!!!

We had dinner with Cam and Anne, and tried fu-fu for the first time finally. There were two types: casava and plantain based, and yam based. It’s this pastey/doughy food that you eat with soup (our soup had chicken in it).  It was really good, and I hope to get it again before we go! The best part about the whole thing is that you eat it with your fingers!  There’s nothing better than some finger food with friends.  Caylor (Cam and Anne’s 10 year old daughter) made us all Valentine’s hats to wear with dinner, and we played Apples to Apples afterwards. All in all, a most memorable Valentine’s day!

February 10th, 2008 by INMED
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Another day at the hospital, which brings with it so many adventures. Lisa and I are starting to feel more comfortable with the medical independence we have here, and are more confident in the decisions we are making. We no longer feel the need to run everything by each other, and we’re spending our days doing different things, one of us in consults, and the other usually in casualty.  It really is true that most people in consults have malaria or typhoid, so you really can’t go wrong with prescribing one of those two regimens (if not both) to any given patient. I heard somewhere, maybe from Cam, that about 40% of outpatient visits are for malaria. I also worry about my diagnostic abilities because of that, since I have malaria and typhoid in the back of my mind. I worry that I’m making snap judgements on cases when there could be something else to explain the symptoms.  It’s hard to think about the fact that we’re both probably missing a lot of diagnoses on our patients, simply because we don’t have the training to recognize the symptoms. I just pray that I’m not missing anything life-threatening.

The independence is starting to be kind of fun, although still a little terrifying when I really think about it. I feel like I’m contributing the most to healthcare here when I’m working in consult, because then I’m able to help out the other providers by seeing patients, in order to lessen their loads a little.  For better or worse, I try to keep myself from thinking about everything that these patients are missing out on by being here, rather than a country with more resources for healthcare, because I think that could easily drive me nuts. For example, Lisa is watching this newborn baby girl who has a temperature and an elevated white count (ie, infection). No one seems to be paying much attention, so she and I started the baby on some antibiotics to protect against the big infections that newborns are susceptible to, in addition to typical malaria meds. The mother can’t pay for the antibiotics, and the hospital won’t administer them without payment, so the baby is not being treated. It’s totally maddening to think that this baby may well die from this infection that is so treatable with simple medications that are available in the hospital, all because the mother does not have money. And I’m sure there are tons of other patients not getting their treatments because of similar situations.

I know that the US is a payment-based system, but we have things like county hospitals, and things like emergency rooms, that cannot turn patients away, and that will treat without paying attention to ability to pay.  Lisa and I have had many discussions about whether healthcare is a right or a priveledge based on our time here.  I’ve got to be honest; beacuse of what I’ve seen, and the huge impact that poor healthcare has on people living in poverty, I lean towards healthcare being a right.  But maybe it’s more correct to say that healthcare is a priveledge that we should work our rear ends off in order to make avialable to all. I don’t know, all I know is that witholding care due to lack of ability to pay does not seem humane in the least.

Ok, I’m off my soapbox. If any of you have anything intelligent to add to my ramblings, by all means, please speak up. 🙂 There was a heat lightening storm tonight that was totally beautiful.  Reminds me of being in Honduras, and makes me miss it a little!

The stir-crazy factor is getting stronger. Maybe it’s a little bit of culture shock kicking in, or maybe I just don’t have any attention span to speak of, or maybe Lisa and I have been spending just a LITTLE too much time around each other lately, considering we don’t really do anything without each other 🙂

February 8th, 2008 by INMED
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I spent most of today in labor and delivery. There was an 18 year old that had to go to c-section when I first got there, so I got to watch that whole process.  The first thing that struck me (no pun intended…read on) was that when they were checking her cervix (sorry to all of you for whom that’s too graphic), she was obviously yelling (which is to be expected, that’s painful when you’re in labor without an epidural!), and one of the nurses reached over and SMACKED her on the thigh to get her to stop yelling. I’m sure there is a very good explanation for it, and it is just part of the culture, but it shocked me! The noise alone sounded really painful! They took her to the theatre, and I got to watch the operation, which was done, mind you, by the general surgeon.

This hospital has two surgeons, both Ghanian, and they do all the operations, no matter what it is. Their form of sterile draping is washed sheets that have had squares cut out of the middle of them for the surgical field. The suction canister still had fluid from the last operation in it, and the suction tubing was an old, yellowing, rubber tube with an open end. There was no drape to split the anesthesia area from the operating area, and the only cansiter of inhaled anesthetic (obviously not used on her) was halothane, something that is not used in the US anymore because it’s toxic to the liver (correct me if I’m wrong, all you doctor types!). There wasn’t much special to the c-section, except that there was a lot more ripping by blunt force than cutting with a scalpel, which makes me wonder how the suturing after the fact goes. I didn’t stick around, because surgery bores me. I headed off with the baby back to the labor and delivery room.  Sterile technique outside of the theatre is also grossly missing, but I guess that’s to be expected.

One of the ‘helpers’ told us she’s going to make foo-foo for us. It’s this casaba and yam based staple here that everyone eats, and it’s supposed to be pretty good. There are a couple other staples that I can’t remember the name of, one of them is maize-based, and we’ll hopefully get to try them too….

We went on the TB rounds today to the village, and it was so enlightening. These people live in absolute poverty. They live in these cement buildings, with sheets for doors and windows, sitting in the dirt preparing meals or playing or just sitting. There are flies and bugs everywhere, and most things are pretty dirty. But everyone is so friendly, and they run to get us chairs to sit in, which are always offered to the white (albruni) girls first. We got to chat with the patients while the pharmacist interpreted for us, and learn about how they are doing, and how the medicines are helping, etc. Then we would get asked a bunch of medical questions by whoever was around, and we would just end up telling them to go to clinic so we could see them.  They get this look of absolute joy whenever we use the Twi words we know, and I know we must sound so foolish saying them, but it’s so fun to make them laugh! Seeing how they live, part of me feels really guilty for the relative luxury we are living in here.  We really are these rich white people who have descended upon them to help them.  Erica (a teacher whose sole purpose is to be here and teach Kaylor, Cam and Anne’s daughter) told us that there is this old saying that if you see an Albruni walking down the street, you can pretty much just die, because that is the closest you will ever get to seeing heaven on this side of death. I just can’t even comprehend that kind of thinking.  I know that my worth is no different than theirs, but they have been raised with such a different line of thinking. It’s astounding.

The evenings are filled with sitting around, journaling, doing devotionals, and reading our books, which was great for the first few days, but I’m starting to get really tired of the monotony, and am hoping that the weekend, will bring a much-needed change of pace.  With that said though, the days are nothing if not amazingly varied and totally unpredictable, which is awesome!  I think it’s just the American way of life instilled in me, where I feel like I have to have something to do every minute of every day. Sitting still is something I have never been that great at….

February 4th, 2008 by INMED
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One word sums up this day: WOW.  The other phrase that comes to mind is: trial by fire.  Ok, from the beginning. We came to the hospital this morning with Cam, and he introduced us to everyone. People here are so friendly, and so welcoming, which makes the transition much more smooth than it might otherwise be.  I’m sure it helps that we’re 2 of the only 3 while (albruni) people at the hospital, so we’re hard to miss! There’s a big teaching hospital in Kumasi, that sounds like it functions more like a european hospital, but this is definitely more rudimentary.  We got a tour of the hospital, which didn’t take long, and I was amazed when Cam walked us right into the OR (theatre) with our street clothes on! Apparently that was ok since they weren’t operating that day!! Absolutely crazy. I’m starting to see how diseases are so easily transmitted here.  Granted, Cam would make so many changes if he could, but his goal is to have this hospital function within the Ghanian system, and be self-sufficient and entirely run by Ghanians, so, as he says, he picks his battles. What I keep reminding myself is that even when things are so drastically different than the way things are done in the US, the way this hospital cares for patients is still 300x better than what they would otherwise have available to them: nothing.  But I’m getting ahead of myself….

After our tour, we were basically cut loose. Now, for those of you non-medical types, here is how a 4th year medical student functions in the US: we see patients, come up with our ideas about what is going on and how we want to treat patients, and then run everything we want to do by our resident or fellow or attending before we even THINK about writing an order. Then, the nurses won’t even do anything we say unless we have the signature of one of those forementioned people.  Well, things are a LITTLE different in Ghana. Picture this: Lisa and I (both 4th year medical students) sitting in a little consult room, maybe 4 feet by 7 feet, by ourselves, with one of the ‘helpers’ to translate what we say into Twi and vice versa, and the patient. Oh yeah, and we have a list of the medications that we have available to us, a couple little booklets from the US to help us with dosing and indications, and a prescription pad. WE’RE TOTALLY BY OURSELVES! At first, we’re trying to run things by Cam, like we would in the US, but it’s quite apparent from the very start that he is thoroughly confused as to why we are even talking to him at all.  So we quickly figure out to just go with our guts, and only grab him when we really don’t know what we want to do.  And that turns out to be whenever we think that the patient needs a much more extensive workup than they really do, or than is available to them or us, and Cam has to give us a quick lesson in the realities of Ghanian medicine.  So we spend the entire day, glued to each others sides (Lisa and I), running our every decision by each other, terrified that we are idiots and going to kill these people who are convinced that they are getting the best care possible because we are albruni.  We also learned quickly that, when in doubt, treat for typhoid and malaria.  Most every complaint here (vomiting, diarrhea, nausea, headache, fever, etc) can be attributed to malaria or typhoid unless there is another blatanly obvious cause. By default, we are getting pretty adept at treating those conditions.  That’s been a big mindset change. I’m convinced that I’m going to start residency with this compulsion to put everyone on malaria treatment, and the program is going to be questioning why they let me in!

Cam gave us our schedules today, and it turns  out that we get to get involved with a bunch of community outreach opportunities, which will be such a great way to get out and see how these people live, and what are the things that affect them the most.  There is a TB visit that happens on Tuesdays, when one of the pharmacists goes to see all the patients in the village with TB (not that many), to see how they’re doing with the medications, and if there are any side effects. They have to come into the hospital every day for their meds, but this is an additional kind of catchment system I think.  Then there’s this ‘Community Health Evangelism’ program on Thursdays, where they go to several different villages and implement basic healthcare knowledge about malaria, diarrhea, clean water, healthy eating, when to go to the doctor, etc.  That’ll be an awesome way to get out and see different villages, I’m sure. We each spend a day in the theatre, and a couple days a week in casualty, in addition to the rest of the time in the consult room, where it seems they need us most.

The staff does devotionals in the morning on Tuesdays and Thursdays, and Cam signed Lisa and I each up to do devotionals once. Yeah, again, for those of you who know me, I am basically terrified of this. 🙂 But, I can’t really complain, I prayed that I would be taken out of my comfort zone.  What better way than to get up in front of a bunch of Ghanians, who barely understand me, and give devotionals! I’m scheduled for Tuesday, Feb 12th, so you can pray for me on Monday night (for you guys) that it’s going well!! Oh, my stomach flips just thinking about it…! They do a devotional time for the patients on Monday, Wednesday, and Friday mornings that is optional. We go, but it’s entirely in Twi, so I don’t know what they’re saying. After that, one of the nurses gets up and gives a talk about some health topic of her choosing, a kind of teaching session of sorts. This week, she’s doing breast cancer and cervical cancer one day, and TB another day I think.  All in all, there are just so many great programs going on here.

Anne (through the donations of churches and people in the US) is having a library built in the village that is pretty close to being done. We went and saw it today, and it’s gorgeous! She’s getting books in English and Twi donated to use, and it should be open by August. What a great way to further educate these kids. You should see the schools here…they are mostly just cement buildings with some wooden chairs inside. It’s absolutely amazing to me that people live this way.  But I’m sure you don’t even question it when you’ve seen nothing else.

The other commonality of African life we are getting accustomed to is ants.  They are everywhere. Not the big ones like we get in the states, but the little tiny ones. If we don’t wash the food off our dishes, or fail to do the dishes at night, or leave anything out on the counters, we will have a line of ants to greet us in the morning.  Pretty gross, but I’m sure it won’t even phase us by the time we leave.

I’m learning more Twi, and trying to use it as much as I can. They mostly laugh when I say Twi words, but I’ve been told that laughing is a sign of approval, so I’m hoping that’s true! The only bad thing about saying things in Twi is that people think I speak Twi, so when they rattle off with their answers, I’m totally at a loss! The other thing I’m learning is how to speak with a Ghanian accent so they understand. It’s amazing to listen to Anne and Kaylor speak with the Ghanians, because they sound just like them! I’m trying to learn it mostly because it makes it so much easier to talk to them! They can’t really understand my slurred speaking otherwise 🙂 Plus, it’s kinda fun. Lisa and I catch ourselves talking to each other that way, which always makes us bust up laughing!

February 3rd, 2008 by INMED
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Well, we experienced African church today….it was awesome! Granted, it was entirely in Twi, so we didn’t understand a word that was said. It started around 945, and didn’t get done until 1245! There was a ton of singing and dancing, people were dancing in the aisles, and up in the front of church, there were tambarines and drums, such energy. They do offerings just a little different than the US…they put these plastic tubs on stands in the front of church, and then people get up, during songs, and basically dance up to the front and put their money in the bins. Everything is held in the right hand, because the left hand is considered dirty. They had I think 3 different offerings, which I’m told is usual for the first Sunday of the month. There was one for someone at the hospital who couldn’t pay their bill (they don’t discharge people here until they pay!), one for regular offering, and then one that was based on the day of the week you were born. Here, everyone has a name that indicates when they were born. Me, being born on a Monday, my name is Adjuah (not the real spelling, but how it sounds phonetically). They have an easier time remembering that name than my English name! It was a big party, and the time flew by. They also had us go up and introduce ourselves, telling who we were and why we were there.  Yeah, if you know me, I was NOT excited about that. 🙂 But this trip is all about getting out of my comfort zone, so I knew it was good for me!

The African Cup of Nations is going on right now, and Ghana is doing awesome. For those of you who don’t know, it’s the big soccer championship between all the African countries, and happens every other year (I think). The last time (2006 I think), Egypt won. This year, all the games are taking place in Ghana, in 4 different cities, one of which is Kumasi. We watched Ghana play Nigeria today, and Ghana won, which means they’re going on to the semi-finals on Thursday. Cam said that we’re going to get to go to one of the Kumasi games, and it’s looking like it will be on Saturday, for 3rd place. I’m so excited, that’s going to be awesome! Can you imagine, a championship soccer game in Africa?!? And it’ll only cost 4 Ghana cedi (about $4) for the tickets.

Cam gave us a phone to use today if we want to, but I almost feel like I’m cheating myself out of the whole Africa experience by calling home on a cell phone, especially when I’m only going to be gone for a month. Mom and dad, sorry 🙂  You’d think I’d have the same line of reasoning with the hot water heater in our place, but I’m admittedly inconsistent with my convictions on that one!  Tomorrow is hospital day #1…I have no idea what to expect.