April 23rd, 2019 by Galit Rudelson

There was a power outage all night, and into the afternoon today. The lights just came back. Honestly, I am going to miss these power outages a little bit. I think they add adventure to life here. And it’s a fun comraderee for everyone to talk about how the power is off. Equally as fun to hear I quick whoop of excitement every time the lights come back on. Today I was showering when they came back, so I did not notice, as I had no lights on in the shower. But when I came out the fan was on in my room, and it was such a plesant surprise, I was excited.
Yesterday I went to lake Bosamtee (sp?), but I will write about that later. I am getting a little behind in my posts. So first I think I should cover my last week in the hospital.
Last week I worked in females wards. This is the inpatient females section of the hospital. The females have one large room, with about 20 beds in it. The males ward is right next door, also one large room with about 20 beds in it. It makes sense to divide them up, as these are not private rooms by any means. The women sleep there, change, shower, and lay ill in the ward. Therefore it would not make sense to have both males and females in the same room.
I began each day with rounds with the doctor. I arrived around 8:00am, and depending how busy the doctor was with other things that morning (I have no idea what he does in the mornings) we started rounding between 8:00am and 9:30am. The patients had various reasons for being inpatient, but some conditions were more common. Out of control diabetes and hypertension was there often. In Ghana hypertension is much more common than diabetes, which I do not completely understand. Their diet consists of mostly carbs, so logically they should also develop diabetes. Maybe it is the lack of fat and artificial sugar that makes it less common. But hypertension is everywhere. Again, unsure of how to explain this, or if its just as common as the US, just harder to control here. Therefore the secondary health concerns from hypertension and diabetes were common: stroke and DKA for example. In the US when someone comes in with stroke like symptoms they are rushed through a workup, including CT scan of the head, and you know your answer within 30 minutes. Here there is no CT scan on site, so they have to be transferred for scanning, up to several days later. So unfortunately the outcomes are not usually very promising from stroke.
Cellulitis, or infection of the skin, is also very common. The doctor asked me if I knew why it occurred so often. I ventured to guess it was because hygiene is difficult in the heat, and with limited water. Furthermore many of the women are farmers, so it is probably easy to cut yourself in the field and become infected. He said that was a good guess, but doesn’t explain why cellulitis happens much more often in females and not males (as they are farmers too.) He explained to me that many women here use topical steroid creams to help bleach their skin and make it lighter. The effects of this are dangerous: causes hypertension, diabetes, and weak skin. Many of these women have weak skin leading to infections, and hypertension that is so bad they have heart failure by their 40s. Kind of interesting that we go tanning until we have skin cancer, and here they bleach their skin until its falling apart. Nobody is every happy with their looks.
I also saw a couple cases of HIV/AIDS and the complications that arise from that (meningitis mostly). Some chicken pox in adults. This one was actually interesting, because I have had chicken pox, and it used to be so common in the US. But I realized that I have never in my working memory seen chicken pox rashes, and therefore had no idea what I was looking at when I first saw the patient. Vaccines are amazing things. Guess we shall see what this anti-vaccine epidemic does. I saw a patient tested for TB, but decided it was COPD instead. The doctor asked me what I thought, and I realized how unprepared I was to distinguish TB from COPD. I had my educated guesses, from all of my studies, but having never actually seen TB in a patient, I was not confident. Just shows that although we study similar medicine, there are vastly different focuses between the US and tropical medicine.
After finishing rounding I would accompany the doctor to outpatient general consultation for the rest of the day. These patients would arrive to the hospital as early as 6am. They would first go through admission to collect their charts (everything is paper chart). Then they would sit in a general waiting area and wait to be seen by a doctor. We spent between 3 and 15 minutes with each patient, depending on how difficult their complaints were. The doctor saw probably about 100 patients a day. He was exhausted every day, and I was too, despite not doing any real work.
Much of the same conditions we saw inpatient were common outpatient. There was also a lot of gastritis (stomach aches) caused by a bug called H. Pylori. Also lots of muscular-skeletal pain that we could do little about. I also saw 3 people come in with broken hips, which is sad, as even in the US with the best treatment, these are very difficult to deal with. Lots of pelvic inflammatory disease in females as well.
All in all, this was a completely different experience from my OBGYN and ER rotations. I felt that I learned a lot while on this rotation, saw diseases I would rarely see in the US, and in general felt comfortable with the way patients were treated