Dr. Haun

June 28th, 2018 by melindaroney
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This week Alex and I have been working with Dr. Haun, the surgeon here at BMC.  She is amazing!  She is the only full time surgeon here.  She had a brief respite when Dr. Faile was here but otherwise she is on call all of the time.  She is a wonderful example of a Christian woman.  She does the work that several surgeons back home would be doing (on call all the time, handles all emergency surgeries) and does it all with an attitude of service and a smile!  She is also a wife and a mother.  I am certain God is glorified by her life.


Today was a difficult day in that she had a patient who presented with an acute abdomen late yesterday.  She is in her 50s or 60s we think (many people over here do not know their age) and had 4 days of severe abdominal pain and bloating.  Her abdomen was quite distended and her exam was consistent with an acute abdomen (inflammation of the lining of the abdomen usually from a perforation of something in the abdomen, needing surgery to fix it).  She got IV fluids, a catheter and an NG tube overnight.


This morning Dr. Haun was ready to take her to surgery but the anesthesiologist was uncomfortable as she was breathing fast.  Her oxygen saturation was good and her pulse and blood pressure were fine.  The chest x-ray and abdominal x-ray had not been done for some reason (a fairly common occurrence).  Her sono showed what looked to be thickened and dilated bowel.  Her hemoglobin was 8.  He wanted her to have a transfusion, so that was done.  By 4 PM she had had the blood but was actually looking worse.  Dr. Haun talked with the patient about the high risk of her surgery but that she would likely die without the surgery.  The patient said “Take me to surgery and if I die they can take me home and bury me”.  Her family was not around at the time but others heard this statement.


The anesthesiologist was not comfortable without the family being in agreement.  She had 3 sons, 2 of which finally arrived to discuss her prognosis.  One son was intermittently contacted by phone.  There was also a daughter there but she did not seem to be a part of the decision making process.  The sons said they would take her home to die, stating that mom was not in her right mind.  More conversation ensued with the anesthesiologist, most of which centered on the cost of surgery/hospitalization and that payment would be required irrespective of outcome.  Dr. Haun pointed out that mom wanted surgery even if there was a possibility she would die.  The anesthesiologist seemed to indicate that it was the sons’ decision.  After more deliberation, they came back and had decided that she would have surgery.  This was 6 PM.


The approach to consent in a high risk, emergency situation was quite different in Ghana than the US.  I felt myself wanting to say “she wants surgery!” and “she is of sound mind!” Alex turned to me and said “don’t worry, if anyone is asking us (my 3 sons) about your potentially life-saving surgery, I will say “do the surgery”!  Good to know…


We did operate on her and Dr. Haun removed her dead bowel due to a sigmoid volvulus (her intestines became knotted like a garden hose and a section of large intestine died).  She now has a chance to lead a normal life, barring complications in her recovery.


Also we saw a great example of compassion as Dr. Haun consulted on a boy with an osteosarcoma.  The boy is about 12-13 and presented 4 months ago with a swelling in his leg above the knee.  At that time, Dr. Haun thought it was cancer of the bone and recommended an amputation.  They wanted to see an orthopedic specialist in Tamale.  He also recommended an amputation.  They came back to clinic this week to see Dr. Haun for surgery.  The leg is now the size of a basketball, from above the knee to the groin.  He has palpable lymph nodes.  Dr. Haun sat down with the boy’s father and explained the situation and expressed how sorry she was that there was nothing she could do.  She told him about her faith in Christ and that although there is sickness and pain in this life, eternal life is free of those things.  She made sure he understood the gospel and then asked about his son’s understanding of his condition.  His father said he was aware as the chaplain had spoken to them earlier.  She asked if his son knew about Jesus and his father said he did.  She asked if she could talk to his son about Jesus and pray with him.  He agreed.  She presented the gospel to him in Mampruli and we all prayed with him.  A large group of nurses were also there to hear the gospel. Please keep him in your prayers for comfort and strength in the days to come.


So we saw Dr. Haun (with God, of course) save 2 lives today:  one physical and one eternal.  This week we have also seen her plant innumerable seeds of God’s love through service to others in her words and actions.

The Patients

June 20th, 2018 by melindaroney
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I have been seeing patients for 2 weeks now.  Both in-patient and out-patient medicine are much different than at home.  Diagnoses are made clinically for the most part.  We can do a malaria test, a complete blood count, blood type and cross match for a transfusion, clotting times, blood sugar, Hepatitis B and C, HIV, sputum testing for TB, urinalysis, urine pregnancy testing and stool for ova and parasites.  They can analyze a few things on the cerebrospinal fluid to help diagnose meningitis.  We have x-ray but it is not always in a timely manner.  The doctors here are quite proficient at sonography.


There is a ton of typhoid here.  This is related to sub-optimal sanitation.  Headache, fever and abdominal pain are the usual complaints.  Malaria presents with similar symptoms.  We haven’t seen much malaria yet as it is just the beginning of the rainy season.  Everyone with this clinical picture gets a malaria test and if negative is treated for typhoid (with an antibiotic).  A major and common complication of typhoid is a perforation of the small intestine.  These patients present with an acute abdomen.  Surgery is life-saving.  I watched Dr. Faille do a repair 2 days ago.  This boy had only one small perforation, but it had allowed bilious fluid to escape into the peritoneal space (inside the abdomen but outside of the bowels and organs).  He closed the hole with suture.  Then he took the bowel wall about 1 cm from each side of that area and stitched that together over the closed perforation.  He said this will reinforce the repaired bowel. The peritoneal space was then suctioned, irrigated and suctioned again before the patient was closed.  This took about 30 minutes.  He repaired 4 perforations on a patient yesterday.  He had another repair today.


Snakebites are a huge problem here.  Since it is the beginning of the rainy season, everyone is farming.   The bites are either from the carpet viper or spitting cobra.  Most bites are on the feet or legs.  The snake venom causes a bleeding disorder.  The patients are hospitalized and receive anti-snake venom until the bleeding disorder is corrected.  If the leg is significantly swollen the patient is also treated for cellulitis and given tetanus anti-toxin.  Each vial of anti-snake venom costs 200 cedi (about $45 in the US).   The usual dosage need is 2-4 vials.  This is quite expensive for most people and is in addition to the price of hospitalization.


Everyone must pay their bills here, in cash.  Even with the state insurance, the bill must be paid before discharge.  Hospitalization is fairly reasonable by our standards, since BMC is a not-for-profit institution.  I saw a bill of 1150 cedi for surgery to repair typhoid perforations with 3-4 weeks of hospitalization due to complications.  That is around $255 US dollars.  My understanding is that at the larger hospital in Tamale, it is more expensive.  Apparently they want you to purchase your own supplies like IVs, catheters, etc. and once you acquire these items they will use them to treat you.


My third day rounding I saw a woman die of tetanus.  It was horrible.  There was nothing anyone could do.  Her teeth were clenched and she could not open her mouth.  Her head was drawn back due to the muscle spasms.  Anti-toxin and muscle relaxants were given but could not overcome the spasms that prevented her from being able to breathe and clear her saliva.  Google images of “lockjaw” and “opisthotonus” and you will see what I saw.  Then make sure your tetanus vaccine is up to date.


One of the men on the floor was unresponsive when we rounded one day.  He had had a stroke and was showing signs of increased intra-cranial pressure.  He died later that morning, on the floor, with family nearby.


I saw a lady about my age in clinic for a boil.  She told me she had been having it treated locally by a healer, but that it was not better.  She also showed me a black ulcer on the bottom of her foot about the size of a half-dollar.  She said it started like a mole but had grown to the current size.  The “boil” was a hard mass the size of half a football in her left upper thigh/groin region.  She received her clinical, terminal diagnosis of metastatic malignant melanoma in clinic when she expected to get treated for a boil.


I saw a 58 year old woman today who had post-menopausal vaginal bleeding for the past month.  Her exam was consistent with a cervical cancer with at least local spread.  She was referred to a Gyn specialist ASAP in a larger city.  I hope she can afford treatment (if there is treatment here) for her stage of cancer.


Dr. Faille told me about a patient he had seen with esophageal cancer.  He thought it was at a treatable stage.  He referred him to Tamale.  For some reason, the doctors there repeated much of what had been done here before the referral.  When they were ready to treat him for the cancer, he could not have the treatment.  He had spent all the money he had on the testing.  He died of his esophageal cancer, twice evaluated.

The Hospital

June 10th, 2018 by melindaroney
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I have completed my first week in the hospital and clinic. I started out rounding with Dr. Tim Cahill. We start in one of the men’s wards and then proceed to the second men’s ward, the two female wards, then onto Peds if need be. The Ghanaian doctors would start in the pediatric or female wards and we would work toward each other so all of the patients are seen in a timely manner. Sometimes one or more of the doctors are doing C-sections or procedures. Most all of the deliveries are done by nurses who have trained as midwives so we have not been to OB.


The first male ward (as an example) is is a rectangular area around 20′ x 40′. It has 13 beds around the periphery. Sometimes there is a chart with an “x”, like 1-11x. That patient is located in the first ward and is on the floor next to bed 11. If the chart says “veranda-2” that means he is in the hallway. They do a good job of doing what is needed to accommodate all of the patients. The patients never complain and hardly ever express any sign of pain. Most patients bring 1.5 to 2 yards of fabric to serve as a sheet on the bed. Some (usually the men) just lie on the bare waterproof mattress. There are sheets on some beds but those may be limited as not everyone has those. If hospital linens are used on a bed, the next patient may use the same linens after that patient has been discharged. The patients on the floor are usually given a sheet of plastic or may even have a mattress on the floor. The room and the floor are clean and there are usually no odors. There is a small wooden bench for a family member to sit at most beds.


The family usually comes to stay at or near the hospital with the patient. There are courtyards and shelter where they can prepare food, get water, etc. Patient’s families supply their food. There is no cafeteria or food service here. There are no drinking fountains. There is of course no air conditioning, but with all of the windows open it is fairly comfortable. There is no shortage of nurses as there is a nursing school nearby.


There is an incredible sense of community that I have observed. If we are speaking to a patient with a translator and are not “getting it”, the patient in the next bed might jump in and help explain, especially if he speaks English. I was seeing a boy (children are often in the appropriate men’s and women’s wards as well) and the nurse could not find his parents, so our snakebite patient in the next bed got up to help. The patients and families do not seem to be concerned about privacy. One of our patients had hallucinations the day before and his sister was having trouble telling us what happened. The mom of the boy in the next bed chimed in and explained what she observed. I have observed the same sense of community in the clinic. In clinic 4, where I have seen clinic patients, we have had 4 providers and 4 patients at the same time. There is a desk in the middle and 3 providers sit at the desk with a chair for the patients next to each provider. One provider is against the wall. We all share one exam room. There is a staff translator at the desk. I had a patient who was there for her 6 week post-partum visit. Before entering the exam room, she handed her baby to a patient seeing one of the other doctors. This woman happily accepted her baby and held him while continuing to talk to her doctor. Those of us new to Ghana thought that was really neat!

Melinda Roney, MD

Our welcome to Nalerigu:

June 5th, 2018 by melindaroney
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It has been an eventful 4 days in Nalerigu!  We flew into Accra, the capital of Ghana, which is on the coast.  From there we flew north to Tamale (pronounced TAH-meh-lay).  William (a missionary from the US) and his son Trey picked us up in Tamale and then drove us 2 more hours into Nalerigu in northern Ghana.  We passed many people planting crops (by hand) as it is the beginning of the rainy season.  When we arrived we were welcomed to the Guesthouse and were shown around the grounds of Baptist Medical Center.  The accommodations and grounds are quite nice. We toured the hospital and were introduced to some of the nursing staff on the wards and some of the doctors.  The hospital has 2 male wards, 2 female wards and a pediatric ward.  They have a maternity ward which is staffed by midwives and also have an isolation ward.  Surgery is called “Theatre” and they have 2 good sized ORs and a few procedure rooms.  We also saw the lab, pharmacy, the clinic area and the x-ray room.  There are 6 physicians here, 3 Ghanaian physicians and three from the US.  I am working mainly with Dr. Tim Cahill but his wife, Dr. Laurie Cahill, is a physician too.  Both are family physicians.  Laurie has just started back part-time as she has been raising and home-schooling their 3 daughters.  Dr. Heidi Haun is a surgeon and is married to William.  All are missionaries serving the people of Nalerigu and the surrounding area.

On Sunday, I rounded with (observed) Dr. Tim.  They invited us to go to church with them in town.  It was a simple, beautiful one room church.   The sermon was from John 8, mostly in Mampruli but some in English.  God is “”nah-WOO-nee”, and Jesus is “YEE-sa”.  Most in attendance were women and children since the men were planting crops.  After the service we met Pastor Alex and his family.  Pastor Alex also works in the pharmacy at BMC hospital.

Later that afternoon many people gathered to play Ultimate Frisbee on a field near the Guesthouse.  Alex (my son Alex) played the entire time and had a blast.  I spent some time talking with Laurie and her two older girls as well as one of the Ghanaian physicians’ children.  The children showed me the large population of bats that live in the trees in the complex, which is really cool since I love bats.  They are very large bats!  The Cahill girls showed me that when you clap all of the bats take flight.  The bats are odd in the sense that they are active in the daytime, not just at dusk.

Later that night the Hauns invited people over for “movie night”.  We met some teachers from Germany who are in town teaching at the school in Nalerigu for a year.  In other “critter news”, the Hauns have camel spiders in their driveway.  I have yet to look at them as I do not care for spiders.  I have just heard Alex and Stefano say “That’s a big spider”.  Should I see one, I will remind myself what William said, namely that they are not spiders and they eat insects (which is probably why the reside under the Haun’s bug zapper).

In the next blog I will focus more on the patients, diseases of poverty and giving the best care possible with limited resources.  If you are interested, google Baptist Medical Center Ghana to see some pictures.  There is also a great video featuring Dr. Haun regarding BMC’s mission.

Melinda Roney, MD

Introducing Myself

May 30th, 2018 by INMED
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Hello! My name is Melinda Roney. I am a Practicing Professional, and I’m starting my INMED service-learning experience at The Baptist Medical Center in Ghana beginning in June 2018.