Janie Hemphill’s Blog

Market day, Friday clinic, & the Chief’s palace

The week started by saying goodbye to Heather and Kate.  I was moving in to Kate and Julie’s room in House 6 as Kate was packing up to leave.  It was sad to see Isaaku drive them away in the van.  Bonds form easily when people who have never been here before are suddenly experiencing a BMC clinic day together, or helping the other get a gecko out of their shower, or ganging up to get the noisy little children off the porch so that post-call naps could be taken in peace.  My new room eases the discomfort a bit.  It’s like an over-sized screened-in porch with pretty tile on the floor.  It was nice to be staying there last night because a hard rain started just as I laid down for bed.  My roommate and I gave up on our conversation because we were having to yell to hear each other.  The rains are very heavy.

Market is every 3 days, and I decided to go after rounds on Thursday.  Julie had already been there and went with me.  There were lots of waves from just about every child on our way there.  I heard them yell, “Silaminga!” to their buddies or to get my attention.  Silaminga is “white woman” in Mampruli.  I respond to it well by now.  The market had a lot of food and clothing, but my only purchase was a few packets of laundry detergent.  The markets in this part of the country have mostly things that are needed by the people.  The markets I saw in Accra were geared to tourism, and they bothered me to look at their things a lot more.

There have been a lot of new faces at the BMC this week.  A group of doctors arrived Wednesday from Massachusetts and will relieve Dr. Faile while he’s in the states for a couple weeks.  They have all been here before and knew what to expect.  The larger staff was no match for the patients who came to clinic on Friday, however, as it lasted from 10am to 9pm.  Before then, I had only admitted one clinic patient out of all the clinic days.  I admitted 4 on Friday.  I wanted Vince, one of the visiting doctors, to give me some direction on one of them, and as I waited I just had to wonder if the patient would make to one of the beds alive.  He ended up having surgery that night.  The findings were a typhoid perforation that likely happened days ago and pockets of pus throughout his abdomen.  The most shocking sight was a very severe case of paraphymosis.  I had never seen a case before, but the look on Vince’s face when I had him see the patient was telling of how severe it was.  Since we’re usually out of clinic by 6pm, I could tell that the translators were a little disappointed that we were still there so late.  I tried to kill some time as we waited for more patient charts by asking them how to spell their names and writing them in my notebook.  Agnes told me to write, “Agnes is #1″, and Lamisi wanted to give me her address, too, so that I could send her some gold when I get back to the states.  We laughed, and they laughed harder when I told them that we were doing pretty well to be so happy when we’re in clinic at 8:30pm.

Today was rounds as usual and then one procedure after another.  There was a malaria baby with a hematocrit of 13% that had no family members with matching blood types.  I was a match and I went to the lab to give blood after lunch.  I was hoping they would just trust that I knew my blood type, but instead the lab tech jabbed by finger with a primitive-looking lancet to type my blood.  I cringed as I sat up on the donation table.  It was nice to see how thankful the family was, and they were able to express it without a single word.

We all took a break in the afternoon and changed into our Mamprusi-appropriate clothing to go to the Nayiri’s palace to greet him.  The palace is a small compound with about 10 huts attached to the courtyard.  Each of his wives had her own hut and his area was 2 rooms that were also connected to the courtyard.  I was given a few pieces of advice by the others in the group before I walked into the greeting room.  I was told not to make eye contact with the chief and to keep my heels pointed away from him.  There was also a hand maneuver we were supposed to do at certain times when the men clapped.  It involved flicking the pinky finger on one hand with the index finger of the other.  We walked into a room that had about 4 couches lining 2 sides of the room and the chief was at the front sitting on a platform.  A lower-level chief translated his message to us, which I was told later was a series of proverbs.  He talked a lot about how great the BMC is to his people and how they are willing to give more of their land to the hospital.  When he finished his message it was announced that we had permission to take pictures of him and the palace.  We walked around in the courtyard for a while and watched all of the kids playing and begging to have their picture taken.

When we got back from that intense experience, Vince guided me through a pleural aspiration procedure.  I got 10cc of pus and then they placed a chest tube.  There are a lot of opportunities for experience in procedures here, and I’ve been able to do things in the last few weeks that I thought I may never get to do as a medical student.