Jenny’s Blog

Home Again

    So this will be my final post.  I know it has been almost two weeks since I have been back in the United States.  I am actually doing an ob/gyn rotation in Anchorage, Alaska at the moment.  I flew home July 31st and left again August 2nd.  Before going to Africa I thought the transition was going to be pretty rough.  But to be honest, it’s almost better that I haven’t had to enter a normal day of Kansas City quite yet.  The month of July just didn’t seem to have enough days, and being here in Alaska has been a nice way to delay reality for a little while.  Granted, the transition from tank tops and shorts to pants and jackets hasn’t been easy, but that’s the least of my concerns.  It’s absolutely gorgeous here.

On July 27th, I had to say good-bye to everyone at the BMC.  I’ve decided that saying good-bye is just an impossible task.  I caught myself saying “see ya later” like I would meet up with everyone next weekend or something.  But the truth is, I have no idea when I will ever come across these people again in my lifetime.  It makes me so sad everytime I think about it.  I almost started crying about one hundred times when leaving house 6.  And I could hardly stand leaving the nurses and staff– so grateful for the little work I was able to contribue, so friendly even though I asked a million questions and probably frustrated them more than anything, and so happy to just meet a new face.  There were lots of hugs and questions of when I’d be coming back.  My only response was “as soon as possible”.

Tiffany, Carolyn, and I traveled with the Faile family to Tamale.  They were going on vacation, so we hitched a ride to spend a day at an orphanage, called Anfaanni (meaning “Blessed”).  The 28th, we spent the morning feeding the babies and just playing with them.  You want to talk about some of the most precious faces I have ever seen!!  I could have taken all nine of them home with me.  Most of their stories include the mother passing away and the father unable to take care of them.  The children stay at the orphanage until three years old, and usually the father comes back into the picture to take them to his village or they enter a foster care-like system.  It’s heartbreaking to think what little opportunity is available.  But to be positive, you have to remember that Anfaani is the reason why these children are alive today.  It’s a wonderful place, and I’m so grateful we had an opportunity to visit.

On July 29th, Tiffany and I flew back to Accra to stay at the Baptist guesthouse until our flights home.  Carolyn eventually met up with us, and our trio went down to Labadi Beach to spend the afternoon.  It was nice to finally take the time and relax– just really think about nothing.  So much had happened that month that I needed a break- physically, mentally, and emotionally.  It was cloudy that day, but it was still a perfect afternoon.  And on July 30th, Tiffany flew home so it was just me and Carolyn until Peter met up with us later that day.  We walked around Osu, bought some souveniers, and took a tro down to Le Palm Resort.  It cost about 5 ghana cedis to get a towel and lay by the pool.  And this place was gorgeous– big fancy hotel pool.  It was glaringly obvious that we didn’t belong.  I mean, nobody packs their own lunch (cold pizza from the local grocery store) and takes a tro (the equivalent of a jam-packed mini van for 15 pesuas) to Le Palm.  But we could have cared less.  We just wanted some sun.

July 31st– I stayed up most of the night with Peter and Carolyn so the days seemed to blend together.  I think my reasoning was to make the trip extend as long as possible.  But regardless, we had to say our good-byes early that Friday morning.  Again, “see ya later” was all I could do to avoid the obvious thought that when we get back to the US we have very different lives/schedules.  At the airport, going through customs was a circus.  But, while waiting for the plane (which was 1 1/2 hours late), I heard my name overhead.  I went up to someone who looked like he was in charge and he switched my coach ticket for a business class ticket.  In my daze, I didn’t really understand what was happening at first.  But then I saw my seat number was 4A…what??!!  My last seat was 36C!!  Talk about the best present ever from Delta.  And then when I was sitting there in my big cumfy seat, looking at a menu for the three course meal I was about to be served– my stomach literally dropped.  I didn’t expect culture shock to hit me so quickly on the way home.  The entire month was a humbling experience, and there I was being handed a warm towel to wipe my hands and face…I was disgusted by the whole thing and ready to run off the plane to go back to Nalerigu.  But instead of running, I just closed my eyes and slept the whole way to New York.

Making it back to St. Louis was wonderful.  Just getting a glimpse of my mom and Kyle while I was waiting for my bags was perfect.  I just remember hugs and constant questions and me trying to keep up.  The next day we flipped through pictures on my camera which was fun, but unless I had every day on video I couldn’t come close to describing the month.  Later we cooked up some frozen food things like french fries and jalepeno poppers…delicious!!  Some things you never think you’d actually miss.

Since I’ve been home, I keep thinking about what I’ve learned while living in Ghana.  I can now put a picture to what malaria and thyphoid look like.  I can walk up to a new patient in the middle of the night, gather enough information, do a physical exam, and feel confident.  I can debride and sew up just about anything.   But more importantly, I have a new appreciation for international medicine, and I will go abroad any day or time if it means I will be offering good care to those in need.  I always had the idea in the back of my mind, but it is much more evident that I need to take this idea and run with it in the future…and the sooner the better.   I am so grateful for my teachers– Drs. Dickens, Faile, Hewitt, Howard, Matt, and all the staff.  I can’t imagine a better learning experience.  And, the most unexpected part of my trip are the new friendships that I pray will never dissipate.  I have a better realization that there is a reason why we find ourselves in certain situations and with certain people…someone’s actually looking out for us.

When I think about what I accomplished by going to Africa for such a short time, I don’t really know what to think.  I’m not sure if I made an impact during my trip.  I know I did nothing earth shattering, that’s for sure.  All I hope is that I made a connection, if only for a moment, someone in someway felt better because I was there for them.  That’s all I ask.  And I hope I never for a second forget the impact they have left on me.

All Creatures Great and Small

So I’ve mentioned the miniature donkeys in one of my earlier posts.  They still crack me up though.  And when I tell people that we have them at home, they are just shocked that we don’t put them to work like carrying water.  It just feels like home when I hear a donkey bre in the distance each morning.

I should have done more research before I came to west Africa.  Like most people, I think of giraffes, elephants, and lions.  Doctor Faile said the other day “East Africa may have the animals, but West Africa has the people”.  I’m beginning to learn that is true.  The people here are incredible and just treat you like their long lost friend everyday.  For example, one of the nurses has a daughter named Jennifer.  So everytime I see her, I not only get a good morning, but she raises her hands in the air and yells, “My daughter!!” and gives me a huge hug.  She told me once that I should always remember that I have an African mother.

But anyways, back to the animals…I always watch my step around here.  You just never know what you’re going to stumble on.  I have seen several chameleons walking on the path.  I have never seen one before, and to be honest they kind of creap me out.  They walk in slow motion or just stop walking mid-step and their eyes kind of role in the back of their head still staring…very curious creatures.

The Failes have a pet monkey in their backyard.  They act like it’s nothing special, but come on it’s a pet monkey!!  or a Minkey for all the pink panther fans…

The night of course brings out all of the scariest animals.  Snakes definitely scare me the most.  After seeing so many snake bites in the hospital, I’m on my guard constantly.  But, I almost stepped on one the other day walking back to the guesthouse.  I’m sure the guard at the corner saw me freak out.  As long as he got some entertainment for the day, I guess.  There’s also a whistling noise that starts up outside around seven pm.  It’s more like a screech or rusted wheel.  Come to find out, they’re bats.  And I’m not talking about one or two.  It feels like hundreds.  By now, I have gotten used to them though.  One mystery animal is called a “bush baby”.  I’m told they’re monkey-like and nocturnal.  I’ve been shining my flashlight in all the trees as I walk home late, but still haven’t found them.  I think it’s a volunteer trick, so all the locals can laugh at us standing outside at night getting eaten by mosquitos while we’re staring at the trees. 

So I have a huge confession to make.  I’m pretty ashamed of this story considering my father and brother are both veterinarians.  The other night Yissah, John, Peter, Carolyn, Tiffany and I went out for some dog.  That’s right, a big tub of cooked up dog meat with onions.  Now I’m going to take a moment to say I’m sorry to my dear pets at home– Maggie, Snickers, Bailey, Daisy…I would never eat you, I promise.  My reasoning was…well, I had no reasoning.  I just wanted to know what it tasted like.  Let’s just sy it’s not the most delicate of meats.  It tastes like a tough roast beef.  And it’s pretty disturbing how they leave the skin on– gross.  But even worse, Yissah explained that the paws are the best part.  Well, I found a paw and quickly passed it off.  Towards the end of the bucket, John actually started feeding a stray dog some of the scraps…that was just a little over the top for me.  Overall, it’s pretty disturbing when you really stop and think about it.  Can’t say I’ll ever forget that experience.

When It Rains…It Pours

So, I had to use this title for one of my posts.  When I first knew this was the rainy season, I thought- great… (my thoughts are even sarcastic sometimes).  My frizzy hair adn that less than desirable smell (like wet dog) that follows the rain were two things I wasn’t looking forward to tolerating.  The rainy season in Ghana is not what it is cracked up to be.  First of all, it doesn’t rain but once a week or so.  But obviously when it does rain, it’s buckets– meetings get delayed, roads wash out, gutters overflow.  And as for being cool…I’m curious to know what the dry season is like.  Yeah, it’s cool after a rain or in the early morning/evening.  But for the most part, it’s hot…especially in clinic where you’re working in a small space or in the OR just before they decide to turn on the air.  Fans really are a blessing.

I don’t know why I think so much about the rain.  but I thought the title held a significant metaphor to one particular instance– my first night on call.

We were all at house 6 finishing station meeting (getting together, praying, singing, etc) when there was a knock on the door.  One of the nurses was standing there asking for Dr. Dickens.  Dr. Faile actually spoke up and said, “No, you want to speak to the people on call tonight.”  So me and Tiffany stepped up.  At that point, I took a deep breath and thought– alright, I can do this.  The nurse explained to me that a pregnant woman full-term has the complaint of vaginal bleeding.  We were given no other information.  I even asked about exact weeks, how much blood, any heart tones or fetal movement, the patient’s stability…anything to give me a better clue as to what is going on.  At that point, my deep breath and positive attitude switched to my stomach sinking and my only thoughts were- Oh my God.  Dr. Faile and Dr. Hewitt were sitting close to the door and just told us to check an ultrasound first to see if there was a placenta previa.  Now, I had been working with Dr. Dickens doing all of the ultrasounds, but a few days of training wasn’t enough!!!  But we said, oh yeah, no problem…  As we were walking out the door, Elizabeth Faile tells us, “Girls, you will be fine.  The patient may not, but you girls will survive”– big thanks for the encouragement.

When we get to the maternity ward, we see a woman lying there writhing in pain.  Luckily, I thought, she’s stable.  There isn’t any obvious bleeding, but you can tell this woman is not in a very happy place.  She’s pretty much screaming bloody murder.  So Tiffany and I take her down to the theater for ultrasound.  I see that the baby is cephalic, and I can’t see the placenta anywhere near the cervix.  I then move to find a heart beat…nothing is moving!!!  I kept thinking I was doing something wrong.  I think I was staring so hard that it seemed like the whole screen was moving at that point, but still, I couldn’t see this baby’s heart beat!!  Since there was no obvious placenta previa (placenta that covers the exit), I did a cervical check.  This lady was fully dilated, and the head was hanging out just outside the uterus at 1+ or so.  We wheeled the lady back to maternity ward to let the midwifes know what we found.  At that point, one of the midwife says, “Oh yeah, I had trouble picking up heart tones on this baby also.”  I had mixed feelings on that comment– glad that I was right about the baby’s heart, or upset that I had to deliver a dead baby that first night of call.  It was pretty brutal.  My thoughts were still blank at that point, but I couldn’t stop saying– Oh my God.

We decided to call on Dr. Dickens to help us at that point.  The lady was pushing with contractions, but she was holding her knees together like she had been waiting hours to use the toilet.   While Tiffany was gone getting Dr. Dickens, I tried my best to position the woman for pushing.  Language was the biggest issue– no English, no Mampruli, nothing remotely close to either.  There was no way to instruct this woman on how to push much less give the heartbreaking news that she won’t have a baby to take home.  The nurse just sat backa dn watched while I tried to move the woman on her back adn teach her how to take a deep breath adn push but I might as well have been doing an interpretive dance while speaking Chinese.  Dr. Dickens finally came to the rescue adn reassured us that we did everything correctly.  But at that point we tried to assist with a vacuum, which popped off three times.  We then decided to let her push for awhile on her own.  So in the meantime, Tiffany and I finished rounding on the wards– checking labs, writing new orders, seeing new admissions.  Luckily it was pretty quiet elsewhere in the hospital.  By the time we walked back to our lady, the Labor and Delivery room was empty– Dr. Dickens came back just before us, and he used the vaccuum to deliver the baby.

I remember the rest of the night was a blur.  We didn’t have anymore calls, which was nice.  But the whole next day seemed to just drift off.  I hope I never forget how hopeless I felt at that moment.  There was nothing I could have done differently.  Everything had already taken place by the time Tiffany and I got there.  But it’s still a chilling feeling, nonetheless.  I’m not sure what I learned from that experience– relieved that I can handle really tough situations without a whole lot of instruction?  disconnected because I will never know how this woman was really feeling?  motivated to work in underdeveloped areas to teach and provide adequate obstetrical care?  humbled by the fact that some situations cannot be fixed or helped– they just are?  My feelings are mixed, and I’m learning each day how to manage all of this.

It’s a Steep Learning Curve

So I haven’t written anything in a very long time.  One reason being the internet was down and there seems to be a line every time I try.  Plus, when I’m done for the day or have a break, I’m ready to crash.  We have been very busy as I’m sure is the norm here.  With rounds at 7:30 am, clinic, surgeries, and now being in the call rotation, most of the Africa I see is in the hospital.  I’m not trying to sound like I am complaining, however.  This is the trip I wanted.  These last two weeks have flown by.  And in the midst of it all I have learned a great deal about medicine, medical missions, and the culture here in Ghana.

People travel hours to come to the Baptist Medical Center for treatment.  Elizabeth Faile said that there was a survey asking why people come such great distances.  And the replies included the fact that BMC employees/volunteers will actually touch and examine their patients.  I ‘d have to agree with Tiffany who said there must be a lot of power in just showing that extra concern for people.

So clinic days are just intimidating.  There’s no other way to describe it.  I will run by the hospital at 6 am, and the waiting areas infront will already be full.  Granted, the market days (every third day here in Nalerigu) bring many more people to the hospital…you know, pick up produce and stop by because you’ve had a fever for the last week or so.  Dr. Dickens and I worked together in one room seeing mostly ob/gyn patients– and that was still a hefty number of people.

I think one difficult aspect of clinic is knowing how old someone is.  Your differential on certain problems can vary greatly depending on whether the woman is 30 versus 50.  People here don’t keep track of their birthday because it really has no significance.  So on the card that has the patient’s main complaint it also has an age written.  But more often than not, you have to go by looks and questions like how old is your oldest child or how many children does your oldest child have?  Looks are very deceiving.

When seeing mostly women, you have an opportunity to learn a lot about the culture– the good and the maybe not so good.  Fertility, for example, holds a very significant role in a woman’s life in the culture and most others as well.  Here, having many children gives proof to your economic status.  (I think that’s interesting because it seems to be opposite in the US)  Also, it is socially acceptable here to practice polygamy.  This brings more conflict when a “rival” (another wife) is able to have children and you cannot.  I think there is in vitro available in Accra, but I’m sure it is very expensive.  The cost to get there alone would be tough for most people.  The best help we provide is to make sure nothing else is going on to prevent a pregnancy, offer medication that could stimulate ovulation, and advise patients on their fertile window.

One case that really opened my eyes to this cultural reality was through a young woman who had been married for only a short time.  She said she had irregular cycles and wanted to know why she cannot get pregnant.  She looked like a very healthy, well-developed lady.  On exam, Dr. Dickens could not feel normal anatomy.  We sent her for ultrasound to figure out what was going on.  Come to find out, this woman does not have a uterus!!  There is no fertility future.  The nurse had to explain our findings in the best way possible.  And at the end, she also told her it would be a good idea not to tell her husband since he would most likely divorce her.  The woman simply took the news and walked out.  I learned then that sometimes it’s nice to have a language barrier to block the emotional impact.  But the people here are incredibly stoic.

Another case that was particularly heartbreaking was this young couple who came in because they had been married for two years and still haven’t been pregnant.  I sent the husband to have a semen analysis which showed an extremely low sperm count.  I’m pretty sure the paper said “nill”.  So when the couple came back in, I told my translator, Agnus, the results.  And before she said anything, she told me to send the wife to the other room for an abdominal exam– just an excuse to speak to the husband alone.  Now Agnus has one of the most boystrous voices I have ever heard.  But for those five minutes, she spoke so quietly I could barely hear.  I felt terrible for that poor guy.  And who knows if he will ever tell his wife.  I just hope they are happy and grow old together.

Another social issue is urinary incontinence…of all things.  When women live far away from medical attention, going to a hospital for care during a delivery is out of the question– even when complications arise.  And during prolonged labor, tissue compliance becomes an issue and fistulas develop.  When someone has a fistula connecting their bladder to vagina, she has constant leaking urine.  I had a patient come in with this exact problem.  The hole was a tad bigger than a quarter.  And the real kicker was, she has had this for about ten years!!  Dr. Dickens performed the surgery to close up the fistula but because it was there for so long, the edges were really scarred, making the operation very difficult.

The next day, I went to visit her and I could have cried when I saw a full bag of urine drained from the foley (urine doesn’t usually do that to me, by the way).  This is a woman who can now lead a more normal life without leaking and smelling like urine.  She can re-enter her community after being shunned for so long because of her “uncleanliness”.

This woman in particular was left by her husband, but she has done well to survive on her own.  Her tribe is Fulani.  You can notice these people immediately by their braided hair like corn-rows with beads on the ends.  They also wear a lot of jewelery like earrings because they believe in wearing their wealth.  The Fulani people are herders but many have settled in this region.  Their skin is lighter and the marks on their faces are horizontal instead of the more common vertical marks here.  They are also deeply rooted in Muslim tradition.  And for whatever reason (probably religion because that’s why most people don’t get along) they are looked down upon.

But anyways, this woman has been in the hospital for over a week now, and I pretty much see her everyday.  You would think by now this woman would know that we do not speak the same language.  But everytime I walk past, she says something and smiles or laughs and I’m left without a clue.  (she’s a little quirky).  Just yesterday she told the interpreter that I must be Fulani because of my skin color and because I have a lot of hair.  The comment was pretty hysterical to everyone around, because obviously my skin is about 100x lighter, my hair is light, and I don’t have braids.  But she was pretty convinced that I look like one of her children.  I just didn’t realize I was so ethnic.

Akwaaba, Nalerigu

Well, I just completed my first full day of working at the Baptist Medical Center in Nalerigu, Ghana.  But it’s been a couple days, so I’ll back-track to bring this blog up to date.

I eventually landed in Accra, Ghana Friday, July 3rd.  I stayed at the Baptist Mission guesthouse not too far from the airport.  Even though it was technically three am Missouri-time, I couldn’t help but start exploring the city.  Besides, I had a trusty Ghana guidebook, and some great resources at the guesthouse to point me in the right direction.  I went to Osu, a happenin’ tourist area of Accra just a mile or so down the road.  I finally got to exchange some money, and wander through the vendors along the street selling anything you could ever want.  But a little bit of that goes a long way, you know.  The biggest craze though is Obama is coming to Accra July 10-11…pretty big deal.  So instead of buying trinkets that wouldn’t fit in my already stuffed bags, I decided to leave more Accra exploration to my last 24 hours at the end of the month.

On July 4th, I made the journey to Nalerigu.  I took the one hour flight instead of the fourteen hour bus ride…it was a really tough decision.  The mechanic who works at the BMC picked me up immediately from the airport, and we made the long haul down the red dirt road.  We made as much small-talk as possible, considering the language barrier.  We got the basics though- family, food, religion, politics.  It was a two and a half hour car ride after all.  He was gracious enough to buy some fried yams with a ground peanut  topping to share along the way.  We got along great.  One of the biggest surprises when I was just staring out the window was the sight of a donkey.  And not just any donkey…it was Miniature!!  And even my new friend thought I was crazy when I told him we own about 26 of those things back in Missouri.  But, I’m used to that reaction by now.

I had no idea what to expect when I got to the Baptist Medical Center and the guesthouses.  But to be completely honest, it really is a home away from home.  The accommodations surpass everything I have thought possible in the middle of nowhere.  Sure there are things that keep me on my toes, like a lizard that decided to hang out in my closet last night, but it’s really more than I could have asked for.  We had a 4th of July celebration including all of America’s favorites– burgers, kabobs, baked beans, apple pie, sweet tea, and baseball.  I think I had the most culture shock in those first ten hours, because I thought I was supposed to be in Africa!!  j/k.  It was great to meet everyone who lives here along with the missionaries from the surrounding villages.  I also met my roommate for the next thirty days.  Her name is Tiffany, a fourth year med student from the great midwest.  She was here two years ago, so it’s nice to have someone who knows what is actually going on.  She’s great.

Sunday, July 5th was Father’s Day and we all went to the First Baptist Church for mass that morning.  I have never been to a Baptist service before, much less two and a half hours of Mampruli.  But it was just so exciting– the singing, dancing, clapping, Alleluias…it was a great experience. 

I had a kind of a bet with someone that I could run in Ghana just like I do at home.  So I talked to some people who pointed me in the right diection, and I was on my way.  (keep in mind, Nalerigu has to be one of the safest places I have ever visited)  The look of surprise on the people’s faces when I ran passed them on the main road, was an experience alone.  I got lots of laughs, waves, and a boy who just started running with me.  Running to the TB village, past Public Health, to the main road, and back through the BMC gates was my route.  I felt like I was in a movie.

Today, July 6th, was my first day really in the hospital.  Yesterday I went to rounds and got a tour, but this was a full blown clinic day.  I heard stories of how tons of people travel forever to wait outside all day to be seen, but it is a sight to behold.  Today I worked with Dr. Dickens, an ob/gyn who has been living in Nalerigu for the last 8 months or so.  He basically has his own women’s clinic.  We probably saw about 40-50 patients today, but it flew by.  Since most of the patients speak Mampruli, a nurse sits at the desk with us and works as a translator too.  It was great how the visits are direct and to the point, especially after seeing the crowds of people outside.  But I have to say, there is a missing piece to patient interaction with a language barrier this huge.  But, you try to do little things like help a woman down from the table or just make eye contact to at least try and make a connection with people.  I saw two cases of cervical cancer today.  Dr. Dickens let me do all of the examining while he filled out the paperwork.  It’s quite a feeling that drops in your stomach when you feel cancer like that.  And then you realize there is not a treatment available…that makes the news easier to take.  Besides that, I’m really looking forward to the experience in the hospital.  I have a lot of days ahead, so there’s no telling who will come in.

Pre-Flight

Hello,

So let me start off by saying this blogging is very new to me, but I will try my best to get the hang of it.  It’s almost two in the morning, and I can’t even think about going to sleep even though I have to start getting ready in a few hours.  My nerves are probably the culprit, especially that nagging feeling that I’m probably forgetting something…and I have a tendency to forget.  I’m sure whatever it is I leave behind, I can live without it for a month. 

My expectations are pretty much wide open at the moment.  I have heard countless stories and have received a lot of helpful advice, but even the best wisdom cannot possibly give a perfectly clear view of what this next month will entail.  Only time will tell.   All I know for sure is my plane is taking off at eight am.  I’m just so excited and truly thankful for having this opportunity. 

With that said, I will continue with this story when I finally make it to Ghana.  Adios!