Jenny’s Blog

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.