Julie Myhren’s Blog

So much to say, so little time!!!

August 10th, 2008 Posted in Uncategorized

It has now been an embarassingly long time since I’ve updated you all on my adventures in Africa and I sincerely apologize.  There is simply too much to say to fit in a blog post, but I will try to give the highlights since I last wrote.  Thank you for your patience!

A Hike to Togo (Saturday, July 26):

      On a Saturday off, Peter, Coty, and I decided to head back to Nakpanduri for a little adventure.  Dr. Faile had told Peter that it was possible to hike all the way to Togo by following the escarpment.  Apparently, the scarp starts leveling off as you cross the border from Ghana to Togo and there’s a concrete marker that serves as the boundary between the two countries.  We were told that it could be done in a few hours, so we left in the middle of the day, armed with a loaf of bread, groundnut paste (aka peanut butter), suncreen, cameras, and water (yes, Ben, I used my Camelpak and I love it!)  It was a beautiful, sunny day (I got a sunburn to prove it) and we had a blast enjoying our hike.  Unfortunately, however, we had to abandon the Togo idea when it got to be around 2pm and we realized that we had never found the reported trail.  So instead, we sat on the edge of the cliff, drinking in the scenery for a while and looking at Togo, hours away in the distance… A quote by Ralph Waldo Emerson kept running through my mind as I looked out at the savannah and red rocks: “Never miss an opportunity of seeing something beautiful, for beauty is God’s handwriting.  Thank God for it!”  Life lesson: Enjoy the journey and the friends along the road! 

Tackling the Stock Room: (Week of July 28-Aug 2)

      While Jane and the other missionaries were away in Cote d’Ivoire for their conference, a medical team came from the States to cover at the hospital.  It was a great privilege to meet Mr. Gene Covington, the first pharmacist at BMC.  He is the one who orchestrated the creation of the IV room, and he lived in Nalerigu for several years with his family.  We were chatting one day about pharmacy things and I mentioned that I like organizing and had an interest in cleaning/organizing the stock room as a surprise while Jane was away, but that I wasn’t sure whether the pharmacy guys would see that as a worthwhile endeavor or an unnecessary waste of time.  As with everything else in the pharmacy, they had a working system in the stock room, and while any expatriot who walked in would have a very hard time finding things, the guys always seem to know what’s hiding back there and exactly where it is.  Gene explained to me that there actually was no established rhyme or reason to the stock room, because it had originally been a supply room for the entire hospital and then had gradually become a room for drugs as space became available.  He said he’d talk to the guys and see what they thought.  Well, after a visit to Public Health on Friday morning (July 25), I walked into the pharmacy and Gene said, “So, Julie, if you’re interested and willing to get a bit dirty, we have a job for you!”  Hooray!!!!!! 

        And so, it started.  I will post pictures when I get home, but the stock room is rather large and was full of all sorts of things amassed over time.  There is an understandable perspective here towards hoarding old things that may be useful some day.  I am nostalgic to a point, but as most of you know, I like efficiency and organization.  So, I prayed for lots of wisdom and grace, because in my experience, I haven’t had to go without very much, and it is difficult for me to relate some times to a culture where going without has been a way of life and a new use can be found for almost everything that I would classify as junk.  As time went on, though, I was granted permission to get rid of a few more things and, in the end, I think everyone is pretty amazed at the amount of space available.  The project took an entire week, and by the end, I was tired.  But, the stock room is now organized, cleaned, and labeled, and it will be much easier for visiting physicians, volunteers, etc, to make use of many of the donated medications that were previously hard to find. 

             –A quick observation: Donated drugs are an excellent thing, in theory.  It is wonderful for a hospital like BMC to be able to offer medications to patients, particularly patients with chronic health conditions like hypertension, asthma, or diabetes, that are otherwise unavailable in Ghana.  However, after organizing the stock room, I came to the conclusion that it would be most helpful if those who are donating truly think through the utility of their donations.  This is not meant to disparage people from giving–please don’t misunderstand me!  But, as I noticed this, I realized that from now on, I will take the time to ask what is most helpful before I just give, so that the resources I have been blessed with will be used to maximally bless others… A quick example: As I was sorting through bags of donated drug samples, I found small quantities of several statins, like Lipitor and Zocor, for management of cholesterol.  Statins are expensive drugs, and it was, indeed, thoughtful of those who sent the samples to do so.  However, BMC doesn’t have the lab facilities to test for blood lipids.  While it is likely that there are a few patients, maybe even several patients, in the area who would benefit from statin therapy, we can’t really identify them or monitor them appropriately.  Further, once a patient starts taking a statin, they will be taking it for a very long time, probably for the rest of their life.  But, in Ghana, long term statin therapy at this point in time is impractical.  In the future, it may be more feasible, but by then, statins will most likely be manufactured in Ghana and the samples will have long expired.  Also, our current inventory of Lipitor samples would treat one patient for maybe three months, with no guarantee that we’ll have more by then.  So, while the thought was genuinely compassionate to donate the samples, the resources may, in this instance, have been a bigger blessing in a different situation, like to an elderly patient in the US who has had multiple heart attacks, depends on the statin to reduce their risk of death from another heart attack, and has reached their insurance coverage gap and can’t afford to pay for their Lipitor for two months until the new year starts.  Again, I hope you do not misunderstand me here, but I found another life lesson.  LIFE LESSON: Give often, but give wisely. 

Stepping Out in Faith: Morning Devotional (Friday, August 1)

       Every morning at 7am, the BMC chaplains host a morning devotional time for employees and visitors.  Generally, there is prayer, a song or two, and a short message to start the work day by recognizing that God is the Healer and that it is a privilege to partner with Him to touch the lives of patients and of each other.  Daily devotions are normally presented in Mampruli and occasionally translated into English.  Usually when I attend, I understand the Bible passage (usually read in English) and then have to depend on one of the pharmacy guys sitting near me to translate a main point every so often.  So, basically, I think about the passage, make up my own mental list of applications from it, and ask the guys later what they got out of the message, but don’t really have a clue what was said in Mampruli.  (That is hard for me!!!)  I was quite honestly terrified on a Wednesday morning when Yussif volunteered to one of the chaplains that I would like to speak at morning devotions.  I love talking about who Jesus is, what He’s done, and how we might better represent Him to the world around us, but my experience is in leading small group discussions, not in presenting sermons, and particularly not when the sermon will be translated into another language!  I almost declined, but felt that God was asking me to trust Him.  I agreed to speak Friday morning. 

        I spent quite a bit of time praying about what to present.  The group that attends devotions varies from day to day, but ranges from people who have been trusting in Jesus for years to people of different faiths who are just curious about Jesus.  Specifically, I prayed about the guys from the pharmacy who would be there–at least four of the guys, including Yussif, grew up Muslim, but attend devotions more regularly than many of the Christians.  Yussif asked what I would be speaking about and I told him I was still deciding…  He laughed and said, “Just think of it as your one chance to tell me anything you want about Jesus.  Maybe I’ll finally change my mind!”  Talk about pressure!  Thankfully, though, Jesus reminded me that my words and my life are a tool that He uses to show people who He is, but changing hearts is His department. 

      God led me to Matthew 14:22-32, the story about when Jesus walks on water and Peter trusts Him enough to get out of the fishing boat in a storm to be closer to Jesus.  It’s a story that applies at all stages of our journey with Jesus–whether we need to trust Him with our hearts for the first time or for the millionth time or for giving our very first sermon to strangers with a translator…  I love how His Word meets us wherever we are!

Ghanaian Cooking 101 (Saturday, August 2)

       On Saturday for dinner, Janie and I had the awesome privilege of spending time with Yissah’s family.  Joyce taught us to make banku and okra soup in the charcoal pot, the way Ghanaian women have been cooking for generations.  It was a fabulous experience!  Joyce and Yissah were great about the details of the cultural experience, too–Janey and I started the whole thing off by sweepng the courtyard with a local palm broom and finished by eating dinner with our fingers.  Banku is made from fermented corn (kernals are soaked for several days to give a sour taste), water, salt, and cassava flour which is stirred in a big metal pot over charcoal for a REALLY long time.  Eventually, it reaches the consistency of homemade playdough and when it no longer sticks to your fingers, it’s done.  It is then formed into a ball and eaten with soup.  The soup we made was okra-based with onions, tomato paste, and a little bit of beef.  I had never had okra before Ghana, but I like it!  Joyce explained that people like their okra soup at different consistencies–some like it more crispy, while some like it slimy.  She prefers slimy, so we added saltpeter.  The banku was definitely sour, but overall, it was good and fun.  Janie and I got the Yissah and Yussif stamp of approval for our cooking, although, Janie’s comment speaks for both of us: “I am neither strong enough nor coordinated enough to make that by myself!” 

Clinic (Friday, August 8 )

       Clinic on Friday was crazy busy, as usual, but crazier in that we only had Dr. Faile, Janie, two medical assistants, and Femke (just finished medical school in Holland) to see patients.  I debated this decision for quite a while, but eventually decided to step out of yet another boat and trust, because I felt that it was the right thing to do… So, after weeks of reading refill orders and making suggestions for changes, I offered to help with clinic, if needed, to see the patients with chronic disease states that just needed to be evaluated for medication refills: hypertension, asthma, diabetes, and seizure disorders.  Trust me, I was scared.  I struggled for quite a while with whether or not it was appropriate, but as Yussif and Janie both said, I have been trained to manage chronic conditions and to know more about the drugs than the MAs or even the med students.  And, so, in four hours, I saw 28 patients who needed refills–checked their blood pressure, checked their pulses, asked them questions about their drugs and conditions, and sent them on to the pharmacy to pick up their meds as needed.  Janie and I were in the same room, so when it sounded like a hypertension patient also had malaria, I could confirm with her before writing out an order.  By the end of the refill patients, I was mentally exhausted.  I knew Yussif and Jane were checking my work in the pharmacy, but it is draining to have that kind of responsibility for the first time.  Here, there are no lawyers or malpractice insurance.  There are very few checks on anyone’s work.  The burden of patients is so overwhelming and the resources are simply not available.  The key is to entrust your best skills to God’s grace and do the best you can with what you have and what you know.  The responsibility to say “I can or can’t handle this patient’s case” was entirely mine, and even though I was exhausted, I came out with the confidence that my long hours of studying truly affected the care of those patients, that though my clinical skills are limited and relatively untested, they are still solid and valuable and worth developing further. 

         I came to Africa wondering how God might want to use me permanently as a pharmacist in the developing world.  Specifically, I was hoping for an answer to whether I should pursue a Physcian’s Assistant license and get some experience in surgery or whether I should continue to a pharmacy residency, etc.  Clinic showed me that I love the challenge of managing disease states and made me quite sure that I want to pursue further training in chronic disease state management, probably through a family medicine residency.  I love building relationships and seeing the same patients repeatedly would allow me to help with their medical conditions, but also to know them as people.  In the US, pharmacists are managing disease states like asthma, hypertension, and diabetes in several states and through federal programs with incredible success.  The ultimate goal is, of course to improve patient care by reducing the workload on prescribers.  Why not in the developing world, too?  In the US, there are 250 medical care providers/100,000 patients.  In the developing world, there are about 14 medical care providers/100,000 patients.  Are we lightening the load in the right place? 

HIV Radio Show in Bolgatanga (Saturday, August 9)

Yesterday, I had the privilege of being guest speaker on an HIV awareness radio program that Carolyn is involved with through the Peace Corps–yet another thing I had never done before, but wait, yesterday was a day of crazy firsts!  We met at the hospital gate at 4:50 am to make it to the bus station by 5:15.  The bus wasn’t leaving for Walewale until 6am, but public transportation in Ghana is an adventure to say the least and, since yesterday was Bolga’s market day, there were many people trying to get there to sell their goats and chickens and okra and cloth.  The whole thing seemed to an outsider like a disorganized mess, but, as if by magic, everyone somehow got on the bus and we left promptly at 6.  At about 7:30am we arrived in Walewale (pronounced wallywally and written on cards at the hospital as Wale^2) and tried to find a tro or lorry (aka a somewhat roadworthy vehicle packed with way too many people with animals and goods on the roof that would be driving in our general direction).  We were shown great respect and given the front seat to share, but I can now understand why Carolyn gets her best praying done on tros.  At times, I thought, ‘Julie, this is crazy. What on earth are you doing? This car would NEVER pass inspection even with a bribe in the US–one of the doors is tied shut with a rag!’  But then I remembered that nothing in life is truly safe, that God is bigger than lorries with bad doors, and that I had asked God to stretch my understanding of who He is and how He provides for us.  I also thought for a good long time about the fact that our tro was good enough for the Ghanaians riding in it.  Whether it seemed foolish or not to Western born and bred me, they were not concerned about reaching Bolga in one piece.  And so I told myself to shut up and learn yet another lesson in trust and humility.  And, well, we did indeed make it safely to Bolga and I have a bigger picture of God from the experience.  (When we finally arrived and were eating our egg sandwiches–yes, they have awesome egg sandwiches here for about 70 cents–Carolyn confessed that our tro had been the culmnation of every bad tro experience she’s had in Ghana, all rolled into one… We thanked God again!) 

        The radio show was pretty neat!  Kimo, the dj, is extremely friendly and fun and leads the conversation by asking questions, taking calls form listeners, etc.  The show lasts for 45 minutes and covers everything from modes of transmission to testing to treatment (our focus yesterday, due to the guest pharmacy student) to stigma to social implications of HIV.  I was very glad I participated!  (PS–Our rides back were much less eventful than our ride there)

Chicken Tender Night (Saturday, August 9)

           Last night, after the Bolga adventure of the morning, I had the great privilege of cooking American food for the pharmacy guys at Jane’s house–it was a blast, although, I had to improvise quite a bit.  (Ex.  no bread crumbs… so I had to make my own by toasting and crushing an entire loaf of bread…)  I made Old Bay chicken tenders and Mexican rice with banana pudding for dessert (there were no mangoes to be found even in Bolga and my idea for mango crisp had to get thrown completely out the window… sad times!)  Almost all of the guys came and it was special to spend some time with them outside of the pharmacy.  After dinner, Solomon acted as spokesman for the group and had such honoring things to say about how I’d become one of the team and left a legacy and how they want me to stay, or at least to come back very soon.  I had intended the dinner to be a blessing and a thank you to them, and in the end, I was the most blessed, I think.  I will truly miss them!!!

It is now my last Sunday.  I am sleeping at Carolyn’s tonight and learning to cook another Ghanaian meal.  Tomorrow, we have clinic again and then Tuesday morning, Janie and I leave Nalerigu.  Time has truly flown!!!!