Kristen Kenny’s Blog

Seeing patients

10/10/08

I couldn’t come up with a clever title perhaps I am tired. These past three days I have been in the OPD seeing patients. After rounding with the doctor in the ward I tell the nurses I am there and will be in room 4. Then I sit at the desk in consulting room 4 and wait for the onslaught or the trickle of patients depending on the day. Monday was pretty busy. It started out slow but then they decided to send me all the mothers and babies for 2 or 6 week check ups. These would take me some time because I would have to assess two people at the same time. The babies were incredibly adorable and for the most part healthy. A couple colds, baby rashes, too much pooping, not enough pooping. The day is a blur to me at this point. The only case I can remember was one mother was worried about her baby’s testicles. One hangs lower than the other but both were down. Reassurance. There was a phone call to the father to assure him his son is normal. Baby boys are dangerous though and during the exam he managed to pee on me, the exam table, and the floor. All I could do was laugh. You gotta watch out for boys.

Tuesday was also busy and I was at it again. This time there were more varied cases as opposed to mostly malaria. The day started with some diseases that are very common in the US, namely hypertension, arthritis, type 2 diabetes, hyperlipidemia. I’ve seen these before. I can do it. Some of the hardest things for me are the rashes. A lot of patients especially children come in with rashes. Luckily for me there aren’t too many choices for treatment but sometimes I just wish I actually knew why they had rashes. The day ended with a kid with a small dog bite on the leg. It was her grandmother’s dog and had its shots luckily. She got away with a wound cleaning and a tetanus shot. Wednesday was slow but had some interesting cases as well. Some BPH, more rashes, PID, a type 1 diabetic with malaria and DKA.

One of the saddest things I saw was a woman with exophthalamos, her eyes were popping out of her head. It turns out she has a brain tumor that wraps around her optic chiasm. I have no idea why she came to the little Manna Mission hospital. She had already been seen at the large teaching hospital in Accra but was told the tumor was too complex. The surgeons there could do nothing for her. Her only option would be to go to a specialist in the US or Europe. But how could she possibly find the money to afford that? The cost of medical care, medications, imaging, procedures is a real probably. It is very clear that medical care is not free and a fair amount of people do not have the money. On the ward there was a pregnant woman with malaria and anemia, her Hb was about 5. She needed a blood transfusion but neither she nor the baby’s father could afford it. So she was waiting in the ward. You can’t discharge a pregnant woman with a hemoglobin of 5. But the patient wanted to be discharge. They would try to find some money and come back latter. Trying to explain to patients and families the importance of expensive (by Ghanaian standards) treatments is a common occurrence. It is frustrating and not just to me. The doctors, nurses, administration, and of course patients feel it too. Or a pregnant woman with gestational diabetes had decreased fetal movements and needed a stat ultrasound. But the first question is has she paid for it yet? It makes me marvel at the massive amounts of lab tests and imaging we have ordered during my rotations in the US. The situation also makes me wonder how things work at the bigger hospitals in Ghana. One positive of the cost issue is that the Ghanaians do have a national health insurance scheme which makes things cheaper and at times free. But some things are not covered especially uncommon problems. One of the issues for the upcoming elections in Ghana is the national health insurance. So health care is not just a political problem in the US. How best to provide health care is a global problem and the poor always get the shaft.

Enough ranting. This week has been challenging and I have seen many interesting cases. I still struggle with medications especially dosages but feel better diagnosing and treating the more common problems. Only two more days. It is hard to believe.

a super tourist for a day

9/7/08

From what I can tell when people visit Ghana as a tourist at some point they all go to Cape Coast. I had been meaning to go since I arrived but the planning hadn’t quite worked out. Since this was my last full weekend in Ghana it was now or never. My original plan was to get to Cape Coast Friday night or Saturday morning and leave Sunday afternoon. One of my friends from the lab, Jake, said he would go with me. I was glad to have someone to go with and a Ghanaian besides who could speak the language and get us fair prices for things. Jake thought we could see everything all on Saturday so the new plan was to go and come back all on Saturday. It ended up working out well but made for a long and tiring day. Next time I would spend two days for sure.

Saturday morning I got up at 4am so we could make the earliest bus possible. Jake showed up late at 5:30 and then we were on our way. There are large, more comfortable buses that travel between cities called STC buses so we took that instead of a tro tro. It is about a 3 hour drive from Accra to Cape Coast if traffic is light. The ride went well despite some a/c issues. An African movie played on the bus but I kept falling asleep so I missed most of it. It seemed similar to many of the African tv shows and the novellas I had watched. The movie was a drama about the troubles this woman was having with love, marriage, and family.

On our trip we visited Cape Coast Castle, Kakum National Park, and Elmina Castle. The first stop was Cape Coast Castle. The castle was originally a fort that had changed hands among European powers before the British finally took control around 1665. At that time the British began expanding the fort into what is now Cape Coast castle. Cape Coast was the capital of Britain’s Gold Coast and was a key city for trade especially for the slave trade. Inside they now a have a powerful museum about the slave trade. It follows the history of the people from the region, through the slave trade, to the abolition of slavery and even covers the American Civil Rights movement and people of African descent coming to trace their roots. We also went on the guided tour of the castle through the slave dungeons, in tunnels, to the Governor’s room, etc. It is difficult to fathom the massive amounts of people held there as slaves and the horrible conditions they lived in. Also the history of what happened there contrasted sharply with the beautiful day and gorgeous views of the ocean. It was shocking to go from the tiny dungeons that held hundreds of slaves to the large rooms just above meant for the governor alone. The dungeons were dark, tiny, poorly ventilated, with no place for people to relieve themselves or drainage. So many people were held captive and died in those rooms. The dungeons are connected by large tunnels to a door that opens to the ocean. It is titled the Door of No Return for through this door the slaves were put on ships and sent across the ocean to the Americas. Several years ago the descendents of slaves were invited to the castle and came in through the Door of No Return making it the Door of Return which is posted on the ocean side of the door.

Our second stop was Kakum National Park to go on the 40 meter high canopy walk. The park protects the largest concentration of rainforest in Ghana. There is a guided and at times steep walk to the canopy. We did not see any animals on the hike (except for a snake near the entrance) but the forest was full of large beautiful trees. Our guide knew a lot about plants and trees including which plants were used for medicines. The canopy walk included 7 bridges with 6 tree stops. The bridges have a plank floor about a foot wide with interwoven rope sides. The walk is very wobbly but there are no places where you could fall out. A number of visitors started out on the first bridge but turned back due to fear. To be honest I wasn’t scared and enjoyed the canopy walk very much.

By the time we were done at the National Park it was late in the afternoon. We debated but eventually decided to head to Elmina Castle. Elmina is a small fishing town very near to Cape Coast. There is another castle there which had been first built by the Portuguese in 1482. Eventually it was taken over by the Dutch, later the British and today is controlled by the Ghanaian government. It was also prominent in the slave trade, having housed thousands of slaves. The castle is similar to Cape Coast castle but seems to be larger and to have a more intricate architecture. Again it was hard to reconcile the beauty of the white walls and views of the ocean especially at sunset with the horrible things that had occurred in that place. One of the interesting but very sad and disgusting stories from the castle was about the women slaves. They were housed right underneath the Governor’s room. He would pick women to come to his room and were they were raped. When these women became pregnant they were moved to houses near the castle where they lived with their children. These children were then given positions of power with in the castle because of their Dutch fathers. Now there are a number of Ghanaian families with Dutch last names dating back to this time. It is curious how even though they had African mothers they were given positions of authority and shows how the European powers turned Africans turned against Africans to maintain rule.

Finally we were on our way back to Accra after a long hot day of touring, walking, and learning. I am glad we were able to cram all that we did into the day. I think spreading it out over two days would have been a little more manageable. We could have taken our time and wandered around a bit more. The ride back was an adventure unto itself. By the time we were leaving there were no more STC buses for the day. We took the biggest tro tro I have seen back to Accra. First we waited on crowded and hot on the bus for it to fill up. We were some of the last people on but waited 30 minutes for the last seat to be filled. Then about 2 minutes outside of the station we stop to fix something. The other passengers were mad and yelling at the driver for not fixing it before we left. Finally we were on our way again. About 5 minutes later there is more grumbling and yelling from the passengers. I hadn’t noticed but the headlights were not working and we were driving in the dark. Finally the driver pulled over after passengers threatened to call the police. The lights took awhile but eventually came back on. Luckily we made it back to Accra with no other mishaps. Our ride from Accra to Manna Mission was another story. There was a festival in Teshie so there were tons of people out on the street walking around and dancing. There was music blasting from every other shop on our way home. Traffic was ridiculous. I think it took us 2 hours to go about 5 miles. It kind of reminded me of LA. I am pretty sure I could have walked there faster. It wasn’t all bad though. It was fun to hear the music and see all the people dancing and celebrating. The driver was friends with many of the people outside the bus and the crazy boys would jump on the bus, dance in front of it and up on it. It was pretty wild. At last I made it home to my bed. My day as a super tourist ended with some sweet sweet sleep.

so many pregnant women, so much malaria

9/6/08

Thursday also started out slow. I told the nurses I would be in room 4 and to send me some English speaking patients. I waited. I went and asked again. Oh they are coming. More waiting. I finally saw one patient, a college student with a small lymph node in her arm pit and nothing else. She was reassured and told to monitor it. Then more waiting.

The midwife came into my room looking for something and invited me to work with her. Antenatal appointments are Mon, Tues, and Thurs so there are tons of pregnant women those days. They have talks for the women about what to expect during labor and other important topics. Then patients come into the little antenatal room to get fundal height, fetal position, and heart tones checked. After that they go back out to wait. In the same room at a desk patients’ charts are reviewed by the midwife and she writes them prescriptions for drugs and vitamins, talks to them about nutrition, and assess any problems they are having. First I was helping out with the measuring and recording. Then the midwife had me sit at the big desk and interview the patients. She was there to help me and answer questions. After about the second patient the midwife was called in to help with a difficult delivery. She said to go ahead on my own and if I had questions she would be back in a bit. There was also a nurse helping out but she was on break. It was just me. I was doing ok with the first few. They had few problems, some needed refills on prenatal vitamins. Then I had a patient with malaria and a UTI. Treating the malaria was decently straight forward but I had no idea what they typically prescribed for UTIs. The midwife was still in the delivery so I went to ask a doctor.

Before I even asked a question we went to go check a baby. In the delivery room one mother had just given birth and another was in the process of delivering. The baby of the first mother had not cried for the first 5 minutes after birth so we were there to assess him. The baby was on oxygen, wrapped up but there was no warmer. He was crying, lungs were clear; he looked ok. The other woman in labor was having difficulty. The baby was large and just wouldn’t come out. For all the work she was doing the woman was very quite. She was doing breathing exercises. Anytime she started to make noises the nurses would remind her, “don’t make noises just breathe.” I was impressed. All of the sudden I noticed that I was very hot. The delivery room was small and the fans were off. The room started to get cloudy and I got nauseous. I ran out of the room just in time and laid on an unclaimed patient bed. I was so relieved I hadn’t fainted in the delivery room. It was probably a combination of the heat, not eating much for breakfast, and the woman having a hard time. I decided I had enough of the delivery room for the day. Grabbed a bite to eat and head back to see more pregnant women. Unfortunately I heard later that the baby of the woman who was having trouble had died. It was very sad. At least we could be thankful the woman had survived.

Back in the waiting room the pregnant women were getting annoyed. They had been waiting a long time. I began seeing patients again. There were so many women. I felt we would never be done. To borrow another student’s thought, it was like there were women getting pregnant in the waiting room. Luckily the nurse came back and would help me when I had questions. The majority of the women in the afternoon had blood films positive for malaria. I wrote out malaria medications and prenatal vitamins all afternoon. Finally we had seen all the patients. I was tired but it felt good to have been useful. The midwife, nurse and I ended the day in a prayer. We prayed for all our patients, especially the one whose baby had died. They also prayed for me and said they would still be seeing patients if I hadn’t helped out. It was good to be so loved.

Friday I woke up early to go round with the doctor on call only to find that my insides had liquefied. All morning I was either in my bed or running to the bathroom. Even one small sip of water would come right back up. By afternoon I felt much better and was able to eat some fufu but I spent the rest of the day lying around. It was a bummer missing a day in the clinic but I am glad I spent the day resting. Only one week left. It is hard to believe. Sometimes I wish I could stay longer. There is more I want to see and do. I feel like I finally understand what I am supposed to be doing on this rotation and am comfortable where I am. Then a minute later I will be dreaming of being home and counting down the days. I have made lists of foods I want to eat when I get back. I can’t wait to hug my friends and family, take a hot shower, drive my car, understand what people are saying, and (I never thought I would say this) have a working cell phone. I’m sure that day will come sooner than I can imagine.

Dr. Kristen???? Let me introduce you to malaria.

9/4/08

This week seems to be flying by. I was scheduled to be in the OPD (out pt department) all this week. Monday I mostly just shadowed one of the doctors. He would see patients, they would talk in Twi. I would try to follow along and ask questions. Lots of children with malaria, adults with malaria, elderly persons with malaria. Headache, stomach ache, dizziness, fever, chills, bitter taste in the mouth (I had never heard that one before), decreased appetite, any one of these symptoms or combos meant malaria. I kept trying to think of other diagnoses but finally gave up and now think malaria first. The clinic was decently busy. My doctor was finished early in the afternoon so I decided to go back to the eye clinic. They perform surgery on Mondays. There was only one case that day and it was a quick one but I had never seen eye surgery before. The doctor removed a pterigium from a woman’s eye that was bothering her. Such tiny instruments. The staff in the eye clinic are very welcoming and funny. One of the women always calls me Dr. Kristen. It makes me laugh because I certainly don’t feel like a doctor especially in the eye clinic.

Tuesday was very busy. It was my first day with my own consulting room and my very own line of patients waiting outside. The experience was challenging but I finally felt like I was doing what I came to do. Seeing the patients was all about the history and physical. In the US we do so many labs and imaging studies. Here we rarely do at least at Manna Mission, at bigger hospitals it might be different. Most patients are treated empirically. Some patients are sent to do a hemoglobin or a blood film for malaria and a fair amount for urinalysis or urine pregnancy test. But even if the blood film comes back negative you often still treat for malaria anyway. A lot of the patients I saw we treated for malaria. I saw a decent amount of skin issues as well, chicken pox, random kid rashes, allergic reactions. One kid had a sore neck for the past three days. I checked for meningeal signs but he didn’t have any. We ended up treating him for malaria. I still think of him though and hope he isn’t sicker than he seemed. One of the hardest things about seeing patients for me was the drug choices and dosages. I have a drug book but many of the drugs are either not in it or go by a different name. And there were so many children for whom you have to calculate the dosages. Luckily my attending was very helpful and patient. He would help me with the treatment plan and dosages on patient after patient. Hopefully I will learn them by the end.

My Tuesday experience had pumped me up for the rest of the week. Unfortunately Wed was a bit slow. It was rainy and the busiest days are Mon, Tues, and Thurs. I sat in my room waiting for patients but only saw one, you guessed it with malaria. I ended up hanging out with one of the new doctors who recently finished his training. You can tell he is young because he takes more time with the patients and tries to build a little repoire. It was kind of a sad afternoon patient wise. We had one woman hearing voices but who didn’t want to go to the psychiatrist. Another patient had been sexually assaulted and was having chest pains and abdominal pains. I didn’t get the whole story but she seemed in desperate need for some counseling. One woman was from the Northern Region and she and the doctor were having trouble understanding each other. She mostly spoke a language from the North but understood some Twi. It was an example of what I had been feeling/experiencing for the past 2 weeks. Lastly a woman who had given birth to her baby at home with no prenatal care came in and the baby died. Sort of a depressing way to end the day but there was a good lecture on diabetes before I left for the day to cheer me up.

After my time in the clinic I have been coming home tired, ready to rest for the next day. One of the days though I did go into town to see the National Museum. One of the lab techs at the hospital has wanted to show me around Accra so we went. The museum is a little cheesy but I am glad I went. There were exhibits on culture and history and archeology. I saw some cool drums, clothes, masks, pots, etc. I will try to put up some of the pictures. The most exciting parts was the journey into and out of Accra. On the way back it was getting dark and picked up a tro tro at the station. The station was so crowded with people coming home from work. It was dark and there were buses and people everywhere. Finally we found the right bus but it went a way I had never gone before on a dark and very bumpy street. I kept praying that the tro tro wouldn’t break down going over all those huge holes in the dirt road. We made it back safe and sound, an overall enjoyable outing.

Mini Adventures

8/31/08

This weekend I tried to be a little more adventurous. I didn’t quite do as much as I had planned but with my guide book in hand managed to have some mini adventures. Friday night after the eye clinic I was ready to go somewhere, anywhere. Miriam and Tina the girls across the street were both tired and in bed early. After stopping by their place I came back to the mission house frustrated. After some pacing and convincing I decided to go out on my own. I wasn’t sure exactly where to go so decided to try La Palm Hotel just to see it mainly and get out of the house. It is a fancy hotel on the ocean at La Beach. I chartered a taxi there and then wandered around the hotel for awhile. It is very nice and expensive. There is a small casino, restaurants, and bars. I found the pool and the Ghanaian village, an outdoor bar with live music overlooking the ocean. I was watching the waves and listening to the music. Then a group of Ghanaians introduced themselves to me and we talked for a bit. They asked if I wanted to go with them to a near by bar/club. So I went. At the bar the djs played good music, old American rap and R&B and then some Ghanaian and Nigerian songs as well. I had a great time dancing but eventually called it a night. I caught a taxi home and fell asleep the moment I hit the pillow.

On Saturday I tried the girls but they were not home. Since I had such a fun night I decided to venture out on my own again during the day. After consulting my guide book I decided to go into Accra and hit up the typical sites one should see as a tourist. I attempted to get a tro tro but was having a hard time understanding where exactly each one was going. I stood there for quite awhile and probably watched a dozen pass by. Finally I just got in one that was going to Accra and luckily it happened to be going to the station closest to where I wanted to go. Tro tros can be hot, crowded and a bit uncomfortable and the driving can get crazy. However the best part in my opinion is that you can do your shopping right from your seat. When the tro tro is stopped or at the station loading, people come by trying to sell almost anything. Often they are selling food or drinks like crackers, plantain chips, fruit, bags of ice water, soda but they also sell random stuff. I saw people selling belts, straw cowboy hats, razors, toilet paper, thermoses, even cell phone chargers. I can’t imagine how those people sell their wares. The interactions have to be very quick and they nearly get run over by buses and cars.

I arrived at the station which was bustling. Accra is much more crowded then Teshie where I am staying, well it is the capital city of Ghana. My first stop was the cultural center. The place is full of stalls with people selling souvenirs. I wasn’t really in the mood to deal with shopping but wanted to take a look around. When I got through the gate this man wanted to show me his shop which was towards the back. I tried to make it clear that I wasn’t there to shop/hadn’t brought a lot of money with me/was a student. He was very friendly but not in a pushy way. He carves masks and statues. He asked if I knew how to play mancala which I didn’t. So he taught me how and we played a bit. As I was leaving I mentioned I was going to the lighthouse, my next stop. The man, his name was Tetteh, said he would take me there and his boss allowed/told him to do it. I am usually wary of people who are so friendly but so far everyone I have met has been extremely helpful and genuine. I eventually agreed.

We walked to Jamestown, it is the oldest area in Accra, with colonial buildings, a fort built in the 1800s, and a light house. I went up in the lighthouse and thanks to Tetteh got a reduced entrance fee. There is a beautiful view of the ocean and all of Accra from the top. I will try to post some of the pictures. Then we went to the harbor. It is at the foot of the fort and full of large wooden boats, people fishing and selling fish, and interesting smells. We continued our walk along the ocean for quite a ways till we got to Independence square. It was nice walking on the beach but at the same time I was trying to hide my disgust for all the trash. I would cringe as the surf would wash trash over my feet. Independence square is a large open space surrounded by stadium seating. It is where people marched when Ghana gained independence. Now it is used for concerts and programs. There was hardly any one there and it was quite, a nice place to sit for a bit. After all the walking I was sweaty and tired so thanked Tetteh and headed back to the tro tro station and on home. It turned out to be a wonderful day and I finally got to see some of Accra.

Today I decided to take it easy. After church I have been relaxing, reading, watching tv. I felt very satisfied with my mini adventures. Thankfully God is watching over me and I met some truly kind and helpful people. Tomorrow is back to the hospital and good experiences in the out patient clinic.

Nurses’ Station and Eye Clinic

8/29/08

This Wed and Thurs I was in the out patient department (OPD) nurses’ station. This is where patients get checked in and their vitals are taken. Also there is a treatment room where they do injections, ear lavage, suturing, wound care, and any emergencies go into that room. I spent about a day in each area. The day I spent in the nurses’ station I took vitals and wrote down patient information. It was good though to talk with the patients a bit and see why they were coming in. Also there were a group of student nurses there. We talked about their schooling and even talked about some health issues like diabetes. The clinic is busiest in the morning and that is when the most nurses are there. There are three shifts at the hospital the morning being from 8-2. So at two most of the nurses left but I stuck around.

We had three emergencies come in a row. One was an older man who had been hit by a car. I am not sure exactly how they got him to the hospital. He had a laceration on the back of his head as well as both a broken arm and femur. Because of the multiple fractures we had to send him away to the main hospital. We just cleaned up his head wound, gave him some pain meds, and sent him away but not without him paying for the medications and bandages first. They were going to call an ambulance which it seems that few people use at least in this area. But I think they ended up just taking him in a taxi. I can’t imagine how they go him into the taxi with his broken bones. It must have hurt. The next patient was a young women crying and doubled over. She was having left sided flank pain. We were thinking kidney stones. She got admitted. The last was a young boy with a huge scalp laceration. There was a large flap of skin hanging open. The head nurse stitched him up. The kid was scared after receiving injections of pain meds so when they tried to put in the lidocaine he was screaming and kept jerking his head and arms around. It made things very difficult and almost dangerous it seemed because the needle could get flung around. He was doing more of the same when the nurse was finally suturing his wound. The other nurses didn’t seem to be trying to calm him down so much as getting angry with him and trying to shame him into submission. I’m not sure of what if anything would have calmed him down.

The next day I was in the treatment room. Patients seemed to come in spurts. I helped do some dressing changes and took out some stitches. We also had some injections. A woman had what looked like a bunion on the lateral aspect of her foot. She said it bothered her and wanted something done so the head nurse scraped off some of the skin. Then he removed what looked like a sebaceous cyst. Two emergencies came in while I was there. A man ran in with an older man on his back. He plopped him on the exam table and then left. The man was drowsy and not responding but breathing. Apparently alcohol was involved and his blood sugar was very low. Other than that he turned out to be ok. The other patient was a woman very sick with malaria and her newborn baby.

Friday I was in the eye clinic. The ophthalmologist comes three days a week one of which he performs surgeries. I helped check some patients in which is when the do the vision exam. Then I shadowed the doctor while he saw patients. They also have a optometrist that works in the refraction room and gives people glasses. We saw some typical eye complaints, glaucoma, conjunctivitis, allergies, people in need of glasses. On Monday evening they do eye surgery so I think I will stop by and check it out.

After I get off from the hospital I usually come home, eat, read, and go across the street to the girls’ house and watch tv. Pretty laid back. One day we did go into town to go to the big supermarket so I could get some food to cook for dinner. We went to one of the few supermarkets that sells a lot of imports so there was a lot of food I was familiar with. I try to cook dinner for myself but for lunch I have been eating in the canteen. I have tried a number of Ghanaian dishes. They often have rice or yams with different sauces and either chicken or fish. I tried benko the other day which is sort of a cross between a tamale and a dumpling. It is tamale shaped and made out of ground corn and plantains. You can eat it with different sauces. Also I tried fufu which is similar to benku but stickier and mushier and made out of cassava. You have it with soup. The sauces have a little kick to it that I like. They also have very tastey fruit, mangoes, pineapple, bananas, plantains, guava, etc. People usually eat with their hands (only the right hand though) which I have tried a couple of times. I haven’t been eating many vegetables though so I need to work on that.

After this weekend I will be half way through my trip. It has been good so far and certainly interesting. I am looking forward to seeing patients next week.

The female ward - Gotta love the ladies.

8/26/08

Monday and Tuesday of this week I was in the female ward. The ward consists of a room each for general medicine, pediatrics, patients in labor, delivery, and postpartum. Take for instance the general medicine room. There are no partitions, just 10 beds lining the walls and one shared bathroom. The rooms are not air conditioned but do have fans. The patients wear their own clothes and often bring their own sheet. Their family members bring them food or they go buy it from the canteen. While they are being admitted, the patient or a family member goes to the pharmacy and buys the medication and fluids they will need during their stay. Any medications they can’t afford or that are not available they just don’t get. The hospital doesn’t seem to bill so much as to collect payment up front or at least before the patient leaves. There are no machines controlling IV flow rate, the blood pressure cuff used for vitals has real mercury in it, and there are no tvs. Well there is one tv in the peds room which the nurses watch sometimes when it is slow.

During my time there I hung out with the nurses and tried to help them with things. I took vitals, made beds, helped get meds ready, talked with patients and reviewed their charts. The general med room was pretty full while I was there. A number of the patients had hypertensive urgency/emergency, malaria, threatened/complete abortions. One patient had a diabetic foot ulcer. Another younger girl had fallen out of a moving car and possibly had a wrist fracture. A woman was admitted for GERD which didn’t make a whole lot of sense to me but she also as it turns out had malaria and was pregnant. There were a couple children in the peds room most with malaria along with other infections (UTI, URI, pneumonia). A couple of women were in the post partum room with their adorable newborns.

The doctor that is on night call rounds on the all the patients usually early in the morning. Since I hadn’t done much with any of the doctors I figured it would be a good opportunity and a chance to learn more about management. Tues I was on the ward at 5:15am and the doctor finally showed up an hour later. During that hour of waiting I was so tempted to just go back to bed. It was a good experience. The doctor is young and very nice. We rounded on all the patients and went next door to the male ward as well. It is much smaller and only had 2 patients at the time. I had gone to bed late the night before and the rest of the morning was a struggle. I would have to keep moving to prevent myself from falling asleep. I should probably go on rounds a couple more times before the end but it is hard for me to voluntarily wake up so early. If I do I am definitely going to bed early.

In the afternoon I got to watch a c-section on a term patient with premature rupture of membranes. It went much like the other c-sections I have seen but a lot of the equipment is older. Also they sterilize and reuse much of the stuff we throw away in the OR like caps, gowns, towels. I am still amazed by c-sections. The incision never seems big enough but they always manage to tug and pull the baby out. The baby looks like an alien rag doll and then minutes later when it is all clean and crying it is a soft, beautiful newborn.

One last brief wards story, one of the new admits was a very large woman with very high blood pressure. The nurses were trying to get an IV started on her but were having the hardest time. I think they must have stuck her 10 times. I totally could have tried to start the IV but felt so bad for her. I figured my one blood draw experience was much less helpful than the years of experience the nurses had starting IVs. They finally called in the doctor and he stuck her about 4 more times before he finally got it. By the way calling someone fat does not seem to be offensive in Ghana. Supposedly being fat means you are healthy and is preferable to being skinny. I wonder if this cultural preference is changing with the rampant spread of American culture.

Thanks for the comments! I really enjoy reading them. I have also been checking my yahoo mail but either comments here or email works for me. Things in the mission house have been going well. I have a bit of a routine now and the house doesn’t feel quite as big and lonely. The girls across the way are Ghanaians and work in the office at the hospital. I hang out at their place pretty much every night. They are very friendly and nice. We eat, watch tv, talk. They have taken me grocery shopping. I still would like to get out a little more and am going to work on making it happen. I hope all is well at home!

Settling in

8/24/08

Since Friday I have been feeling a lot more settled here at the hospital and living in the mission house. Nothing in particular seems to have changed. I suppose I finally got over the initial shock of the new place, people, languages, food, sounds, culture, weather, etc.

My weekend was laid back and relaxing. I had the itch to do a little traveling at least out side of Manna but I didn’t get far. Saturday was Miriam’s birthday. She lives across the way and I hang out at her place everyday so I decided to stick around to celebrate with her. A couple of her friends came over. We danced a bit, had pizza, cake, and ice cream, and talked. It was a relaxing and fun evening.

Sunday started bright and early with church. It was an energizing service and unlike any I have attended. We sang and danced. We listened and participated in the sermon which covered bible passages, current events, life lessons. Towards the end of the service people came up to receive the gift of speaking in tongues and then came up to receive blessings. Some of the ladies would become unsteady on their feet and fall to the ground. It was certainly different and more animated than Catholic mass. Unfortunately I don’t know how much praying I did. I was watching to see what would happen next. At one point Dr. Ablorh the director of Manna Mission who happened to be preaching that day invited any one new to the church to come up. I was the only one and got to say a little about myself. He said he doesn’t always remember all of the students that come through but that he would remember me because I am always smiling. Which of course made me smile more. Everyone has been so welcoming and kind.

After church I decide to venture out on my own and go to Coco Beach. I chartered a taxi and made it to the beach with no problems. In Ghana there are tons of taxis, buses, and tro tros, which are vans that hold about 15 people and they works kind of like a bus. Taxis can either be chartered, the same as getting a taxi in the US, or they can be shared which is cheaper. Shared taxis travel a specific route. At the taxi station random people get in until it fills up. The beach turned out to be just 5 minutes away and I probably could have walk though it would have been long. The beach was decently crowed. I enjoyed walking on the beach and relaxing/reading in the sun. (yes I put on sunscreen) I took some pictures of the fishing boats at the end of the beach and will try to put them up.

I had a rest full, enjoyable weekend and am eager to put my new found enthusiasm to work in the hospital.

The weekend comes

 8/22/08

I can’t believe I have already completed one week in Ghana. The time is already going by fast. Per request let me tell you a little bit more about the hospital. Manna Mission Inc also includes a school and a church on the grounds as well as some housing including the house I am staying in. The hospital is fairly small but they have plans to expand it. They have male and female wards, an operating room (that I haven’t seen yet), about 5 or so clinic/consultation rooms, a lab, a pharmacy, a separate clinic building where they have an eye and dental clinic, a canteen/cafeteria, and imaging which includes X-ray and ultrasound. They have a number of Ghanaian doctors who are permanent staff but medical mission groups come through also. Unfortunately there aren’t any right now or I would have more company. The hospital’s motto is evangelization and quality health care and the atmosphere is spiritually focused. There are a number of pastors present, including the head of the hospital who is both a pastor and a doctor. Every morning the staff has devotion and a larger hospital wide devotion on Fridays. As for the patient population I don’t quite have a handle on it yet but a majority of the diagnoses include malaria, typhoid, parasitic infection, URI, gastroenteritis, HTN, anemia, pregnancy.

I have a schedule for the rotation that has me going to different departments throughout my time. I started this week in the pharmacy for 2 days then to the lab for 2 days. To be honest I could have done with just one day at each. I feel like I have been here for a week and haven’t really seen any patients yet. But that is not to say that I haven’t learned anything. In the pharmacy I was introduced to the various malaria medications they use. I got to learn which drugs the pharmacy has in stock to help when prescribing in the clinic. There are certain drugs in stock that the hospital purchases from drug companies but they also receive donations of medications from the mission groups. The strange thing is that it is often hard for them to get rid of the donated drugs. Many of the patients have national health insurance and the donated drugs are not covered by the plan and are much more expensive for the patients. So it is hard for them to get rid of these drugs. Sometimes they sell them to other area pharmacies so that they don’t expire and get thrown out. I don’t really understand why if the drugs are donated they can’t just sell them to the patients for less. I sort of tried to ask but did not really get an answer. Also while in the pharmacy I helped a little with their new computerized inventory program. Almost all of the hospital records (charts, lab results, inventory) are paper often handwritten in log books. The administrative offices have computers with internet and there is one laptop with wireless. The pharmacy’s new system is an excel program to help track which drugs are in stock and which need to be reordered. It seemed a little convoluted and difficult to use but I am sure the pharmacy staff will make it work.

My two days in the lab were also a bit boring but again I did learn a fair amount. The lab has a couple of automated machines several of which were broken and awaiting the repair person. Many of the test are done by hand often plus microscope. Perhaps that is how labs are done in the US but I imagined not. The tests they do perform are done right away so results often take a couple minutes. The patients wait for their results and then bring them back to the doctor in the clinic. I was impressed with the rapid HIV and Hep B test strips. I got to see malaria under the microscope as well as sickle cell anemia. They also test for two types of typhoid with the Widal test which I had never heard of before and often check for G6PD deficiency.

During the down time at the hospital I did get the chance to talk with pharmacy and lab staff members and learned a lot about living in Ghana. Also hopefully I kindled the beginnings of some friendships. One of the lab techs is trying to teach me Twi, one of the local languages. Unfortunately my ability to pick up new languages is pretty poor but I am trying. I’ve eaten a few Ghanaian dishes in the canteen, was treated to pizza last night, and love the fruit here mangoes, pineapple, bananas, plantains. Everyone has been very friendly and kind. I am still the only person at the mission house and it looks to be this way probably for the rest of my stay. I’ve gotten more used to it but the nights can get lonely. Luckily I have been able to go over to the girls’ apartment across the way. It is nice to have the company. We talk and watch tv, mostly news, soccer, and dubbed Spanish novellas. I have taken a few walks and a run around the Manna Mission complex but haven’t really been off the grounds other than my one trip to the grocery store. I hope to be more adventurous this weekend. I will let you know how that goes. Also my sleep has still been a mess but might finally be turning around. 4 out of 5 nights this week I would be very tired, fall asleep around 11 and then wake up at 2am unable to go back to sleep until hours later. I am feeling more comfortable in the house and hopefully have won the war of wills against my body.

Thanks for everyone’s thoughts, prayers, and support. I really appreciate it. Let me know how you are doing. And feel free to guide my blog with questions about anything you might find interesting. Peace.

First day well in Ghana

8/18/08

I fell asleep last night easily only to be lying in bed two hours later wide awake. I think my body was confused and my mind was racing. Also when I woke up all the cool breezes had disappeared; everything was still, sticky/humid, and a bit warm. Finally I managed to get back to sleep a couple hours later. Needless to say this morning I was pretty tired. I met some of the doctors and staff and we decided that I should rest today and start tomorrow.

One of the staff and I went to the supermarket. It was similar to ones in the US but smaller and a lot less options to choose from. I haven’t quite figured out my food situation yet. They have a canteen/cafeteria at the hospital so I think I will eat some of my meals there. After getting food, I took a four hour nap. I guess I was really tired. I just hope I can fall asleep tonight.

Then I didn’t know what to do with myself. Some of the staff said I can hang out at their place across the way at night. Unfortunately they are away at a program tonight so I am left to entertain myself in the mission house. I went for a walk just around the Manna Mission complex. It lifted my spirits. It was a beautiful day with some cool breezes and blue skies. I said hi to a number of people and children on my walk. There seem to be a lot of Ghanaians out and about, walking, riding bikes, working at all different kinds of stalls selling things. There are animals mostly chickens and goats roaming about as well.

On my way back I watched a soccer game near the hospital. The people were friendly and one of the players talked to me for awhile. He is a professional footballer named Joshua. There are no games or practices on Mondays so some of the pro players from different teams in the area play games together. We talked about a number of things but most interesting to me was his attitude about America. He said that everything from America is great and that people in Ghana love America and want to go there. He said he wonders how Americans can do and make so many things that Africans can’t. I tried to ask him what he meant. He said that there are farms in Ghana but Americans farm enough food to feed themselves and the world and why can’t Ghana do that. It is an interesting question and perspective. There may be a lot that Ghanaians can learn from America but I think there are a lot Americans could learn from Ghana as well, like spirituality, taking care of family and the elderly, a love for soccer We also talked a little about politics and he was asking me about Barak Obama and if people like him in the US. He said people in Ghana like him. More proof in my mind that Barak could do wonders for America’s image internationally. Ghana is also having an election this year. Joshua said elections are dangerous. If I remember correctly the country has only had one successful democratic transition of leadership that was four years ago. Some people seem to be worried how this one will go. The election is in Nov. or Dec. so luckily I won’t be here but it will be interesting to see how it turns out.

I woke up this morning anxious, a little lonely and homesick, which I suppose is to be expected. My afternoon renewed my enthusiasm and I am excited to experience tomorrow, my first day of work. I’m going to eat some Ramen (Yeah ramen. I don’t cook much. Tomorrow I am going to eat some real Ghanaian food.), then do some reading, and call it a night. Till tomorrow.