Silvestri’s Blog

We Saw a Crocodile!

Well I guess this is the last post!Tomorrow is the last day of work in Nalerigu.  I have clinic all day and Darryl will be off the TB village and doing rounds with the chaplains.  All week we have both felt somewhat tired and were sad we were leaving but looking forward to traveling home but now that there is only one day left I am more sad than excited.  I am tired and I have only been here a month.  I have such an appreciation for the people who make BMC run and all of the amazing workers we have met.Just a few last medical storied.  Lastnight I was on call and I had a baby that came in septic and cyanotic (blue).  He was three days old and had been born at home and hadn’t taken to breastfeeding since birth.  I did do a month of in-patient pediatrics last June but as always things here are so much more advanced in severity.  The baby was not doing well and had nasal flaring and a really high temp so I put him on O2 (which was available thankfully… very few tanks here) and gave him antibiotics.  When I walked home I just prayed he would live till tomorrow so another set of eyes could see him and maybe find something I missed.  Today I was surprised to hear he was still alive and not blue anymore.  He was really dehydrated so I am sure all the fluids made a world of difference… its just nice when something like that happens unexpectedly.  I hope he does ok.  I had some maternity calls which thankfully a Ghanian OB doc who is here volunteered to take care of so I didn’t have to wake up Dr D.Today was procedure day and we amputated a toe which normally wouldn’t be that exciting but a lower part of the metatarsal was involved so we needed bone cutters and thankfully the nerve block worked really well and the guy didn’t feel us hacking away at his toe.  He had a moto accident awhile back and had inadequate care of an open fracture so he actually came to us a few days ago and go an above the knee amputation of his other leg just yesterday…. I hope his toe is the last part that needs to go!  I was so happy to send a few patients home today that had been hanging around awhile.  I know I am going to wonder how a few people do when I leave so its good to know already that some are well!  After procedures Darryl and I took a long hike.  We decided that we wanted to get to the top of this hill we saw far off… we did eventually get there.  It was an adventure forsure and we learned that next time we should bring more water.  From the top of this rockface we had a beautiful view of Nalerigu so it was nice to just sit there and think about all we have experienced.  On the way back these little boys were all in a crowd and told us there was something we needed to come see.  Turns out there was a crocodile waiting to jump this cow.  We didn’t wait long enough to see it attack the cow but I asked Essau (our friend) later and he said there are very few around but they mostly jump at goats and chickens but people here try to bait them with chickens so they can catch the croc and eat it… eww.  Anyways, that was kinda cool to see.  We also saw some more crazy funnel clouds.  By the end we were so thirsty we almost wanted to drink out of the stream…. which actually looks clean at some parts but I just remind myself that we just saw cows and pigs wading in the water.Tonight Darryls favourite person, pastor Kofi who runs the TB village and his wife stopped by the house to say goodbye and thank you.  I am a sucker for old couples and they are the cutest but the fact that they have dedicated their lives to total service of others is what makes them so awesome.  He prayed for us and it was amazing to have someone like that just want to thank you.  I feel like we have done so little compared to what he has done in his lifetime.  They are a couple we won’t forget.As we pack up and leave we will definitely be sad saying goodbye to some of the people we have grown to care about.  I think we both would like to come back one day.  Everytime someone prays for us they pray we will return.  I would love to and Darryl would to… kinda just depends on where life takes us.  Thanks for all the emails and prayers this month… its kept us going.  We have lots of pictures and videos and I will eventually post them on picassa so just email darryl or myself if you want the link.  Hopefully we can see many of you in person soon.  We leave at 4am sat morning to Tamale to fly to Accra then we fly out of Accra late sunday night to germany then michigan!  OK thats enough blogging for my lifetime. : )

Hamarttan

Its crazy it is our last week!  I am not going to lie though, getting pretty tired.

We have stayed just long enough to experience the Hamarttan which is a wind that carries the dust from the Sahara desert along the northwest coast of Africa into the gulf of Guinnea.  So for the last three days it has been super dusty.  The first morning it came I got up and thought it was so “foggy” out… but really its a cloud of red dust.  We can’t even see the hills which aren’t that far.  Its neat to experience but I can’t believe how dirty everything gets.  If you leave a book out for a day it will be dusty like its been sitting there for a year.  Im glad I have nose hair.. its come in handy haha.

Anyways, so things have been somewhat sane around here.  I did call and it wasn’t too bad.  I rounded at night by myself which felt weird and good at the same time.  It was a Sunday when I was on call so during the day I had calls too. One was for a little boy who was very very sick.  The nurse brought the chart to my house and when I read “unconscious for two days” I got up to the hospital very fast and went right to the ward.  The little boy was aspirating his stomach contents so I hoisted him up and got his dad to help me pull his mattress up over this box so he could breathe better. I checked his meds and fluids and he was on all the right doses etc…  so I knew that was all we could do.  While I was there a nurse from maternity came to tell me she had a couple patients I needed to come see.  One was post-partum and had elevated blood pressure - so that was pretty simple but the second patient was in labour for 24 hours and fully dilated.  I got a little panicked because I hadn’t done OB since the beginning of third year and even then I admittedly wasn’t that keen on it.  Anyways, the midwives here are awesome and knew all the answers to her history.  This was her first baby and her pelvis was small and since they had already tried inducing her I headed off to get the surgeon.  Being on foot and trying to hurry in flipflops is funny but eventually we sectioned her and I got to open and do a lot so that was fun.  The baby was far down into the pelvis so it was hard to get him out but he was alive.  By the end of the section the first boy I went and saw had died… sadly I wasn’t surprised.  His family brought him in late but that was probably because they didn’t have  alot of money and were trying to wait it out or they lived so far it took them that long to get here.. who knows.  I know we did all we could.  They don’t intubate people here… which is sometimes a blessing in disguise I am sure… sometimes.

That night I slept near the front door so I would hear them but I kept thinking I heard them knocking so sleeping was sparse.  We had clinic the next day and the resident I was with left to help with a csection for part of the morning so I was there solo… thankfully I am very comfortable now with most things I see so I was good.  The crazy thing is that I saw over 100 patients in clinic on my own monday.  yeah.  I was kinda surprised… and then at night I just crashed.  Our friends showed us a couple episodes of the show Glee… I think Lindsay likes it.  Just watching that made me realize its been awhile since entertainment and I kinda miss it.  Maybe thats bad but just watching something and not thinking can feel really good at the end of the day.  Oh yah, one patient in clinic I wanted to mention was this guy whose card said “dizziness for 4 days”.. I thought it probably was like most other people who are dizzy but as usual I put my stethescope on his chest and felt his pulse (always my first test to see how sick they are) and his heartrate was above 140.  I freaked out.  He had a 5/6 murmur and a palpable thrill and a heave.  He had something bad so I took him to see the main doc and asked if we could get an ecg but in the end he had a good point that there is nothing we can do for him anyways inpatient wise so I put him on some drugs to slow his rate and told him to take the pills before walking home.  But the thing was he had that look in his eyes like he was scared…  and I felt horrible sending him home but maybe the drugs will work and he will come back tomorrow or friday and we can check on him.   I hope so… we will see.

Today was an easier day because there was no clinic.  I was pretty pumped that one of Dr Tias post op prostatectomies was good to go home today.  We pulled his suprapubic catheter and I have never seen a man so excited to urinate on his own before. I was happy for him.  He said he was going on a vacation and he hopes he can keep urinating this well.. ha I hope so too.  I did some procedures… tapped another knee.. I+D… got squirted with puss… typical procedure day.  I+Ds here are pretty rewarding with the amount of puss you can get out.  Anyways, Darryl and I went exploring later today and found a river that Dr D had told us about.  Its so beautiful to see… there is even green around it!  Its the dry season and so everything is pretty parched and it was refreshing to see water.  We will have to bring the camera next time… definitely something we will want to capture.  Its awesome when  you are walking and cows are just wandering around you and mooing.  People own animals but they just wander.  Today we met a guy with a big knife and mangoes and who knew a little english.. he told us he was going to “check on” his cows, I wonder how he knows which ones are his.

Well Darryl is waiting to go have dinner and I am hungry.  Hope this post makes sense… I feel tired so Im sorry if its just rambling.  Miss you guys.  Looking forward to seeing some of you soon!!!  Darryl is looking forward to jamming. Sabeo… or something like that

Slowing the pace

Hello again!

Friday AM the team we came with left to go back to the US.  Darryl and I miss them a lot but are so thankful we had the chance to work with such great people.  I love seeing people do what they are passionate about and everyone was so it was awesome.  You bond with people pretty fast in this environment so I miss them all and hope I see them again!

Darryl and I moved into a new house today so we could compact things and we now live with this other couple who is here with their little boy.  Its fun having a 2 year old around… hes adorable.  Friday and today were just adjusting to how things will work with just four of us here (two docs who are full time here).  Friday clinic was my favourite clinic day so far.  I really love clinic here although it is non-stop I just like that I have independence and the ability to make people happy that they are going to get taken care of.  Friday was another market day on a clinic day so usually they are super busy but we got through it all at a decent time and even with the procedures we weren’t done too late.  Darryl and I had time at night to hang out with the resident and his wife and just chat about our experience here and what they have found easier or harder to adjust to.  Its nice to have people to kind of talk it out with and just share things.  Its also nice to have the time to do that now.

Today was my first half day off since we arrived and it feels SO good!  We rounded on all the patients in the AM and did procedures.  I tapped a knee on one guy and drained an abscess on my patient who I admitted… its kinda neat to take care of someone from clinic to procedure room all by myself.  She actually was the first patient I have seen get better overnight. She presented at clinic yesterday with an abscess on her leg that is already partially amputated but the whole limb was swollen and sore so I was really worried she would need the whole thing off.  We put her on IV antibiotics and kept her overnight and today when I brought her down for the I+D her leg was way less tender and less swollen and I was so happy I almost cried.  If she had actually had to lose the rest of her leg that would have changed her life drastically.  Anyways, I just poked the abscess and although I like lots of puss I was happy I only got a litttle :).                                                                                                                      So today I was home by noon and it was amazing to have the rest of the day to do whatever we wanted.  Darryl and I honestly acted like little kids and played with a ball part of the day… Im not sure why it was so fun but it was!  Its nice to do something lighthearted… seeing lots of death gets you down.  We also took time to explore and walked back near the hills and through part of the village.  For part of the walk because it was just the two of us we created less of stir than when we go with a bigger group so it was nice to just see life happening around us and not be pointed out.  Life here is so communal and you really feel that walking through the village.. everyone is at the water pump doing their laundry or just sitting outside talking.  We also saw a funnel cloud.  First I saw this lady running and pointed her out because it just looked funny and then Darryl noticed she was running from this funnel cloud of dust and leaves.   It felt like wizard of oz watching it blow by us haha.  Anyways, I was exhausted yesterday so today was so refreshing to not think about medicine for half the day.  I think Darryl is going to go to the TB village every AM this week and then spend time with the pastors.  Here the chaplains or pastors are really the “bad news” breakers.  They are the ones who host a family meeting when one member is diagnosed with HIV or TB.  They also get consulted when we are sending home patients who are going to die.   Tough job.

Well tomorrow I am on call so I am going to go enjoy the rest of my evening with Darryl.  He is trying to upload a couple pictures so I can post them here so if it works you will see them soon!  One is of this guy from clinic who has keloids… to the extreme.  I know it all started with a bump on his ear and I am not sure what surgeon would keep cutting but someone must have thought they could help but trying to remove them… anyways.. I tried to explain to him Friday what exactly keloids are and to never let anyone cut on his face again.  The language barrier made it hard but eventually he said he thought there was just infection in all of the scars and that he needed me to get the “bugs” out.  I wish it was that easy.  They do a lot of tribal cutting which is normally really cool looking but I am sure that contributed to some of his keloids.  The other picture is of a little girl at the TB village who got some new clothes and a couple balls.  SO many cute kid pictures.. its hard to choose.

Ok. all for now!

TB Village

Hello there!

A quick update on some recent thoughts and experiences.  Today Darryl and I went to the TB Village together.  Darryl had been before with his friend who runs the village and lives there.  I think I already explained what the village was before but anyways today we went to hand out clothes and flipflops and toys for the families living there.  The female surgeon who is here and her friend rounded all this stuff up and brought 4 duffle bags stuffed with gifts.  It was so awesome to be a part of it and I mostly went to just see how something like this works.  Because there are only a limited number of families living there it was a little more sane than handing out stuff in the middle of Nalerigu.  The kids were adorable and so excited about bubbles and toy cars.  So awesome to see faces so excited.  Fun to experience it with Darryl.   He has a little boy there that he loves and he is so cute playing with him.

On a totally different note the other day I peeled someone alive.  Yeah, I felt less human afterwards.  This girl had burns over so much of her body; both of her legs, her buttocks and one of her hands.  She needed to be debrided so she could heal and the burns were only 2nd degree most places (I say only because usually the kids we get with burns are worse).  So I helped peel off the superficial skin and she had a spinal so we worked quickly to get it done (limited time till the anesthetic wore off).  At some points I would just ask Vince “this is going to help her right?” and of course he explained patiently to me yes and why and all that.  There is just something weird about peeling off someone’s skin.  I won’t go into more detail about the peeling (although I so want to) but I think one of the good parts about it all was working with the scrub techs and surgery staff.  It took a lot of us to roll her around to bandage her and at one point there were 6 of us working together.  It was just cool to work with these amazing people who have such a different background than myself and have the same goal.. to help this patient heal.  I love working as a team.  The staff here work so hard and know so much its great to learn from them.

Thats all for now.  The Malaria meds are giving me crazy dreams but its just amusing so far.  Here some of the men have multiple wives but in my dream I had multiple husbands ha.  Darryl laughed… of course I would reverse it eh?

Hope all is well with you guys!  We have another funeral tomorrow after clinic… Darryl is getting a smock from someone so I hope he dances (the guys have to be wearing one to dance).  I will get a video if he does : )

The best funeral we’ve ever been to!

Hello again!

Everything here is going well.  Friday was clinic, busy as always.  I did some ultrasounds on my own after which was kinda new… I just looked for baby’s parts and heartbeating, they were my patients and I was just doing it to make the mom not worry as I had already heart fetal heart tones in clinic.  I think friday was also the day I did a debridement of a decubitus ulcer on a parapelegic.  It was interesting that both the wounds were on the ischial tuberosities and not the sacrum.  I think its because people here sit up instead of lie down and are skinnier.

Saturday was rounding and then we went to the market.  Last time I went I had Sheila to guide me but this time Darryl and I were on our own for a bit.  Its weird how I don’t even like shopping here… I would rather just buy mangoes.  It is more exciting shopping here though I must admit, you go and buy cloth and then get a seamstress to make things for you.  Anyways, the more interesting part of Saturday was later in the day when I went to check on my patient who was in respiratory distress and breathing more than 40 breaths a min when I admitted her Friday.  When I got there a crowd was around her bed and I saw her mother was really upset.  I soon realized it was because the patient kept pulling out her IV and taking off her oxygen… she was exhausted and wanted to die.  She was only 16 and actually looked super healthy besides her pneumonia.  I talked to one of the nurses and tried to learn how things like this work in this culture.  They got the pastor to come see her (Darryl tags along sometimes but wasn’t there for this one) and I didn’t get involved.  I personally thought if the girl wanted to stop the interventions she should be able to but I didn’t say that because I know I have no place to say anything.  It was interesting to see how it unfolded.  Later she was back on oxygen.  During this same ordeal I had another patient who didn’t want to leave because she was afraid she would come back.   I later found out there were other social reasons and it was sad because I know we can’t just fill up a bed because the patient doesn’t want to leave.  People here deal with so much.  I am constantly amazed at their strength.

Ok, so on to the good stuff.  Friday night Darryl and I went with the group to the first part of a 3 day funeral.  Here funerals are like weddings but more fun and longer.  They celebrate anniversaries of deaths as well.. like at a year and 5 years etc.  The one chief explained to us that they like to make a big celebration of everything because it brings the community together and they think that is the most important part of their culture… community.  Its so evident and it feels so right.  They have a lot of things right here.  So Friday was the Christian part of the funeral and it was pretty interesting.. singing and afterwards we were invited inside for refreshments which is a big honour.  Today was amazing though.  Today was the traditional part of the funeral and there was incredible dancing and drumming and all kinds of unique local instruments.  They also slaughter animals that are brought as a gift (are group brought a sheep but thankfully we missed the slaughter).  At the beginning when we got there we danced in behind the Tarana (the guy whose mom the funeral was for) and we sat behind him as everyone arrived.  It was the COOLEST thing I have ever seen hands down.  I was just mesmerized the whole time.  Its organized by different roles.. like the warriors were beside us and they sit up on benches with their sticks or whatever they are.  Then the elders of the Torana sat below him on mats. The Muslims sat infront on mats and then on either side were friends and other chiefs in chairs.  So amazing how rich the culture is. We are so blessed to have this experience…  I didn’t feel so blessed when the gumba player came and asked me to dance (yeah.. theres a video) but I was kinda into it so it was not embarassing. They laugh anytime anyone white dances cuz clearly they ooze coolness and rhythm from their pores and we do not.  I love watching them.  All the women were dressed so amazing and I loved how they brought their gifts in, some had huge bowls of corn on their heads and some held sheep.. just wow.  We were there for a long time and at the end before the dinner break they kept shooting off muskets.  These guns looked like they were from the revolutionary war.. seriously.  Since I have seen so many wounds from this and sewn so many hands up I wasn’t into the idea of the muskets.. but it was loud and exciting.  I took lots of video because a picture just can’t do it justice.  Tonight the party continues all night till morning.  I have clinic tomorrow and I like to have some energy to expend in clinical decisions so D and I decided not to go… also we had a trauma to take care of after rounding so its already late.

Anyways… Vince actually is having a funeral for his mom this week so we are lucky enough to experience this again on wed and thurs… I can’t wait!!!! I know tomorrow will be a long day but definitely the experience of all that energy and spirit was refreshing and makes me again appreciate the culture so much.

Thanks to all who have emailed.. it means a ton.  We feel so encouraged reading notes for you guys.  Take care.

Pictures!!! Finally!

Life is Beautiful

Hey Folks!                                                                                                                                                                                                                                I have a couple hours off and Darryl is around… thats awesome!  Sorry the video didn’t load… the internet is slow.  They pay over 300 a month here for internet .. crazy.  Anyways, update on how things are going.  We are both still healthy and doing well.                                                                                                                                                                                                                                                Yesterday was the hardest day so far for me (and thus probably the hardest for Darryl too haha).  We have patients who don’t make it quite often because they present usually at the critical point in their illness or with severe trauma but Tuesday night I had a girl come in that just broke my heart.  This was a healthy looking 10 year old girl who fell from a tree on her head and fractured her skull.  We have had two other kids who fell from trees before this girl; one who lived and one who didn’t.  This beautiful girl came in with her dad and she couldn’t even protect her airway by the time she got here.  The patients that come often travel from far away so I am sure her neck got jarred around in the car - not to mention all the brain damage from the skull injury.  She had no reflexes and was just mentally gone.  The dad could speak some english and he just so badly wanted me to say there was something we could offer but there just wasn’t.  She actually survived overnight which surprised me but I just couldn’t swallow the pain in her dad’s eyes.  Heartbreaking.  I had to do clinic yesterday after we rounded and I saw more than 60 patients on my own.  Its great to have the chance to make clinical decisions and learn so much and have an overwhelming amount of responsibility but emotionally I was just so empty yesterday.  Today is better though.  Just please pray for strength. I can’t believe we aren’t even halfway through!  I love it here and I feel very useful but it is definitely a time when I really need to reach outside of myself to give to these people.                    Monday was a holiday and Vince took us all to greet the chief of the Nieree (I am probably botching that spelling).  It was so neat and you always have to bring gifts to the chiefs.  I found it hillarious that Vince was bringing trailmix so I thought I might as well offer the Werthers since they are in gold wrapping and look nice (dad I have a pic for you!).  It is always a neat experience to go greet these important pillars of the community here, we just always wish we knew what they were saying!  Vince gives us a rundown when we are through.                                                                                                                                                                                                                                                                                                                                                                                                                                                              Tuesday was surgery day and of course taking care of the wards (my favourite part).  I made myself go in on surgeries because there are some pretty rare things we do.  I do some procedures that I want to do and that the residents don’t jump at but for the most part I have just been making sure I see all the cool stuff.  I am trying to remember what we did that day surgery-wise.  I remember there was a horrible car crash guy who needed lots of lacs sewn and had a skull fracture.  Lots of babies and c-sections.Wed was the hardest day as I have said.  Clinic is awesome and horrible all at the same time.  Its so fun to try and use sign language and learn some of the Mamprulli language - Darryl and I both know all the greetings and I know some common words I need to use.. diarrhea, pain, vomiting and fever ALL the time are used.  I have also learned how to say “sorry” before I am going to poke someone or whatever I have to do for a procedure.  We were in clinic till 630pm because monday there was no clinic and wed is market day so everyone is in town I guess it just all accumulated.  All together I bet we saw 500 patients… crazy.  After clinic we powered through a ton of proceedures (lots of people need wound debridements.. ultrasounds… and most are important and have waited since early in the AM so we feel bad eating and making them wait.. but man dinner is so good at 9pm or whenever we are done).                                                                                                                                                                                                                                                                                        I think one of the most valuable skills I have learned is to tell if a patient is very sick and needs to be admitted (most are sick to start off with).  John, one of the FP residents and I share a clinic room with likes to play his ipod and the patients love the music… you definitely have to have a sense of humor and enjoy yourself or clinic would be torture.  I am so blessed to work with great people.. I don’t know how I would do it without them and all the fun we have.  We can just start laughing at something and the patients will have no idea but they will start laughing.. its infectious… I love it.                                                                                                                                                                                                                                                                                                                                                                                                             The most common things we see are malaria malaria and more malaria, typhoid (which can get really bad and perforate the bowel and need surgery), osteomyelitis, infected wounds (saw one with maggots yesterday.. I videoed it.. amazing), pregnant women with miscarriages, kwoshiorkor (protein malnutrition), HUGE ginormous hernias (amazing how big testicles can get.. no kidding.. grapefruit or bigger), snake bites (carpet viper… thats why we use a flashlight at night) and trauma.                                                                                                                                                                                                                                                                            Anyways, little update on Darryls side of things.  He has been asked to speak quite a few times (not surprising).  The first day he spoke he talked about the good smaritan and loving your neighbour which is really good for the Mamprusi here because there are lots of tribal disputes (thus a lot of the gunshot wounds).  Hes such a good speaker and today he rode on the back of Pastor Kofi’s “moto” (a dirtbike.. freaks me out) to the TB (tuberculosis) village where all the TB patients live and get their meds till they are better.  While he was there he got asked to give an ad-lib devotion… he was a little flustered but of course came up with something.  I think its good for him to just do it on the spot.. he agrees : ).  Hes becoming friends with some guys who are around a lot and getting to know people pretty well.  Its nice he has time to really get to know some of the locals.. I know that its something I am missing out on so I listen to all he learns about people.  He really cares about people and I think hes doing a lot of good here.  He is speaking this sunday somewhere else but sadly I can’t go because hes going on the back of a moto again…. boo  But I want to go to the dancing church  so I will probably do that.  Oh and he also helps in pharmacy counting pills and putting them in church offering envelopes (ha yes they use anything you send them).                                                                                                                                                                                                                                                                                                                                                                                                                                    Well, this sporadic updating is kinda like binging and purging so sorry about the verbal diarrhea.  I am writing some of this stuff so I remember it too.  Hope all is well with you out there.  I love hearing from you.  Thanks for the emails so far. Its encouraging just to hear from you.  Its only been less than two weeks but it feels like forever… Darryl says its because the days are so long.. hes pobably right.  Ok, going to try to post some pictures.. I will spare you the gross ones and try to put up some cute kids!  Until next time! Don’t climb trees.

Sweet music

I am going to try to post a video from church today.  The song was awesome and the little girl dancing at the end is so worth the watch. Next week we are going to hit up the Ghanian version of a pentecostal church because there is more dancing.  I love listening to them sing.. so beautiful.  They have so much joy and love for life and it overflows into everything they do.  enjoy.

Update

dahsubah! (good morning)

Wow, I am so sorry there has been zero time for us to write but here it goes!  We are loving it here.  Its hardwork so far but so fulfilling.  Its been an adventure!  Im not feeling super creative so Im gonna just list days and say what we did and hopefully that will capture the gist of it.  We flew out of Accra Monday at 5am and landed in Tamale which is about a 2 hr drive from where we are now.. Nalerigu.  We are lucky enough to be travelling with Vince a doc who used to practice here full time for about 14 yrs I think and his friend who has been here many times and two family practice residents.  Vince knows so many neat things about the region so he took us to a “natural healing” orthopedic place on the way here.  It was so neat to see and definitely a good intro to the spirit of the people here.  This one guy who had been there for 11 months because he fell and was paralyzed we asked him “so can you move your legs at all” and he says “not yet”.  It is something that stuck with me.  They have such hope and strength.  It amazes me constantly.  I have such admiration for what they go through and still have faith and so much strength to go on.  We have some pictures of this ortho place so we can post some when our battery charges.  (yes dad we have been using the camera.. kinda proud of us.. its annoying but i know we are seeing somethings I want to show people).  We went to greet a chief as well which is a formal process.. the women and men do different actions and its kinda cool to know (we used that again this A.M. when some chief came to breakfast… I definitely am still learning all the rules.. it was funny, I came out with my cup of coffee and sat down and said goodmorning to him not knowing it was someone important.. oops…  status is a big deal here, I love how rich the culture is that way)  After the ride to Nalerigu we arrived at the hospital .. ate a quick lunch and started clinic.  Darryl came to clinic to see how things worked.. he left after this girls leg had a chronic osteo with the bone just sticking out…  he has seen a lot and been so good with it.  Hes kinda amazing me : ) Clinic lasted till 8pm and we ate dinner then did rounds on the wards till about 1am.  Long first day!  The good news is all the other days have been only till 11pm.There is so much need here that the work doesn’t seem as tiresome.  I am exhausted but its really not hard to motivate myself to work all day and night because the people come with such acute illnesses and they really need attention or they will not survive.  I have seen a lot of death.  The first night I was there this young girl died and that was hard because we actually coded her (did CPR)… which they never do here but we thought there was hope for her.  So many patients have died but many have gotten or are getting better.                                                                                     Clinic is crazy.  The first day I hung out with Vince and Sheila (pediatrician…  and probably one of the coolest people I have ever met).  The illnesses here are things I havent seen so it was good to get a clinical picture of what a “sick” patient looks like here.  A LOT different than my previous experience.  I am now doing clinic on my own and seeing my own patients because the volume is SO SO big.. we see around 400 patients on clinic day.  The best part is that they are all interesting and I have seen so much pathology in clinic.We have clinic mon wed fri and tues thurs are just surgery.  A typical day now is rounding at 730am and then either clinic or surgery all day and then rounding at night…. usually home by 11pm.  We all eat meals together so Darryl and I get to see one another throughout the day.. its awesome.                                                                                                             So Tuesday was a surgery day… anyone who knows me Im a thinker not a doer… surgery is boring but I went in on a few cases. I prefer to keep an eye on the wards and see what new patients come in.  We always have things happening so always things to be done.  Darryl went out with the dentist tuesday and learned how to pull teeth.  Dr Robinson is this super old guy (80s) and he comes every year with his granddaughters and they go to these remote villages and do teeth cleaning and pull teeth.  Ha, it was so funny that Darryl ended up doing that but he was a big help.               Wednesday - the most exciting thing was that this girl had a placental abruption and needed a stat C-section .. I was in on the case and the girl ended up having a uterine perforation when we went in so she needed blood.  I volunteered to find some blood.  After some running around it turned out Darryl was the only universal donor I could find… he kindly volunteered and after giving his unit he passed out.  It was kinda hillarious I must admit but we took care of him… he sat up to quickly.  Hes ok now : ) and the girl lived so that was awesome… he saved a life after only 3 days here!!! Thursday - Darryl and I went out with the dentist… another resident arrived so they had enough help at the hospital.  It was a fun day… very tiring but the kids in the villages we went to had so much energy it was amazing.  It continually amazes me that despite all of the disease, hunger, heat and poverty there is so much life… and the life is so full too…  definitely just reinforces that there is something bigger than all of us keeping this going.  Darryl pulled teeth as did I… Darryl had a hard time making people have pain.  I took pictures of him.. haha.  Its crazy that people line up for this painful procedure.  We do use some local anesthetic.  It was fun to do that together.                Thursday night D gave the devotional at this group they have every week.  He was very good.  Im glad hes getting a chance to share things… hes got a gift forsure.                                                         Friday - Clinic again… it was fun but I don’t remember a lot.  I did some OMM (the manipulation I learned in med school) and people loved it.  Its kinda hard to find time but I try to go it when I know it will be helpful.Today we had a field trip!  We went to visit this hippie couple who just live here and plant trees… it was awesome.  Hes been here since 1961 and shes been here since 1978 (D just told me that haa.. why he knows that I don’t know haha).  They had pets .. antelope.. monkeys etc.  Then we went to an escarpment.. very beautiful.  ITs the dry season here so its not as lush as usual but still so cool.Anyways… I have tried to finish this post a few times today… I finally got up the motivation to come write after evening rounds.  Hope its not too wordy… just somethings I don’t want to forget!                                                                                                                                              The team I am working with is the best.  Vince is a genius…. he knows everything I think… but hes so easy to work with at the same time.  He practiced here for awhile so he knows the language.  He also did surgery along with his FP residency so he does lots of surgery and its just amazing.  Sheila is a pediatrician who is a fun amazing spirit who just makes everyday enjoyable.  I am learning lots from her.  Dorothy and John are FP residents who are so great.  ITs nice to work well as a team.. it makes the long long hours go by fast and work seem really productive.                                                      The people here are so welcoming.  Its been fun learning some of the language.  They are always telling us we are welcome and  constantly smiling and thankful.  I think one of the things that makes caring for people so easy is that they trust you.  They just want to be well.  When one family member is sick many other family members sleep around the bed and care for the patient.  They do all of the feeding and bathing and they nurses just do the clinic things. It works really well.  Life here is so communal.  We are learning a lot just observing that aspect of life here.Ok, time to sleep.  Darryl might upload pictures soon.. he will do the next update I think.  Sorry if its one big paragraph… I can’t figure out how to fix that.Until next time!!