Tuesday, March 29, 2011

Mar 28

It is 1:30 pm and I'm already finished with rounds!  Richard took care of the male and children wards, so I only rounded in the female ward.  Everyone is doing well so it didn't take long.  And God has been good and we have had no more cholera cases.

There is a lot of unrest at the hospital.  Since this is an open blog, I can't describe what is happening.  Your prayers would be greatly appreciated.  Just pray for Dr. Jean and Bob, that God gives them wisdom.

Ghana fact...
It is very impolite to use your left hand.  Pastor Jonah told me yesterday that I needed to stop using my left hand to pass items to someone or to wave in greeting.  I'm basically doing to equivalent of flipping someone off.  This is a huge insult and unfortunately it has taken 2 weeks before anyone told me this. 

Today I was writing orders at the nurses station when I overheard one nurse say "She is using her left hand!"  Thankfully my friend Joseph was there and he said that I was left handed.  Since I'm completely left-hand dominant, I must say "excuse my left hand" anytime I used it to examine a patient or write.

You may wonder why the left hand is so insulting...the people do not use toilet paper.  They use their left hand for cleaning purposes.

Sunday, March 27, 2011

Mar. 27

Yesterday was a nightmare.  I was too emotionally exhausted to write before bed.  It was 2 am when Nikki and I made it to bed.
The morning began with me doing rounds in the female ward.  I completed rounds with very little interruptions. 
One interruption was the 19 year old with seizures.  She was sitting comfortably in bed when I spoke to her.  The girl later went outside to visit friends and she collapsed on the ground screaming.  A few men carried her inside and I walked over to assess the situation.  The girls said that her back hurt.  She had her hand over the left lower back.  In just a couple of minutes the girl stopped crying and lay calmly in bed.  I had given her no medication but simply stood next to her bed and watched.  A nurse standing next to me said the girl had problems at home.  I don’t know what to do with this information.  I still haven’t figured out what is causing this.
Since Tuesday a day with sickle cell anemia has been in the ward.  She was admitted with severe abdominal pain and we originally thought that she had a perforated bowel due to typhoid.  The lady was started on antibiotics and fluids and Dr. Jean was notified.  By the time the patient was in the OR, her pain was significantly improved so the surgery was canceled.  We assumed that she had had a sickle cell crisis and it could be managed with fluids.  The key to these patients’s is to keep them well hydrated.  Dr. Jean placed her on 4 liters of fluids that day.  During rounds on Wednesday and Thursday the lady was complaining of abdominal pain and she had no appetite.  I kept her on 2 liters of fluid per day and started the treatment for Typhoid.  On Friday morning rounds the lady reported that she felt better and was able to eat without a problem.  So I didn’t place her on fluids and just continued the antibiotics.  I finished rounds and left the hospital.  That evening Nikki and I were visiting Pastor Jido.  While at his house I received a phone call from Dr. Jean.  She informs me that the patient’s abdomen is now distended and painful.  That the patient was not kept on enough fluids to flush out the sickled cells and she has probably clotted off part of her intestine.  The woman needed surgery but had no insurance so the family would be in financial crisis.  And I was told the woman would probably die in surgery because she wasn’t kept on enough fluids.  As you can imagine I felt terrible.  I felt as if I had just killed this patient.
Nikki and I left Pastor Jido’s house to go to the hospital and see if we could help.  We arrived at the hospital to find out there was no blood to give her.  Since I’m O negative I walked with Emery, a lab tech, to see if I could give a pint.  In order to safely give blood, a person needs hemoglobin of 12…mine was 10.4.  I’m a chronic anemia, which I knew before coming to Africa but I wanted to still try to give.  We decided that I would be able to give a pint IF there was no other option.  Finding a person with O negative is rare, that person is considered the universal donor.  The patient had B positive blood type.  Thankfully she had 2 relatives, who were matches, but her hemoglobin was 2.2 and she needed at least 4 pints of blood in order to survive the surgery.
Nikki and I went to the nurses at the hospital to find more donors.  I found 2 male nurses who were willing to donate but no one else was a match or was willing to give.  Several nurses said no even though we were begging for this lady’s life.  Nikki called Emery and said we found donors and he needed to return to the lab right away.  Emery said he had to eat first and would be there in 30 minutes.  I couldn’t believe it!  We waited outside the lab for Emery to arrive.  Meanwhile Dr. Jean is performing surgery and the patient desperately needs blood to survive.  I’m sitting on a bench outside the lab blaming myself for this patient’s surgery because if I had kept her on enough fluids it could have been avoided.
While we were waiting for Emery, the electricity went out.  There are no backup generators at the hospital and the only lights in the OR were flashlights and Dr. Jean’s headlamp.  I just couldn’t believe all of this was happening! Thankfully the electricity came back on in a few minutes.  I continue to sit on the bench begging God to be merciful and save this lady’s life because I don’t want her life on my conscience.  After about an hour of praying silently I’m so emotionally exhausted that I finally just say “God, do as You will”.
I walk back into the OR and Dr. Jean tells me the lady had a ruptured ectopic pregnancy.  She just finished draining 2 pints of blood out of the patient’s abdomen.  There was no way I could have known this lady had an ectopic pregnancy.  So keeping her on the fluids wouldn’t have made a difference.  The lady survived the surgery.  Afterward I went and thanked the male nurses for donating.  Without their blood the woman would have died.  I lay in bed last night thanking God for showing mercy.  The odds of finding 3 donors in a matter of minutes were extremely slim.  The electricity was only off for a couple of minutes during surgery but after we finished surgery the electricity shut off for a full hour and continued to come off and on for the rest of the night.  This night was just completely unbelievable.
4:30 pm
I was planning to visit Pastor Jido’s church this morning, but Dr. Jean came into my room and said there was a patient with cholera at the hospital.  Cholera is the result of dirty drinking water.  The symptoms are rice water stool (milky white fluid) and severe vomiting.  The patient will die in a matter of hours from dehydration if not treated appropriately.  This news truly made me afraid because this could indicate a cholera epidemic.  Dr. Jean sent me to the hospital to evaluate the patient.  We had placed the patient in an isolated room.  By the time he reached the hospital his diarrhea and vomiting had slowed.  We started fluids, gave Promethazine, and Doxycylcine.  This patient should be fine.  Please God let this be the only case of cholera.
While I’m sitting in the men’s ward a nurse requested that I see another patient.  The 75 year old man was sitting on the edge of the bed breathing very shallow and fast.  I could look from across the room and tell that he was extremely ill.  I called Dr. Young and told her I thought he had pneumonia, after receiving the orders I moved on to the next patient.  Dr. Jean came to the hospital and we completed rounds on the female ward then returned to check on this man.  He had deteriorated in just 2 hours.  He was now gasping for breath and using his accessory muscles.  Dr. Jean called for an ambulance to take him to Yendi.  We don’t have Oxygen at this hospital and he needed Oxygen.  He was loaded into the ambulance and was taken only 50 feet before he died.
Female Ward
God is great and he performed a miracle.  The woman with the ruptured ectopic pregnancy is still alive.  Not only is she alive but when I looked at the inner lining of her eyelid (easy way to assess patient’s hemoglobin level) it was a healthy pink.  Last night her inner eyelid was pure white.  The woman was able to sit on the edge of the bed for a few minutes.  God is good!
The 19 year old with seizures was discharged today.  She is back to normal.  I will never know what caused all of this.  She has a referral to a neurologist in Tamale but the girl said that she didn’t want to go.  I just hope this doesn’t happen again.
Ghana fact…
Pastor Jido has promised that he will cook a dog for Nikki and me.  He will throw a big party and kill a dog.  The family now has two dogs.  The new dog is called “God’s timing”.   He will be kept for awhile to fatten up.  So I think that Pastor Jido will feed us the dog Faith.  This family also has a cat that will be eaten soon.  I asked if Pastor Jido ate rats…his response was “Oh no, I do NOT eat rats!  Who could eat a rat?”

Saturday, March 26, 2011

mar 25

Today I was responsible for rounding of the entire hospital.  I rounded from 9 am - 3 pm and hopefully I was able to take care everyone. 

The 19 year old that was seizing is doing better today, but I still can't figure out what's happening.  She stopped seizing last night but when I saw her this morning she was unresponsive.  I wasn't able to rouse her.  I tried slapping her arm, sternal rub, and Babinski reflex.  There was no response to painful stimuli.  So since I had her on fluids and the appropriate antibiotics there was nothing else I could do.  The government hospitals don't accept transfer patients on the weekend.  So transferring is not an option.  As I continued with rounds I turned and saw the girl sitting upright and wailing that she was in pain.  She cried that her back hurt and she started writhing in bed.  I looked where we did the lumbar puncture but saw nothing.  I couldn't find the source of her pain.  We raised the head of her bed and gave her a dose of Paracetamol (pain med).  In just a few minutes she was unresponsive again.  I don't know what's happening.  Now it is just a wait and see situation.

Also in the female ward...a mother that had undergone a C-section yesterday was having difficulty breathing.  Her lungs sounded terrible and I think she has pneumonia.  While I'm by the bed I notice her baby is extremely dehydrated and looked ill.  These two old ladies were sitting by the bed holding the baby on the other side of the room from the mother.  In the next few seconds the nurses began shouting at the mother and old ladies.  I have no idea what is going on and I wasn't in the mood to waste time with drama.  I just called Dr. Jean and wrote the orders and moved on.  A nurse later told me that the old women were keeping the baby from the mother because the mother was ill.  They thought the baby passed the infection to the mother, so the nurses forced the women to leave.  Once the baby was given to the mother, he immediately began feeding.  This was a close call another day and the baby would have been dead.

Another patient that weighs on me is a little girl with a knee infection.  I hadn't seen her for 4 days because Richard was taking care of the children's ward.  When I removed the dressing white filmy fluid shot out of a hole in the knee.  As I continued removing the dressing, I found another hole on the other side of the knee.  Gauze was packed into the hole about 3 inches deep.  Now in the states we would use a special type of gauze that keeps the wound free of infection.  This gauze it the same type that you would buy at WalMart.  The two holes communicated with each other.  The knee smelled and a never ending amount of fluid seeped out.  Once again I can't transfer this patient anywhere.  I wrote for IV Ceftriaxone but the father only has money for 1 day of treatment.  This man spent all day with his daughter and when he saw her knee I could see the pain on his face.  It was painful for me to explain the situation because I couldn't allow myself to become emotional or I wouldn't have been able to continue rounds.  At that point I still had about 30 patients left to see so I had to keep moving.  I can't imagine how the man feels seeing his child suffer and not being able to do anything.  (And no, socialized health care is NOT the answer.  Ghana has socialized care and not everyone can afford it or be able to receive the care they need.)  I think this infection has done so much damage that the girl will lose her leg.  But it is hard to say without being able to x-ray the leg.

On a brighter note...
The word "puppy chow" takes on a whole new meaning in Ghana.  I noticed there were very few dogs in Saboba.  When I remarked on this to Joseph he said "Oh yes, dog is very good."  He said there are people who's business is to steal dogs to sell.  That people will keep a dog until they decide it is time for a special meal.  When Nikki commented that Joseph's family has a dog, he just smiled and said "Not for long".  Apparently, dog meat has a lot of fat and its very tasty.  The funniest part was when Joseph said "Dog is my favorite Christmas dinner"  He didn't understand why this was so funny to us.  I could tell that he was serious about how much he liked dog meat.  Another thing is they name each dog.  The dog at Joseph's house is named Faith...poor Faith, her days are numbered. 

Thursday, March 24, 2011

Mar 24

What a day!  Dr. Jean was stuck in a meeting all day so that left me to take care of the wards.  Thankfully Nikki was there to help or else I may not have made it.  We started rounds in the female ward about 9 am.  Things were going well and I was almost finished with one side of the ward when a patient was rushed by on a gurney.  It was a 19 year old female who is actively seizing.  The nurses place her on a bed and her friends crown around trying to hold her down.  A nurse gives me the chart and it has the diagnosis as shock....this isn't shock.  Apparently the girl was running outside at school when she fell to the ground convulsing.  I push my way through the crowd and call out to the nurse for help.  At this point I have no idea what we have available to treat seizures.  After asking 3 times I find out they have Diazapam.  Then I had to yell repeatedly for a nurse to get the Diazepam our of the emergency kit.  Things were NOT moving fast enough for me.  After giving a 10 ml dose of Diazapam, the girl finally stopped seizing.  She became still so suddenly that Nikki bent down to check if she was still breathing.  I couldn't tell from where I was standing if the girl was still alive for a few seconds.  I thought she may be dead.  I took my stethoscope and, yes, the heart was still beating.  After writing several orders I moved on with rounds only to be interrupted again by another gurney rolling by with a girl who had collapsed.  At least this one wasn't seizing so I started fluids and she revived quickly.  Her lab results indicated that she had malaria.

Once again I continued rounds.  I managed to see one more patient before the 19 year old girl started to seize again.  We gave more Diazepam.  Her labs came back indicating that she also had typhoid.  A friend of the patient's told me that the patient's brother also "struggles".  So I think this patient has epilepsy and the typhoid lowered her seizure threshold making her more likely to seize.

And again I go back to rounds.  At this point Dr. Jean swings by to check on the seizure patient.  I was so glad to see her!  As we are discussing the patient a woman in labor is brought in.  Dr. Young rushes off to perform a C-section and I'm left to continue rounds.  I wasn't able to finish rounding until 5 pm.  The 19 year old continued seizing.  We tried to give 50 ml Dextrose 50 IV push....didn't help.  I tried IM 200 mg Phenobarbitone.  This was the last thing I tried because after this effort there is nothing left to do.  When I go to round tomorrow I will find 1 of 3 things: 1) the patient is better  2) patient is still seizing  3) She is dead.  I guess I'll find out tomorrow.  There is nothing more I can do tonight.

Wednesday, March 23, 2011

Wed. Mar. 23

As I’m sitting here typing this we are having a crazy dust storm.  The dust storms in Texas are nothing compared to this.  Out of nowhere the wind picks up and reaches hurricane force winds (maybe I’m exaggerating but it feels like hurricane force winds), dust fills the air and everyone starts to run for cover.  I’m sitting in our bedroom and I have to occasionally wipe off my journal and computer.  They tell me Saboba is beautiful during the rainy season…this is hard to believe right now.
Recap of my first full day rounding with Dr. Jean.  My entry for Tuesday was completed early in the morning and did not cover the entire day. 
A patient chart at the hospital consists of loose papers and lab slips and all of the papers aren’t related to the current hospitalization.  At one point on rounds Dr. Jean was called into a meeting so I was left to run rounds…talk about being thrown into the line of fire.  I had no list of drugs available in the hospital pharmacy and every drug I wanted to use wasn’t available.  I wanted to start fluids on a patient but the fluid I wanted to use wasn’t available.  I felt like a first year med student yesterday because I quickly ran out of ideas.  Thankfully Dr. Jean returned and we were able to finish.
After rounds we then started seeing surgical patients.  Of course there were multiple interruptions.  One involved a retained placenta.  As we walked into the room I saw a nurse using a cup to scoop the blood off the table into a bed pan.  The bed pan was almost full of blood.  Dr. Jean put her hand up into the uterus and started to separate the placenta from the uterine wall.  After a couple of minutes the placenta came out and the bleeding stopped…the lady is doing fine now.
Later in the afternoon we began the surgeries.  We had 4 hernia repairs and 1 hydrocele.  As I was putting on the surgical gown, my hands kept catching in the holes in the sleeves.  There was no general anesthesia only a local injection of lidocaine.  When the patient started to squirm too much, Dr. Jean would drive her elbow into his thigh and yell for the patient to be still.  I know that in the U.S. this sounds barbaric but these patients are desperate for help and Dr. Jean is one of the few surgeons who does a good job repairing hernias.  The patient knows that she won’t cut corners and will do a correct repair.  We finished surgery about 7 pm.
The Youngs, Nikki, and I were invited for dinner at Pastor Jonah’s house…Unfortunately an emergency C-section came and Dr. Jean had to miss dinner.  A group of men were traveling through Saboba on their way to Mole National Park (I think this is what it is called).  They were part of an organization that develops young leaders in Africa.  It was an enjoyable evening.  I particularly enjoyed speaking with a man, Roland, from Liberia.  Roland owns a construction company in Liberia and he became involved with this organization when he attended a Baptist convention in Accra.  Roland is a big fan of Dr. Henry Blackabee and wanted to hear Blackabee speak, so he invited Blackabee to Liberia and Blackabee spoke at a convention there.  This morning at breakfast Roland gave me a devotional book written by Dr. Blackabee.  In the cover he wrote a scripture verse that is meaningful to him.  It was 2 Timothy 2:2.

Tues. Mar 22 7:50 am

Yesterday was a full day.  We don’t have a fixed schedule but the days still fill up.  I rounded with Dr. Jean from 10:30 – 12:30.  We started in the female ward and worked our way towards the men’s ward.  The nurses would join us and translate when needed.  The ward consists of 1 long room with beds lining each wall.  There are windows along the walls that open into the hall so there is very little breeze in the ward.  Most of the patient beds have thin sheets but there are several with none and the patients are sleeping directly on the plastic mattress.  Dr. Jean is a great teacher.   The main diseases on the wards are typhoid and malaria.  One woman had a retained placenta after delivery and we plan to evacuate the uterus today.
Last night I met Joseph at the female ward to review Anatomy.  We went over the digestive tract.  I discovered that he has been taught very little Anatomy and the book is a little too basic for the nursing level.  Joseph had drawn a diagram of the entire tract and we reviewed it step by step.  I hope that I didn’t overwhelm him.  During our session Joseph had to get up several times to take care of patients (he was working night shift).  I asked how many nurses were in the ward and he said 3 nurses (remember there are probably around 25 patients on the ward).  One nurse was sleeping and the other nurse had gone home for awhile.  Joseph had to take care of the ward by himself.  While we were sitting at the nurse’s station a couple of people rode by on bicycles and one person rode a motorcycle straight into the ward and parked it…unbelievable!  The fumes filled the hallways for several minutes.  There are many times where I’m just so frustrated.

Monday, March 21, 2011

Sunday Mar 20th

It was so hot today!  Nikki put the thermometer in the window and it measured > 120 F!  I don't know the exact temp because the thermometer only goes up to 120 F.  At least the house was a little cooler...it was only 100 F.

Nikki and I were invited to attend the Church of Pentecost today.  The church was a big cinder block building.  The floor was gravel and the roof was pitched in the middle.  There was a 1 foot space between the roof and the top of the wall.  This is to allow enough light into the building so the bats won't nest.  There were big holes cut into the walls for windows.  Nikki and I were given seats in front of the congregation.  I wasn't too thrilled about being in front of everyone, but that's where they put guest of honor.  The music was terrible!  Before I came to Africa, I just assumed that all African people sang well....wrong!  A person would just walk up to the front of the church and start a song and then the musicians would try to play the tune.  There were 3 singers and each singer was on a different pitch.  During the music the people would file out and dance single file in a circle.  They did this in groups by age and gender.  Once the singing and dancing was over, we had the sermon.  The sermon was in English and Tre (pronounced Tree) so it took twice as long.  One thing that I really didn't like was the speaking in tongues.  It was just too much for this Baptist girl.

After church, we met Joseph and his friend, Enoch, for a walk.  Enoch is Joseph's best friend and is a teacher at Miss Ivy's school.  The guys took us to the dam.  It is a large pond of green, stagnant water where many people go to collect drinking water.  This is one of the causes of the typhoid epidemic.  Just across the dam are 3 bore holes that were drilled by World Vision.  Only 1 of the 3 bore holes is functioning.  I was confused as to why only 1 pump was functioning because I assumed that World Vision should come in and fix this problem.  This is the way it was explained to me...in order for a town to have a well drilled by World Vision, they must provide evidence of sufficient funds that may be used to maintain the pump.  World Vision only agrees to drill the well, not to maintain the pump.  The town is responsible for any repairs.  So, somehow the town didn't have enough money to fix the other two pumps.  At one point this past year, all 3 pumps were out of order.  The town fixed a pump and charged the people a small fee to pump water.  The repair has now been paid and the people are able to pump water for free now.  The other two pumps are still out of working order.  The handles on both pumps were broken. 

During the walk we stopped by Miss Ivy's school.  A woman was there and she said that she hurt her arm.  For reasons I don't understand, she was on the roof and fell on her arm.  The are was obviously broken.  It was swollen and the distal radius was misaligned (there was a dip where her arm should have been straight).  Her thumb was also displaced down and it was slightly twisted, so I think she also has a broken wrist.  I said that her arm was broken and she should come to the hospital where we could place it in a splint and immobilize it.  Joseph said "no it is not broken it is only swollen due to blood inside the arm".  He took clay and started at her elbow and pulled along her arm to her fingertips.  The woman was screaming and writhing in pain.  Another man came and held her down.  It was terrible to watch and I knew it was making her arm worse.  I'm concerned that the woman may have osteomyelitis.  This fracture is over a week old, so at this point if she were in the States...she would be having surgery.  I could do nothing but sit on the bench and watch.  They didn't believe what I said and didn't ask for my help.  Later, Joseph asked me what I would have done in the U.S.  We looked at an Anatomy book and I showed him where I thought the breaks were and how it could be fixed.  The people here are really intelligent, but they have been told that clay will fix broken bones all of their lives..they don't know anything different.  

Saturday, March 19, 2011

Mar 19th

Bob left early Friday morning to travel to Tamale to pick up Dr. Jean.  He and Dr. Jean are supposed to return sometime on Sunday.  Nikki and I were left alone for the night...it was nice to just relax and visit with people

Now to describe Joseph

Joseph looks like a men's magazine model.  If Joseph were an American I would have the biggest crush on him.  He is a highly intelligent, handsome, christian man.  He's a nursing student at the hospital.  Joseph's dream is to go to medical school, return to Saboba, and start a medical clinic.  When Joseph is not working at the hospital, he is teaching at Miss Ivy's school.  Joseph wanted to be an engineer so he applied and was accepted to a university.  The educational system is extremely corrupt.  When Joseph showed up for class he discovered that his seat was given to another person whose family had political connections.  He was denied entrance to the university and had to return home.  The next year he reapplied to the university and also applied to the nursing school.  He was accepted to both but chose to attend nursing school.  The nursing schools are extremely competitive in Ghana.  For Joseph's class, 754 applicants took the entrance exam and only 174 passed...this indicates how intelligent Joseph is.  The nursing degree is a 3 year program.  Joseph contacted a medical school and asked if the nursing degree would be acceptable.  He was told that he would still have to go to a university.  Unfortunately Joseph has been sucked into the corrupt educational system and it will be hard for him to reach his goals.  In this country, simply making the grades and perseverence aren't enough.  Now, Joseph wants to continue on and receive a master's degree in nursing.  This will allow him to be a physician's assistant.

In the years that Joseph was waiting to be accepted to school, he helped a local woman, Miss Ivy start a private school.  He traveled from town-to-town and house-to-house telling people of the new school where the teachers would show up everyday to teach.  The public teachers in this area are unreliable.  They will collect pay but will rarely show up to teach.  Most of the teachers only have a high school level of education.  Joseph and Miss Ivy were able to start the school with the help of a U.S. woman.  The woman donated money to buy the land and build the school.  The children love Joseph and when he left for nursing school, their little hearts were broken.  Now that he is doing clinicals at the hospital, the children will pretend they are sick so they can see him.  Joseph had to talk to the children at school about this problem.  Now when Joseph has a day off he volunteers at the school.  Joseph is just an amazing person who feels that God has given him a calling.

Now if I can just find an American Joseph...

Mar 18h

Today I'm sick.  I woke up with diarrhea and have had bouts of it all day.  Even though I wasn't feeling well I still managed to function.  This morning I walked to the hospital to visit the men in the theatre (OR).  There a very few patients at the hospital, so the nurses had nothing to do.  I visited with Ishmael and Joseph for awhile then went home to lunch.  This afternoon Joseph took Nikki and I to the market.  Every 6 days Saboba has market day where vendors from all over come to sell their goods.  I should have taken pictures but at this point I was feeling really sick.  Joseph and Nikki noticed that I was feeling bad so we went back to the house.  This is a boring note to write tonight.  Maybe tomorrow I will describe the market.

Mar 17th

Yesterday was a much better day.  Nikki took me to the hospital lab where I met Emery and Jacob.  It was like stepping back to 1941.  They hardly ever change gloves between patients.  They had old floor tiles on which they placed drops of blood and performed the Widal tests and blood typing.  They also used the same pipette to draw up the different blood samples...I'm sure the samples were cross contaminated.  I was a bit startled when Jacob turned to me and asked "Would you provide the control?  We have to do an HIV screen and need a control".  I didn't understand what he was asking.  Nikki spoke up and explained that they needed a sample of my blood because I was HIV negative.  I said o.k. even though in the back of my mind I worried about the sterility of the needle.  Nikki found a new needle with an unbroken seal and she drew my blood (I promise we made sure everything was sterile).  Sigh...to be in the U.S. where everything is clean and sterile!

Later in the lab I was standing by the window with Emery.  A man rode by on his bicycle and stopped to visit.  Once the man noticed I was there he wanted to know what I was called.  I could hear Nikki, Jacob, and Emery snickering in the background so I knew something shocking was about to come out of this man's mouth.  Gabriel then opened his mouth and said "are you single?" "Uh, yes for now" "Then you will marry me!"  "Um, no I won't" "Yes, you will"  "No, I won't.  I need to finish medical school.  I will marry later."  "Then I will wait for you!"  By this point I was a little exasperated by the man.  Of course when I become exasperated my Texas accent becomes extremely thick.  I reverted to the typical Texas woman stance...hand on hip with other hand pointing at man.  My response to him "WELL!  You will be waiting a very long time!"  Nikki thought this was hilarious and videotaped the whole episode.  I think Gabriel got the message because he hasn't asked to marry me again.

Last evening we wallked down to the river.  A local man, Joseph, joined us.  The river is about 1/2 mile from the house.  Once we reached the river bank it was a steep climb down on slippery rocks.  I took pictures of the beautiful scene.  Women were washing clothes and hauling water, children were fishing.  Only when you look closer at the women's faces you notice lines of fatigue and weariness.  The women carry huge jars of water on their hands and they make countless trips a day.  The children also help with the task of collecting water and firewood.  Trinity (a girl who cleans for the Youngs) told me that she spends 4 hours a day hauling water.  It takes 2 hours to make one complete trip.  At this time last year, they didn't need to haul water because it was pumped into town.  But a water pipe burst and the government has not made repairs.  The national election is coming up in 2012 and the officials have promised to repair the pipe by 2012.  They say there is no money for the repair right now but the money will be there during the election year.

Culture fact:
1. Potty training - there are no diapers here.  Mostly the children wear shorts and t-shirts or nothing at all.  Yesterday, James (he is 2 1/2 years) stood in the hall outside of our room urinating in the floor.  The urine simply poured down his legs and puddled on the floor.  Bob walked into the hall and called for Jame's mother, Aggie, to come clean up.  She simply took a mop and soaked up the puddle.  James was not changed.  He was left to air dry.  I have seen this happen several other times.  The children just eventually become potty trained this way.

2. The women carry huge jars of water on their head.  Well, if you have ever tried to carry water, you quickly realize that the water will slosh.  The women solve this problem by putting leaves and twigs into the water to disrupt the serface tension....brilliant

Friday, March 18, 2011

Wed. March 16

Wednesday March 16th  6:55 am

Today is my parent's 31st wedding anniversary.  The internet is still not working so I'm not able to send an email.  On the schedule for today....meet the cheifs.  I'm looking forward to this, it should be interesting.

A few cultural things that I have learned so far...
1. Ghanian people are very affectionate.  It is common for 2 men to hold hands while walking.  Hand holding has no sexual intent.  It is a sign of friendship.  It is not acceptable for a couple to hold hands in public, but a man and woman who are just friends may hold hands.  It is a sign that you are not romantically interested in that person.  This concept is so backwards to me.  I still catch myself thinking that every couple holding hands are an item, but they are actually showing only friendship and nothing more.

2.  When hand shaking, it is common to continue holding the hand through the entire conversation.  When pulling the hands apart the other person will catch your middle finger and make a snapping motion.  It is like you are snapping each other's middle finger.  This causes a popping sounds at the end of the hand release.  This is a sign of friendship.  The first time a man did this to me, I was taken aback...I thought he was hitting on me.  Now I just kinda go with it.

we are back in business!

The internet has been down for several days and I was really becoming anxious to check my email.  I felt a little out of the loop with everyone back home.  I have been keeping up with my journal entries so I'll copy down a few to share.

March 15th 7 pm
Today has been an emotional roller coaster.  I have gone from a feeling of intense frustration over spending an entire week out of the hospital to the feeling of satisfaction with making new connections with people. 

We left Saboba this morning to travel to a nearby village.  We met 2 community nurses, Vivian and Polliana.  The community nurses will visit the village every few weeks in order to give vaccinations and weigh the babies.  They also give very limited medical care.  A community nurse has 1 year of training in nursing school.  Nikki and I spent the morning sitting on a bench watching the nurses work; I think we were a main form of entertainment.  The children are fascinated, curious, and a little afraid of our white skin.  It took a couple of hours for many of them to come within a foot of us.  The locals have told me repeatedly that I am very white.  They tease that we are easy to spot in the dark.  Since I wasn't able to be of help to the nurses, I have a lot of time to notice the town and people.  The village is very isolated.  The "road" into town is a patch for motos (motorcycles).  All of the buildings were circular huts made of dung, mud, or concrete with thatched roofs.  The huts are built in a circle connected by a wall of thatched grass or mud.  In one part of the wall it juts out and this portion is the outhouse.  I have yet to go inside a hut, but I'm curious to see what they look like.  When we visit a home the people will place plastic lawn chairs in the courtyard for us to sit.  These compounds are not just for one family, but also for several members of the extended family.
While I was observing the town, the nurses were busily weighing babies and giving vaccines.  The women sew fabric slings that are able to hang from a hook.  They place their babies in the sling and attach the sling to a hooked scale that resembles a vegetable scale at the supermarket.  It took several hours to weigh and vaccinate the babies and soon it was time to eat.  A couple of the village women made lunch for us.   Now to the really good part...

Lunch was served in 4 pots. 
Pot 1 - Fufu  -  crushed yeams.  This was eaten by rolling the dough in your palm to form a ball
Pot 2 - unknown sauce  -  it had a fish that was smothered in sauce.  This is what we dipped the fufu in
Pot 3 - Tizeetizee (just spelling how I hear it) - crushed maize that is also rolled into a ball.
Pot 4 - Ayoyo  -  crushed leaves of some type that reminded me of spinache.  It was really slimy like boiled okra.  My family at home knows how much I despise boiled okra but I surprisingly like the tast of this dish.
As I was eating Vivian asked if I like the food.  I said that I did.  The girls started to laugh and Poliana reached into the pot and pulled out a RAT!  This rat was complete with the head and tail!  I was so shocked that I just started laughing.  It was so ridiculous to me that anyone would cook a rat.  Poliana offered me the rat.  So I tore off its little leg and pulled the meat off.  The meat had a strong tangy taste.  I had no choice but to eat it because the local women were watching us.  One of the women in the group made the sauce and I didn't want to offend her.  It is amazing what a person will eat so they won't offend someone.  Once I got past the thought of it being a rat, it was good.  Nikki was too busy laughing and taking photos of my shocked face to try the rat. 

Later this evening Nikki and I went for a walk through Saboba.  In the evenings the town is buzzing with activity.  People are sitting in front of their shops visiting or going to fetch water.  We stopped several times to visit.  I'll write more about the town later...  

Tuesday, March 15, 2011

Saboba!!

Yesterday was the day that would never end!!  Bob, Jean, and Nikki met me in Tamale.  We had breakfast together at a roadside stand and then we dropped Dr. Jean off at a conference.  It was a huge disapointment to find out that Dr. Jean will be gone the first week of my stay, but I'll be following the community health nurses this week.  They go to the villages and weigh the babies and then give vaccinations. 

It took 2 hours to drive from Tamale to Saboba.  We didn't leave Tamale until 1 pm because Bob had several errands to run.  The road to Saboba was paved until we reached Yendi and from there it a was dirt.  I will never again complain about the dirt roads at home.  I think that my spine has been permanently disconnected from my head.  The farther from Tamale we traveled, the more primitive the villages became.  Saboba is a reasonably well developed town.  Several of the roads are paved and there is electicity and running water.  The hospital is within walking distance of the house which is nice.  Nikki (the other volunteer here) showed me around the hospital and I was introduced to several of the nurses.  Things are really slow at the hospital now because Dr. Jean is gone.  I'm curious to see how things will be when she returns.

I also found out that Dr. Jean and Bob will be leaving again on April 12th to travel to another conference on the coast.  So, the last week or so that I'm here I will be traveling Ghana with Nikki.  My time here at the hospital will be short and fast!

Sunday, March 13, 2011

Finally in Ghana

So I arrived in Accra about 11:15 am today.  It was a really looooong flight, but thankfully I was able to watch a movie for free.  The lady who sat next to me was a character.  She had a very "in your face" personality that I don't think the flight attendants cared for.  We got along fine because I pretty much did what she asked including holding her pillow and blanket for the first few hours of the flight so she would have room to spread out.  I think the flight attendant finally had enough when she sent her breakfast back because it wasn't a low carb meal.  Considering that no one else got breakfast on the plane until we were in line to unload this was a pretty bold move on the lady's part. The attendants handed out the biscuits right before we lined up so no one got to eat it anyway.  The interesting thing about this lady was that she was traveling to Africa to teach college students conflict resolution skills.  Apparently she travels around teaching different techniques of how to listen to others and improve inter-cultural communication.

So, I don't have much else to report because I have been hanging out at the mission house today.  The missionaries are hosting an area meeting tonight and I'm invited to attend.  They are expecting around 20 guest and it will be a time of fellowship and prayer.

So far the heat hasn't been too bad (I think the mission trips I used to take to Mexico were much worse).  But I'm not in Saboba yet, so I shouldn't get too comfortable.  Tomorrow I leave at 5 am to fly to Tamale and then on to Saboba! 

Friday, March 11, 2011

And so it begins...

This will be my last night in the U.S. for 6 weeks!  I'm not looking forward to the flights to Saboba.  It will take 3 days before I finally arrive at the mission.  I leave for Ghana tomorrow morning and I'll arrive in the capital city, Accra, on Sunday morning.  After spending the night at a Baptist mission house in Accra, I will board a plane on Monday morning to fly to Tamale.  From there someone from the mission will pick me up to drive to Saboba. 

I'll admit I'm a little intimidated by the thought of what I may face at the hospital.  I'm so used to having all of the latest technology and medicines.  I have also been spoiled when it comes to working with great nurses and supporting staff.  I'm taking several small reference books with me and I have reviewed diseases such as typhoid, malaria, and parasitic diseases.  Although I have spent time studying this month, in no way shape or form do I feel ready to face this task. 

I pray that I will be a help instead of a hindrance to the doctor and supporting staff at the hospital.  My goal is to learn as much as possible from them and I hope that I will have the chance to teach them a little in return.  And as always, I pray that God will use me for a greater purpose.

And the journey begins...