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.