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.

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?”

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. 

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.

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.

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.