Nalerigu Day next - 12/4/10

Wow! The past 48 hours have been crazy!! I apologize for not blogging yesterday, but have had only 3 hours of sleep in the last two days. Let's just say that the thunder doesn't stop in Ghana (for those that don't know, several of the residents call me thunder because of the "black cloud" I have when on call. This means that most of the admissions and bad stuff seems to come my way). :) The last two days have been some of the most interesting yet. I have a few pictures, but will mainly just have to use written language to explain all of the events that occurred. In usual, non-creative/medical influenced fashion, I will use chronologic order to describe the days.

Sunday. I awoke around 6am and stumbled into the bathroom for the am, you know. I'm thankful for my dad always reminding me to check the toilet before sitting down since when I opened the lid, a large rat was swimming around in the toilet bowl. This is a true story and just a wonderful start to my day. In usual girly fashion, I screamed and ran out of the bathroom. After regaining my composure, Jessie and I returned to the restroom to take a picture of the little rodent and then initiate discussion on what to do with it. Several options were considered including scooping it into a container and swishing it out the front door. Instead, we chose option #1 which was to flush it. It didn't go down the first time, but after a couple flushes it finally vanished from our site to hopefully never be seen again. We then abused the water system by flushing it an extra 8 times after that to ensure its extinction from our toilet bowel. Don't worry, we continue to check the toilet each time before we sit. We are trying to avoid being part of the term "better watch what you do/say or it's going to come back and bite you in the (bum)"

After the rat incident, I got my scrubs on and we headed to the hospital for am rounds. The most interesting baby of the day was a little child with congenital herpes. The infant was extremely ill with blisters all over the body. The fontanelle was full and the hands and feet of this African child were white. Unfortunately, 50% of these children in the US die even with therapy and of course, in Northern Ghana, there is no acyclovir to even attempt treatment. The child died later that day.

We all finished rounds quickly and most left the hospital to have the rest of the day off. Today was my day for call, so I stayed to care for the patients and take admissions. We had four admissions before lunch. Two were incomplete miscarriages needing D&C (the procedure). The other two were children with likely typhoid fever. We completed those admissions when we were called by the obstetrics ward to come and see a patient who had just been admitted. This was a 25 year old PH 279 (HIV positive) female who apparently had her membranes rupture five days prior (that's a really long time). She was seen at a local clinic where labor induction was attempted without success. She then came to our hospital for further evaluation.

Nurse midwives are the main caretakers in the OB ward. Dr. Dickens is an obstetrician here, but couldn't possibly care directly for every women delivering in the hospital. We (the medical student and I), were called to the OB room as the nurse midwives had difficulty finding the fetal heart rate. I was able to get a good heart rate documented with doppler ultrasound, so induction of labor was initiated and antibiotics were started (don't worry, I had obstetric consultation throughout this process from our staff OB).

We then went to lunch where I indulged in some iced tea. Soon after lunch Joe (the medical student - I designated him from husband Joe by calling husband Joe "my Joe" and med student Joe "brother Joe") and I headed back to the hospital for 2pm rounds. We started out in the maternity ward at which time the pregnant women could no longer feel fetal movement. Having no continuous fetal monitoring is quite difficult. We took the woman to ultrasound and no fetal movement or heart rate were captured. We then started a medication to help the women's uterus contract so that she could deliver the fetus that had died. We went on to the rest of the hospital for more admissions.

An hour later, we returned home to chat with friends for only a short time, when we had to return for 4pm rounds. More admissions this time including the most interesting admission EVER...

As I was just leaving the OB ward, a man came from outside and said "doctor, doctor, please help us". I followed him to the outside courtyard in the middle of the hospital where a white truck was parked. This scene will be forever printed in my head. I went to the backseat of the truck where a woman was sitting with her legs in the air, a placenta on the floormat and a living baby in her lap still attached to her by the umbilical cord. I ran back into the hospital, yes ran, to grab a delivery kit. I then proceeded to clamp and cut the umbilical cord in the truck, wrap the baby, take the baby back to the nursery and then care for mom until she was able to be brought in our makeshift wheelchairs back to the maternity ward. WOW!!! That was an incredible experience. I really wish I could accurately describe the scene to you all, but I did capture a photo of the baby that was delivered for you to view. Babies are truly amazing and resilient little creatures!!!

After the patients were cared for, we returned to the main house for dinner. We were soon called back to the hospital for another admission. After the admission was completed, we headed over to Dr. Hewitt's house for the highlight of the day which was an ICECREAM social!!! It was delicious. Mona (Dr. Hewitt's wife) had created all sorts of wonderful toppings which we all were delighted to endulge in. Icecream here is a real commodity. We then headed back to the house to wait for 9pm rounds.

9pm came around and we went back to the hospital to see what was needed from us. We ran through the wards which had some orders for a us to write or labs to view (not many labs to worry about here). We then headed to the OB ward where our woman with the fetal demise was actively in labor standing next to her bed talking to us. The midwife assured us that they had no further concerns.

We were pretty excited that we were making it out of the hospital in just 30 minutes until we walked out the front doors to find two people sitting on a bench above a man who was lying on the ground. One of the men on the bench came to me and said "doctor, please help us. we have come here because this man fell to the ground and will not wake up. We talked to the medical assistant who told us to leave. We do not know what to do or where to go." I need to explain one thing, medical assistants are trained in Ghana and similar to nurse practitioners in the US, just with less training. Overall they are fantastic so I knew something must be up. In the meantime, of course, I was a little worried about this man on the ground but confident that at least he had a good pulse. That was a start. I went to talk with the medical assistant who told us that the patient was a psychiatric patient and had been seen at a local clinic where he was given too many psychiatric medications that do not combine well. He had told the family that he would just need to "sleep it off". I then returned to the people in the front of the building and reassured them that their friend would likely be fine. He could sleep on the ground overnight and if he hadn't awoken by the next morning, clinic would start where he could be seen for further evaluation. He was up and awake by the morning...

We finally headed back to the main guest house for some drumming and interpretive dancing done by Jessie, Stephanie and others in the group on their new African drums. I headed to bed around 11pm, but at 12pm there was a knock on our door. I could here them calling me from my open bedroom window saying "doctor, doctor, there is an admission for you". I opened the door, grabbed the chart, headed to the med student house to grab brother Joe and drove our guest truck to the hospital for our admissions. This time we had two pediatrics admissions. I am always relieved when they are pediatric patients. They are often very sick, but at least I feel somewhat confident in what to do for them. The first patient had malaria with severe dehydration. We got her orders in and then headed to the second patient.

The second patient = disease of the day. I walked over to the bed to find a 2 week old (<2kg) formerly premature (gestational age uknown) baby showing signs of neonatal tetanus. The child was extremely stiff and had flexed posturing. The fontanelle was soft and the reflexes were absent. The child was already only hours from death. We started the appropriate medications (including those that would cover other causes). I made sure to tell the nurses to translate to the mother that the child was very sick. We were doing everything we were able, but the chance of survival was low.

After these admissions, we headed back to our prospective homes to try to get a bit more sleep (yes, it is still difficult for me to sleep since I think about the sick children often). At 0530, I was awoken again by a knock on the door and someone outside yelling "doctor". I opened the door and the nurse handed me the chart for the women with the fetal demise. She told me to come see the patient. I grabbed brother Joe quickly and we headed to the hospital. What we witnessed after we arrived I hope to never see again. The nurse midwife told me before I entered the room that the patient would not tell them what was wrong with her. When I got into the room, she was grunting (in respiratory distress) and had altered mental status. I ran to Dr. Dicken's home (the staff OB), but by the time we returned the woman had died of sepsis. This was a terrible experience for me. My staff reassured me that there was nothing more we could have done for this woman. She was already immunocompromised from her HIV status and had been ruptured for 5 days before she even got to the hospital. This still didn't make it any easier. I keep thinking "if only we had continuous monitors", "if only the midwives would have called, "maybe we should have sent this woman to c-section right away". Lots of "if only"s. In the end, none of this probably mattered. I have come to peace with the fact that God was there and although I don't understand the spiritual complexities of the event completely, I do hope to someday understand. Many people die here everyday, but it hasn't gotten any easier and I'm somewhat glad about that. We do the best we can for them, but we just can't do everything. I've found that the goal is to help those that can be helped and pray to God for those that can't. That's the way I get through.

Unfortunately, the day doesn't end for us after that event. We still have a responsibility to take care of the other patients who have a chance at life. Just as we were about to leave the OB ward, the midwives told us that there was another woman that wasn't progressing. This was quite a different story as this woman was otherwise healthy and hadn't been in labor that long. We sent this patient to c-section which proved a healthy baby and mother. I was very thankful.

I was also thankful for am rounds as the nurses were wonderful. Without knowning what had happened only an hour before, they kindly came to me and thanked me for providing great care to the babies on the peds ward. I was so thankful and definitely needed to hear that. As expected, a short whilte later, our little baby with likely tetanus had died. I still believe in the work I'm doing here.

After am rounds, I headed to clinic which lasted until about 6pm today. Busy as usual with many interesting and sick patients. I then returned home for dinner which was a cheesy rice dish with my favorite dessert...MANGO COBBLER!!! This dish would make anyone feel better! After dinner, a shower was in order and I have now found myself to the schoohouse where one of the missionaries is watching the Minnesota Twins play Boston in their new stadium!!! How exciting!! It was nice to feel a little taste of home. Go Twins!!

I apologize for this long blog. There was just SO MUCH to include!! I ask again that you keep the people of this area in your thoughts and prayers as well as the missionaries and volunteers. Within the devistation, there is so much hope. As always, find a way to be thankful today.

Jill