Nalerigu Day 15 and 16

Gaffula (sorry)!

I am very sorry I wasn't able to make it to the schoolhouse yesterday to write. I am very sad myself as much has happened over the past couple of days and I am afraid that many things will be left out of the blog today.

Yesterday morning started like any other day, including another rodent in the bathtub. Darn! Jessie took care of this one before I had even awoken which was much appreciated. We headed off to the hospital for rounds. Rounds that day needed to be quite fast since the medical assistants who normally see patients before we arrive to clinic where away getting some training. We tried to hurry through as fast as possible. Most of the children were doing much better which was great. I had admitted one child the previous day that I didn't think would be there that morning, but somehow had pulled through and looked much better! The little child who hadn't stooled in their life had a normal rectal exam that morning and showed me the first stool of their life during my examination. How exciting! Most likely, this child had a rectal stricture that opened after the initial rectal exam that I did. The other students and residents are now calling me magic fingers. :)

Clinic was busy as usual. Because the medical assistents were away, Jessie and I had our own separate rooms where we were able to see only children once again. That was great!! The only problem is that the children all come in with the same complaint. It usually reads something like this "fever. diarrhea. vomiting. not eating. cough.". One of the medical points I am learning most here is the importance of good physical exam skills. With everyone having the same complaint, we are responsible for examining the child and deciding what the diagnosis will be. With limited laboratory tests, things are even more difficult. In addition, we cannot always rely on the lab tests that we do have. For example, a blood film that checks for malaria can be negative on initial screening and then positive the next day. Also, around 30% of the population around Nalerigu have latent malaria, so carry the disease chronically without having symptoms. This makes there blood film always positive! It can be difficult! The good news of clinic day is that all of the children were well enough to go home and I didn't have any hospital admissions! A near miracle I'd say.

Something interesting that happens here which we would not know about had we not befriended the people that work around our complex. Caleb, one of the men who helps cook food for us, has a 5 year old son named Ezekial. Caleb was missing for a couple of days and one of the volunteers asked him why that was. He told them that his son was ill with fever and vomiting. He had taken his son to one of the medical assistents who started him on some medicine. The medical assistent then told Caleb that was the best he could do for him and he would have to wait one week for his son to see an "American Doctor". This broke my heart. I talked to Caleb and his son was seen by myself yesterday. I also consulted with Dr. Hewitt to ensure that the plan I had made for his treatment was appropriate. Today, I talked to Caleb who told me that his son is doing much better which made my day. Children just shouldn't have to wait a week to get appropriate care.

This brings me to one of the interesting points about Northern Ghana. Things are VERY slow here! There is no rush to do anything. This can be good for some things like taking time to enjoy life, but makes things difficult in other ways. If a patient is near death, the workers casually come to our door to get us and say "we would like you to come see this patient". A lab may be ordered one morning, but you may not receive the results until the next morning (if you’re lucky). It’s especially problematic when there are emergencies. Something that overlaps with this problem is that Ghanians don’t like to give bad news. So if there are no emergencies the workers won’t tell you if something bad is happening. If someone dies here the staff members tell you that “the patient’s status has changed”. I didn’t realize this until this week. So many things to learn in a new culture!

After clinic finished around 4:30, we went to the theater where some procedures were going on. My favorite was the casting of a child with club feet using the Ponsetti method. Dr. Ponsetti was an orthopedic staff at the U of Iowa that this method was named after. He died suddenly this past year, but was an integral member of the ortho crew. I have thus made club feet the disease of the day. Google the Ponsetti method for more interesting information about his works!
After the procedures were complete, we headed back to our prospective houses, took our showers and had pizza for dinner. I love the homemade pizza here! Definitely one of my favorite meals! We enjoyed a little Karaoke after the meal, then Jessie and I headed over to the house of our friends from Wichita for movie night. We watched Night at the Museum #2. I believe at least three of us fell asleep during the movie. We were tired!! Unfortunately, right before the movie started I developed another episode of “illness”. I now call Immodium my Vitamin I. There should be a Nobel Prize for the people who discovered that medication!

After the movie, I headed to bed at one of the earliest times I have since I’ve arrived, 1130. The hamartan winds returned last evening which was a great treat, making the night much cooler (although the dirt flying through the window wasn't as nice). Today was another morning of inpatient rounds. Overnight, a child with severe malnutrition (I chose to not take a picture of this child as it was too disturbing) died. We attempted to refeed the patient slowly, but there are many problems that can occur with refeeding . There is something very wrong about a child dying because they don’t have enough to eat.

Overall, the children on the ward were doing much better. My child with abdominal distention pooped several more times, the abdomen was much improved and started eating again today! The child with pustules all over the body with likely a staph skin infection had completely cleared. Rounding ended at 10am this morning, so we returned home for a short nap before lunch. After lunch, I was motivated to go on a run. Interesting decision! There were several factors that affected the run which made a 30min run feel like a marathon. The first is that I haven’t run since I arrived in Africa. I also have underlying dehydration and anemia here. The most important factor is that it was over 100 degrees. Yikes! I was sort of feeling bad for myself until I ran by the nutrition center and a woman around 65 years of age came up to me smiling, holding a baby and proceeded to run with me for around a half a mile with barefeet (still holding the baby)! I decided to stop being such a wimp and ran a couple more laps around. The people here are amazing!

For the rest of the afternoon, Jessie, Stephanie, Isaac and I went to the village to wander. See the pictures for more info about that. It was wonderful. The most exciting part was that we saw two other Sulamingas (white people) in the street. As we are generally the only Sulamingas here, we stared at them like the Ghanians stare at us and then went over to greet them. They were two women around our age who had come for Norway to work in the local orphanage for around a month. It was a really great experience!

Dinner was mashed potatoes, beef and cooked peas, so it was bread and chocolate cake for me. After dinner, I started my blog, but the group decided that they wanted to go over to Yisah’s restaurant/hotel for some fun. Almost the entire group went and had a blast. Yisah’s place is called “the iceberg”. It’s a really neat little place with outdoor seating and clear Christmas lights surrounding the complex. I enjoyed a delicious Coke with not only the volunteers, but also several other workers from the Medical Center. After returning home we had a short dance party (there is not that much to do here). I’m hoping to get to bed semi early tonight, since we have rounds as usual in the morning followed by church.

I continue to pinch myself everyday as a reminder that I am Africa living this dream. Today I am thankful that my niece and nephews as well as all our other beloved children back home are fed. Hello Ethan, Mya, Ben and Isaac! I miss you!

What are you thankful for today?

Jill

Side note:
To answer David: I asked about the day names today. Apparently they do have day names but are not used very frequently around here. Interesting!
I’d also like to give a shout to Jeff back in West Virginia. We all enjoyed your email!! I laughed so hard (especially the part about the Argentinian)!! Hope you are well. We send our best to your mom…