Nalerigu Day 3

Dina ola!



Today was another wonderful day here in Nalerigu. The morning seemed a bit cooler or I'm actually starting to become adjusted to the weather (fingers crossed). Rounds started again at 8am in the pediatric ward. The baby with NEC has continued to worsen, but several children are doing much better and have even been discharged. Microbiology disease of the day: H. nana. A tropical disease that causes gastrointestinal problems due to worms. You don't see this in Iowa!!



One of the obviously difficult things about practicing medicine in an area of poverty is the very limited abilities you have. I am amazed by Dr. Hewitt's excellent skills at doing the very best with what he has to offer (he really does an amazing job), but many times it is just not enough. Two days ago a woman was admitted with diabetic ketoacidosis (DKA). She appeared fairly well at that time, but had glucose levels in the 600s (that's very high). She was started on an insulin drip with intravenous fluids (IVF). Today, she had altered mental status and a repeat glucose was 40 (that's low). She was started on glucose through her IVF, but eventually died. Type I diabetics in the US are insulin dependent, so require insulin many times throughout the day. Here in the Northern region of Ghana, it is not possible for these patients to carry and store insulin. They are therefore treated the best way possible with Type II Diabetic medications and diet control. There is no way, however, to prevent DKA and it is nearly impossible to monitor these patients as closely as necessary when they are in DKA. This makes Type I diabetes an essentially deadly disease here.



This brings me to another interesting fact about medicine here. We have only 8 lab tests that can be ordered (glucose, hematocrit, white count, diff, urinalysis, blood films for malaria, stool studies without culture, HIV, TB testing) and plain x-ray as well as ultrasound for studies. Today we also saw a man with persistent hematuria (blood in the urine) on urinalysis. We did an ultrasound of his bladder which showed a large bladder tumor compressing his left ureteral junction which is now leading to kidney dilation. Dr. Hewitt told his family that he was now terminal. The family wished to bring him home to die. He will receive some pain medication if needed, but that is really the best we have to offer. Our formulary of available medications is only one page long and certainly does not include chemotherapy.



To be honest, I find myself in personal debates frequently here. Today's personal debate: I feel so thankful for all of the services and opportunities the US medical system has to provide (yes, even in the silly turmoil of healthcare reform). We are able to cure certain cancers, prolong life in many otherwise terminal diseases and Type I diabetics can live just as long as any of us. On the other hand, sometimes I wonder if there is something to be gained from the way healthcare is delivered here. It is so much more simple, without all the frequent doctor visits, lab draws, imaging studies, hospitalizations, chemotherapy, medication side effects, surgical attempts with successes/failures, not to mention the enormous cost that goes along with all of those things. I take no sides to this debate right now, but do find it an interesting discussion.



On to more happy things...



Today I was able to go to church after rounds and enjoy a true African Easter experience. It was wonderful!! There was so much energy in that room! They even sang a song that I was familiar with. The church was full and the music was LOUD. Both women and men would stand to dance if they felt compelled. I have to admit that I was a little compelled since the beat of the African music is amazing. Don't worry Joe, I stayed in my seat and didn't embarass you!! Following Easter service we had some lunch and then went over to the Hewitt's home for another easter egg hunt with the children of the missionaries. We also enjoyed a wonderful Easter Bunny decorated cake. It was great!



My favorite part of the day...



On the way home, one young boy around 9 years of age came to me (the young children love to play near all of our homes) and said "will you teach me math?". At first, I questioned whether I had heard him right, but eventually realized it was true. So, I went in our house, got a paper and pen and started writing down math problems on the paper. Eventually, we had several children over and we were teaching them complex addition, subtraction, multiplication and division. They just couldn't get enough. Then a young lady came to try to sell us mangos and she also stopped to practice some division. It was wonderful!!! I was amazed at how quickly they were able to pick up on our lessons. I was even more amazed at how resilient they were. They would bring me a problem and if they had an incorrect answer, I would tell them mosobe (try again). So they would go back 4-5 times if they had to, just to try to get the correct answer. They never got frustrated, just longed to learn. We sat on the porch for 2 hours teaching them math. That was an unbelievable experience!! Check out the picture on the pic blog.



This evening, we had dinner again with the medical students and played some funny card games like spoons and Egyptian ratscrew. We have really been having a great time.



Today, I apologize for the length of these blogs. I am so afraid that someday I will forget. Gaffula (sorry)!



Hope you all had a very happy Easter!! I miss you, but am well!



Jill