Nalerigu Day 4

Hello all you Sulamingas (Non-Africans),

Today was another interesting day in Nalerigu. The weather here was again sunny and hot. As usual the day started at 0800 for morning rounds. Interesting disease of the day: CNS malaria. The day started with Jessie (my cohort from Iowa) and I as we made decisions independently in the pediatrics ward. We reviewed the decisions we made with our attending physician and all seemed well. Then later in the morning, sadness once again overcame the hospital. We initially started with a small child around 6 months of age that had seizures and likely CNS malaria as their blood film was positive. We were then told by the medical assistants (who are fantastic) in the ward that another admission had come in with similar symptoms. We went to see the child who was already having abnormal posturing and lack of pupillary reflexes. Since labs take a very long time to come back we were unsure of whether this was malaria or meningitis which we also see quite a lot of here. We started therapy for both, but prior to therapy discussed the patient with our staff and decided on a lumbar puncture just prior to initiation of antibiotics. Jessie did the lumbar puncture (which is definitely different and less sanitary here) and started an anticonvulsant medication. We then continued on with our rounds.

Soon another admission came in who apparently had been in convulsions since the evening before. We (myself and Joe a medical student) went to see this 6 year old patient . Upon our arrival, the patient was having agonal breathing (close to death). We did the same management, but excluded the lumbar puncture since the patients convulsions had stopped and the symptoms fit more consistently with CNS malaria. We were fairly certain this child was going to die. When I went to talk with the nurses about the situation, they agreed that the child was close to death and told me that in Nalerigu, when a patient is at this point and nothing more can be done, the treatment is to pray to God.

Right after these two terrible pediatric admissions, we then caught up with two other medical students who were seeing a woman with vaginal bleeding. They appropriately brought the patient back to the ultrasound area for further evaluation. They then decided to perform a vaginal exam at which time a deceased 18 week old fetus was found hanging between the mother’s legs (I apologize for this description, but it is true and appropriately depicts life in poverty). This mother had attempted self abortion as she did not wish/feel she could care for this child. I held the child in my hand.

As soon as we finished the D&C on this patient with our medical staff, we then heard the news that the first child with CNS malaria had died. We went to see the family and were amazed to find no tears, only acceptance. Death was a sad sort of commonplace in the ward and within the village.

Our other patient with CNS malaria continued to do poorly in the early afternoon. We maintained the only management able. I returned this evening to see him and found him sleeping much more comfortably. He had even awoken shortly before to ask for water. Amazing! He, however, is not out of the woods yet. Not only does he need to get through this infection, we are also unaware at this point how much neurologic deficit he has suffered from having seizures for such a long time.

I have a whole new respect for CNS malaria…

Debate in my head today…there are so many medical needs in this community. On a normal clinic day, hundreds of patients need to be seen with only two staff physicians. Is it better to allow 4th year medical students to see patients independently just so that the people might receive care or is it ethically inappropriate to send less experienced trainees to see these patients without staffing?

On to more fun things…

Today we went outside of the medical center to visit the main road which is filled with members of the community selling all sorts of goods. I bought an African shirt for Joe as a keepsake, made by one of the male tailors in town. I also was able to get a small piece of inexpensive fabric to cover our very dirty couch in our house. After our visit, we came back to the complex for lunch where we met two new residents and their children from Wichita, KS. They have come to spend a month here also doing medical mission work. They seem great and I look forward to getting to know them better.

After lunch some of the local children brought math homework that was sent by Jessie back to our house, complete and correct. She filled them full of more math problems and sent them on their way. We then went back out the main street to visit the shop that is run by our cook’s (Yasah) wife. She is a wonderful person who I believe has the most beautifully crafted goods in town. I enjoyed supporting her business by buying several items to bring home and share. I also enjoyed the adorable young child she has, Susan, who was carried on her back. I’ll shop there again if time before I leave. I also need Yasah’s wife to show me how to carry babies that way!
Dinner was next and again was great! I am definitely not going to lose much weight here. I am trying, however, not to overeat as I feel that would be inappropriate considering the people that I serve. Following dinner, we played some cards and then were surprised by the most enjoyable event of the day…RAIN!!!!! I have never loved rain as much as I did today. I even felt cold for a while, but stood outside with the rest of clan, soaking wet, just to feel relief from the hot sun. It was FABULOUS!!! We sang the song “Africa”, but in true Christiansen fashion couldn’t remember all of the words. We came back inside for more cards games and now plan to enjoy a semi cool evening of sleep. I can’t wait!

Tomorrow is a day of surgeries. I will try to remember all of the interesting things I see to share with you all.

Best wishes as always. Please pray for the people of Northern Ghana.

Jill