Nalerigu Day 6

Read the below to learn more about this pics..

Hello again from Africa!

Today is day 7 in Africa which has made for perfect timing to experience my first bout of traveler's diarrhea. Oh yes...I awoke this morning to so much joy and fun (this is sarcasm). The experience that I had this morning makes traveler's diarrhea the disease of the day today. This disease is most frequently cause by one of the non-hemorrhagic straings of E.Coli. It starts between days 5-15 upon entering the country. It normally causes diarrhea and vomiting which is self limited. The treatment is either with a flouroquinolone antibiotic like ciprofloxacin or with azithromycin depending on the region you are traveling. The most important thing with this disease is rehydration. I've started my antibiotics that were prescribed for me, took some immodium (which the Sanford guide says is OK to do) and began oral hydration and sleep for the morning. Bummer!

Unfortunately, my illness means that I missed rounds this morning. What I can report from morning rounds is that the baby with severe jaundice that I posted about previously has died. There is so much death here and children are a large part of that. I'm not sure what caused this baby's jaundice, so won't know what could have or could not have been done.

I won't go into detail about my morning as certainly know one wants to know that, so it leaves me with only the afternoon to talk about!

For lunch I served myself one crescent roll and water. :) I then went to clinic which was an INCREDIBLE experience. On clinic days there are hundreds of people waiting outside the clinic to be seen. It appears to be total chaos, but somehow/somewhere there is organization and the patients are called into the clinic rooms one by one until all are seen. It's amazing. I saw so many interesting things today! When I first started, Dr. Hewitt gave me a kind lesson on the general structure of seeing patients in clinic. He then let me off to see patients on my own with the help of a Mampule interpreter. I was very excited because Dr. Hewitt had separated his pile of patients and let me see the pediatric patients until they were done when I started to see adults. I love seeing kids! So, some of the pediatric diseases that I saw today were:

Pneumonia

Asthma

Child his the stomach when playing soccer with right sided abdominal pain (he looked just great)

Hepatitis with significant ascites

Gastritis

...and of course malaria

The two most interesting patients of the day were the following (see above pictures):

1) 3 week old child with severe fever and a rash for 3 days. The rash was almost blue in color. It was difficult to determine if the rash appeared that color because of the increased melanin in the African skin making this a sepsis or meningitis case or if this was congenital rubella. Regardless, I started the patient on ampicillin and gentamicin (US NICU treatment for sepsis) and admitted the child to the hospital. I need to read more about African skin diseases.

2) 6 year old female with right sided hand swelling. When looking at her hand it appeared that she had some fascitis (hand tissue infection) that started in her hand causing swelling up near her elbow. She also had several blisters around her hand. She otherwise looked very well. I treated her with Septra to cover strep, staph and gram negatives since we didn't have oral therapy for anaerobic coverage. She'll follow-up in the clinic on Friday for re-evaluation. I hopeful we can keep her out of the hospital, but am not convinced. The antibiotic coverage we have is limited so we do the best with what we have.

On to the adults...

I saw several patients with hypertension which can actually be treated fairly well here. I saw women with menstrual cramps, pneumonia, malaria, gastritis. I saw several patients with "thin man syndrome" or HIV. There was a woman with a keloid (overgrowth of a scar) on the umbilicus (belly button) that was causing her pain. There was also a man with a terrible anal fissure and fibrous tumor in which surgical therapy was not an option. Hepatitis with ascites was also very common.

There is never a dull moment here. Just when you think you've seen everything, the next day comes. :) Oh! One funny thought I had for today which the UofI people will enjoy...after clinic is finished the hundreds of people stand in a line to receive their medications from the pharmacy (everyone gets some kind of medication, even if it is just a multivitamin). When I left the clinic I saw a picture someone similar to what it is most often like outside the Pomerantz Pharamacy at the University. The only difference...this pharmacy dispenses their medications in VERY timely fashion. All of the people where gone within 30 minutes!!! :)

After clinic I went back to the house for more fun with my traveler's diarrhea. Yes, Joe and Dad I am drinking my fluids as I am able. It was then time for supper which is always a nice part of the day. Today they served my favorite Ghanian dish which is chicken with a peanut sauce. Unfortunately due to my illness, I had some rice with just a small amount of peanut sauce over the top. At the end of dinner, however, I was starting to feel a little better so thought the piece of chocolate cake looked delicious. Yes, it was!! I feel that is a good sign that I am on the road to recovery.

Many of the American missionaries have decided on favorite foods they have learned to enjoy here. Some feel mango is clearly the winner, while others have decided on plantains. Some people love the yams. My favorite treat is sweatened iced tea. I used to despice this drink back home, but now find it to be one of the things I most look forward to. It contains a little sugar and takes MUCH better than my warm water that I lug around everyone. Yum!

So it is evening again and I am at the school house typing. Tomorrow is another day of rounding and surgeries, though nothing here is "just another day". The surgeon that had been visiting here from Texas, Dr. Cargisle, is leaving tomorrow which is disappointing for all of us. He is certainly the kindest surgeon any of us have ever met and a great teacher.

I have couple other thoughts before I sign off...

I live in a home that would certainly be low-income in the US. It does have running water and a refrigerator, but that is the extent of it's riches. With that, I still feel incredibly guiltly for the place that I live here. I have a bed to sleep on that is not dirt. I have a roof that is real, not straw. I have a shower and a toilet. I have food provided to me at every meal. I have clothes to change into every day. I have shoes to wear. I have a pantry full of medications for whatever minor ailment I may have. I have a book, pen and bookbag. I have. Others do not.

Funny and not funny quotes from the Ghanian people...

"Money is like a servant. If you abuse it, it runs away"

"If two people carry a log, it does not press hard on their heads"

"Treat your guest for two days and on the third day give them a hoe"

"A good wife is more precious than gold" (This one is for Joe)

"If one person eats all the honey, they are sure to get a stomach ache"

"If power is for sale, sell your mother to get it. Once you have it, you can then get her back" (Watch out mom, I may consider selling you when I get back!)

"Just as someone has looked after you when you grew your teeth, so should you look after them when they lose theirs."

OK all. I hope as always you are well. Your are in my thoughts and prayers often. Please think and pray for the people here and once again find something to be thankful for.

Jill