Nalerigu Day 8

Ni Un Tonga (good afternoon),



Today was another extraordinary day. It will be difficult to remember all of the things I wanted to tell you about that happened today, but I'll try. Every evening I've been getting to bed semi-late for one reason or another and last night was no exception. This morning, therefore, I felt that there were 100lb bricks on feet when trying to get up and get ready. Eventually, I made it out of bed, got myself ready, filled my water bottle and had a spoonful of peanut butter in preparation for another day. The interesting thing here is that no matter how tired I feel in the morning, the minute I step foot in the hospital, I am energized.



We started out rounding again in the pediatrics ward. Our baby with the abdominal distention seemed a little better today. I was also able to discharge several other children from the ward alive and healthy! Hooray! Unfortunately, with the well children come nearly as many sick. As a team, we had been caring for a small baby with CNS malaria causing seizures. Yesterday, she actually looked as if she was improving and had awoken for several short times. This morning when I went to see her she was clearly seizing and apparently had been seizing all night long. Her neurologic exam at that point was abnormal. I contacted my staff, we started some other medications, but eventually she died late this afternoon.



The good news of the morning...



Our little boy who was in status epilepticus for nearly 24 hours and appeared 2 minutes from death when he arrived at the hospital was awake, eating, talking and walking around the ward today!!!!!! I couldn't believe it! This is one of the first patients in Ghana that I truly feel we saved his life (Joe the medical student helped with this one) . We were able to discharge him to his home today after nearly one week. That makes for a good day!!

For lunch we had some chili which you won't think would be good in 100 degree weather, but is definitely more enjoyable than the liver appearing bean patty we had yesterday. I again delighted in the iced tea. :)

Before and after lunch was full of patients in clinic. I saw around 80 patients today with the help of one medical student. That was just one station. When this whole process started, I was very hesitant to see adults since I haven't really cared for them since residency, but it really hasn't been that bad. I've found that I actually can find ways to help them and haven't lost all of those skills I had previously learned.

Interesting facts about clinic:

1) I have never seen so many people at a clinic...ever
2) Most of the patients have at least one of their complains as fever (subjective), waist pain(= back pain) or GBP (generalized body pain)

3) Everyone gets a prescription before they leave

4) Any woman with abdominal pain gets a vaginal exam. I have done many!!

5) There is more HIV here than you would think. It's constantly on the differential diagnosis

6) Nearly 0 people get radiographic imaging. I did one x-ray today which is the first since I got here which diagnosed a patient with osteomyelitis (bone infection). We sent this patient to Accra to see an orthopedic surgeon. Referrals rarely happen here.

7) Treating patients is fairly easy since the choices are very limited

8) We use translators as the majority of patients speak Mampule. They can be very helpful to not helpful at all depending on their mood. I am always suspicious of my translator when, after you ask them a simple question like "is the patient having diarrhea or vomiting", then enter in a 5 minute conversion with the patient in Mampule and then answer you with simply "no". It's fascinating.

9) It takes around a half day to get most lab results back if you order them to be done that day.

10) Most women do not know their age. They simply say a number that they like. Many post-menopausal women in the states would like that part. I've seen many women that appear around 80-90 years who say they are 37. Although, there is some truth to the fact that people here in general appear older than their stated age. Just not THAT much older!

11) When admitting a patient to the hospital and you want to start them on intravenous fluids, you do not specify a rate. You just say "slow", "moderate" or fast. The nurses then decide at what speed they wish to run it. The same goes for blood transfusions.

12) THe people may come with many complaints, but they are almost always legitimate. Wouldn't you have "waist pain" if you had to carry around logs to keep shelter in your home? Wouldn't you have "fever" if you had to live and work in 100 degree weather all day without fan or air conditioning?

Interesting cases in clinic today (MANY!)

1) 4 lb baby with severe malnutrition - eventually died this afternoon

2) 2 year old girl with severe malnutrition and pneumonia (see pic). I admitted this one to the hospital for rehydration, antibiotics and an attempt to figure out what is wrong with this child. The PH# on this child was 278 which means she is not HIV positive.

3) Filariasis AKA elephantiasis (see pic). This is definitely the disease of the day today. Fascinating!!

4) Goiter (see pic)

5) 6 year old female who cut her leg falling off her back. I brought the child back to the theater (minor surgery suite) and put in 6 stitches. Thanks to Blank Children's for getting me good practice at suturing because you do it here on your own. It's sort of a need to know kind of thing.

6) Osteomyelitis as I mentioned before

7) Sexually transmitted diseases

8) The usual internist things like: hypertension, congestive heart failure, arthritis, back pain, epilepsy, pneumonia, typhoid, malaria, gastroesophogeal reflux disease, inguinal hernias, pregnancies

After clinic completed, we spent some time out in the village again. I tried to get more pictures of the children which they thought was very silly. I found that if you show them the picture after you've taken it, they are much more ammenable to posing. We then went back to the house for dinner (and rehydration). Dinner was delicious!!! I said I've never had a bad piece of pizza. Today was no exception to that rule either!! We had pizza with goat meat on it which was DELICIOUS!!! We also had banana bars (similar to banana bread for dessert). I'm stuffed!

Tonight is another night of fun at the schoolhouse. I'm planning on heading to bed early tonight since tomorrow we are rounding at 630 am so that we can all go visit a town around 2 hours away that I can never remember the name. They apparently have beautiful baskets and homemade drums. I'm excited to see another village, but am starting to be less interesting in buying things here. Another debate in my head is if I'm buying things only with my own self interests ("i need to have this") in mind or if I am buying it to have as a memore of Ghana with the added bonus of helping out a local community member. I keep trying to focus on the latter.

So that ends my blog today. As usual, I hope this is not too boring. I also apologize for the improper grammer and punctuation that may be used. My sweet Aunt Lorie is probably gasping at some of the English being used. Sorry Aunt Lorie!! It just takes to long to think about that stuff too.

I hope that you, my friends and family, know how much you are missed right now. I wish you could all be here with me, but hope this blog finds a way to bring even a part of these people to you. Sleep well and be thankful!

Jill

PS One interesting thing about Ghana...the men hold hands here when walking down the street. It is not a form of homosexuality, just of friendship. I'll try to get a picture sometime without being rude. :)