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

Nalerigu - End of Day 1 and all of Day 2 pics

The group of students and residents

The donkey with the hat

Stephanie, a med student from West Virginia

Gambaga Escarpment

At the market

The woman with the beautiful fabric!

On the way to market

Timothy

Dinner at the med student house

Fufu and goat meat with peanut sauce, yum!

Day 2 - Nalerigu

Dena ola (good day in Mampule, the local tribal language) from Nalerigu!

Today was just another amazing day. The other students and I keep feeling like we need to pinch each other to remind us that we are really here. It's wonderful and we are starting to fit right in. I'll break this blog up into four pieces of the day which are: my first day of rounding, the market, the escarpment and Easter potluck.

#1 Today was the first morning for rounding and what an experience it was. We started in the pediatrics ward/room which at the time is holding around 18 patients (very low as the rainy/high malaria season is now gone). Today I saw pediatric patients with malaria, typhoid bowel perforation, necrotizing enterocolitis, neisseria meningitis, retroviral infection/immunodeficiency/public health #289 (we don't use the term HIV here), femur fracture and a little girl with a bacteroides sarcoma (I'm getting a picture of this one). Yes, I even saw some normal things like constipation and a febrile seizure. We then went through the other wards which is broken up into a women's area, men's area and OB. Other than the vast array of diagnoses seen today, the thing that I noticed most was the strength of the people in this city. When children are born to mothers without anesthetic, there is no groans by the moms. When patients are post-op from bowel surgery, they get tylenol for pain. There was one man there who had a femur fracture with a pin through his leg for traction who looked comfortable and was also receiving tylenol. Amazing!

It was a short day at the hospital today because of all of the other events that were going on, but I look forward to seeing more. My first clinic day (hundreds of patients are seen during each day by only two attending physicians with the help of some students/residents) is on Wednesday. I'm excited to see what that is about. I've heard that the majority of patients have one of two chief complaints: generalized body pain(GBP) or waist pain. Interesting!

#2 We were able to go to Market today which was very exciting for all of us. The temperature was blistering, but the surroundings were fascinating. The white people are called Sulaminga in the Mampule language, so people were screaming out this word the entire way to and at the market. My favorite was a little girl around three years old who, while we were driving by, busted into song and dance which went something like "Yel-lo (hello) sulaminga, Yel-lo sulaminga). She was adorable! I've heard that when Dr. Hewitt, the head physician at the hospital, goes to the market the people of Nalerigu flock him, calling him Gollum (meaning something like head spiritual leader) because of what he has done for this community.

Many things were sold at the market including fufu, sardines, rice, beads, used clothing and baby items. My favorite thing sold at the market were yards of fabric. I have to say that Ghanians have some of the most beautiful fabric. I bought a swatch for myself in hopes of making it into a skirt after I arrive home. It was an amazing place. The other side of the market story is, of course, the poverty that you see there. These men, women and children rely completely on this market as a means to providing even just a small token to add to there home/hut/family. This doesn't mean new shoes or clothes, but instead maybe an article of underwear for their child or the ability to use rice to provide some sort of nourishment to their family. There is a significant amount of pain that you feel in addition to the joy the people bring you.

#3 After the market, we all jumped in a van with the other physicians and there families for an interesting adventure to an even more rural area of Ghana. The area we went to was called the Gambaga Escarpment. We hiked for about a mile and then climbed to the top of boulders where we were able to see for miles. The day was a bit foggy, but on clear days we were told you are able to the see the countries bordering including Burkina to the North and Togo to the East. It was a beautiful place.

#4 Our final event of the day was an Easter potluck held at a missionaries VERY rural home near the Escarpment. The food was excellent. There was bread, rice dishes, fresh pineapple, mango and a desert that was an apple bar with butterscotch cream on top. Delish!! The children had an Easter Egg hunt while we were there and everyone enjoyed great fellowship. We really had to pinch ourselves at this point, as we never thought we'd have an Easter potluck with hard boiled eggs in Ghana. The people here are wonderful.

So there are my descriptions of the day today. I again have to apologize since I really don't have time to review these blogs, so there may be many grammatical errors including run-ons. I wish that you all were here to experience this with me. Plan for tomorrow: attend rounds in the morning, then head for Easter Service at 2nd Baptist church in the village with the other physicians...should be interesting!

Stay well!

Jill

Nalerigu Day 1 Pics

Getting on the plane to Tamale

Our new home

My bedroom (It's clean mom)

Kwame

Our new friends. Jessie brought a soccer ball which she gave them to play with. I also did a little playing myself, but soon was hot and needed water.

Cute baby standing alone in the field. You will see more pictures of kids since I like them! :)

Day 1 in Nalerigu

Hello again,

Today was an incredible day. We left from Accra early this morning and took a flight to Tamale. In Tamale, we were greeted by two members from the medical center who then took us on a truck ride to Nalerigu. This was truly one of the most incredible truck rides I have ever been on. We initially started on paved roads which were well navigated by our driver since there are extremely large holes throughout the pavement. We went through several villages and were interested to find the landscape someone similar to eastern North Dakota, meaning very flat. Around an hour into the trip, our driver then turned to us and said "do you have your seatbelt on?". This was because we were about to embark on the most washboard of washboard roads I have ever experienced. A trip to my Aunt Sharon's ranch has nothing on these roads. The most incredible part of the journey happened during these travels. Throughout the road to Nalerigu, there are many very small villages that contain small huts made of mud with peaked, straw roofs. While driving by these tiny villages, the children would look at our car and wave, many without clothes and all without shoes. I was amazed by their ability to live in such in environment, particularly when it was over 100 degrees outside. Several of the villages along the way had women with hand-cranked black sewing machines, definitely not my mom's Bernina. We then finally made it to our destination at the end of the red dirt road.

I like to describe the Baptist Medical Center as a camp. You travel through the village of Nalerigu where there are vendors on the side of the road selling all sorts of goods. The Medical Center is at the end of the road and is surrounded by fencing. Upon arrival, we were given our keys, taken to our new home for the month and allowed to have the day to freely roam. It was a little overwhelming at first since we really weren't sure where we were going, but eventually we pediatricians befriended three young boys named Kwame, Timothy and Felix. They then brought us down the dirt path to the hospital. The hospital is quite amazing. I will describe this in more detail after I've spent more time there and done some rounding on the patients. We, of course, magneted ourselves to the pediatric ward where we met several medical students (most from West Virginia) who are working here this month. They are so friends and I am so thankful for all of the advice they have given us today. We also met a visiting surgeon who was extremely friendly and helped us to find water which is ESSENTIAL on such a hot day. I know what your thinking, a nice surgeon? We thought that was pretty crazy too. Eventually, we were able to get to know the camp well and made it back to our home where a nap was in order.

This evening, a dinner was planned with all of the mission staff at the medical students home. For dinner, we had an authentic Ghanian dish which was called FuFu (sort of like a big dumpling) with a peanut butter sauce and cooked meat on top. Of course, in my mind I thought this meat was beef, but later found that I had eaten my first piece of goat. I guarantee Joe is laughing very hard right now. I have to admit that I think goat tastes better than peasant Joe. Dinner was great with wonderful fellowship.

After dinner, I've come here to skype and blog. I still find it hard to believe we have internet and cell phone access in this extremely remote village. Satellites are wonderful things. I now plan to head to bed, so that I can be ready for rounds in the morning. Tomorrow afternoon we plan to head to the market which only occurs on Tuesday and Saturday. I'm looking forward to finding some beautiful fabric. Later in the afternoon, an easter egg hunt is planned for the local children which were are all able to attend as Dr. Hewitt has kindly taken responsibility of the hospital for the afternoon. Sounds like a great day!! As usual, I'll try to keep up as possible. Internet is quite slow, so I'm not sure how many pictures I'll be able to post while I'm here. Hope you are all well!

Jill

Pics from Day 1

Jess and I in Cedar Rapids. I'm the giant one. :)

This is for Joe to see how nicely my backpack fit in the overhead compartment. Oh thee of little faith. :)

JFK waiting for our flight

Ghana International airport

We've arrived!

Outside the airport

Hot and tired after a long trip and plenty of heat/humidity

Tennis court at our guest house

Our guest house in Accra. Jessie is the little dot in the picture.

The door at our guest house

Post #1 - We made it!

Hi All,

Well I have finally completed the first part of my dream which is visiting Africa. We left yesterday at 0600 from Cedar Rapids, IA, flew to Minneapolis, MN, then to JFK in New York. We then took a 10-11 hour flight from New York City to Accra, Ghana and arrived in Africa around 0700 in Ghana or 0200 in Iowa. Needless to say, it is hard to get much sleep in an airplane, particularly when in just a few short hours you will be visiting Africa for the first time. Upon landing in Accra, the members in the plan all clapped and cheered. The pilot said Akwaaba, which means welcome in the native language. After exciting the plane, the green of the plans was vibrant, but the heat and humidity were what was most noticable. It is HOT here!

So far the most exciting thing that has happened on our trip is seeing what I like to call our "gardian angel". Just after exciting the plane, in an airport/country/continent I'd never been before, I looked up to find one of my friends from Concordia College, Nana!!! It was wonderful. Nana knew that we were flying in that day and took the time away from work to greet us. It was a great surprise. Nana soon had to leave, but we were then helped by our guest house friend, Jimmy Huey. Jimmy kindly took our bags, loaded the van and brought us to our sleep house where we will stay overnight. We definitely felt the hospitality from the minute we arrived.

Once settled in the guest house (after a wonderful cold shower) we then decided to head down the street to the "Vodophone" store where we bought some phone cards that can be used throughout the country to call those husbands that we already miss dearly. Exciting event #2...Nana was in the store getting help with his phone!! Thank goodness for Nana, because he was able to hook us up with the appropriate phone gadgets we needed, brought us for some delicious Ghanian food and then drove us on a personal tour of Accra until we were so tired we were forced to return to the guest house. I am serious about him being our "gardian angel". we are so thankful!!

So now here were are, getting ready for dinner at the guest house and planning to head to bed soon after for our much too early exit to Tamale at 0500 (or midnight in Iowa land).
Thanks again for all of your prayers during this journey. Please continue to pray for the people of this amazing country! I will continue to update as able...

Jill