Nalerigu Day 12 pics

Chocolate icecream on my shirt. What a waste!

Group picture with the children. Some man going to play soccer joined in the back.

This is the child who fell down while trying to follow us and later fell asleep in my arms

We really are a hot item in the village

More children following us

Child standing outside Joyce's shop

Selection of fabrics at Joyce's shop

Beautiful child visiting our home with her mother who was selling papayas, limes and plantains

Stephanie, Hollynn and I being silly in the heat

My favorite treat aside from iced tea and mango cobbler...chocolate icecream!

The children who followed us after returning from the village. Note the child sitting on my lap with his legs crossed.

I thought my lap seemed to be getting a little warm while he was there. Yes, that is urine.

This is Chinny (also known as Hallelujah or Strange Horse). He lives in the TB village, but does not currently have TB. He is somewhat developmentally delayed, but knows enough to believe in God and preach it to everyone he meets. He is a great person to have around the community.


Below is a group of pics from the Nutrition Center

Where's Waldo?

The OR...actually the nicest area of the hospital

These are the top diagnoses we see...malaria, pneumonia, anemia, peritonitis, meningitis, respiratory failure, shock, CHF, CSM, malnutrition. This also shows that in 2009 the outpatient clinic alone saw over 100,000 patients

The is the baby with the large firm belly. Although he may still look stick to you, he looks approximately 1 million :) times better than he did before. His belly is so nice and soft. We're pretty proud of this little guy!

Nalerigu Day 12

Nisa Nuri (Good evening),

Today was a much better day (although maybe will seem more boring to y'all). The majority of my babies were doing well this morning on rounds! I was even able to send several home. The most exciting discharge was our little baby who previously had severe abdominal distention and concern for possible necrotizing enterocolitis. He has been tolerating his feedings well and abdomen has returned to near normal!! Another baby with severe malaria who had major fluid overload was also significantly improved today. It’s wonderful to see some children get better. It gives some hope for the work we’re doing here.

After rounds, we headed to the theatre “operating room” for procedures. I did a cyst removal above a woman’s right eyebrow with some help from Terry the medical student and John the family medicine resident. It was fun! I got it all out in one piece which is critical. We had a few other procedures to do and then headed back to the house for lunch. My lunch included rice, Ghanian chocolate ice cream (see pic) and of course, iced tea. At lunch, we were greeted by a new staff member from West Virginia named Hollynn. It’s always exciting to have new people come to join our crew here!

Following lunch, we relaxed for a short time, took Hollynn for a tour of the campus and then came back to the main house for some fun. On our way back from the hospital, we walked by the nutrition center (place for the malnourished children to come for food/portage). We took one picture of a beautiful child, showed it to the mother at which time the rest of the mothers decided they all wanted a picture of their child. Of course, this was wonderful for me since I’m gathering pictures of the children, but did become a bit overwhelming. Overall, it was a blast! I’m making kwashiorkor and marasmus (severe malnutrition) my diseases of the day. Read about these diseases on the web to learn more!

When the weather improved, Jessie, Hollynn and I headed to the village to do some wandering. We stopped at Joyce’s shop again since I have plans for her to make a skirt for me with some of the fabrics I’ve gathered. She’s just wonderful and has become a great friend. We continued around the village which was another fun experience. The children are all fascinated by the sulamingas (white person). So, we were followed around the village by a mass of children. The smallest child tried to keep up with us, but tripped on the ground in the process and started crying. I picked her up and she placed her head on my shoulder. I then continued to carry her throughout our excursion until she fell asleep on my shoulder. We eventually ended up back at Joyce’s shop where I dropped the sleeping child off to be sent to her family.

Joyce made the children stay with her until we were able to get away to head back to the hospital. Little did we know that several of the little munchkins continued to follow. When we returned to our house, we soon found a small group of children had followed us. We helped them find their way home and returned back in time for dinner. Dinner was leftovers which meant more rice for me as well as another dose of chocolate icecream. I’m now uploading pictures and finishing my blog in preparation for laundry and sleep.

Interesting point of the day…I changed my clothes three times and took two showers today. I got blood on my scrubs this morning, so showered and changed. When the children followed us back to our house after the village, one sat on my lap and proceeded to urinate on me. I showered after that one as well. The third change came when my delicious chocolate icecream dripped all over my shirt. That one was worth it! Overall, everyone here has been kept entertained by my frequent tiny disasters. I'm glad somewhat is enjoying it! :)

Tomorrow I’m on call once again (and not very excited considering my last call). Please pray that this one is better than the last!!

Today I saw a man with a large growth on his face. He came for an elective procedure and did not have insurance, so would have to pay out of pocket to have the lesion removed. The procedure was to cost 35 Cedis which is around $25 in the US. He told us that he only had 6 Cedis and could not afford the procedure. He was sent home until he was able to save enough to have the procedure done. I’m thankful today, are you?

Miss you all!

Jill

PS This is a “shout out” to Stephanie who will be reading this blog after we return home. We have vowed not to read each other’s blogs as to not skew the process. Hi Steph!! Hope you are well!

Nalerigu Day 10 and 11 Pics

Our toilet friend :)

Twins Home opener in Ghana (that's Joe Mauer)

Baby with likely neonatal tetanus

Baby from the white truck story

Neonatal HSV (herpes)

Neonatal herpes

Nalerigu Day next - 12/4/10

Wow! The past 48 hours have been crazy!! I apologize for not blogging yesterday, but have had only 3 hours of sleep in the last two days. Let's just say that the thunder doesn't stop in Ghana (for those that don't know, several of the residents call me thunder because of the "black cloud" I have when on call. This means that most of the admissions and bad stuff seems to come my way). :) The last two days have been some of the most interesting yet. I have a few pictures, but will mainly just have to use written language to explain all of the events that occurred. In usual, non-creative/medical influenced fashion, I will use chronologic order to describe the days.

Sunday. I awoke around 6am and stumbled into the bathroom for the am, you know. I'm thankful for my dad always reminding me to check the toilet before sitting down since when I opened the lid, a large rat was swimming around in the toilet bowl. This is a true story and just a wonderful start to my day. In usual girly fashion, I screamed and ran out of the bathroom. After regaining my composure, Jessie and I returned to the restroom to take a picture of the little rodent and then initiate discussion on what to do with it. Several options were considered including scooping it into a container and swishing it out the front door. Instead, we chose option #1 which was to flush it. It didn't go down the first time, but after a couple flushes it finally vanished from our site to hopefully never be seen again. We then abused the water system by flushing it an extra 8 times after that to ensure its extinction from our toilet bowel. Don't worry, we continue to check the toilet each time before we sit. We are trying to avoid being part of the term "better watch what you do/say or it's going to come back and bite you in the (bum)"

After the rat incident, I got my scrubs on and we headed to the hospital for am rounds. The most interesting baby of the day was a little child with congenital herpes. The infant was extremely ill with blisters all over the body. The fontanelle was full and the hands and feet of this African child were white. Unfortunately, 50% of these children in the US die even with therapy and of course, in Northern Ghana, there is no acyclovir to even attempt treatment. The child died later that day.

We all finished rounds quickly and most left the hospital to have the rest of the day off. Today was my day for call, so I stayed to care for the patients and take admissions. We had four admissions before lunch. Two were incomplete miscarriages needing D&C (the procedure). The other two were children with likely typhoid fever. We completed those admissions when we were called by the obstetrics ward to come and see a patient who had just been admitted. This was a 25 year old PH 279 (HIV positive) female who apparently had her membranes rupture five days prior (that's a really long time). She was seen at a local clinic where labor induction was attempted without success. She then came to our hospital for further evaluation.

Nurse midwives are the main caretakers in the OB ward. Dr. Dickens is an obstetrician here, but couldn't possibly care directly for every women delivering in the hospital. We (the medical student and I), were called to the OB room as the nurse midwives had difficulty finding the fetal heart rate. I was able to get a good heart rate documented with doppler ultrasound, so induction of labor was initiated and antibiotics were started (don't worry, I had obstetric consultation throughout this process from our staff OB).

We then went to lunch where I indulged in some iced tea. Soon after lunch Joe (the medical student - I designated him from husband Joe by calling husband Joe "my Joe" and med student Joe "brother Joe") and I headed back to the hospital for 2pm rounds. We started out in the maternity ward at which time the pregnant women could no longer feel fetal movement. Having no continuous fetal monitoring is quite difficult. We took the woman to ultrasound and no fetal movement or heart rate were captured. We then started a medication to help the women's uterus contract so that she could deliver the fetus that had died. We went on to the rest of the hospital for more admissions.

An hour later, we returned home to chat with friends for only a short time, when we had to return for 4pm rounds. More admissions this time including the most interesting admission EVER...

As I was just leaving the OB ward, a man came from outside and said "doctor, doctor, please help us". I followed him to the outside courtyard in the middle of the hospital where a white truck was parked. This scene will be forever printed in my head. I went to the backseat of the truck where a woman was sitting with her legs in the air, a placenta on the floormat and a living baby in her lap still attached to her by the umbilical cord. I ran back into the hospital, yes ran, to grab a delivery kit. I then proceeded to clamp and cut the umbilical cord in the truck, wrap the baby, take the baby back to the nursery and then care for mom until she was able to be brought in our makeshift wheelchairs back to the maternity ward. WOW!!! That was an incredible experience. I really wish I could accurately describe the scene to you all, but I did capture a photo of the baby that was delivered for you to view. Babies are truly amazing and resilient little creatures!!!

After the patients were cared for, we returned to the main house for dinner. We were soon called back to the hospital for another admission. After the admission was completed, we headed over to Dr. Hewitt's house for the highlight of the day which was an ICECREAM social!!! It was delicious. Mona (Dr. Hewitt's wife) had created all sorts of wonderful toppings which we all were delighted to endulge in. Icecream here is a real commodity. We then headed back to the house to wait for 9pm rounds.

9pm came around and we went back to the hospital to see what was needed from us. We ran through the wards which had some orders for a us to write or labs to view (not many labs to worry about here). We then headed to the OB ward where our woman with the fetal demise was actively in labor standing next to her bed talking to us. The midwife assured us that they had no further concerns.

We were pretty excited that we were making it out of the hospital in just 30 minutes until we walked out the front doors to find two people sitting on a bench above a man who was lying on the ground. One of the men on the bench came to me and said "doctor, please help us. we have come here because this man fell to the ground and will not wake up. We talked to the medical assistant who told us to leave. We do not know what to do or where to go." I need to explain one thing, medical assistants are trained in Ghana and similar to nurse practitioners in the US, just with less training. Overall they are fantastic so I knew something must be up. In the meantime, of course, I was a little worried about this man on the ground but confident that at least he had a good pulse. That was a start. I went to talk with the medical assistant who told us that the patient was a psychiatric patient and had been seen at a local clinic where he was given too many psychiatric medications that do not combine well. He had told the family that he would just need to "sleep it off". I then returned to the people in the front of the building and reassured them that their friend would likely be fine. He could sleep on the ground overnight and if he hadn't awoken by the next morning, clinic would start where he could be seen for further evaluation. He was up and awake by the morning...

We finally headed back to the main guest house for some drumming and interpretive dancing done by Jessie, Stephanie and others in the group on their new African drums. I headed to bed around 11pm, but at 12pm there was a knock on our door. I could here them calling me from my open bedroom window saying "doctor, doctor, there is an admission for you". I opened the door, grabbed the chart, headed to the med student house to grab brother Joe and drove our guest truck to the hospital for our admissions. This time we had two pediatrics admissions. I am always relieved when they are pediatric patients. They are often very sick, but at least I feel somewhat confident in what to do for them. The first patient had malaria with severe dehydration. We got her orders in and then headed to the second patient.

The second patient = disease of the day. I walked over to the bed to find a 2 week old (<2kg) formerly premature (gestational age uknown) baby showing signs of neonatal tetanus. The child was extremely stiff and had flexed posturing. The fontanelle was soft and the reflexes were absent. The child was already only hours from death. We started the appropriate medications (including those that would cover other causes). I made sure to tell the nurses to translate to the mother that the child was very sick. We were doing everything we were able, but the chance of survival was low.

After these admissions, we headed back to our prospective homes to try to get a bit more sleep (yes, it is still difficult for me to sleep since I think about the sick children often). At 0530, I was awoken again by a knock on the door and someone outside yelling "doctor". I opened the door and the nurse handed me the chart for the women with the fetal demise. She told me to come see the patient. I grabbed brother Joe quickly and we headed to the hospital. What we witnessed after we arrived I hope to never see again. The nurse midwife told me before I entered the room that the patient would not tell them what was wrong with her. When I got into the room, she was grunting (in respiratory distress) and had altered mental status. I ran to Dr. Dicken's home (the staff OB), but by the time we returned the woman had died of sepsis. This was a terrible experience for me. My staff reassured me that there was nothing more we could have done for this woman. She was already immunocompromised from her HIV status and had been ruptured for 5 days before she even got to the hospital. This still didn't make it any easier. I keep thinking "if only we had continuous monitors", "if only the midwives would have called, "maybe we should have sent this woman to c-section right away". Lots of "if only"s. In the end, none of this probably mattered. I have come to peace with the fact that God was there and although I don't understand the spiritual complexities of the event completely, I do hope to someday understand. Many people die here everyday, but it hasn't gotten any easier and I'm somewhat glad about that. We do the best we can for them, but we just can't do everything. I've found that the goal is to help those that can be helped and pray to God for those that can't. That's the way I get through.

Unfortunately, the day doesn't end for us after that event. We still have a responsibility to take care of the other patients who have a chance at life. Just as we were about to leave the OB ward, the midwives told us that there was another woman that wasn't progressing. This was quite a different story as this woman was otherwise healthy and hadn't been in labor that long. We sent this patient to c-section which proved a healthy baby and mother. I was very thankful.

I was also thankful for am rounds as the nurses were wonderful. Without knowning what had happened only an hour before, they kindly came to me and thanked me for providing great care to the babies on the peds ward. I was so thankful and definitely needed to hear that. As expected, a short whilte later, our little baby with likely tetanus had died. I still believe in the work I'm doing here.

After am rounds, I headed to clinic which lasted until about 6pm today. Busy as usual with many interesting and sick patients. I then returned home for dinner which was a cheesy rice dish with my favorite dessert...MANGO COBBLER!!! This dish would make anyone feel better! After dinner, a shower was in order and I have now found myself to the schoohouse where one of the missionaries is watching the Minnesota Twins play Boston in their new stadium!!! How exciting!! It was nice to feel a little taste of home. Go Twins!!

I apologize for this long blog. There was just SO MUCH to include!! I ask again that you keep the people of this area in your thoughts and prayers as well as the missionaries and volunteers. Within the devistation, there is so much hope. As always, find a way to be thankful today.

Jill

Nalerigu Day 9 with pics

Hello all from Africa!! It was another blessed day and I am EXHAUSTED!!! I am keeping the blog short today and just doing a picture story. Please read from the bottom up as this is how the pictures are introduced into the blog. Sorry about that!!! Tomorrow should be another wonderful day. I'm on call, however, tomorrow and am not sure how busy we will be. I say this as I may not have a chance to make it to the school house to blog. If there is anything interesting, I'll be sure to include it on Monday's blog. I still pinch myself everyday to remind myself I am here. I also catch myself forgetting that although this is just a visit for me, this is where most of these people were born, raised and will die. Incredible. I have shown many people their faces after I've taken their picture which is very interesting to them as most have never even seen what their face looks like.

You all remain in my thoughts and prayers as always!......Jill

START FROM THE BOTTOM AND WORK YOUR WAY TO THE TOP

Yes! I did wear sunscreen, but being at around 10 degrees latitude can be a problem. Yikes! Thanks to Jessie for the aloe.

The little craft market in Bolgatanga where we loaded up the van with goods. I got a small hand woven basket, carved wooden bowel and a couple bracelets for friends. Other people got large hand-carved drums, large baskets, a rifle (true), sewen bags, bowels, necklases and purses. This place was a hit. All of my items cost 22 Cedi which is around 16 US dollars.

Our driver with Stephanie

After the scorching sun, we then drove to Bolgatanga for lunch at a real restaurant. I had chicked and fried rice. Yum! We also able to rehydrate at that time.

This is the rock that slaves were put on if they disobeyed. They were forced to shackle their ankles and hands and look up to the sun. You can see where the chains rubbed at the base of the rock. I figured Joe will want to get one of these for me when I get back. :)

Here is the cemetary where the bodies were laid. Only a rock was placed to mark the grave.

Our next stop was the lookout. This is the highest rock in the area where a guard would sit to ensure nobody escaped or was set free.

This is the area were the slaves were put on market

Here is the whole group performing.

We then moved on to an area where they reinacted the entertainment the slaves had occasionaly in the evenings. There was a large rock platform which was raised up above a large area of flatland. They sang, danced and made a beat with only rocks. This is the young boy that was dancing. Doesn't he look fierce?! I have an amazing video of this whole concert, but can't upload it at this time due to internet speed. (Oh! Yes, his shirt does say Obama)

Here is a rock they used to use to grind the grains. He asked for a woman to try. I figured my amazing cooking skills made me the prime candidate (that is a joke)

These are the dishes that were carved out of the rock. 4-5 slaves would be placed around one "dish". Only the strongest got to eat.

This was the first stop. A natural water whole that has water below regardless if it is the dry or rainy season. On a side note, I really liked our guide since he wore a hat like my Grandpa Christiansen always used to wear. :)

We then travelled to the Pikworo Slave Camp where a guide took us through the came describing the history of slavery in the area. Very interesting!!! It was around noon at this time and there was little for shade. It really made the whole experience more real as I can't imagine being outside at this camp day after day in the hot sun.

Some children watching us with the crocodiles.

Another crocodile pic. This pond seemed like it was truly in the middle of nowhere

They first feed the crocodiles live chickens after poking them some with a stick to wake them up. (I have a great video of them feeding the crocodiles). They then let people come one by one to sit on them. I preferred to keep my hands and legs and chose not to acquire any strange diseases so did not partake in that. I did get close enough to shoot a picture and pretend I was touching it. You should see the picture before this one. I look terrified! :) I know my Joe would be proud of me for this one.

This is the man that took the fee from us. He most likely had polio previously or a terrible fracture that set incorrectly
We then went to the Zenga Crocodile Pond. Don't let this sign fool you. Essentially, this is just a small pond out the middle of the desert with a group of men who charge a small fee to see the crocodiles. It was awesome!!!

We left for Bolgatanga at 0800. After rounds we were already thirsty and tired. We found plastic bottles of coke at the "gas station" on the way out (yes, I have falled off the wagon and started drinking Coke every once and a while here. There is just not much else). How exciting. Friends from Wichita brought Twizzlers from the States which we all thoroughly enjoyed!!

Today we started rounds at 0630 today so we could all head to the town of Bolgatanga and Paga today (Dr. Hewitt was so kind to let us go while he cared for the hospital). We were able to discharge this baby home since he was doing so well!! (this is the one with the blue spots all over). Hi mother was so very thankful. It felt good. Our little girl with the severe malnutrition is HIV negative and malaria negative. We are still waiting on other tests.

Nalerigu Pics Day 8

Children in the village

Joyce's daughter (the woman who makes the purses)

Children on the street in the village. They were being silly and jumping in and out of the camera view. I'm lucky to have gotten them in one shot.

Rasta Man (or the colors of Ghana)

Amazing goiter. This had been there for nearly 20 years

Elephantiasis or cause by the filaria parasite (disease of the day)

Child with severe malnutrition

This girl is 2 years old and about the size of a 9 month old

Inside the hospital during a clinic day

Our little boy with seizures on his day home!!! Hooray!!I think he is still scared of me because of my white skin (and the weird camera thing in his face). I never thought I could be a scary person! :)

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. :)