I wanted to let you all know that the guy I was telling you about in my last post is doing much better. In fact, I sent him home today to finish his pencillin regimen. He will be coming back to see me on Friday to be sure everythign is still headed in the right direction. I know it is the Lord that healed him and I told him that today. I pray this whole situation will make an impact on his life.
Just in case you were wondering, it is still hot here. I am sweating as I type this and it is not because I am the world's fastest typist.
Talk to you all again soon,
Jeremy
Monday, May 31, 2010
Sunday, May 30, 2010
Third post of the Day!
Hi everyone,
I know it seems like overload today, but we have had some free time and the internet is actually working well. You should find a post from Jeremy from earlier today, some pictures (we learned how to use photoshop to make them smaller and upload faster), and now a brief update from me.
I just wanted to write and share some positive news as I think many of my previous posts have had some negative topic to talk about. Today, I write with a smile on my face because I see things are going much better than a week ago.
On rounds this morning in the pediatric ward, I was able to discharge 3 patients, and have 2 or 3 more who may go home tomorrow if all falls into place overnight. It is very encouraging to see the patients healing, and regaining their strength, and also to see the delight of their parents when they are allowed to go home. For the majority of the week I was questioning myself and finding I had to rely on God to help me with treatment because I was definitely dealing with illnesses I have never encountered before. Now, however, I am becoming more comfortable with some of the presentations of various common illnesses here, and feel God is guiding me not only with the care, but with confidence in myself, and again reminding me it is OK to say, "I don't know."
I was also encouraged this evening when one of the nurses came down to talk to me for a while at the guest house. He was having some problems and just wanted someone to talk to and chose to come talk to me. I am glad that I am earning their trust, and hopefully setting a positive example for the staff here. At first I was worried he was upset with something I had done, but actually he was complimenting me with my work over the past week, and also encouraging me to know he and the other nurses would continue to help me learn the system and culture here. The nurses here are very good, and I can give nothing but the highest compliments to them.
I did feel a little ill earlier today, just with some fatigue and some GI discomfort, but after some gatorade and a couple relatively long naps, I feel much better. I believe I was mostly likely a little dehydrated, and getting fluids back on board really was the answer. I would bet we are drinking upwards of 3-4 liters of water every day here just to stay hydrated. As Jeremy mentioned in his post, the temperature is hot and nothing but clear sky with the sun boiling down on us. He is definitely correct regarding our pale skin, I have even been straying away from sunscreen, because we are only in the sun for a few minutes walking back and forth from the house to the hospital. Supposedly the rainy season has started with the 3 small rains thus far, but it will apparently get even more intense over the next few weeks, so who knows how much sun we will even see as we continue on here.
Today, I also started taking pictures with various different camera settings. Hopefully I will be able to continue to learn some of the tricks of my camera and we will get some great photos to post and also a few to have to show when we get home. We have several photos from the hospital, but felt it is probably best not to post most of those here, because some are pretty gut-wrenching.
One last thing, if you get a call from an unknown number, it could be us. We have learned there is a prepaid cell phone here we can use from time to time, so when we are able to purchase cards, we will try to call.
I think that is all I have for now. Take care, and keep us in your prayers. We will post again soon, assuming the internet is our friend!
Love,
Steve
I know it seems like overload today, but we have had some free time and the internet is actually working well. You should find a post from Jeremy from earlier today, some pictures (we learned how to use photoshop to make them smaller and upload faster), and now a brief update from me.
I just wanted to write and share some positive news as I think many of my previous posts have had some negative topic to talk about. Today, I write with a smile on my face because I see things are going much better than a week ago.
On rounds this morning in the pediatric ward, I was able to discharge 3 patients, and have 2 or 3 more who may go home tomorrow if all falls into place overnight. It is very encouraging to see the patients healing, and regaining their strength, and also to see the delight of their parents when they are allowed to go home. For the majority of the week I was questioning myself and finding I had to rely on God to help me with treatment because I was definitely dealing with illnesses I have never encountered before. Now, however, I am becoming more comfortable with some of the presentations of various common illnesses here, and feel God is guiding me not only with the care, but with confidence in myself, and again reminding me it is OK to say, "I don't know."
I was also encouraged this evening when one of the nurses came down to talk to me for a while at the guest house. He was having some problems and just wanted someone to talk to and chose to come talk to me. I am glad that I am earning their trust, and hopefully setting a positive example for the staff here. At first I was worried he was upset with something I had done, but actually he was complimenting me with my work over the past week, and also encouraging me to know he and the other nurses would continue to help me learn the system and culture here. The nurses here are very good, and I can give nothing but the highest compliments to them.
I did feel a little ill earlier today, just with some fatigue and some GI discomfort, but after some gatorade and a couple relatively long naps, I feel much better. I believe I was mostly likely a little dehydrated, and getting fluids back on board really was the answer. I would bet we are drinking upwards of 3-4 liters of water every day here just to stay hydrated. As Jeremy mentioned in his post, the temperature is hot and nothing but clear sky with the sun boiling down on us. He is definitely correct regarding our pale skin, I have even been straying away from sunscreen, because we are only in the sun for a few minutes walking back and forth from the house to the hospital. Supposedly the rainy season has started with the 3 small rains thus far, but it will apparently get even more intense over the next few weeks, so who knows how much sun we will even see as we continue on here.
Today, I also started taking pictures with various different camera settings. Hopefully I will be able to continue to learn some of the tricks of my camera and we will get some great photos to post and also a few to have to show when we get home. We have several photos from the hospital, but felt it is probably best not to post most of those here, because some are pretty gut-wrenching.
One last thing, if you get a call from an unknown number, it could be us. We have learned there is a prepaid cell phone here we can use from time to time, so when we are able to purchase cards, we will try to call.
I think that is all I have for now. Take care, and keep us in your prayers. We will post again soon, assuming the internet is our friend!
Love,
Steve
A Few Pictures
Jeremy excising a Giant Lipoma.
Steve in deep thought.
Steve attempts to remove a rock from a 3 year-old's ear.
Jeremy tries some pineapple juice.
Typical Ghanaian Lady toting child and load of fruit.
A traditional home.
Front of BMC. This is a very short line of people waiting.
It's getting hot over here....and I'm still wearing long pants..because it's the culturally sensitive thing to do..even if you are sweating profusely!
Hey again everyone. I am glad I have a few minutes today to post something on the blog. I am technically on call today but have not been called in so far. I will be rounding here for the evening in a few hours and then again around 8:30 pm for night rounds. On call nights we sleep on the couch in the guest house so we can be near the front door and hear when someone knocks. There is a ceiling fan in the living room so it is bearable to sleep there. The fan is definitely the answer to living here in Ghana. Even if it is hot and humid, which it usually is, the fan makes it infinitely better. The temperature today in Tamale was 102.2 and we are about 2 ½ hours north of that, so I would imagine even a little warmer. I did tell Steve people might not believe we were on the equator for a month when we come back so pale. We have been inside most of the time so far between the hospital and the fact it gets dark here at 6pm….then the mosquitoes come out in force.
I have been in charge of the men’s ward for morning rounding and am enjoying getting to know the nursing staff and the patients. I have decided I want to try praying each morning with the nursing staff and the patients prior to rounding. I want to keep an attitude of prayer present in my healthcare here as well as to encourage the staff to do the same. It seems the hospital here is in a big transition. The founder’s son just retired last year and the Hewitt’s, who have been here for about 20 years, are leaving for furlough for 1 year. They may or may not be returning depending on if the IMB can help to find another permanent physician, as the work here is way too much for one person. The current surgeon, who has been here for almost 2 years is getting ready to head home in July. That leaves a void which needs to be filled. The leadership of the hospital has also recently changed. So, all that together leaves them at a crossroads of sorts. There are talks now about a church planter coming full time and another surgeon coming full time from another part of Africa to continue the work. I am praying for the continued witness of the hospital to the love of Christ so people will be cared for physically and changed forever spiritually. I know it is in the capable hands of the Lord and this is His hospital. He has things under control.
I am enjoying learning how to trust God more and more with my medical decision making. In the states it is easy to seemingly do medicine without God. I try to be conscious of him and I do often pray with my patients, but in the actual “doing” of medicine it is easy to not involve him. Here on the other hand, we are so limited in out diagnostic and treatment capabilities I am often relying on the Lord’s help and guidance. I have never treated malaria, typhoid fever or leishmaniasis before this trip. It is hard for me to treat many medical problems without a basic chemistry panel or chest x-ray (we ran out of film the other day.) But I am asking the Lord always to guide my clinical decision making. I pray this continues when I am back home where the answers seem to come so much easier.
Here is an interesting case for you all to figure out as I still am not 100% sure of the diagnosis. I have been treating a 20-something year old guy who initially presented with abdominal pain and fever and extremely elevated BP (180/120, 160/110). His fever went away after only one check of being febrile and being started on ciprofloxacin for what at that time was presumed by one of the other physicians to be pyelonephritis (based on CVA tenderness and reported dysuria, and small blood on U/A.) The next day the story changed a bit and he complained of epigastric pain. His BP was still elevated and while he did not have a recorded fever, was diaphoretic. His U/A did not show any protein or blood. He was negative for malaria on the blood film. His hematocrit was in the 30’s, which is really good here. One of the other residents also started an ACE-I and lasix to help with the BP. The next day he was still hypertensive (150’s/110’s) but now complaining not of abdominal pain but of cough when lying flat and inability to walk more than about five feet without becoming very short of breath. He sounded to me on exam to only have crackles on the lower right, with the left being clear. I changed the antibiotics to penicillin to cover for pneumonia (it responds relatively well to it here), did an ultrasound of his heart myself (no U/S technician here) which did not show any fluid or myocarditis and appeared to be functioning correctly. I couldn’t get a CXR. So, I increased his lasix from 40mg po BID to 40IV BID. This morning he says he is feeling better and is able to lie flat. He is afebrile and his BP is slightly better. He still has normal heart sounds and still with the rales in the right lower lobe. His complaint now is of nausea with eating.
I was really stumped last night and talked to some of the other doctors here about the case. I actually went back to the hospital because I was so worried about him. I and Dr. Adams looked back over everything and based on our resources here decided there was not anything else to do or change. We prayed for him that he would be healed despite our inability to tell him what was wrong or know exactly how to treat it. He said he was muslim but was fine with us praying for him. My prayer is the Lord would heal him and this would provide an opportunity for Jesus to make the ultimate difference in his life. We will see.
Well I will talk to you all again soon. Church was fun today in Nalerigu at the Assemblies of God…loud, colorful and hot…sort of like I pictured it. It was great to be with believers in another country praising God in a different language…it reminds me of just how big our God is, but also how he can know each one of us individually. If you don’t know him the way I do….I encourage you to seek him out. He is there plain as day and wants to love you the way he loves me. Try starting in the book of John or sending me an e-mail.
Jeremy
I have been in charge of the men’s ward for morning rounding and am enjoying getting to know the nursing staff and the patients. I have decided I want to try praying each morning with the nursing staff and the patients prior to rounding. I want to keep an attitude of prayer present in my healthcare here as well as to encourage the staff to do the same. It seems the hospital here is in a big transition. The founder’s son just retired last year and the Hewitt’s, who have been here for about 20 years, are leaving for furlough for 1 year. They may or may not be returning depending on if the IMB can help to find another permanent physician, as the work here is way too much for one person. The current surgeon, who has been here for almost 2 years is getting ready to head home in July. That leaves a void which needs to be filled. The leadership of the hospital has also recently changed. So, all that together leaves them at a crossroads of sorts. There are talks now about a church planter coming full time and another surgeon coming full time from another part of Africa to continue the work. I am praying for the continued witness of the hospital to the love of Christ so people will be cared for physically and changed forever spiritually. I know it is in the capable hands of the Lord and this is His hospital. He has things under control.
I am enjoying learning how to trust God more and more with my medical decision making. In the states it is easy to seemingly do medicine without God. I try to be conscious of him and I do often pray with my patients, but in the actual “doing” of medicine it is easy to not involve him. Here on the other hand, we are so limited in out diagnostic and treatment capabilities I am often relying on the Lord’s help and guidance. I have never treated malaria, typhoid fever or leishmaniasis before this trip. It is hard for me to treat many medical problems without a basic chemistry panel or chest x-ray (we ran out of film the other day.) But I am asking the Lord always to guide my clinical decision making. I pray this continues when I am back home where the answers seem to come so much easier.
Here is an interesting case for you all to figure out as I still am not 100% sure of the diagnosis. I have been treating a 20-something year old guy who initially presented with abdominal pain and fever and extremely elevated BP (180/120, 160/110). His fever went away after only one check of being febrile and being started on ciprofloxacin for what at that time was presumed by one of the other physicians to be pyelonephritis (based on CVA tenderness and reported dysuria, and small blood on U/A.) The next day the story changed a bit and he complained of epigastric pain. His BP was still elevated and while he did not have a recorded fever, was diaphoretic. His U/A did not show any protein or blood. He was negative for malaria on the blood film. His hematocrit was in the 30’s, which is really good here. One of the other residents also started an ACE-I and lasix to help with the BP. The next day he was still hypertensive (150’s/110’s) but now complaining not of abdominal pain but of cough when lying flat and inability to walk more than about five feet without becoming very short of breath. He sounded to me on exam to only have crackles on the lower right, with the left being clear. I changed the antibiotics to penicillin to cover for pneumonia (it responds relatively well to it here), did an ultrasound of his heart myself (no U/S technician here) which did not show any fluid or myocarditis and appeared to be functioning correctly. I couldn’t get a CXR. So, I increased his lasix from 40mg po BID to 40IV BID. This morning he says he is feeling better and is able to lie flat. He is afebrile and his BP is slightly better. He still has normal heart sounds and still with the rales in the right lower lobe. His complaint now is of nausea with eating.
I was really stumped last night and talked to some of the other doctors here about the case. I actually went back to the hospital because I was so worried about him. I and Dr. Adams looked back over everything and based on our resources here decided there was not anything else to do or change. We prayed for him that he would be healed despite our inability to tell him what was wrong or know exactly how to treat it. He said he was muslim but was fine with us praying for him. My prayer is the Lord would heal him and this would provide an opportunity for Jesus to make the ultimate difference in his life. We will see.
Well I will talk to you all again soon. Church was fun today in Nalerigu at the Assemblies of God…loud, colorful and hot…sort of like I pictured it. It was great to be with believers in another country praising God in a different language…it reminds me of just how big our God is, but also how he can know each one of us individually. If you don’t know him the way I do….I encourage you to seek him out. He is there plain as day and wants to love you the way he loves me. Try starting in the book of John or sending me an e-mail.
Jeremy
Saturday, May 29, 2010
Poor Internet Connection, Delayed Posting
Hello everyone,
Sorry we haven’t had a blog post in a few days. It has been quite busy here, and for the past 48 hours, we have had some trouble with our internet connection, and unfortunately have not been able to post some of our recent stories.
Jeremy and I have now survived our first night on call. He had a lady who needed a c-section during his night-time rounds, but otherwise had an uneventful night. Last night, when I was on call, I had a patient with a snake bite admitted during night rounds, and then around 3AM the nursing staff came to get me to evaluate a woman who was in labor. Obviously, I am not the most qualified physician to evaluate obstetrics patients, but I knew enough to check her out and make the decision she too would need a repeat c-section, so return and called on the OB/Gyn here to handle the patient’s care from that point forward. Her c-section went well and she and the baby are doing fine.
Outpatient clinic has also been very busy. On Wednesday it was not as busy as usual which was credited to the rain on Tuesday night, as most people were likely out working on their crops. Friday, however was much busier, probably because there has been no rain since Tuesday, so the people did not have to tend to their crops. Jeremy and I together, with 1 translator, and sharing an office, saw just under 100 patients total for the day from 9:30AM to 4:30PM. We were very busy, but we are also getting better at understanding more of the local illnesses. We did have some complicated cases as well. Jeremy diagnosed an elderly lady with HIV, had a case of Leishmaniasis, and a young man with a tooth abscess so bad it had formed a tract and was draining pus from what looked like an enormous pimple on the outside of his cheek. I had a child with nephritic syndrome (puffy face, losing blood and protein in the urine) following a recent bout of malaria, a young man with severe abdominal pain, that was likely bad constipation, and a young girl with leg pain, who I think has osteomyelitis, so I started treatment, although I don’t have any means to further evaluate her here to confirm my diagnosis. Hopefully she will get better with the antibiotic treatment.
We also continue to do many procedures. Many patients receive paracentesis for drainage of extra fluid in the abdomen here. We do several per day. We have also performed spinal taps, attempted to remove foreign bodies from a child’s ear (unsuccessfully), set fractures and place casts, I &D many abscesses, debride various wounds, D & C, ultrasound, lipoma excision, and several more that I am forgetting as I type.
Outside of the hospital we have also had some great interactions with people here. Tonight, for example will be a special dinner for Dr. Hewitt and his family as they are about to leave for a year furlough. They have served here for about 20 years and will be going home to the US for a year off beginning next week. On Thursday night, we had station meeting, which is a time when all the missionary staff and volunteers meet for a time of worship and sharing. It was truly a blessing to meet some of the others and their families here and see some of the great work they are doing. Jeremy has gone into town with some of the other volunteers while I was on call yesterday. There is market every 3 days, which hopefully I will get to experience tomorrow. I am thinking I may find some African fabric and have one of the local seamstresses make a shirt for me. Many people here have them and they are very nice and appear to help keep you cool on the hot days as well. Interactions with the local people are also very good. The Ghanaians are all exceptionally friendly, welcoming, and thankful for our willingness to come here and help them. Greetings are a very important part of their culture. We are trying to learn some of their greetings in the local dialect here, but they all understand good morning, hello, etc easily, too, so it is relatively easy to engage them.
I feel like there is so much to write, but looking at how much I have already written thus far, I think I may stop here. Please keep Jeremy, the other volunteers, and me in your prayers as we continue our work here. Jeremy and I both have patients at the hospital tonight we are concerned for, who we are not sure the cause of their current illnesses, and who need many prayers to help with healing, because we are quickly running out of medical options in our limited setting here.
I hope everyone is doing well, and appreciate all your comments, emails, and prayers. We will post again soon.
Love,
Steve
Sorry we haven’t had a blog post in a few days. It has been quite busy here, and for the past 48 hours, we have had some trouble with our internet connection, and unfortunately have not been able to post some of our recent stories.
Jeremy and I have now survived our first night on call. He had a lady who needed a c-section during his night-time rounds, but otherwise had an uneventful night. Last night, when I was on call, I had a patient with a snake bite admitted during night rounds, and then around 3AM the nursing staff came to get me to evaluate a woman who was in labor. Obviously, I am not the most qualified physician to evaluate obstetrics patients, but I knew enough to check her out and make the decision she too would need a repeat c-section, so return and called on the OB/Gyn here to handle the patient’s care from that point forward. Her c-section went well and she and the baby are doing fine.
Outpatient clinic has also been very busy. On Wednesday it was not as busy as usual which was credited to the rain on Tuesday night, as most people were likely out working on their crops. Friday, however was much busier, probably because there has been no rain since Tuesday, so the people did not have to tend to their crops. Jeremy and I together, with 1 translator, and sharing an office, saw just under 100 patients total for the day from 9:30AM to 4:30PM. We were very busy, but we are also getting better at understanding more of the local illnesses. We did have some complicated cases as well. Jeremy diagnosed an elderly lady with HIV, had a case of Leishmaniasis, and a young man with a tooth abscess so bad it had formed a tract and was draining pus from what looked like an enormous pimple on the outside of his cheek. I had a child with nephritic syndrome (puffy face, losing blood and protein in the urine) following a recent bout of malaria, a young man with severe abdominal pain, that was likely bad constipation, and a young girl with leg pain, who I think has osteomyelitis, so I started treatment, although I don’t have any means to further evaluate her here to confirm my diagnosis. Hopefully she will get better with the antibiotic treatment.
We also continue to do many procedures. Many patients receive paracentesis for drainage of extra fluid in the abdomen here. We do several per day. We have also performed spinal taps, attempted to remove foreign bodies from a child’s ear (unsuccessfully), set fractures and place casts, I &D many abscesses, debride various wounds, D & C, ultrasound, lipoma excision, and several more that I am forgetting as I type.
Outside of the hospital we have also had some great interactions with people here. Tonight, for example will be a special dinner for Dr. Hewitt and his family as they are about to leave for a year furlough. They have served here for about 20 years and will be going home to the US for a year off beginning next week. On Thursday night, we had station meeting, which is a time when all the missionary staff and volunteers meet for a time of worship and sharing. It was truly a blessing to meet some of the others and their families here and see some of the great work they are doing. Jeremy has gone into town with some of the other volunteers while I was on call yesterday. There is market every 3 days, which hopefully I will get to experience tomorrow. I am thinking I may find some African fabric and have one of the local seamstresses make a shirt for me. Many people here have them and they are very nice and appear to help keep you cool on the hot days as well. Interactions with the local people are also very good. The Ghanaians are all exceptionally friendly, welcoming, and thankful for our willingness to come here and help them. Greetings are a very important part of their culture. We are trying to learn some of their greetings in the local dialect here, but they all understand good morning, hello, etc easily, too, so it is relatively easy to engage them.
I feel like there is so much to write, but looking at how much I have already written thus far, I think I may stop here. Please keep Jeremy, the other volunteers, and me in your prayers as we continue our work here. Jeremy and I both have patients at the hospital tonight we are concerned for, who we are not sure the cause of their current illnesses, and who need many prayers to help with healing, because we are quickly running out of medical options in our limited setting here.
I hope everyone is doing well, and appreciate all your comments, emails, and prayers. We will post again soon.
Love,
Steve
Wednesday, May 26, 2010
Accepting Death...
The title says it all. As you probably guessed already, Jeremy and I need your prayers to give us strength and wisdom.
We have found over the past 3 days here that death is viewed quite differently than in the US. We have come to the conclusion that death is seen more as a routine part of life, and is no real surprise or emotional event when it does occur. This has been an area in which we have had to adjust our own practices and realize that we do not have to always do "everything possible" for a patient, especially if it is not going to do much to prolong or improve their life.
Here are just a few cases I will share from our first 3 days.
First, the gentleman Jeremy wrote about in the last post passed away only a few hours after we had initially met him. Despite our best efforts in this hospital setting, we were not able to change the ultimate outcome. While it seemed to bother us quite a bit to lose a patient, everyone else seemed to go on like it was an everyday routine.
Second, this morning I was rounding on the pediatric ward, and noticed a young child with a seizure disorder who had been very ill recently with uncontrollable seizures was no longer there. I later learned she had passed away during the night last night. I felt sad inside, but I also know that we had done all things possible for her prior to her expiring. In fact, as I look back today, she is probably better off, because the possible outcomes for her were limited.
Third, we had a patient with tetanus here in the hospital who passed away overnight as well. He was not my patient, so I don't know all the details, but I basically know he was in very severe condition upon arrival to the hospital, and was not responding well to the medications.
Finally, i have a very sad case from today. During clinic this morning, an OB/Gyn resident came to find me and get "a NICU consult." She had just delivered a full term baby by C-Section but the baby was not doing well. He had required some bagging and suctioning in the OR, and had been brought to the mother/baby ward. After discussing the child's condition with her, I promptly went to examine the patient. When I got there he was breathing only a few times a minute, very cyanotic (blue), had a slow heart rate, and very poor muscle tone. We opted to take him back to the OR where we had suctioning available as he had meconium aspiration in utero and had only received bulb suction at birth. In the OR, we had to improvise and use a nasogastric feeding tube because it was the only one small enough to pass through the nose into the airway for suctioning. We also had to struggle to get oxygen available. We bagged the baby for a while, his color improved, and he opened his eyes and was crying, so we took him back to the ward, and started him on some IV fluids and antibiotics due to our concern for infection. Later when I went to check on him, he was the same as when I first met him. Despite multiple other interventions, and several prayers over him, he passed away later this afternoon. I feel we did everything possible to help him in our setting, and I honestly don't know if we could have done any better at home, but it is always a struggle to see such a new life pass away. I must have run through my head 50 times anything I could have done differently, I have reviewed neonatal resuscitation, and I have come to the conclusion that we did everything correctly, but ultimately God had another plan for this little boy.
Preparing for death is yet another issue we have come across. In addition to the children, I also see a few adults each day to help out with clinic flow. (by the way we see 500 patients/day on Monday, Wednesday, and Friday in clinic in addition to the inpatients). Today I met two older women, both of whom likely have cancer and will die soon. One I talked with the family regarding her poor prognosis and just provided some pain medicines for her and referred them to the chaplain. (Here you break bad news to the family, not the patient). The other had a large mass sticking up in her abdomen, likely a uterine or ovarian tumor. She is going to come in and have it removed by the OB/Gyn doctors, but likely she will not have a good prognosis either. Hopefully we will be able to take away some of her pain by getting rid of the mass, and let her have some comfort as she lives the remainder of her life.
Now for some more positive stories!
I think Jeremy and I are getting more comfortable with the system here. We are actually working together in an office room, sharing an interpreter. It is really great because he is teaching me many things I have forgotten (or should we say stored so deep within my brain they are hard to retrieve!) and I feel as though I have also shared a few pediatrics points with him as well. The staff here is also very helpful to guide us if we are unsure or if we need to do something more the "normal way" for here as opposed to our US ways. Today we each sort of had the opportunity to work in our comfort zones, mine in the pediatric ward, his in the adult wards. It is kind of strange to think I am seeing most of the kids here myself and treating illnesses I have never seen, but I know a power far superior to me is guiding my thoughts and hands!
There are also a lot of procedures to do here. Today alone I did a paracentesis (drained fluid from the abdomen), and sutured up a finger. Yesterday I helped to fix a fracture and cast a child's arm. We also do a lot of ultrasound, and OB/Gyn related procedures here, which I personally don't care to do a lot of, but having a good knowledge base is always beneficial.
We start taking call for the hospital tomorrow. I am on tomorrow and Jeremy will be on Friday. One of the other residents here is leaving this weekend, so call will be every 3rd night, but it is from the house, mostly for emergencies or lab results, etc. We are lucky to have good attendings here, who are available if we need them. We are also the distributors of snake venom after hours when pharmacy is closed, so that should tell you how common carpet vipers and spitting cobras are here.
I know this is long, but I want to leave you with our schedule, just so you are familiar with our routine.
Monday, Wednesday, Friday: Hospital Rounds at 7:30AM, start clinic when rounds are over until 9:30, then break for patient devotional from 9:30-10:00. Resume clinic at 10 and go until 12 or 12:30. We then go to Theatre (OR) to do any procedures from the morning. Lunch is for about an hour after procedures. We then return to clinic and see patients until all are seen which is usually around 3 or 4PM. Finally we again go to Theatre and complete and remaining procedures for the afternoon. Then home to dinner and rest.
Tues, Thurs: Rounds at 7:30 until finished. Then to Theatre for any scheduled elective procedures or surgeries. Work until those finished then we are free for the afternoon.
Sat, Sun: Rounds at 8:00 until done. Then to Threatre if any procedures need to be done, otherwise done for the day.
The only exception to this schedule is when we are on call. We then round briefly at around 5pm and then again at about 8:30 or 9PM just to make sure everything is taken care of and no new concerns or problems have come up.
Ok, so this chapter is complete. I could type a ton more, but I am afraid the internet connection may not last, or you may soon fall asleep reading.
Thanks for following along and thanks for your prayers and support,
Steve
We have found over the past 3 days here that death is viewed quite differently than in the US. We have come to the conclusion that death is seen more as a routine part of life, and is no real surprise or emotional event when it does occur. This has been an area in which we have had to adjust our own practices and realize that we do not have to always do "everything possible" for a patient, especially if it is not going to do much to prolong or improve their life.
Here are just a few cases I will share from our first 3 days.
First, the gentleman Jeremy wrote about in the last post passed away only a few hours after we had initially met him. Despite our best efforts in this hospital setting, we were not able to change the ultimate outcome. While it seemed to bother us quite a bit to lose a patient, everyone else seemed to go on like it was an everyday routine.
Second, this morning I was rounding on the pediatric ward, and noticed a young child with a seizure disorder who had been very ill recently with uncontrollable seizures was no longer there. I later learned she had passed away during the night last night. I felt sad inside, but I also know that we had done all things possible for her prior to her expiring. In fact, as I look back today, she is probably better off, because the possible outcomes for her were limited.
Third, we had a patient with tetanus here in the hospital who passed away overnight as well. He was not my patient, so I don't know all the details, but I basically know he was in very severe condition upon arrival to the hospital, and was not responding well to the medications.
Finally, i have a very sad case from today. During clinic this morning, an OB/Gyn resident came to find me and get "a NICU consult." She had just delivered a full term baby by C-Section but the baby was not doing well. He had required some bagging and suctioning in the OR, and had been brought to the mother/baby ward. After discussing the child's condition with her, I promptly went to examine the patient. When I got there he was breathing only a few times a minute, very cyanotic (blue), had a slow heart rate, and very poor muscle tone. We opted to take him back to the OR where we had suctioning available as he had meconium aspiration in utero and had only received bulb suction at birth. In the OR, we had to improvise and use a nasogastric feeding tube because it was the only one small enough to pass through the nose into the airway for suctioning. We also had to struggle to get oxygen available. We bagged the baby for a while, his color improved, and he opened his eyes and was crying, so we took him back to the ward, and started him on some IV fluids and antibiotics due to our concern for infection. Later when I went to check on him, he was the same as when I first met him. Despite multiple other interventions, and several prayers over him, he passed away later this afternoon. I feel we did everything possible to help him in our setting, and I honestly don't know if we could have done any better at home, but it is always a struggle to see such a new life pass away. I must have run through my head 50 times anything I could have done differently, I have reviewed neonatal resuscitation, and I have come to the conclusion that we did everything correctly, but ultimately God had another plan for this little boy.
Preparing for death is yet another issue we have come across. In addition to the children, I also see a few adults each day to help out with clinic flow. (by the way we see 500 patients/day on Monday, Wednesday, and Friday in clinic in addition to the inpatients). Today I met two older women, both of whom likely have cancer and will die soon. One I talked with the family regarding her poor prognosis and just provided some pain medicines for her and referred them to the chaplain. (Here you break bad news to the family, not the patient). The other had a large mass sticking up in her abdomen, likely a uterine or ovarian tumor. She is going to come in and have it removed by the OB/Gyn doctors, but likely she will not have a good prognosis either. Hopefully we will be able to take away some of her pain by getting rid of the mass, and let her have some comfort as she lives the remainder of her life.
Now for some more positive stories!
I think Jeremy and I are getting more comfortable with the system here. We are actually working together in an office room, sharing an interpreter. It is really great because he is teaching me many things I have forgotten (or should we say stored so deep within my brain they are hard to retrieve!) and I feel as though I have also shared a few pediatrics points with him as well. The staff here is also very helpful to guide us if we are unsure or if we need to do something more the "normal way" for here as opposed to our US ways. Today we each sort of had the opportunity to work in our comfort zones, mine in the pediatric ward, his in the adult wards. It is kind of strange to think I am seeing most of the kids here myself and treating illnesses I have never seen, but I know a power far superior to me is guiding my thoughts and hands!
There are also a lot of procedures to do here. Today alone I did a paracentesis (drained fluid from the abdomen), and sutured up a finger. Yesterday I helped to fix a fracture and cast a child's arm. We also do a lot of ultrasound, and OB/Gyn related procedures here, which I personally don't care to do a lot of, but having a good knowledge base is always beneficial.
We start taking call for the hospital tomorrow. I am on tomorrow and Jeremy will be on Friday. One of the other residents here is leaving this weekend, so call will be every 3rd night, but it is from the house, mostly for emergencies or lab results, etc. We are lucky to have good attendings here, who are available if we need them. We are also the distributors of snake venom after hours when pharmacy is closed, so that should tell you how common carpet vipers and spitting cobras are here.
I know this is long, but I want to leave you with our schedule, just so you are familiar with our routine.
Monday, Wednesday, Friday: Hospital Rounds at 7:30AM, start clinic when rounds are over until 9:30, then break for patient devotional from 9:30-10:00. Resume clinic at 10 and go until 12 or 12:30. We then go to Theatre (OR) to do any procedures from the morning. Lunch is for about an hour after procedures. We then return to clinic and see patients until all are seen which is usually around 3 or 4PM. Finally we again go to Theatre and complete and remaining procedures for the afternoon. Then home to dinner and rest.
Tues, Thurs: Rounds at 7:30 until finished. Then to Theatre for any scheduled elective procedures or surgeries. Work until those finished then we are free for the afternoon.
Sat, Sun: Rounds at 8:00 until done. Then to Threatre if any procedures need to be done, otherwise done for the day.
The only exception to this schedule is when we are on call. We then round briefly at around 5pm and then again at about 8:30 or 9PM just to make sure everything is taken care of and no new concerns or problems have come up.
Ok, so this chapter is complete. I could type a ton more, but I am afraid the internet connection may not last, or you may soon fall asleep reading.
Thanks for following along and thanks for your prayers and support,
Steve
Monday, May 24, 2010
The First Day.....
Wow the first day was a little trial by fire. I think Steve and I are both a little overwhelmed at this point. I know the Lord is looking out for us and will continue to give us wisdom and strength. We saw some clinic patients today including what I think was chickenpox with the worst case of impetigo I have ever seen. (that's a secondary bacterial infection from scratching....for those non-medical people) I saw plenty of people with generalized body pain and many with fever, headache, diarrhea, etc. The two most common infectious diagnoses here are malaria and typhoid fever. It is crazy to think we are now in charge of trying to diagnose these people. However, we have some other doctor friends here who are available to ask questions and get second opinions....and have no fear I exercised that today.
The hospital is limited in their formulary (which makes things easier in a way) and in their lab capabilities. We cannot check any electrolytes, BUN/Cr or any type of cultures. We can get a CBC, a blood smear for malaria, U/A, fingerstick blood sugars, AFB sputum (for TB), CXR and ultrasound. That is pretty much it. So diagnosis goes alot by physical exam and history. Getting the patient's story seems to be something that takes a lot of skill and a good helping of patience.
On last thing before I go to bed....We were rounding this evening on the inpatient service with Dr. Jim Adams (another short term volunteer from Canada) and they asked me to come and see a patient who was actively coughing up blood. He was breathing probably 40 times a minute, heart rate in the 120's, was sweating so much the bed was soaked and was coughing up a lot of bright red blood. His hemoglobin was 5.5 and his WBC was 24. I have no idea what his temp was but I know it was off the chart. He was very thin and was probably in his 30's. He said he had been coughing for about 6 months and that he started coughing up blood last night. He had already been started on penicillin by the medical officers who admitted him. I gave him a 2 liter NS bolus and 2 units of blood and started septra instead of the penicillin because Dr. Adams and I thought he most likely has HIV, which we also tested for. He did not look very good at all as you can tell from the description. I pray that he is still alive tomorrow...there really is a distinct possibility that he may not be. I will try to let you know. It was so crazy I didn't even catch his name. They will take care of him tonight and we will round tomorrow morning and I do pray I see him there.
I love you all and I will talk to you again soon hopefully.
Jeremy
The hospital is limited in their formulary (which makes things easier in a way) and in their lab capabilities. We cannot check any electrolytes, BUN/Cr or any type of cultures. We can get a CBC, a blood smear for malaria, U/A, fingerstick blood sugars, AFB sputum (for TB), CXR and ultrasound. That is pretty much it. So diagnosis goes alot by physical exam and history. Getting the patient's story seems to be something that takes a lot of skill and a good helping of patience.
On last thing before I go to bed....We were rounding this evening on the inpatient service with Dr. Jim Adams (another short term volunteer from Canada) and they asked me to come and see a patient who was actively coughing up blood. He was breathing probably 40 times a minute, heart rate in the 120's, was sweating so much the bed was soaked and was coughing up a lot of bright red blood. His hemoglobin was 5.5 and his WBC was 24. I have no idea what his temp was but I know it was off the chart. He was very thin and was probably in his 30's. He said he had been coughing for about 6 months and that he started coughing up blood last night. He had already been started on penicillin by the medical officers who admitted him. I gave him a 2 liter NS bolus and 2 units of blood and started septra instead of the penicillin because Dr. Adams and I thought he most likely has HIV, which we also tested for. He did not look very good at all as you can tell from the description. I pray that he is still alive tomorrow...there really is a distinct possibility that he may not be. I will try to let you know. It was so crazy I didn't even catch his name. They will take care of him tonight and we will round tomorrow morning and I do pray I see him there.
I love you all and I will talk to you again soon hopefully.
Jeremy
Arrived at BMC
Hi everyone,
We arrived at Baptist Medical Center this morning. It was a good flight here from Accra. We got a quick tour, and by mid afternoon, Jeremy and I were sharing a translator seeing patients alone. It is amazing how many people you can fit into one room around a desk. We have lots of stories already, but will share more of those a little later. Let's just say I started the say off with a well-child check for school, not too far removed from at typical day at Children's!
We will post more after we are a little more adjusted and collect our thoughts.
Blessings,
Steve
We arrived at Baptist Medical Center this morning. It was a good flight here from Accra. We got a quick tour, and by mid afternoon, Jeremy and I were sharing a translator seeing patients alone. It is amazing how many people you can fit into one room around a desk. We have lots of stories already, but will share more of those a little later. Let's just say I started the say off with a well-child check for school, not too far removed from at typical day at Children's!
We will post more after we are a little more adjusted and collect our thoughts.
Blessings,
Steve
Sunday, May 23, 2010
Arrived In Ghana
Hi Everyone,
We arrived safely in Ghana about 2 hours ago. We are now at the Baptist Mission Guesthouse, where we will spend the night and then leave at 5AM tomorrow on the flight to Tamale, and then drive the remainder of the way to the hospital. We had a good flight, were able to get some sleep, and all of our luggage arrived, which is a blessing given some issues with luggage we encountered in Atlanta.
FYI, we are 4 hours ahead, so it is 9AM here currently, and my computer clock shows 5AM there. You are all about to wake up, and we are going to take a nap and try to adjust.
We will post again once at Baptist Medical Center to give an update. Take care and have a great Sunday.
Steve & Jeremy
We arrived safely in Ghana about 2 hours ago. We are now at the Baptist Mission Guesthouse, where we will spend the night and then leave at 5AM tomorrow on the flight to Tamale, and then drive the remainder of the way to the hospital. We had a good flight, were able to get some sleep, and all of our luggage arrived, which is a blessing given some issues with luggage we encountered in Atlanta.
FYI, we are 4 hours ahead, so it is 9AM here currently, and my computer clock shows 5AM there. You are all about to wake up, and we are going to take a nap and try to adjust.
We will post again once at Baptist Medical Center to give an update. Take care and have a great Sunday.
Steve & Jeremy
Sunday, May 9, 2010
Preparing to Go
Hi everyone,
I am starting this blog as I prepare to depart to Ghana. I will be working at Baptist Medical Center in Nalerigu, Ghana. Jeremy, my med school roommate, and I will be leaving on May 22nd and return on June 19th. If you wish to see more about the hospital, you can view their website at http://www.baptistmedicalcenter.org. I will update as frequently as possible to keep everyone up to date on the work we are doing.
Steve
I am starting this blog as I prepare to depart to Ghana. I will be working at Baptist Medical Center in Nalerigu, Ghana. Jeremy, my med school roommate, and I will be leaving on May 22nd and return on June 19th. If you wish to see more about the hospital, you can view their website at http://www.baptistmedicalcenter.org. I will update as frequently as possible to keep everyone up to date on the work we are doing.
Steve
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