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
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment