Hi Everyone,
Just wanted to post and let you know that Jeremy and I both made it home safe last night. Despite the long delays in Accra, we managed to get home safe and with all our luggage. We will likely post some final thoughts a little later.
Thanks for following and for your comments. It was a great experience and we are glad we could share it with you.
Love,
Steve
Sunday, June 20, 2010
Saturday, June 19, 2010
Departure Take 2
Good Morning from Accra,
We are now scheduled to depart at 9:30 this morning. We had to go to the airport last night at 9PM to check in, get boarding passes, and check our luggage. Then we stayed overnight here in Accra, and Delta says we will depart at 9:30 this mroning, and arrive in Atlanta at 5:15PM. They told us the plane was en route when we left the airport, so hopefully everything will fall into place. We simply arrive at the airport, go through immigration and security, and then we should be all set.
As for the connecting flights in Atlanta, they say I will have to wait until we are there to sort that out, so who knows what time I will actually get home tonight!
We will talk to you all soon!
Steve
We are now scheduled to depart at 9:30 this morning. We had to go to the airport last night at 9PM to check in, get boarding passes, and check our luggage. Then we stayed overnight here in Accra, and Delta says we will depart at 9:30 this mroning, and arrive in Atlanta at 5:15PM. They told us the plane was en route when we left the airport, so hopefully everything will fall into place. We simply arrive at the airport, go through immigration and security, and then we should be all set.
As for the connecting flights in Atlanta, they say I will have to wait until we are there to sort that out, so who knows what time I will actually get home tonight!
We will talk to you all soon!
Steve
Friday, June 18, 2010
A Little Delay
Hi all,
We have made it safely to Accra. Our flight out at 1AM tonight has been delayed and we will be leaving at around 9:30 in the morning if all goes as is currently scheduled. We have placed a call to the local Delta office, who is checking on everything (or so they say) and they are supposed to call us back by the end of business hours today to confirm everything. This will hopefully put us back in Atlanta around 5:15 tomorrow evening, rather than 9AM as was previously scheduled.
We will keep you updated as we know more. We are well, staying at the guesthouse here in Accra. We were able to get out and walk around the town for a while today and experience a bit of the local culture, and a lot of vendors trying to sell us their goods.
Updates pending,
Steve
We have made it safely to Accra. Our flight out at 1AM tonight has been delayed and we will be leaving at around 9:30 in the morning if all goes as is currently scheduled. We have placed a call to the local Delta office, who is checking on everything (or so they say) and they are supposed to call us back by the end of business hours today to confirm everything. This will hopefully put us back in Atlanta around 5:15 tomorrow evening, rather than 9AM as was previously scheduled.
We will keep you updated as we know more. We are well, staying at the guesthouse here in Accra. We were able to get out and walk around the town for a while today and experience a bit of the local culture, and a lot of vendors trying to sell us their goods.
Updates pending,
Steve
Thursday, June 17, 2010
Coming to an end!
Hello Everyone,
It is Thursday afternoon, and we are sad to write and say that our time here is quickly coming to an end. Today was our last day at the hospital, and we have said a lot of good-byes. Many of the local staff have asked, "When are you coming back," as if we are coming back on a schedule. I would say that we have both had a great experience, and would both be honored to have the opportunity to serve here again in the future, if that is indeed what is in store for us. We will just have to wait and see.
Just to sum things up a bit, this week has been busy at the hospital. We have seen a large volume of patients, especially since the surgeon has arrived. We have seen both very joyous outcomes, and unfortunately have continued to have many more deaths than we are accustomed to at home, however we have maximized the care to the best of our abilities in the system which is in place here.
Outside of the hospital setting, we had the opportunity to return to the orphanage today. Greg and Wendy, who are missionaries here, had obtained mosquito nets for the children. We were able to go help hang those in the rooms. Hopefully they will be used, and the children will be protected. While there I noticed that 8 of the 18 children have ringworm on their head, and only a few are being treated. The local public health will give treatment for 2 weeks, which is certainly not enough. I talked with one of the volunteers from there, a young lady from Germany, and I am going to calculate the dosages for the children and leave the money with her to see to it that all of them get the full 6-8 weeks treatment that they need. I will also leave a little extra for any of the others who may get ringworm and for the few who need treatment on their skin as well. It is a very minimal price (less than $10) to treat all of them for the full course.
Tonight dinner will involve all of the volunteers here as we are preparing to leave. It is a traditional Ghanaian dish, groundnut soup (peanut soup) served with rice. It is very common here because it is inexpensive and there is a good supply of peanuts. Afterwards will be station meeting, and then we will all say our good-byes. Jeremy and I will leave here at 4AM in the morning, travel by car about 2 1/2 hours to Tamale and then catch our 1 hour flight to Accra. We will be in Accra for the entire day, then leave on a 1AM flight, arriving back in Atlanta between 8 and 9 Saturday morning. Please pray for our safe travels and our continued health as we return home.
Talk to you all soon,
Steve
It is Thursday afternoon, and we are sad to write and say that our time here is quickly coming to an end. Today was our last day at the hospital, and we have said a lot of good-byes. Many of the local staff have asked, "When are you coming back," as if we are coming back on a schedule. I would say that we have both had a great experience, and would both be honored to have the opportunity to serve here again in the future, if that is indeed what is in store for us. We will just have to wait and see.
Just to sum things up a bit, this week has been busy at the hospital. We have seen a large volume of patients, especially since the surgeon has arrived. We have seen both very joyous outcomes, and unfortunately have continued to have many more deaths than we are accustomed to at home, however we have maximized the care to the best of our abilities in the system which is in place here.
Outside of the hospital setting, we had the opportunity to return to the orphanage today. Greg and Wendy, who are missionaries here, had obtained mosquito nets for the children. We were able to go help hang those in the rooms. Hopefully they will be used, and the children will be protected. While there I noticed that 8 of the 18 children have ringworm on their head, and only a few are being treated. The local public health will give treatment for 2 weeks, which is certainly not enough. I talked with one of the volunteers from there, a young lady from Germany, and I am going to calculate the dosages for the children and leave the money with her to see to it that all of them get the full 6-8 weeks treatment that they need. I will also leave a little extra for any of the others who may get ringworm and for the few who need treatment on their skin as well. It is a very minimal price (less than $10) to treat all of them for the full course.
Tonight dinner will involve all of the volunteers here as we are preparing to leave. It is a traditional Ghanaian dish, groundnut soup (peanut soup) served with rice. It is very common here because it is inexpensive and there is a good supply of peanuts. Afterwards will be station meeting, and then we will all say our good-byes. Jeremy and I will leave here at 4AM in the morning, travel by car about 2 1/2 hours to Tamale and then catch our 1 hour flight to Accra. We will be in Accra for the entire day, then leave on a 1AM flight, arriving back in Atlanta between 8 and 9 Saturday morning. Please pray for our safe travels and our continued health as we return home.
Talk to you all soon,
Steve
Monday, June 14, 2010
Steve Gets a Wife!
Good Monday Evening Everyone,
It is time for a celebration, Steve has landed a Ghanaian wife. Or so was the story at the hospital today. We had some clothing made by a local tailor, and I had a suit made like was worn by one of the previous long term docs here, basically an oversized set of scrubs that keep you very cool because they let plenty of air flow through. When I showed up at the hospital today, one of the translators said I should marry Lamisi, one of our other translators. She patted my stomach and Lamisi's shoulder and said, "the two fat ones." She thought this was hilarious as did everyone else, considering Lamisi has children who are over 18, and we are two of the more heavyset people here. It was a good laugh, and I hope you will think so, too. There are photos below.
Aside from some good laughs, we are doing well. Today was one of our busiest clinics. Jeremy and Jim saw a total of 130 patients in clinic today, and Michelle and I saw 98. I think this was probably the busiest day we have had so far. A surgeon arrived today, so we now have a little more capability to help patients, but only so far as we can use spinal or local anesthesia, unless you or anyone else really thinks biting a bullet is a true form of pain tolerance.
We finally had a day without a death on the peds ward last night. However, the same may not hold true tonight. Jeremy admitted a 6 yo girl with a snake bite (remember we have no anti-snake venom) 3 days ago, was taken to a local healer who made many cuts on her ankles and arms to let the toxins out. Now, however, she is here with bleeding from all these sites, because the snake venom inhibits your clotting system. She will probably be needing a tetanus shot, too if she survives. In discussing snake bites, we have also learned there is a black market for snake venom. Apparently if you know the right people, and have the correct cash amount, you can get anti-snake venom. The translator would not ask how much it cost for us, but we hope to find out tomorrow. There is word we may get a few vials in the next few days from Accra, but that is still pending.
We have taken several photos in the past few days, so a few of those are below. We just haven't really had time to edit them and post them. We included 10 of the best below. No worries, no gross medical pictures are on here.
We hope everyone is well at home, and ask for your continued prayer as we work through this final week here. The hospital is in a real time of stress and need, and we just hope our efforts will be a blessing to them. We look forward to talking to everyone soon.
Love,
Steve
Steve with Lamisi. She always smiles, except when she is in front of the camera. She is an excellent translator and has been a blessing to work with.
Steve, Jeremy and Enabong (an OB resident from Canada) with their attire made from the Ghana Health Service fabric. This took a little effort, but it was worth it.
Steve rounding on the peds ward.
Jeremy rounding on the men's ward.
Steve resuscitating a 34-week old child in the OR following a C-section. Although we had a lot of concern prior to the surgery, the baby did very well after a few minutes of support, and went home a few days ago after she learned to suck well enough to gain weight.
Steve with a 3-year-old who had a head laceration after falling into a concrete ditch. His parents own the local gas station where we buy soda and fruit juice. Although he was numbed very well, while being held down for the sutures (all 7 of them) he screamed, "You are killing me!" in the local dialect. The father found it very funny.
Steve with Majeed. This is the young man was fell off the truck and required the many hours of suturing. He has just finished getting his sutures out. With the exception of a little wound ont he side of his forhead, everything has healed very well.
Jeremy eats some charcoal cooked corn at the local market. Cost less than 50 cents.
Jeremy eats peas. We have them quite often, so he gave them a try, and didn't have any major
breakdowns or flashbacks to childhood.
The tiny Falani (one of the local tribes) Church we attended on Sunday. It was so small I hit my head on the doorway. There were probably 10 local people, plus 8 or 9 of us there, and it filled the building. There was a church next door (not sure what type) whose members were having some fun with their speakers and amplifiers.
That's all for tonight!
It is time for a celebration, Steve has landed a Ghanaian wife. Or so was the story at the hospital today. We had some clothing made by a local tailor, and I had a suit made like was worn by one of the previous long term docs here, basically an oversized set of scrubs that keep you very cool because they let plenty of air flow through. When I showed up at the hospital today, one of the translators said I should marry Lamisi, one of our other translators. She patted my stomach and Lamisi's shoulder and said, "the two fat ones." She thought this was hilarious as did everyone else, considering Lamisi has children who are over 18, and we are two of the more heavyset people here. It was a good laugh, and I hope you will think so, too. There are photos below.
Aside from some good laughs, we are doing well. Today was one of our busiest clinics. Jeremy and Jim saw a total of 130 patients in clinic today, and Michelle and I saw 98. I think this was probably the busiest day we have had so far. A surgeon arrived today, so we now have a little more capability to help patients, but only so far as we can use spinal or local anesthesia, unless you or anyone else really thinks biting a bullet is a true form of pain tolerance.
We finally had a day without a death on the peds ward last night. However, the same may not hold true tonight. Jeremy admitted a 6 yo girl with a snake bite (remember we have no anti-snake venom) 3 days ago, was taken to a local healer who made many cuts on her ankles and arms to let the toxins out. Now, however, she is here with bleeding from all these sites, because the snake venom inhibits your clotting system. She will probably be needing a tetanus shot, too if she survives. In discussing snake bites, we have also learned there is a black market for snake venom. Apparently if you know the right people, and have the correct cash amount, you can get anti-snake venom. The translator would not ask how much it cost for us, but we hope to find out tomorrow. There is word we may get a few vials in the next few days from Accra, but that is still pending.
We have taken several photos in the past few days, so a few of those are below. We just haven't really had time to edit them and post them. We included 10 of the best below. No worries, no gross medical pictures are on here.
We hope everyone is well at home, and ask for your continued prayer as we work through this final week here. The hospital is in a real time of stress and need, and we just hope our efforts will be a blessing to them. We look forward to talking to everyone soon.
Love,
Steve
Steve with Lamisi. She always smiles, except when she is in front of the camera. She is an excellent translator and has been a blessing to work with.
Steve, Jeremy and Enabong (an OB resident from Canada) with their attire made from the Ghana Health Service fabric. This took a little effort, but it was worth it.
Steve rounding on the peds ward.
Jeremy rounding on the men's ward.
Steve resuscitating a 34-week old child in the OR following a C-section. Although we had a lot of concern prior to the surgery, the baby did very well after a few minutes of support, and went home a few days ago after she learned to suck well enough to gain weight.
Steve with a 3-year-old who had a head laceration after falling into a concrete ditch. His parents own the local gas station where we buy soda and fruit juice. Although he was numbed very well, while being held down for the sutures (all 7 of them) he screamed, "You are killing me!" in the local dialect. The father found it very funny.
Steve with Majeed. This is the young man was fell off the truck and required the many hours of suturing. He has just finished getting his sutures out. With the exception of a little wound ont he side of his forhead, everything has healed very well.
Jeremy eats some charcoal cooked corn at the local market. Cost less than 50 cents.
Jeremy eats peas. We have them quite often, so he gave them a try, and didn't have any major
breakdowns or flashbacks to childhood.
The tiny Falani (one of the local tribes) Church we attended on Sunday. It was so small I hit my head on the doorway. There were probably 10 local people, plus 8 or 9 of us there, and it filled the building. There was a church next door (not sure what type) whose members were having some fun with their speakers and amplifiers.
That's all for tonight!
Steve
Saturday, June 12, 2010
Saturday, Saturday....
Good Morning everyone,
It is Saturday morning, and we are already finished for the day (it is just before 11AM here). Quick updates: Still no snake venom available and still no x-ray film available. We are not sure when any of either will be available, but this certainly limits some of our treatment options.
At the hospital it has been a difficult week on the pediatric ward. We have had at least 1 death each day, and several days had 2 deaths each. It seems that several of the children with GI problems, whether they were gastroenteritis or typhoid related were all unable to overcome their illness. A couple of them I really had thought were improving, but then quickly passed away. We had 2 malnourished children with multiple problems also pass and last night we lost a little boy with what was likely bronchiolitis and pneumonia, who we just didn't have anything more than bulb suction to help with his secretions and mucus. He had looked in less distress yesterday on rounds, but I wasn't sure if he was truly less distressed or becoming more sick and just unable to mount an appropriate response. Meanwhile, there are two children (a newborn, and a 2 year old) on the ward who may have Hirschprung's disease (where the nerves of the colon do not develop normally so they cannot pass stool). The newborn presented with a very large, hard abdomen, having never passed stool in the first few days of life. We were able to find on exam that his anus is not completely open and he has formed a fistula tract where stool leaks from just under his scrotum. He is passing stool through the fistula, however, his belly is much softer, and he is eating well. We are going to let this continue until monday when a new surgeon arrives and let him help us determine the best course for the child. He will ultimately need some kind of anal surgery to help him, but since he is OK for now, we felt it best to do no more harm than already exists. The 2 year old is a child who also presented with a hard abdomen and having difficulty passing stool. it was very difficult to get a good history from the mother with the language barrier. Initially she reported the child had normal stools until recently. While the child has been in the hospital, he has not had a single stool in several days. On further questioning with a different nurse doing the interpreting, I was able to learn that the child has never had a stool on his own since birth. They have always "mixed up" enemas to give him when is belly became hard to help him stool. So, I think this child may for sure have Hirschprung's. We are doing small enemas daily now to help him stool and the surgeon will also evaluate him on Monday. Otherwise he is doing well. One last child to talk about is a little 2 year old boy who came in overnight with a femur fracture. The parents took him home today because they wanted "Local treatment" not casting or traction. Local treatment here varies by illness or problem, but usually is not a very good option from a medical standpoint. For skin wounds, the medicine man creates some liquid, which contains who knows what, some have said snake parts among other things, and then pours it on the skin. usually we see them a week or so later because the solution causes the skin to peel off and then it gets infected. They also have a similar concoction for internal problems that the people drink, and many others for a variety of different illnesses.
On a more positive note, Majeed, the young boy whose pictures you saw a few days back after all the suturing, returned yesterday for suture removal. After multiple attempts to be sure we had them all out, he looks great. He has a little area from the wound next to his right eye that is still healing, but otherwise all the other areas have healed very well and hopefully won't scar too badly. He is a very polite young man, very loving and grateful, and just makes your heart bleed for the suffering he has endured the past week and a half. I really pray for blessings for he and his family as they are all very loving and compassionate. I am surprised how attached to him I became in just a few days, but there is definnitely a special bond there. I guess he is just one of those patients who touches your heart in a special way, a blessing sent from Heaven.
Outside the hospital, the past few days have also been fun. We bought some fabric from the local market and are having some African clothes made. The wife of one of the caretakers of our guesthouse is making them for us, for a very cheap price. She tailored everything on Thursday, and Friday we tried them on, but let's just say that my butt is a little bigger than she perceived or measured. She came by in the evening yesterday and is going to alter them with the extra fabric to make it possible for me to get the pants above my lower thighs! Jeremy and I also got some of the Ghana Health Service fabric from the hospital, and are having shirts made from this. Hopefully they will be done in time for us to wear them to the hospital and get some pictures made before we leave. The clothing here is very colorful, and very simple in they way it is tailored, but seems to be very durable. Michelle (the pediatrician from Kansas City) has made the observation that it is amazing how many layers of clothing some of the people wear, even in this hot weather. It reminds me a lot of our experience in South America with some of the women wearing many layers and bundling their babies in many layers also.
As you are probably aware, the World Cup competition is officially underway. The Ghana National television is carrying every game, so we are hoping to see the US play tonight. Yesterday, as we were returning from the local market I saw a few groups of people gathered around TVs watching very intently. I can't wait to see the local energy and activities when Ghana plays tomorrow!
As most of you know, my sister Danielle graduated from high school last night. I hated to miss the ceremony, but I did have the chance to call and talk to her for a while yesterday before the graduation. I am very proud of her and excited she is going to attend Northern Kentucky University, which is only about 5 miles from my house in Fort Thomas. I am sure there will be plenty of photo and video coverage from our family. Pray for her as she goes through this big period of transition in her life.
It is hard to believe this time in 1 week we will be getting back into the USA. Jim one of the other docs here reminded me today. Our time is going by so quickly. I just hope our work and efforts are a good example to the local people. We know the hospital is going through transition and some serious financial struggles currently for multiple reasons (not being paid by the goverment insurance for 6 months now, having difficulty purchasing medications, searching for more long-term physicians to help staff the hospital). I just hope God blesses them to be able to continue the good work that is happening here so the local people can continue to receive good care and spiritual nourishment. A large part of the community's life is due in part to the hospital at some point, past or present.
My goal for the coming week is to begin putting together some of our photos into a slide show, or a printable format, so that we can have them ready pretty quickly to share with everyone when we are back. It is always frustrating to try to tell people about the trip and not have the pictures ready to show when we return. Pray that I would get this done or at least a good start. We have a lot of pictures to sort through, and many more we will acquire/share with some of the others here with us.
I will stop for now. I hope you are all having a great weekend. We will post again soon, and maybe even try to get a few more pictures on here in the next couple of days.
Love always,
Steve
It is Saturday morning, and we are already finished for the day (it is just before 11AM here). Quick updates: Still no snake venom available and still no x-ray film available. We are not sure when any of either will be available, but this certainly limits some of our treatment options.
At the hospital it has been a difficult week on the pediatric ward. We have had at least 1 death each day, and several days had 2 deaths each. It seems that several of the children with GI problems, whether they were gastroenteritis or typhoid related were all unable to overcome their illness. A couple of them I really had thought were improving, but then quickly passed away. We had 2 malnourished children with multiple problems also pass and last night we lost a little boy with what was likely bronchiolitis and pneumonia, who we just didn't have anything more than bulb suction to help with his secretions and mucus. He had looked in less distress yesterday on rounds, but I wasn't sure if he was truly less distressed or becoming more sick and just unable to mount an appropriate response. Meanwhile, there are two children (a newborn, and a 2 year old) on the ward who may have Hirschprung's disease (where the nerves of the colon do not develop normally so they cannot pass stool). The newborn presented with a very large, hard abdomen, having never passed stool in the first few days of life. We were able to find on exam that his anus is not completely open and he has formed a fistula tract where stool leaks from just under his scrotum. He is passing stool through the fistula, however, his belly is much softer, and he is eating well. We are going to let this continue until monday when a new surgeon arrives and let him help us determine the best course for the child. He will ultimately need some kind of anal surgery to help him, but since he is OK for now, we felt it best to do no more harm than already exists. The 2 year old is a child who also presented with a hard abdomen and having difficulty passing stool. it was very difficult to get a good history from the mother with the language barrier. Initially she reported the child had normal stools until recently. While the child has been in the hospital, he has not had a single stool in several days. On further questioning with a different nurse doing the interpreting, I was able to learn that the child has never had a stool on his own since birth. They have always "mixed up" enemas to give him when is belly became hard to help him stool. So, I think this child may for sure have Hirschprung's. We are doing small enemas daily now to help him stool and the surgeon will also evaluate him on Monday. Otherwise he is doing well. One last child to talk about is a little 2 year old boy who came in overnight with a femur fracture. The parents took him home today because they wanted "Local treatment" not casting or traction. Local treatment here varies by illness or problem, but usually is not a very good option from a medical standpoint. For skin wounds, the medicine man creates some liquid, which contains who knows what, some have said snake parts among other things, and then pours it on the skin. usually we see them a week or so later because the solution causes the skin to peel off and then it gets infected. They also have a similar concoction for internal problems that the people drink, and many others for a variety of different illnesses.
On a more positive note, Majeed, the young boy whose pictures you saw a few days back after all the suturing, returned yesterday for suture removal. After multiple attempts to be sure we had them all out, he looks great. He has a little area from the wound next to his right eye that is still healing, but otherwise all the other areas have healed very well and hopefully won't scar too badly. He is a very polite young man, very loving and grateful, and just makes your heart bleed for the suffering he has endured the past week and a half. I really pray for blessings for he and his family as they are all very loving and compassionate. I am surprised how attached to him I became in just a few days, but there is definnitely a special bond there. I guess he is just one of those patients who touches your heart in a special way, a blessing sent from Heaven.
Outside the hospital, the past few days have also been fun. We bought some fabric from the local market and are having some African clothes made. The wife of one of the caretakers of our guesthouse is making them for us, for a very cheap price. She tailored everything on Thursday, and Friday we tried them on, but let's just say that my butt is a little bigger than she perceived or measured. She came by in the evening yesterday and is going to alter them with the extra fabric to make it possible for me to get the pants above my lower thighs! Jeremy and I also got some of the Ghana Health Service fabric from the hospital, and are having shirts made from this. Hopefully they will be done in time for us to wear them to the hospital and get some pictures made before we leave. The clothing here is very colorful, and very simple in they way it is tailored, but seems to be very durable. Michelle (the pediatrician from Kansas City) has made the observation that it is amazing how many layers of clothing some of the people wear, even in this hot weather. It reminds me a lot of our experience in South America with some of the women wearing many layers and bundling their babies in many layers also.
As you are probably aware, the World Cup competition is officially underway. The Ghana National television is carrying every game, so we are hoping to see the US play tonight. Yesterday, as we were returning from the local market I saw a few groups of people gathered around TVs watching very intently. I can't wait to see the local energy and activities when Ghana plays tomorrow!
As most of you know, my sister Danielle graduated from high school last night. I hated to miss the ceremony, but I did have the chance to call and talk to her for a while yesterday before the graduation. I am very proud of her and excited she is going to attend Northern Kentucky University, which is only about 5 miles from my house in Fort Thomas. I am sure there will be plenty of photo and video coverage from our family. Pray for her as she goes through this big period of transition in her life.
It is hard to believe this time in 1 week we will be getting back into the USA. Jim one of the other docs here reminded me today. Our time is going by so quickly. I just hope our work and efforts are a good example to the local people. We know the hospital is going through transition and some serious financial struggles currently for multiple reasons (not being paid by the goverment insurance for 6 months now, having difficulty purchasing medications, searching for more long-term physicians to help staff the hospital). I just hope God blesses them to be able to continue the good work that is happening here so the local people can continue to receive good care and spiritual nourishment. A large part of the community's life is due in part to the hospital at some point, past or present.
My goal for the coming week is to begin putting together some of our photos into a slide show, or a printable format, so that we can have them ready pretty quickly to share with everyone when we are back. It is always frustrating to try to tell people about the trip and not have the pictures ready to show when we return. Pray that I would get this done or at least a good start. We have a lot of pictures to sort through, and many more we will acquire/share with some of the others here with us.
I will stop for now. I hope you are all having a great weekend. We will post again soon, and maybe even try to get a few more pictures on here in the next couple of days.
Love always,
Steve
Wednesday, June 9, 2010
Welcome Aboard!
Good Evening Everyone,
I know Jeremy wrote earlier this evening, but I just returned from hospital night rounds and thought I, too, would give some updates.
The title may have you a bit curious. Well, we are happy to be joined by another pediatrician, Michelle, from Kansas City. Today was her first day on wards and in clinic. She was paired with me for the day, so we were able to share the shock of being a pediatrician who also sees some adults throughout the day. I think it went well though, because clinic wasn't too busy today, so she had some time to adjust and bring back some old med school memories about treating adults. It is a wonderful blessing to have another person who will share call and help divide up the patient load at the hospital.
The week otherwise has been quite busy. Jeremy had posted about a few of the patients earlier. I, too, have patients who need prayer. It seems the peds ward is now with less patients, but not because of discharging them home. Already 5 patients have died since Sunday night this week. 3 of them were a complete shock to me, and a couple of the others were expected. The three that were surprising were children who had typical viral gastroenteritis with dehydration, 2 of whom were very close to going home, but during the night the past 2 nights have passed away. I don't know if something else went wrong suddenly or if there was another illness that we were not able to recognize because of the symptoms from dehydration. They all had some component of malnutrition, however, so I am sure their immune systems were weaker than normal, and they had no reserve to help fight an infection or acute bodily stress. Some of the others had respiratory illnesses and little hope of survival from the time they were admitted, because they were very ill before they got here, and honestly the antibiotics probably never had a chance to work.
Meanwhile, there are a few new kids on the ward who are very ill right now, one, maybe two of whom I expect to pass very soon. One is a little boy with a respiratory illness that looks like pneumonia and maybe bronchiolitis, but he also has some large tonsils and is having a lot of trouble breathing. He is on oxygen (via NG tube in the nose), but is working VERY hard to breath. Unfortunately we only have bulb suction available at the bedside, so some of the routine treatments we would do at home are not available. Pray for his recovery, because if we could get him through this acute phase, he probably has a chance, but he is really in some distress tonight. The other one I expect to die is a little 4 day old who likely had a hypoxic brain injury during birth, who presented with seizures soon after birth. I was able to get the seizures to stop with meds, but the child is not at all normal in regards to a neurologic status. I had the chaplains come spend time with the mother today to help her prepare for the reality that her child will likely not survive. In the meantime I am treating with antibiotics for the slim possibility that the child has a severe meningitis picture that is complicated by the long birth history.
This evening on night rounds I also had a few sad cases. One is a young man in his 20's who drank car battery acid this afternoon to try to commit suicide. He said he had an argument with his mother and wanted to die. He would not answer when asked if he still wanted to die or if he was wanting to live. He appears well currently, but anything is possible with acid in the gut. Another is a younger man who apparently had a bicycle accident today. He seems very intoxicated or encephalopathic one of the two. I think he most likley is intoxicated based on my exam, but I am testing for malaria tonight, in the case that he has cerebral malaria. Either way they both need prayer as the outcomes for both could be good or poor. I also had 2 children who had fallen out of trees and had leg injuries. I suppose today was a great day to climb a tree. Since we have no x-ray film, we will likely take them to the procedure (theatre) area in the morning, sedate them, and exam them better so that we can reduce any fractures or dislocations they have. Pray for us to have wisdom as we do this.
On a more positive note, today the wife of one of our workers here came by this evening. She is a seamstress. She is going to make us some African clothing from the fabric we purchased on our trip the market a few days ago. (No, in case you are wondering, there was no Obama fabric. Those are all manufactuered clothes.) I am excited to see how the clothes turn out. The best part is the whole thing, fabric, sewing and all, are going to cost less than $30.
I suppose I should conclude for the day. I need to take a quick shower, and get some rest in case I get called back to the hospital tonight--several women are currently in labor. Please keep us in your prayers. We are learning a lot here, and enjoying our time to the best of our abilities. Please keep the comments coming, we have a lot of fun reading them.
Love always,
Steve
I know Jeremy wrote earlier this evening, but I just returned from hospital night rounds and thought I, too, would give some updates.
The title may have you a bit curious. Well, we are happy to be joined by another pediatrician, Michelle, from Kansas City. Today was her first day on wards and in clinic. She was paired with me for the day, so we were able to share the shock of being a pediatrician who also sees some adults throughout the day. I think it went well though, because clinic wasn't too busy today, so she had some time to adjust and bring back some old med school memories about treating adults. It is a wonderful blessing to have another person who will share call and help divide up the patient load at the hospital.
The week otherwise has been quite busy. Jeremy had posted about a few of the patients earlier. I, too, have patients who need prayer. It seems the peds ward is now with less patients, but not because of discharging them home. Already 5 patients have died since Sunday night this week. 3 of them were a complete shock to me, and a couple of the others were expected. The three that were surprising were children who had typical viral gastroenteritis with dehydration, 2 of whom were very close to going home, but during the night the past 2 nights have passed away. I don't know if something else went wrong suddenly or if there was another illness that we were not able to recognize because of the symptoms from dehydration. They all had some component of malnutrition, however, so I am sure their immune systems were weaker than normal, and they had no reserve to help fight an infection or acute bodily stress. Some of the others had respiratory illnesses and little hope of survival from the time they were admitted, because they were very ill before they got here, and honestly the antibiotics probably never had a chance to work.
Meanwhile, there are a few new kids on the ward who are very ill right now, one, maybe two of whom I expect to pass very soon. One is a little boy with a respiratory illness that looks like pneumonia and maybe bronchiolitis, but he also has some large tonsils and is having a lot of trouble breathing. He is on oxygen (via NG tube in the nose), but is working VERY hard to breath. Unfortunately we only have bulb suction available at the bedside, so some of the routine treatments we would do at home are not available. Pray for his recovery, because if we could get him through this acute phase, he probably has a chance, but he is really in some distress tonight. The other one I expect to die is a little 4 day old who likely had a hypoxic brain injury during birth, who presented with seizures soon after birth. I was able to get the seizures to stop with meds, but the child is not at all normal in regards to a neurologic status. I had the chaplains come spend time with the mother today to help her prepare for the reality that her child will likely not survive. In the meantime I am treating with antibiotics for the slim possibility that the child has a severe meningitis picture that is complicated by the long birth history.
This evening on night rounds I also had a few sad cases. One is a young man in his 20's who drank car battery acid this afternoon to try to commit suicide. He said he had an argument with his mother and wanted to die. He would not answer when asked if he still wanted to die or if he was wanting to live. He appears well currently, but anything is possible with acid in the gut. Another is a younger man who apparently had a bicycle accident today. He seems very intoxicated or encephalopathic one of the two. I think he most likley is intoxicated based on my exam, but I am testing for malaria tonight, in the case that he has cerebral malaria. Either way they both need prayer as the outcomes for both could be good or poor. I also had 2 children who had fallen out of trees and had leg injuries. I suppose today was a great day to climb a tree. Since we have no x-ray film, we will likely take them to the procedure (theatre) area in the morning, sedate them, and exam them better so that we can reduce any fractures or dislocations they have. Pray for us to have wisdom as we do this.
On a more positive note, today the wife of one of our workers here came by this evening. She is a seamstress. She is going to make us some African clothing from the fabric we purchased on our trip the market a few days ago. (No, in case you are wondering, there was no Obama fabric. Those are all manufactuered clothes.) I am excited to see how the clothes turn out. The best part is the whole thing, fabric, sewing and all, are going to cost less than $30.
I suppose I should conclude for the day. I need to take a quick shower, and get some rest in case I get called back to the hospital tonight--several women are currently in labor. Please keep us in your prayers. We are learning a lot here, and enjoying our time to the best of our abilities. Please keep the comments coming, we have a lot of fun reading them.
Love always,
Steve
Another quick update
Hey everyone,
I just wanted to give you all a quick update and ask for your prayers for a few things. The guy I talked about in the last post who has the abscesses in the muscle layers of his legs has finally stopped having a fever! He had been febrile for the past week and a half. Please continue to pray for him as he still has a considerable amount of pus that is still draining. Pray for a quick and full recovery.
Two other prayer requests involve the supplies at the hospital. We have been using between 5-10 vials of anti-snake venom at the hospital each day over the last few weeks. We have been using more recently as the people are out in the fields working now that the rainy season is beginning. We learned today there is no ASV in all of Ghana! The hospital is in contact with people in Accra, the capital, but so far it does not appear to be looking hopeful. We need this stuff to save people's lives. Please pray God would answer this problem supernaturally and keep the people out of harm's way while they are in the fields.
The second request is we would be able to find x-ray film for sale. Apparently the hospital has not been able to find film available for purchase even in Accra. It is a regular occurence that we run out but are usually able to replenish in a few days. Please pray for the supplies to become available.
One more thing before I go. Greg and Wendy Nyhus, the family who is in charge of the volunteers and other things here in Nalerigu, has been working with the orphanage here in town that Steve and I talked about last week. Hopefully tomorrow we are going to return and put up mosquito nets for them as long as the supplies arrive.
I wanted you all to pray about something. There is a possibility of buying a chicken coup from a friend of the Nyhus's and buying chicks to raise to be egg-laying chickens. The chickens and coup would be donated to the orphanage and it would provide both nutrition
(eggs as a good source of protein) and a source of income (from selling the extra eggs). This is still in the idea stages and we are praying along with the Nyhus family to see if this is the best way to help them. We have some logistics to check on and are appreciateive of your prayers as we move forward. We are looking for guidance and leading from the Lord as to the answer.
Thanks for following along with us. We enjoy getting your comments.
Talk to you all again soon. Steve and I are well and having a great time. Continue to pray for us as we pray for you all.
Love,
Jeremy
I just wanted to give you all a quick update and ask for your prayers for a few things. The guy I talked about in the last post who has the abscesses in the muscle layers of his legs has finally stopped having a fever! He had been febrile for the past week and a half. Please continue to pray for him as he still has a considerable amount of pus that is still draining. Pray for a quick and full recovery.
Two other prayer requests involve the supplies at the hospital. We have been using between 5-10 vials of anti-snake venom at the hospital each day over the last few weeks. We have been using more recently as the people are out in the fields working now that the rainy season is beginning. We learned today there is no ASV in all of Ghana! The hospital is in contact with people in Accra, the capital, but so far it does not appear to be looking hopeful. We need this stuff to save people's lives. Please pray God would answer this problem supernaturally and keep the people out of harm's way while they are in the fields.
The second request is we would be able to find x-ray film for sale. Apparently the hospital has not been able to find film available for purchase even in Accra. It is a regular occurence that we run out but are usually able to replenish in a few days. Please pray for the supplies to become available.
One more thing before I go. Greg and Wendy Nyhus, the family who is in charge of the volunteers and other things here in Nalerigu, has been working with the orphanage here in town that Steve and I talked about last week. Hopefully tomorrow we are going to return and put up mosquito nets for them as long as the supplies arrive.
I wanted you all to pray about something. There is a possibility of buying a chicken coup from a friend of the Nyhus's and buying chicks to raise to be egg-laying chickens. The chickens and coup would be donated to the orphanage and it would provide both nutrition
(eggs as a good source of protein) and a source of income (from selling the extra eggs). This is still in the idea stages and we are praying along with the Nyhus family to see if this is the best way to help them. We have some logistics to check on and are appreciateive of your prayers as we move forward. We are looking for guidance and leading from the Lord as to the answer.
Thanks for following along with us. We enjoy getting your comments.
Talk to you all again soon. Steve and I are well and having a great time. Continue to pray for us as we pray for you all.
Love,
Jeremy
Tuesday, June 8, 2010
Ghana Loves Obama
I thought I would give the topic a little change from the typical medical stories you have been reading, so I hope you enjoy this.
Love,
Steve
The title says it all. I would say that Obama’s approval rating and his popularity are higher here than in the US. He is on billboards along the roads. His picture is on many of the composition books the children have for school. There are Obama shirts with sleeves made like the American flag, with the slogan, “Yes We Can,” and some that say president-elect. There is even underwear with Barack Obama on the waistband instead of the typical Joe Boxer or other brands. Here are a few pictures for your enjoyment.
Obama composition book. There are several different varieties, this just happens to be the one I could get a picture of.
Obama Boxer shorts, complete in their packaging at the market. They have the name Barack Obama sewn into the waistband.
Obama shirt worn by a patient's son, who was happy to pose.
Obama shirts and other merchandise for sale at the local market, which comes every 3 days to Nalerigu.
Monday, June 7, 2010
A Wild Monday Night
Hello again everyone. We officially started week 3 of our stay here in Nalerigu today. Monday is clinic day and we were quite busy with various complaints and diseases. Between Steve and me, with our translator, we saw 91 patients. The triage people were sort of running behind today so I am pretty sure we could have broken 100 if things would have been running smoothly. Our goal is to have an “over 100 day.” We saw various things including plenty of hypertension, general body pains, fever (usually malaria or typhoid), vomiting, waist pain (my personal favorite, as this is different from abdominal pain), multiple women in their third trimester of pregnancy with low abdominal and low back pain, and various other complaints.
I did attend to a younger gentleman who was involved in a RTA (Road Traffic Accident), although in his case it could also be called a Rural Tractor Accident because while he was out working in the field, his left chest and arm were run over by a tractor. Amazingly he did not appear to have any broken bones in the arm or shoulder area (maybe a few fractured ribs), had clear breath sounds (no pneumothorax) and was able to carry on a lucid conversation. I admitted him mostly for pain control and further observation, but I think he is going to recover well. He is very blessed the accident was not worse than it was.
Other admissions between Steve and myself were: concussion in a child who had fallen from a donkey cart (used to haul 55 gallon tubs of water), a snake bite, the RTA and a gentleman with atrial fibrillation with RVR.
After clinic we go to the theater for any small procedures which need to be performed on the waiting patients. Today I performed repeat incision and drainage on a young guy in his 20’s. We did an initial incision and drainage several days ago for large abscess along the muscle layers in the left thigh and right buttock. Despite cloxacillin and bactrim he continued to have fevers in the 103F range. We decided to take him back again today for additional incisions. We made the incision and got some pus out but did not really get back as much as we thought we would originally based on the Ultrasound we had performed. Please pray for him as he has a very serious infection and the antibiotics do not seem to be helping. Today I changed him to another antibiotic regimen, please pray this works for him and the abscesses would dry up and he would recover.
************Interruption for an update in Real Life in the ER, Nalerigu*********************
As I was typing this post the surgeon came to pick us up because Dr. Jim had called him from his night rounds saying there was a lorry (truck) accident and many people were hurt and needing suturing. By the time we arrived he had already triaged several of the patients and decided one of them would need a skin graft on her shoulder in the morning. Others were receiving stitches from some of the OR staff. The lady who was the most critical had a large chunk of flesh out of her left shoulder, mangled skin on her fingers and the top half of her left face was shredded. The pictures are much too graphic to share but we did take a few to hopefully compare before and after. It was a blessing that most of the bleeding was stopped and it really is a miracle her temporal artery was still intact. You could see it pulsating along its course on the side of her head. She had not received any pain medication because she had just eaten and the anesthesia tech was concerned about not having digested food and giving conscious sedation. We gave her Demerol and plenty of lidocaine locally prior to starting. I was in charge of the fingers and am not sure how it is going to turn out. I just reapproximated skin as best I could and cut off the pieces which were no longer viable. Dr. Joel started on the area of the face and placed a few sutures but then decided it would be best to wait until the morning and take a closer look in the OR. He then moved on to the shoulder and tried as best he could to sew the shreds back together after cleaning out the gravel and glass. I know I am being graphic but there really is no other way to describe it. She was all bandaged up and will have her dressings changed again tomorrow and we will take another look at her wounds. It took about an hour with the two of us sewing and Steve and Dr. Jim being our assistants/anesthesia administrators to get it finished. She will have a long road for recovery.
Please pray for her and the other ladies involved in the accident. They were actually patients here today and were on their way back home from their visits when the accident occurred. It really is sad to know how hard life is here on a daily basis and then an accident like this occurs. I know the Lord must have a plan for all of it but you still ask the question “why?” Please pray for their recovery and quick wound healing and that there would be no complications with wound infection. We’ll try to keep you updated on the outcomes over the next several days.
Love,
Jeremy
****Continuation from Steve***
I echo much of what Jeremy has written for today. I was on call yesterday and it was much easier than the previous call was. No major trauma, only a few snake bites which had to receive snake venom, albeit one was at 5am this morning, meaning I had to wake up to give it out, since we store here at the house during the night (pharmacy is only open during the daytime).
On the pediatric side of the world today, we had a little infant a few months old pass away after battling pneumonia and likely developed sepsis. It was just in such respiratory distress it didn’t have a good chance from the time it arrived. We placed it on oxygen, which is an interesting task here. We have no nasal cannulas here, so they take an NG feeding tube, insert it into the nose on one side just a little ways, then tape it down. They then tape this to the hose coming from the oxygen generator (a portable machine). The hospital is equipped for oxygen in the different areas, but for some reason does not have an oxygen supply or delivery is malfunctioned. This can be a real stress in the operating room, and also when trying to save a child’s life. I am not exactly sure what all was wrong with the kid, because I sort of took over on rounds, after the child had been admitted by a medical officer. I was worried yesterday she may not survive, and today she was still in significant distress on my exam (although the staff said she was “much” better today).
Another interesting case was in regards to circumcision, which is common in some groups here, and not common in others. We had a patient come in on Friday with parents requesting a redo of his circumcision. He is about 1 year old and had the initial one done at home soon after his birth. We brought him in on Saturday to do the procedure. After much hassle and examination, we determined that the child’s circumcision could not be redone because when they had performed the initial one they had actually removed the foreskin and the glans penis (the tip) which is termed glans penis amputation. So basically this child still has a lot of swelling and a little urethral opening to urinate through (amazingly has not closed off) and will be deformed all his life now. It was very sad to see this and to see his parents’ disappointment with the whole situation. A few of the children who have been here for the whole two weeks have actually been able to go home in the past couple days, so there is some good coming from the work with all the kids.
On a more positive note, we are expecting some new short term physicians over the next week or so. The first is supposed to arrive tomorrow. She is a pediatrician from Kansas City. We are looking forward to having more medical staff, and also to having more people to divide up the call schedule. I am not sure the dates, but I think a surgeon and a few others are coming in the following weeks.
We are all preparing for malaria to continue to increase in frequency. It is now rainy season, although here in Nalerigu we seem to be getting less than some of the surrounding areas. With the increase in water, comes more mosquitoes and hence more malaria. Currently on the peds ward there around 10-15 patients per day, but when this happens, the story is that there are usually around 2-3 patients per bed in the peds ward (which has 30+ beds). So, as you can imagine, it could get busy very quickly.
I think I will leave you with that for the day. I see this is already 3 pages long. Please keep praying for our work here, and for the patients now and after we have returned home. It is a situation that words and pictures will never be able to describe, but is filled with wonderful, happy people who love one another, and show us love for the work we are doing. We will post again soon.
Love,
Steve
Saturday, June 5, 2010
Relaxation Saturday
Hi everyone,
Below you will see a few pictures of our Saturday adventures. We did not necessarily have the day off, but we did have a little excursion after rounds were finished this morning.
A few updates from the hospital. The young man whose pictures were posted yesterday continues to do very well. In fact, today in the town we visited for our excursion, we ran into his dad, who was again thanking us and telling us that is son is completely normal mentally. Overnight, we had 2 deaths on the pediatric ward. First was a young child with horrible malnutrition and an illness we could not really fully diagnose or treat, other than some severe malnutrition, which obviously didn't help her chances. The other is the infant I admitted a few days ago, who would have been 8 days old today, if I remember correctly. Regardless, despite our best efforts to treat what appeared to be sepsis, she ultimately ended up in multisystem organ failure and died overnight. She was very interesting, because when the nurses told me her name, they had to explain its meaning. The name (which I will not even attempt to spell) means infant girl. They don't actually give the child a name until is 8 days old (having survived the first week on earth). This is whent he child technically becomes a person to them. I was surprised by this, but to the credit of the mother, she never left the bedside of the patient from admission until death.
We also were able to get some sun today. Even with SPF-30, Jeremy and I both have a little more color now. It is amazing what just getting outside the hospital will do for you. Of course, riding in the back of pickup truck along dirt roads, we also had a bit of an orange tint to us until we showered and removed all the dust.
Today we drove about 45 minutes to another town called Nakpanduri, where there is an escarpment....basically a giant cliff which looks out onto the plains leading to Burkina Faso and Togo, two of the neighboring countries with Ghana. This is a view from the bottom of the hike.
This is Jeremy trying to get through what the kid's call "Fat Man's Squeeze." And for those who were wondering he did make it.
This is part of the view from the top with our group today. It really was an amazing view. The pictures don't do it justice. We were up high enough there were birds flying below us.
This tree is called a Baobob (I have no idea if this is the way to spell it) The trunk itself is huge and the branches are so little. Many people here believe the Baobob tree holds special powers. I just think it is a cool looking tree.
After our time at the escarpment we visited with a man and his wife (he is from Holland and she US) who have lived here for over 50 years. They originally came with the Peace Corps and helped with reforestation of the area. These are some of the animals people have dropped at their doorstep.
The baboon did not like his picture to be taken.
One of the monkeys was enjoying groundnuts (AKA peanuts)
After returning from Nakpanduri, we went to the local market here in Nalerigu, which happens every three days. It is a market for the everyday Ghanaian, not really for tourists. It was interesting to see all of the produce, grains, cloth, clothing, junk, etc. available. This picture only serves to show a very small portion. To get the feeling think lots of people, hot, some good smells...but mostly not, plenty of color and little kids saying "Suminga, Suminga" (again sorry about the spelling), which means "white person, white person!" Many of the kids also want to touch you...kind of like being a rockstar I guess. Anyway it was fun and we are planning to go back again before we come home.
I think that is about it for today. We will update again tomorrow. We are trying to catch up on some sleep. We are not used to working all day post-call, so it has been a bit of an adjustment for us, but preparing us for real life after residency. In the meantime, please keep us and our patients in your prayers.
Love,
Steve and Jeremy
Below you will see a few pictures of our Saturday adventures. We did not necessarily have the day off, but we did have a little excursion after rounds were finished this morning.
A few updates from the hospital. The young man whose pictures were posted yesterday continues to do very well. In fact, today in the town we visited for our excursion, we ran into his dad, who was again thanking us and telling us that is son is completely normal mentally. Overnight, we had 2 deaths on the pediatric ward. First was a young child with horrible malnutrition and an illness we could not really fully diagnose or treat, other than some severe malnutrition, which obviously didn't help her chances. The other is the infant I admitted a few days ago, who would have been 8 days old today, if I remember correctly. Regardless, despite our best efforts to treat what appeared to be sepsis, she ultimately ended up in multisystem organ failure and died overnight. She was very interesting, because when the nurses told me her name, they had to explain its meaning. The name (which I will not even attempt to spell) means infant girl. They don't actually give the child a name until is 8 days old (having survived the first week on earth). This is whent he child technically becomes a person to them. I was surprised by this, but to the credit of the mother, she never left the bedside of the patient from admission until death.
We also were able to get some sun today. Even with SPF-30, Jeremy and I both have a little more color now. It is amazing what just getting outside the hospital will do for you. Of course, riding in the back of pickup truck along dirt roads, we also had a bit of an orange tint to us until we showered and removed all the dust.
Today we drove about 45 minutes to another town called Nakpanduri, where there is an escarpment....basically a giant cliff which looks out onto the plains leading to Burkina Faso and Togo, two of the neighboring countries with Ghana. This is a view from the bottom of the hike.
This is Jeremy trying to get through what the kid's call "Fat Man's Squeeze." And for those who were wondering he did make it.
This is part of the view from the top with our group today. It really was an amazing view. The pictures don't do it justice. We were up high enough there were birds flying below us.
This tree is called a Baobob (I have no idea if this is the way to spell it) The trunk itself is huge and the branches are so little. Many people here believe the Baobob tree holds special powers. I just think it is a cool looking tree.
After our time at the escarpment we visited with a man and his wife (he is from Holland and she US) who have lived here for over 50 years. They originally came with the Peace Corps and helped with reforestation of the area. These are some of the animals people have dropped at their doorstep.
The baboon did not like his picture to be taken.
One of the monkeys was enjoying groundnuts (AKA peanuts)
After returning from Nakpanduri, we went to the local market here in Nalerigu, which happens every three days. It is a market for the everyday Ghanaian, not really for tourists. It was interesting to see all of the produce, grains, cloth, clothing, junk, etc. available. This picture only serves to show a very small portion. To get the feeling think lots of people, hot, some good smells...but mostly not, plenty of color and little kids saying "Suminga, Suminga" (again sorry about the spelling), which means "white person, white person!" Many of the kids also want to touch you...kind of like being a rockstar I guess. Anyway it was fun and we are planning to go back again before we come home.I think that is about it for today. We will update again tomorrow. We are trying to catch up on some sleep. We are not used to working all day post-call, so it has been a bit of an adjustment for us, but preparing us for real life after residency. In the meantime, please keep us and our patients in your prayers.
Love,
Steve and Jeremy
Friday, June 4, 2010
A Photo Tour
At the hospital
Steve in the outpatient clinic. We share this office with one interpreter between the two of us.
There is a small exam table behind that curtain to my right. Very old and very small but it works great.
The "Clean" procedure room. Site of various lipoma removals, suturing, paracentesis (or this is also done in the hallway), foreign body removals and amputations.
This is the room where steve did plastic surgery with our battery operated head lamp because the power went off at least twice.
The "dirty" procedure room. This is where we do various I&D (incisions and drainage), wound debridement and ultrasounds.
The bucket of sutures Steve had to choose from in the dark!
The on-call vehicle for nighttime rounds....our insurance policy from needing to use the anti-snake venom supply on ourselves. But at least it is in our refrigerator if we need it quickly!
House #6...home sweet home..or is that home sweat home? Hey but it is nearly mosquito free.
One of the main streets in Nalerigu after a brief downpour.
Naomi's Fund - This is a biweekly program with the 1st Baptist Church (there is a 2nd and apparently a 3rd) which provides grain for widows and blind people as well as their children. The Nyhus family took us along for the ride and we were able to hand out the shorts and dresses Jeremy's grandmother and her friends made for the kids. We were caught for the second time in an absolute deluge. Steve protected the camera while Jeremy passed out the gifts and was soaking wet.
So, here we are at the end after the madness of trying to hand out the clothes. We managed but the rain made it a little difficult to be civilized.
Steve caught this little guy sneaking some food while the people were listening to Wendy talk. I think he might be eating a relative...not sure.
Passing out the clothes with the help of some local boys to translate and push when needed. They were crowd control. We had to tell the older ladies these clothes were only for children but it didn't really help, hence the older looking hand at the bottom of the picture.
One of the dresses. Perfect size.
A pair of the shorts. The kids were all very happy to receive their clothes. Next time we will bring more for sure.
A child listening to the devotion. Steve's shot of the day.
Steve in the outpatient clinic. We share this office with one interpreter between the two of us.
There is a small exam table behind that curtain to my right. Very old and very small but it works great.
The "Clean" procedure room. Site of various lipoma removals, suturing, paracentesis (or this is also done in the hallway), foreign body removals and amputations.
This is the room where steve did plastic surgery with our battery operated head lamp because the power went off at least twice.
The "dirty" procedure room. This is where we do various I&D (incisions and drainage), wound debridement and ultrasounds.
The bucket of sutures Steve had to choose from in the dark!
The on-call vehicle for nighttime rounds....our insurance policy from needing to use the anti-snake venom supply on ourselves. But at least it is in our refrigerator if we need it quickly!
House #6...home sweet home..or is that home sweat home? Hey but it is nearly mosquito free.
One of the main streets in Nalerigu after a brief downpour.
Naomi's Fund - This is a biweekly program with the 1st Baptist Church (there is a 2nd and apparently a 3rd) which provides grain for widows and blind people as well as their children. The Nyhus family took us along for the ride and we were able to hand out the shorts and dresses Jeremy's grandmother and her friends made for the kids. We were caught for the second time in an absolute deluge. Steve protected the camera while Jeremy passed out the gifts and was soaking wet.
So, here we are at the end after the madness of trying to hand out the clothes. We managed but the rain made it a little difficult to be civilized.
Steve caught this little guy sneaking some food while the people were listening to Wendy talk. I think he might be eating a relative...not sure.
Passing out the clothes with the help of some local boys to translate and push when needed. They were crowd control. We had to tell the older ladies these clothes were only for children but it didn't really help, hence the older looking hand at the bottom of the picture.
One of the dresses. Perfect size.
A pair of the shorts. The kids were all very happy to receive their clothes. Next time we will bring more for sure.
A child listening to the devotion. Steve's shot of the day. (Note the umbilical hernia common to every child and almost all adults here)
Well that is all for now. It took us several tries to get this all up at the same time. We hope you enjoy it and we will talk to you all again soon.
Love,
Jeremy and Steve
A Miracle (with some gross pictures--Warning!)
Hi everyone,
I am writing early this evening to update you on the young man I wrote about in the post last night. Amazingly, when I walked into the hospital this morning, I found the young man sitting up in bed talking to his mother and the staff. Yes, he was talking and completely mentally intact. I walked over and talked to him and he had a brief conversation with me in English, thanking me for working on him last night. His only problem this morning was pain, and as I mentioned earlier, he likely has a fractured arm which we will address in the next day or so. X-rays were scheduled for sometime today. i have to say I am impressed and pleased with the way he looks today.
His neurologic status was intact, his vision is normal, he could talk and swallow, and he was moving all of his extremities. He could remember some parts of the accident. After he and his mother repeatedly thanked me for working so hard on their son, I obviously told them they were welcome, but that the thanks should be to God because he is very lucky to be a live and it really is a miracle he survived. I emphasized to them again how close to death he was. To my surprise, he did not have to get blood last night, despite the large amount he had lost because his level was still in the low-safe range.
Below are some pictures of him today. Sorry, I didn't have my camera with me last night when it all happened because I didn't take it to the hospital with me in the rain.
As for his friend, he did well overnight and was discharged home today with some minor bumps, bruises, and a few stitches.
More pictures and stories from the week to come later this evening as I get them loaded onto the computer.
Thanks for the comments and prayers,
Steve
Thanks for the comments and prayers,
Steve
Sitting up in bed. Where there is a bandage there are a LOT of sutures!
Face shot.
Lip and Nose. Left side is where all the work was done. You can see only a couple of the many sutures. Also has sutures below the eye and on the chin.
Thursday, June 3, 2010
TRAUMA! Real Trauma!
Hello all,
Sorry we haven't written in a few days, but we have been quite busy. Hopefully the weekend will give us some more time to update everyone.
As for the title, I am sure your curiosity is piqued. I am on call tonight. Just as I was fininshing my evening rounds at about 8:30 the staff came to get me to see a pateint at check in. I walk around the corner and here is an 18 year old man on a stretcher with an obvious head injury and blood literally everywhere, and on the ground lying is a 20 year old man who looks like he has just been beaten up very badly. On questioning, we found out the two were riding in the back of a truck and either jumped or fell out. the rain returned today, so I am not sure if this had anything to do with it or not. The 20 year old, ended up only have a small laceration to the back of his scalp and to one of his fingers and lots of road burn all over him.
The 18 year old is another story. I have honestly just spent the past 4 hours suturing his head. His scalp was almost completely removed, his lip and lower nose were completely mutilated, he had a large laceration to his temporal area and a few small lacerations on his face. (keep in mind I am just talking about his head now). Wendy, the wife of one of the missionaries, who is also a nurse, happened to be there as well and stayed to help. We sutured for nearly 4 hours, using almost every suture available whether it would have been appropriate or not in the US. He was bleeding profusely from his scalp, literally pulsating blood out onto the table. He also had what looked like a gravel embedded in his skull in the front top part of his head. I tried to get it out, but given the large blood loss he was having, I opted to just clean it well and start sewing to try to save his life. I would venture to say there are more than 100 stitches in his scalp alone. One I had it all closed up, though, the bleeding seemed to slow down significantly and only remained with a little oozing. As for the gravel, I hope it didn't penetrate the bone completely, because it could set up an abscess and cause infection near his brain on the inside.
As for the remainder of him, I crafted him a new form of a lip and nose on the upper left. It was completely multilated when I first looked at it and I thought there would be no good way to fix it, but after a slow approach, it finally came together and I am proud to say looks semi-decent given how terrible he looked on arrival. He has many other lacerations as well on his face, elbow, and knees that were sutured, and hopefully will heal well. His teeth are also dstroyed. He has several missing, the majority of the rest are displaced, and his palate is more swollen than anything I have seen in a mouth before. He does talk some though.
Given the mechanism of injury, there is still a good chance he may not survive because he could easily have an intracranial injury that could be lethal. When not under the drugs I gave him to do the repairs, he was moving everything well, and seemed to be somewhat consciously aware of what was going on. I placed him on strong antibiotics, steriods for brain swelling, and ordred some labs, so that he may get blood if his blood counts are very low.
Please keep him in your prayers. I can honestly say this is the worst injury I have ever sutured and I could not have done it without the support of Wendy, and a lot of prayer to guide me as I went through the wounds trying to close them. I explained to his family the possible outcomes of death, neurologic impairment, and the slim chance he may be normal, and they seemed to understand, but they are not religious and need prayer for support and strength.
I will update you tomorrow when I have some time in the evening.
Love and prayers,
Steve
Sorry we haven't written in a few days, but we have been quite busy. Hopefully the weekend will give us some more time to update everyone.
As for the title, I am sure your curiosity is piqued. I am on call tonight. Just as I was fininshing my evening rounds at about 8:30 the staff came to get me to see a pateint at check in. I walk around the corner and here is an 18 year old man on a stretcher with an obvious head injury and blood literally everywhere, and on the ground lying is a 20 year old man who looks like he has just been beaten up very badly. On questioning, we found out the two were riding in the back of a truck and either jumped or fell out. the rain returned today, so I am not sure if this had anything to do with it or not. The 20 year old, ended up only have a small laceration to the back of his scalp and to one of his fingers and lots of road burn all over him.
The 18 year old is another story. I have honestly just spent the past 4 hours suturing his head. His scalp was almost completely removed, his lip and lower nose were completely mutilated, he had a large laceration to his temporal area and a few small lacerations on his face. (keep in mind I am just talking about his head now). Wendy, the wife of one of the missionaries, who is also a nurse, happened to be there as well and stayed to help. We sutured for nearly 4 hours, using almost every suture available whether it would have been appropriate or not in the US. He was bleeding profusely from his scalp, literally pulsating blood out onto the table. He also had what looked like a gravel embedded in his skull in the front top part of his head. I tried to get it out, but given the large blood loss he was having, I opted to just clean it well and start sewing to try to save his life. I would venture to say there are more than 100 stitches in his scalp alone. One I had it all closed up, though, the bleeding seemed to slow down significantly and only remained with a little oozing. As for the gravel, I hope it didn't penetrate the bone completely, because it could set up an abscess and cause infection near his brain on the inside.
As for the remainder of him, I crafted him a new form of a lip and nose on the upper left. It was completely multilated when I first looked at it and I thought there would be no good way to fix it, but after a slow approach, it finally came together and I am proud to say looks semi-decent given how terrible he looked on arrival. He has many other lacerations as well on his face, elbow, and knees that were sutured, and hopefully will heal well. His teeth are also dstroyed. He has several missing, the majority of the rest are displaced, and his palate is more swollen than anything I have seen in a mouth before. He does talk some though.
Given the mechanism of injury, there is still a good chance he may not survive because he could easily have an intracranial injury that could be lethal. When not under the drugs I gave him to do the repairs, he was moving everything well, and seemed to be somewhat consciously aware of what was going on. I placed him on strong antibiotics, steriods for brain swelling, and ordred some labs, so that he may get blood if his blood counts are very low.
Please keep him in your prayers. I can honestly say this is the worst injury I have ever sutured and I could not have done it without the support of Wendy, and a lot of prayer to guide me as I went through the wounds trying to close them. I explained to his family the possible outcomes of death, neurologic impairment, and the slim chance he may be normal, and they seemed to understand, but they are not religious and need prayer for support and strength.
I will update you tomorrow when I have some time in the evening.
Love and prayers,
Steve
Tuesday, June 1, 2010
A Well-Balanced Day
Hello Everyone,
As you may have already seen, we posted some more pictures earlier this evening. We have learned how to shrink the file sizes so they will upload with the slower connections here.
We have had a great day today. First, the temperatures are quite a bit cooler today, with a nice breeze, which is a welcome arrival to us all. At the hospital today, we had our normal morning rounds, then several procedures in Theatre, including some debridements of wounds, removal of a foreign body from an eye, lipoma excision, and several surgical cases. I actually learned how to do a D&C today, although I may never have to do one again in my life, I thought what the heck, here is an 18 year old I admitted who had a miscarriage and needs the procedure, and I have the opportunity to learn something new. In the OR, there were several cases. One was of a young man in his 20's who presented with abdominal problems and we determined to have a perforated small bowel as a result of typhoid infection. We took him to the OR, where we encountered many problems. He coded twice in the OR, requiring multiple doses of epinephrine, atropine, and several fluid boluses. He required chest compressions twice. And remember this procedure is only under spinal anesthesia! So, meanwhile, his oxygen levels drifted down and we had to bag him with a very old device, but had no supplemental oxygen to connect to it, so we were basically just giving him extra breaths with room air, so we probably weren't doing a whole lot to help his oxygen levels. His bowel also looked very ill in the procedure and as a result we had to make an ileostomy rather than sew it back together. With all these things taken into account, there is a very low likelihood he will survive, but as of this time he is still alive. Keep him in your prayers, because we are sort of at a watch and wait period as we are using every resource available which will likely not be enough.
In the afternoon, Jeremy, some other volunteers here, and I went to visit an orphanage started by one of the pastors of a local church. They have a total of 18 children, most who are without a mother or father, and few who can't be cared for by their parents. The ages range from 2 or 3 up to 8 years old. Ages here are not well recorded or recalled, so it is always a rough estimate. The orphanage is probably nice for what is available here, but is still quite sad, as you can see in some of the pictures. It is a rented facility, a small compound with 4 rooms in a "house" and 3 little huts connected to it. The children all sleep on carpets they can roll out on the concrete floor. There is 1 window in each room. They have no electricity and no bathroom facilities. Cooking of food takes place outside in the little open area of the place over a wood fire, and the children get 3 meals per day. They are all very sweet children and it just breaks your heart to see them there. In talking to the pastor, he said it is almost impossible for a Ghanaian family to adopt any of the children because of the country-wide poverty here. His hope is for them to be adopted into other countries and loving homes. Currently, a young woman from Germany who has just completed college with training in Special and behavioral education is here working with the children for a few months. Hopefully she will be able to help with some of the behavioral issues they have at the orphanage, and also to help set a good example for the people who routinely care for the children. Please, pray for the safety of these children and that they will find homes. It is truly only by the grace of God that they are even alive at this point in their lives!
After returning home from our visit to the orphanage and town, Jeremy and I took a walk nearby the hospital complex. We were in search of a river that is often mentioned nearby. After a long walk, we found a dry river bed, with a few puddles. It is obvious where water would be due to the lay of the land and the rock bed of the river, but it is very dry now. We had hoped to take some really good photos of the countryside while walking, so I carried my camera tripod, backpack with extra supplies etc, only to realize about 30 minutes into walking that I had left the piece that connects the camera to the tripod lying on my nightstand here. We still got some good photos, but not as many as I had hoped. Unfortunately, I was not able to take any timed photos of the two of us, because I refuse to set my camera down in the sand here for obvious reasons. We posted a few of the better pics, and hopefully on more of our free afternoons we will have the opportunity to get some more good visuals of the country to share with you.
Tonight we had a traditional Ghanaian dinner (our first since arriving at the hospital). It was peanut soup and rice balls. It was very tasty, but man the peanut component was strong, so strong that I could only eat about a half bowl, even as much as I love peanuts! We also were treated with a chocolate cake and ice cream which was great. Otherwise, our food has mostly been North American stuff--hamburgers, hot dogs, spaghetti, lasagna, tacos, vegetable beef soup, many variations of chicken and bread, pot pies, etc. I honestly do not expect to lose much weight on this trip because we are fed so well, and definitely aren't getting as much exercise as we did in South America since we spend a lot of time at the hospital.
It is getting late as I type this, so I think I will stop here for tonight. Keep us in your prayers and please know that we really enjoy your comments and emails. We will post again soon.
Love always,
Steve
As you may have already seen, we posted some more pictures earlier this evening. We have learned how to shrink the file sizes so they will upload with the slower connections here.
We have had a great day today. First, the temperatures are quite a bit cooler today, with a nice breeze, which is a welcome arrival to us all. At the hospital today, we had our normal morning rounds, then several procedures in Theatre, including some debridements of wounds, removal of a foreign body from an eye, lipoma excision, and several surgical cases. I actually learned how to do a D&C today, although I may never have to do one again in my life, I thought what the heck, here is an 18 year old I admitted who had a miscarriage and needs the procedure, and I have the opportunity to learn something new. In the OR, there were several cases. One was of a young man in his 20's who presented with abdominal problems and we determined to have a perforated small bowel as a result of typhoid infection. We took him to the OR, where we encountered many problems. He coded twice in the OR, requiring multiple doses of epinephrine, atropine, and several fluid boluses. He required chest compressions twice. And remember this procedure is only under spinal anesthesia! So, meanwhile, his oxygen levels drifted down and we had to bag him with a very old device, but had no supplemental oxygen to connect to it, so we were basically just giving him extra breaths with room air, so we probably weren't doing a whole lot to help his oxygen levels. His bowel also looked very ill in the procedure and as a result we had to make an ileostomy rather than sew it back together. With all these things taken into account, there is a very low likelihood he will survive, but as of this time he is still alive. Keep him in your prayers, because we are sort of at a watch and wait period as we are using every resource available which will likely not be enough.
In the afternoon, Jeremy, some other volunteers here, and I went to visit an orphanage started by one of the pastors of a local church. They have a total of 18 children, most who are without a mother or father, and few who can't be cared for by their parents. The ages range from 2 or 3 up to 8 years old. Ages here are not well recorded or recalled, so it is always a rough estimate. The orphanage is probably nice for what is available here, but is still quite sad, as you can see in some of the pictures. It is a rented facility, a small compound with 4 rooms in a "house" and 3 little huts connected to it. The children all sleep on carpets they can roll out on the concrete floor. There is 1 window in each room. They have no electricity and no bathroom facilities. Cooking of food takes place outside in the little open area of the place over a wood fire, and the children get 3 meals per day. They are all very sweet children and it just breaks your heart to see them there. In talking to the pastor, he said it is almost impossible for a Ghanaian family to adopt any of the children because of the country-wide poverty here. His hope is for them to be adopted into other countries and loving homes. Currently, a young woman from Germany who has just completed college with training in Special and behavioral education is here working with the children for a few months. Hopefully she will be able to help with some of the behavioral issues they have at the orphanage, and also to help set a good example for the people who routinely care for the children. Please, pray for the safety of these children and that they will find homes. It is truly only by the grace of God that they are even alive at this point in their lives!
After returning home from our visit to the orphanage and town, Jeremy and I took a walk nearby the hospital complex. We were in search of a river that is often mentioned nearby. After a long walk, we found a dry river bed, with a few puddles. It is obvious where water would be due to the lay of the land and the rock bed of the river, but it is very dry now. We had hoped to take some really good photos of the countryside while walking, so I carried my camera tripod, backpack with extra supplies etc, only to realize about 30 minutes into walking that I had left the piece that connects the camera to the tripod lying on my nightstand here. We still got some good photos, but not as many as I had hoped. Unfortunately, I was not able to take any timed photos of the two of us, because I refuse to set my camera down in the sand here for obvious reasons. We posted a few of the better pics, and hopefully on more of our free afternoons we will have the opportunity to get some more good visuals of the country to share with you.
Tonight we had a traditional Ghanaian dinner (our first since arriving at the hospital). It was peanut soup and rice balls. It was very tasty, but man the peanut component was strong, so strong that I could only eat about a half bowl, even as much as I love peanuts! We also were treated with a chocolate cake and ice cream which was great. Otherwise, our food has mostly been North American stuff--hamburgers, hot dogs, spaghetti, lasagna, tacos, vegetable beef soup, many variations of chicken and bread, pot pies, etc. I honestly do not expect to lose much weight on this trip because we are fed so well, and definitely aren't getting as much exercise as we did in South America since we spend a lot of time at the hospital.
It is getting late as I type this, so I think I will stop here for tonight. Keep us in your prayers and please know that we really enjoy your comments and emails. We will post again soon.
Love always,
Steve
A Picture Perfect Day!
Today we visited an orphanage, went into town, and also took a walk nearby the hospital. Here are a few of the pictures.
The Town of Nalerigu. One of the main "streets."
A few kids in town selling charcoal.
Jeremy talks to 3 local boys while we are walking.
Our group at the orphanage. 18 orphans (only 15 pictured), Jeremy, Steve, and the Nyhaus family who are local missionaries here at BMC.
Cooking area at the orphanage. It is all outdoors.
Carpets which serve as beds for each of the orphans. 4 rooms, concrete floor and walls, 1 window in each room. No electricity, no bathroom.
The outside of the orphanage. A typical home structure here with a larger house portion and a few surrounding hut-style rooms.
A dry river bed about 10 minutes away from the hospital. Beautiful landscape.
Gotta take a picture with the sign. It's the American thing to do!
The Town of Nalerigu. One of the main "streets."
A few kids in town selling charcoal.
Jeremy talks to 3 local boys while we are walking.
Our group at the orphanage. 18 orphans (only 15 pictured), Jeremy, Steve, and the Nyhaus family who are local missionaries here at BMC.
Cooking area at the orphanage. It is all outdoors.
Carpets which serve as beds for each of the orphans. 4 rooms, concrete floor and walls, 1 window in each room. No electricity, no bathroom. 
The outside of the orphanage. A typical home structure here with a larger house portion and a few surrounding hut-style rooms.
A dry river bed about 10 minutes away from the hospital. Beautiful landscape.
Gotta take a picture with the sign. It's the American thing to do!
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