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

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.

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

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

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!

just a quick update

I wanted to let you all know that the guy I was telling you about in my last post is doing much better. In fact, I sent him home today to finish his pencillin regimen. He will be coming back to see me on Friday to be sure everythign is still headed in the right direction. I know it is the Lord that healed him and I told him that today. I pray this whole situation will make an impact on his life.
Just in case you were wondering, it is still hot here. I am sweating as I type this and it is not because I am the world's fastest typist.

Talk to you all again soon,
Jeremy

Third post of the Day!

Hi everyone,
I know it seems like overload today, but we have had some free time and the internet is actually working well. You should find a post from Jeremy from earlier today, some pictures (we learned how to use photoshop to make them smaller and upload faster), and now a brief update from me.

I just wanted to write and share some positive news as I think many of my previous posts have had some negative topic to talk about. Today, I write with a smile on my face because I see things are going much better than a week ago.

On rounds this morning in the pediatric ward, I was able to discharge 3 patients, and have 2 or 3 more who may go home tomorrow if all falls into place overnight. It is very encouraging to see the patients healing, and regaining their strength, and also to see the delight of their parents when they are allowed to go home. For the majority of the week I was questioning myself and finding I had to rely on God to help me with treatment because I was definitely dealing with illnesses I have never encountered before. Now, however, I am becoming more comfortable with some of the presentations of various common illnesses here, and feel God is guiding me not only with the care, but with confidence in myself, and again reminding me it is OK to say, "I don't know."

I was also encouraged this evening when one of the nurses came down to talk to me for a while at the guest house. He was having some problems and just wanted someone to talk to and chose to come talk to me. I am glad that I am earning their trust, and hopefully setting a positive example for the staff here. At first I was worried he was upset with something I had done, but actually he was complimenting me with my work over the past week, and also encouraging me to know he and the other nurses would continue to help me learn the system and culture here. The nurses here are very good, and I can give nothing but the highest compliments to them.

I did feel a little ill earlier today, just with some fatigue and some GI discomfort, but after some gatorade and a couple relatively long naps, I feel much better. I believe I was mostly likely a little dehydrated, and getting fluids back on board really was the answer. I would bet we are drinking upwards of 3-4 liters of water every day here just to stay hydrated. As Jeremy mentioned in his post, the temperature is hot and nothing but clear sky with the sun boiling down on us. He is definitely correct regarding our pale skin, I have even been straying away from sunscreen, because we are only in the sun for a few minutes walking back and forth from the house to the hospital. Supposedly the rainy season has started with the 3 small rains thus far, but it will apparently get even more intense over the next few weeks, so who knows how much sun we will even see as we continue on here.

Today, I also started taking pictures with various different camera settings. Hopefully I will be able to continue to learn some of the tricks of my camera and we will get some great photos to post and also a few to have to show when we get home. We have several photos from the hospital, but felt it is probably best not to post most of those here, because some are pretty gut-wrenching.

One last thing, if you get a call from an unknown number, it could be us. We have learned there is a prepaid cell phone here we can use from time to time, so when we are able to purchase cards, we will try to call.

I think that is all I have for now. Take care, and keep us in your prayers. We will post again soon, assuming the internet is our friend!
Love,
Steve

A Few Pictures

Jeremy excising a Giant Lipoma.



















Steve in deep thought.















Steve attempts to remove a rock from a 3 year-old's ear.




















Jeremy tries some pineapple juice.













Typical Ghanaian Lady toting child and load of fruit.


















A traditional home.














Front of BMC. This is a very short line of people waiting.