Ghanaian Optimism

Death of course is always a part of life, but here in Nalerigu at the BMC it just seems more real somehow, more present than back home.  I am not sure why that is completely.  Losing a patient always weighs heavy on your heart and I have lost patients in the US before but somehow here it hurts more.  I think a lot of it has to do with the fact that although I know that I did my best for the patient, I know that it is not the best that the World has to offer.  It is hard to watch people suffer and die when I know if there were better resources available they might live.  The little girl I operated on last week for a Typhoid perforation passed away.  Ultimately from sepsis and respiratory failure, things we would have been able to support her through in the US with medications and a respirator.  When I showed up in the morning her bed was empty, striped clean.  I can’t quite describe the feeling when you walk into the ward and encounter an empty bed.  The mattresses here are black and so in a ward with painted walls, full of colorful cloth and patients strewn all over other beds and on the floors, it is just a glaring black emptiness . . . saying death was here last night.  No matter how many times I have encountered an empty bed, I still hope that for some reason the patient was just moved.  I go to the nursing office to ask, just to hear, “The patient has died.”  Blunt and to the point.  To me sometimes the hospital staff seems caviler about death, but I know they are not and it is because they see so much doing what they do every day.  We have all learned that you have to compartmentalize the death we see because you have to move on because truthfully, there is another sicker patient right around the corner that needs you at your best. 

Life is hard in Ghana, especially in the poorer North of the country.   But what really impresses me is the amazing optimism people here have.  For a pessimistic, like myself, it is truly awe inspiring.  How do they muster such hope and confidence things will get better right around the corner?  The ultimate optimist was my friend Solomon, who unfortunately passed away this winter.  I don’t know how old Solomon was, in fact I don’t think Solomon even knew his age.  When you would ask Solomon a question he did not know the answer to he would just flash his broad smile, giggle and look away.  That is what he did when I once asked him his age.  I think he was most likely in his early to mid-twenties though.  I met Solomon my first week at the BMC in 2012.  Solomon had sickle cell disease and had developed a chronic wound on his right lower leg.  By the time, I met him he had already failed many skin grafts.  The surgeon at the time was handing off patients to me before he left and introduced us.  Solomon would stop by the outpatient clinic almost every week to just say hello and greet me, eventually he hung around the outpatient clinic so much that we put him to work as an unofficial translator.  Every month I would see him as a patient and evaluate his wound.  Since he already had failed so many skin grafts, after talking with the other surgeons that knew Solomon, we all decided we would not offer him any more surgeries.  We all knew what the outcomes of more skin grafts would be and it would just be putting him at risk for operative complications.  Solomon however would not give up hope that one day his wound would heal.  He would come to clinic and beg me to perform another skin graft and he was always sure this next one would work.  He had a way about him . . . he would smile at you and say “Please Doctor!”   Because of that I broke the promise and tried one more time, but of course the skin graft failed.  Over the years his leg had become slightly deformed and he walked with a limp.  He had dropped out of school and did not finish his education, although he spoke very good English.  He didn’t have a job and I frankly don’t know how he fed himself, but he would talk about how when his leg healed he would get married and have a family and work.  He was absolutely sure all of this would happen . . . that right around the corner life would be better.  Last January, Solomon approached me and asked me to amputate his leg.  He said that he was tired of the wound and he thought that maybe it would be better to have an amputation and get a new leg.  I was shocked that he was finally resolved that his wound might not heal.  I could see he had it all planned out in his mind though . . . I would amputate, he would easy peasy get a new prosthesis (very difficult to get in Ghana), then next would come job, education, and family.  I talked with him for a long time about what a life altering decision this would be.  I was extremely worried that because of his sickle cell he would most likely not heal at his amputation site.  He would have lost his leg and his independence, just to have a new wound to manage.  He was positive all would be well.  I wanted him to think about it more and I told him if next year he still wanted the amputation I would do it and then try my hardest to get him set up with a prosthesis.  I never imagined I wouldn’t see him on my return to Nalerigu this year.  No one is sure what exactly happened, but while he was down South in his village it was reported the he had a seizure and died.  He and his smile are most definitely missed around the outpatient clinic. 

On a lighter note, when I think of Solomon, I think of his smile, laugh, generosity, optimism, and when I had the funniest miscommunication of my entire time living in Ghana and I always smile and chuckle a bit.  I think that is the best way to remember someone.  I wrote about our episode of miscommunication in a past blog entitled, “Say What?”  But for easy I have copied and pasted that blog post below.  Hopefully it will make you smile.

Say What?  Posted 10/4/2013

Between the different accents and the “Ghanaian” English that is spoken, miscommunications often occur and they are usually quite funny.  Here are a few examples:





There is a young man, in his early 20’s, I inherited as a patient from another long-term missionary when I moved to Nalerigu.  He has a chronic wound on his leg.  He came to me one day saying that he needed to talk to me . . .

S (in a hushed tone):  Doctor, could you help me count my pennies?

Me:  Why do you need help with that?

S: My mother never helped me.

Me:  S, you know how to count, why don’t you just count them yourself.

S (looking confused): When I was young my pennies was never counted and I would like to count them, could you help me?

Me (looking confused):  I don’t understand, there are no pennies in Ghana.

S (looking more confused):  My pennies, my pennies, when I was a small boy my mother never helped me count my pennies!

Me (looking at S with a quizzical stare): What are you talking about!

S (now yelling a bit and talking slowly): My mother never count my pennies when I was a small boy!

Me (with an enlightened face): Ohhhhh, she never CUT your PENIS?

S: Yes!  She never count my pennies and I would like you to help me count my pennies now.

Me (relieved to be finally getting out of this confusing conversion): Okay, I think we can arrange a date for that.

  

There is a middle aged man, C, who guards our volunteer house during the day.  He tries to speak English, but it is very poor and his accent is horrible.  Every day C was going to one of the long term volunteers, Michael, and telling him that he was angry.  Michael would tell him that he was very sorry for his anger and that they should pray that God would resolve whatever it was in his life so that he could get over his anger.  They would stand on Michael’s front porch and pray that God would take C’s anger away.  This went on for a few weeks time.  One day someone else was at Michael’s house when C stopped by to tell him about his anger.  They prayed, C walked away, and then the guest turned to Michael and asked him why he prayed for him, it seemed a lot easier to just give food to a guy that is coming up and telling you that he is HUNGREY. 





Many of our common phrases are not understood here.  For example my neighbor, T, was talking to one of the drivers who makes the 2.5 hour trip to Tamale about three times a week.  T told him that he makes the trip so often he must know the road very well.  The driver agreed and then T said he knew the road so well he could probably make the trip with his eyes closed.  The driver looked at T with a very serious and concerned face and said, “Oh no, that would be very dangerous.”