Around Town

This is my pal Rebecca in her store.  It is located just down the main road from the hospital.  Rebecca is an excellent cook.  Meals here have to be all made from scratch.  When I lived here I had little time to spend cooking.  Once a month Rebecca would come and cook a few meals for me that I could then freeze into smaller portions.  My favorites  . . . her Ghanaian style chicken enchiladas and lasagna.  She also makes excellent banana muffins!

I love how things change in town, new shops are always opening and changing. If you have an entrepreneurial spirit and are a hard worker you can carve out a good living.  In Ghana, there is a growing middle class, which I would say Rebecca is a part of.  Four years ago she worked mainly as a cook for missionaries families at the hospital (As an American living here you are expected to hire help).  Now, she is an owner of a shop in a prime location.  She has a freezer and fridge in her shop which is a big deal.  Since I was here last year, she now has an oven so she makes fresh bake goods daily. 

In the evening, people go to shops and buy what they might need for their evening meals.  I love the small-town community here.  Her costumers come and usually sit a bit in front of the store visiting, then get their groceries, before heading home.  I have come to enjoy spending my evenings sitting with Rebecca talking outside her store, yelling at kids that are going by misbehaving, and drinking a cold passion fruit Alvero.

Where I am

I have arrived at the Baptist Medical Centre in Nalerigu, Ghana.  This is the same hospital where I lived and worked in 2012-13 and have travelled back to the last few years.  I left Accra early this morning on a 6am flight.  My friend, William Haun, who now lives at the BMC with his wife Heidi and their children travelled North with me.  I am used to making this trip on my own, so it was nice to have a travel companion.  His wife is the current surgeon at the hospital.  She picked us up in Tamale, the biggest city in the North, and then we travelled by car to Nalerigu.   

Ghana is located in West Africa and has a population of about 27 million people.  The capital, Accra, is located along the southern coast.  The official language of Ghana is English, but many still do not speak English and instead only speak their tribal language.  In the village where I work the language is Mampruli.  Ghana is this beautiful and strange combination of old world tradition meets modern development.  The cities are busy growing metropolitans were you can find the latest and greatest, while just outside in the villages people are still living in huts with mud floors. 

Nalerigu is in the Northern Region of the country and is one of the poorest areas.  The Northern Region is mostly undeveloped and is inhabited by people that live in small villages that are connected by a network of small dirt roads and foot paths.  These people make their living farming small plots of land that have been passed down through generations.  Nalerigu is considered a bush village.  It has hard to estimate the population but is probably about 1-2 thousand people.

The Baptist Medical Centre (BMC) is a very well respected mission hospital that was founded in 1958 by a general surgeon, Dr. George Faile.  It is currently a 123 bed hospital that serves the surrounding population of about 600,000 people, as well as people that travel from as far south as Accra and from neighboring countries like Burkina Faso and Mali to the north and Togo and Nigeria to the East.  In a given year about 60,0000 people are seen in the outpatient clinic, 10,000 people are hospitalized, 1,200 major operations are performed and 2,500-3,000 minor procedures are performed!  I am excited to have the opportunity to return again to the BMC.  

After being picked up at the airport, Heidi filled me in on the news of the hospital and also did a checkout of the patients.  She and her family are heading today to Burkina Faso, the country to the North of Ghana, because her son has a passport issue that needs to be worked out.  They do not know when they will be back so I will be holding down the fort.  This week I have a variety of hernias scheduled, a mastectomy for breast cancer is on the books for tomorrow.  A 5 year old boy, had an accident with a gun and shot off his middle and index finger.  She completed the amputation of the middle finger and attempted to save the index finger.  Right now it is not looking like it will survive, so that might have to be amputated this week.  There are a variety of post-operative patients on the wards I will be looking after.  After arriving at the BMC today, I basically threw my bags in a room and headed to the theatre and repaired three hernias!!  I am happy that I don't have much of a problem with jetlag, but I am looking forward to a nice nights sleep tonight! 

In Accra

I have arrived in Accra!  The flight over was long and uncomfortable, so I am happy to be here.  No matter how many times I arrive in country, what always surprises me is the heat that just hits you as soon as you walk off the plane.  We de-board on the tarmac and walk to the terminal which I don't think helps the situation, but pretty much as soon as you are here you start sweating from places that you didn't know could sweat!!

I am staying the night at the Baptist Rest House, it is basically like a hostel for missionaries coming and going from the country.  When I arrived the rest house was pretty quiet and looked like I would be the only guest.  I was a bit disappointed because in the past I have enjoyed meeting other travelers who are involved in projects around the country and in the neighboring Togo and Cote d'Ivoire.  Everyone knows everyone else in the Baptist missionary community.  Since I started coming here on my own through a different organization, I don't know everyone, but constantly hear names and stories.  It is nice when we would have a chance encounters in Accra, to place the face with the name. 

I decided to take nap for a few hours while I was waiting for my friend William to arrive from South Africa.  When I awoke a few hours later, a bit hot and sticky (because I didn't realize that I could run the AC for free here!), I was pleasantly surprised to see that another physician I know from Dallas was hanging out for a few hours prior to his flight out tonight.  We have not seen each other in a few years so it was great to catch up.  After William arrived, we all went down the road for some Chinese food because why wouldn't you want to eat Chinese food in Africa!
  

I am going to have an early night tonight, enjoying the AC in my room and will be picked up at 4:45 am, to head off to the airport for my flight to Tamale.

Ready to Go!!

I am packed and ready to go with 12 hours to spare . . . a record for me!  I have two 50 lbs bags packed tight with medical supplies and a few random gifts for friends in Ghana.  My clothes all fit into the Adidas bag, which is making me slightly nervous that I am leaving something very important behind.  Last year, I forgot to bring a stethoscope, I pretty big faux pa for a doctor and so I have made sure at least that is packed away safe this year.

I am excited to start my journey.  Tomorrow afternoon,  I will fly to DC and then from there to Accra, the capital of Ghana.  I will arrive in Ghana on Sunday morning.  I heard today that the next leg of my travels, a flight in country to a city in the North, Tamale, was cancelled (no explanation why . . . when you travel in Africa you just kinda get used to the fact that scheduled things are sometimes just optional).  So right now, I am not sure if I will be spending Sunday in Accra and heading up there on Monday or possibly catching a flight on another airline.  Being flexible with travel plans has certainly been something I have gotten used to over my years traveling to Ghana!! 

Ghana or Bust

            Well my bags are packed and tonight I leave for Ghana.  I can’t really describe what I am feeling.  I am so excited to be seeing my friends and to be back working at the hospital helping the people of Northern Ghana, but I feel a bit apprehensive at the same time.  I know that so much has changed at the Baptist Medical Centre in the year I have been gone. 

            When I picture my time in Nalerigu, I remember not only the work I did at the hospital, but the missionaries that called the BMC home.  I will never forget the fellowship of the Coram, Hewitt, Welch, and Gibb families and I know they will be missed these next two weeks.  On the same note, I can’t wait to see the Coppola Family and hang out with the two cutest Americans girls in Ghana, Sarah Grace and Elizabeth.   I am also looking forward to spending more time with William, Heidi, and Trey Haun.

Playing games last year with Sarah Grace, Elizabeth, and some local girls.

            I have to admit I am nervous about the medicine.  I have spent the last year engrossed in Western Medicine, starting a practice and gaining confidence in my first year in practice as a surgeon.  I am worried I have forgotten all my tropical medicine.  I know I will be spending some quality time on the plane reviewing the hospital protocols and reminding myself of the presentations of various diseases.       

            I know that next two weeks will be filled with great fellowship, as well great challenges and I am looking forward to finding out what lays ahead and hopefully sharing some of it with you through this blog. 

Bonjour Dakar!

I am spending my last week in Africa with a friend in Dakar, Senegal.  Dakar is the capital of Senegal and is located on the Cap-Vert Peninsula on the Atlantic coast of Africa and has the distinction of being the westernmost city on the African mainland.  Because of its location, Dakar has developed into one of the most important ports in Africa for trans-Atlantic and European trade.  The population is estimated at about 2.45 million people.  Dakar was a French colony so the people speak French as well as local languages, which is making traveling around the city interesting as I try to pull the little French I can remember out of my brain.

The modern feel of the city has surprised both Julia and I.  Dakar is actually a very wealthy city with over 1/3 of the population making more than the average American per year.  This can be seen in cars they drive, the fancy restaurants around the city, and the products that are being sold in the mall and grocery stores.    

Yesterday we arrived at 2am so we slept for part of the day and then went and bought groceries and had a mini tour of the city by a missionary that lives here.  I think I am defiantly experiencing some reverse culture shock, the entire day was very overwhelming.  The city is amazing and although there are still some parts that are clearly Africa, it feels like a western city.  There are actually lanes on the streets and people follow rules driving.  I was absolutely amazed at the things that could be found here in Dakar.  We went to an American import grocery store were both Julia and I were shocked about what you could find.  There was a whole isle of American candy and snack food, not to mention syrup, pancake mixes, Manwich, Olive Garden pasta sauce, American brand juice, etc!  It seemed like the entire day all I kept saying was “Julia!  Look at this; I can’t believe they have this here!”  We ate lunch in a mall food court which looked like any food court in America; I was amazed I was still in Africa.  So much more development, advancement, and wealth than you see in Ghana (even in the capital of Ghana). 

Today we visited the Le Monument de la Renaissance Africaine.  It is a large monument which stands 49 meters high (3 meters taller than the Statue of Liberty) and sits on top of a 100 meter hill so it is easily visible no matter where you are in the city.  It was finished in 2010 at the expense of 27 million US dollars.  There is much criticism of the monument especially surrounding the cost in a country and region of the world that is so economically depressed.  In addition, many objected to the fact that although it is suppose to show African pride and represent the new Africa after independence that it was designed by a Romanian architect and built in North Korea, a communist country with no freedom.  The local imams (Muslim leaders) objected to the statue since it depicted a half naked male and female figure.  Overall the statue is pretty impressive, although not that pretty.  We climbed 189 steps to reach the top of the hill and from there had a nice view of the city.  We then when up a tiny elevator and looked out over the city from the head of the man. 

Julia and I then visited the most western point of Africa and had crepes in a little restaurant where we surprisingly enjoyed free WiFi and a semi-ocean view.   I think that we will plan to visit this site again for dinner some night and watch the sun set over the Atlantic!

On the western most tip of Africa with the Atlantic ocean in the background!

Good-Bye BMC!

It has been over a year since I first arrived in Nalerigu and at the Baptist Medical Centre.  Today as I leave I cannot really describe what I am feeling.  It is bitter sweat . . . I am excited to go home and see my family and eat Chinese food, but I am feeling like I left so much work undone.  I am sad to say good-bye to people I have become so close to over the last year.

As this date has neared, I was starting to get trouble from some of the staff about leaving.  They would ask why I was going home and at first I told them I was going home to get a job and they would look at me funny and tell me I already had a job here at the BMC.  It was hard to explain that I needed a job that could pay my loans, etc.  Then Chief John (our X-ray and lab Tech) told me there were only two reasons people could return to the states.  One: To receive more training that they could then return and utilize at the BMC.  Two: To get married.  After that I have been telling everyone that the reason I was returning to the states was to get married.  That answer was much more satisfying to the Ghanaians and they would answer back, "Oh yes you need to get married and then bring your husband and child back to Nalerigu!"  (The fact that you get married implies that you will quickly have a child after.)

As I reflect back on the good, the bad, and the ugly of my year here in Ghana and drive away from the BMC for the last time for who knows how long I know that I will defiantly miss this place and these people and I am already yearning to come back.  Below are a few of things that I will and will not miss!

Things I WILL NOT miss:

1)  The constant drumming coming from town can drive one a bit nuts, especially at night when you are trying to fall asleep.  It is like living in a drum circle. 

2) Waking up to the Muslim call to prayer at four in the morning is not my favorite thing in the world, especially because I am really not a morning person.  Over the year, I have gotten used to it and usually I can turn over and fall back to sleep.    

3) Everything in Africa comes in seasons and that includes the bugs and other small animals.  Each season brought some new creature that always seemed worse than the last.  Beatles, scorpions, snails, spiky large caterpillars, termites, fire ants, earwigs, snakes, tarantulas, a super large and really fast spider that I have never been quick enough to kill, these giant worms, bush rats, and geckos to name a few have all made my stay here interesting.    

4) I have always been a bit of a tom boy and back home it is rare to see me in a dress or a skirt.  Here I have worn a skirt to work every day because it is culturally inappropriate for a woman to wear pants.  Although, I have come to appreciate wearing skirts a bit more (and will probably wear them more in the future), I cannot wait to get home and put on a pair of slacks for work.

5) Market is an interesting cultural experience, but having to buy your food from there is exhausting. I am so ready to be able to head to a grocery store whenever I want (market is every three days here) and not have to worry about bartering for my food.

6) The lack of entertainment . . . Although we have played some riveting games of Pictionary and Monopoly Deal, there is not much to do here in the Gu.  What I really cannot wait to do is go to a movie theatre. 

7) My twin bed . . . I have not slept in a twin bed since I don’t know when and I am constantly almost falling out at night when I roll over!

8) Feeling disconnected from the world . . . I am a bit of a news junky.  I used turn on the television as soon as I was home to a news station and let it play, in the car I listened to NPR, and at work between cases you would often find me on the internet reading article from some news outlet.  Here it is often days before I get the chance to check the internet for news, I feel like I am always playing catch up on the worlds current events.

9) Burning my trash!  I can’t wait to just be able to leave my trash at my curb to become someone else’s problem!

10) The heat and constant sweat coming from parts of my body that I never knew could sweat!

Things I WILL miss:

1)  Although I do not enjoy being woken up at night for emergencies, I have come to love the walk to and from the hospital at night.  The campus is calm and quiet, and although I know that my attention should be focused on the ground watching for snakes, I find myself always staring up at the sky where there are more stars than I have ever seen before.

2)  I have met some incredible people here that have given up the comforts of a western life to serve the poor of Northern Ghana.  The short term volunteers that have come and gone have all been wonderful to meet and work with at the hospital.  But it is the long term missionaries who over the year I have built relationships with that I will truly miss.  T and Julia Welch, Bart, Jane Anne, and Elizabeth Gibbs, The Coppola Family (Mark, Lynn, Sarah Grace and Elizabeth), The Hewitt Family (Earl, Mona, Emily, Abby, and Benton), and The Coram Family (Michael, Julie, Taylor, and Noah).  

3)  Wearing flip flops to work everyday . . . there is defiantly nothing better than that.  I was thinking the other day how I have actually not worn real shoes for almost whole year.

4) Being outside . . . Even when you are indoors here in Africa the way the windows are made it is very open to the outside.  Basically there is just a screen with some open slabs of glass.  Being here is a lot like how it was in back in college, I walk or ride my bike everywhere and as I go I appreciate the chance to be outside.  At home, I used to spend my whole day in the depths of the hospital and often never saw the sun (especially in the winter) because there are no windows in the operating rooms or ER rooms and patient’s curtains are often pulled tightly shut.  Going to lunch here is not running through a building down to the cafeteria, but a 5 minute walk across the campus, under flowering trees and blue skies.  I go from ward to ward though open air hallways and between operating cases I enjoy sitting in the theatre break room which is just enclosed by screens. 

5)  Rice balls and ground nut stew . . . yummy goodness in a bowl.  I was taught by a Ghanaian friend how to make the dish so I am hoping I will be able to find the proper ingredients in America!

6)  The patients . . . Although at times they can be incredible frustrating, for the most part they are kind and thankful for the care they have received.  They are poor humble people that when it really comes down to it, they are just trying to get by and survive the day.  Their smiles are incredibly large and beautiful (even the toothless ones) and I have enjoyed working with them throughout the year.  Laughing with them, mourning loss with them, and most importantly seeing the sick get well.  The most awesome thing has been to see patients walk into clinic after they had been so sick in the hospital.  There have been some that I truthfully did not think would survive and I just prayed they would not die.  Seeing those people in clinic always reminded me why I was here and why I was called to become a physician in the first place.  

7) The easy pace of life here in the Gu.  Don’t get me wrong, I am incredibly busy at the hospital, but when the work day is done or the weekends are here, the pace of life is slower here.  There is no rushing around to appointments or engagements.   

8) Having a personal watch guard . . .  any time of night when I would come home he would jump up and walk over to make sure I got into my house okay.  It made me feel safe to know that he was around. 

9) The friendly greeting you get from friends and strangers alike.  Along this line I think I will actually miss hearing the children yell at me “Saminga Hello,” because that greeting is always accompanied by excited waving children with great smiles.

Case of the Week: Gunshot wound to the abdomen

A volunteer group has just arrived at the BMC to do hernia surgeries over the next week.  They were asking me about what cases I have been doing over the last year.  One question in particular was about penetrating trauma and I told them that I have been very lucky this year with not having much penetrating trauma.  In a low resource hospital a critical patient with a penetrating trauma can be very hard to manage. 

I told them about the tribal war earlier in the year when I had gotten 9 gunshot wounds (GSW)  in one night, but luckily 6 were extremity wounds, one was a GSW to the chest that only needed a chest tube, one was through and through the 1 cm of fat the patient had on his abdominal wall (a few millimeters the other way he would have been getting surgery), and the final one was a patient that was shot through the face, who I quickly stabilized and sent south to a larger teaching hospital.  Other than that one night the only other penetrating trauma I had seen was bull horns to the abdomen and in those patients although I did surgery to make sure everything was fine, I never found an injury.

About two hours after that conversation, I received a phone call from the physician on call that a young girl had shot herself in the abdomen by accident.  I rushed to the hospital to find Abena in the males ward because when they brought her the nurses had mistaken her for a boy.  She was alert and talking and when I peeked under the large bandage on her abdomen to see the wound my heart sank because the entrance wound was in her upper abdomen right under where her breast bone ends.  Many important  structures live right below that area and I was just praying we would be able to do something to help this little girl. 

Abena on post-operative day six . . . It drives me nuts because
Ghanaians will not smile for a camera and she has a
great smile.  Just before this picture she was smiling and laughing
with me and then I went to snap the photo and she got all serious,
which makes it look like she is sad and not well.

Everything at the BMC seemed to work perfectly that afternoon.  I ran to the lab were they happened to already have a unit of blood in the blood bank that matched Abena.  The anesthesiologist arrived quickly and the staff readied the OR and Abena.  We were able to get started in the OR in less than thirty minutes, which is record time.  One of the visiting surgeons with the hernia team first assisted me in the OR, which in a traumatic case like this is so important to have a good skilled first assistant.

The bullet had passed through Abena’s abdominal wall and blew off a crescent shape wound on the edge of her left lobe of her liver.  It then traveled through and through her stomach leaving about 5 cm defects on each wall.  The bullet tickled the distal end of her pancreas before lodging itself into her spleen.  During surgery I did a quick splenectomy and packed her liver to control bleeding.  I then repaired the holes in her stomach and explored the rest of the abdomen for injuries.  After packing, her liver injury was not bleeding so I left it alone and placed a drain into her abdomen to watch for pancreatic enzymes leaking from her pancreatic injury or bile leaking from her liver.

Abena has done remarkable well and on post-operative day one she was sitting up begging me for food!  I held off feeding her for several days because of the extensive injury to her stomach and the small pancreatic injury.  Today on post-operative day six she is walking, eating, only taking Tylenol for pain, and most likely heading home tomorrow!  This was a great save and a great case to end my year in Ghana! 

Nalerigu Market

Market days in Nalerigu are every three days.  On market days, women travel from the outlying villages to sell their produce.  Depending on the season different things are available in market, but there are always staples that you can buy; onions, tomatoes, cabbage, peppers, dry fish, rice, ginger, bread, beans, yams, and bananas.  Half of the market sells food items when the other half the stalls sell fabric, clothes, and other house hold goods.  There is an area in market to get meat (I always avoided this area, because they just butcher the animals on the tables in front of you.) 

 

I feel like going to market was an ordeal.  You negotiate prices for your food which is always interesting.  I always pay more because I am white so over the last few months I have been able to form a relationship with a Ghanaian women who will go to market for me.  It has been a huge help because often I cannot get to market because I am working at the hospital.  It also gets old because as a white person you are constantly being yelled at to come see stalls.  It is the highlight of Nalerigu’s week, but we all dread going to market, missing the opportunity to just whip into a nice cool grocery store at anytime we would like to pick up whatever we would like!

 

It is extremely hard to describe an African market and I don’t think that pictures really do it justice either.  Going to market is truly stimulation for all of your senses.  Here is a list of adjectives I would use to describe Nalerigu’s market: smelly, loud, no personal space, colorful, sweaty, crowded, busy, tight spaces, dirty, hot . . . I’m sure the list could go on!

Party!

I hosted my first Ghanaian party this evening for the operating staff at the hospital to thank them for their work this past year.  My friend Rebecca helped me to navigate the cultural differences.  One difference is that everyone expects to go home with a present, similar to a goody bag you would get at a kids birthday party.  She helped me to make jollof rice and chicken, which I served for dinner and then we sent everyone home with a goody bag of more rice, chicken, and a drink.  Making jollof rice for plenty of people is a lot of work and Rebecca was cooking all day long in my back yard.  I think in the end the party was a success.  

I have found that the supplies need to host a party here are much different than in America!  There is a large bag of coal on the left, the biggest bag of rice I have ever bought in my life, which goes along with a huge cooking bowl and charcoal cooker. 

Rebecca cooking the chicken

Preparing the soup (broth) that then the rice is added to which makes it Jollof Rice