Easter

We had a great Easter on campus complete with a honey baked ham, thanks to Megan’s willingness to pack a ham in her luggage and bring it halfway around the world!  The meal was really a special treat to the missionaries here in Nalerigu.  We spent Sunday in Nakpanduri hiking the escarpment and sharing a meal with John and Denise and older missionary couple that have been in Ghana since the 60’s.  I am very proud of myself because I drove the entire 45 minutes to Nakpanduri in a manual truck avoiding rocks, pot holes, motos, trucks, and all of the other road hazards that can be found in Ghana!

 

Hiking at the escarpment with Megan and Julia Welch

Megan hugging a balbo tree

Case of the Week

This man showed up in my clinic.  He was from Togo which is the country to the east of Ghana.  He has these masses only on his face.  No other part of his body is affected.  He said that about fifteen years earlier he had two masses on his forehead removed and then after that all of these other masses have been growing.  There are clearly places that the masses ulcers on them that look like skin cancers, but I have no idea what the underlying process is.  I, unfortunately, had to tell him there was nothing that I could do to help him. 

Trauma Team to the BMC

Yesterday was Ghana’s Independence Day, which meant no outpatient clinic and a day to rest and recuperate.  Or at least that is what I had planned.  It all changed late in the afternoon when a tribal war broke out north of Nalerigu.  These two tribes have been warring since the early 80’s over a little patch of land.  There will be long times of peace and then the tribes will find some reason to start fighting again. 

The gun shots started rolling into the hospital in the late afternoon and kept me there most of the night.  As soon as I would patch up one guy and think I was done, another would roll in the door.  Eight people in all were brought to BMC with gunshot wounds.  The worst was shot right to left through the front of his face, I have never seen an injury like that before.  Everyone was extremely lucky.  Ghanians’ have no fat on their bodies.  Two men had bullets travel through the 1 cm of sub-q fat on their abdomens.  Amazing the bullets did not enter their abdomens.  Another bullet went through and through the skin of a man’s chest, not entering the chest at all.  The rest were extremity injuries, which I just stabilized overnight until I could refer them to the orthopedic hospital a few hours away in the morning. 

To make matters worse a truck load of soldiers that was actually running from the fighting (because they said the fighting was too intense) overturned in a ditch.  Nine soldiers were admitted for injuries from being thrown from the back of the truck.  It was a blessing that none of them were very injured.  I was able to tuck them all into the ward for observation. 

In the end, it will be a Independence Day I will not likely ever forget anytime soon!

Case of the Week

 

Today I removed a cystic hygroma from the neck of a 3 year old girl.  A cystic hygroma is a congenital multiloculated lymphatic lesion that can be found anywhere in the body, most often in found in the posterior triangle of the neck.  These are benign lesions, but can be very disfiguring.  I was able to resect the entire mass, which I was very happy about.  There were some very hairy moments in the case though.  The cystic structures went right down and ran along her jugular vein and carotid artery.  Resecting the mass off these structures was a bit nerve wrecking, but all went well in the end. 

Camping

The girls at the escarpment.  From left to right Front: Taylor
Coram, Elizabeth Gibbs, Emily and Abby Hewitt.  Back: Me
and Julia Welch

The missionary families and I went up to Nakpanduri, about a 45 minutes drive north, to camp on the escarpment.  It went like most camping trips go . . . You are excited to take off and had fun setting up camp.  We all enjoyed hiking the escarpment and had a great evening of fellowship telling stories and playing cards.  Jane Anne Gibbs, Mona Hewitt, Julie Coram organized a great dinner which included the special treat of beef shish kabobs and s’mores.


The teens hanging out

After the excitement of being on a camping trip wears off and you are settling down to sleep the reality of what you are doing sets in.  The tossing and turning trying to sleep on the hard ground makes one wonder why they said yes to the crazy idea of camping in the first place.  (I know the Ghanaians I work with all though I was crazy.  As I told them what I was going to do for the weekend, they looked at me with quizzical stares and I know the thought going through all of their head was why would someone choose to sleep on the ground in the middle of nowhere for fun.  Everyday life for most Ghanaians is like a bad camping trip.) 

 



The sunrise at Nakpanduri

But the next morning as you are driving home sore and exhausted you think about the sunset and sunrise you saw and all of the laughs and jokes you shared with friends and you say that wasn’t so bad, we should do it again sometime.

Our campsite . . . if you look closely at the rocks on the right you will see a few people up at the top.  That is where the teenage girls and Dr. Hewitt slept under the stars.  I happily slept away from snakes and bugs in the tent!

 

The morning after with Julia Welch and Julie Coram











Alvaro is my new favorite drink!  It is a “non-alcoholic natural malt based drink with a refreshing taste of Passion Fruit;” or at least that is what the label says.  It is made here in Ghana by Guinness.  It is hard to come by in the village so I bought a case when I was in Tamale.  It is great on hot afternoons, especially after being in the operating room all day, to come home and have an ice cold Alvaro.  It comes in pineapple, pear, or passion fruit., but I'm partial to the passion fruit. 
 

Venders here are very particular about their bottles because they get money back for the bottles.  So if you buy a coke at one of the street vendors you have to bring the bottle back . . . if you go and try to get another drink and you have not brought the bottle back they remember and will give you a hard time.  So I have bought a case of alvaro bottles and all and I have to return the empty

Case of the Week - Abdominal Mass

A 13 year old boy presented with an abdominal mass in his right abdomen.  The father stated that it had been there for many years and was getting bigger.  On ultrasound it was seen to be a cystic mass with some dense material inside.  I took him to surgery and found an easily resectable cystic mass.  The appendix was closely adhered to the mass so I did an appendectomy.  On exam after the case the appendix did not seem to communicate with the cyst itself and was distinct from the mass.  I sent a piece of the wall for pathology and it just returned a non-distinct inflammatory process.  The boy is healing well and will be going home today.

Ultrasound of mass

Resecting the mass

 The mass with the appendix associated (the S shaped structure on the top of the mass)

New Years at Mole National Park

I spent a few days over the New Year’s holiday at Mole National Park with some of the other long term volunteers at BMC.  It is about a 6 hours drive from Nalerigu and is the largest wildlife sanctuary in Ghana.  We had an incredible time.  We went on three safari tours and saw elephants, monkeys, bushbucks, antelope, and plenty of warthogs.  We always started out riding in the truck, but then we would eventually ended up tromping through the bush tracking the elephants.  Elephants are amazing creatures.  They are massive and I could not believe how close we were to them and they did not seem to really care much.  This was defiantly a New Years I will not forget anytime soon! 

A huge termite mound on the side of the road on the way to Mole Park

Julia and I enjoying the safari

Enjoying a rare Dr. Pepper poolside.

Noah and Taylor Coram with our guide.

 

 

 



The Joys of African Living

I am settling into life here in Nalerigu.  One of the things I needed to get used to is that normal chores take a bit longer and are more tedious here in Africa. 

I am very blessed to have a washing machine, but driers take too much energy and so I hang my clothes out to dry, which I have never had to do before.  I never thought that there was a right or wrong way to hang clothes up, but the first time I hung laundry out, two of my little friends, Thomas and Hamza, told me I was doing it all wrong and they took it all down and re-hung it.  I did not think it looked much different, but they were please that they had taught me how to hang my clothes out.

At home, I was always forgetting to put my trash out on trash day or I would remembered late the night before and convinced myself I was too tired to walk the 100 yards to the garage to put it out for pick-up.  I took it for granted that the trash man would just be coming the next week to whisk my trash away.  In Nalerigu, taking out the trash has whole new meaning.  I not only have to take out my own trash, but I have to dispose of it also by burning it in my trash hole in my back yard.  Hint; the best way to burn trash is by putting it into a cardboard box, the box goes up in flames pretty quick and just incinerates everything inside of it, otherwise you sort of have to move stuff around and try to get all of the pieces of trash to catch fire and it takes forever.  I am constantly on the lookout for used boxes to burn.

Burning trash with Thomas

Food preparation is another thing that just takes a bit longer here.  Here I only drink water from a special water filter, but it does not really run like a normal faucet, so whenever I am home, I turn on the water filter and let it collect in a huge pan, which I then pour into a water cooler.  A few nights ago, I got up in the middle of the night thirsty and just wondered into the kitchen and got a glass and filled it with tap water.  It wasn’t until I pretty much downed the entire glass that I woke up enough to realize what I had just done.  That is defiantly a mistake I will be paying for in a day or two.  Here, you cannot just simply clean vegetables and fruits with soap and water.  It does not kill the bacteria, so I soak everything I will be eating raw in bleach water.  If it is going to be cooked it does not have to be soaked.  Different things need to soak for different amounts of time, but mostly it is about 20 minutes in bleach water and then I rinse them off with the filtered water.  Eggs also have to be soaked in bleach, but before I soak them I get the added pleasure of cleaning off the chicken poop on the eggs.  We basically buy everything straight from the farmers in market. 

 

One of thing I am very grateful for is having someone to clean for me. The windows are different here.  They are made in a way so air can always flow into the houses, but with that air come the dust and the dirt.  You have to clean the floors almost every day.  I could never keep up with that myself so I hired a girl from town, Rachel, who cleans three times a week.  She is a great help.

Case of the Week - Osteosacroma of the femur

This week I amputated the leg of a 16 year old boy named Timothy.  He had a tumor growing at his distal femur for the past several years.  The tumor was quite an impressive size.  Unfortunately here amputation is the only option for cases of malignancy of the bones.  They also usually present very late in their course, sometimes already metastatic.  There is no chemotherapy that can be offered after surgery either.  I am told that most of these kids will eventually succumb to their disease.

The tumor was growing on the bone right above his knee.  His foot is off the picture on the left and the markings on the right on the leg is where I performed the amputation.