Merry Christmas

   Merry Christmas! How grateful we are that God sent Jesus so we can know Him! I first want to apologize for not having posted or kept up with prayer requests. Things have been a little busy with our trip to Accra for Tim's test, Abigail's birthday, Thanksgiving, and Christmas. To make things a little more difficult, our internet went out for a couple of weeks. We are alive and doing well- I promise. I hope to be able to sit down soon and write a proper post, but we do have 2 more birthdays within the next two weeks. There has been much to write about and pictures to post, so I hope that I will just sit down and share it. We did have a wonderful Christmas, although we did miss our families. Thank you to many of you who helped to make it so special. It certainly was different than anything we have experienced before, but more on that later.... Again, Merry Christmas!

Life at the Baptist Medical Centre, Part 2

          Practicing medicine here is in some ways more mentally taxing than practicing back home in the US. For example, at our hospital, it is far more common for people to present late in their illnesses, having advanced beyond the point of being able to be treated adequately with the medicines we have. Therefore, many patients die despite any treatment that we give. On the other hand, because there are limited options for treatment, we don't have to worry as much about if we have offered every imaginable possibility for treatment or ordered every diagnostic test that we should have. Additionally, people here, in general, accept death a lot easier than the average person in the US. Oftentimes, the patients do not have the funds to be transferred to a bigger hospital for further management, so we do the best that we can for them. We use what medicines that God has given us here, and we pray a lot for His healing and comfort for these patients. Many of the patients show their appreciation by greeting us with big smiles every morning when we round on them in the hospital.

            A couple months ago, there seemed to be a surge of diagnoses which we could not treat here and had to transfer to one of the government hospitals (usually either Tamale, which is ~3 hour drive away, or less commonly, Kumasi, which is ~9 hour drive away). Just to name a few:

            * Mid-20s man found on ultrasound to have severe bilateral hydronephrosis and hydroureter (enlargement of tract from kidneys to bladder), as well as a bladder mass. He also had left leg swelling. He also had an ultrasound finding of a spider web-like mass taking up the entire central part of his abdomen, which was not distended bowel. I discovered a couple days later that what I was seeing was a somewhat classic appearance of abdominal tuberculosis on ultrasound. This patient had already been transferred, so I guess I'll know for next time!

            * Teenager boy came in with 4 year history of worsening chest pain and shortness of breath. His family had taken him to see many doctors in Burkina Faso (country to the north of Ghana) before coming to BMC, but he wasn't getting any better. On exam, he had an extremely loud murmur. The heart ultrasound showed an enlarged heart, a very thick left ventricular wall (chamber of the heart that pumps blood to the rest of the heart) and a somewhat narrowed tract between the left ventricle and the aorta (the large blood vessel that carries blood from the heart to the rest of the body). I was concerned for HOCM (hypertrophic obstructive cardiomyopathy- basically a large, thickened heart that puts patients, often teenagers, at risk for sudden cardiac death), so I transferred him.

            * Twenty something year old man with anasarca (whole body swelling), very minimal urine output, and resistant to diuretics (medicines used to make the body urinate more so that body swelling can go down). He was transferred for dialysis (machine hooked up to patient to serve like artificial kidneys so that the fluid could be removed).

            * Two patients with intractable vomiting after eating. I performed an EGD on both of them. One had a stomach mass, and the other had an esophageal mass. The man with the stomach mass was able to be transferred to another facility for further workup and possible surgery, but the other man did not have any money, so he chose to go home with palliative care.

            * Teenager who presented with back mass and paraplegia of two weeks duration. The list of diagnoses that I considered while the patient was here included Guillain-Barre syndrome, transverse myelitis, spinal TB (with back mass being a "cold abscess"), and tumor compressing the spinal cord. Unfortunately, the latter was the final diagnosis. We took a biopsy of the mass early in the hospitalization, and the result came back about 3 weeks later showing cancer. He was one of the patients I had grown close to and enjoyed seeing his smiling face every time I entered the isolation ward. It was difficult to have the discussion with the patient concerning his diagnosis and the need to be transferred, but God was good and allowed me the opportunity to pray with the patient, which seemed to provide him some comfort.

            * Twenty-something year old with swollen left leg. Ultrasound showed clot in one of his major veins (the iliac vein) coming from his left leg. He had to be transferred because we do not have the blood thinning medicines that are needed to treat this condition.

            It can be a little disappointing though, because, oftentimes, I never hear about how these patients do after being transferred to another hospital. However, I received my first phone call the other day from the sister of the patient with a stomach mass mentioned above, and she said that he had surgery a couple days previously and is now doing better. I also heard an update the other day about the guy that had the blood clot. He had gone to Tamale and was started on blood thinners and was doing much better. Praise God for these updates!

            As you might have guessed from some of the cases I mentioned above, ultrasound is an invaluable tool here, especially since we don't have CT or MRI scans. I ultrasound just about anything, from hearts to livers to kidneys to thyroids to babies in pregnant women to others. I am very grateful for the superb OB/Gyn ultrasound training that I received from my residency and OB fellowship faculty back home. It has served as a great foundation for picking up on performing ultrasound on other structures.

            Pregnant women here go to their local Public Health unit for their routine antenatal care and only come to BMC for problems or for delivery, and they bring a pink card with them that has their fundal height (how big the uterus measures from the pelvic bone), blood pressure, and some other important pregnancy information on it. One of the most exciting cases that I have ultrasounded recently was a pregnant lady whose fundal height at her antenatal visits seemed to be growing much faster than it normally should.  Usually, I will find twins in this type of situation, but this scenario was different. I did my usual scanning of the entire abdomen to check on the five basic things: how many babies, how much fluid, was there a heartbeat, where is the placenta, and what direction is (are) the baby (babies) facing (i.e.- head-first, bottom-first, etc). I saw very quickly that there were two
babies, but then I soon discovered that there was also a third one- TRIPLETS!! This was the first time that I had ever seen triplets on ultrasound, much less been the one to discover them. It was very exciting, and I hope to be present for her delivery in the near future.

            Lastly. I would like to give praise to God for Lynn and I being granted our Ghanaian medical license extensions until the end of the year so that we could continue to legally practice medicine here. We will both be taking an exam next week that, if we pass, should allow us to be able to renew our license for 12 months versus only 3 months, which would make it possible for us to continue to stay and work here. We do not have any idea what will be on the exam (and no one seems to be able to tell us what to study). The entire exam supposedly consists of an English proficiency portion, a problem-solving portion, a written medical exam, and an oral medical exam. Please be praying for us as we take our exams this week in Accra.

           *I must apologize because I do not have any photos directly related to the post above, so I have decided to post two photos from our airplane flight from Tamale to Accra*

 

BMC Celebration

   Three days ago, we had a neat cultural experience, a durbar. Baptist Medical Centre was having a celebration to publicly announce the IMB turning the hospital over to the Ghanaian Baptist Convention. It was supposed to start at 10am, which in African time means 12-12:30ish. As the celebration began, there were drummers and dancers that performed, even one of our very own midwives danced. As the drummers and dancers performed, various important people came: the chief of Gambaga (a nearby town), the District Commissioner, and the Nyiiri with his elders. It was an honor to have them present. The girls became hot, tired and thirsty/hungry, so I left early. I have to admit that I was grateful to attend and glad to leave early as well. The celebration began with prayer and was followed by several speakers (from the GBC, IMB, and the Nyiiri representative). There was more music and dancing. It finally ended around 3:30pm. I was going to post a video of the drumming so you could experience a little of the culture, but our internet will not allow for it. Sorry, pictures will have to suffice.



Rebekah and Lori with dancers and drummers behind



Nyiiri wth some elders
 



IMB giving GBC the hospital

Tim, Rebekah, Abena, and Abigail before ceremony

Vacation in Ghana and back to Nalerigu

   We did get a small vacation after all, thanks to the Coppola family. They were kind and gave us a couple of their vacation days so that we could leisurely make our way fom Accra (on the coast) to Nalerigu (in the northeast). We spent our first day of vacation at the beach. The water was too cold to play in, but we played in the sand and enjoyed the cool breeze. It was nice to fall asleep to the sound of the waves crashing on the shore.

 

 

   The next day we went to Kakum National Park, which is a rain forest in southern Ghana. We walked across the seven canopy bridges and then took a guided tour on one of the trails. We didn't see any large animals (as they move north during the rainy season), but we did see plenty of lizards, butterflies, and ants. It was a beautiful area. As we drove north towards Kumasi, we saw many farms growing palm trees, coconut trees, cocoa trees, banana trees, plantain trees, and orange trees. Tim even stopped at a roadside stand and bought bananas and oranges for us to enjoy.

 

   

  We stayed in Kumasi to visit with a missionary family that we met shortly after arriving in Ghana. They have two boys and Rebekah loved getting to play with them. She still keeps talking about her 2 friends. We were able to go grocery shopping in Kumasi, which was quite a treat. They had American-style peanut butter (the peanut butter here is made of raw peanuts, not roasted peanuts) and Dr. Pepper. We then ventured on to Tamale, where we arrived just after dark. We ate out for dinner, a family date night:) The next morning, Rebekah played with the goats and chickens as we packed up the car. We also did our Tamale grocery shopping, picked up lunch to go, and then headed back to Nalerigu.

 

 

   

 

 

 

 

 

 

 

 

 

 

 

     After being gone for a little while, it was good to be home. When we arrived at home, we were warmly greeted by some of the kids that frequent our house, and they helped us unpack our truck.  We enjoyed a few days with the volunteer team that was here. We also went with them to greet the Nyiiri (the head chief in our region). We have tried to go a few times previously, but Tim's schedule has never permitted it. The girls did very well and enjoyed interacting with his many children. Sadly, the team had to return to the US this past week, and, along with them, the volunteer coordinator and his wife. Peter and Erin had served here as volunteer coordinators at BMC for about a year. We enjoyed getting to know them over these past few busy months. Rebekah is already missing Peter (her bug hunting friend) and Erin, as she keeps asking to go visit them at their house. We are praying for their safe return home and transition to life in the US.

Vacation...Sort of

            So we have been looking forward to having a little over a week off for vacation for a little while now. A team of American physicians was scheduled to come to BMC this past Sunday for about 2.5 weeks, and we were going to take off that Sunday to go to church and then leave Monday to visit some of the areas within a few hours drive of the hospital. Plans changed a little on Friday night, 2 days before our vacation was supposed to start. I was on call for the hospital and was asked to see a new patient that was sick and had been admitted to the male ward. I won't go into full details, but the patient ended up dying from lung problems and bleeding problems. We were able to obtain further information the next morning, and it made us very concerned for possible Ebola. Blood specimens were obtained from the patient and sent to the capital city of Accra for tests. I also had to isolate myself from my family, monitor for symptoms such as headache, and check my temperature several times per day, as well as travel to Accra as soon as possible in case I were to get sick and needed more advanced treatment or evacuation. Therefore, at about 5AM on Sunday morning (the first day of our scheduled vacation), I left for Accra in our truck, along with a medical student that was with me when I saw the patient.  We had to keep ourselves isolated from others until all of the labs had come back okay. We were officially released from isolation yesterday after all of the tests for viral hemorrhagic fever came back negative.

            Fortunately, Lori and the girls had flown down to Accra a few days after I had left Nalerigu and were staying in a different location. We were finally able to see each other and, in essence, start our vacation yesterday. Please pray for us as we try to recuperate from this event and get some rest before we have to drive back to Nalerigu in a couple of days.

           

Life at the Baptist Medical Centre, Part 1

            I feel like I have been going through medical internship all over again, except this time with a lot more surgery. During the month of July, I was on 24-hour call every other day for the maternity ward and on call for the entire hospital every 4th night, on average. In July, the American obstetrician/gynecologist, Lynn, who will be here for another year, was on vacation for a month, and an American family medicine doctor, George, who had worked for 22 years at BMC, was here to cover for her. During his twenty-two year tenure, he had learned all sorts of surgeries and procedures, as well as recognition and treatment of common tropical diseases, so I gleaned as much from him as I could over that month. We have also had an ER doc from Texas and a general surgeon from Ohio come to help out for a few weeks. We were very grateful for their help!



Tim and George

Tim, Rebekah, and Jim

             While Lynn was gone in July, I started morning rounds in maternity ward most days and then went to the isolation ward (where there are patients with chronic wounds, tuberculosis, and other infectious diseases, such as hepatitis, meningitis, and chicken pox). Also, if I had admitted any patients from clinic or seen some on evening rounds while I was on call, especially those who had interesting cases or were sick, I would try to see them as well. Since Lynn has returned, I have been rounding mostly on the male medical ward and isolation ward (and sometimes on the male surgical ward, whenever we don't have a surgeon). I also take call for the maternity ward every other night and a 24 hour call on one of the weekend days.

   The following is a short list of some of the procedures that I have done/assisted on during the past 3 months: Skin grafts, EGDs (camera used to look inside the esophagus, stomach, and first part of the small intestine; looking for ulcers, masses, etc.), hernia repairs, exploratory laparotomies (for suspected ectopic pregnancy, gastric ulcer perforation, abdominal abscess, and typhoid ileal perforation), sequestrectomies (removal of dead bone from patients with chronic infections of their bone), AKA (above the knee amputation), oophorectomy (removal of ovary), wound debridements (cleaning dead tissue from wounds), incision & drainages for acute osteomyelitis (infection of the bone), mastectomy (removal of breast), and a suprapubic catheter placement (for a patient with urinary retention and inability to place a regular urinary catheter). I have also done numerous ultrasounds to help with management of patients (including OB, heart, abdominal, testicular and thyroid), paracenteses (draining fluid from the abdomen of patients that usually have liver disease), thoracenteses (draining of fluid from around the lung), Cesarean sections, tubal ligations, lumbar punctures ("spinal taps"), incision and drainage of skin abscesses, joint aspirations, laceration repairs, ileostomy bag/base changes, and many neonatal resuscitations, among others.


Large abdominal abscess

           



Air under the diaphragm in patient with stomach wall perforation

Necrotizing fasciitis after debridement, just before skin grafting



Chicken pox

Common conditions that I have seen here include the following: Malaria, typhoid fever, pneumonia, malnutrition, meningitis, chronic osteomyelitis, hepatitis B and C, HIV, chronic liver disease, nephrotic syndrome, cancer, snake bites, tuberculosis (pulmonary and extrapulmonary), hypertension, diabetes, congestive heart failure, stroke, gastroenteritis, fractures, chronic wounds, asthma, COPD (i.e.- emphysema), dog bites, peptic ulcer disease and road traffic accidents, among others.

Squamous cell carcinoma over previous burn site (Marjolin's ulcer)





Pulmonary tuberculosis

            There has been some changes in the doctors here over the past several weeks. Two of the previous doctors, the Nigerian ER doc (in ER residency training in Ghana) and the Ghanaian medical officer who is about to start surgery residency, have now left, but they were replaced during the month of August with two new Ghanaian medical officers, one straight out of housemanship, and one about to start surgery residency. These two new docs stayed until the end of August. What remains now are two Ghanaian medical officers straight out of housemanship, Lynn, and me (as far as long-term folks).

            I think that this would be a good time to stop and explain the Ghanaian medical training system (as best as I understand it) and some of the terms that are used, which I may use later. After graduating from secondary school (US equivalent of high school), students apply for medical school, which lasts 7 years. The first 3 years of medical school is similar to a mix of the US equivalent of college and the first and second years of medical school. The 4th and 5th years are similar to our 3rd year of medical school, where they rotate through the major areas (i.e.- surgery, OB/Gyn, Adult Medicine, and Pediatrics) as junior level students. In the 6th and 7th years, they rotate through the same areas as senior level students, where they are given a little more responsibility. These two years have a slight resemblance to our 4th year of medical school. During years 4 to 7, they are working and learning under house officers (explained next). After graduating from medical school, they move on to housemanship (where they are called house officers), which is two years of rotating again through the same 4 areas of medicine. This time, however, they are given primary responsibility of the patients. These years would most closely resemble US medical internship in each of the areas of expertise (or similar to what doctors in the US awhile ago used to do, which was complete one year of training after medical school, and then go practice as a GP, or general practitioner). After they graduate from housemanship, they then become medical officers and are assigned for at least two years to a hospital, often rural, in Ghana. Sometimes they may be the only doctor there and therefore responsible for seeing all types of patients and performing procedures and surgeries. For those who wish to specialize, they must complete at least two years as a medical officer, and then they can apply for residency in their area of interest (equivalent to US medical residency programs, which students in the US go to straight out of medical school). In the US, doctors must graduate from residency before they can practice on their own.

To be continued...

         

Garden

            We have planted a small garden! We thought that we would broaden our selections and try to grow a few things. People have kindly bought us seeds to plant and we're so excited to see if anything will grow. A local man helped us find some composted leaves to add to our sandy soil and till the small plot of land. We have planted sweet corn, okra, cantaloupe, green beans, squash/zucchini, and cucumbers. If nothing else, this has been a fun experiment for Rebekah and me. Hopefully, we will have some food to eat and possibly some to share. Our friend, Abena, did inform us that we could drive to the country above us to get most of the things we are growing in our garden. I don't think that purchasing visas and driving 6 hrs in the car one way with 2 little girls would be worth it right now.

 

As we have been watching things grow ever so slowly, I am reminded of the growth that God has been doing in us. This growth has been slow at times, but more recently rapid and a little painful. Our moving to a new country and finding a new way to live has been gently molding us to rely on God as He takes us out of our comfort zone. Tim has been growing as a physician ever since starting work here. He has learned so much since being here, like how to do skin grafts and improving his ultrasound skills. Tim is having to trust God to reveal to him what is wrong with some of the patients and how to treat them. At times he is having to rely on God to give him the words to say to a patient with a grim diagnosis, especially those who are not Christians. Rebekah has been growing into a good big sister, a pretty good singer, and quite the little helper. She is having to learn that the world does not revolve around her and all her wants, as she now has a little sister that also needs attention. She is also struggling with having fears, and we are working on giving those to God. Abigail is not only growing physically, but she is reaching milestones, becoming more independent (sleeping through the night in her and Rebekah's room), and has been eating solid foods (pureed baby food). Tim and I are both growing as parents as we face the 'terrible twos' with temper tantrums and lots of defiance. I have had to learn to make yogurt and baby food, how to care for a garden, and how to trust God with my daily fears. All of our growth comes with a certain amount of pain, but I am grateful for growth, knowing that it is from God (1 Corinthians 3:7).

 

 

  Recently, we have had to watch helplessly from afar as our friend Kent became sick with Ebola and how his family was unable to help him. This reminded us how fragile our life is and that our lives here are but a vapor. Watching Kent and Amber going through this reminded us that God is the Great Physician and He is worthy to be fully trusted.  We have also had to face the reality that Ebola may come to Ghana. We are praying and trusting God to show us what we are to do. It is not to say that we have no concerns, but our faith in our God is growing daily.  I am also having to trust God daily even with letting Rebekah go outside to play. Snakes are not infrequent here on the hospital compound, and Rebekah has no understanding of avoiding them. To make it more concerning for me, Ghana has been out of snake antivenin for almost 2 months. God is teaching me to be careful but to trust Him. He wants this little girl to be able to get out and run around just as much as she and I do, and He will be the One to protect her. Even if Ebola comes to BMC, or someone is bitten by a snake, or some other calamity comes, we have a promise from God onto which we can hold. Romans 8:28 says that "God causes all things to work together for good to those who love God who are called according to His purpose." When I am willing to look to Him, I am constantly reminded of how much God loves us. I was reminded just last night of God's immeasurable love for us and his ability to do anything (Ephesians 3:18-20). I pray that we are able to do just as Abraham did and "not waiver in unbelief, but grew strong in faith, giving glory to God and being fully assured that what He had promised, He was also able to perform" (Romans 4:20-21).

Kent

   For any of you who have not heard or are not praying for him, Kent Brantly is the American doctor in Liberia who has Ebola. He has been all over the news for several days. What you may not know about him is that he is our dear friend. We met him and his family while in residency at JPS. We not only worked with him, but our families spent time together and watched our children grow up together. Rebekah prayed for them daily for months after they left for Liberia and has begun again. We love this wonderful family and are honored to have had time with them. We are also blessed to be serving with them as post residents with Samaritan's Purse, even if we are 2 countries away. I remember how excited they were after speaking with one of the physicians going to Liberia. They began praying and seeking God's will about serving in Liberia. They knew that was where God wanted them. Even after Ebola came to Liberia, they knew God wanted them there. They stayed and worked in Liberia, even knowing the possible cost. Kent and another missionary, Nancy, have contracted the virus. Please be praying for them and their families! Today, Kent has taken a turn for the worse after showing some slight improvement yesterday. God can heal them of this virus. Please continue to be praying for West Africa as well. There are many who have the virus, many more will likely get the virus, many others are affected by the virus (families and friends), and still many more are working to stop the virus (health care workers, educators, volunteers...). This is a terrible disease that is continuing to spread. Please pray for a quick end to this. Thank you!

Food

     Sorry it has been a while. Our internet has been down. We would like to give you insight into what our lives are like here, since many of you will never get to visit us. We will try to write a few posts on different topics to allow you a little glimpse. For any of you who know us, you know that we enjoy food. I have found that food is not only a necessity, but in many countries is a time to commune with family and friends. While in Ghana, we have enjoyed a few meals with others (mostly at the guest house in Nalerigu). We have enjoyed going to the markets and eating some of the different foods from Ghana. We have seen many differences between Accra, the capital of Ghana, and Nalerigu, the rural town in the northeast where we live. While in Accra, we sampled chicken and rice (very common here), Red Red (black-eyed peas with a tomato-based stew) and a spicy hot dog pasta dish. While in Nalerigu, we have had ground nut (peanut) soup with fufu (balls of mashed cassava) as well as a different version of Red Red served with fried plantains. We have seen rice balls, banku, tezet .... I have even managed to make Red Red and ground nut soup that was similar to the one we had made by a Ghanaian.

    The markets in Accra are very similar to a small grocery store in the US. In contrast, Nalerigu has market days every third day. People come from neighboring villages to sell what they have, many of them selling food. Each time we go, it is a new experience. There is a large area in the middle of town filled with small stalls, which are made up of four large sticks plunged into the ground and supporting a roof made of cloth, tarp or tin. Each small stall will have someone selling anything from small plastic bags filled with spices or fresh vegetables from their farm to colorful plastic bowls to ornately designed cloth to garden tools to objects used in common animistic rituals. It is filled with all sorts of smells: bread, oranges, sweat, fish, livestock .... Around 3-4 in the afternoon on weekends, there are crowds of people that you have to push your way through. In the early afternoons, there are few enough people, due to the sweltering heat, that you can have an entourage of children following you shouting suminga (Mampruli for "white person"). As you walk along, you must greet all that you pass with a "dasuba" (good morning) or "neewoontonga"(good afternoon) or you might face a chastisement from those that you missed. Most of the time, you are met by friendly smiles.

We came to the market in the morning on a rainy day. No one was there, due to the rain.

Tim buying fruit with Rebekah

   In general, there is not a lot of variety of foods in Nalerigu in comparison to what I am used to. I find that we have almost anything we could want within reach in the US, and I love having the variety. I think that I will have to get used to a smaller selection of core foods here. The vegetables currently are onions, tomatoes, cabbage, okra, bell peppers, and a small egg plant. For fruits, there are mangoes, coconuts, bananas, limes, oranges, and occasionally apples. There are other 'berries' that we do not have in the US that we have tried as well. They have plenty of spaghetti noodles, peanuts/ground nuts, shea nuts, black eyed peas, and a few grains (millet, whole wheat and rice). During season, they have cashews. I have recently learned that I can buy dried corn in the market and have someone grind it to make corn meal. They have fish (fried or dried fish and canned tuna) and 'the cold store' has chicken legs (with bone and skin- and a few feathers).  There is a butcher in the market, but we have been told that the meat may be old (so try at your own risk). We have found a few spices: salt, curry and ginger. There is a kind missionary who has given me several spices that she acquired in a neighboring country. We have been told that we can get fresh/raw cow's milk from a nomadic people group, the Fulani, but many people use powdered milk. Some day soon we hope to pasteurize and try some of the fresh milk. Baking needs are easily attained, such as flour, sugar, baking powder, baking soda, and eggs.

one of our grocery stores in Nalerigu

   I will give you an idea of what we eat each day. For breakfast, we typically eat Corn Flakes or quick oats and a banana. On Saturdays, we enjoy making waffles and eggs for breakfast. For lunch, we eat a peanut butter and jelly sandwich, fruit (mango or apples), and possibly some yogurt (I make from powdered milk). For dinner, I will cook a meal, which frequently takes most of the day to prepare. On Sunday, we typically eat pizza. The cheese comes from the city and we are creative with our toppings- veggies or mangoes and pineapple or chicken. The rest of the week is a mystery;) It depends on what I have and what sounds good at the time. Our first meal that I made was tuna fish salad, which is humorous to those who know me well. I have also made spaghetti with a marinara sauce, chicken and dumplings, potato soup, chicken korma, chicken tacos/fajitas, baba ganoush, salsa, and hummus. In order to learn new dishes, I made Ghanaian foods like Red Red and ground nut soup. We have enjoyed several quarts of ice cream- vanilla, cinnamon, chocolate, mango and banana, and most recently peanut butter. I do like to be adventurous with food, but it has become my small touch of home most days. It is nice to have something that seems calming and familiar amongst so much that isn't.  Maybe soon, we will even have our own garden that will provide a few more options. In relationship to food, please be praying for the people of Ghana, especially in the area where we live. We live in a farming area and are in great need of rain. We are in the rainy season, and yesterday was the first rain we have had for over 2 weeks. Many of the farmer's crops are dying. This is not only praying for their livelihood, but also this area produces a great amount of food for people in this country. Thank you for your prayers!

Red Red with some okra

Happy Birthday Tim!

 

  So, yesterday was Tim's birthday. It was a day similar to most days, with Tim waking up early to go to work, but with a few surprises. We also woke up early and made him breakfast. Tim was able to come home from work around 2pm for lunch, and he was able to stay home for the rest of the day:) We had a good dinner together, Red Red and watermelon. We were even able to have cake and ice cream, or actually an ice cream cake. I like to make something a little different for birthday cakes, so I attempted my first ice cream cake. We received a package from family with a few birthday gifts for Tim. Since we couldn't find what we wanted to give to Tim for his birthday, it was very nice that Tim had something to open. Hopefully, we can find it when we go to the city this weekend. To top it all of, Tim was on call for OB last night and he never received any calls! Thank you for all your happy birthdays and well wishes. It is wonderful to know that we are thought about and prayed for.

First Week in an African Mission Hospital

            Our prayers were finally answered regarding my Ghanaian medical license. Praise Jesus! I was granted my license last Friday, and I began work at the hospital on Saturday morning. It has been a steep learning curve. I begin my rounds most days in the isolation ward, where there are several patients with chronic wounds, a couple patients being treated for or ruled out for tuberculosis, and a smattering of other patients with infectious diseases. After finishing there, I usually go to either the pediatrics ward (children <5yo) or Ward 5 (mostly older children/adolescents, but occasionally there will be adults if the other adult wards are full). After I have seen those patients, I go to make sure that there are no more patients to be seen in the other wards. I start rounds around 7:30 AM Monday through Friday and 8 AM on Saturday and Sunday. Monday, Wednesday, and Friday are clinic days (where clinic starts around 10 AM), and Tuesday and Thursday are procedure/surgery days.

            There are a total of 8 wards in the hospital: maternity, men's medical, men's surgical, women's medical, women's surgical, Ward 5 (as I described above), pediatrics, and isolation. The hospital administration had just brought two new doctors onto the staff a couple days before I started, one Ghanaian surgeon and one Nigerian ER doctor. They then added another two Ghanaian doctors a couple days ago. There is also one American OB/Gyn that has been here for almost a year. That brings the doctor count to 6 now, which is much better than what I thought that it was going to be, which was 2. It helps out tremendously on morning rounds when we have to see all of the patients in the hospital, which can potentially be around 120 patients when all beds are full. Not all of the beds are full right now, but they are starting to fill up as we enter rainy season and the cases of severe malaria start to increase.

            Just to give you all a sense of what working at the hospital is like, I will share about a few of the cases that I have seen this week. I saw a teenager present to clinic with elevated blood pressure (180s/130s; normal is 120/80), anasarca (whole body swelling), including fluid in the lungs (pulmonary edema) and shortness of breath. We gave her some oxygen and some medicine to decrease the amount of fluid in her body and to help her breath better. Then after some basic workup, including a heart ultrasound and urine analysis (blood tests are very limited here), it appeared that she had a condition called acute glomerulonephritis (essentially injury to the kidneys) in addition to heart failure. I placed her on all of the medicines to help treat these conditions, and she has improved greatly. She is no longer on oxygen, her lungs are clear, her blood pressure has normalized, and her swelling has almost gone completely away. Thank you God for your healing of this woman! Please pray for her continued healing and recovery, as she has some residual right-sided weakness that started before she came to the hospital, probably secondary to her severely elevated blood pressures.

            I have also assisted on a couple C-sections and a bowel perforation (hole in the intestines) from a typhoid infection (a common infection in this area that comes from consuming contaminated water). I have done a few paracenteses (draining fluid from the abdomen of people with liver disease) and lumbar punctures (collecting samples of the fluid around the spinal cord to look for infections like meningitis). Additionally, there was a young man who presented with an abscess of his thigh, but this was no ordinary abscess. It was as big as half of his thigh, and after cutting into it to drain the infection, it appeared that the abscess had actually spread between different layers of his muscles (a condition called pyomyositis).

            Lastly, the most memorable experience of the first week of work at Baptist Medical Centre was getting to be an anesthetist for an emergency surgery. There was a pregnant woman that had come in with a ruptured uterus and had blood in her abdomen, so she needed to go to surgery right away. The Ob/Gyn approached me on rounds that morning and told me that the anesthetist on-call was not available and asked if I could be the anesthetist for the surgery. We agreed to use ketamine (a type of anesthetic) so that the patient did not have to be intubated (tube placed in her windpipe for breathing). Plus, if she were intubated, I was going to have to manage the anesthetic gases, with which I practically have no experience. I read up quickly on ketamine use, prayed, and then went to the operating room. Everyone worked together as a team, the surgery went well, and the patient did well. All glory to God!

            Those are just a few of the cases that I saw this week that I wanted to share. Please continue to pray for the hospital, healing for the patients, wisdom for the doctors and medical assistants, endurance and joy for all workers at the hospital, and that Christ would be glorified through all of the work being done here.

My First African Sermon

            We had planned on checking out a different church this Sunday, one that one of the other missionary families had told us they attended. They had said that it met under a big tree by the TB village. The TB village is associated with the Baptist Medical Centre, and it is where patients and their families stay as they are finishing 6 months of treatment for tuberculosis. It is about a 10-15 minute walk from our house. We tried to contact the missionary family to meet up with them before going, but we were unable to reach them (we found out later that one of them was not feeling well, so they didn't go this morning). So we decided to try and find the church ourselves.

             Even at 9 AM, it was already in the high 80s to low 90s, but God blessed us with occasional breezes to cool us off as we walked. We arrived at the TB village and were not seeing any gathering of people under a tree. We were about to turn around and go back home when one of the people sitting on the front steps of her small house got our attention and said "church?" in her best English. We nodded and said "yes", and she pointed us towards the direction of a big shea tree where a group of people were starting to gather and set up benches. We said the usual good morning greetings ("Dasuba") and sat down to wait for the pastor to arrive. After a good amount of time, it was apparent that the pastor would not be coming. Shortly after that, a young man who spoke good English came up to the group and confirmed that the pastor would not be coming. He then proceeded to ask me if I was going to preach. After some slight hesitation, I agreed.

            The service started out with some singing accompanied by a djembe. The guy leading the singing was someone we knew from the hospital grounds. He seemed to want to incorporate us in the singing, so he sang a song in English that went like this: Alleluia, 1-2-3-4-5, Alleluia. This repeated over and over again, and sometimes he would sing 6-7-8-9-10. After the singing was over, it was time for the sermon. The young man that had come translated into Mampruli for me. It was probably not the most well organized sermon ever since I did not have any time to prepare, but I talked about trusting God and shared the Gospel.

            So from what was almost a failed search for a church this morning, God turned it into an opportunity to trust Him and share about Christ with some of the local people. Alleluia! 1-2-3-4-5!

 

Proverbs 3:5-6 "Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge Him, and He will make straight your paths."

Ghana at Last!

            I would like to start this blog by mentioning several ways that God has blessed us since we have left the US. First, none of our checked bags (we had 9 large bags, 1 car seat in a box, and 1 stroller) were lost, delayed, or damaged on any of our flights (and we unloaded in the country where the missionary conference was, in Accra, and again in Tamale, and there was a total of 3 layovers). Second, we have been charged much less for excess baggage than what we were anticipating. Third, we received abundant help from flight attendants, airport personnel, and perfect strangers as we have traveled with two little children, 3 bookbags, 1 diaper bag, 1 car seat, and 3 duffle bags through airports and on and off airplanes multiple times. Fourth, we found a car (details below). Fifth, a new acquaintance that we met in Accra the first night we arrived offered to drive our large amount of luggage up to Tamale the next morning, which saved us hundreds of dollars of excess baggage fees. Other missionaries on the hospital compound then picked up all of the luggage from Tamale and brought it up to Nalerigu so that it was all there when we arrived. Sixth, our house went under contract 3-4 days before we left the US, and the closing papers were signed a few days ago. Seventh, our passports were stamped by the immigration department in Ghana within 1 week (it usually takes 3-4 months, and we would have been without our passports for that period of time). Eighth, our youngest, Abigail, developed a fever of >102 degrees within a day of arriving in Nalerigu, and we could not figure out a source for it. After much prayer, by us and people back in the States, the fever disappeared without treatment, and she has been well since. Abigail has also started to sit up on her own. These are just a few of the big ways, among many others, that God has blessed us in the past few weeks.

            So we arrived in Ghana during the first part of May, and we spent nearly a week in the capital, Accra. During that time, we met many missionaries at the guesthouse where we were staying. Some were from the US, some from Nigeria, and others were from Ghana. Rebekah also made several new friends during the few days we were there. We also spent a couple of days with the mother of one of our Ghanaian friends from the US, and she showed us around Accra and helped us to meet some of the people involved in health services within Ghana. Since the International Mission Board just recently gave control of the Baptist Medical Centre over to the local Ghana Baptist Convention (GBC), we also met with one of the leaders of the GBC to just say hello and start to form a relationship.

               

                

            We had been told that having a car in Nalerigu, where the Baptist Medical Centre is, is practically essential. Nalerigu has a limited supply of groceries and other miscellaneous items, so the missionaries on the BMC compound make a trip to either Tamale (3 hours away) or Bolgatanga (2 hours away) to stock up on items every 4-6 weeks. Because of that information, we had been communicating with a person in Accra for the past few months regarding purchasing a car. We had mainly looked at SUVs and trucks, but after awhile, we settled on looking only for trucks. The terrain in the Northern Region where we were heading is not very conducive to cars (many dirt roads with large potholes), so a truck would be a perfect vehicle in our situation. The dilemma that we were facing was that the trucks were all outside of our price range. However, God, in His perfect timing, provided a truck one or two days before we arrived in Ghana. It was within our price range, in good shape (except for some minor problems, which were fixed), and had good mileage. I was able to test-drive it when we arrived in Accra, and it drove great. That was actually my first time driving a car in a city in Africa...quite an adventure, but that is another story for another day! The person that helped us find it drove it up to Tamale after he had registered and purchased car insurance for it. I met him there a couple days ago and drove it the rest of the way to Nalerigu. This is only the third car that I have owned, but it is the first car that I have had to purchase (the first one was my dad's old car that I inherited when I turned 16, and the second one belonged to my late grandma, and my uncle gave it to me after my first one was totaled in a crash a few years ago).

                                   

            After spending about a week in Accra, we flew up to Tamale, where someone picked us up at the airport and drove us to Nalerigu. We were assigned to the house where one of the previous long-term missionaries had stayed. The other missionaries on the compound have made our transition much smoother by providing us with some basic foods and supplies as we were unpacking, organizing our house, and getting used to shopping in the local market. Many things were left behind by the missionary family for us, and several of the items have come in very handy. Two items that have been a special treat are a yogurt maker (Lori brought some yogurt starter) and and an ice cream maker that doesn't require ice (we have already made 3 batches).

                                                              

            There is a lot to which we need to become acclimated: the hot weather, the limited local food selection, the unpredictability of the electricity and internet, the daily (and sometimes multiple times a day) encounters with visitors at our front door, the local customs, the common and almost expected use of house help (a local person you pay to help cook, clean, and/or take care of your children) and the more intense preparation of foods that is needed, among many other things. God has been gracious in allowing us to feel more at home each and every day that we are here. Both Rebekah and Abigail are adjusting well to all of the change.

            One final story for this post: we found out the day after we arrived in Ghana that we actually did not have our medical licenses due to unforseen circumstances, so we had to resubmit the application. Unfortunately, it usually takes 6-8 weeks for the license to be granted after submission of the paperwork. Therefore, I am not currently working at the hospital, and there is only one long-term medical doctor (an OB-Gyn) that is running the entire 120-bed hospital. It has been a blessing to get to spend more time with my wife and kids, to get the house a little more organized before I start working long hours, to brush up on tropical diseases, and to just be more flexible with my time. However, I would like to start working soon and start reaching into the lives of the patients I treat, for the glory of God. I know that it will be on God's timing, but please pray that my medical license will be processed quickly (we will be obtaining Lori's medical license later, probably after Abigail is weaned).