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.
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*
*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*
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