Saturday, September 17, 2016

Black cloud

   When I was working in the hospital as a medical student, some of the craziest things would come in on the nights that I was there. It was always very busy on those nights. Later, when I was a resident, it seemed to be even worse. I would always have very busy call nights and rarely get to sleep at all. Tim and I would compare how our nights went, and they were always starkly different. He would be what we termed a ‘white cloud’ with less business, and I would be a ‘black cloud’. I remember pondering this one time during residency, and I decided that God knew that I learned things best by active learning. As I reflect on the mornings that I have worked this last month at BMC, things don’t seem to have changed too much for me.
   I went to the hospital to help out this morning. At first, I thought that I was going to get to watch Tim and Charlie do a C-section and possibly help out with the baby. Well, it was postponed due to another surgery that had already started. So, I went with Tim and another volunteer, Tony, down to isolation to round. There were only two patients to see, so Tim saw one and Tony saw the other. As I stood watching Tim change the dressing on this man’s skin graft on his arm and remove the staples that held the graft on, I wondered why God had brought me there this morning. All I was doing was tagging along like a small child, looking over Tim’s shoulder. I didn’t want to get in the way, nor take any experiences away from the volunteers that were here. There was nothing for me to do.
   I tried to be helpful, so I went to see what needed to be done to prepare for the C-section. They were bringing the patient to the theater (OR) and they were ready for Tim and Charlie. I was discussing a patient with Heidi, our surgeon, when a man came toward theater holding a small lifeless girl in a light blue school uniform with blood on her face. We found the one open procedure room and the man placed the girl on the bed. Heidi rushed to her side to see what was wrong. Then, another man came carrying another small girl in a light blue school uniform with blood on her face. There were no empty rooms to put her in, so we placed her on the gurney in the hall way and wheeled her beside the other girl. What had happened, a car accident?
     One of the men who brought the girl down said that a wall had collapsed at their school. Were these two girls the only girls that were hurt and brought to BMC? Our question was answered as a few more girls were brought down to the theater. After a quick assessment, we determined that the two that were brought down first were the ones needing our attention the most. Heidi began with the first girl. No one knew her name. She was a small girl around 8 years old, unconscious with blood around her mouth and nose. Her lungs sounded like fluid in the airways and her oxygen saturations were dropping. Heidi kept examining the patient trying to determine if the patient needed a hole in her skull to release pressure from bleeding around the brain, as she and Oleta (a surgical nurse volunteer) cleaned her face.
   As Heidi addressed the first patient, I began assessing the second patient. She was also a small girl around 8 years old, lying on the gurney fearful and in pain. She had difficulty speaking, but she was alert, knew who she was, and knew what had happened. She had a deep laceration across the base of her nose that penetrated through her lip to the roots of her upper teeth. She had another smaller laceration that went from the corner of her nose down towards her swollen, bloody red lips in a ‘Z’ like fashion. Her front 8 teeth were missing leaving behind bloody gums. We determined that she possibly had a facial fracture, but she was stable. She would need her wounds to be washed out and repaired, but she would be ok.

         Meanwhile, a man appeared at the door of the procedure room looking for his daughter. When he entered the room, he recognized the unconscious girl as his daughter, Memunatu, and his face froze for a few moments in shock. We escorted him back out into the hall way, assuring him that we would take care of her as best we could. As her breathing worsened, we asked the anesthetist about giving her oxygen or intubating. We moved her to the small OR room to give her oxygen and to monitor her better. Although she laid still on the OR table, we prayed that God would spare her life.  As we watched and continued to examine the little girl, she slowly began to show signs of improvement; her oxygen levels were higher on the oxygen, her lungs sounded better, her pupils began to respond more normally, she began spontaneously moving her arms and legs. Heidi decided against drilling a hole in her skull since she was improving, but she was still unconscious and needed monitoring. A little while later, Heidi noticed that there was some clear fluid also draining for her nose, revealing that she did have a fracture of her skull. After being monitored for several hours, Memunatu remained stable. She was moved to a bed in the wards, where she has been improving slowly. Yesterday evening, she finally woke up enough to tell Heidi that she wanted to lay down. Although she is still in the hospital and is not back to her normal self, she appears to be doing well with exception to now having fevers. We are grateful that God spared the lives of all the girls in that classroom. Please pray for Memunatu as she is recovering. Pray that she and her family will also come to know Jesus. Please pray for the other girls and their families as they heal. 

    Unfortunately, my phone isn't connecting to the computer, which means I can't attach any pictures. Sorry!

Saturday, September 10, 2016

Two hard weeks

     The past two weeks have been pretty hard weeks in the hospital for both of us. Tim had previously admitted a woman who was pregnant with bleeding. He did an ultrasound and saw that she had a placenta previa, the placenta covers the cervix and won’t allow the baby to deliver vaginally. He also saw something unusual and was unsure what it meant. He came home and thought there was a possibility that it was a placenta accreta, where the placenta has actually grown into the wall of the uterus. If this was what he saw, this can be very dangerous for the patient. They continued to monitor her for several days, as her bleeding slowed to occasional streaks on the pads placed underneath her. On Tuesday last week, Tim was on call and rounding in the different wards as usual and I was preparing to come to the hospital, as this was my morning to work at the hospital for the week. Tim received an urgent call from maternity, asking him to come evaluate the patient as she had begun to bleed more rapidly. I arrived at the hospital just after Tim realized that this mother needed to have a Cesarean Section right then. He asked me to come to the OR, so that I could help resuscitate the baby. At this time, the mother was only 29 weeks pregnant. Although she had been able to receive steroids to help the baby’s lungs to develop faster, this baby would likely need as much help as we could give her.  Tim did the C-section rapidly, attempting to get the baby out and stop the bleeding as quickly as possible. He handed the pale bluish, lifeless small baby to me, as he continued to work quickly to save the mother’s life. As I placed the new little girl on the cold hard table, her chest caved in as she tried to gasp for air. There was no sound made and only a slow heartbeat. We quickly dried her off and began CPR, as Tim was working on removing the placenta. As Tim was removing the placenta, he realized that what he had seen on ultrasound was a placenta accreta and this mother was in great danger of bleeding to death. He was able to remove most of the placental tissue in pieces, but the patient continued to bleed a lot. This is the sort of case that only OB/GYN trained doctors do in the US, because it is rare, and dangerous complications are associated.  Tim was considering performing a Cesarean hysterectomy (taking out the uterus after doing a Cesarean section), when a Ghanaian physician poked his head in the OR room. He had previously seen a couple of placenta accreta patients in his housemanship training, where they placed a special balloon to stop the bleeding from the placenta accreta. They gathered together the tools needed and placed the balloon. Meanwhile, a midwife and I continued CPR on the little girl, also giving her epinephrine and an IV fluid bolus. Her chest would occasionally cave in as she tried to gasp for air, and her coloring improved only a little as we continued CPR. After a while, the little girl stopped trying to breathe and eventually we decided that the CPR was futile. This little girl, who was just born into this world, died before she was able to experience being lovingly and warmly held by her mother, who was also fighting for her own life. As Tim and Dr. Yakubu worked to place the balloon in the mother’s uterus, her bleeding began to slow. The doctors finished the operation, were cleaning up and noticed that the balloon had fallen out. They tried to place a new balloon but it would not stay in place. Thankfully, God had slowed the woman’s bleeding to only a slow trickle. We were still nervous that Tim may have to do a hysterectomy over the next day or two, but the bleeding stopped and the mother continued to improve. She was able to return home a few days later, but sadly leaving without her little girl. Tim did see her again in clinic this past week, and she was doing well (had no more bleeding, her blood count was stable, and the ultrasound did not show any retained tissue in the uterus). Praise God for preserving this woman’s life!
     Later that same day, Tim was also called for another C-section. Mother and baby did well. Then, he was called to evaluate a possible ruptured ectopic (pregnancy outside of the uterus). He performed an ultrasound and confirmed that she did indeed have an ectopic pregnancy with lots of blood in the abdomen. The patient ended up having the ectopic where the Fallopian tube connects to the uterus, a rare location. Again, God guided Tim’s steps as he quickly rushed her to the OR to remove the ectopic and give her back some of the blood that she had lost into her abdomen. The patient improved, and several days later, she was able to go home. Tim will follow up with her next week.
      This week also came with its own challenges. Tim was on call on Wednesday and had to perform a C-section in the middle of the night (Thursday morning) for another lady with a bleeding placenta previa. He had only had a few hours of sleep, so he had hoped to finish rounds quickly that morning and return home for a nap. This also happened to be my morning to work at the hospital. I went to maternity to see if I could help Tim round on the patients there. As we were finishing rounds, one of the midwives approached Tim. She was concerned about a patient who had just arrived. The Kakumba woman had been in labor and pushing since daybreak and it was now 10:30am and she had not delivered. Her contractions had stopped and the midwife thought the patient’s stomach felt unusual, like a possible uterine rupture (where the uterus tears open). Tim quickly examined the patient and agreed that it was likely a uterine rupture. He grabbed the ultrasound to confirm and to see if the baby was still alive. Sadly, the baby, that she had carried for 9 months and had been trying to bring into this world, had bled to death inside her abdomen. However, this tired, frightened mother was pale, cold, and internally bleeding. We had to rush her to the OR or she would bleed to death as well. We asked for anyone who could communicate with this woman and finally found someone just before taking her to the OR, and they confirmed that she did not desire another pregnancy (she had 7 children at home). Tim and a volunteer, Charlie, worked hard and were able to stop the bleeding by repairing the badly rent uterus and tied her tubes. She required a couple units of blood during and after the surgery, but currently she is in maternity ward and doing well.
     Even early this morning (despite the fact that Tim’s day off was to begin 1 hour later), Tim was called in to see a pregnant woman. She had delivered her seven previous babies too early, and she had no living children. This pregnancy, she had a cerclage placed (helps an incompetent cervix hold the baby in the uterus) in hopes that she could carry this baby to term. She had gone to a clinic in her town, Bunkpurugu, early this morning in labor. They realized that she still had a cerclage and needed to go to a hospital. They referred her to Tamale Teaching Hospital, but as she passed by Nalerigu she decided to stop at BMC (God’s divine guidance). The midwife called Tim to come quickly, as the patient was bleeding profusely. Because of the cerclage and the patient being in labor, she was at risk of a cervical laceration A cervical laceration can cause severe bleeding, putting the mother at risk of bleeding to death. Tim ran to the hospital, was able to remove the cerclage, and fortunately, there were no cervical lacerations. Because of her poor obstetric history, current bleeding, and history of one previous C-section, Tim took her to the OR for a repeat C-section. Praise God that the baby and mother are doing well after the procedure.

   These are not all the stories from the past two weeks, but a sampling for you to see what is happening here in the hospital and how to be praying. Thank you to those of you who prayerfully support us and the people of northern Ghana!

chicken lesson

   Oh, to the best laid schemes of mice and men. Before returning I had told myself that I needed to be much better about blogging. It is difficult for people to understand and prayerfully support what God is doing, if they don’t know what is going on. Upon return, there were so many things that I wanted to blog about, but we were so busy doing all these things that we had no time left to write about them. Then by week 2, we began the cycle of sicknesses. At least one of us has been sick the majority of the time we have been back. We have gone through flu-like stuff, pneumonia, pink eye (twice for me), and now cold-like stuff. I complained to Tim the other day that I was just tired of being sick and tired.  All of this has kept me from having much time or energy to sit down and write, until now.
bacterial acute conjuntivitis- not pretty, but healing
paramount chief and girls
    I will recap some of what we have done. When we first returned, things were calmer at the hospital than typical (which means that Tim was home more). I don’t remember all the things that we did, but I do remember two things. While we were gone, the brother of the paramount chief (who was a chief of one of the local towns) died. We returned just before the funeral, but we were not able to attend (Tim had to work and it was in a town about 2 hours away). However, we did go to the paramount chief and pay our condolences. We took a gift for him, so Rebekah wanted to bring a gift too. That morning, she picked out and colored a picture in her coloring book of David playing the harp for King Saul to give to the paramount chief. When she presented her gift, the paramount chief responded with a saying in Mampruli talking about a child’s friendship, meaning that they were very close friends now. Rebekah and Abigail spent the rest of our time there running all through his courtyard, chasing his animals (cats, turkey, baby goats). All had to stop what they were doing to watch the girls as they ran after the animals (even the chief’s grandchildren stopped playing to watch them).
girls chasing turkey and everyone watching
Ben in a chicken house
Shea nut fruit
building chicken coop

all three 

 The other thing that I remember was that we were able to go out to town more to visit with people. There is a man in town, Ben, who has asked us several times to come and see his farm. We did not realize the extent of his farming, but some of the volunteers went with us to see his farms. I say farms, because he had a chicken farm, corn field, bean fields, a fish farm…. We enjoyed getting to know Ben better and learning about all different types of farming. We were able to try our first Shea nut fruit. Rebekah also acquired a small white hen, which she named Rebabigail. As a side note, originally we thought about raising chickens while in Ghana. Once here, I decided that the risk of enticing snakes to come around was too much for me and I nixed the idea.  Anyways, Ben gave Rebekah this small chick and she was instantly attached (ex: ‘Daddy, you are not allowed to ever kill my little chicky’ ). Now, we had to make a home for it. Tim spent all his free time the rest of that week building a chicken coop. We really enjoyed Rebabigail, as she would follow us around when we were outside and stand at the door watching us when we were inside. Two weeks later we bought two more young hens, a brown and a black one. Sadly, a few days later, Rebabigail disappeared. The other two are beginning to grow accustomed to us, but they are still afraid. The other day, both of the hens disappeared for several hours. They had never really left the back yard before. I was so sure that they had met the same fate as Rebabigail and almost started to cry. I went so far as to tell God that I really didn’t like the way things worked around here. God then reminded me how much more valuable the people’s lives here were than these chickens’ lives. It was a pretty sobering thought. I had almost cried over chickens, but had I ever cried over the lives of the people here? Sadly, I find myself too often focusing on unimportant things and missing what is truly important. After letting that sink in all afternoon, I watched God bring those two young hens back to their chicken coop that evening.

planting our garden
making friends at grinding mill
last time to pick Bella berries
Rebekah and Rebabigail

Tim with chameleon
in town with store owner Rebekah drinking Alavaro fruit drink
trekking through the jungle at Nakpanduri with volunteers