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.