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).