The Last 36 Hours

The last 36 hours have been quite busy at the hospital (a little more than usual). It was probably a combination of people waiting until after the New Year to come into the hospital and being short staffed (only 2 long-term general doctors-including myself, one general surgeon, one temporary doctor, and 2-3 students). Patients are lying on the floor (due to overflow) in Male, Female, and Maternity Wards.

I was on-call for the hospital starting yesterday morning. In the subsequent 36 hours, I have performed the following (to all the non-medical folk, sorry for the medical jargon!):
- 7 Cesarean sections (placental abruption with Hct of 14% with IUFD at ~30wks- she had a Couvelaire uterus, woman with two previous C-sections in labor, fetal distress, failed induction for woman with severe preeclampsia, and arrest of dilation for the others)
- 1 Manual rotation of a baby from occiput posterior to occiput anterior with successful delivery of healthy baby soon afterwards
- 1 Incision and drainage for large forearm abscess
- 1 D&C for retained placenta fragments after delivery of a non-viable 15 week baby
- 1 Debridement for Fourniere's gangrene (necrotizing fasciitis of the private area)
- 1 Splinting of a lateral humeral epicondyle fracture
- 1 Suturing of knife stab wound to the upper arm

Other cases seen on the ward in the last 36 hours:
- DKA in young boy with Type 1 diabetes
- Status epilepticus in woman with presumed meningitis
- Extremely low birth weight (~0.6kg) neonate born to mother with HIV
- Two cases of necrotizing fasciitis of a leg (from knee to foot)
- Two cases of Ludwig's angina (bad jaw infection from abscessed tooth)- one in a pregnant woman who began having preterm contractions- now stopped
- One case of tib/fib fracture who did local treatment for two weeks before coming to hospital for wound care. Now in long leg cast with windows in the cast for wound care.
- Polycythemia in a neonate born at ~37 wks via normal delivery a copy days ago to a mother who delivered monochorionic monoamniotic twins - both babies now doing well despite their umbilical cords being twisted in a knot before delivery (mother was referred in to our facility because of labor and loss of fluid)
- Bowel obstruction in older gentleman
- Enlarged right atrium and right ventricle in adolescent boy with hypoxia and elbow abscess

Hope you enjoyed the snapshot of a not-so atypical day here at BMC.
God is good :)

Good bye 2018 and hello 2019

     Merry Christmas 2018 and Happy New year 2019! We want to thank all of you who have prayed for us and given to us this year. You have blessed our family so much! We hope that you have all had a wonderful time celebrating the coming of Jesus with friends and family. We have been grateful to see some patients come to know Christ this year and to minister to those around us. Thank you for allowing us this opportunity! I hope to soon post the blog that I have been writing slowly since October with some pictures. 

Unplanned Trip

Once again, we apologize for the prolonged times between our blogs!

A quick recap of our last several months:

-          We finally received Hannah’s birth certificate in April- yay!- so we made a trip to the US Embassy in Accra in May to apply for her US passport (and to renew Lori’s, Rebekah’s, and Abigail’s passports as well)

-          A couple weeks after arriving back in Nalerigu from Accra, we received a call that Lori’s grandmother had fallen ill, and then a day later, that she had died. We then made an impromptu visit to the US to attend her funeral. She was an amazing godly woman who is now worshiping our heavenly Father at His feet! She will be missed by so many who loved her. We will miss our visits and conversations with her. She was so faithful to point others to Christ and to pray for those who God placed in her path, including us every day.
         We had planned on coming home for a visit at the end of 2018, but because of the time and cost of Ghana to US travel, we made this our trip home, staying for a couple months total with family. We did not have access to a consistent car this time, so we were able to enjoy more time with our families and less time traveling on the road. Sorry to those of you we were not able to see this time! God allowed this visit to be rejuvenating and reorienting, preparing us well mentally and spiritually for our return to Ghana.

Also, God worked in amazing ways to make it possible for us to make this trip home! At the time we received the call about Lori’s grandmother, we had none of our passports in our possession. Hannah’s had just arrived at the US Embassy in Accra, and the rest of our passports were at Ghana Immigration awaiting renewal of our resident permits (reportedly going to take at least 2 months, and we had just turned them in a couple weeks prior). In Ghana, it’s all about who you know (as it kind of is in most other countries as well J). Tim called his contact at Immigration in Tamale, told the guy our situation, and asked for help. God used that man to get our resident permits expedited (without bribing!) so that we could pick them up on our way driving from Nalerigu to Accra. We also had a friend in Accra pick up Hannah’s passport from the embassy as we prepared to travel to Accra.

Lori's parents

We were able to spend a little over a month with each family. During our time, we got to celebrate several birthdays, including Lori's brothers', Tim's, Tim's parents', and Hannah's.

Tim's mom's birthday

Tim's dad's birthday

       






     Hannah turned 1 year old while in the US! Since it was our last weekday before returning to Ghana, she had the privilege of getting her one-year vaccinations (plus some extra travel vaccines- a total of 8) that day at our local county health deparment. Happy Birthday Hannah!

 

Rebekah with some cousins,
two of whom had just
helped pull two of her teeth

      Rebekah lost several of her teeth while we were in the US.  She and Abigail also got better at riding bikes and swimming. Rebekah's favorite memory from our time in the US was her opportunity to ride a camel when we visited the zoo. Abigail said her favorite memory was getting to play with all of her cousins!

      

      

Rebekah officially started 1^st grade homeschooling curriculum back in July. Abigail is also wanting to do some school, so they are doing it together right now.

       Rebekah and Abigail making slime for   
homeschool

Making ''snowflakes for
homeschooling

                                 

Abigail's first haircut

          Other random outings in US:

Cow Appreciation Day at ChickfilA.
You get a free sandwich if you
dress like a cow!

Visit to the aquarium

The deep thoughts of a baby

 Our two adult hens had more chicks (one had two more, and the other had seven) while we were in Accra. Several of our chickens later died presumably from snake bites while we were gone in the US, but we still have 12 chickens left

We arrived back in Nalerigu about three weeks ago. Tim then spent a week fixing things around the house that were breaking or had  already broken. Thankful to God for protecting him when he almost fell through the roof while patching some holes. Fortunately, some friends had just arrived when he broke through the roof, and these friends had experience with roofing locally. They helped Tim repair the large hole he had made. He then resumed work at the hospital the following week.

shiny new roofing over hole area

Please pray for us for the following:
- Tim and Lori waking up earlier together to have devotions each day before Tim goes off to work
- Rebekah (and Abigail) focusing during school and obeying mama
- Lori is registered for the Ghana Foreign-trained doctor’s exam this fall in hopes to start officially practicing part-time at the hospital soon.
- Wisdom on what changes need to be made to make it possible for both Tim and Lori to work at the hospital and homeschool the children
- God to raise up more prayer warriors to fight battles alongside us

Easter, hatched chickens, and a new church

What’s going on?

First, Happy belated Easter! We hope that you and your families enjoyed celebrating the death and resurrection of Jesus Christ. What love God showed us so long ago (and continues to show us today)! As Easter fell on April Fool’s Day this year, it made me chuckle a little. Jesus played the greatest “trick” of all time – all the Jewish and Roman leaders at that time thought they had killed Jesus and that was the end of His revolution…wrong! Jesus conquered death and rose from the dead – can I get a Hallelujah!! – and His followers were later emboldened (aka His revolution had not ended, but only just begun) by His reappearance and with help from the Holy Spirit (the Helper that Jesus promised to send His disciples as He ascended into heaven).

Well, our lives have been full since the birth of Hannah. A couple of months ago, one of our hens decided to go broody. She was sitting on about 8-10 eggs. Then we realized that our other hen had been sneaking her eggs under our broody hen making a total of 17 eggs before we stopped her. We learned a lot about hens and eggs during the 21 days of incubation. Twice we made the hen move off her eggs so that we could candle them and see what was inside. It was good for us and the girls to see the chick developing. Shortly before hatching began, one egg disappeared (probably eaten by something). Then, little chicks began hatching. After 2 days, the mama hen was tired of sitting and took her 5 hatched chicks out for food and water. After a few hours of her not returning to the eggs, we decided to try a DIY incubator inside. We grabbed a plastic tub, a lamp, a thermometer, and a water bottle sprayer. We decided that if it didn’t work, that it wouldn’t be any different than leaving them outside. The girls were able to see some of the little chicks actually hatch! Nine of the remaining eggs hatched over the next several days (one died trying to hatch just before mama came off the eggs and another egg failed). We tried to add the chicks to the mama, and she accepted all but 3 of them. We kept those three in our “incubator” inside our guestroom bathtub for a while. One had a problem with its leg, so Tim played Physical Therapist for a few days to help it, using some band aids to help straighten the legs. Now, we have moved those three to a small pen (the old chicken coop that Tim built a year and a half ago) outside away from the other chickens, but where they can be seen.  We look forward to possibly having more eggs from these chicks in the future, but our friend tells us that most of our chicks are going to be male. More recently, our other hen went broody and is sitting on about 9 eggs, so we will see how that goes.

Hen with first hatched chick

Our makeshift incubator

Our hen with her 9 accepted chicks

Abigail playing with the 3 other chicks

Rebekah holding Brownie-first chick hatched inside

To coincide with learning about chickens, we have learned a little about their predators as well. The other morning, Lori went out to feed the chickens and let them out. We had a storm blow through that moved the plastic sheet over the small pen. She went to straighten the plastic out and found a baby snake about 1 foot away from her hand as it slid off the side of the cage. If Lori was not very awake before that, she was surely awake then. Of course, she let out a scream and ran to get Tim. He got a shovel and, from up on the steps, cut off its head. We were so grateful that neither of us or any of our chickens were hurt. God protected us and kept its mouth shut.

Tim with dead snake

         Another thing that we have been able to be involved with a little bit, is the building of a new church building. The church we attend is a small church on the pastor’s land. As our church is unable to hold everyone on Sunday mornings now, the church has purchased a new property and has begun building. They have finished building the walls with cement blocks. The next part is to back fill with dirt for the flooring. A couple Sundays ago, in the afternoon, many of the adults in the church gathered to begin this process. It was such a blessing for our family! We were able to work together with Ghanaian brothers and sisters in Christ despite not really being able to speak each other’s language well. The girls even got involved and loved it.
 

Abigail carrying bucket of sand/dirt

Lori filling up bowls with sand/dirt (while backing Hannah!)

Rebekah carrying bowl of sand/dirt

New unfinished church building

    

     For those who support us with your prayers, we would ask you to be praying for a few specific things:

1. Continued safety for us and our chickens from snakes.

2. Continued spiritual growth for our family

3. Prayer for Baptist Medical Centre as it goes through a few staff changes in the next few months. Also, prayer that it would continue to be a place that represents and magnifies Christ well.

4. Prayer for the building of the new church as it is trying to reach a good stopping point before the rainy season begins

Reflecting on God as the Great Physician, Part 2

To continue from my last blog reflecting on God’s goodness and His role as the Great Physician, I will start by talking about a young woman whom I will call AZ. She came in to BMC back in November last year with a history of fevers, cough, and weight loss for the past few months, as well as lumps on her neck. She was very thin and had diffuse neck lymphadenopathy (enlarged lymph nodes) with some of them with open wounds that were draining some pus (a classic appearance of lymphadenitis due to tuberculosis- also known as scrofula). Her sputum was checked for AFB (acid-fast bacilli- to test for tuberculosis), and it came back positive, so we initiated TB treatment. A few days later, I was on-call for the hospital and was called in the middle of the night to come see AZ because she was having extreme difficulty in breathing. She could not lie down and was sitting on a chair next to her bed with her forehead resting on the bed, breathing very fast, lungs were not clear, and her legs were now very swollen. I gave her some diuretics (medicines that cause someone to urinate more in order to get fluid off of the lungs and help with leg swelling), and then I did an ultrasound on her heart later that morning. The ultrasound showed a very large, thick pericardial effusion (fluid around the heart), and her heart was just waving back and forth in the fluid (for medical people- this motion would have caused something called electrical alternans on EKG if we had had that available, and it is a sign of cardiac tamponade- too much pressure on the heart from the fluid surrounding it, and it causes the heart to not pump the blood adequately; it requires emergent drainage of the fluid- a pericardiocentesis). So later that morning, Dr. Haun (another missionary here) and I drained some of the fluid from around her heart- approximately 1 liter of lightly bloody fluid was removed! By the next morning, AZ was walking around the hospital, breathing much better; and by three to four days later, her leg swelling was gone and she was able to lie down to sleep at night. Praise the Lord for such a miraculous recovery! I later had the opportunity to sit down with AZ to pray with her and tell her a story about the ultimate Heart Specialist- Jesus. Please pray that AZ would come to know the peace and comfort that comes with having a relationship with Jesus Christ.

Another woman, whom I will call Bima, came into BMC a few years ago with difficult to control diabetes. She was treated for a while with oral medications to try to control her blood sugar, but eventually she had to be switched to insulin. In our setting here in Northern Ghana, being on insulin is not an easy task for the average person because most people do not have refrigerators to make the insulin last, do not have access to a glucometer for checking their blood sugars, and have no good way of administering the insulin because of not living close to a health facility and feeling nervous about doing it themselves. Bima actually moved from her village to Nalerigu so that she could come to BMC every morning and every evening to have her blood sugar checked and insulin given. Most patients are unable to make this sacrifice. She was very thin, and during one of her admissions for hyperglycemia (high blood sugar), she began spiking some fevers and reported having a cough for the past couple weeks. We tested her for TB and it came back positive. We treated her for pulmonary tuberculosis- aka TB of the lungs- and by the end of her 6 months of treatment, she had gained a significant amount of weight- now up to a normal weight- and had her diabetes under much better control. I still see her fairly often in the hospital coming in to get her morning insulin injection. The drastic change in her appearance from before and after TB treatment reminds me of what Paul says about the change in a person who accepts Christ as their Lord and Savior in 2 Corinthians 5:17 “Therefore, if anyone is in Christ, he is a new creation; the old has gone, the new has come!”

                I am realizing that many of my memorable patients had tuberculosis. This next story also fits that same theme. A few years ago, there was an ill-appearing 7 year-old girl, whom I will call Mary, who came in with a few day history of a swollen right thigh and fever. She was admitted and treated with antibiotics, but her condition was not improving. Her knee was becoming stiff, so we took some fluid out of her knee joint (which ended up being pus) and placed a drain in her knee. A few days later, she also had an abscess in her thigh which we drained. Not long after that, she began having difficulty breathing, so a chest X-ray was done.  It showed that her heart was enlarged and she had a pneumothorax (air inside the chest but outside the lung). I did an ultrasound on her heart to see the cause of the heart enlargement, and it showed a pericardial effusion (fluid around the heart that isn’t supposed to be there) as well as heart failure (the heart was not pumping well). I also placed a chest tube for the pneumothorax. Over the next several days, Mary was placed on several antibiotics to cover almost any bacteria possible, but she continued to spike high fevers and not improve much. She did not have much cough and did not have sputum, so we were unable to test for pulmonary TB. After much thought and prayer, I finally decided to start her on anti-tuberculosis treatment to treat suspected TB pericarditis (infection of the sac around the heart) and TB osteomyelitis (infection of the bone). Oftentimes in children, particularly in our setting where specialized TB tests are not available, a diagnosis of TB (more commonly extrapulmonary-TB outside the lung-in children) is confirmed after the patient responds favorably to empiric TB treatment. After a few weeks of anti-tuberculosis treatment, Mary began to improve dramatically and her fevers disappeared. She had always looked so tired, sick, and unhappy during the first several weeks in the hospital. Now she was a happy, playful little girl with a big smile (along with her mother).

Lastly, I would like to share a story about God’s protection and healing for a group of gunshot victims- this one is not related to tuberculosis. Back in December of last year, I was on-call and doing my night rounds in the hospital when one of the nurses asked me if I had heard about what happened at an area about 2 hours from BMC. I had not heard anything, so we sat down and he showed me some texts and WhatsApp messages that he had received from a friend in that area describing an attack, where several masked men on motos carrying semi-automatic guns opened fire on innocent people in the market. There were 11 casualties, 4 of which had died right away, and the other 7 were supposedly en route to BMC. I called Dr. Haun, the general surgeon, to give her a heads-up, and about 30 minutes to 1 hour later, I received the first phone call from theatre: there were 4 patients with gunshot wounds to the abdomen. Dr. Haun, myself, and a couple of the volunteers went right away to the hospital and started triaging the patients. There were 3 adults and one child; 3 of the 4 victims were eviscerated (intestines were hanging outside the body); two of the patients were in shock and very anemic (low blood count); there was only one anesthetist and one general surgeon. Dr. Haun operated on the patients all throughout the night while I stayed up managing the IV fluids, blood transfusions, and urine output of the other patients that were waiting for surgery, while periodically giving updates to Dr. Haun in the operating room. A few hours after the first 4 patients had arrived, another 3 arrived: one with a femur (or thigh bone) fracture, one with a tibia/fibula (the two bones in the lower leg) fracture, and one with a gunshot wound in the buttock with the bullet lodged in the scrotum. I splinted the first two and put them on traction, then transferred them the next day to see an orthopedic surgeon. The third one recovered without any procedures needed. By God’s grace, all 7 of the gunshot victims that arrived at BMC survived.