Point A to Point B

Our WONDERFUL Ghanian National Fire Service bus that took us from Larabanga to Mole.
View from inside the a tro-tro, by the way, this one isn't full, we picked up another 4-5 people after this shot.
Dancing fireman.

My fantastic sidekick on this trip was my roommate, Christy. If it wasn't for her travel experience, I probably would not have been as open to going on this trip via public transportation. However, she's been to Africa several times, and had already made a trip to another country during my stay on public transport. Therefore, I felt assured we could do it with a little prayer.

We rounded Friday morning, then walked to the bus station. We caught a bus to Walewale, which a nurse from BMC was on. He then insisted he find us a ride to Tamale via tro-tro. We were convinced he would miss his own connection (he was going in the opposite direction), but he kept his word and found us a tro-tro to Tamale. We got to Tamale early enough to do some shopping and enjoy a nice dinner. We took a taxi to our accommodations at the Catholic Guest House, and were surprised when a caretaker from missionaries in Tamale, met us there to ensure we had arrived safely.

We knew there was a bus from Tamale to Larabanga (a town right outside the park) in the am, and in one of those God-planned things, someone at the guest house informed us we needed to go a ticket that night to make the bus in the am. We got one of the last tickets! So we boarded that bus at a nice early 5am the next morning, and took the bumpiest road ever to Larabanga.

Being that Larabanga is right outside a major tourist site in Ghana, they can be rather hostile or in your face about everything. Christy and I quickly escaped these "helpful" people, and thought we would walk the 6km to the park. We take off walking, when we here this loud bus of singing men, a red bus. It literally looked like some scene out a movie.

The singing red bus pulls up and tells us to join them. It's the Ghana National Fire Service! They were training in a town outside of Mole and were going to visit the park for the day. They were excited to be there. They literally danced and sang the entire ride! They were hysterical! We had to stop to pay our entrance fee, and they all filed off to dance some more! They were FANTASTIC!!!! I cannot think of a more perfect way to arrive at the park!

Then we were at the park, in the morning we wanted to fit in the morning safari (especially because the evening safari, we hadn't seen any elephants). But we also knew we were cutting it close because a bus back to Tamale was supposed to arrive in Larabanga around 10, and safari shouldn't finish until like 9:30am. We loved safari, and we saw our elephants up close. We begged out ranger to let us sneak off early to get moving, which he thankful let us do.

We overpaid a man (everything is more expensive in this part of the country since it's such a big tourist thing) to take a moto back to town, then he disappeared for like 10 minutes. Finally he reappears and after an argument with friends, it is determined his bike is too unsafe for 3 of us to ride. By the way, by US standards 3 people is always unsafe, but here, you can easily see 4 people on one moto! So his friend agrees to also use his moto, so it'll be only two people per moto. They drove so crazy! I prayed for my life on this ride, I was certain it wasn't going to end well! They would speed up, then slow down. Christy's guy at some point was chasing down this truck for an unknown reason. It was bad! Something I do not wish to repeat any time soon!

HOWEVER, they got us there with the bus already there, so were were grateful to not miss the bus! I'm just a bit frazzled at the moto bike incident and stress about making or not making the bus. We get on the bus, and the entire Larabanga football team is on there, singing, and dancing preparing for a game with Domongo, a town down the road. They completely melt away all of our stress!!! In fact, they insist we dance with them. Refer back to the note about this being one of the bumpiest roads EVER, but we did it! And in case Christy #2 reads this.....we got them to sing "You are the Most High God"!!!!!!!

To shorten the story, we got back to Tamale, stayed at a missionaries' house overnight. And took two tro-tros back to Nalerigu today! We missed Nalerigu, we had a great trip, but we were happy to return to our little town!

I loved my weekend, but I also learned how much I LOVE Nalerigu! The town is very good to us!

Elephants, Baboons, Crocidiles...Oh My

After much scheming, dreaming, planning, re-planning, praying, packing....this weekend my roommate and I headed to Mole National Park to go on safari! I had been dreaming of this trip since my last trip to Africa when I missed out on safari.

Not only did we go on safari, but we had decided to make it a true adventure (and in our budget) so we took all public transportation to and from the park!

I took:
-bus
-tro-tros (take a van, and put in about 20+ people, add more to the roof, and you have a tro-tro)
-hitchhiked (NOT in the true sense that we were actively seeking a ride, but in the sense that we were walking when we were offered a ride)
-moto (this was scary, very scary, but I'll have to post later about some of my getting to and from adventures)
-taxi
-walked

The Lord was so good to us because public transport in Ghana comes with alot of baggage, and miraculously we ran into relatively few problems. We made every connection we planned out. The Lord went before us in this entire adventure from the most small detail (like someone telling us we needed a bus ticket the night before, and we got one of the LAST tickets) to the big details (seeing those elephants!).

Ghana is not known for it's animals and it lacks many of the big animals (aka lions), but I was just so excited for the opportunity to go and the support from the hospital to let us go. Mole National Park is located 56 km outside of Tamale, down one of the worst roads in Ghana. The park has one motel, which is situated on top of an escarpment (ridge), overlooking two main watering holes in the park. So we could look out our hotel window, and see monkeys, warthogs, etc. We ate breakfast with elephants bathing in the watering hole below!

We actually only spent about 24 hours at the park, but it was well worth the trip! I can't remember the last time I lost sleep because I was so giddy about a trip (I was like a little kid Christmas eve). We went on an evening and morning walking safari, it's one of the few places in the world, where you can go on foot with an armed ranger.

I saw:
-Elephant
-Kob (kind of like a deer)
-Water buck (a really big deer)
-Crocodile
-Green monkey
-Baboon
-Countless pretty birds
-Warthogs
-and more...

If the location of the hotel wasn't cool enough, the hotel had AIR CONDITIONING and a SWIMMING POOL!!!!! I won't let people tell me how hot it is outside because it would depress me. But Elisabeth Faile let it slip the other day that it was 107 IN THE SHADE! So with that in mind, you can imagine how excited we were with air conditioning!

I wish I could express to you just how blessed I feel to have been able to enjoy such a great weekend! I hope through pictures and a few stories, you'll see a glimpse of it.

Faithful Readers

Hello.

I know some of you check my blog often. It's been a busy week, so I haven't had time to post. I apologize. I also wanted to thank you for all the support I have received.

Finally, I just wanted you to know I won't be near a computer again until at least Monday, so you will have to live without a new post till Monday. Hopefully though I'll have good stories when I'm back online!

But meanwhile, no one has gotten the correct answer about what was in the picture from the compound we visited, you have all weekend to guess.

Many blessings!

Damba III

More Damba Photos

Local Medicine

Local medicine happens here, sometimes called witch doctors. Often you can diagnose a sickle cell patient, by merely noting the small cuts on his body from the local treatment. There's a struggle between patients choosing local treatment vs traditional medicine. One barrier to traditional medicine is the cost, our facility tries to contain cost, but at other facilities you must pay before treatment. Then families can put pressure on loved ones to seek local treatment first, even the educated. The full time doctors told a story of a medical assistant choosing local treatment for his daughter's femur fracture over traditional medicine. It's something very different than America.

Tommy had brought us to a compound, where a man was receiving local medicine for his knee on our Sunday trips to the bush. How it worked out, we went to the compound two Sundays in a row, so we saw two different types of "healing." I'll try to post both pictures of the same guy above. In one picture, multiple small cuts have been made all over the knee. In the second, he has cow dung spread over the knee. In fairness to the man, he had been at our facility at some point, but the doctors were not sure if he had tumor or what, he was referred to go to an orthopedist, but then opted for local treatment.

People believe in witches here, in fact you can be accused of being a witch, and exiled to a witch village. I was privileged yesterday to get a motobike tour around one witch village just 10 km from Nalerigu, in a town called Gambaga. (That does mean I finally got on a moto outside of the BMC compound) We would have had to gotten permission from the chief to do anymore than circle the place on moto, so it wasn't much of a tour. I tried to find out how one gets accused of being a witch, but there is no set way. Often the accusation is made after someone gets sick or dies, the matter is taken before the chief, and sometimes the accused just admits to being a witch or is judged to be a witch. It reminds me very much of the Salem witch trials from our own US history.

There are many little signs of superstitions at homes, from crosses on houses to keep ghosts away or sacrifices put outside the home. They will mark trees they think are bewitched, tying cloth around to hold the evil spirits in.

Happy Easter!

I'm late! I was on call on Easter, and just never made it to the schoolhouse to post.

I hope everyone had a very blessed Easter!

Saturday evening, the Christys and myself dyed Easter eggs! They came out surprisingly well for not having the usual little Easter egg dying kits you get in the US. We also made Easter baskets for the missionaries, which was alot of fun! The Failes had us to dinner for Swedish pancakes (Elisabeth is from Sweden, Dr. Faile met Elisabeth when they were both on the mission field in Yemen).

Easter started out with my usual tradition of going to see the sunrise. Ok, we didn't actually make it for the actual sunrise, but only because everyone felt it was a bad idea to walk in the dark up the "mountain" with waifu (snake) around. I'm pretty sure I scared the night gaurd, I think he thinks I was sleep walking. Because I come out of the house at 5:30 am and stare at the sky (it rained the night before), and we determined it was pointless to go if it was too cloudy. He comes running over speaking Mampruli fast, and I cannot understand him or explain that I am merely looking to see if it is cloudy. He had a very concerned face, I'm certain he thought I was sleep walking. I walked back in the house satisfied we could go.

Christy #2 and I did head for the mountain. We enjoyed some quiet time, until we were interrupted by bees, which Christy is allergic too. When I looked out from the top, I just kept thinking this is what the Garden of Gethmane must have looked like. Despite being cut short by bees, it was a very pleasant time.

We made it back to the hospital to round (there are sick people EVERY DAY of the year). I will spare everyone details, but I witnessed a very dramatic death. I've seen people die before, but not quite like this. The patient had been talking and answering my questions not 2-3 minutes before. What was more difficult for me is that I still had about 4 patients to see in the ward, we don't have private rooms like in the US. So I have this family, who just witnessed a very graphic death of their loved one, and now I have turn my back and see the patient in the next bed. That was my downer of Easter.

However, the Lord lifted me up. I had time to quickly change for church (and might I add, I had a second African dress made, which I wore and love). We had heard the Presbyterian Church has a very good choir, so we decided to attend. The church was tiny, like maybe the size of our living room and dining room combined, but it was PACKED! I mean my knees were jammed into the bench beside me, people were everywhere! We were NOT disappointed we came, the choir was AMAZING! The Christys and I often joke about Ghanaian music, because they tend to play very very very loud and off key, but this was not like that. It was the most worshipful beautiful singing! It's a sad comparison, but the closest thing I can relate it to is the African hymns in Lion King on Broadway. Of course, I don't know most of what was actually being sang, but I'm sure it was very reverent! It put me right back in the Easter mood. We are going try to locate some kind of CD of African gospel music.

I was on call, so I spent most of the afternoon at the hospital. However, we had planned a big surprise for one of our patients. Grace is a high schooler, who broke her leg, actually she had a pathologic fracture. What that means is that she didn't just fall and break it, but that some other pathology (in her case infection) had weakened the bone to the point of fracture. There are no orthopedics here, so her option was traction, which she thankfully took. (I owe you a post on traditional medicine/witch doctors, but often patients refuse to have bones treated here, instead opting for local treatment) Grace had been sitting in her bed since before I got here in traction. We got permission from Dr. Faile to move her into one of the operating theaters, which had American plugs. We plugged in my laptop, made popcorn and watched, "The Chronicles of Narnia." She LOVED IT! I actually missed most of the movie due to seeing other patients, but I know she loved it! We had told the nurses if her family came to tell them where we took her, unfortunately that message didn't get passed along. When I got called to see a patient, I found her very frightened mother thinking her daughter was in surgery. We quickly made amends, and showed her mother what kind of "surgery" we were doing! We've been supplying Grace with some books to read too, but she's really taken to the Children's Bible I brought, so I think I'm going to just give it to her. However now that I know Mrs. H reads this, when I get back I will need another copy of that Children's Bible!

Since I missed most of the movie anyways, I hung out with some of the nurses, who were sharing mangoes. They are messy to eat, and I didn't want to eat the skin because I didn't have the proper way to wash it at the nursing station. Needless to say, I made such a complete mess of myself! Whatever, it was fun, and all the nurses had a great laugh watching me.

Compound

According to my guide book in Paga, you can visit Pia's Palace, which is supposed to be a great example of an extended family compound. We drove by, and it looked like a cheesy tourist thing, and decided to skip it. The reason I was originally interested in it was because the architecture of the huts are different near Paga than in Nalerigu.

As I said in my last post, a nurse, Kate, came with us because she is from the area and wanted to see her family. She brought us to her mother's house, which is exactly the style hut I wanted to get a closer look at. Her family was so gracious in giving us free access to tour the compound, the top picture is her mother fooling around with a basket on her head.

What is different with these huts is that they do not use thatched roofs. Instead they have flat mud roofs that they have stairs up to. The roofs are multi-functional, they can then be used as sleeping quarters in hot weather or to dry things out.

The 3rd picture above was taken as I stood on the roof of one hut and overlooks the entire compound. The center of the compound is a pen to hold their cows. The small domed shaped huts are equivalent to what we would call silos. You can see stairs up to another roof if you look in the back right corner. Also in the front left corner, one hut has no roof, but some thatching just laying there, that is used as one of the kitchens.

The 2nd picture was also taken in the house. Who can guess what that is?

We had alot of fun at the compound, thanks to Kate!

Dr. Hewitt also took us to the Bolgatanga market. Bolgatanga is a much larger city than Nalerigu, and rightly their market is much larger. We enjoyed walking through all the alley ways with Dr. Hewitt, who is fluent in the language. We were looking for these baskets that are local to the region, actually the same one on Kate's mother's head. We found them, but unfortunately they only had large baskets that could not be packed in a suitcase. It was fun still. He also earlier in the day took us to a fantastic fabric store. I think the owner enjoyed our visit because we gave them quite a bit of business.

Paga

Today is Good Friday and a holiday here, so Dr. Hewitt graciously agreed to take Christy #1 and #2, and myself to Paga after rounds. We also took along Sister Kate, a nurse who is from a town near Paga.

Paga is a town, right on the Ghanian border with Burkina Faso. Why would someone travel there? To see the sacred crocodiles, of course!

The legend, according to my Bradt's Ghana guide, is that in 1670 an important chief died. His son, Paniogo, lost succession and was forced to flee. He was being chased, and when he got to Tampala, he was blocked by a raging river. He desparately asked a crocodile to help his party across the river, and in return they would never harm a crocodile. The crocodile beat his tale so hard that the water parted, and they were able to cross, but the water rolled back when those in pursuit tried to cross. Does that sound familiar to anyone?

Then years later, the son of Paniogo, Naveh, fell into an aardvark hole, and the entrance collapsed. He was trapped for 2 days, but then a crocodile living in the hole found him and showed him an escape path. He reaffirmed his father's pledge, but when he made it back to his village, he realized they had killed crocodiles. Naveh decided he needed to find a new home, so he went to the crocodile pond, and declared it his new home. He was the first chief of Paga. It is said that no one in town has ever been hurt by a crocodile.

So you pay about $5, which pays for your access to the crocodile ponds, as well as the fowl that will be sacrificed to the crocodile, after you have your photo-op. They told us there are over 200 crocodiles in the pond, and that they go swimming with them. I'm not sure I believe that.

Sorry Dad, I believe you technically told me no crocodiles before I left. But you said it was ok, if you didn't know till AFTER I went. And I still have all my appendages! :-) I'm home safely! Therefore, I don't think I broke any rule.

Damba!!!

About a week ago, we were told that there was going to be a festival in town. We could only get vague details about it. In fact, no one really knew WHEN it was. Some said it pasted already, some said it was Tuesday, some Wednesday, etc. It was yesterday. Dr. Faile kindly pushed us out of clinic so we could attend, and we had no idea what was in store for us.

Welcome to DAMBA!

We headed out for the chief's palace to find a massive crowd gathered. A little Ghanaian kid greets us saying, "Suliminga (foreigner), you are LATE!" We break out laughing, when in Africa is anything late. It's looking like there is no possible way we are going to get close enough to see, when the crowd parts for the white people. Next thing you know, we are in the front row and being led towards the chiefs.

Damba is a celebration where all the tribal chiefs from the northern region come to honor the king of the northern region.

I should mention as soon as we get to the front a old time musket gun shoots in the air about 5 feet in front of us, and I startle like crazy. The gun will continue to go off every few minutes the entire time the king is out, and I continue to jump, which just sets the crowd off to roaring laughter. We meet up with one of the princes, which there are many, being that we learn the king has about 17 wives (I've meant to do a post about polygamy, we'll have to save my thoughts on that for another day), but he is the one who then grants us permission to take photos at will and gives us access to go in the palace, and even attempts to keep the militia people with their muskets far away from me.

The first part of the celebration is the chiefs and important people dancing for the king, who mustn't stay out past sunset. There's drummers EVERYWHERE, and they follow the dancer around. Here when you dance, people pay you. Actually they try to stick coins to your forehead. Oh and to tell who is important, they wear these colorful smocks, which kind of remind me the bajas people used to wear. So swarms of people, guns, and dancing. Eventually though the king is led in procession back to the palace, before the sun sets.

We were invited in the palace, which is like a very large compound of huts. Each wife has her own hut. We head home after this, very happy we went.

BUT we knew it wasn't over, the dancing will continue all night long, Christy #1 and I return around 8 pm, we again get the royal treatment, and end up in chairs sitting with the chiefs! And by God's providence, the swarms of children that are attracted to us, kept us out of reach for the drummers and dancers to come for coins. We stayed for another 2 hours, seeing all the traditional instruments and dancing. It was fun.

We learned that when the sun rises, the king will come back out and bless those who are there. We had to round at the hospital at 7:30am, but Christy #1 and I got back up there around 6am. We unfortunately missed seeing the king, but we did get in more dancing. This time we didn't get pushed to the front, but we were given a bench to stand on.

By the way, two of the times we made it to town, we were picked up by cars! Christy and I found this so funny because almost no one owns a car in Nalerigu. Granted many out of towners came for the festival, but of the maybe two cars in Nalerigu, we got free rides from both!

It was such a fun surprise because we had no idea what to expect! And it is nothing like any festival I've been to in America.

PS For the past 2 hours I have attempted to load a short video clip to no avail, I will have to settle for a picture. I owe you more in the future. I do have nice clips of the dancing and drumming, maybe when I get back to the states I can load it.

Happy St. Patrick's Day

Ok this is a day late!

But we did celebrate St. Patrick's Day here in Ghana! The Ghanaians don't celebrate, but we did. However, I had this patient come in with shamrocks on her dress. I tried to explain to her that it was a holiday where I am from, I think I only confused her, but I told her she was wearing the right outfit for the day.

The top picture is of Bowa and I on his moto! I beg him to ride me to the gate after work daily. Bowa is one of our cooks.

Cleaning up messes

One thing this hospital almost specializes in is cleaning up messes by other hospitals. When a patient visits a government hospital here, to get any kind of care, the patient must pay up front. That is not possible for many patients. They end up staying at the hospital, not getting treated, usually allowing the condition to get worse.

Today, I performed an incision and debridement with Dr. Hewitt on such a patient. She had fallen in a gutter, causing an infection in her leg. She spent the last 5 days at another hospital, receiving no treatment because she could not pay. People have to pay up front here for elective surgery and many procedures, but all emergencies we treat first. And if a patient absolutely could not pay, they do have "special needs" which helps find money for the patient. We were forced to cut open a huge chunk of her leg, basically from mid-thigh down to her ankle. There was necrotic, pussy tissue everywhere. It was nasty!

What you can't see in that picture is that when we opened her up, the pus pockets went all the way up her thigh. The only way to get the infection out here is to open them up, then continue to debride them every few days. You also can't see in the picture how smelly of a process this is.

Then there are cases where we have to clean up accidental messes of another facility. A 3 yo male had a tourniquet placed on his right arm for some procedure, the staff never remembered to take it off. Dr. Faile was forced to amputate the hand. It's a big deal here to not have a right hand, because they eat with their right hands here.

Zippity-do-da

The Hewitts have a zipline at their house. Christy and I checked it out on Saturday.

There are two ways to get on. One is from the ground, you jump up and sit on, then you get pulled to the top. The second is from a tree, Christy tried it. It was a little too high for me.

Two Cute Patients

Some pictures

This little girl got hit by a cow. But I stitched her up, and she's ok now. The funny thing was that I was really hot, and the clean procedure room has AC, so the staff turned on the AC for me. However she FROZE! She was shivering at the end.

I have a need, a need for speed

Dad should not read this! :-P

Everyone rides motos here (motorcycles). And I have wanted to ride one....and last night was the night. It wasn't exactly how I imagined my first moto ride was going to be, but I'll take what I can get.

I was on call last night, and at 3am the doorbell goes off. The nurse says a guy had some kind of accident, and I needed to go the hospital. She hitched a ride on a moto, so she leaves. I get dressed and start walking up. I get to the Failes and realize there is a moto coming my way. The guy came back to pick me up. I quickly explain that I have never been on a moto before, he goes that's ok. I climb on, he shows me where my feet go. Then says we'll drive really slow. He meant it too, I don't think we hit 10 MPH. So I wasn't exactly a speed demon. BUT I think I have convinced each of the cooks that they should take me, so hopefully there will be more moto rides in my future.

By the way, the patient I was going to see had his gun explode. He took off part of 3 of his fingers and had some other lacerations. I sutured up a little, but decided it wasn't the right time to try my first amputation. He wasn't bleeding badly, so we wrapped him up. Then this morning I had assistance to do my first amputations.

Skirt vs Bike

This is Foster standing on a termite hill. These things are all over Ghana. Sometimes they take over whole trees. This has nothing to do with my next story, but I like the picture.
Today Christy #2 and I wanted to quickly go to market on our lunch break. The Failes had generously let us borrow their bikes to speed up the process. We are supposed to wear skirts to go to market. So I change into my skirt, and I'm already thinking can you ride a bike in a skirt? I should have known better.....

I get on the bike with my skirt on to head to the house. I feel like it's going to get caught, but I get there fine. On the way back to the hospital though, the skirt got completely tangled in the chain. So I get off the bike, but I am unable to free up the skirt. I'm yanking on it and it's doing nothing. No one is at the house, so I decide I will just have to try to walk up towards the hospital with the bike attached to my skirt. The pedals wouldn't work with my skirt stuck in there. It was kind of an akward walk, the skirt now caught how it was, didn't leave me alot of room to take steps. Christy Lee sees me from afar, giving me the what's up look? Then she realizes how stuck I am, and breaks out laughing. So she tries to free me, unsuccessfully. Let me add, she wanted me to take my skirt off at some point, she's yanking on it. I'm trying to hold the skirt up, citing immodesty. We are close to the Faile's house, and I suggest, let's just get Dr. Faile. But Christy is like NO, there's some Ghanian boys coming, they can help. I'm mortified, and she's trying to get their attention, she's like it'll be even more funny if they help. Amused they come over to assist the helpless white girl. They FREE me!!! So off I go again, after Christy tucked my skirt under me so it wouldn't get stuck.

Christy #2 and I make it to market, get what we came for, and head home. Of course, my skirt gets stuck again. I really really don't want to repeat the earlier scene, especially being in town. As white people, we attract plenty of attention without having my skirt caught in the bike. I'm imploring Christy #2 to rip the skirt, so she obliges. It wasn't torn badly. We finally make it home, laughing hysterically.

Be warned: Long flowing skirts and bikes do NOT mix!!!!

Praise God from Whom All Blessings Flow

Yesterday was a day of thanksgiving, that just extended into today. I had three answers to prayer, all so small, and yet so large to me. Then when I thought that was pretty cool, it got even better....

First, I had been missing fruit, fresh fruit. It's the dry season here, so we can get fruit but it's not very good. Christy, my roommate, had gone to Burkina Faso over the weekend, and brought me back mangoes and oranges! We've been devouring them!

Then, you know I'm a northern girl, and this heat gets to me. All I ever hear about it how much hotter it will still get. Yesterday I was on my way to market, and I realized there were clouds coming in! What a nice break! Just breaking up the direct sunlight, did so much to lift my spirits!

I came home, and Yisah had taken out REAL butter! Hallelujah! Who knew you could miss butter, but you can. And I didn't even realize I was missing it, until I had a chance at the real thing! It was actually Christy's butter, but she let us use it! YUMMY!!!

I was already really thankful with these three blessings, but the Lord had something even greater in store......those clouds were RAIN CLOUDS! Yes sir, we got a thunder and lightening storm last night complete with rain! The dust went down today, and it was still overcast. The Ghanians are a bit cold, but the northern chick is perfect! I'm guessing it's probably in the mid to high 70's. Very comfortable!

Then we have the final big BIG blessing! I got word today, that one of my best friends, Tamar, delivered a healthy baby boy! Welcome to the world David!!!!!!

Crayola Crayons

I'm not on my computer, so I can't attempt to post pictures. Sorry.

I did an incision and debridement (I&D) the other day on a little girl. The girl screamed bloody murder for the whole thing. We have lidocaine here and ketamine, I don't remember why we didn't use ketamine, but from the sounds of her screams the local was doing nothing. People have a high pain tolerance here, sometimes yell, but this was bad. Dr. Faile held her hand through the whole thing, and I just felt miserable inflicting this pain.

I wanted to give her something, so I broke out a pack of crayons and a coloring book, thinking I just want to ease this kid's pain. Well the gesture was nice and all, except that she didn't know what crayons were. She also spoke a different language, so it basically took half the day to find someone to try to explain what crayons were and that they were hers. I demonstrated for her. I think she got it by the end, because the next day she had colored some of the pictures in the book. I'm not sure she realizes it's a gift for her, I get the feeling she's waiting for me to come back for them.

Christy and I were just talking about how something an American child would find so commonplace is foreign over here. A pen is something an adult is allowed to use, but not for a child's use. There are definitely no mounds of toys piled in a corner of a hut. When you do get a child to draw a picture, it's like a toddler drew it because they haven't had extra paper and pencils and things to just draw.

Lost in Translation

This patient has neurofibromatosis. She needs surgery, but Dr. Faile does not think he can manage the surgery.

We have fantastic translators here, and I would say most of the staff speaks about 5 languages. Still there are many tribes, and people travel hundreds of miles to get to BMC, therefore, often it's still difficult to get the message across.

While at Nakpanduri, we visited an American couple doing tree conservation work. They often send patients to us. One of the folks they sent to us to have a cleft lip repaired. The surgery took place last week. After the surgery and recovery, the patient was supposed to go to the pharmacy and get his medicines and pay for his stay. At some point, he was told to find the white lady in the pharmacy (Jane is a full time missionary in the pharmacy), apparently this was explained to him about 5 times. Well the patient did find the white lady., just the wrong one. He traveled over an hour (by car) to Nakpanduri to this couple. He even brought her his chart! Now she is used to bizarre stuff like this happening. She collected the chart, and had it sent back to BMC. I guess she is the only other white lady he knows, so he did as was directed.

My translator calls my patients for me (and all the other volunteers) since no one can understand us. They call the patient and hand me the card with their medical info including the chief complaint. So I have a guy today, whose chief complaint is "anus itching." Laugh as you may, that isn't that crazy of a complaint here because there are alot of parasites, worms. So my translator is talking with him, I'm asking him basic review of systems. It seems like that is what he is here for. So I tell him I need to peek myself, so he drops his pants, I look. I fill out his card and send him to pharmacy. Right then, another man comes angrily in the room, and him and my translator are going back and forth. It turns out I was NOT seeing the patient whose name was on the card! The patient didn't seem to mind I was looking at his rectum, made no mention of it. SO then I had to repeat the entire process with the CORRECT patient! Here's what made it crazier for me, I never saw the first patient again. For all I know, he wasn't even there to see a doctor, but he had no problem dropping his drawers for me.

Daily I get a patient that prefers to sit on the floor instead of the chair. I can't figure that one out either. Actually today (granted this patient was being admitted), but she decided to just lay on the floor.

Tommy picks up and drops off many people on his way to and from church weekly. His basic rule is that mom's with young children can sit in the cab, and everyone is outside. Why is that the rule? Mainly for practicality, most of the people around here cannot figure out how to open a car door. Tommy says after awhile it's just too cumbersome to always be opening the doors for them. I didn't get it at first, until I watched our mom's get stuck in the truck, every one of them. At least 10-15 times a day in clinic, my translator either has to instruct a patient on opening the door, or just go open it for them.

Patients are not used to stethoscopes at all, so when you ask them to breath, they basically hyperventilate, and you frantically try to listen everywhere before you make them faint.

Isn't there alot we take for granted???

Nakpanduri Escarpement

Yesterday Elisabeth Faile took Christy #2, Cindy, and myself to Nakpanduri. (Christy Lee is my roommate and another 4th year med student, Christy #2 is a 3rd year surgical resident from TN. Both have the same initials, so we just refer to her as # 2)

The Escarpement is a beautiful set of cliffs, with views all the way into Burkina Faso, if it wasn't the Harmatten. It has alot of views that make you think, yes I am in Africa. There are all these great boulders on top, that Christy and I climbed all over.

Elisabeth then drove us down to the river, where I took the picture above, if the pictures could load faster I have a great picture of the road. It would not meet US standards by any means. On the way back up we picked up two guys walking along side the road (this is a very common practice here, in fact you are quite rude to not do it), and they gave Christy and I some tomatoes.

We also learned how Shea Butter is made from a Shea tree. It's quite the process, so be thankful the next time you put on lotion with shea butter.

Christy #2 and I had gone with Tommy to church in the morning, so I now have completed his 3 village Sunday circuit (he is going back to the US this week, so I wanted to enjoy the time I could go with him). Church was great, what wasn't as great is that I had been very good about putting suntan lotion on, until yesterday! I remembered before Nakpanduri, but I already got a little burned from church with Tommy.

Maybe It's Maybeline

So I asked in a post a few days ago (likely over a week ago), what was in the picture? There were some rocks and some spools.

It's mascara or more like eye liner.

Men and women wear it here. I believe they grind up the rocks, and then somehow use the spool to apply it to their eyes.

I tried in the picture above to show you the eye liner, it's not a fantastic picture of that. But it is a great picture of a chew stick, what is hanging out her mouth. Basically, it's the African toothbrush, they use it daily. It can be any stick from what I gathered during my short dentistry career. Dr. Fuller, in his 20+ years, going to villages here, has found the farther from civilization, the better the teeth. Go figure. So the chew sticks must work.

You can see little feet sticking out from behind her. Everyone carries babies this way around here. I keep trying to get a woman to let me borrow her baby and let me carry it like that, but so far it's been lost in translation. They seem amused that I like how she carries her child, and then demonstrates the process, but I don't think they grasp that I want to try. Trust me they let me try everything else, and hand over their babies easily, so it really is just lost in translation so far. It seems to work rather well, until they pee on you. (No diapers in Ghana) You quickly learn to grab some kind of cloth mom has nearby, whenever you pick up a child.

Huts

I did skip over some basics about where I live, so here's one attempt to catch you up. I was asked what people live in here. The answer is most live in huts in a compound. A compound may have 4 or more huts, with walls connecting the huts, and an enclosed courtyard in the middle. As you can see most huts have straw roofs, some have tin. They have these other huts they use to store their food, that are raised off the ground. I've been to some very comfortable looking huts. Although it is changing, for the most part, the extended family can live in one compound.

I do not live in a hut. I live in a very Americanized house on the BMC compound. I have running water, a toilet, a washer and dryer, stove, etc. We have three cooks that feed and take care of us, they are Caleb, Yisah, and Bowa. We are fed well, mainly on American type food. I do miss things like butter (they have their own version, but it's nothing like what we use in the US, in fact you don't have to refrigerate it, it's rather scary looking), milk (they have powdered here), and fruit and veggies. There are tons of fruit and veggies here, but for the most part unless they are cooked, I can't eat them (due to the water being unsafe). What we get that is excellent, Bowa makes the most excellent bread and even more delicious tortillas for tacos. In fact, his tortillas are my all time favorite. And we end up with about 2 cakes a week. Christy, my roommate, says that if the cake does not have icing, we can call it a muffin, and therefore it can be eaten for breakfast! :-)

My house is about a quarter mile from the hospital. We have use of a truck, but I don't get along with the truck, so I avoid it (that could be a whole other posting about me dealing with the truck). Then from our house, it is a short walk to the schoolhouse. It's at the schoolhouse I can get internet, as well as satellite television. There is a path between our house and the schoolhouse, but we are advised to only use it during the daylight hours, at night there could be snakes, so we take the road instead. I nightly encounter some kind of animals, mainly bush rats and lizards.

Nalerigu has electricity, but it often goes out. During some parts of the year, there are continual rolling blackouts. On the compound, it's not an issue, we have backup generators that immediately kick in. Basically, we notice the lights flicker occasionally (ok more like daily), but we always have electricity. We are even more spoiled, because they outfitted our house with American plugs, so although I brought 2 converters, I haven't used them.

The best thing I brought with me was my headlamp. I haven't figured out why, but it is DARK here at night, I mean much darker than at home! I use my headlamp DAILY! See dad, I told you I needed the headlamp.

Funeral Practices

Last week, the husband of a BMC nurse died. It was actually the nurse, who helped me find a seamstress to sew my dress. I know I have only been here a few weeks, but this nurse had been very kind and generous to me, so I did feel the sorrow of her loss. Anyways it has given me access to some funeral practices here. I still don't fully understand the entire process.

As soon as possible there is a wake, similar to the United States, except held at the deceased household, then comes the burial. All of this can happen in a matter of days, but the actual funeral depends on the finances of the family and time of year. Funerals are held during this the dry season. During the rainy season, everyone is working on their farms, and do not have time to go to a funeral. Then if the family does not have the finances for the funeral, it can be put off for years.

I went with the missionaries to visit Joyce, the nurse, today. She was at her family's compound. As a new widow, she is put in a hut (generously it was probably 5 by 10), and she cannot leave for the next week. The only times she can leave would be to use the toilet, but she must be accompanied by another widow. Next weekend, there will be a ceremony with drums and dancing, during which Joyce will have her head shaved (she has long beautiful braids right now). I believe at that time, her dress will change from black to white. The head shaving can only be performed if the wife has been faithful to the husband during the marriage. Her hair will then be buried next to her husband. I believe they are holding the funeral next weekend too, which is an event that will last a few days. At some point the funeral turns into a large celebration, but I'm not exactly sure when that is.

Then in a year there is another ceremony that is performed.

As I said, funerals all happen in the dry season, so it also happens that one of our cooks, Caleb, was also holding a funeral at his house all week. For the past few nights, we have gone to sleep to the sounds of drumming and celebratory music, all coming from his compound. He invited me to attend, but unfortunately I was on call. His tribe is the one with the cowies (what I refer to as the African answer to the thigh master), so he's been shaking his cowies alot over the last week.

I see a donkey

I have a thing for cheesy little songs, my roommate taught me one she learned here. Here's the words to the entire song:

I see a donkey,
A donkey follows me.
Hee-haw, hee-haw,
Hee-haw, hee-haw, hee-haw.

All the schoolchildren sing it here, and we can get Yisah, our cook, to sing with us, but now I'm kind of starting to think it's the Ghana equivalent of Row, Row, Row your boat or something like that. Christy and I are coming back from the mountain, and these boys were bringing firewood home on a donkey cart. Christy and I start singing the donkey song (because after all the donkey was pulling the cart), and the boys join in! It was too cute!

Today I got a nurse to sing it in the wards, like a guy probably 30-ish. I took a patient back to his bed after a procedure today, and he started singing it. It might replace the beaver song, it's a catchy little tune!

Happy Independence Day

***This was supposed to be posted yesterday, but as I posted one comment yesterday, the lights started to flicker (it means the electricity went off in town, but on the compound we have backup generators), and the internet went out. It turned out to be in God's perfect timing because as I was leaving the schoolhouse, a moto drove up to tell us they needed everyone at the hospital for a lorry (truck) accident with 15 people hurt. That's how things work around here.

**Internet won't let me post pictures tonight.

Thursday was Ghana's Independence Day! Did you remember to celebrate? 51 years they have been broken away from England. It's not celebrated as widely as say the 4th of July. But they have "marches," and most people get the day off. I work at a hospital, so hospitals never get the day off, but we did get out early.

It also happens to be Dr. Faile's-the founder of BMC-birthday! He is deceased, and it is his son whom I work with now. But they have this bust of Dr. Faile senior in front the hospital, and it kind of makes March 6th a more special day at BMC.

Finally, you know like most of the world in Ghana when they list a date they put the day first, then month, then year. So March 6th, 2008 would be 6/3/2008.....and that is also a VERY SPECIAL DAY! Does anyone know why???? I can see Erica rolling her eyes from here.

Christy and I decided to go climb the "mountain." I use the term mountain very loosely, it's much more like a hill. Anyways, it does overlook all of Nalerigu. Christy had brought walkie-talkies, and so we left one back at the house with our cook, Yisah, because he was worried we would get lost or find a waifu (snake), neither of which happened.

We crossed the river that borders Nalerigu, tons of kids were swimming and women washing clothes. Supposedly there are multiple crocodiles in the river, so you won't be finding me swimming there.

I had brought along my newest amusement, a slingshot. I bought 3 at the market for a grand total of 30 cents! I broke two, but someone at the hospital fixed and upgraded it. After a lesson or two from Yisah with candy as ammo, I can finally actually get stuff to fly, now he says my job is to kill a waifu.

There's no real trail to this mountain, so you kind of just weave through fields and aim for the right direction. We didn't have the most fantastic view because the Harmattan, but we plan to go back like on Easter morning.

This and That Medical Stuff

I was on call last night and ended up in surgery for a majority of the night, and then clinic all day today. Therefore, please excuse all typos and grammatical errors.

We are dangerously low in our supply of anti-snake venom. We were able to obtain 15 vials from Tamale, but we've been averaging 2-4 snakebites a night. We could use some prayer that we get more fast. We are forced to space out when people can get venom.

Today I saw another side effect of snakebites. A boy was discharged 10 days ago with a snakebite, he had a laceration on his finger, that he didn't take care of. He had the nastiest finger today in clinic, it was amputated this afternoon. I was unfortunately involved with debriding a leg at the time, so I didn't get to do the amputation myself.

I also saw an ainhum today. Yeah, what is that? I had NO CLUE! Thankfully, Dr. Faile did! It's another one of those, you only see it in Africa things. Basically the guy came in complaining of pain in his pinky toe. I look at his toe, and it literally looked like someone had tied black thread around his toe really tight. It was this fibrotic ring that formed, they think from some infectious origin, but the only cure is amputation (it was amputation day in clinic for me, which is a nice change, I have been stuck with alot of male genitalia cases). It was already getting necrotic. He was supposed to have it amputated this afternoon, but he didn't show up.

We also have been getting a rash of cerebral spinal meningitis cases--they are scary sick! I've already had a few die on me. BUT I have learned how to do a lumbar puncture myself, where you stick a big needle into the spinal canal to see if the fluid is infected. My first one was on this 3 year old in the middle of the night, I'm not sure who came out more traumatized, me or the child--I think it was me.

I'm off for some much needed rest!

What is it?

Can anyone guess what these are? Ignore all the circular metal things, I'm referring mainly to the rocks and the spools of string. Go ahead and guess. I'll give it a few days before I tell you.
This is a Fulani woman. Fulani's are considered a tribe of lower socio-economic class. Essentially they are nomads. They have distinctive features, like her high cheekbones. This is the first woman I met in full dress.

A conversation

The blog is not working well, but since it is Sunday, I will share a conversation I had with Christy and Tommy Harrison (note: I previously called him Tommy Harris, but it's Harrison). Christy and I joined Tommy again today to go to a bush church. Church was held in the schoolhouse we stopped at last week.

Anyways on way home, we got into a conversation about how being here, it's easier to understand Bible stories. When Paul talks about shaking off his sandals and moving on to another village, it's a completely vivid picture. Or talking about Jesus washing people's feet, it's completely different here. All the farming stories are easy for the people to relate to.

It's not that we don't understand the stories at home, but we don't have these nasty dusty feet at home that need to be washed or many other examples I could use. It's more simple here.

Cultural Dance

At Station meeting on Thursday, we met Caroline, a Peace Corps volunteer, stationed in Nalerigu. She works at Nass, a secondary school (high school), that serves the entire Northern Region. She teaches computers. She invited us to come down to the school last night because they were having a cultural dance. Christy and I took her up on her offer, and we are glad we did.

Since everything starts on Ghanian time (late), she had time to show us the campus. The students pay to be there, the yearly fee for room/board and tuition is around $400. It's kind of kind a college campus in the US, but much more basic. The "cafeteria" is basically a field, that the cooks make food over open fires in large cauldrons (in many ways, it looks like something out of Harry Potter with all the cauldrons). The students live in very cramped dorms, they have to go to the well to get water everyday (usually a task delegated to freshman).

Caroline teaches computers as I said. The average class here is 65 students. I believe she has 20 something old old computers. Students sit two to a computer. They only actually get to be in the computer room once a week. She was given a very ambitious curriculum, it's kind of ridiculous. Most of the children have never seen computers before, and now once a week, they share a computer. It's a start, but the curriculum bites off alot more than the children can learn. She intends to make up some cardboard keyboards, so they can practice typing when not in the lab. She spends alot of time trying to fix up these old beasts.

She showed us this room of completely dead computers, that cannot be resurrected. Then she told us they are donating them to the primary schools. Why? Well they primary schools are also required to teach computers, but they don't have any. So these dead computers will be donated so the teachers can at least show students what a computer is supposed to look like as they teach. It's a start. But when you think you have an old useless computer, try teaching computer class without a computer.

Anyways, so we were invited to this cultural dance. Being that students come from all over the Northern Region, several tribes are represented. The tribes were competing doing their traditional tribal dances. Three tribes organized to compete: Manprusi, FraFra, and I forget the last one. The competition was held at the school "auditorium"-a dirt field. Over 1300 students attend school, and since this was a special event, most faculty, support staff, and families of students were present. It was dark, but you'd look out and see people everywhere, including trees just to see.

We, as Obruni (foreigners) and as guests of a teacher, were considered guests of honor. We sat in chairs right behind the judges. They actually got out of sorts, whenever Christy or I stood up to try to get a better view because I guess part of the honor is that we SIT in the provided chair.

The top photo is African's version of the thigh master, they shook their bottoms and got those hip things moving like crazy! The hip things are called cowies. The bottom photo is a male dancer wearing a traditional smock, which is worn by important people (like chiefs).

Christy and I really enjoyed the experience. At the end, in the US you know someone would stand up and say how well everyone did, and that it is so difficult to pick a winner, well that's not how it works in Africa. Instead one of the teachers says they will now tell the performers how they could improve. Each judge proceeded with details how the dancing could have been improved. Elisabeth Faile was picking us up, so we actually never got to hear the winner announced.

Caroline showed us her hut on tour. Actually she has a pretty spacious layout, with three huts and a yard to herself. She made it quite homey. But she also introduced us to some Ghanian candy. Christy and I loved it! In fact, we tried to surprise each other and separately went to the market today to get some for the other. We both found one kind of the candy we tried, and bought each other a bag. Now at home we have two huge bags of candy. Guess we'll have to eat it! :-)

African Dress

There is not a great deal to buy in Nalerigu, but bright vibrant African fabrics are readily available. It's cheap to have a seamstress make a dress. I knew before I arrived, I wanted an authentic African dress. I had been talking with nurses during clinic about what kind of dress I wanted, we had alot of fun with me taking pictures of my patient's in dresses I liked. The nurse's granddaughter was as seamstress, and a friend sold fabric. So yesterday I was off to find fabric and go to the seamstress. The most expensive part of the dress is the fabric, which costs around $13.

I arrive at the seamstress, I showed them the dress (of course, it took awhile because they are completely fascinated by cameras, so I take pictures of them, and show them, then I have to find the picture on my camera of the dress), they took my measurements, and told me I could have the dress by MONDAY! It cost about $6 for them to make the dress, add the liner to the dress, and for the lace. That doesn't happen in the United States.

This morning I'm eating breakfast, when there is a knock at the door, my dress was done! Not 24 hours after I ordered it. The result is above! I'm pleased! I know it's not exactly the height of fashion in the US, but it's very typical for around here. They also made me a wrap to go with it, but we can't get it on me correctly. It's warmer than the skirts I have, but I do plan to wear it to church while I'm here.

Viewer Discretion Strongly Advised

I do struggle with how many pictures to show you of my work. I know many of you viewing this blog are not doctors, although a fair number are training to be doctors. This is the work that I do. I get strongly conflicting feedback either requesting more pictures or no pictures. So I apologize. I am trying to edit what graphic material I do post.

This is a baby who was burned, but I'm not sure by what. Burns are frequent here. This child does not represent the typical story, which is walking onto fire. People burn their trash here, and often dig pits to put the trash in, then burn it. A child may see something they want, not realizing it is a deep fire pit and then burn his/her feet. The worst is then as the child panics, they put their hands down in the fire, or worse yet is when they start sinking into it. This child is being prepped for a skin graft. You might note, that we are not in an operating theater for this procedure, it's simply a procedure room they'll do the graft in.
This is an incision and drainage of a knee, I'm performing. That is all pus that you see in the bowl being held under the knee. Basically, we put a needle in and aspirate, if we get pus, then we make an incision and attempt to drain all the pus out, pack it, give antibiotics, and send them back to the wards to be monitored. It's amazing how much pus we have gotten out of some of these wounds.

Waifu

At Uncle Paul's request...
This is a photo I took of a dead carpet viper a patient brought in. It was about a foot long. People generally have one of two stories about how they got bitten. The first is that they were simply walking on a path and were bitten on their foot. The second (and very common) is that a common game for little boys to play is stick your hand in a hole. Basically little boys go around sticking their hands in holes to see what they can find, maybe a bush rat, maybe nothing, and maybe a waifu (snake).

In general, the actual bite site is not impressive. In fact, I don't think I've taken any pictures because there really isn't much to show. The affected limb starts to swell, usually with what looks to be cramping in the limb (trying to get that translated is an issue, but that is what it looks like). We either tie arm to an IV pole to keep it elevated, or raise the foot, to help bring the swelling down. Immediately a clotting time is drawn on the patient because the venom's deadliest quality is that it affects the ability of the blood to clot, it disrupts the bodies clotting cascade. I just spoke with Dr. Hewitt, who said he has an article on how it affects the blood and how the anti-venom works, so I might be a little more educated in a few days.

So pretty much universally the blood won't clot because of the snake venom, at that point the nurse finds a doctor and we order ASV (anti-snake venom). I'm not exactly sure how the ASV works, Dr. Hewitt's article will hopefully clear that up. It likely either binds to the venom, inactivating it, or competes with the venom for binding sites on the proteins it affects in the clotting cascade. We then order another clotting time to be done about 12 hours later.

Depending upon how fast the patient gets to the hospital after the snakebite and other factors, sometimes one dose will be enough to correct them. Some though can go through several doses before their blood clots, Dr. Faile said the upper limit is 10 vials of ASV. We keep them at the hospital until they have had at least 2 successive blood draws that clot. It is frequent for them to have one that clots, and then the next one doesn't clot, so you have to go back and give more ASV. ASV has to be refrigerated, and it seems most bites come in during the night. All the doctors and at the guest house, we keep a supply of ASV, so when we are woken up in the night, we just go get them the ASV and write the order to give it.

We are heading in snake season because it was explained to me, the snakes get too hot in their holes. So they come out near paths, and then people walking down the path get bitten. Since no one (except us Obruni--white people/foreigner) use flashlights, and because the the snake blends in well with the path, it is very easy to come across one unexpectedly.

By the way, they do eat snake around here. However, not usually the carpet viper. They usually eat cobra. Yesah, one of the cooks at the guest house, is known for cooking us waifu, if the opportunity presents itself. (it has not so far)

I am horrible at speaking Manpruli, the main tribal language here, but waifu (snake) is one of the first words I learned.

I hope that satisfied you Uncle Paul!

Random photos from work

This is me removing a large lipoma on man's chest. A lipoma is a benign fatty tumor, it was larger than a golf ball, but smaller than an orange.
This child is thought to have Hirschsprung's disease, a disease that causes a pseudo-obstruction of the intestines. This would be fixed shortly after birth in the US, but that is not possible here. His belly is that big because his intestines are very dilated proximal to the obstruction.
A woman with a double thumb

Dust vs Heat

When I first arrived in Ghana, I thought it was hot, but surprisingly barable. It was definitely hotter and more humid in Accra than in Nalerigu, and that is because of something called the Harmattan. The Harmattan is a wind that blows from the northeast, bringing dust from the Sahara. It greatly reduced visibility. It kept the temperatures down, but the trade off was all the dust. Everything everywhere was constantly coated in a layer of reddish dust. It was a losing battle to try to rid your things of dust. Literally, daily everything would get covered with a new layer of dust. You take a shower and come out 2-3 shades lighter than when you got in.

Over the past week, the Harmattan winds have greatly reduced, and with that the temperatures have soared upwards. According to some folks with thermometers, we've already hit 120 on occasions. It's HOT! I don't think white northern girls are meant for this weather!

I haven't quite decided which I dislike more. With the Harmattan winds, we all had constant cold like symptoms from all the dust. Now we just roast like we are in an oven.

It's still dusty. The picture of above was taken this morning, after I did rounds and made one errand in town. That's not a tan on my feet, it's all dust.