Last Day in Nalerigu...

...and my camera broke! I took a few pictures early in the day and then around noon I tried to take pictures for one of the families here and the camera quit.

It has been a busy last day and it is late. Past time for bed as we leave tomorrow at 4:00 AM for the airport.

Here are some of the pictures I was able to get today.

Working in the farm and going to school

Some of the outpatient staff

Patients in front of hospital

Twins

Taking blood pressure

Weighing

 It was a good last day. I will miss everyone and the work. But I am looking forward to getting home so we can prepare to come back. Elisabeth will come with me next time.

Salvation Dolls

In Northern Ghana when something bad happens, it is sometimes blamed on a spell by a witch or wizard. Through various ways and means a person can be named as the cause of misfortune and thus be accused of being a witch. Women who have been accused of being a witch are then subject to ridicule, abuse and expulsion from the village. Their lives are often in danger.

The chief of Gamabaga, the district capital of our district here, has power over witches and their spells. He therefore is able offer a place of refuge for the ladies who have been accused of being witches. A section of Gambaga has been set aside where the ladies can live. This is one of six, so called "witches camps", in Northern Ghana. They remain subject to the chief and have to work in his farm and pay him.

Erin Faile has been going every week to visit with the ladies there. She has been providing music therapy, counseling and fellowship for them. They have been meeting in groups and sharing their stories with one another. Erin has been working with Madam Lariba who has worked with the ladies in the village for a number of years.

First Baptist Church of Dawsonville sent 50 salvation dolls with me. I gave most of them to Erin and Lariba to share with the ladies at the camp. Here are some pictures Erin took of the day when they gave out the dolls and shared the salvation story with the ladies.

Though some of the ladies don't look very happy in the pictures, Erin assured me they were really excited and happy to get the dolls and did a good job of learning the story and the meaning of the different colored beads.

Last Week at BMC

Today I started my last week here at the hospital. The hospital has started accepting insurance again and I was anticipating a heavy clinic day. It was heavier than last week, but not too bad for a Monday.

Dr. Jim Howard arrived over the weekend and is here for a couple of weeks so that is a help. He has been here several times so pretty well knows the ropes.

Waiting to be seen

Though this may not look like a lot of people, it is only a few of those who are waiting to register to be seen.

Patients come from far and wide and many wait for hours to be seen. Some have passed other hospitals or already been to other hospitals








Since people come from all over, there are many different languages spoken. So all of the providers, whether Ghanaian or expatriate, needs to have an interpreter. Jim's interpreter today was a medical student so both he and Jim benefitted from the time.

Dr. Howard and Reuben with a patient

 



 

 

 

 

Rain!

We finally got some much needed and much prayed for rain. It did not last long but was hard and gave a good soaking.

Courtyard outside the main wards

View from my office

Walkway from outpatient department to wards

Another Day at BMC

Today was another day in the operating room and again it was pretty slow due to the insurance issue. I was able to take some pictures today and would like to share some of them with you.

Every morning starts with a devotional period for staff before they report to work. Today when the devotion was over, some of the staff received longevity awards. Workers with 10, 15, or 20 years were recognized.

Thompson Duut receiving 15 year award from Director of nurses, Stephen Yiddi

One of the cleaners receiving 10 year award

After devotions and awards we made rounds. Here are a couple of the patients we saw today. A young man with a strange rash on the legs. We are not sure what it is and if any medical people out there have any ideas, let me know. The rash started shortly after taking an unknown medication.

Any ideas??

Later we saw a young girl with neglected burns that we had skin grafted. She still has a way to go, but is better.

Burns before grafting

Healing, but still a way to go

A couple of days ago I posted a picture of a tree in our old yard, but Elisabeth said it was hard to tell how big it is. So today I took another picture with Peter and Erin under the tree to show better how big it is. Peter and Erin have been here almost a year running the guest houses and taking care of all the volunteers who come to work at the hospital. It has been nice to be able to spend a little time with them.

Elisabeth's tree, son and daughter-in-law

Peter and Erin

Surgery 15th July, 2014

Just as yesterday was a light clinic day because people who were used to getting free medical care had to pay for services, today was a light surgery day because people were not able or willing to pay for elective surgery.

We did have work to do and I hope the pictures from some of what we did will not bother anyone.

Part of what I am doing while here is to help Dr. Tim Cahill learn some procedures and help him get experience with others.

Since I have been here, I have done about 30 major operations and many minor procedures. So far I have done general surgery, urology, orthopedic, OB, and plastic surgery cases.

Today we did GI and plastic surgery.

Dr. Cahill performing EGD

First, we did an upper GI endoscopy looking for ulcers. This gentleman had been treated in the past for duodenal ulcer and we could not find any evidence of ulcer disease today.

Next, we did 3 skin grafts where one takes donor skin from one part of the body and covers a large defect elsewhere. Dr. Cahill had not done this before and so it was helpful to  do several in a row.

Young girl with large wound

Young man with even larger wound

Both patients had large skin defects from severe infection and both needed grafting to speed healing. These pictures show the wound before grafting.

The next pictures show the wounds after the graft has been harvested, meshed and attached to the raw surface of the wound.

Graft applied and stapled in place

Graft in place

A dressing was applied and we will check the graft in 3 days to see if it has been successful. Check back in 3-4 days and hopefully we will have some pictures of a good result.

After finishing in the operating room, I went to the guest house to eat lunch. The cook had prepared a Ghanaian dish for me and it was very good.

Rice balls and peanut soup

 



 

 

After lunch I went by our old house to check on how things looked. Elisabeth had planted a Baobob tree years ago when it was very small and I wanted to see how it had grown.

 

Elisabeth's baobob tree



Monday Market Day Clinic

Every third day is market day in Nalerigu. People come in to town from all of the surrounding villages to sell, buy and socialize. Many also come to the hospital while they are in town and since there has been no clinic for two days over the weekend, Monday market clinic has always been one of the busiest days of the week. Today we finished around the unheard of time of 3:30 in the afternoon.

There is an explanation for the short Monday Market Clinic day. Ghana has in the past few years introduced a national health insurance scheme and encouraged everyone to sign up, though it is not mandatory. The insurance covers all medical care rendered at a clinic or hospital, covering consultation, labs, medications, admissions and surgery. For the past 8-9 months hospitals have not been paid for services provided under the insurance scheme. As a result, all mission hospitals have announced that they will not be taking insurance and patients must pay cash for any treatment they receive. As a result few patients have felt they can afford to come to the hospital. And so we had a light day.

And since not many are willing to pay for elective surgery, we only have 3 cases scheduled for tomorrow.

 I hope to be able to get some more pictures to post over the next few days.

Ladies on the way to market

Bicycle Ride

I took a short bike ride today after work. So here are few pictures from the ride.

Woman working in the field

 People are getting their farms ready but the rains  have not really gotten started yet. The days are warm and muggy and we keep thinking it will rain, only to be disappointed.

TB village

 

 

One of the programs at the hospital is treatment of TB. Patients come to stay for the 8 months of treatment so they do not have to travel far while being treated.

 

 

 

 

 

 

 

 

Carrying water home

 

 

 

 

Most people do not have running water in their houses and so need to carry water home for cooking, cleaning and drinking.

 

 

 

 

 

 

 

 

Hiding in the tree

 

 

 

When I got home there were some birds in the yard and I tried to get some pictures to share. Most didn't come out very good.

 

 



Pictures from BMC

The past couple of days have been very busy and I have gotten to the house late and very tired. So I am sorry I have not posted anything for a few days. Tonight I am also pretty beat and it is rather late. So I thought I would just post some pictures I took yesterday and today so you all would not think I have forgotten to keep this up.



Making porridge at the nutrition center

Dr. Victoria making rounds on pediatric ward

Performing a procedure

Patient and mother on pediatric ward

Dr. Cahill examining a sick child

Nakpanduri



One view of the escarpment

 Yesterday Peter and I drove to the town of Nakpanduri, about 17 miles and 45 minutes east of Nalerigu. It is on the edge of an escarpment that runs for many miles from the Togo border to west of Nalerigu.

We went to visit Denise Klein Douwel who has lived in Ghana since 1970 when she was in the Peace Corps. She married John Klein Douwel who was from Holland in 1981. They worked for many years raising and selling trees in northern Ghana and both of them had been good friends for most of the time we lived in Nalerigu. John died from cancer in February and so Denise is trying to carry on the tree project alone. I had brought a few things for her and wanted to go say hello and give her what I had.

She always has lots of animals. Dogs, monkeys, baboons, ducks, turkeys (mean ones!), deer, horses and donkeys to name a few. One of her donkeys had been attacked by other donkeys and was pretty beat up. She asked that I check him out and give her some advice. So we went with her to see the donkey and to do what we could.

Washing off wound and trying not to get kicked

 

 

Spraying medicine on the wound while Denise holds him down

 



Denise wrestled the donkey to the ground and sat on the neck while I cleaned off the wound on the chest and sprayed medicine on it. We practice a little broader scope of medical care here. But it keeps things interesting.

 

Crowds at the installation of a chief

 

 

On the way to Nakpanduri we were held up in one village by crowds of people on the road as they were in the process of installing a new chief.

 

 

When we got back to Nalerigu, we drove through the center of town and saw piles of watermelon for sale. That seems to be a new crop here at this time of year.

 

 

Watermelons for sale



 

 

 







Malaria

People often ask what is the most common illness we treat here at BMC. By far, it has to be malaria. Especially from now to the end of the year after the rains start and mosquitoes are more numerous. So far there is not a vaccine or good preventative medication that will work well for the general population. Fortunately, there are some good drugs for treating the disease once one is sick. The problem is that children have not developed any kind of immunity and tend to get very sick very fast. Every year nearly 700,000 people die from malaria, mostly children.

When we lived in Ghana malaria was fairly easy to treat and there were not so many choices of drugs to use. And I felt like I knew pretty well how to take care of the sick kids and what meds to give. Today I realized that there are more drugs available and recommended. And I have to learn the new treatment regimens.




Some of the drugs available to treat malaria

 

Chart with guidelines for diagnosis and treatment of malaria

Those of us who are visitors in Ghana usually take medicine to try and prevent malaria. It is not always 100% successful. When we lived in Nalerigu all the time, we could count on getting malaria at least once a year.

 



July 4th in Nalerigu

Ghana has a holiday on July 1st for Republic Day, but of course, July 4th is just another day here and in most of the rest of the world. It has been a pretty good day, but busy as usual. Made rounds this morning, attended patients in outpatient clinic, did 3 C-sections, and made night rounds since I am on call and responsible for all admissions since clinic.

We always see lots of kids and many are very sick. Here some waiting to be seen today in clinic:

Some staff taking vital signs on children

Weighing

Taking temperatures

Toward the end of clinic each day we are served a cold drink. Maybe they did think about US July 4th after all! This is what they served some people today:

 

...But bottled in Ghana

 

I like that it is the "Original". I guess Coke and Pepsi are just imitators!