Thank you first for your concerns and prayers.
I am better, I think. The fever is down, the cough is much better and I can sleep for hours.
I am still under immediate threat of being kicked out unless I get a LOT better by tomorrow so....don't stop.
Saturday, January 19, 2008
Friday, January 18, 2008
Now is the time
Since arrival I have not been doing well medically. I started coughing more overnight and the treatments I was taking were ineffective for more than a handful of minutes. Given the high local concentration of medical students, medical residents, internists and surgeons, it seemed possible to get some advice. I was advised to start a potent steroid intravenously (I was already taking one by mouth). This is a new high (low?)-water mark for my asthma. After a number of attempts to keep an IV in, we seem to be successful as of Friday morning.
The reason for this deterioration appears to be a small pneumonia as I woke up with signs and symptoms thereof (I will spare you the details). The coughing is so paroxysmal and frequent that I am pretty much in constant
abdominal pain. On consultation with George Faile M.D. he has given me antibiotics, continued the steroids, put me at rest at the bunkhouse and 48 hours to get my act together; if I persist in my transgressions I will go home.
Dear friends, visitors and family. I would covet your prayers for my healing, recovery and alleviation of pain. More to the point, I ask that you pray for my faithfulness at this time, my patience (never in great supply) and a witness be derived from these circumstances.
That having been said and the substance of things hoped for communicated to you, I will go on to other matters. The pediatric patients are divided into several groups: the acutely ill, the malnourished, the isolated and the newborns. The acutely ill are a hodge-podge of surgical and medical patients; mostly with malaria, burns, fractures, pneumonias, and parasites. The malnourished are handled by a feeding station run by Joanna, a medical assistant (nurse with additional training). It is one of my goals to become a best buddy and indispensible to this good soul before I leave. Just in passing I found a 11 month old who has not gained weight in 7 months. Mom is still breast-feeding; very curious and I have my concerns. I had difficulty pushing together enough baby to fit under my tiniest stethoscope in order to listen to his lungs. The newborns are also mostly relegated to mid-wife care as patients are admitted and discharged dead without much input from a doc. We shall see. The isolation ward is generally more airy but fetid with the smell of open wounds and phenol antiseptic. There we find tropical ulcers, Burulli ulcers (a particular nasty requiring wide excision to heal) and TB.
Please keep ALL the patients at
Thursday, January 17, 2008
Arrival and Departure
The night was hot and the draft created by the fan was welcome but more monotonous than sleep-producing. I awoke about every 2 hours feeling like I was drowning from my asthma. (Regimen: “Get up, cough, drink, treat, go to bed, roll over and sleep”). 4 AM came quickly and Jimmy Huey was there to drive me through the compound gate to the airport. I was well checked in 45 minutes before the take-off time. This however is not when the airplane actually took off, mind. Three hours with no word, no advisory and only the continued seeming-complacency of my fellow-passengers before a terse announcement of immediate boarding with a brief apology that the delay was due to “personal matters” (apparently the pilot had no-showed) and we were off in a crowed turbo-prop.
Tamale (TAM-a-lay) is hot, dust-blown and extensive. I had been warned that the party meeting me would be doing errands before bringing me to Nalerigu and indeed it was so. Everyone should take advantage of being an inconvenient supercargo at times. It is good for one’s humility and improves the accuracy of one’s self-image immensely. I was the inconvenient fact that disrupted three hospital workers with more important things to do. I was met by Chreesy, Issa and James. The latter two spoke with me not at all and all three spoke around me for the hours it took to arrive.
For efficiency sake therefore, I was dropped off at a gas-station restaurant. As I had missed breakfast, I decided to make a lunch memorably with my first Ghanaian meal. I ordered banko and tilapia (I got redfish, “This Is Africa”). Banko is a thick pudding made from taro-root and is the local replacement for bread and potatoes. It is grey slightly translucent and mucinous, served as a great piping-hot cow-paddy on the plate. As is the usual custom, hands are washed at the table in water before and water and soap (this time dish-washing liquid) afterwards. The taste of banko is bland, something like potatoes or grits and quite satisfying especially with several sauces available. The fish was deep-fried and too hot to dismember immediately. I ate, enjoyed and had a surfeit. (USD 4.5 with coffee, water and a tip) Lunch was a leisurely affair. I washed up and waited the 2 hours before I was collected listening to African rap, drinking water and reading.
There were several more stops. Chreesy unnecessarily informed me that we had stopped at the “meat market.” It was a small off-road plaza surrounded by tables of dismembered cow parts and a stand of several wide-eyed young veals awaiting an early retirement or a mother-less adolescence. After several more stops and a quick trip to an open–air, waterless loo which needed no advertisement (other than odor), we were finally off to Nalerigu (na-LERI-gu).
Northern Ghana is dry this time of year and I watched dust-devils form over a sear landscape. The road was paved and we barreled along at over 80 mph at times. Passing was a much more relaxed affair as it could be done on blind curves and on hills, dodging bikes, goats, children and pot-holes. Despite all, we gradually rose above the dusty plain to a ridge of truly Africa perspective, red-brown sandstone carved by the rains and the winds into vast rounded blocks with steep-sided gulches filled with green water.
The land became increasingly verdant as did the diversity. Arabic script beside neat mud mosques with pigs running stiff-legged away from our noise and dust. Large schools with there students blossoms of intense color in their uniforms walking and biking from the halls of learning. A long-haul truck, taking a curve too fast, appears to be reclining for at least one more rainy season yet. A man in a burnoose, it billiowing out behind his motorcycles like a small tan sail. Men endlessly pushing hand carts filled with mountains of produce. Donkey carts kept at a jolting trot by small boys with thick sticks and a mean streak. More stops to find a favorite vendor or drop off a purchase of taro root. Finally a truly remarkable sight, a small pond, a reservoir for East Mamprusi district, Nalerigu and the site of Baptist Medical Center.
We were let into the compound by the gate-guard in front of the hospital built in 1957 by George Faile II, father of one of the current doctors. I was deposited at number 6, the “bunkhouse” shown a double room with sparce furniture on a tile floor and left to recuperate. It is an African room. High ceiling, two huge fans, with a single florescent tube, two low single beds, a wardrobe of beautiful wood with a sturdy lock warped so that the door doesn’t close, and a set of drawers for the two occupants the size of a bed stand. I note as I enter, that 14 hours of no therapy has made my breathing audible even to the house workers. I am out of breath walking to the room. I treat myself and spend the afternoon coughing and using a nebulizer. I may not be better after all. The air is dry and I am having diffilculty keeping hydrated.
By 5PM I was hulloed by Burt Young a 79 year-old “retired” OB-GYN from Murphysboro, TN who undertook to show me around. We have a truck at out disposal and use it to haul the equipment and meds given me to deliver. As we emerged from the truck we were met by some of Burt’s “boys,” youngsters of 8-12 who have chosen to become Burt’s shadows, general factotums and go-fers on the expectation that they may get a tip and (as I said) they knew a sucker when they saw one. I was hit up for a tip and when I declined was asked if I had brought any books, “so we may read them.”
Burt and I wrestle the duffel to the pharmacy to deposit the meds and then to the surgery suite to drop off the suction equipment. Our shadow, Elisah, is only too happy to put the duffel back into the truck for us as I got a short tout of BMC. Burt naturally started in the women’s ward and we took a detour through post-partum to look at a lady he had delivered of a still-born. As I passed the nurses’ station I noted that an elderly (and inoperative) incubator is occupied. As usual no one was notified when a 3 lb baby was brought in that morning. She is purple with an occasional breath. I quickly listen to her heart rate; it is agonizingly slow. Nevertheless she is warm, and when I give here a few breaths here heart rate climbs and she starts to breath on her own again. Burt comments that I am trying the impossible and I admit it. I talk with the nurse-midwife and try to make a plan. Any intravenous therapy is out of the question as maintaining it would be impossible. I write for some fluid and base through a stomach tube and a respiratory stimulant.
We returned to the bunkhouse and met our roomies, Tomas (an Argentinean medical resident), Megan (a 2nd year Med-Ped resident from U of Va), and Marise (a 3rd year med student from Magill University, Canada). We had a convivial dinner of chicken pot pie, cabbage salad, and watermelon.
After dinner, I went back to the hospital in the dark, following the road. The incubator was now empty.
Tamale (TAM-a-lay) is hot, dust-blown and extensive. I had been warned that the party meeting me would be doing errands before bringing me to Nalerigu and indeed it was so. Everyone should take advantage of being an inconvenient supercargo at times. It is good for one’s humility and improves the accuracy of one’s self-image immensely. I was the inconvenient fact that disrupted three hospital workers with more important things to do. I was met by Chreesy, Issa and James. The latter two spoke with me not at all and all three spoke around me for the hours it took to arrive.
For efficiency sake therefore, I was dropped off at a gas-station restaurant. As I had missed breakfast, I decided to make a lunch memorably with my first Ghanaian meal. I ordered banko and tilapia (I got redfish, “This Is Africa”). Banko is a thick pudding made from taro-root and is the local replacement for bread and potatoes. It is grey slightly translucent and mucinous, served as a great piping-hot cow-paddy on the plate. As is the usual custom, hands are washed at the table in water before and water and soap (this time dish-washing liquid) afterwards. The taste of banko is bland, something like potatoes or grits and quite satisfying especially with several sauces available. The fish was deep-fried and too hot to dismember immediately. I ate, enjoyed and had a surfeit. (USD 4.5 with coffee, water and a tip) Lunch was a leisurely affair. I washed up and waited the 2 hours before I was collected listening to African rap, drinking water and reading.
There were several more stops. Chreesy unnecessarily informed me that we had stopped at the “meat market.” It was a small off-road plaza surrounded by tables of dismembered cow parts and a stand of several wide-eyed young veals awaiting an early retirement or a mother-less adolescence. After several more stops and a quick trip to an open–air, waterless loo which needed no advertisement (other than odor), we were finally off to Nalerigu (na-LERI-gu).
Northern Ghana is dry this time of year and I watched dust-devils form over a sear landscape. The road was paved and we barreled along at over 80 mph at times. Passing was a much more relaxed affair as it could be done on blind curves and on hills, dodging bikes, goats, children and pot-holes. Despite all, we gradually rose above the dusty plain to a ridge of truly Africa perspective, red-brown sandstone carved by the rains and the winds into vast rounded blocks with steep-sided gulches filled with green water.
The land became increasingly verdant as did the diversity. Arabic script beside neat mud mosques with pigs running stiff-legged away from our noise and dust. Large schools with there students blossoms of intense color in their uniforms walking and biking from the halls of learning. A long-haul truck, taking a curve too fast, appears to be reclining for at least one more rainy season yet. A man in a burnoose, it billiowing out behind his motorcycles like a small tan sail. Men endlessly pushing hand carts filled with mountains of produce. Donkey carts kept at a jolting trot by small boys with thick sticks and a mean streak. More stops to find a favorite vendor or drop off a purchase of taro root. Finally a truly remarkable sight, a small pond, a reservoir for East Mamprusi district, Nalerigu and the site of Baptist Medical Center.
We were let into the compound by the gate-guard in front of the hospital built in 1957 by George Faile II, father of one of the current doctors. I was deposited at number 6, the “bunkhouse” shown a double room with sparce furniture on a tile floor and left to recuperate. It is an African room. High ceiling, two huge fans, with a single florescent tube, two low single beds, a wardrobe of beautiful wood with a sturdy lock warped so that the door doesn’t close, and a set of drawers for the two occupants the size of a bed stand. I note as I enter, that 14 hours of no therapy has made my breathing audible even to the house workers. I am out of breath walking to the room. I treat myself and spend the afternoon coughing and using a nebulizer. I may not be better after all. The air is dry and I am having diffilculty keeping hydrated.
By 5PM I was hulloed by Burt Young a 79 year-old “retired” OB-GYN from Murphysboro, TN who undertook to show me around. We have a truck at out disposal and use it to haul the equipment and meds given me to deliver. As we emerged from the truck we were met by some of Burt’s “boys,” youngsters of 8-12 who have chosen to become Burt’s shadows, general factotums and go-fers on the expectation that they may get a tip and (as I said) they knew a sucker when they saw one. I was hit up for a tip and when I declined was asked if I had brought any books, “so we may read them.”
Burt and I wrestle the duffel to the pharmacy to deposit the meds and then to the surgery suite to drop off the suction equipment. Our shadow, Elisah, is only too happy to put the duffel back into the truck for us as I got a short tout of BMC. Burt naturally started in the women’s ward and we took a detour through post-partum to look at a lady he had delivered of a still-born. As I passed the nurses’ station I noted that an elderly (and inoperative) incubator is occupied. As usual no one was notified when a 3 lb baby was brought in that morning. She is purple with an occasional breath. I quickly listen to her heart rate; it is agonizingly slow. Nevertheless she is warm, and when I give here a few breaths here heart rate climbs and she starts to breath on her own again. Burt comments that I am trying the impossible and I admit it. I talk with the nurse-midwife and try to make a plan. Any intravenous therapy is out of the question as maintaining it would be impossible. I write for some fluid and base through a stomach tube and a respiratory stimulant.
We returned to the bunkhouse and met our roomies, Tomas (an Argentinean medical resident), Megan (a 2nd year Med-Ped resident from U of Va), and Marise (a 3rd year med student from Magill University, Canada). We had a convivial dinner of chicken pot pie, cabbage salad, and watermelon.
After dinner, I went back to the hospital in the dark, following the road. The incubator was now empty.
Tuesday, January 15, 2008
Accra
I arrived at Accra about 830 local (+5 hrs to EST) and breezed thru immigration and customs despite the "contraband" hospital equipment I receved from Cindy and Paul Schumpert Sunday evening.
I spent the day sweating and taking cabs to what I had hoped was an enclosed fixed-price Ghanaian folk craft market. Taxi number one deposited me a grocery store and I hiked off, not knowing where I was, and hailed another taxi. This driver, James, was a gem extolling the merits of Ghana's football team in the upcoming matches; showing me independence park (1957) and the new stadium (which really was impressive).
We wound up at the "Cultural Centre" a flea-market of local Ashanti, Dan, Mooshi, Yorubu and other tribes art. I saw maybe 10% before hunger, stimulus overload, and one too many "just a second, look at this for just a second" got me. We had a light meal and I got dropped off, once we found the guest house again.
Spent the afternoon dozing and sweating under fan (a/c is available but I am trying to acclimate). Reorganized the bags, incorporated a load of Cipro and came down for dinner at 630pm. It was the usual melange of people going up -country and coming down; returning from a mission, going to a conference, leading a conference and returning home. There is always a gaggle of children and their familiars.
I am doing better but pray for my continued recovery. The cough is exhausting and disturbs what little sleep I can find.
I spent the day sweating and taking cabs to what I had hoped was an enclosed fixed-price Ghanaian folk craft market. Taxi number one deposited me a grocery store and I hiked off, not knowing where I was, and hailed another taxi. This driver, James, was a gem extolling the merits of Ghana's football team in the upcoming matches; showing me independence park (1957) and the new stadium (which really was impressive).
We wound up at the "Cultural Centre" a flea-market of local Ashanti, Dan, Mooshi, Yorubu and other tribes art. I saw maybe 10% before hunger, stimulus overload, and one too many "just a second, look at this for just a second" got me. We had a light meal and I got dropped off, once we found the guest house again.
Spent the afternoon dozing and sweating under fan (a/c is available but I am trying to acclimate). Reorganized the bags, incorporated a load of Cipro and came down for dinner at 630pm. It was the usual melange of people going up -country and coming down; returning from a mission, going to a conference, leading a conference and returning home. There is always a gaggle of children and their familiars.
I am doing better but pray for my continued recovery. The cough is exhausting and disturbs what little sleep I can find.
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