tag:blogger.com,1999:blog-64141806040814226632024-03-05T20:29:39.734-05:00WVU Ghana 2008Sarah Moerschelhttp://www.blogger.com/profile/17558918235459876741noreply@blogger.comBlogger51125tag:blogger.com,1999:blog-6414180604081422663.post-88414795923416715442008-10-14T19:22:00.001-04:002008-10-28T19:13:34.425-04:00Ghana YouTube Video LinkHere is a link to a short youtube video of the trip - enjoyShelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-31986334386544188822008-05-01T12:02:00.005-04:002008-05-01T12:11:50.356-04:00Last few pics from our trip!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLaO4VonVxMmhkuxoBoEwUc4ZSY9n010hGXlTCV6joOTA18cO7m_rsJ7dFqLHtzkh_n9WfwjzHm_eUtaoUoEKQJtd6dDN7n5Icm4Xy0zaKRHVTtiPTSOu1TC6YzQBfbmN9J5Rd8H8ct_jy/s1600-h/100_0761.jpg"><img id="BLOGGER_PHOTO_ID_5195442798306470354" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLaO4VonVxMmhkuxoBoEwUc4ZSY9n010hGXlTCV6joOTA18cO7m_rsJ7dFqLHtzkh_n9WfwjzHm_eUtaoUoEKQJtd6dDN7n5Icm4Xy0zaKRHVTtiPTSOu1TC6YzQBfbmN9J5Rd8H8ct_jy/s320/100_0761.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIAbWMHEG7K5EDSEGYEXm8Ut9ynkqTixYYSI09cPDpPlVoN_1jFSfq_gjE4U663hSlwYSYRxXkNXB81yzz5wuI3oKfc0c00MKQqquY9npRx2WaZQB_-PvmD0LHBc0SBusvmKyl2lLbYrn0/s1600-h/DSC01227.JPG"><img id="BLOGGER_PHOTO_ID_5195442574968170946" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIAbWMHEG7K5EDSEGYEXm8Ut9ynkqTixYYSI09cPDpPlVoN_1jFSfq_gjE4U663hSlwYSYRxXkNXB81yzz5wuI3oKfc0c00MKQqquY9npRx2WaZQB_-PvmD0LHBc0SBusvmKyl2lLbYrn0/s320/DSC01227.JPG" border="0" /></a><br /><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNxkii2DWbGheiv2026pams00mhYA6KMaem2aVz2RB3ohkW9XNJN6QKxyt1l1Y723XEJcharyuY5uNeYokHrQt7XyfvmKA8nQ6UceEyLernu8SypRjo-kUmIqlnAXtcY5w_3rOUteJK9Pc/s1600-h/100_0814.jpg"><img id="BLOGGER_PHOTO_ID_5195442484773857714" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNxkii2DWbGheiv2026pams00mhYA6KMaem2aVz2RB3ohkW9XNJN6QKxyt1l1Y723XEJcharyuY5uNeYokHrQt7XyfvmKA8nQ6UceEyLernu8SypRjo-kUmIqlnAXtcY5w_3rOUteJK9Pc/s320/100_0814.jpg" border="0" /></a><br /><br /><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifkYRf9Dywo2GW6NJ6y6KboXzpldOYvzdPMBqMasm3coZKz1-Uud3XvfGv2ISyS1FSHVaw7zfuh3tFdf4upA19zZ82JvTfjv8bXSk3sQqlfuveX9uqMY9F9D5l3IUuu-KjwbJZhfumLhya/s1600-h/100_0801.jpg"><img id="BLOGGER_PHOTO_ID_5195442343039936930" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifkYRf9Dywo2GW6NJ6y6KboXzpldOYvzdPMBqMasm3coZKz1-Uud3XvfGv2ISyS1FSHVaw7zfuh3tFdf4upA19zZ82JvTfjv8bXSk3sQqlfuveX9uqMY9F9D5l3IUuu-KjwbJZhfumLhya/s320/100_0801.jpg" border="0" /></a><br /><br /><br /><br /><div>I have heard from a few on the trip - and I can speak for myself as well. Coming back is difficult as we move from the experiences we had in Ghana back to our reality in the US. As I had thought, a wide range of emotions have come rusing back - feelings of guilt, annoyance, thankfulness, and so on......we need and should be thankful for all that we have back home, especially for our families and friends. I have posted a few more pics of our trip to end on. We hope to all get together on the evening of May 19th to share some more and talk about how we are doing.....so long and thanks again to all that showed support along the way.</div></div></div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-80274564902762207832008-04-30T10:46:00.003-04:002008-04-30T10:55:49.910-04:00Arrival back to the states......Well - we all made it safe and sound - a total of 23 hours from waking to arriving back in Morgantown ! It was a long but safe day - we had to race around JFK to get through customs and immigration and move all our luggage around, but we managed and made the flight. My body is still on Ghana time - I woke up early and didn't sleep too well, but hopefully that will fade quickly. We worked hard, shared stories, witnessed miracles and death like never before. We saw people that are so thankful for their lives, their families and for us who came to help and provide medical care. We have been touched by this experience - I'm certain all of us will have a wide gammot of emotions over the ensuing weeks - emotions that we will carry forward and will change the way we practice here in the U.S. I do believe we have been changed by this experience - we have grown and been shaped by all that we have seen and been witness to. To Becky, Mary Ann, Kavara and Tracey who graduate in a few more weeks - you all did awesome ! Sarah and I are proud of all your hardwork and dedication over the past 3 weeks. We wish you well in your future endeavors - reflect on what you have done, who you have touched, and what you have witnessed often......it's now apart of you and who you are and has only strengthened you as a physician and person. I will try and post a few more pics soon as we wrap up this blog from Ghana....and the Baptist Medical Centre.Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-77976778007587657952008-04-29T01:45:00.004-04:002008-04-29T02:01:55.141-04:00Leaving Africa...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpnmCLI0YcJPULY-hyM04WN5qNU9uLRKS6OOvN_4KGT2oLE44TvPtCBZD6KlgVwzMXf5s_HYm5eOShvTpXI2Byxr7bjV442cAQj7jtjaxBY8dPY4ca5N7-0CiuW9_MEzXJ92hNVRP7sEVX/s1600-h/100_0834.jpg"><img id="BLOGGER_PHOTO_ID_5194543513759066514" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpnmCLI0YcJPULY-hyM04WN5qNU9uLRKS6OOvN_4KGT2oLE44TvPtCBZD6KlgVwzMXf5s_HYm5eOShvTpXI2Byxr7bjV442cAQj7jtjaxBY8dPY4ca5N7-0CiuW9_MEzXJ92hNVRP7sEVX/s320/100_0834.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6HoEOARFOc8ebU9xAiyh-P_T_DV8hx735Ib6mYKh7DWKNdxQspJcbPyvqrbMPLDe9BOkH6NRS0d5uzonV_xaW9pvy2ifX-1tewXPzmXXGWVOyGkFJmEmayxfPoik4bPyzjhGTCrah61Dv/s1600-h/100_0767.jpg"><img id="BLOGGER_PHOTO_ID_5194543393499982210" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6HoEOARFOc8ebU9xAiyh-P_T_DV8hx735Ib6mYKh7DWKNdxQspJcbPyvqrbMPLDe9BOkH6NRS0d5uzonV_xaW9pvy2ifX-1tewXPzmXXGWVOyGkFJmEmayxfPoik4bPyzjhGTCrah61Dv/s320/100_0767.jpg" border="0" /></a><br /><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZW-8lFsdQO0Vlgr9CKE1KsxtwxVZBaBECy7dS39ge0_k6_rD9tsd0am-lasGGuvKAX_7BJnVnGP38riBVm9R41LPeiRtvYcVWMCIMbRvlzH6NxoCF3q7UqXy2MuTwHmpHt1Mg8OjZ-z2W/s1600-h/100_0826.jpg"><img id="BLOGGER_PHOTO_ID_5194543281830832498" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZW-8lFsdQO0Vlgr9CKE1KsxtwxVZBaBECy7dS39ge0_k6_rD9tsd0am-lasGGuvKAX_7BJnVnGP38riBVm9R41LPeiRtvYcVWMCIMbRvlzH6NxoCF3q7UqXy2MuTwHmpHt1Mg8OjZ-z2W/s320/100_0826.jpg" border="0" /></a><br /><br /><br /><div>Well, the day has arrived for us to depart Accra. We are all sad - George Faile and his wife Elisabeth are here with us at the Guesthouse. They are on our same flight back to the States.....it was good to reminisce over dinner our past wonderful few weeks at the Baptist Medical Centre. We leave here different people, touched by the people we have met, moved by the patients we worked with and shaped by this entire experience. It's hard to describe all the emotions we will have as we board the plane this morning. We hope we have forged new friendships that will last a lifetime and that WVU and BMC can work together in the future providing top quality healthcare to those that desperately need it. </div><br /><br /><br /><div></div><br /><br /><br /><div>We have a long day ahead - we leave for the airport in a few minutes. The slave castles were amazing yesterday - I have posted three shots of those. Enjoy and talk to everybody soon !</div></div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com1tag:blogger.com,1999:blog-6414180604081422663.post-40876782357422008292008-04-28T03:23:00.002-04:002008-04-28T03:27:38.325-04:00Monday morning from Coconut Beach<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLoC2QzDU36kjR7YNU2vVwT9nO62T529nm2sgBPzOMIF-FRrOsBySQinteksVHnqWSJVLXdFz-Xnr-3UFNcxrNZVRVFdTUg-rXaEYchW478fCooyZ8zvgj45z-JssyIIk7kvBG2ipQfzVO/s1600-h/100_0202.jpg"><img id="BLOGGER_PHOTO_ID_5194194427407182178" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLoC2QzDU36kjR7YNU2vVwT9nO62T529nm2sgBPzOMIF-FRrOsBySQinteksVHnqWSJVLXdFz-Xnr-3UFNcxrNZVRVFdTUg-rXaEYchW478fCooyZ8zvgj45z-JssyIIk7kvBG2ipQfzVO/s320/100_0202.jpg" border="0" /></a><br /><div>We are packing up this morning and heading out to explore the castles before heading back to Accra for a good night sleep before we flight on Tuesday morning at 10:15 am. We have had a very nice few days here at the beach - I pretty much look like a lobster as do most others. We needed a little sun before coming back to the states. Thanks again to all for your supportive emails and posts. We read them everyday. Have a good week and so long from Coconut Beach.</div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com1tag:blogger.com,1999:blog-6414180604081422663.post-48736366099529462862008-04-27T05:43:00.002-04:002008-04-27T05:48:44.571-04:00Sunday morning..Hello everyone - we have been out of internet for over 24 hours and unfortunately the phone is in the ocean.....therefore we will not be calling anybody until possibly we are back in Accra on Monday night. We leave Tuesday morning for the states. Yesterday we beached it in the afternoon and went to the Kakum National Park for a hike in the rain forest. We walked the Canopy walk which was exciting and got your pulse going. We were 350 meters up in the sky !! I will try and attach a picture if it works this morning......<br /><br />Today we will be at the pool as well as the beach - you can walk up the beach for miles - it is beautiful. We will visit the slave castles either this afternoon or tomorrow morning.<br /><br />Gotta run for now - take care...Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-92209508262321213012008-04-25T17:19:00.003-04:002008-04-25T17:33:55.897-04:00Our arrival in "heaven".....<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjg79FDRAgOqfIfYybnn0f65oYm0wF13Rmiuf5cp458izdFRqxpvaMdGsWreWn-tcYeeBCfgsfNaDwCiPu9VwrzrJodmX3BllrSfioRZH-cY7PJ42S3OS3WJgDsqimgv-3yh-0GmR8f_7Dd/s1600-h/100_0673.jpg"><img id="BLOGGER_PHOTO_ID_5193299296093153618" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjg79FDRAgOqfIfYybnn0f65oYm0wF13Rmiuf5cp458izdFRqxpvaMdGsWreWn-tcYeeBCfgsfNaDwCiPu9VwrzrJodmX3BllrSfioRZH-cY7PJ42S3OS3WJgDsqimgv-3yh-0GmR8f_7Dd/s320/100_0673.jpg" border="0" /></a><br /><div>Our day started out quite early - up before the sun was up - off to Tamale we went on the washboard, unpaved road that wouldn't let anyone but Tracey sleep. We arrived safe and sound but unfortunately there was a huge thunderstorm in Accra so our plane was over 2 hours late arriving. We finally got to Accra and Jimmy picked us up. We left some stuff quickly at the Guesthouse and off we went in our SUV to eat at Frankie's restaurant....Becky and I enjoyed cheeseburgers and fries, Mary Ann a pizza, Tracey fish and chips and Kavara a tuna sandwich with grilled onions ! A small taste of america - it was delicious. We then headed to Elmina and the Cape Coast which took over 3 hours partly because our driver was lost and had to ask for directions many times - the last person he asked just happened to be a local police officer who jumped in our car and took us straight to Coconut Grove Beach Resort. This place is awesome !! We walk out and the beach and Atlanic Ocean are just 50 yeards away....waves are crashing as I type this now - we are sitting out on the patio and the table as the waves pound. I have attached one image for you so you can imagine what we are seeing. The house is fantastic - clean, fresh and new.......all of which we haven't seen much of. We decided to stay an extra day here it is sooooo cool. Tomorrow we will head to Kakum National Forest to hike on the canopy walk and try and catch some slave castles in the afternoon before heading back to just hang out on the beach. We are all pretty tired and will get to bed soon.....we ate a delicious dinner at the open-air restaurant also sitting at a table along side the beach. This is what we will call our "temporary heaven" for now.......enjoy your evening and good night from Coconut Grove !!</div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com1tag:blogger.com,1999:blog-6414180604081422663.post-30404425669587712582008-04-24T13:13:00.005-04:002008-04-24T13:40:08.758-04:00Another day at the hospital.....Becky and I experienced another heartwrenching story this morning........A father showed up at the emergency check-in area with his 10 year daughter looking very, very ill. He had been out of town several days apparently and arrived home to find his daughter sick. The girl's name was "Rachael"........she had a seizure while they were checking her in to be seen by the medical staff. Apparently she had been seen by a local clinic in Gambaga just 3 days ago for similar symptoms but we were unclear as to what treatment had been rendered. She was lethargic, not eating, and very weak by the father's report. She was rushed down to the Theatre area where we all hang out on Tuesdays and Thursdays. She looked very ill, curled up in a ball on the cart, foaming from her mouth, wimpering. Becky and I looked her over and Dr. Faile wanted us to proceed with a lumbar puncture to rule out meningitis. After what we have seen over and over here, we were apprehensive to say the least. With the help of the tech and father, we rolled her to her side and Becky was able to get a very cloudy, slightly bloody spinal fluid from her back. Initially the fluid came quickly, the it slowed. We sent it for immediate gram stain and cell count and took her to the isolation ward. Becky ordered stat antibiotics, labs, treated her for seizures, and started IV fluids. Things were not looking so good as the next few minutes passed. When I gazed over where her father stood at the end of the bed, Rachael started to have agonal breathing - a labored breathing pattern that can mean herniation of the brain and increased pressure on the brain. Becky and I watched over the next several minutes, and we knew in our hearts it was going to be over soon - Rachael would need a miracle to survive the infection we believed she had. We called for the chaplain, and then met with the father to tell him of the impending death of his 10 year old daughter. Our hearts just sank, as we sat and watched her for the next 45 minutes succumb to her overwhelming infection of the brain. Throughout our time with Rachal, the father stood at the end of the bed, coming in and out of the ward, never once holding his daughter, touching her or speaking to her......a woman came in shortly later, we assumed it was her mother, but we didn't know for sure....she also stood at the end of the bed, watching patiently to see what was going to happen. The father then picked up a small metal basin, filled it with cool water and sponged his daughter to try and cool her. Her temperature was well over 104 degrees.......as he sponged her so gently, with the mother standing at the end of the bed, Rachael took her last breath. The woman cried for just an instant........Becky listened and could hear no heart beat.....her battle was over................it's overwhelming at times to see all this......a few hours later we checked on her spinal fluid results. She had Neisseria Meningititis on gram stain in large amounts. Despite our efforts, Rachael was going to die......even in the US children and adults may not survive an infection of this magnitude. And I say again, this happens all over this hospital and others like it in Africa all day long.......<br /><br />There are many miracles here at BMC too......many that we do save with meningitis, and in fact the woman who was in the bed next to Rachael, had severe mengititis on admission and is doing great and will go home soon........she sat and watched, as did all the other patients and families in the isolation ward, as we did our best to care for Rachael.........<br /><br />Good night from Ghana........we leave at 4:30 am for Tamale then onto Accra for some rest and relaxation. We should have wireless in the hotel to keep blogging for everybody. This experience has changed us all - I can't speak for all the others, but I don't think any of us will leave the same person that we came......a better appreciation for life and death, and how others live in this world. So long from BMC. All is well as we pack for our trip home.Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com2tag:blogger.com,1999:blog-6414180604081422663.post-85496730603770491412008-04-24T13:01:00.004-04:002008-04-24T13:13:09.275-04:00Last day at BMC.....<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbWuzj0G4acPq2OQTLAnOt2LoGtIEOYqt8aNuHacnxzZjUgRE3fINlfJ1pZ_qTVjIJHSRQlqR1gRYt16n0tj_1chzAjLpVWIz1mcIRnUu1yk-EXteuUw0A3Yg4oKE07YOMYVmIfURymWTJ/s1600-h/100_0631.jpg"><img id="BLOGGER_PHOTO_ID_5192860311780796738" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbWuzj0G4acPq2OQTLAnOt2LoGtIEOYqt8aNuHacnxzZjUgRE3fINlfJ1pZ_qTVjIJHSRQlqR1gRYt16n0tj_1chzAjLpVWIz1mcIRnUu1yk-EXteuUw0A3Yg4oKE07YOMYVmIfURymWTJ/s320/100_0631.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7Wz3-VhTKPUQSdi1AljsBCrQB-vPJPRt1qTdFszKnm1OLcQpLjVpWiTSCWxAFgSckWNxLCFhq87OxmpwkXKkjKBxYOdusDrTrDQZl4R6io4Joqguwkn52MtKb7XPubdTiRH5gNO0UvKVl/s1600-h/100_0581.jpg"><img id="BLOGGER_PHOTO_ID_5192860024017987890" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7Wz3-VhTKPUQSdi1AljsBCrQB-vPJPRt1qTdFszKnm1OLcQpLjVpWiTSCWxAFgSckWNxLCFhq87OxmpwkXKkjKBxYOdusDrTrDQZl4R6io4Joqguwkn52MtKb7XPubdTiRH5gNO0UvKVl/s320/100_0581.jpg" border="0" /></a><br /><br /><div>We all can't believe our last day has come and gone. We did rounds, then procedures, then OR and everybody is back packing up their belongings now. The heat has let up some and we are all feeling good, but ready for some site-seeing and beach time in Elmina. We will be at the Coconut Beach Resort for 2 nights and 3 days. We have a driver hired to take us there from Accra when we fly down early tomorrow morning. We leave BMC at 4:30 am - the drive is about 2 hours and our flight about 8 am. We will eat dinner around 6 tonight and head to the weekly Station meeting at Jayne's house, the pharmacist. I have posted the pics of the "high-powered vacuum" procedure that Becky did yesterday. You can see her here holding the tube in place and I am showing the contraption that removed the fluid in record time. We did it again today but the vacuum machine ran out of power - we're not even sure how it is powered actually. So today we just kept pulling fluid with a large syringe to remove her fluid. She is in pretty significant heart failure....we hope this makes her feel a little better. Enjoy</div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-44246398924066391752008-04-23T18:15:00.002-04:002008-04-23T18:39:22.008-04:00Pound Cake and more.....Today was a really good day at BMC. We had a nice, even pace in clinic and actually finished up early....we got down to the Theatre early to start on the procedures of the day. We did what I would call a "High-powered Vacuum" thoracentesis of the lung on an elderly patient in pretty significant heart failure. Her left lung was almost full to the top with fluid and the right about one-third of the way up. We don't have the usual vacu-tainers that we drain fluid into in the US. Normally you put the needle in, hook up the tubing and pop it into the suction container where you take off 3-4 liters over an hour. Here we do it quite differently. Becky put the needle in perfectly (on the third try - she'll be a pro before she gets back to the States though), she got a flash of the yellow colored fluid into her syringe. She pulled out the metal needle leaving the plasitc angiocath inside the patient where the fluid was. At this point, the tech handed Becky the large tubing that is connected to an electric-powered vacuum device that is normally used in the OR to suck up blood during a case. She put the tubing on the catheter and the tech flipped the power switch and what happened next was quite amazing to see !! All the fluid in her lung was instantly, and I mean instantly removed from her lung - like a vacuum cleaner would do. For a moment we were all scared the patient may crash. A liter was sucked out of her body in a matter of seconds and we repeated it several more times. She breathed better in the end and could lie a little flatter in bed now without becoming short of breath......we just do it differently over here but in the end the outcomes all appear to be the same !! So there you have it - the "high-powered vacuum" thoracentesis. I guess it beats an hour - we were done in seconds !!<br /><br />After the day ended we went to the Hewitt's house for a movie and pound cake with fresh strawberries - just for a moment we felt like we were back in the USA. It was delicious and the movie was the "Illusionist" which was quite good. Mary Ann and I are on call tonight so we'll see what comes in tonight. We leave for Tamale and Accra on Friday morning at 4:30 a.m. <br /><br />That's all for tonight - good night all and I hope you enjoy the stories - I have a picture of this I will try to post tomorrow.....Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com2tag:blogger.com,1999:blog-6414180604081422663.post-86175696073838113212008-04-23T02:31:00.003-04:002008-04-23T02:35:40.766-04:00Pics of "one large knee"....<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6QFVZOtRE68BL3uYnhuyWTIXAluMqo1o6IzSjCr4bgTST1qNKd0J0Nieslr0PSGlLodNDsMHJuT8GZeD5LfI2yJbw5Xsinuzx0sEI4n62fsVwkq_1uXHusPTI1F1DPJZBnHyyHQuSFaoZ/s1600-h/100_0119.jpg"><img id="BLOGGER_PHOTO_ID_5192325493863164194" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6QFVZOtRE68BL3uYnhuyWTIXAluMqo1o6IzSjCr4bgTST1qNKd0J0Nieslr0PSGlLodNDsMHJuT8GZeD5LfI2yJbw5Xsinuzx0sEI4n62fsVwkq_1uXHusPTI1F1DPJZBnHyyHQuSFaoZ/s320/100_0119.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghCtomV37uoCd7pNMQ6jG-TmSNHiCkiGAPoVlNJUFK1LHzAGPUZv-FDzQFuZ5FhyphenhyphenM7bIPTY9be5MeT2hUGrRbaALm8dcNZREhrU7UfkybLxZg5LiCbNs04-fv_PIsImpcrRmDUl3CHYYqe/s1600-h/100_0118.jpg"><img id="BLOGGER_PHOTO_ID_5192325227575191826" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghCtomV37uoCd7pNMQ6jG-TmSNHiCkiGAPoVlNJUFK1LHzAGPUZv-FDzQFuZ5FhyphenhyphenM7bIPTY9be5MeT2hUGrRbaALm8dcNZREhrU7UfkybLxZg5LiCbNs04-fv_PIsImpcrRmDUl3CHYYqe/s320/100_0118.jpg" border="0" /></a><br /><br /><div>Here it is - I will let everyone know if we do an amputation today - it is so heavy and he is so thin he can barely move around - i think you get the "real" picture now on this one.</div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-89782540750580597642008-04-22T16:21:00.002-04:002008-04-22T16:36:57.705-04:00One large knee.........Sorry I don't have the picture yet but I will post it tomorrow. We have a boy that is around 20 years old - presented to clinic with a massive right knee - like he has a pumpkin there. It is incredible really - he can barely walk because of it. Just picture a tiny upper and lower leg and in the middle a large pumpkin. It is extremely painful to even light touch. Now the bad news - likely an osteogenic sarcoma - a fatal cancer at this point. His CXR showed some pulmonary nodules so already metastatic. For palliative care and comfort we will most likely do an amputation above the tumor tomorrow. Unfortunately, he has been febrile all day so this makes surgery a little more risky. He is so great, and so thankful to all of us and he speaks pretty good english for a change. The outcome will not be good but we hope to make his last few months a little more liveable......pic coming soon - if we do the amputation we may have a before and after shot for everybody.<br /><br />All of us are doing really good - the students have been awesome and working hard !! And we are all healthy, well-fed and showered everyday !! I thought the parents would like to know this. We head to Accra then Elmina Coast for a little R and R this Friday - well deserved for everybody ! Take care a good night from Ghana - thanks to everybody who has emailed support and posted comments on the blog - we appreciate everybody's kind words.......Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com1tag:blogger.com,1999:blog-6414180604081422663.post-38905863323480280112008-04-21T16:47:00.002-04:002008-04-21T17:02:52.772-04:00Experiencing death in AfricaOn Saturday, Kavara and I were assigned to call. We had several admissions that we were called to evaluate and work-up. When Kavara and I got there we started to work up the first patient. He was a small 10 month old baby boy that looked pretty sick - he had a high temp, vomiting, and diarrhea for 3 days as well as a cough. On exam, he was irritable, eyes rolling around in his head, painful belly, and chest exam showed diffuse ronchi throughout. With the fever and how bad he was doing, we did a lumbar puncture on him. It went beautiful - Kavara had attempted only one other time, but she got this one on the first stick. Here they don't use spinal needles on kids - just a regular old needle. The fluid was clear and we sent it for a VERY basic analysis - WBC's or not. I ran down to the OR suite to get something for a brief minute and then the nurse came running down saying the medical student needed me right away. I ran back up the hallway and turned into the peds ward. Across the room I saw Kavara giving chest compressions and mouth - to -mouth rescuscitation on the baby. I ran over - no pulse, no breathing - the mother stood quietly at the end of the bed, saying nothing. The families of other patients all sat and watched - the nurses watched us.....the baby coughed only once in this entire thing but blurped up some phlegm into Kavara's mouth. None the less we kept on, but knowing in our hearts it was over. After a couple of more minutes - it seemed like an eternity, the mother waived her hand at us to stop. She had seen enough, and we weren't making any progress. We had not been told what to do should an infant or adult patient code. Our instinct in the US is to save - here it is to let die. I broke down in tears and put my head down on the cart and gazed into the childs blank stare - Kavara got teary eyed - then we got up and walked back to the work station. The mother cried for just an instant, patted the baby briefly and walked out of the ward. The death certificate came up and three men that were obviously part of the family, came in, wrapped up the baby in african cloth and left. I have never been part of anything like this.......they just see death differently than we all do in the US you know. Dying is just part of living, and is accepted as part of illness. A similar event occurred the following night as well. This time however, the baby stopped breathing a little later after the LP was completed. Our team let this baby go........no code, no CPR.....just let the family be with the baby......and be together to say goodbye......what I describe above, happens everyday in this hospital.....adults and children alike. It's so different from how we practice back home........it really opens your eyes and you learn so much from these special people we are taking care of everyday.Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com3tag:blogger.com,1999:blog-6414180604081422663.post-41331188537999078082008-04-20T18:09:00.003-04:002008-04-20T18:13:02.607-04:00Two more pics<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf4CefiZBHyPe9N81rugGx4zCwrFfquIRAIGjee_hOkTSmN5f28gnRc4s65LwrdldLc7Y2GeKzCD-CRBbJu9dV9YtQhUUSG9mPX3f8qG5EqG_hgIKboCWas-YHg6lX5tfK0MNYtpvzWADf/s1600-h/100_0475.jpg"><img id="BLOGGER_PHOTO_ID_5191453940738308578" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhf4CefiZBHyPe9N81rugGx4zCwrFfquIRAIGjee_hOkTSmN5f28gnRc4s65LwrdldLc7Y2GeKzCD-CRBbJu9dV9YtQhUUSG9mPX3f8qG5EqG_hgIKboCWas-YHg6lX5tfK0MNYtpvzWADf/s320/100_0475.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6k4kyHbxqHtRHNHC1pWwuAEb3_0e7IJpIrSPAtFG2P838OEFWzwU05Eu4c_eFVHInNmIxFpq3VpXkTVFm1Q9N5wMPl4seqmyBXnAjsONL3VjNXvt9cVeg22WciUDE4vWbQ406gO7hPfyA/s1600-h/100_0532.jpg"><img id="BLOGGER_PHOTO_ID_5191453760349682130" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6k4kyHbxqHtRHNHC1pWwuAEb3_0e7IJpIrSPAtFG2P838OEFWzwU05Eu4c_eFVHInNmIxFpq3VpXkTVFm1Q9N5wMPl4seqmyBXnAjsONL3VjNXvt9cVeg22WciUDE4vWbQ406gO7hPfyA/s320/100_0532.jpg" border="0" /></a><br /><br /><div>For those of you who like to see more pictures - two more. One is the Nalerigu Market that we went to on Saturday afternoon. The other is Colleen, Becky and I on the hike up to the rocky overpass ! Enjoy !</div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com2tag:blogger.com,1999:blog-6414180604081422663.post-56814720738680568342008-04-20T17:53:00.004-04:002008-04-20T18:00:59.234-04:00Sunday evening...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8XHjuZCYlLFhoSv8oqJl8yAsOFHDdabXKB2eGxqeSvl2moXEKsyjTBo4UZ_h5Ypk_6YpUCev5nAeWdZdbUD5MIJj0n5aZDzh5z8S19F_QKZYCMZOQfLExVgyVAxJ1ZOXscIHqbSMXn15I/s1600-h/100_0519.jpg"><img id="BLOGGER_PHOTO_ID_5191450728102771138" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8XHjuZCYlLFhoSv8oqJl8yAsOFHDdabXKB2eGxqeSvl2moXEKsyjTBo4UZ_h5Ypk_6YpUCev5nAeWdZdbUD5MIJj0n5aZDzh5z8S19F_QKZYCMZOQfLExVgyVAxJ1ZOXscIHqbSMXn15I/s320/100_0519.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_J0C6kPJQK3UmP0FTXlami9jG7cbYERp5haDk09j-MrMszSA0ZaAFkj-VaPVn4MyUup_XT-_RjH2PHa47UFGTSxOCDvXsif34ZjLHlLGA4d8fxsfDML463sEc3sFkT8F5KHZE-riiB5zk/s1600-h/100_0510.jpg"><img id="BLOGGER_PHOTO_ID_5191450590663817650" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_J0C6kPJQK3UmP0FTXlami9jG7cbYERp5haDk09j-MrMszSA0ZaAFkj-VaPVn4MyUup_XT-_RjH2PHa47UFGTSxOCDvXsif34ZjLHlLGA4d8fxsfDML463sEc3sFkT8F5KHZE-riiB5zk/s320/100_0510.jpg" border="0" /></a><br /><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRGAs4kukh1wnaOwthAde5P7nlGQtsxW0fIRoQHusAyFJrbfb8kdhn3qg2-PDyOn18Lz94J7Z4VZwjnuIak4gx7ipH3EIE0Lg5K7i690JhmmvfDd4zgyR0ofHztwDVA8tcy1Xe3B3hbNyc/s1600-h/100_0504.jpg"><img id="BLOGGER_PHOTO_ID_5191450453224864162" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRGAs4kukh1wnaOwthAde5P7nlGQtsxW0fIRoQHusAyFJrbfb8kdhn3qg2-PDyOn18Lz94J7Z4VZwjnuIak4gx7ipH3EIE0Lg5K7i690JhmmvfDd4zgyR0ofHztwDVA8tcy1Xe3B3hbNyc/s320/100_0504.jpg" border="0" /></a><br /><br /><br /><div>Today, Becky, Colleen and I travelled up to Nakpanduri with Dr. Hewitt and his kids. They were going fishing, and we were going on that beautiful hike and up the rock formation that overlooks the valley. It's the same hike the group went on the first weekend. I have uploaded some pics for everybody to see. At one point you have to hike through the "Fat Man Squeeze" - a very narrow rocky pass before reaching the summit. In the pictures we made it all the way to the top of the rocky cliff !! Only a dead fish was caught with hooks that were apparently large enough to catch a small whale. We head back to clinic tomorrow all day and look forward to rounds every morning at 7:30a.m. Night from Ghana.</div></div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-18333576911126387182008-04-20T10:02:00.005-04:002008-04-20T10:06:17.173-04:00Sunday morning<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjmEphXwnw9Y2cYgyegvWO305i4EXZfIvFwOTU4nizHqCRrzDb5yWJG_4kDGztzsl3qr8FEU40Jn1VoCSwpxPGjccgTFDsVf82RFBesw5rliWXXuv2Vz90xPGHoVFCllbpc0VnG1lAfpNq/s1600-h/100_0458.jpg"><img id="BLOGGER_PHOTO_ID_5191328239930456466" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjmEphXwnw9Y2cYgyegvWO305i4EXZfIvFwOTU4nizHqCRrzDb5yWJG_4kDGztzsl3qr8FEU40Jn1VoCSwpxPGjccgTFDsVf82RFBesw5rliWXXuv2Vz90xPGHoVFCllbpc0VnG1lAfpNq/s320/100_0458.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfhn0a6Hx4gZu43Wma6nCIosQP5vjUEKX1T-X1pK5nDqmWzbFTFd9ALYHs4vPT_AjHf4IhSUrF0OdRNHeM9M606k8ZW16Ge7kUGl5Dx8syfWrGoGNhyH7XLR_0ptoKAAnNkvDAxglefB6a/s1600-h/100_0449.jpg"><img id="BLOGGER_PHOTO_ID_5191328085311633794" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfhn0a6Hx4gZu43Wma6nCIosQP5vjUEKX1T-X1pK5nDqmWzbFTFd9ALYHs4vPT_AjHf4IhSUrF0OdRNHeM9M606k8ZW16Ge7kUGl5Dx8syfWrGoGNhyH7XLR_0ptoKAAnNkvDAxglefB6a/s320/100_0449.jpg" border="0" /></a><br /><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKT_zVVxCrlgcYE4f4oh-X1T-OBQF2vPzKhTIyRdtOULTK38-rGQ50VUZ2OVZVyuq84sFwcOd421zMoVUKAyTDqmTKHSV7o70s_6eTCYtOCRoqnFbgR6QihreJBJRh6uar87SmKzHELrpW/s1600-h/100_0445.jpg"><img id="BLOGGER_PHOTO_ID_5191327969347516786" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKT_zVVxCrlgcYE4f4oh-X1T-OBQF2vPzKhTIyRdtOULTK38-rGQ50VUZ2OVZVyuq84sFwcOd421zMoVUKAyTDqmTKHSV7o70s_6eTCYtOCRoqnFbgR6QihreJBJRh6uar87SmKzHELrpW/s320/100_0445.jpg" border="0" /></a><br /><br /><br /><div>A few pics from clinic on Friday - the tuberculoid leprosy ones I mentioned earlier !! We all went to church and now Becky, Colleen and I are heading out to the Nakpanduri rock formation. She required a 4th finger amputation and that is what you are seeing in the pics....it was done without anesthesia because the nerve endings are gone from the leprosy. Don't look at these before you eat ! Warning, warning...</div></div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-46602165221827201172008-04-19T11:47:00.002-04:002008-04-19T11:52:15.913-04:00Hello WorldYes, the picture below is what you think it is . . . a hand protruding from the birth canal! If you have not yet seen this picture, scroll down. It is included in Shelley's post from 4/17. The woman and baby in this picture came to the hospital around 6:00 p.m. At 11:00 a.m. that day, her water broke and her baby decided to say hello to his mama for the first time. Neither the baby nor his mom were in any distress. Before taking my history, I felt for a radial pulse in the baby's hand, which was present, and even got a grip/grasp reflex. This means that when I pushed really hard on the baby's palm, his fingers began to close into a fist. Isn't that cool?! Dr. <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Faile</span>, our most excellent surgeon here, performed a C-section immediately and both baby and mama were fine!Kavarahttp://www.blogger.com/profile/09217701764318822549noreply@blogger.com2tag:blogger.com,1999:blog-6414180604081422663.post-21349022523447579262008-04-19T06:51:00.002-04:002008-04-19T06:56:55.305-04:006 yo boy follow-up...It's Sat am - it rained for awhile last night and all the bullfrogs came out. I did see a carpet viper on the way back from the computer lab the other night and we admit 3-6 snake bites per day to the hospital. The 6 yo little boy that I mentioned in my last blog, survived the surgery but inside the belly was lots of pus as he had perforated his small bowel - a well known complication of typhoid fever. He looked better on rounds today. A little perkier and a lower fever. We will advance his diet gradually and say a prayer he makes it. Kavara and I are on call today. We are going to the market at 1 pm to shop then back for a down day.....one of us will have to stay to handle admissions, etc so we will trade off going. I hope to buy some african items to bring back home......off for now. Will try to post pics later. Our cell phone has been down, so no one can call home right now. Have a great weekend back in the states.Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-3000996589764180612008-04-18T17:25:00.002-04:002008-04-18T17:30:35.477-04:00Friday !!it was another very busy clinic day and worked really hard before heading down to the Theatre to do some minor procedures. Today I saw a patient with two years of Leprosy - Tuberculoid Leprosy to be specific. It was truly unbelievable. One of her fingers on her hands that were so terribly crippled, required amputation. Dr. Faile did this for her without anesthesia as she has no feeling in her hands. I got to watch and take picture - sorry I didn't get them compressed for upload tonight - but I will post it on Saturday sometime. I admitted several from clinic today including one little 6 year old boy with an acute abdomen. He could barely walk into clinic, and could not stand up straight let alone let me examine his belly. Probabloy Typhoid Fever with perforation. He is in the OR tonight with Dr. Faile and Becky getting an exploratory laparotomy......I hope he makes it....I started stat IV antibiotics, fluids and said a prayer he would be okay......will let everyone know soon.....off to get a shower and to bed now. Phone service is down - we have a thunder and lightning storm going on right now - and a heavy downpour - unusual over here in Ghana - all the red clay dust is now MUD !!! Good night !Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com3tag:blogger.com,1999:blog-6414180604081422663.post-42531235140251235862008-04-17T19:09:00.003-04:002008-04-17T19:13:12.650-04:00More pics - what everybody wants to see right !<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_NR491SKtA-wVi-6gs5d1c2iOBnt4FWUgcy9-DDTTZ8DP9QMzuuYrPaSMeyMOMVuIYRmW-H61e31E5er4-vsimKD5qyn_5wCA_6VuyQ_jP2QgAYLU_TqLBMyUMMf2OP3jIRq-YNn-nsHC/s1600-h/100_0404.jpg"><img id="BLOGGER_PHOTO_ID_5190355936954857010" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_NR491SKtA-wVi-6gs5d1c2iOBnt4FWUgcy9-DDTTZ8DP9QMzuuYrPaSMeyMOMVuIYRmW-H61e31E5er4-vsimKD5qyn_5wCA_6VuyQ_jP2QgAYLU_TqLBMyUMMf2OP3jIRq-YNn-nsHC/s320/100_0404.jpg" border="0" /></a><br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR-Jl-t9YNM1bGpo4RliTc9u1eLVgkhkoBXkaIFblQq2h2A6WezlMENBxrACViq6wUIBCjduB6XC6W_rzmTB4BlDkeSyau52PwXapO2TsVCB4IOBlJm0a481G0sBveXJgDZCGdT1sne7Mw/s1600-h/100_0425.jpg"><img id="BLOGGER_PHOTO_ID_5190355769451132450" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR-Jl-t9YNM1bGpo4RliTc9u1eLVgkhkoBXkaIFblQq2h2A6WezlMENBxrACViq6wUIBCjduB6XC6W_rzmTB4BlDkeSyau52PwXapO2TsVCB4IOBlJm0a481G0sBveXJgDZCGdT1sne7Mw/s320/100_0425.jpg" border="0" /></a><br /><br /><div></div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com1tag:blogger.com,1999:blog-6414180604081422663.post-25709980388655724702008-04-17T18:44:00.007-04:002008-04-17T19:02:52.433-04:00Thursday blog...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOnKco9_t__4SjCKRqW0EPAgnBPw-bmKpwOBKet2q0K-TgdQrFPMAnFHzNhbxbSJa1p8glSDSO6NZVKFEwAKIJ4y1JSANDdAFKJuHqJUJDKsdzVpx8pfZT2-eAoD3GEb4H-I4MfBK-o_sO/s1600-h/100_0405.jpg"><img id="BLOGGER_PHOTO_ID_5190350624080311778" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOnKco9_t__4SjCKRqW0EPAgnBPw-bmKpwOBKet2q0K-TgdQrFPMAnFHzNhbxbSJa1p8glSDSO6NZVKFEwAKIJ4y1JSANDdAFKJuHqJUJDKsdzVpx8pfZT2-eAoD3GEb4H-I4MfBK-o_sO/s200/100_0405.jpg" border="0" /></a><br /><div><img id="BLOGGER_PHOTO_ID_5190350447986652626" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxTkXsL_6r4WK3j8xLUMfV1ArFVfCD-2m-Bd-gnkXiZUVxQBMH3z_QVU_ANkR6_l6uohIKzEYx2L9OCfJ6GO-y4wiOnFcTFwMvq27RT9qBPee7qe8VU-mUk4J-7tOiGSrJDNEqnRi_D5jj/s200/100_0377.jpg" border="0" /><img id="BLOGGER_PHOTO_ID_5190350795879003634" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyLq4-zUuR5h1FI1yXu1_UDF9o9NJ6w163ZFHo_VHp-Ygo4SVppNcBU1Rt8fHhAiOBo406HPYYo8A_agHZqtzNVOOC_KX0OqO2kcsx7LM_cG6TWZuTV4R6RPdA_jmlGRtbCtlhbM5BKfXy/s200/100_0430.jpg" border="0" /><br /><div><div>Hello everyone - the internet has been hit or miss so we haven't been able to upload pictures for the last two days. We have seen some pretty amazing stuff here - things you can't even begin to put into words. The dedication that the career missionaries have here is beyond what I can describe. They are amazing in every sense of the word. I hope I can get some pics up - Kavara will post about the "hand" picture at a later time because it was her patient. I just wanted to get it up for everybody to see. The patient went to C Section and the baby did fine !!!</div></div></div>Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com0tag:blogger.com,1999:blog-6414180604081422663.post-18781468787101620332008-04-15T17:47:00.002-04:002008-04-15T18:35:40.263-04:00Another Tuesday post...It was a really good day today. We saw lots of cool things like TB, and malaria, and more malaria......and did plenty of procedures......Becky and I are on call tonight together. We just finished up doing evening rounds - visited with the patients and nurses....and now Becky just came down - we are heading down to see a gun shot wound and someone unconscious from either malaria or etoh?? Go figure.....gotta run - may be up all night !!Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com5tag:blogger.com,1999:blog-6414180604081422663.post-19471279743281037452008-04-15T17:20:00.003-04:002008-04-15T19:23:11.762-04:00My yellow eyed patient<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6XXuD_dSwpCLl9vmtwcCRrOEDYBr6CJkZFAcktM-rSlcqX3RxW2P6iebYa1hh7PwBsGtFap6vNeqwicU0KAirbCEv9e8mbUJpf-5YWrc9BTunF3dmZkhqFNfPj3Sfr_dvTZh2qKEEfTc/s1600-h/Kavara's+photos+057.jpg"><img id="BLOGGER_PHOTO_ID_5189586498873507922" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6XXuD_dSwpCLl9vmtwcCRrOEDYBr6CJkZFAcktM-rSlcqX3RxW2P6iebYa1hh7PwBsGtFap6vNeqwicU0KAirbCEv9e8mbUJpf-5YWrc9BTunF3dmZkhqFNfPj3Sfr_dvTZh2qKEEfTc/s320/Kavara's+photos+057.jpg" border="0" /></a><br /><div>I finally took the time to figure out how to post pictures, so I hope to start contributing more to the blog. We are all going to start trying harder since Sarah is leaving today and she has been the heart of our blog thus far. This picture is from a few days ago, but I want to tell you about this man. Thus far, he is the patient who has had the most impact on me and, although I can't say for certain yet, I think he is the patient I will remember most after leaving here. He came to clinic last Tuesday a week ago. About one month ago, the whites of his eyes and his skin started to turn yellow, he developed severe abdominal pain, and began to have difficulty eating because his stomach hurt so bad and he vomited when he tried to eat. He has lost 20 pounds in the last month. By the time he came to our clinic, he had already been hospitalized three times in the last month and was treated for three different diseases without any relief . . . they were nowhere close to getting his diagnosis correct and did not even send him for proper lab work. I am not sure why this is . . . it may be because they knew there was nothing they could do, so they just treated him for other things just to be doing something for him. He came to us in desperation. After reading through his records, hearing his symptoms, and performing his physical exam, I knew there was something very wrong with his liver or another organ that affects his liver. The problem is, we only have a few blood tests here and cannot do liver tests in our lab here. Towards the end of my interview with him, he looked at me and told me he felt very weak and could not eat or drink and wanted to know if I could admit him and give him IV fluids. I consulted with the doctor I was working with and we decided it was best to send him to another hospital to get his lab work as soon as possible, so I had to tell him no, which I really did not like. I thought about this man a lot over the ensuing days . . . I just couldn't stop thinking about him asking me for such a simple thing and having to tell him no. I realize that I have not been practicing in this environment very long and that is was probably the best thing to do since we could do nothing for him here to treat his disease, but it was still very hard to send him away. I did not think I would ever see him again. Well . . . on Thursday of that same week, I was working in clinic with Sarah. Two people work side by side in each clinic room. I was not paying attention to the patients she was seeing that morning because I was focused on my own. After reading a patient's chart, Sarah nudged me because she recognized my writing from the note I wrote in his chart earlier in the week. I looked up at the patient she was seeing and have never been so happy to see bright yellow eyes in my life! Sarah sent him my way. He showed me his lab tests which showed there was indeed something severely wrong with his liver (his bilirubin was nearly 20, an obstructive process for those of you who know what this means). He told me he was in such severe pain that he could not sleep at all the last two nights. I admitted him for pain control and IV hydration. I also had the idea that I would be able to orchestrate him getting other tests or treatment at another hospital while he was here. After he got to his hospital bed, I went and talked to him for a long while. I told him that he most likely had cancer in an organ in his stomach (liver, gallbladder, or pancreas) causing his symptoms. This diagnosis is a death sentence for almost everyone here because there is nothing we can do . . . no surgery, no chemo. These cancers are even hard to treat back home. I told him he could try to go to another hospital to see if they could do more tests or offer him more treatment (I thought that he may have stones that our old ultrasound machine did not catch, which are treatable, unlike cancer). This was probably not the right thing to do though. This man may be seeking money from all of his friends and family for money to travel to hospitals and for treatment and he may be spending a great deal of his last days travelling to get this treatment. I should probably have told him to go spend time with his family. It is not easy to get around here . . . only the wealthy have cars. He does not have a car. I guess I will never know. I told him this because he was a young, healthy man otherwise and this diagnosis was so unexpected to him and I just thought we might be missing something . . . even through he was stoic and brave, I could see his shock and sadness and desire to live. It was hard to see him go. I sent him home on our typical meds for cancer treatment . . . phenobarbital (a seizure medicine that takes the edge off pain), ibuprofen, and elavil (for sleep). For those of you who don't know, these medicines are nothing at all compared to the pain medicine we give for cancer pain in the U.S. . . . absolutely nothing. To end this story, my patient told me that his wife wanted to "greet me." I went to the courtyard to meet her. I talked to her for a bit and ended up telling her what I thought her husband had (which you don't do at home without permission from a patient). I later told him this and apologized and he said, "It is okay. She is my wife and needs to know." She had no idea . . . she thought it was an ulcer. Tears welled in her eyes, but she very bravely thanked me and told me she did not have any questions when I asked. She then gave me the two loaves of bread she had brought with her for their journey home (she is a breadmaker). It is rude to not accept gifts here, so I accepted it. It was very hard to see this man go . . . it is hard to see a man who was healthy and strong one month ago head off with his beautiful young wife knowing there is nothing I could do for him . . . I couldn't even give him that much for the severe pain he is going to face over the next few months. His trust in me and his bravery and stoicism, as well as his wife's generosity made it even harder to watch him go. It was uncomfortable for me, but it was likely what was best for him . . . during my internal medicine rotation at WVU, I watched my patient who likely had the same type of cancer as this man sit in a hospital bed for 2 of the last 3 weeks of his life waiting to be stabilized so he could start chemo. He just wanted to go home to be with his family . . . he spent very little time at home because of all the tests we were running and procedures we were doing on him . . . it is just different here. I hope my patient went home to be with his family. </div>Kavarahttp://www.blogger.com/profile/09217701764318822549noreply@blogger.com8tag:blogger.com,1999:blog-6414180604081422663.post-5548295844008948972008-04-15T15:47:00.006-04:002008-04-15T16:20:22.868-04:00A good Tuesday<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwjOWylyRW3jSEvQd5H3osbaDcC13x-bHoWP9jwir2VYvNr1l8FRNLFE9JNKtgQrMiBrLzmoisqjp5W89aepHgeHww9q537LvQG3uf4KGJkpzoROMx1xn2-61GOMAS3dBlq-UaEB4N87Mq/s1600-h/ghana+3+003.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwjOWylyRW3jSEvQd5H3osbaDcC13x-bHoWP9jwir2VYvNr1l8FRNLFE9JNKtgQrMiBrLzmoisqjp5W89aepHgeHww9q537LvQG3uf4KGJkpzoROMx1xn2-61GOMAS3dBlq-UaEB4N87Mq/s320/ghana+3+003.jpg" alt="" id="BLOGGER_PHOTO_ID_5189565875713978050" border="0" /></a><br />Today is my last day in Nalerigu, and I was able to do all my favorite things. I went for a walk just after sunrise, then we did morning rounds on the Pediatric patients. After doing CPR to try to revive a child on yesterday's rounds, today was refreshingly good. Everyone had improved. I went to the Nutrition Center to round on the malnourished patients and had some good conversations with the mothers about feeding their children. It is universal that some first-time moms need to learn how to feed their children, so I gave some routine general peds advice. The patient who has kwashiorkor seems to be doing a bit better now. She is the one with the wrinkled face, due to edema. One baby was HIV positive, so I discussed treatment options with her grandmother. The nurses, mothers and children are so appreciative of any help I am able to give them. I find the Nutrition Center to be one of my favorite places.<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoGdY40rrL_0vP9s4-n8BV2m1Sl01Mn8bdm3Q9hcIgLaAjgg75hF2vmhPZOXxl29EdSMQMYi9YCgjtanO2R4-SC87PtimfX8f1kiyEkx0eACcQKm2o0s2ZUgZBU2qzsLfU1gzDD4WjidZx/s1600-h/ghana+3+106.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoGdY40rrL_0vP9s4-n8BV2m1Sl01Mn8bdm3Q9hcIgLaAjgg75hF2vmhPZOXxl29EdSMQMYi9YCgjtanO2R4-SC87PtimfX8f1kiyEkx0eACcQKm2o0s2ZUgZBU2qzsLfU1gzDD4WjidZx/s320/ghana+3+106.jpg" alt="" id="BLOGGER_PHOTO_ID_5189565712505220786" border="0" /></a><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhid2FLm-PPdPe88hfONwIHzsW7Mttgde9wjIWXiD0bB5vA2qW6-sKdIBm7TM4eBcUoIJem1zyOvkIp54aXomt3-xkDp8ZhOJZltah59hHHJ2wJ7Sr6af-xRGeE3Xvxs_A4otstY3yOikDQ/s1600-h/ghana+3+007.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhid2FLm-PPdPe88hfONwIHzsW7Mttgde9wjIWXiD0bB5vA2qW6-sKdIBm7TM4eBcUoIJem1zyOvkIp54aXomt3-xkDp8ZhOJZltah59hHHJ2wJ7Sr6af-xRGeE3Xvxs_A4otstY3yOikDQ/s320/ghana+3+007.jpg" alt="" id="BLOGGER_PHOTO_ID_5189565575066267298" border="0" /></a><br />In the afternoon, I went out with the Public Health officers to a remote village for a health festival which was designed to educate the villagers about exclusive breast feeding and the importance of immunizations. In return, the villagers danced for us and made us a meal. It was about 120 degrees by mid afternoon!<br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh_NGclYSRy80gTWQ0eGSt-UE0fviVE2CwGqy91bvdjKCyiyXxCFnjxRzCfqW0jSmPi3g2zS640PTvL8Xl0KgmtVYsNe-IWTPFhsuuhazmORgQvOWdE-IBB2-_uypqTQWYu-lgvkNYghb5/s1600-h/ghana+3+028.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh_NGclYSRy80gTWQ0eGSt-UE0fviVE2CwGqy91bvdjKCyiyXxCFnjxRzCfqW0jSmPi3g2zS640PTvL8Xl0KgmtVYsNe-IWTPFhsuuhazmORgQvOWdE-IBB2-_uypqTQWYu-lgvkNYghb5/s320/ghana+3+028.jpg" alt="" id="BLOGGER_PHOTO_ID_5189565420447444626" border="0" /></a><br />I returned for afternoon rounds and to take some more pictures of some of my favorite patients, and here they are!<br />Tomorrow I will leave to start heading home. It is sad to leave because this has been such a wonderful experience...but it will be nice to be home again.<br />Many thanks to all who have been wishing us well and following along on the blog!<br />Sarah <br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifk00bSNZeLGcF2Ar6QViwjVBV9UKYeVnzPLix-LF4dxEIcHIM0QeHG-UoUH9GD2YsSDEk4rdevDE6yXhbLb1La_9RllkcMInx5hB-3l7ooDHYfeeUTZifALB5ulrrh8WCPWs7rF6X5O25/s1600-h/ghana+3+115.jpg"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifk00bSNZeLGcF2Ar6QViwjVBV9UKYeVnzPLix-LF4dxEIcHIM0QeHG-UoUH9GD2YsSDEk4rdevDE6yXhbLb1La_9RllkcMInx5hB-3l7ooDHYfeeUTZifALB5ulrrh8WCPWs7rF6X5O25/s320/ghana+3+115.jpg" alt="" id="BLOGGER_PHOTO_ID_5189565162749406850" border="0" /></a>Sarah Moerschelhttp://www.blogger.com/profile/17558918235459876741noreply@blogger.com1tag:blogger.com,1999:blog-6414180604081422663.post-57840408714206253992008-04-15T03:07:00.001-04:002008-04-15T03:09:20.911-04:00Arrival at BMCBecky and I made it up to BMC yesterday around 2 pm. We ate, put on our scrubs and headed down to the hospital. I saw alot of patients on my own and Becky saw Peds patients with Sarah. Becky also did a couple of paracentesis and I got to see some cool stuff. Will blog more later tonight and try and upload some pictures. We tried last night and it was too slow.Shelleyhttp://www.blogger.com/profile/11414546355771649394noreply@blogger.com1