WVU Ghana 2008

Ghana YouTube Video Link

2008-10-14T19:22:00.001-04:00

Here is a link to a short youtube video of the trip - enjoy

Last few pics from our trip!

2008-05-01T12:02:00.005-04:00

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.

Arrival back to the states......

2008-04-30T10:46:00.003-04:00

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.

Leaving Africa...

2008-04-29T01:45:00.004-04:00

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.

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 !

Monday morning from Coconut Beach

2008-04-28T03:23:00.002-04:00

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.

Sunday morning..

2008-04-27T05:43:00.002-04:00

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......

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.

Gotta run for now - take care...

Our arrival in "heaven".....

2008-04-25T17:19:00.003-04:00

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 !!

Another day at the hospital.....

2008-04-24T13:13:00.005-04:00

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.......

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.........

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.

Last day at BMC.....

2008-04-24T13:01:00.004-04:00

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

Pound Cake and more.....

2008-04-23T18:15:00.002-04:00

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 !!

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.

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.....

Pics of "one large knee"....

2008-04-23T02:31:00.003-04:00

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.

One large knee.........

2008-04-22T16:21:00.002-04:00

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.

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.......

Experiencing death in Africa

2008-04-21T16:47:00.002-04:00

On 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.

Two more pics

2008-04-20T18:09:00.003-04:00

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 !

Sunday evening...

2008-04-20T17:53:00.004-04:00

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.

Sunday morning

2008-04-20T10:02:00.005-04:00

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...

Hello World

2008-04-19T11:47:00.002-04:00

Yes, 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. Faile, our most excellent surgeon here, performed a C-section immediately and both baby and mama were fine!

6 yo boy follow-up...

2008-04-19T06:51:00.002-04:00

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.

Friday !!

2008-04-18T17:25:00.002-04:00

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 !

More pics - what everybody wants to see right !

2008-04-17T19:09:00.003-04:00

Thursday blog...

2008-04-17T18:44:00.007-04:00

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 !!!

Another Tuesday post...

2008-04-15T17:47:00.002-04:00

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 !!

My yellow eyed patient

2008-04-15T17:20:00.003-04:00

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.

A good Tuesday

2008-04-15T15:47:00.006-04:00

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.

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!

I returned for afternoon rounds and to take some more pictures of some of my favorite patients, and here they are!
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.
Many thanks to all who have been wishing us well and following along on the blog!
Sarah

Arrival at BMC

2008-04-15T03:07:00.001-04:00

Becky 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.

Leaving for Baptist Medical Centre

2008-04-14T04:14:00.002-04:00

We slept well in A/C last night !! Looking forward to leaving in an hour for Tamale then onto Nalerigu. We're excited to begin seeing the patients and joining the rest of the WVU team !

Becky and Shelley arrive in Accra

2008-04-13T05:29:00.002-04:00

Hello everyone - Becky and I arrived safe and sounds in Accra this morning !! It is so hot and humid ! We got through customs and immigration without a hitch and Jimmy was right there waiting for us. We are resting now and catching up with our loved ones via email then we are off to lunch and to explore Accra. Will see everybody else on Monday !!

A good Saturday!

2008-04-12T11:49:00.007-04:00

Today is Saturday. Yesterday was a difficult day, with our first real experience of death and hopelessness. Today is looking hopeful. Here's a picture of one of our patients who was very ill with a small bowel obstruction and had 2 abdominal surgeries. He is up and out of bed and looking very happy now.

Kristen, Kavara, Tracey and I went to a local "restaurant" for lunch in town. We had rice balls and soup. The women cook the food over fires on the ground and there are a couple picnic tables for eating. Notice the absence of silverware.

Here are Baba and Gago, writing their addresses for me. There is a post office in town, which was built in 2006, but it has not opened yet. The nearest post office is 1 hour away.
These boys would like me to bring a soccer ball next time I come. "Football" is the main source of entertainment for kids. I think William and Hannah would have fun playing soccer with them.

A challenging day

2008-04-12T03:18:00.008-04:00

Yesterday was a challenging day for all of us. Within 24 hours we lost 6 of our patients. Some died of overwhelming infections, and others died from lesser infections but without the strength to fight the infections off, due to malnutrition. The weather was also unbearably hot. Even the Ghanaians were uncomfortable in the heat.

Here's a patient with a seizure disorder and developmental delay, due to meningitis 3 months ago. I have a patient just like her in my practice at home.

Here we are on Thursday, looking cool and well rested.

Here's the front of the hospital, on a clinic day . Here's the view into town from the front of the hospital. Notice the bus, which has brought patients from several hours away.

At the side of the hospital, these patients are waiting to be served at the pharmacy at the end of the day. Going to the doctor is an all-day affair.

We slept well last night and now we are ready to head back to the hospital. Mary Ann is on call today (Saturday) and Tracey and I are on call tomorrow.
Shelley and Becky should be arriving Monday morning, and it will be great to see them! They are bringing us more Crystal Light.
Somehow, these photos are not lining up as well with the text as yesterday's post, but I need to go to work, so I'll post it now so everyone can see.

Thursday in Ghana

2008-04-10T18:48:00.007-04:00

Here are some photos from our days in Ghana.
On the left are some boys at church who found us more interesting than the choir.
This boy has tetanus, 5 days after a cut on the foot. He has the textbook facial grimace called "risus sardonicus" or sardonic smile, from the contraction of his facial muscles. If it progressed further, it would have paralyzed his respiratory muscles. He is doing better now.

This mother is getting nutritional assistance at the Kokodu.
She really wanted me to take this picture. We were at the mill, getting the millet and soy beans milled to prepare them for making porridge or koko. The babies breast feed almost constantly, and there seems to be no modesty about it. (but if you wear pants it is not appropriate, and don't even think of showing your knees!) Giving the mother koko will enable her to make good milk for the baby.

Here's a little girl who was playing with Tracey's stethoscope before she had a bath. She has a family member in the hospital. This is the passageway between the hospital and the isolation wards. One ward is for wound care, one is for meningitis. TB patients live further away in "TB Village" for their many months of treatment.

More Pics

2008-04-09T15:39:00.009-04:00

Hi everyone....
Dr. Moerschel is at the Nutrition Center [Koko Du] where she finds patients with Kwashiorkor and Marasumus. Then the ladies and their babies head down to the mill with the very heavy (like >50 lbs) containers of food on their head, which will be ground to make porridge.
~Tracey
(posting for Dr. Moerschel and Kavara who are now on call for the hospital.)

2008-04-08T17:03:00.003-04:00

Finally . . . my first blog post since my bio many days ago. It has been a highly fulfilling last few days in Ghana . . . all of the things I said I wanted to experience on this trip are already happening. I said I wanted to learn more about the people who devote their lives to God's service. Those people are here! We are working with about ten individuals who are here because God has led them to use their medical skills to help the people of Ghana who are so very in need of medical help . . . they are also here to witness to them, sometimes directly and sometimes indirectly by helping heal them and showing them respect and care. There is one man here named Dewey Dunn. He is a gastroenterologist from Vanderbilt. He has served as a medical missionary in many countries over the last few decades . . . to put a number on things, he has been to Venezuela alone 30 times! He is big on us going back up to the hospital for night rounds . . . we were tired and a little stressed about this at first, but it is hard to keep feeling this way when you hear him talk. He has been to this hospital in Ghana three times and he told me this morning that yesterday was his best day ever here because we all pulled together so well yesterday to serve the people here . . . we did have some really sick patients when we went back to the wards last night who may not have made it through the night had we not changed some things about their management. I am getting a bit long winded here has usual : ) As for the other things I wanted to experience . . . I am privileged to be a part of helping these hard-working, kind, brave, grateful Ghanians get better so they can get back to their families and lives. We have a lot of responsibility as students here. We take call alone at night (one student at a time) . . . and crazy things that we have never ever seen back home will come in at night . . . even things like snakebites and malaria and typhoid are scary to me . . . let alone a "moto" (motorbike) accident. If we are comfortable, we will be able to do procedures we have never even attempted back home, all on our own here. We do have physician backup if we want to call the doctor on with us, but the other students that have been here seem to be self-sufficient. None of us from WVU have taken call yet. I am on tomorrow night. Pray for me! Dr. Moerschel knows I am nervous and will help me out a lot and go up with me every time if I need her . . . still nervous though. Geez . . . long-winded. We are also getting great exposure to the culture and the land . . . church and the escarpment on Sunday . . . just talking to the people from Ghana we meet in the hospital and in town . . . and the things that happened today. Today has been a great day for a few reasons. I saw patients on my own this morning for the first time on rounds. I read through the entire chart for each of them and finally feel somewhat competent managing the care for these diseases that are so unfamiliar to me and patients that are so sick. It is hard to believe how overwhelmed I was Saturday when we first got here compared to today. I am still scared about tomorrow, but it doesn't seem impossible. You still have to help me Sarah : ) There is a feeding center on the hospital grounds for babies and their mothers who don't have enough money to pay for food . . . both the moms and babies eat. Every day, the women take whole corn and soybeans down to the mill to grind it and then bring it back to the feeding center where it is cooked in a big kettle. Like everything else, they carry the basins full of corn/soybeans on their heads . . these basins weigh sooo much!! They were very happy to have us walk with them and took care of us the whole way . . . a woman dressed me up for the walk with a ground graphite material that is a makeup for them. It comes in a little bottle and they apply it with a nail to their eyebrows and under their eyes like we apply eyeliner. A woman put this stuff on me! When we got there, a woman took me in the room and led me close to the grinder so I could see it . . . she pulled me away when I got about an inch from the whirring belt! After that, she put her shirt down on the ground so I could sit on it comfortably while we waited. And then . . . tonight I was able to donate 500 mL of blood for a baby with malaria and a hematocrit (has to do with red blood cells) of 10%, which is really low for those of you who don't know. Some of the blood was going to another woman too. I feel so lucky to have been the blood type they needed. I do admit I was a bit nervous about having a needle from here stuck in my arm. I voiced this fear to Dr. Dunn after I finished having blood drawn. I asked him if he thought the needles were clean. He said, "We pray to God they are, but sometimes you have to take risks to help people." I thought that was a good answer. I think this is long enough . . . I'll end at this. To all my family and friends (including Bradley who posted a really nice comment . . . thank you), I love you guys and hope you are doing well at home.

After church

2008-04-07T02:33:00.004-04:00

Here are two pictures of kids outside church on Sunday. This morning we will start our first clinic day, and we're expecting many hundreds of patients.
Sarah

Day 3

2008-04-06T15:56:00.002-04:00

Today we rounded on the patients and then went to the Baptist Church across the street. There are many churches in the village nearby and lots of people attend. Murray you would be happy to know that there are lots of well behaved children there. They gather on the floor in the front with their dresses and nice clothes with flip flops. As we left we bought mango's at the Hospital "cafeteria" which is a handful of shops in the front of the village to sell food to the family's of the loved ones in the hospital. Then we had lunch which is always very good...we had burrito's, chicken pot pie. Then we went to Nakpanduri and Escarpment which is a long cliff that extends miles along a fault line. We saw the "fog" which Dr. Hewitt says was a result of the sand from the Sahara Desert, which is over 1000 miles away. Good time... and gotta run...time to round!

First day in Nalerigu

2008-04-05T11:36:00.003-04:00

Today we flew from Accra to Tamale, which took about an hour. To drive the same distance would have taken 12 hours over paved and dirt roads. We looked out over the city as we left, and then watched the countryside become more sparsely populated as we went further north. We were picked up at the airport and rode for 1 hour over a paved road, and 1 hour over a dirt road. The dirt is red here. Along the way, we went through several small villages. Homes are made of mud here. Each home is a compound of several small round rooms, connected by a wall. The roof of each small, round room is thatched. The extended family lives in the compound, with one room for cooking, one for guests, one for sleeping, etc.

Nalerigu is a larger town. It is the central town for the Mamprusi tribe and the chief lives here. The Mamprusi tribe rules this region of Ghana and the surrounding countries (Burkina Faso and Togo).
We settled in to House #8, which is a guest house with 3 bedrooms, 2 baths, and a kitchen. We had 3 young boys on our doorstep as soon as we arrived, so we met them. They live in the village and like to hang out around the volunteers. Tracey sat with them for a while and got to know them.

Dr. Hewitt and Dr. Faile are the full-time family physicians who are career missionary physicians and live here all the time. We were pleased and surprised that there are some other volunteers here. There is a gastroenterologist, a retired surgeon, and 3 medical students. I think more students are coming tomorrow.

We had a tour of the hospital and met some patients. In our quick look around, we met patients with the following ailments: tetanus, malaria, typhoid, meningitis, gunshot, wound infections, and a really sick looking baby who might have pneumonia as well as malaria. I bonded with him and will check on him later. He is getting all that we have to offer (oxygen, antibiotics, and quinine for malaria). I hope he will get better.

Some of the patients' relatives were quite pleased and animated that we had already learned to say "good afternoon" in Mampruli, and the universal response, "Naaa."

Tonight we will all have dinner together and tomorrow we will round and then go to church.

I'll try to post some pictures tomorrow.
Sarah

WE ARE HERE!!!

2008-04-04T09:11:00.002-04:00

WE MADE IT!! Safe and sound in the guest house after a long flight! We are freshening up before going out to eat and seeing the city. We definately plan to rest tonight! We will write again after we settle in tonight.

We're off!!

2008-04-03T05:57:00.002-04:00

Today is the day that 3 students (Kavara, Mary Ann, Tracey) and 1 faculty member (Sarah) depart for Africa. We will be in transit to Accra all day and night today, and will arrive in Accra tomorrow morning. We will be met by Jimmy Huey, of the Baptist Mission program.

Countdown

2008-03-28T22:55:00.002-04:00

We leave this Thursday! Pack and sort on Monday. I am getting really excited.

Will we be able to post video?

2008-03-27T14:49:00.002-04:00

Here's William, helping me test my blogging ability.
Sarah

Kavara's Bio

2008-03-25T22:21:00.006-04:00

Hi : ) I am a fourth year med student at WVU. I'll be starting my residency in Psychiatry at WVU in a few months . . . although I have only lived in West Virginia for the last 10 years (only!), I am a West Virginian at heart now and I could not feel more privileged, proud, or content about staying here. If you want to be a Psychiatrist when you grow up, come to residency here! I will most likely do a fellowship in Addiction Psychiatry after residency. Speaking of addicts, I am a running addict. If I am unable to run in Ghana, it will be the longest consecutive amount of time that I have gone without running since I was 13 years old, so watch out! Seriously. I've been running ultramarathons for the last 6 years (races longer than 26.2 miles). I ran my first 100 mile race at age 22. Other than that, I spend my time bowhunting, engaging in various activities in the mountains, and going to as many small, "indie" concerts and theatre productions as I can. I hope I don't upset my parents by saying my heart is in West Virginia now. I think they know this though. I grew up in Virginia and have two younger brothers (Hi Max!), parents who love and support me, as well as many other family members and a few close friends who do the same. I love and appreciate them back even though I am not always the best at showing it. I am looking forward to this trip . . . to serving the people of Ghana, living simply, pushing myself physically and emotionally, seeing Africa (for the first time!), spending time with my friends from here who are going, and learning more about what it means to devote one's entire life to God's service like the doctors we will be working with in Ghana have done.

Mary-Ann's BIO

2008-03-24T14:35:00.002-04:00

I am a fourth year medical student at WVUH. I will graduate in December, hoping to match in pediatrics. I grew up in Clarksburg, WV, but I have been in Morgantown since 1999. I went to undergrad here for a major in biology and minor in philosophy. I come from a large family. I have 3 sisters, 2 brothers, 4 nephews, a niece, and a step-nephew in addition to my parents, step-mom, brother and sister-in-laws. I am very close to my family. Holidays and parites are a lot of fun!! I also have a cat, Muffy, who's 10 yo and fat, and 3 fish, Snape, Longbottom, and Minerva. Yes, I am a Harry Potter fan. I am a member of Chestnut Ridge Community church in Morgantown, WV, but I also attend First Methedist in Clarksburg with my family. I have been out of the country one time. I travelled around Spain for 2 weeks. I have never done a medical mission trip. I am very excited and nervous!! I look forward to what I am sure will be an amazing educational and spiritual experience!

Becky Reece: brief bio

2008-03-21T08:59:00.003-04:00

I am a fourth year medical student at WVU going into Internal Medicine. I am from a small town in southern WV, one of four kids. I have always had an interest in international work since my first mission trip to a Russian orphanage in my junior year of high school. Since then I’ve had several wonderful opportunities to travel, both mission oriented and leisurely. Places I’ve been besides four trips to Russia, include studying in France, backpacking through Europe, and a medical trip to Zambia. I am really excited about this trip to Ghana, helping the people as best I can, as well as learning as much as I can. I hope to continue international work with my career. Other interesting tidbits: I have an identical twin, who will be in Uganda while I’m in Ghana on her own medical rotation; love to read, huge Harry Potter fan; enjoy sports, both playing and watching.

Dr. Shelley Nuss - Brief Bio-Sketch

2008-03-18T09:39:00.004-04:00

I was born and raised in Cleveland, Ohio where 200 inches of annual snowfall was the 'norm'. I attended Purdue University where I earned my Pharmacy degree, prior to attending medical school at West Virginia University. I completed a combined residency in Internal Medicine and Psychiatry at WVU and have been on faculty at WVU since then. I have been active in medical student and residency education and in my own clinical practice I split my time between IM and Psychiatry. Anyone who knows me soon finds out how much I love medicine and the longlasting relationships we form with our patients. I also have an identical twin who is a Peds/ER doc at Children's in Columbus, Ohio.

My only 'international' travel has been to Scotland to golf, so coming to Ghana, Africa will be an adventure for me !! I look forward to sharing my knowledge, lending a hand to those in need and seeing and learning things I have never seen before.

In my spare time, I enjoy Mountaineer football games, golfing, beach trips and spending time with my family. My partner and I have a daughter, Carly, who is 5, and son Andrew who is almost 7. They keep us pretty busy and by March each year they yearn for our annual beach trip to Hilton Head or the Outerbanks of North Carolina ! This should be an amazing trip is so many ways. Thanks to those that have helped coordinate this from the Baptist Medical Centre.

Tracey Mehlman - Brief Bio Sketch

2008-03-18T09:31:00.002-04:00

Hi everyone ! I am a 4th year medical student who will soon be graduating from West Virginia University School of Medicine in May 2008. I will be startinga residency in Diagnostic Radiology with hopes of specializing in pediatric radiology. I love to travel and since High School have aspired to join medical missions such as Operation Smile, and have always wanted to visit Africa. I am very excited to be a volunteer at the Baptist Medical Centre in Nalerigu, Ghana and look forward to meeting the people and gain valuable clinical experience, especially procedures. For fun, I enjoy making jewelry, reading, swimming and sunbathing ! Thank you for coming to our blogspot - we welcome your input and questions.

Dr. Sarah Moerschel - Brief Bio-Sketch

2008-03-18T09:29:00.001-04:00

I am a general pediatrician from Harpers Ferry, West Virginia. I attended medical school in Chicago and did my residency training at the Children’s Hospital of Philadelphia. During my medical training, I had the opportunity to participate in two international electives, in St. Lucia and India. These experiences had a profound effect on me personally, and helped shape my approach to the practice of medicine. I am looking forward to lending a hand in the medical care of the people of Northern Ghana. I am very excited to be one of the faculty members for 4 students who will be having their first international medical experience.
When I am not "doctoring," I am a mother of two children, ages 5 and 7 years. My husband and I like to camp, cook, and run. In my younger days, I played women’s rugby, but most people would not guess that by looking at me. I don’t look very intimidating, but I had a reputation for being pretty tough on the field.

Next Africa Meeting

2008-01-10T13:54:00.000-05:00

Our next and final meeting with all those going will be Thursday, March 6th at 4 p.m. Dr. Moerschel will be in town and it will be the last face-to-face meeting before the trip begins on April 2nd. Things are moving along as far as the donations from Mylan. I am waiting for the 501C3 to send - they have my license. Once they have the non-profit paperwork we are good to go. We will each be responsible for taking part of the medications in our luggage. Dr. Hewitt does not think he needs the surgical trays, but he needs all the BP cuffs we can get him.

Everybody will need to get a "student" visa as the last piece of paperwork. Please go to the link I have previously provided. You will have to have 4 forms and 4 passport photos to get the visa. So don't wait until the last minute to get the photos taken. Processing time is approximately one week. Posting pictures is easy and I think video would be just the same. See everybody in March !

Testing a Picture Post

2008-01-03T18:37:00.001-05:00

Just testing how to upload a photo - enjoy !

Meeting Thursday Jan 3rd

2008-01-02T11:52:00.000-05:00

Hi all - we have our second Africa meeting set for Thursday afternoon around 4 pm - possibly earlier to go over logistics, details etc. I hope everyone is getting excited about our trip - 8 inches of snow on the ground here in Morgantown will seem heavenly after being in 100 plus temps without A/C in April ! Hope to see everybody tomorrow !

2007-12-28T11:23:00.000-05:00

I am just testing it out. Happy New Years to everyone.

Blog working !

2007-12-27T11:07:00.000-05:00

Hi Sarah - looks like it is working. I am enterting this new post to see how it works as well. I got quite a few things for Christmas for the trip. I am getting so excited as you might imagine ! I am still working on the Mylan contact for the charitable drug donations. ! Happy New Year !

First blog entry

2007-12-26T22:56:00.001-05:00

This is the first attempt at blogging, as we prepare for our trip to Ghana!