conakry, guinea

22 Jul

we arrived safely to conakry last night… the trip was seamless, and we are happy to be here.  rachel and adam were surprised to find that a completely new area of the airport had been built since their last visit!

we have been welcomed by so many people already, old and new friends.  we made several visits around the city today — a school called “emmaus”, the home of pastor sanyo, and a local clinic.  we are adjusting to the humid heat, but enjoying visiting with everyone.

we will not likely make it to the internet cafe often, but wanted to let everyone know that we arrived!  thanks again for all your love and prayers.

ghana in pictures

21 Jul

If you get a chance, visit the baptist medical center in Nalerigu, Ghana. You will fly into the capital of Ghana, Accra (a-craw). There you will be greeted by someone who is holding your name on a piece of paper. From here you will drive to the guest house. This is a great transition point for your trip because there are several comfortable amenities and different types of people. The amenities will make your transition a little less difficult and the people will tell you great stories or give out advice from their own experience. From here you can either take the bus up to Tamale or you can catch a flight. We took the flight and we were served tuna or chicken sandwiches with juice or coffee at 6:30 am. In Tamale you are again greeted by someone who will drive you to Nalerigu which is a two hour drive over paved and dirt roads. Upon arrival there is a quick drop off and they tell you your room. Pretty much from here on out, you are on your own, to work or find work or relax or build a door or work in the peds ward or farm with the locals or walk to the river or drive with the long-term missionaries to the escarpment. We did it all! Or at least we collectively did it all! Here is a great glimpse of our time at the BMC.

in accra! videos!

21 Jul

We’ve been away from fast reliable internet for 20 or so days now. But in the Accra guesthouse we are able to load and load well. So without further ado… here are some of our experiences!

When we first arrived in Tamale we were picked up by Issahaku. The drive from Tamale to Nalerigu had a portion that was dirt and was quite bumpy.

 

One of the first places we visited in Nalerigu was a food orphanage. (Adam and Aaron fixed the door.) They danced a really fun dance and one of the volunteers got in the line.

 

Chini was one of our favorite people and we miss him dearly already. Here is the day he brought over his guitar and played for Adam and Aaron.

 

The escapades with the monkey were a always entertaining. This one was a particularly funny interaction.

 

The peds ward was always slammed. Here is one corner with both the doctors working hard.

 

Devotionals for the staff were at 7:00am every day. Here is the First Baptist Choir at our devotionals.

 

A view of the escarpment where Ghana looks into Togo and Burkina Faso. Pretty impressive!

travelling in africa

20 Jul

We woke up around 2:30 a.m. this morning to get ready to leave Nalerigu.  It was hard to wake up, but of course we all planned to go immediately back to sleep in the van on the drive to the Tamale airport.  We packed up the rest of our things, got dressed, and waited for our ride.  He pulled up in a Nissan pick-up truck – about the size of the truck in the picture below:

Our hearts sank as we realized we would definitely not be sleeping since we would be crammed into the small backseat.  We loaded into the truck and started driving.  It became quickly apparent that our driver would not be using the A/C, and in fact, had what felt like the heater on low.  We were all getting warmer… and warmer… and then noticed that he reached down to adjust the temperature setting on the truck.  Sweet relief.  Or so we thought.  Within about 5-10 minutes, it was at least 15 degrees warmer and we were all sweating and sticking to the pleather seats.  Below is a sampling of the thoughts going through our heads on the drive…

Rachel:

“I’m going to suffocate.  I’m going to suffocate. I’m suffocating.”

“Why won’t Adam turn the A/C on?  We can’t breathe in here!”

“Where are we… HELL?!” (shout out to Chuck Jamison!)

“Lord, get us out of here, please.” (an actual prayer)

Adam:

“What is that smell? Is it somewhere between a fart and pleather?”

“I can’t breathe.”

“I think my left leg is falling asleep.”

“Where is Issahaku?  I don’t even like this guy.”

Courtney:

“Why in the world do cars have to have a hump in the middle seat?”

“Aaahh.  So comfortable (leaning her head back on the seat, waking up every 5 minutes when we hit a pothole).”

Aaron:

“Where’s the van?!”

“God, get us off the dirt road as quickly as possible.” (another actual prayer)

I realized I had a problem when I felt sweat dripping down my back at 3 a.m. in a truck with “air-conditioning” turned on.

My knees are literally bruised from banging into the seat in front of me with each bump.

“All I can smell is body odor and pleather… AIR! (after rolling down the window)”

If we hadn’t experienced Africa to the fullest before today, we definitely have after the truck ride.  We were dropped off at the Tamale airport and then waited for the plane to arrive.  We flew back to Accra which is about a 1.5 hour flight without problems and Solomon picked us up and took us to the guest house.  We were so happy to be done with travelling for a day.

We sat around for a short time, and then walked to the supermarket down the street from the guest house to pick up some refills on food items – namely oatmeal and peanut butter – to take to Guinea.  We are so excited to eat in Paris that we don’t want to chance getting “Guineabelly” (a well known phenomenon that occurs after eating food in Conakry for any period of time and consists of cramping and frequent runs to the restroom).  We also needed to get something to eat for lunch today and tomorrow.  Luckily, the supermarket nearby is one that imports many foods from Europe and theU.S.  We were able to find Jif peanut butter, Quaker oatmeal, and Reese’s pieces candy.  We also got deli meat and cheese, tomatoes and fresh bread to make sandwiches for lunch!  We picked up some pineapple and mango from some ladies across the street before heading home to eat.  The turkey sandwiches were amazing and the mango was sweet.  We went to sleep for a long nap with full and happy bellies.

We will eat dinner at the guest house tonight – pot roast and veggies.  We then hope to rest and watch movies and just relax.  We are looking forward to some down time over the next week before it’s time to get back to the grind at Children’s.  Our flight to Guinea doesn’t leave until 3 p.m. tomorrow, so we will get a chance to sleep in and pick up some more food items (the bread was so tasty that we think we might need some more).  We will continue to try to post in Guinea, but our access to internet will be limited – we will likely have to post several blogs at once.

– Rachel (with quotes from others)

last day in the ward

19 Jul

Today was our last day to round on our patients in the pediatrics ward.  The ward was beyond full with 59 patients (remember, only 37 beds).  Moms and children were sleeping on the floor in the middle of the room and between beds, and there were two children per bed along one side of the ward.  IV poles were everywhere with fluids and blood transfusions hanging.

The nurses lined up the kids in the middle of the room who weren’t connected to an IV pole for us to start seeing.  We essentially start at opposite ends and the moms carry their children down the line of stools until they get to us to be seen.  We then round on the children with IV’s connected – they stay in their beds and we come to them – though the ward has been so busy lately that Dr. Hewitt, Dr. Wilson, and Dr. Dickens usually make it through the rest of the hospital before we finish and come to help us with the kids.

We were able to send many home today – a lot of the admissions from last night just needed some extra fluids or a transfusion.  It’s crazy how much our concept of an acceptable hematocrit has changed since being here in the middle of malaria season – we pretty much only transfuse for hematocrits below 19% (in the U.S., we typically transfuse for anything below 24%, sometimes higher).  We have also become experts at feeling large spleens and livers in kids when examining them – a skill we were excited to master.  We feel ready to be senior residents in charge of many patients, and are not as scared to be the one to run a code in the hospital when we get back home.  It has been such an amazing experience.

Rachel’s translator for today is named Ralph.  He is a fabulous translator and is so interested in learning – he always asks questions and does such a good job explaining things to the moms of our patients.  He told Rachel at the end of rounds that if he had the power, he would give her an award for the hard work she has done here.  He said that it “is better” with us in the pediatrics ward and he wishes we could stay longer.  All of the nurses have been telling us how sad it is we have to leave and that we must return some day.  It has been so encouraging to hear these words from them.

This afternoon, we held an in-service for some of the nurses on treatment of seizures (see previous post, “all for good”).  We discussed the physiology of seizures, the potential complications of having seizures, the mechanisms and indications for valium and phenobarbital, and the proper doses of each.  We were surprised by their enthusiasm to learn – they participated actively and asked great questions throughout the presentation.  We went over several cases at the end to illustrate the concepts we covered and they had clearly been listening as they were able to answer all of our questions correctly.  We then spent some time answering their questions and discussing some scenarios they had seen on the wards.  It was encouraging to see how interested they were in learning and how appreciative they were for the in-service.  Unfortunately, the pediatrics ward was so busy that none of the pediatrics nurses could come.  However, those that attended agreed to teach others and we are planning to type up our presentation and provide it as a handout for all the wards to review.  We have also re-designed the protocol of standing orders for the pediatrics ward – it will be hung in the pediatrics ward.  You can see the new protocol under the documents section on our blog.

We then distributed all the left over supplies to various wards – blankets, onesies, diapers, and bulb syringes to the maternity ward, surgical supplies to the theater, medications to the pharmacy, and band-aids, medications, medication syringes, pediatric nasal cannula, and the glucometer to the pediatrics ward.  The nurses in the maternity ward were so sweet – they thanked us and expressed their sadness that we were leaving “just as we were getting to know each other.”  Everyone was appreciative and wished their blessings on us – it was like Christmas.  So fun.

Tonight, we are apparently having pizza for dinner – they must have read our minds!  We are then going to the Nyhus’ house for dessert (ice cream sandwiches made with chocolate chip cookies!!  so excited) before heading to the village streets to pass out glow bracelets and necklaces as our last hoorah with the kids.  We leave at 3 a.m. tomorrow to drive back to Tamale to catch our flight into Accra.  We are sad to be leaving, but so thankful to have gotten to come.  We have been so deeply blessed by the people here – by their hospitality, bravery, sense of community and willingness to accept us into it, joy, and faith.  Our God is so, so good.

– Courtney & Rachel

de-swa (describes a person who was sick and now is better)

18 Jul

Yesterday, we all went to the escarpment with the Wilson and Hewitt families.  The escarpment is the one tourist attraction in this part of Ghana and was definitely worth the 45 minute bumpy drive in the crowded van.  It is a large cliff that overlooks a valley – you can see into neighboring countries from the cliff and it is just breathtaking.  To get to the cliff, you have to “hike” for about 15 minutes down a dirt path and over rocks through what seems like the jungle of Africa– very authentic.

Once at the top, there are two rocky cliffs to climb up and around.  The views are amazing and it was so nice to be outside in the fresh air.  We were glad we got the chance to see Ghana in this way.

The drive itself was also beautiful and interesting.  We passed through several villages with lots of waving children, huts, crops, goats, donkeys, etc.  We stopped in a few villages for snacks (cookies, peanuts, and dried dates) and sodas.  It was so fun to see a glimpse of the daily life of the people in the villages, sitting around selling harvested goods and enjoying each other’s company.

Today, we rounded on the peds ward in the morning after getting an amazing night’s rest due to a big rainfall with cool winds.  We finished early and had time for a short break before heading to clinic where we saw just under 100 pediatric patients.  Most were malaria or viral respiratory illnesses, and of course the rashes we still can’t diagnose with certainty.  We also had the joy of seeing follow-up patients from recent admission or clinic last week – most were doing much better with smiles on their faces.  We decided we should have had all of our patients come for follow-up so we could have seen then well and acting like children again.  Of course, that would mean seeing 200 patients in clinic, so probably not a good idea!  We’ll just be happy knowing that the majority of our patients go home and stay home, because they are well again.

Just an update – our two premature babies we have been taking care of are doing very well as of today.  One of them is 9 days old and the other is 5 days old (and feisty as can be).  The moms are so sweet and are doing such a great job of using the oversized diapers and clothing to keep their babies warm like we asked them to.  They are also trying to breastfeed them so the babies can learn how to, then cup feeding them so they can get the calories.  Both are on aminophylline (a medicine that helps them remember to breathe) and the younger is still completing a course of antibiotics (a measure taken here for all premature babies to give them the best chance).  We feel like we have finally gotten into the groove of taking care of these tiny babies in such a foreign way.  Because there are no labs or respiratory support or cultures, etc, we’ve decided they do best when you let the mom’s try to feed as best as they can and provided minimal support (a little IV fluids, antibiotics and aminophylline).  And so far, it seems to be working.  They still have a ways to go, so continue to pray for them and the moms, but we are happy with the progress they are making.  We took pictures of them side by side today and with their moms.  Adorable!

We had a term baby who had neonatal seizures and respiratory distress that we treated for pneumonia.  We were also concerned about brain injury during birth because she wasn’t feeding well and had abnormal muscle tone.  She got to go home yesterday after being weaned off oxygen, seizure free and starting to breastfeed.

Over the last couple of days, we have started to say good-bye to some of the people we have worked with.  We are sad to be leaving and feel like the time has passed by much too quickly, but have gained so much knowledge and understanding that will be priceless as we start to plan our future work overseas.

– Courtney & Rachel

deep hunger

18 Jul

“the place where God calls you to is the place where your deep gladness and the world’s deep hunger meet.”  frederick buechner

it is a beautiful thing: to feel like the thing you are doing is exactly what you were made to do.  i have felt it this year, in my first year as a doctor to children, and i have felt it even more here, being the doctor for children in a developing country.  the rhythm of waking up to go see patients in the pediatrics ward has been surprisingly fulfilling, despite all of the sadness and frustration we have faced.  the ability to show people i care about them, the intellectual stimulation of thinking through a patient’s disease, the opportunity to witness the joy of a recovering child and also to sit beside a mother who is grieving a loss, experiencing the thrill of a new culture and language, basking in the natural beauty of the world… these are the moments i expected, as i followed God’s call on my heart to medicine and to missions.

and yet, even as we feel those moments of sheer joy in doing what we were made to do, i imagine that many of you can sympathize when i tell you about the moments when i question His plan.  i know you created me uniquely for this call, God, but… why did i have to be the one you chose to go through the grueling hours of medical school and residency?  why did you have to choose me to give up the comfort of the western world to eat goat meat and cabbage salad?  

no matter where we find ourselves — whether in places of growth through hardship, or even in places where we are envied by others — the question comes, often at times of exhaustion.  why did you call me to teaching high schoolers?  why did you choose me to minister to the homeless?  why did i have to lose my father to gain a ministry to others who have lost their loved ones?  why do i have to struggle with infertility?  why did you call me to be a stay-at-home mom? 

i don’t mean to imply that God imposes pain and hardship on us.  the problem of pain is much better detailed by c.s. lewis and others… i am ill-equipped to go there.  but i do think that each of us can see the good that God has done through our sacrifices and sufferings.  and to that extent, we can say that he has called us to that ministry.

so as i ask that question, wondering why this “deep gladness” in me (as i care for pediatric patients in ghana) has to be so challenging and difficult… he reveals to me one answer.  an answer that, while not always enough, is undisputable.

and the King will tell them, ‘i assure you, when you did it to one of the least of these my brothers and sisters, you were doing it to me.’  matthew 25:40

the least of these.  yes, it is hard for me to be far away from my family.  it is difficult for me to sacrifice the comfort of a beautiful home and my favorite foods.  but it is so very hard for that mother to walk four miles to arrive at our clinic.  it is incredibly exhausting for her to keep all three children calm, while the white doctor examines one of the them and the other has an accident on the floor (no diapers here).  and it is heartbreaking when her beloved child, who was playing with his friends two days ago, takes his last breath because malaria has taken his body hostage.

that is why he has called me here.  that is why he has called you there.  he knows the hardship we endure — he gave up his only Son.  but he knows that the trials we endure pale in comparison to the wonder of His love.  the love that we will experience and “the least of these” will experience, if we only heed his call.

i once thought all these things were so very important, but now i consider them worthless because of what Christ has done.  yes, everything else is worthless when compared with the priceless gain of knowing Christ Jesus my Lord.  philippians 3:8 

-courtney