Ghana Adventure

top pic is the outside of the dental clinic.

second is the view from the door of the clinic, looking right (still can't get over how cool it is that these ladies can carry so much on their heads).

third is a pic inside the clinic...curious schoolchildren peeking through the slots.

fourth is a cute little boy who
stopped by.

sorry i haven't been keeping this up to date the past few days, but things here have gotten quite busy. i've found out what my job is going to be like for the next three months and, as with everything, there are pros and cons. i am basically going to be splitting my time between the medical and dental teams. true, i have no experience with dentistry but fortunately my job does not require it. the dental team is in desperate need of administrative help so my official job title is "dental coordinator." i had told mercy ships on my application that i would serve wherever i could be of most use and this is what was needed most at the time, so i am happy to do it. basically it involves running the mercy ships dental clinic, which is located on shore in one of the poorest sections of tema. the advantages of this position are that i get to get off the ship more often and that i get to use my organizational (aka neat freak) skills. i started my dental clinic job on friday, and my work included things like getting the patients organized/triaged (many non-dental patients show up, which i have to refer elsewhere), registered, histories taken, appointments made if the clinic is full for the day, taking pictures of all the adorable kids that filter over from the school next door, and making sure that all the supplies are well-stocked and the sterilizer is working correctly (it has been on the blitz lately). the cons of the job are that we are out in the heat, and here the heat is brutal...we're like an hour from the equator. also, it has the potential to get repetitive after awhile...

...which is why i was really happy when i found out that i'll also be working on board with the medical team by taking part in the doctors' night/weekend call rotation for the wards and crew. the anastasis has only been in ghana for a couple of weeks and it takes awhile for the ship to get fully stocked/settled/legal issues worked out so the surgeries haven't started up yet. the process in which they recruit and select patients for surgery is an unbelievable model of efficiency. they basically spread the word weeks in advance via churches, flyers, etc that there is going to be a screening day for certain conditions. yesterday (monday) was the screening day and thousands of people were waiting in line by early morning, some who had traveled ten hours or more and many who had camped out several nights. in a matter of 48 hours all of those patients go through a process in which they are interviewed, selected out for those conditions that we have the capability to treat (those who we can't treat are offered referrals to local health services and/or prayer), registered, full histories/vitals taken, meet with appropriate surgeon for exam, biopsies taken and results obtained (if necessary), full physical exams performed, pre-op lab work done, necessary prescriptions dispensed, appointment for CT or other test on ship made, and surgery scheduled. all of this happens in a room about the size of a high school gymnasium and by the end of the two day period, we have our OR schedule filled for 3-4 months.

my role in all of this is that i was one of the three doctors to do the full physical exams on the patients who had been selected for surgery. our goal was to make sure that they were all medically cleared for anesthesia...a challenge since most had had no previous health care. it was an amazing experience in several ways: i got to see the surgical pathology close up (HUGE...10-12 inch...neurofibromas, goiters, keloids, hernias, jaw tumors of every size/shape/composition, full cleft lip/palates in adults, burn contractures, and a variety of other facial abnormalities that i can't even put a name to). i think the smallest facial tumor i saw was about 4-inch diameter...they were all just so advanced and many had become so heavy that over time they had pulled and stretched the orbit to where it was completely covered and hung down around the chin. the culture here is such that most of these people are ostracized because of their deformities, so it's going to be so awesome to provide a service that will both help their functional status and their self-esteem and ability to work and support their families. another fun part of the physicals was that i heard all sorts of interesting heart sounds (i now feel quite the expert on the murmur left by rheumatic fever...others were so strange i could only describe them and wish we had an echo machine.) amazingly, despite their late-stage tumors most of the patients were very healthy overall...i saw no diabetes, only a few hypertensives, no pneumonia, and only a couple with asthma, all very common in US clinics. the scary part of it all (which i'm sure my classmates can appreciate about now) is that there was no one checking my work, and none of the diagnostic tests available that we rely on so heavily. so i hope i didn't give the okay to anyone who will end up having some condition that i overlooked that causes them to code during surgery.

one patient stuck out in my mind: a woman with a gigantic jaw tumor that extended into her mouth to the point that when i looked in her mouth to see what kind of airway she had for intubation, all i could see was tumor...no teeth, no tongue, no pharynx. she was tachycardic at 114 and had lost 20 lbs/month over the past few months because she could barely even take in liquids. her surgery wasn't scheduled until september and we didn't have any IV fluids at the screening, so i arranged for her to come to the ship on monday to get rehydrated and she'll be sent home (7 hours away) with lots of nutritional shakes...i don't know if she'll make it to september for her surgery but i hope so, because her biopsy showed that it is benign so i think that the surgery will turn her life around.

anyways, i'm going to bed now because these two days, while exciting, were also physically and emotionally draining (screening ran from 6am to about 7pm both days, with 15 min for lunch). i didn't get any pictures from screening because we weren't supposed to bring our cameras as not to make the patients feel more self-conscious than they already do. but i have some pics that i took at the dental clinic which i will post tomorrow.

hope everyone is well. would love to hear back from classmates as to how residency is going so far...love, j.

[*this entry was written saturday, posted sunday*]

i've learned a lot so far about life on the ship and am becoming rather well-versed in ship speak...for instance, my cabin is on the port side of A deck, port being left and starboard being right as you face the bow (front) of the ship. the aft (rear) deck is where the all-important snack bar is (only place where you can procure soft drinks, as the dining room serves just water and tea). the anastasis has five main levels...starting with the bottom is the C deck, which houses the laundry room, ice machine, ship shop (sells toiletries, etc), inpatient ward and a host of cabins. above the C deck is the B deck, where the crew clinic, hair salon, bank, post office, lab, CT, xray and operating rooms live. (that's right...post-op patients have to be moved down stairs (no elevators) to the ward...i'll give more details about that process in a later post as it is really quite interesting and deserves an entry and pictures of its own). as you may have guessed by now the next level up is the A deck, which is the level you are on when you enter the ship from the gangway. on the A deck is the reception area, pacific and aft dining rooms, email cafe, academy (K-12 school), library and lots of cabins. above the A deck is the "upper deck" which has cabins/offices in the center and two large outdoor sections at either end...the area at the aft has a small basketball court, snack bar and bike rack. finally, the top deck is called the "promenade deck" and it has a central, indoor area with the gift shop, med lounge (called the living room of the ship...lots of couches and coffee tables) and the international lounge, which is a large auditorium where we have ship-wide meetings and worship services. the outdoor area of the promenade deck encircles the indoor part and is a large deck that you can walk laps around...it has tables and chairs on it for sitting and reading, looking out at the ocean or whatever. i'm just starting to feel somewhat comfortable finding my way around the ship...it is rather maze-like as many of the stairways only connect between one or two levels and on some levels you can't walk from fore to aft of the ship because it's blocked off, so you have to go up or down a level, walk to the other end of the ship and then find stairs that go back to the level you want to be on. argh! at least it gives me some exercise.

so that's my intro to the anastasis. the ship overall is in very good condition although she is definitely showing her age in areas and will be retired in november when the africa mercy is launched. i haven't yet gotten a picture of my cabin but i took one today of the ship from the outside...A deck is the row of portholes that is right above the blue line...one of those portholes is right next to my bed, which is kind of cool.

i have weekends off so today jessie, oliver (guy on the ship from benin) and i went into tema to one of the markets, which was pretty crazy...it was super-crowded with people selling all sorts of things. women grilling bananas, lots of ghana soccer jerseys, various nuts, fruits, vegetables, raw meats, fabrics, etc. i bought a whole pineapple for 4000 cedi, which is equal to about 40 cents...i didn't even bother bargaining with her as i generally have to pay around $2 to get one at kroger. afterwards we went to a chinese restaurant for a late lunch...i know it sounds crazy to go to a chinese restaurant in ghana but there are lots of them here and are known on the ship as some of the best restaurants around. i will definitely find somewhere to eat some good local food but at the time we were really hungry and it was all we knew of so far. it turned out to live up to its reputation...food was great and service wonderful. (see pic above)

the day was blazing hot...by about fifteen minutes into our little trip we were all soaked in sweat, covered in dust and had drank most of the water out of our nalgene bottles. so what to do but head to the ave maria health farm? hee hee! the name cracks me up...it's basically an outdoor pool and spa right next to the ocean, about ten minutes cab ride from the ship. around here it's pretty common to go to a hotel or spa if you want to go swimming...most of them charge a small fee (in this case $2.50) to use their pool. it was a salt water pool (easy to float!) and we swam around for a couple of hours, feeling greatly refreshed afterwards.

lest you think my time here is too vacation-like, i'll give an update on my work activities tomorrow...this post is already too long and i've got to get to bed now.

i'm here! flights were long but went smoothly...i passed the time by watching about 4 movies and playing trivia against fellow passengers on the plane's excellent in-seat entertainment system. flying into accra was really interesting...we landed at dusk and the landscape from the air was so different than in the US. no golf courses, swimming pools, high school tracks or grid-patterned highways could be seen. instead, about 20 shades of green with the occasional brown dirt road pushing through. it wasn't until we were directly over accra that i could see any lights, and even then it was only about 1-2 per city block area. getting through the immigration lines took about an hour but i had no trouble. i was met at the airport by bev, one of the ward coordinators from england, and andres, a guy from south africa who has been with mercy ships for 10 years. we all hopped in the mercy ships land rover and drove out to tema, where the anastasis is docked. once on board i was escorted to my room...pretty small but sufficient. i have two roommates: jessie--nurse from connecticut and rachel--dental hygenist from australia. both are really nice and have been super-helpful so far. in fact, everyone i've met on the ship has been so friendly...so far i've met lots of brits (love the accents) as well as americans, a lady from jamaica, some south africans, a dutch guy and some aussies.

i still don't have many details about ghana, the ship or my job...i fell into bed last night, slept about 10 hours and am now just hanging out until my 1pm ship tour, at which point i'll be given more information. will also try to get some photos in the near future. i'm hoping the tour will be over by 2pm so that i can watch the US-ghana world cup match...there's been a lot of trash talk already as most of the ship's non-american crew are rooting for ghana. i don't have a strong preference either way...obviously i like to see the US win but at the same time i know how important soccer is here in ghana and i think that it would mean more for this country than for us.

off to find the cafeteria for some lunch! love and miss you all!

today i got my hair chopped...i had convinced myself that africa would be a good place to try out a new short style, but i must admit that i was a bit nervous when i showed up at the appointment this morning...haven't had short hair since about 1st grade. but it turned out there was nothing to fear...shawn is an absolute genius and i love my new look! now i'm ready to beat the heat (or at least hang in there...i still prefer snowy winter days to the heat of summer).

will be taking off tomorrow evening, arriving in ghana on wednesday. i don't know exactly when i'll be able to get to the computer lab but look for an entry from africa sometime in the next week! woo hoo!

okay, so i've been hearing a lot of grumbling lately about the fact that i haven't had a new entry in so long...apparently many of you (official shout-out to dr. england) check this site multiple times a day in hopes that something new has popped up, only to have your dreams shattered when "ouch!" greets you once again.

truth of the matter is that there hasn't been any new africa-related news, unless you count the fact that my departure date is exactly two weeks from today...woo hoo! since graduation i've mostly spent my time getting ready to move, helping friends pack/move and working my way through a two-index-card-double-sided "to do" list. anyhow, in lieu of any exciting updates i'll leave you with a picture from graduation day (which was awesome but surreal). hope this entry makes some of you happy again...and don't worry, only two more weeks til you get to read some real news.