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.
# posted by Jenn @ 5:00 PM