Ghana Adventure

sorry for the delay in posting...the ship's satellite internet service has been on the blink the past three days so i've been unable to get online. however, i've put the extra time to good use by gathering a bunch of random bits of info to share:

-- first off, a big shout out to tricia, layla and grandma for the cards/packages i got from them this week. you girls are the best!! (seriously, everyone else here is jealous because it's a big deal to get a piece of mail, let alone THREE in a single week!)

-- i am happy to report that my nose has finally retired from it's snot-making duties, though not without a kick in the pants from amoxicillin. after 14+ days of feeling horribly tired and stuffed up (and noticing that the breeze of a fan blowing on my face was enough to make my sinuses hurt) i decided maybe this wasn't a common cold after all (yes i know, i'm sharp). i went to the crew clinic and turns out i had sinusitis, a first for me. 24 hours after starting antibiotics i felt like a new woman...thank goodness because my kleenex bill was about to prevent me from having any cash left over to buy souvenirs for friends and family. three cheers for amoxicillin!

-- several different people on the ship (on separate occasions) have been shocked to hear an american accent come out of my mouth as i apparently look very dutch (news to me!). are you sure your grandparents came from czechoslovakia, mom?

-- i've gotten my first mosquito bite, on my right forearm. urban legend here says that if the mosquito's tail-end is up in the air when it bites, then it carries malaria. well unfortunately i had no premonition that a mosquito was going to bite me, so i didn't get a chance to see the bug, let alone make extensive observations about the position of it's tail-end. thank goodness my mefloquine is protecting me.

-- speaking of mefloquine, i have had several strange (though not particularly vivid) dreams lately...however my unmedicated dreams are also weird so these may have just been regular plain-old dreams. one of them involved me and my roomie alaina chillin with julia roberts at her place.

-- yesterday in clinic we saw a "julius caesar" and a "mohammed ali." love it.

-- besides the seven or eight african languages that i encounter each day at clinic there are also a lot of packaged foods, signs, etc on the ship written in various european languages. i have found that when faced with an unknown word in a foreign language, i reflexively apply the spanish pronunciation rules to it (as it is the only foreign language that i do know how to pronounce)...i figure hey, what's good enough for all of latin america is good enough for everyone else, too. =)

-- we have a new dental hygenist in our clinic...donna, from sacramento. her daughter susan was a bronze medal triathlon winner at the 2004 olympic games in athens. cool, huh?

-- i saw an african guy in town this week wearing a Son of Beast t-shirt (presumably some cincinnati kid donated it to a clothing drive after figuring out that rollercoaster t-shirts aren't that cool). the reminder of Kings Island made my day though as i'm sure jessica can appreciate. (girl, we have GOT to go back to cedar point and hit millennium force again!)

-- i have now gone 39 consecutive days without a dr. pepper.

-- had my first doctor moment in clinic yesterday. it's mid-afternoon and i'm sitting in dental clinic, minding my own business, getting the next day's schedule in order when all of the sudden i hear a child scream right outside the door and someone yell, "get a doctor!" i just about had a heart attack when it finally occurred to me that i was the only one there with any medical training. i went outside to find a lady lying on her back on the ground, unconscious. i quickly surveyed the scene and, finding that i was in ghana, opted to skip the "someone call 911!" step as a) i don't know if that's the emergency number here, and b) there is no EMS service anyways. i forgot to take my pulse but did remember to check for hers and was greatly relieved to discover that her heart was beating and (bonus!) she seemed to be breathing, too. i don't know what possessed me next (i think a neurosurgery spirit or something) because i then decided to open her eyelids to see what her pupils were up to...well she didn't seem to like that very much because she started looking back and forth and then pushing my hand away. next thing i know, she's sitting up talking to me about how she hadn't had anything to eat since the night before. of course, being the card-carrying ACLS certified superstar that i am, i did what any good doctor/candy addict would do...whipped out the ziploc baggie of skittles i had stored in the back pocket of my scrub pants and--voila!-- good as new. i was about to do a little victory dance but instead was stampeded by a wild herd of children attacking me for my skittles.

had a good weekend...saturday morning the
dental team went to the fishing village of ningo (N-I-N-G-O and ningo was it's name-o), located about and hour east of tema harbor. we went at the invitation of a former interpreter, moses, who interpreted for the dental team 12 years ago when mercy ships was last in ghana. now he's a pastor and sponsor of an orphanage in ningo..."hearts of the father outreach" which was started by an american couple after they lost their three children in a car accident. the couple now sponsors several such orphanages in various countries.

anyways, i had a mental picture of what an orphanage would be like...lots of disheveled little kids hoping to be adopted...and i was prepared to have my heart broken. well it turns out that my heart was more blessed than broken...

the kids at this orphanage are not
up for adoption, they have simply been abandoned by their parents. in ghana a child cannot be put up for adoption unless their parents sign a consent form. so kids who are abandoned are not eligible for adoption. however, often these abandoned kids are left homeless or worse, shuttled into the child trafficking industry. hearts of the father is run by a ghanaian couple who, with the assistance of two paid helpers, have taken in 27 of these abandoned children and are raising them in a large single story home. the two girls in the pic above are twins whose parents abandoned them after using them to beg for money. the couple feels that both ghana and the children are better served if the kids stay in the country (as opposed to being adopted out) and are raised as upstanding ghanaian citizens. the home has boys/girls dorm rooms with bunk beds, a kitchen, a family room and bathrooms, all surrounding a central courtyard area.

the place is amazing...the
"mama and papa" are some of the most loving, caring people i've ever met and the children are thriving in their care. after giving us a tour of their facilities, they gathered the children into the courtyard area and invited them to come forward individually to sing songs for us or give testimonies. mama's pride in the children was obvious in her smile and in her constant cheering and encouragement. afterwards we spent the afternoon playing games with the kids. we left there feeling
that they had blessed us way more
than anything we had done
for them. some of us are hoping to
make a financial contribution to their home...they rely on donations to keep the place going. they had to stop hiring a security guard recently because funds were short ("god is our security guard now") and the little bus they own has broken down and sits rusting in the yard. they said that their biggest need is for bicycles...they currently only have five that are shared between all the kids to get to school and back.

i've spent the rest of the weekend
doing laundry and catching up on sleep. this cold is refusing to go away so i'm trying the "if i'm asleep i don't notice my nose running" approach.

the pic at right is me and my friend meg (from seattle) sitting in the back of the land rover on our way to ningo.

two quick notes about this blog site:

1) some pics are published slightly smaller than the actual size. to see the full-size version, simply click on the picture.

2) the "front page" of the blog only shows my most recent posts. to access older posts, click on the monthly "archive" links on the lefthand side of this page.

peace finally got to go home yesterday, and apparently there was quite an entourage from her home town to accompany her back. it's not hard to believe, considering her sweet nature and quick smile. peace is from takoradi, a town that is about a 5 hour drive from here. she is a baker, and specializes in pies and doughnuts (i told her that i'll definitely have to visit sometime!) she lives with her husband, a woodcarver who makes furniture for the government, including an amazing table that ghana gave as a diplomatic gift to germany. she also has four children and one young granddaughter.

on wednesday evening i got to take peace around the ship...we mostly sat out on the aft deck and chatted. she was so excited to be going home to her family. her NG tube is out and she has been eating soft foods on the ward...she was excited to get home and eat some real ghanaian food, as it has been seven years since she has eaten anything solid...her tumor has been large for that long. i got to take some pictures of us on the aft deck and also got the "before" picture that the mercy ships photographer took. quite a difference, eh?


i am sad to see her go but am so happy to have gotten the chance to know her. i'll never forget the day i saw her at screening, severely malnourished and unable to keep the drool from spilling out of her mouth, nor the day that she woke up from her surgery and couldn't stop staring at her new tumor-free face in the mirror. she just smiled and smiled...

am almost over my cold...my nose still wants to be a professional snot-maker, so have been toting kleenex around. but overall i feel much better and more like myself. today i went to the OR to assist in a dental surgery...this time with Moses, a patient we saw in dental clinic who has severe osteomyelitis (bone infection) in his jaw. the surgery was short, relatively easy and went without complication. i don't know what it is about dental stuff though...it's the only thing in all of medicine that makes me cringe. i'll take a colon resection, hip replacement or bicoronal flap any day of the week...just don't make me watch a tooth extraction!

sorry so long between posts...i've come down with a nasty cold and so there's no exciting adventures to report from this weekend, unless you count going through an entire "family size" box of kleenex in 48 hours an adventure. honestly, i think i've lost at least 10 pounds in snot alone. any potential meth lab enthusiasts around here will be mightily disappointed to know that my stock of 48 sudafed tablets is almost down to zero. not a big deal since they don't seem to be helping much anyways (nyquil, on the other hand, is a lifesaver). two days in bed has given me time to plow through a lot of pleasure reading...am currently working on "into thin air" by jon krakauer, which i checked out of the ship library (don't worry, mom...i have no current plans to scale everest).

my nurse-roommate reports that peace is doing well, taking po liquids and her NG tube will be removed tomorrow. i'm hoping to feel well enough to see her myself tomorrow, though don't want to start an epidemic on the wards.

love and miss you all.

to the right: me, charles (interpreter in orange),
and sampson (in white...my interpreter, who we couldn't get to smile in a posed photo, so we caught him in this candid one...without him i'd be lost)

below right: charles blowing bubbles for the kids at clinic

below: frieda playing hand game with kids

top: me and agines, one of the dental patients.

bottom: close-up of agines' "ID card"

coordinating the dental clinic has afforded me the unique opportunity of speaking with hundreds of ghanaians every day. some of my thoughts:

-- mensah, lartey and adjei seem to be the smith, jones and johnson of ghana...and the only last names i can now consistently spell on my own without my translator.

-- the kids here are unbelievable...have yet to hear a single child whimper or complain while getting dental treatments/extractions. kids back home would have to be coddled, coaxed and eventually bribed to behave. and ghanaian kids often come to clinic by themselves, bringing a signed permission slip from their parents.

-- schooling in ghana is now free but that's a recent change, so many adults don't know how to write or spell their own names. about half of the patients i register have to use their thumbprint instead of a signature.

-- some of the women here have their name and hometown branded/tattooed? on their forearms (handy for me when they don't know how to spell their name). i asked my interpreter sampson about this and he said that some women are afraid that they'll be killed or hurt in a traffic accident while they are away and no one will know who they are. they do this to be sure that their body gets back home...sort of a permanent ID card, i guess. (he said that guys don't seem to have the same concern)

-- about a fourth of the patients i register don't exactly know how old they are so they guess. one 70-ish woman i registered answered "older than 60" when i asked her age. others will give me an age that is obviously not accurate but i usually write down whatever they say because i don't want them to feel bad about the fact that they don't know...

-- lots of women are named after virtues...some of the most common first names are comfort, wisdom, blessing, gifty and patience.

speaking of, peace is doing great...i visit her every evening and she looks better and better. if it weren't for her NG tube she'd probably be going home by now. she has to be fed through it for about three more days (decreases chance of her incision getting infected) and then she'll be able to eat regular food again, which she's really pumped about. i asked her what her first meal will be when she gets home and she said "rice and a BIG piece of meat!" she wants me to take some pictures with her before she leaves so hopefully i'll have some posted soon.

this morning i got down to the OR at about 8am and got to talk to dr. gary (surgeon) a bit...he was concerned that the tumor would involve some of the major vessels in peace's neck, in which case she could easily lose too much blood..."she may not make it out of the OR alive, but if we don't operate then the tumor is guaranteed to kill her..."

i'm happy to report however that the tumor did not involve the vessels and in fact was fairly well circumscribed. we removed about 3/4 of her lower jaw bone (hemimandibulectomy) along with the tumor, and replaced the bone with a metal plate. she has only a couple of lower molars left but that will be good enough to be able to crack groundnuts with. the whole procedure took about 5 hours and she already looked so much better. i plan to go down to recovery later this evening and see how she's doing.

some observations from my first day in the anastasis OR (or theatre, as they call it here) :

-- it was amazing to see how they make do with so few supplies...they only have one or two bair huggers (the inflatable part) and so they just wrap it in a sheet and use it over and over...all of the IV tubing and supplies are mismatches so you have to make sure you have the types that fit together...only one operating light...the metal plate they used is a type that they can buy cheaply from a european company who has a bunch left over since they moved on to a newer/better design...no such things as foley or central line "kits"...must assemble supplies individually, from things that may not have been made for that specific purpose.

-- the ship's crew serves as the blood bank...peace is B+ so this morning they rounded up the four people on board who are also B+ and drew a unit from each for use during the procedure (and it must be used within four hours or else it goes bad).

-- peace's body temp was running too low so the anesthesiologist had me running back and forth from the OR to the break room to microwave her IV fluids (fyi, three minutes on high for a one liter bag will do)

-- blood loss was estimated and replaced accordingly by counting the number of blood-soaked laps (each holds approx 100 ml)

-- intubation can be a bear with these huge intraoral tumors...luckily that's one area where the ship is well-equipped...we did an awake fiberoptic nasal intubation on peace.

-- there are three portholes in the operating room...it was funny being able to look out and see the horizon bobbing up and down during the procedure.

-- the OR staff were so nice and optimistic...a noticable difference from the cynicism so prevalent in US operating rooms.

despite all of the so-called "deficiencies," i don't think that the surgery could have been any more elegant, clean or safe than if it had been in the US...maybe sometimes less is more.

although we weren't allowed to take cameras with us on screening day, the communications department had two professional photographers there to take official photos...which are way better than any pictures i would have taken. all the pics have just been made available to us on the ship's intranet...there are over 150 of them and all amazing. i have posted five here but will bring all of them home with me on CD.

top pic is child with cleft lip/palate, next to it is a picture of the line to get into screening, second row is a guy with keloids...you can see one peeking out under the right side of his scarf, next is a patient with a neurofribroma and last is me trying to decipher a heart rhythm.

i looked to see if there were any screening pictures of peace and didn't find any. but i'll be going to the OR with her tomorrow and she has already asked me to take a picture of her after her operation, so hopefully i'll eventually be able to post pics of the "new" peace. =)

happy 4th of july! (though it may not be the most significant day in our nation's history)

the port authorities here in tema turned down our request to set off fireworks on the anastasis (boo!) but the day was saved by a group of american ladies here on board who made enormous numbers of homemade apple and cherry pies...i must admit that i was a bit doubtful about the event when "4th of july pie celebration on aft deck tonight" was posted on the ship's event board this morning. the food on the ship is, as my roommate jessie aptly put it last night, "questionable." the dinner menu often suggests tasty dishes that unfortunately rarely live up to expectations (limp veggies, dry meat, crunchy tasteless ice cream, etc.) so as you can imagine i was not overly optimistic about the pie...just hoping that it would be edible and give me the feeling of being part of the celebrations back home.

boy, was i wrong...the apple and cherry pies were not only scrumptiously delicious, they were also served warm, a la mode! in short, they were as good as (if not better than) any pie i've ever had, ramsey's included. i treated myself to two servings (plenty to go around), and am now ready to fall into bed, hugely satisfied. indeed, happy 4th!

nothing terribly exciting to report about dental clinic today...my mind was back on the ship, wondering if the lady who i saw at screening (tachycardic with large tumor) would show up this morning to see dr. roy for IV fluids and a nutrition plan.

i fortunately ran into dr. roy only a few minutes after getting back onboard this evening and was relieved/overjoyed to find out that she did show up...after examining her, dr. roy agreed with my assessment that she would not survive until her surgery in september and so he spoke to dr. parker (head/neck surgeon) about her...dr. parker is only operating through this week and then will be off the ship and not back again until september. so they decided to move her case up to this friday...they went ahead and admitted her (HR 125, crit 25) so that she can get IV fluids, nutrition and pain control this week.

i went down to the ward to see her this evening and she remembered me from screening. she understands english pretty well although has a hard time talking around her tumor. i looked through her chart and found the path results...the tumor is an ameloblastoma (hers looks like top left pic on link), which is benign but locally invasive. i'm working on getting excused from my dental duties on friday so that i can go to the OR with her.

i'm so happy that things worked out...although i won't be the one holding the scalpel on friday i can't help but feel that i helped set the wheels in motion to change (save?) this woman's life, and that makes me think that maybe all of that med school craziness was worth it.

the patient's name? peace.

am enjoying a restful day today after what was
a hectic week. slept 12 hours last night, which i rarely am able to do anymore unless my body is really tired...

last week i signed up to go on a saturday group trip to boti falls, which are some waterfalls about an hour north of tema. so yesterday morning about twenty of us piled into the land rovers and took off, anticipating a nice day of relaxing/reading/swimming. about halfway there we were reading through the description of boti falls in the guidebook, the last sentence of which said something like, "Boti falls is usually a serene place, except for on the 1st of July holiday each year, when thousands of Ghanaians converge to celebrate at this sacred site." someone was like, "ummmm...isn't today july 1?" so of course out of the 365 possible days we could visit the typically-serene falls, we happened to choose the one crazy one. although our mental pictures of nice quiet relaxation were disrupted, we quickly switched gears and looked forward to getting to participate in a holiday celebration.

the area around boti was jammed with tour buses and parked cars...after making our way through the crowds and paying a holiday-rate of 30,000 cedi (about $3.50) to get in the park, we found that the guide book was indeed correct: a huge celebration with loud music, food/drink vendors, dancing, picnics, etc. it was pretty neat to see...the only downside was that the area around the falls themselves was really crowded (with lots of litter) so it was hard to appreciate the natural beauty of the area.

on the road to boti we had spotted a
sign pointing to "akaa falls"...we had no clue what they were like but after fighting crowds for two hours at boti we decided to go check them out. turned out to be a great decision, as the area was both beautiful and much more serene. several people in the group swam and climbed back behind the falls. the hike there was also pretty...almost felt like i was in red river gorge. by the end of our time there we had attracted a huge crowd of children from a nearby village who seemed to take humor in seeing the crazy white people splash around in the water.

my favorite part of the day was probably the
drive...getting out of the city and seeing the african countryside was really cool. we passed through lots of little villages with mud huts and thatched roofs. the people on the side of the road always waved and smiled at us as we passed by...it almost felt like we were local celebrities or something. the countryside was also beautiful...we drove over several large hills/small mountains with gorgeous views from the top of them. it was more similar to what i pictured africa to be like...tema is great but more of an urban area. unfortunately i didn't get any good pictures of the countryside because we were driving so fast and the roads were bumpy. hopefully i'll get back there again later when i can get some good shots.

top pic here is of food vendors (one lady selling hard boiled eggs, the other a local bread/onion dish) at the boti falls site. the second is on the hike leading up to akaa falls. the third is of akaa falls and the fourth is our crowd of curious onlookers.

back to work at the dental clinic
tomorrow. i've added a link on the left of a really cool blog that a photojournalist did earlier this year while he was on the anastasis in liberia. it has pictures on it of patients with conditions similar to what i saw at screening day here in ghana.