NEWS FROM ANNA

Anna, Jon's girlfriend, is currently volunteering in Ghana before she starts her residency in general surgery at The University of Virginia. She has some very interesting stories to tell about her adventures.

March 9th 2007

It's Friday. I just finished my first 2 days in the hospital. They started me in the lab, which was pretty clean and easy. It's actually kind of interesting to see how the tests are run. They have very basic facilities, but that includes a scope, centrifuge, sink, and refrigerator. They do a lot of blood counts, which literally entails counting the various cell types under the microscope. You can also check for malaria and sickle cell with that. We did blood typing and cross matching by putting a drop of blood on a piece of white tile along with a drop of antibody solution. If the blood starts to clot, then it's positive. Three drops, A, B, and rh+ or -. They can do pregnancy tests and syphilis with strips and a typhoid test that's like the blood typing. We don't have any chemistry's, but those are way over ordered in the US anyway. Given that we couldn't put a patient on dialysis anyway, know precisely what there kidney function is isn't all that helpful. Everything is washed and reused at the end of the day and the numbering system starts fresh again with #1. Results are recorded in what looks like a big accounting ledger, and when you're done you write the results on a form and hand them to the patient waiting in the hall. They go back to the clinic side when they have their results.

I've seen that there is a radiology department, but I'm not sure what we can actually get, or whether patients would be able to afford it anyway. After spending a day in the chest Xray reading room at UVA though, I feel like that's more akin to reading clouds that to objective info. It'll be important for setting bones. It's strange not to have microbiology or any cultures. There's an awful that that will get treated
empirically (when you treat based on suspicion rather than confirmed diagnosis.) Yesterday they were really busy because they had prenatal
clinic in addition to the normal patient load. That meant they didn't have much time to teach, and I sat around along time. I spent the
afternoon chipping things out of their freezer. Everything was literally encased. That was probably really good. It gave me something to do, and they were really impressed that I'd stay and work on it as long as I did. (a good 2-3 hour job) I got major brownie points for that, which I'm guessing may come in handy if I'm trying to get something quickly later.

I eat lunch in the canteen which is all traditional Ghanaian, and mostly unidentifiable. Today there was a ball of some sort of starch made of corn (different than what you made Jon). It was about the size of a baseball, and I assumed stuffed with something. (nope) When I asked for it the lady offered my rice instead, but I was thinking tamale, and it looked good. I got that along with some really spicy sauces and a small piece of fish (for $0.70) Some of the others in the room were apparently entertained by my attempt to eat it with a knife and fork. Another women came over to sit by me and show me how to eat it. You just pick up a bunch of mush (tastes like tangy grits- weird), dip it in some really spicy pepper sauce, and eat it. Not much on texture, but the sauce did make it better. In the cooler, alongside the Coke and Fanta, they serve Amstel light. Not what I'd have expected from a Christian Mission Church.

It's a very evangelical place. They gave me a bunch of information about their founding, and it's more like a church with a hospital that the other way around. I had to fill out an employment application which included the questions:

What church do you attend? (none)
Have you accepted Jesus Christ to be your Lord and Saviour?
Do you believe that God heals the human body?

Except for the first one, I left them all blank. I'm kind of wondering if people are going to actively try to convert me now. The women I sat next to on the plane spent a good 2 hours talking about how the Lord had changed her life, and then actively trying to convince me that no amount of good living matter until you accept the Lord. In the US it would have been pretty easy to shut that conversation down, but it's definitely different here. People are more open and friendly. There's less that's considered personal, and that includes spiritual views. One of the other students was in the well baby clinic and said they all prayed together 5 times in 30 minutes to bless one of the new babies. I don't mind that, but I doubt I'm going to be able to dodge direct questions but for so long. Morning devotional is every day.

Outside of that though, everyone has been really friendly. They'll help you do and go anywhere, and without expecting anything. Everyone says hi on the street, and are really helpful if you look like you need anything. At the gate and on the plane, it was about 90% nationals, and was pretty easy to pick out the foreigner. Multiple people came up to ask me if it was my first time, and what I would be doing. It was the 50th anniversary of Ghanaian independance the day I arrived, and everyone was very proud of their country and wanted me to have a good time.

I think this has been the easy part though. The lab is pretty sterile emotionally. They get alot of patients with cerebral malaria and meningitis that don't survive. The boat is even more restricted. They get lots of abscesses and infections that they just can't treat in the few hours the boat is there. They're are really sick kids. One 6 month old who died later that evening after really heartbreaking arguments with the local nurses about what level of care they could try. It may have been too late when they first got to him, but you don't know, and too late in Ghana is different than too late in the US.

I'm nervous about starting in clinic, but a little less so after being around the lab. It's definitely a good way to ease you in. I'm expecting this will get hard soon. For now things are good. I'll be in touch.

Yours,
Anna

March 29th 2007

I hope everyone is enjoying the Spring weather at home. In Ghana it's warm and sunny, but with strong seasonal winds most days. Today was the second big rain in 10 days and may be the beginning of the rainy season. It's hard to believe a month ago I was cross country skiing and winter camping in feet of snow out in West Virginia.

Little kids here are great. I went up to a small city north of the capital my first just to look around. The little kids will see you and call out "abruni abruni" (white lady) just wanting you to wave to them. There was a group of 6-7, 2-3 years old who all ran out to hug my legs. They were really adorable. Another group was kicking a ball around, and it came straight to me. They got a huge kick out of it when I kicked it back.

Transportation is really convenient, but different from home. There's a shared taxi stand about 5 minutes from the house. When they get 4 people they're full, and we go. (Usually 2-3 minutes.) Then you pick up a van headed the direction you want, and get off at the main station. Vans to a specific destination leave as soon as they're full, so if you know the city you want, it's really easy. (crowded, but easy)

Last I wrote, I'd just finished a couple days in the lab. I moved into the pharmacy last week, which was much better stocked than I'd expected. We've got about 250 drugs in stock, but there are no computers. Imagine trying to track the inventory on paper with every sale recorded as a line item, frequently as just the patient name and the total collected. They hired a new pharmacist a few months ago to help get things organized. He trained for 6 years in the Ukraine, actually USSR when he started, and had his own pharmacy until deciding to go into hospital pharmacy. We worked on a developing a computer based inventory on Excel which is actually pretty slick given I have no programming skills, and everything needed lot numbers before we could even get started. I presented it to the head of the hospital at the end of the week, and he's in the process of getting a computer to run it from.

Update- Just got the computer today. I spent today getting is set up, and showing the pharmacist how to log in everything. He's very bright, but I think this was the first time he'd used a mouse. I feel pretty confident though that he'll be able to run it entirely independently before I leave.

In the house: When I got here, there were 2 other UVA students who'd been here since January. They went home, and another student arrived about a week ago. There's also a recent graduate from the Ghanaian medical system here who moved in last week. Really interesting guy. They only graduate about 180 med students a year, but the ones they have are really well trained. They do 3 clinical years (to our 1), and are truly ready to practice everything straight out of med school (despite the 5-7 more years they'll put in as house officers/residents). Here there's alot stronger focus on generalist practice, and they train you to be good at everything. (23 deliveries required to graduate med school- we don't teach people to deliver babies unless they're in OB/GYN or Family medicine residency). It's been really great working with him. I haven't done general medicine since before my research years, and it's a great review.

I've been in clinic for a week now, and it's not that different from home. (back pain, diabetes, hypertension...) We see people with malaria and typhoid several times a day, but they usually come in with symptoms something like a bad flu. It's very common here, and generally treated as an outpatient.

The difference is on the wards. We don't have much in the way of diagnostic tests, particularly for patients that are really sick. We had a patient this weekend who went into acute respiratory distress. We were able to treat her that night, but she was delirious, with a fever to 104 despite a whole gament of antibiotics, and we had no way of identifying what we were dealing with. The same thing happened the next day, and she didn't recover. We still don't know what we were dealing, or what we could have done differently, but she really needed full ICU care.

On a happier note, I saw one of my patients from last week today. She'd been losing weight for a month, with several gastrointestinal problems, and I was really worried about her. We treated her for parasites and reflux and sent her for an ultrasound to look for something more serious. She came back today and looked wonderful. She's been able to eat, and has started gaining weight and energy that had been gone for weeks. That was really great. It just made my day.

That's it for now. Have a great week.

Yours,
Anna