Out in the village

Today was a quiet day at the hospital....we were done most of our rounds and procedures by 11am and that gave most of us the day off. It was actually quite nice because when you live 5 minutes away from the hospital...it's easy to always keep going there and checking up on your patients and making sure they are ok....doing this everyday for 7 days can get a little tiring...so we enjoy the short days. I got to catch up on some sleep, watch some tv shows and read a bit.

In the afternoon, me and one of the doctors went to go play volleyball with the local kids. This was actually pretty fun. For the first time, I got to walk off the grounds of the hospital and walk through the village to the main road in order to find this volleyball net. This was took us about 20 minutes....the village road is this red dirt road, all my shoes, flip flops and crocs have pretty much been stained red by this by now...my feet too...hard to get this off in the shower. Walking through the village gave me a glimpse of the day to day life of most people living out there. Lots of people walking, kids on bikes, woman carrying things on their heads, people welding on the side of the road, some making couches, others just staring at us. You some times feel intimidated and don't want to look them in the eyes...but when you greet them in their language...they smile at you and either say hello back or say something which they are probably making fun of us lol We met up with one kid on the way there who the doctor already knew...his name is Ibrahim and supposedly his grandfather is the king of the village. He invited us to go visit him one day and say hello...should be interesting! Ibrahim is 21 and when we asked him what he does, he said that he is in the moto business...selling motorcycles, which he then went on saying that he smuggles them from Togo. I was quiet shocked how he was explaining this and expecting us to think this is something normal. He said that we all need to start somewhere and that he was using this as a stepping stone to move up. Don't worry Mom...I made sure to watch out for any funky business ;)

We finally got to the volleyball court which was next to this huge school. The court was still empty as most people were slowly ending school around 4:30pm. We were also in search of the ball...supposedly someone had it somewhere and they were on the search for it! Finally, someone found the ball and then all of a sudden there was like 25 people waiting to play! It was so much fun...most of all the kids spoke english and they were really nice. They were pretty good also...setting, spiking and man did you have to make sure to follow the rules! I also think they didn't think I knew how to play and they kept telling me where to place myself...good times! It eventually started getting dark and we began to head back.

The kids here are so cute and all them yell when they see us...most scream from far and wave saying "hello...how wa yu" So cute...some will even run up to us and shake our hand. I will usually take pictures of them and then show it to them....they are fascinated by this! Some kids are like little gangsters too...they walk up to you and stare you down. The other day 3 kids walked up to me while I was heading back to the hospital...I stopped and shook their hand. Then one kid grabs the strap of my bag and says: "Your bag, I will collect it and go" Here I am getting taxed by three ten year olds...lol I laughed and said sorry boys....not today! Most people here expect you to give them everything you got...someone asked for my iPhone when I leave, others asked for my shirt. Thankfully my mom gave me a dufflebag full of tshirts which I plan on giving to the kids here....however I still havent figured out how I will do this without causing a crowd of kids running up to me and attacking me!

Finally I got back to the house...safely lol I say this laughing but I don't really feel threatened at all...sometimes just feels like we're the odd ones sticking out...actually we are...there are no tourists here. But everyone is really nice!

Ok...time for bed

Gnight everyone!

The plumbing is up and running again :)

Boy was I happy to see some formed stool today...as gross as this may seem to all of you...this may have been one of my happiest days, knowing that I fought this acute gastro enteritis without having to take my medication! I only have enough to cover me once....so I must use this wisely! Feeling much better today...no vomiting, fever, or diarrhea!! I ate well :) It's amazing what 24 hrs can do to you!!

Another regular day at the clinic...so busy! What's interesting about these clinics is that the people who are coming here are all presenting with such different problems! Graves disease, prolactinomas, abscesses, pregnancies  endocarditis, liver cancer and much more. The only problem is that we don't have that many labs to get to a proper diagnosis. Really the labs that we commonly do are: blood smears for malaria, WBC, HCT, urinalysis, clotting (for snake bites), stool culture, sputum. If we need anything else, we will probably refer patients to go to Tamale where there is a teaching hospital, about 2 hours away. Also, we have X-rays and U/S (ultrasound). It's amazing how useful the ultrasound is over here....they only got this portable one about 4-5 years ago. Basically ultrasound everything...I have gotten pretty good at the basics. We mostly use this to screen for pregnancies, free fluid in abdomen, suspicious masses. So most of the diagnosing will stem from the limited investigation tools, following your gut and infectious disease textbooks!

Tonight I am on call...there was a boy who we brought to the OR for a suspicion of a volvulus ( large bowel obstruction)...he had fever, abdo pain and xray showed lots of stool stuck! His abdomen was huge! Felt like it was going to pop any second now. Only issue was that the local anesthetist for some reason was not able to be reached. We sent someone to his house and it seemed like he went off to some village. So we used one of the ER docs from LA (Dr. Sam) to fill in as the anesthetist and I was the first assist with Dr. Ravi the other ER doc from LA.  Operation was a success...the boy didn't have a volvulus but ended up with a bowel perforation likely due to Typhoid fever! We sewed this up and brought him back to the ward. It's amazing to see how little monitoring we do here, just simply sedate him with some ketamine and valium....then wake him up and back to ward...no recovery room. Hopefully he will recover well from this operation with no further complications.

I was talking to a friend here today and told him I was blogging...I realized that most of my stories seem depressing and may paint a scary picture...I do however want to say that we do a lot of good for a lot of people here. Everyone is always so appreciative when they see us, they smile, will bring me stool to sit while I chart, will breastfeed their children while I am examining them so they don't cry from the scary white man! The communication may be difficult but seeing the sick walk out better, happy and lively is a great accomplishment here! We all do with what we got and try to make the best out of every situation!

On another note...I got some other news for my family and Evie and her family :) I got accepted to do a surgery elective in downtown Vancouver at St-Paul's Hospital from July 2nd to 27th!! I am so happy fort this :) Will get to spend a month with Evie and her family during summer while doing a surgery elective! AMAZING! This time Evie will be coming with me :) Yayayayayaya :) Helene...if you are reading...we need to book the flights soon ;)

Bed time! Unless they call me to go back to the hospital!!

P.S.

Dear Lexi - your mom tells me that she reads you my blogs at night for bedtime :) So happy to hear that you enjoy them. To answer your questions - I have made lots of friends here! Most of the little kids are scared at first but then they open up and smile :) Africa looks really beautiful, the weather is always hot! and the ground is dry with this red dirt road everywhere. There is lots of grass too and you need to be careful for the snakes at night! So far I havent seen any yet! I am not sick anymore and I feel much better :) I am sad for a little bit, but I know that they got the best care possible over here and we tried our best to help them! But I know that I am really happy for the kids that leave the hospital with their moms - all the mothers carry their kids on their backs here...seems like so much fun to be a kid! Thank you Lexi for all your questions! Hope you have a good night tonight! Take care Phil

P.P.S. Evie - booojoobodowowow :) xox

Already one week!!

Dinga oula! (Hello in mamprulli)

Lot's has been going on here since I last wrote to you guys. 

Thursday was a regular day at the hospital. It was procedure day....so we change patient's dressings, go to the OR and do minor procedures. There is this one little girl that we saw that day...she has been admitted for a while now but this was the first time I changed her dressing. She is about 4 years old and one of the toughest I have seen yet. She got a hot bowl of soup spilled on her....burning her right arm, chest and right side of her face. The burns were so bad that we had to make an incision on right arm to relieve the pressure from the swelling. Every 2 days she comes to change her dressings and this is most painful thing for her. She cries but has the cutest face when she does. It hurts me to see this, especially being a little child and she will forever be scarred with these burns. 

That afternoon, the doctors who live here invited us over for American Thanksgiving! So we had everyone over at one of the houses and we had lots of food! Turkey was really good :) All the families were over and it was a nice time. 

Friday night was a very frustrating night for me. I was on call and there were lots of sick kids on the peds ward. There were about 3-4 kids who needed oxygen therapy because they were in distress. The only problem was that there were only 1 working oxygen purifier to go around the ward of about 40 admitted kids. At one point, a mother came to get me and made some sort of sign for me to follow her...I headed over to her and she brought me to her 2 month old kid. This little girl had been operated that day for an obstruction to her large bowel. Once I got to her bed side....she was barely breathing...we started assisting her breathing and this helped her for a bit. The question was....how long do we do this for? There is nothing more to do for her because there is no other resources available. The poor kid was going to die and it was only a matter of time. At one point, I was listening to her heartbeat and it was so faint that I thought the child was dead. She had a tube in her mouth which we removed and this seemed to help her breathing a little more. The next day, we found out that the mother took her child home to die with the rest of the family around. It just sucks to see that if this kid was in Canada...we would be doing so much for it until it was able to recover on its own. 

Later that night, a guy came in after having gotten into a motorcycle accident. He was unconscious and not responding to any sort of stimulus. Usually we would be doing xrays, ct scan, blood work up etc...None of that is possible here...well an xray but we only use those when we are absolutely sure we want to use them. We were suspecting that he was probably bleeding into his brain and this was causing increased pressures in his head. The only way to fix this was to drill bur holes into his skull. One of the surgeons from LA thats visiting here was ready to perform this procedure. However, the Ghanaian anesthesiologist here was a little hesitant to do so because of the bad possible outcome with the resources we have available here. We ended up drilling 3 bur holes in this mans head the next day...we definitely relieved some pressure, but there was no bleeding in his brain. Now we are just observing him, he is probably going to be comatose and will likely die. 

Saturday was a very relaxing day - we rounded in the morning and then hung out in the afternoon. Me and this ER resident from LA went to this bar after our night rounds. This place is called Chesterfields and is in the middle of nowhere. You basically show up there, pull up your own chair and they bring you a table. We were sitting outside in the front of the building, there were 4 other people at this bar, who had their music on from their car. We had some beers and then headed home. This was a nice experience.

Now getting home is where all the fun started last night! I got into bed and started watching Game of Thrones on my laptop. Then all of a sudden...started feeling nauseous. I got out of bed and ran to the bathroom....puked my brains out! At this point I knew that I had not been initiated after a week of being here. That night, I puked about 5 times and felt like crap! This morning, I didn't get out of bed...skipped morning rounds and stayed in bed all day. Had diarrhea and fever today. Nothing like a bad case of acute gastro enteritis in Africa :) I haven't been the only one....3 other people have been sick the last few days...I guess this is something normal to expect when travelling to Africa. I am now feeling much better and havent eaten yet....will try that tomorrow! 

So after one week of being here - I can truly say that I am having a great time and really enjoying this experience. Seeing how others live is a real learning experience. People don't complain much over here, they live one day at a time and are grateful for a new day. Most people don't even know their ages out here - the other day in clinic I asked a girl how old she was and neither her or her mom knew...they said 25 and I later found out she was 12. A sense of time doesn't really mean much to them....very interesting. 

I got another 3 weeks left and I am sure its gonna keep on getting better out here. I am starting to settle in and being comfortable with the patients, wards and details of how things work. The only problem is that I am missing my peops from back home. Today, laying in bed all day got me thinking of home and how grateful I am to have such a great family, friends, life and most of all....Evie :) 

I can't wait to come home to you my love :) I really would have loved for you to be here to take care of me while I was puking but I know that would have grossed you out regardless! Je t'aime mon amour!! 

Until next time....thx for reading guys :)

Day 3 :)

Today was clinic day...basically everyone knows that Monday, Wednesday and Fridays is clinic day at the Baptist Medical Centre...I really mean everyone. We get to the hospital at 7:30am to round on our patients and there's already hundreds of people lined up to register to be seen. Again, it amazes me to see how far some people come from in order to be seen...even sometimes if its a simple dressing change or follow up. Some can even be seen by public health centres near the village...yet they choose to come and see us.

Clinic days are usually long and the goal is to try and see as many people as we can. Everyone helps out here...we all get into rooms and start seeing patients. Some rooms will have 3 of us seeing people and we are all sitting side by side with a translator. I have to admit, the one thing that disappoints me while I am here is that I am not able to speak their language (Mamprusi)...there are so many dialects here that even our translators have a hard time sometimes. One thing I love doing when interviewing patients is being able to get to know them quickly...interact with them...make them feel comfortable and try to cheer them up! MOst patients are quiet, we examine them and they interact with the translators and our on their way. It's tough...I try smiling and especially with the kids...try to not scare them....for some it's the first time they see a "white man". Today though, there was this one young girl who walked into the examining room with a huge smile on her face...she was coming for a follow up on her seizures and needed more medication. She also complained of "generalized body pains"...the nurse we had laughed at her and then they both broke out into laughter. Nurse said..."why do you have pains? I am way older than you and don't complain of these pains" The young girl just kept laughing and talking and talking and talking...very unusual because most a really quiet. She kept saying that she's in pains because she bends her back a lot while working in the fields at home. We quickly showed her the proper way of bending while working...hopefully this will help her. I was just so amazed by her though...seizures, working in the field, walked a few miles to come today, waited several hours....and still smiling.

Another interesting man I saw was this little old man who we really don't know how old he was. Most people don't actually know their age here...when they register, most times the nurse will "guesstimate" their age and write it down in their chart. This old man was walked in with his grandson...had a walking stick and looked very intellectual and wise. Probably the leader of some tribe it seems...he was very quiet, not complaining at all but rather sick. We admitted him to the male wards to keep a closer eye on him.

The rest of the clinic day was interesting...I got to see some obstetrical cases and even tell this one woman that she was pregnant after doing an ultrasound on her. This was a really cool feeling...she was happy yet quiet. It's a very important part of their lives here to have children...it makes the women more "important". On a sadder note....had to tell a woman who thought she was 4 months pregnant with a history of bleeding that I no longer saw any baby on ultrasound.

Later on, there was an urgent call for us to come to the to the maternity ward to see this woman who was admitted this morning after delivering at home and feeling weak. She was in shock, bleeding and not looking very great. Postpartum hemorrhage is something that can be a serious complication for woman...especially in Africa when most are anemic and with malaria. We quickly examined her...did the necessary things to stop the bleeding and stabilized her. When we returned to follow up on her later in afternoon...the nurse called us over to where her newborn baby was in an incubator while the mother was been looked after...no response. A day old and this baby for some reason....we will never know...died. Child mortality is something you don't see often....once again...here this is just another day. We waited to tell the mother about the loss of her child....she needed some time to recover from the shock of blood loss while we transfused her with blood...hopefully with no other complications.

At 5:30pm our day ended...headed back to the house while the sun was setting...bats were flying in the air...crickets making their noise and our flashlights out trying to avoid any snakes that may cross our paths. I am sure as we walk passed the Ghanaian people that they must be saying to themselves "look at these white people...so scared to walk barefoot without any light".

Again gooood foood....we were served this nice lasagna dish! I don't know how our cook is good at making these meals...a local here but he made an awesome lasagna...better than some I've tasted back in Montreal.

See you all tomorrow! It's american thanksgiving demain...so there's a party planned for all the medical team here. Very excited for turkey :)

BYE

P.S. Evs...I wore my blue cargos with the yellow shirt today...great match! Je t'aime mon amour xox. I know you got a busy day at school and evening...miss you!! xox

P.P.S. Babes...I just saw that there's a blizzard! Please drive safe tonight...I am not sure if you changed my winter tires yet...be extra careful!!!!!!

My first two days...

I don't even know where to start when it comes time to explaining everything that I am experiencing...I have to admit that this is definitely life changing. 

Yesterday, we landed in Tamale and was greeted by our driver. We dumped our luggage on the back of his pick up and embarked on a adventurous drive...this 2 hour drive is one I will always remember. Dirt road for the most part...people walking in the streets with their heads carrying whatever they were transporting (water buckets, sewing machines, clothes...anything you can think of!) and their little baby attached to their back. 

Upon arriving to the Baptist Medical Centre, it was around noon....one of the busiest times there...I was shocked to see hundreds of people in line, waiting on floor near the hospital, mothers breastfeeding, kids playing....there must have been over 100 people that I was able to see inside. 

We met Holly, who gave us a nice tour of the hospital....5 adult wards, 1 maternity ward, 1 pediatric ward, 1 isolation ward, 2 theatres for surgery, 2 procedure rooms and 1 delivery room. About 125 beds, all full....patients even on the floor in order not to refuse people....who usually walk for miles to get here. Once introduced to the doctors, residents and other people volunteering there, we went for lunch. Now on the hospital grounds, there are several houses...for the doctors and their family, other doctors volunteering, our house is House 7! House 6 is where the food is at! Everyday we have a chef who makes us lunch and supper....OMG so far the food is sooo good! He will even make westernized dishes....had hamburger patties with fries yesterday! Yummy!

Once we ate, we changed and headed to the hospital to be thrown in there from Day 1! We were each assigned to someone and observed them see people in clinic. There are 2 staff ER docs from LA here, 1 resident in ER from LA and a sweet couple from the Netherlands who do Tropical Medicine. They are all very nice and really helpful! 

People basically line up and we call them one by one to come and see us once we have their chart. This is a quick process and most people come here with Malaria and so we ask a few questions and give them medication and off they go. There are lots of really sick people that we admit to the hospital for IV medication, closer follow up and because we may not be sure what they have. Most people have Malaria...but most also have typhoid, TB, snake bites, severe dehydration...list goes on. It's amazing how you learn about this back at home, but here you are experiencing it LIVE and its textbook presentations. 

On the first day...I got to see lots of patients in clinic, debrided bad wounds that some people have. Really bad infections happen here all the time. This one girl....got a bad tooth abscess that ended up spreading to her chest as a skin infection and they had to cut off all her skin on her chest including her breasts in order to get rid of this infection. We see her every 2 days to change her dressings....the amazing thing is, she always has a smile on her face and she is so brave. It's amazing to see how tough the people are out here...sometimes its scary because they wait a long time before coming to get seen. A lot of the times, they seek help from their tribes people and try some local natural medicine. 

Today...well I started off my day rounding on the pediatrics ward. There was a little boy who I saw from far and the nurse was looking after him. We went over and noticed he was non-responsive very weak pulse, fever....we changed his antibiotics and gonna check him for meningitis...by the time we came back the poor child died. This is something that happens often here...there is only so much that can be done for this kids, that you just need to accept it. Would this be different back at home? Of course it would...there would be a whole team of people trying to resuscitate him and do everything they can to keep him alive. Here...well we did that too...only thing is it's not enough. 

The rest of the day went better...tuesdays and thursdays are procedure days...so we see people for wounds, amputated a diabetic toe, debrided a bad ear infection. Also saw some interesting cases on the ward....seizing child, huge spleens everywhere, people with large livers. But everyone is doing their best here. One of the most inspiring things here is that....the family is very much involved with the care of the patient. There is always someone at the bedside watching them over, they feed them, clean them and sleep together. 

Tonight I was also on call. Basically after supper at 7, we go back to the hospital and round on the patients again to make sure that no one is getting worse and check up on the new admissions. We also had a little boy who had Typhoid fever and it affected his bowel. We brought him to the OR and found perforations in his small intestine. Oh, the OR had no scrub nurse, so along with being an assistant while we removed his intestine...I also acted as a scrub nurse. Very interesting OR experience when you are used to the way things are done back at home. They boy did very well during the surgery...however next few days will be important...they usually get bad infections no matter how clean and sterile we are here. Once the OR was done...another patient came in with an open Tib-Fib fracture...his leg was hanging on itself....he got hit by a car. I cleaned up the wound and tried my best to straighten his leg and tomorrow we will check up on him for fixation. Nothing to do now because he will probably get an infection if we close it up. 

Once we finished everything from the hospital...around 11:30pm, we go back home and try and sleep. If anything happens over night, they will usually call us or send someone over to knock on our door to come. 

We also have a school house that has access to wireless internet. So I can always come here at night and check email, skype with my parents and talk to my baby love Evs :)

It's 1:30am now...gonna head back to my house. Fun thing is that its about a 5 minute walk and you need to have a flashlight....there are snakes to watch out for and it's pitch black!

Until next time! 

Thanks for reading :)

P.S. Evie...the stars here are beautiful....wish you were here to see them with me xox

And so it begins...

Sitting in the airport lounge in Atlanta waiting for my connection flight to Accra!

This might be the first time I am able to sit down and take it all in...last 2 days have been extremely stressful with surgery exam and trying to see family, friends and uhmmm pack before I left today!

Last night was nice...went for dinner with my family to Mythos...nothing like a good greek meal before I leave. Most memorable moment was when I was saying goodbye to everyone and seeing my grandfather cry...never ever have I seen him cry before....it was special. Really enjoyed a nice dinner with the family...always very fun and interesting times :) Then went for drinks with friends at Benelux...good beer!

Still hadn't packed my bags till this morning...Evie was still asleep as I had all my stuff everywhere around the house, trying to figure out what I was gonna pack. I wanted to pack light and enjoy the experience....suitcase 56lbs and dufflebag 26lbs...oh well! But i managed to get lots of supplies from the hospital....lots of sutures, gauze and meds to bring with me there.

Then finally made it to the airport with my mom, dad and Evie :) They sent me off and I met up with Patrick and Eric...my travelling partners. This was tough to say goodbye....especially to Evs...she was in tears and I didn't want to make it worse...so I held it all in until I was no longer in her sight.

Had a nice flight from Montreal to Atlanta....little rocky, no leg room, a larger habitus person sitting beside me....but I watched movies on my laptop. It's all good. For some reason though...the flight attendant thought this was his night in stand up comedy and wouldn't stop talking on the overhead PA and kept talking and talking...sooo annoying.

In Atlanta aiport...supposedly one of the busiest airports in the world....who knew?! Went to eat at TGI Fridays...so good! Free refills though and she gave me 3 large glasses worth of coke...my stomach hurts now along with those malaria pills....oh well

Alright guys...it's time to board right now...everyone is in line and they are checking our visas...oh and lots of crying babies...great! It's going to be a 10 hour flight...can't wait.

When we land in Accra....there should be someone holding a sign with our names...will be escorted to a lodging place for the night. Hopefully we'll get a chance to visit some markets! Next morning we will be flying to Tamale and then drive to Nalerigu where the baptist medical centre is!!

See you all soon!

Love you guys...Evie...still missing you....28 more days xox

Ghana!!

Hey everyone!

I am leaving this Saturday for Ghana!

This will be my first month of 2 being away for rural rotations. I decided to take this time and go somewhere else other than Montreal. Once I get back from Ghana, I will be leaving 2 days later to spend one month in Mistissini, Qc....this is way up north and I will be working with the Cree population in a small town of 3000 people.

I have decided to do my family medicine rural rotation in Nalerigu, Ghana. I will be there for one month working at the Baptist Medical Centre along with two other students from my class, Patrick and Eric.

The Baptist Medical Centre in Nalerigu is a respected mission hospital located in the Northern Region of Ghana that was founded in 1958. Currently the BMC is a 123 bed hospital whose reputation brings people from as far south as Accra, as far east as Togo and Nigeria, and as far north as Burkina Faso and Mali. Most recent yearly statistics are as follows: 60,000 outpatient visits, 10,000 inpatients, 1,200 major operations, and 2,500-3,000 minor procedures. 

www.baptistmedicalcentre.org

I am very excited and kind of scared as well because I don't know what to expect! I am sure however that this will be an unforgettable learning experience!! 

I have still not packed because I have a surgery exam tomorrow that I am studying for but I am used to pushing everything to the last minute...so hopefully I will be packed in time and ready to leave on Saturday!! 

I will keep this short now but I just wanted to get a blog started because I figured it would be a cool way to keep my family, friends and anyone interested in being updated with what's going on while I am away.

So follow my blog! 

I will be sharing all my experiences with you guys whenever I get a chance to get a hold of a computer. 

Evie...I am missing you already.