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I got back to Baltimore safely on Thursday night. It was a long journey back to home. Had to wait in Accra for 2 days, and a 10 hour layover in London airport.

It was Christmas Day when I was in Accra. The baptist guesthouse was all empty. The city was pretty quiet as well. I think people were all at home with family. I didn’t do much during those downtime. Watched a lot of Netflix as I have reliable internet for the first time. I think I watched an entire season of project runway, and I don’t even like fashion that much.

I guess watching TV has always been an escape for me. There’s way too much to process and too complicated emotions to sort through. It’s difficult to answer how was my trip or what lessons have I learned. I think I just have to be patient with others and myself. I’ve jumped right back to work. It feels pretty weird. Everything seems so foreign but at the same time familiar.

I’m really grateful for having the best friend ever. Ashley came picked me up from the airport and we hung out all day the following day. We made a beautiful gingerbread tree and tiny house together!

It’s also amazing to sleep on my bed and take a proper shower!

There’s not that much to see in Accra. But the coconut was very tasty!!

Greatest danger

It’s been a great comfort knowing that my friends and family are praying for me and above all, Jesus himself is interceding on my behalf. Sometimes it’s easy for me to forget during the mists of things that nothing can actually harm me. My Father is in control of all things.

John Piper’s devotional reading on December 18 was particularly helpful for me. https://www.desiringgod.org/articles/the-christmas-model-for-missions

The danger of all dangers would be to lose trust and confidence in the mercy of God. . . . To distrust him would be a far more terrible thing than any physical evil which all the enemies of God put together could inflict on us, for without God’s permission neither the devils nor their human ministers could hinder us in the slightest degree.

The greatest danger a missionary faces is not death but to distrust the mercy of God. If that danger is avoided, then all other dangers lose their sting.

I’m grateful for the constant opportunity to perfecting my trust in the Lord. I’m also grateful for friends who encourage me to turn my eyes back to Jesus.

This is what is morning rounding at pediatric ward is like for me. After I see the more critical patients, the staff would call on the patients name. They will line up with their moms in front me me. And I would see them and review their cases like that. All 50 kids to one big room. In some way, it makes rounding go a lot faster as I don’t have to move very much.

Doubts

It’s been a rough couple days as I try to work through my ongoing gastro problem. So it turns out my body didn’t actually clear the illness. I felt better for one day and the diarrhea started all over again. Tomorrow will mark one whole week. I Everything I tried to eat just comes right out. But not eating is also making me feel quite weak as I continue to work. I finished a course of azithromycin earlier for respiratory illness, it should covered any traveler’s diarrhea. Since it didn’t work I went to the pharmacy and purchase some cipro. It’s a fun process to watch how drugs are filled here. 🙂 I’m convinced I have some parasite infection now since it’s still going on, I need to go buy some flagyl and albenazole tomorrow…

Anyway, I do want to spend a little time to reflect on a particular feeling I have for the past few days, which is inadequacy. It’s a really hard condition to work here. I’m seeing deaths everyday, including patients I’m directly taking care of. I don’t think I’ve ever felt so ill equip before. Back at home, a lot of times I felt like we have too much supervision. Sometimes I wish my attendings would give me more space and independence. In contrast, most of the times here I have no one to ask for help and panic someone will die in front of me. Everything always seems so hectic, busy and disorganized. Sure Heidi and Tim are here, but they are so overwork already I can’t just bombard them with questions. The only diagnostic tool that’s easily assessable is the portable ultrasound, which I’ve didn’t know how to use before this month. For instance last night when I’m on call (by myself), I need to use the ultrasound to find out if there’s a intrauterine pregnancy and another few cases of if there’s free fluid in the abdomen. All important questions that I would not want to trust my own ultrasound skills for… I’m questioning my medical ability as well, as everything works differently here. Drug formulations, treatment plans, language, etc. Chart review here means looking over people scribble in a folder. Everyone who knows me, understand how horrible I’m with reading people’s handwriting, most of the time I can make out maybe two words. The combination of the above things adding on ongoing diarrhea with exhaustion, makes me feel like I’m not meant to be here.

Maybe all these feelings are normal? I don’t see what I’ve could of done to better prepared for this trip. Tim described his first year here as “intern year on steroid”, learning by mistakes.

Patients wait to be seen by doctors and medical assistants on clinic day at the Baptist Medical Center in Nalerigu, Ghana.

Sunday, fun day

Sundays are busy but fun time here at BMC! My day started by rounding on my patients in the hospital. It become the unspoken agreement that I’m covering all the pediatric ward now. I think I’m gonna start helping out maternity and isolation ward tomorrow. To see if I can ease up Dr. Tim’s load even more. It only took a bit over two hours rounding on the patients today.

Then I went to church with Tim’s family. The have three little girls, Rebecca, Abigail and baby Hanna. Rebecca and Abigail are really found of me after I gave them some presents and played with them at last station meeting. They are really cute and cuddly, they want to follow me everywhere. Church is fun, enjoying hearing folks singing in Manpruli. The preaching today is on the meaning of Christmas. Emmanuel is God with us. The preacher mostly spoke in Manpruli so that’s kinda all I got out of it.

Afternoon I had some meaningful conversation with Gesche (the young girl from Germany). It’s also nice to see young people willing to slow down and think deeply on life. I admire her courage for coming her, to a complete foreign country for an entire year. I’m not sure I would be able to do that at 18 years old. Praying for her that the Lord will show her His face and guide her on the right path. That she will come to know the true God and enjoy all the riches in God’s family, and she would use her many talents to glorify God during this lifetime.

It’s a tradition the Huan’s family started-ultimate frisbee on Sunday afternoon. Many of the local kids gathered in front of the open area by my house to play ultimate frisbee. I played with them last Sunday, I wasn’t good but it was fun. Except for the LARGE amount of dust flared up my asthma. So today I just sat on the side and played with KJ and buster the dog.

Kids are wonderful. They all love me and follow me everywhere! This is John, my private Manpruli tutor 😝 I think I can get through majority of the rounds on my own now. I really only ask 10-20 common questions to patients anyway.

Station Meeting

Every Thursday night at house 6 is the station meeting. There’s 9 houses very close to the hospital complex. I think most of the hoses were built over 60 years ago when the hospital was built. They are occupied by the long-term missionary families, pastors, medical officers and medical students. House 6 is reserved for the short-term volunteers like me. Daniel the other resident from the U.S just left to go back 2 days ago, so I’m the only volunteer left. They said December they needed help the most because usually no volunteers come during the holiday season and many staffs take vacation during this time.

Thursday evening is a fun time, it’s a small group meeting for the missionary’s family. We share dinner together, sing some songs and just have a good time. This evening we sang many Christmas carols as Christmas is coming. As we celebrate the birth of Jesus our Savior, we also eagerly waiting for the second coming of the Lord. It’s such a joyful time. It gives hope to all who is willing to hear.

I brought some card games from the U.S for the kids as presents. Trey, the oldest son of William and Heidi loves Phase 10 I gave him. Trey is such a smart and thoughtful boy. There’s two German kids hanging out with us too. They just finished high school in Germany and are spending a whole year here teaching at the local school. Apparently in Germany, the government pays for the kids to volunteer for a year after high school. And there’s many NGO organization help to send them to various locations according to their interests. Anyway, we had a great time playing phase 10, and yes I won the game 😉

Unfortunately I got food poisoned from the food. About two hour after dinner I started having bloating and abdominal pain. The next 24 hours I was either on my bed or on the toilet. It’s funny how tiny bacteria can make you feel so miserable. Now I can finally keep the food down almost 48 hours later. It’s really expected to get some sort of GI illness coming here.  I’m just so glad it only lasted for a day and I felt good enough to back to work today. Thanking God for protecting my body that so far I’ve only gotten a short course of food poisoning and pneumonia.

 

This is “spirit”, which is the hand sanitizer/ diluted alcohol we use here.

A quiet heart

“But He has promised to never abandon us. This promise is the ground of our contentment. In every need, remember that He will not leave you. In every condition, remember He will not abandon you. In every circumstance, take courage and be strong, knowing your good Savior will never forsake you.”

I knew that it wasn’t right for me to be so angry yesterday. But I also knew that God have mercy on me and give me a bigger perspective on the situation. Even the walk home from the hospital yesterday, when my eyes were filled with tears, there was a small voice asking my heart, “God what are you teaching me this time? Why did you allow me to save the baby but now watch her dying?” All things is under His control. So why am I here now. How can I obey God and honor him in this circumstance that is so difficult for me?

I’ve skipped the evening hospital rounding last night and gave myself time to rest and reflect. I picked up a book called Learning Contentment by Nancy Wilson and reread it, God really used it to encourage my heart.

Many things can make us unhappy and cause us to complain. Thinking back my comfortable life in the U.S, I can still find many many things to complain about. I complain about the work, being tired, injustice, the food the weather and so on. Being here really makes me be more aware of this disease of my own heart. In the book, it describe contentment is a deep satisfaction with the will of God and discontent is a deep displeasure at what God is doing, a prideful attitude of the heart. Circumstances should not be the excuses for me to discontent. I can’t change other people’s attitude or conduct. It’s silly for me to be frustrated and angry for the condition and culture here. I’m so thankful God is giving me opportunities to exercise my faith and trust Him. He does not promise that I would understand the reasons behind each situation, but He has called me to learn from Him. Be more like Christ, gentle and lowly in heart. All our time on earth is short, is limited. I need to make it count. My purpose on earth is not to solve world hunger or poverty, I’m called to love God and his people with all my heart and strength. Seeing people suffer and die cause my heart to ache. But I think it’s healthy and normal. Jesus himself is a “man of sorrow” too. But I pray that my heart would not grow weary and become bitter. Rather I would turn to my Savior for comfort.

I walked by the maternity ward to check on my baby earlier. I learned that she had passed away a little bit ago. I saw her body wrapped around in a blanket by the trash can. She is resting in God’s hand now.

When things go bad on call

I apologize in advance that there might be a lot of venting for this post. I’m sure my heart will soften and can see a wider perspective in a few days but not at this current moment. I can’t remember the last time I’m so frustrated and angry about something. This all started last night when I’m on call for the hospital.

Taking call alone for the first time for BMC was a scary thought. Over 200 beds with male, female, pediatric, OB and isolation ward. People are sick, resources are lacking and staffs are not very attentive. Staff not being attentive have been somewhat frustrating to me since day one, but last night it got to a whole different level.

Let me explain the staffing situation of BMC hospital briefly. They are two missionary doctors from the U.S, they have been here for the past four years. Heidi is a general surgeon, well she’s the only orthopedic, plastic, general, trauma, colorectal surgeon for this whole region. Tim is a family med doc, who is also doing the c-sections for the hospital. In Ghana, medical school are 6 years, students go straight from high school to med school. After med school, people don’t go straight to residency. Mostly because there are only two (maybe three) teaching hospitals with residency programs in the entire nation. They work at local hospital with close to none supervision as house staffs. After they completed the 2 years of housemenship they become medical officers. Medical officer or MO are completely independent, doing surgeries and all in Ghana. BMC was a Baptist mission hospital for the past 60 years, but 4 years ago it was turned over to the local government. All I can put it is that it’s not the best hospital administrative. All the meds are provided by the government. Most all of the supply are provided by Baptist convention and volunteers. But hospital don’t have sufficient money to hire enough staff or keep equipment in working condition. The two missionary doctors are probably among the two most hard working individuals I’ve met. They have such a big heart for the patients and are working beyond their max capacity. On the other hand the house staff and MOs are a hit and miss. But majority of the staff have attitude that patient care is not their business. A big issue is that there seems to be no consequence or accountability for bad outcomes. When patients died, that’s expected by everyone. There at times patients don’t have to die, BMC definitely have the capability to save more people. Patient have to pay up front for everything. On admission, if you don’t have enough money you sleep on the concrete floor with rats all kinds of other things. You have to pay for water, oxygen, medications, gauze, labs (there’s total like 5 labs we can do here), xrays or anything else you can think of. If you can’t pay even its critical no one would do anything. Family members feed, change, do PT for the patients. The only thing nurses seems to do are give the medications. Vitals are check 1-2 times a day, usually only temperatures were checked. You’ll get a weight and BP on admission. Just take a second to think about how frustrating this could be. As a patient is dying in front of you, nurses just stand around and look at you. You ask them to do something, they respond okay but keep standing there. The patient died, and everyone just move on. This actually happened. Multiple times already. I’m sorry again to be so negative today.

Okay so let’s move on to what happened last night. It was a busy call, but I handled it fine until around 4am. A nurse from female ward called me saying a pregnant patient is admitted for abdominal pain and want me to come see. After walking to the ward, I sweet talk a nurse to get up and help me translate, and I finally get to speak to the patient. Her story is that she started having abdominal pain with minimal vaginal bleeding since 4 days ago. Upon further questioning her symptoms started after she fell off her motorcycle. She doesn’t know how far along the pregnancy is. I ran to grab the ultrasound machine, I identified the placenta position, and see fetus was about 25 weeks, and see the four chamber heart but it was not bleeding. At this time patient started screaming in patient and have large amount of vaginal bleeding. All 50 patients in the same room in female ward, children and elderly women were staring at us. I escorted her to the OB ward. Long story short, baby was half way out of her body, I had to deliver the baby in breech presentation (head up), on the floor. No nurses were helping me. After baby is out I yelled for people come help me with the mom. Baby was limp, no heart beat and not breathing. I did a round of CPR and gave rescue breaths. The nurses then asked me to stop because anything before 28 weeks of gestational age is consider an abortion here. Baby would not survive. Miraculously when I stopped the resuscitations, baby is now breathing spontaneously and heart rate of over 100. Baby is tiny weighing 0.7kg (1.6lb), but she looks perfect and has a fantastic chance to live a healthy life to adulthood. I called Tim (the missionary doc) for help and told him the story. We put the baby in the only working incubator with two other babies. Working for about an hour to improvised to give baby some oxygen using duck tape and submersing tubes under water to see if it’s working (as there’s only one oxygen tank).

The part that makes so so sad and frustrated is that. After doing all this, and the child doing so well. She is most likely going to die. And that make so so upset. Mom is not very excited about the baby after seeing how small she is. She is not trying very hard to express breast milk. After searching the whole hospital I finally came to term that there’s no correct size NG tube. And nurses are not placing the IV line. Mom is not willing to go out and buy formula to feed baby.

As I hold the baby, I can feel her heart beat and breathing by my chest. Baby is getting cold, looking more lifeless. I’m so angry that people don’t seem to care. I’m angry that she’s going to die and I can’t do anything. It’s a mere miracle that she’s even alive now, after having no heartbeat for at least 5 minutes but she’s not given a chance to fight to live.

So that’s my call last night, the most dramatic call I’ve experience so far…

Sad day

I couldn’t get myself to write last night. I knew it could be hard before coming to Ghana. I was warned that patients died here, and I was mentally trying to prepared myself. But I was still heartbroken when it actually happened. Nothing could of prepared me for this.

I’ve seen someone died everyday since I’ve been working at BMC. This is a lot compared to the normal patient population I taking care of as family medicine doc in suburban Baltimore. I hasn’t hit hard until yesterday afternoon. This was a baby girl I’ve been seeing in the pediatric ward. A very malnourished 10 month old. She is here for gastroenteritis symptoms, she is on the right IV antibiotics and IV fluids to help her get through this. When I rounded on her yesterday morning I was concerned. She was put on oxygen by the staff because of respiratory distress. When I saw her she was still working hard to breath and her heart rate was slower than I expected. There wasn’t much more I could do so I was just going to monitor her. In the afternoon, I came back to the pediatric ward to check on a few more patients. I was called by staff to come see her. The mother was hold the baby in her arms. Baby has no heart beats, no heart sounds, pupils are fixed and dilated. Baby was dead. I told the mom and staff that baby had passed away. The mother didn’t cry or scream, she just looked at me. I didn’t know what to say and I walked away.

I still can’t describe what I’m feeling. I would much rather just buried these feelings deep and don’t think about it. But I know the right thing is to take courage and reflect on the experience. I am sad I think. It was terrible to see a baby died. The baby’s face and her mom are now burned into my mind now. I couldn’t sleep all night yesterday. The baby’s face was hunting me. I wish I could have done more, or maybe I’ve missed something. I wish I have stayed and comforted the mother. I wish there’s no more malnourished kids. But mainly I just feel numbed and sad.

I guess it’s might be a positive thing that I’ve had been extremely busy and didn’t have time to just sit around and be sad. I’ve diagnosed people with so many serious conditions, started patients on actual life-saving medications since yesterday afternoon. I’ve caught 2 likely bacterial meningitis or cerebral malaria and started them on treatment. (I’ve never seen such positive Kernig and brudzinski’s signs before, it was really impressive). It’s funny how quickly one can learn when it’s necessary. I can now do OB ultrasound, locating placenta, measuring gestational age and fetal heart rate.

It was almost 10pm when I was walking back home from the hospital tonight. I turned off my headlamp and looked at the sky. It was so beautiful, so vast, so clear and filled with shining stars. I feel small and insignificant looking at the stars. It’s a good thing because that means I’m not in control. The God of universe knows every star by its name and he knows everyone on earth.

That’s it for now. There’s always something to be sad, frustrated, happy and excited about here at BMC.

Market day

Every third day at Nalagrie are the market days. Village people bring their crops, produces and set up shops. I’ve been looking forward to this day to check out the the village. The hospital complex is a pretty big part of this small village, walking out of the complex there’s a main dirt road, on either side Thera mud houses. At the end of this road is where the market is held. It’s a fun walk down to the market. Except for the heat and the dusk of course, but that’s also part of the experience. I forgot if I mentioned it before, but I love the Ghanian people. People are so friendly and welcoming here. Kids would run up to me, put on big smiles and say hi. I think I must look very amusing to them. EVERYONE is starting at me when I’m walking. It’s kind of funny. One little girl ran up to me in the market to see my face, when I turned to her, she was startled and jumped a little! Another funny thing was that today along, three people asked me to married them. One was when I was rounding this morning, the mom wants to know if I would married his toddler boy when he grew up. He must not even been 4 years old… I really couldn’t tell if she was joking or not.

I’ve only been here for less than one week so far. But for some reason it feels like it has been a lot longer than that. I can’t believe how quickly I’m adjusting to living and working here. There’s more differences than similarities working in the hospital. I feel like working here is more like doing wilderness medicine than my actual wilderness medicine training. Just to give a quick example, today for a trauma patient, I incorporated shoe laces and tape to make a cervical spine collar worked. It’s still really hard to see some patients laying on the floor or when I see a kiddo struggling to breath, but his oxygen tank is shared with 2 other patients. It was definitely not a fun experience when a guy died in front of me this morning when I’m seeing patients on the wards. Daniel (the other volunteer resident) and I were jumping on to do CPR. But the local doc came over said don’t bother with CPR, he never seen anyone saved by CPR here. 25 other patients in the room, all silent, starting at the diseased patient and us. The family is sobbing outside the room.

Although death feels so imminent here, it’s also fills with hope. It’s great to see kids getting better from cerebral malaria, see post-op patients recover nicely from their bowl perforation, amputation, etc. I think all of us, regardless races or ages all need hope. A hope that tomorrow will be better than today. A hope that the world will be a better place. Hope will help us pushes through difficult time and continue to move forward. Therefore it’s so important to put our hope in the right person. Everything on earth will pass away but his words will still remain. When we have plenty of resources, they give us a false sense of security, that we can hope if our own ability, intelligence, youth or money. But no one can predict tomorrow. I can see it more clearly being here. It’s such a good reminder for me that my only hope is in the Lord Jesus Christ.

Friends, who and what are we putting our hope in?

“May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope.” Romans’ 15:13

Sunset

Today is a national holiday here. It’s known as “holy day” aka “farmer’s day”. It’s really nice because the afternoon clinic is closed so we get a free afternoon.

There’s a beautiful overlook area where two rivers meet that’s not too far from the hospital. Daniel (the other volunteer resident doctor from the US) and I were going to walk there to check it out. “Cough” of course it was my idea. I’m very glad we didn’t walk there because it was a 30 minute car drive on very bumpy road to get there. We passed by a few small villages, farmers, all kinds of animals, cross over a stream and we were there.

I’ve seen many beautiful places by now, but creation never ceases to surprise me. It was beautiful. Time also seems to slow down when I’m in nature. Everything is peaceful, and everything is pointing to “how great thou art”.

Thank you Lord for today. For letting me experience the beauty of your creation. To experience the kindness of other people. To live an another day to worship you.

“Ever since the creation of the world his eternal power and divine nature, invisible though they are, have been understood and seen through the things he has made. So they are without excuse.” (Romans 1:20)