Getting Back Into It

Ever since Dr. Jonathon left, my time at the hospital has been very slow. I usually wander around the different wards with Amelia, another volunteer, looking for things to do. After a couple hours of talking to nurses and patients, reading charts and fruitlessly asking if any births or surgeries will occur, I end up going back to the hostel. 

Today however, things turned around. After inquiring about any imminent births or c-sections at the maternity ward, Amelia and I were presented with the opportunity to help bathe newborn babies! (And by presented with the opportunity, I mean I saw a nurse carrying a newborn, followed her to the labor ward, observed for a bit and then asked if I could help. I’ve discovered that I need to be a bit pushy in order to get involved.)

Washing the babies was such an amazing experience! They were so incredibly tiny, yet perfectly formed. Holding them made me forget the trauma of watching a birth, something I was sure would not happen for a quite awhile.

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A freshly washed, moisturized and wrapped baby!

After helping bathe, dress and wrap seven babies, Amelia and I decided to check up on the patients we had been following in the female ward. Unfortunately, two of our four patients had passed away over the weekend. At first, it was very difficult to grasp the idea that, despite the best treatment the hospital could provide, these two women had not recovered. I knew that both women were extremely ill and required costly treatment that the Ho Municipal Hospital could not afford. Yet seeing new patients in their cots was more shocking than I had anticipated.

Upon further reflection, I’ve begun to come to terms with their deaths. Both women were unconscious and suffering immensely. One was obese, hypertensive, diabetic and had renal failure. She badly needed dialysis, which is only available at a hospital in Accra (the capital of Ghana) and is prohibitively expensive. The other woman was HIV positive and had toxoplasmic encephalitis, a type of brain infection that can be deadly among those with HIV. Death was probably a welcome escape for both. 

The presence of a new doctor doing rounds in the female ward helped me take my mind off the two patients. I followed him around the ward (this has become one of my new hobbies) until presented with an opportunity to introduce myself. He was very friendly and seemed genuinely interested in explaining the thought process he went through in diagnosing patients. 

The new doctor, Dr. Akobo, is very young and has only been out of medical school for one year. He spends an extraordinary amount of time with each patient, particularly in comparison to some of the doctors. (One nameless doctor skims his patients’ charts, glances in their general direction and shouts instructions to the nearest nurse before moving on.) I’ve come to realize that the younger the doctor is, the more idealistic and focused on patient interaction he (all the doctors I’ve met have been male) is as well.

After an interesting and informative hour doing rounds, the day ended with us making a plan to continue shadowing Dr. Akobo, both in the female ward and in his consulting room. I’m so thrilled to have found another doctor! Dr. Jonathon was a great mentor and will definitely not be replaced, but I think shadowing Dr. Akobo will be a valuable learning experience as well. Can’t wait for tomorrow!

Malaria, unless proven otherwise

At all the wards I’ve been to at the hospital, malaria is by far the most common illness. In the outpatient department (OPD), where I’ve been spending most of my time shadowing Dr. Jonathon, everyone with fever and/or chills is immediately diagnosed with malaria.

In response to my questioning the frequency of malaria diagnosis, Dr. Jonathon responded, “Fever is malaria, until proven otherwise”.

He continued by explaining that during the rainy season, malaria is so common that any complaint of fever or chills is immediately diagnosed and treated as the disease. Often times, patients just have a case of simple malaria, which is characterized by fever, chills, weakness and frequently a lack of appetite and vomiting. Simple malaria is easily treated with a three day course of pills, usually Artemether/Lumafantrine or Artesunate.

I was surprised to discover how straightforward it is to treat malaria. From all the hype about malaria prophylaxis in the US, I was expecting treatment to be a grueling and drawn out process. Instead, malaria is so common, and its treatment so basic, that most people get malaria several times a year and recover by day two of their pill course.

However, if untreated, simple malaria can quickly become severe, and many complications can arise. A common cause of death in children under six, severe malaria is a general term that describes a variety of symptoms. On an assignment from Dr. Jonathon, I researched the different clinical and lab manifestations of severe malaria and discovered that there are about 20. Most common in the municipal hospital, and apparently throughout Ghana, are severe anemia (characterized by hemoglobin <5), cerebral malaria (where the patient’s brain swells and he/she often experiences seizures and loss of consciousness) and prostration (where the patient is too weak to stand or sit up).

In order to avoid an increased incidence of severe malaria, Dr. Jonathon usually prescribes malaria medication to anyone who has any of the illness’ classic symptoms as well as to anyone with a cold (since they are more susceptible to the disease) without a blood film test confirming the presence of the malaria parasite, p. falcipirum.  A very knowledgeable, patient and intelligent man, Dr. Jonathon explained to me that while drug resistance can develop by overprescribing medication, lab technicians often do not conduct an adequate blood film test, consequently incorrectly concluding the absence of the parasite. Therefore, he believes it is better to prescribe the medication, as side effects are minimal.

Dr. Jonathon has been a tremendous wealth of information, both about clinical medicine and about Ghana’s health care system. He not only patiently answers my incessant questions, but also quizzes me on topics he has previously explained or has asked me to research. Standing in for a doctor on leave, Dr. Jonathon had his last day at the hospital yesterday. I’m very sad to see him leave.

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Dr. Jonathon admitting a patient to the Children’s Ward from OPD

Genuinely interested in helping his patients and practicing good medicine, Dr. Jonathon is one of the few medical professionals I have met here who is not yet jaded by the health care system. Despite being restricted by administrative barriers and certain cultural practices, he does his best to advocate for his patients.

Two instances stand out the most in mind. The first occurred a couple of weeks ago with a girl who had hydrocephaly, an enlarged cranium due to an excess of water. Although the girl was at the hospital for a variety of other symptoms that turned out to be malaria, gastroentiritis and an upper respiratory tract infection, Dr. Jonathon was very concerned that nothing had been done about her hydrocephaly when she was younger. He prescribed her a variety of medication for her other complaints, and upon noticing she did not have health insurance and was struggling to make ends meet, gave her money for the prescriptions. He then instructed her to come back in a week, after she had recovered, so he could sign her up for health insurance. It was so touching to see this act of empathy in a hospital environment where many of the staff treats patients brusquely.

The second has been an ongoing battle with hospital administration. While doing rounds in the female ward a few days ago, Dr. Jonathon discovered that a woman with tuberculosis was in the same room as two HIV patients. As they are severely immunocompromised, the HIV patients had a high risk of contracting TB from their highly infectious roommate. However, the TB patient was no longer producing sputum, so although her chest x-ray displayed a very large granuloma, the diagnosis could be confirmed by a sputum test.

Dr. Jonathon has been arguing with the female ward nurses, the head nurse and the administrative staff to have the woman put into an isolated room, to no avail. Despite being told by other doctors that his battle was futile, he is still determined to get the TB patient isolated. The last time he was in the ward, he declared he would wheel her out himself if it came down to it.