Monday, March 31, 2014

Sure is hot out here.....well no, it's actually raining which means I get nothing done apparently.

Well, what a productive day......NOT.

The day started off with pouring rain. So heavy that even if I had an umbrella, walking would not have been an option. I wanted to be in the gynecology clinic by 9:30. Since today was the start of my solo trip without the students, I wasn't sure if it was that productive to be there that early since I'd be waiting for the consultants. Nature took care of that worrying for me since I really couldn't leave the hostel until about 9:45. In the mean time, Joy gave me a mini lecture about personalities and how you have to know yourself before you can find the person you want to be with. I sometimes feel like the world is playing one big match maker in my life. But its with good intentions so its fine.

That's a lie... it's raining lions and elephants.
I walked a bit before a taxi came by that I had drop me off at the surgical department. I only had 10 Cedis and told him 3. He only had 5 cedis change (mmmmhmmm....I'm sure there were some 1 Cedis bills in his pocket he was hiding). He said he drives the same route everyday and sees me and will take me to the campus again for the 2 Cedis. Yea sure, I'll believe it when it happens.

Of course, none of the consultants were there....they weren't there for the next 2.5 hours either. I sat there and waited, chatting with friends around the world and reading my lecture script from back home. The nurses asked where my fellow students were and I informed them they had exams this week and that I was on my own. I didn't really see the sense of me being in the clinic beyond sitting next to the doctor and listening. Most of the patients here were not proficient in English, so I wouldn't have been able to take a good detailed history in the first place. At 11 it was announced that Dr. Damale would be there by 12. At 12:10 I told the nurses I was heading to the NICU if anyone was looking for me. I doubt it.
Oh How I love wasting time

At NICU, I visited my little guy. Still alive! He had another seizure over the weekend. He wasn't as active as he was Friday and looked to be having either little seizures or was shivering. I asked the attending doctor how the weekend was. She said it must have been fine since nothing was reported to her. I don't give much value to that statement since I think the general level of "fine" here and my standard of it are worlds apart. But he is alive and that is most important to me right now. The doctor couldn't tell me if the mother had seen him yet or not.

Afterwards, I headed to MedDiner to meet up with Felix, the German. We had lunch and chatted about past experiences. He moved off campus so he grabbed a trotro there and I walked home buying some fresh fruit along the way.

Back in my room, Joy had a few girls visiting her. They fairly quickly left though. Joy gave me her hard drive so I could watch a movie. Now I am just sort of waiting to see what the plans are tonight. Nana wanted to get in touch and perhaps go out and Pablo already asked me through Felix what we are up to. I'm sure something will come about.

Sunday, March 30, 2014

Sure is hot out here........Happy Sunday!

Hello everyone! Happy Sunday!

Sorry this weekend hasn't been that interesting to report on. I can't complain about some of the rest I am getting but I would have liked to do something a bit more exciting but don't have the travel buddies yet and had some people to meet.

As you know, my roommate wanted to take me to church this morning. I was told we were leaving at 6:50. I couldn't really sleep after 6:10 due to noise. Joy and I were ready to go by 6:50 but the other girls coming with us weren't. We didn't leave the hostel until 7:20. All five of us jumped into one cab which took us to the church. We probably would have been quicker walking because the taxi had to drive around the Korle Bu enclosure to get to an entrance to then drive us to the church in the compound.

The service had started at 7. We got there just in time for "bread" and "wine". I had expected a lot more gospel but it was a fairly standard service. At one point, any new visitors were asked to stand up. So I had to stand. People shook my hand and an usher handed me a piece of paper with info about the church and a form to fill out. At about 9 the first service was done. In the break, multiple people came to Joy and I to welcome us to the church and ask what we were doing in Korle Bu.

We only stayed for about 10 minutes of the second service because Joy wanted me to experience the more dancing, singing, gospely stuff. They didn't get too crazy unfortunately. After that, we left the service and grabbed some food to take home.

Since then, all I've been doing is napping, watching New Girl and How I Met Your Mother, downloading info for the USMLE Step 2 (ugh) and reading a bit in my mom's Ghana travel guide in the hope of planning something for the next weekend. I can't really get any work done though because I feel so lazy. I think I'm just trying to recover from all the interrupted sleep from the last two weeks.

Tonight, I will most likely meet up with Sandra and Nana if they have time after their family meetings and appointments. If not, you know I have my back up plan with the boys. I'll let you know what went down tomorrow!


Saturday, March 29, 2014

Sure is hot out here....Happy Birthday Uncle Dirk!

So, Pablo picked me up after work last night. I really didn't pack clothes to go clubbing....I didn't know I would be. But I'm actually okay with that because I don't need to make myself any more noticeable than my skin color already makes me :)

I made spaghetti at his place and had some good ole spaghetti with ketchup! Yum! I just needed something familiar for my stomach once. We watched Hangover III and then took a 1.5 hour nap on the couches before we went out.

We went to two clubs.

First up was Bella Roma: The interior was simple but club like and the music was actually really good. I haven't really gone clubbing to music other than rap/hip hop/R&B which is my favorite kind of music to party I had to get used to pop/club/house again. They played some really good songs though and threw in a song from a Ghanaian artist here and there. The club continued to fill up. I'm happy I didn't wear heals, for various reasons. The streets aren't really made for heals, it's comfier in flats and even in flats, I am still taller than 97% of the population here, so heals.....not that practical.

The second club, whos name I forgot, something with Divine maybe....its interior design was even closer to European clubs but the music was a lot more Ghanaian heavy. I was really missing my hip hop lol. Although it is fun dancing to Ghanaian music as well. At around 3 I wanted to go to bed. I figured sleeping in wasn't really going to be an option so I at least wanted to get a few hours in.

My fears were confirmed. I was in bed by 3:30 and was up at 7 for the first time since my whole hostel seemed to be awake, yelling, running around, my roommate doing laundry and cleaning. I threw on my eye mask and tried to get a few more hours in. I was not all too successful.

I decided to take it easy today. Get some work done, do some laundry, try to get in contact with my family in Germany. It's my uncles birthday today, so shout out to my uncle! Happy Birthday Dirk!

I used some Internet credit to catch up on my Glee episodes. Joy, my roommate, asked me if I wanted to take a stroll. We headed out and grabbed a taxi to the campus gate. Joy needed some things from the pharmacy and I had to grab some groceries. It's kind of fun hanging out with her. I think she sort of feels like my mom sometimes and I am okay with that. :)

Sandra picked me up and took me out for a drink and some food by the ocean. Afterwards she dropped me off at Pablo's where I met Felix, a German that arrived yesterday. We all watched 300 with David and then I came home. It's off to bed now, church at 7 o_o

Friday, March 28, 2014

Sure is hot out here....91 degrees Fahrenheit!

My alarm clock went off at 5:15 this morning. I was told to be at Yaa's store by 6. It was still a bit dark out and it had rained all night, so the walk was in a comfortable temperature. I was in the hostel at exactly 6. Of course, Yaa was not there yet. I figured she wouldn't be but I'd rather be on time and wait than too late.

Yaa showed up at 6:25. She invited me into her store and informed me that due to the bad weather, the seamstress wasn't able to make it and I should stop by after my classes. I left my fabric at the store and grabbed a taxi back to my room. There I slept another 1.5 hours before heading to the hospital for rounds.

I was sort of dreading them because they had been so long last week. This week seemed to be the mega grand rounds since it seemed every doctor I knew was there. Today was a lot warmer again as well so I was sweating like crazy. The standing was still annoying but not as bad as last week. Only 5 Students were there besides me. Dr. Damale took notice and asked for a list of the names of the students missing. He is having them report to him next week a few hours before the written exam. Awesome. I'm sure they are going to feel really good after that. I think it's funny how teachers like to point out how people are missing and how those missing are slackers and ask where they are asking the non slackers and present. Don't be mad at us.

Dr. Damale released us at 12 while we saw the last patient. Nothing interesting to report on the patients we saw. I went to the NICU to check on my little guy. The doctor that had eventually helped me on Wednesday night was there again. She informed me that the little guy had a seizure during the night but was doing good today. He is also the only one that really makes noises of all the babies. The other ones just kind of lie there. He will stay there over the weekend and I'll check on him Monday.

After all that, it was off to MedDiner for some white rice and plantains. Pablo came by and we headed over to Yaa's together. She told us to come back at 2.....he and I decided that meant 2:30.

We finished watching the movie from last night at his place before heading back to Yaa's. I figured the seamstress was coming to her. I was wrong. Yaa closed up her shop and told me to follow her. We headed to the main street and grabbed a trotro. After a few minutes driving, we got out and walked a bit. Eventually we came to a house where two ladies and a little boy were. Yaa introduced her as her sister...but I don't think they are actually related. The seamstress took my measurements and we discussed my sketches I had drawn up for her. Her little son was adorable. The mom took his hand and told him to say hi to aunty. I thought she meant Yaa but then she guided him to me. He shook my hand and quickly ran off again.

After discussing all the necessary details for the dress, Yaa and I headed back to the campus. I went over to Pablo's since he still had my bag and then he dropped me off at my hostel before he headed to work.

My roommate wants to take me to church on Sunday.......7am to like 11......this should be interesting. I've always wanted to go to a gospel church.....I just hope they don't quiz me on anything.

About to take a nap and then see if Nana (wife of my dad's colleague) calls to plan something for the night, otherwise I will do something with Pablo and maybe David.

Today was definitely a hot day again. 33 degrees Celsius/ 91 degrees Fahrenheit. Perfect weather for a beach outing that I hope to happen this weekend.

I forgot a detail in my baby rescue story. When we arrived on NICU, the nurse asked me for the baby's APGAR score. That score had always been a bit of a pain for me in my rotation because I never completely studied it. Well great. Thank god for the Internet and Siri. I thought it was crazy though that I was asked to give the baby an APGAR score. Just thought I'd share that. My fellow students in Germany might understand.

Well, I'll be sure to report of what I did tonight tomorrow. Have a good weekend everybody!

Thursday, March 27, 2014

Sure is hot out here....but my little guy is kicking and screaming!!!


The gynecology ward has a lot of tumors. Unfortunately, the tumors seen here are usually late stage tumors. Ovarian tumors are hard to detect, even in Germany, because of their limited signs and symptoms until its almost too late. Not having routine ultrasounds done here or the desire of the patients to want to have them done or the means of doing it, they are usually stage 3 or 4. These stages are hard to battle in well developed countries so you can imagine the success rate here.
One thing I learned in my OBGYN rotation was that elderly women with ovarian tumors can be really skinny but have a huge stomach because the tumor can really be massive! We don't usually see that extreme in Germany because of detection but here I saw one patient. She was fairly skinny but her abdomen was filled to the brim, totally protruding and I was told the mass was the tumor and blood in the abdomen. It looked absurd. She was about to go have a CT done. The doctor had her lie down and only then did I see the sheet that was around her waist was soaked. I saw a patch of gauze which was also soaked. The doctor removed the gauze. I expected some kind of horrific wound to be under it. All it was was a little tiny hole in the skin that was leaking. The women was literally leaking fluid from her full abdomen. Another patient with a chorion tumor (not a good one to have either, very aggressive) was lying in bed, clearly in pain, sort of out of it, mumbling and her hands were in contractions while her legs were extended. One of the patients started reading out load to the group from her phone about tetanus and what that looks like in patients. I didn't catch the whole conversation before that because some was not in English so I am not sure if they thought she had tetanus as well or if that is a differential diagnosis. She really looked like she was in pain though. Other patients just sat in bed quietly waiting for the time to pass.

We visited one more gynecology ward before being done.

I headed directly to NICU to check on my little baby boy patient. As soon as I walked onto the ward, I was approached by a nurse asking what I wanted. Wow…..first time this has happened since I've been here. I told her I wanted to talk to the attending doctor. She directed me to a room where supposedly the doctors were having a demonstration. This however seemed to be over by the time I made it to the room. The doctors just walked past me. So I turned around again and approached one of them. I told him I wanted to talk to the attending doctor and follow up on my patient. He directed me into the room where the babies were. There I was told by a doctor that lab coats aren't allowed in there and that I should go hang it up. Wow….so there are rules. I talked to the doctor in the room after hanging up my lab coat. He somehow knew I was the one who helped with the resuscitation last night (helped, did it all, was left alone to try…whatever you want to call it). My little guy was crying and kicking! I was so happy to see that! I was afraid he might still be floppy after last night. I inquired how long he might be in NICU and if he had been fed yet. He informed me he hadn't been fed yet (which I feel is odd because he is definitely fit enough to do that, maybe the mother isn't) and that they evaluate on a day to day basis. However, since he is getting antibiotics, he will be there at least 5 days until that treatment is done. I told him I'd be coming by everyday shortly to see how he was doing. I want to go see the mother as well in the coming days to see how she is doing.

On my way out of NICU, I ran into students from my group and they asked if I was going to the tutorial. The topic was supposed to be sickle cell anemia. Since we don't really have that in Europe, I decided to go along. Also the info that it should only take 30-45 minutes was intriguing. Dr. Buofuh was leading the tutorial. He said he only had about 20 minutes. I didn't end up looking at the clock but I think it was a bit longer than that. It was a good tutorial though, covered the most important aspects of the disease pertaining to pregnancy.

My little guy yesterday

Afterwards, I headed towards R Block hostel. I was accompanied by one of the male students. I stopped to have a fresh coconut. We proceeded to R Block where I said goodbye to him and ran into Michael. After telling him about what happened last night, I went to the trotro station to catch one to Kanishie market. This was my first solo trip into town. It was all good. Back on the bustling streets around the market, I went to the fabric floor of the building to go shopping for more fabric for my dresses. Maria had already warned me not to go too crazy and buy too much. Opps. I did a bit of bargaining but couldn't do much. In the end, I was at 4 different vendors, bought 6 different designs and 13.5 yards altogether. Some are gifts as well. I stopped to by a new carrying plastic bad because the straps on mine broke. After that, I was on the search for the trotro back to Korle Bu. After asking a few drivers, I found the right vehicle.

Back at Korle Bu, I stopped by Yaa's store quick and then walked home. I took a 1.5 hour nap. My roommate was there and she said she needed a nap as well, she hadn't slept well the night before….no kidding.

Pablo is picking me up after work and we will try to get a few people together to go have dinner and then maybe watch a movie at his place. Just something relaxed since I have to be at Yaa's store to meet the tailor at 6am!

Sure is hot out here......I think I saved his life O_O

I hardly slept last night. For some reason my roommate was up all night and then the noise from the front desk started around 7 again. My roommate has an exam today so I can not understand why she was up literally all night moving things around, cleaning up and just being loud....

Well yesterday was definitely a day to least the evening was.

I was in the OB Clinic in the morning. One student and I looked through the maternal books coming in with the head nurse looking for a good case to clerk. We found a woman with gestational diabetes and one with sickle cell anemia.

The student and I took the gestational diabetes patient. The patient told us she had to go pick up her lab results from the central lab. I guess in a place where there are no computers used for patient care and the patients have to pay certain things in cash, this was necessary. The patient left but the student and I were soon on our way over to see if we could expedite our patients lab results recovery. Once we had the patient and her results, we headed back to the OB clinic.

The student started taking her history while I sat there and listened in. Of course I hardly understood a word because they spoke Twi so I worked on my sketches for the seamstress. On physical examination, the patient requested that not everyone be in the room, more specifically she didn't want the male students but gave in and let two stay and examine as well. This shocked me a bit because she was the first patient to voice such an opinion. She also requested to see a specific doctor because she didn't like another one. I guess this is the equivalent of a difficult patient for their standards.

We presented the other patient to the doctor. That all went well. Our patient was supposed to be presented to a different doctor. The problem seemed to be that the one doctor was busy grading exams and the other had an appointment. The doctor we had first presented to agreed to see the second patient but first after seeing his patients. So there we sat waiting. I hate waiting. Our patient wasn't very amused either.

Then it turns out she didn't have her blood sugar level measured because she didn't have the 4 Cedis cash to pay for it because she needed to the cash she had to get home. The students were annoyed because this would further delay our presentation. They had joked that everyone could pitch in 20 Pesos and it would be covered. I asked if having this procedure done would expedite this whole presentation thing (I had lunch plans with Pablo at 2 and that time was approaching). They said it would and I told them I'd pay for it. It was worth the about 1 Euro to me that this lady gets her blood sugar measured and I get out of there for lunch on time. So I paid, she got tested and we were ready to present. We eventually found another doctor to listen. He said he had 5 minutes and seemed to be in a rush. He started all hectic but then started asking questions and explaining things and my watch was quickly approaching 2 o'clock and then passed it. I was getting antsy because I don't like being late but Pablo said it was all good and he had already ordered the food. At 2:15 I was out of there and headed directly to MedDiner.

After a quick break back at my hostel and charging my phone, I headed back to the hospital for duty in the labor ward. I stopped by Michael's place to pick up my USB (we are trading music, he gets american and I get ghanaian) and chat. Duty officially starts at 5pm but I didn't go unitl 5:30. Thinking this was very african of me, I texted Pablo of my doings....he said I was still way to German and needed to try harder, haha.

The work on the labor ward started off slow. Not much was going on and I just sort of wandered from one ward to the next. Eventually one of the doctors asked me to help him with a bed side clotting test. I'd never heard of it but its basically drawing blood, putting it in a glass bottle, holding that bottle in your hand and seeing when it clots. If its under 10 minutes, you can operate, if not, you give the patient clotting factors with fresh frozen plasma to get them under 10 minutes.

I headed into the OR to watch a C section. The same Anesthetist from last week was there again. We chatted a bit about my weekend and then he said next week, his colleagues and himself would take me out for a beer after work so I can get to know Ghanaian beer.

The first C section was uneventful except for the fact that I thought we might lose the baby. We resuscitated and gave her oxygen and she quickly recovered. After that I told myself I would have to look at neonatal emergencies in my notes the next day to be better prepared for a situation like that.

The next day was too late....I was in the other OR room chatting with the team there while we prepped a patient for her C section. After a while, I headed back into the other OR to see if they had made the cut yet. The surgeon was just beginning. He was through the skin, fat and fascia and was just about to tear the muscle apart to expose the uterus when out of nowhere the uterus must have ruptured because amniotic fluid started gushing out. This usually doesn't happen until the surgeon cuts open the uterus. When he cut the uterus, it started gushing blood. I assumed he must have cut into the placenta. He pulled the baby wasn't wasn't screaming. I thought it was dead.

In Germany I know there would have been a neonatal team there to help right away. Here, the midwife wasn't there to accept it so the female anesthesiologist took it and brought it over to the baby table. There she and I stared taking care of it. She called for the labor ward (I assume that meant she was calling a midwife. Their response was, yea we heard you....but no one came). The anesthesiologist started ventilating the infant with an AMPU bag while I performed chest compressions. I've never performed actual CPR on a living human so this was a first....and then a baby. She didn't seem concerned about heart beats really but I was. I luckily always carry my stethoscope with me. At first the child had no detectable heart beat. Not hearing one made my own heart beat faster. All I wanted was to hear a heart beat. After a bit of CPR, we had one! He still needed to be ventilated though because he was not breathing on his own. The anesthesiologist intubated him. The slowly accelerating heartbeat was still a comforting sign for me though. The first gasp he took also gave me hope. He was completely floppy though. No movement on his own. I tried stimulating his breathing. During all of this I was happy I liked pediatrics so much and paid attention but was scared I didn't know enough. And there was no actual pediatrician there to help us! We kept up with the CPR while I monitored heart rate. No one seemed to be really concerned. The doctor would even stop with the ventilation at times which almost made me freak out because ventilation is the most important thing for an infant. At some point the midwife came with a cart to take him to NICU (neonatal intensive care unit). She asked if I would go with her. Of course!!!!! I'm not leaving this child until it is breathing on its own. I was still shocked at how little everyone seemed to care! I was checking the heart rate while simultaneously ventilating and pushing the cart to NICU. Once we got there, the nurse calmly said, "See, you hurry up to get down here and then no body has time." What do you mean!!! This baby needs help ASAP!!!! I didn't care what was happening around me (which from the looks of it was not much), my main concern was this baby and monitoring as much as I knew how. A nurse helped move him to a NICU bed, next to another baby. The midwife wanted me to give her the AMPU bag because she was going back upstairs. ARE YOU KIDDING ME?!!?!??! THE BABY ISN'T BREATHING ON HIS OWN! TO HELL YOU ARE GETTING THIS BAG. I obviously didn't shout that at her but I did tell her she wasn't getting it unless she brought me another one. She just told me to bring it along when I come back up. Yea, thanks for all your concern.

So there I stood, all by myself except for a few nurses. One took some blood but otherwise they just looked. I asked for a blanket for the child. They put an oxygen saturation meter on him and he was down to 73%. I told them I wanted oxygen for the baby. These are things I would never be able to just say in Germany and have done but I saw no other option than to make these decisions here. Nurses came and went and finally one asked me who I was. I told her I was a med student and it would be great if the attending could finally come over here and help. She said no one knew who I was so they assumed I was the attending for the baby.WHAT! Don't assume I am the highest qualified position! I told her that the midwife asked me to accompany her and that is what I did and my only focus was getting this child to breathe again and not for me to introduce myself to the team since that hadn't been necessary all week. Besides, if a new patient comes to the ward you are responsible for, you sure as hell better look to see what is up. Unbelievable.

Finally, I had the little guy breathing on his own. The nurse told me they aren't used to getting intubated babies on NICU. Really?! She knew I was a med student since she had asked me a few questions and then she asked me when I thought it would be a good time to extubate. You're asking me?!?! What?!?! Ok, I thought, since I've been making decisions this whole time, this one is mine too. Since he was breathing on his own and we wanted to get a mask on him, I made the decision to extubate him. I stayed a few more minutes just to monitor him before heading back upstairs, returning the AMPU bag and calling my parents to report what had just happened. Before leaving, I went to check on him one more time. He was doing fine.

Pablo picked me up and I had dinner at his place and we watched American Hustel. I fell asleep in the middle for a bit so I kind of lost the plot. At about 1am he brought me home. My roommate was awake and as I've mentioned, stayed that way the whole night. My cellular data stopped working for some reason so I am not available over WhatsApp and will head to the Vodafone store after ward rounds to get it fixed.


Tuesday, March 25, 2014

Sure is hot out have a lot of piercings...and you are skinny Day 9

The forecasted rain apparently didn't want to come. Still wasn't as hot as some of the days last week but sufficiently hot.

The day started off in the gynecology operating theater. It's all very british based medical terminology we are in a theater and not an operation room. I waited in the, I'd call it "prep room". The area before going into the actual operation room. Beds were standing where ever there was room. Anesthisiology was going around laying IV lines. One of the girls from my group was there since she was assigned a patient. We couldn't operate though because her blood sugar levels were too high. She was supposed to get a new IV bag attached. The girl and the other one that showed up didn't really seem to know what to do. I guided her through it. I think the students do get to do some things before we might in Germany, at least with less supervision at times. Had I not told her to get gloves, I don't think she would have on her own. I know my hygiene standard in medicine is much higher than of others here because I'm just used to it, the endless supply of supplies and the many. many, many rules in Germany. Had it been at my disposal, I would have made her disinfect the area first but that is a luxury not available here. I ran her through the process, adjusting to what is available here. I also made her run the fluid out first because there was a lot of air in the tube. Had she not done that, she could have caused an air embolism! She kept on asking me what to do next (not that I'm an expert by any means) and it made me think this whole thing could have gone wrong. Not that someone will necessarily die right away but infection and embolism are legit risks. Maybe I'm just crazy paranoid coming from the system in Germany.

As the other students starting coming in, we headed into one OR to watch a myoma be removed from a uterus. The hygiene set up was obviously different than that in Germany but seemed sufficient.....until the students who wanted to watch got really, really close to the sterile surgeons. I'm talking shoulder to shoulder almost, right next to the instrumentation....

We watched the removal and the start of the sewing back up but left before it was completed to go to a tutorial. I'm not quite sure if they have a set schedule or just schedule things with doctors. I asked them how long a tutorial lasts. They replied saying it could take 3 hours. That would never work in Germany, everyone, including myself, likes to know exactly when they have to be where and for how long so everything else can be planned accordingly. Here, they just don't have other plans and wait to see what happens. Takes the pressure off of the seminar though. Dr. Walter did a great job! One of the best seminars I've been in actually. Everyone had to contribute, even me. Most of the time the doctors don't require me to answer questions which in honesty would also be difficult at times because the questions often pertain to procedures which are quite different here from in Germany. In this seminar though, I was actively involved in the discussion. He is an older man, had his coffee tray brought to him at the beginning of the seminar and had a very calm way about his talking. He really wanted the students to understand what they were saying and suggesting. I really appreciated this since I often feel they can recite information but haven't completely thought about why. The topic was postpartum hemorrhage....bleeding after giving birth. He really took us through every aspect of cause, clinic, signs, management and prevention. The chairs in the doctors lounge where we were in were really comfy and made me quite tired. The last 15 minutes of the seminar were a bit of a struggle. Not because of the discussion though, which is sometimes the case back home. Seriously, I liked the seminar a lot.

Afterwards I headed to MedDiner for lunch before heading home for a nap.

Pablo picked me up at 8 to watch the soccer game at MedDiner. Manchester United lost 3-0 to Manchester City for those interested. Afterwards I hung out with Pablo and David at their place and watched movies until about midnight. Really nice guys them two.


Monday, March 24, 2014

Sure is hot out here.....less today but with more fabric and black power

It rained this morning! A lot! I was excited because I knew this meant it wouldn't get too hot and the smog would be cleared a bit in the city air. It had stopped by the time I left for class and it was quite enjoyable. I saw kids wearing sweaters...

I was in the gynecology clinic by 9:25 with it all beginning at 9:30. Well maybe in Germany it would, the first student came at about 9:45 and it was a slow coming in of the others until about an hour later. The patient being interviewed spoke no English. I sat there anyways and listened in while making a list of things to do in my moleskin and thinking of sketches for the dresses I want to have sewn for me.

We started presenting our patient to Dr.Damale at around 11. He does a great job at teaching. The presentation was given and then turned into a full blown seminar about infertility. I assume the patient was bored out of her mind and I guess that all could have happened without her present but of course she didn't say a word. 

The second patient was presented to a different doctor. This presentation went quicker due to the fact that it was almost 2pm. My legs felt so heavy and I couldn't really sit comfortably. I don't have muscle aches yet from yesterday but they are sure to come tomorrow.

At 2, I headed to MedDiner for some plantains and rice. Maria and I then went to the Kaneshie market to go fabric shopping. I really could have gotten everything else imaginable along the way. We took a trotro to the market. The place was just full of vendors selling everything. The fabric market was in what appears to be an old factory. A lot of them sold the same fabric which makes me question the origin but the patterns are more African here than in Germany. I limited myself to three this time around. I also picked up some detergent, flip flops and a mug along the way.

Afterwards, Maria and I grabbed the same trotro back to Korle Bu and from there grabbed a taxi to the art market. Since it was already 5, it was beginning to dim. The stores had little windows in their ceiling which usually provided enough light. At this time we were basically running through dark stores using our cell phones for light. Maria still had to grab a few souvenirs for friends back home. We were approached by almost every vendor. Amongst them was a rasta man who did carvings. My dad had seen my post and asked if I had boughten the penis bottle opener. I truly had regretted it so he encouraged me to get one and one for him! I knew he would understand my humor. So the rasta man showed us all the carvings including black penis bottle openers. Of course this time I bought them and an Ashanti mask to one day hang in my big apartment. (So typical African tourist but also cool). I was told the penises are standard Ghanaian size and are called black power....

We both needed to get money from the ATM because we didn't bring enough along to pay him. Kombolo, our rasta man friend, walked with us to the ATM. We stopped at 3 places since the first bank had no working ATMs, the second wouldn't work with our cards and the third finally being a success. Maria and I jumped into a taxi back to Korle Bu. Since it is Maria and Radu's last night here, we are all going out to eat.

Sunday, March 23, 2014

Sure is hot out here....the water from the waterfall is great though! Weekend report!

Have you ever spent the whole day in a trotro? No, well me neither until now.

Our original plan was to leave Accra at 10. With the combination of having been out the night before, people liking to sleep, some wanting to go to the tailor before we leave and everyone on African time,  we didn't leave  Korle Bu until 11. We being Alex, Alexis, Maria and I. We grabbed a cab that took us to the bus station. This bus station was full of street vendors, vans and minibuses. We were immediately stormed by the vendors as usual. When people asked where we wanted to go and we told them Hohoe, we were quickly directed to a minibus going in that direction. The system of these buses is that they leave once they are full. There are 11 seats beside the driver available and at that point of our arrival, there was only one other passenger in the minibus. We ended up waiting about 1.5 hours before departing. In that time, we just sat in the bus and let the vendors walk by and bought a few items. 

Throughout the day, a lot of the stops, be it a traffic light still in Accra or in the villages along the way, there were always a lot of vendors trying to sell their goods. Maria and I started trying out some of the food. We bought Papaya, fried bread, fried yam and frozen yogurt.

The bus was full of passengers and the seats were not the most comfy. It's all part of the experience thought. Due to that, it didn't bother me half as much how close the person next to me was sitting as it may have in Germany. I tried to nap a bit but that really only worked for about 45 minutes. It was hot out but luckily our car had air conditioning. The countryside took on a more green color as we went. 

The first major stop we went through was at the river crossing. There was a huge line of cars that circled a big plot of land. The cars we're lined with equally the same if not more vendors walking around with goods on their heads. Maria and I tried most of our stuff here. Mostly due to boredom. We walked around a bit as well. Eventually after about 1.5 hours we were on the fairy boat over. The ride was only about 5 minutes. Hardly worth the wait.

The driver seemed to be in a hurry from this point on because we were driving so fast and passing all the other cars. Along the road, we often had to slow down, especially in the towns because they have a lot of speed bumps. 

I've also sort of figures out their honking strategie. They honk because they want to get your attention to take a ride with them, to get animals a and humans off the street, to say hi to people they know, around corners to let others know you are coming and just for the hell of it. So really, any occasion seems appropriate to honk in Ghana.

The road quality definitely declined the further north we got. All of us just really wanted to be in Hohoe finally because we knew we had another 45 min trotro ride from there to the hotel. After what seemed like a life time and driving through a rain shower and it being dark, we finally arrived. 

We were immediately asked where we wanted to go next by a couple of guys. We told them we needed to get to Wli. The first guys said they could take us in their trotro. Perfect we thought. The ride was only supposed to cost 3 Cedis. (The long trip in the minibus was 20 Cedis per person, about 5,60€ for a 7 hour trip basically).

We hopped into their trotro and thought we would be on our way in no time. They started driving but then made multiple stops for what seemed like no good reason. We told them we really wanted to get going. After a few more stops we ended where we started and picked up enough people to overload the van. After dropping the other people off along the way, we finally made it to the hotel. It ended up costing us 4 Cedis per person because he drove us all the way to the hotel itself.

There we were shown our two rooms and hung out on the patio a bit with a group of three German medical students. The lights were turned off on us at 10 though and so we headed to bed for a hopefully good night sleep before our 6 hour hike tomorrow.


Cross another thing off of my bucket list! Swimming in a waterfall! It definitely won't be my last time, it was just too beautiful.

Our day started off with the alarm clock going off at 6:50. I took an ultra quick shower and jumped into my bikini and clothes for the day. We had a good big breakfast. First European-like food since I've been here. Toast with eggs and an extra omelet to go with it. The little ants in the honey were a nice rural Africa touch. Little extra protein.

After breakfast, we headed to the waterfall tourist office down the road. We had to pay 10 Cedis each for entrance into the area and a 2 Cedis camera charge. We had out own tour guide. Francis and his dog Jack (who came on the whole tour with us) waited for us while we bought water and a few snacks. There were a few stands selling hand crafted things. Amongst them was a wood carver. He had bottle openers attached to wood carvings. He even had big black penises with a bottle opener attached to the base for sale. I very seriously considered getting one. As a hopefully future urologist, it would be such a funny object to have around. And if a guest wants to open their beer, they would have to grab for the penis. I didn't end up buying it though. Didn't think everyone would appreciate the humor. 

We started our tour, what ended up being 6 hour hike. It started with a walk through the rainforest before we started walking upwards. Francis brought his machete along and cut walking sticks for us out of palm leave stems. They were very helpful along the way. 

We quickly cleared the trees and found ourselves climbing up grassy, sandy and rocky grounds. It was really steep at times. Looking over at the falls on the other side of the place we were at that point, it seemed impossible to get there. The first hour was somewhat exhausting because we had to get used to all the steepness and climbing of rocks. We stopped here and there for some water and picture ops. We continued along the top of the mountain (I'm not sure if that is the technical term but calling them hills would not do them justice). I felt like we were in a scene from The Lord of the rings. Wondering on our quest. 

Eventually, we started wandering down into the trees again. At times it got really steep. Without the help of protruding roots, rocks and our walking stick, we never would have made it "safely". 

About three hours into the hike, we made it to the upper falls. Coming out into the clearing and seeing the pebbles going into the water pool where the water from high above landed was breath taking. We quickly ripped off our clothes and jumped into the cool water. It feels so nice standing under a waterfall. The force of the falling water is a welcoming massage. Since I have a waterproof camera, a lot of pictures were taken. Francis was really great. Besides gathering bananas and other exotic fruit along the way for us and bringing avocados along to share with us, he explained things along the hike and was a great photographer in the water for us. We took some time to swim, water fight, wrestle and take more pictures. 

After that really refreshing break, we headed towards the lower falls. This required backtracking some of the very steep paths before everything seemed to get even steeper. Our muscles are going to hurt so bad tomorrow. Along the way, Francis went into the bushes and came back with little green fruit. He cut them open, peeled out a dark thing covered in clear fruit meat and opened one end. The we were told to suck on the opened end. It was super sweet! After that he told us to drink some water, it was sweet to! It has a slight licorice taste. I had the taste in my mouth for about an hour after that. Crazy. I'm sure that stuff is used as sugar substitute by now.

About an hour later, we made it to the lower falls. They were nice and impressive too but more people were there. We had the upper falls to ourselves. We took a dip regardless. The water had more force in this one, it bordered on painful.

The walk back to the hotel took about half an hour. We each paid Francis 20 Cedis. The rate was 3/person/hour and we were with him for 6 hours.

Back at the hotel we had some spaghetti, quick showers and then Maria and I left for Accra. We walked into the center of Wli to catch a trotro. There were two people waiting as well. We asked them how long they think it might take. They said there was no way of saying but soon. In fact, about 2 minutes later a trotro came. It took us to Hohoe for 4 Cedis. There we got a minibus for 22 Cedis to Accra. We finally arrived back in our hostels at 11:30. So much for the predicted 3 hours. Of course that is African time so 3 hours equals 6. Back to the constant sweating in Accra. That water sure was nice today :)


Friday, March 21, 2014

Sure is hot out here... Four hours standing in the hot 5

My poor back! 

My nights aren't getting much better. My alarm was set for 8:30....I was up and there was no saving it at 7. My roommate did laundry and I posted that report from yesterday.

After getting ready, I headed out. I always know leaving the hostel, I will be completely soaked sweating by the time I get to class. Putting on the lab coat makes it even worse. We were on the obstetric ward today. There are five levels of OB filled to the brim with patients. Most have beds but many also just sleep on a mattress on the floor with their baby. The rounds took...forever!!!! We were there for about 4 hours. Standing around for 4 hours is exhausting, especially in this heat! I thought I was just weak but then the others started shifting their weight, leaning against things, squatting down just to move a bit. We were all getting really tired and trying to figure out how many patients we still had. After four hours, we were through and allowed to go.

I headed to MedDiner, ordered some plantains and rice and got in contact with Alexis. I also had another Blue Skies drink. It's fresh squeezed juice produced here in Ghana. It costs 4 Cedis but is so delicious and in all honesty, that's about a 1€ and totally worth it. I was done with my food by the time Alexis got there. I was so exhausted so I hung out and waited for him to be done as well. I grabbed a taxi back to my place for 3 Cedis. My feet are starting to develop blisters and I don't want to deal with that the next few weeks. 

I took a two hour nap and was sweating so much. It's insane. I don't know if it was really the weather or my body's reaction to the food but I'm better now.

I am getting picked up in an hour by the same group of people from yesterday. We are going to a fish joint (which also serves plantains according to Pablo, just for me) and then "going out", whatever that means here in Ghana. 

We are going to plan what we are doing this weekend tonight but the options seem to be a waterfall or a surfer beach. I'd be down for both. The tendency was the beach I think. I'll have to keep in good touch with the people who are still here the next few weeks so I can try to do and see as much as possible. 

Baci V

Sure is hot out adventure outside of Korle Bu Day 4

Grrrrr.... I knew it wouldn't last forever but I now have a roommate. She is very nice so no fault to her. It's just I'd rather have a room for myself. It's so much to take in everyday and I just recently moved out of my apartment in Germany so that I could live alone. I'm just being a complainer, sorry. I'll get over it.

So today we did rounds on the gynecology ward. I was told to be there at 9:15. I eventually found the right place at about 9:20. Only one other student was present and shortly after me another one joined. So it was us three girls, the main consultant and two doctors. The main consultant asked where the others were and the one girl tried to cover for them. He was not amused and said he was disappointed in this groups attendance rate. Thank you! Finally someone comments on it! (Sorry that was the German in me). During the next half hour the others started to come in and join. 

The wards are quite different here. While in Germany patients tend to try to get a private room and are often annoyed by roommates (I might have that symptom), here, all patients are in one big room with the beds placed where it fits. I don't think the patients would dare complain or even think to. There is still a very old fashioned respect system here. The patients don't really talk unless talked to, the students respond very quietly to consultant questions and seem to have great respect. Now, I have respect for my superiors in Germany too as long as they act accordingly. The students here are almost afraid of them. I don't know if it's because I'm a girl or because I'm white or both, but me and the one doctor where getting along great last night on duty.

We saw multiple patients and again the doctor was great at bedside teaching. He always brings things into perspective for the students. He urges them to think within their realm of possibilities. For instance, while discussing ovarian cancer and how one can diagnose it, the student mentioned looking for a tumor marker. The consultant said he was correct but also asked him what he would do if he was in a village hospital where there wasn't a lab that could do that. Korle Bu has that possibility but not all would be working there. He often mentioned what might be done in facilities with more money but would always direct the conversation to what they could do here and now.

A few students were talking while the consultant was discussing things with the doctor and the rest of us. That kind of stuff annoys me but I tend to try to ignore it. He did not. He turned to them, asked what kind of conference was going on and that the three of them could go. So they had no other option but to leave! No warning, just consequence. I'm okay with that.

Afterwards, a tutorial on a partograph was supposed to take place. I would have found this quite interesting. Sadly, it was canceled because the doctor was not available.

I headed to the Internet building but got no connection. I went to MedDiner knowing the German would be there at 2. I ordered and sat outside waiting. He happened to walk by on his way to the hostel, told me he'd just go change quick and then join me. I had vegetable fried rice and plantains. The plantains are really yummy. We decided that we would meet up in an hour and then head into town with the spaniard girl. 

On my walk home I bought a pineapple, papaya, bananas and mango....for 8 Cedis! And it's crazy yummy too. While walking past the school, two little kids ran across the street, grabbed my hands and started hugging me. They were so cute. To get them out of harms way, I brought them back onto the other side of the road. There, we were met by a huge crowd of kids. They all wanted to hug me and kissed my hand. I took pictures with them and chatted a bit. I even recognized some of them. This could turn into a daily occasion, who knows how many little friends I'll have by the end of my time here. 

I quickly headed back to my hostel only to change and charge my phone before walking back to the hostel of the others. Alexis, Maria and I left to find a Vodafone store. Along the way, Alexis's friend Alex joined us. We grabbed a cab into town. The cabs are quite cheap here, even cheaper though are the tro-tros. Passenger shared cabs that don't seem to have a schedule but they get you were you want to go and might only cost you less than 1 Cedis.

The cab dropped us off at the Vodafone store and I was able to get a SIM card for my phone and now have Internet! We walked to the market. I don't know if this market is any kind of confined place because the whole town was one enormous market. Everyone seemed to be selling something. The streets were lined with vendors. You could probably find anything here if you looked long enough. There were also a lot of kids again. A lot of them would say hi and want you to take their picture. Alex wasn't really having it and told me not to give in because then they wouldn't leave us alone....well I like kids sir. I took a picture. 

The streets became more of pathways and the they continuously became more narrow, every inch seemed to be used as selling ground. Chickens, goats and dogs were running around. In between stores there would be the occasional hairdresser. A lot of the vendors addressed us, wanting us to buy their goods. We also walked over a big open area that was just overflowing with plantains and avocados and more. So much produce, I have no idea where that is all supposed to go before it goes bad. We were on the search for a machete for Alexis but were not successful. Maria bought some Ghanaian music from some boys and we got ourselves some fresh coconuts. After that, we got into a tro-tro which transported us back to Korle bu.

I returned to my hostel to relax a bit and eat some really yummy fruit while the plans were being made for the night via what'sapp in the group I was added to by Alexis. Then, my former one night roommate returned out of the blue. And just like that, I had a roommate. Roommates always mean a big adjustment. Especially when you literally share a room and not just apartment. Luckily she is nice. Nonetheless this means having to plan a lot more when it comes to getting ready or getting things done.

The group decided we would go to the beach resort opposite of Korle bu. The guys were nice enough to pick me up. We left the Korle Bu campus and only drove a bit before entering through a gate and parking. Immediately I saw the big pool. I really had the urge to jump in. It must be some kind of resort. It also recently opened or so I was told when I tried ordering a cocktail and the waiter informed me that they only had Long Islands right now since they were just building up their menu. I tried a Ghanaian beer instead. Wasn't half bad. It was a lot of fun sitting there with Alexis, Maria, Pablo and Michael. We chatted for quite a while. The place seemed to want to close so we left. We stopped by, who they call, the beer lady and picked up another beer. Then we headed to Pablo's apartment. Pablo is one of the doctors in Korle Bu and was responsible for the exchange students at one point and is still pretty active in that field. He lives with David, whom I had met at the Vodafone store by chance. They have a lot more room and a living room with couches. We started watching Anchorman 2 but only half way. It was 1AM and we were all tired. They dropped me off at home and I tried as quietly as possible to get ready and sleep.

Thursday, March 20, 2014

Sure is hot out here...I've never sweated so much I my life. Report day 3

Report from yesterday:

I am in a bit of a shock...but I'll get to that.

The day started out with another night of multiple awakenings. Hopefully I'll adjust otherwise I might have to ask for a different room. I didn't have to be at the obstetric clinic until 9:30 but I left early to use the Internet. (Might have a nifty solution for that, I'll explain later.) 

I headed over to the OB building but had no idea where I needed to go. I called Selom to see if he could come get me. He said he would have one of the girls call me and get me...aka I think he was still in bed lol. I just started exploring. The crazy thing is no one really seems to question your presence. 

I ended up finding Warlanyo...or rather he found me. I was walking through a room filled with a crazy amount of pregnant women. So..many...pregnant....women. The students were working with the nurses to find a good patient to interview. Once found, we all crammed into the examination room. As it was Monday, people were walking in and out, on the phone, listening to their music, carrying on conversations...I'm still trying to get used to that. Apart from answering questions, the patient never said anything. They just take it all as it comes. Even crazier, this woman couldn't recall what year her children were born! She would give one answer and when asked again a different one. One of the students asked me if that happened in Germany. All...the...time. Dr. House was spot on when he said all patients lie. Intentionally or not, you will meticulously interview a patient and when presenting to the consultant all of a sudden they have diabetes, the dad died of a heart attack and they were operated twice although you specifically asked about all that! So then you look like a sloppy history taker and want to hit people. 

We hung out interviewing and examining this one patient a few hours until the consultant had time for us. We presented our two cases (with copious amounts of interruptions, phone calls taken, doctor looking through his phone, breaks I can't explain). At around 2:30 the doctor told us to go home. The other students informed me that we were on duty tonight in the delivery ward. I was so hungry at this point so I walked over to the MedDiner with some of the guys. There I saw two white people. One of the guys from my group went and talked to the guy. When he got back I asked where the two where from. Already sensing the guy was German. So it was. I ordered my food and got a drink, said goodbye to the guys and said I'd see them later and then headed to the table with the German. The other person was a girl from Spain.

Both of them have been here a few weeks. We chatted a bit and discussed hanging out. They have been around Accra a bit and I haven't even left campus! Perfect. They also told me they have a SIM card for their phone which includes 3G. We planned on stopping by the Vodafone store tomorrow so I can get the same. Yes! I will be connected again! Once I got my food, we headed out. They went back to their hostel and I headed to the college of health science building for my internet fix.

Still having two hours before the duty started, I walked back to my room. Quick freshen up, change and back on the road. 

Again, I had no idea where I had to go. But since I realized that really no one questions why you are there, I just decided to start going places and looking at things. I found the labor ward, entered, did find a familiar face but she went up a level. I hung around labor ward 1 where it seemed the bit more complicated pregnancies lie. One level up are the spontaneous deliveries performed by the midwives. I looked around, peeked into the OR, looked at babies. I stood around a lot hoping one of the doctors would question my presence. Nope. Finally one of the consultants on my team entered. I followed him and the others for about 15 minutes before he finally asked what my name was. Then he remembered I study in Göttingen and that I am on his team. He asked himself why he didn't know my name... I told him it must be the fact that I blend in so well in this environment. Lol.

We looked at one patient and then headed into the doctors room...which has AC. I was sweating profusely before that. This heat is really effecting me. I was getting annoyed though that I was sitting in the room with a bunch of pregnant women out there. As in Germany, as long as nothing is complicated, the midwives take care of it. But since no one seems to care where you stand here and what you watch, I headed back out. I went to the OR room and got invited in by who I assume was anesthesiology. 

My state of shock had already begun a bit as I walked into the ward. Coming from a country like Germany which probably has some of the strictest hygiene rules and strictest if not anal workers (don't you dare stand there or get too close or touch that or even look in that general direction) this was a shock. I really don't want to say anything bad about their situation because they work with what they have, do their job, treat their patients and are genuinely nice people. Just to compare to the situation in Germany, I had to get a pair of scrubs from a doctor the day before, I couldn't find a hair net so I asked and was given one from a locked cabinet, hygiene doesn't seem a huge priority, a lot of the equipment is broken, the surgical gear was minimal and some people weren't even wearing masks in the OR! But....they are making it work and people are getting treatment. I'm sure the infection rates are much higher and probably the mortality as well but maybe Germany would suffice with less as well. The team was very nice. I again was a bit shocked when they started watching YouTube videos but hey, I'm comparing to anything fun would be different. (Now obviously that is not true for all of Germany, I had a lot of fun in urology. Those are my people. But I don't think chief would have appreciated me whipping out my phone, putting on a YouTube video and running around without a face mask...just saying.) I watched them perform a c section on a woman with twins. These little babies are so cute. 

I hung around until 9 and then started getting tired. One of the girls from my team was so sweet. While on the ward we hung out and then she said she would walk me out and make sure the taxi doesn't rip me off just because I'm white. On the way a lady asked if I needed scrub shoes. I did. We three walked over to the gyn building and I got shoes and a OR cap for just 12 Cedis (3.30€). The girl and I waited for a cab, she talked to the driver and I was brought home for 3 Cedis. Tomorrow it's off to the gynecology ward.