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!

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