July 12, 2010

At the hospital, I started in the male ward today.  Dr. Kudoh, the doctor in charge of the male ward, came in for rounds around 10:00.  He was very nice and informative about the patients and their conditions.  As Dr. Kudoh went around the ward he probed me and the student nurses with questions about the patients. 

A patient named Thom Johnson had pitting edema (when the skin remains indented upon a firm touch due to accumulation of fluid under the skin) in both legs.  Dr. Kudoh said bilateral pitting edema indicates a systemic problem rather than an acute problem, such as varicose veins or deep vein thrombosis.  The doctor quizzed us about possible systemic causes of pitting edema, getting out of us that it may be due to renal failure (inhibited salt secretion by the kidneys leads to fluid retention), cardiac myopathy (heart is too weak to pump blood sufficiently, kidneys sense low cardiac output as decreased fluid volume, kidneys trigger salt retention, fluid levels build in blood,  blood serum leaks into and collects in interstitial cellular spaces - especially in the legs where venous return is diminished from weak cardiac pumping ), liver failure (blood protein albumin levels decrease -albumin is normally synthesized in the liver, osmotic pressure in blood decreases, fluid passes from blood into interstitial spaces) , and malnutrition (insufficient nutrient input to form blood proteins, blood serum is lost to interstitial spaces through osmosis).   I was full of questions for Dr. Kudoh, which he gladly answered.  I think I will learn a lot from Dr. Kudoh.

I also became acquainted with a second year medical student, Francis, who was shadowing doctors of CCDH during his vacation period.  Interestingly, Francis has scars on his face, which he told me were tribal scars given to him when he was a child.  He said tribal scarring is still widespread in many villages throughout Ghana.  He said they are given to ward off evil spirits.  I asked if he was angry that his face had been disfigured.  He answered that he was not because his face had been that way for as long as could remember, so he didn’t know any different. 

Francis informed me about the health insurance system in Ghana.  Citizens of Ghana pay 25 Cedi for 1 year of health coverage, which covers most hospital expenses (patients must pay for atypical tests or materials).  If parents have health coverage, their children under the age of 18 are also covered.  Without coverage, a patient would have to pay for any material or care given them.  Francis thought every citizen should take advantage of health insurance, but said some people do not due ignorance of health insurance availability, or lack of money for even the 25 Cedi payment. 

For lunch, I met some of the other volunteers for lunch at the Vegan restaurant Asassa Pa, which is popular among the volunteers.  The food was very good and cheap, and the service was good and fast (which is rare among Ghanaian restaurants).

After lunch I returned to the hospital to find that the patient with the pitting had died 15 minutes earlier.  I could not help but feel that more could have been done for Mr. Johnson with more resources.  Mr. Johnson’s body was still in the bed.  This was the first time I had seen a dead body.  It was a bit unnerving to imagine that only hours ago Mr. Johnson had been a living, conscious person, able to sense his surroundings and interact with others.  Now, however, he was a lifeless body, never to interact with anyone again.  Some thoughts of “hear one moment, gone the next” went through my head.  I reminded myself that death is an important part of life, as the prospect of death reminds us that life is finite, and so, should be lived to the fullest each day.

After the hospital I went home and relaxed, then got ready for the afterschool program. 

Today at the after-school program was more difficult than the previous day.  I continued to teach from where the kids had left off in their English books.  Some of the students did not seem to grasp the concepts, while others seemed to be bored by what I was teaching.  I have a new found appreciation for the difficulties of teaching young children.  I talked with another teacher in the program about the difficulties I had run into, asking if she had any solutions.  She teaches French and has been there for 9 months.  She said she has run into similar difficulties, and that she just tries to keep the children engaged in their studies.  She tells me that the children come from different schools and that their exposure to English will therefore greatly range.   

For homework, I instructed the students to write a 4-5 sentence paragraph about what they did today, to help me gauge the level each is at.  Hopefully once I determine the level of each child I can teach at some middle-ground.  From there I can give more challenging problems to the advanced students, while giving more help to those students who need it.