walk with me strong

Wednesday, August 30, 2006

Patience

'Show me your ways, O Lord, teach me your paths; guide me in your truth and teach me, for you are God my Savior, and my hope is in you all day long.' (Psalm 25: 4-5)
This is David's prayer for guidance, upon which I stumbled in a book last night. Anne and I have really been struggling with the slow pace at which things move here. Everything lacks a sense of urgency, and we have a hard time adjusting to that, coming from the full speed attitude of the U.S. This has been a challenge for us because we look at the situation here and all we see is the things that we want to fix or change, and we have overlooked some of the good things that are being done here. We have been focusing on the things that we are unable to do and the resistance we have faced, instead of realizing that this is not in our control. We must be patient and willing to work at God's pace, to follow His plan for our time here. For the two of us, both very goal-oriented and strong-willed, this is a hard thing to accept, but we are working on it every day. Patience. Guidance. And Diane gave us some great advice, that we must find something beautiful about each day and be thankful for that. Thank you, Diane, you're right, and Anne and I need you more than you know! My perspective is changing, and I will continue each day to find the beauty.
For example, our hospital is one of the better hospitals available to patients. It is the only hospital in the district, which means that it serves people from villages hours away. We visited one of these villages yesterday, where there is a small clinic staffed by only one nurse and an assistant. No doctors, no relief. This nurse is in charge of the clinic 24 hours every day, so the villagers know where she lives and they come to find her at night for emergencies. The clinic has two private areas, a labour ward and a recovery ward, each with only one or two beds. If a woman comes to the clinic in labor in the evening, she is then referred to our hospital, an hour drive by taxi. There is a small dispensary for medications at the clinic, which the nurse prescribes and dispenses herself. There is little treatment available at this clinic for emergencies, so anything serious must be referred. The village consists of small homes made of clay, the walls are falling apart, some with straw roofs. They have no running water and I don't think they have electricity. When we visited yesterday, my heart ached for this nurse who has been assigned here to be solely responsible for keeping this clinic running. How lonely she must be, I thought, and Anne and I have been complaining about being bored. How ashamed I feel for complaining about our living conditions when we have been so blessed here to have families to take care of us. And even though we have no running water, we still have a warm bath every day. Anne and I decided to request to spend some time with this nurse at the clinic, to help her and to show her that we care about and support what she is doing there. Yesterday, I saw the beauty in this nurse, and I hated leaving her alone there in the evening. Thank God for this special person.
So whenever we walk down the street here, we hear endless exclamations of "Obruni!!", which means "white person". Most of the yelling comes from excited children who just want to smile and wave at us. But many times it comes from men, who then proclaim their love for us and offer proposals of marriage. I had an admirer at the hospital, an older, shorter, cute man named Solomon, who would hold my hand and just smile at me for minutes at a time every day. Well, finally when he kissed my cheek, Anne said, "her husband won't like that very much!" And that was the end of the hand holding. There is something about an obruni that apparently has an effect on the men here and they will promise us their undying love forever, without even knowing our names! Rich men here take many wives, a practice that has become less common over the years, but nonetheless still occurs. One such man has proposed to Anne that she become his third wife, an offer that will include a house and a car, and whatever else she will need to be comfortable here. Of course, Anne said NO - so don't worry parents, she is still coming home unmarried. But so is the daily routine here, "I'm sorry I can't marry you, my husband just wouldn't approve".
Things are going well here at the hospital - we are continuing our efforts to recover postoperative patients, hopefully soon we'll be able to convince the staff that they need to join us. We have a baby warmer, an incubator, and a suction machine that we are planning to teach the maternity ward nurses how to use. This equipment has been sitting unused on the ward, so we have cleaned them and are planning some teaching sessions for the end of the week. We are also building a relationship with the Health Director, after spending the day with him in the OR, we are now good friends, which will hopefully work in our advantage. This afternoon we have a chance to sit in on a clinical meeting, in which the chief doctor will be teaching about stroke care. We are interested to experience an educational session here, and maybe we can get in on the action next time.
Overall, things are getting better every day, but we still have days where we feel like we haven't done a thing. I know that I must be patient, but I am concerned that we will leave here in two months feeling like there were things we could have done better. I just don't want to regret any wasted time. I have written David's prayer and I will read it every day to remind myself that I am not in control here, that God has a timeline for His plan. I will keep this in mind, my frustration levels will decrease, and I'll be able to focus on the amazing beauty of this country and its people.

Thursday, August 24, 2006

A good day!

Anne and I held a teaching session today! The chief doctor asked us to teach the nurses how to use some nebulizers that the hospital purchased for the wards. Currently there is little treatment available for asthmatic patients, so hopefully having nebulizers will change that. We taught them how to assemble and manage the machines so that they would be able to administer the medications when needed. It was very strange to watch them with these simple nebulizers, machines that many people use at home, as they had a difficult time trying to figure out how to assemble the parts. Something that is so straightforward and easy to understand for us is something that required a 60-minute teaching session for them. But we feel that we have actually done something productive, by giving them knowledge that will hopefully be lasting and will benefit many patients. Of course, we must now go around to the wards and make sure that the machines are being used properly and encourage the nurses. Now we look forward to more teaching sessions covering different topics, and we are excited about the potential there.
Yesterday, we recovered two patients in the operative theatre. The doctor told us that the anesthesia they use during surgery has no analgesic effect, so the patient has no pain relief whatsoever after surgery. Currently, the patients are sent directly back to the wards after surgery, usually before the patient has even awakened. So the nurses on the wards receive the semi-unconscious patient after a major procedure with no pain medication available. Yesterday, with the help of the doctor, we medicated both patients immediately after surgery and ensured that the patient was awake and stable before returning them to the wards. We still have a lot of work to do there, but we are happy so far with the doctor's cooperation with our ideas. Believe it or not, he actually asked me what medicine I wanted to give after surgery, what dosage, and he asked me to write the order for pharmacy to dispense it. I can't imagine doing that at home!
And we also introduced a new drainage device to the doctor that he placed on the patient's surgical wound, which will improve healing and recovery. We taught the nurses how to manage it, and hopefully they will be able to use the drains more often for better patient outcomes.
Yesterday we had a meeting with the director of health for the Kwahu region, Dr. Opare. He would like for us to accompany midwives on preventative health checks in the very remote areas. He mentioned that they travel on motorbikes, but I assume that he would arrange special transportation for us... Also he wants us to visit some of the smaller clinics of the region, and we have brought 94 pounds of medication with us that would be well-used there. He also asked me if I'd like to go with him to his gym for a workout this weekend, but he goes at 5:45 am, way to early for me! But we might climb the mountain here sometime, something he does with some friends fairly often. He seems very interested in our help and wants to accomodate us and help us however he can. Anne and I are looking forward to these excursions, for a change of pace and scenery, and we would love to see other areas of the region. We also feel that we would be of great help with providing vaccinations and other general medical treatment in these settings, similar to the work we do in Honduras.
Thank you all for your prayers and your encouragement, I love knowing that we are supported here. We miss you!

Monday, August 21, 2006

I love African pineapple!

Anne and I spent a couple of days in the capital city of Ghana, Accra, with our organization coordinator, Fred. We welcomed a new volunteer, Aaron, who will be working in the adjacent town at a center for HIV/AIDS education. I couldn't believe it, but many people of Africa believe that HIV is a myth created by Americans to discourage them from having sex. The number of people infected in Ghana each year exceeds beyond the number of people that are able to receive treatment, so there is a much-needed focus on education and prevention. Aaron will be here for three months, so we welcomed him to Ghana and spent a couple days in the city. Anne ate a hamburger, I ate hummus, and we got showers of running water, so it was a great weekend.
We returned to the hospital for work today. I checked on my newborn twin, and he seems to be doing much better after the doctor gave him some antibiotics for his lungs. He has a chunky little face and he was resting comfortably with his brother, so I am thrilled. His mother, on the other hand, isn't doing so well - she seems to be fighting infection and high blood pressure, so I hope that she can recover.
I have moved into a new home with the nurse matron, so I have my own room now. I appreciate having my own space without having to worry about being in the way. She actually listens to me when I say that I don't want monster portions of food, so I think this will work out well! I even went for a run yesterday morning before church, and it felt good despite the many strange looks from people on the street.
Anne and I are looking forward to receiving boxes of stethoscopes that our mothers are sending - Thanks Mom and Mrs. Halfman! We hope to receive them soon and we will then teach the nurses how to properly assess their patients' conditions. Anne and I are both doing well, and we are so grateful to have each other here. Together we can handle anything and we have been laughing more as the days go by. We spend a lot of time talking about home, and we love getting emails from all of you so that we have new things to talk about!!
I will soon have to break down and do my laundry by hand. Anne did hers a couple of days ago and rubbed the skin off of her fingers. My plan: soak, agitate and swirl, minimal scrubbing, rinse, hang. It takes about 3 days for laundry to dry in this weather, so it's no quick job. Never again will I complain about having to do my laundry at home!
I'll say it again - I miss everyone and I hope you're all doing great. I appreciate your emails, and I'd love to know how you're all doing. I send my love!

Friday, August 18, 2006

Better Every Day

Just a quick post to let you all know how much I appreciate your comments - I miss you all so much! I appreciate your encouragement, and I get tearful when I read them.
I think we are on the way to progress here - we have approval to hold some teaching sessions for the nurses, and we are making good use of some donated supplies that had previously been sitting boxed up in a room. We continue to build relationships here, and I think it will pay off when it comes time for us to influence some real change.
The other day, a man could not afford to pay for his medicine, which in a cash and carry health system, that means that he receives no treatment until he can come up with the money. In the meantime, his lungs filled with fluid and he could not breathe. Anne and I were able to pay for his treatment ($14), and he was able to make it until his family found more money. Otherwise, a curtain is pulled and the patient is ignored until money is presented.
I was called by the doctor to the labour ward the other day when they were unable to resuscitate a newborn. They delivered breech twins and one was not breathing. I think he aspirated meconium, which causes severe lung damage, so basically I forced air into his damaged lungs while he struggled to breathe on his own. I finally stopped and he was a fighter, so I took him to his mother and said a prayer. He survived through the day but I have not been able to check on him since. In their culture, they often blame death on evil spirits, when the cases I have seen have actually been due to lack of medical care and knowledge.

I know that we are making a difference here and I know that we can make a lasting difference by teaching the staff how to handle situations like these. I appreciate your thoughts and prayers very much.

Monday, August 14, 2006

we have our work cut out for us!

This past week has been very difficult to get through, and I don't really know how to explain the things we have seen. We are treated very well, in no way are we physically suffering, but every day has brought something emotionally challenging. The hospital here is one of the best in the country, actually one of the more progressive. It must be at least 50 years behind in technology and knowledge. Even worse, there seems to be little compassion for the patients. Anne and I helped deliver a stillborn baby, stillbirth as a result of poor knowledge and neglect, and the nurses seemed completely unaffected by the death. As I performed CPR on this newborn, the nurse looked at me as if she hadn't a clue what I was doing. That was probably our lowest day here so far, as we sobbed in another room and prayed for the mother. Every day, we have been put in situations where we've stepped in and taken control of situations involving patients that the nurses haven't seemed able to handle. We have a lot of teaching to do here, and it's not going to be easy. To be honest, I never expected it to be this difficult - I thought that to be a nurse, you possessed a natural desire to help others, but here it is very different. I don't understand it, and I can't explain it, but it's something that will take awhile for us to wrap our heads around.
Our goals are many. We want to create a recovery room in the operative theatre, where currently patients are awakened from anesthesia with no monitoring afterward. The doctor would like us to create an intensive care unit, but we first must teach the nurses how to assess their patients, as they currently do not even have stethoscopes and do not know how to use them. We would like to develop some education on postoperative patient care and general nursing knowledge, hopefully then we can hold some teaching sessions for the younger nurses who may still be open to learning. With a goal, we feel motivated to make a change and empowered to do it.
We played a soccer game yesterday at the orphanage, with boys who have been playing with a soccer ball since they could walk, so they were very good! And the babies are all cute here, so once in awhile we go to the maternity ward to see them! There are many good things that we are enjoying and we love our new friends who insist upon taking care of us every day! We are learning a little bit of the local language, too - we are really good at "how are you?" and "I'm fine", as well as the word for "white person", which we hear constantly on the street.
It has been a difficult adjustment, and I can honestly say that I often dread going to the hospital, but things are improving. We have been able to make some differences already to a few specific patients, and God willing that will continue. As far as our living conditions, we are becoming more accustomed to the spicy food and lack of water supply. I should be moving in with the matron today, so I will have my own private room, which I think will make a difference too. Anne and I found a church where an American Reverend has been working for almost 2 years, so he and his wife have invited us for dinner sometime, and we now have an English sermon to look forward to every week.
We think about home a lot, and we talk about our friends and family often. We miss everyone and every time I long to come home, I remind myself that we are needed here so much more than we ever realized. And my consolation is that in three months I can return to my safe, convenient life, where these people will not. So my heart is here, and I ask for your prayers that we can find a way to effectively bring about change. I hope everyone at home is well, and I love you all!

Tuesday, August 08, 2006

Such a different world...

Anne and I arrived in Ghana only 5 days ago, yet we feel like we have been here for much longer. We are living in the nurses' quarters, a group of bungalows located just across the street from Kwahu Government Hospital, where we started work on Monday. Anne lives with a head nurse and her family, and I am living with a nurse named Christy. I am supposed to move in with the nurse matron, but she is out of town and will return after Thursday. Christy is such a kind, giving, wonderful person - she has welcomed me into her home that consists of two rooms, each smaller than my bedroom at home. Her kitchen is located in a separate building accross from her bungalow, and the bathroom and toilet room are just down the way. We share the bathroom and toilet room with others, and there is no running water. Never before have I understood until now how people live without water. She has to walk to collect water from a running faucet, near the hospital about an 8 minute walk. She must cook, wash dishes and clothing, bathe, and flush the toilet with this water. I have taken a bath from a bucket every day, and I am actually becoming very good at conserving water - I can wash my hair every other evening and I am not too hideous by the second day! I saw a cockroach in the toilet room and lots of ants in the bathroom, but so far no rodents.
It is currently the rainy season in Ghana, which means cooler temperatures and it rains for short periods throughout the day. It becomes humid at times, but it is pretty comfortable I think. Ghanaians believe that this weather is cold, so they dress more warmly than we do. September begins the hotter weather, so much more sun and dry heat is to be expected. The first night we arrived, the electricity had been shut off, which happens occasionally, so we used candles. Since that night we have had electricity for our lights, which is useful because it gets dark here around 6pm. I've been going to bed around 9pm because the roosters and chickens start waking us up around 5am.
The people of Ghana are known for their graciousness and kindness - Christy will not let me cook, clean up, or work while I'm at her home. Their tradition is to prepare food and serve their guests a meal, but they do not sit with us to eat. I have convinced her only once to eat with me, otherwise I eat my meals alone and she will either eat later or eat alone in the kitchen. It is a tradition that I do not understand and it is difficult for me to accept. I feel that as a guest in her home I should be giving in return, but they just do not accept that. Anne's family is the same way - she will eat alone while 4 other people wait for her to finish. As for the food, it consists of a lot of rice, starchy vegetables, and most things are prepared in a sauce - for example, white rice with a fish sauce, or plantains and yams dipped into a spicy spinach-like sauce. I am still waiting to try fufu, which is plantains and casava pounded into a pasty mixture, eaten with a sauce of course. We have to do some walking every day, but I'm pretty sure that I'll be gaining some weight here - they serve huge portions (like a heaping plateful of rice) and they're surprised when we can't eat it all.
The hospital is a hard place for me to go every day. They literally have no modern monitoring equipment, the nurses do not have their own stethoscopes, and the conditions are very discouraging. They perform a few simple surgical procedures, but they put the patient under anesthesia with no ventilator - they have an ambu bag to assist in respiration. They have few supplies, so the patient must pay in cash up front for all medicine if they do not have insurance. They literally must walk to the pharmacy to purchase their own medicines during their hospital stay - if they can't walk there, their family or the nurse must do it. We worked on the labour ward today, and a laboring woman had to walk to the lab to have her blood drawn. I am continuously surprised by their way of doing things, by the nurses' lack of knowledge, and by the general poor sanitation of the hospital wards. The wards are separated by male and female and they are true wards with beds lined up on each side of the room, probably 20 beds total in the room with one nurse station. The nurse-patient relationship is very cold, the nurses do not smile and they almost neglect their patients. There is one oxygen tank on the male ward, able to be shared by two patients, but there is no equipment to measure the patient's oxygen level. I want to do so much to make it better for the patients, but I don't even know how to start. In talking with the head doctor, he asked Anne and I to do some small lectures for the nurses and student nurses, so I think that we could definitely educate and make a good contribution there. The scope of practice is so small because they have so little to work with, so until they can acquire some medical equipment, they are making due with the bare minimum. Looking back at the labour ward's records, almost evey day there is an infant death, which far exceeds our death rate in the U.S.
Our experience here in Ghana so far has been very challenging. We have tried to remain open-minded and loving. We are struggling with the conditions at the hospital, yet we know that we will be seeing much worse at the other clinics that we visit. We are feeling very welcomed by all of the people here - we get many stares on the street because we are truly the only white people in town. Kids point to us and laugh, yelling "obruni" which means "white". But of course the people here are so beautiful. I miss the luxuries of home simply for their convenience, but I am really more upset than anything. I don't understand how things are so unfair - In the U.S. we are so wasteful and we take everything for granted, and we all complain daily. Here, they have little and they never once complain, instead they give whatever they have in order to make us comfortable. I am ashamed to tell them what it is like at home, because it is such a disgusting difference. I get discouraged every day and I get tearful as I write this, but this experience is exactly what I have come for - I am trying to humble myself and accept their situation for what it is while trying my best to help improve it.
Please pray for Anne and I and for our stay here in Ghana, pray for the people here as they work so hard every day. I miss everyone at home and I hope you are all well. Internet access is in a town down the mountain, so I may not blog more than once a week, but please be faithful in reading it as I would love to share this experience with all of you. Until next time...

Tuesday, August 01, 2006

hot plate!

Here's my latest purchase, something I have been lusting after for awhile now... A Colts license plate! Isn't it beautiful? To own this plate, I had to sit in the overcrowded BMV for over an hour - WORTH IT!
With the power of this plate, I think this year might be the year for Peyton and his team... hot plate, hot Peyton, hot team!