Today has been Jeff's day to shine. After being primary provider on one shoulder dislocation and a possible gnarly osteosarcoma v. Rhabdomyosarcoma, he is now being sought out for orthopedic admissions. In reference to the sarcoma case, Brett took a photo that may be documented on his blog. We've been concerned about protecting patient privacy, which is essentially a moot point when you consider there are about 20 patients plus their families per room with no partitions. 

I won't lie, these first few days at the BMC have felt long. There is such a steep learning curve for the diseases here alone, not to mention the time it takes to get used to the customs, the language, the culture of medicine, the formulary, the climate, etc. It is easy to really appreciate the value of having a long term commitment from a physician here. 

The BMC has done a very good job in that sense (in my humble opinion). It's founder lived and worked here for most of his career, and his son, who grew up in Nalerigu, returned to work here for 22-ish years, and still visits at least once a year. One of the family medicine docs here is halfway through his two year commitment, and a surgeon is about to begin a four year stent at this hospital. The Shumperts manage to return at least twice a year on top of their other commitments in the surrounding region, and there are two Ghanaian doctors working here that the BMC hopes will stay on full time. I like to think of our role as relief pitchers, and hopefully some of us will be returning after completing more training.

Today was Easter Monday. Easter is not "celebrated" in the same sense that it is in the US, but it is observed. Basically people go to church for a sermon, and clinic is cancelled. Today will be our first night on call ( at least it will be Dr. Cohen's), so we may be in for some excitement later. I am mostly concerned that we will receive a call concerning a patient who was rounded on in the pediatrics ward today. He is a 1 year old who was admitted last night in respiratory distress with presumed cerebral malaria (everyone is presumed to have malaria). He was on quinine and ceftriaxone. When I first saw him this morning, he was lying limp on the bed taking slow, agonal breaths. I can't adequately convey how frighteningly sick this child looked. We kept trying to think of anything else we could do. We knew there weren't any ventilators, but was there a BIPAP? No, only nasal cannula. What about ampicillin? No. Zosyn? No. Transport? Would not make it in time. In the end we added Augmentin, just to be doing something for him. I know we will get a call about him later, or worse, we will show up for night rounds and his bed will be empty. Codes are rarely run here, as they are very rarely effective. We don't even have a EKG machine, so how would we know what to give? 

Not to leave on a depressing note, I will report one success story, in which an elderly patient came in reporting complete loss of function in his legs after being treated somewhere else for an acute illness (I'm not too clear about the details as it was somewhat lost in translation). They did not know what he was treated with, or his previous diagnosis. We were initially thinking Guillan Barré, or a diabetic neuropathy (common here), but in a typical House-like moment, Dr. Cohen surmised he had been given an anti-hypertensive agent and was now hypokalemic (low in potassium). There is no way to measure electrolytes here, which makes the diagnosis all the more impressive. The man walked out of the hospital the next day! 

The rest of my posts will not be as long I had a little extra time today, considering it is a holiday. We are all doing well, and are healthy and enjoying our work.