Accident victims, sick and hard of hearing children in Africa

Upon returning from leave, there were six children with aspirations or ingestion of foreign bodies which were successfully removed with endoscopes donated by Karl Storz Endoscopy.
Three weeks ago, two buses collided head on resulting in twenty six immediate deaths with a total of thirty. Speed, alcohol, drugs, reckless driving and fatigue are the causes of these preventable accidents which occur once every three months. We were able to save 25 victims. A bride of three weeks died within minutes of arriving at the hospital.
In November, the Starkey Hearing Foundation distributed 1,000 pairs of hearing aids to the children at the four northern schools for the deaf and to 200 Tamale Teaching Hospital patients. However, a follow up visit to two of the schools found five percent of the children with the wrong or broken aids, feedback problems, or with dead batteries.  A person will be properly trained and hired to visit these deaf children every two weeks to ensure that the aids are working properly. Some of the students are now exhibiting better speech.
Thanks to the generosity of many individuals, we are able to help those who are truly in need.
Today, 7 December, is Ghana’s election day, a holiday, and all Ghanaians are praying for a peaceful transfer of power.

 Foreign Bodies removed from the Lungs or Esophagus.

  Bus accident victims. A woman with bilateral rib fractures and frail chest in foreground.

Starkey Hearing Foundation distributing hearing aids to deaf children in Tamale.

New Tamale Teaching Hospital Building.

New Surgical Tamale Teaching Hospital Building.

Medical leave from Ghana, West Africa to New Jersey via Istanbul, Turkey

 Preoperative photo of a child with a congenital herniation of brain through nasal defect who did well with surgery.

 A malnourished child whose infection destroyed the side of her face two years ago and will need extensive surgery now that she is nourished.

 The friendly Ear, Nose and Throat staff of Marmara University Hospital who taught me while visiting Istanbul.

 Turkish desserts in Istanbul.

 Turkish desserts in Istanbul.

 Mosque, Istanbul at night.

Istanbul, Turkey from the Bosphorus Strait.

 Istanbul, Turkey from the Bosphorus Strait.
 
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I am currently home in the US to spend time with my family and to attend an ear, nose and throat meeting at which I intend to procure critical medical equipment for Tamale Teaching Hospital. On route, I flew Turkish Airlines and had an interesting two-day layover in Istanbul. My work in Ghana is rewarding - teaching medical students, treating infections, saving the lives of children choking from inhaled foreign bodies and repairing facial lacerations and fractures resulting from road traffic accidents. It is also stressful. There are cultural conflicts, more work than can be accomplished and a lack of laboratory, pathology, radiology and anesthesia support. Although medical care is available in the southern part of the country, the majority of patients we see in the Northern Region cannot afford even the cost of travel to get to those facilities. Hopefully, I will return to Tamale with renewed enthusiasm and strength to both overcome the challenges and continue to provide care to those in need.

New Hospital Building in Africa

After three years in construction, Tamale Teaching Hospital’s new building was opened and our patients were transferred. The move has been stressful, with arguments and flared tempers. Over the last few days, new linen was stained, paint was spilled and the floors were damaged when alcohol was used to remove it.

There is also a serious problem with the water supply to the hospital. Prior to signing the contract to build, the Ghana and Dutch governments agreed to a dedicated water line to the hospital. On the day of the opening ceremonies there was water; the very next day there was none. The “dedicated water line” evidently utilized two kilometers of an old line which also supplies the football stadium. When the pump was turned on to supply the hospital, the old stadium pipes could not handle the pressure and water leaked all over the stadium. The pump had to be turned off and the hospital is presently without water. Toilets will not flush, steam sterilization will not work and dirty sheets cannot be washed. A new two-kilometer water pipe will now have to be laid bypassing the old segment. However, this proposed solution has to be first approved by the water commission and then will take three weeks to install.

Eleven Years Old

Happy Birthday Maggie McGarrity

A Rough Day for Cattle Boys

A warm feeling of happiness came over me when six sick children smiled and squealed with delight when given clean attractive stuffed animals donated by Loving Hugs, Incorporated. My heart broke when one three-year old was too sick to appreciate or respond to a toy. Another child was frightened of his large Teddy Bear and it was quickly exchanged for something else. The day before, this young boy, a member of the cattle rearing Fulani tribe, was taken at dawn from his compound by an intruder and his throat was cut.  When the child cried, the intruder ran away and escaped. The laceration severed the trachea and thyroid gland and barely missed major blood vessels. After surgery he is doing well. Another teenage Fulani male was gored in the face, resulting in palatal and facial fractures, lacerations of nose and lips, and loss of upper and lower teeth. He is also better after surgery, but still needs his fractures fixed. It was a rough day for cattle boys.

 

Doing a little good

 A Thankful Woman. There was weakness in the lower lip after the operation.

 Preoperative: Parotid Salivary Tumor.

 A Grateful young woman.

Preoperative electrical burn of nose and lips.

   Arrival of forty foot container with needed medical equipment.
 
Needed incubators for the newborns.

     Some good is accomplished here at Tamale Teaching Hospital and for many individuals, it can be life changing. The good accomplished is only possible through the help of many generous, caring people and companies.  In the following blog, are preoperative and postoperative photos of an elderly woman with a large parotid tumor and of a young lady with a destroyed nose caused by an electical high wire. Because these graphic photos may be upsetting to some, only those who wish to look at the next blog can do so if they wish. When the young woman presented, she would not look at us or speak to us. After four operations, with the help of two visiting British maxillofacial surgeons, she is happy and friendly with a nice smile and now has the possibility of being married, which was unlikely prior to her reconstruction.
     The donated Anspach Synthes drill system and Stryker Leibinger plating systems have enabled us to correct many facial fractures and do intricate ear operations. Next week, we will use the Medtronics microdebrider for nasal polypectomies. This equipment places us at a higher level of care and does a world of good. We cannot  adequately thank all those responsible for these generous donations. The scrubs and operating gowns from the nurses at New York Medical Center now enable us to do surgery daily which in the past had to be cancelled due to lack of clean scrubs.
People ask if one is afraid of catching tropical diseases. The threat to a surgeon is the same the world over, that of being infected with HIV and hepatitis from a sharp puncture during surgery. And that, of course, can happen anywhere.

Working In A Different Culture Is A Learning Experience.

This week thirty new physicians graduated from the medical school here in Tamale, an equal number of men and women. They now have a license to learn. For the past few weeks, my lecturing, writing exam questions, and testing of the students’ clinical skills - all while caring for patients at the hospital - has kept me very busy. Their answers showed me where to put more emphasis next year. It is satisfying and I am proud of my part, but I am glad it is over.

Two children recently presented having had coins in their esophagus for four months. The children originally went to their local hospitals where they were told the coins would spontaneously pass. After four months of losing weight, coughing and chest pain, x-rays were taken which showed the continued presence of the coins and they were referred to Tamale. We successfully removed the coins from grossly inflamed esophaguses.

Working in a different culture is difficult. “Instant justice” is practiced here. Two of my patients were caught stealing goats and were immediately beaten and unsuccessfully hung. I cannot reduce one’s fractured mandible because he has a collapsed lung and the other is just regaining consciousness. Because of this tradition of “instant justice,” it is strongly recommended that if a person happens to injure a pedestrian while driving, one should not stop even to offer assistance, but rather continue on to report it at the nearest police station.

Why do parents allow children to place small objects in their mouths?

Many extremely sick children arrive late in their disease due to the scarcity of health care, distance and expense of hospital treatment and a culture where they are treated by the local traditional healer. The following three cases presented this past week.  A fourteen-month old came in with a history of coughing after she fell four days before. With persistent questioning, we learned the child had been eating peanuts two days before the fall and the cough was caused by a peanut which was aspirated into her lungs. Removal was partially successful and a second attempt will be made in two days. Another child had had a coin in his throat for four months. He originally went to a hospital closer to his home where the family was told the coin would pass. When the child ate poorly the family brought the child back where he was treated for ‘tonsillitis’ and sent home without an x-ray. After four months, the poorly eating child was taken again to the hospital and the family demanded an x-ray which showed the coin. The patient was finally brought to Tamale Teaching Hospital and as we removed the coin, it was thickly coated and the esophagus wall was hemorrhagic and friable. There was a danger of esophageal perforation, but the child did well. The third pediatric case, a little boy, septic and drooling, had had a fish bone in his throat for four days and developed an abscess. He is doing better.
Tragically, too many parents allow their children to place small objects into their mouths. In addition to picking things up from the ground or floor, I often see a mother buying a small bag of popcorn in order to keep her child occupied and free from crying. Better education concerning this danger is sorely needed and can perhaps be accomplished through articles in the newspapers or on the radio. In the United States, 2,000 children, between the ages of one and three, used to die annually from the aspiration of peanuts, popcorn or corn. With proper legislation and education now only 25 die annually. In Ghana, I fear the number is much higher.

The poor patients of northern Ghana thank you for your generosity

The container with all its life-saving medical equipment has arrived fully intact at Tamale Teaching Hospital. I wish to thank each of you for your generosity, help and support in making this possible. The supplies and equipment are quickly being put to good use with our many sick patients.
The poor people of northern Ghana would surely welcome you into their homes, give you water, mangoes and their love if they knew how to reach you. I pass their deep appreciation on to you.
Sincerely,
Jim Murphy, MD

PS With the newly donated scrub suits, surgery will no longer have to be cancelled due to lack of clean ones (we only had seven pairs), the headlights will enable us to effectively diagnose our clinic patients and perform better surgery (we were working in the clinic with only one broken mirror Storz-Lempert headlight), the drill bits and microscope drapes will allow us to again perform ear surgery, the two anesthetic machines will add to our three machines, only one of which is fully functional, and with the new supply of tracheostomy tubes we can stop using ones that have expired. Tears came to my eyes when the container doors were opened and I saw the needed equipment that took a great deal of work on the part of so many generous, donating people .