A working holiday

Kola Nut


Doctors Joel Dickens and Andy Norman


The Gambaga Escarpment


A Female Pet Baboon

Last weekend, I visited the Gambaga Escarpment at Nakpanduri and stayed at the well respected Nalerigu Baptist Hospital. At the hospital, the doctors presented a young man who had a kola nut wedged into his throat for eight days and for which they did not have the equipment to remove it. Examination of the patient revealed air in his neck indicating that the kola nut had perforated through the esophagus. His history revealed that because his girlfriend had left him, he sought the advice of a traditional medicine healer who advised him to swallow the biggest kola nut he could find. This, the young man was told, would result in bringing his girlfriend back. The patient was transferred to Tamale Teaching Hospital where the nut was removed endoscopically and a neck drain and nasogastric tube were inserted. He is doing well several days after surgery.
For the past three weeks, Dr. Andy Norman of Vanderbilt University has been in Ghana performing vesicovaginal fistula repair on several women who developed complications from giving birth. If a woman has prolonged labor, the baby’s head can constantly pound on the urinary bladder and this may cause a permanent, open tract between the vagina and urinary bladder. When this occurs, urine leaks continuously out of the patient’s vagina causing the woman to stink of urine and to be ostracized from her family and village. The complication is rare in the developed countries where obstetrical care is available during labor but here, there are far too many women who are not as fortunate.

Thanks for the medical donations which are necessary in caring for the patients

Post operative photo.

Preoperative photo.


The endoscopic equipment, so generously donated by Karl Storz Corporation, is ready for the next child presenting with an aspirated foreign body. Recent donations of drill equipment by Anspach, microscope light bulbs and drapes by Karl Zeiss and tracheostomy tubes by Smiths Medical are greatly appreciated and are so necessary in caring for patients.
With the help of a visiting maxillofacial surgeon from Kusmasi, a neck tumor (teratoma) which was causing airway obstruction was removed from a five pound, four-month old girl. Post-surgery, the child’s breathing improved remarkably.

The child seen above is alive through the generosity of Mrs. Karl Storz and the Storz Corporate family. Karl Storz Company’s large donation of pediatric endoscopic instruments had just arrived when this three year old presented with a coin lodged in his esophagus. The child refused to swallow even breast milk and had a cough and fever with an aspiration pneumonia. With the newly arrived finely crafted telescopes and optical hard foreign body removal forceps, the coin was successfully removed from an esophagus that was edematous and inflamed.
The generosity of many companies such as Karl Storz, Carl Zeiss Meditec, Anspach, Surgitel, Smiths Medical, Covidien, Boston Medical Products, Dale, Westone Labs, Widex, Jedmed, Starkey, ArthroCare, Stryker, Grace Medical and KayPentax is heart-warming. When I am tired and discouraged, a request for needed medical supplies to save lives is granted and makes one realize how much good there is in the world. Businesses and corporations sometime receive bad press, but their contribution to this family is immeasurable. They have a living child and are eternally grateful.
Like many of our patients, this rural indigent family did not have Ghana National Health Insurance and were unable to pay for medical care. I am sure the Storz family is even more delighted that their instruments were used to save a child whose people are among the forgotten in the world.

An eventful week.

Doing well after surgery.

One week later he is doing well after surgery.

The child as he presented in the operating room.

Sitting lower than the chief who actively works for peace in the region.

Lower resistance allowed a tooth infection to spread to the neck obstructing her breathing.

A congenital lymphatic malformation became infected resulting in septicemia. Prior to drainage.

***

“What exciting thing is going to happen today?” This statement was certainly proven true during the past week.
A young man, riding his five-year old brother to school on a motorcycle, ducked to avoid a long steel pipe protruding from the back of another vehicle as he tried to pass it. The pipe, however, struck the little boy sitting behind him, penetrating the forehead, and pushing the skull into his brain. Now, several days after removing the displaced skull fragments, the child is doing well. Another man presented in septic shock from an infected neck cyst. A liter of exudates was drained and he responded well to antibiotics. Surgery to remove this lymphatic malformation will be performed after the inflammation subsides. A woman came in with difficulty breathing from a swollen, infected neck (Ludwig’s angina), caused by an infected tooth. She has purple skin discolorations, Kaposi sarcoma, and has adult immune deficiency syndrome, AIDS. Her husband died two years ago and her prognosis is poor. Her mother sits besides her bed and she will leave a nine year old son.
Our 110 volt electrocautery machine, kindly donated through Project Cure and transported by the Rotarians, exploded and burned when it was incorrectly plugged into a 220 volt outlet by a member of the nursing staff. The loss of this machine is heartbreaking as it takes months to replace and the cost will be high. Hopefully, the one available backup will continue to function.
Karl Storz’s large donation of endoscopic equipment arrived today. These telescopic endoscopes and forceps will enable us to remove the foreign bodies which many one to five-year olds swallow and aspirate into their lungs.
Many corporations have been extremely generous in supplying the finely crafted tools which have saved the lives of the patients described above. I, and the poor people of Northern Ghana, sincerely thank each and every one of the persons responsible for such an important contribution. I met with the Tamale chief and his elders who work to keep peace in the region.

Pursuing the Impossible Dream

X-ray of infant who aspirated an earring into her right lung which was successfully removed with modern bronchoscopic telescopic equipment.

After two and one half years has a modern ear, nose and throat department been established at Tamale Teaching Hospital? No. Some days we have moved backwards. The light at the end of the tunnel is seen, but the end is never reached. All things considered, however, our clinic now has equipment which is not available anywhere else in the country.
A modern, “state of the art” ear, nose and throat clinic cannot be established in a developing environment in one’s lifetime. It would necessitate all surrounding structures to be modern and functioning well. This does not exist. Examples of how outside conditions, over which we have no control, interfere with the goal of a modern ear, nose and throat department are an unreliable supply of water and electricity. The lack of water prevents sterilization of surgical instruments and the washing of surgical scrub suits resulting in surgery being cancelled. Electricity fails daily and the returning power surges destroy electrical equipment.
Why continue the uphill, difficult, strenuous struggle for a state of the art department? Because such a department, with modern equipment and technique, saves and improves lives. The modern pediatric bronchoscopes, telescopic optical forceps and magnified image on a monitor enable the removal of aspirated foreign bodies from the lungs of small infants saving their lives.
Sometimes I think I benefit the most from these efforts. There is peace and satisfaction in doing something worthwhile and good. The others who benefit are the poor in the northern region of Ghana. If the equipment were not here and we did not care for these patients, they would not have the money or means to travel four hundred miles to the capital of Accra to seek treatment.