Although we've come to end of the road...

Africa fun fact #5: Africa is awesome. You heard me, punk. AWESOME.


As we type this final entry into our Blog of Africa (or "Blafrica" for short), we thought we'd take a bicameral look back at what we've learned about each other during our time here. And yes, I said "bicameral."




BEN SAYS:






Farhan is a many-faceted creature...








For those of you who don't know, he and I first met over a cadaver we named Beyonce, and we've been inseparable ever since. This month in Africa was born out of some random comments we made to each other while studying at a Starbucks in Dallas about a year ago, and, a year later, here we are, preparing to leave Ghana and trying hopelessly to process the past 4 weeks of our lives. These have, without a doubt, been weeks that I will never forget for the rest of my life, and not just for the reasons you think.

But before I get to that, let's talk about what I've learned about Farhan. And, for easier organization, let's listify:

1: He's a sucker for Daniel Bedingfield. "If you're not the one, then why does my soul feel glad today?" Amen, brother. Amen.

2: He is a rare delicacy for mosquitoes. They chase him like he's made of crack, man.

3: He can haggle down a marketplace shopkeeper like no one's business. I think he talked one of them into giving him his shoe, then paying him $2 to take it. Incredible.

4: He has difficulty opening bags full of liquid, which, surprisingly, are ridiculously common in Africa. Go figure.

5: He cannot recognize any quote from any movie. Ever. Unless it's from "Encino Man". Then he's all over it.

6: He causes dogs to bark. I have a running theory that he's actually a Terminator. Time will tell.

7: He has a true passion for public health. And I mean PASSION. I've been blessed in my life to meet a handful of people that, when you look at them and see what they've chosen to do with their lives, you just know that it's exactly what God designed them to do. Farhan's got something very rare in young people today... a genuine concern for the world around him, and the motivation, brains, and creativity to actually affect change. I'm extremely lucky to have shared this fantastic experience with him, and he's going to be an incredible asset to the world of medicine and public health.


That is, if the mosquitoes don't get him first.

FARHAN SAYS:

Some of you may remember Ben's attempt to introduce Christ into my life via a bottle of holy Mirinda. And now you have also read the chicken sacrifice blog entry. What Ben doesn't know is that just before he sacrificed the chicken I whispered Allahu-Akbar (Allah is Great). SO THE CHICKEN BECAME HALAL MEAT!!! Welcome to the Muslim brotherhood suckaaaa!!! Farhan-1 Ben-0

Anyway, there are so many things to say about my Ben Brown aka white tiger aka my Caucasian counterpart aka my surgical soulmate. These last four weeks have been incredible. And other than Carmen Elektra, I can't think of anybody that I would have rather had with me. I've learned a lot about the Benster including...

1. He absolutely cannot appreciate a good British accent when he hears one. Nor can he appreciate a Ghanaian Christian minister's accent when he hears one. To him all of the accents that I do sound like Borat.

2. Mosquitos don't like him. Or at least the African ones don't. My theory is because his skin is so glaringly white, they don't recognize him as a human.

3. He can have entire conversations with me while he is asleep.

4. He makes up quotes that don't exist and then asks people what movies they're from.

5. His ability to understand English spoken in a Ghanaian accent is terrible. He once told me he didn't understand anything said to him for an entire 30 minute car ride.

6. He can sing like a pro. I was fortunate enough to have him serenade me one day, and let me just say that on the outside I was like, "It was ok." But I was crying on the inside.

7. He should quit this whole surgery business and go back to pediatrics. Although there is no doubt in my mind that he will be an excellent surgeon, he is amazing with children and loves them too much to not be a pediatrician. His level of patience with them and his ability to connect with them was amazing. I hope that maybe one day I can be something similar. And when I think about him and his career, I can't think of anything that sums up my thoughts better than that I am very excited to see the incredible things that he is going to do.

But in the meantime, keep him away from your pets... unless you want them to end up in a stew.

THEY BOTH SAY:

We cannot begin to express our gratitude to our families for allowing us to take off into the unknown like this. You all mean so much to us, and your words of encouragement while we've been here have been what's kept us going when we were tired or worn-down or just ready to turn sour. Our bodies have been in Africa, but our hearts have been with you all in America.

And to everyone reading this, wherever we're going from here, know that we're looking forward to nothing more than being back with you all and seeing your faces again. Ben will be back in Dallas on Friday, Feb 22, and Farhan will be back in Houston on March 8. Hopefully we'll see you all soon!

But, for your own safety, you might want to let us shower first.

I'll never scoff at Colonel Sanders again...

Africa fun-fact #4: Pedestrians absolutely do not have the right of way. In fact, they have the opposite of the right of way. They have the wrong of way.

So this is Ben, yet again. As our time here in Africa comes so close to completion, there have been so many stories we would've loved to have shared with you on this bloggy thing... the visit to the place where the slave trade originated, our constant battle with the evil nurses of Korle Bu, our walk on an 8-inch-wide suspension bridge elevated 100 feet above the rainforest floor, our tour of an incredible orphanage outside of Accra, or even how we somehow got conscripted into serving as chaperones on a bus tour for a group of high school students from Seattle. But instead, I'd like to take a brief second to tell you a story. A story of love, a story of loss, a story of sickness and health, pain and healing, and a chicken in a grocery bag.

So let's start where all good stories start...at the beginning. It was last week, and my travel companion/big brown soulmate Farhan had been feeling a tad under the weather. Let's just say that the Ghanaian cuisine was letting him know who runs the show. In any case, in an effort to escape the inevitable fish-based dish that we would likely have had for dinner that night, Farhan made a passing comment to our hostess that, if it were possible, he'd like to have some chicken soup tonight. She replied that she'd be happy to arrange for it, but that we'd have to pick up the chicken on the way home so that Farhan and I could kill it. Oh, how we laughed...

...until we pulled up to the house with a sign out front saying "Poultry and Egg Farm". As we approached the gate, the sound of the chickens could be heard slowly rising over the afternoon breeze. In my mind, they were screaming "Oh crap, customers are coming! Quick, look like you've got the bird flu!" But in reality, they were probably just sayin, "Look at meeeeee, I'm a chicken you're a chicken everybody's a chicken wheeeeeeeeeeeee..." In any case, their cries fell on deaf ears as Christina, Charles, Farhan and I approached the pen. It was at this point that Christina reiterated that we'd be doing the killing, and, in fact, made a point that it should be the surgeon's job to make dinner tonight. Curse these gifted hands!

So then they proceed with the chicken selection process, which was by far the most entertaining thing I'd seen all week. They're picking 'em up, flipping 'em over, rapping them with their knuckles to make sure they're ripe (well maybe not the last one, but still). Finally, one is chosen who I'm sure contained some immutable quality that was imperceptible to the American eye, and then placed into their specially-designed ergonomic poultry transportation device, a.k.a. a plastic grocery sack. Adorable!

So as we drive home with this soon-to-be-succulent fowl in the trunk of our car (and by the sound of it, NOT having a pleasant journey), I'm having an internal debate that I never though I'd have to have. To cook or not to cook... that, my friends, was the question. At first I was like "There ain't no way I'm goin' kill that chicken." And yes, my inner monologue reverts to a 1930's southern black man occasionally. But, after a great deal of soul-searching, I opted to proceed, and the reasons were threefold.



1) This chicken was born and bred for this purpose. If it wasn't me doing it, it'd be someone else, and it would be naive of me to enjoy chicken on a daily basis and not acknowledge that this is a necessary step in basic human cuisine.

2) My great-grandmother used to kill chickens for dinner on a south Texas farm with her bare hands when she was like 8 years old. So there's no way she's showing me up on this one.

3) Brown Bear was sick and needed his chicken soup. End of discussion.




So yes, ladies and gentlemen, the chicken met an untimely end at my hands. And let me tell you, chickens do not go quietly. And frankly, neither would I, so it was understandable. But in the end, my vastly superior medical knowledge combined with my opposable thumbs proved me the victor, and we feasted on soup the likes of which you have never tasted.














So, for all the work we're doing here, and all the life-changing experiences we've encountered on a daily basis, I can tell you the most important thing I've learned about myself on this African adventure:








Campbell's ain't got nothin' on me.

Children: More than just shorter versions of real people

Africa fun fact #3: Beards itch WAY more in Africa than they do in America.




And yet again, this is Benton... today's heat-exhaustion-fueled ramblings are about what is undeniably the cutest aspect of our trip here (besides the baby goats roaming the streets): the children we get to work with!!

So for those of you who don't know me (or who just don't know me very well), I'm going into the field of surgery. But for the longest time, my career choice was a constant tug-of-war between the fields of general surgery and pediatrics (specifically pediatric oncology). And, frankly, while I love surgery, I still have moments when I wonder if I made the right choice. Let's just say that this month definitely isn't helping to assuage my doubts.

So I guess I should explain what exactly our role is here with the kids. We operate primarily out of a school in a town called Mallam that has kids from ages 1 to 16... our main job is to run the school clinic here and to be around for any emergency situations (of which there have actually been a few... but we'll talk about those later). But, with the exception of a few minor cases of headache or scraped knees, our days at the school are relatively bereft of medical excitement. We have, however, worked out a nice triage system of which patients go to which of us... any kid with a fever goes to my friend Brown Bear, and any kid with a trauma gets his ABC's done by me. God bless you, Parkland... your training is helping to save the world.

Now, don't get me wrong... we've kept mighty busy during our stay here. As we've said, we spend time at the local Police hospital and at community clinics and, just recently, a local orphanage in Accra. But, while the thrill of actually making a difference in a community does make these excursions well worth it, there's nothing like hanging out at the school and seeing the looks on these kid's faces when we walk by their rooms. In fact, this is one of my favorite stories... so in the local dialect here in Ghana, the word you hear a lot out of people's mouths when we walk down the street is "Obroni". Roughly translated, it means "white guy"... kinda like "gringo", I think. So, for the time being, I've pretty much adopted this as my African moniker and try to wear it proudly wherever I go. And, while the older kids call me "Doctor" or "Ben" or some combination of the two, the REALLY little ones (like the ones who are eye-level with my kneecaps) just call me Obroni. So yesterday, I was walking by their classroom, and I stopped by the window and waved at them. Within a matter of about 15 seconds, the entire class had burst into an impromptu chant of "Obroni has come!" over and over again. And, for those of you music-types who can appreciate this, I took the liberty of writing it out to give you an idea of the cadence:




I'm currently in the process of securing the publishing rights, so don't even think about it.







So while it sounds like the majority of our day is spent basking in the adoration of 4-year-olds, we actually do a bit more than that. When we're not treating medical issues, the headmistress of the school here has us going into classes and teaching, mainly on science and healthcare issues like hygiene or a balanced diet or stuff like that. And, to be honest, I almost enjoy that part a lot more than the actual medical work we're doing. The kids here are really eager to listen to us and to learn, and I've always been really passionate about having teaching as a huge part of my life, and I really do love doing it. So like yesterday, when I gave a big lecture to the 3rd graders on first aid and sanitation and stuff, one of them came up to me during recess afterwards and showed me an injury he had on his shin from a week ago. It didn't really require any medical attention, but when I asked him what the first thing we do for a cut is, and he and his friends all said "Clean it!" like we'd talked about in class, it... was... awesome. That's the exact reason why I love teaching.... I've never had anyone make as much of a difference in my life (other than my parents) as my teachers did. Teachers can change the world one kid at a time, man. I love it.

But in any case, I digress. Sufficed to say, the kids are fantastic, and we're falling in love with every one of them. Here's a few pictures that I'm a fan of:
































If you only knew how many high-fives, thumbs-ups, and wet willies we've given (ok, maybe not the wet willies... yet), you'd be amazed at how much a human hand can withstand. And, against all my instincts, I've been successful in avoiding the temptation to create some weird phrase and try to pass it off as what all the cool Americans are saying (my leading contender was to say goodbye as "Smoke 'em and joke 'em, cheesenugget!"). But there's still plenty of time.

Also, before I sign off, Farhan and I found a few famous faces at L&A Memorial Academy that we thought you'd get a kick out of. First off, fresh from his critically-acclaimed role on "Private Practice", Mr. Taye Diggs:



















Also, we have a celebrity from years past... you might recall him as "Nicky" from the last few seasons of "The Fresh Prince of Bel-Air":



















Now, I'll just tell you that I disagree with one of these resemblances... 10 points if you can figure out which one!

So more more blogs to come as our last week approaches. But I'll leave you with my favorite picture of my trip so far... little Stella. Peace out!

How do you weigh a Ghanaian baby?

The answer is...like produce! Hey everybody, Farhan here. We had a very eventful week last week. Probably the most public health oriented week we have had yet. We spent some time in the local police hospital with one of the public health doctors. Then we got to go to a local community nurse clinic. Both were definitely eye opening experiences.

We started out at the police hospital. Probably the biggest problem that this hospital deals with is HIV. The hospital is for police officers as well as civilians. Dr. Sam (neither myself or Ben can remember his last name, and I definitely can't spell it) told us that about 4-5% of Ghanaian police officers has HIV. In this hospital, they started HAART (Highly Active Anti- Retroviral Therapy) about one year ago. And use of HAART only began in all of Ghana 5 years ago. The patients that we saw all looked great. They looked like normal people and you would never guess that they had HIV. After seeing a few patients Sam told us, "This is the new face of AIDS." Quite honestly I've seen much worse looking patients in Parkland. I was coming to Africa hoping to see some Kaposi Sarcomas, some Pneumocystis Pneumonia, disseminated Histoplasma...but man we got nuthin. I was glad to see the patients doing so well, but man I wanted to see some crazy stuff. Maybe next time.

The hospital has a policy of never refusing a patient for inability to pay. The HAART drugs are all bought, of all places, from India. In addition to raising your CD4 count, they also cause male pattern hair loss, uncontrollable flatulence, and fingers that smell like curry. No just kidding. Apparently in India generic versions of the HAART therapy are more readily available and are cheaper.


I had the opportunity in the morning to hang out in the Obstetrics ward where they did pre-natal and post natal screening and education. There were probably over 100 women crammed into this tiny room where they were being educated about all kinds of stuff. They were instructing the HIV positive mothers not to breastfeed and only use formula because of the risk of transmission. This reminded me of a statistic I read during my OB/GYN rotation: breastfeeding is #1 worldwide cause of HIV infection in children. They were instructing all the other women to never use formula and only to breastfeed. During this lecture I began talking with one of the nurses who told me that, because it's easier for a man to infect a woman than it is for a woman to infect a man, there were many cases of newly married coupled in which the woman was infected but the man was not. She said most of these cases end in divorce. She then proceeded to ask me what I would do if I was in that situation. I said, "I really don't know, maybe divorce." She then looked at me disapproving and responded with, "That's terrible. Love transcends all things." In order to control my sudden onset nausea and the overwhelming urge to laugh, at that point I left.

The next day we got to go to a local community clinic run by a local nursing school. It was friggin fantastic. They did everything from birth control, pre-natal screenings, well-child checks, vaccinations, the works. It was like a smaller version of the AKU clinic I worked in 2 years ago. The nurses are all trained public health nurses and are all very good.

There were some shocking differences though in the ways that they did things. Last week my surgical sweetheart was examining a patient in the school clinic who came in with 1 hour of abdominal pain and a subjective fever. He was probably just trying to get out of class. A nurse that was visiting us for the day touched his forehead and, much to our astonishment, quickly proclaimed, "He has fever, this is malaria!" Ben and I couldn't figure out why, only based on a subjective fever, she would think malaria. We took his temperature (which was normal) and watched him for the next day and he was fine. Later when we went to their clinic, we learned that malaria is so rampant in Ghana, and the diagnostic testing is so expensive, that every person with documented fever who presents to the clinic gets treated for malaria. Amazing!

As soon as we got to the clinic we were overwhelmed with patients. The first one we saw looked like a simple viral infection and we were about to send her home with a bottle of cough syrup, but when we remembered...low grade fever! Treat for malaria! So we did. In the few hours we were there we diagnosed all kinds of stuff, from eczema to gastroenteritis. One two year-old girl came to us having had 7 large volume, watery stools overnight. Looking at her past medical record she was underweight, had been treated for malaria four times and gastroenteritis 3 times in the past. When we saw her she was very lethargic, had no urine output since the day before, and at rest had a pulse of 190 beats/min! Ben and I were like holy crap! We think she probably had cholera and referred her immediately to the hospital for IV fluids.




A little boy with presumed malaria. He was actually quite sick so I wouldn't be surprised if he actually had it. When asked, his mother told us that he always sleeps with a bed net. I'm not sure I believe that. He has had malaria several times before.

















A little baby, being weighed in the traditional Ghanaian fashion.














A kiddo in our school with an extremely large and extremely malformed skull. We think the result of craniosynostosis or increased intracranial pressure during his early years. One of the friendliest kids you would ever meet.








So, its been a very interesting and very educational week. Tomorrow we head to the orphanage. So be expecting an entry about that soon. In addition, Ben (a.k.a. white tiger) will soon be posting about our awesome weekend. Peace out.

As long as we don't have to call it "football"...

Africa fun fact #2: No matter how much I tan here, I'll always look pale.

Yeah, this is Ben. So for those of you who've expressed (rightly so) that the blog entries have been few and far-between, let's just say that the only thing that's been more exciting than our actual trip to Africa has been the constant hunt for viable internet access points. Please accept our deepest apologies, and know that, were we not spending so much time providing free medical care to African children on a daily basis, we'd be blogging more. Hopefully, this last statement has overwhelmed you with guilt, and you will therefore have no choice but to enjoy the rest of what I write. Dance, puppets, dance...

Whilst Farhan has taken it on himself to tell you about the public health work we're doing here in Ghana, I'd like to put that on pause for a moment and talk to you about something else we've been up to while we're here. I speak, of course, of the Africa Cup of Nations 2008! Now most of you (at least the Caucasian ones) are probably saying to yourselves "What is this 'Cup of Nations' he speaks of? I've never heard of it, and new things frighten me." Well don't worry everybody, we'll get through this together.

The Cup of Nations is an intra-continental soccer tournament for Africa that serves as a World Cup qualifier, and it's the biggest thing since Hootie and the Blowfish over here. And Farhan and I happened to find out about a week before we came that, this year, it's being held in Ghana! Not only that, but the main stadium is in the very city we're working at for the month! NOT ONLY THAT, but we're here just in time for the end of group play and the start of the play-offs! Now, I'm the first to tell you that I'm not a huge fan of watching soccer matches, but what I AM a huge fan of is watching crazed fans in body paint and wigs beating giant inflatable objects together while screaming their heads off, so we knew immediately that we had to make it to this thing.

But alas! Our first setback... in true "Africa" fashion, the Local Organizing Committee for the tournament only has the word "organize" in its name as some sick form of humor. Tickets are nearly impossible to come by, and that's only if you know the right people in the black market. Luckily, we have some shady friends here in Ghana!

So Sunday rolls around, and it's the big day of the first quarterfinal match: Ghana vs. Nigeria! Now, when I asked our host if Ghana has a rival that they must always beat, his response was "Oh it's Nigeria" (make sure you read that with an African accent in your head... it sounds more intimidating). So for you Americans who are still reading along, think of this match as World Cup meets UT/OU Red River Shootout... then imagine that the Super Bowl was being held in your home town for the first and last time EVER, and that would be a good gauge for the demand for these tickets.

But, before I talk about the game, let me tell you how Farhan accidentally became a Christian for a day. So, in preparation for the game, we went to church with our family that morning, which is a whole other blog entry in itself, but at the end the church leadership pulled us aside and sat us in a hallway with other visitors. Everybody shook our hands and greeted us, and then they gave us some Mirinda soft drinks. A pastor came by and asked me if I followed the teaching of Jesus, to which I said "Absolutely." He then asked Farhan (for those of you who don't know him, a devout Muslim), who, in a noble effort to avoid a scene and not embarrass our host family, said a quiet "Yes." Afterwards, I informed Farhan that that had constituted accepting Jesus as his personal savior, and that, by accepting the holy Mirinda drink, the Bible says he's now a Christian. It's somewhere in the back, I think. But we decided that, since he didn't finish the drink, the effects would wear off at midnight. But I will say that Farhan was much nicer to me that day... woohoo for Christian brotherly love!

So anyway, then we made the trek to the stadium for the game, after appropriately donning our Ghana gear. Outside the stadium was PACKED, and, once we got inside, we couldn't believe it. I'll never forget walking up the stairs and getting our first look at the filled-to-capacity stadium cheering like nuts... it was like that scene in "Gladiator" when they first walked into the Colisseum, except that they knew they'd never leave there alive and we only had a faint suspicion. Now, we were both concerned that we'd get bored trying to watch two straight hours of soccer, but, surprisingly, it was a great game! Nigeria went up by one, but Ghana came back right before the half, and the place EXPLODED! Literally, I wish I could describe it, other than there is absolutely nothing like it back in the U.S. They jumped and danced and sang, and, since it happened right before halftime, they went ahead and continued all throughout the break. Continuously. Without any decrease in volume. It was amazing.

The Ghana Black Stars (that's the team name) came back on the field, and ended up scoring again to take the lead, and again it was redonkulous. We were getting all sorts of crazy hugs from all the huge guys around us... we were feelin' the love, baby. Ghana ended up taking the game 2-1, and that's just when the fun STARTED. The streets were filled with people, the parking lot had turned into an impromptu party, and we were quite content with staying out as much as possible. We drove through the town on the way home, and, with me and my Ghana facepaint, Ghana captain's jersey, and Ghana flag on my shoulders, we definitely overheard a group of girls say in the local dialect "Look at the white guy supporting Ghana!" Bridging gaps here, people... bringing people together. Someday they'll just be saying "Look at the guy supporting Ghana!" Someday...

We returned to the stadium yesterday for the semifinals, but Ghana lost in what was not the most exciting game ever... but even then, the crowd was wild, the excitement was palpable, and we both said it's one of the coolest experiences either of us has ever had...

...but if you ever hear me call it "football", please call me a tool and kick me. Hard.

Hey everybody, Farhan here on a beautiful Monday afternoon in Accra. It's great here. I was talking to the Benster over the weekend and we both decided that something that is way way overdue on this blog is the hospitality of the Ghanaian people. It's really incredible. We are staying with the family that runs this school/clinic and they are treating us like kings. They feed us way too much food and treat us like family. And one big difference between Ghanaians and us is their level of companionship (I guess thats the best way to put it). They just hang out. Whenever one of them brings us food, even though they don't know us they don't just drop off food and leave. They hang out and chat with us until we're done. And man is the food over here great. Our hosts are making sure that we get to try lots of authentic Ghanaian dishes. It's great. Lots of fish. Lots of corn type stuff that's ground up. It's very different from American and Pakistani food. Its one of my favorite parts of this trip. Every morning they all come up to our floor of the house and hang out while we eat breakfast. They turn on the tv and come up to our floor and watch rather than watching on their own tv. It's great. It's like having a family here. And over the weekend they spent a lot of time with us (details of the weekend will be posted later by my Caucasian counterpart). They are incredible people. Every member of the family is involved in keeping this school going and each of them has a different role. One person is the headmaster of the school, another does all the computer and technical stuff, several others are teachers, other cook the food, etc. It's a huge family and they're all involved. They make such a huge difference in the lives of these kids (and the community overall) but if you talk to them about it they all just brush it off as if its nothing. We come over here for a month and we feel all good about ourselves, but they have been doing this everyday for ten years. To them I think this is more responsibility than altruism. They're incredible. I have a lot to learn from them. I feel very privileged to be able to hang out with them for a month.
The kiddos at the school never cease to amaze us. Man they're great. They're hyper like crazy. One just walked up to Ben right now and said, "I've heard of Santa Claus and I want to know what he is and if he's real." Ha ha. Classic. Then he got asked if we use caning in the U.S. to discipline children and why or why not. To which, after stuttering for about 10 seconds, he replied,"People in America, we...ummm...like to sue each other a lot." Haha. A girl walked up to me very embarrassed this morning and asked to speak to me alone. Long story short, I explained to her for the first time what menstruation is. Oh well. We found out today that most of them have some type of medical record kept at a nearby community clinic. One of the nurses came by today and asked us to come and check the clinic out on Thursday so we're going to do that. And tomorrow a community physician is going to show us around one of the local hospitals. Next week we go to the orphanage. The disparity in healthcare compared to the United States is amazing. One of the parents wanted to speak to Ben and I this morning to get a second opinion about her daughter. Before meeting with the girl's mother we got to meet the girl. After talking to her for a few minutes it seemed to Ben and I that she had mental retardation (or at least acted similarly to every patient we have seen with mental retardation). When we finally met her mother she confirmed this to us. She also told us that she has been having seizures once a month since she was a baby and never has been put on anti-epileptic medication. She said that she had seen a few doctors about it but none of them ever mentioned it to her. So her daughter has just been seizing for the last 13 years (she's 15 now and has not had a seizure for 2 years). Her mother described the seizures to us as full Grand Mal Seizures. The last doctor she saw was a homeopathic doctor who told her that her daughter has a brain infection and then gave her a shot that he told her would boost her IQ. He also recommended a high protein diet to fight the infection. Amazing. I reassured her that her child does not have have a brain infection, and told her to take her to a neurologist (there's only one in town apparently). She told me that would be tough financially. So I told her that since she has not had a seizure in 2 years she would probably be ok, but if it were my child I would definitely find a way to see a neurologist. She said she would take her. What a difference...if it were my child she would have seen a neurologist 15 years ago.





A case of scabies. It looks a lot worse in real life. Unfortunately we have nothing here that will treat scabies so this kiddo is still running around with this on his hands. Fun Fun!






Some of the kiddos that we saw last week are improving. It seems like lots of them have poor diets. I spoke with the founder of the Adakum foundation two nights ago and he told me about some of the initiatives that they're planning and I was able to change his mind on a few issues that I thought would be of little benefit and talk him into others that might be of more help. Ben and I are really the only medical people behind this organization right now, which makes me really nervous because we're just medical students. And even though this is not a hospital or even a full clinic, education and health care are so mixed in this setting that there should be someone with medical expertise on the board of the Adakum Foundation.
But anyway, thanks for all the e-mails of support and comments on the blog. I loved reading them. More to come. Peace Out

Hey everybody, Farhan here. So lets blog...


I knew that coming to africa would be an incredible experience. The reason I made this blog before I left for Ghana was so that my family and a small group of close friends could share it with me as much as possible. One thing that I'm very happy about is the perspective that both Ben and I have. We both understand that this is going to be incredible, but the really incredible part of it will not be the patients we see or the meds we bring, because after we leave and our meds run out all of the infections, anemia, and gastroenteritis will come right back. It will be as if we never came. The incredible part of this experience will be the lessons that we learn from it that we will hopefully be able to apply somewhere else in the future. We came here to get a better understanding of the issues, because there's only so much you can read in a book. So that being said, lets blog some more.



So a little background info... As most of you already know this is my second experience working in a rural clinic. During my first and second years of medical school I was fortunate enough to have had the opportunity to work in a clinic in a village called Rehri Goth in southern Pakistan. I got to work with people that had a really good understanding of the determinants of health of that community and who were willing to impart some of that info to me. In addition to that they did microcredit finance, womens literacy, community cleanups, vaccinations, prenatal screenings, birth control, etc. They did pretty much everything that, from what I read, is effective in the third world. I got to learn a real lot there. It was an amazing experience and man I feel lucky to have had it. So throughout this month, I will probably make lots of comparisons between the two clinics.

So now we've been at this clinic for two days and man we've learned a lot already. Compared to the clinic in Pakistan this clinic is way behind. There's a fantastic school that does a great job teaching the kids. They learn everything from biology, chemistry, algebra, to even medicine. Yesterday Ben and I got to talk to the kiddos about the endocrine and pulmonary systems (NOTE FROM BEN: The best part was when they asked Farhan "What is pregnancy?" and he just stared at them for about 10 seconds. Classic). But they're not doing any microcredit finance, they don't have a proper clinic even, they don't do any adult education, and they don't do enough practical education (hygeine, etc.) These are all things that worked great in Pakistan and, from what I read, all over the world. Another major issue with this school is that it is completely funded by a person in the U.S. There's no self sustainability or local contributions. Nor have we heard of anybody talking about that. They also have very little recruitment of people from the community to work in the school, which as I learned in Pakistan is very key to maintaining sustainability.

As far as the health of the kiddos goes, there's several issues that are rampant around here. One of the major ones that we've seen so far is tinea capitis (scalp infections). On the first day we must have spotted ten kids in the crowd who had infections and pulled them off to the side to treat them. Another thing that we're seeing a lot of is anemia, although we don't have the lab capabilities to prove it. We are getting lots of fatigued, pale looking kids who are coming to us with the typical symptoms. Unfortunately the only thing we can do for them is give them iron tablets. We can't order bloodwork to try and determine the cause so its kind of a shot in the dark. It could be dietary, it could be because of a tapeworm, or something else. It sucks. We're also seeing lots of gastroenteritis (GI tract infections) in the kids. This is likely a hygeine issue, or at least thats what it was in Pakistan. There are these three year old twins in the school who, for lack of a better word, just look like crap. We don't have so much as a scale to prove it, but I bet they're really underweight. They look fatigued all the time. And from what their teacher tells us, they get gastroenteritis at least once a month. This is definitely a hygeine issue at least. If this was a kid that I was seeing in a U.S. hospital, I would order a ton of bloodwork, including probably an HIV test. But his parents, like all the other parents here, don't have the money to go to a hospital.

Another huge problem, and the one that the people seem to be the most aware of, is malaria. I was told by Japhet, the founder of the Adakum foundation that runs this school, that most of the people around the school have malaria nets but don't see the importance of using them. Yesterday the local pharmacist, who has a lot of interaction with most of the locals, told us that only about 50% of the locals have malaria nets, and many of them don't use them. The nets cost about 6 bucks a pop which is out of reach for just about everybody. There has been an initiative recently with the Ghanaian government to procure more malaria nets, but for whatever reason they have not found their way down to Accra. There is a spray thats available but it is apparently more expensive than the nets even. So basically, were only left with trying to educate the people that have nets about regular use. We understand there's a kind of voo-doo aspect to it. We have to make people with no medical background or understanding of disease process believe that if they hang this thing over their bed they will be healthier. It will be a challenge.

So those are some of the issues and challenges that we're seeing and that one day, maybe, we will be able to overcome. Understanding some of these things better is why we came and I don't think we will be disappointed. In the meantime, the kids are friggin awesome. Both of our hands are sore from giving high fives. They're fascinated with Ben's skin pigmentation problem (i.e. his blinding whiteness) and with the healthy fur coat growing on my arms. And we're being fed all kinds of Ghanaian food, from whole fish to mushy millet seeds to spicy soupy stuff. It's amazing! More to come later....Stay tuned.