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.