Wanderings of the lost boy – 4

My name is De-Graft. You can choose to call me Digi/DeGi/De-Ge/DeG…etc, whichever works for you. I am a medical student in my 5^th year of study. As part of our requirements for the medical school programme, in 5^th year we are posted to various districts to experience medicine outside the boundaries of the teaching hospital. We also collect data for our final year project work and thesis. I hope to take you along with me on my exciting trip with these memoires. Enjoy!

 

Episode 4 – Fire on the Mountain!

 

1

 

It’s Monday, 18^th March 2019 and another day in Abetifi. The winds are rumbling and the cold weather is gearing up gradually. It’s quite cold here but still a far cry from the maximum according to the residents. The part of Abetifi where I stay is close to the level of the highest habitable point in Ghana, and so is one of the spots that have the coldest of weathers in this region.

 

Once more I have to go to the health directorate. I finally have the permission to start my district health posting proper. All I have been doing is more of volunteering work. The posting we have here is for public health and not a clinical posting. Hence my days are supposed to be spent at the Public Health division and not in the consulting room. But anyway, I am making use of the chance I have to learn and gain experience.

 

From the health directorate, I move to the education office (in the same building) to follow up on my letter – One that will grant me the permission to go collect data from the Secondary Schools around. The director is not around though and I have to go back the next day.

 

About 15 minutes later, I am at the clinic. Today, there’s no consultation for me as the Physician Assistant is around. I spend the day at the Reproductive and Child Health unit. The nurse there takes me through a lot of stuff! From counseling, to the contraceptive choices, to child immunization. There aren’t many patients who come to the unit on this day. As we go through the records, I notice that there are a lot of young mothers in the community, with women as young as 24 years of age already with 3 children. However, family planning methods have become popular lately and so has planned parenthood.

 

 

2

 

The next day is Tuesday, and I am supposed to be at the disease control department. When I get to the clinic, there’s no one at the consulting room and I have to stand in for the day. By noon, I’m done seeing all the patients for the day. I get a call from Bra. Osei, an old friend of the family who found out that I am in the region. He works at the district Hospital in Atibie and he tells me he’s coming around to say hello. I’m very grateful for the visit and I feel so grown up. I was such a tiny little boy when I got to know him.

I decide to move to the disease control department for my tutorial. There is so much to learn about vaccines. How they are transported, stored, ordered, how records are kept on them, etc. I am also shown the map of Pepease and the schedules they follow in Public Health Administration for the district.

I am having such a great time. I learn about the vaccine Refrigerator,

Vaccine carrier,

Cold box and Ice packs

 

Ice pack freezer,

 

And many others.

 

I am also taught how to mix vaccines and measure them with the diluents. Then they show me the vaccine vial monitor and I make a sketch in my notebook on how to read and interpret it (I should add that I’ve been taking notes all along). With that, I learn what the indicators on the vaccine vials mean and what indicates whether they are still viable.

 

 

Life is so good at the moment with my teacher. They tell me we will be going for CWC (Child Welfare Clinic) tomorrow. It is a clinic they have in the community once every week and the women bring their children for weighing and immunization.

 

 

3

 

In all the calmness of the day, I know nothing of what’s coming up… Hm.

 

While at the disease control unit, one nurse from the OPD area calls out my name from the walkway just in front of the office I am in. Less than a minute ago, I overheard a conversation from the walkway about an emergency, but I didn’t pay much heed to it. Right then (when she calls me), I start hoping she isn’t calling me on account of the said emergency. I really hope the word “emergency” only came into their discussion when talking about a hypothetical situation. Or better still, that they were reliving an old experience.

 

So yeah, the nurse calls me and I have to cut my tutorial session short. I walk slowly out of the disease control office toward the nurse with a plain, unaffected face. I mean, my mind is telling me, “all is well.” Just when I step out, she tells me there’s an emergency. Ei! Wow. I hope my face doesn’t betray what’s in my heart and mind. I breathe in deeply. “Calm man, calm down” I mutter to myself. I follow her slowly to the consulting room and she tells me the patient is in the nurses’ room. I don’t know if that’s what I should call that place but it’s where they take the vital signs of the patients before they are seen at the consulting room. That’s also where the records are kept. So all the folders are there. On the other side of the consulting room is a ward where patients who come on emergencies are detained and given treatment till they are good enough to be discharged. When the cases are severe, then it is referred to a bigger health facility. And these three rooms all have doors that lead to one another with the consulting room being the middle transit point.

 

Okay, so let’s go on with the story. I go to the consulting room to calm myself down for a while. Right then, they barge in with this half – conscious, hysteric man held on both sides by two other young men. He is quite tall and slim, with shabby clothes and some gray hair. He smells of alcohol and is groping to his chest and neck with both hands, making incoherent sounds. He is followed by two nurses and they cross over to the ward on the other side of the consulting room. I follow them to the ward and one of the nurses asks me what they should do for him.

 

Ei! At this point, I’m very confused and shaken. I mean, this isn’t at all what I signed up for! I mention that he has to be given IV fluids (I don’t even know how that came out). I realize the need to calm down and keep my head because everyone is scared. Right then, I know what’s wrong with him. He has had an overdose of alcohol on an empty stomach and is running hypoglycaemic. Additionally, the alcohol and gastric acid seems to have irritated his oesophagus and stomach giving him the constant burning chest pain he is experiencing now. I mean, this is essentially what I am good at. At this stage, most of what we have done so far in medical school includes arriving at an accurate diagnosis, while we are relatively deficient when it comes to managing the cases.

 

He needs an antacid, and that is obtained for him. He gets about 20mls of it as a start dose. Then his blood glucose is checked. It’s quite low too so he needs IV fluids aimed primarily at helping him restore the blood glucose. In fact, now I’m starting to think straight, I realize my first IV fluid option would’ve been a disaster for someone with low blood glucose. So we get him two 500ml bags of IV fluids ready and we have to set a line for him.

 

The nurses all look to me to set the line. They bring me the cannula to find the vein through which we will pass the IV. I protest and ask one of them to take care of that rather but she is insistent that I do it. I plainly tell her that I am not so comfortable with setting lines yet – as I have never tried setting a line on a human. I mean never. Not even once in my life! I don’t tell her that bit though, I only tell her it’s not something I’m very comfortable doing. But upon her insistence, I am left with no option but to do it. I ask for gloves. After a minute of scurrying and trying to find gloves, they bring me a pair of sterile surgical gloves. It’s a whole size smaller than my hand size and putting them on is a struggle in itself. I mean, the tips are hanging on my fingers as they are too small for my fingers to fit in. But well, it’s all we’ve got and we have to work with it.

 

I can feel my hands shaking as I take the cannula and tie the tourniquet. I mean, I’m shaking within but it’s not obvious to an observer as I somehow manage to make my cognition override emotion. I apply some spirit at the site and I get ready to enter the vein. I carefully pierce his skin, then the vein and right at that moment, I know I’m in! Relief!

 

But there’s a problem. Right then, the site where I placed the cannula begins to swell (usually due to his tissue reacting to the needle). Once swollen (or inflamed), that site cannot be used and I have to find an alternative site. My relief is indeed short lived.

 

Let me add that at this point, the man is still making noise – this time more coherent than it was at first. At least he is regaining some consciousness.

I try another vein and that also gets inflamed immediately the IV fluid starts running. At this point, I really don’t know what to do next and I ask the nurse to try with his other hand to see if it’ll be any better.

She does, and after her third prick, she finally gets a compliant vein around his cubital area (the area between your biceps and your arm – that depression there). Finally, we can run our IV fluids. At this point, his wife (more like ex – wife) comes around and starts complaining bitterly about his alcoholism. They bring him two bottles of blended kenkey and they open up the first for him to drink. At this point, he can sit up and is a relatively more conscious but keeps groping to his chest complaining bitterly of chest pain. We give him a pot and encourage him to vomit since it will relieve him of the symptoms. I can’t give all details here lest I disgust my reader.

In short, fast – forward about 10 minutes later, the guy falls into a very deep sleep. It’s obvious he’s coming around now and the medication is working.

 

…

I wash my hand, leave the ward and go back into the consulting room (alone) and I sink into the chair. I feel so weak and shaken. I don’t know if you’ve ever had that feeling but I could feel myself shaking on the inside. I pick up my phone and I have to draw my lock pattern about three times before I get it right. At least I can breathe now. My head, my mind… Did this just happen?

 

After about five minutes alone, I go out and tell the nurses to monitor him and let me know when his IV fluids finish running. I also ask them to do a recheck of the blood glucose when it’s done. I go back to the disease control office and ask that we continue our session. But with my recent struggles, we all agree that it’s better we continue tomorrow.

I go and check up on the guy again and he’s quite stable now. He can walk on his own and asking that we give him a place to sleep (Annoying!). The nurses shout at him telling him to go and sleep in his house, or sleep on one of the benches there. They find his patient folder for me and I document the details of his admission and the treatment given.

 

It’s past my closing time now and I have to go home. One of staff here decides to give me a free ride home – on a motorcycle! I have never been on one and the thought of trying it excites me. I get my bag and accoutrements and hop on to the back of his motorcycle.

The ride is exciting with the twists and turns and the hills described by the mountains! The glee and joy I feel override any feeling of fear or doubt I have had on this day!

P.S. Sorry I couldn’t get a picture of that. It started raining before I got to my destination!

 

4

Wednesdays are for CWC with the public health department of the health facility. A stand is set up at a known point in the community and babies are brought for weighing and immunization.

 

 

 

The future is exciting… And I’m living it!