Children's Hospital Boston in Ghana

Our last day in Kumasi

The team had their last day of surgery yesterday and all seems to have gone well. I'll check in later with more detail, but they operated on 12 children this week. There were some hiccups, but nothing they couldn't handle.

Last night we had dinner at the Mayor of Kumasi's house and this morning we have an audience with the King. Something tells me they appreciate the work this team is doing here in Ghana.

I've been having problems uploading photos, but was able to add a gallery this morning of our trip to the Kente Village, which is known for its hand-weaved cloth.

While the Internet is playing along, here are 10 interesting things that I've learned about Ghana:

1. No one smokes here. I've seen exactly two cigarettes being smoked and that wasn't until Wednesday.
2. They have a lot of respect for the dead. The roadside is filled with billboards showing the faces and names of people who died recently.
3. There are a million places for women to get their hair done.
4. There aren't many trashcans in the buildings and what they do have are tiny.
5. They're very religious. One example is that cars everywhere have window stickers saying things like "Rejoice in the Lord" and "Thank U Jesus."
6. The women have names like Patience, Charity and Favour.
7. Soccer is on TV everywhere. It's like Red Sox season in Boston.
8. Celine Dion is on the radio everywhere. And I don't mean that in a good way.
9. They LOVE candy. The team hands it out to adults and kids and both groups seem equally crazy for the stuff.
10. An animal called a grasscuter, which is a large rodent like a mole, is considered a delicacy here.

- Matt Cyr

What a week.....

First, I should thank Bev, Christine, Judy and Francis for inviting me to come again on this trip. I know you guys worked so hard and long to put this together, and the work done here this week shows it. Every detail was taken care of, so congratulations to you guys; I am proud to work with you guys.  Second, what a fabulous team of professionals; you were a joy to work with. We raised the complexity of care we provided this time, and doing this far away from home was only possible because of all the expertise available with this team. Along with all medical care, the team of volunteers provided many schools in the area with books and school essentials - making this team really multidimensional in the help provided to this region.

Choosing who we provide care for is always a difficult task, but I can say we changed the lives of those we picked - and I am sure there will be more trips in the future to help others.

We also got to test the medical emergency system this week, and I was glad that help was just around the corner (7 minutes in all) - just like home! I might use it again in the future!

So one more day to go, and I am hoping that things work well on our last day, and as we close shop, I feel I have had a great time this week.

Ravi

Daily challenges

As nurses in the Cardiac Intensive Care Unit at Children's Hospital Boston we face so many daily challenges. These include alleviating fears for the children and their families, proving comfort and pain control, adjusting medicines to assure essential cardiac output, dressing wounds, etc. Every nurse always asks, "Did I give enough? Could I have done more?"

Here in Ghana, we ask ourselves the same thing. We are reminded of the huge abundance of tools, equipment and educated providers that we have at home. And we improvise and do our best to give our all.

Yesterday I made diapers out of washcloths and tape that we brought from home. We taught local nurses about cardiac defects and shared biscuits from home.

But the most rewarding part of the day was sharing smiles, learning a little bit about each other and watching the children recover.

There is always more to do and more to give, both at home and here.

- Moira Carroll, RN

Things are different here

I have to keep telling myself that. There aren't the resources, education or training here that there are in the U.S. But there are times like this morning when the differences between the way we provide care and the way it's provided in Ghana are brought into stark contrast.

The team went to C5 for rounds and found that Lisa, one of the girls who had surgery on Tuesday, was in pain. The children here are very stoic and are expected not to complain - even after open-heart surgery - so Lisa wasn't crying or moaning. The main giveaway was her shallow breathing. Patients in pain breathe very shallowly because it hurts to breathe deeply. People who don't breathe deeply don't get the oxygen they need throughout their bodies, so don't recover as quickly.

The Children's nurses checked with the Ghanaian resident and nurses and found that Lisa hadn't received a dose of pain medication at the scheduled time. This is not uncommon. Another patient recently went through an entire night without pain meds - two nights after surgery.

Bev Small, Moira Carroll and Judy Hurley leapt into action this morning. They quickly gave Lisa oral and IV pain meds so she could start to feel some relief and changed the dressing on her incision site. They were simple things that these nurses do as a matter of course, but they made a point of telling the nurses and the resident that they needed to watch the pain meds more closely in all of the patients.

Without this type of teaching, the impact of this mission will be limited, so I was reminded of something that I've heard and thought about a thousand times this week: Give a man a fish and you'll feed him for one day. Teach him to fish and you feed him for a lifetime.

Touching hearts

Several times this week I have been asked to write an entry for this site, but how do you put into words what is happening in Kumasi? Smiles from the parents, tears from the children. At the end of the week, numbers will not count. The only thing that will matter is how we have touched these children's hearts in many ways.

- Bev Small, co-leader of the mission to Ghana

A drop in the ocean

I've been trying for a couple days to post some photos of our trip to a shelter and orphanage on Tuesday. The Internet finally played along this morning.

Our two stops were the Missionaries of Charity, Sisters of Mother Teresa, a home for abandoned children and mentally and physically disabled children and adults, and the Kumasi Children's Home, an orphanage run by the state.

The Sisters of Mother Teresa have been caring for Kumasi's children and some of their destitute mothers since 1965. Among their services are weekly meals for very malnourished children. They would allow us to take only one photo in the home, which I can't seem to get to upload to the site. I'll leep trying.

The Kumasi Children's Home houses 86 people, aged 2 months to 25 years. It was established in 1965 by Social Welfare and cares for children who have lost one or both parents, or who have been abandoned. They provide education and living facilities on site.

Both were clean and well kept and the children were obviously well cared for, but as Sister Ursula, the nun who gave us the tour said, they are "the poorest of the poor and what we do is a drop in the ocean."

- Matt Cyr

Wednesday morning at KATH

Today will be the fourth day of surgery for the clinical team. After this, there's only one more before we begin to close up shop and start getting ready to head home. They've so far operated on six children and hope to do six more (including the one they just started). Their days have been long, arriving at the hospital around 7:15 and returning to the hotel as late as 9 pm. Even still, I can tell they all wish they could do more while they're here; the need is great, but the resources are limited.

During morning rounds, the team reviewed the progress of the three patients in the ICU, made recommendations for how their care should proceed today and discussed plans to move them to C5, the inpatient pediatric ward where the other three patients are recovering. As we've passed the mid-point of the trip, you can see that they've fallen into a rhythm that would be familiar to anyone who has seen them on the Cardiac ICU at Children's. Medical terms and recommendations flow quickly and easily, plans are made and necessary medications and equipment are gathered.

C5 is a bit of a different story. There are often multiple children in each bed (this isn't the case in the section where our patients are; they each have their own bed), mothers rest on the floor next to their children's beds and it is generally noisier and more active than what you see in the U.S. Still, you can see that the doctors and nurses are doing their best to care for their patients.

David, Favour and Dora, the three the patients who have had surgery and were moved to C5, seem to be doing quite well, especailly considering it's only been, at most, two full days since their operations. In another example of the amazing job the team is doing to plan for the care of these children after we leave, David is about to transition to medications that the team got donated to ensure that each child has enough to cover them for a full year after their surgery. They're less expensive than the meds that children have in the U.S., but are often more expensive than the families here can afford.

I spent some time talking with David's mother, Caroline. She told me that David has gotten out of bed to do some walking (this helps speed the recovery process) and has been talking and playing games. Here are some excerpts from our conversation:

"We're happy he had surgery. For 10 years we went to the hospital every month. It's very stressful for the mother. I run a small schoool and it's hard to work continuously when your child is sick."

"The school term is 60 days. Before, he was only able to go to about 40 of them. I think now he'll be able to go to about 90%."

"We'll need to put a lot of effort into his academic life. The foundation is not good because he has been sick. He'll have problems with math and science because of the lack of consistency. But his memory is sharp. And he likes computers, so I hope something good will come of that."

"After many prayers, God used you to fill a great need in our lives. It hasn't been easy. We hope God gives us the ability to continue to do this."

"Since we won't be here [in the hospital] long, we have to work very hard in our house to make sure he is taken care of."

"We appreciate [the surgery] so much. We hope eveyone who contributed lives to be 100 and is never sick."

Check out a gallery of images from today's rounds.

- Matt Cyr

Helping outside the hospital walls

We are so proud to be a part of this trip not only for the medical aspect of this mission, but also for the amazing community outreach that has taken place. So far, we have been able to touch the lives of children in the Trede School thanks to St. Raphael Elementary School in Medford, MA. A local orphanage, which is in the process of starting a school for their children, ranging from 2 months to 25 years old, was provided with supplies thanks to the Upham Elementary School in Welsley, MA today, and on Thursday we will be bringing school supplies and books to a local village school that were donated by the Robinson, Jordon Jackson and Qualters Middle Schools in Mansfield, MA.

With all of these supplies and some toys from the last trip, we were also able to donate to the hospital's primary school, the hospital's day care, another village school right outside of Kumasi, and the Missionaries of Charity Shelter, which provides housing and food for the area's poorest mentally and physically disabled children and adults. While visiting this shelter today our group was told that a freezer was in desperate need. We discussed this as a team and quickly decided to pool our money and donate enough for a new freezer. The shelter will receive it by the time we leave Kumasi on Saturday.

Today and yesterday, a group of us went to present our donations, and although the need seemed overwhelming, each place was so very grateful. We were all able to tour the grounds, visit with the children and take in a little something different from each place. These experiences will stay with each and every one of us, and we certainly are grateful to have had a chance to be part of this gift of giving. The plan for this group is to continue to give to these community schools in the hopes that the young children will grow and contribute in great ways to their own community.

This group is here for 10 days, twice a year to help dozens of children by repairing their heart conditions. The hope is that by working with KATH hospital and donating to these schools, shelters and orphanages, we can impact thousands of families in the years to come.

- Krystal and Jeremy Small

What day is it?

It's a frequent question as our week moves forward here in Ghana. Let's see, we left on Thursday, arrived on Friday, set up the OR on Saturday and started operating on Sunday. In the OR, it's easy to lose track of time. Our days are long. We get up at 6 am, arrive at the hospital at 7:30, find the instruments, set up the OR and get ready to start the first case. We're used to preparing for emergencies. Here, they take the form of lights flickering, no power to the pump equipment and mosquitos in the OR (they're hard to catch!).

As we meet the patients, their eyes say it all - dark brown and "as big as saucers" as my mother used to say. They try to be stoic, but their eyes show anticipation, fear, hope and trust, as we prepare to change their lives forever. And they smile, unsure of the journey they are taking. Do they know what we do behind those closed doors? They take the pre-medication and come into the OR, ready to go to sleep. They lie very still and look around our strange environment, questioning with their eyes, but saying nothing. Mom and or Dad stand by politely, just watching and waiting. They are entrusting their child, their life, to us, and that is all that matters. Their child's heart is broken and we will do the best we can to fix it.

Today is Tuesday - our third OR day. Lisa brings the patient into the OR and I say, "Hi, my name is Patti. What's yours?" She smiles, says a quiet hi and we share a wave. I go to set up the instruments. She hopes to feel better soon, but I already do.

Patti Galvin, OR nurse

Technical difficulties

When you're around all the incredible machinery it takes to perform cardiac surgery and care for the children after they've had it, it's easy to forget that we're in a third world country. But there are times when we're reminded just how much we take for granted that we'll have consistent access to technology in the U.S.

Internet access here is spotty at best and the computers are typically several years old (that doesn't include the "Internet cafe" in downtown Kumasi where I tried to do some work yesterday; it had computers from circa 1984 and an Internet connection of a similar vintage).

This applies to the hospital as well. During the first surgery on Sunday, there was a brief brown out that had everyone from Children's looking around in disbelief (it didn't have any impact on the surgery) and when the team arrived at the OR yesterday morning, they found that there was no power to the bypass machine. The problem was quickly solved, but it was a not-so-subtle reminder of the challenges this team - and any other group of clinicians doing similar work throughout the world - face when they take on these missions.   

To me, it makes the work they're doing even more amazing.

- Matt Cyr

PS - The aforementioned technical problems have kept me and others from posting today, but now that we've gotten them sorted out, I think we'll be adding several items tonight (it's 7:30 pm here now), so stay tuned.