PJS (and not that’s not pajamas)

A 13 year old boy, who years before had a bowel resection for an intestinal obstruction, was admitted to our hospital several times with abdominal pain. The pain was intermittent but severe.  After conservative treatment, he got better, but only for about a week. He then returned with pain, vomiting and inability to pass stool or gas. I decided to operate.

I found an intussusception causing a bowel obstruction. A tumor attached to the inside wall of the small intestines caused the bowel to fold and twist upon itself. I was able to reduce the intussusception and remove the tumor. As I examined the remaining bowel, I realized that he had multiple other small tumors throughout the small intestines. I removed several of the larger tumors, but could not remove all of them.

As I examined the bowel and resected the tumors, I remembered something peculiar that I had noticed on the patient even as he was lying on the operating table waiting for surgery. I had not yet made the connection. He has black spots on his lips, palms and soles of his feet. Together, these findings constitute a syndrome, Peutz Jehger Syndrome.

The good news is that this means the tumors are benign, but have potential to become cancer. I explained to the family that he would have to be examined on a regular basis, including colonoscopy to rule out the presence of any cancers.

He is a sweet kid who lives close by, and always has a smile for me whenever we meet.

** WARNING: GRAPHIC IMAGES **
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Appendicitis

It’s been a busy week! In five consecutive days, I did five procedures for five patients with appendicitis. For each patient, I used the ultrasound to guide my approach. This week really helped me to fine tune my skills of finding the appendix with ultrasound!


** WARNING: GRAPHIC IMAGES **

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A New Leg to Walk Proudly

Last spring, I met a 15 year old girl with a sweet smile and a large fungating tumor on her left foot. She had been to other doctors who did not offer any help or the cost was too high.  The tumor appeared to be cancerous, but she was otherwise strong and healthy.

Cancer care is a difficult thing to navigate here. I can offer amputation as a palliative measure, but any other adjuvant treatment such as chemotherapy or radiation are exceedingly expensive or impossible to obtain. Her family agreed to an operation, so I performed a below-knee amputation. She healed nicely without complication.

While she was recovering in the hospital, I encouraged her with truth about Jesus. I shared the gospel with her, the good news that Jesus came to help us to live life to the fullest both in this life and the next. He came so we can have certainty that our sins are forgiven, not by our own merit, but through Jesus’ sacrifice. The patient said she wanted to follow Jesus, but knew it would be difficult as her family is also very strongly Muslim.

About three months later, an orthopedic/prosthetics team came through Nalerigu. After discussing her case with the leader of the team, we agreed that it would be best for her to be fitted for and trained to use a prosthetic leg. With some funding help from a US-based non-profit called Friends of West Africa, she was able to receive a new leg. 

After she returned home with her new leg, she came to visit me. She looked great and was confident walking on the prosthetic. I was able to give her a microSD card with over 50 Bible stories in Dagbani, her native or heart language.

The pathology report confirmed my fears for cancer — melanoma. I don’t know how long it will take for the melanoma to take her life, but until that day comes, she is walking proudly and upright on two feet.

Gun-Related Injuries in Mamprugu

Guns play an important part of life among the Mamprusi and many other ethnic groups in northern Ghana. All the major cultural festivals involve guns being fired. But it might be more accurate to say that guns play an even more important role in death.

When a Mamprusi man dies, three gunshots are fired to announce the news to the community. A deceased woman receives four shots. During funeral observances – especially for important elderly members of the community, many rounds of guns and mortars are fired.

These guns being fired are not your typical, modern manufactured weapons. They are all homemade guns that come in all sorts of shapes and sizes. They are always muzzle loaders and usually look like single barreled shotguns. Problems arise when those in the firing squads get a bit overzealous and pack too much gunpowder down the barrel.

Our hospital sees its fair share of gun-related injuries. The more of these cases have to do with these DIY weapons exploding in their owner’s hands instead of people being hit by gun shot. Gun owners come in with horrible wounds to their hands that usually require the amputation of fingers.

With Bugum Toobu (Fire Festival) approaching in a few days, we thought it appropriate for Heidi to discuss some of the gun traumas she has dealt with at BMC.

** WARNING: GRAPHIC IMAGES **
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Concerning Ovarian Masses

Lately, I have seen a fair amount of Gynecologic pathology. I have treated pelvic abscesses (pus in the pelvis) related to pelvic inflammatory disease or complications of pregnancy and delivery. The number of ovarian cysts, tumors and cancers has also increased in the last 9 months.

** WARNING: GRAPHIC IMAGES **
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Recovering from a Facial Nerve Palsy

After heavy rains last year, a wall of a local primary school building fell on top of children who were in the classroom. The most severely injured patient was a young girl who sustained a closed head injury with a basilar skull fracture. She was treated with medicine to reduce the swelling of the brain and steadily showed improvement. She also developed meningitis during her hospital stay.

As she continued to improve over the following days, it became apparent that her facial nerve (which controls the muscles of the face) had been damaged in the accident. After a couple months, she complained about the inability to close her right eye when she sleeps and therefore the eye was watering. She is the granddaughter of one of out friends in town, so I was able to regularly provide saline drops for her eyes until they improved.

The facial nerve palsy is still recovering, but I see improvements every time I run into her in town. Each time I see her or talk to her grandmother, I am just thankful that she is alive and thriving.