A Long Week--And No Green Mamba Anti-venom!

I want to say this week was fabulous; this week just flew by; I want to say I’ve been spiritually uplifted, that I’ve been rejuvenated, and that I’m itching to get started on the coming week.

The truth is, that I’m emotionally spent. I’m physically drained—I’m tired and I’m on a spiritual low. In short, I gots me a BAD ATTITUDE! Sister Fife says it’s got to change. I’m looking forward to that.

Today marks the end of a very long week, and I’m very happy to see it go. We spent endless hours at the office on the phone only to come home each night to spend more endless hours on the phone! There is a lot of serious illness here in Africa; lots of stuff going on. Some things are exciting, some sad, but most are just routine. We are very much looking forward to the return of the missionaries to the MTC (that seems to be our boost) and having the Temple open again.

I will mention a couple of things in this entry, mostly for myself, just so I can have them recorded. Forgive my ramblings, but these are things I don’t want to forget. This week, I was asked to get involved in a couple of area welfare matters. Sometimes these can to be very sad, sometimes uplifting, and again, sometimes just mundane.

I was asked to get involved with a very sick young woman (26 years old whom Michelle and I actually met a couple of weeks ago down in Cape Coast). She took ill a couple of days before we saw her and was being treated in the hospital for what her husband assumed was malaria. (It turns out that half of all hospitalizations are a result of malaria.) Her condition deteriorated quite suddenly and unexpectedly last Friday morning—she essentially lapsed into a coma. Her physician said that she needed to be transferred here to Accra, which has a large tertiary hospital.

Her husband, Stephan, was beside himself because of her condition and because of the fact that hospital fees needed to be paid in advance before any transfer would take place. In her case, a fee of GCD 1000 (about $800) would need to be paid or she couldn't come. This was Friday night. He had nowhere to turn, so asked the church for assistance. That’s when I was called to "figure out" what was going on and make recommendations.

I spent most of the night on the phone trying to piece the puzzle together. The physicians initially refused to talk to me because I was an American doctor, and it was none of my affair. The nurses were belligerent. The family was beside themselves with worry and fright. Financial assistance could not be approved without approval from the area presidency, and this required the report that I was supposed to write. Meanwhile, the husband kept calling me with reports—she is having a seizure and nobody will do anything about it; she is bleeding from her nose and mouth and nobody will do anything about it...on and on, every half hour through the night. I would call and demand to talk to the head nurse or to have the physician’s phone number, but was hung up on many, many times through the night. Well, after many hours of calls, and many prayers, the physician actually called me about 10:00 on Saturday.

The story I received was that she presented to the health clinic in her village initially with a blood pressure of over 260 systolic and that is why she was hospitalized. She had been in the hospital for almost 2 weeks and had only two sets of labs drawn and somewhere along the line had managed to receive four units of blood. She did have a CT scan which showed an "enlarged kidney". Anyway with the few pieces of information we had, it was obviously that she was having severe kidney failure (I think probably from polycystic kidneys) and had developed uremic encephalopathy (the toxins in her blood were too high for normal brain function) and her condition was rapidly deteriorating; she needed dialysis.

This country has 20 million people and 3 dialysis machines! In the city of Minot alone we have 20,000 people and 20 dialysis machines.

I asked how bad it was, and he told me he wasn’t sure. I asked how her creatinine was, and he had to go find it--6.9. I told him that in fact that was very bad. What was so astonishing to me, was that this lab value was four days old...and that no labs had been done since. Hence the reason she was unconscious and not doing well. Un-Freaking-Believable! The way it works in most of these hospitals is this: if a lab test, a medication, an x-ray or scan is ordered, the family immediately gets a bill that they must go and pay. Once the bill is paid in full, and the receipt is in hand, then you can go to the pharmacy and pick up the medication or to the blood bank and pick up the blood etc. If you can't pay, you don't get the service--no exceptions.

The physician then told me they planned to transfer her Monday morning. MONDAY MORNING--are you kidding me? I immediately called the mission President and the welfare specialist and told them that she would soon die if not transferred, and my report would soon be coming. The funds were released and plans were made--but still for Monday morning.

Later that night, plans had in fact changed. Her condition “deteriorated” (how much worse can it get?) to the point that they felt it necessary that she come immediately. They first tried to put her in a private car, but the husband insisted on the ambulance (and this happened), but she was taken off her oxygen and not monitored. She left at 6:00 pm and didn't arrive here until 2:00 am. (The husband called me every half hour along the trip for updates, but could never tell me about her condition.) Once they finally arrived, the husband reported that the doctor came in, put his stethoscope on her chest and told the family that it was too late. I figure she died sometime shortly after leaving Cape Coast.

Now for Abomosu. Abomosu is a fairly large sized village. There are a few branches of the church around that area as well. In that district, there are 10 missionaries and one senior missionary couple. Two weeks ago, they flooded—and they flooded bad.



This is the only way to get to Abomosu

The village elders (70 years old or more) could never remember waters like this. Needless to say the whole district became an island. Isolated. Cut off on all four sides by rivers now a mile wide.  No one knows how to swim, they had 4 people drown the first day.  One young mother was found after two days in a tree with a baby strapped to her back. She spent the time fighting off the snakes and scorpions that were vying for a spot on the tree. We have been in touch daily if not more often with Elder Dalton who is the district leader.

There are huge problems that come with the rising waters. First is the fact that there is now real sewer system and most people just use the ground, hence the water is foul, contaminated and likely to cause major health problems in the days and weeks to come. My biggest fear is a Cholera outbreak. We managed to get water filters to the missionaries along with some medications and supplies. They are set for now. In Sunday school, the topic has been cleaning hands, cleaning water, cleaning food, and just overall sanitation.

Life at home in Abomosu
Thanks Elder Dalton for the Photos

 They have done a great job and are frantically teaching whoever will listen how to avoid becoming sick. Michelle and I will go to Abomosu as soon as the roads become passable. For now, they are doing well. The missionaries are trying their best to stay clean, but they need to wade through the water to get to the farms for food. We pray daily for their safety.

Another problem with the flooding (besides the fact that it has wiped out the entire village's food supply and farms (the yam and cassava crops were decimated), is the snakes and scorpions. They have been coming up and into the yards by the dozens. The missionaries are good at identifying the cobras and have also been staying clear of the scorpions. They have not been as careful with the cute little green snakes however. I sent them updates on the poisonous snakes and scorpions and some are very deadly—including the cute little green mambas and the green scorpions. I sent pictures of a green mamba, and since then they have been much more careful around even the cute little green ones. With all of the snakes and scorpions that were trying to find dry places, I wanted to get antivenin (anti-venom) for green mambas, green scorpions, and cobras to the health clinic, as the closest hospital is two hours away (and that is when there is not a mile of water on the highway). After a day and a half, we gave up. These supplies are very limited here and carefully guarded by the ministry of health. Only the regional hospitals are allowed to have these. (The green mamba bite can be deadly within a half hour, and they would have at least a 3-5 hour trip.)   Hence, our Elders now are on careful guard as they walk around these villages.  As of now, we have a stalk of medications and can treat typhoid, malaria, and cholera for at least the 10 missionaries. I don’t know what we will do if the villagers become sick. We hope for the best.

One blessing that we count on is that we get to come back to our nice little flat each night—it’s a little slice of home.



Ruth's fruit stand just down from our flat



One other little welfare matter that I am working on this week is for this little girl who is about as cute as a bugs ear. She is so beautiful. She needs surgery for a tumor behind her right eye. She lives in Enugu (The northern part of Nigeria). We are on a fact finding mission—again in hopes of getting some funds released for her needed surgery. So far, things look very positive. We remain optimistic. I think she has a neuroblastoma (nerve cell tumor), and with treatment has a pretty good chance of survival.

Our scheduled trip to Nigeria has been postponed for now. The area presidency is out of the country and all travel is essentially on hold until further notice. We hope to get into Nigeria this fall, but we were told that we needed to arrange to visit all four missions in one trip rather than trying to make 4 small quick trips.

The calls keep coming. One Elder this week was in surgery for appendicitis. Another we are dealing with chronic headaches, many with stomach issues. I think our malaria count this week has improved—I am only aware of 3 cases, and one is not responding—I suspect Typhoid. Several Elders from Accra have been in with ingrown nails. I wound up removing one nail entirely. I have been trying to avoid this when possible as I am worried about infection. I gave one sister an occipital nerve block yesterday. Another was in with uncontrolled asthma. One of the workers that is down here repairing Moroni on the temple came down with malaria and responded nicely to treatment. Lots and lots of other little tiny things.

We went out to dinner to celebrate Sister Woods 82^nd birthday. She and her husband are here now serving a mission in the temple. This is their 6^th or 7^th mission. They are awesome. This was the highlight of our week.

Even the temple workers have had a rough week. We’ve had fun watching out our office window this last week as they have labored diligently erecting scaffolding on the temple in order to replace the statue of the angel Moroni. (The scaffolding does not come in chunks, it comes one pole at a time, hense it was a big process.) We even watched them uncrate, and take the new angel up to the first level. After all that work, everyone came away quite disappointed, because the boom that was brought in is not big enough to hold up the angel and it was bending too far to lift the statue up and out. I am curious to see how this gets resolved.

The Temple in Scaffolding



Unpacking Moroni



Problems with the boom

The new angels ascends

Despite all, we count ourselves fortunate. We still recognize the Lord’s hand on a daily basis and are looking forward to a better week.

...Elder and Sister Fife (even though she doesn't share my attitude)

True Men

"...arise from the dust, my sons, and be men, and be determined in one mind and in one heart, united in all things..."

1 Nephi 1 :21 

Today we met 10 true men.

We were awed.

We were inspired.

We were humbled.

 We are so grateful for the chance we had to meet them and see their work today. These guys know the meaning of work. They work on the true frontier of the church.



True Men (with Elder and Sister Bennett)



They live and work in Sunyani. This is a place where just 9 months ago, no one had ever heard of the church of Jesus Christ of Latter Day Saints. The church has never been in this area. It’s about as far north as Christians go here in Ghana. Good people. The further north you go, the more Muslim the population becomes.

Again, nine months ago there were NO church members.

These missionaries were brought here (about 8 hours away), essentially dropped off and told—go find members. Teach the gospel. Baptize members. Organize sacrament meetings. Ordain  priesthood holders. Organize sacrament services… Go and do.

And they have gone and done!

Today, just nine months later, there are four church buildings. (Each building has a missionary apartment in the back and a chapel in the front.) There are four groups, and three of the groups are about ready to become branches. Church attendance this last week was pushing 50 people in each of the 4 buildings. A church activity is being planned next week (we were invited) and they are expecting close to 200 people!

Chapel and home of two of the missionaries

These guys find their own investigators—they hit the streets. (There is no such thing as a member referral when there is no members to begin with.) They teach every day. They study hard. They plan hard. Then when the people come to church, they run the sacrament, they teach the Sunday school, they teach the converts how to do everything and I mean they teach them everything—how to conduct meetings, how to pray, how to bless and pass the sacrament…

Essentially they have built 4 branches in 9 months!

After our fireside with them, we sat in on a missionary zone meeting and the conversation goes something like this: “we have to move our baptism to Saturday” and “Ok how about you join us on Saturday because we have two baptisms already scheduled at our building”. It was so fun just to sit back and listen to the conversation. We were star-struck—seeing these guys work. Wow. Can you even imagine?

Sunyani is a place that is spiritually ripe. The minds of the people are set for learning. They as a people already have a love of God. Sister Fife and I toured the hospital with one of the guards, who was a bit upset at first with our requests (because we wanted to take a picture of the hospital grounds to document our evaluation).  By the time our ‘tour’ was over, he—along with another employee asked if they could come to church next week and were anxious to hear the missionary discussions. So we got two more good referrals just by our asking a few questions.

FYI: we hate the roads in Africa—Sister Fife and I will never complain again about our road in Seeley Lake. We've been told that next time we travel to Kumasi or Sunyani, not to go without a truck.

A few times we needed to whisper a prayer to help keep the car on the road and not in the river

On the road to Kumasi

Along the road to Kumasi

Also a plug is needed tonight for Elder Aloysius. I think he is our favorite missionary. He comes from our first full group of MTC “graduates”. He is the perfect missionary. We had the opportunity to sit in on one of his discussions with an investigator (baptized on Saturday). It was so exciting. We were so proud of him—we felt like parents. He’s one of the ten greenies in Kumosi—another city of about 2 million here in Ghana. We are anxious to see him again in a few months.

Our favorite missionary--complete with mosquito net and water filter!
Not all missionary apartments that we see are this clean and nice

Elmina Bay and Cape Coast

Elmina

This week we travelled to Cape Coast. This is west of Accra about a 4 hour drive. We stayed outside of a fishing village called Elmina. The hotel was very nice--right on the beach.

Sister Fife at Elmina Bay

We met up with President and Sister Froerer (MTC mission president) and toured the Cape Coast Castle.

It is a very sobering place—it is a slave castle. This is where the slaves were gathered and kept until they boarded the ships bound for the West Indies and the United States. Countless people died here. Out of 500 slaves that were captured inland, only half survived the trip to the Cape Coast Castle. Out of those 250, only about half survived the dungeons of the castle. Of those surviving 125, only about half survived the slave ships to arrive in the United States.

Elder and Sister Fife at the Cape Coast Slave Castle

The castle's outside wall

 

We followed these kids around all day--we had fun visiting with them

In our history books, we read of the tortured lives of only the remaining 60 or 70 that actually survived this whole ordeal. Millions of Africans from Ghana alone died or were brought into slavery. I can find no other words to describe it but—sobering.

This is called the Door of No Return--once a slave stepped through the door, he never returned to Africa

View from the governors quarters

Elmina bay and Cape Coast currently are major fishing villages. This is an awe-inspiring sight. The boats in the harbor burst with color.

To walk the streets of Elmina is to experience living chaos. The streets are lined with huts and shacks full of lots and lots of glorious people. On your right you’d  see a woman scrubbing a naked baby whose wailing at the top of her lungs. On the left a man urinating into the street and a man cart heaped with supplies being pulled down the street by two very strong young men. (A man cart is really a wagon built for a man. It’s made with car tires and are seen everywhere in Ghana. They are on every corner and usually have the owner sleeping in it—I assume waiting for someone who needs his services.) Everywhere there are shacks proudly displaying goods for sale—sacks of flour or rice, dried fish, breads, bakes, plantains, corn, snails, and clothing. There are people hustling for business, there are people sleeping, people playing, people bathing, people eating, people eying you with suspicion, people, people, people.

We saw an obruni in the village and it seemed really weird. An obruni is a white man—and they really look out of place. Who knew…right?

We had a wonderful experience today while we were waiting for President and Sister Shulz (mission president in the Cape Coast Mission). We finished our inspection of the University of Cape Coast University Hospital and parked our car at a local chapel—which is right across the street from the shore. We went for a walk hoping to kill the half hour of time. We saw another incredible site. A picture just doesn’t do it justice, so I’ll try and describe the sights and sounds.

The fishing boats leave early in the morning loaded with yard after yard of fishing nets. They leave one end tied to a tree and tow the other end far out into the ocean. I estimate the nets to be out in the ocean close to ¾ of a mile.

Fishing boats loaded with nets

Then the end is tied to long ropes and brought back around  to the shore where the young men will spend most of the morning and afternoon pulling on the rope to bring the nets back in. The men sing in a cadence all morning as the pull in the nets.  It’s sung in Twi and it is rather quite beautiful. We took the opportunity to join them, and I helped pull on the net for about 30 minutes and I was WIPED. These guys pull all day long. It will take them six or eight hours to finally get the nets in. It was a great experience. 

Pulling in the nets--an all day labor



Kakum National Forest



Jungle Village Outsideof Kakum National Forest



Today we play!

We felt like tourists today. It was pretty great.

This week, we traveled to the Cape Coast mission on a health tour. Our primary focus was to evaluate several hospitals in the area and meet with the new mission president to do some health care training. We had some time this morning to sneak up to Kakum National Park to see the sights.

On the road to Kakum National Forest--I see things in the trees!

A close up, it’s a bit ominous

This is a rain forest…and it is truly awesome. There is a series of rope walks above the canopy built by the Dutch. It takes you about 120 feet up above the jungle. The view is breathtaking. It makes you feel like Tarzan.

The view from the canopy

The jungle sounds are amazing, the monkeys in the distance, the birds and the insects.

The canopy walk

Sister Fife--AKA Jane of the Jungle

We also stopped at an animal preserve and saw the monkeys up close.



Sister Fife being a good example (we teach our missionaries NOT to pet the animalss)
I keep rabies vaccine in the fridge



We came across tons of little villages along the way. They fascinate me. I wish we could just snap tons and tons of photos, but most native Ghanains get upset with photos.

The Beauty and Africa

The Beauty in Africa





The Beauty and her husband

Missionary Work

Today was the first day I actually feel like a missionary.

We work hard every day, but to be honest, most days feel just like any other day back home (aside from the hustle and bustle of Accra outside the office).

Kids from Accra outside our office (they came to visit the temple)

We traveled to Cape Coast this week to find hospitals and meet with the new Mission President there. In the Cape Coast mission, we have 140 missionaries and occasionally they need a good hospital. They can be hard to find. It is our job to find and evaluate the hospitals for the church. Needless to say, we were pretty excited to find a good, solid, and CLEAN hospital. Cape Coast Regional Hospital has about 200 beds, a three bed ICU, an ER, and a nice OPD (out patient department).

Cape Coast Regional Hospital

One of the chapels in Cape Coast

I met a wonderful family practice physician (Dr Kennedy) and he took us for an extensive tour. He promised to watch out for our missionaries and told me to call if I ever ran into trouble.  This was the work part of the day, and actually it went really well. Whilst we were about this business today, we had a couple of great experiences.

As we wandered the wards during visiting hours, there was a woman who came running up to us essentially in tears because she saw our name tags and knew that we were Mormon missionaries. She is widowed and comes to Ghana frequently to work in a nearby orphanage. She had a sick child in the hospital, not doing well. She felt strongly that he just needed a priesthood blessing, but was beside herself as she didn’t have a clue how to find someone to do it…until she saw a couple of missionaries walking down the path. We had the wonderful opportunity to administer to her child and she seemed very content and at peace by the time we left. It’s hard to describe how privileged we felt just to be in the right spot at the right time. We felt the Lord was using us to help her in a desperate hour.

Baby Frances in his hospital bed

While we were leaving, another man came to us and told us he was a member as well, and his wife was sick with malaria. She’d been in the hospital there for a month, and was now needing blood. She was doing ok, but she needed a blessing. He is in the bishopric in one of the wards, but most priesthood holders here (even the ones with significant responsibility) are new and do not have a lot of experience. I had the opportunity to help him administer to his wife, and this as well was another one of those choice spiritual experiences.

It feels great to be useful—especially in these ways!

Malaria

Not a great week.

Not a great way to start a mission.

We had a missionary who contracted malaria on the second of July in Nigeria (Calabar mission). He was started on oral medication, but still no improvement. Subsequently, had to send him to the hospital where he has been treated with IV antimalarial medications and IV fluids. All seemed pretty routine until this morning. I received a call early Wednesday morning in regards to his death. Subsequently spent the morning interviewing the attending physician and mission president in Nigeria, then, frantically putting together a medical report to be used for reports for the brethren in Salt Lake. After two conference calls with Salt Lake, and call with our general authority regarding details of autopsy etc., and finally the calls and “pressure” abated. A very frustrating morning.

The stake president from Accra subsequently called and asked that we join him in a meeting with the family (as Elder Nkrumah is a native of Accra). None of the family are members. They are prominent members of the community. We were nervous. Prayers were said, and things went very smooth.

My faith has been strengthened by his family. Of course it was a very emotional meeting. His uncles (the family elders), upon hearing the news, and after reviewing the medical details made the following comments:

                “We are SO proud of George, he died as a soldier for the cross”

               “I hope that I have the opportunity to die in such an honorable way”

His family has been in our prayers.

Spent the rest of the week basically in the office, finishing up details. Preparing for our first mission health visit to Western Ghana (Cape Coast)

I remain frustrated with malaria, and with the malaria rates in this Africa West area. It is totally unacceptable. We have the mechanism in place to keep our missionaries from malaria—two simple things are required. First, take your medications (most are on doxycycline). Second, sleep under your mosquito nets. In most of our missions, the compliance rate is around 30%. I made the following poster—I “doctored” an old photo from a world war II army medical base (they were then using atabrine, before doxycycline).

This photo is now pasted to the door of our office

Our best mission (Sierra Leonne) went from having 12-14 cases of malaria a month (80-100 missionaries) to now have 0-1 cases each month since the arrival of the current mission president last July who insists on doxy and nets. This month we have 6 new mission presidents in our area, and all have been very receptive and willing to make this a priority.

Things MUST improve.

We are on a crusade.

Snap

Here is a video clip that I have been trying to get to upload since last week. I think it's going to work this morning. These are school girls playing at Pediatorkope Island school. We were fascinated and could of just sat and watched them for hours. We heard the jumping and snapping from quite a distance down the path--its one of the very pleasant sounds of Africa.