Lymphatic Filariasis

I recently attended a training session for volunteers recruited to assist in the eradication of lymphatic filariasis in the Savannah region of Ghana. It was thought that the infection was completely eradicated in 2019. However, random blood sampling indicated otherwise.

Lymphatic filariasis is one of the Neglected Tropical Diseases. It is caused by the bite of an infected mosquito. Those darn mosquitoes again! The adult worm can live in the body up to 12 years. It causes problems when it blocks the lymphatic vessels, causing disfigurement of arms and legs. The person’s extremities start looking like that of an elephant’s leg. Thus, the name elephant filariasis.

 
An aside, I thought “The Elephant Man” had this. I was wrong. I never saw the movie. I have to remember to watch it when I return. WHO had targeted complete eradication by 2020. Now the target date has been pushed to 2030.

The drug Ivermectin is used to treat it. Yes, it is the same drug touted in some circles as a cure for Covid and cancer (not evidence-based as far as I know), but definitely proven to work in killing the larvae in an infected person’s blood. This halts the transmission if bitten by a mosquito, which then bites another person.

The volunteers were instructed to take a household census of an assigned area I learned that their definition of a household differs from ours. In Ghana, a household is composed of all the people who eat from the same pot. Typically, I see this big pot outside on a wooden fire in the yard. I have attached a photo of my neighbor, but she uses it to make “pito”. That’s for another blog.

I learned that it is typical in low-resource countries for folks to bring in what they can for a meal. This is often prepared by the grandmother in a stew. Ghanians love their stews. A person may not sleep in the house, but is considered a member if they eat out of that same pot. This practice assures that all gets at least one meal, including those who may not be able to contribute due to current financial difficulties. It also binds the members to each other.

 
Polygamy predominates in this region. A compound may have one male head, but may consist of different households depending on his number of wives.

The volunteers were equipped with a 2X2 piece of wood to measure a person's height and Ivermectin. The dosage is based on the height. The information is recorded in the volunteer's phone. Members who didn’t take the ivermectin are also recorded. The process will be repeated in a year.

Their definition of a household reminded me of a similarity when we celebrate the Eucharist. We offer our gifts. The priest consecrates the bread and wine. We partake. Our bonds are strengthened as one body and one spirit, one family of God. All are fed.

 
Maybe this appears silly to some of you. I have been known to see connections not perceived by others around me.

 
So be it. Until next time.

Patiently Waiting

It has been 3 months since I arrived in Damongo. Thanks to MDA benefactors, Karlee, my companion & I were able to move into a renovated bungalow close to the hospital & St. Therese of the Child Jesus Church. We were previously staying at the Catholic guest house while awaiting permanent housing.

 

My time continues to be a time of patient waiting. We hit a snag with licensing. Ghana requires passing their licensing exam for long-term volunteers. Also, the NP role is being phased out. Those in their current program are being transitioned into the PA program. As it has been in the US, the debate continues on who shall govern the NP practice - Medicine or Nursing.
 
While I wait, I was granted a temporary 3-month RN license. To make use of the time of waiting, I rotate between the different departments in the hospital, including the outpatient department, observing their processes, learning the formulary, and their treatment guidelines.

 

I have come to admire the resourcefulness of the physicians and health care workers working in a low-resource environment. For example, the X-ray machine has been inoperable for months now. The only tech who is able to fix it is out of the country. Yet, patients with injuries from accidents, folks with pneumonia and TB continue to flood the A&E ( ER). Patients with infections are empirically treated with at least 2 antibiotics for comprehensive coverage of the offending organism. The lab does not have the capability to check for culture & sensitivity of samples. So, to the outsider looking in, it may seem callousness with stewardship of the use of antibiotics. I am reminded by the MDA veteran physicians in formation. “Observe. There is a reason for everything.” The provider here has to be very astute in their clinical skills. There are no CT’s, etc., and the availability of a variety of specialists on board for rapid consultations. Complicated cases have to be referred to the teaching hospital in Tamale, which is a 2-hour grueling road trip for those who can afford the fare. 
 
Other than observing processes and trying to understand, I have mostly concentrated on how patients are able to communicate with their providers. I am reminded by the words of a wise mentor. “Sit & listen. Seventy percent of the time, the patient will tell you the diagnosis. Your best tools are your ears, eyes, nose, hands to touch & feel, and a good stethoscope.” Incidentally, he still used his stethoscope from medical school till the day he stopped seeing patients. May he rest in peace. He was greatly admired by his colleagues, students, and patients.
 
Language barrier is a big hindrance. No language line available here!  Many tribal dialects are spoken.  Often, the clinician has to search around for anyone to assist with interpretation. Yet, they continue to treat and care for those entrusted to them. 
Meanwhile, I sit and pray while I observe, trusting in the Holy Spirit to guide us. “Where 2 or 3 of you are gathered in My name, there I AM with you.”
 
This is it for now. Hopefully, I will have my Ghanaian license at the next blog. 
Thank you for your prayers and support as we continue our pilgrim journey as God’s children to make His Kingdom  reality “ on earth, as it is in heaven.” We are all in this together. 

Part of Mission

It has been a month since we landed in Damongo, where Karlee, my companion with Lay Mission Helpers, were met by smiling faces, a warm welcome, and sadly, news of the death of Mark, a Lay Mission Helper, who had waited prior to moving back to the US, in order to help us get settled. He was well-loved here. Fr. Peter was able to step in for Mark, despite his busy schedule during this Lenten season to assist us. We are so grateful.

The weather is warm, reminding me of an overnight stay in Yuma, Arizona, one summer. We are currently staying at the Catholic guest house as we wait for our permanent quarters to complete renovations. So we wait patiently- to get settled into our new home, resident permit, and license to practice. A reflection sent by Elise, MDA director, reminded me that patiently waiting is too part of mission.

On my early walk today, I noticed a woman and his son, picking something from the forest floor. I gingerly walked towards them, afraid of stepping on what, may be lurking under the pile of leaves to inquire what they were harvesting. Eagerly, she told me they were harvesting “bokoboko” a green leafy plant. She then proceeded to tell me how she prepares it in stews and soups, stating, “ it’s very good for you.” She also had a bucket of very small ripe mangoes which she had foraged amongst the many trees that dot the wooded area. She offered to peel a few for me, which I politely declined.

Upon my return to the guest house, I googled “bokoboko”. It is rich in iron, similar to the water spinach we ate in the Philippines. Chance encounters, like this, I believe is, too, part of mission - presence, listening, and sharing. I can’t wait to try preparing it once we’re settled into our home. I hope it tastes good!

All set for Ghana.

A new chapter in my life on
a new continent. 

It is difficult to leave family. My granddaughter will be a teenager when I return. 

But I am excited and at the same time apprehensive about this journey. 

Should I do this in my 70’s? I hear His voice, saying, “ I still have a lot to show you.” Anticipation. I will share with whatever gift  He has waiting for me. 

Until the next blog, keep me in your prayers. 

Thank you.