It's Too Sweet

I did it! I succeeded in making my host family and St. Martin’s hospital cupcakes and cookies…well kind of. I made carrot cake cupcakes (courtesy of Betty Crocker) with frosting and peanut butter cookies (thank you Jess!).

It was not difficult to procure all of the necessary ingredients and except for the incessant pleas from the twins to help, it was not difficult to mix the correct ingredients together either. Baking the goods was a small obstacle since the oven available was a gas oven that did not have a temperature gauge. I was thus forced to sit in the hot kitchen to watch my cupcakes and cookies bake. I can only hope that Eva’s sweat did not become part of the recipe.





As I laid the stunted but finished goods on the table, I couldn’t wait for everyone to try them! The hospital administrator’s home became the place to visit. I asked the medical officers, the matron, the cook, and everyone else I could flag down to stop by and take some cookies and cupcakes. I am disheartened to report that the reception of the cupcakes and cookies was far less than enthusiastic. Everyone was very impressed with the appearance and process of baking. But, every bite into either a cupcake or cookie was met with a nose crinkle, a request for some water, and a seemingly forced positive comment. After three of these reactions, I gave the cupcakes and cookies a try and tasted nothing unusual or disgusting (thankfully). I actually felt a huge wave of American comfort in sampling the cupcakes and cookies. After my fourth negative response, I asked what was wrong and the lab technician said that the cupcake and cookies were too sweet!

In retrospect, this reaction makes sense. If the Ghanaians don’t normally eat dessert, then of course this will be too sweet. I did anticipate this with the cookies and cut out a lot of sugar from the recipe, but perhaps that was not enough. The only people that seemed to thoroughly enjoy the cupcakes and cookies as much as I did were the twins. I suppose Jess’s suggestion of making fajitas was the better option…

Cooking in Ghana

I’ve been staying in a guest room attached to the hospital administrator’s house at St. Martin’s Hospital in Agroyesum for the past two weeks. Everyone in the hospital has been extremely gracious and accommodating from helping out with my research to letting me observe in the hospital to trying to cook American food for dinner for me. Besides inundating them with Michigan gear, I wanted to do something more personal for everyone, so I thought I’d cook…something Chinese or American.

However, this is a lot easier said than done. Obstacles I need to navigate:

• Daily irregular power outages
  
• Vegetables available: lettuce, green peppers, green onions, onions
  
• Meat available: chicken and maybe goat
  
• Seafood available: canned mackerel
  
• Carbs available: rice, bread, spaghetti, yams, plantains
  
• Spices available: salt, cayenne pepper
  
• Other proteins: peanut butter, beans, eggs
  
• No cheese
  
• Unclear on the pots and pans available
  
• My own limited cooking repertoire

The unavailability of pork or even better ground pork eliminates a lot of Chinese dishes that would have been fun to demonstrate like wontons and dumplings. I didn’t want to make fried rice because they have that and I didn’t want to make a noodle dish like lomein because that again is too similar to what they already eat. I could do Chinese cold noodles, but I’m not sure if peanut butter sauce would be a hit. No cheese means no Italian. After much thought and remembering that Opoku Trading Center, an “Abrofo Market” (White Man’s Market) in Kumasi, carried cake mix, I decided to bake cupcakes. For those cupcake masters reading this, yes, I’ll be making them with a mix rather than from scratch…don’t judge! The typical Ghanaian meal never seems to include sweets or dessert, so this will hopefully be unique enough.

This past weekend, I went to Kumasi and bought cupcake pans and cake mix. Maybe muffins will be a better description since frosting may be hard to pull off…we’ll see what I can do. Wish me luck! I really hope this won’t turn into a disaster! Pictures to come soon.

What Chinese/American dish would you have suggested to best showcase a different cuisine?

Lights Off and Let the Sweating Commence

I haven’t yet determined the reason why this happens, but almost every day for at least 10 minutes and sometimes long hours at a time, the electricity will shut off. This can happen anywhere: big cities like Kumasi and small rural areas like Agroyesum.

I’ve seen the power disappear in the middle of surgery, in the middle of watching soccer games, in the middle of dinner, and in the middle of the night. If someone is actually turning the power off, it’s unpredictable, except that the power has never shut off in the middle of a Ghana soccer match. The hospitals have generators to prevent mass chaos and casualties from ensuing.

In Ghana, the power outages are called “lights off.” We met an engineer once at the Catering Rest House who said he was working with Ghana’s electricity provider and his project was to design ways to increase Ghana’s effective use of energy. Apparently Ghana loses about 30% of its energy while the international standard is 18%. Perhaps this is part of the reason for so many lights off incidents.

Since my computer thankfully has a very long battery life, the biggest inconvenience of “lights off” is that the fans shut off and stop their relieving spinning. Even though I was raised in this weather and have spent summers in equally hot and humid places like Taiwan, Shanghai, and Hong Kong, I still sweat like a smelly boy in this weather. Michigan and Boston can also get pretty horrible over the summer. I don’t even have to do anything to sweat. I can sit and sweat and without the fan, I will sweat while I’m sleeping here. It’s disgusting. So, “lights off” is very bad news for me. If I had the same disposition as the Ghanaians and didn’t sweat in 85+ degree weather, then lights off wouldn’t be so unbearably uncomfortable. Are portable handheld generators available? Lydia, could you make me one?

Perhaps I’m Destined to be a Surgeon: C-Sections, Hernias, and Buruli Ulcers, Oh My!

I think I’m in the minority in that I am a med school student and I have no idea what I want to specialize in. I’m under the impression that all of my classmates know that neurosurgery, cardiology, infectious diseases, pediatrics, or urology is their calling and I still can’t even make the decision between medicine and surgery. However, my time here at Agroyesum in St Martin’s Hospital may change that.

In addition to my research work, the physicians and staff at St. Martin’s have been kind enough to let me shadow and observe their work. I have been in the maternity wards to watch deliveries, and in the pediatrics ward to see the buruli ulcers on children. But, without a doubt, my favorite place to be in St. Martin’s hospital is the operating theater.

It could be because that this is the only area of the hospital with air conditioning, or the only place I feel clean, or that surgery is the only area of medicine that I feel confident enough be able to follow the entire procedure (yeah for anatomy!). In just three days, I shadowed three different attendings and got to see a caesarean section, a breast biopsy, the repair and suturing of a severe mouth wound, an inguinal hernia repair, an incisional hernia repair, an abscess debridement, and four skin grafts to repair buruli ulcers. The technical precision and clinical creativity of each procedure, no matter how routine, absolutely fascinated me.

Even though there is a standard best practice for surgical procedures from administration of anesthesia all the way through to the close of the surgery, each body seems to contain within it a different collection of details as if carefully selected by a curator with a keen eye. This degree of human variation affects all of those standard best practices. How quickly will each individual metabolize the anesthesia? How much subcutaneous fat does each individual have? How much blood will the individual lose throughout the surgery? What kind of sutures would promote healing and minimal scaring? These are all considerations and decisions that surgeons must calmly, quietly, and efficiently make while standing with an individual’s health and life in their hands. Isn’t that awesome?

There is just enough uncertainty within the certainty of surgery to keep things interesting. And the best part is that at the end of the procedure, after you have finished closing, you have the satisfaction of contributing to the health of the individual’s life with your own hands.

What would totally convince me is if I was asked to assist by holding onto a retractor or even helping with cutting through the subcutaneous fat. How could you sit in an office all day when you have this excitement happening in the operating room?

Agroyesum: A Cutting for Stone Experience

Number of mangos consumed: 3

Number of mosquito bites: 1

I left Kumasi on Wednesday (June 16) to officially start my project in Agroyesum. I will be based out of Agroyesum for the next three weeks conducting facility assessments and interviewing physicians and administrators at St. Martin’s Hospital (Agroyeseum), St. Michael’s Hospital (Jachie-Pramso), and Bekwai Government Hospital. My research will specifically focus on the changes that have occurred since the arrival of permanent obstetricians at these district hospitals and compare these clinical and management practices as well as maternal mortality outcomes with district hospitals who have not yet received permanent obstetricians. I will also be designing a complications register to implement at Agroyesum and hopefully the 7 other sites I will be visiting this summer to help the Ghana Health Services collect data on the number and types of complications these hospitals see on a day to day basis. This complications register will help hospital staff and the Ghana Health Services strategically target areas for improvement in the quality of clinical care and clinical management of these obstetrical complications.

Agroyesum is about a 1.5 hour drive south of Kumasi. It takes about 45 minutes on nice paved roads, and then another very bumpy 45 minutes on rugged clay dirt roads to get to the district hospital. Stay tuned for videos! I really don’t know how the tro-tros (bus/minivans) make it out here. These road are also not lit, so if there is an emergency after 6PM, I don’t know how drivers can navigate these roads! Questions that I need to answer by the end of my assessment! I think Agroyesum is located at a higher altitude or perhaps just being far removed from the city and in the trees makes it feel a little cooler than Kumasi. The drive to Agroyesum, though bumpy, was breathtaking. It is so lush and green. The best analogy and probably embarrassingly most inaccurate analogy I can think of is the scenes from the movie “Mighty Joe Young”-- the movie with Charlize Theron and this huge gorilla. Just think of that, and that’s where I am!



Before moving out to Agroyesum, I was lucky enough to do a quick day visit last Friday (June 12) to get familiar with the facility and meet the entire staff. As I entered through the hospital gates, I felt like I was stepping into the book Cutting for Stone by Dr. Abraham Verghese. Cutting for Stone is a rich fictional narrative that follows the lives of Siamese twins, Marion and Shiva, set in Mission Hospital, a district hospital in Addis Ababa, Ethiopia. Like Mission Hospital, St. Martin’s Hospital is a Catholic hospital and the staff are managed by a Matron. The Matron at St. Martin’s hospital is Sister Helen. She is authoritative, maternal, and sweet. I feel so well taken care of when I am with Matron.

The hospital provides several different types of services and is much larger than I had expected. There are outpatient services with three consulting rooms, female and male wards, labor and delivery wards, two operating theaters, a pediatrics ward, physical therapy, lab facilities, x-ray facilities, a pharmacy, nutrition services, and they are expanding to create an emergency medicine ward. As Matron and I walked around the hospital, I couldn’t help but think about the characters in Cutting for Stone (I highly recommend the book and am thinking of sending St. Martin’s Hospital a copy). When Matron asked me what I thought of the hospital, I kept saying, “This was wonderful!” She just laughed at my enthusiasm. I then explained to her that I was a preclinical medical student, so just being in a hospital is a novel experience. She then promised that I’d be able to see all sorts of different cases that I could learn much from. I am so glad I packed some scrubs with me!!!



To tickle my imagination even more, I am staying at St. Martin’s Hospitals as a guest of the hospital administrator, who has the most adorable twin sons (picture pending). It’s like I’m guest at Ghosh and Hema’s house! The room I am staying in is very nice and has everything I could have asked for. I have a bed, a sink, my own bathroom with a flushing toilet and shower (cold water only), a ceiling fan, and plenty of room to spread my stuff out. The windows don’t seem to be completely reliable in keeping mosquitoes out, so I set up my mosquito net. After taking my cold shower, I kept seeing tiny bugs flying towards me, so I have taken refuge in my bed under my mosquito net. I look absolutely ridiculous, but at least I feel more at ease while sitting with my bare legs exposed. I’m sure my courage to sit outside of my mosquito net will build as the days go by.

Wish me luck with my continued goal of not getting devoured by mosquitoes and my first day of real work tomorrow!