The Woman with the Big Heart: A Case of Cardiac Tamponade Secondary to Tuberculosis

Chest Pain, breathlessness, fatigue and weight loss. These were the presenting signs and symptoms of the 67 year old woman with the big heart. Our patient is a lovely woman, very strong and rarely complains, but when you look at her face you can tell she is in unbearable pain. Even worse, more and more pain accumulates with each breath.

Our patient's chest x-ray, showing an enlarged cardiac silhouette.

Cardiac tamponade is very rare, only affecting 2 out of every 10,000 people in the United States, but since I have been in Ghana I have seen 3 cases- all on the same hospital floor.

A chest x-ray showing a normal cardiac silhouette.

In tamponade, the heart becomes compressed when blood or fluid builds up in the space between the myocardium (heart muscle) and the pericardium (outer covering sac of the heart). The excess pressure from the fluid prevents the heart from expanding fully and functioning normally. Our patient had an echocardiogram (ultrasound of the heart) that showed part of her heart had actually collapsed under the pressure.

The fluid accumulates in the space shown, where the flap is being pulled back.














A needle was placed in the pericardial space to drain the fluid. Keeping in mind that the normal physiological amount of fluid kept in the space around the heart is only a few cc’s, it is astonishing to think that 1,000 cc’s (1 liter) of hemorrhagic (bloody) fluid was drained from our patient’s pericardial space.











A giving system, to collect the fluid from around the heart, was hooked up to a bag normally used to collect urine. The hospital ran out of the usual collecting container, but this worked pretty well.  The most interesting thing about this case is the cause of the tamponade- Tuberculosis (TB) pericarditis. TB is an infection that is very common is Ghana, but much less common in the states. In fact, this is the first case of TB I have seen during my 4 years of medical school.












Now that the fluid has been drained from around her heart, our patient is much more comfortable, can breathe deeply without pain, and has a smile on her face:-).















- Ohemaa, Mimi :-)

Formally Introducing the Medical Ward

Every morning I make my way to the medical ward to round on patients with other medical students, housemen (the equivalent of interns if internship lasted 2 years) and residents (doctors who have completed their housemanship/internship). The cases we encounter are interesting but the patient’s story is always more intriguing. By listening to the patient’s story we can piece together their diagnosis and how they may have come about acquiring whatever ailment they have. 

The medical ward is a multi-story building where the male and female patients are in separate wings on each floor.  The ward looks very different when compared to what we are accustomed to seeing in the states. The most striking difference is the lack of privacy that some patients have due in part to a lack of resources.  Nuns are a fixture on the floor as they pray for the recovery of our patients whose cases can seem so helpless except for divine intervention. But I can show you better than I can tell you.

It is not uncommon for doctors or medical students to pay for important tests or labs that patients need if the patient is unable to do so themselves. I was shocked when I first saw it happening. Truthfully, it can be a matter of life or death. What would you do?

Medical students rounding.

Nurses tending to patients. The nurses are excellent and do the best with what they have. At Korle Bu, necessity often drives innovation.

Nurses' station.

Prayer warrior :-).

-XOXO
Ohemaa, Mimi

When the White Coat Comes Off!

From exclusive gated communities and pricey high rises to broken down taxis and risky cut throat drivers, we have been through a wiiiiiiiide range of experiences during our first few days in Accra, Ghana! This week was business as usual; we put on our white coats every morning and made our way to Korle bu Teaching Hospital where we took our place as integral parts of the medical teams. We rounded on the medical wards, assessed patients, worked in outpatient clinics, attended lectures, and took in all the differences between our experiences as med students in Accra versus our experiences as med students in the states. But once the white coats came off we really did our best to explore the city if Accra!

Eating lunch at a friend's house. Can you believe this was only for 3 people lol.  From left to right: shito (pepper made with dried shrimp), fried rice, corned beef stew, jollof rice, waakye (pronounced watch-ay). Fried chicken and grilled fish are not pictured.

Our taxi broke down...twice, not the same taxi either. You have to respect the hardworking attitude of the people here. They do the best with what they have to provide for their families!

Gelato...Tasted like fresh strawberries!

Akua on a Friday night.

Me on a Friday night.

People were doing a dance called the Azonto. If you haven't heard about it, google/youtube it. I guarantee you that it's entertaining. http://www.youtube.com/results?search_query=azonto

Me at the med diner on campus. Apparently, the students were not satisfied with the food options they had on the hospital campus so the student government built a restaurant space and leased it out to a food vendor to run the restaurant. I had a rice dish called waakye with chicken.

Med Diner

Our church, Lighthouse Chapel International, has it's main branch in the town of Kaneshie. The branch is called the Qodesh.

Us with one of our Bishops (2nd from the right), Bishop Sackey.

-XOXO

Ohemaa, Mimi

Tears, Diapers, and Coloring Books

 Korle Bu Teaching Hospital 

Accra, Ghana

For the next two weeks, possibly longer, I will be spending time at Korle Bu's Children Block. Composed of inpatient wards and outpatient clinics it is a bustling avenue of patients, parents, and health care professionals. The wards are broken down based on specialty such as Hematology/Oncology and Renal, with nurses, medical students, house staff, residents, and consultants providing the bulk of care.   

  

 

   Rounds are done in the morning where medical students present patients to consultants and medical therapy is discussed

 During the afternoon, older children watch cartoons on the above television

 

Neonatal/ Baby Ward

 

      Special clinics are done every day of the week including neurology, sickle cell, and cardiology.  

In just a matter of days I have seen some the most amazing cases that seem as if they are straight out of my medical textbook. I hope to share a few of them on the blog in the upcoming weeks.

~Akua

Welcome! Akwaaba! Atuu!

Kwame Nkrumah Circle in Osu-Accra

 

Three different ways to say the same exact thing… WELCOME to Accra, Ghana! This triad of greetings really depicts the diversity, integration and movement of people within and into the city of Accra from surrounding towns, surrounding countries and even surrounding continents! 

The city of Accra itself is assorted with different tribes, customs beliefs and dialects, however the official language spoken- that is the main language taught in schools is English. The face of Accra is changing as businessmen and women set up shop in the peaceful nation filled with opportunity and a growing economy and a relatively stable political atmosphere to boot! We have learned that amenities in Accra are easily accessible and there is something for everyone! 

Kwame Nkrumah Circle in Osu-Accra

Kwame Nkrumah Circle in Osu-Accra

Kwame Nkrumah Circle in Osu-Accra

East Legon -Accra

East Legon -Accra

East Legon -Accra

Lighthouse Chapel International Church- The Qodesh- North Kaneshie- Accra

Me on our friend's balcony in East Legon -Accra

Quick Facts about Ghana:

History: Formed from the merger of the British colony of the Gold Coast and the Togoland trust territory, Ghana in 1957 became the first sub-Saharan country in colonial Africa to gain its independence.
Government:  Democratic. This is an election year.
President: John Atta Mills
Location: Western Africa, bordering the Gulf of Guinea, between Cote d'Ivoire and Togo
Size: 238,533 sq km which is slightly smaller than Oregon
Population: 25 million people in Ghana, 2 million live in Accra
Weather: tropical; warm and dry along southeast coast; hot and humid in southwest; hot and dry in north
Natural resources: gold, timber, industrial diamonds, bauxite, manganese, fish, rubber, hydropower, petroleum, silver, salt, limestone

Akua on our friend's balcony in East Legon -Accra

Thanks be to our Father in heaven for keeping us safe as we explore Ghana!

XOXO- Ohemaa, Mimi

2 Girls, 3 Countries

And we're off! After tons of preparation the day of our departure finally arrived. Excited is an understatement!  From running for planes, sick passengers delaying take-off, and four crying babies on 1 plane (OMG!) our journey to Ghana was an experience in itself. Despite all this we were beyond grateful to God for traveling mercies.
Our itinerary was a busy one with us traveling from Columbus to Chicago then to London and finally Ghana. We were definitely jet lagged but adrenalin and Toblerone White Chocolate kept us from crashing :)

  

Fairy Wings for a special little girl

Snoozing during our London layover

 

I tried to look asleep but Mimi made me laugh, lol

Finally in Accra, Ghana

Please bear with us as we settle in and navigate the internet sources here in Ghana.

Stay Tuned,

Ohemaa's, M.D.