Thanksgiving (or, Grace and malaria) by Suzanne

Well, this Thanksgiving was nothing like we have experienced before; we have a lot to be thankful for. Thanksgiving, of course, is not a holiday here – the kids had the day off of school since it is an International School (with about 20% American enrollment), but Suzanne still needed to teach two morning classes at Ashesi. Since we were invited to some friends’ house beginning at 4pm, her office mate and co-teacher Aelaf agreed to take the afternoon lab session, for which we were thankful. However, none of our plans turned out as they were planned…

Grace had been sick all weekend, with a low grade fever, general malaise, and a stomach ache. Although we are wary of malaria whenever any of us are not feeling well, malaria doesn’t present as stomach pain, and so we assumed she ate something, also very common here. Maybe she did, and the malaria just took an opportune time to surface. By Monday evening she reported feeling better, did her math homework, and thought she would go to school the next day. We were thankful that she was feeling better. Early Tuesday morning, however, she came into our room with a high fever, shaking, crying, saying that her head was pounding. We were thankful that she got out of bed to tell us, as we might have not discovered her for another hour or more (the usual school day wakeup time). We decided immediately to take her to the hospital, and were thankful that we had already decided where we would take someone in such an emergency – the clinic that both a colleague at Ashesi had recommended and that was also on the list of recommended clinics of the Lincoln School. She was doing so badly that we decided we better both go, so we woke Fox and Anna, told them to make their own way to school via taxi, and set off in our borrowed car to the clinic (we were thankful to have a car and not have to take a taxi in such a circumstance). In the parking lot, a guard came and saw Grace’s state and called immediately for an orderly with a wheelchair, who came running, for which we were very thankful. Once in the clinic we were thankful we both decided to come, since Grace was immediately whisked off to be examined, but one of us (Steve) needed to stay and fill out the admission forms. The nurse saw her straight away and took her vitals (her fever was 104) and then we waited maybe two minutes to see the doctor – how thankful we were for that! We realized later as we were on our way to the lab to get the blood work that if we had waited even 15 more minutes, we would have been in a queue to be seen. Six am seems to be the right time to arrive at the clinic! The doctor said that he would start treatment straight away for acute malaria, since her symptoms presented that way (fever, headache, tenderness in the liver area), and he would order blood work to check for several things. We were thankful to be wheeled immediately to the lab for the blood work (also no waiting) and then to a bed in a shared room. They started her on an IV straight away, with malaria meds, and also gave her two shots, one for pain and another different one for malaria. After not too long she said her head wasn’t pounding quite so badly, and then she fitfully slept much of the day, in and out of awareness, with the attentive nurses checking on her and giving her the medicines as the doctor had ordered (the Ghanaian nurse asking if she could come into our sheeted room partition: “Please, am I invited?”). Mid morning the doctor came and reported that some of the blood work had come back, the initial test for Typhoid (which we learned later is unreliable, the reliable one takes 3 days to culture) came back negative, as did the smear for malaria. However, he still thought it was malaria due to the symptoms, and said that it is not uncommon for ex-pats on malaria prophylaxis to have a negative smear yet still have malaria (the doxycycline can suppress the parasite in the blood although it can still be active in the body). With that news, Steve continued the morning at the hospital, and I went off to teach a class at Ashesi.

I returned around noon with lunch for Steve and I, water, clothing for Grace and Meadow (her stuffed bunny) and other supplies. She was still alternating between being hot and cold, sweating profusely, and although her head was still pounding (we could watch her heart beat in her neck) she reported it was better, especially if she stayed still. Lunch came, which was light peanut soup and fufu, Grace’s favorite Ghanaian dish. That brought a smile to her face (after the wincing to sit up to eat it) for which we were thankful. Aelaf offered to take the Thursday Computer Organization class, which was supposed to be my last one to teach before we switched off – I was so thankful for that, because it wasn’t yet prepped and now I wouldn’t have to worry about it. Steve went off to do some errands and get kids from school, and would return to do the night shift with Grace (he knows that if I don’t sleep well, I get really run down, so I was very thankful that he would spend the night with Grace). Sarah (the Fulbright student who is living with us) came to visit during the day, which brought another smile to Grace’s face, for which we were thankful, and she offered to help us however she could. Evening came without much improvement, but we were told that malaria takes 24-48 hours to respond to the medicines, and in the meantime it is difficult to control the symptoms. That evening I called Lori (per a friend’s suggestion), a US Embassy nurse friend of ours, to discuss the symptoms and course of treatment Grace was receiving. I was so thankful to have her as a sounding board. Although she was not convinced it was malaria (since with such a high fever she would have thought the parasites would be found in the blood) she said the course of action was fine for her symptoms and such (you don’t mess around with possible malaria) and even if it was just a bad virus, the IV and pain meds alone would be helpful. I went to sleep feeling reassured by everything.

The next morning the kids set off for school early by taxi and I returned to the clinic, to find that Grace had had a “rough night”. She had vomited, her fever spiked again, and at one point she got freaked out, refused to stay in bed and walked up and down the hall with her IV before collapsing in bed again. Steve said at one point he tried some guided imagery with her to calm her down. “Think of the most peaceful, happy place you can think of.” (Pause) “Where are you?” “In a really nice American hospital’ came Grace’s reply. So much for the guided imagery. The night doctor gave her a shot of antibiotics, just in case. When I saw her the next morning she was weak and sweaty, refusing to eat breakfast. I realized that I was supposed to teach at 8am (whoops) so I called my TA (what a great time to have a TA!) and asked him to discuss one of the readings I had handed out, an article, with the class. It was 7:30am and he said fine, no problem. I was very thankful. The doctor came by again on his morning rounds, assured us that he was still convinced it was malaria, but would call in a specialist that afternoon to get another opinion, and in particular to see if he thought she should stay on the antibiotics. So now I was becoming less assured (they really don’t know what’s wrong with her!), and just at that time I got a phone call from Rebecca, Grace and Fox’s math teacher (and wife of Ashesi President Patrick) who had just heard from Fox that Grace was sick in hospital. She told me that when her daughter Afia got so sick with malaria after they had been here a few months, it also didn’t show up on the blood smear, which she again said was not unusual, and that at the time she had gotten reassurance from a friend who was a peace corps doctor. Wait a minute, I said, we know a peace corps doctor! I was so thankful for the timely advice! I texted Fox to get Miriam’s Dad’s phone number (he is the “International Man of Leisure” that Steve has run across several times at the internet café and at school, and is Miriam’s Dad – Miriam is on Grace’s soccer team and in Fox’s play, and they live just 2 blocks from us). His number came back to me late morning, I called him and he said he would come soon. In the meantime one of the nurses asked if we wanted a private room (we didn’t know there were such things!), Steve went to check them out (they’re nice, he said, – like a hotel room!) and inquired the price – an extra $50/day. We can definitely afford that. In the night apparently the older lady in the bed next to Grace yelled “Mama” all night long, and they wouldn’t turn the light out. I was very happy to move away from the shared bathroom – shared by 3 other sick people and their visitors, with no soap in the sink! I was thankful to always have antibiotic gel and wipes with me! We moved quickly to the private room, which was glorious – 2 chairs and a small couch, a private toilet and sink and tub (still no soap, but gotta love that antibiotic gel) and air conditioning (which we couldn’t use due to Grace’s fever). Today was Fox’s 16th birthday, so Steve went off to do the necessary errands – get money (remember the cash economy – the hospital wanted daily deposits of 1 million cedis, plus Fox birthday supplies, etc.) , pick up birthday cakes, last minute birthday present shopping, food, etc. These errands take SO LONG – definitely no one-stop-shopping here. Again, he would return in the evening, since it was clear that we would be another day in the hospital. Patrick (Ashesi’s President) came as we were moving rooms, having heard from his wife where we were. Just a quick visit – he had just returned from a trip to the States late the night before. Paul came around noon – the last time they were in Ghana he was a peace corps doctor; this time they were here on his wife’s job and he was in the process of getting employed by another one of the clinics in town. He complimented our choice of clinics, and said it was where he would take his own kids. He assured me that they know how to treat ex-pats here, and know exactly what to do for malaria. He said it was far safer to get malaria here than in the States, where doctors just don’t have the experience with it. He looked at the medicines they were giving her and assured me that this was state of the art malaria treatment – a potent quinine derivative in combination with a Chinese herbal drug. The antibiotics he said was likely a shot in the dark, but since she was so sick likely a prudent course of action – it would protect against Typhoid (since the initial test is not so reliable) plus many other things. All in all he said she was getting exactly the right care, they were doing exactly the right thing. I can’t even express how thankful I was to hear that! It’s not that I didn’t trust the clinic and doctors, it’s just that we DIDN’T KNOW and she was SO SICK and we’re in a foreign country, it was just glorious to get such a confirmation of the current course of action. Grace was in the midst of what turned into a 4 hour hard nap, the best she had slept since she had been sick. When she woke, she was hungry (!) and feeling better (!). It was like magic – she went to sleep SICK and woke up 4 hours later, well. Still sweating in the weird, profuse way this disease seems to produce, but back to her old self. The specialist came in and examined her at dinner time, and although she was better he said it was too early to release her – they needed to make sure she didn’t spike again. So, another night in the hospital, but at least this time it was in a private room (without “Mama!” all night long, and they had control over the ceiling fan and lights). The doctor even ordered her removed from the pain/fever medicine for the night (which when I talked to Paul later he said was also exactly the right thing to do – since we were hoping to be released the next day, they needed to see how she would do without the fever reducer). Steve returned to spend the night, and I went on to the next whirlwind, Fox’s birthday.

Steve had already picked up the pizzas, which were very aromatic in the car (I hadn’t eaten anything but a bagel all day!), and had left Sarah and Anna at home preparing other food and the house. I picked up Fox at play practice at 8:30, then went around and picked up various friends, and descended on our house around 9:30pm. They (all 15-18 year old boys) devoured pizzas and apples and pears (the pears were a big splurge, and were delicious!) and sodas and cake. Then we opened presents and visited for awhile, and then I drove them home again. Fox went with them – since there was no school the next day (Thanksgiving) they were having an all night Gamecube party at one of their houses. I was thankful he seemed to have a good time at his birthday celebration, despite the lack of priority it had in reality received. I returned home to find that Sarah had cleaned up, for which I was very thankful! I made carrot pineapple salad for Thanksgiving the next day (which ended up a soupy mess), and went to bed after 1am, exhausted but thankful that Grace was better and Fox’s party was over.

I awoke realizing again, whoops, I had lab at 8am and forgot. Again I called Collins, my TA, and again he said fine, no problem. Aelaf was already going to take the 9:30am and 3pm classes, so I was off the hook for Thanksgiving! I did call Aelaf and tell him I would be in to make up an assignment for the 3pm lab – he said it was not necessary, but when I asked him what he would do in lab he said, “oh…” so I thought the least I could do was make up the assignment for him. Steve left the hospital early since he was preaching at the 9:30am American Thanksgiving service (can we throw in any more stress here?) . The Ambassador read the President’s Thanksgiving Letter, and Steve said it was a very nice service. He returned after with Anna (Fox had gone with his buddies to the American flag football game at the school), and the timing turned out perfect – the doctor had seen Grace and released her, we were just waiting for the final bill and take-home meds. Since she went from being so sick to basically well in such a short time, the general consensus is that it was malaria which responded to the meds – again, typical of malaria I am told. We said goodbye to all the very nice nurses (sisters), who all said, “She is better, praise God!”, got our bill (total bill for 2 ½ days, doctors, lab, medicines, etc.: about $350 US dollars), loaded up and drove away. They dropped me at work before heading home to settle her into bed there. I got my work done just (barely) in time for the 3pm lab, and offered to help with the lab since Aelaf looked very busy, but he said, “no, it is Thanksgiving – you should go home.” I was very thankful for his kindness. I went home, Grace was up and alert, we played a card game and then settled Grace back on the couch for a nap while we went to a friend’s home for Thanksgiving dinner.

We had accepted Christina and Nate’s invitation to Thanksgiving some weeks ago, with the promise that we would bring a bit of the food. This morning at church Steve told them we didn’t think we could come, since we were so exhausted and Grace would not be able to come with us. In fact, when Nate heard Grace was in hospital he asked if we would like to bow out. But later, Christina called to say we should just come and eat and run, but not bring anything. It’s so hard to accept such kindness, but we agreed and were so thankful. We came to their house at 5pm (after settling Grace into a nap) and had an absolutely glorious time visiting with so many nice people, and had an absolutely wonderful dinner of turkey and all the fixins. We did indeed eat and run, but unfortunately got home after Grace had woken, hungry, to a dark house (an unscheduled “light out”). So our poor malaria-child fumbled in the dark for candles and rechargeable lanterns, and found herself crackers and groundnut paste for her own Thanksgiving dinner. Poor thing. So, we don’t win the parents of the year award after all. She did thankfully accept the turkey and fixins we brought home to her though. Shortly after we arrived back home, two of her friends from school came over to visit, which was nice and brought another nice smile to her face. So she ate her leftover Thanksgiving dinner while they ate leftover Fox birthday cake, and visited. One of her friends, David, asked if she smelled like that “hospital smell” – you know, that antiseptic hospital smell. Well, I thought, that’s not really a problem here! While the facility was adequate and the nurses and doctors were very knowledgeable and attentive (Steve says he’s never seen that high level of care (and concern) in any of the Texas hospitals he has visited doing pastor calls), it was still an African hospital – I won’t go into detail as I don’t want my Mother to get too worried. Let’s just say that it was a unique experience, which we hope not to have to repeat, ever again. But, most of all, we were so thankful to all the nurses and doctors, and friends who called and were called to gave with advice, and Paul who came to visit and consult, and Patrick who also came to see us, and my TA and Aelaf who covered for me at Ashesi, and of course God, who helped us through this very blurred experience which was: Grace and malaria.