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Today is our 5th wedding anniversary. For five years we’ve tried to live out the commitment made before many of you who read what we write here. Looking back over the five years Laura and I agree that they’ve been good years with laughter and fun as well as challenges faced and overcome. We thank you family and friends for walking alongside us during the fun and not-so-fun times.

We got our Ghanaian clothes this week. They look pretty good. The fabric is a large pattern with geometric designs and some big hibiscus flowers, I think. Laura’s dress is a two-piece deal. My shirt is like a polo. They seem very well made but, seriously, how do people wear heavy cotton fabric with inner linings here? My shirt is hot.

But everything in Africa now seems hot. Tonight we borrowed an extra fan for the room, only to have the electricity go out. I am tired of being hot. It’s hard to imagine how Laura feels knowing that she has at least one additional month here. But I’m just HOT. I am insanely jealous of the snowfall in DC.

It’s the beginning of the dry season here and the snakes are coming out. I’ve seen one at night that my host swerved to run over with the car. We’ve seen at least 7 snakebites in the hospital over the past two weeks and their frequency is increasing. To date there has been one fatality. The bites look REALLY painful. One 12 year old came in yesterday showing signs of clotting trouble that kills snake bite victims so I made sure that he got a big dose of vitamin K (it helps the liver make the stuff our blood needs to clot) and a transfusion of whole blood because it will give him some more clotting factors until his liver started to be able to make some more of its own.

In the meantime, Doctor Hilarius and the two Ghanaian medical students are off to Accra. I’m here with Dr. Alberto, the Cuban doc who only sees outpatients. The Cuban OB/GYN has returned to Cuba. On Saturday or Sunday the senior doctor in the district will come to cover for Dr. Hilarius but until then I’m at the top of the medical food chain. I’m praying that nobody requires surgery. I am unable to operate, of course. There would be nothing I could do.

Between Sri Lanka and Ghana I’ve spend a total of 8 weeks so far in a developing country environment. Sooner or later I’d get a gut bug and it happened…on the day I had to run the hospital alone and our anniversary. We had to skip our anticipated Prison Canteen date. But I went to work and made it through. I’m feeling a little better already but still don’t have much of an appetite. I know it’s probably not good infectious disease management, but at the first sign of a gut rumble I started popping Cipro and Flagyl.

Most interesting case of the day yesterday was not the cobra bite victim but instead the last patient of the day, a 30 year old complaining of recurrent ulcers on his hands and a strange feeling on the skin on his arms. The guy was a poor farmer and had a dime-sized ulcer on the middle finger of his left hand. He was also missing the tips of his index and ring fingers on his left hand. The skin was a little thickened and scaly over his elbows and he had several light-colored areas on the skin of his trunk. My medical friends have by now made their diagnosis, I hope: Hansen’s Disease. For the non-medical folks, it’s leprosy. I had not even thought about leprosy as a disease I would ever encounter, but here it was. I was really amazed to be sitting there with a man with such a historic condition. I felt this weird connection to the Bible stories of people being shunned and leper colonies. The good news today is the leprosy is easily treated. It’s harder to overcome the stigma of the disease which persists to this day. But within 72 hours my patient will no longer be contagious and after treatment only about 0.1% of patients will relapse.

Food update: The only food I ate yesterday was part of my anniversary present from Laura: an honest-to-God real Snickers bar. I popped it into the freezer section of the mini-fridge in my office and at it for lunch. I though of eating frozen Snickers bars on the mountain while elk hunting with my grandfather and savored every chunk of the chocolatenuttycaramel goodness. I bet that there is not a gourmet chef in the world who can rival the Snickers bar. I’m also really wishing for a Wendy’s chocolate Frosty and hot, salty fries to dip into the Frosty. Or a medium chocolate-dipped cone from DQ. Maybe my appetite is coming back, after all.

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