Monday, November 07, 2016

Home Sweet Home

I'm back home from my adventures, so these posts will go back to being boring as usual. But, I still have to tell you about my final triumph. Well, perhaps triumph is too strong a term, but we did have a bit of success. As you see in the image above, we sent a nuclear study, a thyroid scan, from the to the PACS, where it can be seen on the laptop above. This is definitely the first time this has been done at Korle Bu, and probably the first time in Accra and all of Ghana, and maybe Western Africa as well. We've made history!

But all good things must come to an end, and it was time to prepare to go home. There had been some confusion as to whom was paying for the guesthouse room. I had assumed I was, but then it seemed that I wasn't, and on the evening of my departure, it seemed that I was paying after all. That was fine, but I didn't have enough Cidi's, and had to make a nighttime trip to the ATM farm, which is not a good idea. But Ben came with and played bodyguard, and I survived the experience.

I ended up with about 500 extra GHC's, worth about $125. I thought I'd spend them at the airport, but Delta insisted we head to the gate as quickly as possible so they could conduct the third security check, pat-down included, and then make us sit for an hour before boarding. Anyone headed back to Ghana anytime soon?

The flight home was uneventful, save for the "Is there a doctor on board?" call about 2 hours before landing. A passenger had experienced a seizure, and was still in that groggy, post-ictal state. Fortunately, two real doctors got to him before I did. It was rather amusing in a perverse way to watch the NYC paramedics perp-walk the poor guy from the back of the plane and out to an ambulance (presumably) upon docking.

Since we landed a bit early, I had the brilliant thought (well, Mrs. Dalai thought of it...) to try to get on the earlier flight that I shouldn't have been able to make. I was the last standby to get on, but I did make it, and also the next back home from Atlanta, which was about to close it's doors when I got to the gate, completely out of breath. So I made it home 4 hours before my scheduled arrival. Of course, my bags didn't, but that's OK.

It will still take me a bit to process this trip. It is indeed life-changing, in ways subtle and not. I'm thrilled, for example, to eat salads and to have ice in my drinks again. And looking around my reading room today with 10 monitors and 4 computers all for my own personal use, I shake my head in wonder at the amazing largess we take for granted over here. Today was my first day back at work, and everyone asked me how I liked the trip. I had to do you answer this question? This was not a pleasure trip, and certainly much different than your average vacation. But I loved it, and I certainly hope to do something like this again. Maybe that's the best answer I can give.

Thanks to WhatsApp, I've heard from my fellow travelers almost daily, and I text with Ben several times a day. Things seem to be progressing nicely without us; our training seems to have made a difference, and that, after all, is what we hope to achieve. And I'm very proud of how far everyone at Korle Bu has come. Hey, I can brag a little..."My son the doctor!"  OK, my Ghanaian friends, but you get the idea.

Wednesday, November 02, 2016

It's Just Another Manic Monday...And Tuesday...And Wednesday...

I'm still here in Accra, this morning working on some stuff before my appointment with the Head of Nuclear Medicine here at Korle Bu Teaching Hospital. More on nuclear things momentarily.

We hit the ground running on Monday, after the emotional trip to Cape Coast the day before. We were to meet with the Head of IT and tour the facilities (Brian tells me there is a server room that is right up there with most he's seen) and speak with those knowledgeable in a locally-developed mini-EHR designed for the OB-GYN Department. But due to various scheduling conflicts and the Head of PACS IT taking ill, we ultimately met simply with one of the designers directly, who demonstrated the capabilities of their software. I was most impressed; this system is as good as any in-house developed product I've seen, and better than most.

I delivered my PET/CT talk to the Radiology residents yesterday morning, and they were as attentive as any audience I've had over the years, again asking some of the most insightful questions. Imagine how much good they could do with the actual scanner itself!

Thanks to Dr. B.'s monitoring of misbehavior of a worklist, I've discovered a glitch in the Merge PACS 7.0.x software. Worklists are comprised of a worklist "frame" (my term, but it helps me understand the new structure) and blocks that actually do the heavy lifting of determining which exams show up on the list. A worklist can contain multiple blocks, so one can create a list of all CT's and MRI's done today by combining the individual "Today" blocks. A key element in the block is the "Time Constraint" which tells the worklist the time-frame of exams to display:

The glitch, which my friends at Merge were able to reproduce, is that the Start Time Hours entry can blank itself, simply erasing the entry. It doesn't go to zero, it goes to nothing. Which fouls the block, which fouls the worklist. But now that Merge knows about it, I'm sure it will be fixed.

In the meantime, I'm still slogging away at a solution for those with limited-capacity Mac's. "Dr. Mary", one of the residents, has very graciously lent me her Macbook Air (128 Gb SSD) for experimentation. Unfortunately, the drive is way too small to accommodate BootCamp for a Windows installation, so I've tried anything and everything to work around this. Dr. B. suggested Wine, sort of a program-by-program Windows emulator. I tried this, with some minimal success on other Windows programs, but the Merge client is a large Java app, and getting Java running within Wine so as to run Merge is beyond my abilities, at least within the time I have left to make anything work. My last possibility is to use a program called WinToUSB to turn a USB Hard Drive (won't work on a flash drive, we tried) into a bootable Windows environment. The first disk we tried failed utterly, and I'm trying with another. The installation seems to always fail at the 95% mark. This is one I might have to leave in Ben's able hands. I asked "Dr. Mary" if perhaps there is a new Mac coming for Christmas. She smiled and asked if perhaps she should simply get a Windows laptop next time. Frankly, much as I love my Macs, it is probably the best thing to do if running Windows software is your main focus. Can someone explain to me why a program written in Java, supposedly a platform-independent environment, will only run on Windows? We Mac-lovers feel slighted!

On to Nuclear Medicine. As above, I will meet with the Head of Department today, and hopefully I'll have the opportunity to show her how the Merge PACS works, and explain my idea of connecting their Siemens (which is currently down for service) to the PACS. Keep in mind that here, as in much of the rest of the world, NM is a completely separate entity from Radiology, but I can tell you from long experience that having both Radiology and Nuclear examinations available to compare to each other and to newer studies is incredibly helpful. I'm expecting the same happy reaction I've seen on everyone's faces when I demonstrate the capabilities of soft-copy reading in general, and the power of this particular PACS client in particular. That alone has made this trip worthwhile.

I cannot believe how quickly my time here has passed. We have today and tomorrow remaining here at Korle Bu, and then back to the USA on Friday. (And back to work on Monday!) As I'm donating this laptop to the hospital, I probably won't have another blog entry until I'm back home. Which will allow much time for me to process what I've seen, done, and learned here. I can tell you already that a trip like this is life-changing. You cannot spend this length of time outside your comfort-zone and not come back just a little different. I've been accepted by people of a culture very different than mine, to the point that I feel very comfortable among my new friends. Yes, we stand out as obviously different, but I really stopped thinking about that after Day One, to the point that when I ran into another Obroni here at Korle Bu, my first thought was that HE was out of place. But not me. Perhaps I'll be able to wrap more words around the feelings with time.

Hopefully, I've absorbed some of the profound kindness and hospitality we've been shown on this trip. The common Ghanaian greeting is, "You are welcome!" (Which makes a lot more sense than saying it in response to "Thank you".) We really were welcome here. While I'm anxious to get back home to the family and the puppies, I will truly miss Ghana, and if they'll have me again, I do hope to return someday.

Sunday, October 30, 2016

Slave Castle

There are a few places on our lovely planet that sit in silent testimony to the horrors man can inflict upon his fellow man, and I had the honor and privilege to visit such a place today. I write this with difficulty, but it must be written. What I've felt today must rival what one feels at a concentration camp (I've yet to visit one, but I must). There is nothing but sadness at this place, the knowledge of just how low humanity can sink, how evil can take over a good man's soul.

We left early this morning for a three-hour drive from Accra in a VERY small Hyundai, over relatively good roads. The trip was uneventful, except for being stopped by the Ghanaian Police who warned Alfred, our driver, not to stop for bandits who are dressed in the uniforms of the Ghanaian Police. Got that? The scenery en route was fascinating. I have tried to take photos of the street scenes here, but I simply cannot do it justice. Picture block after block after block, mile after mile after mile, of unfinished storefronts, tables, booths, piles of coconuts, larger piles of coconut shells, smoked fish, every manner of electronics from at least 30 years ago, car parts, tires, motorcycle parts, ornate caskets, statuary, pretty much anything and everything. And every manner of vehicle, from a few Mercedes and even a Lexus GX to little carts pulled by a motorcycle chassis. And people. More people per square foot than I have ever seen in my life. Today, many were in their Sunday Best, and there were several outdoor church services to be found by the roadside. Ghana is majority Protestant, and the people are quite religious.

We arrived at Cape Coast, and with the aid of my Cities2Go app (like I know where I am in Ghana), we found the Castle, one of several on the Ghanaian shore (once called the Gold Coast) that was the center of the African slave trade. You can look up the numbers; they are mind-numbing. Millions of slaves passed through these forts/castles on their way to the New World. Many died here, mainly from disease, many more died en route. Some chose to throw themselves into the ocean from the ship, and as there were a number of them chained together, that created a similar deadly choice for all. Perhaps it was better that way. 

It should be made clear that both Europeans and Africans were involved in the slave trade. Raids were conducted into a good part of Western Africa and human beings who were just minding their own business were captured and delivered to the slavers. Prisoners of tribal wars got sent off to slavery. The sordid list goes on. No party, save the victims themselves, were innocent in this horror. And it should also be mentioned that a majority of these tortured souls were sent to nations other than the United Stated. In fact, about 40% went to Brazil alone, and today, this is the nation with the second-highest number of people from African extraction. There's a lot of guilt and a lot of blame to go around.

This is a shot from within the Male Dungeon. There were multiple chambers here, each holding something like 200 men, without room to lay down, with no toilet, and with water and food delivered once a day. The three window openings provided what little ventilation was to be found.

Here is the walled-up original "Door of No Return" through which the slaves passed through to reach an underground tunnel leading to the port at the base of the castle. There are viewing areas along the castle courtyard looking down into the tunnel, allowing soldiers to monitor progress. The slaves never saw daylight from the time they arrived here until they reached the New World. If they were alive when they got there.

The "Door of No Return" was recut into a different wall, and those of African descent whose ancestors left from this place may request a "Door of Return" ceremony to mark the occasion of their visit, and bring things full circle.

You'll be happy to know that while slaves suffered and died below, the various Governors (this place was built/rebuilt/run/owned at various points by the Swedes, the Dutch, the Portuguese, and the British) lounged in this lovely room with cool sea-breezes that drowned out the stench of death coming from the dungeons.

My readers know I am not a big fan of the current occupant, but it was fitting and proper that the first American President of African ancestry visited here in 2009 and placed this plaque:

Mrs. Obama, in fact, found that her ancestors did indeed pass through this horrible place en route to America. 

A few years ago, I was in Germany, and had the opportunity to visit Hitler's podium on the Zeppelin review stand in Nuremberg. You've seen the stands in newsreels from the end of the war, when the Allies shot the swastika off the top of it. I stood there and felt some small glimmer of the triumph of good over evil. Hitler died a nasty death, and the parts of my family that left for America survived. Up yours, Herr Shickelgruber. I guess the Castle has a happy ending as well, but it's hard to see it standing in the dungeons where men and women were held like animals, where many died like animals. Our guide, Sebastian, put it thus: "The only way this could have happened was for those in power to stop seeing their captives as human." I have no better answer. But at lunch, our driver, Alfred asked this, "How could religious people do this? How could they go to the church on the grounds and then do this to people?" To that, I have no answer.

The profound sadness the Castle inspires is not pleasant, but something I think all must experience. I leave here changed a bit, a little older, a little wiser, a lot sadder. We have not learned the lessons we should have from all this. The Castle ceased warehousing people in the early 1800's, but slavery continued, and sadly still does to this very day. Not 150 years later, the Holocaust not only enslaved people, but deliberately slaughtered them as well.

But here I am in Ghana, a proud, free nation that remembers this shameful past, but goes on with life, building and growing. Maybe that is the answer after all. 

Go on with life. Forgive. But don't forget. Don't EVER forget...

Saturday, October 29, 2016

Weekend Update

I have a short report covering the past couple of days' activities, but despite the relative brevity, you may rest assured that things remain busy here in Accra!

On Thursday, Ben had asked me to look into sending exams back to the modalities in case something needed to be printed from the console and not PACS. (Brian continues to make progress in DICOM printing from Merge PACS; there is still a contrast issue with the printed films.) While I was able to find the mechanism to do this, the transmissions did not go through completely, and I think this indicates a problem with the configuration on the modality end.  However, the CT and MRI both have functions that query the PACS, which would accomplish the same thing we are attempting. I'll test the function if I can ever get some time on the scanner!
In and among that bit of tail-chasing, I was able to spend some time with the residents. A FEW are still using the Query function rather than the worklist, and several were logged in with a generic ID. I cautioned Ben and the resident that this could lead to a number of problems in the future and strongly advised that the generic sign-on not be used except in very extreme circumstances. (I was thrilled to discover the generic login and password on the backgrounds of most of the workstations!) And I made another little discovery...One of the monitors, a 30" consumer-grade HP, was set for a lower-than-optimal resolution. I grabbed the mouse and set it to the proper, higher resolution...and I was then schooled by the resident..."Doc, many thought the icons were too small at the high resolution, so we run it at low resolution to make the icons bigger..." I'm going to have to see if I can buck this trend, as the low-res causes us to lose some of the drop-downs off the lower edge of the screen. That's not a reasonable trade. Keep in mind, many/most of the stations are running on one monitor. There are several Barco's in the waiting, but their workstations lack power-supplies, which are coming. Apparently on a slow boat!

Friday was a bit more frustrating. We had meetings scheduled with various people critical to the project, but many had other obligations, and we did a bit of hurry-up-and-wait. The meetings ultimately did occur, and we had good discussions. There appears to be an in-house team developing a RIS-like program for another division, which hopefully can be adapted and interfaced to PACS. I'm to cast eyes on that on Monday.

One high point was my first lecture here at Korle Bu, an introductory talk about PET/CT, delivered to an apt (and awake!) audience of Nuclear Medicine residents, and many folks from RT as well. You have to keep in mind that the NM residency program is completely separate from Radiology, and these kids have not been exposed to CT. Still, they grasped the concepts readily, and asked some very astute questions. And they even laughed politely at my feeble attempts at humor...  While I think there is only a small chance of PET/CT coming here in the near-future, I believe everyone needs to be aware of its capabilities and know when sending the patient off to South Africa (where the closest PET/CT lives) might be worthwhile. And who knows? Maybe some very nice scanner company will donate one to this very busy (and worthy) Oncology site. Oh, and we'll have a cyclotron on the side with that, please. (Please?)

Finally for Friday, what I thought would have been an easy task turned difficult. You might recall that I mentioned putting the Merge client on the residents' laptops. Well, a couple of them have Macbooks, and I was asked if I could make the Windows/Java-based program work. But of course! I replied naively... Well, the Macs in question are Macbook Air's with 128 Gb SSD's. Oops. I'm having one of the residents try to clear 50 Gb off of her drive (she had exactly 2.5 Gb free) and I'll try to do the most minimal Windows 7 installation possible. If that doesn't work, I've found a reference to creating a bootable Win7 (or any Windoze) runtime external USB disk, and maybe that will work. This is one I might have to dump on Ben.

We are playing tourist for the weekend. We went to the Big Mall, as nice and modern as any in the States, and then had drinks and dinner at the Bojo Beach Resort, a rustic but still quite beautiful site:

Tomorrow we are off to the slave-trader castles at Cape Coast.

I suddenly realize that my time here is more than half over, and I still haven't accomplished all I came to do. So for Monday through Thursday, here's my agenda:

  1. Spend more time with the residents, smoothing out their Merge experience
  2. Give more lectures to NM and Radiology residents
  3. Connect the NM gamma camera, a 2005 Siemens, to Merge PACS
  4. Work on the Macintosh problem above.
I could spend another 2 weeks on those alone. I also come to realize, however, that I'll probably not have much reason to be asked back here, as by the time I would return, the staff will be better versed in the PACS than I am, and could probably teach me how to use it. I'm hoping there will be many more sites, assisted by Rad-Aid, that install Merge PACS, and I would love to be on site at go-live! I'm ready, willing, and able! That's the joy of working part-time, right? 

In the meantime, I bid you good night from Accra. 

Wednesday, October 26, 2016

Preliminary Status

This morning, I spent an hour demonstrating Merge PACS to the residents and those attendings who were able to, well, attend. I went over some basics of the PACS, as well as a few of the more powerful tools, and everyone seemed to grasp very quickly what I had to offer. In particular, in working with several residents in CT and MRI, I found ALL were using the worklists as I had suggested. Wonderful!!! I was able to show those in the CT reading room the ease with with they could create 3D renderings. We tried this with both thin and thick data, and of course the thins gave the best result.

While watching the workflow, it became apparent that the residents aren't the ones (generally) who mark the studies as "Read", but rather the attending does so after review. I was able to make a button (a macro, really) that mimics the "Click study Read and go to Next" Checkmark, but marks the study as in "Preliminary" status instead. I think this fits the way things are done here. The only downside is that each individual user has to place this on the client under their own login, but that's not too much of a problem.

Things are shaping up!

In the meantime, here are a few more shots of Korle Bu Teaching Hospital and environs:

Chest Clinic

Main Entrance (under renovation)

National Cardiothoracic Center

ATM "Farm" on Korle Bu Campus

Street scene outside the gates

Tuesday, October 25, 2016


Time for today's PACS opus...I can report a day of incremental progress.

All three of us met with the Head of the Radiology Department first thing this morning and then with the residents. I will have a session with them tomorrow at 8, wherein I will run a PACS demo on the big screen in the Radiology Conference Room, and take questions as I go. I think this will prove valuable and will lay the foundation for some one-on-one time later on.

The rest of my day was spent mostly in the PACS/reading room, again working closely with Dr. B., the IT-savvy resident. (Honestly, I think that when I’m done here, he will be Korle Bu's resident-advocate for all things PACS!) And thanks to my PACS admins back home, I was able to solve the problem or loading the Merge client onto Windows 10 laptops, so we now have a bunch of very happy residents!

I made several work lists, which I modified as Dr. B requested. The IBMerge PACS is so powerful in this regard that just about any worklist you can think of can made, given enough time, energy, and willingness to work through the list of check-boxes and drop-down menus. I'll be quizzing the residents (and any attendings I can reach) about their needs for more of these.

We found a few possible, temporary (I would hope) work-arounds for the lack of reports. Clearly, what we ultimately need is a RIS, but short of that there are two ways to get a report associated with a particular study. First, one could copy the typed report and paste it into the comment field of the exam's order window. This drops all formatting, and the comment window shows only four lines at a time. The other possibility is to use the “snipping” tool to create a JPEG image of the report, upload it into PACS, and the use the QC editor to merge it into the main study as an extra series. A little more tedious I'm afraid.

I worked with Ben as well on uploading fluoroscopic and sonographic images. We have some hurdles here, in that when multiple studies are loaded from the modality onto a disc or flash drive, and they attempt to load the whole thing at once, all the exams get loaded under the first patient’s demographics. The only solution to this is to load the patients one at a time (my recommendation) or manually split them later (which might be easy to forget to do and would be even more tedious.)

I noted that virtually all CT’s have a huge number of slices, some up to 2500 or so. Even head CT’s are pushing 900 and more slices for a pre and post contrast exam. I spoke at length with Dr. Buckman about this, and I would like to get everyone's thoughts as well. (I read CT, but I'm no luminary.) Dr. B. feels that the thinnest slices should be used to avoid missing tiny abnormalities. While there apparently is no significant malpractice problem here in Ghana, the residents are VERY contentious, and sincerely wish to do no harm. This is admirable to the max. But when I asked for an example of something missed because thin sections weren't available, he showed me a 2cm lesion. In my experience, the thinnest sections (the Toshiba Aquilion One produces 0.5 mm slices) are useful for exquisite reformats and CT angiography. Most of us old folks don't have the stamina to peruse 600 slice sequences 50 or 70 times per day, and I don't think there is much that would be missed by using 5mm (or even 2.5mm) reformats. Add to this the multiplanar reformats created on the scanner and also sent to PACS, and we have a situation that will deplete the SAN very rapidly. Thus, some compromise is needed. I'm thinking that with the Merge PACS ability to create reformats and renderings in the viewer, perhaps only the thin sections should be sent and nothing else. Alternatively, they could create all the reformats on the CT and then lose the thins. But this is a waaaaaay above my pay-grade so I'm going to defer to those much wiser.

Stay tuned!

Monday, October 24, 2016

Monday, Monday...

Korle Bu Courtyard

Our first daily report from Korle Bu!

We had a very good first day! (Well, Erin was under the weather in the morning, perhaps a reaction to her anti-malarial, but she recovered quickly and joined us after lunch.) We had a significant amount of hurry-up-and-wait in the morning. Ben, Mack (PACS/IT), Brian, and I made the trip back and forth to the Nuclear Medicine department several times, waiting on those we needed to see. We finally did connect later in the day. More on that shortly.

While not in transit, Brian and I spent the morning in the reading room with Ben and Dr. B., one of the residents. We were able to solve a few problems, and at least understand several more. Brian had mentioned the problem of multiple clicks required to close a study and mark it as read, and his discovery of the "check mark" button that would do this in one click. (One of those things we AMICAS users have known for years!) When working with Dr. B, we found that his checkmark was greyed out. After some experimentation and observation, we found that the button does NOT function if the study was opened via query and not from a worklist. Which brings us to the problem of them actually USING a worklist. Merge PACS has VERY powerful worklist creation capability. Basically, if you can conceive of how a worklist should look, it can be created. The downside is that as compared to the later versions 6.x, which we are still on back home, the level of complexity in crafting the darn things has increased considerably. I need to have a word with my friends at Merge on that! However, I think I have the hang of the new approach, and I was able to create a simple worklist, "Today's Studies" without too many glitches.

I worked with Dr. B. for about an hour, showing him some of the tools within the Merge Halo Viewer, and he caught on very quickly. I think similar sessions with one or two of the residents (and attendings, and clinicians, and anyone else) would work best rather than try to answer everyone's questions in a larger group. I would like to concentrate particularly on creating departmental worklists and more individualized hanging protocols. That could take my entire two weeks in and of itself.

I spent some time trying to install the Merge PACS client on Dr. B's Windows 10 laptop, but without success. I was able to download an MSI from my server back home in Columbia, and I'll try that tomorrow. Apparently no one has had any trouble with Win 7, and I was able to load Merge 7 onto my Mac running Win10 in Parallels, so it CAN be done.

Now, Erin will tell everyone about the developments within the Radiography Department, which I think are very exciting!

Erin: Very exciting. Thanks guys for making sure I as alright this morning. I am feeling so much better. I met Dr. O who is the Radiography Program Director and we had a great discussion. I donated the textbooks I had brought with me. I will be lecturing the Radiography students tomorrow at 9am on what our Radiography program is like in the States. Also, Dr. O is charged with trying to start more Radiography programs all over Ghana. I learned a lot about the status of radiographers in Ghana and will be lucky to speak to students tomorrow. I told Dr. O that it would be nice to have both of our sets of students interact with each other in the near future. I feel that we could all learn a lot from each other. Maybe even create "sister" programs with each other. Dr. O stated that he is trying to attend the RAD-AID conference on Nov. 5, which Brian and I will be attending also. I was intrigued to learn how similar our Radiography programs actually are. Hopefully the beginning of a wonderful relationship.

Me: I'll close with a paragraph about our meeting (finally!) with one of the Radiation Therapy Docs. The two NM physicians are out this week, I believe, but may be back next week. I'll be giving a talk to the NM residents on Friday. We discussed connecting NM to the Merge PACS, which she generally favored, particularly after we were able to get the client up and running on a laptop and demonstrate its capabilities. She had NEVER seen the PACS in action and was most impressed. (This thing sells itself!) We will, of course, need to defer to the NM Head of Department for approval before proceeding, but the actual connection should be straightforward. (Which I say whilst crossing mhy fingers.) We discussed as well a problem RT has had with importing planning CT's into their TDS planning system,

OK, just one more little paragraph....Never commission someone who was once paid by the word...

The topic of rapid delivery of reports arose at several junctures. Without a functioning RIS, there are very limited options. Merge PACS does have a comment field built into the order window, and a separate voice-clip property. We use the latter to provide instant gratification for the ER docs, and it could work here. There may be a way to use a "print to DICOM" program to load the resident's typed reports into the PACS as a separate series in the exam. It's not optimal but... More on this as we go. Tomorrow we have a meeting with the residents...I'm not sure if I am to lecture them on PACS or on one of the other topics I've brought with, but we'll see. In the meantime, Me ma wo adwo!

Brian: Migaso

Ben: You want to try some Twi already yeah.😉

Me: Did I say it right???😃

Ben:: You mean, did you post it right? Yeah, you did! Will be glad to hear you say that out loud!...😊
Me: I'll need coaching or Mack will laugh at my Southern Accented Twi!

More to come....