Koforidua, Ghana

I was originally due to start work in the male internal medicine this week, but instead I chose to pursue my growing interest in Ghanaian public health.

The Public Health Unit of Koforidua Regional Hospital is quite large. They work within divisions, subdivisions, municipalities, and submunicipalities. Though it would take a significant amount of time just to learn the system and spend time in each division, unfortunately for me, I only have about 8 work days. The few divisions I will try to spend time in include Disease Control, Family Planning, Outreach, and Reproductive and Child Health (RCH). I spent my first day (today) in RCH.

From what I’ve experienced at the hospital, privacy is pure luxury, and in most cases there is none. However, the privacy of mothers and mothers-to-be is highly valued in RCH. Rounds on the wards are completely open, with no curtains or doors to keep other patients from hearing about and seeing each others’ medical problems. Conversely, at RCH, only one client is permitted in one room at a time, examinations and discussions are completely private. The nurses and midwives work hard to build trust and confidence with their patients in order to best support them throughout the pregnancy.

A typical visit includes a brief head-to-toe examination, palpation of the fetus, listening to the fetal heartbeat, checking hemoglobin levels (essentially using the color of a few drops of blood), glucose and protein levels in the urine, and correcting any problems. The nurses and midwives have the authority to prescribe basic medications, but they refer patients with more serious medical problems to the hospital.

As always, I am again out of time, but I will have much more to say about the Public Health Unit!

I’ve mentioned Medical Outreach before, but I think it’s time I talked about more in depth.

Every Thursday, a group of medical volunteers from my NGO (Projects Abroad) go to a few schools in the area (typically 2-3). The children run to get us tables and chairs to work with. I’ve offered to help every time, but every time I’m firmly placed in a chair and told not to worry about it! The volunteers get into groups of 2 or 3, and the kids queue up to wait their turn. Each group sees one kid at a time, cleaning and bandaging minor cuts and sores. If we see something more major, we tell firmly tell them that they must get treatment at a clinic.

I’ve seen a wide range of injuries. Some kids have only a small scratch, which we ordinarily don’t bandage. However, after we’ve finished cleaning it, we often get a sad look and a soft request: “plaster?” (meaning bandaide). Yes, many of them are in for the excitement of just having a bandaide, but there are others who are more seriously hurt. I have seen quite a few wounds that were clearly infected (discharging, swollen, very tender, and sometimes recognizable even by smell), and I’ve suspected systemic infections on more than one occasion. In these situations, we clean and bandage the wound as usual but also call our Ghanaian associate over to speak to the child in his/her language to ensure that the child recognizes the importance of getting treatment.

We often take pictures (as you can see under my blog post entitled “Photos”). Thanks to digital cameras, we can show the children the pictures we’ve taken. I’ll never forget the looks on their faces, just wondering how it was possible that they were seeing themselves in my camera.

The whole of Ghana is very friendly and warm, but above all, the children are the friendliest of them all.

Today is Thursday, and we did Medical Outreach as usual. I got back a bit early, so I’ve taken the opportunity to use the internet cafe!

After having spent two weeks on the surgical ward, I started work this week in the casualty ward – the emergency room. Already I have some significant stories to tell, but it looks like I’ll only have time for one today.

The casualty ward isn’t large: two rooms (male and female respectively) with about 8-10 beds in each. The majority of the patients are in and out and typically do not have to stay very long. There is only one doctor on duty at a time with a handful of nurses. However, every day I’ve been there so far, the doctor has left for no apparent reason, leaving NO doctors on duty and no way of knowing where they are or how to contact them in case of a real emergency. A fellow volunteer and I were left in this situation for quite some time yesterday.

A man with obvious head trauma was pulled into the hallway in a wheelchair. The orderly asked where the doctor was, and we answered that she should be back at some point. Meanwhile, we noticed that the man was spitting/bleeding onto the floor. He had a large laceration on his upper lip that clearly needed to be stitched up. Feeling a bit helpless and frustrated, my partner and I grabbed some gauze and attempted to stop the bleeding.

While cleaning and dressing his wounds, we noticed that his arm was twitching, and he would not answer any of the questions we asked him, though we were speaking in Twi. With the help of a nurse, we asked him to blink his eyes if he could understand what we were saying: he first widened his eyes and blinked twice, very clearly. The side of this head was swelling and painful, his eyes were twitching rapidly from side to side, and his blood pressure was unusually high. Based on what I already knew about emergency medicine from my days as an EMT and common sense, I knew he must have had some brain damage. Where was our doctor? She finally returned, stitched his upper lip, and gave orders to have him brought to a bed on the ward. When I asked what would be done about his injuries, she said that ultimately, he needs a skull X-ray and medication to help drain the swelling in his head. According to my partner, he received no scans or further treatment since yesterday early afternoon when he came in. Moreover, the patients on the ward don’t seem to be watched by the nurses or doctor: about an hour after his stitching, the man had rolled over almost off the bed, nearly ripped out his IV, removed the bandage on his upper lip, and was attempting to rip out the stitches as well. We went to stop him and try to calm him down, and he eventually laid peacefully until our shift was over.

I think my frustration with this ward is quite clear, and I’m still not exactly sure what to do about it. For now at the very least, when the doctor leaves, I won’t hesitate to do what I can.

I’m out of time once again, but I’ll write more later!

Cheers,

Janice

Top left: During our weekend visit to Accra, we fell in with some traditional drum makers! They performed for us, of course, and showed us the process of their work.

Top right: Ghanaian drum makers + me!

Bottom: Every Thursday is Medical Outreach: our small group of local medical and physiotherapy volunteers go to orphanages, villages, and schools to clean and bandage children’s cuts and sores. Here, a Scottish physiotherapy volunteer cleans this girl’s sore while I stress to her that if it becomes worse, she needs to go to a clinic.

I have about 5 minutes left on this computer (the connection is not reliable at all), but I wanted to attempt to get in a post! So I apologize if it’s evident that this was written hastily…

I wanted to talk about the people in general. I don’t think I’ve ever met more genuinely friendly, warm people! Every day as I walk down the street to work, I’m greeted by people who want nothing more than to ask how things are going. The children are also very sweet: there are two children at the same corner every day who run out and hug me! Their mother always smiles and asks how I am, and when I ask the children how they are in their language (Twi), they say “I’m fine. Bye bye!” with huge smiles, and run back to their mother. This has become a daily routine.

I’ll spend the remainder of my time trying to get some pictures up. If I can’t, then I promise pictures next time!

Cheers,

Janice

Today I dressed wounds in the surgical ward. Now I’ve dressed wounds before, but these were some of the largest I’ve ever seen. The patients buy their own vinegar, iodine, and saline solution – yeah, when you clean the wound with that mixture… it hurts. ALOT. From what I’ve seen, doctors and nurses typically don’t hold patients’ hands in any situation. But the women whose wounds I dressed today seemed to really appreciate that I did.

The biggest problem is the stigma attached to hospitals: the people think that they do not have enough money to go, so they wait. In the meantime, the wound gets severely infected until they have no other choice.  When they finally come to the hospital, they need to spend far more money than they originally would have had they come earlier. To make matters worse, people tend to go to herbalists for help because they are cheaper and more accessible, which results in the same situation. To most, a hospital is a place where people go to die, so of course they use it as a last resort. Most of the wounds I see began as minor lacerations. I have seen two cases where this problem led to the loss of a limb. The Public Health division of the hospital is making an effort to educate the community, but it is very difficult to change a long ingrained attitude.

Though I am beginning this blog on a serious note, there is much about Koforidua and the hospital to be happy about. I have some good stories to share and good pictures to upload. The computers here are a bit less than reliable, but I will manage it!

Bye for now,

Janice

I am working at the Regional Hospital in Koforidua, Ghana, for six weeks. Koforidua is a smaller city just north of the capitol, Accra, which is on the coast. Ghana is said to be the safest and friendliest country in West Africa, with a rich culture and very warm people. Their medical facilities are also significantly understaffed. (For example, the next available slot for a non-emergent surgery is November 28th – today is May 30th. And I thought having to schedule an appointment with my doctor 2-3 months in advance was bad!!) I will work to do as much as I can with patients (take vital signs, take them where they need to go, and bandage wounds) in order to free up doctors to do other tasks. However, my biggest and most important goal here is to learn as much as possible so that I can one day return and be able to do much more!

- Janice Harlow ‘09