Day 6: ‘Pills, People and Problems’

Today is our last day in Peki. This village has welcomed us with such open arms we are sad to leave here. We pack up all of our belongings, 12 large suitcases, 12 other assorted smaller suitcases and duffles, backpacks, a few pillows and ten huge boxes of supplies.

Remarkably these items are all crammed intotwo tro tros which will take us back to Peki Adzokoe which is the village that our hypertension clinic is planned. We have to wait until noon to travel there as it is Sunday and this is a big church day for most of the people.

When we arrive shortly before1 p.m. we are met with a large group of people all dressed in their best church dayclothes awaiting a visit with the nurses. For some people this is a great event because they may not have health insurance and most people do not believe in purchasing the health insurance unless they have known medical issues or for a child This is like getting something free.

Preventative care is not a well known concept. We are again amazed at the readings we are obtaining. For those reading this blog who are not nurses, normal blood pressure is usually 120/70 or lower.Most people in the US will start medication if their blood pressure is higher than 140/90. We have had readings has high as 270/140. At home if we got readings like that we would likely be calling an ambulance because a stroke or heart attack could be imminent.

I have established a protocol for giving out some of the medicine I have brought with me. I will give out meds if BP higher than 160/100. I have brought about 2,000 pills that if I allocate a small amount (about 10 pills), then I can treat more people. Each patient is given a written page to go the clinic to get more medicine within the week.

Many people tell me that they have meds at home but ‘are done’ with them. They do not understand that this is a lifetime problembut treat it like an episodic illness. When the pills run out they stop taking them. Hypertension is a silent killer.

Their diet is not high in fat and there is not much obesity (maybe five percentor less). There is some smoking but not very visible like it is in Europe. I am not sure why we are getting such high readings but we experienced the same phenomenon on the lasttwo visits. I need to find out why hypertension is such a problem in Ghana.

It is great to see the students do the teaching, with the help of interpreters. I know that many of the nursing students felt tentative with their blood pressure skills but after doing 50 people in a row they have developed confidence and proficiency and also are interested to see the other advanced assessment skills that I am able to demonstrate to them. Whenever I get an opportunity I am quizzing them about drug classes and what they know about certain drugs. I think this trip is stressful for them in terms of clinical challenges but also allows them to experience a vastly different type of patient and most importantly it teaches them about community health.

We also have some vitamins and Tylenol. I have a few antibiotics but have not seen much infection which I find surprising. I save the vitamins for the older patients and the pregnant women. Tylenol (known here as paracetamol) is given to most of the older people because you can tell by their gait that they have a fair amount of osteoarthritis. I suspect one man was infected with guinea worm and I direct him to the local drug store also known as the ‘chemical store’ to get OTC meds for treatment and prevention of the worms. This is a disgusting disease that is quite prevalent due to the infected persons bathing and defecating in or near water sources and some people do not boil water before usage. Thus begins a vicious cycle of transmission.

After our clinic we take some supplies to the local orphanage. There is actually no physical building (yet) but AFRICED helps to provide care and resources for about 38 children. As I had mentioned earlier these are children who might be rescued from child slavery or orphaned by death of the parents. Sometimes the parents feel that their children might be better off in the care of an orphanage and will try to relinquish their custody over to AFRICED.

We are told that due to today’s donation the coordinators might see a surge in interest from these parents looking to get some advantage for their children and request that they be taken care of by AFRICED. As a parent I cannot imagine giving up my child but I believe that there can be such desperation for survival here that people do all kinds of things.

We have received a donation of about 200 Beanie Babies from Kelly’s grandmother and we have divided them into thefour orphanage boxes. There is a mad rush for the beanie babies and we see more than 50 children in line for a toy. I cannot distinguish between orphan and a child with a home but it is not up to me to decide who gets a toy. We also have some toothbrushes donated by Dr. Fadjo from Chelmsford and we can give those to the older children along with some books and videos donated by our friends and family back home. Our box seems so small compared to the need. The UMass Lowell students recognize that but also realize that we were hindered by high luggage charges. We will try to ship more items from home when we can find a vendor to ship barrels.

At the completion of our work day we are treated to a drink of palm wine which I did not like last year but this year it is nice and cold and does not taste as sour and fermented. Each person takes a sip (or more if desired) and then spills some on the ground and then one more sip. The UML students are hesitant but they do this. The pouring of the wine onto the ground symbolizes a recognition of the ancestors and reminds us that they are still present in our lives.

We have one last meet and greet with the Chief. He hugs all the students which is unusual because most people do not get to touch the chief. He is royalty to the people of Peki and certain protocols must be followed. He is kind and gentle man who wants the best for his people. He wants to maintain the beauty of his region but also is forward thinking and realizes that his community needs to advance and that can be done with collaboration with others.

We leave Peki and the students are a bit sad. They have grown to love this community but look forward to some new experiences. Kpando is about an hour away. It is a much busier town with more commerce, traffic and people. It has been home to Maura and I for the lastthree years in Ghana but the students are taken aback by the differences between the rolling country landscape of Peki and the noisy confusion of Kpando. We check into the hotel and we have been very spoiled by ourtwo previous hotels.

Cedes guest house is a somewhat dirty and poorly maintained hotel. I have not seen bugs but the mattresses and general cleanliness leave a lot to be desired. I am thankful that my silk dream-sack protects me slightly from whatever might have occupied my bed before me. It is unknown if the sheets have been washed. I find a pile of rags (or old clothes) in the closet and I immediately throw them in the hall. We are lucky to have a small refrigerator but it smells like something has died in there. We go to the front desk clerk and demand that the refrigerator be cleaned. Customer service here is not one of Ghana’s strong suits. Food service is very, very slow. I would not mind if I was eating at a 5 star resort in the Caribbean but when I am eating rice in a dirty room with one green fluorescent tube light and broken chairs I get a bit disappointed. I think my peanut butter and jelly crackers will be mainstay diet for the next five days. I havethree lovely oranges I purchased in Accra for $1.50 each and I am saving them for my breakfast for the nextthree days.

We are supposed to speak at the Nurses Conference on Friday but I still have not heard confirmation that they have a sponsor for the event. I again reiterate my concern that I will not be preparing lectures until I hear that it is happening and I need at least a few days advance notice. I do not think our coordinators understand how long it takes to prepare aone hour lecture and they have asked me to speak for at leastthree to fourhours.

Both the Ministry of Education and the Ministry of Health have refused any financial support. There is no such thing as big pharma here so commercial sponsors are unlikely. I have also been informed that nurses will likely resist paying for this conference due to their low paying salaries. I am not optimistic it will happen and I am frustrated by the lack of planning and decision making on this event. This, along with a new charge for transportation (which was not revealed on the original proposal) has me steaming mad tonight.

These unexpected financial burdens almost ruined my experience last year and I am holding firm to no new charges beyond this fee. I have very wisely retained 1/3 of the portion of our land fees until all charges have been established and we get a bit closer to our departure date. AFRICED is a new organization and has improved their services to us this year based on lengthy feedback from us but I have ongoing concerns with communication breakdowns. They are truly wonderful people who are trying so hard to improve the health and welfare of the people of Ghana.I am hopeful this is the only glitch in our otherwise wonderful trip.

Tomorrow we begin our observation and other clinical work at the hospital and clinic in Kpando. I am sure that there will be many stories to tell tomorrow but I must go to bed. We need to be ready by 8 am.I hope there are no roosters outside my window tonight.