Tag Archives: hypertension

Day 6: ‘Pills, People and Problems’

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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.

‘Who has the right of way?’ – December 31, 2009

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By Valerie King

Today we have our first full day in Kpando. After a breakfast of peanut butter and crackers and water I prepare to meet the students for a walk to the District Commissioner’s Office for a formal meeting. This is the first day that the students will get the ‘walk the walk’ that I did so many times last year. Our guest house was chosen specifically because of its central location. I spent many hours last year at the internet caf’ and the small adjourning park that is across the street from our guest house.

This morning we are walking to the Kpando Health District offices which are about a mile away through the busy roads of Kpando. The roads are very busy and it can be treacherous to walk down the street with the many taxis, private cars and other vehicles on the road and every one of them think they have the right of way.

The students are seeing Kpando in the light of day and will learn to call this community home for the next few weeks. They will learn where to find the best pineapples and water and where to get a cold drink or where the children will rush up to meet you. There is much activity and not much has changed since last year. I am a bit dismayed to find the house where the little girl Hannah lived appears to no longer be occupied. She and her mother and (?) auntie were the first people of Kpando that I met last year and I have come prepared with gifts for them and they are not there. I have asked around and no one seems to know where they are. Their home was an unsafe shack before and I can only hope that maybe they have moved into more suitable living quarters.

We arrive at the District offices and have an official meeting with the Director. There is so much protocol that must be followed. We present our plan for clinics and interventions and anxiously await his approval. It seems strange that we could travel all the way here and then to have someone turn down our offer of help. Fortunately that is not the case. He is a lovely man and is appreciative of our efforts and also longs for a continuing relationship with the people of UMass Lowell.

After our meeting I walk to the next building to reunite with Shine. She was my host last year and I am her ‘mommy’. She shrieks and runs to me and we hug. She is such a wonderful person and I realize how much I had missed her and she missed me. I also am reunited with some of the other nurses from last year and it is comforting to see some familiar faces. We meet a medical student (3rd year) who is living with Shine for a while and working at the clinic. Her name is Maria and she is from Puerto Rico. She is excited to have some nurses working with her next week. She said she sees over 100 patients a day.

We gather the students and some supplies and we cram into a pickup truck and drive 4-5 miles to Torkor. This is the impoverished fishing village that we visited last year. Today is market day and the community’s population here has tripled. So as we ‘go where the patients are.’

A quick impromptu clinic is set up. Two tables, 6 chairs and some benches. I give out assignments. Five students for BP readings, 2 recorders, 2 medication sorters, and a roving photographer. My plan is to circulate throughout the stations and the students have been instructed which patients to refer to me for further assessment and medication administration. I was concerned that the experience was going to be too intense but I was very pleasantly surprised and proud of their adaptation to the circumstances. They were being asked to assess patients who did not speak English and to practice some of their assessment skills and critical thinking to determine which patients needed further intervention.

It was a crazy 2 hours. I have not counted the actual number of patients that we saw today but I would not be surprised if we saw over 100 in 2 hours. The incidence of hypertension is mind boggling. I know that my supply of BP meds is not going to last during this trip so I have to adjust my dispensing. I am only giving them 10 tabs and then instructing them to return to a local clinic. Many of them have no insurance and I am not sure that they will go but I cannot in good conscience let them leave the clinic without medications. I have also adjusted my threshold of what patients receive meds. I am only giving meds if the diastolic pressure goes over 100. We have so many people in Stage 1 hypertension but I cannot afford to give them meds. I am saving my meds for the more extreme cases and trying to supplement our intervention with lots of patient teaching. It is a difficult compromise for me to do but I am trying to make the best of the situation.

These people are the poorest of poor. They live off fishing and sales of goods. The clothing is tattered and worn. It breaks my heart to think of all the clothes I have at home in my closet and if I could get them here I would. One woman who was so appreciative tries to give me one cedis (this is equivalent to one dollar). I know that is a fortune for her. I cannot take her money and politely refuse but I realize that I may have offended her. One woman hands us a bag of oranges. Another man, whom I discussed his high BP and urged him to cut out salt, told one of our escorts that I must have heavenly powers because I told him the exact same thing a MD specialist told him. It is interesting to hear that and you wonder if hearing from a nurse from America helped to make a health behavior change for him. We return home to our hotel to get ready for our New Years Eve Feast. We have ordered some Ghanaian food from our friend Patience and she will bring it to our hotel along with some beer and Smirnoff Ice.

‘Hail to the Chief and Heathens’

We had a nice dinner. I am not a huge fan of Ghanaian food but Patience’s cooking was good and the girls loved the meal. We sat around our tables in the courtyard of the guest house. Our 5 small cocktail tables are illuminated by my Barnes and Nobles book lights (thank you Santa). After we finish we have a wonderful discussion with one of our organizers, Maule. He is from Peko which is a village we will be visiting in a week or so. He explained to us the chiefdom system that is the custom here in Ghana. He is the first born son of the Chief of Peko and someday he will be assuming this very important role. He is a personable and educated young man who has love of learning but also love of his village and a desire to return to Peki to make a difference in the lives of his people when he graduates this May from the University of Ghana. He has been incredibly helpful to us and is knowledgeable about local customs, dialect, and history.

We learn that New Year’s Eve is a religious holiday here. After dinner we cross the street to go to the Friendly Spot, local bar/shack that serves beverages and has an MTV type program on a portable TV on the grass outside the establishment. There are large speakers which at this moment are pounding with bass and music. As we sit there we notice many of the people of the town are passing us on the road and are dressed well and going to church for a 9 pm service. We are told that they stay until midnight to welcome in the New Year and then return to their homes and local bars to celebrate until the wee hours of the morning. I suspect that the Friendly Spot will be booming for hours to come. I think I may need to sleep with headphones tonight.

We are the heathens who instead of going to church are drinking and waiting for the New Year to arrive. I have left the UML students to enjoy some relaxation without the presence of the ‘Mama.’ I am enjoying the solitude but am sad that I am missing NYE with my husband and children. I want to call home but we do not have any minutes on our phone and the internet caf’ is closed. I wish all my dear friends, colleagues and family a very happy New Year and I will see you all in 2010.