We returned to the Christian Children’s Orphanage in HoHoe with our donation bins of clothing, toes, vitamins, soap, shampoo, flip-flops, coloring books, pencils, notebooks, books, etc. The community health project group that I am not a member of conducted their Dental Hygiene program with the residents.
The girls doing tooth care with the children did an amazing job. The kids loved coloring their dental related pictures at the end, they were eager to participate in the activity about foods that are healthy for teeth (I’m sure the stickers had something to do with that), and the song the girls taught them was great. The Ghanaian culture is all about music. People blare their radios and sound systems from 7 in the morning well into the night. In school music is utilized to teach moral lessons, about community, about history, etc. The children learned that song very fast (to the tune of Row-Row-Row-Your Boat) and sang it in a round; they won’t forget the dental hygiene message anytime soon.
One interesting thing to report back about here too, not a single student raised their hands to affirm that they had ever been to a dentist. When the girls pried further and asked if anyone knew what a dentist was, again not one hand went up. Personally, I have a total phobia about going to the dentist, but I carry dental insurance and can go whenever I have to. I’ve had numerous cavities filled, but never needed braces. I cannot imagine not knowing what a dentist is, let alone having never been to a dentist. I definitely need to get over my own hang-ups and schedule myself a cleaning when I get home, because I have the luxury to utilize this service.
I also wanted to take a brief moment here to thank Dr Auffinger, who donated almost all of our dental supplies. The children were ecstatic about receiving their own tube of toothpaste and a brand new toothbrush (with Disney Princesses, Winnie the Pooh, snazzy neon colors, Power Rangers, etc.) To all our supply donors’.know that the resources you sent us with are equally valuable and being utilized well and graciously received by the different communities here in Ghana.
Today I went to the Margaret Marquat Hospital and, shockingly, chose to go to Maternity. I hope some other students are taking the opportunity to blog so those of you more interested in Surgical, Pediatric, or Medical concerns are getting some insights into how Ghana operates in other specialties.
There was one patient in Labor. Male family members (partners, fathers) are not present during the laboring process here. No female support person comes with the woman either, which I was surprised to hear. The patient today was actually being induced (with Oxytocin) because she was postdates (the midwife reported her as ’40 plus.) The induction did not bring contractions the entire time I was on the unit, and the oxytocin drip was increased once during my stay. The patient remained alone in her room, except for the three or four visits I made with the midwife, and she has to stay on the small metal table, she could not walk around or sit up because of her IV. She had no pillow, no TV to pass the time, no radio.
In the labor room there are three metal beds with a tri-fold divide for privacy. There is no such thing as a call bell here. I asked the midwife in charge of the induction how the woman could get in touch with us if she did start contracting, her water broke, she had pain, etc. She was very perplexed by my questions, and I had to rephrase it several times. In the end she laughed and said, ‘Oh no, we just check on her to see what she needs.’
How often did we check on her? Well, I was told that when the oxytocin is running the midwife is supposed to listen to the Fetal Heart Rate every 30 minutes. I was on the ward for three hours and she listened to the fetal heart with the Doppler once, the metal cone I’d seen at the clinic another time, and that was it. Each time we left the office and crossed to the building where the laboring primip (first time delivery) was, I usually asked about her rather than the midwife suggesting a visit. It was a slow day on the unit, with many post-partum patients having been discharged the day before. There were 5 midwives chatting in the office, so I don’t know if this is their usual practice or if I caught them on an off day. I don’t know if I am spoiled by the way the nurse’s I work with practice, but I was expecting a more caring environment. I was expecting support people; I was expecting the patient to not be so restricted/confined to her room/bed. I was expecting small talk between the midwife and the patient. Again I was struck by how little interaction there really was between staff members and patients (as in the clinic.)
In any case, it was all a very shocking experience to me. I know many people who hope for natural labor, or hold woman in Africa up as an ideal way to labor and deliver. Given what I saw today, I know that we (in the States) have a very romanticized view of how woman in Africa labor. The bedside metal table was rusted, the paint on the cement walls of the building cracked, the bed shorter than the woman laying on it and (as I said) minus a pillow and linens. Also, some labor without pain medication or epidurals because they have no other option; it is not a conscious decision/choice. I spoke to several women on post-partum who asked if it was true that Americans can give birth without pain, and one midwife said we should bring that pain relief with us to give it to the women of Africa’very interesting things.
We started off the day presenting gifts at both the hospital and the clinic. At the clinic some of the people who came out to receive the items (gloves, bulb syringes, cord clamps, prenatal vitamins, betadine, alcohol swabs, bars of soap, Purrell, gauze, disinfecting wipes, Band-Aids, cotton balls, etc) I found myself having to explain what some of the items were. The clinic does not use alcohol swabs, only dry cotton balls. I never witnessed anyone wiping down a surface either, and did have to explain what the disinfectant wipes were. Shine, a nurse at the clinic and friend to our group, was also helping explain some things to people gathered round. It was good to know that some of the staff has this knowledge to share with their colleagues, but pretty shocking that such education is required. None of the items we donated were high tech.
After our donation rounds were over, I returned to the hospital and shadowed a very conscientious nurse named Peter. He works in the surgical ward. The lack of empathy and personal communication I’d witnessed in many clinical areas in Ghana did not apply in this nurse’s case. He said he enjoys the day shift because he gets to really know his patients, change their dressings, and feel like he has done something positive for them. I missed his brief tour of the patients on the unit, but was informed by my colleagues who were also shadowing him, that he knew everything about each patient (medications, dressing changes, diagnosis, length of stay, etc.)
Even here, with such a kind, compassionate, seemingly educated nurse, I saw things one would never (or hope to never) see in an American hospital. The oxygen had ‘finished’ (run out) that morning, so one patient was hooked up to a nasal cannula but was getting no O2. They had no pulse oximetry available (Peter said they never have them) to check the patient’s O2 saturation, but he was sitting in the tripod position and using accessory muscles to breath; clearly in distress. Peter drew blood without gloves on, utilizing a syringe to take a sample of blood. While he was in the vein, he paused to answer his cell phone before he finished drawing the lab! As with the clinic, only a cotton ball was used before insertion of the needle’no alcohol. Sharps bins here, as with the clinic, were cardboard boxes and the needles the staff has access to are not safety needles. Single rooms are unheard of anywhere in the hospital, the patients are separated by gender and beds line two sides of the room, about half an arm’s length from one another. There is no privacy, no HIPPA here. On most of the beds, patients were sprawled out atop bare mattresses, and the rooms were semi-dark sweat boxes. Again, no A/C or fans (as far as I saw.)
When we went to the lab to bring a patient’s CBC (of full blood count) and BF (malaria smear) Peter asked if we’d like to donate blood. That felt awkward. I know blood is scarce anywhere one works in healthcare; I know it gives life, but I just couldn’t bring myself to expose myself to the tools and techniques this nursing staff has available to them. Sterile technique that I have witnessed is sloppy or just plain wrong, and there are not even alcohol swabs to start IVs. I said no. There are so many problems here that I can witness but do little to change, which can be frustrating.
Today we went to Nkonya to advertise our HIV/AIDS Prevention Education program, which we will be hosting tomorrow (Sunday) with my Community Project group. We split up into four groups and followed interpreters into different corners of the village. Each team was armed with one stethoscope, a blood pressure cuff, and a handful of useful donations to distribute to villagers: soap, shampoo, mouthwash, lotion, etc.
My group (Michelle, Whip, and our interpreter Vivienne) met a girl who has what sounds like epilepsy. She had “an episode” 2 weeks prior; resulting in severe burns to the left side of her body (she fell into a fire!)
I saw a woman who claimed to be 11 months pregnant, but didn’t have money for the cab ride to Kpando to get her “picture” (ultrasound) that the clinic in Nkonya
recommended. She claimed to have already felt the baby move/kick 3x
today, and it was her fourth pregnancy. She had had no pains, bleeding, fever, etc. Still, it didn’t seem like the head was engaged in the pelvis (breech? I thought I felt a head closer to her fundus.) I had no measuring tape to do a fundal height but she looked near term, if not term. I just hope she was wrong about the dates. She is
coming to the clinic tomorrow when we go back, and we plan to ask people for money to get her to U/S. We saw several blind individuals (Val thinks it was the River Blindness.)
Again, we encountered some outrageous blood pressures. We saw a 10 year old boy who appeared to have something like psoriasis. His mother reported he’s had it for 7 years and that it itched. It was over his joints. It’s so hard. We didn’t have Val or any meds with us, so they are coming to the free clinic tomorrow, though all we have is cortisone cream and pain med…and there is no physician readily available to him for any kind of treatment.
Another little girl had some kind of rash…it goes on and on. The people need to very much. I had Tylenol in my first aid kit for the group which I administered to a woman in her young twenties who was drenched in sweat from fever. She confirmed a bitter taste in her mouth, that the fever comes and goes, and cough…malaria. She can’t afford the medication though. All we could do was talk to her about drinking water, adding sugar and salt to her fluids (she wasn’t taking in any food) and stressed going to the clinic or getting someone in her family to help her pay for the medicine. We also told her to come tomorrow as Val may be able to access the appropriate medication if she talks to our guide.