Entries tagged with “Africa” from Nursing Students Without Borders

Today we are schedule to go to Nkonya.  This is the village that I fell at last year and suffered a nasty abrasion to my leg.  It took a few months for the scar to go away but I remember that village very distinctly.  It is extremely poor and has no source of regular medical care.  There is a clinic that is almost completed but the government does not have the money to support staffing and supplies. 


Today we are doing some preliminary work in preparation for our HIV education program and testing that will happen tomorrow.  Every action we take seems to require a lot of preliminary work before we can begin.  We must make our introduction to the community. 


There is a funeral happening to day. The town is very active with families dressed in black and red (traditional colors for funerals). We break into 4 teams and the students are advised to give out condoms and any related teaching to the men and women and young adults that have questions regarding the condom use.  We have been told that this community has a very high incidence of HIV. Because of the poverty many of the young girls are lured into being sex workers and often acquire HIV.  They bring these diseases home to their community and then infect the men there. 


There continues to be a huge social stigma for HIV.  People do not want to know if they are HIV positive because once you are a known HIV infected person you are shunned from the community.  It is not just you who suffers but your whole family suffers from the stigma.  So what happens is that people refuse to be tested and often if positive will refuse treatment. Last year we conducted an HIV testing clinic and one woman was found to be positive I was the one who had to tell her that she was positive.  I have learned today that she refused to acknowledge her diagnosis and would not take the antiretroviral medications.  She is dead now for a few months.  I recall her as a middle age woman with no other medical issues. 


The UML students last year did an HIV program for the youth and this year’s students will be doing a similar program.  It is hope that if we educate the youth then they may be more likely to engage in healthier behaviors but also serve as advocates for the people in their community.   


I am lead by Patrick who remembers me from last year.  He is a community leader and all of our negotiations have to go through him. He has also informed me that another patient that I told had likely advanced breast  cancer last year has died.  There is no such thing as regular mammograms for the women in this region.   I am a bit heartened to hear that one of the patients that I saw last year with an enormous rectocele has been seen by a physician and she is much better.  I don’t think she had surgery but she is in front  of me and appears well. He tells me that she was inspired to see the doctor at the hospital because I told her to go. 


We break into 4 teams and go into the village to distribute condoms and check BP.  At every home they are desperate for any thing you can give them.  I have some Tylenol, Motrin and vitamins that I give out if necessary.  Even if they have no pain or hypertension they want medication.  This is a real big problem here. They want to take the pills short term to solve the problems but are not willing to make the long term lifestyle and sanitation changes that need to be made for overall improvement in their health.   It can be discouraging to see so much need and to realize that we are only making a very small dent in their existence. 


Patrick has many needs and wants me to help him find a medical provider that will stay and work in their clinic.  I struggle with the notion of foreign countries providing aid to these people when their own government needs to make sweeping changes to ensure that there are personnel and supplies available to provide care.   I am taken from home to home to home and the story and the people are the same.  We are supposed to meet with the chiefs but I don’t believe that will happen.  They have had a big funeral  today and many of them are at that ceremony.   


As word gets out in the village that nurses are in town the number of patients amazingly increases about 10 fold.  At every corner there is a cluster of patients wanted some of this ‘free medical care.” At one point we have to physically be directed to our awaiting Tro tro to go home. Tomorrow we return to Nknonya for the HIV program and another stationary BP clinic.  I am dreading that day because I remember last year and it was a mob scene. 


By Valerie King

Today is my first day at Margret Marquat Hospital.  For those that know me this is not my area of expertise.  I am a community based nurse. I am much more comfortable going from hut to hut than to try to serve a purpose in an acute care hospital.  I had hinted at my desire to stay at the outpatient health center but Maura thought my assessment of the nursing care at the hospital would be helpful. 

We have been asked by the new medical director, Dr. Lucy, to do an evaluation of our experience at the hospital.  She wants to make some changes so our input is solicited.  We are treated very kindly by the nurses but there are significant deficiencies in the nursing care that goes against everything that we have been taught as an American Nurse.  The contents of our report are too lengthy to go into in this Blog but suffice to say patient safety, infection control and issues related to competent and compassionate nursing care were some of our biggest observations. 

Later on this evening I created with Maura and the students, a 4 page document that we will use to present our findings to Dr. Lucy.  I am reminded of the comments of my teacher and friend Dr. Geoff McEnany-Phillips when he taught me about evaluation.  It is important to be truthful but we have to be mindful of the stakeholders in this situation and try to present our findings in a thoughtful and professional manner. We create the document over a bottle of wine and with very insightful comments from the students.  I am not sure how Dr. Lucy will use the information but we felt it was our duty to be advocates for the patient but also to help promote professional development of the nurses in Ghana.

To help with our goal of professional development I gave a 2 hour lecture today at the Kpando Health Center on a few topics.  I presented a lecture on the assessment of the geriatric patient and also diabetes mellitus.  The audience of mostly nurses but some other staff seemed to be very much engaged with the lecture.  I had to slow my rate of talking and to try to use appropriate and understandable terminology.  I tried to lose my New England accent. 

The time flew by and I was encouraged by the thoughtful questions that were asked by the participants.  I have truly come to respect these Ghanaian nurses.  They work with such limited resources but have such potential for improved care if only they are given the education.   Throughout my lecture I keep repeating that they have incredible power as nurses to make a difference in their patient’s lives.  I think the nurses could play a larger role in the care of the patients but am limited in their knowledge and sense of responsibility when it comes to patient outcomes.  I pretty much told them that they are much more important than the doctors (my apologies to my physician colleagues).  I think there is a vast difference in the way that Ghanaian nurses and American nurses are educated based on my observations.  

I would like to see these nurses claim their autonomy and professionalism.  Change comes slowly.  I think having the UML nurses work with them opens the door to comparisons, questions and emulation of behaviors.  We have witnessed an obvious change in the demeanor of the patients when the UML nurses address them with respect, touch them and provide the level of compassionate care that is the trademark of the American nurse. I have such personal pride in the accomplishments of the student nurses from UML.  We have had many thoughtful conversations at night about the comparisons of the two countries and their ideas for improvement.  I am proud to be a graduate of UML and I am equally proud to be a nurse educator who will have a role in creating the future American nurses.  I will end now on that positive note.  There are still many more stories to tell but again I am burning the midnight oil and tomorrow is another busy day. 

"Tears, Smiles and Tears"

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By Valerie King

Today we are scheduled to go to the Hohoe Christian Children’s Home. Before we leave Kpando we have become aware of another acute public health problem. We drive a very short distance behind the health center and we are in a small village.  We depart from our Tro Tro (which appears to be held together by not much more than duct tape and rust).  We are visiting a watering hole. We trek into the woods about ¼ mile along a rutted path and we meet many people, mostly children, coming out of the woods with various water containers on their heads. It is amazing that these people have to walk such lengths to get their water. 

Our true shock comes when we come upon the watering hole.  There are actually 3 holes. The first one can only be described in one word. DISGUSTING.  It is a large hole in the ground filled with putrid green water.  We do not see people collecting water from this hole but we are told that people do use it if the other holes are low. We come to the second hole.  I have to tell you that the next part is pretty gross.  If any of you have the seen the movie The Ring you will recall that there was a deep well that a little girl was drowned in.  Well this “hole” is exactly like that movie and the saddest part of all is that over the last year six children have fallen in and drowned and only one body was recovered.  The other 5 bodies have sunken to the bottom of that well and supposedly not retrieved.  These families have to continue to draw their water from this well.  Part of me doubts this story but if it is true I can only imagine the anguish a mother must feel as she has to draw water for the rest of her children from the very well that took the life of her other child.  The third hole is quite active today and surrounded by about 20 people who are drawing up the water using buckets and ropes.  You can see how a small child could fall into these wells and if no one was around there is no way to climb out.  It is a pure vertical cylinder of old stone. The village has been trying to get some funds to dig a bore hole but the government is not listening to their request.  They have asked for our help in this project.  We are unsure what we can do to help them but we will be visiting them on Saturday for a demonstration about boiling the water that they are pulling out of the holes before consumption.  We will see what the costs are for a bore hole.  This is a perfect project for our engineering students at UML and I hope to bring this to their attention.

After our walk out of the woods we load back into the Tro Tro.  We are like little sardines squeezed into a small tin can. Hohoe is about a 30 minute drive down bumpy roads.  We arrive at the orphanage to be greeted by the loving arms and hugs of 30+ children. They are all so happy and affectionate and give freely of their hugs.  One of the Community Projects is implemented today with the orphans. 

The UML students are presenting a dental health program today.  They have donated samples of toothbrushes and paste and have developed a whole program that is flawlessly implemented for the attentive audience of children ages 3-15.  It is interesting to note that even the older children are interested in the coloring pages that are given out. They do not consider them to be juvenile and my impression is that they are sweetly naïve to all the usual American teenage angst.  I am joined at the hip by my new “son” Francis.  He has stayed with me all day today and at our previous visit.  The founder, Nicholas is married to an Australian woman who is back in her country for a Christmas visit.  She is a white woman and I think the children are missing their white mother.  I am missing my own children so it is a nice way for me to give and receive affection.

There is a cute little three year old girl named Lee and she has a very obvious bald spot on one side of her head that appears to be a healed burn.  We ask for her story and it is the most tragic story I have heard yet.  She is from the region of Tamale and has only been in the orphanage for about a month.  She used to live in a village that was very superstitious.  Her parents died, of causes unknown to me, but her grandparents believed that this little girl is a witch and she is to blame for her parent’s death. They chained her and starved her and burned her head with some type of hot metal to get rid of the witch. She was found by a census worker who rescued the child and gave her to a Peace Corp volunteer who in turn brought her to the orphanage.  You can see the fragile bones of this dear child who appears to be thriving in this caring environment but one wonders about post traumatic stress disorder and what type of psychological issues will arise for her in the future.  She is affectionate and loves the clothes and underwear that we have brought with us.  This horrific story has me near tears.

The young boys seem to gravitate to Maura and me probably because we are mothers.  They want to tell us about themselves and share their colored pages with us.  My buddy, Francis is staying close to me and insists on carrying one of my bags. We take multiple pictures and I cannot wait to load them onto the BLOG site.  Our Tro Tro arrives and the children hover around us. Francis is holding tight to me and crying into my shirt.  It breaks my heart to leave him but I am not in a position to take him with me.  I would like to continue to communicate with the director and hopefully Francis will write to me as he has promised he would.  There are so many children here who need a home.

My day ends on a bright note.  I have been able to use my own laptop in the internet café and the access seems a bit quicker.  I have been feeling a bit lost without communication from friends and family and I hope it will improve a bit.  It is now about 11:30 pm and tomorrow will start early so I will go to bed now.

“Sunday is a day of rest”

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By Valerie King

After our lack of sleep last night we are a bit sleepy today and I think many of us could use the rest.  We wanted to go and visit the Fesi Pottery and the Lourdes Grotto today but there was some confusion in our schedule and it never happened. We had also hoped to see the children drummers from the local church but that also did not happen.  I did some administrative work for NSWB and around 2 pm we walked to the local carver, Papa Bones and Billy the Tailor.  The students are buying and ordering some wood carvings and also getting some fabric for dresses to be made. The day is quickly passing and after a brief session at our meeting spot across the street we make the 1+mile hike to Shine and Bernard’s house.  We have been invited to supper.  The students are amazed that Maura and I made that walk every night in the dark.  It is treacherous in the beginning due to the auto traffic and treacherous at the end due to incredibly uneven terrain.  I am again amazed at the air quality here. It is such a poor quality due to burning and engine emissions.  We are all feeling in our lungs and most of us have a dry cough.  Our clothes and hair seem to absorb these smells and there is a huge drying effect upon our hair and skin.

 We have a great meal of Pasta and Sausages which reminded me more of a spicy Pad Thai and fried Kielbasa.  We are all very weary due to poor sleep last night.   We leave and journey back home.  I try to take some of the walking time to get to know some of the UML students a bit better.  They are all lovely so far and I am enjoying my time with them.  We walk past the dim and dirty shack where Hannah (age 6) Michael (age 10) and their mother Edith.  We have gifts for them and we bring them to their home.  They are so appreciative. Edith wants us to take pictures of her officially receiving the gifts.  She is also talking about a plan that she would like us to set up a school in her village which is further away.  We are constantly overwhelmed by needs that this country has but we tell her that we do not have the resources to start a school. 

As I near our guest house I have one last stop.  I must meet with my new friend Foster Dominics, who is trying to enroll at UML in the nursing program.  I have given him some admission information and he has to wait now to take the SAT and TOEFL test. That will not happen until December 2010.  Until then he plans on working and saving money for his dream to get a US education.  I told him I can assist him with making connections in the US but I cannot be a financial sponsor of his education.   He is a gentle young man that appears to have the intellect and desire for a nursing education.  He has a twin sister, Fostine and his mother died about a year ago.  I told him I will do whatever I can to help him with this processs.

As I type this my eyes are very tired from lack of sleep and also the effects of the smoke in the air.  I am going to bed.  Tomorrow is our first day in the clinic.

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 café 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 café is closed.   I wish all my dear friends, colleagues and family a very happy New Year and I will see you all in 2010.

We drive a bit through Accra but the hour is getting late and we are hungry, hot and tired.  We are taken to Frankie’s which was the local restaurant I went to last year on my last day in Accra.  It has wonderful American type food and I am thrilled because I know this will probably be my last Diet Coke for a while. 

We are brought to a newly renovated hotel in Accra. We drive down a rutted dirt road and I am questioning the locale as safe destination but soon we drive into a courtyard with brick pavers and a hotel that has obviously undergone some recent renovations.  We are surprised to be treated by private rooms for each student.  The rooms are clean and new sheets, bathrooms and best of all, air conditioning.   After carrying in our 44+ boxes and suitcases we retire to our rooms for a long awaited shower and rest.   I guess the water fairy is not on my side again this year because I have a lovely bathroom with new tile and sink but no running water.  I sneak down to a student room and after trying 3 different rooms I finally find one room with a trickle of cold water.  At this point it feels like a luxury and I quickly shower.  I hope this is a minor plumbing glitch that can be resolved in the morning.   

Prior to my shower I start to give out some of my gifts to Kwadwo and his wife (who has joined us tonight).  I have given him a used laptop for which he is very grateful for.  It will help him with his work with AFRICED.  I am feeling bad because it is a few years old and not too fast.  If anyone has the inclination to donate a newer or new laptop to AFRICED I would be happy to arrange for shipment to Kwadwo.  I will tell you more about AFRICED in another entry.  

I reflect upon the day’s events that we have experienced.  Some of the sights, sounds and smells are the same. A few of the roads appear better but then very quickly they deteriorate into a rutted dirt road.  Ghana is making progress but it is sporadic in some areas.  We are stopped by the local police at least 5 times as we travel to our hotel.  It is a bit unnerving to be stopped at a roadblock with police in combat fatigues and large rifles on their shoulders.   It is the Ghanaian form of police oversight but it feels a bit weird to be stopped and have the flashlights shinned into the vehicle. 

I have had a conversation tonight with our new friend, Nicholas, from the Education Ministry( I think he is some sort of protocol officer).  He is trying to educate me about the relative safety of Ghana but also some of the traps that are present for the obviously white tourists.  I am encouraged again by the attention that NSWB has garnered from upper levels of government here in Ghana.  There will be more to report on that later. 

We also met a Ghanaian woman in the airport in London who is a nurse at Johns Hopkins hospital.  She is home for a holiday and has invited us to come to her home.  I am reminded of the friendliness of the Ghanaian people.  This woman, who is a stranger to us has just invited 11 of us to her home.   I also am reminded of the poverty as the people swarm our bus as we disembark and try to ask us to purchase little trinkets or just to give them some money.  It is a bit of a shock for the students to have this so visible on their first few hours in Ghana.  The students will have many more eye opening experiences and I can see them trying to acclimate to this type of human suffering that is not so apparent in their comfortable suburban life.

The halls are quiet. It is about 3 am and I need to wake up by 7 am for a 8 am departure.  I am sure my body will crash sometime tomorrow.  All the students are in bed and I am now going to sleep myself.  Tomorrow will be a busy day and I will have a second entry later on tomorrow as long as I can stay awake to write it later tonight.

Technically it is 12/29/09 but just barely.  It is about 2 am but my body thinks it is about 8 pm.  I am sitting in my hotel room at Accra.  We landed a few hours ago after a fairly uneventful flight where I really did not get much sleep but managed to watch a few movies.  The back of the plane (the economy seats) was packed with mostly Ghanaians returning home and a smattering of UML students and ironically a UML faculty on her way to spend her sabbatical teaching Biology at the University of Ghana.  There were plenty of open first class seats and I tried to negotiate my services as “the on flight nurse” in exchange for one of those nice seats but unfortunately the cabin crew could not grant my wish.

The heat of Ghana is overwhelming as we descend down the stairs of the giant British Airways plane.  The sights and sounds are rushing back to me.   As I enter into the customs area I see my friend Kwadwo waving at me from beyond the check in kiosk.  And to my great relief there was an American Lieutenant Colonial from the US Army assigned to the US Embassy who is assisting us through customs and immigration.  He obviously has some pull and we were whisked thru immigration and one of the students who was without her visa was easily able to acquire one onsite at the airport.  Gathering of our 22 boxes, 11 large suitcases and at least 22 carry-on items is a huge but somewhat painless process.  The hardest part was navigating our carts through the line of Ghanaians who were also toting large carts with suitcases. 

Instead of leaving out the customary door to the chaos of the parking lot we were whisked to an alternate door leading to a private lot with a large air conditioned bus awaiting our arrival.  I am amazed at the ease of this process as my recall of last year was one of chaos and frustration and essentially being on our own.  It has helped tremendously to work with Kwadwo and AFRICED volunteers who are our escorts and coordinators for this trip.

We have caught the attention of the Minister of Education whom we will meet with tomorrow and later on in the trip we will meet with the Minister of Health.  They are appreciative of our efforts and have helped us overcome some of the barriers from last year.  Of course it is with the intent of creating a lasting relationship with UML and future benevolent trips to Ghana.  I am VERY grateful for any help that can be provided to us at this stage.

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