Entries tagged with “health clinic” from Nursing Students Without Borders

By Valerie King

I stayed up until midnight to go and sit with the students for the New Year countdown.  No big ball falling from New York City but the tiny glow of a cell phone and wrist watch that tell us the New Year has arrived.  The students are happy and mellow, having spent a few hours relaxing at the Friendly Spot but we all return back to our room because we know we have a clinic to do tomorrow at Torkor. My sleep is interrupted last night by the local singing and dancing that is occurring into the very wee hours of the morning.  The residents have returned from their church services and are ready to have a party.

After a breakfast of Crystal Light and peanut and butter crackers.  I pack up my bag and medications and get ready for another clinic.  We negotiate for a taxi ride (50 pesuas per person which is about 50 cents).  The car is something that you see in our worse junkyards.  Half way to Torkor the car stalls and the driver lifts up the hood and ties a plastic bag around some type of tubing under the hood.   I hope it is not for the brake fluid. 

We arrive in Torkor and it is much less crowded from yesterday.  There are very few market vendors and it appears that half the town is sleeping.  I think that is the case because we don’t have many patients the first few hours except for the small children. 

They are fascinated with the student nurses and are very anxious to have the nurse, "touch them.”  We have been able to do some pediatric assessments.  It is difficult because many of the young mothers do not speak English.  It seems to me that in the poorer communities the young men seem to have some command of the English language but the young women not as much.  We do not have as many interpreters today so some of the young men help us out with instructions to the patients.  

The children appear healthy but we again are seeing the increased frequency of umbilical hernias.  I do not know the reason for that.  We have such limited tools.  I do prescribe some penicillin for a young child who has some type of skin infection.  I am able to demonstrate to the UML students how to do a scoliosis screening.  At one point in the day the UML students engage the children in a clapping and singing game.  It is a moment we catch on video.  The children are always at first hesitant to come to the nurses but after a few moments they relax and are fascinated with the young girls and their cameras.

We see another “Ya-vou” which means white person.  We mimic what the residents have been doing to us when they see us walking down the street. A UML student yells “Ya-vou” and this young white man immediately turns and comes to greet us.  I cannot recall his name but I am going to call him “cute guy from Spain” and his friend Courage who is a resident of Kpando but attends the University of Madrid with Cute Guy.  They are in a PhD program and they study microbiology.  They are touring Torkor today just out of interest but tomorrow they leave for the northern regions of the country (Tamale) to gather some samples for their research.  They are collecting human and animal feces samples and will bring them back to their lab in Spain to research antimicrobial resistance and certain aspects of the microbes.   We invite them back to the Friendly Spot tonight.

We have now been working for about 3 hours and it has been a steady but not crazy flow of patients.  It appears that more people are coming now and I suspect that these are the people who are probably just awakening from their celebrations of the night before.  We try to examine more patients for about an hour but we are starting to get tired and hungry.  We close the clinic at 3 pm and we have to promise to return for another clinic.  

This village is so poor and these residents are happy to have some access to free care.  They need so much and we are only equipped to deal with a few health problems.  Yesterday Alison, a UML student, took one of my big picture books that I use in my clinical practice at home and went out to the waiting crowd to show them pictures of the human body and where the organs are and specifically the organs affected by hypertension. 

This is a totally unscripted educational program and I admire her for her ingenuity and ability to recognize that she had a teachable moment.  She is knowledgeable and this is not the first time I have seen her jump right in and begin teaching the patients.  She recognizes the value of educating the people here and wants to leave them with knowledge about their health.   I find all the UML students very inquisitive and willing to learn something new.  We have had some impromptu teaching sessions about various topics. Often these topics arise because of something we have witnessed.  I am enjoying the process of helping them to consolidate some of their book learning into real life community-based nursing.  I am very honest with them about my in inadequate skills in an acute care setting but I feel that I can help them so much with their community-based care.

We pack up our “clinic” which is contained in a cardboard box and my Barnes and Noble book bag and off we go to get our Taxi back to Kpando.  We become victim to a little price gouging when we try to arrange our taxi home.  We were told it was 3 cedis each way per taxi but now they know that we are trapped in Torkor and they can up the price because we have no other options.  We are now told it will cost 5.9 cedis to get home.  I agree to the increase and I leave in my cab with ½ of the group.  The other half balked at the price and were ejected from their cab to go and negotiate a rate with another taxi.   We are a bit upset that these people would take advantage of us after we have just given them 4 hours of free medical care.  Everyone in this country is struggling to survive and the “ya-vous” represent a revenue stream for them.   This is the part of the trip I do not like.

After returning home we rest for a few hours.  Maura is arriving today.  Maura is the other “Mama” who traveled with us last year and she decided at the last minute to join us in Ghana.  I am thrilled to have a buddy and another RN who will assist me during this trip.  We have arranged a meal of chicken and Yam chips (like French fries).  Our cost is $5 for the meal.  This food expense is something that was not built into the trip cost because we had no way of estimating it.  It is a chore to decide on a menu and arrange to have it prepared by a local woman, Patience.  She is a wonderful cook and I am very glad to help her with our money but for me it is tiring to be the “menu” organizer and I hope to share that duty with the students. 

Maura and I decide to walk to Shine and Bernard’s house (our hosts from last year).  This is about a mile long walk which entails going thru the busy part of Kpando where the walking is treacherous due to auto and people traffic.  We then turn onto a very dark and rutted road to continue our journey (about another ½ mile) down into a residential section.  The road and path conditions seem a bit worse this year and we rely heavily on our flashlight to guide our steps.

We meet with Bernard, Shine, 3 of their visiting friends, Mildred who is Bernard’s 4 year daughter and Maria, the medical student from Puerto Rico, who is staying with Shine for 2 weeks.  We have a wonderful conversation about various things and we share our gifts to them.   This is another aspect of our packing that I did not have last year.   Last year I brought a hostess gift to Shine and I had some cheap t-shirts for Bernard and others.  This year we return knowing so many more people that we feel obliged to bring gifts.  My suitcase weighed so much but 1/3 was food, 1/3 was gifts and 1/3 was clothes.  I am looking forward to a lighter suitcase upon my return home.  

It is getting late and we are tired so we begin our journey home.  Shine and Bernard accompany us ½ way.  The busy street has turned into a mob scene very similar to a Mardi gras atmosphere.  There are hundreds of people in the street, loud music playing in local bars that spill onto the street and many, many people walking.  We follow a walking street band for a while and get a photo of the group.   We are a bit nervous in this crowd and Maura and I walk arm in arm down the street protecting our pockets.  We are happy to return to the safety of Cedes Guest house.

The students are having their own little party over at the Friendly Spot with our new friends from the University of Madrid.   I am introduced to Dominic who had contacted me via the internet a few weeks ago. He is very much interested in attending UML and studying nursing.  He has brought his teacher from high school (who is Courage the student from U of Madrid) who wants to discuss Dominic’s credentials with me. I have come prepared with some admission material and I give that to a very enthusiastic Dominic.  I do not know much about International student admission but I can connect him to the right persons. 

It is getting late and I am totally exhausted.  Maura and I chat for a while in our room and we quickly go to sleep.  We are giggling a bit because our families have such a hard time comprehending the fact that we sleep together in one bed.  The living conditions are so different here.  We are not at the Hilton.  I am thrilled to have a comfortable bed, a flush toilet, electricity and the best of all air conditioning.   I go to sleep in my sheet snug sack I brought with me and the blanket I “borrowed” from British Airways.   Tomorrow is a full day and we need to get some rest.

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.

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