Entries tagged with “Kpando” from Nursing Students Without Borders
It is Thursday morning and we are prepping to do a blood pressure clinic and make donations to the local hospital today. We have been in Kpando for about three nights and we are starting to get used to life here.
Shortly after we arrived here, I asked one of our guides what previous groups of nursing students did that had the most major impact. I was expecting the former nursing students made big strides through teaching and donations, but my mouth fell open when he said it was our compassion. He said Ghanaian nurses do not have the same compassion and caring that has been a part of American nursing for generations.
Our observation in the local hospital was eye-opening. It would be inappropriate for me to cite short-comings in their hospital model if I did not say they did a lot with very little. There were some very sick patients in the hospital, such as a women who presented with a perforated appendix or the severely sick children with end-stage malaria and HIV.
The interaction with the patients left all of the nursing students sick to our stomachs. While I can say some of the healthcare providers treated the patients with respect and dignity, we saw a lot of terrible things. We watched a woman get a c-section only to have the Spanish-speaking doctors verbally assault her in a different language, a midwife screaming and slapping a patient while she was vaginally delivering her baby, and many patients with dry IVs and no fluids at the bedside who were exibiting signs of dehydration.
It is hard to find our place here. Taking in cultural considerations and the fact that we are visitors, making suggestions does not seem possbile. Our suggestions do not seem to be welcomed. While we may seem like all-knowing visitors, our comments are intended to benefit the patients.
American nursing standard of practice is to be advocates for the patient. We are charged with keeping the patient safe and in the best possible state of health while in our care. This means we question the care the recieve, strive to provide the best, and struggle to implement changes for the better. Every time we ask why the doctors abuse the patients, healthcare providers screaming and hitting birthing moms, or patients being neglected and being withheld fluids, we are advocating for the patient. This practice is so fundamental in nursing care that the absence of it is sickening. This is why we find ourselves either intervening in into awkward situations, or leaving the room in frusteration - and even sometimes in tears.
We met an American nurse in the US Embassy here. She said that she originally went into developing nations to provide healthcare, but got tired of "slamming her head against the wall." We met her a few days into our trip, and I think now we understand what she was saying. Our medical and nursing models just seem so different, though I am trying to focus on the fact that no matter where we are from, we are all here for the patient.
I have to leave and post the blog entry stat, as we are about to board a bus to a small, poor fishing village. There we will be screening blood pressures, passing out some medications with our family nurse practicioner, and basically trying to provide first-line care. Honestly, besides bringing down dangerously high blood pressures (some were above 220 systolic), one of our biggest goals in bringing compassion to the patients. We focus on our eye contact, touch, comforting words, etc, to provide for these patients. Many of these people have never been touched by a healthcare providers, and seriously need just the phrase: "your heart is strong and you are healthy."
I will try to write as soon as I can.
The flight from Heathrow to Accra was pushed back by an hour. The wait was fairly uneventful, aside from Stephanie’s entire carry-on bag being rifled through by security; they thought her international electric plug adapter was a bomb or something.
I spent much of the layover trying not to think about being thirsty, given that the unfavorable exchange rate of dollars ($1.77) to pounds (1) made bottled water nearly $8.00. I tried unsuccessfully to catch a vertical nap on a seat and, when the noise and excitement of the day made that impossible, I journaled for a moment before delving into a Rachel Cohn book recommended by my Aunt Nancy; librarians are great people to know.
Our Arrival in Accra
The reception in Ghana was tremendous. A representative of the United States Army helped usher us through immigration and customs. Our guide/escort Kwado met us at baggage claim. We loaded up 22 boxes of supplies, 22 carry-ons, 10 checked items, 10 Nursing Students, and a faculty advisor into a 25 seater van. Our driver, Solomon, is one impressive motor vehicle operator- he could get that enormous van parked most anywhere. Oh, and I almost forgot, it was over 80 degrees when we landed.
Our First Meal in Ghana
It was very late at night when we arrived in Accra, but Kwado, his wife Sylvia, and our other guide (Mawuli) took us out for toasted cheese (grilled cheese) at Frankie’s before we checked into The Samartine Hotel; owned by Sam and his wife Martine (a native of Belgium.) Both the owners were extremely welcoming and hospitable. We were delighted to find our bathrooms contained toilet paper! The first night I had no water to shower by, but this was remedied on the second night of our stay.
Day 3: Tuesday, December 29, 2009
Breakfast: instant coffee or Lipton Tea; mango or orange juice; an order of “eggs” got you scrambled eggs with red pepper and onion; toast (a sweet bread); fat spread (margarine); sugar; creamer
This morning was my first introduction to Ghanaian time. We were all up at 7 am, due to leave for our tour of Accra and the University of Ghana at 8 am sharp…we didn’t depart until 9:25 am. My boyfriend would absolutely love Ghanaian time.
We were honored on this day to be joined by Director Eugene Armani from the Ministry of Education. After our bus tour it was arranged for us to meet a representative of the Minister of Education where we discussed our itinerary and the kind of programs we hoped to implement. He, in turn, offered us some insights into the history and plight of Ghana, and offered us some excellent advice.
“Find out how they [Ghanaian people] live; do not shy away from difference [and] if [the clinic] has no waiting room, no drugs, find out why; evaluate challenges [so] you can help advice, guide, and serve as advocates.” –Mr. P.K. Daneau (sp?)
We also learned in this meeting that 40% of Ghana’s population lives below the poverty line. Though education for all is priority of the Ministry of Education and there are enough teachers in Ghana, deploying these teachers to remote, poor communities is a problem; meaning quality education is not accessible to all.
Stay tuned for pictures. Describing my impressions of the people, the roadways, and the building structures just won’t do justice to what you can see from the pictures I’ve taken. I will say, though we have plenty to complain about with the Big Dig, it’s nothing compared to the roadways here-most often dirt/clay, full of potholes (even those that are paved), with large drop offs on either side where the sewers are. There are no speed limits, no sidewalks, and vehicles claiming the right of way!
Day 4: Wednesday, December 30th, 2009
Another early morning wake-up call but delayed departure. We repacked the van and headed for Ada, a poor community of approximately 15,000, on our way to Kpando.
In Ada we were given a tour of the Kasseh Health Clinic. It was absolutely eye opening. Their “nursery” housed a sink and a metal crib with no mattress. The labor room was two metal tables an arm’s length reach from one another that weren’t even long enough for someone to lay flat. The Post-Partum Unit (the “Laying In” room) is where women go after delivery for six hours before being sent home with their newborn. This area housed four frames with mattresses hemorrhaging stuffing at all four corners, and lacking any kind of plastic or protective covering. I work in Labor and Delivery, so this touched a very sensitive cord for me. Thanks for the tissue Renee; that experience was overwhelming. New mattresses could be purchased for 80 cedis ($55.50 American) but this expense is far too great to be affordable to the clinic. Again, I feel like words are not enough and look forward to when I can post pictures for all to see.
I stayed in Ada for a blood pressure clinic with Zanele, Whip (Stephanie), Lauren, and Renee. The other half of the group loaded up into the van to go to a nearby village.
At our BP Clinic we could not prescribe meds because Val was with the other group, so we worked with the clinic and referred people over to their consulting room when we found extreme BPs. I was shocked by some of our findings.
Male, aged 60, 200/90
Male, aged 47, 248/148
Female, aged 40, 210/94
Male, aged 37, 158/100
Many of these people had been on medication for their blood pressure but reported that it was “finished.” They did not understand that blood pressure medication is something you need to be on for life. Through our translators, Prof and Sylvia, we worked with these clients to explain the complications of high blood pressure, lifestyle changes that help improve BP, and the importance of getting on and staying on medicine.
The hardest thing about this interaction was the patients who sat before us for a BP screening but who really had some other medical problem they hoped someone could treat for free, because they could not afford the clinic.
Female, 75, c/o foul smelling urine, question UTI
Female, 23, severely jaundiced, question TB or Hepatitis
Female, 53, c/o right sided pain radiating to her back, possible kidney stone
We had no antibiotics to give these women, no means of testing for hepatitis or TB. Our possible kidney stone was in tears, but we didn’t even have strong pain medicine to offer her relief. It was depressing, but really drew a vivid picture of just how much these people need, because we were offering such a small service and they were still so thankful to be seen by white “nurses.”
Our First Supply Donation
Though we did not have as much to give as we would have liked the donations we offered the clinic at Ada probably doubled the resources that we had seen during our tour. They were all gratefully received by the nurses and other staff members there.
Day 5: Thursday, December 31, 2009
We are staying in Kpando at Cedes Guest House. The girls last year became familiar with this location because they would eat at Cedes Restaurant, which is closed for the time being. The internet café is located directly across the street, but the owner Eyram informed us that the internet was down for the day and he wouldn’t be open on the holiday, New Year’s Day.
The Ministry of Health
I’ve been amazed at how welcoming important government officials have been to us. Twice now we’ve been invited into Ministry buildings to speak with very important people. Today we spoke to representatives for the Ministry of Health and the Director of Health, a Doctor, for the Volta Region. With them we negotiated how our time would be spent during our stay in this region (through January 12th.)
BP Clinic in Torkor
We saw well over 250 patients on this, market day, in Torkor (a fishing village along the Volta Lake.) People waited in the hot sun, many standing, to have their blood pressure taken at one of our four stations. We also set up two other students with BP cuffs who circulated through the crowd taking BPs. Many were sky high, stroke material, blood pressures. We kept Val very busy calling her over to consult about a patient. It was hard to tear ourselves away at the end of the day, but we had dinner arrangements waiting for us on the other end of the day.
Day 6: January, 1st, 2010
Happy New Year! We spent the day in Torkor again. Lauren, Zanele, Jocelyn, and Mawuli walked through the village with a speakerphone to inform people of our location in the market place. Lauren videotaped a good portion of her journey on foot and had some amazing storied to share about life in the village. If there is ever an opportunity to raise awareness about our presence, I will certainly jump at the chance. One man approached the group asking that they come see his ill mother, too sick to travel to the market. The girls saw a hawk with no wings, being kept as a pet. They reported huts upon huts upon huts corded together. And, as we have found to be the case everywhere, they encountered gratitude that we had come.
Back at the clinic…we had quite an influx of children on Day 2, compared to day one. We listened to heart and lung sounds, checking their mouths and discussed dental care, several went home with antibiotics for ringworm-more than I would have anticipated seemingly had umbilical hernias so parents had to be referred to a doctor for surgery.
The adults waited in line for two stations and, again, we found some very high blood pressures requiring amlodopine prescriptions from Val and clinic referrals. We are very lucky to have an NP with us who had access to prescription medications and the knowledge base to prescribe it appropriately. We also saw ringworm, a large venous ulcer on the calf (that was dressed,) vision problems, bilateral leg edema, etc.
On our way out of the village, there was an argument over our agreed on cab fair (50 cents a person.) It’s the first time I felt somewhat unsafe in Ghana. The vast majority of people are very welcoming and friendly. The people of Ghana are typically friendly, truthful, and thankful. Many young children do call us out as we walk down the street (Yovo: white person) but it all feels welcoming. Adults frequently greet us with a “you are welcome to Ghana.”
Our escorts were speaking rapidly in Ewe to the driver, trunks were opening and slamming shut, one man put a hand to another’s chest- it may have been less frightening had the whole argument been in English, but even though this it the “national language” I have been surprised by how many citizens (outside the cities) do not speak English. Most, even who know English, speak in their native tongue amongst themselves.
In any case, we piled (literally as there were 5 of us girls in the cab) our and jumped in another Taxi. Mawuliu has been an incredible advocate and guide for us. I was extremely thankful he negotiated us out of that tense situation. The root of the problem we encountered in this instance is poverty. When some people here see a white face, they see an opportunity to bargain for a higher price. There is this idea that all Americans are extremely rich. Compared to Ghanaians, we are, so I can see where they are coming from. In reality, however, the NSWB’s funds are limited, so we rely on the help of our escorts to keep extra costs reasonable.
Day 7: January 2, 2009
We spent the day visiting the Christian Children’s Home in HoHoe and touring the Wli Waterfalls. Today was the first time I saw an actual chicken pen; most chickens roam around the streets. The children were absolutely adorable. They eagerly greeted our Trotro, carrying 15 of us, and sang songs I recognized…The Lion King, and songs I didn’t, but that appeared to be the kind of children’s songs that have hand movements that go along with the words.
We got a tour of the facility from one of its leaders, Nicholas. There is a girl’s dormitory and boy’s dormitory, three classrooms that are broken up by age, a kitchen, a sleeping area for the volunteers, washrooms for volunteers, and the chicken coop previously mentioned that houses poultry to provide protein sources to the children. Outside the facility is also a playground with an area utilized as a soccer field, swing sets, and some other metal jungle gym type equipment.
It was heartbreaking to see how little these children had. One little girl grabbed my hand and dragged me from room to room, before pulling me into her dormitory, over to her bed. There she dragged a black trash bag out of a cubby and dumped its meager contents on the bed, two plastic horses, a kaleidoscope, a stuffed bunny, a coloring book, and four broken bits of crayon. These were all her worldly possession and she was so proud to hand me her bunny and show me pictures she’d done in her coloring book. Than she gave me her most complete crayon, purple, pointed to a page and said “You draw!” She gave the best of what she had, and shared. It was touching.
Later, before we left, we gave all the children a page from a coloring book and one crayon. We didn’t have enough, at that time, for two per child. However, we have tons of chalk and crayons that will be given to Nicholas, the director, to distribute. Still, I watched the children share colors or come up to trade for a different color. It was certainly nearly a riot to get their hands on the initial round of stuff, but than they were all very kind and civilized…not remotely whiney or selfish as sometimes children in those age brackets can be. Truly, truly impressive…it makes me appreciate so much all that I have and that my parents were able to provide for me.