Ghana January 4th & 5th 2010
we split up into two groups. My group went with Val to spend the day at
patients were weighed on a bathroom scale that wasnít zeroed; it was probably
about 2 to 3 kg off. However, if all the women weigh in on the same scale each
time, I suppose that isnít a huge concern. There was a sink in the room with a
small bar of soap and even a hand sanitizer dispenser that was about one fourth
full. I saw the head midwife wash her hands in the sink twice, and utilize the
sanitizer once. Her colleague never washed her hands in my presence. The linen
on the exam table, along with the privacy sheet, were not changed between
patients. The blood pressure cuff was mercury, and not every patient had a BP
taken. The same was true with FHR, and even when the babies heart rate was
assessed it was for but a momentÖnot to obtain an actual rate. The tool they
utilized for this intervention was a metal funnel with a round flat base with a
hole in it. They would ascertain the position of the infant and then press the
widest point of the funnel against the motherís stomach, placing their ear on
the round circular part. I was amazed when I was given the opportunity to
listen for myself. You could hear the infantís heart beat fairly clearly. I
asked what would be utilized in labor and the midwife showed me a Doppler but
reported that it was broken, and a replacement was nowhere in sight. This
appears to be a common problem in
When medicating patients with a
I then asked what would happen if
the midwife was able to hear the rate and knew the infant was having
decelerations or in distress. The mother, I was told, would then be referred to
The one intervention I witnessed that I donít see in the States with our patients was prophylactic malaria medication. Along with prenatal vitamins, patients are routinely prescribed a course of antimalarial treatment. They take three pills at 16 weeks, take another 3 a month later, and the last dose of three a month after that. I would later learn at the hospital that, despite these precautions, Malaria is still the number one cause of stillbirth.
The entire conversation/history was conducted in Ewe (the native tongue of the Volta Region) so I did not know exactly what was being said all the time. One of the midwives (Sister Mary) was very good about translating, but the other was not so much. Still, privacy in the clinical setting is very different from the States, and I also observed a much less compassionate and friendly approach in the nurse-client interaction. A patient would come and sit, hand over her maternal record, and the midwife would often not look up or address the patient. She would transcribe from the record to her book and then order the patient on the scale, or to hold out her arm for a BP reading, or to get up on the table for a fundal height check. There did not seem to be much back and forth, or chatting about the day/the pregnancy/concerns, etc. Later in the day, while doing intakes with a few different women, I got this same impression from those other nurses I worked with.
I donít think the three year nursing program here emphasizes compassion and communication skills. There is a lot of staring at paperwork and asking short questions. There is little follow-up, minimal eye contact, no smiles exchanged. I donít think it would be unwelcomed by the patients, making kindness a culturally irrelevant means of practicing nursing. I spoke with one little boy about his thumb, while his father answered the nurseís inquiries about his injury. At first he was timid, in part Iím sure because of my odd color, but then he was smiling and explaining that he fell and it hurt a little. The father turned to me and smiled, and he said thank you later when they left for the consulting room to get patched up.
Kwado, our guide, reported during
debriefing that nurses in
Day 9: Tuesday, January 5th, 2009
Birthday Allison G, NSWB Treasurer! I spent the day at the clinic again. My
morning was with Maria, a third year medical student from
The most common illness seen here at the clinic is malaria. Of the 60 patients that were seen the previous day, I counted 35 as being diagnosed with Malaria when I worked on intakes. Today we also say septic arthritis, this young man did not even speak Ewe, he had just come to town for market and to see a doctor. His complaint was joint pain and a cough for over a month. His elbows and knees were extremely hot to the touch, so Maria decided to start him on oral antibiotics for 21 days. She doesnít have access to IV antibiotics at the clinic and he said he could not afford to go to the hospital. She was going to ďdetainĒ (admit him) for the day to be sure he got his prescription filled and received the first dose. These are the kind of decisions she says she has to make every day when treating patients in this area.
Also interesting to note is that Maria is only volunteering here for 2 weeks, and she is considered senior staff and is one of only two doctors (the other holds a more administrative position and was not present on either day I was at the clinic.)
After work we all headed out to play, including Maria and her host (Shine) who is a nurse that housed both Val and Maura during their stay last year. The market was jam-packed full of vendors, goods, people and animals. I know I have not done a very good job at describing what it looks like here, and (Iíll say it again) canít wait to post pictures, but Iíll try.
Women carry their infants on their backs with long colorful cloth, they are often are attired in dresses or skirts with a top. The men are often in cache, jeans, or black pants, and button-up shirts are more popular than t-shirts. Nearly everyone whereís flip-flops, if they have shoes on. It is more common to see barefooted children than adults. Children, of all ages and sizes, can be found on the streets during the day and night. They run around in packs or small groupings, and are rarely accompanied by an adult as far as I can see. Everyone carries items on their heads. Vendors will have metal bowls full of bags (not bottles) or water or macaroni or plantain chips, etc. Sometimes they have wooden boxes with clear side panels full of meat pies or pre-cut pineapple wedges, or stew in a bowl with cups. Itís not uncommon to see women selling eggs even, balanced on round trays and stacked, god only knows how.
At the market there were permanent looking structures with cover/roofs. There were also makeshift stands as far as the eye could see. The colors and smells and amount of people were overwhelming; as were many of the smells (some good and some not so good.) There was fabric for sale, tomatoes, hot peppers, gold jewelry, sandals, bread, traditional beads, carvings, etc. If you can imagine it, you could probably find it for sale on market day. I ended up buying fabric that I took to Billy the dressmaker later that day to have custom dress made for me before I leave. Maria and Shine were good at bartering, but I just traveled from front to front until I liked the price (and the fabric.) I found two yards for 4 cedis, which is what Billy informed us it would take to make a dress. He only charges 7 cedis for his work, so I feel like this will be an amazing and memorable souvenir for me.
There is so much more I could
report, but need to work on packaging boxes of supplies to present at the
Childrenís Home tomorrow. I just want to note that everyday I miss my family,
friends, coworkers, and (of course) my boyfriend. Still, I am over the major
hump of the culture shock. Iím used to the sights, smells, language, etc. I
know that I am still living a privileged lifestyle even while I live in
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