Remember me? Yeah me either. ALRIGHT!
We’re now back to Accra at the University of Ghana, Legon. Atta Keelson, Samuel Afari and Ekow Quaye traveled here with us in Quaye’s truck under the auspices of doing business in Tema. However, I know better. These three good men have become attached to us in more ways than merely…
|—||Joe upon reception of an email from his wife|
|—||A wonderful teacher at Challenging Heights (via ghanaservice-kate)|
|—||Sign posted in the nurses station of the maternity ward of the Winneba Municipal Hospital, a frequently evident standard of health care within the facility.|
Beiber Fever - Ghana Style
Based on popular demand, I have decided to upload this impromptu Beiber dance vid. From one of the first nights in Accra. With special guest appearance by Zander.
I have been informed the prank war has begun… (via ghanaservice-kat)
Morgan and I are the current victors!
Winneba, Ghana. Municipal Hospital, Surgical Theatre.
Friday, July 13, 2012. 2:45 p.m.
It has been an exciting week for all of us at our service sites, and the medical students like me finally have a lot to rave about. For most of us, this week has provided more hands on experience and unique up close observations in the field than all of our studies in the U.S. thus far.
On Wednesday, Emily and I were scheduled a rotation in the Surgical Theatre at Municipal Hospital in Winneba. Anxious and unsure exactly what sort of “show” to expect at a theatre of surgery, our day was action packed from 8:30 in the morning until 3:00 in the afternoon. First up in the morning, a woman was brought in for a Caesarian section. I had seen three in the U.S. previously, but it was the first time for Emily – and definitely an entirely different procedural atmosphere for both of us in a Ghanaian operation room. We were provided sets of the required scrubs, head cloths, surgical masks and flip flops and interacted with the considerably large staff on duty; all of which were curious about our intent here in Ghana, our education and our home life.
When the room was prepared (there is only one room in the theatre for major procedures, everything else is done on beds in hallways or the entrance area), we filed in – through old saloon-style swinging wooden doors with many holes in them – with five other staff members, an anesthesiologist and the doctor. Entering Contrary to your typical icebox of an operation room, this area was hotter than any other room in the building. The AC units were off and screened slat windows served as the source of ventilation for the room, which contained one bed, three sets of overhead lights, a monitor machine and a handful of instrument trays. Most of the equipment appeared outdated and frequently used, but everything was well sterilized and proper de-contamination procedures were effectively carried out.
The woman was rolled in on a bed as the staff set up and prepared utensils for the procedure. Staff members chatted and joked with one another as everything was slowly prepared, as the patient was given spinal anesthesia and laid in the middle of all the commotion, in anticipation for about a half hour before the procedure initiated. The rest was fairly similar to the process for a C-section in the U.S., aside from the coming and going of many different staff members in the room, joking around and talking on phones – some even holding up the surgeon’s phone to his ear so he could take calls mid-operation. The birth went smoothly, and we watched intently from the end of the operation table with the new grandmother as the new, wailing baby boy was inspected and coddled. She had the perfect character of a grandmother, calm, collected and comforting; and after we left the room she insisted that we write down our contact information so that we could attend the traditional naming ceremony for the boy after the mother’s recovery.
After sitting in on a repair surgery for a severely broken tibia, the nurses asked if we were sticking around for the next procedure. Intrigued and loving the experience, we agreed. We didn’t really take into consideration what they meant when they said we should “scrub up” for the next procedure until we were being handed rubber aprons, operation room footwear and were guided into the prep room. Looking at each other, we realized we were being invited to partake in the operation. After scrubbing from elbow to fingertip, adorning long sleeved operation coats and two layers of sterilized gloves, we approached the operation table. As the patient was put under and trays were prepped as in the previous procedures, we learned we were going to help the doctor remove an exotosis, or outgrowth of the bone on a man’s foot.
Hesitant and unsure exactly what our duties would entail, we were ushered closer and closer to the patient by the surgeon. Emily was instructed to hold the foot at the proper angle for incision and I was handed an instrument that would pull back and hold the skin once that incision was made. In a blink we were taking the front seat in our first surgical procedure. Being handed scalpels and gauze by the surgical assistant, we learned on our feet. Securing the foot we watched as the incision was made and the doctor began chiseling away at the excess bone. We were front and center for the entire procedure, and I think I can speak for both of us when I say that adrenaline fueled us for the rest of the day. As he completed the surgery with a set of five sutures, the doctor promised that after a few minutes of practice on cloth, he’d let us place the sutures the next time we came in for observation.
I was on cloud nine for the remainder of the afternoon, and even more excited that we were scheduled back in the surgical theatre the next day. We went on to observe the removal of a nearly twenty pound tumor from a woman’s uterus, a hernia repair, draining and repair of a hydrocelectomy, multiple circumcisions and also helped cast a man’s leg. There was more experience packed into two days of rounds in a Ghanaian medical facility than we had been able to get access to within our field back home. I think Emily and the rest of our medical gang would agree that gratitude and giddiness would be the perfect description for our demeanor in the hours following our rounds this week. After a week like this, I can hardly wait to see what the next two will bring.
Today we spent our time at the rescue center which exists in an undisclosed wilderness location for security purposes. The facility, built by a private foundation, houses 48 (44 boys: 4 Girls) newly rescued children ranging from age 5 to 18. These children are severely abused and disaffected with long histories of hopelessness under horrific circumstances. They come to the rescue center as “dead inside” as victims of every kind of exploitation, subjugation and abuse that one can imagine. The main focus of the rescue center is to help the children to feel human again. I was advised not to wave at the children when I entered the rescue center, for some of them will think that they are about to be hit. Hitting is unfortunately a very big part of their precious young lives. As you can see by the theme of the library, Hands Are Not For Hitting. Each child traces a picture of their hands and places them on the wall with all of the other little hands. This exercise, while seemingly simple, is rather complex. First, many of the kids have severe fine motor deficits due to prolonged handling of fishing nets to the point at which their neurology betrays them. Secondly, the act of tracing ones hand is truly a challenge to accomplish with the other finger let alone a crayon. Finally, those that triumph in tracing their hand become more aware of their existence. The hand on the wall becomes evidence that they are actually alive, safe and here with others. It is impossible to exaggerate the plight and the suffering that these little kids have endured. They are the most vulnerable among us.
My close friend and colleague GVSU professor, Michael Ott, studies the sociology of religion. In so doing, he examines only the most unanswerable questions-the chief of which is, “Why do innocents [theodisy] have to suffer?” He’ll be the first to admit that he has no idea, but the very exercise of asking the question triggers a quest for justice while serving to illuminate the human arrangements that make suffering possible. To ignore the suffering of others, or worse, to be indifferent to it, is the ultimate in dehumanization and perhaps the greatest affront to anyone’s God. Yet, this kind of suffering is wholesale across the globe in very religious countries. Today I have just enough energy to avoid the paradox.
When we arrived today at the rescue center, Alex was holding a bag of soccer balls. He was swarmed by little eager arms wrapping themselves around his legs with the rapture of the moment. For the next several hours he and Matt played “Full Field” in the hot humidity, in the dust and sun, with big exhausted smiles. Morgan, Ally and Scott, worked on art projects with some of the kids creating hats, bracelets, paper airplanes and joy. Janaan and I floated around watching the magic unfold. Ultimately there must be a helping of justice in healing. It was a very good day.
Winneba, Ghana. Municipal Hospital, Community Outreach.
Monday/Tuesday, July 9/10, 2012. 5:30 p.m.
I am writing this entry from Cloud Nine, as things have finally taken off for me and the other medical students during rounds this week.
On Monday, after touring the new Trauma Hospital and then breaking up into small groups, Emily and I were sent to the Pediatric Ward of the Municipal Hospital. Here we met the head nurse, two general nurses and three nursing students; all very welcoming, informative and constantly making jokes. We began with a tour of the clinic, which is about the size of an extended travel camper. They have a back room for personal items and supply storage, two main desks where paperwork is done and files are reviewed, and three sectioned off rooms for patients 0 to 6 months, 6 months to 4 years and 5 years to twelve years old. We quickly realized that many things were operated much differently here than we are used to.
All the record keeping and charting is recorded and stored on paper in folders, many of which the patient is responsible for maintaining and bringing with them for clinic visits. The back room, which doubles as a break room and storage area, had a small fridge on the floor where we were told is used to store employee lunch items, as well as all the medication vials, tubes and pills that need to be kept cool. Same shelves as the food, in open containers. Also, we saw along the windowsill six or seven small glass vials of medication that were half empty and resealed with plastic. Upon inquiry we were told they were IV meds that had not been completely used up for other treatment and were being saved if someone else needed the same meds. Parents and visitors passed in and out of the ward without checking in or washing their hands and none of the beds or rooms had privacy curtains or separation of any form, so all procedures and discussions occurred in the view and within earshot of other patients and their families.
The clinic was fairly quiet upon our arrival; there were two young malaria patients, two burn victims, and a child with a casted leg. The first patient we got to interact with was an eight year old girl whose entire right arm, back and right side of her face received second degree burns when turpentine from paint supplies caught fire in her home. It was painful to watch the nurses re-dress her injured parts, and peel off patches of remaining dead skin; as all of the epidermis had been completely burned away; exposing shiny pink and white flesh. The nurse doused a cotton ball with a saline wash and proceeded to wipe down all the burnt flesh, followed by applying an antibiotic cream and dressing the wounds with Vaseline-treated gauze. The girl was tough but couldn’t help but cry as her tender skin was wiped down firmly for about 30 minutes before being re-dressed. The mother looked on sternly as the girl fought not to flinch while her wounds were treated. It became apparent very quickly that much more tough love is practiced amongst parents and health practitioners alike. Children are expected to compose themselves and tough out much more stressing conditions than most youngsters in the U.S. could tolerate.
The second burn patient was a twelve year old boy who had spilled hot soup down his back and upper backside. He had been in treatment for over two weeks, and his burns still had blister areas over his pinkish-white skin. We tried to talk to him and distract him while his wounds were dressed, but he just painfully grimaced and gripped the bed beside him while his entire posterior side was treated. Next to him, lying on her back with a cast wrapped around her waist and entire left leg propped up on a cardboard box was a five-year-old girl who had been hit by a motorcycle while walking through the market. Her femur had been completely dislocated. We watched as family members came in to discuss her progress and then her father gently carried her out. When we asked what she would be given allow her some mobility – a wheelchair or crutches, etc. – the nurses just shook their head and said they could not provide anything of the sort and that being carried by family members would have to suffice. After speaking with families like hers, we learned that most of than them had no health insurance coverage, so their children could not continue receiving treatment – dressings, creams, medication – unless they purchased and provided the staff with the supplies on their own.
Tuesday brought even more active experience for the six of us. We were again split up into groups to participate in community outreach expeditions. Every month, three or four groups of nurses go out into the community to interact with local mothers with infants who can’t or won’t visit the clinic on a regular basis. After setting up in a designated wooden hut along the road, the nurses speak to one or two mothers who then go spread the word to others working or living nearby, and bring their children to be evaluated. Bringing with them coolers of vaccines, a kilogram scale and several record books; the nurses perform all the duties of a monthly check-up for local infants, in the convenience of the mothers’ neighborhoods. I was shocked at the extreme closeness and trust within this community dynamic, as more and more mothers gathered in the area, gossiping with one another and cooing over little ones – sometimes three or four in tow.
The first step, and my job, was to collect the child health handbooks from the mothers, which they are responsible for keeping and bringing to every health consult their newborn attends until they are two years old. The small booklet contains birth information, health history, immunization records and an exponential growth guidance chart that the child’s weight is plotted on and tracked every month. This leads to the most interesting part of the process: weighing the babies. I assisted one of the community nurses in tying several successive knots in a tether rope to be hung from one of the cross beams in the roof of the hut station. Attached to that was a metal hook holding a small hanging weight scale numbered in kilograms, below which a second metal hook hung. Mothers also brought with them a small grocery-like sac in which their naked babies were placed and then hung from the hook below the scale. While the infant hung and swung from the scale, I was given a brief window of time to watch for the needle to settle and chart their weight for the month. It was comical to watch every mother come up and hang up their child like a bag of potatoes from the ceiling then snatch them up when they were done. But the babies were overall compliant; some even enjoying the ten seconds of hang time.
After weighing and providing any necessary immunizations (rotavirus, pneumococcal, polio, Vitamin A and a five-in-one multi vaccine), the nurses conduct a health education discussion with the mothers. Anything from safe family planning to hygiene practices to current disease outbreak and prevention was discussed, and the mothers listened intently. You could tell that the nurses were very respected and active within the community; almost all of the thirty or so mothers who attended knew them and had their books diligently filled out from every monthly visit since their child’s birth. It was very encouraging to see obvious adherence to efforts to reach parts of the community that traditional clinic care cannot accomplish. It is important for people to knowthat awareness of need is existent in Ghana, as well as the effort to resolve it, and like the head nurse told me, “Everyone needs help, we just have to find the right ways to give it to them. If you seek them out, they will listen.”