Our first day started bright and early…according to our body clocks. We actually had breakfast at 7:30 and began the clinic at 8:00. Community workers had given out 80 clinic cards first-come-first-serve to people who had been lining up as early as 5:00 this morning. Our community health workers are future church leaders recruited by Rev. Andoh.
Nurses were paired with a community worker who serves as an interpreter during our patient interactions. Ginny and Megan (med-bio) assisted with triage while Jen Bayron (med-bio went with Leda to the pharmacy in Takoradi to buy more medications. They prefer to buy as many medications here in Ghana as possible to help support the local community’s economy. Professor Simpson and Amanda MacAvoy also worked together. After we triaged the patients and helping them to rate their top three concerns, information was gathered about malaria incidence and treatments, hospitalizations, and the last date of worming medication. If a patient’s last deworming was greater than three months ago, we offer deworming medications.
During triage, we also assessed the patients need for PT and/or OT and we referred all patients over the age of 40 to the eyeglass clinic run by Steph Bliss (OT). Steph reported giving out 20 pairs of reading glasses, 1:4 patients was in need of a reading aid. She was especially happy for an excited patient who left the clinic able to read with rhinestone encrusted donated reading glasses.
Elisa and I were both struck by our first encounter with undiagnosed cancer in a developing nation. Our patient had a very deformed, fibrous breast which the cancer had actually begun to penetrate through her skin. She complained of no pain which also took us by surprise. Upon further discussion, she disclosed that one breast had begun to “do this” and the other had recently begun as well. We discovered a walnut sized lump in that breast as well as lympadenopathy in her neck and subclavicular lymph nodes which strongly indicated they were cancerous as well. While debriefing with our veteran instructors we found that we see many advanced cancers in the developing world that have received no treatment and often times there is little treatment available.
Jim, Lindsey and Laura, our physical therapy department, saw about 25 patients today. They exhausted their supply of canes during our first day bringing to light what a need there is here in Ghana for assistive devices. Tomorrow they explore local options to creating assistive devices.
When discussing what my fellow students had been impacted by during the day, Professor Morton was moved by the sense of interprofessionalism exhibited by the students. For example, in triage nursing and med-bio students referred 25 patients for PT/OT services. This suggests a true understanding of what each other does. Karen Lasater from the University of Tennessee chimed in mentioning she was impressed with the competency exhibited by all the students. Brenda, our Physician’s Assistant professor was proud of the teamwork between students, faculty and community workers, exclaiming how impressive it was that we saw 80 patients on our first day and still ended on time.
Several of our students were impressed by how smoothly things felt the day flowed. We were all impacted by how high the incidence of malaria actually was despite the fact that we knew this was a high infectious area. Another diagnosis we had never seen included elephantitis, which is a worm causing swelling and blockage of the lymph system causing outward swelling, blistering and weeping of the lower extremities requiring treatment to prevent chronic disease. Nancy was struck by how effective students’ cultural skills were in context of the patient/interpreter experience.
We had many other experiences today which exuded a very strong sense of community and sharing that I will explore in a later blog. Many other medical diagnosis as well as cultural practices will provide much for me to write about and you, I hope to discuss in our comments section.