We spent two days working as a large group here at the mission in Sekondi. On Wednesday, half of our group boarded a bus and traveled to the “upcountry” in a rural village called Kansawarado which I’m told is about 10 miles away but a much more rural area. I have yet to go up there so I will not speak to that yet; my first trip there will be tomorrow.
Tuesday, we improved from seeing 80 patients to about 95. Wednesday, we saw about 40 patients here in Sekondi and the group upcountry saw about 30. We begin our day with a set number of patients that we triage and have wait to see a provider, if we move patients through more quickly than we thought, we allow several more patients through the triage line. Our goal is to be done at 1:00 to eat lunch between 1:00 and 1:30.
This brings up an important distinction between our cultures, in America 1:30 means 1:30, but here in Ghana the timing is not so strict. Most people do not have clocks or watches and even if they do, the sense of time here is so relaxed that our meals have been ready an average of 15 minutes later than planned. We have been very gracious and understanding of this cultural norm. Ghanaian ice cream, a dessert that we have had every night is rich and creamy with a strong vanilla flavor.
As said before, we have seen many cases of malaria, intestinal worms, and surprisingly, quite a few wounds requiring daily dressing changes. One wound was on the edge of our capability to treat, but we decided to try as the gentleman was a fisherman, who we were told, are not typically receptive to Ghanaian healthcare but rather folk healing. This poor man had the unfortunate luck of having a bench fall on his foot causing a wound three weeks ago. By the time we saw it; it was badly infected and had deteriorated almost all the way through his dermis to his muscle and bone. Dara and I, with guidance from Karen (UT), had to clean the wound very well to asses it because it was covered in a symbolic medicine given to him by the traditional medicine man. We applied a wet-to-dry dressing and were hopeful for improvement. This was not the case and subsequently the gentleman was referred to the local hospital Effia Kwanta.
Another patient seen daily is a two year old girl with a burn on her back from falling backwards on to a bowl of hot soup. After three days of dressing changes, she starts crying when she first sees me at 8:00 AM. The first day treating her was difficult for her and for us as she cried loudly in discomfort. Today she cried much less and her wound looked to be healing nicely. Today, we even got a smile before she left; a smile we will never forget for the rest of our lives.
These cases are the ones we have to hold onto at the end of the day because there are many that we unfortunately to do not have the supplies or resources to treat. Each day we have to turn away many people and ask them to come the next day because we simply do not have the time to treat everyone. As we walk back to our building from the clinic for a break or to use the restroom, many of us are approached by people waiting to be seen through triage. It breaks my heart to have to tell them to come back in the morning.
Many of these patients come to us because they do not yet have the national health insurance. NHI costs approximately the equivalent of 28 cedis ($25 USD) which is more than one week’s earnings for the average employed Ghanaian. When we find a case that is anticipated to require ongoing services, GHM pays for the individual to enroll in national health insurance.
One of our most common patient complaints is translated as “waist pains.” Many of the people complaining of waist pains are women we can directly attribute to their cultural custom of carrying everything on their heads. I’ve been told that women can work in construction carrying large blocks of concrete on their heads. But no matter if it is a basket of laundry or concrete, the pain is very real and there is little besides stretches and strengthening that we can do while practicing culturally competent care. Physical therapy has been very busy with these patients and we are so glad they are along to provide care for these people.
The clinic itself is running smoothly and we are all learning a lot and able to see and practice things we would rarely get to do in the USA. We are all doing well. While living in close quarters can be difficult, we are building friendships I believe will last a lifetime and memories that will never fade.