Weekend Activities

August 18th, 2009 by njandreau

On most trips, the clinic runs a normal day on Saturdays. This year, we are excited and honored to have been invited to a wedding. Leonard Wryder, Pharm.D. a native of Sekondi now resides in Virginia. He has graciously helped our clinic’s pharmacy while he has been home to celebrate his sister’s marriage. Her ceremony was held in the church where our clinic was operating. In order to be sensitive to the family, we moved all of clinic operations to Kansa for a few hours that morning. Ginny Lee (Med Bio) and I here to care for our daily dressing change patients.

I would describe the wedding in a nut shell as an African flavored Christian wedding. Olive green, mint green and crème colored satin were hung from the walls with complementing flowers in the aisle at intervals on short pillars. There was a gospel choir which sang until the bride arrived. The guests wore traditional Ghanaian dress clothing while the bridal party dressed in traditional western wedding clothing. After the bride’s entrance, the couple with their best man and lady of honor sat under a canopy on silk covered chairs. The bride and groom were called forward to state their freedom and ability to marry, exchange of vows and rings, and blessing. We were seated in the back and at this point we all quietly left through the side door because we had a fun afternoon already planned. As we left, the congregation continued singing and celebrating. We were told that although the whole church community is invited to the wedding ceremony, the close friends and family of the bride and groom would go on to a reception later that afternoon.

We piled into our vans and headed for a resort restaurant on the ocean in Takoradi for an afternoon of leisure following a long clinc week.  Our buffet had some American food such as grilled chicken and some Ghanaian dishes as well. We could swim in the pool or ocean and many took advantage of this opportunity for a small fee of 5 cedis. For those who were interested, there were also a few artisan shops just outside the gate selling masks, jewelry, drums, carvings, and much more. The ocean was beautiful; waves breaking at several different intervals coming in towards the shore. A few hours of relaxation with our group was a much needed recharge for this busy week ahead.

doorSunday morning, we slept in half hour, (till 7:30!), ate breakfast, and jumped on a bus to the Castle del Mena, the largest and oldest of the castles on the coast used during the African slave trade. The castle was originally under Portuguese control until the Dutch took over and later the British. The castle finally came under local control when the Ghanaians won their independence in 1957. The castle is in excellent condition and although some supports have been added and wooden beams replaced, the structural soundness is attributed to a 400 ft deep foundation. Touring the castle was a deeply profound experience. It is situated on such a beautiful coastline; it is hard to imagine the atrocities that occurred behind those walls.

We traveled just up the road to Coconut Grove for lunch and a little more relaxation after a morning of history. This British style resort allowed guests to use their pool or swim on their private beach, also for a small fee including a towel and padding for a beach chair. I heard several languages spoken including German, English, and a variety of Ashanti (native languages of many Ghanaians) and a couple I could not identify. We walked the beach picking up shells and taking pictures; no one from our group dared venture into the ocean after being warned of a very strong undertow. Returning home in time for dinner, some of us lighter complexion people were a little pink despite several applications of sunscreen. Luckily, the hot African sun did not burn anyone while out between clouds.

This week will be busy for us. We have half of our group going to the upcountry location in Kansawarado (Kansa) and half staying here in Sekondi for Monday, Tuesday, and Wednesday. Tuesday night we will all be attending a church service in honor of the GHM team here at the mission wearing the traditional dresses made for this special night. Wednesday night there will be a Ghanaian drumming group coming to the mission to perform for us. After our final clinic day on Wednesday, we will leave early Thursday morning for the long drive back to Accra and an afternoon in the market. We will be staying in a hotel Thursday night and at the airport by 7AM on Friday morning for our long plane ride home.

Market Shopping

August 14th, 2009 by njandreau

The Ghanaian market is an experience similar to China Town, NYC only it is much, much bigger.  People on the street are trying to sell you everything from prepaid cell phone minutes to purses to fabric to cured fish carried on plates on their heads.  For many students, Monday was the first venture out into the market.  We went as a group in a bus with several of the community workers to guide and interpret.  Without a Ghanaian with you who knows normal pricing, some market traders will inflate pricing.

girlsThe street was as crowded as the streets of Accra; pedestrians weaving in and out of traffic toting their wares and hollering their prices.  Goats are everywhere here, roaming the streets and I’ve been told that no matter how far they roam, they always return to their owners at night.  Taxis and busses beep incessantly.  They honk for a variety of reasons; to acknowledge other drivers, warn other vehicles from cutting them off, and warning pedestrians not to step out in front of them.

Our first venture into the market was in search of fabric.  We have met a wonderful friend.  Magdalena, a local seamstress, will create anything we wish if we provide the fabric, a description or a drawing.  She took all of our measurements the first evening to make traditional clothing for us as a Thank-You from the church community.  We will wear our new Ghanaian clothing to the church service this Sunday.  She has come every night this week, bringing a few completed items each night.

The market itself is enormous.  There are several main streets surrounding it with shops selling purses, watches, scarves, etc.  Between the stalls about every 500 yards are alleyways that lead deeper into the market.  Shops selling similar wares are gathered in the same areas; we walked through the fish and beading booths to reach the fabric booths.  Ghana has undergone many changes in the last twenty years opening their fashion to more intricate, less traditional fabric.  Traditional fabrics are geometric designs using mainly yellow/gold, black, red, and green.  These traditional fabrics are now mixed in with newer patterns incorporating blues, purples, silver and pinks.  Batiks, Tye Dyes and Kente designs represent the variety available here in Ghana.

Standing at the entrance to a shop can be an overwhelming experience; traditional white and black patterns as worn to the funerals in one area, traditional geometric patterns in another area, batiks covering a whole wall, and other colorful designs with gold or silver markings making the patterns even more intricate filling the rest of the shop.  Some of the shops are only 2ft x 10ft, making group shopping very difficult, where others may be 5ft x 15 ft.  The lighting is poor in many shops making selection of fabric a challenge.  Regardless of how cramped we may be shopping, the fabrics are so beautiful and so inexpensive that we cannot resist.  Fabric is sold by the yard as in the USA, but I am amazed that many of the fabrics sell for only two or three cedis per yard.  With the current exchange rate, a yard of fabric at 2 cedis per yard equals about $1.37/yd USD.

We also went to a craft fair with only a few booths but much different merchandise than we found in the market.  Wood carvings, paintings, drums, masks and jewelry are a sampling of what they had for sale.  Although they are beautiful, we are cautioned by our leaders that the market we go to in Accra on our last day has a greater selection and more detailed work but the prices are a little higher.  A store down the street called the wood carvers shop also sells clothing, purses, masks, paintings, drums, and much more.

First Week Observations

August 14th, 2009 by njandreau

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.

childrenTuesday, 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.

burn-childAnother 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.

boycrutchesOne 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.

First Clinic Day!

August 11th, 2009 by njandreau

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.

elvis_healthworkerJim, 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.

Preparation for our Clinic and a Ghanaian Funeral

August 11th, 2009 by njandreau

We awoke this morning well rested but not necessarily awake.  Instant coffee or tea for those craving their caffeine was an immediate necessity and those of us who don’t need a morning boost had water.  Breakfast was deliciously familiar; eggs and toast with peanut butter (brought from home) and apricot jam.  After, we had a meeting to discuss everyone’s responsibilities in the clinic and the rotation of those responsibilities during the week.  We then were given free time until after lunch as church services were being held in the building we will be setting up the clinic in.  Some of us slept, others read, visited, or took a short walk.

Setting up the clinic required much sorting of medical supplies from previous years and adding in the ones we brought ourselves.  Dara, Matt, a nursing faculty who joined us from the University of Tennessee and myself sorted dressing and skin supplies while others set up the provider tables with various products such as alcohol swabs, germx, band aids, thermometers, tongue depressors and other frequently needed equipment.  A neat tid-bit I picked up from Leda, the founder of Ghana Health Mission, is that here in Ghana, a previous British colony, temperatures are not taken routinely but only if a patient complains of being feverish or looks feverish.  Stephanie, Ethan-Jennifer Morton’s son who joined us for the mission, and Laura cleaned the several hundred donated reading glasses and sunglasses.  Everyone helped in some way making the process go smoothly.

Leda then announced she would be taking us across the street to a small naval facility which served the only beer around.  As we started walking over we noticed tents and Paul went to investigate.  Everyone was in festive black and white patterned traditional clothing and there was a live band and dancing.  He came back reporting it was a funeral and if we wanted to join, someone would either have to die or play dead while they set up tables for us down near the ocean.  Later, that proved not to be the case.

Beer and coca-cola products were available in the older traditional glass bottles.  Under slightly overcast skies, waves crashed against the rocky shore spraying high in the air sending a light mist of spray over the people closest to the ocean.   The water here is a light brownish color but the waves are two to three times the size of waves in Maine.  Although we were nervous about intruding, the Ghanaians seemed as curious about us as we were about them.

As we sat by the ocean some children ran up outside the fence asking to have their picture taken, the camera fever spread to some of the young men who posed dancing on the rocks in front of the ocean.  As we turned back to our conversations, trying to observe the festivities without being offensive or culturally insensitive, one of the young men invited us to dance.  We all politely refused until he came over and took my hand, asking me to dance with him while pulling me to my feet.  Not wanting to offend anyone but nervous also about offending others by accepting, I allowed myself to be led to the dancing area in front of the gazebo.  The Ghanaians around me seemed very excited I was willing to participate, the welcomed me clapping and singing.  Soon I was joined by Jen who had been convinced to come by another young man.  As we sat down they approached several other participants who were all also welcomed into the dancing.  Happy for our participation and full of excitement of the celebration, we left our new friends and returned for dinner.