Student Medical Mission to Ghana

Today we finished up packing before breakfast while a few enjoyed one last early morning run in Ghana.  It will be interesting not to hear the smiling children pointing and  yelling out “bruni, bruni!” (white person), or the women and men who run alongside imitating the run of the brunis.  Before we left our hosts, Rev. Andoh and his family, at Pure Word Chapel, we joined him in a circle of prayer where he asked for safe travels and thanked us for our time and willingness to help the community.  We sang Amazing Grace.  I think that’s what got the water works flowing for most of us!  The sound was amazingly powerful (despite my lack of singing ability) and very moving as we stood in a circle holding hands.

We finally bid farewell to the community health workers and thanked them for all of their help, enthusiasm and humor.  Once all packed up, we headed off to the Cape Coast to tour Elmina Castle.  Elmina was built in 1482 by the Portuguese and served as a trading post on the Gulf of Guinea but later became one of the largest sources of the Atlantic slave trade. It was unfathomable for most of us to imagine what it would have been like as a captured prisoner: crammed in a dark cell with no room to sit or lie down; stepping in your own feces; not knowing when you’ll have food to eat; forgetting what the sun looks and feels like and hoping death will take you before the soldiers do.

On a lighter note, the view from the castle was amazing!  You could see the local fisherman coming in from sea and the carpenters building the wooden fishing boats on the beach.

After emptying out our pockets at the Elmina gift stores getting drums, clay jewelry, and batik clothing, we headed to the Coconut Grove Beach Resort for lunch where we finally got a chance to start decompressing.  Though most of us agreed that the food was not up to par with Enoch’s and the rest of the kitchen staff’s cooking from the week, we enjoyed the ocean breeze and good conversation.  A few of us even tested out the ocean and tried to compete with the futbol skills of the local Ghanaian boys in a beachside futbol game.

After a sufficient workout of getting our butts kicked in the game, we headed to the airport.  Regardless of the traffic and crazy Ghanaian driving (including some hardcore off-roading in our bus) we made it to the airport in time and sped through customs without too much difficulty.

Now safe and sound back in New England, as we adjust to the time change and attempt to rest our brains, we reflect on what we accomplished over the week:

•    Over 6 days of clinic at three different sites (Pure Word Chapel, Mpintsu, and Kansa)

•     We saw about 300 patients over the course of the week!

•    Setting up clinic in the rurual villiage of Mpintsu was a first for UNE. Though there were definitely challenges that arose working in the new space, we were able to see over 100 patients in two days!

•     Our budget allowed us to enroll almost 40 patients AND their families in health insurance for a year!

•    Thirteen healthcare providers, faculty, and students came back with a new awareness of Ghanaian culture and healthcare that will hopefully lend a hand in understanding the importance of providing the most appropriate care to patients of all backgrounds.  The trip offered many memorable experiences that I am sure we will all be talking about for a very long time (a shout our to Jen for making this wonderful journey possible for all of us!).

Meagan Chandler, RN

Starting off the day bright and early, we ventured off to our second day at Mpintsu. We started off by learning some sweet dance moves, like the robotic visor while waiting for the second van (thanks to Shayne). When we arrived at Mpintsu, we thought we would be able to get our stations set up very quickly since we had established a pretty good routine the day before. But once word got out that we were there, we were ambushed with a lot of people and had to quickly assemble order. Frank (the tank), a community worker that organizes everything for us, took the initiative to get everyone under control.

Yesterday we had a patient with an injury in his left knee down to his toes. When I first observed his leg, I would have guessed it was between 2-4 months old. He had been living with a swollen foot and a torn up lower leg for the past 10 years! We put him on our health insurance list and told him to return today to re-bandage the wounds. We were hoping to find out what the hospital said but his appointment was later in the week. Like any other person, he never wanted to go because he did not want his leg to be amputated.  Another follow up we had this morning was with a very sick little boy that was diagnosed with malaria on Monday. He had a fever of 102.5, an extremely high pulse and respirations, and was very lethargic. When he came for his follow-up, we were so happy to see his smiling face full of life. Just witnessing the 360 degree turn around in this little boy made this whole trip worth it. It was definitely a heartwarming moment.

Once we all arrived at the clinic and got the process started, we had to rush one guy to the hospital. He had the textbook definition of heart failure. His blood pressure was 210/150. He was out of breath when talking and said he had to sit up in order to sleep. Dr. Anthony (the local Ghanaian doctor who was helping us at the clinic) wrote him a referral to the hospital and we gave him cab fare so he could go right away. Today we were able to stay later at the clinic and ended up seeing almost 80 patients in 4 hours! Once we were all able to breathe again, Ben (one of our community workers) commented, “You guys are working so fast you are a machine!!”. During those 4 hours, my “adopted child” greeted me again 1 hour into the day. This little girl stayed by my side all day yesterday and today. Oh yoyo ah, how do you feel? She told me she had not eaten in 2 days and was extremely grateful for all the lollipops she was given. I wanted to go and buy her some food, but I was told that I needed to learn very quickly that we cannot help everyone. We wish we could stay for ever, but that is not possible with the amount of supplies we have. If this girl was given food, all the other kids would expect some and a mutiny would occur with this little girl. No matter how bad I wanted to buy her food, I had to learn where to draw the line. Unfortunately, it wasn’t realistic for us to provide food for that many children.

After another successful day at the clinic, we were invited to the chief’s home for a special ceremony. This was a very formal meeting. His wife started it by bringing out a goat fur chair (Akan ceremony chair) for her husband to sit on, along with two elders. The first elder’s job was to speak for the chief at all formal meetings (the linguist). The other elder was a kinman. It was an eye opening experience for the entire group to actually witness how everyone interacts with each other formally. What I really had to adjust to was interacting between the chief and an interpreter. The chief would talk for a good 5 minutes and then at one point we all laughed while the interpreter was coming up with the best way to explain it to us. The chief was asked through his linguist what his two main priorities for the community were.. In his response, he said the top two priorities were health care and education. While improving these two aspects, he said it is it very important that they maintain their community’s culture as well as Ghana’s. He is very proud of their culture and the way everything is run; it defines them and he would never want to change that. I agree with that completely because every community is defined by their culture and religion.

Later in the day we visited Effia Nkwanta Regional Hospital for a tour. When we arrived, I had no idea what to expect. We knew we would be greeted with excellent clinical skill, smiling faces and positive attitudes because that is what all the nurses brought to the table throughout the entire week. The first aspect that caught my eye was the names of every ward in the hospital. For instance, the operating room is called the “operating theatre” and they have male and female wards. I was very impressed with their resourceful to use what they have to their best abilities. For instance, in the U.S. everything is done electronically. If power was lost and the machines stopped working, a lot of the health care providers wouldn’t know how to manually test patients. On the other hand, the nurses here do not have the resources to save time and electronically do tests. They do everything by hand on their own and really understand what they need to do to treat each and every patient. If they do not have the proper supplies, they will find a way to create it. Another aspect of the hospital that I found to be very beneficial was the promotion of breast feeding. In the female/infant ward, there were a lot of posters explaining the proper way to breast feed and the importance of it. Posters were also in the male ward explaining the importance of emotionally supporting their wife throughout the period of breast feeding. They are not only involving the mothers-to-be and explaining the importance and proper way to breast feed but are also involving their husbands in order to provide support. Even with the lack of technology within the hospital, it is very impressive with how efficiently they use their resources to make up for it.

Once we left the hospital and made our way back to the church for dinner, Dr. Anthony joined us to give a talk about endemic disease in Ghana. He reminded us that not every fever is an indicator of malaria.  In actuality, they could very possibly have tuberculosis, typhoid fever, enteric fever, etc. He talked about each illness and how to tell each apart very easily. This ability allows him to make a quick but correct diagnosis’s and move on to the next patient very quickly. Another big issue is diabetes, which goes along side with hypertension. We noticed very quickly how everyone’s feet are really swollen. The majority of the people look like fluid is pooling in their feet. Something we did to help out those with diabetes is teach them proper dietary needs and exercise, making sure to take in their culture and everyday life into account. Suzanne really stepped up to the plate and did some research on how to incorporate their lifestyle with the proper requirements of diabetes. This way they will more likely to be compliant to treatment plans. Another issue we noticed quite frequently was numbness in the extremities. This symptom is usually caused by a vitamin b deficiency. A couple of us went up to Dr. Anthony and asked what he does for treatment. He said that vitamin b deficiency is quite common due to a fish tapeworm. Dr. Anthony is a very smart doctor and definitely works towards the long term well being and health of the people of Ghana. This all starts with promoting health education and healthcare prevention, as well as treating acute care that will prevent a lot of serious illnesses that do not need to be present. A great example of this is diabetes. A very popular side effect that is due to the lack of acute care of diabetes is kidney failure. By just walking up and down the streets of Sekondi, you can see how popular kidney side effects are. A lot of the Ghana health care providers want to start preventing chronic illnesses by providing and educating people on acute care. Jen Morton has acknowledged this act by providing knowledge and health care to the Ghanaian population twice a year for the last 14 years! By coming back over and over again, she has started a longitudinal trend that other health care providers are catching on to. Instead of catching diseases at the end when it is too late, we are now taking care of everything in the beginning phases to prevent chronic diseases. Hopefully today we have made at least the smallest of differences in our patients’ lives that will move them towards a better, healthier life.
-    Sarah Rheault

Hello how are you? (Otenden?) Today the team packed up a van full of supplies and another full of healthcare providers to outreach in a rural village called Mpintsin (about 20 min. from the church we reside in). After arrival, we were graciously welcomed by the people of this small rural area.  With a more diverse and impoverished population, we set up the clinic as strategically as possible. We unloaded the van and entered what used to be the chief’s house.

The lab, pharmacy, and triage room was all tactically puzzled together in an open air 20×10 foot area. The people, eager for attention, reached out for one of the 34 patient intake cards allowed to be distributed that day (typically, we usually see about 50 patients but today we had a shorter clinic day). This was a little chaotic, but with the help of brilliant community workers, our UNE team, locals and Ghanaian Health Service nurses, Sylvia, Evi and Grace, we were able to synergistically organize and find some order to then start the day. The cases that presented were interesting and incredible. Every day, I find myself more and more amazed by the Ghanaians. The patience they possess, their intelligence, strength, and pain tolerance. With this in mind, some of the cases we saw could have been easily avoided with simple health visit and follow-up, a concept much easier for a country with rich resources.

A man today had a sizable (possible) streptococcus infection that ate away at his skin, so large that he could not bear any weight on it and needed crutches to walk. His foot too, was the size and shape of a football. When asked how he got the wound he replied, “it was a curse put on me 10 years ago.”  10 years he had been battling this infection!  This is one of many examples of the resiliency and strength Ghanaians display as well as the cultural overlay that define perceptions of health. He will return tomorrow for a second visit. We plan to see the others tomorrow that could not get numbers today.

We are keeping a running list of those people in need of health insurance. We learned that health insurance usually costs around 35 Ghanaian Cedis (about $25-) A YEAR! Most of those needing care could not afford health insurance. Part of our clinic fund goes to enrolling qualified patients in healthcare insurance for one year or more. We hope this will support more sustainable, long term care.

After the clinic and a nice Ghanaian meal, (favorite) red red (black eyed beans and fried plantain), we ventured forth to Kakum National Park. The park features a canopy walk that is 350 meters high and sits 40 meters above the ground. It was nice to see people face their fears, and push themselves to new African HEIGHTS!  Cheers for overcoming fears!

As we joyfully scampered down the walk and hopped on the trotro (Ghanaian Vans) we got about half a mile down the road until the trotro broke down. The group made the most of the hour long wait for rescue (by constructing a makeshift bench out of bamboo…Emily’s idea) on the side of the road.  We finally arrived home safe and sound.  Although temporarily without electricity, we are happy to be resting easy in our beds, very grateful for this day, its challenges, and its accomplishments.

A special Meda ase (Thank you) to everyone here in Ghana and those back home that support and care for us during this remarkable journey.

Suzanne Bruen, RN
Meagan Chandler, RN