Wednesday, March 21, 2012

March 29th, 2012 by rbuhr

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

Wednesday, March 21, 2012

March 21st, 2012 by njandreau

Today, we began clinic operations at a new site for the UNE program. A rural village outside of Sekondi called Mpintsa. Dr Morton and Reverend Andoh met with the chief of this village last March, 2011 to talk about the possibility of expanding our services alongside the Ghana Health Service in this village.

Today that discussion came to fruition. The community of Mpintsa welcomed us with open hearts and arms. They waved to us as we drove through their village in two vans loaded with supplies and medicine. We disembarked and scoped out the former home of the chief and quickly came up with a plan for how we would triage and treat the crowd that was waiting patiently for us. In a very small space we managed to set up 4 triage sites, 2 exam rooms with 2 providers in each, a pharmacy and a lab! In just a few hours, the UNE team, 3 GHS nurses, and 7 community health educators saw over 40 patients with complaints and findings that ranged from waist pains and cloudy vision to malaria and chronic wounds.

We will spend tomorrow there as well for the entire day while also making a visit to the local health center, Effia Nkwanta Regional Hospital. The students and faculty are creatively and skillfully participating in interprofessional care in a global setting. Teamwork has been effortless for this group as patients move through all areas including eye exams and providing glasses for those who are having difficulty reading and seeing long distances. All services we are providing is evidence based drawn from the World Health Organization and Ghana Health Services treatment guidelines. The students have been invited to chief Nana Adwai Addae’s palace following clinic tomorrow for a ceremonial thank you.

Dr Richard Anthony, a Ghanaian internal medicine physician will be joining us at Mpinsta tomorrow and delivering the first of a dinner lecture series for the students focusing on endemic conditions of the Western Region of Ghana.

Morton and Morgan

Monday, March 19, 2012

March 21st, 2012 by njandreau

They say its best to hit the ground running, so that is exactly what 6 of us did this morning. We ran from 6-6:45am, sticking along the coastline roads, all the while smiling and greeting those who maybe wondering “What is this, an American Co-ed bowling team”? It’s very different being in a place where you are clearly the minority, so seeing people stare is not something some of us are accustomed to. But what an amazing experience to realize those stares are pure curiosity and not hostility, with the local people smiling and shouting encouragement to these running strangers. Thank you for showing us your true hearts this morning, Sekondi.

After the run was a quick, but delicious breakfast, and off to the clinic we went. There was less set-up necessary today, as there were no church services, but we did make a few logistical changes in order to have a better flow. Once again we hit the ground running, this time not literally, and started seeing patients around 8:45am. There was a patient returning for a blood sugar recheck, and Suzanne took this opportunity to educate this enthusiastic patient about all things diabetes. Mostly what we saw today were patients new to the providers, although there were some family members of patients seen yesterday, and it appears that word has spread in the community.

Today I saw a wide range of complaints, both inter-patient and intra-patient. An example is a patient who hadn’t been seen in 1 year who had visual changes, abdominal pains, headaches and intentional tremors. One complaint at a time, I asked the appropriate questions to get a diagnosis, and treated each complaint to the capability of our clinic. Some complaints, such as the cataracts that this man had, were beyond treatment in our clinic. It is a foreign and difficult reality that diseases we treat easily in the USA are the same diseases that an uninsured Ghanain will just have to live with. We are going to try to get him insured and seen by a doctor here, but there will be no guarantees.

The providers (Dr. J, Karen, James and myself) had a much smoother day of caring for patients, and worked quite synergistically today. We recognized our weaknesses, asked each other for opinions, and together came up with the best treatments possible given our circumstances. I feel that we will only move forward from here, and we will be a well-oiled machine as of tomorrow. Despite what appeared to be a great day between providers, we owe most of our day’s success to our supporting staff (Trish, Casey, Chelsea, Suzanne, Meagan, Sarah, Pat, Justice, Felicia, Ben, Frank, and the others). Without their help, we could not provide as good of care to the patients.

What a fantastic Day 3! The plan is to hit the ground running again tomorrow morning…..

-Shayne Foley, PA-S2

I chose to let the young ones run early today and tried to sneak in an extra hour of sleep after doing battle with the high night time temps and humidity – I already had sweated off 2 liters of fluid during the night!

The team is great, everyone playing a role in getting patients in and through in an orderly fashion. The Ghanians are very patient, waiting hours to be seen. I am one of four providers in the clinic and the “elder” of the group so I get great questions to wrestle with as well as the bill at the local establishment we occasionally retreat to.

Last night I mentioned to the group that we were so prepared to treat malaria (something I have never seen before) but was disappointed that on the first day I had not seen one case. Most of what I saw was the same we would see in an acute care clinic back home. Much different today. The sickest young boy I had seen in ages came to the clinic with his mom. Temp 102.5, pulse 128, respirations 40 and very lethargic. He had been having fevers for 5 days and vomiting without diarrhea as well as a headache. Normal exam otherwise. Meningitis? No, with the aid of fingerstick point of care malaria test produced in Scarborough, Maine, we were able to make the diagnosis of malaria. Emily, our expert pharmacist, worked out the dosing of his meds, we started the WHO oral rehydration protocol and hopefully we will see an improved young boy tomorrow.

I also began an OMT clinic and word began spreading amongst the construction workers and traders in the area. We improvised a table and now another 6 people have been introduced to the healing potential first explained by Dr. Still over 150 years ago.

-Steve Jendzejec D.O.

Today was our second day in clinic and once again it was an enriching experience. I saw my first perforated tempanic membrane, my first tinea capitis, and many other interesting patients. My most memorable case was a woman with Hepatitis B. It was a hard case because we did not have any medications for here in our pharmacy, in fact we don’t think there is any treatment available in Ghana. It was heart breaking for me. While I waited for a consult with Dr. J the patient and I talked about our children. She had an eleven month old on her back and I showed her pictures of my two and a half year old son. In the end I gave her a care package with some soaps and lotions. Even though I could not treat her disease she was still very grateful for my time and the care package. Every day the same question comes to mind, who is being healed in this experience?

-James Mabry PA-S

Sunday, March 18, 2012

March 21st, 2012 by njandreau

While a few enjoyed an early morning run and Rev. Andoh’s church sermon, most of us tried to catch up on sleep in order to be armed and ready for the first day of the clinic. After breakfast and orientation we organized all of the medical supplies we brought from Partners for World Health. We then set up the different stations of the clinic in the sanctuary where we had a triage table, a few provider tables, a pharmacy, as well as a wound care and lab station. We had wonderful community health educators work alongside us as translators to help us provide the most optimal care. From about 1-4:00pm we were able to see and treat a handful of patients with issues ranging from malaria to diabetes to urinary tract infections to back pain (most often referred to by locals as “waist pain”). We quickly molded our own micro-systems within the clinic as we learned what worked well and what didn’t as well as what was most appropriate according to the patient.

After clinic, we went across the street for some refreshing drinks while looking out onto the Gulf of Guinea. We had a fun time getting to know the community health workers and bonding with the rest of the team. We have some exciting new plans to add to the clinic in the days to come so stay tuned!

Quotes/stories of the day from different people?…
…Jen Morton pointed out that the balance of our knowledge as healthcare providers and the community health workers‘ knowledge of the Ghanaian culture really helps to make our mission of appropriate and sustainable care successful.

Saturday, March 17, 2012

March 21st, 2012 by njandreau

Thirteen of us all made it safe and sound to Accra, Ghana after a 10hr flight from the JFK International Airport!  Luckily, with a little outside help and influence (a shout out of thanks to Jack/Grandpa!) we were able to breeze through customs in Accra without any issues.  After a 5 hour bus ride from Accra to Sekondi/Takoradi (and a few bathroom stops along the way) we arrived at One World Church where we were welcomed by our hosts, Rev. Andoh and his family, with an amazing dinner of mushroom soup, rice pilaf and spicy shrimp with sweet plantains for dessert!  It was a long day of traveling and we can’t wait to start up the clinic tomorrow.