children's ward madness

For my last full week at the hospital I decided to go back to my favorite place, the children’s ward. I mean I had an idea the staff there liked me the first time I went but it was well confirmed when they thanked god for my return in their morning prayer on both Monday and Tuesday…. and then made me do the prayer on Wednesday. I really enjoy the children’s ward because it’s a nice mix of shadowing the doctor, administering medication, playing with cute kids and hearing interesting cases. This week happened to be extra crazy due to an influx in admissions, but it just made it more exciting. On Wednesday the ward was an absolute zoo with 46 patients and nowhere to walk because we only have 28 beds… but somehow we made it work. We had some of the most interesting patient stories I’ve heard all summer this week so I’ll pick some of my favorites to share. 

Bright and early on Monday morning we got a patient delivered with a police report attached. Apparently the mother thought it would be a good idea to feed her child chicken poop so the police wrote her up for abuse and then sent him to us for treatment. Dr. Boateng gets really mad when “stupid mothers” come in with children that are sick because of their own care. There’s a common practice here in Ghana where the mothers use edemas to try to stop their child from having diarrhea. Edemas are basically clumps of herbs that they stick up the children’s butt and then light on fire. It clearly sounds ridiculous and harmful but for some reason they think it’ll cure their child. As a result we get small children admitted to the ward with severe internal problems that are extremely difficult to treat in a timely manner. I often walk into the ward and find Dr Boateng yelling at the mothers but he admits that nothing is going to change their mind most of the time. He was telling me about a patient he had a while ago that was a completely healthy baby but they only complaint the mother had was that she wouldn’t sleep at night. After running a bunch of labs it clicked in his mind to ask the mother what she gives the child besides breast milk. The mom told him that she also gives her child cowbell dairy milk (which come in powder form that you add water too). Dr Boateng asked her to bring in the packets to see what she meant and sure enough, she was feeding her newborn coffee flavored milk. The packet was full of both caffeine and sugar, which would easily explain why the child was never able to sleep. While yelling at her he realized that she truly had no idea that coffee was bad for children in which he responded that she shouldn’t of had children without first getting an education.

I didn’t realize it until he was telling me this story that it must be really frustrating for those in Ghana who are really well-educated to watch those around them who refuse to get schooling. There are so many problems (especially in healthcare) that could be solved if the people here would just educate themselves and take care of their bodies. During rounds we spend so much extra time explaining proper nutrition and sanitation to young women. We get as basic as, “you must wash your hands after changing your baby’s diaper if you’re going to feed them right after” because these women honestly have no idea. Just yesterday I stopped a mother from wiping her child’s face with a cloth that she just used to put under the baby she was changing. It’s both sad and annoying that they all have access to free education and just refuse to put in the time and effort.

Anyways….back to the interesting patients. During rounds on Tuesday Dr Boateng got called to the maternity ward and told me to follow. Upon arriving we found a mother giving birth but the baby was stuck in the birth canal. Since babies can only be in the birth canal for a max of 30 minutes he took out a vacuum to suck the baby out. As if it wasn’t violent and painful already, in the middle of suctioning the stuck baby out he performed an episiotomy with a pair of scissors on the poor mother. After that traumatizing experience I vowed to not follow him to the maternity ward anymore.

I feel like I haven’t shared any interesting cultural information with you guys lately so I tried to put together some quick little details. First of all, there’s a HUGE stigma in health care here with any life-threatening disease so they have code names for health professionals to use when talking about them. At our hospital they use “ARTI” to indicate a patient’s folder that has HIV/AIDS. If they’re sending blood for an HIV test they’re getting a “spot” test and they call Tuberculosis “Cox’s Disease”. It gets really confusing when you’re looking at the folders and there’s a bunch of initials that you’ve never heard of but if someone glances at a folder they’ll never realize what they’re reading and the patient will be saved from the embarrassment they would face. It’s also very common in Ghana for husbands to live/work far away from their wife and children if the woman also has a career. At first we thought it was just an unfortunate situation for Ashley and Christina’s homestay dad but we now know that it’s extremely common. Surprisingly, the women here aren’t expected to give up their jobs and careers to be close to their husband. Instead, they basically live like single mothers and just get to see their husbands when they get time off. They also consider calling someone fat here a compliment because it means you’re well-nourished and can afford food. However, our homestay knows it’s insulting in America so they were asking me how we nicely call someone fat. After explaining to them that it’s quite impossible they offered the suggestion of calling people “supersized” because it sounds a lot nicer than “fat”. I assured them that was a HORRIBLE idea but they insisted….. so if a visiting Ghanaian calls you supersized in America it’s most-likely my homestay sisters.

This weekend we’re staying in Asikuma for a lot of exciting events. Tonight we’re attending a naming party where Ashley and Christina’s homestay dad will finally give a name to his month-old baby. Giving a baby a permanent name here is a really big deal so we’re going to attend the ceremony and party with our families. Tomorrow afternoon we’ve been invited to Dr Paublo’s house (the surgeon I shadowed for two weeks) where his wife is excited to make us an authentic Cuban meal and teach us how to dance. We’ll finish the weekend on Sunday by going to church with our family…. which should be an interesting experience. I honestly can’t believe this is already my last weekend in Asikuma before heading back to Cape Coast for good on Wednesday. But……. we’re not going to think/talk about that so I hope to update you all again soon!   

A day in Ayedwe

On Friday I had the privilege of participating in a community needs assessment program in a small village named Ayedwe. The purpose of a community needs assessment is for the community members to assess and prioritize needs within their community and to discover sustainable solutions. Ten of us interns from ProWorld were allowed to go along with the staff and I even got to be a focus group facilitator.

I’ll start off by sharing a little bit about the village we went to. They get their water from a borehole but the borehole is currently broken so they get dirty water from a stream and many of them get sick. Their main religion is catholic and they have one wood ditch latrine for the entire community to share. They don’t have any schools and are 30 minutes away from a hospital. The nearest police station and municipality are also 30 minutes away. Ayedwe has a total population of 450 people, no waste disposal system and no electricity. Their main source of income is farming cocoa, cassava, plantains and palm oil. Their main language is Twi so I worked with a translator throughout the day.

The first half of the morning was spent getting to know my group of 10 individuals. Luckily my cluster was made up of people with all different ages, genders, occupations, and roles in the community. After we played the name game they taught me a prayer dance and sang a couple songs. Once everyone was happy and acquainted we started off with a discussion of the major needs of the community. For about an hour they rattled off different ideas like: a palm oil machine, new borehole, electricity, community center, school, pharmacy, tin roofs, farming equipment, new roads, a soccer net, and new latrines. While they shared their needs, we drew them on a piece of construction paper to use while voting. At the end of the discussion they were each given 10 beans and told that they anonymously had to vote for the issue they thought was the most pressing. If they felt really strongly about one particular need they were advised to place all 10 beans on that picture but if they liked a couple ideas they were allowed to spread their beans out. 

The top three needs in my particular group came out to be: a palm oil machine, a community center, and clean water. The next step of the program was to have an open discussion about the underlying problems the community faced that would result in these three needs being the most pressing. I was shocked at how honest everyone in my group was and we seemed to cut right to the core. I won’t go into too much detail but a lot of the underlying issues came back to not having enough money, which was a result of poor income generation. The only income the community members have is coming from farming and petty training. However, they don’t have enough farming equipment to produce crops that will make them a sufficient amount of money.

When we moved to the “sustainable solutions” portion of the day my group was very ambitious and produced an entire plan of action. They stated that if we could get them a palm oil machine they would be able to make a greater amount of money. They could then set aside some of the money to fundraise for a community center. The community center they’re dreaming of would serve many purposes such as a school, meeting place, shaded market, hall for educational health talks, and a room to host any guests that come to the village. In theory, the water problem would be solved simultaneously with the other two problems. Right now the borehole just needs to be fixed by the company that originally put it in for them so as long as we can contact the company that should be easy to fix. However, the group came up with some alternate solutions incase that doesn’t work or becomes too expensive. They suggested building a well, getting a government water tank or creating some type of water filtration system so they can just keep using the water they currently are.

            Looking back on the experience makes me realize how rewarding and interesting the whole assessment was. There are so many remote villages like Ayedwe that just need a little push in the right direction and some aid to get them going. These people were so ready and willing to improve their lives, they just didn’t know how to begin. Facilitating a group and participating in this project certainly enhanced my experience here (I even got a new husband) and is something I’m very happy to have been a part of.

            Side note: I tried a cocoa bean right off of a tree! A really sweet layer that you’re supposed to suck on and tastes like candy surrounds the actual bean. They advise you not to eat the bean itself because it’s really bitter but (of course) we all wanted to bite it anyways….. and then spit it out.

            This week I’m headed back to the children’s ward because it’s basically our last week in the hospital (very depressing) and it’s still my favorite place to be. We’re spending next weekend with our host family instead of coming back to Cape Coast so I’m not sure when the internet will let me update you next but I’m sure I’ll have some fun stories to share! 

theatre: round two

Another week down in the operating room and I assure you, it was just as interesting as the first one. Throughout the week I saw four more hernias of different sizes, a hydrocele, 3 C-sections, a circumcision, a hematoma and last but definitely not least… a foot amputation.

I’ll start with the foot amputation and spare you the pictures. The man who was being operated on had severe diabetes that he left untreated and got really bad gangrene as a result. The man already has his left leg completely amputated and half of his right foot bone was deteriorated. Before the operation the doctor showed us his x-ray and explained that for now he’s going to leave the heel and just get rid of the rest of the right foot. After about a week he will check on the wound and see if the tissue is functioning. If the gangrene hasn’t travelled up the leg he’ll just do a skin graft and leave the right leg alone. The amputation itself didn’t take very long and all he needed was a normal scalpel since the foot was already so mushy and infected.

I’m pretty sure the c-sections I experienced this week gave me some pre-mature gray hair. The only c-sections they do at our hospital are emergencies so it’s always stressful and the doctors are racing against the clock. On Tuesday, the mother’s placenta had moved out of place and was blocking the cervix. When the baby came out he kept going limp and turning blue but eventually stabilized after the midwife slapped him a couple (hundred) times. On Wednesday I got to see twins be delivered! The midwife didn’t correctly read the charts before running into the surgery so it’s a good thing I had a pair of extra hands to help her hold and clean them after the surgeon handed them off. Child birth is really unemotional and routine here because they all have 5-10 kids so once the baby comes out it’s like a football that they just pass around until it’s stable and can return to the maternity ward. Before I left for Cape Coast today we had a baby get delivered with a cone shaped head and no heartbeat for about 3 minutes. The baby was past due and ended up passing feces while in the mother. However, after a lot of suction and CPR the nurse anesthetist (who pushed the midwife out of the way) was able to get the baby to cry and turn pink again.

The hydrocele patient was another surgery I definitely won’t forget. A hydrocele is fluid filled sac in the scrotum. This young man let it get extra big before coming to the hospital so when Dr Paublo popped it during surgery it was like a massive waterfall that got everywhere (including all over the Spanish intern’s scrubs). Usually hydroceles are simple surgeries with little complication but the next day we had to operate again on the same patient because a hematoma had developed in the same place. A hematoma is a blood filled sac that is a complication of surgery when the bleeding isn’t completely stopped before suturing the patient up. Over the 24 hours the hematoma grew into a massive size and Dr Paublo was really upset with himself. He explained to us that it was completely his fault the hematoma formed and that he’s usually so careful before closing the patient’s up.

All I’m going to say about the circumcision it that it was way more violent and awful than I expected and I’m really happy the baby will never remember what happened. Other than that, I learned how to dress different types of wounds and remove stitches. I won’t be in the theatre anymore but it’s safe to say I learned and experienced way more than I expected to.

This weekend we have exciting plans to carry out a community assessment project in a remote village about an hour away. I’ll be facilitating one of the focus groups in order to pinpoint the major problems of the community and help in creating an action plan to fix those obstacles. It’s going to be quite the experience so I’ll be sure to write all about it before heading back to Asikuma on Sunday. It’s insane to think I only have two weeks left in Ghana but I couldn’t be happier with my trip so far. I already know it’s going to be extremely hard to leave such a remarkable country but being able to go home makes is VERY bittersweet. Talk to you soon!

warning: gross pictures ahead

This week was absolutely one of the best ones I’ve had since being here. Skyler and I were in the theatre (aka operating room) and experienced some amazing days that we’ll never forget. Sorry if this post is a little lengthy but there’s just so much to talk about!

            One of the head surgeons at Our Lady of Grace Hospital is Dr. Paublo, an older man from Cuba. He took a little warming up but loves us now and is really good at explaining everything he does. On average he does about 400 hernia surgeries a year since it’s one of the most common problems among Ghanaian men. This week alone we saw 7 hernia surgeries, a breast lump removal, a prostatectomy, hysterectomy, C-section, bullet wound, cist/possible hematoma, and a goiter removal.

            I’ll begin with a little background information on how they do things here. Epidurals and localized anesthesia are basically the only numbing methods used at our hospital. Most of the time the patients are awake throughout the entire surgery and can feel a lot of pressure in the area that’s being operated on. We only saw general anesthesia used three times this week and it was on children and the woman who was having her throat operated on. So unless you’re under 15 or an extreme case, you’re lucky enough to be awake. The hospital only has one type of monitoring device that doesn’t really work so to monitor patients they usually tape a stethoscope to the patients chest and listen when they think there’s something wrong. In addition, they clamp an O2 sensor to the patient’s finger to keep an eye on the blood pressure throughout the operation. Overall, I’d have to say they’re extremely sanitary and work very efficiently with what they have. Yet, when a patient starts to crash (which I’ll talk about later) they don’t really have the means to save them that well.

            My favorite surgery this week was the goiter removal. An overweight woman came in with two masses on either side of her trachea that needed to be removed immediately because they were starting to affect her breathing. Going into the surgery none of us knew how extreme these masses would be…. I put the picture below because I don’t know if I could properly describe the size of the goiter, just think of those two large lumps in someone’s throat. The operation took longer than the doctor expected because he never thought they would be as big as they were. In the middle of the surgery we began to lose the patient when her blood pressure dropped really fast. Since he was operating on her trachea the nurse anesthetist had to breathe for her with a bag pump throughout the surgery. Sure enough, in the middle of her bp crash the bag also popped…. Luckily we had another one just across the room and within a couple minutes she was stabile again but they equated a lot of her success to luck.

            The bullet wound was also a really interesting case to see even though there was no surgery involved. A hunter accidently shot his foot and came in with half of the bullet still lodged in there by the pinky toe. I’ll do you a favor and refrain from posting the picture but after a lot of cleaning we were able to see tendons and bones, which was pretty amazing. The hospital doesn’t have an orthopedic surgeon so the only thing we could do was clean it, stitch it up and send him to a bigger hospital.

            Seeing a total hysterectomy is definitely something I never thought I would see… especially when the uterus was as big as this lady’s was. She had five children already and they were planning on going in and just removing the problematic section. Since they don’t have adequate technology at the hospital it’s really difficult to prepare for what the surgeons will see once they open the patient up. As a result, once we got in there he realized the entire uterus was huge and misshapen and decided to take out the whole thing. It was one of our longer surgeries since it takes a lot of attention to detail but watching it was absolutely worth it.

            After a while all hernias look the same but we saw three different methods for how they take care of them. A hernia is where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. If the patient can afford it, the doctor will clean up what he can of the protrusion and then put mesh on the weak spot so it won’t happen again. However, insurance only covers the conventional method so they have to pay about 100 GHC ($50) for the piece of mesh. Most patients can’t afford that so the surgeon will just tuck the bulge back in the opening and then suture the weak spot. Dr Paublo explained that both methods provide a chance for the hernias to grow back but the mesh lasts much longer and has a better success rate.

The breast lump removal, prostatectomy, and cist removal were also really awesome surgeries but I’ll spare you all the details for now since I’ve already rambled long enough. The only thing I will say is I NEVER want to have a C-section after seeing how they’re done. But no worries, the baby boy was super cute and healthy after the delivery!

This week was one for the books and I’m so thankful for the OR staff for dealing with Skyler and I and our endless questions and jokes (that they don’t understand…ever). This weekend we’re back in Cape Coast to relax and do another community project so I’ll update again soon!