Week 3

In relation to my practicum, activities this week shifted from patient interviews more toward office work, as I met my total number of antenatal women and the postnatal/newborn patients only seek care on Wednesdays. Unfortunately, not many showed up this week so I only added an additional six interviews bringing my total to 42 patients. My contact information was left for the midwives to call if any labor cases come in so my time is not wasted sitting in hopes of a patient arriving to deliver. It has been well established that any complicated or high risk case gets referred out; therefore the actual amount of births that occur at Kpando Health Center is limited. My timing has been really bad trying to be present at the health center for a delivery. Both times I have missed the birth by only a few minutes. I am still hopeful however that I will get this experience before my time is up. Nonetheless, I have been extremely productive when it comes to starting my reports and making conclusions. I have made a document on the summary of services through each phase of care including antenatal, delivery, postnatal/ newborn, and child welfare. This was made based on observation as well as drawing information from the health records as far as what is supposed to be documented. Supposed to be is the key… I find much of the information is missing. My cumulative interview results will be a working document until all of my patient data is collected. It has been very interesting to identify trends in data thus far, which has helped me establish focus areas and reasonable recommendations. I have interviewed a wide representation of patients, gaining the perspective of recipients from several backgrounds. Additionally, I have five staff interviews and have informally questioned others about maternal and newborn health services provided within the municipality. All seem to have similar opinions. My summary of statistics has turned out to be challenging to analyze in some parts as there are discrepancies in the numbers. It is only from the health information unit at the clinic that I am able to obtain the necessary information so I have to make do with what I have. The most important sections on maternal and neonatal mortality rate and the proportion of causes of each are accurate though which is a relief. I have slowly began developing a PowerPoint, which will be presented as an overview of my project, results, and recommendations for future opportunities to improve the maternal and newborn health services. I even had the opportunity to speak with the director of Ghana Health Services for the District of Kpando to learn more about the general health system as well as what he envisions at the health center. Finally, I am planning to make poster(s) that will serve as a means of education within the community on those topics which I feel are inadequate. A lot of work to finish in a short amount of time…

Muslim family a few hours after delivery

Although I feel that public health research is important in order to assess the condition and needs of a community, I have learned that it really is not my forte. I much rather be in the field actually serving people rather than just talking with them. For this reason, I unfortunately am not finding the same fulfillment as I had during my previous volunteer work in Ghana. I am the type that wants to be busy all the time providing intensive treatment, education etc. to people who are really in need. I want to feel like my time and energy is worthwhile and at this point I am not so sure what will come of my project. Maybe some kind of transformation will take place over the next week but it doesn’t look promising. So I have decided to spare time in the mornings twice a week to participate in my old wound care outreach program and enjoy afternoons with the children at HardtHaven, which are both full of feeling accomplished.

Wound care is always a nice way to start the day as I am up at 530 to begin my walk into the three small communities following my subdivision of Kpando-Konda. It is important to go early to try to catch the patients before they leave for work either in the market or on the farm. I love conducting home visits to really get a glimpse at the daily life, see inside their homes, and feel that sense of emerging deep into their lives. It helps you to relate more on a personal level as well as understand some of the health concerns based on their immediate environmental conditions. They are all very welcoming, sending children for plastic chairs for volunteers to be comfortable. A basic cleansing of the wound with pure water, followed by placing Vaseline on the edges to keep the tissue soft, and covering with a piece of gauze is so much appreciated. However, in my opinion there is a clear need to change the treatment plan for those with chronic ulcers. It is disappointing in a sense as some are the same patients I met 2 ½ years ago when the outreach program was initiated and the wounds all appear the same as I remember. Yes, they have not gotten any worse but they certainly are not healed nor do I see any substantial progress. It is almost a waste of supplies when nothing good other than prevention is coming out of it. I do not even know the course of treatment that would be provided if they were fully funded to seek regular hospital care. The only option for some might even be amputation, which has an entirely different impact on their ability to be productive members of society and get around town. The other problem is that the design of the program is not daily anymore so there is no monitoring of how the patients are treating their wounds in between volunteer visits. Some refuse application of medication and rather soak their foot in herb infused water or open capsules of medication and place the powder directly on the open sore. The outreach is still very much needed within the communities but would preferably be lead by qualified and committed medical professionals in the long term. Additionally, it requires attention on confounding factors to promote healing such as nutritional support, appropriate activity, and managing co-morbidities such as diabetes and hypertension. I always automatically think of all the resources, medications, specialized supplies/ equipment, and procedures available in the Western world and what it would be like to take one person from here and show them what could be done with these things. However, I know this is not feasible and rather there is an indication to adapt to their local context. It amazes me the patients still have hope and are usually accepting of care after suffering with wounds that are unchanging. To top it off, they all have an incredible amount of pain tolerance.

Diabetic patient

I had the pleasure of attending Lovia’s funeral. It was a very interesting cultural experience to learn the tradition specific to that community. It began with an introduction to the chief and greeting with the community elders while the younger individuals went to prepare the grave site. They are said to be called into the position by the spirits. They returned and carried the coffin open on their heads, with only a piece of fabric covering the body. This was a very long process as they carry the coffin all over the community being lead by the spirits to places where Lovia supposedly needs to depart. Finally, they returned to the tent in which the elders were sitting and present for questioning. It is said that the coffin answers. If the spirit accepts, they bow down and move forward in a knocking motion but if she is not happy, they abruptly back up and spin the coffin around nearly dropping it off their heads and return to resolve any problems. I never actually saw the burial as we paid respects to the mother and had been there nearly half the day. Not many were in attendance as would be the normal for funerals in Ghana but it was nice to have some showing seeing as it seems the stigma of the AIDS takes over from the person being human.

I have really taken to baby Emmanuella. She is just six months old and came into the care of HardtHaven because she was found abandoned in a drain. I learned how to carry her the African woman’s way on my back with just a piece of cloth and love just holding her in the afternoon. I teased with the children that I was going to take her home with me which they got a quick out of. Another girl is Precious. She is two years old and is the younger sister of another child in the home called Bless. She doesn’t know any English yet but always comes to me when I arrive at the home. One day she was really amused by a book with a butterfly on it. She kept grabbing my hand and pointing to it. Later I found her carrying the book on her back too. It’s interesting how the form of play mimics lifestyle- small kids carrying things on their head even if it’s just a sachet of water or a single book, girls with things on their back, and boys with fabric tied like the chiefs. Kids are kids no matter what country you live in. A quick introduction to Bless as well which is a very sad story- she is 14 years old but looks like maybe a 4 year old. When she was very young, she is believed to have contracted cerebral malaria, effecting her growth and development. She is now immobile in terms of walking but she can sit and roll from side to side. She is also unable to talk. She was actually locked in a room, hidden from society. See the report on her story https://youtu.be/SrHaogElFmc. Since being in the home, she has been working with physical therapy volunteers and will get an instant smile on her face, even making laughing sounds, when we interact with her. Goes to prove what good a little personal contact can bring to one’s livelihood.

Baby Emmaneuella

Bless- 14 years old

[Not in your own strength] for it is God who is all the while effectually at work in you [energizing and creating in you the power and desire], both to will and to work for His good pleasure and satisfaction and delight. Philippians 2:13