My main day at the
health center was Wednesday to attend the child welfare clinic and attempt to
interview postpartum women. However, no patients in this phase of care came for
their visit. As a result of it being my last opportunity to conduct direct
interviews, I decided to bring my total number of patients to 50, disregarding
which service they were seeking. Therefore, I added the final eight interviews
from the reproductive and child health center. In all, my research included 20
antenatal women, 25 patients from the child welfare clinic who have children
ranging in age from newborn to 2 years, and 5 deliveries (none of which I was
able to directly observe). Although I was unable to obtain my original goal of
15 women from each category, it seems like all women were able to answer the
questions related to their most recent pregnancy and contribute to my research
process. There also did not seem to be any different patterns dependent on
which service they were attending, thus the results were not adversely
affected.
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| Waiting area at the outpatient department |
An additional
opportunity I took advantage of was to follow the community health nurses on a
home visit outreach into the sub-areas of Kpando. They supposedly do this on a
weekly basis, changing their desired location each time. The intentional
service is really good but I saw the actual process as a priority for future
investment and commitment. The objective is to identify children who are not attending child welfare regularly and are
not up to date on the recommended immunizations by requesting to see their
health record, as well as to assess for any immediate health concerns through direct
observation. Additionally, the nurses provide health education and counseling
as appropriate to individual needs. If the child qualifies and has not yet
received the vitamin A capsule, they will also give it in the home. However, no
immunizations are given nor are the children weighed because it would require
carrying the small cooler, supplies, and an appropriate scale. For this, they
are referred back to Kpando Health Center (the same place they have not been
attending). If a child is identified but has no health card, the nurses just
write down their name and contact information to follow up rather than register
them and provide the necessary care at once. I was expecting to be gone the
majority of the day conducting home visits but it turned out to be a complete
failure and almost even a waste of time. The team seemed to walk aimlessly just
looking for people with children under age 5. We literally saw 5 mothers and
her child(ren) before the nurses said they have closed for the day because the
weather was too hot. They even admitted they prefer to only do home visits only
for about 1-1 ½ hours then return to the health center for the remainder of the
day, although a nurse stays there as well in case anybody comes for care. This
adds to the opposite problem which I actually encountered earlier in the week
when it was raining. They postponed the clinic then as well because nobody
would show for care (staff and patients alike). Additionally, it becomes nearly
impossible to pass between the houses as the paths are all uneven dirt trails
that become a muddy mess. Although I understand the complications, it is very
unfortunate that the weather acts as such an impediment to reaching the
vulnerable populations and providing essential services. In my opinion, it
definitely represented a missed opportunity to invest in maternal, newborn, and
child health.
I gained access to a
maternal health workshop manual which was designed by a previous group of
volunteers with the organization but has not yet been fully implemented due to
a lack of volunteers. It is directed toward encouraging self-efficacy of
pregnant women by preparing them for the normal delivery and postnatal period
as well as educating them on unexpected complications during childbirth or the
postnatal phase. It also encourages the presence of a birth partner whether it
is the spouse or a family member. I feel the manual is very well organized and
culturally appropriate, including small posters with English and Ewe
translation. I was unaware of this project prior to my arrival, and actually
would have preferred my practicum experience to focus more on the
implementation and evaluation of the workshops within rural communities, as it
is very similar to my topic. I also think this project would have made me feel
more beneficial to the community and given me that greater sense of fulfillment
I was looking for. Maybe it just means I will have to take over the program on
my next trip to Ghana
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| Since outreach was so quick, this is the only picture I got of the community health nurses at work |
I am getting the
sense that some of the wound care patients are not adhering to our own
recommendations thus are not helping in the healing process. This is only
working against all of our own efforts. Many refuse the Vaseline. Some do not
soak the foot regularly to get rid of the buildup of dirt. One was referred to
the hospital but failed to show with her insurance card and health record. The
next time we went to visit we were told she had gone to the bathroom when in
reality, she was actually running to hide from us because she knew what we were
going to say. This is really disappointing to me as it is abusing our resources
when they could be invested into something else. On the positive, some are in
fact kept very clean and one man has taken over all of his own wound care, we
only stop by to assess and give additional tips. A 1 ½ year old girl fell into
a pot of boiling water in January and suffered severe burns to both hands/
arms. It also somehow deformed the bones in her hands, where she now has very
limited function. To me, it appears as a crush injury. The skin has healed very
well but unfortunately the hands will probably never be fixed. Even back home a
case like this would require several plastic surgeries. The funds that people
back home helped me raise were meant for wound care supplies. Some of the money
will go to basic needs but a larger portion is probably going to start
investing in intensive care one at a time in the regional hospital so the
patients can graduate out of our program. Although this was not the original
intention, I agree that it is the best option for now as what volunteers have
been able to accomplish is very little over the past 3 years. Getting local
advice may prove to be very beneficial so those who are committed can move on
and become productive members of society. On the walk back, I noticed two
signposts significant for public health. The first was to promote hand washing
as a means to prevent illness. The second was to use latrines rather than open
defecation. I don’t know how effective they are, but it was at least
encouraging to see an effort.
I had my first
episode of not feeling so great but luckily it only lasted a few hours in the
evening. I had an awful headache and was nauseous. Probably a combination of
dehydration, heat, and the dinner I was served. I remember this dish from the
last time I was in Ghana and it definitely is not one of my favorites.
Unfortunately, as a practicing nurse now, I had the special honor of relating
the color and consistency to NG tube canisters which is never a pleasant thing
to think about when you are trying to eat. The dough is called Akpele which
actually doesn’t taste too bad in small amounts. It has a wheat/oat taste. It
is made of corn flour and cassava. The bad part however is the stew, which is
made of okra and goat meat. This gives it a very green and slimy texture. I try
my best though as I don’t want to offend the cook and most of the time the food
is quite good. I have actually been quite blessed though to stay healthy. All
of the other volunteers have been sick at some point throughout their stay and
all have taken oral rehydration salt to help with their diarrhea.
I was able to meet a
new referral case from another community and see the intake process at the
children’s home. She was brought in by the social worker and her mother. Vanessa
is a five year old girl who has multiple open sores on her face. These were
acute. The real problem was her eye sight. Since 6 months of age, the mother
realized her daughter could not see well. Just from observation and a quick
assessment, both eyes had a white center and were constantly moving from side
to side with no focus. If you held a pen in front of her and asked to reach for
it, she would do a swiping motion to feel for it rather that reach out and grab
it directly. Her brother also has the problem but he is older and attends a
school for the blind. The plan is to get her registered with health insurance
and attend an eye clinic to get more specialized assessment and see if she is a
candidate for any surgery. They do not know if it is cataracts, neurological
disorder, tumor, hereditary, etc. I also sat in on the doctor rounds at
HardtHaven. A family medicine resident comes from Accra every month to work
with the sick kids (those who are HIV positive, are on medication, or have
health concerns). It was nice to see his process of providing more focused
therapy and giving recommendations for treatment. Also that he is familiar with
each case so can know baseline and track progress.
I have been trying
to spend as much time in the children’s home as possible as my time is flying
by so fast and I just love being part of the group. I continued with movie
night both Friday and Saturday, playing the film of their choice on my laptop
(even if it happens to be a Japanese film with French subtitles that nobody can
understand- for whatever reason they love the movie and laugh the entire time
insisting we watch the subsequent parts the next time haha). They all crowd
around and look at the small screen. I also joined in on sports day but can
never live up to their soccer skills. They are really happy I have gone to
church and lasted through the entire service, as many volunteers try to go once
and leave partially through because it is so long (one week I was there for 4
hours!). One child came up to me and gave me a big hug saying, “Auntie, thank
you for coming today!” I was the only person to show and it is obvious they
keep track of what each volunteer is doing. It made my heart melt.
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| Selase |
One introduction I
will make is of an 11 year old boy named Selase. I remember prior to arriving
in Ghana when I heard of him. He is extremely stunted and malnourished but is
now thriving under the care at the children’s home. He is smaller than many of
the 7-8 year olds. Initially, he weighed just 13 kg (<30 lbs) but now is up
to 18 kg (nearly 40 lbs). He has never attended school so is being prepared for
a short amount of time in the home so he doesn’t have to begin in pre-K. It is
normal here to have older children mixed in the same class as a child of normal
age for that class. So he will likely be started in class 1 and sit with 6-7
year olds. He is very lively in the home and always is full of smiles and
laughter.
My days are already
limited so I am beginning to have very mixed feelings about coming home. I knew
this would be a quick trip compared to my previous adventures but I didn’t
realize how fast 5 weeks would go by. I plan to spend my final days completing documents,
making a health education poster, and preparing for my presentation that will
be given to the maternal and child welfare staff, director of Kpando Health
Center, and Ghana Health Services director. Additionally, there are several
small errands which always turn into big tasks for whatever reason. So wish me
luck, keep me in your prayers, and hope for a safe travel back to the U.S. Quick
side note: I have worn a bead anklet for nearly 3 years without it ever coming
off and this week as I was walking home, it finally fell apart. I thought it
must have a significant meaning as I bought it in Ghana and it lasted until I
returned. Kind of cool!
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| Michael relaxing after his bath (HardtHaven) |
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