Day 30-37

This life is yours. Take the power to choose what you want to do with it and do it well. Take the power to love what you want in life and live honestly. Take the power to control your life. No one else can do it for you. Take the power to make your life happy!

Following your dreams sometimes means taking sacrifices but believe me it is well worth giving up everything in the world to do something you love. I have had the adventure of a lifetime so far. Some experiences good and some not so good, but in all everything I see and do has been an amazing opportunity. 

Over the weekend I learned about one of the most important concepts in Ghana (or lack thereof) is the concept of time. I learned if you think something will take you 3 hours to get to, always at least double that by the time you take into account tro-tros breaking down, traffic, horrible road conditions, and finding your way around the stations. I decided to go back to Tema to visit my previous host family. A journey that should take 3-4 hours ended up taking almost 7.5 hours! BUT all that really matters is I made it there safely, praise God! The only downfall was not eating and arriving in the dark to someplace I had to get to off of memory. Oh and since it was in the dark, it means mosquitoes come out which I was wearing a dress and no repellent so clearly not prepared. I could actually feel them biting my legs as I was walking. In all about 14! The ride back wasn't much better. I decided to take the STC bus that costs a bit more but is air conditioned and goes directly from Tema back through Cape Coast. A great idea in the beginning but the bus broke down before we even made it all the way out of Tema. I was stuck on the side of the road for almost 2 hours before another bus arrived. On the positive note, I met the cutest little boy named Lord who was 6 years and insisted on me sitting next to him for the remainder of the trip!

 I took Majua to the hospital by myself this week. I honestly felt like her mother. She fell asleep on my lap in the taxi and behaved so well during the dressing changes. Her legs look amazing and are all healing. I can see our difference in her life which is a wonderful feeling. It surprised me when we left the leprosy camp one of the girls who help look after her asked to take Majua with me when I go back to my country. Wish it was that easy. The RN also asked where her mother was and why I was the one bringing her to the hospital. It broke my heart to hear the words come out of my mouth: "SHE WAS ABANDONED AND DOESN'T HAVE ONE" Obviously her heart was broken too and said God Bless us for our volunteer work and care. She then went on to say a boy age 17 she knows had to have an amputation, has no medical insurance, and can't receive the proper care. She asked if there was any way we could help him too but unfortunately there are plenty of similar situations we could help in. Story after story touches your heart and its just a matter of funds to provide the appropriate care.

Most of the schools have vacated now for a month so this means more children are on the streets and more came to the camp for dressing changes. Most appear to just be mosquito bites gone wrong. The kids scratch them and they get severely infected. I have taken over storing the supplies for medical outreach and preparing the bag for the following day as it wasn't getting done on a daily basis and the supplies would run low. I actually enjoy having the responsibility so I know it gets done.

The biggest excitement and shock has been starting in the delivery suite. The first room has 10 beds for those in labor and 5 additional mattresses to lay on the floor for when it gets overcrowded. Once the woman is fully dilated and ready to push, she must waddle over to one of three delivery rooms. It's just a bed with stirrups amd a tray for the afterbirth. The next room is the first I have actually seen monitors and it's for those who are recovering from c-section. I was impressed by the theater as well with the equipment. It was set up much like a western operating room and to my surprise they did practice sterile procedures. The last room has about 6 beds and is for those postpartum.

Delivery Room

Right after my arrival a woman was in active labor. People walk in without permission to watch. The lady was screaming in pain but the RN's don't give her any support to make it a pleasant experience. At one point, she was slapped across the face and hit several times on the thighs to stop yelling! I honestly couldn't believe my eyes. They then pull the baby out forcefully by the neck right after the head comes out, obviously resulting in at least a first degree tear. I haven't seen one birth yet where the woman hasn't torn. AND unless I missed it, she doesn't receive any anesthetic block when she gets stitched up either! Talk about pain. The baby is cared for in a similar manner as in the U.S. in terms of being cleaned, weighed, measured, given vitamin K injection, adn eye ointment. The only bad part is hanging them upside down by the legs to stimulate them and wrapping them then leaving them to lie on a table until the mom is transferred back to the unit. Nobody is allowed in the delivery room as in family members or the father of the baby. There was no "it's a boy" or "it's a girl" or even "congratulations!" Nothing! The mom is shown quietly a glimpse of the baby's genitals to know and then most of the time rolls over in bed and takes a nap. I am overall impressed with how well they all deal with the labor pains and having no support from family, staff, alternative measures to keep comfortable, or even an epidural. I know how strong most of the women are based on the conditions they must tolerate for the entire birthing process.

Everything is done manually. None of the women have monitors on. The fetal heart rate is assessed on admission and only every eight hours by the doctor on rounds. They use a bell shaped object that one end goes against the abdomen and the other you must bend down and lean it against your ear to hear. I tried and found it very difficult to hear anything. Today though I learned they actually have a doppler too which makes the job a bit easier to assess. Contractions must be palpated which ideally should be done every 30 minutes according to the staff but is unrealistic and usually only gets done on admission as well. You sit at the bedside with your hand over the uterus for 10 minutes, feeling for the contraction of the muscle to measure the intensity, frequency, and duration. Talk about a long process. I am realizing how easy we have it with all of the equipment and technology to do things much more efficiently and consistently.

The lack of privacy still gets to me. On doctor rounds, everyone listens to the other. The woman, who faces the entrance to the ward, must pull her gown up and lay with her legs apart for vaginal examination. They do have a mobile screen but I have rarely seen it used. The MD asks to see her pad saturation and she just pulls it out and flashes it for the whole world to see. Their gowns and sometimes sheets get spots of blood but they are only allowed one per admission so can't be changed! I watched two membranes be ruptured and the gush of fluid come out. They don't have the hook but rather inset a type of scissors and cut. I would definitely be worried I would accidentally perforate something else. Each patient has a small bucket she carries around. Some use it for vomit but others to empty their bladder or bowels right there in the middle of everything. I was actually surprised though that most women get catheters inserted to help with fetal descent into the pelvis. Something I didn't expect to see done regularly here. I have only seen a few with IV fluids or pitocin running.

I have watched about 5 vaginal births and two cesareans for now. I have been able to take over the care of the baby which I definitely enjoy handling! Of course they watch my every move but at least I can do something to feel more engaged. I also run all the small errands that nobody else wants to such as transferring patients, going to lab, or sitting in the ultrasound room with a patient for literally half the day. On the plus it gets me off the ward to get a breath of fresh air!

Plenty more to say about L&D but I'm running short on time. I'm sure I will have tons of stories to come in the next couple of weeks!

Shadee and "Henry"

 The only other experience I have had was taking a day off of work and attending an AIDS clinic and visit to the orphanage that my roommate works at. We arrived to this district hospital in a small village that provides seminars on the first Thursday of each month. Some of the children from the orphanage are HIV positive and must attend. It's an interesting sight to see as you walk into the room and know every person inside has tested positive. Originally I went only to see the process they go through but it ended up to be waiting in the 8 bed pediatric ward with an 8 month old baby boy the volunteers named Henry! His story is another one of those heartbreaking moments. He is believed to have some kind of physical or developmental disability. He was abandoned into a  drain along the side of the street with the hopes he would be "taken away". In Ghana, many people traditionally believe the disabled are cursed and thus neglected in society. This helpless soul was found alive by someone just passing by and taken to the hospital. The orphanage is hoping to adopt him! The RN's want him gone because nobody can devote the time he needs. When first picking him up, his arms and back were as stiff as a plank of wood but as the afternoon passed he loosened up. You could tell he hadn't had any cuddles and had been stuck lying in bed for the full two weeks there. Shadee has the biggest heart than anybody I know. She held him non-stop for our entire visit, bought some diapers and wipes, and offered to stay overnight with him in addition to donating money and forming a sponsorship just to convince the orphanage director to take him that very moment. In the end, it didn't work and Shadee was devastated. I am praying he is able to leave the hospital before Shadee goes home to England this week.

I decided that unfortunately, you tend to build an immunity to the things you see. I have formed a habit of putting up a wall when I experience something heartbreaking just so I don't let my emotions get the best of me. It's an everyday occurrence I walk past a child with torn clothes, no shoes, selling water sachets on his head when he should be at school, and goes home to a house made of practically mud and a tin roof. It's just a matter of taking the time at night to reflect on the true implications their living conditions have on their lives to realize how truly blessed I am for the life I have been given!   

Pediatric Ward in the Asebu-Dunkwa District Hospital