Only one word can be used to describe my past 4 days: AMAZING! I decided to spend a day in female surgical just to get exposed to different conditions, meet new staff, and I heard you get to see a lot... wasn't that the truth. A lot of the cases had to deal with complications of uncontrolled diabetes. Patient after patient had a diabetic foot ulcer infected with gangrene, some leading to sepsis and eventually all likely leading to amputations. It made me chuckle that the ward was actually separated into the "clean" side for those post-op and the "dirty" side for those with active infections or open wounds. The staff were all great and took the time to explain cases or let me get involved. One woman had an AKA, had extremely poor hygiene, and was not properly caring for herself to assist in the healing process. Her wound was weeping purulent drainage with a very strong odor. The nurses had to remove two end sutures to relieve pressure from the festering bacteria. They were good at trying to follow sterile technique the best they could with what they had. For example, a drape happens to be the inside surface of the sterile glove package and they don't have sterile packs of tools like hemostats thus for one patient who needed the hemovac removed, I was told to manually clamp off the end using my hands while the other nurse removed it from the wound. Innovative concept!
I was surprised to find out that the patients who have received amputations must attend physiotherapy before being discharged. They have an option for prosthesis but it's clearly unaffordable for the average person and must be fitted in Accra. Other diagnoses I saw were cellulitis, thyroidectomy, breast cancer, goiter, ludwig's angina, enterocutaneous fistula, and a woman who had been physically assaulted by her husband. The first case I've heard of while in Ghana. The police and social services were actually conducting an investigation and came to the hospital to take pictures as evidence.
An extremely cute elderly woman kept speaking to me in Fante so I had no idea what was being said. Finally the nurse asked if I understood and obviously I said no. Come to find out she said "Nyame Sho" which means "God Bless"! It was so sweet! I acted as the extra set of hands for all the dressing changes on the ward, pouring the NS and iodine for the nurses. Some of the wounds were intriguing to see but absolutely disgusting at the same time. One was open all the way down to the bone, consumed the entire anterior surface of the foot, and reached all the way up to the knee. The patients have to provide their own bottle of iodine and elastic bandage if it's preferred to gauze. A tally sheet is kept in the front of their folder for costs which must be paid before being discharged. With a woman being transferred to theater, the staff were all practically useless in assisting her from bed to stretcher. She was in her 70's, had a very severe ulcer on her leg, hooked to an IV, and had a catheter. She was made to roll onto and climb up in bed while everyone just stared there and watched. I finally went over and grabbed the IV bag so she didn't get tangled and held her shoulder for support. Probably wasn't too much help but at least I acted concerned for her welfare.
Projects Abroad has developed a new medical outreach placement in Cape Coast which happened to be one of my favorite experiences so far. It is located very close to my home in a place called Adisadel Health Clinic. We work in the maternity and family planning unit. Each Wednesday the clinic holds an event for women in the area to bring their children under age 5 for regular check ups to include weight, vaccinations, and vitamin A supplements. They also begin each session with an educational seminar on nutrition, the importance of preventative medicine, and general health topics. All of the services are free of charge yet some still choose not to come for treatment. For those located in distant villages or who can't afford transportation to the clinic, the nurses participate in home visits and their own outreach program where they set up makeshift weigh stations and bring the vaccines to them. I'm so disappointed this is being developed right at the end of my time in Cape Coast as it is exactly the type of project I would've loved to be involved in on a daily basis.
My participation started off as being a professional cotton ball roller! I never actually thought of the manufacturing process- they always are bought in the U.S. pre-packaged in balls already! In Ghana however, you must pull apart a big roll of cotton and roll individual pieces to fill a bucket. Quite sterile procedure for sure! As the bucket filled, a nurse came over and pushed everything down further saying "it's not full yet, you must continue" So one after another we dropped cotton balls until the roll was finished. I was then assigned to assist at the registration table which is the least involved for medical skills but probably the most beneficial for gaining an aspect of how the program works and learning that organized, community driven projects really do exist in Ghana. I met the most amazing staff who were all so friendly and willing to answer any questions about the clinic. They also encouraged our involvement. I was in charge of filling out the child health record cover page for new registrants ad then would be a member of the assembly line for patient files, filling in the vaccination schedule of what immunizations were due, the batch number, and date of next visit. In the beginning they walked me through step by step but then I caught on really quickly and was able to do it all independently. I even got a high five from the nurse I was working with and she said I was doing really well.
The clinic keeps track of various statistics such as child's age, attendance of the parents, percentile for weight, vaccines received, and father involvement to write a report at the end of each month and track trends. Since it is extremely rare for a male figure to be the one bringing the child (two out of 100+) they get the incentive of jumping to the front of the line. I thought it was a clever idea to encourage their involvement. Each baby has its own harness to be weighed in. They are then hung by gravity. I didn't have a part in the weighing or vaccination administration this time but plan to rotate areas with the other volunteers for next week. I was loving every minute of this new experience even if it was just doing paperwork. I figure we are here to serve even if it's in the smallest way and even if there are periods of nothing to do. You better believe I stayed until the very last patient was gone! This experience gave me direct insight into community health in a developing nation and also a perspective on how the medical program could be further developed.
For leprosy outreach, I felt like a had an active role in patient advocacy and making a difference in someone's life which is always a rewarding experience. We learned about a man who lives in a home directly beside the camp who needed special attention. After doing our usual routine, we entered into this home to find a frail 75 year old gentleman who could barely move. The singe of rotting flesh filled the air. He lay on a foam pad with very little cushion. He was wearing only a button down shirt and a incontinence brief. On inspection, we found a very large pressure ulcer on the right lateral aspect of his hip and buttocks. It tunneled down to the bone in the center and had necrotic tissue all along the edges. It was oozing loads of very purulent drainage of brownish white color, soaking through all of the gauze and onto the bed linen. He appeared extremely malnourished, dehydrated, anemic, and had a suprapubic catheter in place. I knew exactly what needed to be done and could wait no longer- he needed to go to the hospital for advanced treatment from what we were capable of providing and needed antibiotics immediately or he would likely die from sepsis. We met his eldest daughter who came to visit and found him in this state. She had been trying to care for him with the little she had but couldn't fulfill all his needs. I am still just amazed it took so long to find out about someone in such horrible condition who lives right next to the camp that medical volunteers attend every morning.
Two other volunteers and myself cleaned his wound and changed the dressing. We then proceeded to get him a clean shirt and briefs. That's when I saw they were completely soiled in feces that he had been laying on for who knows how long. It became part of my innate nursing care to ensure he was clean and comfortable before transportation to protect his dignity. We used the bedding as a draw sheet to get him to the taxi. Since he was too stiff to sit, I climbed through the backseat and pulled him onto my lap for the entire ride. Our driver acted he was driving an ambulance, cruising through town honking his horn non-stop and weaving in and out of traffic. We settled him into the E.D. and stayed by his side for a few hours. The doctor pushed fluids continuously, gave IV antibiotics immediately, and took blood for samples. He will then receive surgical review for debridement and be admitted to the male surgical unit. I told the daughter I would stop by for a visit in the morning and see how his night faired!
While standing in the E.D., I was put to use in many ways. I wore only my street clothes and flip flops but the nurses were having me take vital signs, testing blood sugar (which they don't have lancets and must use regular injection needles and the patients have to pay GHc 2 before it can be done). I decided with so much commotion, lots of work to be done, and a ton of stories I would be able to share, my time would be well spent and hands on in the unit so I will definitely be returning to work in the E.D. next week on my hospital days. I really wanted to work a night shift but they said it's not advised for volunteers as the unit is an open area and they fear for us getting malaria from all the mosquitoes. I will take the advice and stick to days. One of the other volunteers wouldn't stop saying how amazing I was in providing care to the man. She even compared me to an angel! I didn't see it as trying to be some kind of hero; to me I was just doing my job for someone in desperate need. I hope the remainder of my time is just like what I have experienced this week... AMAZING!!!
The poor taught me about love, joy, and generosity. Living among them and serving them taught me about patience and relationships. Working beside them taught me about courage, strength, and incredible faith!
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