Hospital has been really slow this week but the staff is so wonderful to me! I have observed a couple vaginal births and been the one to clamp off the umbilical cord, weigh and measure the newborn, and give it a bath. Of course there is always the duty to take vital signs too. The ward thermometer wasn't working so only BP and pulse were taken. When I entered the ward, the patients all were in the mood to mess with me and speak twi. It's always an awkward feeling when they are laughing as you know they are talking about you on purpose and you can't understand. The fun part though was when everyone practiced saying my name at the same time! I feel so bad for the patient who is isolated in the eclampsia room. Supposedly they have this set up though so she can have closer attention and in the case that she starts convulsing or something, the others don't have to see.
There has been a Ghanaian medical student on the ward who has actually been really beneficial for my learning as well. The main doctor takes the time to explain things in more detail and when it's slow, I am able to discuss medical conditions with him. We talked about abortion (which is currently illegal in Ghana but many want it legal as most women find a way to abort on their own which may end up harming themselves). When I searched through the patient files, I noticed a handful had sickle cell disease. The med student explained the management plan for giving extra fluids to flush the sickle shaped cells through the vasculature to prevent occlusion of blood supply to the baby. Since stress is a trigger for sickle cell crisis, these patients are also given oxytocin to augment the labor process. Almost every complication of pregnancy is at an increased risk too including intrauterine growth restriction, low birth weight, preterm delivery, etc. Since the baby's lungs aren't fully developed, the mom will receive steroids prior to delivery. Ideally artificial surfactant would be given to the baby upon birth but in Ghana it is too expensive and not readily available. Also the NICU is not established (as seen in Cape Coast) so the chances of survival before 36 weeks is very rare.
We also were given the opportunity to talk about payroll, hours, and nurses responsibilities. In Ghana they only get paid every month and even then it can be delayed. Everyone seemed amazed to learn we get paid every two weeks and it will even reflect overtime! Explaining the concept of benefits such as PTO and sick days was another story. The idea of getting paid even when you don't work is like a dream to Ghanaians. At the same time, even thinking about working 8 or 12 hour shifts then go home and tend to the children is so unrealistic in this lifestyle and sounds exhausting compared to their 6 hour days. The staff always asks "why don't you sit?" They can tell when I am bored as I begin pacing the unit and reading signs that are posted or the report book for the hundredth time. In the USA it would be a rare chance to have a minute to sit and take a breather or take your full lunch break without thinking about the next shift assessment that needs to be entered in the computer or medication to be hung. It's no wonder why nursing is seen as such a high stress job where I come from! Although equipment makes the manual labor easier in a sense, it also increases the number of things to assess and document. I told about barcode administration, shift assessments, report, I&O's, diet, patient education, and discharge instructions. Add all of that and more for maybe four patients and the work becomes plenty. Here they chart changes in treatment, when care is given, admissions, and discharges with such little detail that I really wouldn't know what was wrong with the patient without investigating for myself. I would actually say the majority of the time is spent sitting and listening to the radio, making personal calls, or just socializing with each other.
I learned that Wednesdays are designated theater days for all cesareans and gynecological procedures. Unless it is an emergency, everyone requiring a surgical procedure will be scheduled on the same day. I also found out that because the lack of pain control in the laboring patient, it is actually a traditional view of making the woman suffer for what she gets. Giving a completely natural birth is seen as forming a bond between mother and baby.
When working evening shift, I caught movement out of the corner of my eye. At closer look, eyes were peering at me from underneath the shelves in the storage area... it was a RAT! Totally grossed me out and made me never want to be a patient in the hospital!!!!
Gifty, the medical director, organized my first medical outreach to a small daycare center called Wonderful Love. The class has almost 60 students ranging in age from 3-8. All are in the same level as they begin school whenever the parents can afford it. We had a long walk up a dirt road to reach the village. The children share benches to sit on and have no desks. They are quite interactive and seem really excited to learn. Our role was to dress wounds. We attempted to have the students cue outside and enter the room three at a time to receive one on one attention from a volunteer but this only lasted the first five minutes before everyone was inside wanting to get a bandaid for the smallest of cut or to assist in treating their friend's wound. It was sad to observe that the majority were just infected mosquito bites. We also had to check their heads for fungal infections which are really common among the youth. We had vitamin C tablets to distribute also to aid in wound healing and building up the immune system. All the kids thought they were toffee though and kept asking "Madam more, more, more. I want toffee!" This is the kind of outreach that feels really rewarding though because you know if it weren't for us, their cuts wouldn't be cleaned and something small could turn into a major infection. Apparently we go to a different school or orphanage every week, sometimes giving a basic health education, so I can't wait!!!
I did my first handwashing at my new home. The clothes line is outside the gate. Around 6 pm, Jessica came and told me to take my clothes off the line. I said they weren't dry yet and she said someone would steal them during the night! I guess that was good to find out as I may have woken up and learn I have no clothes! I am getting used to the rural set up and food. My favorite part is lunch now because I get an orange and baby banana each day. The fruit here is so sweet and delicious! My host family is very nice but keep to themselves. Dina lets us come and go as we wish and this group of volunteers love to go out together. The only bad part is everything is so far in between that it becomes a bit of a hassle relying on taxis and tro tros to get anywhere. I would've expected the fare to be cheaper here too but it is actually more expensive than in Cape Coat. The quiz nights are a lot more fun. We start around 3:30 pm for a meeting or event then go to dinner afterward. This week we traveled to a village called Kwamoso and participated in a soccer game against the locals. I chose to hang with most the girl volunteers though and play with the children on the sidelines! Clearly we lost 4-1. The field was very uneven, had long burnt grass, and even chickens running around. The kids kept me entertained playing with their bicycle tires and fighting for the most attention. It's always a treat no matter where you go to pull out the camera. Wishing for the perfect child portrait is a dream as most don't usually smile until after you take their picture and show it to them on the LCD screen or too many kids gather at once holding up their hands, blocking their faces, making silly faces, or getting directly in front of the lens. It's worth every minute though because you will eventually capture that one image that is priceless!
Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring- all of which have the potential to turn a life around!
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