May 13-24: Part 2

My transition back to the Ghanaian lifestyle has happened almost instantly because I know what to expect thus few things come as a surprise. My mornings start off waking to the call of the roosters, children already playing even by 6, women sweeping, and sometimes music playing at the surrounding houses. I often get a ride to the health center from the director on our way to drop their daughter off at school, and then opt to walk home. I feel I am able to experience more of the culture and environment rather than relying on a car, plus it allows me to walk through the market and soak up some hot sun. This weekend I did my first set of laundry, which I had forgotten how long it actually takes to wash just a few items. It is obvious the locals are far more efficient and probably get the clothes cleaner too.

I have allowed time to visit HardtHaven Children’s Home nearly every day in the afternoon once the children arrive home from school. I usually jump to the opportunity to help complete homework, although some are not motivated to learn and are searching only for answers. Play time is then a priority whether it be chasing each other, tossing a ball, reading, or just cuddling. I even enjoy just sitting back and watching their natural interactions. I have always been a baby/toddler person so of course my favorite evening was hold baby Emmanuella while little Precious held my hand and we ran around the premises. Both children are new to the home since my last visit, so I am anxious to learn about their individual stories of what brought them under the care of these very special matrons.    

The first week at Kpando Health Center was spent primarily in observation as my hired translator ended up traveling to Accra to accompany a family member with surgery. This provided a good opportunity however to get settled with the staff, learn the process in the maternity ward, and gain an introduction to the reproductive and child health welfare clinic that is put on by community health nurses. I am actually quite impressed with the care that is being provided under these conditions. I came with the expectation that gaps would be easy to identify; however, with just a few surveys completed, it seems people are satisfied with the maternal and newborn care. I have spoken with a midwife, nurse, statistician, and the health center’s director to analyze various perspectives on this topic. My favorite encounter has been with the health information unit as they have all the facts and numbers, which of course a Westerner who is doing research welcomes. I have learned that the vast majority of births are skilled deliveries although some still give birth at home with traditional birth attendants. In 2014, Kpando municipality had five cases of maternal mortality (one heart failure, two hemorrhagic shocks, one sickle cell crisis, and one acute intestinal obstruction) and 22 newborn deaths (ten asphyxia, six sepsis, three meconium aspiration, two prematurity, and one immunosuppression). All of the latter occurred under five days of age. The limitation from this data however is that it only monitors institutionalized cases thus anything that happens outside of the Ghana Health Service facilities are not accounted for. The true incidence may therefore be much greater. The entire municipal and Kpando Health Center appears to have good antenatal and postnatal care attendance with mothers coming monthly for checkups. Additionally, 71.55% of the community is active members of the National Health Insurance Scheme. The amount of qualified health workers is surprising to me. For example, there is only one OB-GYN doctor in all of Kpando and one midwife per 5,178 people. This greatly limits where specialty services are available, thus impacting accessibility to care. I found it very ironic that the week prior to my arrival was child health promotion week where the focus topic just happened to be on keeping newborns clean through caregiver hand hygiene. This is in effort to reduce newborn infections. With my primary interest area being that of the neonate, I hope to explore this topic more and identify ways to benefit newborn outcomes.

Since Kpando Health Center does not have admission wards other than accepting normal deliveries, any complicated cases or women with risk factors get immediately referred to the local hospital. Therefore the actual amount of deliveries at the health center is extremely low. I was able to speak to one lady after she had delivered during the night and learned that all are discharged within 24 hours. So far, the most common reasons for seeking maternal and newborn care has been to get a urine test to determine pregnancy, routine appointments, ensuring that the baby is healthy, seeking prescriptions for anemia such as iron supplements, and distribution of intermittent preventative treatment for malaria during pregnancy. I was taught how to assess for fetal heart tone using a fetoscope (which I found very difficult to hear from), measure the fundal height, and palpate the fetal position. It would be interesting to witness the mother’s reaction if they were able to hear the heartbeat themselves like we experience in the U.S. Also to see the baby in an ultrasound, which I learned they have available at the referral hospital.

I really enjoyed what services the community health workers are providing at the child welfare clinic (appropriate for someone studying public health!). This occurs every Wednesday, encouraging mothers to bring their children up to age five for weight monitoring, vaccination administration, and education on a maternal or child health topic of choice. There were probably a total of 20-25 women who came in my one day there so far. I was asked to provide counseling to one mother whose son has gradually been reducing weight. For those that are acutely malnourished, the government has provided the facility with nutritional supplements to distribute. All children also receive a mosquito net at their 18 month appointment. Mothers have to bring their own sling to weigh their babies in. The children are stripped down to nothing and then hung from a ceiling scale. Some cry while others look with curiosity. Many of my postnatal and newborn interviews will come from this clinic and since my reports should all be completed by the Monday before I depart, I am hoping my last day can be spent assisting throughout the entire process. 

He gives power to the faint and weary, and to him who has no might He increases strength (causing it to multiply and making it to abound). Isaiah 40:29