Today
was the first of four days on the medical brigade, and it was awesome to be a
part of a group that was small enough for the tasks to be spread out amongst us
so that we could all have the opportunity to be crucial to the process. For
those of you who are not familiar with the setup of our mobile clinic, the
patients essentially go from intake/registration to triage, to doctor
consultation, to dentistry or OB/GYN, to education, and then receive their
medications. We work in each of these stations except for intake/registration
and education (where only staff works because the interns have a lot of
difficulty spelling most of the names or communicating directly with the
patients); we take blood pressure, pulse rate, respiratory rate, temperature,
and weight, and ask about several important facts in triage. In doctor
consultation, dentistry, and OB/GYN, we are mainly observers, and in pharmacy,
we gather the drugs prescribed in the previous stations. When we arrived and
started to set up, I saw one of the elders of the community that we visited the
day before, which was kind of awesome. It was a cool feeling to know that we
were important enough to take up some of his time. Today, however, was the
market day for the community, so we had a pretty chill turnout.
I spent
the whole day in the pharmacy, which gave me a really great reminder of how
difficult it is to be a pharmacist. When the head Pharm D was explaining the
different types and dosages of malaria medication, for example, I felt that the
information went in one ear and immediately out the other. The detail that went
into figuring out the details of such a simple prescription made me want to sit
down and do something mindless for a little bit. Learning that information
without an interest in it was a task that really tested my patience and focus,
but when we were actually collecting the drugs for the prescriptions that the
doctors had written, I had fun! One of the most interesting things to note
about writing instructions for the patients is that we had to take into account
the fact that not everyone is literate in these communities. Instead of just
writing out the instructions of the prescription, then, we also included small
pictures; the number of circles indicated how many pills to take at once, and
the number of sets of these circles indicated how many times they should take
the pills per day. It was awesome to see the ingenuity in that solution. We saw
less need for malaria pills than I expected, and I was surprised that most people
were only prescribed 2-4 medications, including the multivitamins that were
given to everybody. This is reasonable, seeing as most people only have one or
two illnesses at once, but it makes me wonder how big of a difference that
particular station makes on the community members that we come and see because
we met many people who wanted medication from us while doing the family
profiles. The inconsistency is very interesting and I’m excited to learn more
about why this happened when I get more involved with interacting with the
health professionals and patients tomorrow.
One
thing that I appreciated was being able to interact with the native Ghanaian
staff more today than any of the previous days, and we always saw them laughing
and making fun of each other. They would also come up to us and squeeze our
hands until they really hurt, and Aziz, one of our coordinators, would put his
thumbs in the crook of our shoulders and press really hard on a point I assume
is a pressure point. It hurt like hell, but he definitely enjoyed it. I could
also tell that many of the staff members liked to play with the fact that we
didn’t speak Fante, and would either talk to us in Fante with the understanding
that we were just shooting in the dark for the meanings or deliberately talk
just amongst themselves. We suspect that they are probably talking about us,
but who knows? It doesn’t really bother me, so I’ll let them be.
Before
we left, we saw a couple kids from the community outside the windows of the
classroom outside we were working. They seemed to be very interested in my pen,
but I couldn’t go without one, and one of the staff members said that we should
hold on to them, so I did. It made me think about how important education is,
though, and I thought about the organization Pencils of Promise and how amazing
their work is.
One
thing that I haven’t yet written about is the soundtrack of our bus rides. They
take anywhere from 45 minutes to about 1 hour 15 minutes, and the Ghanaian
music that is played is usually a combination of English and Fante. I enjoy how
upbeat it is, but the content is more funny than classy. There is one where the
most repeated are, “I need a strong, black man,” and another that repeats, “Big
booty girl” many, many times. They are hilarious to listen to, but I remember
the lyrical quality being similar when I was in Nicaragua and Panama, so I’m
curious to know if there is any rhyme or reason to the pattern. Nevertheless,
one of the interns and I were talking about the Fante lyrics and relating our
singing along to them to children singing along to lyrics that they don’t
understand (usually about mature themes). We were speculating that it could be
one of the reasons that they play the music and that they get to constantly
laugh at us, but we decided that, since we couldn’t understand them, we
couldn’t draw any conclusions.
When we
got back to our lodge, most people starting to head to the beach, but because I
was feeling really tired, I decided to take it easy and stay back. I thought
that I was going to be able to get some writing, reading, or sleep in, but I
overheard two of the other interns that stayed back talking to our other
in-country coordinator, Regina, about their experience with the internship so
far, as well as their suggestions for the organization. Breanna, who is one of
the older interns, has an MPH, and is gearing for med school in September,
suggested taking the interns for a day in the city to learn more about the
political, health, and national insurance system before we even get to our
compound. She also mentioned that it would be great if we could invite one of
the elders of the community we were going to so that we could discuss the needs
of his community and make him feel more comfortable inviting us to his home if
we invited him to ours first. We also talked about how simple gifts (GB
t-shirts, sunglasses, and small candies) could make a really big difference in
how we were welcomed into the community, and could really help in getting
honest answers from people who are hesitant to share sensitive information
about their health and economic lives.
During
the conversation, I asked a little bit more about Ghanaian culture, and she
shared that the exchange rate between the USD and the Ghanaian cedi might have a
fixed rate a little above 3, but the real rate, the one that you can find to
actually trade in your money, varies with the location you exchange with and
the denomination of the bills you use (larger will get you a better exchange
rate). That was interesting to hear. She also told us that there are several
Ghanaian “chip” stations in various communities (like the one from Ekumfi
Ebuakwa that I mentioned yesterday) that are health stations staffed by
government employees. Their quality is not very good, but we talked about how it
might work well to try to integrate the medical work we do with their work.
Regina mentioned that the separation between government and NGO would be
severely blurred in that case, but I would be interested to see what the GB
administration had to share about that, or whether efforts to improve faith in
those stations (local resources, which helps our work be increasingly more
sustainable) have been considered or worked on.
I also
asked her a little bit about religion in Ghana, and she shared that the South
(especially the Central Region, where we are staying) is predominately
Christian while the North is more 50-50 with Islam. There is little conflict
between the two major religions because they have learned to coexist, but there
are virtually no atheists because families will kick you out of your home if
you reveal that you adhere to atheist principles, which I am disappointed in. She
also said that, though there have been some protests and political rallying for
gay rights, homosexuality is against the law in the country and it doesn’t look
like much progress will be made in that realm, either. What she shared was very
much what I expected, but I was sad to head that reality. Either way, I’m
really thankful that I was able to ask her because those two topics (and
especially religion) are key to understanding a culture.
When we
were talking, Breanna also shared a little bit about what it was like to go to
the Ghanaian regional hospital (she had to go because of a rash that was
getting pretty bad this morning). Because most people lack the financial
resources to get adequate and regular health care, they only go to the hospital
if they are in critical condition. She described the smell of body fluids as
she walked in and the fact that people are seen not due to the severity of
their situation but rather in accordance of the order in which they come in
presumably because everyone is in pretty dire need of the care. She talked about
an old lady that barely moved the whole time they were waiting (several hours)
and didn’t even have the energy to blink her eyes regularly. When she was seen,
she was brought onto a bed that was covered in urine because it hadn’t been
cleaned after the last patient. When Breanna finally got to see a doctor,
everything had to be paid for in advance – her bloodwork would not be taken
until it was paid for, her steroid shot wouldn’t be administered until it was
covered. In addition, she didn’t see the sterile package for the needle that
was used for it, so she hoped that it was clean. I have to say that she could
very well have been exaggerating her experiences, but if there is a kernel of
truth to be learned from that experience, it’s that we have some really
incredible facilities in the United States that we should be grateful for and
really value.
After a
really short lesson tonight about community-based participatory research, we
all walked to Weeda lodge, another compound that is owned by Global Brigades
that houses other brigaders when they come to Ghana. It looked to be absolutely
beautiful, especially because it was on top of a hill overlooking what looked
to be a more city-like area on one side with a more rural view on the other,
and the Atlantic Ocean in front of us. The full moon tonight was really
beautiful on the water, and I imagine that it would be a gorgeous place to live
and/or watch a sunset. I almost wish that we had lived there, except for the
fact that our lodge, Abba lodge, has air conditioning, which is enough to win
over the beautiful view.
I
thought that the day was over at that point, and started to read and write
before getting ready for bed when I saw a giant spider climbing down the wall
next to my bed (it’s about the size of an adult palm with its leg length,
perhaps slightly larger). The ladies in my room and I had seen it a couple days
before but missed killing it, so we all freaked out a little bit again and
immediately called Ed, one of the guys, into the room to kill it. It’s
significant enough to write about because it was a very energized, tense
ordeal, and the concern that we had for a jumping spider that has no poison and
probably eats some of the insect pests that would otherwise bother us is
surprising. The whole process lasted way longer than it needed to, more than
five minutes, but I guess it’s all part of the experience of living for three
weeks in Ghana! Hopefully, though, we don’t see any of its friends or family
looking for it if that’s the way that spider families work.
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