Wednesday, August 13, 2014

Ghana Day 7, 8/9/14

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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