Today was the last day of clinic, which made me really sad
to think about because I have genuinely enjoyed working in clinic these past
several days. I’ve been able to interact directly with patients, see how the
vital signs and symptoms add up to a diagnosis, observe tooth extractions, and
fulfill their resulting prescriptions. On the hour-long bus ride towards the
community, I was thinking about the work that I’ve been doing in the Ekumfi
district of the Central region of Ghana over the last week or so, and I
couldn’t help but think that I was exactly where I wanted to be, doing
something that I wouldn’t want trade to do anything else. Working with global
health is definitely something that has been incredibly rewarding and very fun,
and I’ve had such a great experience with this internship so far. Even though
it is tough to get over the language barrier that I have with most of the
Ghanaians that we are working with in community, I feel that I have helped so
many people (I found out after clinic today that we saw 360 total patients) and
gained so much from my 9 days of work here so far. I am ecstatic with the
opportunities that I’ve had to learn more about health and work directly with
natives of Ghana, and see a little bit of what it’s like to do public health
and grassroots research. It’s not to say that our tasks have been easy, because
getting used to speaking to people for the information that they have is always
difficult. Despite the awkwardness I’ve felt, the bug bites that I’ve had to
endure, the long bus rides, the late meetings, not having internet for the past
9 days, etc., I am so thankful that I have had the opportunity to really
experience global health clinical and research work in a hands-on environment.
I obviously still have a lot to learn about the field and about how to become a
successful professional, but I couldn’t help but think that I was in a really
great place and doing work that I just want to continue for an indefinite time
so far. It’s a feeling that I know is difficult to find and is often absent
from most professional environments, so I need to remember what it feels like
so I can make the most of what I do in the future.
The first thing that happened today was that one of the
interpreters, Bernice, braided my hair into a fishtail braid, which was
awesome!
I spent the day in OB/GYN first, and then went to triage for
the afternoon. I’m really happy that I had a little bit of downtime with which
I was able to ask the midwife and OB/GYN nurse, Georgina Afrifa, about her job
and the knowledge that the community members have about topics of women’s
health. I thought back to the Millennium Development Goals, which are 8 broad
goals that have quantitative targets and indicators, many of which we are
working on by having this clinic and, more specifically, an OB/GYN station. In
case you’re wondering what those MDGs are:
- · Eradicate extreme poverty and hunger
- · Achieve universal primary education
- · Promote gender equality and empower women
- · Reduce child mortality
- · Improve maternal health
- · Combat HIV/AIDS, malaria, and other diseases
- · Ensure environmental sustainability
- · Global partnership for development
I’ve highlighted the ones that fit with this internship,
both directly and indirectly. Especially with our short presentation that we
used today to show some of the women that came to our focus group yesterday
about nutrition; they asked whether we could put together some information
about how to feed themselves and their children better. Taking their request in
mind and knowing that they have a limited variety of foods, I hope they can
take our information and implement it into their lives.
When I asked, Georgina told me that women from rural areas
often don’t know that the vaginal area has natural discharge and think that
they are infected or sick when they see discharge from that area. As a result,
they sometimes try to get it out with their fingers, which leaves it very dry
and more prone to infections and other health problems. Throughout the morning,
we saw several people who came to the station asking for their discharge to be
checked out, but after asking the patients some questions, we could tell that
they were healthy and just unaware of their body’s natural phenomenon. In some
of the older women that we saw, they started to bleed as soon as Georgina
opened the vagina because they had become so dry and tight.
Additionally, Georgina explained to me that women in these
communities know to expect their period every month and starting at a certain
age for the girls, but they don’t necessarily know what it is for or what it
indicates. They know that it means the girls can physically start to bear
children (as in, they can get pregnant) and start to tell them about it, but
sometimes Georgina has seen pregnant women who tell her that they’ve been expecting
their period for the last however long and it hasn’t yet come. I was taken
aback by that because I’ve been taught about reproductive physiology and
pregnancy since elementary school, and here were expectant mothers who did not
know information I’ve had for almost a decade.
When I asked about maternal care, Georgina told me that they
know that new mothers should not use cold water to bathe or drink (which is
also the case in Chinese culture) and that they will sometimes have help from
the grandparents in the first month or so. However, because their economy is
rather poor, they often go back to working (farming, typically) within about
two months. They don’t have the luxury of taking any more time off and have to
support their families with their manual labor. Some mothers will sit in hot
water for the first 5 days, but this practice is quickly going out-of-date
because more and more women are having their vaginas cut during the birthing
process to make more room for the child to come out.
When we started seeing patients, we saw many different
cases. I saw several young women who said vaginal discharge was a symptom they
were seeing because they didn’t know it was natural, a couple patients who had
infections, etc. There was one 23-year old who seemed to be extremely reluctant
to allow Georgina to check on her and was very uncooperative, which I guess
comes with the profession and a culture where women are expected to constantly
take care of other people before themselves and to give way to men first.
There was one elderly lady that came to our station, lay
down, and showed us these hard and dark lumps that had formed under her
breasts. Georgina didn’t know what they were, so she called in Dr. Appa to
check them out. His diagnosis was that she had something like a skin infection
that could very likely be a precursor to breast cancer, so we had to refer her
to a hospital to get it checked out. The funny thing is, she told us that she
had been seeing these bumps only for the last 2 months, but when her granddaughter
came in (the 23-year old who was incredibly uncooperative with us), she told us
that her grandmother had those for the past 4 years or so. Clearly one or both
of them are not telling the truth, but we have to assume that the longer time
period is the truth in this case and act accordingly.
Even though I had no part in it, I enjoyed the part of
OB/GYN where Georgina doesn’t do any exams and instead just sits the teenage
patient down and educates her about her body and health. It was great to see her
take that time to talk individually with them and be candid with the
information, delivering it without judgment. I think that she was very skilled
with creating an environment of privacy and open dialogue, which I very much
appreciate from a health professional. I admired her ability and desire to just
sit down and give young girls information that they would have very little
access to otherwise because that is how we can actually start making a
significant difference with the younger generation, especially in problems such
as teenage pregnancy.
I spent the afternoon after lunch in triage. I worked with
an interpreter named Nana, but there were not very many patients. I was only
able to see about four or so patients, so I spent most of my time talking a
little bit with Nana and the other interpreters. She told me that she had never
traveled outside of Ghana either, but she definitely wanted to. She has
siblings and family in the US and the UK, and she said that each time she
compares the presents that her family members bring from the US and UK, she
finds that the US items are cheaper but higher quality. I’m not sure that I
believe it, but I think it’s interesting that she thinks this way.
When we were packing the leftover medications into the van
at the end, we were swarmed by the kids and were able to take some really great
photos. The most interesting thing that happened was when one of the interns
decided to pour some of her clean water from her water bottle into the cups
that we had given the kids earlier, and they treated the water as if it was a
precious commodity. They scarfed it down and started to ask for more and one
little girl who didn’t have a cup tried to take the cup of one of the infants,
which we tried to stop right away. In a community that is lacking clean water,
I was not so surprised to see water treated that way but I’m sad that it has to
come to this.
The little girl who tried to take the other girl’s water
also happened to have visited us on day 2 of the clinic, and at that time she
was wearing a cloth neck brace. Her father explained that she had fallen before
and hurt her neck. When we asked her how her neck was and started to rock our
heads from side to side, she imitated us but with more force. It was really
cute to see how much she wanted to interact with us, but we quickly stopped her
because we didn’t want her to injure her neck further after she had the brace
removed.
One of the kids we were playing with suddenly pointed at me
and said, “China” when we were playing too, and it reminded me of the kids from
the Anomabo community we met on Day 2 of the internship that called Ed “China”
as well. It makes me wonder what kind of information Ghanaians, rural or from
the cities, have access to about Asians, or Chinese people specifically. I was
definitely surprised to hear the little girl say that to me, but I guess it’s
an indicator that they have some awareness about the world, even if it is very
little. The thing is, out of all the Ghanaian staff that I’ve asked thus far,
none of them has mentioned any country outside of the US that they would like
to travel to. I imagine it’s because they have the most exposure to the United
States (which I’ve noticed in the UK and Ghana is just called “The States”)
through media and language, and it seen as a beacon of opportunity. The
interesting part of that is that I have merely asked where they would like to
visit, not whether they would like to live there. Nevertheless, the US is the
most highly-desired travel destination based on the people that I’ve have the
opportunity to ask.
The last thing that happened today when we met back up with
the sustainable development interns was that they shared some tiger nuts that
they were gifted from the community they visited. Before this, I had no idea
what they were, but I decided to try them and was pleasantly surprised because
they taste like shredded coconut.
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