We have finished all of our official experiences in Ghana. We are leaving in stages and are getting well practiced at good-bye's.
It has been a wonderful and intense experience that will remain with all of us for a lifetime. Thank you to everyone who made it possible!
Friday, 12 April 2013
Initially it seems easy to look at Africa as a continent and see what needs to be done to help improve it. You can look at each country and pick out different aspects that need more development. These can include but are not limited to health care systems, infrastructure, governments, or economies. From the perspective of a high-income country, it is too simple to point at a flaw, and say “this must be fixed” without truly understanding how to go about making a change. While I have been in Ghana, there have been many situations in which it was clear that something needed to be improved. Unfortunately, just recognizing a problem does not help to fix it. This simple recognition only acts as an identifier, not a solution.
Before doing my rotation in general pediatrics at 37 Military Hospital, I believed that I would see a very different level of care provided than what I am used to in Canada. I prepared myself for improper sterile technique, lack of resources, and different procedures for dressing changes and IV insertions. Therefore when I observed these procedures I was not shocked to see that what I thought was true. I was actually more shocked to see the amount of resources that do exist in Ghana, and therefore found myself silently critiquing their procedures and techniques instead. I had built up such a stereotype of Ghanaian health care in my mind that I didn’t expect there to be normal saline, or gauze, or even sterile gloves. Therefore I did not expect a sterile fields or sterile dressing changes. And so when watching these, I could only picture how a sterile field would be treated in Canada, and how a sterile dressing change would be completed in Canada. Originally I could not overcome my shock of such a lack of sterility and organization in these procedures to see that they were providing competent care to the best of their abilities. I then questioned myself: who was I to criticize their process when I was not helping them to change or improve it?
It was at this moment I recognized that I should not have entered the unit with such prejudices in my mind. It is better to keep an open mind and be willing to learn, so you can see how you can truly help. I had come in thinking I could provide the unit and nurses with resources. Then through my own disdain, looked down on their process as being incorrect. Based on Canadian standards, the majority of their procedures are done without proper sterility or technique. The nurses however, are aware of this. They explained that they understand what they should be doing for proper sterility and what the technique should be. They just cannot perform to such standards because of their resources. It therefore does not help the patient or the nurses to shake your head at their actions. Yes, what is reported is true. Ghana does need more resources in their health care system. What is not reported however is that they do not need criticism for what they are currently doing. They are doing their best with what they have.
The way to really help Ghana and Africa as a whole is to break your stereotypes against them. Do not form quick judgments from what you see in the media. Do not decide that a country would be better if one thing – such as health care – was fixed. Do not assume that the citizens living within a country do not want to or are not working towards change. You cannot help a country that you do not fully understand. It is important to educate yourself and others about a country and culture before making a decision about what kind of help is really needed. You cannot make an uneducated guess on how to truly help a country. For example, I could not help with a dressing change when I scoffed at the improper sterility. I, like many others should, needed to set aside my prejudice and judgment and see that they are simply doing the best that they can with the resources they have available.
Tuesday, 9 April 2013
Nana, our very favorite Chief ! Nana did is PhD in Australia and Masters at UofA--that is how the connection with our faculty began. Our link with the nurses of the CHPS clinic is one of several initiatives he has fostered to help the village.
The nurses of Apemanim: Christie, Naa, Gloria, Adowa
Stephanie, Kelsey and Carly in the clinic store room almost finished doing inventory of the supplies that we brought.
Children and women's clinic in a neighbouring village. We walked to a couple villages to do immunizations, weigh and assess babies and assess children for various health issues.
Sadly we've learned how to recognize signs of malaria in children. Kofi is one of the children feeling really miserable with it.
The nurses pounding fufu. It is amazing that no fingers get squashed!
All the nurses, Ghanaian and Canadian, dressed for the Derba.
Chiefs' procession at the Derba. This event was to raise funds for a school.
Traditional dancing as part of the ceremony.
All attendee's contribute to the school fund; this is the nurses making their contribution.
Adwoa was the first nurse in the Apemanim clinic. She is currently doing midwifery training and will return as the village's midwife in a year. She was recognized for her work.
Jaime and some of the children.
Morgan and Rachel. We all had a child on our laps for the event--obrunis are quite the novelty.
Jac getting a big smile.
How to tie a baby on your back. That's Kirsten getting the privilege. Somehow, babies from newborn up 'know' to stay still while you put the cloth around them.
We're thrilled when people ask to have their photo taken!
This lady lives next to Nana's compound. She asked for a photo of her sweeping. Sweeping is a sound we wake to each morning--along with roosters.
Informal chat time with the nurses.
There's nothing like a warm Ghanaian welcome.
Christie and Naa were brave enough to take 11 obrunis to the Kumasi market. That's Kirsten's back again.
Buying Africa necklaces--yes it is total bedlam!
With the Queen Mother.
One thing about Ghana is you spend a lot of time waiting. Rarely do things happen at scheduled times. We have learned to be incredibly patient and are wondering what it will be like to return to Canadian schedules after living on "Ghanaian time" for three months.
The good thing: lots of time for great reading.
Monday, 1 April 2013
Photo of us weaving our way through Medina market on our way to a primary school.
An Imperfect Offering: Humanitarian Action in the Twenty- First Century is a novel written by Dr. James Orbinski which explored the author’s personal experiences working with Medecins Sans Frontieres (MSF/ Doctors without Borders). Established in 1971, MSF is one of the world’s leading independent international medical relief organizations providing emergency relief to populations in distress, victims of natural or manmade disasters and to victims of armed conflict (MSF, n.d). Dr. Orbinski was drawn to working in developing countries to provide humanitarian aid after completing research on Human Immunodeficiency Virus (HIV) in Rwanda in the mid 1980’s. He began volunteering with MSF in 1991 as one of the founding members of MSF Canada working in Peru, Somalia, and Afghanistan. The book begins by outlining his experiences in these countries and the many different health problems he encountered in these areas. By 1994, Orbinski was appointed Chef de Mission for a mission in Rwanda. At the time, the country was in civil war between the predominantly Tutsi Rwanda Patriotic Forces (RPF) and the predominantly Hutu Rwanda Government Forces (RGF). Throughout Rwanda, Tutsi and moderate Hutus were systematically butchered in the genocide. During Orbinski’s time in Rwanda he was confronted with many patients who were affected by the brutality of the war. The author described the horrific scene of suffering among the men, women and children of Rwanda and the cruelty they faced. He recounts his memories of the struggles he encountered trying to provide care to refugees while struggling against the political powers and various rebel groups. After many years providing humanitarian aid Orbinski was elected the international president of MSF. In the final chapters of the book Orbinski discussed the influence of politics on the organization. Throughout the book he highlighted the political contributions to war as well as the failure of many political bodies to act during humanitarian crisis. Emphasis was placed on MSF’s desire to directly focus on medical needs and humanitarian principles while maintaining independent neutrality. The strong humanitarian values maintained by MSF over years of service earned the organization a Nobel Peace Prize in 1999. In conclusion, Orbinski encourages readers to become global citizens and actively engage in humanitarian action by becoming involved in an organization of choice and to bring new ideas to the organization as well as challenge current practices in order to continue to strive for global equality.
The connection the author makes between humanitarian aid and the political obstacles faced during crisis helped me realize of how interconnected the two are but how important it is to keep them separated. Even during the most dangerous periods of war MSF proved that remaining politically neutral allowed them better access to the patients who desperately needed their help. The author explained that other aid organizations who received government assistance and protection were often rejected by the opposing groups which often restricted their ability to provide vital medical care. I was surprised to read about the lack of action taken by many powerful countries to intervene during the Rwanda genocide. The author talks about the effects of the media and how the refusal to use the term “genocide” prevented countries from being obligated to take action against the crimes occurring in Rwanda. My naivety has allowed me to believe that the governing bodies of developed countries are striving to do what is best for the people and it was a rude awakening to realize that there is corruption in almost every system. While reading I was also ashamed of how little I actually knew about the most devastating genocide of the twentieth century. The stories told and the experiences described will encourage me to continue to become a more globally aware citizen. The devastation that the author described were experiences that no person should have to endure and by becoming more aware I feel there is hope these kinds of crimes will be prevented in the future. I feel it is important to continue to read and learn about global issues because it creates an understanding of the world and how we are interconnected as people.
Medecins Sans Frontieres (n.d). MSF charter. Retrieved on March 24, 2013 from http://www.msf.ca/about-msf/msf-charter/
Orbinski, J. (2008). An Imperfect Offering: Humanitarian action in the twenty- first century. Toronto: Anchor Canada.
Friday, 29 March 2013
After being in Ghana for almost two months now, it is difficult to say what my biggest lesson has been because there have been so many! Having to choose just one, I believe that my biggest lesson has been the importance of the nursing role of patient advocacy. There have been numerous times during my stay here where I have witnessed the need for a patient advocate or have been the advocate myself.
As I am sure you can imagine, hospitals in Ghana are much different from hospitals in Canada. Saying this, I would like to stress that the differences are not all negative. In fact, there are many tips from Ghanaian hospitals that Canadian hospitals could pick up on, such as maternal and pediatric health information booklets.
One difference that has been prominent for me is the variation in family-centred care. For example, on multiple occasions I witnessed husbands being shooed away when they tried to accompany their partners to their postnatal appointments. Sometimes the husbands were simply yelled at by the nurses for attending. However this is not universal; family-centred care was promoted at one of the polyclinics that offered priority appointments to the babies who had both their mother and father present. We observed how beneficial it is for nurses to adjust their practice and effectively advocate for maternal patients. Not only does this advocacy involve the father in the pregnancy, but it also helps to form a bond between the mother and the baby.
In other instances, I have had the opportunity to advocate for the patients. Primarily, this has been teaching staff members’ best practice techniques during patient care in a variety of settings. These settings include pediatric emergency, maternity, and the female outpatient department. One instance that stands out for me involved a one-month-old premature twin boy. He visited the neonatal intensive care unit (NICU) for a dressing change for a wound caused by an infected intravenous line. The neonate was still very small for his age and was still quite vulnerable to infection. The nurse informed me that she was going to leave the open wound uncovered to save on resources. Shocked, I told her that it would be best to cover the wound as leaving at open would only increase his risk for infection. This would subsequently lead to more resources being spent on treating the worsened infection. Much to my surprise, the nurse listened to what I had to say and covered up the wound. After reflecting on the day, I realized that one of the most important roles of my job as a nurse is to ensure that patients are receiving the best possible care and guaranteeing that the best practice is made known in unclear situations.
In Canada I have had many opportunities to advocate for patients. One of the most important aspects of care in my daily nursing practice is focusing on precautions to prevent pressure ulcers. Patients often cannot move themselves or speak for themselves when they have remained in the same position for a long period of time. Consequently, there are high rates of pressure ulcers on the unit I work on. In order to prevent this, I make it part of my everyday nursing care to turn the patients minimum every two hours, apply pressure relief boots, and keep their skin dry. On a busy day, I often witness these preventative measures being overlooked and hear the phrase “it’s good enough for now” or “I’ll try and do it later.” Unfortunately the voices of patients in need are often not heard. It is our role as a nurse to advocate for them, to make their voices heard.
I think that the importance of advocating for patients in Canada is often overlooked in part due to the availability of resources – we often place other aspects of care at higher priorities. After working in settings with an astonishing lack of resources, it became apparent that advocating for patients is something that must be practiced and enforced by nurses worldwide.
As our clinical time in Ghana is coming to a rapid close (only two weeks until we’re graduate nurses – time flies!), we have been visiting different facilities every day as part of our cultural experience. This week we are spending a day at each of the following facilities: the Osu Children’s Home, Princess Marie Louise Children’s Hospital, Korle Bu Teaching Hospital, and the Accra Psychiatric Facility. Last Thursday, we were all very excited – and maybe a little bit nervous – to visit a traditional healer! Now, when you read “traditional healer,” what was the first image that popped into your mind? I will not lie to you. I was expecting one of the makeshift lean-to’s we have seen on the road, claiming to have cures for everything from the common cold to gonorrhea and more, with Rafiki chanting behind it and mixing something in a squash. Pushing it? Maybe. However, after discussion with my peers it became clear that I was not the only one in the group who imagined something along the lines of a witch doctor, or a “quack doctor,” as they are fondly referred to in Ghana.
Imagine our surprise when we pulled up to a very large, concrete building with a large sign indicating that we had arrived at the Centre for Scientific Research into Plant Medicine (CSRPM); this was definitely not the traditional healer that we were expecting! As it turns out, we were sorely mistaken in what we had imagined our adventure was to be that day, but we learned a lot about traditional healers and medicine. First and foremost, we learned that this practice of traditional healing does not involve crazy antics or quack doctors.
As a developing country with an average life expectancy of less than 60 years, Ghana has the need for “effective, appropriate and efficient means of meeting the health needs of its growing population” (Tabi, Powell & Hodnicki, 2006, p. 52). This approach blends aspects of both traditional and modern medicine due to the lack of medical resources, cultural traditions, and a belief that one must have a deep understanding of their health, life, and being (Tabi et al., 2006). Typically, the choice of an individual regarding choosing traditional or modern healing methods will depend on the illness and its perception by other relatives or friends; however, rural populations will more often seek the help of traditional healers as they are more affordable and accessible in such regions. Tabi et al. (2006) state that, “80% of the population in Africa uses traditional medicine for health care” (p. 53).
There are several different types of traditional healers in Ghana, including: traditional pharmacists, who use herbal medicines made from leaves, roots, or other animal and plant parts; plant drug peddlers, who travel selling herbal medicines; and, “the priest and priestess of deities and gods who use techniques and rituals in healing practices” (Tabi et al., 2006, p. 53), who use divination and rituals to cure what they believe to be spiritual diseases. During our tour of the CSRPM we also learned about herbalists: doctors who begin in medical school and choose to specialize in and work with traditional medicines.
In Ghana many families and individuals do continue to use homemade remedies that have been passed on through generations, but that is not the image of traditional healing that the CSRPM projects. The centre has held World Health Organization Collaborating Centre status and continues research and development of herbal medicines with hopes of achieving their vision “to make herbal medicine a natural choice for all” (CSRPM, 2008).
When local individuals believe they have found a remedy from a natural source, it is brought in to the centre where it undergoes testing in a variety of departments: phytochemistry, pharmacology and toxicology, microbiology, production, plant development, and scientific information. After this, the CSRPM sends a report to the Ghanaian Food and Drug Administration (FDA) who then decides whether or not the product is safe for market. The CSRPM also runs an outpatient clinic where patients see the herbalists and can get traditional remedies – even visiting nursing students from Canada can purchase ointments for mysterious bug bites!
It is important for us as nurses, both internationally and at home in Canada, to recognize different cultural traditions and indigenous beliefs of our patients. Especially in Ghana, traditional and modern medicine will always be a large part of the healthcare system and it is important to acknowledge our role in helping patients recognize the positive elements of both (Tabi et al., 2006).
So while the vision and use of traditional medicine may not be as strange and extreme as we may have thought, the origins and current beliefs surrounding these practices are deeply rooted in the Ghanaian culture. Herbal remedies have been used for generations and hopefully, through the work of facilities such as the Centre for Scientific Research into Plant Medicine, they will be considered viable, scientifically accepted, resources for ailments all over the world.
Centre For Scientific Research Into Plant Medicine. (2008). Welcome to CSRPM. Retrieved from http://www.csrpm.org/index-2.html
Tabi, M., Powell, M., & Hodnicki, D. (2006). Use of traditional healers and modern medicine in Ghana. International Nursing Review, 53(1), 52-58.