Tuesday, 26 February 2013

My Biggest Lesson -- Nathaly Herrera-Lopez




My life in Canada is busy, with the combination of work, school, friends, family and my big involvement in church, there never seems to be any extra time to talk to strangers or those friends you are slowly losing contact with.  Being in Ghana, I have realized the importance of the smaller things in life like taking time to talk to strangers, to friends and family, and especially to patients. 

The first few days on a unit at 37 Military, there was some down time during my orientation on the unit.  This gave me an opportunity to talk to the young patients and their mothers.  Humility was the key to building these relationships; I was the stranger, or the Obruni, in their country.  I could have pretended I knew what their culture was about or I could humbly ask.  I started with the few greetings I knew in Twi (the language of the Akan people of Ghana, the biggest tribal group), which really helped to break the ice as I surprised the mothers caring for their children in the step down Neonatal Intensive Care Unit (NICU).  Every time after I stopped and chatted with them, they would teach me new words or ask about how I liked Ghana.  Not only did these conversations build on the relationships I established, but they also gave me an opportunity to learn from them, see how they care for their children, and how they diligently listened to the doctors in an eagerness to go home—yet their faces showed discouragement and stress. 

One mother in particular stands out: she was a diploma nurse, she knew her patient rights and appeared to have a strong personality as she was the most outspoken one of the mothers in the NICU.  One day, she excitedly prepared to go home only to find out later in doctor rounds that her baby had developed a new fever and could possibly have meningitis.  The doctors moved on and I noticed her eyes fill with tears.  When I asked her how she was doing she responded with “fine”, but her face told me a different story.  She did not want to share but she accepted a comforting touch.

Oberg describes six key aspects of culture shock, one of which is feelings of impotence due to not being able to cope in alien situations.  I felt that being the foreigner made me unsure of what was culturally acceptable in probing further discussion on what upset her, but I knew touch was appropriate (In Stewart, & Leggar, 1998).  I still felt impotent and unable to really help but it was a step in the right direction, and becoming culturally competent is not a destination but more of a process and unending journey (Crigger, & Holcomb, 2007).

These women are strong and care so deeply for their children and this is evident in my conversations and observations with the mothers.  They might pick their babies up less gently than our North American coddling style, or carry their child slung on their back without neck support but this is their norm and culture; besides, it leaves both their hands free to complete other tasks or care for their other children.  I have come to accept and admire some of the norms the mothers have here and maybe one day I will adopt them when I have kids of my own. 

One thing is for sure, I have learned the importance of taking my time despite the busy schedules to talk and share with the people around me.  Even a small greeting can go a long way as it opens the doors for further interactions.  The importance of humility has resounded within me being in a new country with new experiences and sights.  Just because something is done a certain way in one country doesn’t make it right and now I am seeing there is more than one right way to reach the same end goal.  In an attempt to be accepting, I have been able to see more than I would have thought and paved a way for me to interact with people in ways I do not at home, but hopefully I will adopt as my own.  It would be a lie to say I am truly immersed, but it is a journey and I am sure I will hit some road bumps along the way when my values collide with a different world view or experience.

References

Stewart, L., & Leggar, P. A . (1998).  Culture shock and travelers.  J Travel Med, 5, (2), pp.84-88.
        
Crigger, N. J., & Holcomb, L.  (2007).  Practical strategies for providing culturally sensitive, ethical care in developing nations.  Journal of Transcultural Nursing, 18 (1), pp. 70-76.                                                                 DOI:10.1177/1043659606294198

Unanticipated Strengths by Kirsten Ziegenhagel




While working on a general paediatrics ward for the first week of my clinical in Ghana, I discovered a number of strengths among the mothers with sick children. I have come to the conclusion that Ghanaian mothers are: (1) resilient, (2) courageous, and (3) patient. I was not expecting to see these types of strengths among mothers who were facing the uncertainty of whether or not their child would survive.

            The Ghanaian women seem very resilient. Resilience is defined as “the ability to bounce back” (Smith et al., 2008). The personal attributes of resilient people include “an internal locus of control, pro-social behaviour, empathy, positive self-image, optimism, and the ability to organize daily responsibilities’ (McAllister & McKinnon 2009, p. 373).” The Ghanaian women showed these attributes through the way they cared for their children.  No matter what circumstances they faced, they were still able to persevere. An example of the resiliency I saw on the unit was portrayed by a young mother with two-month-old twins weighing only 2 kilograms each. They were facing malaria, sepsis and gastroenteritis. The mother was advised to supplement her breast milk with high caloric formula in order for the babies to gain some weight. Everyday, the mother would attempt to feed her babies the extra formula with a teaspoon, the only resource she had to feed her babies. It would take her a very long time, but she would sit there spoonfeeding her babies one by one until they were no longer hungry. Whatever challenges she faced, she always did so with a smile on her face and at least one baby in her arms.

I was particularly impressed with the courage that these women portrayed. A lot of the children on the ward were extremely ill and these parents faced the possibility that their child may die. Yet every day on the unit when I would approach the mothers to talk to them they would smile and have a conversation about their child. They were able to laugh when something humorous happened on the unit and able to comfort or scold their child if needed. Their role of a mother did not change. The women were strong for their children and always able to comfort their sick child. An example of the courage seen would be in the mothers of the children who have unshunted hydrocephaly, an anatomical condition where the ventricles are unable to drain cerebral spinal fluid. These women would shower their babies with love and affection, continue to breastfeed and hold them. Despite how different their baby looked, this did not deter the mother’s from treating them any differently. Even when husbands were not involved with the babies after their diagnosis of hydrocephaly, the women continued to love their child.  I did not once see the mother’s of these babies cry. The women handled their baby’s condition with tremendous strength.

            The last strength I want to shed light upon would be the patience these women have. Some of these babies are hospitalized for months at a time. These mothers did not leave the bedside unless they were washing up or getting medication from the pharmacy. Everything revolved around their child and their child’s wellbeing. The women slept in plastic lawn chairs beside their child’s bed, they were patient while awaiting rounds from the doctors in the morning and the mother’s never complained of how exhausted they were.  I was amazed at how they were able to sit and comfort their child for as long as needed. Their patience was an invaluable lesson on what is truly important in life.

            The Ghanaian mothers I've seen are incredibly strong. The circumstances they may face never seem to knock them down. They continue to be resilient no matter how many children they have previously lost or how ill their child is. They continue to show courage by always smiling and patience by never complaining and always diligently waiting at the bedside. I was not anticipating discovering these strengths. I had the assumption that because their child was hospitalized, the mother’s would have shown their distress. I don’t think I have ever met such strong, incredible women. Their will to keep going even after all the hardships they endure has inspired me to be stronger woman in the difficulties I may face in my lifetime.

Monday, 25 February 2013

Kakum Canopy Walk


Starting out on our canopy walk







One of the crocodiles at the place we stopped for lunch.  

Elmina

On Saturday we all went to Elmina castle in the Cape Coast area west of Accra.  Elmina was a primary site from which African slaves were sent by the Portuguese, Dutch then the British.  The site is profoundly sobering as it forces each visitor to face the evidence of unimaginable cruelty that persisted for hundreds of years.


Our first glimpse of Elmina--it doesn't look so ominous from a distance.  



A cell in which up to 300 women could be held for as long as 3 months waiting for a ship to transport them.




The gate of no return.  Once through this doorway the slaves were loaded onto ships.


Our brief experience inside one of the detention cells--this is the cell where people survived because there was air and light.



Carly


Elmina fishing boats seen from the top of the castle.



Up top the wind, ocean view, and fresh air was wonderfully refreshing !




Kirsten and Nathaly


Nathaly and Morgan


Rachel



Elmina fishing boats.



Elmina at sunrise.  

Friday, 22 February 2013

How Can We Really Help? Jaime Sehn


      

Help:  a fundamental role attributed to a friend, neighbor, and more frequently identifiable to me, as a nurse.  Nurses sustain both a professional and personal accountability to the public as a person whose characteristics are compassionate, caring and helpful by nature.  After four years of nursing school, clinical placements and work experience, I have certainly mastered the art of helping my patients.  It was not until I began my journey in Ghana that I came to realize the act of being “helpful” can prove to be a much greater challenge in an environment that is vastly foreign to your own.  From the language barrier, to an unfamiliar culture and diverse health system than what I am accustomed to, my notion of how to really help has been the subject of self-scrutiny.  The story I am about to tell describes the struggles and strides I have encountered in discovering what I believe is my epiphany of how to really help.  

As I began to wash a woman lying in emesis soaked sheets, I intuitively performed an internal skin integrity assessment noting multiple skin tears and bed sores on her body.  How can I help?  Immediately, my nursing instincts took over and I began to search for gauze, saline, a towel – anything to clean or cover this woman’s wounds.  Something for the pain…pillows to alleviate the pressure…where else had skin breakdown occurred?  I checked her ears, the back of her head, and all other bony prominences.  The sheets had been soiled in blood.  To no avail, these essential items could not be attained, and reality set in that all resources are a scarcity here.  It became obvious to me that the gauze, the sheets, and the pain medication would be salvaged for another patient with a better prognosis.  Again, the question arose in my mind…how do I help?  The irony in answering this question is such that despite my routine efforts in fulfilling this fundamental nursing role, I have truly never felt so helpless.  I went home that day filled with conflicting guilt, frustration, and a sense of defeat.  In Canadian hospitals, helping is made easy by means of material items; here you must dig deeper, and illuminate your innovative self. 

The following week my two colleagues and I knelt alongside a family whose son was close to death.  Though we did not necessarily carry out any particular intervention, we provided comfort care and emotional support by remaining present, and encouraged the family to do so as well.  A couple days later, we ran into this same family. They had returned to the hospital to collection their young son’s body.  The family embraced us with open arms and expressed their sincerest gratitude for all of our support the day their beloved had passed.  It was in this moment that the answer of how we can truly help began to surface.  Help may not necessarily transpire as an action or intervention, but stems from compassion, empathy and kindness.  The answer to how we really help is simple, when we extend our hand, offer a smile, or wipe a tear; this is how we truly help.  We are also helping in ways we may not even recognize, for example, setting a positive example for others, or exhausting all efforts to look for the extra bed sheet that might not necessarily exist.  After sharing this particularly moving experience with our instructor she said to us something I will not soon forget, yet so basic in principle, “simple caring translates across all cultures”.  The story I have told is indeed a testimonial to this statement and I believe it will forever leave an imprint on my nursing practice now and for years to follow.            

Morning Commute


Kayla and Jacqalyn looking pretty perky for the early morning bus ride to clinical.


The ever-present traffic vendors--such a dangerous way to make a living!


Lots of new upscale construction.


Lots of huts and street shops.

End of a Good Day in Clinical


Rachel, Jamie and Jacqalyn after a good day in Surgical ER.

Teaching for Antenatal Moms at 37Military


Kelsey, Carly and Stephanie teaching expectant Moms under the watchful eye of Gramma Abigail.  

Getting Wifi Access


Morgan, Jacqalyn and Carly getting onto internet at Lynne's

Tuesday, 19 February 2013

Akwaaba! (Welcome!) by Rachel Gaudry




Welcome to our blog! Or, in Ghanaian terms, Akwaaba! In the next following weeks we'll be posting a variety of blogs to share our experience in lovely Ghana. Our hope is that through our recounts and reflections you'll also share in a part of the adventure, and hopefully learn some new things, just as we have. Before all of that though, let us give you some background on the country and share a bit of our experience so far!

Ghana is situated on the Gulf of Guinea and bordered by three former French Colonies, Burkina Faso to the North, Cote D'Ivoire to the West, and Togo to the East. There are 10 different regions throughout the country, with Accra being the capital city. With a population just over 24 million people, Ghana's urban centers in the south are densely populated, and continue to grow rapidly.  The northern regions however, are declining in numbers as many individuals migrate towards the south in search of employment. The contrast between the north and south regions in terms of socioeconomic standards and access to health services are concerning, and the subsequent implications are profound. As this is an issue of great importance, more explanation and discussion will be present throughout our following blogs.

Although English is Ghana’s official language, there are huge varieties of dialects and ethnicities scattered throughout the regions. The vast number of tribes gives a Ghana a diverse and rich culture. Following English, Twi (pronounced ch-wee) is the most common spoken language. Our single word attempts at speaking twi to our hosts remain a great source of entertainment for them, as well as a wonderful way for us to connect and build relationships with the Ghanaian locals. One interesting example of Ghanaian culture is the significance they place on Schnapps. As a product of the Dutch, the importance of Schnapps goes back to the colonial era in which this alcoholic beverage was associated with power. Subsequently, it remains a prestigious beverage among Ghanaians, especially the Chiefs. The role of traditional cloth (wax print, fugu, kente) also holds a rather complex and extensive role as the type, color, style are all determined by a variety of customs. For example, to remain in good social standing, both men and women must have a set number of cloth outfits in their wardrobe for various events. In fact, if an individual has not attended an appropriate number of funerals, it is suspected that the individual does not have enough cloths to keep up appearances.

Ghana gained independence from their British colonial power on March 6th, 1957, making them the first independent nation in all of Africa. As a result, Ghanaians take great pride in promoting human rights and politically stability, and are recognized by the international community for their strong peacekeeping role. Kwame Nkrumah, one of the men who negotiated Ghana’s freedom and the country’s first president, is well celebrated and loved by the people. The most recent election occurred this past December with John Mahama gaining office after receiving 50.8% of the vote. With such a close race, an investigation was undertaken to ensure that the results had not been tampered with. Following a rigorous examination, the Supreme Court declared the election fair and the results valid. Many outside observers view Ghana’s adherence to an organized legal system as a display of their democratic maturity.

In 2003, Ghana launched their public healthcare system, the National Health Insurance Scheme (NHIS), as a way of reducing barriers to accessing health services. Even with 15% of their GDP going to health spending, the system remains under-financed and variable in quality. Other challenges the system faces include regulating traditional medicine, staffing shortages, and lack of resources.
Many of the major causes of illness and death are preventable if only there were more access to clean water, immunizations and primary healthcare. Although progress in these areas is slow, there are improvements, and the nurses and doctors work tirelessly to make the most of what is available. From our experiences so far, we have witnessed an unprecedented number of long-standing hypertension cases, accompanied by secondary conditions such as strokes. Other common health problems include malaria, gastroenteritis, hydrocephaly in infants and maternal deaths. After our first two weeks, we’ve noted a number of differences between our two cultures on topics such as patient-healthcare provider interactions and the management of death and dying in the hospital setting. As we rotate through our various clinical placements – medical emergency, trauma/surgical emergency, pediatric emergency, general pediatrics, female obstetrics and gynecology, polyclinics and our week in the village of Apemanim – we will continue to acquaint ourselves with the various similarities and differences between our two countries, and build on the strengths of each.

We hope that you’ll find our blog both educational and enjoyable to read. Our goal for both ourselves’ as individuals and as a group is to take what we’ve experienced in our practicum, and to apply it in a more meaningful and in-depth way. Through critically reflections, we are able to share both our thoughts, as well as challenge others to gain new ideas and knowledge in what it means to be both a nurse, as well as a global-oriented citizen. 

Wednesday, 13 February 2013

Thank You Abayiwa !


Lt. Col. Sally Mensah--Abayiwa--Our Week One Saviour

We owe a huge debt to Abayiwa.  She has looked after us, kept us from getting lost in the maze that is 37 Military, answered inummerable questions, and made actually escorted us on our first tro tro ride home.  Today we ended clinical with post conference in the Officer's Mess.

Birthday Girls


Jacqalyn and Kelsey celebrate birthdays after our first week.