Friday, 12 April 2013

Farewell to Ghana

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! 


How to Really Help - by Morgan Nikel



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

Apemanim



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.  


Baby Yaa.  



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.


We gathered at Nana's after the event.


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!  


Fabric anyone?  


With Nana.


With the Queen Mother.


Waiting



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

An Imperfect Offering: reviewed by Kayla Strickland



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.

References
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.