Another Day in Triage

Tema, Ghana - Another day in triage...

The heat in the outpatient department is oppressive and sweat rolls off my back. Sluggish children and their mothers crowd the benches waiting their turn in the “queue” to see the doctor. Most are here for fevers and body aches, most likely malaria, Beatrice, the pediatric triage nurse tells us. In the United States the word “lethargic” is reserved for our critically ill patients. As I look down the benches, I see lethargic children, with sunken eyes and fontanelles. It once again is a sobering sight.

Beatrice and I have been talking all morning about the need for standardized triage protocols at Tema General Hospital. “Sister, come and look,” as Beatrice motions me to a mother delicately holding her small child wrapped in a sheet. The 4-day-old boy’s axillary temperature is 40.3 degrees Celsius; this is roughly 104.5 degrees Fahrenheit. I recognize this situation as a true emergency and question Beatrice regarding the neonatal and maternal history. “I do not know,” she says as she places the child’s chart in the front of the queue. I think to myself, it is good she recognizes this as a high risk situation and places the child at the front of the line, but in our practice, this patient needs immediate attention; he should not wait.

It is a difficult balance as an outsider trying to mentor nurses while taking into account the vast deficit of resources that we have come to depend upon. In no way do we want to discount their standard of care but we also want to ensure patients get necessary and timely attention. I quietly suggest to Beatrice that it might be best if we send the infant back to the “baby ward” and alert a physician as to the patient’s condition immediately. As we walk toward the ward, I can appreciate the stress the nurses of TGH face. They are working with a high volume of acutely ill patients with few resources. As part of the Project HOPE team, I look forward to facilitating realistic goals based on solid practices for their triage system.

Thanks for reading-Elise Chamberlain

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Changes and Challenges in Ghana

As the days progress, we continue our needs assessment of the emergency services and continue to evaluate skill sets and standardized procedures of the medical and nursing staff. We are amazed at the ingenuity, energy and dedication of the staff. They seem to do so much with so little, and so efficiently. We are identifying many similarities in our practices as well some major differences in training, standards and procedures.

The hospital lacks some very basic necessities. There is one EKG machine for the entire facility. Worse yet, is the fact that it is available less than 12 hours per day. There are no readily available airway adjuncts in most areas. Basic cardiac monitoring is nonexistent. Oxygen is a precious commodity. X-ray equipment lacks repairs for years. Trolleys (stretchers) are few and far between. Wheelchairs are craftily designed from plastic chairs.

We and those that will follow us from Project HOPE are committed to helping Tema General strengthen its weaknesses and move forward. There are certainly many stumbling blocks along the way, including lack of resources, fear of change, cultural differences, and motivational factors at all levels. We feel that this is a worthy and necessary challenge and will forge ahead one day at a time, helping and providing support as we step forward.

Thanks for reading-Marley Gevanthor and Elise Chamberlain

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Volunteers Experience Controlled Chaos

Tema, Ghana -As well seasoned triage nurses in large, high volume hospitals in Washington State and California, Project HOPE volunteers, Elise and Marley walked in to the Out Patient Department today feeling confident and prepared to start their day working side by side with their host nation counterparts. It was stifling hot. The background noise was near deafening and certainly distracting. A mass of humanity awaited care.

It was agreed that Elise would work with and mentor Beatrice in the Pediatric Department. Marley would work in the adult section with Mary, another experienced senior nurse. Patients and families were in queues at registration, medical records, the vital sign stations, the interview areas and in every available chair and bench in the consultation area. Patients arrive by walk-in, private vehicle and ambulance. Many have been referred from other facilities and clinics. Our nursing hosts are masters of organization, multitasking and directing. There is a constant bombardment of questions, interruptions, and distractions of every conceivable nature.

Elise had barely been oriented when an infant she was assessing began to seize. The child’s skin was burning. In fact, the axillary temperature was 39.7 Centigrade, a significant fever. Elise instructed the mother and nurse while demonstrating the proper technique to protect and maintain the baby’s airway. She then calmly escorted the group to the acute care area for immediate evaluation and treatment. By 1400(2pm), 93 children had been triaged by Elise and Beatrice.

Our day concluded with an elderly patient being rolled in on a trolley by her sons and daughter. “Our mother is in a coma” they stated simply. Marley immediately got up to assess the patient. The patient was unresponsive. The patient’s skin was cold. The patient was not breathing. While the patient was being moved to the acute care area for a glucose check, Marley gently suggested that perhaps the physician should be summoned while she repositioned the airway and tried to find the pulse. Although our patient most likely had died prior to arrival, her treatment might have been much more aggressive in the United States.

One of Project HOPE’s goals on this mission is to help our fellow healthcare providers optimize their limited resources and to provide mentoring and support to improve care and outcomes in these very challenging conditions.

Thanks for reading-Marley Gevanthor and Elise Chamberlain

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Need for Pre-hospital and Emergency Medical Protocols

It was only 9:30 a.m. as we walked into the Accident and Emergency Center located on the far end of Tema General Hospital (TGH) campus, but the air was thick with humidity. Seven of the eleven beds were already filled with patients that had come in over the previous days and additional patients lined the wooden benches waiting to be seen.

One of the patients, Joseph, a 35-year-old male who suffered an open fracture and dislocation of the left ankle, lay in the corner staring out the window, with a small black bible in his hand. When we went to talk to him, he greeted us warmly and explained that a metal bar had swung out and hit his leg while he worked three days ago. He had been taken to TGH where he received initial treatment including splinting and pain management. But, with no orthopedic surgeon on staff at TGH, Joseph was now awaiting transfer to the 37th Precinct Trauma Hospital in Accra, where he would receive the necessary definitive management that his injury required.

Unfortunately, Joseph's story is not unique. In a country where OSHA laws do not exist to protect workers, occupational injuries are a daily hazard in this port town. Health insurance is not offered through most employers in the region, so the patients themselves are burdened with the cost of their medical care including transfer to a higher level of care. As Dr. Charles Annan, the head of the Emergency and Accident Center at TGH explained, one of the area’s vital needs is appropriate pre-hospital protocols and proper trauma facility designation. Joseph's story highlights one of the many facets of pre-hospital and emergency medical protocols that the Project HOPE team is evaluating during our two week assessment of TGH.

Thanks for reading - Elise Chamberlain and Marley Gevanthor

Even With Minimal Resources, Emergency Preparation Possible

During our stay at Tema General Hospital (TGH) we have been afforded the opportunity to meet dozens of clinical employees. Time and again we have been impressed with the skill sets and forward thinking of these staff members given their limited resources.

One of these visionaries is Dr. Sylvia Deganus, head of the OB unit at TGH. We were fortunate enough to meet her as she passed through the hospital to pick up her mail, as she is on vacation for two weeks. While on vacation she has traveled to rural communities throughout the country to perform workshops for midwives on the importance of preparation for OB emergencies. Dr. Deganus teaches these skilled practitioners to prepare for emergencies by creating “emergency packs.” As Dr. Deganus noted “time is crucial” and “readiness during an emergency” is of the utmost importance.

Dr. Deganus has put her plan into action at TGH. In a country where the maternal mortality rate is 500 deaths to 100,000 live births and a hospital where 8,000 deliveries occur annually, she recognized the importance of swift and prepared action during maternal emergencies. Dr. Deganus was the driving force behind pre-made “emergency packs” in the maternity unit at TGH. Currently, three types of packs have been made; eclampsia, post-partum hemorrhage and ante-partum hemorrhage. These lunch-box sized, clear plastic boxes are filled with gloves, an IV catheter, tourniquet, bag of normal saline, and medications specific to the condition. Centrally located in the department the outside of each box is labeled with the contents.


As Julianne the lead OB nurse, explained she personally checks the boxes each morning to make sure all of the supplies are present. Written protocols for management of the various conditions and the responsibilities of each team member line the walls of the OB unit at TGH.

Even though evaluating maternal services was not the primary goal of this mission, by being acquainted with the different units at TGH we have found ideal practices in one unit that can be modeled throughout the facility. It is this type of emergency preparedness that Project HOPE hopes one day will be the standard throughout TGH.

Thanks for reading - Elise Chamberlain and Marley Gevanthor

A Sobering Day

Our day started on a somber note. As we approached the hospital for our first day of observation and integration into the staff of Tema General Hospital (TGH), an ambulance passed us and pulled up in front of the receiving area of the outpatient department. Since one of our focuses of this mission is to evaluate disaster response and emergency preparedness within the hospital, we stopped and introduced ourselves to the emergency technician that was cleaning and restocking the ambulance.

We had an interesting, informative discussion comparing our two countries’ disaster response and multi-casualty incident command system. Although Ghana is many years behind the U.S. in training and use of sophisticated equipment, they are striving to meet our standards of technology and education. This was a collaborative exchange with a meld of local pre-hospital providers, and our Project HOPE/Navy team.

The patient that was transported to TGH was a 10-day-old baby transferred from another facility. The baby was born prematurely at 32 weeks gestation. The EMTs escorted us to the consultation area where we observed the treatment and care of the baby. The parents waited quietly and patiently on a hard wooden bench outside the area. The baby was tiny, jaundiced, and fighting for life. The physician and nurses were quiet, solemn and calm in their approach. The baby succumbed after a few hours.

It was a sobering sight. Life is hard and cruel here in Ghana. Death often comes early and is not unexpected. Resources are limited. Yet, the people are strong and resilient and our mission could not be more clear. Our role here is to help build emergency room capacity at the facility, to make a real difference and assist in bettering these kinds of outcomes.

Thanks for reading-Marley and Elise

Volunteers Get Acquainted With Tema General Hospital in Ghana

As we drove through the gates of Tema General Hospital (TGH) we were amazed with the vast campus before us. Tema, is located approximately 30km from the capital city of Accra. TGH is a 200 bed hospital that serves a catchment area of 400,000 residents. The campus spreads over 10 acres and includes numerous buildings that house both inpatient and outpatient services.

Our first day was spent introducing our team of three Project HOPE volunteers and Lieutenant Kazmer Meszaros of the U.S. Navy, to the staff of TGH. We were welcomed with open arms into the hospital by Ms. Magdalene Ayettey, the director of nursing services, Ms. Patience Mamattah, the hospital administrator, and Dr. Charity Sarpong, the medical superintendent.

As we toured the facility we were overwhelmed with the sheer number of patients waiting to see one of the various providers. TGH sees over 500 adults in their outpatient department daily, as well as over 70 children in their outpatient pediatric department. Compounding these numbers was the amazing sight of over 150 newborns and their mothers waiting to see the midwives for their 2 week well baby check. The mothers were striking in their traditional white and black dresses, which we were told symbolizes their joy and thanks for a healthy delivery. The babies looked content nursing and amazingly not a cry was heard.

Tomorrow we look forward to meeting our emergency department counterparts at TGH and beginning our assessment of TGH’s emergency response capabilities, mass casualty operations, and health care provider skill sets.

Thanks for reading--Elise Chamberlain and Marley Gevanthor

Project HOPE Volunteers Now in Ghana

While volunteers continue work in Haiti, three more Project HOPE volunteers began a health education mission on the other side of the world in Tema, Ghana. Three emergency room specialists are volunteering at Tema General Hospital from March 13 -27. The team is focusing on emergency care and education and is providing coaching, teaching and mentoring to local emergency room care providers. Training will include disaster management, mass casualty operations, health care provider skill set evaluations and emergency room protocols.

The HOPE volunteer team in Ghana is supporting the United States Navy Africa Partnership Station 2010 program.

Meet the Project HOPE volunteers in Ghana

Robert Andrews, M.D., from Alabama Veteran's Health Care System in Montgomery, Alabama, is an emergency room physician with 28 years of experience. He is a first-time volunteer for Project HOPE.



Elise Chamberlain from St. Francis Hospital, Federal Way, Washington, is a public health and emergency room nurse. Last summer, she served as a nurse educator for Project HOPE onboard the USNS Comfort.


Marley Gevanthor, a nurse with 28 years of experience from San Francisco General Hospital in San Francisco, California is a five-time HOPE volunteer. She has volunteered for HOPE all over the world including Belize, Guatemala and Panama onboard the USNS Comfort, Papua New Guinea and Micronesia onboard the USNS Mercy and Liberia and Ghana onboard the USS Swift.

Check back for updates on Robert, Elise and Marley as they continue their work in Ghana.

A Project HOPE volunteer reflects on his recent work in Ghana

Below is a note that the team from the recent--it's hard to believe we haven't even been home a week--Africa Partnership Station (APS) Mission to Ghana received from our fellow Ghana teammate and Project HOPE volunteer Brian. Brian is wonderful volunteer and ER doctor in Colorado Springs. I thought readers would enjoy reading reflections about what he learned and coming home from an experience like APS.

Thanks for reading!

-Marisol

Email from Brian:

42 hours.

That is how long it took Marina and I to return home to Colorado Springs after leaving Sekondi- I think I slept about 6 hours of it. After we said good-bye to the last group in Frankfurt, Marina and I were the last two of the little HOPIES to make our way to the gate.

We "secured" seats with no one next to either one of us, spread out, and became fluent in German ("Rot Wein, Bitte") for the next ten hour journey. The plane ride turned into a series double then triple movie features, and yes, I finally finished off the last of Vicky Christina Barcelona.

Despite my listless, somber and stuperous sleepy state, I disembarked the plane to hear the words of my 2 year old daughter saying "Daddy's home, Daddy's home!" as she ran in circles and hopped/jumped around. I do not think any one of us in my family had a dry eye. Her epidemic joy infused me with happiness. "Taps" came early that night at 2100 after catching up with my family and telling stories.

0700 it was "heave out" and "breakfast for the crew". My request for "pop tarts" fell on puzzled eyes and shocked ears. The day was already so different from the others from the last 4 weeks with humidity and heat quickly replaced by clear, light, cold air, and a day filled with many watches and little time.

Being back now for a few days, I think what I have learned over the last month. When colleagues ask me "How was Ghana?", I am still stumbling in putting the whole experience into a well rehearsed paragraph to be spit out with ease without loosing their attention.

I have learned how resilient many people are around the world. I have learned and re-enforced my belief that people are generally good. I have learned that one can diagnose malaria by touching one's forearm. I have become better at looking at one's eyes to tell varying degrees of anemia, but despite how pale, their life and soul fluoresces. I have learned that influencing or educating just one person can make a difference in care that will be provided, and tomorrow the person they touch will be better for it. I have learned that we need to take great time and effort to establish peoples' trust, and it is only through side-by-side education will our efforts transform into action.

I hope everyone is settling back into their routines without difficulty but somewhat changed from the whole experience somewhat different. I appreciate the friendships that have been formed and the memories.

Perhaps I'll see you on another mission,

- Brian

Project HOPE Volunteers Begin Work in Ghana

These missions require some adjustment for Project HOPE volunteers including learning to live in small quarters, learning to love stair climbing and also learning to work on military time. What I mean by military time is the hours they use, 24 instead of 12 for the am and 12 for the pm, and also their really early rise and meal times. Hot breakfast is from 6:00 am to 7:00 am and you miss a nice, warm breakfast of things like eggs, bacon or sausage and sometimes French toast if you show up late. Also, dinner is from 4:00 pm to 5:30 pm which is probably early for most people. However, this schedule has been great for the volunteers as their work day hours, 8:00 am to 4:00 pm, seem to work well with the Ghanaian health workers they work with. Also, the whole APS team has been super accommodating to us and helpful.

Project HOPE volunteers began their first day of working side-by-side with their Ghanaian counterparts today. Although we all seemed to make it to breakfast on time we fumbled a little because our drivers were late and Michael was sorting medications this morning to take to both locations. Michael, like he did last year, brought some medications with him. He is an expert on tropical diseases, having traveled to many countries like Ghana to provide care to the communities. But they still made it to their locations and seemed to all have a great time. The people in Ghana are as friendly and lively as I remembered them from last year, so our volunteers are bonding really well with their counterparts.

After making sure everyone was on their way, I went with the second group to Essikado Hospital. This is a relatively small hospital that does see some emergency patients and also women in labor but functions more like a clinic. When we arrived we were taken to the hospital administrator’s office and met with the administrative staff and also the head doctor, Dr. Paul. They all seemed excited to have us there and asked where the volunteers would like to work. Dr. Paul seemed especially excited. Essikado is a 24-hour facility with two doctors, one dentist and an x-ray tech that doubles as a radiologist. After the meeting the volunteers were given a tour and lead to where they would be working.

Meanwhile, I went to go run an errand in the city of Takoradi. The goal was to purchase cheap phones for use while in Ghana and also the kind that can be used worldwide so we could keep them for Project HOPE and reuse them. We went to this area where lots of people, hundreds, had little shops along the roads and whatever other empty space they might find. They sold everything from shoes to jewelry and cell phones. The place is buzzing with people shopping, selling and also on their soap box. Along our route there was a gentleman, whom I couldn't understand, speaking excitedly into a microphone about something? I imagine he was either preaching or talking about politics. After trying to bring the prices for each phone down to 30 Ghana Cedi at three different stores we settled on two phones each for 40 Ghana Cedi. The same phone would have been 20 Cedi cheaper in Accra but we tried to bargin with multiple locations in Takoradi and could not get the same price.

When I got back to the Essikado hospital it was hard to find the volunteers. I should have gone on the tour. The first volunteer I found was Marina Rivera, the x-ray tech. Marina is a very fun person. She's pretty laid back and really enjoying sharing her knowledge with the x-ray techs she works with. This is her second mission with HOPE and she is very proud to be HOPE's only x-ray tech in the volunteer database. When I approached the x-ray room, I saw a light sign to the side of the door that lit up when a x-ray was being done so no one would walk in and even though it was off I still knocked because I just wasn't too sure. I found out later that the sign doesn't work so knocking was a good thing. In the room Marina introduced me to the x-ray tech. His name is Prince and he has a smile that just lights up the room. He's probably in his late 20's. Prince works everyday of the week but no weekends. However, he is on call since he is the only x-ray tech. Because the hospital is open 24-hours a day he is also on call every night.

The x-ray room at Essikado is nice. Their equipment is newer and works. Marina took the time to show me around and talk to me a little about x-rays and how they are made. Marina is not only going to be helping x-ray dental work she is also going to be helping Prince with the positioning of patients for the x-rays among other things.

Although the air in the x-ray room was really nice I went to find Lara, the midwife. As I was looking for her I ran into her and Michael. They had just assisted in two cases so I followed her to her next stop—the labor unit. The labor unit at Essikado is very small. The women who have had their babies were in a room next to the labor room, which only had two beds. When Lara began to work there was only one woman in the labor room. In Essikado they deliver close to 80 babies a month or three a day. The woman was 9 cm dilated. Every time she had a contraction Lara held her hand and told her she was doing great. Lara also learned how to use a tool that I had never seen before. It is used for listening to the fetus’ heartbeat. It was a long metal tube with a hole running through it, it almost looked like a clown horn without the squeeze top. I don’t know what it is called, so if you do, send me a comment. The baby never came while I was there but I had a good time observing.

When I went back to Michael he was sitting in the office of Dr. Paul and they were both seeing patients together. They would share information with each other and try to help the patient together. A woman in who was pregnant and complaining of a pain in her stomach. After further investigation they realized that she had not been taking her medicines for hypertension for two weeks even though it was a risk for her baby.

Towards the end of the day I went outside. The hospital is made of small rooms and offices facing courtyards. Gabriel was also outside because her “shift had ended” and sitting next to a little girl named Amrita. She was showing Amrita how to spell her name, the abc’s and numbers. They were inseparable until we had to leave.

-Marisol

Technology and Fieldtrips in Ghana, all in a Sunday's Work for Project HOPE Volunteers

It's Sunday but there's no rest for the weary today if you are part of Project HOPE or any Africa Partnership Station Staff. Tomorrow volunteers start working in their respective places so everything that can possibly be in place needs to be. This meant today we had to get our Internet access from the USS Nashville staff so we could access email and such and then head out to the different locations Project HOPE would be working.

Group one which will be lead by Dr. Brian Crawford, an emergency medicine physician from Colorado, will be working at the Effia-Nkwanta Regional Hospital (ENRH). He will be joined by ER nurse Donna Featherstone, midwives Lara Holbrook and Jennifer Oh, pharmacist Earl Rogers, and physical therapist Beth Habelow. ENRH is a big hospital that also includes a nursing and midwifery training college where the midwives will be training students (for this component they will also be joined by Ruth Madison, MPH). They will also be helping deliver babies or as some midwives say "catching babies". Brian and Donna will be working in the small emergency room; Earl will be working with the 9 pharmacists. Beth will be seeing perhaps both in and out PT patients.

We actually got to meet the health administrator today for the hospital. A couple of things Mr. Micah told us about ENRH are:

• the name of the hospital means on junction of two cities, it was named that because of this place between Sekondi and Takoradi
  
• it has 416 beds, 35 doctors including a medical director
  
• the hospital serves two counties and therefore is represented by two members of parliament and is state hospital
  
• while it is not a teaching hospital it takes new medical school graduates for one to two years for training
  
• ENRH was established in 1938 by the British as a transition point for the British Military before they went on to other countries, the hospital's age and the fact that was created to be a hospital means its infrastructure is a problem
  
• 135,000 people receive outpatient care per year, 14,000 are admitted into the hospital and about 2,000 babies are born a year or 5.5 a day
  
• ENRH serves a whole state which means some of the population who would get services there would have to travel from as far as 9 hours away to get them
  
• impressively they give free treatment to TB and HIV/AIDS patients, free prenatal care, have one 24 hour pharmacist with one pharmacy especially dedicated to neonatal care, and 24 hour emergency obstetrics

The ENRH campus is quite large, with lots of buildings serving different purposes and while it is worn it is in much better shape than other places HOPE volunteers have worked.

The second group will head right down the road to the small Essikado Hospital. The group working at the pink, grey and other bright colored building will be lead by Dr. Michael Polifka, an emergency medicine physician from Vermont. He will be joined by pediatric nurse practitioner Gabriel Seibel, certified nurse midwife Marilyn Ringstaff, registered nurse Joanne Machin and x-ray technician Marina Rivera. Although the place has an operating theater it functions more like a clinic. Because it was Sunday we got a tour but were unable to meet with someone like Mr. Micah at ENRH who gave us more information about the facility.

All of our volunteers will be working side-by-side with their counterparts to provide training and mentoring to them while still offering care to the local population.

When we got back to the Nashville it was close to dinner time or chow time as they call it here. Some volunteers made and excursion to a place called “Monkey Hill” which is suppose to be a place to see monkeys but from what I have heard they only saw two monkeys and one headed up the tree as soon as they saw it. The guide they negotiated with said it was because of the color of their white skin. None the less they had fun hanging out, as did the rest of the volunteers. I believe we are all ready to get started tomorrow.

Thanks for reading!

-Marisol

Midwife Training Onboard the USS Swift

Mornings always begin at 6:30 for most of us working with Operation Africa Partnership Station. We wake up get dressed, apply sunscreen, spray insect repellant all over us and head to breakfast were we are met with eggs and a warm cup of coffee. Having breakfast in al fresco in the wee mornings in Africa is really quite spectacular. I really hope before the trip is over I can start waking up early enough to enjoy the dewy mornings just before the sun rises because I love mornings such as those.

This morning we caravanned to the Manheam. On the way there some of the medical volunteers got into a discussion about the myths surrounding breast feeding in different countries. Christella, whose parents are native Filipino, mentioned she had recently been to the Philippines on a mission with other Filipino American health care professionals. What was so interesting was the myth behind why women in the Philippines don’t breast feed, they think their milk gets to hot and spoils because they work out in the heat all day long and they can’t feed their children spoiled milk. Obviously breast milk comes in a temperature controlled container so this is not true but still women believe it. She also mentioned that a friend of hers had volunteered in Kenya recently to teach women how to purify water for cooking and drinking. Although this seems like a pretty simple process it was apparently very hard to teach the women in Kenya. They would boil water and use it for cooking or drinking but if there wasn’t enough they would add un-boiled water to the boiled water in order to have enough which would in turn defeat the purpose of boiling the original pot of water. It was hard for them to grasp that they could not add dirty water to clean water and still have consumable water. The longer I hang out with these Project HOPE volunteers the more I learn about medicine and cultures around the world. It is truly inspiring how much they love learning and giving back to the world through their knowledge.

After we arrived at the clinic 5 local midwives joined Robin, Sue, and I in one of the vans and we headed off to the USS Swift while the nurse educators and those who would be helping the clinic by providing basic care stayed behind. Robin and Sue are the nurse midwife volunteers who will be providing training throughout the mission to local midwives in Ghana and Liberia. They were set to teach a class of 34 midwives today, tomorrow and Thursday in a make shift class room aboard the U.S. Navy ship the Swift.

The Swift is not just a military boat it looks like a giant speed boat and is very impressive. You can tell it was built for speed. It isn’t as large as some of the other military ships but still huge and a boat man’s dream. The main eating and sitting space on the boat has built in theater chairs that are super comfortable and in between the two sections of seats is a dinning space. This entire spaced is surrounded by windows that provide a panoramic view of the ocean ahead of it and also television sets for movie nights.

I was awed when I saw the Swift as we drove up to where it was docked. It’s made from aluminum and is almost a charcoal color and has lots of angles. We got out of the car and walked up ramp leading to the hull of the ship where we found our make shift class room. It was a building that looked like our barracks—like a storage unit—in the middle of the hull. It fit all 38 of us comfortably and had windows and ac units. This classroom even had a projector screen. It was as if someone took a forklift, picked up a building from shore and dropped it off in the hull where it was strapped in to keep it from shifting as the ship moves.

When we opened the door to the classroom we were greeted with a loud welcome from the midwives, it was quite a site most of them in their white uniforms and white shoes. One of the Navy officers would later comment to me that it’s funny how the white uniform and white shoes is the universal nurse uniform and that nurses always provide a comforting feeling. These nurse midwives were very eager to learn and get started.

After a formal introduction Robin began teaching the basics of midwifery. She began with a lesson on normal and abnormal labor, followed by a lesson on using the Partograph. A Partograph is a special chart used by midwives so they can track a woman’s labor progress and plan ahead or prevent serious complications. Never having children myself a lot of this information was new to me and I tried to pay attention while I was taking pictures and swaying from the rocking boat.

After Robins lecture she had the midwives do a couple case studies using the Partograph. The seemed to really enjoy working in groups so much that we had to remind them it was lunch time.

The Navy provided us with lunch aboard the Swift.

Lunch was followed by Sue’s lesson on Hypertensive Disorder. Sue and Robin were both surprised with how much these women knew about delivering babies because in their experience with other missions in which they taught women “how to catch babies”, as Robin says, the midwives were so far behind. However, in Ghana the basics lesson was just a review for the midwives. They are all so knowledgeable. In fact because they knew their stuff we ended early enough to ask them about the way they deliver babies to see if it was any different from the U.S. Interestingly enough:
· Only 2 of the 34 women in the class delivered babies in a hospital.
· The midwives not only deliver the babies but also handle the prenatal and post natal care of the women they care for.
· The Ghanaian Government pays their salary and also licenses them.
· They have to renew their license every three years and a renewal requires them to take continuing education.
· C-sections are done in the hospital and are also elective.
· They don’t use epidurals.
· After a c-section a woman remains in the hospital 6 days and after vaginal birth they remain for 7-12 days.
· Annual Ob-gyn visits and regular exams are not common but they do use different types of birth control—such as Norplant, Depo, birth control pills while breast feeding and also condoms.

After the questions a couple of the Navy folks were kind enough to take us on a tour of the Swift, for some midwives this was their first time on a ship so they really enjoyed it. When the tour ended we took them out to the dock to show them the gift-in-kind (GIK)—GIK is donations made in actual products like medical supplies, equipment and medicines—they would be receiving at the Manheam Clinic. The donation comes from Project HOPE and its partners and totals over $1 million dollars.

We ended up spending an hour and a half longer with the midwives because their bus arrived late. They are staying in a hostel because some came from as far as three hours away to attend these classes. They were very patient and we bonded with them. We talked to them about the U.S., our families, Robin showed everyone the family photo album she had in her bag, and someone invited Sue over to have goat since she has never had goat. When we left Sue also mentioned we were invited to visit a clinic in a town two hours away which we may have an opportunity to see. We will actually be off on Thursday because it is the Ghanaian Independence Day and also because the midwives are ahead of schedule which means we will finish the classes tomorrow.

It was a long day today; we barely made it back in time for dinner. The good news is we stopped by the airport to check on Sue’s luggage and it appears to be arriving tomorrow. Better late than never! When we arrived we were told the three working in the clinic on basic care had a great day. Cramped in a small room and with the help of a translator in some cases they were able to see 91 patients today. The nurse educators also had a successful day of teaching even though their projector burned out. They just improvised.

--Marisol Euceda

Help support the Project HOPE mission in Africa.

Meet Project HOPE's Africa Partnership Station Volunteers

Only a few of us actually knew each other from previous missions but throughout our 14+ hour journey we all managed to find each other—thanks mostly to Robin, who wore her Project HOPE t-shirt so everyone gravitated toward her—and learned a little about what each person was doing on the mission.

Meet Project HOPE’s Africa Partnership Station Volunteers:

Marley Gevanthor
Marley is a nurse educator from Novato, California in the San Francisco Bay Area. She currently works for the Community Health Network at San Francisco General Hospital. This is actually Marley’s second time volunteering with Project HOPE. She was on the first rotation of the Latin American Mission on the U.S. Navy Ship Comfort.

Christella Guzman
This Christella’s first time volunteering with Project HOPE. She is the Lead Clinician at Women’s Community Clinic in San Francisco. Christella is also a Nurse Practitioner volunteer with Seton Medical Center Rota Care Clinic where she provides acute care to uninsured residents of San Mateo

Susan “Sue” Hoffman
This is Sue’s first mission with Project HOPE. She is a clinical nurse midwife from Lyndonville, Vermont and works for Women’s Wellness Center Northeastern Vermont Regional Hospital.

Robin Jones
Although this is also Robin’s first time volunteering with Project HOPE she is an experienced volunteer. She is a clinical nurse midwife with volunteer experiences in places like Liberia and Afghanistan where she says women can’t believe men are actually allowed into the delivery room in the U.S. Robin is from Chesapeake, Virginia and is a part-time faculty at the Medical Career Institute in Virginia Beach.

Dr. Michael Polifka
Dr. Polifika is also an experienced medical volunteer with experience volunteering in Africa, Latin America and Southeast Asia. This is Polifka’s fifth time volunteering with Project HOPE. He served on two rotations aboard the U.S. Hospital Ship Mercy during the Tsunami relief in 2005, one rotation in 2006 again on the Mercy in Indonesia, and last year aboard the USNS Comfort. Dr. Polifka is serving as the Africa mission’s Chief Medical Officer. He is also an ER physician at North Adams Regional Hospital in Manchester Center, Vermont.

Faye Pyles
Faye has never volunteered with Project HOPE but also has experience with medical missions. She recently retired from the Navy where she served as the Primary Triage Officer for Humanitarian Mission to Cambodia, and served on the Primary Care Team providing pediatric assistance in Port Au Prince, Haiti. She was also assigned to be the pediatric nurse practitioner for refugees in Guantanamo Bay, Cuba and was part of the Department of Pediatrics in U.S. Naval Hospital in Naples, Italy. Over all Pyles has over 28 years of pediatric nurse practitioner experience. Faye is from Norfolk,Virginia.

David Vuurman
David is a nurse educator from Plainfield, Indiana. This is his third mission with Project HOPE. He previously served aboard the USNS Mercy in 2005 and then again in 2007 aboard the USS Peleliu. When he is not volunteering he works for the Indiana University Medical Center as the Charge Nurse and in the Neuroscience ICU.

Joy Williams
Joy lives in Medford, Massachusetts where she works for Massachusetts General Hospital in the Department of Radiology. She has over 17 years experience in the ER, four in radiology nursing, three in burn surgery, and 3 years in medical surgery. She has worked with Project HOPE before on the USNS Comfort after hurricanes on the Gulf Coast and again in Latin America in 2007.

--Marisol Euceda

Also Meet Valdez and Julia who joined the mission later in Liberia

Help support the Project HOPE mission in Africa.

Project HOPE Volunteers Arrive in Africa

After getting just about every vaccination known to man and some ugly khaki shorts to go with my Project HOPE t-shirts, I was finally packing so that I could be on my way to West Africa, specifically Ghana and Liberia, with Project HOPE. Project HOPE is a non-profit. More importantly they are a non-profit that focuses on sustainable advances in healthcare across the globe. They teach healthcare workers how to better care for their patients and train other health professionals so the cycle of learning and teaching continues long after Project HOPE has left the country. This is not the only thing Project HOPE does—Project HOPE has programs in 36 countries across the globe in women and children’s health, HIV/AIDS and TB, health systems and facilities, health professional education and humanitarian aid—but it is one of their main focuses and what the HOPE volunteers will be doing while in Africa.

Project HOPE volunteers and Project HOPE staff –myself included—were on our way to Africa to partner with the United States Department of Defense (DoD) for Operation Africa Partnership Station. This is not the first mission in which HOPE has partnered with the DoD. The first time was in January of 2005 when they asked Project HOPE to join them in a disaster relief mission to areas in Southeast Asia that were severely affected by the Tsunami. Asked to fill 200 positions HOPE reached out to the medical community and received over 4,000 volunteer applications. After the Tsunami Project HOPE again went on to help but this time stateside when Hurricane Katrina and Rita devastated the Gulf Coast. The Katrina and Rita missions were followed by another mission to Indonesia to continue caring for those still affected by the Tsunami. Most recently Project HOPE again joined the DoD for a 2007 summer mission to countries in Latin America and Southeast Asia. Now HOPE is at it again in West Africa.
With one suitcase and a cool back pack, that surprisingly held not only my laptop nicely but also a camcorder to record the work we will be doing, I was off to the airport for my 14 hour flight to Ghana. Traveling to Ghana required an almost seven hour flight to Germany and a two hour layover in the European country which almost took an unexpected turn when the volunteers and myself were asked if we would give up our seats for 600 Euros in cash because the flight to Nigeria/Ghana was over booked. After thinking about it for maybe 30 seconds –because that would have been a lot of money in U.S. dollars—we decided people needed us to be somewhere so we should continue our travels. Interestingly enough on our six hour flight from Germany to Lagos, Nigeria the flight attendants kept asking us if we wanted red or white wine or Bailey’s Irish Cream or cognac—don’t worry we all resisted the temptation. After an hour layover on the plane in Lagos we finally took off and landed Ghana an hour later where I and all the volunteers showed up exhausted but extremely excited.

After going through the immigration process rather quickly we proceeded to grab our luggage only to find out Sue—one of the nurse midwives—was missing one of her suitcases. She didn’t get very bothered because the suitcase that did arrive had her most important stuff in it, all of her education materials. When we actually exited the airport we were greeted by the heat and humidity of a country closer to the equator and what appeared to be hundreds of Ghanaians waiting and picking people up. We waited around too for our DoD counterparts to arrive. We than caravanned our way to what would be our home for the two weeks in Ghana. It was dark on our way so we could not get a glimpse at the country until the morning.

Our living space is barebones white and looks like a storage facility with one door leading to the men’s side and another to the women’s located across from what looks like an out of use hanger which is now our meeting place and mess hall. Inside the walls are white paneling and the floors look like they belong in a gymnasium but are not as bouncy. In the middle of the building there are two bathrooms divided by a simple curtain to separate the men from the women. Each bathroom has three stalls and three shower stalls and six sinks. Each room, because we have fewer women all the women got their own room while some of the men had to bunk up, has two sets of white metal bunk beds with blue bedding and eight lockers. These might sound like very basic rooms but we are all really impressed with the accommodations. The rooms are air-conditioned—a plus when you are trying to sleep in 90+ weather—and the showers have hot water and good water pressure.

With our accommodations settled we had a brief meeting went straight to the showers and bed. It seemed and still seems everyone is in high spirits and ready to work despite the weekend long travel.

--Marisol Euceda

Help support the Project HOPE mission in Africa.