World TB Day 2009

Project HOPE began working to fight tuberculosis (TB) disease in Kazakhstan in 1993, piloting early DOTS programs, which are the current international standards for TB control. In the 1990s, the break up of the Soviet Union led to serious deterioration in the health systems in Central Asian Republics (CAR), leading to poor health outcomes and drastic increases in the number of reported TB cases.

By 2001, Project HOPE was working with TB programs in all five CAR countries (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) and is currently implementing the largest and most comprehensive TB program in the region. By training health providers on DOTS, improving TB case management through monitoring and supportive supervision, strengthening the laboratory network and conducting community education and mobilization activities, Project HOPE has worked with the CAR countries to improve TB control.

Read about Asya and Ahmed.... a nurse in Uzbekistan and a TB patient who benefited from Project HOPE training.

Project HOPE volunteers continue reflecting on their work in Africa

Just shortly after I received the previous blog post from Dr. Crawford, I also received another email from California ER nurse Donna Featherstone. She and Brian worked together in the ER at ENRH in Ghana. Donna is a wonderful volunteer who originally served on the USNS Mercy during the Tsunami efforts. I'm not sure if I mentioned earlier that the ER at ENRH was one of the most difficult places to work. It was crowded, small, often out of supplies and linens, and people were at times abandoned in really bad condition with no money or family to help. Donna did what she could with the little facility resources and training. She taught nursing students how to reassess their interventions, encouraged weight based medication and fluid administration in children, did some teaching on the use of IV therapy. Also, hoping to lead by example, she became proactive with cleaning beds and finding linen.

After her work in Ghana Donna met her husband in London for a vacation. Below she reflects on her work and how different life can be with just a plane ride.

Happy reading!
-Marisol

What a difference a night makes. One day I am walking through crowds of people selling large snails and okra for dinner, watching goats and chickens competing for scraps of fish bones; wearing damp clothes from perspiration, dodging trees with coconuts falling off, wondering how young mothers tie their babies to their backs. The next morning I am wandering through shops selling fruit tarts and sausage pies, watching swans and geese leisurely slurp up the abundance of seed thrown to them, wearing damp clothes from a light, cool drizzle; strolling by trees, roses and crocuses sprouting bloom, and wondering how the young mothers talk constantly on their cell phone and ignore their crying babies in strollers.

As you can tell I am now in London...........my departure from Takoradi and Accra, Ghana was bittersweet. I left with an element of frustration but a renewed vigor to appreciate all that I have--frustration from not being able to assist enough and also from witnessing first hand some of the problems that occur when there are people to take advantage of. All of the nurses, doctors and students I worked with are a little more excited that we really do care. And I will remember my experiences good and bad forever.

-Donna

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 Complete Mission in Ghana

Total patients seen: 1,467

Total educational interactions: 1,097

Saying Goodbye

Yesterday was the volunteer’s last day working because we were set to leave early Tuesday for Accra. We were told to have our stuff on the pier by 5:30 am so we could eat breakfast one last time on the USS Nashville and then head out.

Saying goodbye to all the people who you have worked, formed relationships with and who have helped you through this big process is very hard. We definitely had some tears yesterday as many of our volunteers were thanked by the folks they had been working with for their efforts and asked to come back. Many received traditional Ghanaian shirts, dresses, outfits as gifts. As the midwifery training came to a close a midwife from Essikadu, Angela, gave a closing thank you that was so moving Lara and Ruth began to cry. All the folks at Essikadu received sashes that read “with appreciation from Essikadu.” Marina received three beautiful Ghanaian dresses from the x-ray tech and his dark room guys. Brian and Michael received really nice shirts from Nicholas, a Ghanaian Navy Nurse. His wife had made the shirts. We also left some Project HOPE stuff behind for them.

Everyone formed such good relationships with the people they worked with here in Ghana and many exchanged emails to keep in touch. It is truly important when we conduct these missions that we form these relationships and build trust and it was achieved. Without building the trust we will only hinder the operations of the hospitals and they will feel more like they are babysitting the American doctors rather than working with them.

After many goodbyes we made it back to the ship to have chat and thank you with the Commodore of the APS mission. She is a very personable woman and it was nice of her to make time for us in her schedule. She thanked Project HOPE for their hard work and gave each of us a thank you note from APS and also an APS coin. If I am correct each ship/mission has its own commemorative coin. The APS coin has the APS logo on it and is blue with a gold edge. It was a really cool gift to get. We also wanted to thank our Navy friends for their help on this mission. I don’t think a lot of people realize how much work goes into one of these missions. You have all these people working to get you on board the ship, make sure you get a ride out to and back from the location you work in, feeding you, making sure you have internet connections etc. They do a lot if not most of the logistical part that pertains to our volunteer work. They also deliver our donations for us. We thank them for all their help and for their hospitality on board the ship. The cooks, Senior Chief, everyone took such good care of us.

Later today we will have to say goodbye to each other. For almost three weeks we have seen each other daily, worked together and played together. It is impossible not to bond in these types of situations. And they are such a good group of folks. We lived in small space where it is impossible to have alone time and people leave the base without a buddy and yet people didn’t seem to tire of each other too much. Now we will jump on a plane tonight to Frankfurt and once we arrive in Frankfurt separate. It’s been great working with these volunteers and I hope they return to do more work with Project HOPE. Everyone would definitely love to come back to work in Sekondi-Takoradi again.

This was my second trip with Project HOPE to Ghana. I am blessed to even have been able to visit this wonderful country once. Every time I am here I am amazed at the loveliness of the people, everyone so willing to learn and always so friendly. People in Ghana are social butterflies, something I am not, introducing themselves to everyone in a room. It’s really great. I hope to be able to return sometime soon again.

-Marisol

Midwives Saving Lives: Skills Training Update In Ghana...and babies

A blog entry from first-time Project HOPE volunteer, Jennifer Oh, a certified nurse midwife from Lawndale Christian Health Center in Chicago, Illinois

One of the goals for Project HOPE's mission in Ghana was to conduct a training for midwives that was held at Effia Nkwanta Regional Hospital in conjunction with the Nursing Midwifery Training College. The Regional Health director selected specific hospitals/health centers in the region to send a couple of their midwives to the training. They were sent letters of invitation and we had 16 participants the first day.

From the start of the training, I was quite impressed with the level of experience of our participants. Their experience ranged from one year out of school to as many as 28 years of experience as a midwife.

Most of them are in positions of leadership or administration at their respective hospitals/health centers and/or are in teaching positions at 2 of the local midwifery colleges. From our introductions, I knew that I was going to learn more from this training than I was going to be able to teach! It was both a humbling and inspiring feeling for me to know that I had close to 80 years of midwifery experience in the room! Therefore, it was great that from the onset, we established a collegial relationship and reaffirming the idea that this training was going to be mutual exchange of ideas and experiences as well as hopefully serve as an update for clinical practice.

It was hopeful for me to see such a breadth of experienced midwives willing to come and have a posture of learning. As often in the U.S. as well, sometime there is a gap between clinical practice and the knowing the reasons behind certain clinical practices. It was wonderful after the pre-eclampsia lecture, one of the participants who had 15 + years of experience shared that she had been managing pre-eclampsia/eclampsia but never fully understood the reasons behind the management steps. We also were able to share a great conversation about the practice of routine episiotomies on primiparous (first-time mothers) mothers and about female genital mutilation and how to care for these women. Another important topic that created a lot of discussion was the clinical practice of administering Rhogam for rhesus negative women. Currently, Rhogam is being given (not routinely) but after delivery of the baby in the postpartum period.

After reviewing the physiology of Rh isoimmunization and the purpose of Rhogam, there began a healthy discussion of changing practice to administering Rhogam earlier at 26-28 weeks gestation (which is the standard of care in the U.S.).

It has been a privilege to meet these women who are working and serving the women of Ghana with very low resources. I have grown an intense respect and admiration for the participants in this training and see the potential for practice change that can potentially make an impact on maternal and neonatal mortality in Ghana.

A lesson in Ghanaian Culture

I meant to write about this a couple of days ago but have been completely sidetracked by other items like our donation drop off at the ENRH and the Ghanaian Navy Clinic. Project HOPE again donated medicines and medical supplies to the region. I would like to just say “Thank you!” to our distribution center that does such a fabulous job organizing, packing and shipping our donations to the various countries. It is really impressive.

Also included in the busy schedule has been a reception all Project HOPE volunteers were invited to attend on the flight deck of the USS Nashville celebrating APS’s work in Ghana. This was a really fun event including an African dance group and great food put together by the USS Nashville’s crew. Marina has gotten to know the USS Nashville’s food crew very well because she gets up so early in morning she helps them set-up the tables and start the coffee in the morning, so they all know her.

Anyway, I just wanted to share a little about Ghana’s Central Region Culture. When our volunteers first started working in the hospitals many of them were asked what day they were born, as in Monday, Tuesday etc. Most of us couldn’t answer this question. It was explained to us that a baby is given a name for the day of the week they born on and they wanted to give us these names. Below is a list of the names:

Below I am also copying something I saw on plaque at one of the castles about the region’s culture.

Family Life and Social Organization

The Family: The extended family is the bedrock of society in the Central Region. Each person is born into an ebusa, a clan or system of blood relationships. Because Akan inheritance is matrilineal, a person belongs to the same ebusua as his or her mother. The clan is the largest family unit. Each clan traces its origins to an ancestress, members of the same clan regarding themselves as distant relatives.

Within the family, children are instructed in proper social behavior. In addition to their formal schooling, they learn a wide range of skills that will enable them to be productive in society. If a member of the family is a tailor, a seamstress, a metalsmith, or a potter, for example, interested children from the immediate and extended family may apprentice themselves to learn the trade.
Religion: It is within the family that children are introduced to the religious beliefs and practices that frame Akan social ad spiritual life. The Central Region is characterized by a large number of religious traditions existing side by side. Traditional religious beliefs remain strong in this area, coexisting with Christianity and Islam.

Among the Akan peoples it is believed that the Supreme Being—called Nyankopon, Nyame or Twereduampon—created the universe and works through lesser deities called Abosom. Lagoons, mountains, rivers, and trees are believed to be inhabited by these spirits who can be invoked at times of trouble. The Akan believe in life after death, and that dead relations play an active role in society. Offerings of libations and prayers are ways of communicating with venerated ancestors who offer a means for intercession between God and the living.

I hope you enjoyed our cultural lesson on Ghana today!

-Marisol

Project HOPE Volunteers Build Relationships with Ghanaian Health Professionals

Monday began with news that the Western Regional Director of Health Services in Ghana was coming to the USS Nashville for a tour so Joyce, our medical officer, and myself stuck around to accompany her on the tour. I am sure I have mentioned how the USS Nashville is an older ship with lots of stairs. She had to navigate the stairs in her brightly colored skirt. We got to see the medical unit and went up to the deck where they steer the ship. She seemed to really enjoy her tour and is really interested in collaborating again.

Today the Project HOPE midwives began training. They are training and providing an update on midwifery skills to the local Ghanaian midwives. The 15 experienced midwives will then take what they learn back to their respective facilities.

Beth (the physical therapist) and I took a break at one point and wandered over to see how the class was doing. They had a model abdomen with a removal belly to demonstrate how to birth a baby and remove the placenta. Beth was really curious about the process since she has never seen a birth so Lara showed her how the birth happens. What was really cool was how the baby just seems to know what to do during the process. They know how to turn and when to turn to come out the correct way.

Before Beth and I went to see the midwives I went by to see her and found her working with a 7-year-old girl who appeared to have a neurological disorder. She couldn’t walk because her legs would not go straight and her arms were also the same way. She was brought there by a caring aunt, uncle and her father. Her mom, we were told, left to South Africa. In all my travels through Africa I have never heard of a mother leaving her children, the men yes, but not the women. Maybe it happens more than I think but I was surprised. We were told the little girl's disorder was caused when her mother had dropped her when she was a baby, trying to wrap her on her back the way women carry children all over Ghana. However, Beth and Mavis also noticed a huge scar down her spine. When they asked about her spine they were told someone taking care of the child had accidentally burned her with hot liquid. This was really hard to believe because of the shape of the scar. We know that in this area many times people still go to their faith and traditional healers so perhaps this something they had tried which resulted in the scar.

When working like our volunteers do in these different countries we have to be mindful of the culture. Well, in general, whenever anyone visits a foreign country they should be mindful of the culture. Sometimes it’s hard to know where to step in especially in medicine since people practice differently. You can’t always step in and tell people who have been at it a long time that they are wrong or take over their unit because you will offend them and not gain their trust. You can only lead by example, make suggestions, and work side by side with them. You have to form a relationship first. I think our volunteers have done an excellent job of that and they are learning as much from the folks in Ghana as the local health care workers are learning from them.

-Marisol

Volunteer Photos Working in Ghana

Project HOPE Volunteers Working in Ghana

Six-time Volunteer Returns to Ghana...Listen to his Story

Dr. Michael Polifka is a six time volunteer for Project HOPE. The ER physician from North Adams Regional Hospital in Massachusetts is now working in Ghana with 11 other medical volunteers from Project HOPE, treating patients and mentoring health professionals. This is Dr. Polifka's second time to Ghana as a Project HOPE volunteer. Last year, he served on a similar mission as Chief Medical Officer. When he returned, he taped a segment with ReachMD XM Radio.

Listen Now

Volunteers Enjoy a Day of Rest After Busy Week in Ghana

Volunteer accomplishments in Ghana to date:

1045 patients have been cared for

954 educational interactions have taken place
16 births attended
1696 prescriptions filled
27 x-rays taken

...and a day of rest

The weekends are pretty light out here in Ghana. Most of the Project HOPE team did not work since their departments are on-call during the weekends. Only the midwives and the ER team went to work on Saturday. The rest went to hang out by a local hotel pool and catch up on emails. The rest of the crew joined us when they got off of work.

Because we have limited personal space on the ship getting off the ship is always great. The weather is mostly sunny here in Ghana and very hot so the pool comes in handy too. It was really nice to relax and spend time with the team away from all the noise and hustle of the ship. However, this means that I don’t have much in the way of medical/health education work to talk about for Saturday.

On Sunday we headed to Cape Coast to visit the historical castles there. Brian, a Project HOPE volunteer and ER physician in Colorado, set up the trip to the castles. Brian is a wonderful volunteer who works really hard in the small, cramped ER at the ENRH. On this trip, he has served as the resident funny man on Project HOPE’s team and also social chair.

We woke-up early Sunday to meet a van that Brian had set-up to take us to Cape Coast. The town of Cape Coast is about one and a half hours away from Sekondi. Along Ghana’s coast there are castles built by the Portuguese and Dutch in the 1400’s. The buildings have a vast and tragic history as they were where the jumping off point from Africa for America during the slave trade.

We got to see both Cape Coast and Elmina Castle. They are beautiful structures with such a horrid history of torture. The tour was very somber.The tour guides took us to all the dungeons and told us about the history of the structures. Hundreds of African men and women would be kept in small crowded cells and only let out to be shipped to the new world or sometimes a governor would have the women paraded out for him to pick from. At the time, Ghana had many tribal wars and the tribes would sell their prisoners of war to the Portuguese and the Dutch and they in turn would sell them as slaves. It is really hard to imagine what the people went through. They were torn away from their families and sent to a new place where they were treated like animals and worked to death.

Ghana is a very family oriented country with deep roots and traditions so they still grieve for the ones they lost to the slave trade. In the dungeons there are funeral wreathes and flowers in memory of ancestors lost. Between castles we stopped to eat and reflect on what we had seen. We were disgusted by the way humans can treat other human beings.

We spent the whole day out and made it back to the ship in the evening. Having missed dinner we found our way up to the dining room and looked around for some bread and PB and jelly. It was a really good trip for us to learn more about the history of the people we are working with.

-Marisol

Volunteers Get Creative In Providing Care

I don’t think I have ever associated creativity with medicine (even though I guess you do have to be pretty creative to come up with some of the methods we use to treat people and the treatment) but yesterday I got to witness the creativity our ER nurse Donna and our physical therapist, Beth.

Today was the first day I was able to visit the ER—they call it casualty here—at the ENRH. It took me a couple of minutes to find it because like most of the wards it is separate from the main building and I had never been there. While the ER is not the worst I have seen, it is pretty bad. The unit is small, and has a smell, from the waiting area through the door leading to a small foyer that leads to two consult rooms and the main emergency room. Once in the main emergency area if you go right you can reach the pediatric section—not much of one but it does have two cribs—and then the female patient area. If you go left, once in the main emergency room, you go the suture room. The suture room is not very tidy; sharps (needles and razors) are not disposed of properly. Patients are left without treatment until their relatives pay and there is very little patient care besides getting them an IV. When I visited there were no sheets on the beds, and currently they are transporting patients to other units—up the hill—like the operating room, by taxi because the ambulance has broken down.

When I came down Donna gave me a tour and told me they had run out of drainage bags. They had put a catheter in a man but had no bags which meant the man would be left exposed to infections, seeing this Donna found an empty, small, clear plastic bag and attached it to the catheter. She used what limited resources she had available to keep this man from being at risk for an infection. When she did this a local nurse said to her “welcome to Africa.”

I followed my trip to the ER with a trip to visit Beth in physical therapy. While I was there a woman, who suffered a stroke 6 years ago, came in and wanted help with her walk. Beth worked with her but also noticed she had not regained full use of her hand and asked her if she writes. The patient responded by saying that she was learning. To make it easier for her to grip a writing utensil Beth showed her how to wrap a piece of cloth around a pen and pencil so that it is wider and easier to grip.

I’ve been writing a lot of stuff lately for this blog but I am not sure I have touched on how hard this can be for our volunteers. The Project HOPE volunteers know they are going to see some things that will be hard for them to be around but it isn’t in-your-face real until you see it. Experiencing a loss of a child who could have been saved had they been brought in a couple of hours earlier, wondering when the local docs will tell a new mom that her child hasn’t been brought to her because it was actually still born, or if a patient’s family has abandoned them or will come back with money to cover the cost of his treatment can be a really hard pill to swallow when you know you can help these people if only you had more time or the right equipment. Many days I have run into one of our volunteers and seen the same look on their faces and when I ask if they are ok they tell me a patient has passed away. It’s not that the local people don’t care it’s that the resources are lacking and the training isn’t there which is why Project HOPE sends in volunteers not only to work with patients but also to mentor the local providers and try to teach them new strategies.

Since we have been here there has been mention of so many simple, everyday things they need that we take for granted. For instance Donna says the ER has run out of surgical gloves—can you imagine this happening in the states—or even tennis balls for walkers. Many of the walkers people use here don’t have wheels on them, putting tennis balls on them would make them glide. Also sheets, once the sheets in the ER are all dirty they don’t have any others to replace them with while they are cleaned.

These are items you and I might just run to the store for but in other places around the world they may be hard to find, too expensive to purchase or not a priority.


-Marisol

All in a Day's Work for Project HOPE Volunteers in Ghana

Through life and death circumstances, Project HOPE volunteers find lots of opportunities to provide health education in Ghana
by Project HOPE Volunteer Gabreille (2-27-09)

Essikado clinic is the worksite for Marina (x-ray tech in the radiology department) JoAnne (RN who is primarily in the “gynae” or gynecology ward) Marilyn (midwife in labor and delivery), Michael (physician working with the clinic physicians), and myself (pediatric nurse practitioner ion the "causlutiy" or outpatient department).

The day was certainly a bit unusual compared to the rest of the week here. Early in the day we got word that a mother who was pregnant was going to have a c-section due to meconium (baby poo) in the amniotic fluid. JoAnne and I attended the delivery which sadly ended in the death of the infant. While it is troubling to see a delivery end this way and managed very differently than we are used to, it was also a starting point for many rich discussions between the volunteers and the Ghana staff regarding infant and child death, grieving, and delivery practices.

After the delivery, JoAnne headed to the gynecology ward. There are several nursing students doing their practicum there, and she has been an inspiration to these new nurses. Today a student came to her crying because the nurse was unable to get an IV in a woman with intrauterine fetal demise. JoAnne was able to quickly get the IV in place, then sat with the students and nurses to talk about IV insertion as well as gynecological anatomy. JoAnne has become a good friend to many of the staff in the clinic.

Marina was kept very busy in radiology working with her counterpart Prince. They had a friendly “competition” going throughout the day comparing their two methods for determining amount of radiation delivered vs outcome of the film quality. The radiology department stays happy and upbeat with the combination of Marina’s sense of humor and easy manner, Prince’s happy and easy attitude and eagerness to share and learn. The fact that this is the one air conditioned room in the clinic doesn’t hurt either. We all find ourselves going to check in with Marina often (honest – we’re just concerned about her….it has nothing to do with the air conditioning!).

Michael has a fantastic working relationship with Essikado physician Dr. Emanuel Darko. They see patients together, discussing the details of each case. There is an easy give and take of thoughts about diagnosis and treatment. Today was a particularly busy day as a local pier had a fire, and some people were trampled in the escape, including a 39-week gestation pregnant woman. Michael and Marina combined efforts to evaluate for possible pelvic fracture and the baby’s position. Michael has been able to teach on a variety of topics – including steroid injection into the joint for one patient, cardiac issues, and numerous other topics. Michael’s expertise was requested on a variety of other unusual radiologic issues today as well, including a case of Paget’s Disease with extreme complications.

Likewise, I and my counterparts, Tina and Elisabeth, have an incredible work dynamic. I am learning about malaria and local cultural approaches while teaching about physical assessment, lab value interpretations, and expanding the scope of possible diagnoses. The give and take of information benefits everyone and makes for a feeling of commradery. Today I was asked to teach the practitioners about nebulizer treatments, using a new nebulizer brought by Michael. The class started with three providers, but grew to include about 10. The practitioners are very excited to be able to offer this as a treatment option.

Marilyn returned to labor and delivery for a day with ups and downs. The reality of life in a developing country is that the birth outcomes are not what we enjoy in the U.S. Although two babies died today (including the baby born by c-section mentioned earlier), there were two healthy live births. Marilyn works with the midwives through these ups and downs, finding teaching points along the way – such as discussing the importance of a proper face mask seal when delivering oxygen resuscitation to a baby.

At the end of the long day, all the volunteers came together on the ship for a formal reception involving all groups involved in the African Partnership Station – including the community counterparts and the American Ambassador to Ghana. It was a special evening with local dancers, the Navy band playing, and wonderful interactions between volunteers and the diverse group involved in the African Partnership. It was a memorable way to celebrate the wide range of work being done in the area by so many groups.

Birth in Ghana

Babies, babies, babies, everywhere you look in Sekondi women are either expecting or have just had a baby. They walk around in the heat looking absolutely fabulous in traditional Ghanaian dresses with elaborate patterns on them; their hair is always done and with a baby wrapped in cloth carried on their back.

I spent Wednesday morning with Ruth in the public health unit of the ENRH. Wednesday mornings the unit holds a combined educational session and health clinic for new moms. The nurse begins the class as soon as every seat is filled but women keep pouring in long after. There must have been at least 50 women with babies in the clinic that day.

I was speaking to nursing students when the class began with a beautiful song. The sight and sound was awe inspiring—all these beautiful women with their babies in their arms singing. I asked the student what they were singing and she said a song to praise God. After the song they said a prayer together and got the lecture started.

I didn’t understand the lecture because it was in a local dialect but I did understand the nurse when she said “family planning.” The lecture was on the importance of family planning and how to do family planning. One woman participating said that she had a family member who came into the clinic for contraception and died shortly after beginning it. The nurse answered that contraception does not cause death; it is a common misconception. She explained that some women come into the clinic with a previous illness that causes their death. It is just an unfortunate coincidence that they die after getting contraceptives.

Later I went over to the labor and delivery ward to check out what Lara and Jennifer where doing. I expected to see more women in labor but there was only one. It is amazing how quiet these women are during their contractions. The young woman in labor was becoming a first time mom and would snap and moan lightly when she had a contraction. While I was there Lara and Jennifer spoke to the midwives about how they use the partograph, a chart used to track a woman’s labor—if used properly it can signal possible problems the woman maybe having in labor. I wanted to see the birth of a baby since I had never seen one so I stuck around. Sticking around allowed me to see the Ghanaian midwives process and also ask Lara and Jen how their process is different. In Ghana it is believed that any other position besides lying on the left side is thought to do harm to the baby so women are told to lay only on their left and another common practice to speed things along is to break the woman’s membrane and then give oxytocin which apparently makes the uterus open and judging by the louder moans by the young lady increases the intensity of the contractions. Within an hour of giving her the oxytocin the baby girl had arrived. She was 5lbs 7 ounces and cried until she was bundled up.

I am sure I have said this before in the blog but it is really inspiring to see how family members care for their relatives in this country. Family members are usually around 24 hours a day, bringing food to their relatives in the hospital and paying and picking up their prescriptions (you have to buy and bring your own required meds to the hospital, the doc will write you the prescription and your relatives walk to the pharmacy to get them; you also have to bring your own food). The same goes for the physical therapy unit where relatives spend hours shuttling their family members back and forth to the clinic and then working with them while there.

There are no visiting hours you just come, offer support and help.

-Marisol