Friday, July 23, 2010

Fasin village and health center!

Last week I spent again on obs and gynae but didn't manage to update my blog.

This week has been amazing. I have spent it in a rural village called Fasin, working in the community health center there. The village is what you would imagine an African farming village to be - no electricity or water, very basic style of living, mud huts etc! I lived in my guide's hut (a man called Meshack who has links with Work the World) which was again basic but definitely an experience! Had a couple of run ins with nasty very large spiders.. All his family live right nearby so I got to know a few of them, like his very lovely and jolly father called Prince, and his sister Vaida who cooked for me, and many of the children running around and playing. I have been eating fruit and rice basically all week so it was very nice to get back to the main house in Takoradi this afternoon and have 'normal' food and a good old cup of tea!

The health center is the biggest in the area, but when i say biggest it is still pretty small, with 3 rooms and 6 lovely staff, 3 of which are community health nurses and 3 'assistants'. The community nurses here have only 2 years training (as opposed to the hospital nurses who have 3 years) so are technically as qualified as me, yet their job is basically the same as a GP doctor back in the UK (who would have about 10 years training) is quite scary how much responsibility they have for how little trained they are! They see all the patients, diagnose, treat and prescribe everything, and there are no doctors around so if a person is ever too ill for them they send them off in a taxi to Dixcove Hospital about 30 mins away. On Monday my first day I felt quite out of my depth as they expected me to know a LOT more than I do and were asking me to examine and diagnose every patient which is a responsibility of course I have never had and it was a little scary! But I got into the swing of it and learnt how they do ante natal checks (they see a lot of pregnant women at the clinic), did a lot of injections and vaccinations, and generally saw a wide variety of things, including lots of malaria, very sick babies and old people, a few horrible wounds and lots of pregnant women who have had millions of children already. A lot of children come to the clinic too and they ALL get diagnosed with malaria, no matter what symptoms the mother is saying the child has. They also all get a lot of drugs prescribed, a lot of which are completely unnecessary and I did question this, but I have been told this is simply what all community clinics 'do', which is frustrating for me as I know this isn't right. For instance most patients get prescribed antibiotics when in most cases they won't need it, which just makes resistance to the drugs higher which is a big problem here. However despite these differences in health care to the UK I learnt so much this week and was definitely an experience.

My highlight of the week was delivering a baby on Tuesday! I have seen a couple in the UK and here too but not delivered one myself before...the nurse handed me an apron and gloves and said 'you do it, i will help'! It was such a responsibility playing midwife and slightly terrifying but i felt confident and was such a good experience. The facilities and resources at the clinic are somewhat sparse and even less than Effia Nwkanta hospital where I have been based, but maneagable. My other highlight was doing 'outreach' on Thursday morning, where me and one of the nurses went to the even more rural local areas and did vaccinations on the new born babies (the first of which was the baby I had delivered on Tuesday!)

Yesterday I met the village chief and the village elders which was a little scary, and on Wednesday I met the chief's chief, an older (slightly gangster!) man already with 2 wives (polygamy is very common here) and got another marriage proposal from him, he was being deadly serious! It was such a good week and really glad I did it. The people in the village were so friendly and so curious why a white person was there, I felt (uncomfortably) a bit like a celebrity at times as whenever I walked anywhere I would get stares and people saying 'hello, welcome' and children running after me calling their friends and shouting 'obruni!' (white person) which sometimes got a little tiring but was cute all the same! Was really nice seeing other white faces today when I got back to the house and having a normal conversation instead of restricted English (and having a flushing toilet and electricity again!).

Anyways sorry I have written an essay - so much to say for this week though! I get back to the UK on Wednesday 28th (yay not long) and am really looking forward to coming home now.

Lots of love from Ella xx

Friday, July 9, 2010

Obstetrics and gynaecology/Volta region

Currently writing this in the midst of a slightly terrifying tropical thunderstorm at the internet cafe! Before when we've had massive storms the electricity goes out for quite a while so hope i can finish writing before it does!

After a very hectic week in A+E at Effia Nwkwanta I have spent this week (and will spend next week) on obstetrics and gynaecology. I chose to spend 2 weeks in this department as I did a gynae placement in my first year back in the UK, and really enjoyed it. Compared to A+E (and paediatrics too) this week has been relatively calm. I have seen 2 cesarean sections, both of which I got dressed up in beautiful gowns, hats, shoes and masks for to go to theatre; I have seen C-sections in the UK but here they are just even more brutal and quick with it! The second case had a complication with her labour and at one point the surgeon said 'I am going to lose this lady' as she was at a big risk of massive bleeding, but she eventually pulled through and her and baby boy were fine, hurrah. There is a much higher incidence of maternal deaths here, about 400 out of every 10,000 women, most deaths are mass bleeding or pre-eclampsia (condition in pregnancy); in the UK maternal death rate is 300 per year (mostly indirect reasons e.g. suicide or road traffic accidents).The gynae side of it here is pretty varied but similar to the UK e.g. uterine fibroids, various cancers, incomplete abortions, ectopic pregnancies, infertility.

Last weekend me and 2 other girls visited the Volta region in Eastern Ghana. It is a beautiful area with the huge Lake Volta, Wli waterfalls (highest waterfall in West Africa, so so amazing, we swam under it and it was so powerful), fed monkeys from my hands (they were so cheeky and jumped on my friend Heidi's face!), and stayed the night on top of a mountain (we were the only guests there) which was in the middle of absolutely nowhere, had to go on a very questionable and bumpy road for ages, but was worth it as it overlooked Mount Gemi and the Kulugu river and valley...was breathtakingly amazing, especially early in the morning, hard to describe really! Was a trek to get back to our base in Takoradi (13 hours travelling back in total on various modes of transport, with our last bus breaking down at 11pm..) but was well worth it.

We often get stopped by the scary police here and they check for overcrowding in public vehicles, but on our journey back we got stopped about 4 times as the road leading back to the capital Accra is near other borders, and they get a lot of illegal immigrants coming into Ghana on this road. At one stop everyone had to get off the tro tro and produce their passports - we of course didn't have ours with us so we had to go and see someone else and managed to convince him we weren't Togolese or Nigerian or any other nationality but definitely British volunteers! The police here are pretty terrifying actually (especially when they have guns with them) and feel like they are trying to catch you out instead of being on your side (there seems to be a lot of corruption too).

It was such a massive shame when Ghana narrowly lost the World Cup match, the atmosphere here was amazing and so many people had their hopes they would go through! It really was Football Fever here (still is sort of) with massive celebrations every time Ghana went through or scored a goal or something.
Can't believe I have been here for 6 weeks now, time has flown by especially the last couple of weeks.
Lots of love xx

Thursday, July 1, 2010

A+E and sleeping in Kakum rainforest!

Hello everyone :) Happy July. I have recently put photos up on Facebook, feel free to look through them!

I finished my 4 week main placement on the paediatric ward last Friday. This week I have been in the Accident and Emergency department, and it is definitely an interesting experience but not particularly one I would want to repeat! It is so so busy, with a constant queue of people waiting to be seen, some really ill and some not so ill. I haven't quite got it figured out yet but there does not seem to be much of a system as to how it works. There is no way of 'sorting through' how ill people are (in the UK this is known as triage) which means (apart from the really ill people who get carried in by family either unconscious or convulsing or nearly dead) that ill or really in pain people who need urgent attention don't get it, as they have to wait their turn in the queue behind someone who may have come in because they have a nosebleed or a cold. Which is frustrating because people who need help deteriorate quickly and don't get the urgent medical attention they need.

Things commonly seen in A+E here are malaria, severe dehydration (to the point of collapse), burns, convulsions/coma due to diabetes (when it is poorly controlled this can be a result of high blood sugar), and a LOT of injuries due to road traffic accidents which are pretty common here. There is no monitoring equipment here, no resuscitation equipment and the only oxygen available (given through tiny nasal prongs which wouldn't really help in an emergency anyway!) is from a cannister that often gets used up and not filled up again, so when it is needed it is empty. One man yesterday was really ill and he stopped breathing on a number of occasions, and no one would give him oxygen as they thought it was a 'waste' and should be kept for someone that needed it. Only after explaining to the Sister and a medical student that this man definitely needed oxygen was I allowed to put it on him! On my first day (Monday) a prisoner was brought in unconscious by another prisoner, accompanied by two prison guards (who looked a bit scary in their massive boots and uniforms) who were asked by the doctor to talk to him in his office, which left both prisoners unattended standing in the middle of a very hectic A+E department. This was a little terrifying but no one else seemed to be bothered...apparently this is fairly normal! But the staff in A+E are amazing and do the best they can with the limited resources.

At the weekend six other girls from the house and I visited Cape Coast, a small city one hour east along the coast from Takoradi. We stayed at a questionable guesthouse on Friday night, and on Saturday visited the huge and amazing Cape Coast Castle, where they use to keep slaves captured and deport them in the slave trading years. We went down to the dungeons and cells and it was actually quite scary! Was so interesting though and made the awfulness of the slave trade feel really 'real'.

Saturday afternoon we traveled another hour up to Kakum National Park, a vast rainforest which is a big tourist attraction in Ghana. We slept overnight on 'tree platforms' which was literally 3 half walls, a tin roof and a mattress with a holey mosquito net in the middle of the forest with no-one but us around...a tad scary! It was an interesting experience to say the least and glad I did it but probably wouldn't choose to do it again! There were a HUGE amount of soldier ants, which are giant ants with fangs and bite you and cling onto you and get inside your shoes, not so nice. Also spiders, millipedes and a most unwelcome mouse in the middle of the night! When I say slept, we decided to stay up all night, but eventually fell asleep in the pitch black at midnight to the very noisy sounds of lots and lots of insects and monkeys and other things we had no clue of. However we woke up an hour later to find a mouse amongst us... Fun!! Sunday morning at 5.30am we did the 'canopy walk' which is an pretty scary but amazing walk along treetops in the middle of the forest and saw loads of monkeys and birds, was so beautiful and well worth staying overnight for!

Everyone here doesn't stop talking about the World Cup (I have had a few comments about being English and rubbish at football from people and had to hang my head in shame), but whenever Ghana has got through there are huge street parties and so much celebrating it's amazing!

Lots of love from Ella xx

Thursday, June 24, 2010

Babies, Egyam Orphanage and Green Turtles

Have had a bit of a crazy week this week! It has been my last week on the paediatric ward. On Monday during the ward round a mother started shouting and wailing so loudly and wouldn't stop for ages until she was sent off the ward, sadly her child had just passed away from 'breathing difficulties'. What I find so hard here is that so many people die unnecessarily simply due to a lack of equipment - there is no resuscitation equipment in the hospital and no monitors to detect when a person is deteriorating, and not enough staff to keep an eye on all the sick patients. There was hardly any response to this child passing away and ward round continued as normal, with staff seeing the mother as an inconvenience for disrupting the routine. Later that morning three children came in at the same time, all critically ill, and not enough was being done quickly enough as there is not really any sense of urgency so it can be very frustrating.

I spent Tuesday on the Neonatal Intensive Care Unit just for the day. There were 3 tiny very premature triplets all squeezed in one incubator, definitely adorable! Again the mortality rates for neonates are so much higher here in Ghana simply due to a lack of equipment and babies die from things which they would never die from in the UK.

Today was a really interesting day, I spent it on the delivery ward (infection control in England would have a field day) and saw 3 babies being born Africa-style. 2 of them had to be resuscitated as they were very blue and not breathing when they were born. The women in labour get NO pain relief whatsoever, and they are not allowed anyone with them until after the baby has been delivered, even the fathers. The women all are in labour in one room together, then when they are fully dilated they have to pick up their plastic sheet, walk through to the delivery room with no dignity at all, have their babies then walk back through to another room where they are later joined by their baby if it is well enough. The midwives slap the women if they make too much noise. I saw a few rather bloody procedures which they did without anaesthetic too, I honestly don't quite know how the women withstood it!!

This afternoon went to Egyam Orphanage with a few people from the WTW house, which was amazing. There are about 50 children there. We took toys and rice to donate. We played with the kids for a while, was so much fun! We took hula hoops but they didn't know what to do with them. Really puts into perspective how much we have and how fortunate we are.

Last weekend me and 7 other girls from the house spent the weekend at one of Ghana's favourite backpacker haunts called Green Turtle Lodge, about an house West along the coast from our base in Takoradi. We stayed in a round mud hut type thing about 30 meters away from the sea. It was so beautiful.

Am really enjoying my time here, it is going so quickly. Am missing home quite a bit too especially on days when bad stuff has happened at the hospital!
Hope you are all enjoying the World Cup - if England play Ghana I may have to stay indoors for a week.
Lots of love from Ella xxx

Wednesday, June 16, 2010

Surgical wounds and Kumasi/Lake Botsumtwi

Today I spent the day on the female surgical ward at the hospital, just to see what it's like there and because there are children there too. The ward itself is pretty big with a huge variety of patients there, all women who either have had or need surgery, burns, wounds of any description or orthopaedic patients. I have never seen such awful wounds as today!! There are a lot of awful leg or foot ulcers due to diabetic patients which come about because diabetes is poorly controlled. These often end in amputations as the leg or foot becomes so gangrenous. Other common wounds are from fractures e.g. from people in car accidents which protrude through the skin. Procedures are done with mild sedation which in the UK would be done under general anaesthetic. The only dressings here are gauze and iodine and things tend not to heal very well so end up horrendously infected. Not for the faint hearted!

Every Tuesday all the students at the Work the World house have Fante lessons (the local language after English) from a teachers called Mr Atta. I had my third one yesterday and after we had a test, if we failed it we would have to repeat a class but luckily i passed and am now officially an intermediate! It's actually really useful having Fante lessons as it enables us to communicate with the patients at a basic level, as not all speak brilliant English. People here love it when you speak to them in Fante too. My favourite phrase is 'Mi ma wo ache' (good morning) and 'mintiase' (I don't understand)..does come in useful!

Last weekend me and 5 other girls from the house visited Kumasi, which is a big city about 4 hours inland of where I stay in Takoradi. We had an awful journey there on Friday night, as our tro tro (form of public transport) didn't leave for 3 hours and it took us 6 hours to drive there on bumpy crazy roads as there were huge crates of fish on top. So we got there at midnight and after a lot of hassle from people we managed to get in a taxi and the place where we stayed on Friday night was HORRIBLE!! But we left early on Saturday morning and visited Kejetia Market, largest open market in West Africa, which was definitely an experience but not particularly one I would want to repeat. It was HUGE, so so busy and because we stood out like a sore thumb we got a fair bit of hassle! But we explored a few other places in Kumasi on Saturday then got a tro tro to Lake Botsumtwi, about an hour further travel which was in the middle of nowhere and was absolutely stunning, a stark contrast to the big sprawling city.

There are now 21 medical and nursing students in the house which is a bit maniac sometimes (especially in the mornings when we are fighting for the bathrooms...) but really fun. Feels like I have been here a lot longer than 3 weeks now.

Lots of African love from Ella xx

Thursday, June 10, 2010

Second week at Effia Nkwanta and Nzulezo Stilt Village

This week has gone so fast! It has been my second week on the paediatric ward at the hospital. Today there were 3 critically ill children all rushed in from A+E, all 3 with cerebral malaria with convulsions and i honestly didn't think they were going to survive the morning but they were still there when I left to go home. I have come across a few cases of where parents use 'herbal remedies' or go to 'medical healers' to cure their children of coughs, colds etc and end up having to bring their child to hospital as a result of this, for example one mother gave her child an enema of ginger, another child had very strange cuts all over from a 'healer' and another child had been given garlic to stop him convulsing...

There are also quite a few children who come in with infections and is is discovered through blood tests that they have HIV, it is heartbreaking when the parents are told. I am starting to learn a lot about malaria, TB, typhoid, and sickle cell disease, all of which are so common here in children. The consultant, Dr Eghan has really taken me under his wing and teaching me so much. Basic things are in such short supply here but they really do improvise, for example plastic tubing for tourniquets to take blood, folded cardboard boxes for splints etc.

Last weekend me and 4 other students from the house traveled 3 hours West along the coast to the most secluded village called Beyin, where we stayed at a beautiful beach resort. It was so nice to sit in the sun and relax and admire the picture perfect beach! On the Saturday we visited Nzulezo Village, which is a village literally build on stilts in the middle of this HUGE lake, it was amazing! Took an hour canoe ride to get there, in the middle of absolutely nowhere. Was such an experience to see though, so hard to think people actually lived in these wooden huts on the water. It was a really good weekend and although had a slightly hairy journey back on sunday evening (our tro tro didn't turn up so we ended up getting a lift from this very strange but obviously hugely rich lebanese man, from the resort to a nearby town (30 mins drive along the WORST road ever) then a tro tro from there back to our house which went so fast it was terrifying. Never been so pleased to see our house!

Hope you are all having a good week.
Lots of love from ella xx

Wednesday, June 2, 2010

Start of placement..

So i started my placement yesterday and thought i would add a blog to write about it as there is so much to say!

At the moment i am on the children's ward. it has about 40 beds and is constantly busy, there is only 3 nurses on each shift. There are two main rooms (almost like small village halls is the best way of describing it) and a few other side rooms for 'isolation' cases (no infection control whatsoever though so definitely not isolation rooms!). There is no monitoring equipment at all and the most advanced equipment is a drip stand.. the whole children's area is very open, no privacy at all, beds crowded close to each other, patient toilets are so smelly and disgusting, the whole place is quite dirty, and was a bit of a shock the first time i walked in but i have sort of got used to it already!

About 70% of the children admitted are for cases of severe malaria, often with complications e.g. anaemia. Other cases include typhoid, TB, malnourishment and dehydration, and a few cases that I would see in the UK e.g. kidney problems, high fevers etc. I asked one of the consultants about the provision of mosquito nets and he said everyone can easily and cheaply get them here as so many are donated through aid organisations, but people apparently do not like using them as they are too hot and irritating...

The attitude of the nurses in particular is so different to the UK and to be honest, they often seem very aloof and 'not caring' towards patients and families but this is just the culture and how they do things here. In particular the attitude to a child dying is so different - for instance when i got in this morning one of the doctors told me a child had died over night rather unnecessarily, as they had needed a blood transfusion as they had severe malaria but no one had bothered to pick it up from the blood bank as it was late evening so the child died overnight. One of my friends also from the UK is on the neonatal unit and on her first day a baby died in her arms...there again was no monitoring equipment and so no one had noticed the baby deteriorating and then when resuscitation was started there was no oxygen in the cannisters. So it is frustrating in situations like that but just have to get on with it and accept that is how it is here; I am not here to change the whole system but to learn how they do things in a place with such limited resources.

Better go now as slow internet...
love ella xx