April 5th, 2017 by georgiawheeldon
Posted in Uncategorized|
So we have officially been in Nalerigu at the BMC for a little over a week now. It’s been a week of adjustment and learning for me, which has delayed my being able to post. After arriving last week Tuesday, I hit the ground running in the hospital the following day. Here at the BMC there are 4 Ghanaian physicians (although 1 was just on leave), 1 American missionary surgeon and 1 American Family Practice physician (who has just returned from leave). Then there are periods where there are volunteer physicians who come and spend some time at the hospital and the physicians who are here around the clock have some time to take some rest. When Sean and I arrived, we arrived the day after a team from West Virginia who will be here for 3 weeks, and just this past weekend a team from Massachusetts arrived who will be here for 2 weeks. So I have been working a lot with those teams while the Ghanaian physicians are able to take some rest.
The flow of my day starts with rounds at 7:30am Monday-Saturday, and we round until we are done seeing patients. I have been working mostly with the West Virginians, and we start in the 2 male wards, then move to the 3 female wards, then check on if help is needed in the pediatric ward, and then check on the isolation ward. The male and female wards range in size from 8 beds to 10 beds per ward, however it’s not uncommon that a bed is ‘double occupancy’ where there is one patient in the bed and another patient on the floor next to the bed. The pediatric ward has around 50 beds, which also might be ‘double occupied’ by twins or siblings – there are a lot of twins. On Mondays, Wednesdays and Fridays there is outpatient clinic after wards rounds which start when we’re done rounding and go until we’re done seeing patients (we’ve been done as early as 4 and gone as late as 7). Then there are days that we are on call where we will then also round at the hospital in the evenings and take any new admissions to the hospital.
There’s been an adjustment for me as far as language barriers and an adjustment for me as far as resources.
The thing that is important to understand when thinking about language in Ghana, is that there was a very long term tribal and village run system throughout Ghana that tracks back prior to when the British came and made Ghana a British colony. Since Ghana was a British colony, English is technically the national language of Ghana. However, all throughout Ghana there is still very much village rule and differing regions. There are many different languages spoken throughout Ghana depending on which region you grew up. Here in Nalerigu, the language is Mampruli. But, the BMC is a regional hospital and receives patients from other villages, as well as from Togo and Burkina Faso (which both have French as their national language – in addition to village dialects). Patients from other villages don’t necessarily speak Mampruli OR English. The BMC provides interpreters for visiting volunteers, as well as for some hospital staff and physicians who grew up in Southern Ghana and also don’t speak Mampruli. The patients I truly empathize for though are those who are inpatient and don’t speak Mampruli or English. They have to bring a family member with them or hope that someone is on hospital grounds that speaks their regional dialect as well as can either translate into Mampruli or English. I truly feel for these patients because not only are they in the vulnerable situation of being sick, but also they are sick in not their home village, in a ward full of other sick patients, and they cannot easily communicate with their nurses and physicians. I can only imagine how terrifying that would be.
The other adjustment has been due to the limitation of resources. The positive about limitation of resources is that as a diagnostician you truly can see the importance of a strong physical exam. There is no double-checking your findings and suspicions on imaging or with lab work, so you need a truly strong physical exam and history taking. There was previously an x-ray machine at the BMC, but it broke in the Fall and because of the way it was given to the hospital, it is not under warranty and is not easily able to be fixed. There are ultrasounds – which is about the extent of imaging capabilities. Labs are limited and variable. You can always check a hematocrit, blood glucose, blood film for malaria, hep B and C, HIV, do a gram stain, do a smear for tuberculosis, a urine pregnancy test, and a urinalysis. There are some other hit or miss available labs, but mostly its labs for common diagnoses and things that can change treatment. The interesting thing is having limited diagnostic testing does make me think a little more about what I might order in the states and what is necessary and will change treatment based on what we have available.