May 14th, 2018 by INMED
Posted in Uncategorized|
13 May, 2018 – Nalerigu, GHANA
I can’t believe that Billy and I have been at Baptist Medical Centre (BMC) in Nalerigu, Ghana for almost three weeks now. Time has flown by! What an amazing experience it has been. I came as part of my Family Medicine Obstetrics Fellowship to get more OB training in an international setting, but have gotten so much more valuable, life-changing experience than I could ever have imagined. The American physician with whom I was supposed to work had an unexpected situation that took him and his family away from Nalerigu two days after we arrived. The Ghanaian doctors (“medical officers”) have so graciously welcomed me and have allowed me to work alongside them, patiently fielding questions and giving directions on how things are done here at BMC. This, in and of itself, is quite amazing to me, but more so because they have been very short-staffed most of the month and have been working 24-hour call every third day for the last 2 ½ weeks! “Call” here means a full day of morning rounds, performing any C-sections or other procedures that need to be done, attending patients in OPD (outpatient clinic on M, W, F) until late in the afternoon or early evening and then doing evening rounds and being available overnight for any patient needs that require a physician (which often means being at the hospital most of the night.) There is no “post-call” day, so the process repeats itself the next day and another doc is on call. When they are fully-staffed, they are usually able to leave the day after their 24-call when morning rounds are done, but …… Drs. David, Isabella and Yakubu have worked tirelessly, without a break and without complaints the whole time and been wonderful examples of perseverance and dedication to their patients and the staff here at BMC.
Maternity care is quite different here at BMC. There are a large number of midwives and midwife students who attend all of the normal vaginal deliveries. From what I have been told, there are over 300 babies born here every month and the majority are vaginal births attended by the midwives. The midwives are able to do breech deliveries, VBACs, twin deliveries, (even twin VBACs) and are pretty adept at delivering most babies and all without any epidurals for the laboring mothers. The women here have an incredible tolerance for pain and are amazingly stoic. The docs are called if there are difficulties, complicated patients, patients referred from surrounding village health centers or if the patient needs a vacuum-assisted delivery or a C-section. Unfortunately, I have gotten to practice neonatal resuscitation quite often as women frequently present to the hospital too late – not having had any prenatal care or after laboring unsuccessfully at home. Having to write “severe birth asphyxia” on a newborn chart is not something I’ve had to do before and is so sad. We round on all the complicated antepartum, postpartum and post-op patients every morning before heading to the other wards to help with morning rounds there. There has been plenty of opportunity to practice C-section skills and learn how to conserve suture (3 per section) and do without many of the “necessities” of the OR in the US. Ingenuity and resourcefulness is the name of the game here at BMC and is practiced by all the staff.
It has been a “steep learning curve” as far as treating other patients as well. Malaria, typhoid fever with intestinal perforation, malnutrition, motor vehicle accidents, gastroenteritis, serious skin infections, tuberculosis and advanced liver disease (from Hepatitis B and C or from hepatotoxins) are daily fare on the wards. There are also your typical chronic diseases such as hypertension, diabetes and CHF which are treated with the limited medications available and without the benefit of imaging or laboratory studies that would be “standard of care” in the US.
What has struck me is the graciousness and patience the patients (and staff) extend to me as I stumble through trying to obtain even the most basic medical history and then communicate diagnosis and treatment plan to them (because of the language barrier.) Although English is the official language of Ghana, only the more educated actually speak it and there are multiple languages spoken by the patients that come to BMC for treatment. This is a constant challenge as even the local staff sometime struggle to communicate in a language the patient and their family understand. There are many humorous moments as well and it is heart-warming to be in the middle of a large, open inpatient ward and have someone across the room come over to help communicate with a patient they are not related to and don’t even know, if they notice we are struggling.
There is a strong underlying sense of community that permeates the hospital environment as family members spend day and night with their loved ones, bringing them food and water, caring for newborns if the mother is unable to, sleeping on the cement floor outside the wards or just outside the hospital and also looking out for the needs of others on the ward that may not have family there. There does not seem to be any outward hostility between Muslim and Christian patients here and they interact and relate to each other freely. One incident illustrated this so well – “R” was a young Christian primigravida who presented with eclamptic seizures. She had an emergency c/section and, fortunately, her young infant son was born healthy and vigorous. Unfortunately, she continued to experience severe seizures for hours after her surgery. When we went to check on her later that evening I noticed a young Muslim patient, “A”, standing by “R’s” bed helping the nurse. “A” had been admitted to Maternity two and a half weeks earlier for premature rupture of membranes at 31 weeks’ gestation and had been on complete bedrest the entire time. The goal for “A” was to reach 34 weeks’ gestation so her baby would have a better chance of survival. While “R” was having seizures for hours, “A” stood by her bedside (with one of the midwives and “R’s” sister) straining with all her might to hold down her arms and keep her from injuring herself when she seized. Thankfully a little after midnight “R” stopped having seizures and was able to rest. When I asked the nurses in the morning how long “A” had been by her side, they told me it had been most of the night. What amazed me even more was that these two patients were complete strangers – one Christian and one Muslim. That same morning, most likely as the result of her exertion, “R” went into premature labor and, by God’s grace, delivered a healthy 33 4/7-week baby girl. Her selflessness and willingness to sacrifice for a stranger of another faith brought tears to my eyes and gave me hope. When I communicated to “A” how grateful I was for her help the night before, she shrugged her shoulders and smiled shyly as if to say – “that is what members of a community do for one another.” “A” was discharged the next morning with her tiny, yet healthy, baby girl. “R” went home two days later with her infant son, thanking Jesus for her recovery and the kindness of a stranger. Praise God for this demonstration of love and His faithfulness to both these women.