This is Nancy again.
Yesterday we traveled to Accra, the capital city of Ghana, and the only city with an airport. We saw some of the famous sites like the W.E.B. Dubois museum and various other monuments to past presidents and rulers. We also stopped at an open air market, but didn't stay too long. The sellers were really pesty and we got tired of being shown various wares and expected to buy. We then went to the Golden Tulip resort for supper and paid the most for our various meals that we paid during the whole trip.
We had an early night and are now waiting in the Accra airport for our flight to Amsterdam and then to Detroit.
And that's about all we have to report. It's been an interesting trip and one that I hope some of you can take in your future.
Thursday, March 18, 2010
On Tuesday
On Tuesday, I got to teach my specialty unit of Women and Autoimmune Diseases. I enjoyed that although it was very hard to hear and understand questions from the junior level students.
That afternoon we picked up the traditional Ghanain dresses we had had made and paid our bill to the International Center.
That evening we went to a professor's house for dinner. Along with our contingent of five Americans, there were 3 Cuban doctors and 2 nurses. We had met one of the nurses earlier in the ICU of a large hospital. Our host wanted us to see a movie of Paul Simon from 1987 called Graceland. It featured several well known African musicians. It would have been interesting to talk to the Cubans and learn more about their health care, but unfortunately, we didn't get a chance.
That afternoon we picked up the traditional Ghanain dresses we had had made and paid our bill to the International Center.
That evening we went to a professor's house for dinner. Along with our contingent of five Americans, there were 3 Cuban doctors and 2 nurses. We had met one of the nurses earlier in the ICU of a large hospital. Our host wanted us to see a movie of Paul Simon from 1987 called Graceland. It featured several well known African musicians. It would have been interesting to talk to the Cubans and learn more about their health care, but unfortunately, we didn't get a chance.
Sunday's Information
Hi, this is Nancy speaking.
On Sunday we decided to attend a huge interdenominational church service set up on a field on the University of Cape Coast campus. There were hundreds of chairs set up under tents, but of course, it was still very hot. There was about an hour and half of singing by the choir and other groups and then we were an hour into the sermon when we left. Everything is very loud which was different for me, but interesting.
That afternoon we went to the beach. Despite not having a bathing suit, I decided I would go into the ocean. The waves were very high and would knock us over and then suck us back out. The water was very mild and very salty and it was a fun experience. Then a sudden rainstorm came up with heavy winds and rain and I got cold for the first time. My clothes were full of sand and then that was the only night we didn't have any running water. Good thing I had filled a bucket with water earlier in the week!
On Sunday we decided to attend a huge interdenominational church service set up on a field on the University of Cape Coast campus. There were hundreds of chairs set up under tents, but of course, it was still very hot. There was about an hour and half of singing by the choir and other groups and then we were an hour into the sermon when we left. Everything is very loud which was different for me, but interesting.
That afternoon we went to the beach. Despite not having a bathing suit, I decided I would go into the ocean. The waves were very high and would knock us over and then suck us back out. The water was very mild and very salty and it was a fun experience. Then a sudden rainstorm came up with heavy winds and rain and I got cold for the first time. My clothes were full of sand and then that was the only night we didn't have any running water. Good thing I had filled a bucket with water earlier in the week!
Monday's Happenings
Today we started early and visited examples of the Ghana Health Care System (they call it the Ghana Health Care "scheme" interestingly enough. We went to Ankaful Psychiatric Hospital and Ankaful Leprosy Hospital as well as the Central District Hospital (very large and much nicer...has an ICU and everything...of course the pumps don't work, etc.). There still is some leprosy in Africa and we saw a few males in the male ward missing various parts of their feet...it apparently strikes there first. Leprosy has some neuropathy so those afflicted don't feel when they get wounds on their feet and the disease progresses from there. It's sad.
The Psychiatric Hospital was also interesting. It has a very large grounds area and then the male ward or female wards. Lots of the grounds are for housing for the workers. The male ward was a very large open area in the center with "housing" around the open area. There were 97 male residents. The most common diagnosis was cannibus related psychosis. The males were grabbing and touching as we walked through...it was HOT and there were all 97 very close to us. They have 2 workers and no real security that we could see. The female ward was much quieter and more in control, but you could see a couple of schizophrenics walking about, talking to the voices, etc. The treatment was mostly medication...and the male nurse in the male ward said some residents had been there for years, while others are in and out in a few weeks.
Finally, the very large District Hospital was pretty well staffed from what we could see. This had an ICU, a peds, OB, surgery center, medical and surgical wards, etc. It had some but certainly not all of the equipment, meds etc that we are used to...overall though it wasn't too bad.
After all this, we ate at a lovely beach resort, Oasis Beach Resort where we watched drummer and dancers do their thing...very entertaining!
The Psychiatric Hospital was also interesting. It has a very large grounds area and then the male ward or female wards. Lots of the grounds are for housing for the workers. The male ward was a very large open area in the center with "housing" around the open area. There were 97 male residents. The most common diagnosis was cannibus related psychosis. The males were grabbing and touching as we walked through...it was HOT and there were all 97 very close to us. They have 2 workers and no real security that we could see. The female ward was much quieter and more in control, but you could see a couple of schizophrenics walking about, talking to the voices, etc. The treatment was mostly medication...and the male nurse in the male ward said some residents had been there for years, while others are in and out in a few weeks.
Finally, the very large District Hospital was pretty well staffed from what we could see. This had an ICU, a peds, OB, surgery center, medical and surgical wards, etc. It had some but certainly not all of the equipment, meds etc that we are used to...overall though it wasn't too bad.
After all this, we ate at a lovely beach resort, Oasis Beach Resort where we watched drummer and dancers do their thing...very entertaining!
Saturday's Happenings
Boy, sorry this is so very far behind...we have been on the road quite a bit and there hasn't been as much time to update this blog. So here is a bit of an abbreviated version of what we did on Saturday. We went to Kakum National Forest where we walked on one of the 6 walkways of this kind in the world. These walkways (and there were 6 of them that we carefully traversed this day) were about 60 meters above ground and were only a single plank, with roping on each side. Our guide said if anyone was afraid of heights, then don't look down (which of course no one listened to!). I have lots of pics of this adventure plus some other pics of this rain forest which I will load hopefully later Friday when I get home. And we had to climb for about 20 minutes to get to these walkways. It was very hot (of course) and it was hard work. After the rain forest, we went to a monkey sanctuary where a guy from Holland had made it his life's work to gathered injured monkeys. Nancy will blog more on that. After this we went to Hans Botel for a late lunch/early dinner. Had some fried rice and shrimp which didn't set too well. The view was interesting however...lots of crocodiles surrounding the Botel which sat on a river (near as I could tell). The rest of the evening was just resting and a bit of blogging. Will post pics on all this soon!
Saturday, March 13, 2010
What a graduate nurse does
Hi, this is Nancy Schoofs speaking. I had a chance to talk to a graduate nurse who is doing her one year of service in a hospital in Accra, the capital city of Ghana. She went to the University of Ghana. She'll be taking her Nursing and Midwifery Council of Ghana skills exam and written essay exam next month. She showed me the booklet with all of the skills written out step by step and the scoring scale used for each skills testout. There was a long list of skills and the graduate nurses have to be ready to perform two of them for their exam. Everything from inserting a foley catheter to readying a dead patient for burial to preparing a child for an examination were included. Nurses are not allowed to draw blood or start IVs--only the doctors can. Day shift nurses work 6-2 or 8-4 and night nurses work 8p-8a for three nights a week. They get a fixed monthly fee no matter which shift they work. She said she wants to be a patient advocate, but does see a lot of nurses who don't care and wear artificial nails (her words, not mine!)
I asked her about the essay exam and she said the graduate nurses might get a question such as: You are in the market place and a woman is in labor. You must provide for her privacy and then examine her. How do you do that? Then, after you examine her, you find that the baby's head is in the birth canal. How do you care for her?
I asked her about any patients with cardiovascular disease. She said they see congenital heart disease, some CAD, but not much heart failure. Considering that the life expectancy is 60, this is not surprising. There are no heart procedures, so heart disease patients are just treated with medication.
They're seeing more diabetic patients due to the starchy diet (no desserts and not too many sweets except pop), but lots of bread and a starchy powder made from the manioc root that they cook. She said renal failure patients can have dialysis if they can afford it, butmost can't and just die.
I asked her about the essay exam and she said the graduate nurses might get a question such as: You are in the market place and a woman is in labor. You must provide for her privacy and then examine her. How do you do that? Then, after you examine her, you find that the baby's head is in the birth canal. How do you care for her?
I asked her about any patients with cardiovascular disease. She said they see congenital heart disease, some CAD, but not much heart failure. Considering that the life expectancy is 60, this is not surprising. There are no heart procedures, so heart disease patients are just treated with medication.
They're seeing more diabetic patients due to the starchy diet (no desserts and not too many sweets except pop), but lots of bread and a starchy powder made from the manioc root that they cook. She said renal failure patients can have dialysis if they can afford it, butmost can't and just die.
Friday's Info
We had a very full day on Friday...we met Doris Ahelegbe the District Director of the Ajumaku District Health Directorate. She accompanied us to her district (about 1 and 1/2 hours away) for a tour of the Ghana Health Care System. This trip, partially because of very poor roads, took all day. Ghana provides health care for all of its citizens, but first they have to buy this health care...otherwise they private pay. Many Ghanaians do not buy health care (it is very cheap BUT most of the citizens are very poor). The HC system however is set up as the WHO recommends: Level A is where people can go to get minor issues resolved (first aid, minor infections, etc.)...this is called CHP Community Health Planning Services. The CHP we visited was manned by a (nursing?) student...but this is someone with SOME advanced medical training but does not have to be a nurse. She says she sees about 6 patients a day and if someone is supposed to come in but doesn't then they will go do a home visit.
The next level is Level B, which has a health center. This center is manned by an equivalent of our nurse practitioner or PA. We talked with "Suzie" who was posted there (all health care jobs are government jobs)...she says she doesn't see her husband often as he is posted elsewhere...and she is on call 24/7...she gets no days off. She will be granted a leave of usually about 1 week/year. This health care clinic sees abut 30-40 people/day...and does about the same number of home visits. Suzie has a staff of ancillary personnel to assist her.
The third level is Level C where the district hospital is (the main hospital was being built when we were there). They also handle some of the more serious cases of illness and disease.
The last level is Level D - this is the very large hospitals, like the one in Accra which has much more technology (MRIs but not PET scans,etc.) then the other levels and have 1000 or more beds. We will drive by the one in Accra but not visit this. Each level has protocols of what is appropriate for them to handle and when to refer.
All in all, the entire day was very enlightening...we did not get the impression that anyone would be turned away even if there was no insurance. There is not much technology and very basic medications, but they take health care and health promotion VERY seriously. There are lots of campaigns for malaria nets, HIV/AIDs, STIs, TB prevention and the list goes on and on.
When we got back to UCC, we changed and then went to another beach resort for dinner. The electricity was out, but they were able to grill our food (I had lobster and fries...very good!).
The next level is Level B, which has a health center. This center is manned by an equivalent of our nurse practitioner or PA. We talked with "Suzie" who was posted there (all health care jobs are government jobs)...she says she doesn't see her husband often as he is posted elsewhere...and she is on call 24/7...she gets no days off. She will be granted a leave of usually about 1 week/year. This health care clinic sees abut 30-40 people/day...and does about the same number of home visits. Suzie has a staff of ancillary personnel to assist her.
The third level is Level C where the district hospital is (the main hospital was being built when we were there). They also handle some of the more serious cases of illness and disease.
The last level is Level D - this is the very large hospitals, like the one in Accra which has much more technology (MRIs but not PET scans,etc.) then the other levels and have 1000 or more beds. We will drive by the one in Accra but not visit this. Each level has protocols of what is appropriate for them to handle and when to refer.
All in all, the entire day was very enlightening...we did not get the impression that anyone would be turned away even if there was no insurance. There is not much technology and very basic medications, but they take health care and health promotion VERY seriously. There are lots of campaigns for malaria nets, HIV/AIDs, STIs, TB prevention and the list goes on and on.
When we got back to UCC, we changed and then went to another beach resort for dinner. The electricity was out, but they were able to grill our food (I had lobster and fries...very good!).
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