Wednesday, 27 July 2011

Ok I am officially a lazy blogger. But I think one post per week isn't too bad, no?

Church on Wheels

Over the weekend, Pat and I took a quick trip to Takoradi, about 4-5 hours drive west of Accra. The bus trip was only 9 Cedis (about 6 US dollars) which I thought was a great deal! The bus was relatively comfortable, same as a big coach bus at home. But the amazing deal was challenged when a man hopped on the bus at the start of the trip and stood in the aisle, preaching from the bible and singing songs to everyone. He seemed very unassuming at first, but once he whipped out his bible I knew it was time for me to get out my ipod. The other passengers seemed to be totally into it, but Pat and I were not. I'm all for people enjoying their own religion on their own time, but for over an hour on a slightly cramped bus it is not too pleasant.

The place we stayed at (Safari Beach Resort) was awesome, it is an eco-resort with self-composting toilets and outdoor showers, 4-poster beds and mosquito nets. This may not seem very luxurious to most of you, but it was really very comfortable and relaxing. The food was amazing, and the beach was pristine. Unfortunately we only had Saturday evening and Sunday morning on the beach, and then had to head back to the city. It was worth it though, even just to have a few hours lying in the sun and listening to the waves.

I have been working at Korle Bu teaching hospital in Accra this week. My day is split between the pediatric general surgical unit, the orthopedic unit, and the burns/plastics unit, and I have 6 students with me for the day. We have seen many of the same things I see at home, and I was totally in my element when we admitted a postop appendectomy this morning. The ortho unit is kind of sad though, it is busting at the seams with kids in traction, and parents are only allowed to visit during designated visiting hours, which are pretty much 0800-0900, 1200-1300, and 1600-1700. That makes for a lot of crying during the day, and I don't really understand the rationale for having it that way. At home, I am used to parents being at the child's bedside 24 hours a day. The only reason the nurses gave me for the restricted visiting hours is that "the mothers cause problems". Nobody cared to elaborate on what these problems are, and I think it all just depends on who is in charge of the unit, because the burns/plastics/general surgery units all had parents present. This is one thing I hope that the students will take from this program, to challenge the rules and restrictions that have been in place for years and open their minds to more efficient and family-centered ways of providing holistic care. I never thought I'd be the one going on and on about "family centered care", something we are so sick of
hearing at SickKids, but when you see kids suffering without their parents around, or see a mom crying because she wants to take her dying baby home and palliative care is not a concern to the doctors/nurses, it really strikes a chord.
Students learning about pulmonary
function tests and asthma

Children's Block at Korle Bu

All sadness aside, I have really enjoyed being a part of this program. As the students have learned from me, I have learned from them. Their compassion and enthusiasm is like none I have seen before, and so they really can improve nursing in Ghana. Even in only these 5 weeks working with my 11 students, I can see changes happening within them. Not only have they learned a lot clinically, but their confidence in their assessments and when working with doctors has grown. Discussions between nurses and doctors here are usually unilateral, and the nurses are often not respected enough to give recommendations or challenge things, even if they have been working for 25+ years in the same unit. I would love to bring them all to Canada and let them see the way things work at SickKids! (If you work there, you know how much you have taught new medical residents, and even sometimes staff physicians!)

I will be leaving Ghana with a heavy heart on Friday, but will have fond memories of everything I have experienced here. And I will miss the random biblical references on store signs and taxis. I can't wait to try to make some Ghanaian food when I get home (Jed, can you please pick up a giant bag of dried beans?) and go through my pictures.  And although I'm sad to leave, I will be happy to be home to my normal everyday life, and I'm even happy to go back to work :)
I hope to see you all soon, and thanks for reading! (and no, I will not be continuing this blog... nobody wants to hear my rambling on a regular basis)

Wednesday, 20 July 2011

Last week was quite productive at the hospital. Not only did I sneak some photos, but the group of students in the surgical ward got to go to the outpatient department (clinics). Although they have been learning on the surgical ward, most of the patients are in traction and are waiting waiting waiting to be discharged home (for, like, months). Needless to say, the learning opportunities have come to a bit of a plateau in the surgical department, so I wanted to take advantage of our time and go somewhere with a little more action.

Me and 2 students and a staff nurse at Military Hospital (Surgical Unit, treatment room)
 There is only one paediatric clinic at the hospital, and every day is a different clinic. Monday and Wednesdays are "general clinic" days, which is basically a walk-in clinic. The other days vary between HIV ("special") clinic, asthma, neurology, and NICU follow-up. The students have had many opportunities to see different things and perform physical assessments based on the presenting symptoms, and the doctors in the clinics are amazing and have been very supportive of the students' learning. One baby that came to clinic had a huge piece of tape on her abdomen, and the doctor pulled it off and revealed an umbilical hernia. A common practice here by the families is to place a coin or a rolled up piece of gauze over the hernia and then tape it on tightly to keep it reduced. This is continued for years until the hernia resolves (or until the child has corrective surgery). The doctor and my students discussed the importance of keeping the bandage off to prevent skin breakdown, and that the hernia can resolve on its own. It is interesting to see the home remedies and herbal/spiritual management of medical problems that these kids come in with.
3 of my students in Pediatric Emergency

New graduate nurses wear green with white aprons

Outside Pediatric Emergency Unit at 37 Military

On the roads (and highways), Hawkers (sellers)
approach each and every vehicle hoping to sell
you whatever they've got on their head.

On a non-work note, last weekend we took another trip to Kakum National Park and Cape Coast Castle, only this time it was a school trip! Our students' bus driver drove us all in the University of Ghana Nursing School bus, and about 15 students came and brought along some of their children too. We had a great time and the students were very grateful for the trip; they said they don't usually make the time on weekends to take trips and just have fun with their friends and family. There were a lot of laughs, (gospel) singing and clapping, and picture taking.

Students and their kids hamming it up  for the camera

View of Cape Coast from the castle

View of the Atlantic from Cape Coast Castle

Sunday, 10 July 2011

Last week was a good week at 37 Military hospital. I worked with my 2 groups of students (11 students in total), one in the pediatric surgical ward, and one in the emergency department. The day usually begins with the students arriving one by one over the course of an hour (timeliness is not as much of a concern here than at home!), and the students chatting with one another and having some breakfast. People here love to talk and learn everything about you as much as they can.

In the surgical ward, the main patients we see are orthopedic cases, usually caused by motor vehicle accidents or just children being children and climbing and falling. The interesting thing is most of the patients are placed in traction and on bedrest for weeks to months at a time. Usually in Canada, we would perform traction for a short period of time, followed by surgery to stabilize the bone so the patient can go home. Here, those specialized surgeries we have in Canada just do not occur and the patients basically live at the hospital with their mom (or nobody). Unfortunately, there is nowhere for parents to stay other than a small plastic chair at the bedside, and only one can stay. Visiting hours are for a total of 4 hours per day (not including one parent). There is one tv for at least 12 patients and there are no children's movies or shows on, and many days it doesn't work. There are also no toys. It's not very family centered :(

In the pediatric emergency department, many of the patients arrive with moderate to severe dehydration, Malaria symptoms, cholera, pneumonia/asthma, accidents (burns, injuries), or malnutrition. There were also some tiny (TINY) babies in the back who were both pre-term and malnourished. Something I have never seen and will probably never seen again in Canada.

I wish I could take pictures, but it seems to be greatly discouraged, as when I ask people they look at me like they have never been asked that question in their life. I was referred to ask one of the military officers (I think he's pretty much in charge of the entire pediatric medicine department), so I'm going to just not take pictures. Maybe I'll sneak one someday, but then again I don't want to find out what the jails looks like here!

Tuesday, 5 July 2011

Slow, but sure

July 1 - 3

When the long weekend approached, Stephanie and I took full advantage and took a trip out of the city to Wli falls (pronounced Vli). If the stars are aligned and the bus is not full and there is no traffic, the trip is a comfortable 3 hours. If you have my and Steph's luck, the bus is full and instead you have to fight your way into a trotro (van full of 15 people), and with traffic the trip is 6 hours. It felt more like 24 hours, sitting on a tiny flip-out version of a seat in a car with no padding, pot holes the size of a house, and stopping in every little town with hawkers (peddlers) running up along the side of the trotro trying to sell you massive grilled snails on a stick. No thanks, ladies!

The crazy trotro station

A shop of some sort we saw on the trip to Wli falls, a good motto for Ghana!

The village of Wli Falls
We finally arrived at the Water Heights Hotel, a small, quiet and perfectly clean motel/resort run by a lovely Ghanaian family. The food there was excellent, and I had my first groundnut soup with omo tuo (peanut and chicken soup with rice moulded into balls that you dip into the soup). The next day we walked through the village and down a forest trail that leads to the falls. Wli falls are the highest falls in West Africa, and they are absolutely stunning. One minute you are walking through deep African rainforest, and the next you are facing an isolated lagoon, a waterfall as high as you can see, and nesting fruit bats scattered along the rock face. I was completely stunned when I first saw the falls and couldn't stop staring; they are so magnificent, even compared to Niagara Falls.

Wli Falls
We also paid a guide to take us on a hike to the upper falls. Oh Kathy, what were you getting yourself into here... So this was a very hot and humid day, and I was equipped only with running shoes, a litre of water, and my camera. Our guide handed us each a long stick to help us on our way, and in the end the only purpose it could have served would be to splint a broken femur. Don't worry, nobody got hurt, but it definitely could have happened. First of all I was DYING on the way up, and I love to hike but this was humidity like I've never felt. I wasn't the only one, the Montrealers in our group were also sweating profusely and panting all the way up. Then, as we were about to reach the falls, the sky opened up and we and the mountain got completely soaked. This meant mud, and lots of it. We slipped and slided up and down the narrow trail, ruining our only pair of running shoes along the way. And the stupid hiking stick proved to be useless in my opinion. Anyway, at the upper falls, both Steph and I were disappointed as it was pouring rain and we couldn't even see the view of the village, we were actually cold for the first time in Africa, and we couldn't swim due to the chance of parasites swimming into our bodily orifices from that fresh water. And to be honest, the lower falls were much more beautiful (at least on this day). The way down was easier, but more technically challenging with the slick muddy terrain. All of this aside, the day was an adventure and we (well, maybe just me) had a good time.
We saw a beetle like this at the hotel. I would have taken a real picture, but the thing was literally the size of a hamster, so I wasn't going to get close to it. <barf>
The trip home took a miraculous 3 hours (I don't know how fast our driver was going, the speedometer was broken), and thank the lord for that because the lovely man beside me decided to buy and eat some of those grilled snails!

Friday, 1 July 2011

Hello everyone! And Akwaaba (welcome) to my blog... I've never done a blog before so I'm learning as I go.

(I will preface this first post by mentioning that I have 6 days to catch up on, so this is most likely my longest one.

June 25:
I have finally arrived in Accra, Ghana. After a bit of heartbreak leaving Jed (and the cats) behind, I boarded my flight to Amsterdam, and then boarded another flight to Accra. I have to say, Schiphol (Amsterdam) airport is by far one of the coolest airports, nay, buildings, I have been in! It's like an airport meets shopping mall meets library/museum meets Ikea. If you've ever been there, this makes sense. They even have mini pancakes. I can't wait to go back.

Anyway, onto Ghana. The woman I was sitting next to on the plane was Ghanaian but now resides in Amsterdam (and is a nurse!) and we chatted for a bit. Until I noticed her pull out a few "Watchtower" magazines, at which point I promptly put my headphones on to watch a movie. Poor man on the other side of her, she read to him from the bible and those magazines for the entire 6 hours and 40 minutes. Good on him if he is into that stuff, but even if he is I don't think anyone wants their ear talked off for more than 15 minutes by a stranger. Not me at least.

I arrived at the airport and waited, and waited, and waited... in line for customs. Welcome to Ghana, things move at a much slower pace here than I am used to. Stephanie picked me up at the airport, and I couldn't have been happier to see a familiar face after almost 24 hours of traveling. We got to the apartment where I met Pat and Heather, the two other SickKids nurses currently living and working here. They have been doing lectures for the Ghanaian nursing students for the past 6 weeks and now I am here as the first clinical instructor for the students' in-hospital rotation.

The apartment/hotel is fantastic. Living room, kitchen, 3 bedrooms, air conditioning, hot water, and flush toilets. What more could a girl want! It's very clean and the compound seems safe and has 24 hour security (just for you, Dad!).

June 26:
Today, the 4 of us took a day trip to Kakum National Park, where we walked along several suspension bridges roped between trees, about 40 metres up in the air. We were told there were forest elephants, badgers, monkeys, etc. in the area but poaching in the past has caused the animals to take off as soon as they hear anyone coming near. We were then certain we weren't going to see any sort of animal with the loud and obnoxious chinese tour group ahead of us. Jet-lagged me forgot my camera today, so please enjoy these photos courtesy of Google.

We then visited Cape Coast Castle. It seemed almost like any other castle you might see, and I thought "I guess this might be an ok thing to walk around for a bit". Turns out its history is very disturbing and interesting. It was originally built as a trading post, but later became a holding area for the selling and purchasing of slaves. Dungeon after dungeon we walked through, dark like I've never seen, filthy, hot, and there would be hundreds of people crammed in those spaces for months at a time, never to be let out unless to be raped, killed and thrown into the ocean, or led down a tunnel and into the basement of a slave ship destined for the Western world. Devastating and eye-opening, but the castle itself was quite beautiful in a panoramic beach setting.

June 27-30:
I have been to two hospitals, and spent one day in a malnutrition day clinic where the children are fed and monitored. It was a sad and happy place at the same time. I felt happy for the children that they were getting the food they needed, but sad that they were in this situation in the first place. Their parents seemed well-dressed and a lot of the mothers worked as well as the fathers, but the main barrier was education. Something we take for granted, knowing that vegetables/fruit/protein/dairy/grains are necessary for life, they may not have ever been taught. Some of these children were only breastfed for 2 months and then given only bread, water, and sugary foods. I can't stop thinking about those poor kids with their scrawny arms and legs.

I spent one day in the paediatric surgical ward at 37 Military Hospital, where I will be for the next 4 weeks with my students. We were working on taking health histories today and they all did a good job. The ward is mostly orthopedic patients, and of those a lot are from motor vehicle accidents. Cars drive at breakneck speed down these dusty red dirt roads with many pedestrians along the sides, and generally there are no sidewalks. Not to mention many of the cars are not so well maintained, nor are the roads, so accidents are bound to happen. And you're lucky if you get a cab with working seatbelts and doors. Don't worry, Dad, I'm being extra safe :)

Oh and before I forget, and almost most importantly, we went to a Canada Day reception on Tuesday at the Canadian High Comissioner's residence in Accra. It was quite fancy, and there were many ambassadors from other countries, ex-pats, and volunteers from various organizations at the party. We met Trudy Kernighan, the Canadian High Comissioner, as well as the Ghanaian Minister of Health.

As well, we went on Thursday to the Canadian Embassy for yet another Canada Day celebration, but this one was more casual and bbq style. We had poutine and beer and hamburgers, and I won the "guess how many candies in a jar" game. Good times all around!