Goodbye for now Ghana!

We are “far small” from heading home after an amazing six week global health experience. We will be sure to take a few charming Ghanaian catch phrases home with us:

“Far small” – This may mean 5 minutes or an hour, 5km or 100km

“Selfies with Safu” – A laboratory technician from the Enchi clinic who takes the best selfies ever (see below)

Selfies with Safu
10 of us in the van to Kumasi

"Ayeeeee" - said as an exclamation after something interesting or surprising, which in our case was everything. 

“Nahhhhh” – this is said after almost anything; the definition remains unknown. 

“No please” – this means no, politely

“Oburini” – this means white person and was often used in place of our names

“Wow” – used frequently to acknowledge our names, a picture taken, any interesting or unusual statement

“Shake me” – meaning the desire to shake your hand

“I’m fine” – the response to all greetings, whether “how are you?” was asked or not

“You are mostly welcome” – every person we encountered would warmly welcome us to their community with this phrase, charmingly mistaking ‘mostly’ for ‘most’

We will miss all the amazing people and the incredible sense of community. We will also miss their strength, utter selflessness, and devotion to the well-being of their community. We have gained insight and knowledge in regards to global health and another culture’s way of living. We've appreciated the opportunity to witness another health care system and have a new appreciation for our own. We have a new awareness of our privilege in Canada, including our education system and a healthcare system abundant in resources. We have met some amazing people, doing amazing work to better healthcare in Ghana, and we will never forget them. We are grateful for this experience and all that we have learned. We look forward to sharing our stories and experiences upon our return to Canada.

Thank you for following our journey,

Kyla, Samaya, Christina, Nicole, Jeanette

Project GROW - What's Next

Back in September, the Global Nursing Citizens (GNC) began conversations with Vida to determine what the greatest need was in the community so that they could begin some targeted fundraising,   We discussed several possibilities, and thought that power for the Okanagan Community Clinic might be the priority.  Through all of these discussions, Vida kept reminding us that it would depend upon the priorities identified by the community.  I arrived in Nyobok with funds from the GNC and waited to see where we would target these funds.  

On our first day at the village, Vida toured me around the community and we talked about the needs that had been identified by the community.  Over the past 3 years, Hanna, a community member and active volunteer in Project GROW has been going to school to become certified to teach seamstress classes.  She is ready to start teaching, and there are many women ready to learn.  The problem is the Vocational Centre has not been completed.  It needs to be wired for power, furniture needs to be built and windows installed.  

Vida also showed me the building that houses the grinding mills.  This building is complete but has not yet been wired for power.  The women are manually powering the mills and bringing in electricity would markedly improve their productivity.  

We talked about how these 2 projects would have an immediate impact upon the well-being (and health) of the community.  We also talked about the need for the clinic to be wired for electricity so that it could reach full Health Centre status.

Then, I witnessed Vida in action.  She began a tireless process of conversations with the community and the Project GROW team.  We talked about the pros and cons of both projects.  We could either wire the clinic for electricity, or complete the Vocational Centre and Grinding Mill.  She was patient, thorough, and ensured that every voice was heard.  We got estimates on the work and brought these to the team.  

After many lengthy discussions with community members, the Ghana Health Service Team, and with input from the GROW team it was decided that the GNC funds would be used to complete the Vocational Centre and Grinding Mill.  The Project GROW team felt these projects would have an immediate impact on the community.  

We turned the funds over to the team and work has already begun! They anticipate classes starting within a month.   What a powerful demonstration of community development.  

The midwife is coming in 3 months, and we're going to do our best to raise the $1500 (Canadian) to complete the wiring of the clinic.  I believe we can do it!

Jeanette

Update on the Okanagan Community Clinic - Never Underestimate the Impact of our Students

I wanted to add an update to the Okanagan Community Clinic blog.  When we first arrived at the Okanagan Community Clinic in Nyobok, Vida shared that it had been officially turned over to the Ghana Health Service in November.  They had 1 Community Health Nurse, and were not anticipating any more recruits for several months.

Then....the power of our students kicked in....

They set-up, organized, collaborated with Philemon (the 1 nurse at the clinic) to provide screening for 339 community members.  Right in the middle of it, Mary, the District Nursing Supervisor for Ghana Health Service arrived with her team to witness this incredible demonstration of community engagement.  Within a day, I was down in their office discussing the relationship and long-term commitment our UBCO community has to this community and clinic.  Mary and her team were very impressed with the work that has been done and the commitment of the community.

And....guess what???

On Monday, the second Community Health Nurse arrived, and on Wednesday, Philemon was joined by a third staff member.   In less than a week the staff at the clinic tripled.   They are anticipating a midwife to be there within 3 months.  Vida's vision of a fully functioning Health Centre is several steps closer.   What an incredible outcome!

All from 4 nursing students and one very committed Community Health Nurse willing to spend 3 long, hot, dusty days seeing every community member that came to be seen.

Remarkable!

Project GROW Day!!!!

From the Project GROW Website:
http://www.projectgrow.ca/

The Fearless Leaders of Project GROW
Vida is on the left - Philomena on the right

Ghana Rural Opportunities for Women (Project GROW) is a community development project which aims to facilitate women's economic empowerment and community capacity building agenda in rural Ghana.   Project GROW began as a result of the research of international graduate student Vida Yakong, who is from the region and was researching the barriers that prevented women in Northern Rural Ghana from accessing rural health clinics. The primary reason identified was poverty.

Initially UBC students and staff became interested in Dr. Yakong's research, followed by members of the community, and now with independent sponsors, who all saw an opportunity to connect this research with global citizenship objectives.  Building on the success of their years with the University of British Columbia, Okanagan campus, Project GROW is now a Non-Profit Society. The connections and working relationships with UBC academic programs and student learning opportunities remain as strong as ever.  Project GROW still has close ties with UBCO students as well and is a unique combination of research, international engagement and community involvement, inspired by a student who was driven to make a difference in her country.  It is also a model that we hope can inspire other, similar initiatives.

Josbeth - Project Grow Volunteer and Vida and Philomena's Nephew
The Project GROW motorbike was donated a few years ago

Our GROW Day:
On Saturday we had the incredible opportunity attend the Project GROW celebration in both Logre and Nyobok.   The organization is non-profit, and was founded by our dear friends Vida (an Alumni and Adjunct Professor from UBCO) and Philomena Yakong, The mission of the organization is to empower women to be self-sufficient and improve their livelihoods using the skills and resources which are provided through GROW (for example goats, donkeys, micro-loans, and the teaching of vocational skills).

Logre Goats!!!

This day was special because it was the day in which the women were presented with their goats, mosquito nets, dry soup mix and dried fruit (made in our very own Okanagan valley) and a donkey. This presentation day only happens once a year- we were so thankful we were able to attend and be a part of the celebration. The day started with a small celebration at the Catholic Health Centre in Logre, which has a small group of women living with HIV/AIDS who are members of Project GROW.  Vida shared that each year this small presentation gets larger and there is more community involvement.  She believes next year it will be a full celebration like the one at Nyobok.  The most beautiful piece of this is that the original intent in holding a small celebration here was that these women face incredible stigma and discrimination.  What we see now, is that these women are actually pulling the community together.  What a wonderful example of community development. Our hearts were full and we weren't even to Nyobok yet!

Nyobok Community

When we arrived in Nyobok, it was interesting as the majority of the individuals that attended Project GROW day we had screened at the Okanagan Community Clinic the week prior! It was nice to see these familiar faces and reconnect with them on this special day. Over five hundred women are now registered with Project GROW and on Saturday we were able to present thirty three goats and one
donkey to the women.  Vida shared that the women determine who is next in line for a goat.  Each woman who receives a goat agrees that the first female baby goat will be donated back to Project GROW.  There were another 10 goats being donated back, and a few of these goats had already had babies. One had twins.  The total number of goats being donated back was an additional 13.
When we asked who determines who receives the goats, Vida shared that the women decide and priority is given to those who are most in need, and after this, it is determined by when they registered.  The donkey is shared by several families, again identified by the women,

When we first arrived in Nyobok, we were greeted by the women of the community through

traditional song and dance. We were also greeted by the Chief, who was surprisingly young (only 31 years of age as he inherited the role in his 20s upon his father’s passing). Jeanette had a chance to meet the Chief prior to the celebration and shared with us that he has been extremely supportive of Project GROW right from it's initial steps. This young man, who does not speak English and has no education deeply understands the role of women in community and Vida feels he has been instrumental in the success of the program.  One of his Elders shared some words from the Chief and emphasized the need for education, and the need to support women in education.  Vida has a deep respect for his leadership and we could clearly see why.

Jeanette with the Chief

We were the guests of honor at the celebration and we were very touched by all of the warm welcomes that we received. They ensured to translate the presentation for us so that we felt included, and were very thorough in acknowledging the various roles that individuals held that made the presentation possible.

We were humbled by their gratitude for our work within their clinic and organization, many women bowed before us as they walked by and thanked us for our work. It was nice to witness the sense of community throughout the entire presentation. The children were also involved through the presentation of the livestock. The actual presentation of the goats was very touching as we each had an opportunity to present the women with their goats. Kyla’s friend contacted her wanting to purchase a goat and donate it to a woman in need. Vida once again displayed her tenacity by finding Kyla’s friend a goat last minute. It was touching for Kyla on the day of the presentation to witness and present her friend’s goat, Mona, to a deserving woman.

The Presentation of Mona

There is no doubt in our minds that every dollar that is donated to this amazing project is put to very good use and is changing lives.  WOW!!  What a day!!

We will never forget it, and are very thankful to have taken part in.

Update on Mmabil

A Beautiful Smile

While we attended the project GROW presentation in Nyobok, we had the opportunity to see Mmabil
, the young woman that Kyla and Samaya performed the dressing change for. The first thing that we noticed was her smile, and she denied pain when we asked her. This was a big change from the first day we cared for her.  
Additionally, we noticed that she was able to walk without her walking stick, and her gait appeared much steadier. Philemon,  the nurse at the clinic, stated that when he performed the dressing change in the morning it appeared much better, and looked like it was healing well. We were so excited to hear this news, as we were very concerned with the possible outcome. The wound was fairly substantial, and if left for much longer we were concerned that she may have lost her leg. Mmabil doesn't have health insurance, therefore is unable to get further intervention (such as debridement) at a larger healthcare facility. We understood her predicament, and were doing the best we could with the supplies available to assist in her healing process. It was nice to witness the improvement in a few short days, and we are looking forward to hearing updates from Philemon in the future in regards to her progress. We know that she is in good hands!

Mmabil

Okanagan Community Clinic

The View Driving up to the Clinic

For the past 3 days, we have had the privilege of working at the Okanagan Community Clinic which was handed over to Ghana Health Services in November, 2014.  This clinic has been a vision of Vida and Philomena Yakong and has been a work in progress for several years.  It is situated in a beautiful and peaceful village called Nyobok, and was a nice change of scenery from the Tamale Teaching Hospital. Nyobok is the village where Vida and Philomena were born and grew up.  

We were informed that people had been lining up over the weekend as they heard that we were coming to perform health screening. Over the course of three days we were able to see over 300 villagers! They were long, tiring days, but the satisfaction that we felt at the end of each day more than made up for it. We each felt that we had made a valuable contribution and impact on the health and well being of those individuals that we were able to see.  

Okanagan Community Clinic, Nyobok

Ogopogo Maternity Ward

We set up a station where we each had a specific job- one person took vital signs, one person documented the necessary information, and the last person dispensed the required medication. Although it took a bit of time on our first day to work out an efficient system, we managed to eventually! While we were busy at the clinic on the first day, Jeanette heard of a young woman (Mmabil) requiring medication and medical attention for a wound on her lower leg. She visited her in her home, and with Vida's help encouraged her to come to the clinic for treatment (she had just been using traditional medicine).  On the second day imagine our joy when we saw Mmabil using a cane and walking to the clinic just as we pulled in for the day!  

Waiting Patiently

Samaya and Kyla organized what supplies they could in order to perform a dressing change. They had to improvise (Samaya used a pair of scissors as tweezers), but together they made it work! They took the opportunity to teach Philemon, the Community Health Nurse how to change the dressing, so he could perform it independently. Mmabil agreed to return daily for dressing changes, and on the second day her leg already looked much better!  

Philemon is the only staff at the clinic right now and his role is immense. He is expected to independently assess, diagnose, and treat clients as well as fill out their insurance paperwork. We have a lot of respect for his role! He was so kind and patient amidst the chaos, he does beautiful work! Overall, our experience at the Okanagan Community Clinic is something that we will never forget, and we hope to return again in the future!

Visit by the District Director and her Team.

Our Time at Chanshegu

We had the privilege to visit and overnight in the small village of Chanshegu. This village is about 20 minutes outside of Tamale, and is the same village where Muriel was given the honour of being named a King.  Previous years of students have done a lot of fundraising to provide access to clean water, and development of a health clinic.  We were taken to the village by Kassim, who is Sinbad's younger brother, and he ensured we were well taken care of.

Outside the Clinic.  Kassim is in the Centre,
Josef the Chief's son on the left, and on the right is the young man who works with the orphans

 Upon our arrival to the village, we were warmly greeted by the people and children. We were promptly introduced to the Chief, who greeted us into his village. We then walked to the clinic that is secured but not yet ready to be opened.  We were able to see the new windows that we had arranged to be installed the day prior to our visit! The clinic is nearly finished, but further funding is required for plumbing (septic tank, sinks, toilets etc) and then furniture and supplies.  

The Chief in his Traditional Hut

We handed out toys, nail polish, stickers, pencils, crayons, colouring books, tee shirts, and toiletries to the 38 orphan children of the village. They were so excited to receive our gifts. When we first arrived we thought the village had an orphanage. We were pleasantly surprised to find out that the 38 orphan children have actually been adopted into the care of the community and it's families. An amazing sense of unity and love in this village!

They Loved the Colouring Books

 We also had stickers, pencils, and other small goodies for the other children of Chanshegu.

The River
Their source of water

  

We walked down to the "river" which is actually a large, murky watered pond with many of the children. There were children and women at the pond fetching water that they carry in large buckets on their heads back to their homes. They walk on dirt trails through a forest, many bare foot. This water is their drinking, cooking, and bathing supply. Sadly, the village does not have a reliable supply of fresh drinking water brought to them, even  though there are black water  tanks in the village. They are only filled every 3-4 months, which results in the village not having clean drinking water  for months on end. The water from the pond is boiled and filtered using a special stone, though it is still not properly treated or entirely safe to drink. It is all they have.

A local family prepared our lunch and dinner for us. Boiled yam for lunch and TZ and groundnut soup for dinner, a typical Ghanaian dish. We said thank you for their kindness and each took a few bites to show our appreciation, though we are not fond of the local cuisine.

After dinner, we watched drumming and dancing as performed by the villagers. We each took turns entering  the circle to dance as well. The locals were laughing at our lack of rhythm and ability to dance to their dances.  Chanshegu only has power for a few hours at night, so the village is most often without power. This makes it hard to find reprieve from the extreme heat!

Our Home for the Night

We spent the night in the Chief's son Josef's  mudhut, all four of us side by each. We were lucky to have had a thin mattress, though it was not big enough for our whole selves. We found out how difficult it is to get comfortable and sleep in such heat without electricity to power a fan! We all enjoyed our experience of living like the locals of Chanshegu and were happy to have spent time in the village we have all heard so much about.

The Chief has a Canadian flag in his traditional hut, and he shared with us that we too are his family.

Playing by the River

What a wonderful community.

Collaboration with Women in Distress (COLWOD)

On our first day in Tamale while running errands, Vida brought us to a quaint shop called COLWOD( which stands for collaboration with women in distress). Right away we noticed all of the beautiful fabrics, bags, and paintings that adorned the small space. As we were busy stocking up on gifts for our friends and families, the ladies working there provided us with the history behind their shop. It is a charity organization that was founded in 1995 by a Canadian woman from Toronto, to help abandoned women. Through teaching them various skills such as sewing, tie-dye, and other crafts, they have enabled them to regain a sense of independence and dignity. We were all incredibly touched by the history behind the store, and felt it was such a worthwhile cause (not that we needed much encouragement to purchase items- all of our hands were full!) During our stay in Tamale we returned to the shop numerous times. We all purchased 2 yards of fabric to take home as 'baby wraps' (fabric that the women here use to tie their babies on their backs). We are excited to use them and show our friends and families how to carry your baby 'Africa' style! Additionally, through speaking with the onsite seamstress, we were able to make a prototype for a pair of scrubs! We each picked out our individual fabrics and got our measurements taken. Four days later we were presented with our very own custom made scrubs! We are all so excited to proudly wear them while working in the hospitals in Canada! 

The theatre (operating room) at Tamale Teaching Hospital

Samaya

Kyla

On our final day at the Tamale Teaching Hospital Samaya and Kyla spent the day in the Theatre where orthopedic surgeries were being performed. There was a bit of a delay at the start of the day as there was no running water to sterilize instruments. By ten a.m. the first procedure was underway which was an open reduction and internal fixation (ORIF) of the right radius. We counted 20 staff members in the operating room at one point, which we found to be quite overwhelming. We were wondering how the patient felt with so many individuals in the room watching the procedure. We also found it very interesting that nurses are able to place the patient under general anesthesia as this is an anesthesiologist's role in Canada (anesthesiologist's in Canada are medical doctors in Canada that then specialize in anesthesiology). The nurses and surgeons were very welcoming to us, and ensured that we had a front row seat. They were also involving us in discussions with medical students and nursing students, and asking us questions. It was apparent that they are used to teaching students frequently as they were eager to share their knowledge with us. During the procedure, one of the surgeons mentioned that he knew an orthopedic surgeon that happens to live in Vernon! What a small world. It's nice to know that knowledge is being shared across continents, and that we have multiple connections to Ghana!  We quickly learned that although it's nice to have a front row seat, we should've brought our goggles as bone fragments were flying at us! We then explained to the head nurse in the theatre that in Canada we have a sterile border around the patient that only the surgeon and the scrub nurse are to remain in. They found that very interesting as it is not something that they practice. Although the patient remains sterile, there were many individuals that were in close proximity to the patient to observe. The head nurse stated that he felt that our practice of having a sterile border would be beneficial to implement in their operating room. Overall, it was an interesting experience that we were thankful to be a part of.

ORIF

Emergency at the Tamale Teaching Hospital

On our third and fourth day at the hospital, Samaya and Kyla spent time in the Emergency department. Kyla spent the first day in triage while Samaya was on the emergency ward tending to the inpatients. In triage a form is filled out with the patient's name, where they live, why they came to the hospital, vital signs, how alert they are, and if they arrived with assistance. After this information is gathered it is then scored, and based on the score the patient is then placed under a color that indicates acuity. Once the patient was scored they were brought into the emergency ward for treatment or further intervention. Triage was very interesting because you were able to see many different health concerns like lacerations, abdominal issues, head injuries, broken bones and much more.

On the ward, Samaya had the opportunity to feed a patient via a feeding tube (they don't have a special formula like they do in Canada, and the families are expected to provide it. In this instance it was milo which is comparable to hot chocolate in Canada! Samaya also tended to various other health concerns such as broken bones, renal insufficiency, and concerns that were not yet diagnosed.

There was a young boy that had broken his neck falling out of a mango tree, so Samaya advocated for a neck brace as he needed a CT scan performed and it couldn't be done until the brace was in place. It took a bit of time and a few phone calls, but one was finally found!

The families on the ward are expected to perform a large aspect of the patient's care, and are to provide food, clothes, and a container in which the patient's foley catheter can be emptied. It's nice to see the family so involved in the care, and the nurses on the ward were amazing at interacting with the patients and their families. The nurse that Samaya was working with for the day attended the relational practice presentation at the university as he is a diploma nurse upgrading to a degree. It was so amazing to witness his way of being with the patients and their families, and was a great example of relational practice. Yay!!!

We left the emergency ward on our first day feeling happy with our contributions, and increasingly confident in our knowledge and abilities! On our second day in emergency, we were both working on the ward as triage didn't have any patients. The first thing that we noticed upon entering the ward was a teenage boy laying in bed. He did not look well, and upon further inspection we realized that he was absolutely soaked from head to toe and his eyes were yellow. We decided that we needed to change his bed and help to rearrange him as he was facing the wrong way in bed. When we walked up to him and introduced ourselves we quickly learned that he knew very little English, so communication was difficult. He was motioning for water that was at his bedside, so we gave him a bag of water without a second thought. Right away he starting pouring the water all over his body, hence the soaked bed. We had found the source! We were relieved that it wasn't sweat or urine, but at the same time also knew that he was running a fever as he felt warm to touch. We provided him with a cool cloth, and helped to change his sheets and clothes in order to make him more comfortable. As we were busy helping make him more comfortable, one of the doctors approached us and expressed his concern for our well-being while working in close proximity with the patient. He told us that we needed to ensure we were washing our hands thoroughly after caring for him. At first we were confused, and unsure as to why he seemed so concerned as we were wearing gloves. After we finished performing care for him, we stepped aside and had a private conversation with the doctor in regards to the patients possible condition. He stated that he felt the patient either had yellow fever, or hepatitis B or C. The doctor was very concerned for our well-being as he wasn't aware that we had in fact been vaccinated for yellow fever (it is a mandatory vaccine in order to enter Ghana!) The doctor then proceeded to mention that the patient wasn't doing well, and his only chance for survival was a liver transplant. He stated that if the patient lived in Canada, he most likely would have survived. This was an incredibly tough thing to hear, and we continue to think about the patient and wish there was more we could have done to help.

After this we noted a nurse feeding the same patient Samaya fed the day prior. The patient was in laying potion while being fed through the nasogastric tube which we were a bit concerned about. We approached the nurse and explained the rationale and importance of having the patient sitting upright during feeding. She was very receptive to our teaching and assisted us with re-positioning the patient.

Next, we spent some time in the procedure room where we observed and assisted with the suturing of an ankle. The patient came to the Emergency Department after her ankle was ran over by a car. X-rays were taken prior to suturing and no fracture was noted according to the doctor. While he was rotating her ankle to ensure proper positioning the patient screamed out in pain. The doctor was very concerned and asked for the X-ray to be reassessed as he felt there was a possible fracture. We were thankful to see this good practice and further investigation. After multiple Lidocaine injections (local anesthetic) the patient seemed to have tolerated the procedure to the best of her ability but still appeared to be in pain. The doctor explained to us that the procedure was not deemed severe enough to be a surgical procedure that required general anesthetic, however due to the severity of the laceration it required a fine balance of the Lidocaine injections. We felt the procedure was done well and appeared to be comparable to what we would see preformed in Canada. Overall we loved our time in the Emergency Department and hope to one day return as registered nurses.

Samaya and Kyla's time at the Tamale Teaching Hospital

During our stay in Tamale we spent five days in the Tamale Teaching Hospital (TTH). After a quick orientation of the hospital, we started our maternity experience. We were introduced to the lovely staff who escorted us to the antenatal unit where we assisted the nurses in antenatal assessments. We felt (attempted to feel) the position of the baby, and then proceeded to monitor the fetal heart rate using similar equipment to what we would use at home. Many of the women admitted to the unit were  there due to various complications, such as UTI's, PROM (pre rupture of membranes), and hypertension. We took their blood pressure and communicated with them to the best of our ability (not one of them spoke English), however we find smiles and waves to be a universal language. Overall, we felt it was a great first day at the hospital, we learned a lot! We spent our second day on maternity in labour and delivery. We were not aware that we had to bring a separate pair of clean scrubs and shoes to change into prior to entering the unit. However, the head nurse on labour and delivery went out of her way to find us the necessary apparel (even though they were a couple sizes too big) so that we could work on the unit. We were incredibly thankful for her eagerness to help us!

Our first experience on the ward was observing a cesarean section. The procedure had already begun prior to us entering the room, and the first thing that we noticed was how big the incision was! The head nurse of labour and delivery explained to us that it was the woman's third c-section, which meant there was quite a bit of scar tissue present on the uterus making the procedure difficult. Once the baby was born, they quickly wiped him off, showed the mother the sex and and his face, and then proceeded to take him to a different room to have a more in depth examination. The mother was then sutured up, and brought to the recovery unit. It was our first time watching a c-section, and we were relieved that everything went well for both the mother and baby.

Kyla and Samaya suited up.  

 We then intended to grab a quick drink of water when we heard a mother in labour while walking by. We were invited to observe, so we jumped at the opportunity to perhaps assist in a delivery. Once we walked in the room, we noticed that the baby was already crowing, and we didn't even have time to grab a pair of gloves to assist. We were however able to witness the mom deliver a healthy baby girl. At first, we noticed that the baby wasn't crying, and we were both holding our breath, concerned with the wellbeing of the baby. Just as we were about to question why the baby wasn't crying, she cried! We were so relieved and happy that all was well. After the delivery we were busy admiring six newborn babies present in the room from various mothers (Kyla asked if they all had the same mother as there was only one mother in the room-the nurses laughed). We then noticed a nurse enter the room carrying something wrapped in a blue pad in her arms. We didn't see what it was, but she asked Samaya to pick up one of the newborns residing under a warmer. Once Samaya picked up the newborn she glanced over at the nurse, and noticed a very premature baby being placed under the warmer, Then, the nurse casually asked someone to grab an ambu bag (as casually as asking for a glass of water), and then proceeded to start CPR. The nurses were looking for an ambu bag but there was none to be found in the room. Kyla then remembered seeing one in the operating room, so she ran there looking for it. Due to the language barrier the staff had some difficulty understanding what we were requesting, but with assistance from another nurse, Kyla was able to obtain an ambu bag and bring it to the nurse giving CPR. We noticed that there didn't seem to be the same amount of urgency with the medical emergency that was taking place as we would see in Canada, however we later learned this was because the hospital did not have the necessary resources to care for such a premature baby. The nurse was attempting to perform the entire resuscitation independently, as the other nurses were busy with the mom who had just delivered.  The both of us then stepped in to help the nurse to resuscitate the small baby. Kyla was administering respirations with the ambu bag while Samaya performed chest compressions. Eventually doctors arrived and attempted to place an artificial airway, however due to the lack of proper sizing of equipment it was unsuccessful. The nurse who had originally brought the baby in the room made the decision to stop resuscitating as there was nothing more that we could do, as we had exhausted all possible life saving interventions. It was very difficult for the both of us to take part in the situation, as we felt that we were essentially 'giving up' on the baby. After a few days of processing our thoughts, we came to the realization that the baby may not have lived a normal life due to being 15 weeks premature. We were both thankful that the baby is in a happier place, free of pain and suffering. It was a tough thing to come to terms with, but we feel we learned a lot from the experience.

Samaya & Kyla

Tamale Teaching Hospital - Christina and Nicole

We have had the opportunity to work 5 days in the Tamale Teaching Hospital, in the emergency department and triage, maternity, labour and delivery, and the theatre (also known as the operating room). This huge complex takes up several city blocks, not far from downtown Tamale.

Tamale Teaching Hospital

Christina & Nicole:
Our first day in the hospital we witnessed an interesting power struggle between the nursing staff and physicians. Upon arrival we found out that there had been some issues regarding paper work and the acting charge physician felt that he had not been properly notified of our arrival. He was not willing to meet with us or allow us to practice. After several phone calls to Justin, the nurse in charge of orientation and training, as well as Vida and Jeanette, the Director of Nursing of the hospital intervened on our behalf and reminded the physician that nursing practice was in fact outside of his authority.   It was interesting (and a bit uncomfortable) to watch it all play out.  We are thankful for the Nursing Director who stood his ground and made it possible for us to practice in the emergency room.

This situation helped us to understand the struggle of nurses in Ghana to be heard and acknowledged for the work they do. Witnessing this particular situation helps us to understand the care (or lack of) that we see. This was interesting as we were able to tie in much of what we have seen here to what we have been learning in our program regarding bullying in the work place.  Oppressed groups lash out at those with less power and privilege.  Dr.'s bully nurses, who bully patients in a never ending cycle.  How thankful we are that we have learned to advocate, to understand power and privilege, and how to speak up and be heard.  And, it helps us understand what we are witnessing here at the hospital every day.

During our time in the emergency department, we were able to triage multiple patients who had come in with fall injuries from mango trees and RTAs (road traffic accidents). We were informed that because it is mango season, young boys tend to climb to the tops of the trees to pick ripe mangoes, and often fall, resulting in facial lacerations, bruising, and fractures. RTAs are a common emergency due to the high number of motorcycles on the road and the lack of helmets, as many of the locals cannot afford helmets. We had the opportunity to assist with dressing changes of facial lacerations and head injuries, as well as comfort patients and their families during this stressful time. There was a patient and family who only spoke French. In very broken French, Nicole was able to speak to the patient and family and provide some comfort. Christina was able to comfort a semi-conscious patient, and encourage his family to speak with him. She explained to them that he can still hear them, even though he is unable to verbally respond, he could give slight head nods in acknowledgement of the conversation. They were so grateful for her support.

During our time in labour and delivery, we were able to observe multiple Cesarean section deliveries and vaginal births. We were able to hold women's hands, rub their shoulders, and give encouragement throughout the labour and delivery process. We were able to cuddle the babies and ensure they were healthy. We are sad to say that many of the c-sections were emergent due to fetal distress, two of the babies needed resuscitation, and all survived,

Nicole was able to hold a women's hand and rub her shoulder throughout the vaginal delivery of a breech still born baby. The women had come into the hospital in labour, but stated she had not felt her baby move in 2 months and that her belly had slowly shrunk. The midwives were quick to lecture the woman on not knowing to seek health care with those symptoms. This was the woman's first pregnancy, and she did not know any different.  She had gone to a clinic at 4 months gestation and did not return again.  Unfortunately, the fetal demise was not detected. The woman was strong throughout the whole process and only broke down in tears upon seeing her still born child. Nicole was able to stay at the woman's bedside for some time after the delivery holding her hand and speaking with the woman. Afterwards, the woman squeezed Nicole's hand and said "thank you very, very much." Nicole has found her passion in labour and delivery nursing and is eager to begin specialization courses when she returns to Canada.

Upon arrival to the delivery ward one morning, we noticed a post-partum woman start to bleed profusely. We were able to get help from a midwife, begin fundal massage, and monitored her blood pressure. The midwife then attempted to manually expel blood and any membrane left in the uterus to stop the Post Partum Hemorrhage. Unfortunately, the bleeding would not cease and she was brought to the theatre as an attempt to stop the hemorrhaging surgically. The surgeon was not able to stop the bleeding through abdominal surgery and had to perform a total hysterectomy. The lady's fluid and blood loss was corrected through transfusion. The following day, we were informed that she has 4 healthy children and was not upset with the end result of her surgery. Furthermore, the surgeon informed us that she was healthy after her surgery and able to be discharged home with her new baby. We were impressed with the quick response to this emergency, and were grateful the woman survived.

Christina and Nicole Suited Up

Christina

Nicole

We have thoroughly enjoyed our experience at TTH, and have learned so much. We have been able to note the vast differences between our nursing practice and theirs. Some of the differences were seen within treatment, the ability to incorporate relational practice within nursing care,funding, lack of supplies, medications, and sterility. Many of these differences stem from of the lack of voice that nursing practice has here in Ghana as well as issues with power struggles, as we spoke about earlier. With the time we spent in TTH we were better able to understand how beneficial and important it was for us to provide the relational practice teaching that we did at UDS.  Yes....it's true!

Shekhinah- Dr. Abdulai's Clinic - A Place of Love and Compassion

While in Tamale we had a wonderful opportunity to attend Dr. Abdulai's free clinic called Shekhinah. The clinic is run entirely volunteers and all services and care are provided for free. People line up outside the clinic in the morning, and are registered on a first come first served basis.  They register 15 men and 15 women for a total of 30 patients per day. If there is a more serious or acute case they are given priority. 

Azi - Our Guide and Resident of the Clinic

The clinic houses residents with mental health challenges, those who cannot live on their own, people diagnosed with HIV/AIDS, and palliative patients. There are a total of 26 residents at the clinic. They are provided 3 meals a day.

Dr. Abdulai also provides free hernia surgeries. After surgery patients get their own room to recover in for 1 week. The rooms are constructed by the communities who use the clinic, so when a patient is recovering from surgery, they stay in the room constructed by their community.  Once their sutures are removed and there are no signs and symptoms of infection the patients are discharged home. 

The OR Suite

The clinic has 2 gardens they use to grow fruits and vegetables for the residents of the clinic. We brought them 4 bags full of different types of seeds to plant and grow. One garden is used during the dry season and the other is used during the wet season (around this time of year). There are 3 big beautiful mango trees that provide shade throughout the compound, and we were treated to mango right from the tree both days we were there.  

Palliative Care Residences

We had a wonderful opportunity to hear Abrahim's story.  He is a man who lost his leg due to an infection at the age of 15. He came to Dr. Abdulai's clinic as he had been disowned by his family. The staff at the Tamale Teaching Hospital contacted Dr. Abdulai, and arrangements were made for Abrahim to move to the clinic.  Today he is happy, healthy, and  very thankful to be alive.  He currently does work around the clinic to show his appreciation for what the clinic has given to him. His story touched our hearts.

Abrahim - Resident and Volunteer

One of the days Samaya and Kyla took out sutures while Christina was at dispensary (pharmacy), and Nicole worked in the OPD.  When we were finished the staff asked us to make and fold envelopes for medications given out at the dispensary.  It was very relaxing and nice to know we were doing something the clinic would utilize.  

On our final day at the clinic a resident with mental illness was experiencing some difficulty.  Her behaviour escalated quite rapidly, and we were able to witness what non-judgmental, compassionate care looks like.   The staff and other residents did not respond with anything other than kindness. They gave her the space she needed and continued on with their work.  They did not make a big fuss, or try to get her to calm down.  They allowed the situation to just unfold as it needed to.  Within a short period of time all was well.  She had settled.  She gave Jeanette a gift of rocks she had picked up from the ground, went to her room, and fell asleep.  It was the most amazing thing to witness because at home we would probably have called an emergency (code white), physically restrained her and given her medication to sedate her.  It didn't take us long to recognize we could learn much from this situation.  

We had the pleasure of giving the staff at the clinic a donation from the Global Nursing Citizens.  It is nice to know the money given to them will be utilized very well.  All of their food, supplies, medication, and services rely on external funding and donations.  They were so very thankful. 

Two days that have changed our perspective on so many things.  Charitable work, living kindness and compassion and a new approach to mental health.  WOW!

All this and the lunch program.  Pretty incredible.

- Kyla

Teaching Relational Practice Seminars

We have had the pleasure of preparing and presenting a seminar about Relational Practice at the University of Developmental Studies, in Tamale.  We have presented to two groups of third & fourth year nursing students, as well as third year 'top-up' nursing students. Top-up students are diploma nurses returning to school to obtain their Bachelor of Science in Nursing.  We have a similar program at UBCO. 

View from the second story of the Health Science Building at UDS

The girls getting a snack at UDS

Our presentation has been very well received by the students and faculty. The students were engaged and eager to learn, taking notes during our presentation and asking relevant questions. Our presentation discussed the definition and key components of relational practice. We also discussed the reason why UBCO holds relational practice to the same esteem as professional practice and health and healing: Because nothing in nursing is done without relationships with others. We further discussed examples of relational practice and the importance of incorporating it into nursing practice.
After the lecture portion of the presentation we provided an activity for the students to play. We handed out paper and paper clips to the students to pin to each other's backs. Then the students walked around the lecture hall and wrote one positive attribute on each student's back that they identified with that person. After sufficient time for the students to write on their peer's backs, they took their seats and read their own papers with all of the attributes their peers had identified in them. We tied the activity back to an important aspect of relational practice by informing the students that you cannot see an attribute in someone else if you do not yourself possess the same attribute, regardless if you are aware that you possess the attribute or not. For example, you cannot identify a caring, compassionate individual if you yourself are not both caring and compassionate. Jeanette further addressed this key message and spoke to the students about the importance of seeing the positive in each person and patient you encounter.

Overall, we have enjoyed presenting and engaging with the UDS nursing students and hearing their ideas and perspectives on relational practice. We will also be teaching this seminar in Bolga, Ghana, to more nursing students there. We feel passionately about the relational practice learning we have received in Canada and are eager to share it with the UDS students. The UDS students also gave great examples and definitions of relational practice when we asked them questions, and they too agree that relational practice is vital to good nursing practice and patient-centered care.

150 second and third year BSN students.

 Nicole

The Outreach Lunch Program

Today (March 31st) we returned to Doctor Abdulai's clinic. For the first half of the day Nicole assisted in the dispensary and Kyla and I assisted in the out patient department (OPD) where we took vital signs. Kyla and I really enjoyed interacting with all the people and practicing our Dagbani , the local language.  We also had some fun with the children that arrived for treatment and handed out Canadian stickers; they loved it!

We were again struck by the sheer volume of patients (especially kids) sick with malaria or enteric fever (tyhpoid).   It is so interesting that we (the western world) have ideas around how to solve the "malaria problem".  We've asked about mosquito nets, as they are provided free at many clinics and outreach centres, but are not being used.  The answer didn't surprise us.  The temperature here is close to 40 degrees Celsius through the day, and "cools" off to 35 at night.  With the mosquito nets up, there is absolutely no air flowing and it becomes stifling.  Not practical.  We have the best intentions, yet we often provide solutions that just don't meet the needs of the population. 


After we finished up with the patients in OPD we joined the volunteers in the outreach lunch program. Dr. Abdulai's clinic provides lunch in the community to people who are homeless and/or suffer with mental health issues.  One of the mandates of the clinic is to reduce the stigma faced by people with mental health issues.  We were all struck with the quiet, non judgmental way they go about this work.  This was an amazing experience to be a part of, which we enjoyed while riding in the bed of a truck. The truck drives along it's route and the volunteers leave packages of food and water for the people.  The food is all donated, and is prepared by volunteers. 

We were all touched deeply when we stopped to deliver a meal to a man who was naked and confused, sitting by the side of a building.   The volunteers found a shirt and without making a scene carefully dressed the man and left him with food and water for the day. One volunteer mentioned to us the importance of maintaining the dignity of these people, caring for them, and keeping them safe and we witnessed this in action. 

We continued on with the deliveries, and made a stop at the Tamale General Prison to leave food for the prisoners who do not have family bringing them in food.  The volunteers at this clinic ensure that no one goes without and the work is beautiful!

We were so privileged to see a living example of de-stigmatizing mental health issues.  Our healthcare system at home could learn so much from this simple practice of loving compassion and service.  James, one of the volunteers who supported us these past 2 days shared that everyone can heal when they are treated with care, dignity and LOVE.

We certainly witnessed this today.

Christina & Jeanette

 

Our Time in Enchi

We are now settled into Tamale and ready to begin our work here.  I wanted to share a few remarkable pieces from our 10 days in Enchi.  We travelled in relative comfort the 5 hours from Accra to Kumasi and then piled ourselves and all of our luggage into a van to finish the journey.  We we were never really clear on how long it would take.  It was another 6 hours.  We turned off the main highway and travelled up and over a "pass".  It was a red clay "road" that became more of a trail and took us through some very rural and remote areas.  It was pitch black, but we could see with the headlights some very small villages beside the road.  The most remarkable thing we noticed was how clean and pristine everything looked.  Philomena commented that that area is considered "environmentally pure" and is protected by the government.  They are all subsistence farmers and they have a very strong sense of community.  We were only able to travel at about 30 km/hour and so we had a good chance to take in the surroundings.  It was a beautiful sight after the noise and chaos of Accra.

It then felt a bit like the twilight zone as we then popped out onto another main highway and completed the final hour into Enchi.  Our hotel was up another trail, a bit outside of Enchi.  The wonderful staff met us and helped us unload.  The "lights" were out, meaning there was no power.  This was a daily affair we were soon to find out.  We also found out that Enchi was without power until 1997.  Remarkable! 

Enchi is a very small town, with limited resources and we struggled a bit to find food we could eat.  I must admit, it felt a bit like survivor.  We would have plain rice and "sauce" and cut up avocados and tomatoes.  It was very hot and humid and we saw a couple of really great thunderstorms with torrential rain.  It is the middle of the rain forest after all!

The Presbyterian Health Clinic is a wonderful place.  It is a primary health care centre, and it is a shining example of this type of care.  They are staffed with a Physician Assistant (Phillip), who really functions in a similar manner to our Nurse Practitioners at home.  They have a lab that can do basic blood work.  In 2009, UBCO donated a microscope that enables them to do some additional tests for malaria and infectious diseases.  This has enabled them to reach the standards required for the national Quality Assurance program, as they are now a recognized lab.  They have done over 24,000 tests using this microscope this year.  To put this in perspective, these clients would all have had to access healthcare at the hospital.

 This is Michael Safu,  the head of the laboratory and our tour guide of the cocoa farms,  with the UBCO microscope (you can see the inscription on the microscope if you look closely).

They have a maternity ward where midwives deliver babies, provide pre and post natal care, and family planning.  There is a casualty department (treatment) and female and male wards as well as a pediatric ward.  Clients are "detained" if they require IV antibiotics or are too sick to leave.  As they are a primary health care centre, they can only be detained for 24 hours.  If they require additional services, they are sent to the public hospital.  They have a dispensary (pharmacy), records and registration department.  The staff is all very warm and welcoming and were supportive of our time there.  We rotated through each of the departments.  We were able to see first hand the devastating effects of malaria and typhoid.  The majority of the patients were receiving treatment for these two diseases.  

The clinic receives  funding from the Ghanaian Health Services and resources are a constant struggle.  They have not been paid for any of the services they have provided since July.  Philomena says it is due to some government restructuring and the clinic will manage.  "It's in the hands of God".  There is such strong faith in the community.  At the clinic every morning, they pray for the health and healing of the patients and the guidance and support of the staff.  What a wonderful way to start the day!  The level of commitment and service we witnessed are something we rarely see at home.

We were invited to the Presbyterian church service on Sunday as honoured guests and were part of a 3.5 hour service. There was singing, and dancing,  and a lot of talking (very little in English).  We were brought up front to introduce ourselves and speak about our mission.  Thankfully, we had remained for entire service, as this was done near the end. Again, we were struck by the very deep faith of the people here.   They live their spirituality, it's not just something they do on Sunday.

I believe we're all caught up now.  We'll keep you posted as things unfold here in Tamale.

Jeanette

Outreach to Nyameboame

Nicole and myself had the amazing opportunity to go on an "outreach day" to the small village of Nyameboame to weigh and vaccinate young children ages 0-5. Nyameboame (which translates to "God help me" in English) is about 20 minutes outside of Enchi (the town we were residing in at the time). The outreach nurses visit Nyameboame once a month to keep up to date on vaccinations and ensure adequate weight gain of the children.

I had the opportunity to be at the 'weighing station' where a scale (resembling produce scales back home) was hung from a door frame. Moms provided their own slings and would hang their child, and I would then record the weight. Each mom provided me with their child's health record book (which they are expected to keep safe at home). Nicole was ensuring the children's records were up to date, and kept track of trends in regards to weight and amount of attendees. Specifically, Nicole was determining which children were of normal weight - unfortunately, all of the children were moderately to severely underweight.

The children were shy, but so adorable. Many school aged children were waiting outside the clinic the entire time we were in there as they wanted to know our names and say hello (this is common here - we feel like celebrities!) The moms were then provided with a 'health promotion talk' regarding child nutrition. One of the women attending the clinic was considered their leader, so she was speaking on behalf of the mothers and would pose and answer questions to the nurses in English. She would then relay the information back to the women in Twi (the local language). It was nice to see this kind of advocacy on behalf of the women in the village.

During the clinic, Philomena asked the women in attendance why there were no men present. The answer was that it is not that they did not want to attend, but that they were working in the farms .in preparation for the following day's Market.

.

We then checked the child's immunization records and proceeded to assist the outreach nurses in preparing the vaccinations. We were taught the technique and landmarks of child vaccinations - the nurses are very experienced and knowledgeable.  We definitely learned a lot!

Overall, we both thoroughly enjoyed our experience, and it was a nice change from the routine of the clinic in Enchi!

Samaya and Nicole.

Amonie Outreach Clinic

Myself and Christina had the opportunity to go to a Amonie, one of the Presbyterian Health Clinic's outreach centres that was located in the center of multiple villages. The location's accessibility allowed for easier access to those in the surrounding villages. We learned that the staff at this clinic are quite dedicated to their work as they do not take breaks, they work 24 hours a day, seven days a week.  Their days off are few and far between and not scheduled into a "rotation".  They arrange rides into town when able and when they can be absent from the clinic.  We found the staff members to be devoted and caring towards their patients and they were eager to teach and help us learn about their mission at the clinic. This is something we rarely see at home! The clinic was quite small but had six different sections of expertise. The six sections included casualty, maternity, dispensary (aka pharmacy), two gender specific lay in rooms, records,and consult.

Once a month the clinic hosts a Child Welfare Clinic and we were fortunate enough to be arriving on this day. At the clinic babies are weighed and the information is documented and monitored on a growth and development chart, as well as routine vaccinations. On our outreach day 139 babes with mothers arrived at this very small clinic for their checkups. We will admit that we felt quite overwhelmed with the noise, heat, and confined space, but we pushed through it! Christina was in charge of weights and documentation. We rather liked this station as the scale looks like one you may find in a produce section back home. While Christina assessed weights and growth Kyla helped to review vaccination history, documented history of vaccines for use of statistics, and confirmed vaccine scheduling. After these two stations we were both able to assist with the baby vaccinations. Once vaccinations were finished everyone was able to go home.   We pushed through from 0900-1400 and it was nice to hear that the clinic was done early that day as they had the extra help.

Something that caught our attention, at both clinics we have been to so far, is that family planning is offered.    Ladies are educated on birth control options and given a choice on whether or not this is something they would like to take part in. The clinic works very hard to try to include the husbands as well. They have seen success with this approach as birth rates have decreased. This is still a work in progress as it can often be difficult to incorporate the husbands into care or they deny the wife access to this care. The hope is with more education to both males and females there will be a further understanding to the importance of family planning. Overall we had a wonderful learning experience and are very pleased with the work that is being done. We are looking forward to the next adventure!
Kyla and Christina