Fly on the Wall....

My recent experience in the Tamale Teaching Hospital, more specifically on the labour and delivery (L&D) ward, was very mind-opening. Having only been exposed to L&D care for one day last year at Kelowna General Hospital, I felt like I had walked onto a ward where I was only qualified enough to be a fly on the wall. Luckily, for the first day that’s all my partner and I were – flies on the wall. Huge-eyed, stunned-looking flies as our brains were trying to take in and process as much as our eyes could let in at once. 

Labour & Delivery Ward

Garbage Bins

The delivery room is empty when we first arrive, which is apparently quite rare. We find this to be true in the subsequent hours and days as they average 25 births per 24 hrs (both vaginal and cesarean deliveries). The “Stage II” room (active labour/delivery room) has six beds in it, each only about three feet from its neighbor. The room is hot despite all of the windows open and the two old ceiling fans twirling. The air is thick and I can feel it on my skin, but maybe this is just in my head. The smells vary depending on how many soon to be mothers, women currently becoming mothers, already mothers, or recovering mothers there are. It’s not hard to imagine though, since each bed has a garbage basin sitting at its feet that collects (or at least tries to) all of the less romantic part of the birthing process: amniotic fluid, broken water, urine, stool, meconium, and blood. The room is not air-conditioned and they say it never gets below 30 degrees Celsius here this time of year, today it’s 39C outside.  

Needless to say, it’s a bit different here than in Canada.

We meet, and befriend, a couple of midwifery students on the ward. This is appreciated because I feel less intimidated to ask them questions about what’s going on and their English is great. Actually, all of the staffs’ English is great, but sometimes it’s hard to understand their beautifully thick African accents when they are speaking quickly and with purpose. Everyone’s first language is that of which is spoken in their region (or tribe) and their second language is English which they learned in school. Different regions have slightly different accents when speaking English and it makes my brain go into overdrive throughout the day trying to understand what is being spoken around me. I think it’s so cool that everyone has a mutual secondary language they communicate in.

A woman dressed in a brightly patterned dress-wrap waddles into the room, carrying her own IV bag in one hand while the other is holding her lower back. Her face shows pain that she’s never felt before and yet she doesn’t make a sound. Being stoic is highly valued here and laboring mothers are often given grief if they are making too much noise while pushing a new life into this world. Sweat is dripping off her chin onto the bed as she tries to figure out how to get on top of it and over onto her back with the feeling of something the size of a softball between her hips. The midwife who is preparing to help the mom deliver the baby is getting her gloves on and opening the catheter to insert without any explanation, urethral cleaning, or lube. She is wearing Crocks that are two sizes too small with bare feet inside – the most common footwear in the hospital. The mother was sent down to this room because she is fully dilated and the baby is on its way. It doesn’t take long for me to see the baby start crowning while mom continues to quietly push with the exhausting contractions. The further down the baby comes, the more pain the mom is in and she starts grunting or screaming with her mouth still closed. At one point she holds out a hand in hopes of someone grabbing it, but instead another midwife comes over and moves mom’s hand down to the bed and tells her to quiet down and keep pushing. By observing other people in the room, I started to understand that this wasn’t emotional abuse, but rather just part of their culture; being independent and stoic. Did I mention that 99% of these women give birth without any pain medication?

Needless to say, things are a bit different here than in Canada.

The baby is pushed out and flopped onto a soaker sheet on mom’s chest – almost skin-to-skin, but not quite. The new mother is exhausted and can hardly bother to hold her baby. Sylvia, the nurse who had us under her wing, came in and right away spotted that the baby wasn’t skin-to-skin and took the sheet out from between babe and mom. There, that’s better. This gives baby recognition of who mom is, introduces immunity to the newly extra-uterine human, allows him to be colonized by the same bacteria as mom, and helps with temperature and heart rate regulation. It also gives mom a rush of oxytocin to stimulate uterine contractions to expel the placenta, helps with clotting and reduces bleeding, and tells mom she’s got to get her breastmilk ready for babe. The midwife takes the same

catheter as before out of the basin of (now bloody) water and re-inserts it into the mother, again, with no cleaning or lube. Mom is now ready to get a bit of lidocaine and get her 3^rd degree tear sutured up. Watching this made me flinch too, it almost looked more painful than the birthing process. Baby is wrapped up and placed in a basin along with other newborns under the window.

I quickly notice that after delivering, the mothers are either told to walk down to the recovery room to wait or they are kept here for observation if a post-partum hemorrhage (PPH) is anticipated. Delivering babies is a bit like a fast food place down here; they’re ushered in and out as quickly as possible. It’s efficient and resourceful, seeing as how they are often short on staff and are trying to do the best they can with what they have.

Needless to say, things are a bit different here than in Canada.

Sylvia tells us to check out the Theater, the operating room where back to back c-sections are done throughout the days. We need a face mask and hair net to get in and join the other 20 people in the room. The door is often left open and many of the masks I see are not covering either the user’s nose or mouth. Two staff members are sporting bare feet in flip-flops. A few flies are playing around the large brown belly sticking up from a sea of turquoise cloth on the operating table. The baby hasn’t been taken out yet. Despite the lack of resources and equipment, the surgeons do their best to practice sterility once they are scrubbed in. Boiling water is being used to rinse tools, one of the surgeons is wearing eye protection, and four students suddenly jump out of the way to semi-avoid getting doused by a projection of amniotic fluid and blood when the uterus is entered. Three minutes later the baby’s feet stick out – I piece together that mom is having a cesarean because the baby is breech. The surgeon pulls on the baby’s feet, then legs, then reaches up inside to scoop out the head. The baby is very pale and almost grey-tinged. I naively wonder if this is the color that most Black babies are in their first minutes of life, the first one I saw was only a few minutes ago. The babe’s head has a funny shape to it, a shape that I thought was only common with vaginal births because it has to squeeze through the small birth canal. There is no crying, even when the midwife is drying him off and stimulating him. There are a few whispers from the other students as we all watch the midwife feel for a pulse. After a few seconds she takes a cloth and wraps the cold tiny body up to show mom.

My three days at TTH went by quickly and I experienced and learned a lot more than I could have asked for. I saw into some women’s (potentially) most difficult moment of their lives after losing a child before even being able to hold him or her. I also saw some precious moments where mom looks into her newborns eyes for the first time and smiles. There were ups and downs to each day I was there.

Here are some of the things I was privileged enough to witness. (I use the word privileged carefully. I don’t mean to say I was lucky to see these things, but on a global, mind-opening, world-understanding scale, I believe myself to be privileged to now have this insight.)

·       12 vaginal deliveries and the traditions and cultural aspects that come with these.

·       5 cesarean births and the rituals, chaos, and composure of the OR.

·       3 term stillborns and how the mothers and staff deal with this. I was surprised to see that the body and placenta are placed in a cardboard box (typically an empty equipment box) and left on the floor of the room until mom is ready to leave. She will then take this box home and give both her baby and placenta a proper burial when she is ready.

·       A spontaneous abortion of 15-week-old twins fetuses.  

·       A post-partum hemorrhage (PPH) where the mother was getting cleaned out of many clots and what appeared to be a lot of blood. This process also looked more painful than the delivery itself. Blood products are not abundant here so it’s up to the nurses and midwives to do the best they can.

·       A PPH that was being managed by inserting four condoms full of water into the vagina to apply pressure to the bleeding sites to assist with clotting. The mother was to lay there for 24 hours with the four metal clamps hanging out from inside her.

And here are only some of the things I learned:

• How resourceful the staff members are; they need to be due to a severe lack of supplies, equipment, and financial aid.
• How the ball can get slowly rolling by continuous advocacy – skin-to-skin!
• Culture is a beautiful thing. I really appreciate learning about it and find it so fascinating, although sometimes hard to witness. But, just because it contradicts my own culture and beliefs does not make it wrong. It just makes it different. And makes all of us different. And unique.
• How welcoming everyone is here and willing to share what they know.
• How to be left alone with my school partner to keep a brand-newborn alive while they are suturing up mom’s belly right beside us. Oxygenating, suctioning, warming up, and stimulating baby for about 45 minutes until he finally gained enough energy to start to fuss and eventually even cry (probably the happiest I’ve felt to hear a baby cry).
• That babies are cute. But I guess I already knew this…

Posted by Janelle Greer, UBCO 4^th year nursing student.

Under the Mango Tree.....

Our first week of clinical, half of us were at the Tamale Teaching Hospital, and the other half at Shekhinah Clinic that Dr. David Abudulai opened in 1991 to serve the poor and destitute. Upon arrival, you see two big mango trees on either side of the entrance, and underneath the left hand side is where Dr. Abdulai performed his first surgery. 

Where it all began....under the mango tree.

Maggie, Krista, Michelle and Tameka with Charity

The energy from the entrance alone makes a person feel not only welcomed, but also humbled. After a tour of the whole property we had three options of where we could volunteer: the OPD (out patient department), the pharmacy/dispensary, and the kitchen. At the OPD, two volunteers in the morning start by giving out ‘medical cards’ which consisted of the person’s name and today’s date.  After they received this, they formed into a line for us to take their blood pressure and pulse. One student was doing the assessments while the other transcribed the patients name and their community into what was the clinic’s book keeping. They see anywhere from 30-50 patients in a day. These patients travel to the clinic from near and far. For those patients who travel far distances, the clinic has small guest houses for them to stay at, as well as providing them three meals a day. For example, If they arrive on Monday, they will be given a number and told to come back the next day. On the Tuesday, they are asked to help clean up the property to maintain its grounds. Then on Wednesday they are able to sit in the lineup at the clinic and be seen by the volunteer doctors. Normally there are two working who will see all patients and write prescriptions that they can go fill for free at the dispensary.

Dispensary

Once at the dispensary, the patient will hand the volunteer their ‘medical card’ from which their blood pressure, pulse, and prescriptions are written. The volunteer will then write the medication name, and draw circles if the medication is to be taken once daily, twice daily, or three times a day onto an small envelope as not every person can read. Each medication has its own separate envelope. The dispensary is small with many shelves labelled for medication types, along with bottles all over the counter. 

The third place students were able to volunteer was in the kitchen. On all three days, each student participated in making and bagging food. On Wednesday, I helped prepare Kenkey, which is a traditional Ghanaian dish. 

Rebecca and Michelle

 

It looked like mashed potatoes wrapped in corn shucks. Along with making meals, the Shekhinah clinic also offers a food program that was started January 6th, 1992 and has run every day since. The food program was started to ensure those who are poor or mentally ill still received food and water daily. Dr. Abdulai himself grew up poor so this was extremely important to him to give back and support those who can not support themselves.  The food is loaded into the back of a pick up truck and it drives through Tamale every day, serving homeless and “mad people.” This is the Ghanaian term for those suffering with mental illness. 

Shannon, Rebecca and Thomas with the food truck

There is not enough words to describe the energy and feeling you have when volunteering with this clinic. This clinic is solely run off volunteers and donations. The joy and happiness that radiates throughout the staff, in-patients, and-out patients is so beautiful to witness. You can feel the love and support  that everyone has for each other, it truly is remarkable. 

Dr. Abdulai's grave

Dr. Abdulai passed away at the end of 2016 after battling cancer, but his legacy of the Shekhinah clinic is thriving more than ever.  The Shekhinah Clinic for the Poor and Destitute has very powerful yet simple goals, “Shekhinah Clinic for the Poor and Destitute aspires to be a source of light, hope, and joy for the poorest of the poor in the society in  order that they may experience God’s free and unconditional love. The clinic exists to provide 

services: medical care, shelter, meal, clothing and other support services to the poorest of the poor freely and unconditionally purely for the love of God and neighbour and depending solely on Divine Providence.” 

All of us are truly grateful to witness and experience the amazing work the Shekhinah clinic offers. Their work touches so many lives within the community and inspires those around the globe. 

Mission Statement

~ Posted by UBCO 4th year BSN students Rebecca Wheatley & Tameka Coulombe

The Golden Coast

I have come to the Golden Coast
Where poverty and beauty go hand in hand
Here I stand like a beacon of white light
Amongst the dark chocolate tones of the people

Welcome to Ghana

I have come to the Golden Coast
Where the blazing sun saps my strength
Here I stand splattered in freckles and sweat
Wishing for colder nights ahead

I have come to the Golden Coast

Where the church hymns sing joy deep into your bones

Here I stand amongst colorful African prints

Surrounded by smiles and curious looks

I have come to the Golden Coast

Where the woman carry baskets on their heads

Here the mangoes are sweet and goats wander the streets

And in the morning I awaken to the roosters crow

I have come to the Golden Coast

Where there is a place that the mad people are not hungry

I have stood in the shade of the mango tree

Where the flame of the Shekinah clinic was first lit

I have come to the Golden Coast

Where time is not written in stone

Here the people speak in many different tongues

And neither faith nor religion is cause for dispute

I have come to the Golden Coast

Where they say the land wears shimmering red dirt

I have come to see, to smell to taste

To breathe in all of Ghana

I have come to the Golden Coast

Where the swirl of beauty and tragedy are hard to distinguish

Here I stand; often uncomfortable and uncertain

And some days I do not know why I have come

I have come to the Golden Coast

Where the needs are great but the means are not

Here I stand, a stranger in this land

That has forever taken a piece of my heart

Thank you Ghana

Posted by Camille Galloway

And so it begins...Elmina Slave Castle

Elmina Castle

We started our trip off in Accra, spending two nights in the New Haven resort, trying to get our bearings on the heat and dousing ourselves in bug spray which inevitably slid off of our skin due to so much sweat. Accra is an extremely busy, hot, and loud city, with so many sights, colours, and smells. Then we made our way down to Cape Coast, taking a bus with intermittent periods of AC (when none of us could handle the heat any longer). We did our first group road pee and laughed as people passed us in their vehicles, honking their horns. As we rounded a corner, the shoreline of the coast caught our eyes as the turquoise waters of the Atlantic crashed into the beaches which were lined with hand made canoes. Then, a beautiful large white building standing alone on a point took my breath away. I knew what it was, and so many emotions flooded over me, sadness, anger, fear. This is Elmina Castle, once a haven for cultural segregation, torture, and unspeakable atrocities, now a heritage site, the oldest and largest standing building connected to the Trans-Atlantic slave trade.

For those of you who don't know why this particular castle has anything to do with Global Health, let me attempt to paint you a small picture. In the early 1400's Prince Henry of the Portuguese heard rumours of the Ghanaian people trading in precious goods such as gold and ivory. Because of this, the Portuguese decided to explore West Africa by boat and land and found what would be later called "the Gold Coast". In 1482, Elmina Castle was constructed and used as a trading post by the Portuguese, though not without resistance from the local chief at the time, Nana Kwamena Ansa. For the chief knew that "friends were to be better friends if they were not to live together but would see each other occasionally." Most of the items that the Portuguese brought to trade were guns, gunpowder, liquor, iron bars, etc. Later however, the walls that contained such items, would hold something much more sinister and cruel. The castle itself passed through many hands (Portuguese to Dutch to British), yet all of those hands played a large role in the Trans-Atlantic Slave trade which started with the Portuguese using local tribes to capture their enemies (other local tribes at war with one another) and bring them to the castle by force to be sold and shipped off over the Atlantic for slavery. During the next 400+ years, people were brought into this "castle", chained to it's floors, tortured, raped and starved.

Slave Dungeons

 We had a tour of the majority of the castle, where we walked into the hauntingly dark and eerie chambers of both the male and female slaves. All of these chambers were on the bottom floor of the castle, and most had very little light with very little ventilation. Here they were held until a ship arrived to take them away to a distant and foreign land. That is, if they made it out of the castle alive. The day we toured, it was 39 degrees Celsius, with roughly 80% humidity. The moment we stepped inside these haunting chambers, every single one of us had sweat dripping over every inch of our bodies. This is not an exaggeration. I felt beads of sweat dripping down my legs as if I was peeing my pants. Now imagine being in this stagnant heat with no food or water, and then imagine being cramped in there with hundreds of people, all of which are urinating, defecating, and vomiting on that very floor you are meant to exist on, because they are too weak and sick to drag their bodies to the corners of the room where buckets were placed for them.

Room of the Condemed

Then to add insult to injury, imagine as a woman, the blood from menstruation added to those floors, or being chosen by the governor to be "prepped" and washed to come to his bedroom. And what if you refused or put up a fight? Prepare yourself to be tethered to a cannon ball in the middle of the exposed courtyard for the rest of the females to see. You are now an example of what will happen to you if commands are disobeyed; death by heat with hundreds of eyes peering sorrowfully at you, helpless. For those males who resisted, you are marched to a room painted with a skull over the doorway. Ominous, yet accurate, no person who stepped into that room, stepped out again. A room with absolutely no airflow, was an incubator for death. The walls are etched with claw marks, made by those who would eventually succumb to their fate.
 

The View

 Now these are only some of the injustices that occurred within the walls, not to mention what happened outside of these walls. But for now, I will remain with Elmina Castle only. To the second and third floors of the castle was an extreme juxtaposition, where every room was airy with multiple windows from all directions giving way to the most beautiful breeze that would curl and wrap its coolness around your body like a welcomed hug. Looking out of the windows was like a dream, where you could see miles of white beach and rock being shaped and molded by turquoise waters, crashing here and there. It was as if we had stepped into another world, a resort even.

Door of No Return

If it weren't for the horrors occurring below my feet, I would have liked to stay here. These floors of course, belonged to the soldiers, and the governor who ran this castle; treated as kings while they performed heinous acts against humanity. The clincher for me was the fact that the church where they worshiped, danced and prayed, located on the second floor, sat directly over top the slave chambers where people were in extremely poor health, sick, and dying, waiting to be led to the "door of no return", the single door which millions of slaves have passed through over the years, the door which was literally the one and only exit for these people, the door that sealed their fate; off to the ships they go.

You may ask why I think all of this information is important if not relative to global health? We need to know our history. No matter the colour of your skin, no matter where you come from, this is the world's history, and to not acknowledge it is an extreme disservice to yourself and those around you. This plaque was erected at Elmina Castle which serves as a reminder to never again treat people in such a way, as if they are not human.


Now I bring this back to Global Health. This treatment is still going on today, whether we want to admit it or not. It may be in a different context, but regardless, it is still happening. If you can't think of where people are being mistreated, shipped off to unfamiliar lands, fleeing their homes to seek refuge, or living in squalor because of oppression (specifically high powered oppressors), then please pick up a newspaper, or research on the internet, or watch the news (but please choose a reliable source). This is happening all over the world in plain sight. Because of this, our global health is suffering. People are starving and do not have adequate access to things for basic needs. They are being abused in more ways than one, some of the abuse as subtle as a taunt whispered over the wind, reaching it's intended target. Some is outwardly shown as physical violence, bombing in streets, destruction of neighborhoods, lives, and cultures. Global health involves all of us, we are citizens of this earth! This blog was a minute synapse of what has happened in the past, but the effects are still widely felt, on a global level. So please, do the world a favour, do your part, and be kind to your brothers and sisters. Offer a helping hand when you see someone is struggling, lend an ear to someone who needs it, find compassion in something you would never have seen before. Open your eyes, ears, and heart.


Blog post by Hailey Hunter, 4th year BScN


Most of this information was based on my memory of the tour, however the dates and facts were retrieved from Ashun, A. (2017). Elmina, The Castles and The Slave Trade. Elmina, Ghana: Nyakod Printing & Publishing Co. Ltd.

We're packed and ready to go....

We're off on another Global Health Practicum in Ghana, West Africa.  My colleague Maggie Bannerman along with 14 BSN students head out on Sunday.  We've been preparing since the fall, and I've spent the past week in seminars with these amazing nurses, refreshing what we know about global health and citizenship, power and privilege, colonization, tropical diseases and low resource settings.  Our heads and hearts are full!!

I know the next 5 weeks will be filled with joy and sorrow, hope and despair, and I also know these 14 women will come home forever changed.  

We invite you to share our journey.  It always feels good to know we have support at home. 

And so it begins...