So close...yet so far!

How many people can say that they have knelt in the very small, very hot palace of an African chief, with their heads at the butt end of a horse and about twenty-two other people? My colleagues and I can. I must say it was an experience that I will remember for many years to come. 

You might ask why we were kneeling in a Chief's palace and why there was horse there?  Keep reading....the answers will come.   

Chanshegu Clinic

A short history of UBCO's work in Chanshegu:

About ten years ago a School of Nursing professor from UBCO, Muriel Kranabetter, was invited to visit the village. This began the first of many conversations with the Chief (through a translator as  he doesn't speak, read or write English) and it was established that the village had a high infant and maternal mortality rate. With no health clinic near, residents of the village have to walk hours into Tamale to access health care at the Tamale Teaching Hospital. The Chief's wishes were that a clinic be built to serve his community,  and UBCO nursing students answered the call.  They began a fundraising campaign, and this money was added to funds raised at the Global Gala, and given by generous individual donors, and sure enough, the following year work began on the clinic.  Once this project began, UBCO nursing students have been bringing funds, meeting with the Chief and working with him and the village elders to determine the priority for the upcoming year.  This has been a slow and steady, multi-year process.  The land title and clinic are now registered  as a non-profit clinic with Ghana Health Services.  This is a big accomplishment as we are a step closer to having it "commissioned" by Ghana health services.  This means that they will take responsibility for staffing and running the clinic.  Last year was the first year that UBCO nursing students performed community health screening and since then, the clinic has been used periodically through the year to do child welfare clinics and antenatal assessments by a team of Ghana Health Services staff.  It is not yet ready to be opened permanently as there is no shade outside the clinic for those waiting to be seen.  Temperatures can reach over 45 degrees Celsius and without any protection from the sun, it becomes a health risk for those waiting outside to be seen.   

Maternity Bed

OPD 

This year, we committed to another community health screening day.  We arrived at the Chanshegu clinic around eight in the morning. Before heading out to the clinic we were given the history of the clinic and were informed that there are great health disparities in the village.  Describing the village as "poor" doesn't quite capture it.  Our western definition of poverty doesn't really apply here.  A better description is that they are simple farmers and petty traders.  As we drove out to the village, what struck me is the fact that the village of Chanshegu is only about a fifteen-minute drive from the busy city of Tamale. It was interesting to see a village were disparities are so great right next to a big urban center. When we arrived we were greeted by Kassim (he is our contact to the village) and his beautiful wife and daughter along with many other volunteers who would be giving their time to help us. Shortly after arriving and setting up we loaded back onto the bus and set off for the Chief's Palace. It is necessary to go to the Chief's Palace before beginning work in the village to bring our greetings from home and receive the Chief's welcome to his village. We all entered the Chief's Palace (a round mud hut with a raised portion for the Chief), heads bowed to ensure that they remained lower than his. We knelt and ensured that our feet were not pointing at him. Many of us girls had to kneel or sit by his horse which is brought into the palace when visitors arrive as the horse is a sign of strength and stability. We listened as he greeted all of us, Kassim translated for us and Jeanette offered our thanks in response to his welcome. After exchanging our greetings, we were again back on the bus and back to the clinic.   

Kassim, Maggie and Tawa

Before the health screening began we were welcomed by the village’s cultural dancers. After the Chief arrived they came out to dance. The men danced and drummed and the women sang and unfortunately we were called upon to join in the dancing (it was not very pretty.) After the dancing finished the clinic was officially declared open for the day and we began our work. 

Cultural Dancers

Outside the clinic we had rented three large awnings to provide shade and rows of chairs set up for people to sit and wait to see us. Every awning had a table with three-four nursing students taking blood pressures, heart rate and interviewing clients about their concerns (using volunteer translators). After we had done our part of the health screening we determined whether we thought the person should wait to see the Nurse Practitioner or Midwife.  We were fortunate to have a Midwife named Joanna volunteering for the day. Joanna saw the pregnant women who came to the clinic and she provided them with an assessment and counselling. Joanna also took many of the expectant mother’s phone numbers to ensure that they would be followed up with. 

Cultural Dancers

There is something important that I feel I need to point out. The purpose of the clinic as it stands right now is that once a year the nursing students doing the Global Health Practicum come to the Chanshegu clinic to do health screening. This means that people come, sometimes commuting long distances on foot, and we take their vital signs and perform an assessment. We assessed approximately 160 people and of those people 105 went to see the NP or the Midwife. Unfortunately, for many people suffering from various health concerns all we could do was to refer them to another higher resource clinic or to Tamale Teaching Hospital. Many patients received prescriptions but they would have to take them to a pharmacy in order to get the medication.  When performing consults it was not uncommon to hear that they did not have health insurance, they could not afford the medication or that the clinic or pharmacy they were being referred to was a far distance away and it would be difficult for them to get there. These are only some of the challenges faced by people who seek health care in rural Ghana.  

On a more positive note, during the screening this year we found that many of the people coming to see us had been assessed last year, and have been receiving care and their health concerns are being addressed. This is very different from a year ago when for many of the clients, it was their first access to healthcare.  For example, last year many clients had high blood pressure.  It had never been identified or treated.  We did some teaching with them, and referred them to a Regional Health Centre.  Many of these same people came back this year with normal blood pressures, being controlled with medication and diet changes.  This was very exciting...what a difference one year makes!

We're also excited to share that the funds provided by UBCO this year will finance a covered patio to provide shade for those waiting outside the clinic as well as desks and shelves for inside the clinic. Work has already begun!  We are very hopeful that these improvements will be the final ones in the long list of requirements to open the clinic and that sometime in 2018 the clinic will be commissioned by Ghana Health Services. We hope that next year a new group of UBCO nursing students will arrive in Chanshegu and be able to work alongside health care professionals who are keeping the clinic open everyday! 

The Team - Joanna the midwife is in the front row far right

Posted by Danielle Beggs

UBCO 4th year BSN Student