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!