The Shekhinah Clinic

All of us had the opportunity to spend two days volunteering at the Shekhinah Clinic in Tamale. This clinic was started by Dr David Abdulai who was the only child of eleven to survive from malnutrition and poverty. He dedicated his life to helping the poor and destitute through his food program (which began in 1992) and medical clinic. The clinic is run entirely by volunteers and depends on "divine providence" to continue.  All services are absolutely free. The clinic experienced a devastating loss this year as their beloved Dr. David passed away, yet the work continues.

We each spent a day working in the clinic, and another day working with the men and women who provide and deliver the lunches for the homeless mentally ill population of Tamale. We were amazed that this hot lunch program has not missed a day since it began 24 years ago because Dr. Abdulai was adamant, up to his death, that "the stomach knows no holiday."

The medical clinic consists of the outpatient clinic, laboratory, pharmacy, small operating theater and housing which is mostly occupied by mentally ill and HIV infected community members. All of the services provided are completely free of charge and the only request of the staff is that those who are physically able lend a hand cooking and cleaning.

The Operating Theatre Crew

Being at this clinic was truly inspiring for all of us. Each of the staff members, including Dr Abdulai's wife, share his passion and work tirelessly to keep his dreams alive. We felt very humbled by the community spirit and generosity that is clearly present at this clinic. It is difficult to convey the overwhelming emotion and selflessness that we experienced working alongside these volunteers, most of whom have duties and responsibilities outside of the clinic. Like Dr Abdulai, they demonstrated a "never ending work of love and service for humanity."

Jeanette and Maggie were able to share a generous donation from home with the staff. This $1000 CAD will keep the food program running for months.  Everyone was very grateful.  Divine Providence in action!

To date, this was one of the most rewarding experiences that we have encountered during our time in Ghana and we feel very privileged to have been a part of the Shekhinah Clinic.

Posted by Carmen Morgan, Danielle DeYagher, Rebecca Ellis & Mikaela Noble

Emerg at TTH

Walking into the Emergency Department at the Tamale Teaching Hospital, our senses were assaulted. The air hung heavy and still, the smells were overpowering and a heart rate monitor was pinging loudly. However, we were immediately oriented to the floor with a warm and welcoming nurse named Doris, who guided us through the triaging system. As soon as we introduced ourselves, the heart rate monitor began to alarm noisily behind us and a couple of us gravitated towards the noise to see if we could help. A male nurse, David, began to work on the male patient and allowed us to assist him. He quizzed us right off the bat and would later become our primary mentor. We even managed to teach him a thing or two, despite his high level of skill and knowledge.

The hospital is reserved only for the sickest patients. According to nursing staff and students, Ghanaians use the hospital as their last resort. This can be due to a preference for traditional healing, inability to cover medical costs, lack of family support, and fear of hospitals. Some of the common limitations to care were the inability to provide medications until the patient or family paid for them, lack of equipment and language barriers. However, family support in the emergency department was commonplace and frankly, essential. Almost every patient had a loved one at their bedside, washing them up, providing food, paying for medications, going to get the medication, and even arranging diagnostic tests such as running the blood samples to the lab. Where we have auxiliary staff at home, such as porters, dietary and care aids, they have family. At home in Canada, family is discouraged from gathering in the Emergency Department and we are quick to ask loved ones to leave when procedures are being done. There is still much work to be done at home in terms of family centered care. Here at the ED in Ghana, nurses recognize that they could not do their jobs without the support of families.

Although the conditions in the ED were less than ideal, nurses here show amazing resilience and collaboration. We now have a greater appreciation for the resources and systems established at home. We will take what we have learned here at the Tamale Teaching Hospital and incorporate it into our practice back home in Canada.

Posted by:  Jade Geddes, Emma Miller, Carolyn Grinham and Jessica Sherbinin

Pediatrics at Tamale Teaching Hospital

We came into this week on Pediatrics at Tamale Teaching Hospital expecting to see some of the saddest stories imaginable. While that was true, our week was filled with an overwhelming sense of hope and positivity. For all of us, this week has been challenging and rewarding. Here’s just a snapshot of some of our experiences.

Most of the patients that are seen on this floor have multiple diagnoses, making them some of the most critical cases that we have experienced. The acuity of their illness is often because of how long families wait to bring them to the hospital due to cultural perception and barriers. These barriers can include finances, travel, previous experiences in the hospital and family obligations. While in Canada families contribute to care, in Ghana we have seen how much the health care system as a whole relies on families. They are required to buy medications, bring linens, provide food, do personal care, and organize medical testing.  All this while managing home responsibilities and work commitments.

Our Ghanaian colleagues and us on the peds floor at TTH

We were told about the resiliency and resourcefulness of our Ghanaian nursing colleagues, but what we witnessed this week on the Pediatric Ward at TTH blew these expectations away. At times, one nurse can be responsible for up to twenty critically ill patients. The limited amount of resources that nurses have access to, and we routinely take for granted, also challenges their level of care. These nurses are focused not on what they can’t do, but what they can do with what they have. Their scope is different from ours, but the standards of care they uphold are exceptional. Almost immediately, we made connections with these nurses that enabled us to have open and honest communication about issues and barriers in our respective health care systems. Nursing is universal, and the goal is to provide the best care for the patients in front of us. Through this, we are connected.

Us in our happy place!!!

Our underlying reason for being here is to teach, learn and deepen our understanding of global health. Not just with the medicine we deliver in the hospital, but by recognizing the impact of colonization. If we could heal the damage done by centuries of power displacement and hegemony we could repair the loss of culture, identity, health and autonomy. We have come into a low resource country, but we have seen how important the resource of family and community is. At home, we view resources as machines and “things”, whereas here their strongest resource is family and community. Being able to see the family-centred care being provided here has shown us how we can utilize it in our own health care system and nursing practice.

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Alishia Huston, Andrea Kouwenhoven, Megan Lentz, Amanda March and Emily Plant

Tamale Teaching Hospital- NICU

Skin to Skin

Last week we had the opportunity to work alongside the nurses and doctors in the Neonatal Intensive Care Unit. It was an eye opening, rewarding, and challenging experience for the three of us. We saw the tiniest and sickest babies imaginable. Although the NICU looked much different than our's does at home, the same principles were applied, with much more resourcefulness and creative thinking. These nurses individually take care of as many babies as approximately four nurses would in Canada. The infants are very sick with complex care needs. In the critical care unit, there were 19 babies, who each needed to be fed and given IV fluids every 2 hours. At times, there were as few as 2 nurses in that room trying to manage the workload.

Incubators

The doctors do rounds on every neonate each day to reassess their needs and plan for discharge so that the babies can be home with their families as soon as possible. We were surprised by the advanced nature of their equipment and supplies. They had incubators similar to the ones that we use at home. However, there is a high need for the resources, and a limited amount of supplies leading to multiple infants being cared for in one incubator. Ideally, the incubators should house one infant at a time, to provide an optimal environment for their healing, as each child has specific requirements .

In addition to the critical care room, there was a Kangaroo Care room, and an "open crib room", where the neonates who were almost ready to be discharged stayed. In the Kangaroo Care room, skin to skin and the teaching regarding its importance was practiced, as well as breastfeeding, and tending to their infant's needs. The language barrier was difficult and there were many things we wished we could have shared with the moms and were unable to do so effectively. The staff were very receptive to feedback and suggestions for improvement which was encouraging to us. We felt that our knowledge and opinions were valued and allowed for us to feel like we contributed something important. We are thankful that we received such a warm welcome onto the floor and for everything we learned and were able to teach. 

Posted by: Stephanie Bandura, Amanda McCrate, and Harveer Pooni

Labour & Delivery at TTH

Six of us nursing students were excited to hear that we all got our first choice placement in the Tamale Teaching Hospital on the Labour and Delivery ward. We spent a total of four days on the ward, observing, learning, and helping with the deliveries as well as monitoring mothers pre- and post-partum. We weren’t sure what to expect when arriving on the L&D floor, except we knew it would be nothing like what we had seen in Canada. We were impressed with the size of the Tamale Teaching Hospital, and felt very welcome by all of the staff on the L&D ward. We wasted no time jumping in and involving ourselves in the deliveries and with the care of the women and babies. We spent time collaborating with the doctors, midwives, and nursing students, as they have the most active roles on the floor. Each student had the opportunity to work with the midwives through several deliveries. We were also able to observe a couple of C-sections, for twins and for triplets. The triplets were conceived via IVF which we all found surprising since the average Ghanaian woman gives birth to 7 children (in comparison to 1.5 in Canada).  We learned about many differences between delivery practices through observation and through talking with some local 3^rd year nursing students.

Here are some of the comparisons between Ghanaian deliveries and Canadian deliveries:

1. In the hospital, it’s the midwives who deliver babies instead of doctors, whereas in Canadian hospitals it is almost always doctors.

2. The delivery room consists of 9 labour beds with no curtain, in comparison to individual rooms.

3. No family was present for any of the deliveries that we witnessed, in comparison to partners and families being present in Canada.

Delivery Room

4. None of the women that we asked had picked out names for their babies prior to delivery – they all waited up to a week to decide (traditional customs such as day-of-the-week and tribal traditions play a large part in naming babies).

5. Lack of supplies was very apparent, but we found the midwives and nurses to be extremely innovative and resourceful with the supplies that they did have.

6. We noticed the women were more stoic and quiet during their contractions and labour, and received less pain medications and no epidurals.

7. Often due to ultrasound unavailability, the mothers are unaware of how many babies they are delivering until first baby is delivered and the second baby’s head is visible (we were able to witness this).

We were very inspired and in awe by the strength and resilience of the women in labour, and the healthcare team that helped them along the way. It has been an incredible experience being able to collaborate with the Ghanaian nurses and midwives to provide the personal touch and relational practice we have learned throughout our nursing program. In turn, the Ghanaian healthcare team showed us how to be resourceful and innovative.

Posted by: Mikaela Noble, Kenya Mokoena, Danielle DeYagher, Rebecca Ellis, Carmen Morgan, Kelsey Bellerive

Cultural Orientation at UDS

Yesterday we visited the University of Development Studies (UDS) to meet Dr. Nafiu Hamidu, the Dean of Allied Health Science, Dr. Thomas Azongo, the Head of Department of Nursing, and Dr. Kofi Glover who provided a lecture on Culture. Dr. Vida Yakong, the Head of Department of Midwifery, accompanied us to the University.

We were warmly welcomed by each person we met during our time at UDS and had the opportunity to experience a unique lecture that enlightened each of us in many ways. During the opening of Dr. Kofi’s lecture he explained to us that each Ghanaian name has a meaning, and that people “come by their names, rather than being given them”. For example, Kofi is a name given to a man who is born on a Friday. We thought that this was unique and allowed us to gain an understanding of the significance of names within Ghanaian Culture.

Dr. Kofi Glover

“You can see, but not perceive, you can hear, but not understand.” This quote by Dr. Kofi explains how we can go through life paying attention to the things we encounter, while at the same time not challenging our thoughts and asking why something is the way it is. Often, the reasoning may be greater than our knowledge. This situation encouraged us to be curious, mindful, and open to learn new things. There are times where what we perceive to be true, is not a universal truth, and we must be open to other perspectives to gain an understanding of all views. Dr. Kofi explained how the Ghanaian faith is so strong, that many believe they have “already found the truth”, and therefore some people may not be as willing to search for answers outside of their religious beliefs. Learning about this helped us to understand the reasons behind some of the major health disparities in Ghana. As Canadian nurses, we cannot simply impose our beliefs on our Ghanaian colleagues and expect them to be useful. Instead, we must collaborate, ask questions about their needs, and work together to find solutions.

Lecture at UDS

During the lecture, Dr. Kofi said the word “polygyny”, and instantly many assumed that he meant to say polygamy and had mispronounced and misspelled the word. He began to explain the meaning of polygyny and how it is quite different from polygamy. The definition of polygamy is that it is acceptable for both genders to have more than one spouse at the same time. While polygyny means that a man can have multiple wives, but the woman can not do the same. In Ghana, some groups practice polgygny, while polygamy is not as culturally accepted. Our initial reaction is an example of how we often assume that we have all of the answers, or even that our knowledge is superior. We were fortunate to have had this lecture to open our minds and to inspire us to value and appreciate the knowledge that others can offer us.

- Posted by Stephanie Bandura, Amanda McCrate &
  Kenya Mokoena