Just a Small-Town Girl Nursing in Rural Ghana

Let me ask some hypothetical questions to get your minds’ going:

You work ten-hour days farming, seven days a week in rural Ghana. Your one-year-old child hasn’t been sleeping well and you’ve noticed that their skin has been hot and sweaty.

What do you do?

Lately, you’ve noticed that you’ve been getting constant headaches while working, you can feel your heart beating through your chest at times, and often your eyes have been going blurry.

What do you do?

The closest city is an hour away by vehicle and you do not own one, nor does anyone else in your village.

What do you do?

This is a very vague idea of what men and women face on a daily basis in rural Ghana regarding access to healthcare. Fortunately, there are health clinics that are available in rural villages so that people can receive healthcare. We had the opportunity to work at four rural health clinics: Nangodi, Nyobok, Pelongu, and Sakote. These clinics offer a variety of services from health screenings, child health screenings, antenatal care, and laboratory testing; however, not all the clinics offer all these services as some of the clinics are still in the process of growing.

Us and the team at the Okanagan Community
Clinic in Nyobok

I had the opportunity to work at the Okanagan-Nyobok clinic, which has been operating for four years. The staff consists of two nurses, Vincent and Abraham, as well a few volunteers. The environment at Nyobok was very welcoming and positive, and their patients were treated with the utmost respect. A group of colleagues and I were able to run health screenings, as well as one simultaneous child health screening. With the help of translators, we were able to ask questions about patients’ health concerns and figure out solutions to their problems.

We also had the chance to go to two different schools to complete general health teaching to grade 3’s and grade 6’s. The Nyobok clinic often has a community healthcare nurse, Nancy, come and teach at the local village schools about a variety of health topics. We did a presentation on handwashing as children often don’t wash their hands properly, or even at all. After we taught the students to sing their ABC’s while washing their hands, we also taught them basic hygiene practices such as bathing daily and brushing their teeth. Finally, we focused on teaching what malaria is, what the signs and symptoms are, and what to do if they feel this way, or a family member does.

Grade 3 & 6 students writing in their books to give to the
students at Aberdeen Hall in Kelowna

Now that you have an idea of what some of these clinics offer, I would like to ask a few more questions:

You know the Nyobok clinic is 5km away from your village and you are prepared to walk it in 40-degree heat with your one-year-old infant on your back, but you don’t have a healthcare card.

What do you do?

Your child appears to be sicker.

Can you afford to pay for medications?

What if you have to go to another clinic for further testing, can you afford the ambulance drive there?

Can you afford the additional tests?

What do you do?

Healthcare isn’t black or white, it is layers of mixed colours on top of each other. It’s a puzzle. It’s sometimes a “this is the best we can do, but let’s make it work”.  Interestingly enough, these questions I have asked you are not unfamiliar. We ask them at home in Canada as well. It is just a different context. What I appreciate about Nyobok, and the rest of these rural clinics, is the mentality of “let’s make it work”. There was a patient who was left with us unconscious. Long story short it turns out this patient’s medications had run out and was having seizures. Vincent (bless his heart), made sure this patient was able to get more medications, and set up a daily “check-in” routine every morning at the clinic before the patient went about their day. What I also appreciate about these clinics is how they value education. I believe that education is imperative to growth and change. When we taught about malaria, we emphasized how important it is to prevent it by using mosquito nets while sleeping, how to recognize the signs and symptoms, and to go to the clinic if there is a possibility that you have it.

I have asked a lot of questions, and fortunately I have some answers:

The sick woman with the sick child did come into Nyobok clinic. She walked the 5km with her babe strapped to her back in 40-degree heat. We assessed her and her infant and decided to test her babe for malaria; the test came back positive. Since the mom had health insurance, she was covered for the antimalarial medication. After the babe had the first dose along with some Paracetamol, we also assessed the mom. Both the mom and her infant needed follow up, so we completed our appropriate teaching, and the mom agreed to come in for the next four days to be reviewed.

So, what did we do as almost Registered Nurses to ensure that the patients in the rural villages continue to access healthcare?

Frank, the "clinic baby" as they call him.
Our volunteer Dokas' son.

In the Nyobok clinic we assessed patients thoroughly, critically examined their situations, advocated when necessary, and did a lot of teaching. We can only hope that we addressed the patient’s health concerns, as well established a trusting professional relationship with them to ensure that they continue to use the health clinics. Entering into my own nursing career, I will always remember Nyobok clinic for what it taught me; sometimes healthcare is “this is the best we can do, but let’s make it work”, and most importantly how education is key to growth and change.  


Blog post written by: Shannon Marken, 4th year 
UBCO BSN student 

Work hard play hard!

Since stepping off the plane, the past three weeks have been a continuous influx of new sights, smells, sounds, tastes and sensations. Our schedules have been full and our minds have been in overdrive trying to take in all that is around us. The scenery is ever changing as we are privileged enough to travel the length of the country, beginning in the south (Accra) and ending in the north (Bolgatanga). With hours of bus rides behind us and hours still yet to go, we have experienced the humid climate of the rainforest and now the dry weather influenced by the neighboring Sahara desert. For us, there is no settling down. There is no getting comfortable in one place for too long. We are nomads discovering our way in this foreign land.

Our days have been long and nights often sleepless, as I lay awake thinking of the impact the day has had on me. I spend the nights processing, questioning and considering all that my brain has absorbed throughout the day. My mind remembers the smiling faces of the local people, the overwhelming bustle of the markets and the contrasting differences between Ghana and home. I am invested whole heartedly in each experience, not wanting to waste a minute of the limited time I have here. I have so many unanswered questions that I cannot seem to wrap my mind around. Questions that are bigger than you and me. Questions that date back centuries. I have a constant yearning to learn more, to understand more.

Mole Park Entrance

Evenings are often spent prepping for the next days events, including health related presentations for the healthcare professionals at the hospital or organizing health screening for 200+ people in a small village that doesn't speak English. However, the simple action of trying to form a thought in this heat is a challenge in itself, and a cool relief is next to impossible to find. The ceiling fans cannot seem to keep up with the layer of sweat that covers my body at all times, worsened by the sticky layers of bug spray and sunscreen. Being the center of attention also becomes overwhelming. People constantly run up and take pictures of you and with you, often putting their arms around you for a pic or going straight for the selfie. One lady even video recorded our whole conversation together, something I realized at the end as she walked away. I am not used to being an outsider. My heightened awareness and processing of all that is around me is exciting, but mentally and physically tiring. I want to ensure that I continue to maximize my role of teaching and learning while here, and in order to do so effectively I recognize it is time for a break. Luckily, we were able to spend Easter Long weekend at Mole (Mole-ay) National Park.

Elephants in the Watering Hole

As the bus pulls up to the park and 18 of us flail our limbs out of a 13 seater clown car, I am overwhelemed by the sound of nature, the fresh air, and the view from the restaurant that overlooks the expansive national park. I rush down to another view point and see elephants playing in the water down below. I can feel the tears begin to pool in my eyes as I watch these massive creatures move so
gracefully. This is the first time I have seen elephants in real life. I cannot even begin to describe the gratitude I feel to be able to experience this moment. Throughout the day, the excitement grows as our group watches more and more elephants make their way across the desert plain to the large watering hole below. For hours, we watch 12 elephants as they go about their day, enjoying some relief from the hot sun. They are completely unaware of our presence, completely unaware they just made my whole day.

Headlamp? Check. Bug spray? Check. Safari Hat? Check. It is time for the night safari! Eight of us climb onto a not-very-secured roof rack of seating atop a Jeep. Our guide is armed with a gun that doesn't look like it would save anyone...and we're off. At this point, the wind blowing through my hair was enough to keep me happy and everything following was a bonus. I couldn't be bothered by the toonie-sized bugs hitting my face or the swarm of moths every time we stopped to try to spot an animal. I was just appreciative to be detached from my thoughts for the first time in a while. We spent over 2 hours driving the red dirt roads of the national park looking for nocturnal animals. The night sky was twinkling overhead while the bugs sang their songs. The mood of our group was the lightest I've felt it in weeks. There were no shortage of laughs, smiles, or exciting moments as we tried to spot the sneaky animals. We saw all sorts of red and green eyes peering back at us from the shadows. Sometimes we were able to see the body that belonged to the eyes, usually a bush baby or meerkat. As I lay in bed that night, my mind is completely at ease.

On top of the Jeep!

*David Attenborough narration* "As the Jeep from the morning safari comes to a stop, the tourists in the roof rack realize what they have stumbled across. Two large female elephants and a smaller male elephant are playing in the mud, occasionally cooling themselves down with water sprayed from their trunks."

At this point I was so excited I couldn't even manage to point my camera in the direction of the elephants. I'm not sure I was even forming words and I'm not sure I held onto the ladder as I climbed my way off the wobbly roof rack. All I could think about were the elephants. I stood in awe as I watched them do absolutely nothing. It was perfect. I didn't think this day could get any better but boy was I wrong. After admiring these three beautiful animals for some time, our guide ushered a little further into the trees. Here, there were NINE MORE ELEPHANTS and a couple crocodiles swimming and playing in the watering hole. You probably could've just left me there forever and I'd be so happy I'd bounce around like the bush babies we saw earlier in the day. Of course we saw lots of other animals including monkeys, baboons, warthogs, impala, water buck, vultures, and endless amounts of colourful birds I couldn't identify.

The rest of the day was so hot I rotated between the pool and the draft from the rickety ceiling fan in my room. This was really the first down time I've had in three weeks. I wasn't overanalyzing complex experiences from the day, I wasn't thinking about all of the things I still had to do, I was simply present in the moment with myself. It was a great opportunity to practice mindfulness and listen to and focus on the needs of my mind and body. I had the opportunity to read a book, to listen to music and to let my mind wander as it pleased. Could this day get any better?

Sydni and Michelle - Drowned Rats!

As we finished dinner on our last night in Mole National Park, what felt like the most magical thing happened. Drip...drip...drip...dripdripdripdripdrip. RAIN! We watched as a thunderstorm rolled in over the never ending sea of African trees below and with it came torrential downpour, thunder, lightening and even a breeze. With books and phones still in hand, we all went running outside to dance in the rain. We were out there for over an hour appreciating and welcoming the less hot temperature the storm brought. The locals were looking at us like we had lost our minds but soaking wet and standing in the breeze was the coolest I've felt since arriving in Africa. The shiver I felt through my body made me grin from ear to ear and I watched as a few goose bumps even tried to appear on my arms. As I look around at my drowned-rat looking colleagues, I recognize that each one of us is present in this moment. The calm, peaceful energy radiates from each individual, like the rain somehow washed away the last of our worries.




As I lay in bed on the last night, I smell nothing but the fresh rain and listen only to the thunder. I am comfortable in this moment and I've come to realize that home is a feeling that exists within myself. I recognize that I must be fully charged in order to be able to give meaningfully to others. Tonight I am wondering if I'll actually be able to use my bed sheet, as I can still feel the warmth linger in the air. As I close my eyes, I am excited for our nomad ways to take us to Bolgatanga tomorrow, as this means that another adventure awaits.

Posted by Sydni Lutzke
4th Year UBCO BSN Student

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

Everything's Rosy

Goats on the Street

The mornings are my favorite. The humid air settles in as we rub our sleepy eyes on the walk to the taxi stand. Its early in the morning but already the sounds of vendors selling their goods and the traffic of motorbikes, tro-tros, and goats overtakes the stillness. Its not often that we feel a pause from the continuous ambush of stimuli. The birds begin their songs, the Muslim call to prayer starts its circuit for the second time of five that day. We walk past a fabric shop filled with colors I never even thought imaginable. Another pause. The wind blows past the market and fills the air with the smell of fresh produce......or was it fish. Children hold hands as they attempt to navigate the unwritten rules of J-walking through the busy streets. I feel my senses being overloaded. I feel overwhelmed. I feel excited. Tamale is awake. The taxi honks it's horn behind us.

We arrive at Tamale Teaching Hospital and eagerly make our way to the pediatrics ward. Unease sets in as I imagine what I might see today. You don't have to be in Africa to know that there can be both really good days, and really bad days on the pediatrics ward.

As we are showed around by Peter, the head nurse, we do our best to understand his thick Ghanaian accent, as he tries to understand our thick Canadian ones. Our eyes rapidly switch back and forth as if we are dreaming, trying to take in all that is present on the unit. Our movement shifts and we see a platoon of beds made up in colorful cloths. Mothers hold their babies, some so small that they don’t even look human yet. The malnourished babes nestle into their mothers arms and we see each breath they take as their in-drawn breaths dissipate them into nothing, their recoiling breath bursting out through their rib-cage. Another section of the unit opens up and we see a wall of empty cribs. 

Empty Cribs

At first my thoughts are good, maybe this means that there are less sick babes today. I extend my lens. Maybe this means a lack of access or a resistance to care. The hospital is the last resort. When they come it is often too late. How do we change the perception of a place that brings death and misery. A bad experience for a family member or a treatment that didn’t work, why come back? How do we teach health promotion and prevention when their only access is inaccessible? If you think this is only a problem in Ghana, you may need to shake loose those rose colored glasses. 

 Peter receives a call and we are left alone. We speak none of the same languages as the families. We let our bodies speak for us as we attempt to communicate and provide relational practice. Our skin betrays us as the babies eyes open wide and their cries fill the room. We are a swarm of ghosts that were not invited to this Halloween party. This is going to take some work.

We fumble our way through the rest of the day trying to help where we can and cause the least amount of tears. Peter explains their values of family centered care as we see communication and collaboration take hold between families and staff. We see innovation and resourcefulness as the cuff off a rubber glove becomes a tourniquet for an IV start. It’s beautiful, it’s holistic, it’s inclusive. A doctor spots us drowning and asks if we are nurses. He takes us under his wing and immediately a comfort settles in. Healthcare, a universal language! Everything made sense again as we made our rounds. Each child with a different condition, some of them chronic.  I hear my pharmacology teacher yelling in my mind as she lists off all the symptoms of steroid side effects. My mind moves quickly as I get excited about the knowledge I share with this group of strangers. A common language, a link....but it’s time to check my privilege.

Tameka making Elephants

I have power. The English language has power. I have power over these patients. Just as I would back home, I must remind myself of my power relationship with both my colleagues and my patients. The rose glasses become clear again as I see that many of the patients and their families don’t even speak any of the same languages as some of the staff. In Ghana, healthcare is taught in English and each tribe and village typically has their own African dialect. So what do we do, how do we create balance in this ever present power relationship? We advocate. We ensure each patient and their family understands what is happening before a procedure and that consent is given. We make sure they are being provided teaching in their own language. We make sure a mother understands exactly all her options when she wants to sign an “against medical advice” form for her malnourished baby to leave because she is too poor to stay at the hospital and not be working. We check our ethics. We breathe. We share the language of laughter as we blow up our gloves and turn them into elephants for the kids to play with. We share the joy of playing hide and go seek with siblings as their mothers laugh along.

We worked alongside the staff helping with whatever we could, but often it was more relational than skills. After our three days of working on the unit the children’s wide eyes turned into giggles. Another pause from the ever present noise of Tamale. A breath. We see smiling faces staring back at us.

Posted by Michelle Epp 

UBCO 4th year BSN student

Tamale Accident and the ER 2.0 "Faces" a poem by Camille Galloway

There are faces that I see

At times when I close my eyes

I know they will always be there

Throughout the rest of my life

I walked in as a student

And on the third day I stumbled out

I felt like I had aged some years

You could see the faces in my eyes

She was a mother and a sister

A fighter until she passed

Our time together was brief

But in the end I couldn’t save her

As she let out one final scream

I held her hand and she went limp

I pounded on her chest, willing her to come back

But as her ribs cracked, her soul floated away

I still see her face

At night when I close my eyes

And I can still smell her sweat, vomit and blood

In my mind it’s still all too clear

He was a brother, a friend and a son

Born in the wrong country to be saved

But I fought so long and so hard

I couldn’t understand why nothing was being done

As the panic started to rise in my chest

I stepped out to take a breath

And in that moment of quiet I knew

The care he needed was never going to come

Was this murder? I’m still not sure

There are many questions with no answers

I wanted to yell, to kick and scream

Because I knew we could have saved him

But in the end when he slipped away

His eyes rolled back and his chest became still

I was left cold and empty

Just like the body beneath me

I still see his face

When I stare out the window

And the bitterness starts to rise

From the unfairness of it all

We didn’t save him

We couldn’t save him

When it was all over and done

When I stepped out of the room

There was still the brother, the friend, the father

There was still the daughter, the son and the sister

Their faces turned to look at me

And I stared into their hopeful eyes

As my stomach coiled itself into my chest

And I felt their hearts shatter with mine

I still see their faces

In the strangers on the streets

Perhaps they are in heaven now

Or just dust in the wind

Either way I could not save them

They are gone, gone, gone

I will always see their faces

Because I don’t want to forget

They deserved more than what they had

Yet they had more than what they wanted

As time moves ever forward

I will remember and grow stronger

But right now I still see their faces

And sometimes I will get mad

And it’ll be sad

For a while longer

***Don’t worry Mom and Dad we are coping well and heading to Mole to rest and recover! 

Written by Camille Galloway, UBCO 4th year BSN student