Ghana day 4

On Wednesday a group of us took part in a medical outreach programme, which meant we went to a village called Lower Dixcove and screened the residents for diabetes, hypertension and dental problems. I've never seen a systolic blood pressure reading of >200, even in the most severely (pre-)eclamptic women I've looked after, but it this village it was not an uncommon finding. As with many aspects of Ghanaian healthcare, the point of undertaking medical screenings and examinations is undermined by the reluctance to act on any abnormal findings, but hey, it was a great opportunity to practice speaking Fante.

In this region of Ghana it is customary for visitors to meet the village chief, and take him a bottle of gin. I made several enquires about securing this position for myself, but I just got laughed at for being a white girl (and a ginger one, at that) trying to speak Fante. Joseph (the Ghana Work the World  manager) and 3 of us students went to meet the village chief, which was a surreal experience. I don't know if any of you readers have ever watched Prison Break, but Lower Dixcove really reminded me of Sona: similar shades of mud and dust, people not living but just killing time and, especially, an upper-floor grand room occupied by the 'elite' which seemed an impossible contrast to the poverty below it. As the chief entered the 4 of us had to stand and introduce ourselves in Fante. We were then asked what day we were born - "er... Sunday?" seemed to be the correct answer, and the chief cheered and shouted "essi Emily" which translates as "Emily, born on Sunday". Walking from the chief's house back to the village hall took us through lots of back alleys full of roaming chickens, goats, and children. The children kept stroking my skin, shouting "osei" ("ginger"), "abruni" ("white person") and asking us to take photos of them. They were also huge fans of inflated gloves (+/- a drawn on face).

After finishing the clinic we went to Fort Metal Cross; a fort used for the detainment and exchange of slaves. The 'Metal Cross' part of the name derives from the shape of the instrument used to brand slaves upon arrival. We had a lovely (although questionably appropriate) Ghanian lunch on top of a wall overlooking the sea. A football got produced, a dish of chicken went overboard, and we left shortly after.

To cheer things up a bit we went to Busca beach. Even though it was a pretty overcast day you could still appreciate the beauty of the place, and how untouched it is by western tourists. A nearby bar sold beer for 4 cedi a bottle (approx. £1), so we swam in the sea, played football, and knocked ourselves out!

Update: this post was written on the ride back from the beach. We got pulled over by the police, and the minibus driver didn't have a license.

Ghana day 3

There's a huge lag in posts - sorry! I tend to write them at the end of each day, but by that point we either get a power cut or the internet crumbles so they get published the next day. When I wrote this it was my 3rd day in Ghana (Tuesday). I feel like I'm starting to find my feet, but I don't think I'll ever get used to it!

The driving is crazy. I'm a shit driver, but in Takoradi I'd be up there with the safest! I took a taxi today and it had no wing or rear view mirrors. In the UK this would concern me, but in Ghana no-one uses them anyway so I guess it's fine. I've never seen an indicator used. Taxis are identifiable by random yellow panels on their car, meaning every other vehicle looks like an Inbetweeners car in reverse. Ellyn and I commented on this to a nurse at the hospital, and she laughed and said you don't need a licence to drive in Ghana. Whilst this would explain the awful standards of motoring we were shocked so we probed a bit more. It eventually turned out you DO need a driving licence, but there isn't an organisation to enforce this. If you get pulled over by the police you tell them you've forgotten your licence, slip them 20 cedi, and drive off.

Being an extremely Christian country there are images of Jesus and references to God EVERYWHERE. The Work the World minibus has Jesus on the bonnet and "Messiah!!" plastered across the rear window. There are roadside shops called  "Jesus Chop House", "Worship God Computers" and "Believers Shoes". Hospital staff have no issue with asking me if I go to church. Initially I was stupid enough to answer truthfully, and an hour and a half later internally vowed never to repeat this mistake. "Are you married?" seems to be as good a conversation starter as "hello", and as soon as they find out I'm single they try to get me to marry their brother. I'm seriously considering buying a ring to put an end to this - I've already been told I'm going to hell for fornicating (some of the other girls have been called "white devils") so I might as well chuck a few lies onto my sin list!

Takoradi is far less developed than I thought it would be. Only the main dual carriageway going through the city has tarmac; everything else is rubble or mud. I think seeing the Work the World house before I left gave me an expectation that the rest of Takoradi would be of a similar standard. It is not. We are definitely the elite rich in this city. From the house (which is comfortable, but still doesn't have hot water) I can see hundreds/thousands of huts made from iron sheets, wood or - if you can afford it - bricks. These are where the majority of Takoradi's residents live. Children and goats roam aimlessly. Giving that the people here have so little it's really jarring to see Shell garages, Vodafone shops and Cadburys adverts. Even the hospital direction signs are sponsored by Lucozade!

First day Working in Ghana

Today has been my first day working as a midwife in Ghana. I expected it to be under-resourced. I expected there to be education limitations. I knew mortality rates are far higher for both mothers and babies. What I wasn't expecting, though, was a complete "so what?" mindset.

I'm working with another final year student (can I say newly qualified yet...?) called Ellyn, from Manchester. I'm so glad I had her there for support, and I don't think I'd be able to do it alone. Our first day was extremely surreal... we spent the morning observing staff doing their tasks: vaginal examinations with no consent or warning, listening to fetal heartbeats when they could be bothered and when the Sonicaid had battery and ignoring women in pain. I'm not sure what I expected the hospital to be like, but whatever vision I had was very far from the reality. There is one 12 bedded ward; 8 beds for labouring women and 4 postnatal. There are curtains around the labouring beds, but hey are only occasionally used to give these women some privacy. Males are not allowed. There is a bucket by each bed - this is used for vomit and urine. Once women are fully dilated (or, usually, at staff's discretion) they are moved to a delivery room. This is where our day took a turn for the worse.

(This is the delivery room - I stood as far back in the corner of the room as I could to take this photo, which highlights the cramped conditions here)

It says a lot about Ghanaian midwifery that I don't know the name of this woman. Ellyn and I only planned to observe the delivery, but felt we had to intervene. Initially the delivering midwife was using her hands as forceps to bring the baby down, and didn't ease off as the head was crowning. She continued after the head was born, but there was no further progress. At this point alarm bells were ringing for Ellyn and I, as we both shouted "shoulders!". The delivering midwife was still tugging on the baby's neck and hadn't even considered McRoberts (for the civilians: a manoeuvre where the woman lays on her back and brings her knees as far as she can to her chest, to maximise the space in her pelvis), so we stepped in to do it. The midwife was still tugging on the head, and telling the woman to "chim, chim" (push, push). We tried to stop he woman from pushing (in a shoulder dystocia the baby's shoulder is stuck against their mother's symphysis pubis, so pushing it futile and may increase injury to mum and baby), and started supra-public pressure (trying to push the shoulders downwards through the mother's abdomen), and that didn't work either. The midwife was twisting the baby's head to try to get it out, but that didn't work either. I moved to the bottom of the bed to enter the vagina, and at this point the baby was born. 

No two ways about it, this little lad wasn't born in good condition at all. He was as pale as me (which is extremely bad news if you're Ghanaian), not breathing, and the only good thing about him was he had a heartbeat... just. Ellyn and I took him over to a flat surface and did what we could with no equipment. None of the hospital staff seemed willing to do anything beyond stimulating this baby with a towel, and I was the only person in the room with a stethoscope to confirm this baby was still alive. Finding this out didn't seem to alter anyone's perspective of the situation, so Ellyn asked for a bag/valve mask. One was found (after the staff had debated whether or not they had one), and the 'lead midwife' gave the crappest inflation breaths I've ever seen whilst I performed a double jaw thrust. Ellyn tried to persuade her to slow down the maximise the benefit of the puffs she was giving, and I told her I was feeling air on my thumbs so the seal around the baby's nose and mouth wasn't working. Eventually this baby started breathing for himself, but I'm convinced that was spontaneous effort and not a result of the half arsed ventilation he'd been having. After this, I turned around to face the woman again, just in time to see the placenta be delivered. Her blood loss was fine, but the midwife performed a bi-manual compression (inserting a fist into the uterus via the vagina, and using the other hand to abdominally compress the uterus onto the internal hand), did no perineal inspection whatsoever, and then inserted an entire sanitary pad (complete with the paper strip which covers the adhesive side) into her vagina.

After the baby had developed some muscle tone I noticed his right arm remained completely limp. I mentioned to the midwife that I was concerned about a clavicle fracture or brachial plexus injury. She picked up his arm and dropped it 3 times, and agreed with me. And then she did... nothing. At this point I had definitely seen enough, but the final straw came when we saw a bottle of surgical spirit and a pair of scissors making their way to the baby. Ellyn and I left the room to digest the situation we'd found ourselves in, and heard the little boy's first cry as his foreskin was cut off. 

Ellyn - being a far nicer person than I am - was worried we might have offended the hospital staff by intervening and taking charge of the situation. I, however, am happy to take resentment of people I will only know for two weeks over the long-term guilt of not doing all I could to save a life. After we took a breather we went back to the unit and had a chat with the staff. They seemed grateful for our help, and one even tried to persuade me to marry her brother! Ellyn and I got a photo of the baby we helped to save, and also of some of the staff.

 

(This is Sharon. Before this photo was taken she said "I can't believe I'm sitting in between two white people"!)

Our afternoon was far better. Our Work the World manager took us on a tour of Takoradi. Unfortunately it was bad weather, but we were shown some beautiful beaches - and bars which back onto them! We stopped at one for a drink, and then headed to a supermarket. The prices of things here are baffling. 70cl of 40% gin costs ~10 cedi (around £2) but a box of Coco Pops (a staple food in my diet) costs 48 cedi!!

I'm starting to get my head around this no hot water business now, and the general Ghanaean culture. Everyone is so friendly, and they've even taught me the word for redhead (ohse). I'm learning to roll with whatever hospital staff is the best option, and starting to let go of my germophobia. 

Love Emily x

Ghana day 1

So. I have arrived in Africa. At the time of writing this I'd been here for an hour, and it's already been a huge culture shock. Getting here was relatively trouble free - getting out of Heathrow was the tricky bit! Firstly I checked in, received my boarding pass, and said emotional (for Megan...) goodbyes at the security gate. I was re-united with my parents approximately 93 seconds later because my boarding pass wouldn't scan. I marched straight back to the check-in desk to replace it with a functional one (earning lots of dirty looks from other passengers), re-said the emotional goodbyes, scanned it at the gate again, and it worked. I gave my parents a wave - confident the drama had resolved - and headed through to security. Now, I don't know if any of you have used a TENS machine. I've been trying it recently to help with transverse myelitis pain, and it's worked wonders. I now have a thorough appreciation of how it appears through a body scanner: fairly similar to an explosive vest, really. This meant I qualified for a suitcase search (it's amazing how quickly they're able to find your luggage when they want to!), and at that point 32 matching underwear sets, 2 skipping ropes and a shitload of nipple cream becomes extremely difficult to explain. I eventually managed to, and it was agreed I'd done nothing illegal, but I still felt like a terrorist whore.

Since landing, I have witnessed 10 people inside a Mini (father and 1 child on the drivers seat, mother and 2 children on the passenger seat, and 4 others squished into the back) which then had to be jump started, and after getting it moving the guy pushing it jumped into the boot. Traffic lights are seen as an optional guide. Roundabouts operate on a give way to the bigger vehicle system. I've seen a goat roaming a dual carriageway. If you want to overtake you just accelerate in whichever lane has least traffic. The Work the World rep said a prayer for us before we set off. I've seen a family drive truck laden with piles of clothes, a fridge, and three children. It's definitely a country where you just roll with whatever happens, and I can completely get on board with that!

Arriving at the Work the World house was another eye opener. Everying is clean and comfortable, but is a stark contrast to the dusty road, roaming goats and huts we see from our windows. Everyone is so friendly, and it's been really interesting hearing other students stories. I start working tomorrow, and I'm excited and nervous in equal measures.

I did a stock take of what I brought out with me for the orphanage - you guys are awesome!

Thank you all for all of your support and encouragement which made this amazing adventure possible.

Love Emily x

Sunny Hunny

Last weekend my dad organised a scooter ride to Hunstanton (aka Run to the Hun): a great weekend with great weather.

Now academic work is a thing of the past I've been filling my spare time with HCA shifts. I recently worked on an intensive care unit and was amazed at the closure this brought. I booked the shift because I thought it'd be an interesting place to work, and it didn't occur to me that it would affect me on a personal level.

Whilst there, I came across a leaflet which is given to patients when they step down from intensive care, and when they finally go home. It outlined PTSD, but also went into detail about why this can occur. Perhaps the most helpful part was it didn't once mention the phrase "at least you made it out of here", or anything similar.

It explained that your mind makes links with things when you're ill, which you're often too ill to be aware of. It used the example of feeling unwell, in pain and frightened whilst being in hospital, and then associating these feelings with the beeping sound of machinery surrounding you. This is something so simple which I hadn't considered before. Understanding this made me realise why - in December, January and February - I was terrified by most aspects of daily life. I'd associated bleeping with pain, despair and fear and these emotions were re-triggered every time I heard a beep - from a phone, a doorbell, a microwave, an oven, or even an e-mail. It explained why I found it impossible to sleep in a normal bed without some fairly hefty sedation, because I was used to being semi-recumbent on a hospital air mattress with opiates being pumped directly into a central vein. It also described how the relative silence of 'home' becomes an unfamiliar, and therefore unsettling, sound.

Who knew one shift could achieve so much?

Love Emily x

Everything looks like it's all coming together

I'm in very real danger of becoming a proper adult!

I applied for a job back in the Midlands on Wednesday, they asked me to go for an interview on Thursday, I was interviewed on Friday afternoon, and got a job offer on the train home. I've applied for quite a few jobs more because I felt I should, rather than because I wanted to work at that particular hospital. I went to this interview though, and knew straight away it was the place for me. 

There's also talk of me having spinal surgery to try to get a bit more feeling back. It would involve fitting a sort of pacemaker below the level of the lesion to see if the affected nerves can be tricked into working again. It's a pretty big op, so my neurologist wants to give me until April 2016 (18 months post transverse myelitis onset) to see if I make any further spontaneous improvement, and we can see what the most appropriate choice is at that point. 

I'm very happy, and life is great at the moment. I've got 16 shifts left as a student, dissertation results are coming out this week, I'll soon know my degree class, and in 35 days I'm setting off for Africa. It finally looks like it's all coming together!

Love Emily x

Time flies when you're having fun!

I can't believe how close to the end of midwifery training I am! Last week I did my final bit of academic work, and now I'm waiting for results and working flat out as a HCA to fund my elective.

Unfortunately, after the earthquakes in Nepal, I've had to change the destination. Initially I was still set on going - perhaps even more so, given the increased use I would have been. The university got quite anxious about my decision to still go, and eventually flat out forbade me to go on their time. I looked into going on alternative dates so I wouldn't be bound by their decisions, but no insurance company would touch me. I like a challenge, but this was a push - even for me. So, after a couple of strops, I've made plans to go to Ghana instead.

Whilst in Ghana I'd also like to do some teaching at an orphanage in Takoradi. I've built up a stash of pens, pencils, felt tips, colouring books and educational posters to take, but if any of you lovely people wanted to donate something small and light for me to give to some local children it would be very much appreciated.

After I've finished working at the hospital I'm going to explore Africa a bit more... much to Megan's panic. From Accra I'm going to Johannesburg (via Kenya) for a few days to explore the Sterkfontein caves. From there, I'm going to Zambia to be amazed by Victoria Falls (+/-a cheeky microlight flight...) and pick up a safari travelling through Zimbabwe and Botswana - finally ending up back in Johannesburg, and then fly back to the UK.

Not bad, considering 8 months ago I couldn't walk.

Love Emily x