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My time nursing in Ghana...

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At the end of my second year of nurse training I had four weeks off.

I wanted to make the most of this precious time off to learn, experience another culture, to meet new people and most importantly, to work within another country’s healthcare system. I went with a close friend and fellow student nurse to Takoradi in Ghana with a small charity, Agape.

I arrived on a very hot and humid Ghanaian evening to our host father who welcomed us and we quickly set off on our four hour journey full of nerves, excitement and exhaustion. It was past midnight when we arrived in a village called Effia that was to be my home for four weeks. There were no street lights and only a few dimmed lights from homes lit up the paths around the village.

The next morning I was introduced to the rest of the host family; they had two young girls who were very chatty and welcoming. In the days that followed I became familiar with the village, currency and all the new people I met. My host family had a well-built stone home with electricity and toilets. There was however, as in the vast majority of Effia, no running water. This did not faze me as I quickly got used to showering from a bucket and filling the toilet for it to flush.

I started work at Kwesimintsim hospital, a small hospital not too far from the village in an all-white uniform of sewn up dress, hat, apron, socks and shoes. I was to work in each department of the hospital: accident and emergency, gynaecology, labour ward and the dressings clinic.

On my very first day on accident and emergency, the first thing I saw was a midwife holding a newborn baby. The baby wasn’t breathing and had to be carried across the hospital as the only oxygen cannister was in A&E. There were no curtains on the ward so all of the patients could see the midwife trying to revive the newborn baby. It was shocking and emotional. As I am training to be an adult nurse, seeing babies is not overly familiar to me and I’ve never been in a situation of such emergency. Thankfully, the wonderful midwife got the baby breathing.

The general routine on all the wards were doctors’ rounds in the morning, drug rounds and taking observations. Most of the patients were suffering from malaria and being treated with IV drugs and fluids, which generally worked well within a few days.

However, I found it stifling that none of the patients beds had mosquito nets around them for protection from further bites. One of the main things I found difficult to comprehend was the massive difference in the care approach in Ghana compared to the UK. As students we are taught about the importance of the individualised holistic care which we must provide to our patients.

I noticed that the healthcare professionals in Ghana work focus more on a medical approach; they tend to fix the problem and move on. I witnessed doctors diagnosing patients with malaria and prescribing treatment without physical examination or taking blood tests and waiting for the results. It was so different to how patients are diagnosed in the UK.

Kwesimintsim hospital didn’t have running water, making good hand hygiene difficult. Huge buckets of water, washing up liquid and tea towels were our equipment. Even though this wasn’t ideal, many of the nurses, especially those in the dressings clinic, used what they had and still ensured that they washed their hands.

Along with the labour ward, the dressings clinic was the busiest place in the hospital. Leg ulcers, burns, knife wounds, bites and wounds from car accidents were all common. There were many similarities in care to the UK - good hand-washing techniques, maintaing sterile environments and preventing infection through wearing protective gear.

One difference was that Kwesimintsim only had one type of dressing available to them - gauze. This was sometimes used with iodine or antibiotic powders, but it had to suffice for all the different types of wounds at different stages of healing.

The nurses in the wound clinic were the most hard working people I met in the hospital and it is such a shame they cannot deliver even better care due to the lack of resources they have to hand.

The labour ward was a room full of beds with expectant mothers. It had only the one delivery room, so mums to be in the last stage of labour would be walked into the room for the delivery of their baby. I loved being on that ward. I learnt so much about labour, contractions, cervix dilation, how to take observations of the mother and the baby in the womb and how to catch a baby. I felt it all very important information to know even as a student nurse. I was lucky enough to witness two births which were completely different. The first was very quick. No sooner had the mother got onto the delivery bed, she was pushing and the baby’s head was emerging. I was so emotional and in awe of the mum, it was an incredible moment. Fathers and family very rarely attend the birth of babies in the villages of Takoradi, and it made me sad seeing the mum go through it all alone with no support from loved ones. But her little boy was perfect. New mums are encouraged to feed their babies quickly. I was impressed by a talk a general nurse gave to all the new mums educating them on how to feed their babies and why it is so important. I like that all the student nurses in Ghana gain experience on maternity and children’s ward, it gives them an understanding and basic knowledge of other branches in nursing.

The second birth I witnessed was distressing all round. The mother did not make it to the delivery room and was crouched on the floor beside the bed in agony. The midwife rushed over and told her to get on the bed, but she couldn’t. At this point, the midwife struck the woman and pushed her onto her back on the floor. I saw the baby’s head and became frozen on the spot. The midwife was clearly unhappy and shouted at the woman whilst delivering the baby onto the floor, who was then whisked away to be cleaned up.

I couldn’t believe what I had seen. I had to get off the ward. I was angry, upset and in shock from how the mother and baby had been treated. I know little of midwifery, but I know that was unacceptable and dangerous practice. I reported it to the matron who shared my shock. I was relieved that mother and baby were fine and also that it was my last week. Witnessing such disrespect from a fellow healthcare professional had made me so livid and upset that I was ready to go home to our NHS.

My experience of Ghana was not just hospital and clinically based. I felt that I was part of Effia, staying with a family in very much a poverty stricken part of the town. Food was precious, and water even more so, but I met wonderful and generous people with whom I shared great moments with and who I will keep in touch with. Some of the acts of kindness welcomeness and generosity I received by the people of Ghana were overwhelming. The people I met there made my time incredible and unforgettable.

The trip was more than a volunteering experience; it was the most difficult, emotional and amazing journey I have ever had. I hope that it has made me a better nurse and person for experiencing it.

Alison Rose is a student nurse

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Readers' comments (1)

  • Alison, great account and write-up of your experience of healthcare delivery in Ghana. In terms of what could be done to ameliorate some of the worrying discrepancies you witnessed first hand, how about starting a network to connect some of those doctors, who have no experience or knowledge of holistic care as clearly elucidated in your piece, to doctors on the NHS who you know to practice this approach in delivering their service of care?
    Similarly, the midwife you saw whacking the poor expectant mother may benefit from such a connecition. I believe this network connections could go a long way in improving the knowledge base of these professionals who still perform rather wonderfully under such challenging conditions. Conversely, your efforts might help the doctors and nurses in the NHS also learn a thing or two from their counterparts in Ghana. An example of what a midwife in the NHS might want to know and learn is how that midwife could revive the new baby and get it breathing without the use of any sophisticated device with the only oxygen cannister away in A&E.
    I find it incredible too that mosquito nets long propagated to be a good defense against malaria is still not reckoned as important in preventing the onset of the disease in the first place. To me, it sounds like a conspiracy. And what is the price of an average net on the market? Is it so expensive to the extent that even those in hospitals receiving treatment could not be protected from further stings? May be you may want to launch an appeal drive for donations in this aspect too.

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