Wherein I teach women how to breastfeed.

Internet is spotty at best, but is in Ghana! It’s been several days here and eventful. I was in a community clinic (think going to the doctor’s office, but in a rural Ghanaian village), shadowing the nurses for the first two days.

The first day was spent working with a Ghanaian nurse in the outpatient clinic where people from the surrounding towns and villages come to get medicine. For the most part, we saw lots of fevers (malaria) or abdominal pain (worms) and we prescribed antibiotics. (You’re wondering how he made the diagnosis: verbal symptoms and experience).

At one point the Ghanaian nurse and I were trying to figure out why a little old lady was peeing a lot, thirsty, with back pain and hypertension. It was cool because we were basically acting as doctors (some nurses have diagnostic and prescriptive powers over here, far out) and he took my input when I asked whether it could be the start of diabetes. We tested her blood sugar – normal - and decided that perhaps her kidneys were beginning to fail, but a good course of antibiotics never hurt anyone. Hopefully it was an infection that the antibiotics covered and she would not be back; if she returned within a few days the plan was to admit her for intravenous antibiotics.

The afternoon was spent administering the antibiotics, which are painful injections deep into the “buttocks” as it’s spelled here. It’s the rainy season and malaria is rampant, but I’m not sure how much so because we didn’t do blood tests. According to Integrated Management of Childhood Illnesses (IMCI) protocols from the WHO, if a child has a high enough fever during the rainy season in a malarial endemic area, it’s diagnostic for malaria and should be treated with antibiotics even without a blood test confirmation. I don’t know if the same holds true for adults, but that seemed to be the operating assumption at the clinic. I wondered though what treating every fever with quinine does/would eventually do to the local malarial strain’s resistance to it, especially because it’s reserved for severe malaria. Food for thought..

The next day I taught a group of women about breastfeeding because, you know, I have so much experience with that. Ha. But it went really well. There's a bunch of literature from the WHO for health care providers and the Ghana health ministry about it, so I basically reinforced messages they’ve already heard: exclusively breastfeed for the first six months, proper positioning and signs/symptoms to come to the clinic for. There was lots of laughter, weighing of babies, vaccinations and “abroni” (Twi for “white person”) songs.

Today was my first day at the Komfo Anokye Teaching Hospital (KATH) and it was something I’ll never forget. We weren’t sure if students would be allowed to shadow nurses on the labor and delivery floor, but it came through today and lucky me, I was one of the first ones. It took lots of introductions and explaining who we were, what we were doing, and that we were here to learn, but we eventually had a wonderful tour of all the maternal wards followed by several hours watching births. I saw a spontaneous vaginal birth (ouch) and a c-section (double ouch) and was beyond impressed. The nurses and doctors asked me several times how it compared to the US and I honestly said that other than supplies and volume of patients, it was the same. Actually, the Ghanaian surgeon was much faster at the c-section and he seemed pleased when I told him as he left to do another in the next operating theater.

After a very full morning, we took a tour of the new hospital built two years ago. Again, beyond impressive. I wish I had been able to take photos, but patient privacy is more important than my crappy blog, so no photos. Hopefully tomorrow I’ll take some audio snippets interviewing the doctor and nurse I’m shadowing.