^Some of the staff at Passion Clinic, my partner in the program, and me outside of Passion Clinic. We look simultaneously extremely dorky and cool and I love it.
Sorry for the silence over here for the past couple of months (oops). I arrived home safe and sound and have since spent much time wishing I was back in Ghana and adjusting to another crazy busy undergrad year. But now, I figure it’s time to wrap up my experiences abroad and address a few of those worries from the start of my journey.
I thought it’d be interesting to share a few of my internship notes as a final reflection of all that I saw, both the mundane and the terribly exciting. These are my raw observations and interpretations, and looking back, I’m so glad I (somewhat) obsessively took notes. And so, a day in the life at Passion Clinic!
^This was taken towards the end of July. I spent the day in a hospital and saw three C-sections! And I held a baby! I teared up when I heard the first cries. Life, guys. It’s pretty rad.
-family brought in elderly woman in a wheelchair. She was here a little bit ago from a stroke that left her with left hemiplegia. Today she complained of severe chest pain and a cough. The doctor thinks she wasn’t taking aspirin, causing an embolism to form and cause the cough and pain. He referred her to a large hospital with x rays and necessary equipment to remove the embolism.
-a 3 year old and his mom came in. The kid had cuts in his forehead from a fan. They cleaned the wound and put iodine in it. He wasn’t too happy with that, but his resistance was the sweetest. He would softly cry and try to bat Christine’s [a nurse] hand away. At one point, he sat in the ground and just looked sad. He also tried to grab his mom’s hand and pull her out of the room. Once in the waiting room, still softly crying, he tried putting his mom’s purse on her to get her to leave. As soon as they left the building, he stopped crying.
-mom comes in with her 6 wk old baby. Everyone just sits around, eating peanuts, instead of starting the check up. Baby has an umbilical hernia that they’ll fix (someday) with surgery to push the hernia back in and suture it closed. When the baby got fussy, the mom would immediately start breastfeeding. The openness by her and the acceptance/ tolerance of everyone else was beautiful.
-the power went out around midday. Lack of electricity makes having everything handwritten make more sense. No use depending on something that leaves often enough.
-a 2 year old girl is in with malaria. She’s been vomiting and having diarrhea countless times the past couple of days. Poor thing looks exhausted and could barely protest when given the IV (DNS). Her parents are both very attentive and clearly worried. The doctor explained that they can only give her half the IV bc of her size (that’s a thing for pediatrics)
-man in early 20s came in to get a head wound dressed. Yesterday he came in with a huge gash on his head from getting accidentally whacked by a machete. He got 7 stitches. The bandage wraps all around his head.
-Saw a woman get an ultrasound. She’s 4 weeks pregnant! I have no idea how the doctor identified the fetus in the ultrasound–it didn’t look like anything was there! I could only see pulsing that the doctor said was a blood vessel but not the fetus.
-the same preacher came in for morning devotion. He was here for about 20 min. The first 10 were for singing and individual prayer, the last for preaching. I have the bad habit of tuning out preaching, but I think the gist was the god makes impossible things possible. I liked the heavy emphasis on personal prayer. I heard lots of expression of gratitude. It almost sounded like meditating.
-doctor explained a few things about the anesthesia during a cs. The drug is heavier than CSF, so the patient needs to be upright to let it settle lower than the phrenic nerve. Also, it is a vasculodialator, and that’s why the blood pressure lowers when it’s injected. To counteract the bp from lowering too much, the mother is given about 1L of saline IV before to keep the volume higher.
-pregnant mom came in with a note about her baby from Pentecost. The baby has a right cryptorchism, so our doctor found a doctor that can handle the confusion and lower the testicle. Otherwise, it’ll become cancerous by the time the male is about 30 years old.
-talked more about fertility with the doctor. There’s a huge stigma here if you don’t have kids. If a lady has uterine fibroids, she has a myomectomy immediately to increase her ability to have kids. Also, IVF and egg/sperm freezing are becoming more popular. IVF is about 20,000 gh, egg freezing about 1,500, and sperm freezing about 500.
-woman came in with a man. Not sure if he’s a relative or bf. But she has a swollen, black eye from domestic violence. She was wearing an oversized black hoodie, and would slump her shoulders and wear her hood, keeping her head down. She received a tetanus shot and was given antibiotics and NSAIDs to reduce inflammation and prevent infection. I’ve never knowingly seen a domestic abuse victim in person. It’s very tough.
-man who came in with the machete wound the other day got the wound re-dressed. He also had x rays with him, showing that his skull wasn’t damaged. There is edema by the stitches that the doctor says is part of the healing process.
-a pregnant woman got a shot of iron
-doctor explained 3 types of venom from snake bites: hemotoxic, neurotoxic, and musculotoxic.
-2 young sisters came in to get anti malaria shots. Their cries fed off of each other and it was just a teensy bit funny.
-Joe [an administrator] brought us each apple juice and a big box of biscuits!
-woman (with family holding) stumbled in, no control over body movements. As soon as in a bed, in cardiac arrest. Heart beats very far apart (bradycardia) and unintelligible bp (bc blood not pumping strong enough to extremities). After starting a RNS IV (that took a while bc low blood flow) they gave her an adrenaline equivalent to increase her heart rate and thus bp. Then her bp skyrocketed to around 180/130, so they gave her another injection to bring it down. They also gave her furosemide (I think) to get her to pass urine to make sure she didn’t undergo renal failure. They placed in a catheter to monitor urine. They also gave her an oxygen mask and positioned her body on the side so if she throws up, she doesn’t choke on her vomit. Within about 20 min, she regained consciousness. With time, she could slowly, laboriously move her limbs and barely whisper.
-the doctor got us rice and chicken for lunch!
-saw Florence remove a 5 year old birth control implant. Because it’s been in there for so long, the tissue (fat) surrounding it grew around it, making the implants difficult to remove. After removal, the patient received a depo shot.
-I was standing outside the clinic, waiting for the doctor to have a spare moment where I could thank him for welcoming and teaching us. A girl about my age walked up to me. She got close and said “I’m four and a half months pregnant. Can I get rid of it here?” I stopped short a bit. It was my first time meeting a woman who openly wanted an abortion. I told her to meet with a doctor or nurse, as they’re qualified to talk about that, but she didn’t want to do that. She asked to see the pharmacist, hoping for a drug, I think, that could induce abortion. I asked her a few questions, and she said she’s 20, took a pregnancy test to know she’s pregnant, has known for 4 months, and the baby daddy knows too. She looked a bit skittish and scared, but the smiley type of scared. I didn’t know what else I could do for her, but she looked like she needed help. Probably another one of my most poignant experiences here. Naima [another nurse] just told me that the girl also went up to her and asked for a friend.
-man came in needing dressing for feet and knee wound. He only had 30 cedi on him and was worrying about the total cost of everything.
Honestly, I’m still trying to process all I observed. Passion Clinic is small and its medical care capacity is extremely limited, yet a large number of people were treated for malaria and received wound treatment, antenatal care appointments, and birth control. For such a small clinic, it provided the basics for a significant number of people. I suppose that’s what really matters in the end.
But of course, there were the extremely poignant patients. I’ve never really considered domestic violence and abortion from a medical perspective before. I still don’t know what to make of what I saw or what I should have done. What role should I, an international and pre-med student, have in situations like that? And looking to the future, what role should I, as a doctor, have in those situations? I suspect these are things I will grapple with for a while yet.
I remember several times, Dr. William turned to me and, almost as an apology, said, “This is the African way of doing things. It’s the best we can do.” Yes, the healthcare system has flaws. More than once, I raised my eyebrows at what I saw. Yet ultimately, I recognize that the patients received sufficient care from incredibly hardworking and caring personnel. I hope to have such fortitude and spirit as a healthcare practitioner someday.
And now, to address those concerns/ worries I had before I embarked on my journey!
Flying Internationally Alone
Friends, I can fly internationally alone! How rad! How empowering!
Of course, flying always comes with risks, but having all my ducks in a row, knowing where I was going, and getting to the gates ridiculously early helped calm some of my nerves.
Transportation in Accra
Gosh, trotros. What a wild ride. You will be pleased to hear I did not get lost and a trotro broke down on me only once! I had a trick of sitting as close to the mate (the person on the trotro who collected fare and told the driver when to stop) as possible and being very insistent when my stop approached. I found, more often than not, that mates and fellow passengers were kind and understanding of my unfamiliarity with the system.
Another handy little tidbit for transportation in Accra: Ghana has Uber! How delightful! If, say, I wanted to go out in the evening, it was far easier to call an Uber than figure out nighttime trotros.
^A trotro making its way through Madina market.
Working in a Medical Capacity
I think my worry for working in a medical capacity (and possibly doing more harm than good) isn’t one that evaporates within a couple of months in a foreign country. Instead, I have a hunch I’ll carry around this worry for the rest of my life. But I earnestly believe if I have the best of intentions and am prepared and knowledgeable, I will do more good than harm.
I have mixed feelings on bugs. Initially, I only worried about mosquito bites. This was a very worthy worry, as it turns out, because I am particularly attractive to mosquitoes and have somewhat intense reactions to their bites. As in, the bite would swell to the diameter of an orange, turn red and hot, and leave a bruise in its wake. Very strange.
But other bugs were silently waiting to eat me or burrow into my skin that I didn’t even know to worry about! (Look up “neglected tropical diseases” if you really want to get freaked out.) I have a lingering fear of getting schistosomiasis (think of baby worms that hang out in freshwater and can bury into your skin and leave you with an extremely morbid disease) and will never take swimming in freshwater for granted again.
^Do you see that mosquito bite??
I don’t know why I worried about this at all. Just read my previous blog post to get a glimpse into bright and lively (can food be bright and lively?) Ghanaian food. I miss it immensely.
^Fruits I wish were in my belly right now.
And would you look at that, I crossed off every item on my bucket list/ fear list! Giving myself a pat on the back right now.
Lastly, I’d like to thank you, dear reader, for sticking around and listening to my ramblings and musings. I had the time of my life in Ghana, and sharing this journey with you made it all the better. Even now, I find it difficult to articulate all that I’ve observed, all that I’ve learned, so a real kudos to you for bearing with me.
Lots of love,