Time keeps on ticking, ticking, ticking....

Some of you have been e-mailing me asking how I spend my days...well here's the loooooong version of it: Generally life here is very slooooow and very hooooot. I wake around 6:30am and by then the kids have already cleaned our compound (picked up the trash that people drop everywhere, swept every inch of the property focusing mostly on the goat/sheep/chicken feces) and done their laundry (hand washed in a bucket). I have my bucket shower in the outdoor stall (assuming there's water, which there hasn't been for the last 5 days!). We have breakfast delivered in a basket to our outdoor table at 7:30am - every day it is the same: white bread with Lipton tea. I have finally located a stall here who sells "peanut paste" (natural peanut butter) which I add to a banana sold locally as well. Off to the hospital at 8am, which is only  a 5 min. walk - Margret Marquat Catholic Hospital, which is the largest facility within 100 miles or so,  has about 150 beds, 4 doctors and tons of nurses and nursing students. My 1st two weeks were spent in the maternity ward - that was quite an experience! There is a delivery room which has 4 "stretchers" and there are 4 patient rooms, each which have 8 beds. There are no privacy curtains and when the women have to go to the bathroom they usually squat on the floor and use a bucket they brought with them. Unless a woman has a c-section (which is approx. 35% of the births), they are not offered any drugs - all births are 100% el natural!
The morning starts with nurses rounds - we fly through each room with very few words being exchanged with the patients. Although Ghana's national language is English, everyone here speaks Ewe. So it is very difficult to follow any communication because it's mostly in Ewe. The nurses will answer any questions I have in English but it gets rather tiresome to have to ask a million questions to understand what's happening with each patient! Nurses' rounds through 25-30 patients usually takes about 15 minutes. A doctor usually arrives around 8:30 or 9 and then we all do Doctor's rounds. This time each patient is "addressed" by the Doctor however 3 of the 4 doctors are Cuban and their English is...well...let's just say not understandable. So each patient is asked "Are you fine?" and if they do not respond with something convincing then they are often discharged. To watch the attempt of English dialogue between the local nurses and the Cuban doctors, it's a wonder why more patients aren't actually  harmed by the miscommunication! Most of the time I have no idea what they are saying even though it's a mixture of English and body language!

I have now watched/participated in a good amount of deliveries and c-sections. It is so incredibly different than the US. Here, most women are not involved in their healthcare. Procedures are not explained to them and they just do as they're told, often without understanding why. The lack of respect that the women receive during their labor, delivery and very short stay is shocking! It is common for the mid-wives and doctors to yell at the women because because they have not positioned their body appropriately for an exam or during delivery, or because they've groaned during delivery, or because they have items on their bed after they've been admitted. A common procedure here, done almost daily, is an EOU - evacuation of the uterus. This is done when a woman has a miscarriage which results in too much bleeding or, more commonly - almost daily- when a woman tries to self-abort. Women here are able to obtain cytoxin, a prescription used to induce labor at term, without a prescription. So a woman will take this at home, deliver the fetus usually without the placenta which will cause hemorrhaging requiring emergency care. When they arrive at the hospital, it is common that they will not admit that they were pregnant, never mind that they have self-aborted a fetus at home.

Another very different aspect of labor here is that the husbands/fathers are never involved in the delivery. Mother's or Auntie's bring the pregnant woman in but even they are not allowed to stay in the delivery room. Instead the patient is brought to the communal delivery room where she will join everyone else in labor without any privacy - there are no dividing curtains nor any sheets provided and the sarong style dress that most women wear upon arrival is removed as they hit the later stages of labor. They each lie on stretchers/tables that remain flat - no elevation of their back nor anyone or anything to help hold their legs.   Even after birth when the Mother is returned to the Maternity ward patient room (shared by 7 other women, again without any privacy curtains), the husbands do not come to the hospital.

Each woman is responsible for bringing just about everything needed for delivering a baby. In the delivery room they must bring a small plastic sheet, an absorbant square pad and a "sheet" for the delivery table/stretcher (a piece of fabric). Also a smaller sarong of fabric to swath the baby in, as well as another sarong of fabric for the nurse to clean up the baby and the mother following delivery, is also required. They must also bring their own blade for the nurse to shave them (not a razor, but an old fashioned blade), as well as a bucket to urinate in, petroleum jelly to rub all over the baby and more plastic and sarong sheets for the bed that they will transfer to in the maternity ward after delivery. Sanitary napkins are also required....graphic/rated R info here....these are used to stop the bleeding after giving birth or any other situation where a woman may be bleeding vaginally. Those of you who are Mom's or are in the medical field should be feeling appalled right now....they insert the sanitary pad into the vagina, through the cervix and to the uterus to stop any bleeding. They leave this in place and instruct the Mother to remove this pad an hour later when she is back in the communal maternity ward! Can you even imagine!!

After the birth, the baby is immediately taken away from Mom, and is not returned for at least half an hour or so. They wait until the placenta has been delivered and until both Mom and baby have been cleaned up. During that time, Moms rarely ask about the baby - what the sex is, is s/he healthy etc etc?

Another oddity is that most medication needed is the responsibility of the patient. If they require anti-biotics etc the doctor will write an rx and the patient or a family member has to go to the hospital pharmacy to purchase the medication. It seems the only medication that the nurses provide are IV blood, saline or Ringers lactate etc.

This hospital is in much better condition that I anticipated. There may be 8 patients to a room in all wards (surgical, medical, maternity, children's and outpatient) and only 4 doctors for 150 beds and only 1 mercury blood pressure monitor per ward but it has running water, real toilets, normal walls/ceilings/floors, overhead fans for most rooms, A/C in the operating room, latex gloves, 1 x-ray machine, 1 ultrasound machine, 2 ventilators, an oxygen tank in each ward and some rather sophisticated eye exam equipment.  Although many of their techniques are antiquated or unsterile by western standards, I'm still surprised at the relative cleanliness of everything, especially given that everything outside the hospital is layered with dirt and grime.

The biggest challenge that I am having thus far is that I am very much under-utilized and therefore I may, in fact, die from boredom! I work at the hospital from 8-12:30 M-F and usually do not return after lunch because I have spent much of the morning doing nothing. Of course there are births etc but there is so much waiting for.... nothing! I have found that the hospital is really overstaffed! There are only 4 doctors but there are lots of mid-wives and nurses, and at least a gazillion nursing students. So it is actually hard to DO anything when there are so many  healthcare workers present, and this leads to a lot of sitting around. So many of the white volunteers (there are 5 of us in the hospital currently) are resigned to watching rather than actually participating - not exactly what I had in mind for this venture!This has lead to frustration in areas where I had never expected 1) Even though this area is very poor, there really is not a need for more healthcare workers 2) It is very difficult to learn anything because, although the national language is English, everyone actually speaks Ewe and 3) It is very difficult to share anything with the nurses because, for the most part, they do not care about learning or improving. They are not interested in learning how to keep equiptment sterile or how to educate their patients etc etc. So all in all, I am not doing as much as I'd like, I'm not learning as much as I'd like and I'm not sharing as much as I'd like....hhhhhmmmm....what's wrong with this picture??!!  :)

Over the past week, I've taken some steps to hopefully improve my experience here....I'll write more about that the next time.

Miss you all!!