Lessons Learned From Ghana

Words by Seema Pattni

The Beginning

Several years ago I visited Ghana.  This warm hearted country gave rise to some of my first few adventures as an Exploress.  It all started in a tiny red and yellow Daewoo taxi which ascended through a rainforest, and up a mountain.  Climbing up the pot-holed winding mountain road, the foliage grew denser. We passed small waterfalls, exotic plants and over-took lorries loaded sky-high with yam; we reached the Plateau and took a left turn into a small puddle-ridden mud-track.  The track was lined with tall coconut and trees, papaya trees and huge bushes.  After five minutes we arrived at what appeared an abandoned brick building, painted yellow and pink.  It was announced that this was the student doctor house.  It was in the middle of the forest, a mass of rich green met your eyes whichever direction you looked in and there was certainly no lack of aural stimulation – birds, crickets, goats, roosters and elusive animals all formed a resident outdoor choir.

The House

I walked up the uneven cement steps into what was to be my home for the next five weeks.  Through the wooden front door I entered the living room, which was nice enough, and looking into the disused kitchen I caught site of hundreds, maybe thousands, of tiny white insects crawling over the surfaces and sink.  On the kitchen floor were ten buckets filled with murky water – “for bathing and for the toilet” commented my guide, Soloman.  There was no running water and electricity was temperamental.  At least the bedroom was big, with a decent bed.

Working in Ghana

The hospital was several small, white, one-storey buildings connected to each other by an open walk-way, flanked by green lawns dotted with chickens!  I was shown the paediatric ward which had about 10 beds in an open bay and a few side rooms as well as a tiny play area with the alphabet painted on the wall and two big toy cars to play in.  Next were the female and male wards both again with about ten beds, and some side rooms, there were also a few occupied beds which were fitted in where-ever there was space.  There were two operating theatres, and a labour and maternity ward.  Casualty was an unassuming building at the front of the hospital outside which was a road that led to the various mountain villages.

On my first day, I witnessed one of the saddest episodes I have ever seen.  A young woman was in labour.  The baby was breech.  When the baby was delivered, there was no cry, no movement.  The baby was blue.  The nurses placed the tiny baby boy on the resuscitation unit and half heartedly attempted to revive the baby.  The consultant had already moved onto the next patient.  I could not believe what I was seeing.  After hurriedly finding the right protocol in my medical handbook I tried to resuscitate the baby with my colleague but we were unsuccessful.  The baby was stone cold.  There was no pulse.  The nurses told us to stop.  They attended to the mother, who seemed unaware of what was happening, or perhaps she did not need to be told that her baby had been still born.  It was a painfully emotional episode.  In front of us lay a tiny human being, his features so clear and fully formed.  He was so still.  His face wore a serene expression.  It was meant to be the day on which his life began.  A surge of anger rose within me, coupled with feelings of guilt and sadness.  I wrapped the baby in his blanket.

Later that day the consultant explained that my colleague and I would be the ‘doctors’ in charge of the casualty department from 2pm till evening.  We would have nurses to translate for us and there would be a doctor on-call (off site) if we needed help.  Responding to what I presume was a panic stricken expression working its way across my face, the consultant attempted to reassure me “you will find it within yourself; you know more than you think and this is your chance to grow.  Don’t be afraid to use your books or each other”.  He added that we should take a torch to help us walk back to the house at night as there were no street lights.

Casualty consisted of crowds of patients sitting on wooden benches in a waiting room that looked out onto the forest.  The triage room was cramped: one wooden desk, two chairs, a fridge and cupboard half-filled with outdated medication and equipment.  Next to the triage room was a bay with three emergency beds and four beds for patients to be admitted in.

The lack of emergency equipment was, for me, the biggest challenge.  It was also apparent that many of the nurses did not know protocols for dealing with urgent cases.  When a 37 year old man was rushed in as an emergency it was down to me to deal with him.  He was sweating profusely, his pulse was ridiculously fast and bounding.  He had a soaring temperature and was fluctuating in and out of consciousness.  My instinct told me that he had suffered a subarachnoid haemorrhage.  My own heart began to race.  I gathered from his friend that he had been complaining of a headache when collapsed and that he had been unable to stand up again.  His wife and baby were in the waiting room.  I measured his blood pressure and it was an alarming reading.  I arranged for him to be given medication to reduce his blood pressure but the nurses were so slow to respond – I wanted to shout.  It was hard to leave that night, the patient was not improving.

The next morning I went back to Casualty and the nurse informed me that his blood pressure was getting worse.  They had not followed our instructions either.  I went to see the patient.  Another doctor was present and confirmed that the patient had suffered a subarachnoid haemorrhage.  He concluded that there was nothing we could do to save the patient and moved on to another patient.  I stayed.  I looked at the man and felt responsible for not being able to save him.  I tried to rationalise to myself that his condition had a bad prognosis in any part of the world.  His bed linen was soaked in sweat but the nurse did not want to use any more medication or resources on him knowing that he would not survive.  As I walked away I heard him gasp.  I turned back and his bounding pulse was gone.  His face was rigid.  He had died.  Inside I cried.

I took a while to understand that not everyone can be saved.  The doctors work incredibly hard but with limited resources there are many situations which cannot be resolved – that is the signature of healthcare in many economically developing countries.  It is not a lack of good intention or drive, it is a lack of money and training.

I went on the outreach trips to schools and remote villages.  One village I visited consisted only of 6 round mud huts in a circle.  We set up in a derelict school room – there were still sums chalked out on the old blackboard.  There were twenty-four children living in the village, none of them had ever been out its vicinity before.  It was a complete novelty for them, therefore, to see a car and an ‘Obruni’ (white person).  The children arrived in small groups, whispering hurriedly and pointing at me; after plenty of staring and poking they established that I was indeed a real person but just with different colour skin.  I am British Asian but to these children, and in fact most Ghanaians, my brown skin is still classed as ‘white’!

The nurse explained that the children’s parents were farmers who worked all day and did not have time to take their children to the local clinic or hospital.  Immunisations (and contraception) were provided for free but the families did not have the finances to support a healthy diet or to buy medication.  The children had no schooling, no books and no toys, not even a ball, to play with, yet they were happy and mischievous.  I was taken aback with how material possession for these families was almost non-existent in stark contrast to how we live in ‘the West’.   

The Country

There is a wealth of natural beauty in Ghana:  the majestic mountain-lined Lake Bosumtwi and the breath-taking, mystical Boti Falls.  I walked a rope bridge in Kakum National Park at a height which made tall trees look like small bushes!  I stood twenty metres away from two wild elephants and swam in a pool that overlooked the animals’ watering hole at Mole National Park.  I stumbled through a group of man-sized baboons chasing each other and then ate my lunch in the company of a family of warthogs on a walking safari.

The cities are bustling hubs of activity.  I got lost in the maze that is Kjeti Market, the biggest market in West Africa.  I partied in a tiny bar with locals having a funeral ‘after-party’, they taught me how to dance ‘properly’.  I visited Cape Coast Castle, a former British Fort, where I learnt about the slave trade and the impact this had on Ghana.

The palm-lined, white sand beaches are untouched, with only a few tourist resorts.  The waves are strong and the sea is luxuriously warm.  Often is the case that the only other people on the beach are fishermen or a local passing by with a huge tub of plantain balanced on their heads.

In Ghana, everything is public.  Not much happens behind closed doors!  Walking through the streets you will see people socialising, cooking, eating, washing.  Funerals and weddings are both colourful and loud street-affairs.  Lively music is playing on every street corner with children dancing around the speakers.  Food, clothes, shoes and televisions line pavements, all for sale.  Town streets are busy: there are scores of taxis honking their horns on the main roads and you have to weave your way through the crowds of people.  During daylight hours there is not a single quiet moment!

Ghanaians are over-whelming in their hospitality and friendliness, they are fun-loving, happy, very helpful and earnest people.  Everywhere I looked people were smiling, laughing.  The street vendors were up at the first light of dawn and hawking at the top of their voices – adding to the noise and chaos of the roads.  Even on the cramped death-trap tro-tros (minibuses) passengers would talk and joke with each other.  The word ‘stress’ did not feature in the average Ghanaian’s vocabulary when I was there; Ghanaians are pragmatic, enduring and eternally positive.  It is the people and their unshakable attitude to life and hardship that made the biggest impression on me.