A Day in the General Hospital Wards

Monday June 12

Today I was in the general wards which is where patients are admitted if they need to stay overnight or longer. Usually, the order is they go to the outpatient department (which is like urgent care), then if it’s bad enough, they go to the ER, then when they’re stable enough but need to stay longer, they go to the general wards.

We started by sitting next to the resident doctors who were filling out online charts, one on a desktop and one on an iPad. We then followed them around on their rounds and then Dr. Nyarko came and took over most of the rounds since she’s the supervisor and needs to check in on the patients most days. There are two floors and they have long rooms with cribs or beds and chairs for families. It definitely feels very different than US hospitals, things are not as disinfected as much, the metal cribs can be rusty, etc. She said that if moms need to stay overnight with their kids, they have mattresses they can put on the ground, and that someone donated some fold-out beds but they take up space so they need to figure out where they’d put them. Here is a picture of the hallway of the wards (the doctors chart at desks in the hallway) and one corner of one of the wards, some were more colorful than others.

We saw a baby girl who had an abscess on her chest, although this was not noticeable to me.

Dr. Nyarko said that it’s common for new mothers to go stay with their mothers or their mother-in-law in the postpartum period (or have them come stay). But, this can cause problems sometimes when the older generation has old wives' tales that aren’t medically accurate. This particular baby had a condition where she was lactating (this can happen to newborn girls when all the postpartum hormones in the mother's body are passed to the baby so their lactation is stimulated). The grandmother thought the best thing was to express the milk and squeeze it out which caused mastitis.

In the burns unit, we saw a kid who had hot oil spilled on him (or he knocked it over), his mother is a food vendor and probably had a big pan of oil to fry things. He was bandaged and sleeping. We also saw a kid with hot water burns on her stomach. The doctor said that the burns seemed as if they had been poured on, but they didn’t suspect child abuse because the mother and grandma explained that they were pouring water on to wash her and underestimated the temperature.

The doctor said that in the hot season (even though it’s very hot now it’s not their hottest season!) the burns ward will be empty, but in this rainy season they see more burns. Usually when preparing bath water, moms will have a bucket of boiled water and then leave it to get cold water to add in to make it cooler, but when they leave the child can knock it over. So, the doctor recommends adding cool water first but the moms don’t always do that because it’s easier to control the temp by adding cold water later.

This reminds me of a former Willamette student who I heard wrote a children's book on kitchen safety to distribute somewhere where she interned in Africa and saw lots of kitchen burns on kids.

We saw a baby with fetal alcohol syndrome who was 7 weeks old. She had been there for maybe 2 weeks and had seizures in her left arm. The doctor showed the mom pictures of the facial features of fetal alcohol syndrome and concluded that she did probably have that, considering that the mom was drinking during pregnancy.

One of the more shocking things was that we had seen about 4 kids in the parking lot coming in, and they were the siblings of the baby with fetal alcohol syndrome. They seemed close in age and one had an infant on her back who I thought was a sibling, but the doctor said that was her daughter. She seemed super young and was maybe 14-15 but it’s hard to tell. So, the mother of the baby with fetal alcohol syndrome is also a grandmother. Dr. Nyarko said something about trying to tell her to stop having kids if she can’t afford them, but she also said that she has lots of family problems.

The baby was released but as they were going out, the mom was arguing and crying with the doctor and nurse. The doctor later told us that the mom was mad at the hospital and said they didn’t do anything for her, mainly because she had to pay for the visit. Apparently insurance doesn’t cover most prescriptions and hospital visits, and the government recently made it so people have to pay more for visits because now the cost of hospital utilities is included. Apparently the hospital was supporting the mom and paying for some things because she couldn’t but now she has this bill she can’t pay. The doctor said it was for 97 Cedis which would be about 9 US dollars so that was very humbling to hear that the family couldn’t afford that.

It also gave me more understanding of why the family planning clinic in the hospital is so important- they give birth control implants or injections to women and it’s often without the husbands knowing. But, that resource is probably underutilized and they can’t even really afford to have lots of condoms on hand to give out. And, family size is normally pretty large here and birth control is definitely stigmatized.

In the ward, we also saw a one-year-old kid with vomiting and diarrhea. They measured the circumference of his upper arm and he qualified for moderate malnutrition because his arm measurement was 12cm. 11.5-12.5 is moderate malnutrition and 12.5-13.5 shows mild malnutrition, but they don’t have a program for mild malnutrition so they only focus on moderate and severe. So, they are going to refer him to the dietician.

Another thing that was shocking was that his brother was taking care of him; there was no mother present. The brother said he was 14 but seemed maybe 11-12. The doctor asked him what school he went to and said that she knew he should be in his exam week right now. He was very used to taking care of his brother, he fed him and gave him water, changed his clothes, etc.

We also saw a girl with stomach pain and no mother present, they were trying to figure out where the mother was and why she hadn’t been given the medication.

A peer saw a patient with septic arthritis in his shoulder and x-ray showed an enlarged heart but they didn’t tell the family about the heart issue because they knew the family couldn’t afford to do anything for it. It wasn’t causing pain so they were just going to focus on the thing causing pain presently. So, that was quite different than what you’d expect them to do in the US, where they probably would have to tell the patient regardless of circumstances.

There was also a girl with sickle cell who was getting an IV. As we were standing waiting for them to get the IV in, my peer who was also standing there fainted and I grabbed her and laid her down. She was ok, so then we had lunch then went back home.

Another peer saw a patient whose family had traveled from Togo to seek medical care, so they were mostly French-speaking.

We then went out to a gym that was a short ride away. It was 3 stories and I bought a 10-visit pass. There was a nice view from the top. Unfortunately, a lot of machines were broken but it was still nice and there was a smoothie place next door with smoothies for less than 2 US dollars.