Family Structure in Ghana and Perception of the US

 Wednesday June 14 

We were in the maternity hospital again. We started in the labor ward and saw the mother who had been only 3 cm dilated yesterday afternoon, but this morning she was lying with her baby by her side! My peer who is a PA student did some basic assessments like listening to heart and lung sounds and the mother seemed very healthy. She was very excited to see us and show us her baby who was a boy She is 29 years old and this is her 5th child. 

Also in the labor ward was another postpartum mother who said she was having abdominal pains. The midwives said that when the patients are soon transferred to the postpartum ward, they will be given medicine for the afterpains of birth. 

There was a mother in the early stages of labor and we heard the midwife check the fetal heartbeat which was strong. There were no other mothers in labor there.

We talked to the midwife students (there were 3 in the ward) and they said midwife school is 3-4 years here. They said that this is the only maternity ward in the Jamestown area but I’m not sure how many others there are in Accra. 

Ghanaian Family

While waiting for the doctor to go on rounds, we talked a lot to one of the nurses in the OR. We talked about the differences between the US and here and what working in this clinic is like. She said family size is a big difference, it’s normal to see moms with 4-7 kids. She laughed when I said I only have one brother. We did show her a picture of the 19 children in the Duggar family and that surprised her. 

She also said they definitely do see 13-14-year-old moms. She said that babies are definitely seen as a blessing and the community will support the mom. They don’t often encourage young mothers to marry the father, and she said people don’t get married very young here, maybe around 25, and it isn’t that weird to have several kids by that age and get married then. She did say that they have many single mothers. Family planning is definitely stigmatized here, my peer helped in a talk at a school about STI prevention and they weren’t allowed to talk about birth control. 

So, it’s interesting that in a very religious community, you might expect young marriage and children only in wedlock to be more common, but it isn’t, even though other religion-informed elements like no birth control are common here. It seems like sleeping outside your marriage isn’t as unusual as you would think too. My roommate saw the HIV clinic and one man said that due to his HIV + status, he used condoms outside of his marriage, but did not use them inside his marriage or tell his wife about his status. That didn’t seem too unheard of for a man to have an affair outside his marriage, although apparently the doctor did bluntly say, “Is your wife not good enough for you?” and the man talked about traveling away from his wife. 

Back to the nurse in the OR, she said they do scans at 18-20 weeks to check for abnormalities and can determine the sex at 16 weeks. 

Immigration

Her and another nurse asked us a lot about life in the US and seemed curious about how they could go there, asking about midwife schools there and hinting that we were friends so they could put us in the visa, we have experienced that before here and just kinda laugh and say we don’t know how that process works. One nurse asked if we had single brothers she could marry. It almost feels normal now for people to ask if they can come visit us in America or think of some way to marry in. 

Outpatient Visits

Each patient would come in and sit in the small office with a doctor and nurse, usually alone but one brought her husband. 

One mother had gestational diabetes and was 38 weeks pregnant, the doctor was encouraging a c-section but the patient wanted to wait until 40 weeks because she wanted to go natural. 

Another woman had twins and was 37 weeks pregnant so they scheduled a c-section for next week. 

A few mothers had high blood pressure and the doctor talked to them about their meds, apparently the oral meds used are the same as in the US. 

Each mother brought a maternal and child health record book that had places to record each visit and measurement, as well as sections to record visits and measurement for the child when they’re born and educational material about child health. These seem like a great way to record the whole pregnancy through childhood and it makes it easy for the doctor to see past info. They haven’t used electronic charts in outpatient and the nurse records some things in a master book. 

A few postpartum mothers came in with their baby, one had her c-section wound checked. The doctor said that there’s no set date for postpartum visits and it depends on the woman and how she’s feeling, she might come a few days or a week after delivery but obviously more if she has a condition. 

The doctor talked about his own background and said that he didn’t like pediatrics, partly because it included malnutrition and it’s so hard to get an IV into a malnourished child. 

One 29yo mother came in with chicken pox who was 20 weeks pregnant. The doctor said there’s not much they can do to prevent risk to the fetus and they will mainly manage the symptoms of the mother. 

One woman came in and is going to be induced tomorrow. The doctor said that they like to induce in the morning so they hopefully give birth by the end of the day. They use the medication Misoprostol to induce and start contractions and open the cervix. 

One woman came in who was 36 weeks but her ultrasound had just shown that the baby had died. So, they were going to induce her pretty soon to start labor and deliver the stillborn. It was obviously very sad. They said they would try to keep her in areas away from babies but she would deliver in the normal labor ward. 

One woman was pregnant with twins and about 36 weeks. Her scan had just shown that the babies were sharing one placenta and the doctor explained to her that this meant that she couldn’t deliver naturally because if one baby came out then the placenta came out, the second baby would be without oxygen without its own placenta. The mother was a little distraught to hear this and the doctor suggested she get another scan because there’s a chance they just couldn’t see the second placenta in that scan. And, the doctor said that the scan would be cheaper than the c section they have to do if there’s only one placenta (he said it would cost 2000 cedis which is about 200 US). 

A lab rep came in and tried to pitch the doctor to send patients to their lab for tests and scans even though it would be more expensive and further. 

Labor Ward

We then went to the labor ward and there was just one mother in labor. She was 5cm and I watched them do a cervical check. They had started her on oxytocin and ruptured her membrane to try to speed it up. 

She was definitely in a lot of pain and they don’t do epidurals here except in C sections. One nurse said that they are supposed to give medication for pain (I don’t know what the “supposed to” means exactly or who is saying that), but that they don’t it and logistically it would be hard. So, they use natural techniques like pressure on the back. 

The husbands are allowed to come in if the wife is the only one in the laboring room but they don’t often come in, and the nurses said they are sometimes fishermen who won’t be here on land. The head nurse also said that traditionally it’s bad luck for fathers to see the baby in the first two weeks so they might often stay away. 

This particular mom did not have anyone in with her, it felt very different than the idea of birth in the US and it felt like this mom was very much on her own with only the midwives coming to check on her every so often but didn’t have a consistent person there with her and no pain relief. 

Mall and Bolt Driver Dreams

We then left and went back to the house. On the drive back our driver stopped at 3 different tire fixing shops on the side of the road. Then, we went to the mall which was an hour drive. Our driver fell asleep at the wheel while stopped in traffic but it was ok otherwise. He talked a lot about travel and how America seems great except that people aren’t as friendly and you have to be more cautious. But, it was his dream to go to America or Europe. Several people had said that they really want to go to America and they do try to say you're friends so they can use you on a visa.

We shopped some then watched the new a little Mermaid movie which was really good. We thought it would be like the US where there is 20 min of trailers, but we showed up 15 min late and the movie had started. They had popcorn and candy but also things like plantain chips and yam chips. 

We used an ATM at the mall then went back, it took only 30 min to get back because the traffic is lighter.