OPD, Malnutrition Mortality, and US Hot Topics- June 29

Thursday June 29

Today I went to the outpatient department. Normally this would have been a special clinic day (I think either sickle cell or HIV), but today was supposed to have been the holiday celebrated yesterday so they didn’t schedule any clinic appointment for today (the lunar calendar that decides when the holiday is wasn’t totally accurate since it’s based on when a human first sees a certain moon and there is often cloud cover, so they had to change the date about a week before). The outside statues of Princess Marie and Dr. Cecily Williams (a malnutrition pioneer researcher) were decorated for the holiday.

Some people still came in and the doctor had to tell them to come next week since the staff for the clinic weren’t in today. Here's a picture of part of the inside of one of the OPD rooms, there are usually lots of posters about disease prevention or treatment of malaria, TB, and HIV.

The OPD functions mainly as an urgent care here, stats say that this hospital sees 165 patients per day in OPD but it’s hard to tell how true that is because I’m only here for part of the day and in just 1/4 rooms. The kids we saw were in for malaria, foot worms, a cold, and a heart problem that needed to be referred to a cardiologist at Korle-Bu Teaching Hospital.

Dr. Mensah only speaks English so sometimes the parent’s English wasn’t that good and I’m not sure if things were communicated fully but I think in the end things got across. Almost all of them were sent to another part of the hospital to get labs or an x ray done.

The doctor would get the social history from each patient and would also ask if there’s anything they’re allergic to, but wouldn’t use the word allergic. Today in the ER my roommate saw a girl come in with a bad allergic reaction that wasn’t into anaphylactic shock, but the doctor said that next time it happened it would be fatal so the mom should figure out what she’s allergic to. They do not have Epi pens here and she said that allergies are a “rich man’s disease” and if you have an anaphylactic reaction you just have to rush to the hospital and pray. I think allergies are pretty rare here but they don’t have any allergists near here and definitely no allergy testing to see what you’re allergic to.

The doctor had a meeting so we went to the malnutrition ward. We learned that one of the 2yo severely malnourished kids passed away this week. It was initially unbelievable because we had seen her all last week and assumed she was maybe moved to another hospital or the ER, but she had been here a month with no weight gain and on Monday she couldn’t even sit up, was still vomiting everything from her NG tube, then she passed the next day. This is obviously very sad, especially sitting in front of the cot where she had been the whole time. But, I do believe she’s in a better place in Heaven now and doesn’t have to suffer anymore. A lot of us have had mixed emotions about the mother because she waited so long to bring her in and was eating some of the food intended for the child. But, she almost definitely has a really hard home life and is in a cycle of poverty (she couldn’t afford any of the food or supplies; social welfare paid for everything including eventually food for the mother).

In the malnutrition ward, there was a new patient so the doctor walked us through the new patient assessment. They took his weight, height, and arm measurements and checked charts that classified him as severely malnourished. The TV in the malnutrition ward was switching between playing Cocomelon or really old-school Christian kids songs (they advertised cassette tapes at the end). It's probably good for the kid's stimulation to listen to music; they have a small play area in the ward but I've never seen it being used.

We then went out to lunch at Kakun, a coffee shop and cafe. On our bolt ride home, the driver talked to us a lot. We talked some about America and he mentioned how Kamala Harris had visited here recently but that he didn’t like it because he thought she was just telling them what to do and imposing America on them. He then started talking more about America and asked what we thought of transgender people. This is the third time my roommate has been asked this by a driver. He talked about how he thought ‘making a mistake’ like that affects your whole family so it’s not good. I explained that in America we have a much more individualist mindset than they do here in Ghana where family is your identity, and we have a more you-do-you perspective. He said that it was taking the easy way out for men to transition and we talked about how gender roles are not as rigid in America than in Ghana and our occupations can be the same, to which he talked a lot about women cooking and cleaning. He asked if our goal was to have women be as ‘powerful’ as men to which we said yes and then he laughed. So, it’s interesting to see how that perspective is very normal here and that transitioning genders seems extra shocking here because of the divide in roles. I’ve definitely noticed that while there are female doctors, most roles are very traditionally deprecated by gender. It would feel unheard of to have a man cooking in the hospital kitchen; or a male nursing student.

We talked a little more about America and he said that he wants to visit somewhere cold in the US. He was shocked when we said there are 50 states.

That night Dr. Christian came and gave a lecture on the Ghanaian healthcare system and we mainly learned about the different levels of facilities. We also learned about Ghanaian medical school, it’s 6 years of medical school (no undergrad here before that though) then two years as a house office then you get your certificate and can be a resident. Each doctor in training needs to spend time at a district hospital, most of which are rural and with low resources, which apparently most doctors do not like and this can motivate them to go practice somewhere else.