Life in the ER of a Hospital in Ghana

I’ve been staring at my laptop for 2 hrs trying to figure out how to adequately capture my experience in the ER of the Volta Regional [teaching] hospital today. I decided to back track and retrace my steps in hopes of painting an accurate picture of my interactions throughout the day. I didn’t sleep well, woke up before my alarm and eventually realized I was extremely excited about my upcoming day at the hospital.

The entire week I’ll be wearing Emory [scrubs] styled by Traci, and will probably forget to take a selfie to send her the rest of the week just as I did today. My first stop was at the hospital administration office with the HR director who needed to give the official nod that I could visit the week.  The room was packed with his staff all waiting their turn to speak with him as he barked out orders for everyone he laid eyes on. He called me over to his desk and immediately after our brief intro asked if I voted for Trump.  Our exchanges on the topic was pure comedy for the next 5 mins and everyone in the room laughed hysterically.  He asked me what I wanted to see while at the hospital, I rattled off a bunch of ‘ish, he told me that wasn’t happening pick 2 departments and I chose the ER and herbal dispensary. He stared at me a few seconds and seemed surprised I picked the ER, then “ordered” one of his staff members to walk me to ER and told me to start there today.

As Salam walked me to the ER I jokingly asked if he was going to take the HR director's job to try to cut thru the tension a bit since his boss was just pretty intense with him.  He laughed and respectfully said no that’s his job, but I will fill it when he leaves. He dropped me off in the ER in the hands of Yvonne who’s the equivalent of a charge nurse in the US.  She had a look on her face that said [I don’t have time for this ‘ish today] which I completely understand since that ER was PACKED!

Here was our initial exchange:

Yvonne: Who are you?

Me: Taryn, nice to meet you

Yvonne: What are you?

Me: I paused and thought [I’m a lot of things] but replied I’m a volunteer

Yvonne: So, you’re not a nurse. You’re nothing.

Me: Another pause and thought [oh no I’m a lot] but replied yeah I’m nothing with a smirk to ensure our English translated 1:1 especially since I knew she didn’t intend to be offensive.

I’m grateful I interacted with Yvonne the way I did because she wound up being my biggest advocate throughout the day.  She handed me to off to Paul another nurse to have him show me around.  Ok so imagine if our US hospital ER facilities were one room that included admin intake, vital checks, triage, trauma surgery, overflow and finance | discharge.  I’m sure its hard to imagine but that’s the exact setup at this hospital!! The triage and surgical “areas which are 3 beds on opposite sides of “the” room are referred to as the diaspora, with the hallway that can hold two beds serving as overflow. At the end of the hallway there’s a room where they treat people with broken bones, etc and around the corner is the “transition” area where they move patients after they’ve been stabilized in the diaspora. The pharmacy and herbal dispensary are the same facility and adjacent to the ER.

After my “orientation” with Paul he handed me off to Dr. Afran who was manning the consult | intake desk.  Paul gave me an overview of the physical setup of the ER and now I was going to learn about how they staff and manage the space. Dr. Afran was responsible for diagnosing | treating | determining if in patient or out of patient care was needed.  Most of the cases he diagnosed and treated on the spot by writing a prescription. He’s a first year resident and I noticed he kept referring to a book that looked like dictionary before he wrote each prescription.  I got up to look at the book and it was the official Republic of Ghana Standard Treatment Guidelines. I snapped a few photos of it.

Each patient that came in while I shadowed at the desk were either having complications from hypertension or respiratory viral infection which I was told is very common for patients with HIV.  Yvonne was watching me like a hawk while I was with Paul and Dr. Afran, so sensed I was getting bored.  She called me over to shadow her and Dr. Moro as he was following up with a patient.  This is the moment and start of one of the most meaningful days of my life. I also realized Yvonne was warming up to me since she was extremely friendly the remainder of the day.

The ER is managed by residents and attendees are only called when something comes up they can’t handle.  Dr. Moro was responsible for all of the patients in the diaspora and I got to shadow him on his rounds at each of the 8 beds.  He’s patient, a great teacher and I quickly learned he studied medicine in China 6 years learning western coupled with traditional Chinese medicine and spent 1 year in Japan.  I wanted to gain his respect so I showed my hand by diagnosing a couple of patients. I’m intense, this is my gift and is also the only party trick I have. After my two diagnosis he was very curios about me and we began a great conversation | exchange on why he intentionally chooses not to prescribe plant based medicine to patients even though he uses TCM [traditional Chinese medicine] to treat himself.  In short, he feels its irresponsible since herbal meds aren’t regulated and available in enough to hospitals to not cause greater harm to patients.  He further explained that if he prescribes herbal meds and a patient goes to another hospital where they’re not available, they will self treat with the herbs not understanding the proper doses.  Dr. Moro gained my respect with that response, however I warned him I’d be continuing this conversation the next 3 days.  He laughed and said he was going to make time for me tomorrow. He’s exceptional and I know there are great things in store in his future.  I hope I can share a perspective that stays with Dr. Moro and motivates him to consider how he can integrate his knowledge of TCM into his daily patient care routine one day, since there’s a mission in Ghana to make these options more mainstream. More. To. Come.