Ghana Blog: Patience in the Frustration

Chandler standing outside the dietitian ward at PML. Notice that they spell dietitian different.

July 7th, 2017

This week I have had the honor and the privilege of being in Princess Marie Louise Children's Hospital in Accra, Ghana. The hospital is located in the heart of Accra: the market. One must drive down the busy streets of the market to get to the hospital. The hospital is open air meaning that some of the building is open to the outside and the rest does not have air conditioning. There is air conditioning in the operating rooms and pharmacy for safety protocols. When you walk into the hospital, the first thing you see is the mortician ward. There's a coffin outside of it. Needless to say, it's depressing to see that as you walk into the hospital. You then walk into an open area that has multiple rooms along the side. When patients come, they receive their patient records and wait to be seen for vitals. The nurses and doctors have a triage system where the most severe patient is seen first.

There are always about 200 woman waiting with their children. They sit everywhere among the hospital waiting for their child to be seen. The hospital has many different wards including a cholera bay, retrovirus clinic, x-ray, lab, emergency, ICU, PT, malnutrition ward, and nutrition rehabilitation center. The emergency area is crammed pack. It is a very small space with about 10 nurses and doctors and about 30 patients. There aren't enough beds so many parents sit in chairs and have their children sit in their lap while they receive IV fluids. The smell hit me as soon as I stepped into the ER. I didn't know if I was going to be able to work at this hospital. There's no air flow and it just smells of sickness. Thankfully, I was able to calm myself down by taking deep breaths and relaxing.

When I think of the ICU, I think of a very sterile, cold, clean, contained environment. It's the complete opposite here. There are two babies/children at each bed, there’s no air flow, the room is full of sleeping parents, and children receiving oxygen, IV's, and blood crammed into one average size American bedroom. I was shocked by the sanitation of the hospital. The hospital's sanitation protocol is nothing like the hospitals in the U.S. There's no sewage system. This means that surrounding the border of the hospital are concrete slabs with slits in it. Underneath is a moat exposed to the air with all the urine and feces. There's no fresh air. It always smells of urine and poop. There’s also not a lot of trash cans conveniently located around, so it is common to see trash and waste on the ground.

One thing that I have thoroughly enjoyed at this hospital is their emphasis on malnutrition and nutrition rehabilitation. Malnourishment is common in many of the patients that are brought to the hospital. Most children that are diagnosed with malnutrition are at the hospital for different reasons like malaria or pneumonia. I cannot wrap my mind around the fact that some parents have no idea that their baby is malnourished. I just wonder if they ever think that maybe their baby is too skinny or if they even worry about those things. The dietetic interns at the hospital told me that most children/babies are malnourished because their parents just don’t know how to properly feed them. The child/baby will stay in the malnutrition ward receiving different milk formulas until their weight rises to the correct range for their age. Once they are discharged from the malnutrition ward, their next step is the nutrition rehabilitation center. They receive nutrition counseling about what foods to add to their child’s diet. The amazing thing about this place is that the mothers come in everyday and cook breakfast and lunch for their child free of charge. The hospital funds all the food that is needed for the recipes. It creates a welcoming and supporting environment where the moms can come and cook healthy foods for their children so they can be healthy and continue to gain weight. The community amongst the woman is astounding. They get along so well and share a common goal of providing a healthier life for their family.

The last thing I want to share is an experience I had recently in the emergency ward. I was going on rounds with some of the dietetic interns and our first stop was the emergency ward. There was a patient that had been admitted the day before for malnutrition and malaria. I actually saw this patient the day before running around with her mom. The mom seemed very young. When we walked into the ward, she and her daughter were both asleep. The intern tried waking her up but she would not respond. The woman next to her gave her a big push and she woke up. I’m not sure what exactly happened because they were speaking a different language. All I know is that we did not weigh her baby and ended up walking away shortly after. I later asked what happened and I was told that the mother is not being cooperative. She believes that her daughter is not malnourished and does not need any sort of treatment. I could visibly see that her baby girl was SAM, meaning severe acute malnutrition. I asked the intern if she ever gets frustrated when situations like this arise and she simply said no, I don’t ever worry myself. She understood that the patient will come to her when she is ready to be counseled. She doesn’t push it because she wants the patient to choose it for herself and her family.

I was so inspired by that. I am sometimes let my passion for helping people turn into frustration when they are not receptive to what I am saying. I just care so deeply and I want to help in everyway possible. I see this little girl in front of me who is skin and bones and I just want to shake the mom and say, “Why are you refusing treatment for your baby girl? She needs this to survive!” But I have realized that I need to take my own personal agenda out of the picture. This moment was about the mom and the baby and about their needs and frustrations. When the mom is ready, she will seek counsel to help her daughter. In the meantime, I can just encourage her and love her where she is at. I will carry that moment into my profession. I will always remember the importance of patience and understanding.

With love from Africa, 


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