Saturday, March 3, 2018

Cross Cultural Healthcare

Greetings from Ghana! What a busy couple of weeks it has been! We are heading into the Harmattan season here and it is heating up! The winds blow across the Sahara desert and into Ghana, making it very dusty. People say the climate becomes drier during this season but it still feels so humid compared to Colorado!
Since I received my Ghanaian nursing license, Jammie Tompkins and I have started volunteering at a hospital close to where we live. It takes about 45 minutes to get to Dodowa Hospital, and it’s a very rough road. When we started orientation, they made us get the old school white dress uniforms. It felt like I was taking a step back in history 50 years, but at least they didn’t make us wear the hats!
We have been working the day shift in the Emergency Department, and it has been a very interesting experience! Let me tell you about some of the differences in healthcare between Ghana and the United States. Patient care is very family oriented here. While family members are involved in care in the States, it’s not nearly to the degree that they are involved here. Family members usually stay with the patient, bring them linens and clothes, help feed them, and help ambulate them to the bathroom. It’s a big help to the nurses, especially when CNA’s aren’t employed on the unit.  
At Dodowa, when a patient needs a medication or treatment, they must pay for it in advance or  they don’t receive it. The patient’s family brings money to the pharmacy in exchange for the medication, and then they bring the medication to the nurse. If the pharmacy doesn’t have the necessary medication, the family member must travel to another pharmacy to look for it. Patient’s family members also take lab specimens to the lab, but first must pay before it can be run. Dodowa doesn’t have certain imaging services available.( For example CAT scan, MRI) Patient’s family members must take them to other facilities that can provide those services. Then, they must bring the patient and the results back to Dodowa. They have to pay before the imaging will be performed.
It’s always very hard to see when patients have to pay for services before they can receive them. A lot of people around here are impoverished and can’t afford medical procedures. We see people die because they can’t afford medications or treatments that would save their lives. Since poverty is more common here, people wait until it’s absolutely necessary to go to the hospital for help. A lot of the time they wait until it’s too late. A lot of people end up dying from preventable causes because they can’t afford treatment or wait too long to get help. It’s hard to deal with, but just like healthcare in any other area, you have to find a way to deal with the tragedy you see.
I know the United States has a lot of issues with their healthcare, and it is by no means perfect. But we all need to be so thankful that we receive the quality of care that we do. I invite anyone who disagrees with me to come over and see what type of healthcare other people around the world receive. The US is by no means perfect, and yes, they make mistakes. But trust me when I say it can always be much, much worse.  
There are also a lot of cultural differences in medical care between Ghana and the United States. There is a section of the hospital called Traditional Medicine. This is for patients who don’t believe in Western medicine. They focus a lot on using natural herbs and things that grow locally to treat illnesses. Also, I learned that if you transfuse blood here, it is common to cover the blood with a sheet. That way people don’t have to look at it. According to a nurse I worked with, people have different beliefs about a person’s blood. Some people believe that if you receive another person’s blood, some of that person can be transferred to you; including their curses. Parts of Africa are very animistic in their belief system, meaning that everything has different spirits. If someone dies, it could be because a curse was placed on them or their family. Those curses can then be transferred through the blood.
Here’s another case the shows the cultural differences you deal with while performing medical care abroad. During my time at Dodowa, a patient passed away before receiving treatment. The patient was then transferred to the morgue. The next day, family members of the patient tried to break into the morgue to retrieve the body. The family’s pastor had told them that the patient needed to be resurrected. He stayed on the phone with them to give instructions of how to perform the resurrection. The family even assaulted some of the hospital staff in order to steal the body out of the morgue. That’s something you definitely don’t deal with in the States.
Another big difference in medical care from Ghana to the United States is the role of a nurse. According to a member of the hospital staff, nurses are expected to follow orders, and to give medications. It’s not emphasized to use critical thinking to evaluate your patient or question orders that are inappropriate. According to this nurse, the only one that typically uses a stethoscope to evaluate the patient is a doctor or physician’s assistant. I feel very blessed to have received the education that I did. It has been amazing be able to use that education help others in the States and abroad.
We have now finished our Emergency Room rotation. Shortly, we will be moving on to Pediatrics and Labor and Delivery. It has been so interesting to learn more about tropical medicine, and also about the cultural practices here. I am anxious to continue my work and see what else I can do to help! Thank you for all of your continued prayers and the love you send my way. I very much appreciate it!  

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