Hospital Hel(l)thcare and Detective Drew's Data

The past two days my research team and I have been familiarizing ourselves at the Komfo Anoke Teaching Hospital here in Kumasi where we will be conducting our research the next ten weeks. The maternity wards where we will be spending our time are grossly different from those in the States or other developed countries. Our hospital delivers 40-50 babies each day, and the antenatal (before they give birth) and postnatal (after they give birth) wards are overflowing to the point that they often have two women per bed - the overflow rest on sheet-less mats on the floor. There is absolutely no privacy for these women, as people such as ourselves walk through the aisle and the hustle and bustle of the nurses and medical teams ebbs and flows some how despite the ever-diminishing floor space. This is how it is, unless you have the privilege of affording the "VIP" labor ward that offers curtains, actually clean sheets, and a private delivery room.
In the delivery room, up to 10 women in their first stage of labor (before their cervix has dilated enough to begin delivery) wait in a tiny room with a bench, using buckets to relieve themselves as they wait to reach full dilation, at which point they will be transferred to one of eight side-by-side delivery beds where they will give birth without the assistance of any medication or drugs. As is cultural custom, they are urged by the nurses to refrain from making noise or screaming during delivery.
This is one of the top two hospitals in Ghana. Yet it remains understaffed, understocked with essential life-saving medical supplies, overburdened, and overcrowded. These are just a few of the reasons why my research task is so difficult and important: trying to locate all of the necessary information about each woman who comes in to deliver, and conduct interviews with those who have severe or life-threatening complications during delivery, is an exercise in detective work when patient records regularly go missing, women are transferred without notice to different wards, and the nurses are too overburdened to fully record all of the important information for each patient.
For instance, each of the three delivery wards (the regular, overcrowded one, the VIP one, and the surgical one) have an A&D book- Admission and Dispatch - that tracks each woman while she is there. They each have a delivery book as well that records information about the actual birth. There are also the individual patient records. And finally, the anesthesiologist in the surgery ward has his or her own book. Now, imagine a woman who is admitted to the regular ward and is having labor contractions. She is registered in the A&D book for that ward. One day later, it becomes apparent that she has pregnancy-induced diabetes and needs special care. So she is transferred to the "black room" - the ward for pregnant women with complications. So she is signed out of the first book and into the new ward's book. Then her family manages to come up with some quick cash to get her into the VIP ward for the best care. Now she has been signed out of the second ward, and has been admitted to the new VIP ward and is in it's book. But then the doctors detect fetal distress and decide they need to perform an emergency c-section right away. So she goes down to the surgical ward (called the theater) and is recorded in that book, and has the emergency c-section and is recorded in the anesthesiologist's book, before being returned to the VIP ward with her new baby. So now, she has been admitted into three wards, discharged from two, and her delivery was officially recorded in the third (surgical ward). She is additionally in the anesthesiologists book, and has her own personal chart.
So the next day, when I come in and see there was a woman who had a complication and I go to try to find her, I must track her through each ward and book to find all of the information. This is especially complicated because not all of the proper information was recorded in each of the books. Rather, each of the books captures some of her information, and it is possible that even when combined they fail to capture the full picture of what happened, so I need to find her chart, only it has gone missing....and once I find all of that information, I still need to interview her. Now you begin to get the picture of what we are up against.....
There are many additional logistics to be covered before we can begin our research - most importantly the fact that we are still awaiting the final approval of the IRB ( the Institutional Review Board that must clear us for our research). It also includes securing interpreters for the interviews and finding an appropriate place that ensures privacy during the interview, practicing the interviews and the data entry, and meeting all of the appropriate contacts, nurses and doctors we will be working with.

PHEW! Needless to say the last couple of days have been intriguing, exciting and exhausting. I'm incredibly excited to begin the research, to continue picking up the local language (Twi), to learn how to get around using the tro-tros (the mini-vans that act as public transportation) and to finally have a place to stay. Our first place in Kumasi on Sunday night consisted of four cement walls, two bunk beds, and THAT"S IT - unless of course you count the bed bugs...two of the students who were less-than-thrilled opted to sleep on chairs for the night (LOL). So last night and tonight we are "living in luxury" at a very nice guest house our research director has been staying at while we wait for our next place to stay to be ready. We will move tomorrow to the medical students' guest house located right behind the hospital. But after two weeks we will move one more time to the newer quarters of the med student lodging where most of the international medical students are housed (it is currently full as school does not get out until the end of this month).


Such is the current state of affairs here in Kumasi, Ghana.
Detective Drew, signing off.

It's Ghanarific: Sweaty bills and mysterious rice baggies

WOOT! I have arrived. Accra - the capital of Ghana - is a sprawling, lush, bustling city during the rainy season. I have spent the past two nights at a hostel at the University of Ghana, and the days exploring the campus and touring Accra. The weather here brings back memories of Jamaica during it's rainy season - hot hot, humid humid, hot - with occasional heavy showers (though it hasn't actually rained yet). We're talking over 100 degrees Fahrenheit each day and 80-90% humidity. But I actually don't mind (except for my secret money belt fanny pack which holds in some rather unpleasant heat and moisture in my groinal area, making me feel quite sorry for the poor Ghanaian who must take my warm, moist Cedi (Ghanaian money)).

I head up to Kumasi today on a bus with the other U of M students. Besides the four of us who will be conducting research regarding maternal obstetric complications in the hospital, we have been joined by another U of M group of students (undergrads) who are also studying maternal mortality on a four week program and who will be staying with host families. So it has been interesting touring Ghana with such a big group. And by interesting I mean uncomfortable. I have found - through my study abroad program in Jamaica and to a lesser extent in Korea - that it is always better to be a traveler or tourist by myself or with one other person. Groups of obvious tourist/travelers, especially in countries where there are few white people, are such an eye sore, and draw so much (often unwanted) attention, making me feel quite uncomfortable. I much prefer to be on my own, where I can interact with locals better.

However, despite my previous experience being on my own in other countries, I must always start out a newbie, getting a feel for the culture and learning how to go about simple tasks such as getting lunch. For instance, yesterday when we were dropped off on the main busy street to find ourselves lunch and look around, I was DETERMINED not to eat at Papaye, the "Burger King/ McDonald's"-esque fast food chain that all the other students made a beeline for. For I, having traveled around the world and being oh-so-knowledgeable, was going to order street food like the locals and the ex-pats who live here. So I found a popular street stall (always go for a popular one so you know that it at least sits well with the locals) and attempted to order the one dish I knew called Jolof rice (rice cooked in a tomato-based soup). Of course, they were out, and I ended up with a plastic baggy full of plain rice with a mysterious brown sauce. I had no idea if I was supposed to eat it with my hands or if there were utensils around, because all of the locals ordered and took their baggies with them. So I paid and walked away, pretending I knew exactly what I had just gotten and how I should properly consume it (turns out they eat it with their hand, which I'm glad I didn't given how filthy mine were).....and made a beeline for Papaye, for an expensive but delicious grilled fish and Jolof rice...WITH utensils, thank you very much.

And so it goes as I slowly get a feel for my new surroundings, adapting to the heat and constant sweat, and the new food and ways to consume it. West Africa is vibrant and alive, and I am excited to go to Kumasi where I will spend the remainder of my time (besides weekend excursions), exploring the largest open air market in West Africa, the food (I had Bunku last night- a large ball of play dough-like mashed cassava that you pinch off with your hand and dip in sauce- not so great) the countryside, the people, the language (Twi is the main spoken language after English in the Ashanti region where I'll be staying) and the culture.

Akwaaba - Welcome- to Ghana