Struggles

July 1, 2010 – edited July 15

Time is flying. I love it here. I really love Kumasi and I don’t think I’ll ever be able to articulate how good I feel here. (Here, now, in this setting, time of life, body, group of people, I don’t know what it is but it feels easy and natural to be content). I think this is partly an apology for junior year because this is as good as junior year was bad and the happiness permeates everything I do. Anyway, all the international students are noticing huge gaping holes in the system here. Before I go on, I want to make it clear that it is really a luxury for my conscience that I am not here to help with anything. I must observe. I am not burdened with guilt that I’m ‘not doing enough’ or that I’m ignoring atrocities because I’m not supposed to be doing service work, I’m supposed to be an observer. This is because of 2 reasons: 1. I am here doing research. I am not an MD, not close to being an MD, and for me to treat someone would be unethical and totally unreasonable. That is not why I’m here. That would be pointless and even if I had the skills, it would be completely unsustainable. (Side note: sustainable is one of the buzzwords in public health. More to come on this later, but I think it’s something that most people doing ‘international service work’ ignore.) 2. Systems need to change from within. It doesn’t make sense to force new fetal monitors on the doctors when they don’t want them. They won’t use them; they aren’t asking for them. They have seen healthcare in the US or UK but they don’t implement the same patient safety systems we have. I want to know what their reason is, but I know that the reason isn’t because they lack resources. I think saying that doesn’t give Ghanaians enough credit. If they want something, they’ll do everything they can to get it. I know the western world isn’t better in all aspects, and I think that with the amount of resources that we have, we are doing a pretty bad job of promoting a healthier world and being good people, but I can’t help thinking the phrase “don’t crowd out the important for the urgent.” That’s the basic theory behind time management and an appointment schedule. You make time for things that are important to you. Here, if you have 45 women and one is bleeding out or giving birth, you will pay attention to that woman. Then you neglect to see other women who are not at risk yet, but become at risk because they didn’t get proper treatment in the first place. Then they are the women bleeding out or giving birth prematurely. That is unsafe and irresponsible and crowding out the important for the urgent. Not good.

I might be naïve but why can’t all the ob/gyns take 1 day/month and work at a district hospital? There are 30 doctors, so that clinic (hopefully staffed with nurses) could see patients every day. Why can’t the doctors without anything to do see the hundreds of patients that are sitting and waiting all day, just a few feet away from this incredibly concentrated center of educated individuals? Why can’t midwives give weekly lectures on safe home birth practices? Or nurses give safe sex talks? Or secretaries distribute condoms? Or a group of med students take blood pressure and distribute hypertension drugs? Or tackle trash distribution? Nutrition? Warning signs in pregnancy? I guess this question won’t ever be answered, and I won’t be satisfied unless everyone is taking measures to reach their full potential and be incredible doctors.

Ghanaian proverb for the day: When a man is wealthy he may wear an old cloth.