Rubbers everywhere....it's a global health issue!

Sachet of water

 "Rubber" is what they often call plastic bags here in Ghana. In the market, at the stores, and for take away bags it is offered and widely used, just like back home. Here, even water comes in bags that are bitten off at an end to drink. One bag of safe drinking water probably holds about 500 mL. With the heat and amount I sweat here, I go through about 5 - 7 of these bags a day on my own. Once I have emptied them into my reusable water bottle, the bag goes in the garbage can.

Now from this can, where does all this "rubber" go? First, let me take you on a little observational summary of our travel journey thus far. As you know, we landed in Accra - huge city, people everywhere, markets, vendors on the streets, individuals balancing heavy weights of water or food or snacks on their heads in great big bowls and walking between traffic with incredible skill. It was a lot to take in initially, especially after 30+ hours of travel.

From Accra, we drove to Cape Coast to stop in Elmina, and then stayed in Kumasi overnight.  Throughout the drive, I gazed out the windows of our Van, feeling the hot air dance along my cheeks, dust splashing my skin, all sorts of smells awakening my nose, and noticing the changes in landscape. I observed the open spaces, crammed ally ways, and run off drainage systems along the drive. I looked out at the spider-like trees, they way people were interacting with their surroundings and nature, the way animals were roaming about and scavenging for food. 

Spider (boabab) tree

Among other things, what stuck out to me along this ride was "rubber". Plastic lay in all kinds of areas: in the middle of open fields, in large heaps in the forest or water, next to children playing, along roads, and at our feet when we would step out. Throughout the rest of our travels (from Tamale to Mole National Park and Larabanga, to Bolgatanga, I continued to make note of the "rubber" and where it was gathered. 

Roadside Rubber

As we left Kumasi, Larabanga, and the more rural communities we have been involved in near Bolga, I noticed that the streets seemed well cared for with fewer garbage visible out and about.

Forest Rubber

Some of our Ghanaian colleagues and friends express their frustration regarding the lack of efficient garbage disposal in Ghana and in dealing with garbage. Some state, "kids see how their parents dispose of waste or see others do it and think it is okay to just throw anywhere or leave for someone else to clean up" or "people just do not care because there are no resources". 

How do we shift the attitudes and culture towards improving waste disposal? Similar to our blog on TTH, I wonder if there is a sense of apathy towards caring for the earth because of the continuous lack of resources. Many people are simply trying to survive living in poverty or are focused on other pressing global health issues like education and access to healthcare.

Kids playing football

During our two weeks in Tamale, we began to see heaps of plastics and papers near markets, dwellings, trees, and even near water sources. This included pop bottles, cans, glass, and any garbage really. Up the street from where we stayed in Tamale, we saw children playing football (soccer) each evening once the air cooled slightly. Bare foot and determined, they skillfully maneuvered over concrete patches, squished plastic bottles, bottle caps, and "rubber". 

Now why is all this waste polluting the natural spaces of Ghana? In many Ghanaian cities, there is no working waste collection system. So even if you choose to collect it, what do they do with all the garbage? It is burned. From our many Ghanaian friends and colleagues, we have been informed that this is the only option they have. Burn it or put it on the ground. 

Waste management is an essential health service and pollution is a global environmental health issue. This impacts everyone everywhere in small and large ways. Do you know what happens to your garbage when you put it in your can? Yes, maybe a garbage truck picks it up, but now what? it goes to the landfill. And then what? It sits in the ground contaminating water and soil, generates methane gas, which contributes to climate changes and air pollution, which impacts our health and future.

Rural Village - Less Rubber

Nyoboko - Less Rubber

 How do we keep cities healthy and habitable, so that people and the surrounding living environment can not just survive, they can thrive? Plastic pollution is not a Ghanaian issue, it is a global issue, that has implications for all of us.

Now, there are "waste pickers" out there, people who collect and clean up garbage, making an impact, cleaning up communities and natural spaces. However, approximately 840, 000 tons of plastic waste is generated in Ghana per year, now that is just plastic, and these waste pickers cannot keep up. The tons of waste generated daily results in littering and garbage overflowing the water run off systems. This contributes to the creation of standing water, which can be a breeding ground for vector born illnesses like malaria and cholera. How do we even begin to recycle all of that plastic waste? Is recycling the answer to the plastic pollution issue? By 2050 there will be more plastic than fish in our oceans if we do not begin to take collective and immediate action.

It is possible....rural Ghana

I would like to question the plastic creators. Is it ethical for companies to be supplying goods packaged in plastics to countries that have no means of dealing with the waste? When I reflected on this thought, neoliberalism came to mind (an ideology we discussed in our preparatory advanced global health course). These companies do not care about the impact of their products or its packaging, they care about profits, about themselves; it is every person for themselves.  Right?

Wrong. The lives of those impacted by climate change, by pollution, by plastic wastes matter.

Not only that, the ecosystems and living things being harmed by our actions matter. This is not a Ghanaian issue; this is a global issue. Nature is screaming at us to stop and make changes, to care for one another and the planet that we call home. The question is not whether you will listen, it is whether you will do: will you take action, and will those in positions of power lead?

It's a global health issue....

Posted by Katrina BSN Student

The Little Village..

 

Okanagan (Nyboko Community Clinic)

During our time at Okanagan Community Health Clinic in Nyoboko in the rural Upper East region of Ghana, we were able to experience what it is like to work in a community with restricted access to resources outside of their village. The Okanagan Community Clinic has been running for about a decade now, with limited staff, resources, and equipment, but always supporting its community to the best of its abilities. 

Emmanuel - Community Health Nurse

Currently they have three staff members.  A midwife, a general nurse, and a community health nurse who have been placed here, away from their home regions, in a community that speaks a different language than them. This is common practice in Ghana Health Services, and creates barriers to forming relationships within the community.  As is common with Ghana Health Services, the staff here are often not paid for their work.  They live in accommodations right at the clinic, and travel home to their families over the weekends and holidays.   

Pre-Covid, our School of Nursing had established relationships with the health professionals in this clinic but over the pandemic they all left the community for a variety of reasons.  Our focus this visit was on building new connections and relationships with the current staff members, being mindful that we needed to build trust with each other before we could begin our “usual” community health screening.   All of the current staff have been in Nyobok 4 months or less. It became apparent that Jeanette knew more of the community than they did (she’s been doing this work awhile).  The staff at first was uncertain what it might look like but they were supportive of moving ahead.  We rolled our sleeves up and got to work.

Vida - The Midwife

Before starting the clinics, we participated in home visits in the local villages, meeting families to introduce ourselves and to get a feel of what to expect.  We were welcomed warmly, and all were very interested in what we had to say. We asked them if there were any health concerns within their families and there were few common complaints; joint pain, eyesight issues, coughing.  The one complaint that came from every family was their lack of money, leaving them unable to provide for their family.  With their focus on feeding their families, their health was not a priority.  Their own healthcare becomes secondary to the survival of their family.   

What became very clear to us is the biggest impact of health in these villages is rooted in poverty. We’ve already shared the impact of inflation in Ghana, and these rural/remote communities are hit hardest.  Covid shut down the markets for some length of time, and they lost their ability to trade goods and services; the backbone of their local economy.  They never recovered after the markets re-opened.  

The nearest town is an hour away by vehicle and many don’t own vehicles and transportation options are limited.   It’s a donkey and cart if critical, and if not, they walk 10 km to the nearest health centre.  And once they’ve made it to the health centre or town, health resources are expensive and add up quickly. This means, the majority of the community were unable to get help to even understand what health issues they were experiencing. 

Walking to school for screening

Keeping all this in mind, we began preparation for the health screening. We collaborated with the staff members to build a list of what we needed, and the next day word had spread that the health screening was running and people began to show up at the clinic.  We were filled with a sense of uncertainty, not really knowing what to expect. 

Over the 3 days we helped out with health screening at the village primary school, as well as ran community health screening.  We assessed, consulted, and treated 243 individuals for various health problems. 

Clients came from the local villages and some even travelled from afar, walking very long distances to be screened. We encountered many different languages which was challenging to our work, and we were extremely thankful for the staff and other members of the community who worked together to support us during this process by translating. We experienced amazing collaboration with the staff, critically thinking and bouncing ideas off each other to determine what to do next. How to treat the symptoms being experienced, and a plan of care for the clients.

We were faced with some difficult situations, we had to learn as we went about the barriers clients and staff had to go through to refer acutely ill clients to areas for higher levels of care. We had to remind ourselves that we have the knowledge and skills and ability to assess these clients, develop a plan of care, and do our best to remove the barriers to implementation.  The staff here have a slogan…. “we improvise”.  What we learned through all of this is a recognition that we are well prepared, we’re good problem solvers, we can trust ourselves and our practice, and we love to work as a team with our Ghanaian partners. 

Here are a few situations we encountered and had to consider:

A little boy appears malnourished. Eyes sunken, sleeping during school and unable to keep up with his peers. He has a very slow and irregular heartbeat.  His siblings are well fed but he is half their size. We’re questioning an underlying heart condition.  Is his mother able to get him to a clinic that has the proper resources for testing? And if she can get the testing, can she afford the care that will be required throughout his life?

Villagers work long hours in the hot sun causing constant musculoskeletal pain, impacting their ability to continue daily life in an agricultural community and making it impossible to trade at the market for food and resources. All we can do is give a week worth of joint/pain relievers and show some techniques of stretching  and body mechanics with the hope to ease their pain long-term.   

What follows is a discussion that the “joint pain” might be sickle cell anemia.  We flagged two such cases in two separate families.  We referred them on to get bloodwork, which they may not be able to afford.  The positive outcome being that the clinic staff is aware of these families, and will follow them in the community, whether they are able to get the blood work done or not.  They’ll become part of regular outreach visits. 

We have limited malaria rapid tests and medications, but not enough to test everyone experiencing symptoms.  How to we decide who to test? And once our resources run out how does the clinic afford more? Not easy questions to answer and our Ghanaian colleagues helped us prioritize. 

One client presented with what was believed to be diabetic neuropathy to the foot, causing severe pain, affecting her ability to walk on her own. The clinic doesn’t have the resources for proper testing of diabetes and are unable to get her to  the hospital that is an hour's drive away.  If she is diagnosed with diabetes, how does she afford insulin? Something that is not easily accessible or affordable, even in Canada. Again, we found comfort in knowing the community clinic staff flagged her and would follow her. She too will become part of regular outreach visits.   

Headaches, eyesight problems, infections, chest pain, snake bites, cuts and more. All these symptoms that have been impacting lives for weeks to years, yet community members only seeking help now because resources are finally available for a limited amount of time.  We ask ourselves time and again…is what we’re doing even helpful?  What happens when we're gone?

After three very long days, we had a chance to debrief with the clinic staff.  They marvelled at our ability to collectively assess and treat so many clients.  They expressed immense gratitude at being able to meet so many members of their community that previous to the health screening they did not know.  They felt a newfound sense of connection and responsibility for the village and were excited about strengthening these new relationships.  We could see it...we were serving as the bridge...the villagers learning to trust the clinic staff, and the clinic staff taking responsibility for their community.   Remember, they’ve only been in the village for 4 months. 

The Team

This newfound sense of community and connection they felt to the villagers and the sense of relief we could feel from the villagers answered our question…

Yes….it was helpful. 

Posted by Sophia

Unity Clinic....Chanshegu

Unity Clinic

Welcome to Chanshegu, a village located in the Volta Basin just outside of central Tamale. Rich in love and appreciation for community members, the village shines brightly through its people. 

UBC Okanagan Nursing students and faculty have been working with the village and Ghanaian colleagues here for over 10 years in hopes of being able to build and hand over a community health clinic.

Parts of the clinic are complete and were being used for health screening and education.  However, during the covid-19 pandemic, progress on the clinic came to a halt and certain dynamics affected staffing. Evidently, community access to healthcare and development of the clinic was significantly impacted over the last 3 years.

The Chief's Compound

As we drove to Chanshegu, our professor Jeanette, who has been working with and alongside the local villagers for many years, noticed that there had been a significant amount of development since she was last here 3 years ago. As you know, in 2020 UBCO students were sent home due to the pandemic, but before going home the students were fortunate enough to meet the now late Chief of Chanshegu, who had a longstanding strong and trusting relationship with Jeanette and UBCO. The passing of the Chief has led to a two-year appointing (enskinning) of the new Chief who we were able to meet. The presence of a new Chief has now allowed space for building a new relationship and trusting alliance with the village of Chanshegu.

Drummers Greeting the Chief

Before we could begin anything in Chanshegu, we needed to greet the new Chief. Our dear friends Kassim and Hamza assisted in setting up the meeting. Collectively, we approached the village and were warmly greeted. Firstly, we greeted the Elders, approaching them low to show respect and using local "hellos/how are you" before sitting. After greeting the Elders, we followed them through the huts, trees, and goats to get to the Chief's Palace. A horse inside, we entered after the Elders and awaited the Chief. We learned the horse represents strength and power within the Elders and the Chief of the village.

Now, we are here and eager to understand what the community needs and how we can move forward so that the clinic is functional and beneficial for its people. As our resources are scarce, we did not feel that it would be ethical to run health screening at the clinic this year because we have no follow up support or resources to offer villagers. We needed more time to organize people to help with screening, translation, and determine follow up supports. And, we recognized, doing nothing isn't an option.  We need to re-establish our relationship.  So, with the new Chief's support, Elders, and local villagers, we all organized a community day for celebration and to inform the community of the plans ahead. 

Before we discuss the plans going forward, we must describe this beautiful day of celebration. The sun shined through the clouds as we cleaned the clinic, picked rubbish from the grounds,  and cleared the outside space for pavilions and chairs with the villagers. As the Chief was drummed in, Elders alongside, the people gathered and listened to the beating of hands against drums. Like water running down a mountain, children, women, and men of all ages trickled in and joined in the celebration, embracing the offering of music and connection.

Drumming and Dancing

Drumming and Dancing

The cultural dancers so beautifully and artistically moved about the dust, chiming to the drums with metal instruments that rang with each movement.  We were invited into the circle, and we did our best!  The day grew hotter and it was time to begin to wrap things up. We could not miss this opportunity to address the villagers and provide some health information. So, we (nursing students) presented a health education talk on stretching to improve what they call "waist pain" here, meaning lower back pain. The villagers are often farming and working their bodies incredibly hard, women commonly carrying heavy weights of materials on their heads and sweeping with bent backs. The examples and stretching practice were well received with many giggles and much laughter.  Even the Chief participated and was a role model to the community, twisting his arms back and forth along with us. Having the Chief participate in our exercise was an immense gesture, and represented him as an example for the community to follow. We must thank our dear friends Kasim and Hamza, for supporting and coordinating many pieces needed for this day. We must also thank the new Chief, who clearly embodies the similar values as the previous Chief.

Jeanette addressing community

The goal in Chanshegu is to hand the clinic over to Ghana Health Services, so that it may be staffed by local healthcare workers, rather than be dependent on outside nursing students who come and go each year. It needs to be run by people here, who know and live in the community, so that the needs of the community are best understood and a trusting relationship formed (grassroots approach). Construction on the clinic began about 10 years ago when the main clinic building was put up, brick by brick. There is a second building, that locals call "the detention center". This ward will be beneficial for both mothers and families, in addition to serving those needing closer clinical monitoring.

Our relationship with the Chanshegu community and community health nurses will only grow stronger and more resourceful over time, and we are looking forward to the detention center to finish development and watching the community grow together as a whole.

Kassim and the Squad

Posted by Katrina and Chloe

A Place of Love and Compassion.....

Resident Houses

Shekhinah Clinic is a special place that we had the privilege of visiting while here in Ghana. We only spent a couple of days here, but we can speak for everyone and say that we have never encountered a healthcare facility that felt like such pure love before. 

Dr. David and Mariama

This clinic is a volunteer run initiative started in 1991 founded by the late Dr. David Abdulai. It is now run by his wife, Mariama who has continued his passion to serve the poor and mentally ill.    

One of their approaches to serve their community is the hot food programme. Every day the Shekhinah Clinic serves about 190 people including the mentally ill around the streets of Tamale, the volunteers at the clinic, underfed prisoners at the jail and the residents that call this clinic home. We got to assist with preparing the food and rode along with the meals on wheels delivery service.

Sophia-Grace and Katrina making lunch

 

Katrina and Kyla delivering lunch

One of the things that was the most impressive was how well they knew their community. They have created such a trusted name that they are often contacted by community members with names of new people that are in need of help. These services are respected by others as the food is dropped off in various locations set out for specific people and will be untouched and left for only them.

Mariama under the mango tree

The clinic itself is set around a mango tree and has a quiet and calming atmosphere. There is a walk-in clinic and patients are seen on a first come first serve basis and all services are free. We had the opportunity to help with the outpatient clinic during our time here. They skillfully and swiftly assess the patients and determine their needs. 

They have a pharmacy on their compound that provides medications free of charge, but their medication stocks rely solely on donations. The clinic also has a small operating room that they run once a week where they do smaller surgeries such as hernia repairs. A local physician who works at the Tamale Teaching Hospital volunteers his time once a week. 

Every year, a Canadian doctor volunteers for 1-2 months and operates 5 days a week.  During the days the operation theatre is open they see around fifteen patients. The surgical patients stay on the compound during their recovery.  The local villages were all invited to build a hut for their community members to heal at Shekhina following surgery.  These are all neatly laid out at the edge of the clinic grounds.  The villagers keep the huts clean and are able to stay with their community members post-operatively until they are ready to return home.  

Those who were previously living on the street and suffering from mental illness now live here at the clinic at their own will. They can come and go as they please and are always met with unconditional love. The clinic appears to run like a tight knit family.

One of the residents helping make lunch

The clinic is not associated with Ghana Health Services and receives no government funding. Everything comes solely from donations which means services provided can be unpredictable. But somehow, they always find a way to make it work Dr. Abdulai and Mariama explain that this is all possible due to “Divine Providence”. It’s really something special to witness and be a part of.

During this experience we all found ourselves wondering how a clinic like this could run in Canada. The beautiful work and care that the volunteers at the clinic provide is admirable and should be viewed as the gold standard of care for those struggling with mental illness.  We have much to learn from this little free clinic in Northern Ghana.  

 If you are interested in learning more about the Shekhina clinic, check out this video:

Under the Mango Tree 

 Written by Kyla & Mika

Travelling (tribal) Marks....

 

https://www.pinterest.com/pin/tribal-facial-and-bodily-marks-in-african-culture--
371547037979219640/

One of the first things we noticed about the beautiful faces of Ghana, was that of “tribal scars”. We noticed that they seemed more present on the faces of older generations and less so in the younger. They appear to be marks or burns present in different patterns on cheeks and around the eyes. We started to get curious about this and did a bit of research on the meaning and origin as we recognized they held importance and purpose for the people we met.

The marks are inscribed onto babies on the eighth day of life, in the home of their father and they are given the same marks as their fathers. They are usually burned or cut into the skin, creating lasting scars. There are a multitude of reasons to be given these marks including:  decoration, spiritual protection, medicinal and for identification purposes. The reasons are all dependent on location and can be different for each ethnic group.

We found that scarification is one of the unique features of Ghanaian’s and hold deep roots in their culture. In northern Ghana these were mostly used for identification and each family lineage had their own unique markings. This is to recognize who comes from what family and what tribe they were a part of. The tradition has been going on for centuries, originally used because tribes would often battle against each other not knowing who their brothers and sisters were. So, to differentiate from other tribes, they would mark themselves and their children. This was also used to guide tribes and their people back together if they were ever separated.  This is where the term "travelling marks" comes from.  

Our Friend Hamzah

When used for decoration reasons, it was due to its aesthetic appeal among many tribes. When used for medicinal purposes, a short scar on the right check can signify a near death experience. When used at this specific time, the marks are done to save a child’s life, inscribed by a herbalist combined with medicine to cure them. This also serves as a permanent reminder for the child of their near-death experience in the future. In other regions, it is said that marking for spiritual protection was done to make children unappealing, so they are not brought to the underworld by spirits. They believed if a child was beautiful that the spirits would take them for themselves, so to make the child unappealing was to protect the child’s life.

The practice of tribal marking is fading as it has proven to be harmful to the health of the baby. This could be due to the blood loss, unsterile equipment and the unknown effects of the herbal concoctions used. Additionally, parents are less inclined to inflict pain onto their children and are now more understanding and educated on the implications of this practice.

Even though this practice is dying out it will always hold strong implications for some. For instance, during the transatlantic slave trade, people that were torn away from their families, culture, and language, now may only have their scars as a connection to their home.

We found this a vital topic to research, and we are thankful for those who shared their stories to help us understand.

Written by Kyla and Sophia

The Hardest Thing ....

 

Main Entrance TTH

"What is the hardest thing you've ever done?" asked a friend on a midsummer evening, lit by the dancing flames of the campfire.

I knew my answer prior to coming to Ghana. When I was five, it was learning how to read. When I was 15, it was speaking in public. At 20, it was holding the hand of a dying woman who had no family present due to initial Covid-19 visitor restrictions. I've learnt over the years that the hardest things we do in life are one day replaced by new and vital experiences. Change shapes us into who we want to become; it is the catalyst for growth. For many members within our group, one of the hardest experiences we've encountered has come from our week of practice at the Tamale Teaching Hospital (TTH). To begin, however, you must have a picture of what TTH is like.

I had never seen sheep at a hospital before. At first glance, it made me laugh as they wandered freely through the hospital grounds, calling out now and then. The center of TTH is like a heartbeat; each function connected to and vital for the survival of the surrounding network. Children run and play. Men and women sleep on matts on the pavement during the day. Mothers wash and hang their clothes and linens to dry. Some cook. Some clean. It functions as a small village; each action is part of the greater network that contributes to the health and healing of those inside the hospital.

If the courtyard acts as the heartbeat of the hospital, the hallways are the vessels and arteries that connect various units. Women come and go, bringing clothes and food to their hospitalized family members. If the patient does not have family present, they do not have access to food, water, or help to gather medications and pay for treatments. As a body cannot live without a heart, so this ecosystem would fall apart without family present.

A soft breeze followed us as we walked through an open corridor that separates portions of the accident and emergency (A&E) departments. The A&E has three zones, partitioned by walls and separated by hallways, varying in size and severity of the patients admitted. I inwardly smiled as I observed the open windows, welcoming the warm and gentle breeze indoors. Oh, how Florence Nightingale would be glad! Such a privilege would never occur in a hospital in Canada; I've longed to breathe in fresh air many times while working in the stifling heat of a crowded hospital room at home. 

The Courtyard

TTH, as described, is beautiful. It is also one of the hardest working environments we have worked in as nursing students. Within these walls hold women who hemorrhage from preventable postpartum complications; children who die from a lack of initial critical care treatment; men who will pass away from the inability to afford lifesaving surgeries. "They come to us with the hope that we will help", stated a doctor, gesturing towards some of the above examples, "but we cannot help".

Working as a nurse in a low-resource hospital with a healthcare system that functions on a pay-as-you-go structure is vastly different from Canada. Nurses face moral dilemmas daily as they witness family unable to pay for recommended treatments, services, or diagnostic tools. When their patient is crying out in pain, they're helpless. They know that without treatment or surgery, the patient will die.

When treatment is a financial option for the family, it is often delayed due to the lack of resources, the pace of the work environment and lack of urgency. Many of these nurses are paid less than a dollar a day, while some are not paid for months. Within this system, the statement, "nursing is not a job, it's a calling" is the dividing line between the level of care provided.  

During our time at TTH, we interacted with nurses who learnt the local language just to communicate with the poor and undereducated population. I saw nurses wash the faces of the elderly who had no family present to help; nurses that walked with patients to appointments and guided them through the hallways. 

I also saw nurses who slept on their shift while their patient bled to death (perhaps tired from their second job that's required to feed their family). Nurses that would scold family members for crying at a bedside (frustration with their inability to help); nurses who wouldn't allow a mother to grieve the death of her daughter at the bedside (it is unbearable). Nurses who sat at a desk on their phone while their patient cried out in pain (they've shut down).  Trying to make sense of what is happening around us, we empathize and feel compassion.  Day after day, faced with immense suffering and a lack of resources, it is very easy to give up and lose hope. 

The hardest thing about practicing in TTH is that it is difficult to make a change. Due to the structure of the healthcare system (pay as you go or cash and carry), critically ill patients wait hours or even days for surgical consults, diagnostic tests, pain relief, and treatment. Each action requires a conversation with the patient's family on whether or not they can afford the treatment and tests. Everything is purchased up front prior to a procedure or test. This results in hours of delay on potentially lifesaving treatments, which would take minutes to process within our healthcare system in Canada. 

Nurses who practice within this environment daily have a greater potential to become apathetic to the pain and suffering of their patients. In contrast, nurses who feel called to their profession actively engage within the difficult working environment by doing the small things they can to make a difference. These are the nurses who hold the hands of their patients crying out in pain. These are the healthcare heroes who cultivate change. These are the people for which a greater healthcare system will one day be built upon. They are there.  We see them.  

As we left TTH, we were filled with many memories of crying with and alongside the patients and family we interacted with daily. What was difficult for us can become the breaking point for those who live and work in such an environment daily. The experiences we encountered within these few short days are only exponential for the nurses who work at TTH. We have compassion.  

It was, by far, the most challenging thing I've ever done. We were grieved for a sense of injustice, knowing that such pain and suffering exists. Knowing that families may not have the capacity to financially support lifesaving treatments for their loved ones; knowing that when care can be provided, it is often delayed due to a cumulative lack of resources and underpaid healthcare workers; knowing that as students, sometimes the most we could do was to hold someone's hand. 

Sophia-Grace, Kyla and Katrina

And so, with heavy hearts, we moved through the week, waiting to experience healthcare from another vantage point in the days to come.

 Sophia-Grace