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| Main Entrance TTH |
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.
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| 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.
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| Sophia-Grace, Kyla and Katrina |
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