Monday, April 17, 2023

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


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