A Masked Suffering....

A local once said, “if I start crying, I may never stop…”

According to Harvard Health, crying releases oxytocin and endorphins which are feel good chemicals to lessen physical and emotional pain. Something most of us accept as an appropriate response. Remember this as I depict the visible physical disparities and the hidden emotional sufferings. 

Something I noticed being here is the amount of physical suffering and hard work Ghanaians go through to survive each day. It’s 38°+ and every day they wake up most likely in their village on a mattress on the cement ground or in the stand where they work. No air conditioning and no access to free filtered clean water. In addition, we are here through Ramadan, and many people are fasting from dawn to dusk.  

In spite of this, they show up for their day 100%. Can you imagine not being allowed to drink water in 40° weather? I would cry, be angry and exhausted. However, every encounter I’ve had simply walking past one another, has always been met with a greeting to ask how we are and a welcome to their home. Not to mention it is with the biggest smile on their face. If you ask how they are regardless of what is happening it is always “I’m fine,” even when it’s not. Physically you can see someone may be unwell and exhausted, but emotionally they are telling you everything is good. 

I am amazed at how much joy and laughter there is circling around, and everyone’s smiles are contagious. But why don’t they express some of their true feelings? It is in their culture to not cry and show emotion in ways that appear as if something is wrong. Many terrible, sad accidents and diseases occur here and they have to brush it off. Having all that mental pain built up inside someone is exhausting. But here it is normal. If you cry you are weak.

In the hospital healthcare is not free. If you can’t afford pain medications you won’t be given any. Many patients experience broken bones, stitches, labour, dressing changes and barely grimace. You may see a tear trickle down their face but nothing more. You may hear the odd scream, but no tears.

I’ve seen a mother at the bedside of her son who had a brain injury take the time to welcome me to Ghana with a smile on her face. I was taken aback, the chances of someone grieving in pain to welcome me with a smile in Canada is rare. 

In Canada we have so much readily available at our fingertips and yet many walk around miserable. In Ghana they live in survival mode almost every day but walk around with a smile on their face and good day to you. Ultimately, the joy and resiliency Ghanaians embody is truly inspiring. 

Posted by Alexis, 4th year BSN Student

A Deeper Meaning....

A deeper meaning and understanding here in Ghana. Expanding one's perspective to embrace the diversity of this world, along with the profound love and stories that Ghanaians have to share.

Shekhinah Clinic

Since our arrival in Ghana, we've encountered numerous wise, resilient, and beautiful individuals. Their warmth and generosity have humbled us, contrasting our own familiar routines back in Canada. We've realized the depth of connection they foster within their communities, showing a major difference to our insulated lives. Unlike the routine nods and waves we’re lucky to receive in Canada, every outing we’ve had here is met with waves, smiles, and heartfelt inquiries about our and our family's well-being. It's a humbling comparison that shows how deeply humans are connected worldwide. Their generosity in sharing their culture, stories, and values has been a profound lesson for us.

I'd like to share an enlightening encounter with a Ghanaian man that reshaped my perspective on life's priorities. He was a resident of Shekhinah Clinic for the Poor and the Destitute, and during our time assisting in the kitchen, he posed a simple yet profound question. He asked which among the pot, ladle, and serving spoon was most important.  

The women used these giant pots, large paddles to stir, and a dried gourds cut in half to serve the food into the bags. He asked us what we thought was more important out of the 3. The pot, the ladle, or the serving spoon. We had to think about it for a moment trying to decide what he meant and pick out what we thought would be more important. It didn’t take long for us to realize that it doesn’t matter what we pick out of the 3, you need all of them to successfully cook and serve the food. 

Without the pot, where would you cook the food? Without the ladle, how would you stir or mix the food? Without the serving spoon, how would you get the food out to the bags? It cannot work unless you have all 3. His analogy of cooking utensils mirrored the importance of engaging mind, heart, and hands in our actions. His words resonated, highlighting the significance of holistic engagement in life. Reflecting on his analogy, I realized that like cooking, life requires the integration of intellect (the head), compassion (the heart), and action (the hands). Without all 3 of these elements, our efforts are incomplete. His insight demonstrates the importance of holistic engagement in making a meaningful difference in the world.

It was such a simple question at the time. I didn’t think much about it, but after some reflection, I realized it meant so much more than we thought. This encounter underscored the profound depth of meaning embedded in everyday life and conversations here. 

The Ghanaians have left an impact on our lives now and showed us that there is more to this world.  This was only one small story that I chose to share, and I can tell you there are so many more we hope to share with our families and friends when we get back home.

Posted by Julia, 4th year BSN Student

The Paradox....

Our six week journey in Ghana began with a flight into Accra, from there we travelled north to Tamale by bus, where we will stay for two weeks before heading further north to Bolgatanga. Along the way, we drove through the Cape Coast, stopping at the Elmina Slave Castle, and spent a night in Kumasi before finally reaching Tamale. Spending approximately 16 hours on the bus allowed me plenty of time to look out the window and observe the world of Ghana.

Throughout my time here in Ghana, the theme of contrast is something that has stuck out to me. I've witnessed the juxtaposition of beauty and ugliness: gorgeous, immaculate clothing worn by beautiful men, women and children, as they sit in packed streets with dirty rubble back drops. Lush green rainforests and beautiful red clay desert sand, all littered in garbage. A stunning castle situated along the coastline with amazing views of the bright blue ocean and white sand beaches, yet so much tragedy and oppression occurred within its walls. Kind, sweet & smiling faces of people who are faced with challenges that would be impossible to articulate unless you have been a witness with your own eyes. Their resilience, despite the many disparities they face each day, is both heartbreaking and inspiring.

However, the starkest contrast I've encountered so far lies within the healthcare system. In comparison to Canada, resources are scarce, and patients must purchase their own medical supplies. Those unable to afford them are denied treatment, which is a common occurrence here. On my first day at the hospital I witnessed a patient being discharged with an open fracture to her radial and ulna (both bones in her lower arm were broken and punctured through her skin). The patient was advised that the open fracture would likely become infected if left untreated and as a result her arm may need to be amputated. Yet, the woman had no other choice but to take the chance and head home without treatment as tears fell from her eyes. As they fell from mine. The same day, I witnessed an 8 year old boy being discharged with an untreated leg fracture for the same reasons. The financial cost of healthcare treatment is simply not attainable for many of the people here. Without treatment the boys leg will likely not heal properly, impacting his growth and ultimately further compound the challenges & disparities he already faces in this physically demanding environment.

Similar stories repeat and repeat here. Worse stories. Stories I will not share with you here.

The resilience of the Ghanaian people, the citizens, the patients & the healthcare workers, in the face of such adversity is admirable. Their stories will stay with me forever. The people here are strong, it is beautiful and it is tragic.

Taylor, 4th year BSN Student

The Epidemic of Road Traffic Accidents in Ghana

 During my first couple of weeks in Ghana, a health disparity that immediately caught my attention was the high prevalence of motor vehicle accidents. When our group first arrived in Accra, we sat down for dinner at a nearby outdoor restaurant. While enjoying our food, we heard a deafening bang followed by silence. Jeanette explained that the noise came from a motor vehicle accident and that they are common in Ghana. That moment served as my introduction to the health crisis of road injuries in Ghana and its detrimental impact on the healthcare system.  

Over time, I began to recognize road safety challenges in Ghana. In Ghana, motorcycles are a major form of transportation and, often, people operate them unsafely. For example, many people do not wear helmets on motorcycles, potentially due to their inability to afford the cost of one. More unsafe behaviours I have witnessed include young children operating motorcycles and women on motorcycles with infants strapped to their back. Those who drive motor vehicles often speed, crowd in lanes, and fail to stop for pedestrians and oncoming traffic. Additionally, road design in Ghana leads to heavy traffic congestion in the city, further increasing the likelihood of motor vehicle accidents. As a result of these contributing factors, a health crisis emerges.

The prevalence of motor vehicle accidents weighs heavy on Ghana's healthcare system. My time spent working in Accident and Emergency gave me a full picture of the detrimental effects of motor vehicle accidents in Ghana. Every day, people are rushed into Accident and Emergency with road injuries, most commonly polytraumas, multiple fractures, and skin abrasions. Some Ghanains practice traditional medicine and attempt to treat fractures locally, which can lead to severe conditions such as infection and gangrene. In A&E, fractures are stabilized in various, innovative ways, such as by securing sand filled water bottles to each side of the affected limb. This example demonstrates how incredibly well the Ghanain nurses problem solve with their limited resources.

When examining the high incidence of motor vehicle accidents in Ghana, I often reflect on the root causes of the issue. As reported by the World Health Organization, in Ghana, road injury is the 7th leading cause of death in males and results in 39.8 deaths per 100,000. Moreover, 92% of deaths caused by road injury occur in low and middle income countries, demonstrating the disproportionate impact of the issue. Although Ghana has road regulations and drivers licensing requirements, there is a failure to enforce them. When considering Ghana's socioeconomic status, which was heavily weakened by colonization, I recognize the financial challenges in reducing road injuries. Many solutions to the crisis require major financial investments, such as hiring and properly paying law enforcement, investing in road infrastructure, and revising road policies. A multifaceted approach that allocates Ghana's existing resources to road safety is necessary to mitigate the epidemic of road injuries in Ghana and reduce the burden on Ghana’s healthcare system.

- Brianna, Year 4 BSN

Tamale Teaching Hospital - Accident & Emergency

3 days in the Accident & Emergency unit at Tamale Teaching Hospital provided the perspective I have only yet been able to read about. It could be expected that sitting in a global health lecture, no matter how informative, would undoubtedly not compare. Without the connection, you cannot feel the realness of the experiences of these people. Suffering is right in front of you, it’s not hidden like it is in Canada. The wards are open, with beds a foot apart from each other, and seldom curtains to pull. Anyone can see the sickness, anyone can see the death. 

I was told that when Ghanaian people go to the hospital they expect to face pain. The same degree cannot be said in Canada. Family members bustle around doing everything they can to take care of the patients. They are the ones bringing food, water, and fan their loved ones from the heat. 

I consider myself lucky to have met several wonderful nurses and doctors during my days here. These types of people are so purely genuine, and their souls stick with you long after your interactions. They were so well educated and competent, and I truthfully learned a lot from them that I will bring forwards in my practice. They make the best of the circumstances even though the system doesn’t set up them for success or positive patient outcomes. They are realistic and logical, but not defeated and angry. There isn’t the same capacity to avoid preventable deaths. There are aspects of cultural differences when it comes to relational practices, but when the system doesn’t support you, how are you expected to support the patients. Many continue to show up without pay. 

These days at TTH were more for personal learning rather than to make a difference on their health system. A system level change is multifaceted requiring analysis of their culture, the country’s power, ability to allocate resources, and ultimately spending their government chooses to place towards healthcare. The power imbalances in spending abilities and resources distribution between Global North and Global South can also be considered when considering the difficulty Ghana encounters procuring necessary resources. 

Many medication and vaccine shortages persist. Money, stigma, distance, and healthcare staff to patient ratios are huge barriers to accessing healthcare. It became a familiar act to watch the priority be placed on the transactional requirement before medications are administered or treatments are done. In several patient’s charts, the doctor’s orders were tagged with - if the patients family can afford. If they can’t, it won’t happen. 

There is no pause button for the patients as they wait for their pain to be managed, their wound to be dressed, their open fracture to be casted, or their medication the urgently require, but there is for the staff. No payment, no treatment. Here, healthcare is not guaranteed.

Blog written by Kyra - 4th year BSN Student

Shekhinah Clinic - A Place of Love and Compassion

The Main Entrance

Working our first day at the Shekhinah clinic was quite unexpected. The minute you step onto the property, you feel how peaceful it is. Shekhinah is a free clinic catering to the poor and destitute (see vision and mission statement). 

Vision and Mission

They depend solely on donations to keep it running. This means that services can be in short supply. It was challenging to experience, coming from such a privileged country and seeing what was able to be done for the 30 people visiting each day. The dispensary (term used for pharmacy) itself was quite bare. I encountered clients coming to the window and not receiving any of the medications they were prescribed that same day. In some instances clients came to the window with two prescriptions, as they didn’t receive all their medications at the last visit. You could see the disappointment and defeat on their faces afterwards. Their only other option is to pay and unfortunately, these people come to the clinic because they do not have the funds in the first place. Knowing how difficult this was for me, after one day, I cannot fathom how it must be for these clients.

I was able to sit in on consults the first day as well. I found it shocking, the level of care I observed. I saw a short assessment followed by a handful of medications being prescribed. This would be an uncommon occurrence in Canada. However, it’s easy to be judgmental coming from a high income country who believes they have all the right answers. It’s not easy to put yourself in their place and realize there’s not much you would do differently. 

OPD

Working with limited supplies and limited volunteer staff, you are left with limited options. It’s impossible to compare our environment in Canada to this one.  Furthermore, I don’t believe you would find this type of clinic in Canada. Based on experience, Canada does not have the sense of community that I have observed here. I cannot imagine a clinic opening for the hungry and mentally ill, offering them a place to stay when they have no where else. If there was, I can’t see it being as successful as this one, now open for over 30 years. You can see the volunteer staff care deeply for those that come. There is never a shortage of clients visiting the clinic, proving that it is needed as well. At the end of the day, this is what’s important.

A group of 4th year students in Kelowna used their Nursing Leadership Capstone project to work with our Kelowna community to gather medical supplies and raise money to support Shekhinah.  We presented the staff and the Director Mariama with these supplies yesterday.  It was a joyous surprise.  We purchased medications to fill their dispensary shelves, and shared many many suitcases of surgical supplies for their operating room.  

Fun fact for everyone: this mango tree was the location where Dr David Abdulai Fuseini (the creator of this clinic) preformed the first surgery for the clinic. It was a hernia surgery, which was a success.

Blog written by Tyler, 4th year  BSN Student.

Elmina Slave Castle

 

On our way up to Tamale, our group explored the oldest slave castle in West Africa, over 500 years old. It is located on the Cape Coast of Ghana. There were bricks, wood panels, prison bars, and more from when the castle was first built. The rooms echoed a hard hitting history that punched you in the gut when you walked in. The rooms where slaves were kept were small and very crowded with little ventilation and no place to use the bathroom. Those who were sick were thought to be weak and when they died their bodies were thrown to sea. Those who survived were thought of as strong enough to go to the new world.  

Slave Dungeon

We saw a prison for freedom fighters that was dark, hot, and marked with a skull to signify that once entering the dungeon, you would not return alive. The only openings to the dungeon were used for the guards to see when someone starved to death so they could drag them out in front of everyone. The prison for the misbehaving European guards however, was ventilated and they were given water and food and released after a few hours of waiting.

Prison

The women faced even more obstacles.  The governor of the castle would select women to come to his chamber and be raped. If they refused to travel to his apartment, they were chained outside without water or food for days until they said yes. This was a spectacle for the other women so they would not also refuse. If the woman fell pregnant, she would get to live with her child for three years before their child would be sent to school. The mother would then stay in the castle and do domestic work. The shocking reality that being raped and bearing a child for a woman may be the better option than going overseas is a horrific reality.

In the room dubbed "No Return", slaves prepared to embark on a tumultuous trip overseas where they would most likely die on the voyage. The room on our tour was filled with blessings from modern day visitors. Expressions of gratitude covered the floor blessing the sacrifices slaves made before the Slave Trade was abolished.  Candles were lit, crosses were decorated, and notes were left for those who were captured, abused, and taken from their home. The air was heavy in this room, and the history was bleak. 

Tributes in the room of "No Return"

This castle proves how far the Ghanaians have come after being treated as savages by their Portuguese, Dutch and then British colonizers.  When they gained their independence, and the British left, they took all their infrastructure with them. This has led to many growing pains for Ghana's development.

Government and healthcare was created from a a model that was not their own. For over 400 years the colonizers pitted Ghanaians against each other, creating tensions across the country and a sense of protecting your people. There are now significant disparities between the South and North. The South houses the capital, Accra, and has more Governmental support. The rural North faces the greatest challenges, as hospitals are far and few between. Many have to travel a long distance by foot to reach healthcare. Ghana is a young country, and a strong country. Its development makes sense when you understand their history. I feel incredibly lucky to be here.

View from the Governor's Window

Blog written by Nadine.