August 4, 2008 Monday– Ride thru town, visit to Korle Bu Hospital, and visiting the Market

Today we had an earlier start (7:30am) with the same breakfast as before. We went to the Mission house to get more supplies to send ahead to Daboase and Kumasi as the van will be packed and we do not have enough room to bring the supplies with us on Wednesday when we go to the remote locations which are 3 hours and 6 hours away, respectively.

We get to Korle Bu around 10:30a and visit with some of the Dr’s in pediatric surgery. We get there just as clinic is to start (which works out nicely). The odd thing is, the clinic is only 2 hours every day- one hour in the morning and one in the afternoon. As you can imagine, not everyone can be seen in 1 clinic and many people must come from far away to be seen at Korle Bu. Families will come early in the morning and if they are not seen that am, they will wait there all day for the afternoon clinic. They must bring their own food as there is no “cafeteria” at the hospital. Should there be too many people there for the evening clinic, they will stay overnight and stay as many days as they need to be seen, sometimes waiting for a week or more. This astonished me- one of many things that baffled and amazed me this day at the “largest and best” hospital in Ghana.

After meeting at the clinic we get a tour of the hospital. We see the children’s ward, the operating theatre, the neurosurgery unit, E.D., the NICU, and of course the pharmacy. The pharmacy is roughly 8’x10’ and is barely stocked. They do a lot of HIV drug management for the children (high HIV rate as you can imagine) and do not have a lot of items to give patients while there; they often have trouble getting supplies. The outpatient pharmacy is larger and I was intrigued by the system they have for dispensing and paying for medications. There is no national plan for medications and they cannot turn people away so they either take cash or if the patient cannot pay they must give the drug to them on “credit” which they tally and track. This amazes me that in a country with millions of people, poor people, that they still track “credits” like the small towns in the US used to do decades ago.

In the NICU we see many babies that are malnourished (starving actually) as there is no way to feed them because they do not take feeds by mouth yet. One baby in particular was in their sole incubator in the hospital (amazing no?) and she was about 14 days old, and just recently had a T.E. fistula repaired. She could almost fit in the palm of your hand she was so tiny from not being fed. Part of the problem stemmed from the remote hospital where she was born and who did not transfer her to Korle Bu until about a week after her birth. When she arrived in Korle Bu she had to wait 3-4 days to get the fistula repaired, which tallied the days without food/nutrition to 10+ days. When we saw her she was about 14 days old and was still not receiving any nutrition as they do not have a TPN program and are therefore unable to feed her until she heals and can suck. As you can imagine, healing capabilities are greatly diminished and infection rate greatly increases when you are not eating and are malnourished. Her sad, hungry little crys tugged and my heart and looking around the “ward” brought tears to my eyes as these children have quite a battle for survival ahead of them- all because of where they were born and the lack of resources in Ghana.

This child in particular can be saved with the TPN program we are beginning to establish at Korle Bu and eventually in outlying areas. Working on the grant back home I knew this was important and has the potential to save many lives but now that I have actually seen a child that can be saved, it makes the work even more poignant and urgent.

Another small child was born with an omphalocele and was abandoned by her mother. The hospital had to feed her until she is well enough to be sent to an orphanage and as you can imagine, they are not feeding her that much (lack of resources) so she too is very weak and tiny.
In the children’s ward there was this little girl whose entire belly was a neuroblastoma. The edema and advanced stage of her disease makes her prognosis bleak- all because of a lack of money and mobility as well as the ability to get diagnosed at an earlier stage.

Another little boy was there for a minor surgery but contracted a typhoid infection while recovering – very sad indeed.

Next we visited the E.D. where the few medications they have are sitting on a shelf in old peanut butter jars (which they call ground nut). At first we did not realize that we were in the triage room as people were sharing beds, there were beds without sheets, as well as the general level of chaos and people.

As we toured the hospital we noticed that outside in the courtyard below was the laundry hanging out to dry.

The best part of the day was meeting with the Chief of Surgery Dr. Hesse who was recently promoted from the head of the pediatric surgery department. SHE, yes, it was a woman (another pleasant surprise) to discuss the TPN program, QA/QC, mixing the TPN, establishing where the center will be, etc… She was extremely excited and as enthusiastic as we are about the potential to save many many children from a death that is 100% preventable. Since her focus before promotion was pediatrics, she obviously has a predisposition to spend more resources (time, $, man hours) on programs that benefit the smallest of patients at Korle Bu. The meeting was very important on many levels and she wants us to come more frequently than 1x a year so we can get moving quickly (well, quickly for Ghana who do everything s-l-o-w-l-y except for driving) on the TPN program and a program to bring Laparoscopy to the pediatric surgery department.

We leave around 2pm to grab some lunch. After finally exchanging our USD to GHC, we find this authentic Indian restaurant and sit down for a “family style” meal. Everything was fantastic, spicy, and was a nice change (already) from the rice and chicken that we have been eating. The entire meal was 15GHC which comes to about 9 or 10USD.

With our converted money, we decide that since we are still waiting for the anesthesiologist to arrive (he was delayed) that today would be a good opportunity to go to the local market and haggle and by gifts to bring home. This way, once he gets to Ghana, we can go to the outlying areas (where they DO NOT have an anesthesiologist) and perform more surgeries instead of coming back early to shop and therefore reduce the number of patients seen and operated on.

The dusky, narrow streets of the market are lined with tiny shacks selling everything from food to fabrics, paintings, masks, statues, and everything in between. I thought it would be fun because I LOVE a bargain, but they are sooooooooooo aggressive and you seriously have to haggle in order to avoid getting ripped off, that it because exhausting rather than exhilarating. I paired up with some of the guys on the mission and they helped me as I KNEW the locals saw us coming a mile away and couldn’t WAIT to try to rip us off. As a female I felt particularly vulnerable (I was not scared or in danger at all, I just didn’t want to overpay). After a draining 2+ hours I have come away with some pretty amazing crafts and local items that I cannot wait to share with you all.

The last stop in our long day as we made our way back to the hotel was to help Dr. Khan find one more piece of equipment that was still MIA. While we did not find the equipment, we did get word that the airport found Dr. Khan’s luggage! 1 for 2 today. The group let off some steam and decompressed back at the hotel with some 40oz beers that cost 1.50GHC (about 0.90USD). We have found that while the exchange rate of USD and GHC is pretty close (0.60USD= 1GHC) things are very cheap here (like internet for an hour is 1GHC or 0.60cents).

Overall today was a real eye opener. I often found myself heavy of heart as many of the deaths and disease states/ conditions seen at Korle Bu are totally avoidable and some procedures and lack of aftercare would actually be criminal back in the States. Wednesday morning we leave EARLY for Daboase. This means that I probably will not be able to connect and upload the daily blogs until around Wednesday August 13th – I’ll keep writing and taking lots of pictures though!