As I write this, it’s hard to believe that less than two weeks ago I was in Ghana, and we were just completing our final health mission of 2017! We had another successful mission, and again, we learned a lot about the health of folks living in remote villages and how we can best impact their wellbeing in a positive way.
Our mission team consisted of a Canadian doctorate-level nurse practitioner and her 13-year old daughter, two RNs from the U.S., and our seven Ghana Health Service personnel (pharmacist, physician assistant, EMT, and community health nurses) who assist with prescribing, dispensing medications, explaining tropical illnesses to our volunteers, and language interpretation. On the organizational side, we had three staff providing us with delicious, nutritious meals and doing our laundry, and Godfried and I keeping everything organized and running smoothly. Together, we were able to examine and treat a total of 650 patients – 590 girls and women ages 10 to 99, and 60 young children that their moms had brought for care. We set up our outreach clinic in three different communities for two days each. This report focuses on the girls and women we saw.
As usual, we learned a lot! The first thing we discovered is that most of our female patients had multiple health problems, some of which had not been addressed in years. They needed to talk about their issues, and our team needed to sort out the most pressing problems that we could address immediately. In our previous (pediatric) mission, we were able to see over twice the number of patients in the same amount of time, but we quickly realized that for this mission, we needed to focus on quality over quantity. We made the decision to limit the number of patients we saw from each community. This proved to be a wise decision. For one thing, women who made it a priority to get medical care showed up early in the morning to be registered. Then the rest of the day was calm, as each of the registered patients waited in the shade to be seen. Secondly, we could take quality time with each patient – they felt heard and we knew we had provided good care. Finally, limiting the number of patients meant we could afford to buy the meds they needed – some of which were relatively expensive. We don’t charge for any of our services, or for medications – our care is totally free of charge to our patients.
The demographics of the patients we saw is as follows:
Total female patients ages 10 and up – 590
Age 10–18 – 16
Age 19-59 – 393
Age 60-99 – 181
The primary occupation of the women was “trader” (267) – in Ghana, a trader is someone who sells various goods at the marketplace. Traders often travel a circuit of markets, because each community has their “market days” on different days of the week. The next most common occupation was “farmer” (73). Farming in Ghana is done mostly by hand and is incredibly labor intensive. These two occupations are physically taxing – and it was no big surprise that the most common physical complaint was body pain. Other occupations represented were:
Sewing – 43
Hairdresser – 12
Teacher or health worker – 14
Cook, fishmonger, or Kente weaver – 8
138 women described themselves as unemployed or retired, and most of our young women were students.
There were 1,013 diagnoses given to our 590 patients, indicating that multiple diagnosable medical issues were present in most of our patients. The most common diagnoses were:
Body pain – 352 (types of body pain were “waist pain” (lower back pain), neck pain, sciatica, arthritis)
Hypertension – 139
Vaginal infection or other vaginal problem – 104
Urinary tract infection – 59
Worms – 58
Respiratory infection – 52
Gastrointestinal complaint – 50
Malaria – 35
Skin infection – 27
Menstrual issue – 24
Allergy (respiratory or skin rash) – 24
81 women received referrals, mostly for follow-up to further assess hypertension and monitor medication. There were several other serious cases requiring hospital referrals – such as prolapsed uterus or anus, heart arrhythmia, possible fibroids, suspected breast or other cancers, cataracts or glaucoma causing loss of vision, dental problems or oral pain. There were also five positive HIV tests, and those women were referred to the municipal hospital in Aflao for further testing and to be set up with the HIV clinic for free treatment. The Ghana Health Service has started widespread HIV screening to catch as many HIV cases as possible. The GHS gave us test kits and we were able to test 264 women for HIV.
We had a few mental health referrals as well. One woman insisted she was eight months pregnant, but her pregnancy test was negative and there were no fetal sounds. Most likely the woman has a large fibroid, but she refused a referral to the hospital. She became extremely distraught at the suggestion that she might not be pregnant. Two women reported auditory hallucinations. There were also several women with seizure disorder/epilepsy – which is considered a psychiatric disorder in Ghana. Luckily two of our GHS staff are psychiatric nurses and were able to evaluate these patients.
As mentioned previously, some of our patients had had their medical condition(s) for months, if not years. One 75-year old women reported a black vaginal discharge, which she stated she had been dealing with for “years.” Most of the women we saw had been in bodily pain for “years.” Women in Ghana typically overwork their bodies through physical labor like farming, and “head carrying” extremely heavy loads for long distances – it’s not surprising they develop sciatica, numbness in extremities, and feel like they are “stepping on fire” as several of our patients described it. Our NP from Canada stated she had “never diagnosed so much sciatica in her life.” Many of our elderly patients could barely walk, leaning on a stick for support, and unable to straighten their back.
Hypertension was diagnosed throughout all ages of our patients, several women with extremely high blood pressure (240/172, 210/142, 260/110). In all cases, the hypertensive patients were prescribed medication to lower their BP and either waited until the end of the day to make sure their BP was in normal range, or came back the next day to have their BP taken and medications evaluated. They were all referred to the hospital for further monitoring, and given two weeks’ worth of meds to last them until they could make further arrangements for ongoing care.
Interestingly, in past missions we found that in our male patients, high blood pressure and high blood sugar seem to go hand in hand. In the women, most with high blood pressure had normal blood sugar. We had only 11 diabetic or suspected diabetic patients total.
Not surprisingly, we saw quite a few patients complaining of reproductive tract issues. We had a feeling that women would be more revealing of these issues during a mission devoted to their care (and without being concerned that male patients could overhear them describe their problems). Vaginal yeast infection, bacterial infection, painful intercourse, discharge, and herpes infection were among the complaints, along with menstrual issues (amenorrhea, painful menstruation, excessive bleeding), and menopausal problems. Vaginal discharge and UTI could also signal the presence of STIs and were treated with antibiotics. Several women described symptoms indicating pelvic inflammatory disease. We learned that fibroids are fairly common amongst African women – we had a few women with possible fibroids that we referred for further care.
All in all, the level of discomfort these women experienced daily seemed like it would be overwhelming. Yet we knew they were out there working hard to support their families, trying to ignore their pain as much as possible. We were grateful we could do something to make a positive difference in their lives.
We had 29 different medications on hand to dispense to our patients. The most commonly prescribed were:
Pain reliever (paracetamol/Tylenol and ibuprofen) – 576 prescriptions
Vitamins (multivitamins and prenatal vitamins) – 462
Dewormer – 100
Vaginal antifungal – 96
Amoxicillin – 75
Metronidazole – 69
Ciprofloxacin – 64
Azithromycin - 41
Anti-hypertensives (nifedipine, lisinopril, amlodipine, bendrofluazide, low dose aspirin) – 204 (some patients received a combination of these meds)
Anti-malarial – 44 (some patients had negative tests for malaria but were treated for this illness based on symptoms)
Our volunteers worked hard – but we got in some fun and relaxation time too! Perusing the local markets, spending time on the beach, and taking a boat ride on the Volta River were a few of our extracurricular activities. Our 13-year old was able to spend the night with one of our Ghana medical staff, and even got to ride on a motorbike taxi, experiences I’m sure she’s enjoying sharing with her friends! Two of our nurses had a great time chatting with the local people, getting their hair done, and dresses made from some of the beautiful Ghanaian fabric. We were especially appreciative of our NP from Canada, who came to Ghana to share her expertise with the poor, despite a fear of air travel and worries about poisonous snakes! (Note: we do have poisonous snakes in Ghana, but I’ve never seen one. Or any snake for that matter.)
Once again, it was a humbling and gratifying experience to carry out another mission. The needs in the remote village communities are great, and Healthy Villages, Inc. healthcare missions are making a difference. We hope to not only continue the missions, but expand our program in 2018. You can support our work by donating (just click on the donate button on our website to make a safe, secure donation through PayPal). All donations are tax-deductible in countries recognizing U.S. 501c3 non-profit organizations.
We have a full schedule of healthcare missions lined up for 2018, including fundraising volunteer tourism trips. You can check out our upcoming missions HERE.