Rather than traveling village to village as we have done previously, we planned three days at one clinic, in the village of Atoklokope. The village has a newly built clinic and is raising money for a labor and delivery building. The clinic is not yet in use, so we were able to use the space to set up tables, chairs, and benches for our work. Our pharmacy was set up outdoors, under a huge mango tree. We learned quickly that the interior office spaces were just too hot for comfort, and everyone moved their tables and chairs outdoors, in the shade of the building or under the trees.
Patients were seated under a canopy until they could be registered and process through the stations we had set up – registration, weighing, vitals, history, testing, evaluation, and pharmacy. It was great having nine volunteers, as it allowed our patients to be seen more quickly than in past missions, and their wait time was less. We had nine Ghana Health Service staff, paired with each of our volunteers for language interpreting and mutual learning.
We worked from around 8am to 3pm with an hour break for a cooked lunch in the shade. Being at the same clinic for all three days made it less stressful in terms of breaking down, packing up meds and supplies, and setting up in a new location every day or two. The downside was not reaching as many people in outlying areas. However, we saw the maximum number of patients we could have possibly treated – we were completely exhausted by the end of each day. Godfried and our volunteer Mike could not have lifted one more box onto the top of the car either!
Below are some data from the mission:
AGE GROUP NUMBER OF PATIENTS PERCENT OF TOTAL
20 AND UNDER 96 18.7%
21-30 75 14.6%
31-40 83 16.1%
41-50 77 15%
51-60 69 13.4%
61-70 66 12.8%
71-80 38 7.4%
81-90 8 1.6%
91-100 1 .2%
OVER 100 1 .2%
BP 140/90 OR OVER, PER AGE GROUP:
AGE GROUP NUMBER OF PATIENTS COMMENTS % OF AGE GROUP WITH BP ABOVE NORMAL
20 and under 12 highest was 155/100 12.5%
3 had a systolic BP of 150 or more
21-30 15 20%
31-40 28 highest was 205/137 33.7%
41-50 43 6 had BPs over 200/130 55.8%
highest was 235/135
51-60 36 highest was 220/120 52.2%
61-70 32 highest was 273/179 48.5%
four with systolic 223 or over
71-80 21 highest was 257/152 55.3%
5 with systolic 203 or over
81-90 7 87.5%
91-100 1 161/101 100%
TOTAL WITH BLOOD PRESSURE ABOVE NORMAL LIMITS - 195 - 38% of all patients
105 (eldest patient) - BP 138/98
It was alarming to find young women with extremely high blood pressure, and to discover that over a third of our female patients had blood pressures indicating the early stages of hypertension to severe hypertension. Out of the 195 patients “above normal limits”, 123 were given a diagnosis of hypertension. 270 medications for high blood pressure were prescribed (some patients received more than one medication, such as an antihypertensive plus an antidiuretic). In all cases, the patients with hypertension were counseled about the necessity of continuing their medication and having it regularly monitored at a clinic.
One of the main disadvantages of providing care through one-time outreach clinics such as what we’ve been doing is that we have no way to follow up with patients. We don’t know if the patient takes the medication or takes it appropriately. We don’t know if they follow up on the advice we give them and continue the medication regimen. Yet we don’t feel comfortable sending away patients with severe hypertension with no medication at all. Medication compliance is an issue overall, no matter what country or situation - and education about, and support for, lifestyle changes to improve health is needed. How we can provide ongoing care and support is a question we wrestle with as an organization.
It would be beneficial for the Ghana Health Service to investigate the underlying reasons for such an extreme level of hypertension.
Malaria – 181 administered – 21 positive, 160 negative
Pregnancy – 25 – 3 positive, 22 negative
During our last mission, we were given HIV test kits by the Ghana Health Service, but unfortunately this time we were not. There was one woman who had previously been diagnosed with HIV and reported she was following her medication schedule. There were a few women suspected of having HIV based on symptoms and were referred to the hospital for testing. We hope to have HIV test kits available on our next mission serving adults. There were many patients reporting symptoms that could be malaria; hence the many tests given. In addition to the 21 positive tests, 17 more were diagnosed without a positive test based on severity of reported symptoms. The large number of negative pregnancy tests coincides with the rate of amenorrhea within this population.
DIAGNOSIS NUMBER OF PATIENTS GIVEN DIAGNOSIS
Body pain 238
GI issue 63
Vaginitis or vaginal infection 55
Respiratory infection 49
(some were diagnosed based on symptoms vs positive test)
Menstrual issue 35
Urinary tract infection 25
Skin infection or rash 23
(139 received dewormer without formal diagnosis, based on body weight and physical appearance. Intestinal parasites are endemic in Ghana.)
Vision impairment 15
Ear infection 8
Skin fungal infection 5
Dental issue 4
Sexually transmitted infection 1
HIV 1 prior diagnosis reported by patient
Eye infection 1
Seizure disorder/epilepsy 1
TOTAL DIAGNOSES GIVEN 781
On all our previous medical missions, we’ve seen a similar pattern of at least half our patients reporting bodily pain. As mentioned in other reports, this is due to the extreme physical labor performed by people in the villages. Women “head carry” heavy loads starting at a very young age, sometimes walking many miles, and engage in other labor-intensive work such as farming by hand, gathering salt, etc. By the time they reach their 30s or 40s, their spine is compressed, and they report neck and back pain, sciatica, numbness in limbs, headaches, etc.
Hypertension was mentioned above; it was the second most frequent diagnosis on this mission.
Rates of URI, UTI, vaginitis, and other infections was similar to previous missions, although suspected cases of STI were less than previously seen.
Interestingly, women do not seem to have the same pattern as men, where diabetes is present in most hypertensives. Only one woman had abnormally high blood sugar requiring medication.
Our practitioners made 45 referrals to the hospital (in addition to all patients given high blood pressure medication, who were all referred for follow up). Reasons for referrals were for abnormal growths or tumors requiring evaluation; eye or vision problems; reproductive problems or infertility; irregular or abnormally slow heart rate; thyroid problems – hyperthyroidism or goiter; uterine prolapse; possible sickle cell disease; concussion; possible mental health issue – visual hallucinations.
MEDICATION NUMBER OF PRESCRIPTIONS
Paracetamol (Tylenol) 279
Total pain reliever 442
Prenatal vitamin 21
Vitamin C 63
Total vitamins 306
Total antibiotics 222
HIGH BLOOD PRESSURE MEDS
Low dose aspirin 95
Total high blood pressure meds 270
CREAMS AND OINTMENTS
Vaginal antifungal cream or pessary 53
Triple antibiotic ointment 33
Hydrocortisone ointment 15
Total creams and ointments 101
Antihistamine tablet 47
Cough syrup 54
Oral rehydration salts 35
Antidiarrheal tablet 2
TOTAL PRESCRIPTIONS 1,711
An average of 3.3 prescriptions were given to each patient (some received more and some less). Almost every woman received pain reliever and/or multivitamins, and about a fourth of the women received dewormer. All medications, as well as exams, were provided free of charge.
In closing, this was both one of our most challenging missions, and one of the most rewarding. Our main challenge was the weather – days on the field were hot, sunny, and humid. We all survived, but we all felt physically distressed by the heat. As a counterpoint, our patients, most of whom were ill, walked from surrounding villages to our location, and then waited patiently to be seen by our staff and volunteers. It puts things in perspective.
Taken together, we provided 1264 services to 1193 individuals. 750 girls and women now have access to washable and reusable menstrual hygiene products that they can rely on every month. 514 girls and women received compassionate and comprehensive care from our volunteers and Ghana medical staff. Another mission successfully completed!
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