Monday, February 9, 2015

Process Mapping in Ghana

Emily Aaronson
Emergency Medicine

Having been here a week, my work is well underway and am sadly realizing a lifetime of dedication to this emergency department couldn't accomplish what I was hoping to do in a few weeks. Ghana itself is amazing – although some things, like the incessant honking from the Ghanaian trotros (shared ride cabs), 80 degree nights (and 95 degree days), and constant call of ‘obruni’ (the Ghanian slang for white lady), are familiar from other travels, there are many things that make west Africa like no place I have ever been. To begin with, I was met by a thick red dust coating the city, which in combination with the stifling heat, felt remarkably unfamiliar. The Harmattan – a dusty trade wind that brings with it the Saharra dessert, coating West Africa between November and March, is apparently at it’s worst in 20 years. This has left everything (including my glasses by the time I got to the hospital) coated in a thick layer of red dust. This, mixed with the somewhat more familiar stench of burning garbage and open latrines, was the first assertion Beantown was far behind.

So although the climate is somewhat unwelcoming, the people couldn't be more friendly. Ghana – an English speaking country roughly the size of Oregon with the population of Canada – is largely lauded as being among the most friendly nations on the continent. Indeed, everyone I have encountered since I arrived have appeared uniformly excited to see me – to show off the city, tour me around the hospital, introduce me to the food or teach me the language (twi is one of many local languages that flows freely in and out of most English sentences).  Having traveled a fair bit in the last decade, I will say that I have been nowhere that I have felt less threatened and more secure than in Ghana.
The hospital however is a less hospitable place. The staff are wonderful and the administrators welcoming, but the state of healthcare here is certainly unfamiliar. The hospital I am working at, Korle Bu, sits surrounded by some of the poorest communities in Accra and has a strong commitment to serving all comers. Despite this principled mission, the infrastructure, equipment, supplies and staffing doesn't exist to support it. I am working primarily in the Emergency Department – on a project aimed at increasing capacity by identifying areas of inefficacy – but recognize the problem is larger than my weeks here will impact.The physician I am working with is truly an inspiration though – a native New Yorker who starting coming here 7 years ago, trained in Emergency Medicine and still supported by NYU and Bellevue Hospital. She has been living here full time for almost 4 years and through incredible relationship building, political navigation and patient care, created the first department of Emergency Medicine at Korle Bu. The department, which she is now the clinical coordinator of, is vital to help resuscitate the hoards of patients that arrive critically ill secondary to a system with almost no preventative medicine, little access to primary acute care, and a mostly fee for service model that leaves people without the medications or diagnostic tests that they need. The acuity of the patients I have seen over the last week arriving in the Emergency Department, is truly unfathomable.

In partnership with the hospital, and incredible local collaborators and colleagues, they have created this department now teeming with over 50 stretchers in various states of disrepair, which admits to an over 2000 bed hospital (MGH has 950  as a point of comparison). The issues remain though: no oxygen masks the day I arrived, a defibrillator that has been broken for over a year, a marked shortage of certain medications and intermittent access to the limited diagnostic tests they have.  With that all said, the commitment is here – the dedication to the patients and belief that through focused work the system will advance – as it already has in recent years.  So that at least, is inspiring.So after a week of observing in ER, meeting the staff, administrators and beginning to understand the cultural communication nuances that will hopefully help me be successful I look forward to digging into the work next week.

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