As I drove out to the Health Center in Shama with the Ghanaian driver, I realized that I am actually quite calm, perhaps because we met the staff yesterday and they were all friendly and welcoming. As we go through a village in Shama, our van is stopped for a huge parade of school children in various school uniforms. There are easily 100 children and as they passed the van and see the foreigners sitting inside, they become excited and smile and wave. I need to continue smiling and waving through this long procession! Vincent, the driver, tells me they are practicing for the Independence Parade on March 6.
I arrive at the clinic and am chided for being late. The clinic is already full of patients and Hilda, the nurse, is already seeing patients. I greet staff and join her in the one exam room. The metal roofed clinic is sweltering, and the electricity is off so the fans aren't working. I explain to Hilda what my training and experience is, but she is busy, so it is not a good time to converse about what I could do for the clinic. This clinic has two nurses who see patients independently, but one nurse is on maternity leave, so Hilda sees all the patients and does all the after-hours call. I decide to spend the day seeing patients with Hilda. The first surprising thing I learned is that most of the patients do not speak English. I will have to use an interpreter to do patient care.
I am impressed with Hilda right away. She has been at this site for four years, and came here right after graduating form the nursing school in Sekondi. She is very knowledgeable and bright, and very likeable. It is obvious she enjoys discussing the patients with me, even though it slows her down. As one patient leaves the room, another comes in without bidding. By 3:30 pm we have seen 31 patients together without a break. Hilda tells me it is hard to leave the patients waiting while she goes to her apartment, which is part of the Health Center, for lunch. As a health care provider who has worked through many lunch hours, I know what she means. Unfortunately she tells me she is losing weight because of seeing patients instead of eating lunch.
The patients had a variety of problems, but malaria was by far the most common diagnosis. Hilda decided to send a school teacher to the hospital who had malaria, anemia, and was in sickle cell crisis. I asked Hilda, who was making her diagnoses, based on history only, if she would like to learn physical assessment skills, and she was enthusiastic about it. Together we diagnosed a UTI (urinary tract infection), a vaginal yeast infection, and other problems that I know would have been missed without a physical exam. We did not treat for pneumonia after listening to the lungs. Though I am down to only one nurse to teach, I think Hilda will be a worthy and bright student.
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