Saturday, March 21, 2015

Sightseeing: Kakum National Park

Kakum National Park is located in the Central Region of Ghana. The team has a great time hiking and walking along the rope suspension bridges. 

Say hi!

Team photo on the rope bridge!

Friday, March 20, 2015

Sightseeing: Cape Coast Castle

As UNESCO World Heritage site, Cape Coast Castle is one of the many slave forts still standing on the coast of Ghana. 

Concluding Observations


From left: Dr. Nadia, Maya, Ann Marie, Dr. C

Anna, School of Social Work
From this week at CCTH, I further began to understand the value of interprofessional collaboration, especially in combating communicable diseases such as HIV/AIDS. During my week, I worked with HIV nurse educators who aided patients to maintain treatment compliance in the hope of preventing defaulting on their ARV regiment. I am interested in researching gender and cultural based adherence methods (i.e. To what extent does gender play a role in defaulting on ARVs and if so, what factors contribute to this discrepancy?)

Ann Marie with her mentor, Dr. Oboudai

Ann Marie, School of Medicine
I had the opportunity to observe some of the major public health issues in Ghana. Like in the States, Ghanaians suffer from high cholesterol, hypertension, and diabetes. Additionally, public health concerns in Ghana are infectious disease, sepsis due to poor sanitation, and malnutrition. Nationalized health care provides a wonderful platform to administer medication and offer education for patients suffering from HIV, and the majority of patients are covered. The opportunity to speak with both doctors and patients during this week gave me a clear perspective on the successes and challenges of the Ghanaian health care system.

Maya, School of Pharmacy
Working and learning with the passionate staff at UCC teaching hospital in the antenatal and HIV clinic was invaluable. UCC TH is continuously working to improve a patient's health outcomes through focusing on optimal treatment, rehabilitation, and a supportive process to reintegrate back into their normal lifestyle . Three words that describe the vibe of this hospital environment is collaboration, community and compassion. Although limited in resources compared to US standards, this hospital is rich in its commitment to optimal care. I have left with a better understanding of the resources as well as structural and process changes that will be a priority for UCC. Additionally, learning about the National Health Insurance Schema helped me understand the intersection of governmental policy, politics and health care in Ghana.

Natalie, School of Nursing
I learned that there are more similarities than differences in the health care delivery practices in the USA and Ghana.  Nurses and midwives struggled with issues of stigma and disclosure among the HIV/AIDS patient population.  These same struggles exist in the USA.  While there seems to be a stigma associated with HIV/AIDS overall in Ghana, I did not observe stigmatization from the health care providers.  I think we have something to learn from the nurses and midwives who work in an empathetic, encouraging, and non-judging way with the HIV/AIDS patient population.

Thursday, March 19, 2015

Observation Day #3


Thursdays at UCC TH is the HIV clinic.  When we arrived, we observed "Models of  Hope," who are empowered HIV+ clients, delivering a health talk about malaria to a group of about 50 clients waiting for services.  We were able to observe medication adherence counseling, anti-retroviral therapy (ART) medication dispensing, antenatal consultations, pediatric consultations.

University of Cape Coast Medical School


Ann Marie, School of Medicine
Speaking with patients one-on-one was an incredibly powerful experience.  They gave me a vivid picture of what living with HIV in Ghana is like.  The stigma surrounding HIV has a profoundly negative impact on patients ability to seek and access care.

Anna, School of Social Work
I appreciated the time that the community health nurses took to explain medication adherence protocols.  Practitioners ask patients to "teach back" their treatment plan which appeared to be a successful approach.

View of Cape Coast from University of Cape Coast Medical School

Maya, School of Pharmacy 
Today, I worked with the HIV clinic pharmacist to serve over 100 men, women, and children. I helped label medication boxes and wrote details on how to take the medications in a simple ways using shapes and colors. I also reviewed some prescriptions and interpreted what ARV treatment was being prescribed for that particular patient. Even in a less than desirable workspace the HIV clinic pharmacist worked tirelessly to ensure all prescriptions written that day are dispense and patients fully understand how to take their medications. I observed that pharmacists can play a key role in reinforcing medication adherence counseling especially in cases where anti-retroviral therapies (ART) are complex and the appropriate use of medication is crucial to disease management. 

Natalie, School of Nursing
I was impressed by the amount of compassion the nurses and midwives demonstrated during antenatal consultations with HIV+ expectant mothers.  In a country where HIV/AIDS stigma is prevalent, I observed practitioners who were able to look past those stigmas and instead provide encouragement.

Wednesday, March 18, 2015

Observation Day #2


Each student shadowed a mentor at Cape Coast University Teaching Hospital in their respective fields. 

Ann Marie, School of Medicine
Today, I joined UCC medical students in grand rounds in the pediatric ward. I learned about the management of a case of severe hydrocephalus concurrent with gastrointestinal issues. Additionally, the attending physician, medical students, and I discussed the etymology of anemia in malnutrition. While fascinating, the cases were also very sad. I was touched when I observed the medical students put together a couple of cedis for food for an HIV-positive neonate suffering from malnutrition. Interactions like these underscored the contribution of health care workers in combating social inequalities.

Anna, School of Social Work
As a social work student, attending medical grand rounds with medical students gave me a firsthand look into the importance of interprofessional teams.  Medical students for each patient mentioned different psychosocial stressors which often contributed to exacerbating their condition. Many of the patients we observed struggled with financial difficulties as well as stigma from their community. Furthermore, I observed that the role of a social worker at CCTH is often dispersed into the roles of the doctors, nurses and community health workers. These compassionate practitioners join together to provide the best services for their patients, even if they cannot afford treatment.

Maya, School of Pharmacy
Today, I had a chance to interview two pharmacists in the outpatient UCC TH Pharmacy Department. I learned in January of this year the government's primary storage facility for medication and supplies burned down. This impact was huge as it supplies all of Ghana. This may have an effect on supplies in the future, but now the Pharmacy seems to be running effectively.  I learned a lot about the structure, staff, and processes in that are in place at the Pharmacy. The Pharmacy usually dispenses 120 prescriptions a day which minimizes the opportunity for pharmacist to patient interaction due to limited staffing. Adherence counseling, focused on chronic conditions such as diabetes, hypertension, and asthma as well as TB and HIV/AIDS is conducted mostly by the nurses and medical with reinforcement from the pharmacist. A good example is the hospital's efforts to combat TB by increasing awareness of treatment that is 99% effective in curing TB and taking advantage of community workers to ensure compliance with treatment.

The second interview was with the lead pharmacist for the ARV clinic which is run every Thursday. I learned that UCC only started dispensing ARV in 2006 and drugs are given to HIV patients regardless of insurance coverage. A small token of 5 cedis is paid by the uninsured during monthly visits. HIV positive patients have a strong adherence counseling process (First 3 weeks upon start of ARV treatment, then monthly thereafter).  Pharmacist adherence assessments include a combination of pill counting, body weight (to determine any drastic decreases evident of noncompliance or lack of response to current treatment regimen), and a teach back method of determining how well the patient understands how to take their medications.

Natalie, School of Nursing
Along with four midwifery students, I observed consultations in the antenatal clinic.  According to the UCC TH protocol, every new client receives an HIV/AIDS rapid test .  That day, there was only one new client and she tested positive for HIV Type I.  The midwife conducting the test did not disclose the results while the UCC students were in the room for fear that the new client would be embarrassed by the result.  It was a powerful experience.

Tuesday, March 17, 2015

Observation Day #1


We were able to observe and informally conduct interviews with practitioners at the antenatal clinic (ANC) at the UCC TH.  We were able to observe antenatal consultations with patients.  We met nursing and midwifery students attending UCC and were able to discuss the similarities and differences between our experiences.

The protocol for antenatal consultations were clearly posted and follow the World Health Organization (WHO) guidelines.

More infographs in the ANC waiting area about exclusive breastfeeding and malaria prevention.

This is the Maternal Health Record Book that is given to expectant mothers to track their pregnancy. 

During our observation of an antenatal clinic, we learned about the various treatment options for an expecting mother and her child. Every mother is given a Maternal Health Record Book to track all their pre/postnatal visits to the ANC. However, retention during pregnancy and postpartum is not directly documented and mothers are free to visit any local ANC with their record book. As similarly observed in the U.S. most retention is maintiained during pregnancy because positive relationships between the mother and midwivery nurses are developed.
In terms of HIV positive mothers, their status in this booklet is represented by a 3-digit code only known to hospital staff to keep her status confidential. This is important because receiving ART does not mean that the mother has disclosed her HIV status to her partner or close relatives. The lag time in knowing HIV status and disclosure is lengthened by fear of domestic abuse, isolation, unwanted stigma associated with the disease. HIV postive mothers are immediately given first line therapy upon being tested positive for HIV and are currently required to take ARVs up to 18 months postpartum for prevention of Mother-to-Child Transmission.

Monday, March 16, 2015

Meet and Greet


With Dr. Nadia Sam-Agudu as our host, we were warmly welcomed to the University of Cape Coast (UCC) and University of Cape Coast Teaching Hospital (UCC TH).  We met the CEO, Daniel Asare, and the Provost, Professor H. Amonoo-Koufie (not pictured).  We we able to tour some of the campus and hospital.  

University of Cape Coast, School of Medicine with Dr. Okai, Director of Pediatrics, and Dr. Eunice, Visiting Fellow

University of Cape Coast with Professor Gladys Amponsa , Dean of Medicine