IVUmed Ghana 2015 – Moments – by Michael Felber

Michael and 10 month old – Ghana

(This was written by dedicated nurse volunteer Michael Felber, in Ghana where he is participating in an IVUmed medical trip.)

Moments
March 24, 2015

You get moments that remind you where you are. This morning was when I walked downstairs to breakfast and felt the warm humid air. It has a heavy feel, like being wrapped up in a warm wet blanket. Then there was another in the hospital, seeing an OR walk by expertly balancing a tray of instruments on her head like it was nothing at all.

Yesterday the moment was when I was in the OR trying to memorize where supplies are kept, putting together hypospadious kits for the surgeons. There were people everywhere, each with their own piece of the action in getting ready for surgeries. And then I looked up and saw Victor, a handsome 10 month old who happened to be our first patient of the mission. And then all the stress about flight cancellations, lost luggage, getting to Kumasi, feeling dehydrated and exhausted all melted away. Victor eyed us warily but held on to him.

International Volunteers in Urology has had a long standing partnership with Komfo Anokye Teaching Hospital in Kumasi, Ghana, teaching surgical skills to surgeons and residents. This week is the annual surgical workshop, where doctors and nurses from IVU work directly with colleagues here in Ghana. The purpose of the week is education. Congenital urological malformations are one of the most significant psychological, social, and economic impact for children and families. But the real problem is availability of resources and trained clinicians to treat these children. An organization can’t operate this problem away. Education is key. When you go home you have to leave something behind.

View from the window – Ghana

But at the moment Victor was carried into the operating room none of that seemed to matter. It was all about him. He went to sleep safely, and woke up with a repaired hypospadious. He cried and fussed until he was safely in his mother’s arms, happily breast feeding.

The hospital is built like a maze. The post op ward is about three floors up from the operating rooms and PACUs, and I have already lost count of how many times I have made that climb. It’s easy to get lost. I already have sort of an inner map of the hospital – I make sure I am walking and climbing around the courtyard with the pink flowering bushes, and if I see the street and other buildings I know I have taken a wrong turn. There are usually patients sitting in the stairwells, and after a short while we recognize each other. There is a prayer room for Muslim patients that I always pass through on my way to the ward C. The wards are full and overflowing with children and parents, maybe 30 in each room. And it is hot everywhere except the operating rooms.

And it is all about Victor, or Mohammad, or whatever child is in front of you at any given moment. A few years ago I worked with a doold me to always remember that caring for another person or for another person’s child is a privilege. If you remember that, she said, you will always do the right thing. The kids we are caring for in Ghana all need skilled adults on their team. It took a lot of work to get to the point of bringing Victor into the operating room on Monday – more work than usual. But it is a privilege to be here, on his team.

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I think there are ten main languages spoken in Ghana, and several spoken by small groups. English is the official language and the language used in the media and all formal written communication. People mostly speak the King’s English – very formal and proper. The signs are The local languages I have heard here sound a lot to me like Haitian creole, but I think they only share roots. Then there are people whose English has been influenced by movies and western TV shows and music. So every now and then I am greeted with “Hey man, what’s happening” or “Yo, Dog”. You never know…

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Health care workers live by routines all over the world. Routines make complex work organized and more predictable, and in the end make it safer for the patients. Working overseas is challenging because you have to learn other people’s routines, and mesh them with your own. And we all have the very human quality of assuming that other people naturally understand how we think and operate, even though they often do not. The experience of being a nurse here is similar to ours in some ways, but in other respects it is very different. It only takes one trip to the hot and crowded inpatient ward on the third floor to understand that.

Post-op Ghana

Yesterday it felt like we were getting out own feet underneath ourselves. That had to come first, just like on the airplane when they tell you to put your own oxygen mask on before you try to help others. Today we spent more time working with the nurses here. It helps to open the conversation by just asking about their day to day work – what their concerns are, what workflow works best for them. You have to learn everyone’s names. (anyone who works with me is laughing as they read that) Based on that we changed the way we dispense medication to the floor – yesterday we sent up individual doses for each patient, but today after talking with Barbara and Dora, the charge nurses on the ward, we sent up enough medicine for every one and let the nurses divide and administer it to the patients. I joined the PACU nurses this morning rolling bandages. Pretty soon everyone was laughing and taking pictures. And Ellen, one of the nursing students in the OR theater, joined us to help recover post op patients.

IVUmed Resident Scholar Dr. Kristi Hebert Reports From Pune, India

Dr. Kristi Hebert

The generous support of the Southeastern Section of the AUA made possible Dr. Kristi Hebert’s IVUmed scholarship experience in Pune, India. During her time there, Dr. Hebert was able to participate and learn techniques from mentor Sanjay Kulkarni, MD, a world-respected reconstructive urologist.

After returning from the workshop, Dr. Hebert reported, “Dr. Kulkarni is so well-respected and performs such specialized procedures, that during several weekends out of the year he hosts a surgical workshop. During these days, several urologists in the country will travel to observe his urethral reconstruction work and to have an opportunity to learn the techniques. My first day at the hospital was during one of these workshops. Dr. Kulkarni is an excellent teacher and host, and took time to explain his steps of each procedure. He was very focused on conveying the thoughts and decision-making process of each step.

“Even with medical conditions inflicting pain and hardship, the patients in general were very kind and appreciative. They were willing to allow any of us to learn from their cases and to observe their surgeries. They appeared to be very stoic and tolerated pain very well. The local scenes did convey a moderate amount of poverty in the region. Despite not having much financially, the peace and happiness they displayed on a daily basis was inspiring.

“This rotation was one that I grew from both professionally and personally, and I appreciate the opportunity provided by IVUmed and my sponsor, the Southeastern Section of the AUA. I would recommend the IVUmed program to any future residents who have an interest.”

IVUmed Surgical Team in Pune, India