ZigZagSigSag

Paramedic N: "Our group mostly works in the 'critical care' section of the ER, so the patients we see are the most sick or the most injured, so our experience is skewed toward that patient group. This is my polite way of saying 'most Ghanaians don't die from awful car accidents or traumatic injury, most illnesses around here can be attributed to combinations of long term, uncontrolled high blood pressure, untreated diabetes, or general ignorance about how to handle common illnesses among the very young or very old'."

Dr.G: "Yeah I might also add that we see treatable disease processes that have progressed through their natural history to the peri-Mortem phase by the time we see a lot of them - lots of infectious disease including sepsis, meningitis, orbital cellulitis; also ARDS and acute pulmonary edema are big ones that we could actually treat and hope to reverse. I think altered mental status must be our number one issue in red ward."

Dr.N: "Agreed."

1) How did you get into the job and why did you decide to work in West Africa?

Paramedic N: I showed up. Honestly. I went into the hospital and asked how I could contribute as a volunteer. A month later I was working in RED and helping to direct some training for the nurses. Another month later I am here offering instruction for other hospitals as they develop their own emergency medical protocols.

2) What are some things you have to struggle with everyday, regarding the different health care provided?

Paramedic N: The system for treatment is pay to play. This means that as a patient is brought in the nurses will take vital signs, strip the patient, obtain IV access and maybe place them on a simple 3 lead cardiac monitor. If the patient needs additional medications or interventions they have to pay for them up front. If the patient is unconscious then the family has to pay for that up front. If the patient is awaiting further consultation (say, from the surgical unit) because they need X-rays, they have to pay for that up front. Otherwise, nothing will happen and the team will typically stand by idly, sometimes even until the patient codes. That's a pretty wild difference.

3) What are some of the differences in health care (e.g. First aid) we can't imagine?

Literally all of it. My personal favorite horror story is watching a doctor here make it a priority to provide a patient with a heart rate of 230+ motrin prior to even placing the patient on a monitor and assessing their electrical status, or even their blood pressure. For every mind blowing decision we've seen here, there are equal moments of really clever, cheap methods used to provide interventions.

Paramedic N: Here in Ghana? No, this place is very safe in spite of some of the pictures in the imgur gallery. I think that as long as you know how to explore urban places and know how to keep your eyes out for trouble and your head cool in a conversation it's possible to keep out of real trouble. There are certainly dangerous places to be in or go to in West Africa but by and large, where we are in Ghana is quite comfortable and safe.

Dr.N: Depends on where you are. Here the work itself doesn't seem dangerous, but is only in the sense that you're exposed to everything that the local people are exposed to. This includes road traffic accidents, knowing that the medical infrastructure is such that if you are injured or ill you may not have the appropriate treatment available.

Paramedic N: Yes but no. We will provide chest compressions and obtain advanced airway interventions, but if the family did not purchase any additional pharmaceuticals (Epinephrine) then none of it really matters.

What's worse is in the rare cases when we do achieve ROSC and there are sometimes no additional meds to maintain that fragile stability.

I haven't heard of any Ghanaian's starving to death, though I'm sure it may happen from literal malnutrition due to poor dietary standards here. I'm also fairly positive its a massive contributing factor to the hypertension and diabetics. Practical help would be large scale human health classes at the high schools to help educate the general public generation by generation. Insulin is all over the place but very few physicians take time to adequately explain proper diet and why to people. That's not a complaint specific to KATH, that's a general issue explained to me by Ghanaians that I'll speak with at spots.