The Ghana Journals – The Ongoing Global Health Mission

Dr. Kayla Bryan (Duke Anesthesiology chief resident, 2015) and Dr. Amy Mauritz (Obstetric Anesthesiology fellow, 2014-15) provide a firsthand account of their mission trip to Africa as part of the Duke Anesthesiology Global Health Program.

AfricaEssay1I had been looking forward to January 2015 for over a year, and I was not disappointed! I spent the month in Ghana, Africa, working as part of the Kybele team improving the care of maternity patients at Ridge Regional Hospital in the capital city of Accra. Each day at Ridge Hospital presented a new experience or a new challenge. Sitting in on OB morning reports and observing patient care on the wards and in the postanesthetic recovery units gave insight into the daily challenges experienced by all staff at the hospital. Medication and equipment shortages, staff shortages, power outages and patients’ inability to pay are common occurrences that significantly impact maternal morbidity and mortality at Ridge.

AfricaEssay2My project while at Ridge Regional Hospital centered around using bedside transthoracic echocardiography in a low resource country to improve the care of critically ill maternity patients. We brought a portable ultrasound machine from the United States generously loaned to us by Sonosite with plans to perform echocardiography on patient volunteers. However, once I unpacked the ultrasound machine on that very first day at the hospital, many of the Ridge staff lined up as volunteers so we could practice TTE. We were amazed at the enthusiasm expressed by physicians, house staff, nurses and students alike! As the month passed, we continued performing echocardiography on both staff and patients improving our skills and teaching anesthetists, intensivists and nurses along the way.

AfricaEssay3While in Ghana, I was given the special opportunity to fly to the northern city of Tamale, which is much smaller and more rural than Accra. The Tamale Teaching Hospital was larger and more updated compared to Ridge Regional Hospital; the operating rooms, intensive care units, and labor wards were better equipped with new anesthesia machines, monitors and surgical instruments. However, in Tamale, many patient beds were empty, and state-of-the-art equipment wasn’t being used. At Ridge Regional Hospital, patients lined the sidewalks daily waiting for beds to become available, and the maternity and female ward censuses were always at capacity. The differences in the two facilities were tremendous. While in both Accra and Tamale, I was teaching nurse anesthetist students who were all extremely bright and eager to learn. It was very refreshing and rewarding to teach such appreciative groups of students.

AfricaEssay4We worked hard while in Ghana, but we also took time to experience the culture and beauty offered by the country and its people. The art markets and rainforests were amazing, but neither came close to the kindness shared by the Ghanaian people. My birthday came and went while I was in Ghana. This was the first surprise birthday party I ever had, and it was magical! There was birthday cake, candles, sparkling grape juice, and more singing and clapping than you can imagine. Dr. Olufolabi, Amy Mauritz and the staff at Ridge Regional Hospital gave me a birthday I’ll cherish for the rest of my life.

Before traveling to Ghana I knew I was interested in global health, but I didn’t have any understanding of what global health actually entails. After spending an entire month immersed in the healthcare system of a low resource country, I now have a much better understanding of the complexities and difficulties encountered while trying to improve patient care in these areas. Global health encompasses a wide range of interventions, personnel and emotions. Adaptability is paramount as is teamwork and compassion. While in Ghana, I experienced wonderful emotional highs as well as many devastating emotional low points. My perspective has changed forever, and I cannot image my career going forward without global health playing a role. I am extremely grateful to Dr. Olufolabi, the Department of Anesthesiology at Duke University Hospital, and Kybele for enabling me to have this wonderful, life-changing experience.

Visiting children at a primary school in a poor area of Accra. Their appreciation for education at such an early age was amazing and made them wise beyond their years.

Visiting children at a primary school in a poor area of Accra. Their appreciation for education at such an early age was amazing and made them wise beyond their years.

It has been more than two weeks since I returned from Ghana yet the sights and sounds of the capital city of Accra are so vivid in my mind that I feel like I just left yesterday. The four weeks I spent observing, learning and teaching at Ridge Regional Hospital in Accra, Ghana gave me the most formative and influential educational experiences I have had thus far in my anesthesia training. In my journey from medical school through fellowship I have seen many patients die, but I have never stared death in the face like I did in Ghana. I held a young mother’s hand as she was spiraling towards an untimely demise. Her air hunger caused her to grip my hand with what little strength she had left as her eyes full or terror pleaded with mine to save her. Unfortunately due to a multitude of reasons beyond my control this young woman became another statistic. Another woman dead because she had pregnancy complications in a low resource country…

Teaching nurse anesthetist students the basics of spinal anatomy. It was such a pleasure to teach eager and inquisitive students!

Teaching nurse anesthetist students the basics of spinal anatomy. It was such a pleasure to teach eager and inquisitive students!

To be honest it was very hard to reconcile in my mind the abundance of resources we have at Duke to the scarcity of basic medical necessities that are available at Ridge. Observing this inequality was my harsh introduction into the difficulties associated with improving maternal mortality worldwide. Despite these obstacles, it was extremely satisfying to collaborate with dedicated local physicians, nurses and trainees to brainstorm and execute sustainable solutions that will work in their environment to put an end to preventable maternal deaths.

The partnership between Kybele and Ridge Hospital has drastically improved maternal care since 2007, but our work will not be finished until there isn’t a single mother that suffers a preventable death. With the help of our very own Dr. Olufolabi and Ridge Hospital staff, I was able to implement a modified obstetric early warning system at Ridge Hospital. This system will aid in the early recognition and treatment of deteriorating parturients. My hope is that by giving the nursing staff parameters to identify declining patients early and by empowering them with a system to summon help from senior physicians, sick parturients will be treated early in their disease process and morbidity and mortality will decline.

I partnered with an anesthesiologist, Dr. Matt Hatch and anesthesia resident, Dr. Sheel Todd from Wake Forest to teach anesthesia basics to student nurse anesthetists at Ridge Hospital. The students in turn presented us with our very own Ridge anesthesia shirts and traditional Ghanaian necklaces and bracelets!

I partnered with an anesthesiologist, Dr. Matt Hatch and anesthesia resident, Dr. Sheel Todd from Wake Forest to teach anesthesia basics to student nurse anesthetists at Ridge Hospital. The students in turn presented us with our very own Ridge anesthesia shirts and traditional Ghanaian necklaces and bracelets!

The enthusiasm and support of the MOEWS that I received from the staff at Ridge Hospital is indicative of the warm hearted and loving nature of the Ghanaian people. I felt this warmth both inside and outside the hospital. I am grateful that in addition to my time at the hospital I was able to experience the beautiful culture of Ghana. I spent time exploring the Kakum National Park, Elmina Slave Castle and walking through the historic fishing town of Jamestown learning about the daily lives of the women I saw every day at the hospital.

I am grateful to the Department of Anesthesiology for supporting my trip and for all the individuals in the department who support Kybele financially. I am also grateful to the Society for Education in Anesthesia and Health Volunteers Overseas for sponsoring my travel. I encourage any resident who is interested in global health to apply for the SEA-HVO traveling fellowship to financially support your experience. I assure you that you will return profoundly changed!