The Other Side

October 10, 2012
Enjoying here, but missing my sister’s birthday (boo)
One of the good things that can come about when you’re living in a different place is that you can re-invent yourself somewhat. Translated to the more specific, I mean that I have been doing things here in Ghana that I normally would not do back home.
Such as, waking up at 545am (uh-huh; which by the way, Ghanaians say ‘ah-hah’) to work out yet another Insanity video. This time it was time for Cardio and Resistance. L asked me what it was about before starting the video. I said I didn’t know but it sounded like a lot of work. And indeed, it really was intense but this time around we finished the video without having to forward it midway. I think the more you do it, that it gets easier. Our helpers didn’t join us this morning, I think partly because it was too early for them and partly because they were both feeling sore. D today kept walking like a woman with a 20-month old baby in her womb. Luckily for her, it should not take a lot for her to build muscles in her arms (they are already on the way to becoming toned) and in her butt (she already has an ass in JLo proportions). I am taking a liking to working out in the morning, although I don’t know how I would be able to keep this up at home when I no longer have 2 girl friends to join me (my girl roomie at home would not be caught dead working out, that I know for sure).
W again went with me to work. Tomorrow I will be on my own, which I now do not find daunting. I think I can navigate through the chaos here, having snaked through throngs of people in crowded streets multiple times now. 
We arrived at the hospital a little past 9, and found G already busy counseling a patient in the very private (not) hallway in the building they call ‘Consulting Room 4’ which houses both the Male and Female/Children’s Recovery Wards, 2 other unnamed rooms and what seems to be the records department. The entire area of the Consulting Room is very small. It would take longer for me to walk from our mailbox to the end of our backyard than to traverse the entire the room.
Later we were called to the office of the Medicare Unit (I don’t know what exactly Medicare means here), which is where HIV/AIDS CT (counseling and testing) occurs—sometimes. This was where we held our HCTs (HIV counseling and testing) yesterday.  Only difference was, the head of the Unit was there today so aside from the room functioning as the HCT room, it was also operating as her office (and her kitchen and dining area as I later on learned when at a little past 12 she started taking out her rice cooker and bowl, put on her apron and began peeling her vegetables; I wanted to rise from my chair and look over her table to see what exactly she was cooking but I thought it was poor form).
I assisted G in some of her clerical work, although I did at one point carry out the First Response Test on one patient (fulfilling) and did some counseling (the patient understood English). It was almost comical how I struggled using the lancet and the pipette. One of the things G had me do was to write up scripts for ART (most of them were on AZT+3TC+NVP, although some who had had reactions to NVP like lipodystrophy and SJS were converted to EFV) and prophylaxis for opportunistic infections (most were on TMP-SMX).  Not being able to sign the prescriptions myself due to not having a license here, it felt odd to be writing the medicines and then handing the scripts over to G to sign. There were times when the patients would have specific complaints, to which G would say you have to go the doctor. It felt again, odd, that the doctor in the room (i.e., I) could not see them on her own.
There were times however when I had to assert myself for the patients’ sakes.  On one occasion G started writing ‘cotrimoxazole 2.5mls’ for an 18-month old boy whose weight we did not know (the weighing scale was only for adults, and from my understanding babies who are receiving only prophylaxis medicines by virtue of their breastfeeding mothers being HIV positive, do not have their own records). I said, why are you giving 2.5mls? She said this is what I see doctors always give to children. But shouldn’t it be weight-based, I suggested. She said yes I get what you’re saying. I asked if she knew the preparation of the medicine. She didn’t know. I looked up cotrimoxazole in my Harriet Lane app, but it only had Bactrim. I knew they were essentially the same apple, but I didn’t want to assume that the preparations of the syrup were the same. So I said, well you know what—if that’s what you see them give then go ahead. I had to swallow hard.
And then one time a woman came and she asked for ART scripts for herself, her husband and her 9-year old daughter.   G asked me to write the scripts and as for the daughter, to just copy the previous doses.  And since I have a hopeless leaning to details, I noticed that we would essentially be under dosing the daughter if we were to just copy the previous doses. Thankfully the folder had dosing guidelines for children, so there was no question about the doses this time around.
I learned today that infants born to HIV positive mothers are followed on regular intervals, to make sure that they remain sero-negative (if at one point they are found to be positive, then they immediately receive treatment). Those who breastfeed from HIV-positive mothers receive prophylaxis until a certain time (if I understood it correctly, up to when they stop breastfeeding).
They had a meeting today with who I assume to be an HIV control officer from the Ministry of Health. He asked questions I have already asked myself, such as—where is the HIV center (there is no physical center), how are cases recorded (pretty good, but on different books and by two different, but inter-connected departments), what are the challenges (lack of a dedicated HIV center, which translates into an absence of privacy for patients, and poor fluidity in the counseling-testing-treatment-follow up-surveillance continuum). He was, quite understandably, bewildered. It was quite an interesting meeting. The head of the unit was starting to get heated up and defensive when questions were arising. G sounded her desperation about trying to get funding for a center, for quite astonishingly, 2 years now without any luck.
I talked to her about it. I asked her what the barriers were. Did they think you did not have enough data? Did they think the presentation was not good? Are they not convinced that HIV is not a simple case of pneumonia, that it needed serious attention? Did they say they did not have enough money? Have you presented a business proposal? Did you give them numbers to crunch on?
She said that they have been promised of a center for 2 years now. Soon, they would always be told. But nothing has been done. Sure, funds are not plentiful. G says that recently money that they thought was going to go to their department went instead to the acquisition of an x-ray machine. I said, well, that’s also important and it would be hard to argue with that.
I asked if she has already drafted a new proposal. She handed be a photocopy of her abridged and hand-written proposal (I am not sure if this is what she actually submitted—god I hope not). The ideas were sound, but like I said if she presented it in this manner (handwritten on one an half page of bond paper) then I would understand why it was not given high priority. I offered my assistance in helping her write up the proposal if she wanted to. She seemed interested. I don’t know if I was chewing more than I could by offering this to her but at that point it seemed the right thing to do.
Working in the non-physician side of the healthcare spectrum is quite the learning experience. I see the difference in the discipline and approach to patient care. I see how our orders are received and carried out. I see the gaps, and I also see our inter-dependence with one another.
This afternoon one of our helpers, P, asked me what we were going to cook. I had to laugh out loud that she asked me because she never did until that point. I asked what we had (yam, rice, cabbage, tomatoes). Oh boy. So I went to the kitchen, rummaged through everything. At the end of my kitchen investigation I had gathered up ingredients for what would be vegetable curry without coconut milk (they neither knew what curry nor coconut milk was). They had curry powder, but they used it for a different purpose (as rice mix).  I think I added too much chili because even I could not eat the curry without having to grab a pineapple chunk as a chaser.
Tomorrow I may teach them how to cook garlic rice. I can teach them chicken adobo but I hesitate because how would that serve me? Haha. And anyway, they don’t know what soy sauce is. Not even sure if I could find one in Shoprite, Ghana’s Wal-Mart.
Another highlight of my day was seeing Dingdong Dantes on screen, with an English dubbed-in voice, while picking out local music CDs at a local store. Not that I am his fan, I just thought it was so amusing that a Filipino film could land its way to one shop in Kasoa, Ghana. I just wish they had a better film to show.


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