UPDATE: Ensuring Insurance

I have finally been able to sit down and reflect upon my experience with the health insurance campaign—being jetlagged has never served me so well. Before I begin, let me preface this post by declaring “Ensuring Insurance” a success. With everyone’s help, we were able to provide health insurance for 494 children! This means that 494 children who previously did not receive prompt, high-quality medical treatment due to financial reasons will now be able to do so.

Throughout the campaign, I encountered obstacles that were at times overwhelmingly disheartening, but ultimately proved to be a tremendous (and much needed) learning experience.

As many of you know, my initial goal was to raise $600 to provide health insurance to the 300 uninsured children in the rural village of Hodzo Ga. While, thanks to generous, compassionate supporters, I was able to more than double my initial goal (so far we have raised $1,780!), I originally believed that raising funds would be the most difficult aspect of the project. I thought that registering children would be simple; the paperwork was extremely straightforward, I had the support of prominent community members and then there was the incentive of free health insurance for a year—a promise that I thought was sure to entice people to attend the gathering.

An example of the formed used for health insurance registration

Let’s just say I was wrong. Fundraising was the easiest part. The hours I spent trying to find the best social fundraising website, writing a campaign blurb that accurately described the project without being excessively wordy (I may have failed on the wordiness aspect…), fighting with the finicky internet connection and convincing my friends, family and complete strangers that my cause was worth supporting were extraordinarily straightforward compared to the rest.

With fundraising, I was in control. My actions and my work were reflected in how many people donated, liked the facebook page and spread the word. With registering children for insurance, I was not. Going into the project, I was oblivious as to just how many other factors influenced the registration process: communication barriers, cultural divides, a lack of infrastructure, and the ever lingering question: is this even the right thing to do?

I had begun the health insurance campaign because I was overwhelmed with the helplessness that I constantly grappled with while volunteering at the hospital. Witnessing people dying and knowing that I could do absolutely nothing motivated me to find some manner, no matter how small, to change the situation. But after the first day of registering children for insurance at Hodzo Ga, I was engulfed with helplessness yet again. However, this time it was worse; I had tried my hardest to do something positive and I had not succeeded.

Looking back, what I considered to be failure—not registering 300 children in Hodzo Ga for health insurance in one day—was actually a success. 157 previously uninsured children in Hodzo Ga now have health insurance! The frustration I experienced at the small number of people who showed up, the chaos of the registration process, and the attitude of some health insurance officials towards the impoverished community members taught me a valuable lesson about public health work: everything is a lot more complicated and requires a lot more work than it may seem.

I learned from the obstacles of the registration process at Hodzo Ga how to plan a more organized registration event for the next day. As difficult as it was to accept, I realized that I needed as much help with the project as possible. This was not a situation where I could work hard independently and immediately see results. Turning to George, one of the nurses who works with Blue-Med, for help was the best thing I did.

He spoke to a friend of his, Gloria, who is a nurse in Dodome, another rural community. Gloria immediately spoke to the community and organized a gathering for the next day. Together we discussed the situation with the insurance officials and figured out a way to make the event run more smoothly. The registration at Dodome was a huge success. We were able to sign up 337 children for health insurance in one day!

Registering everyone for insurance in Hodzo Ga

The health insurance officials, Freya and Amelia (two of the other Blue Med volunteers) and me. So excited after ensuring so many kids in Dodome!

Throughout the entire process, I have learned so much, both about myself and about doing public health work in a developing country. Having now left Ghana for my final year at UC Berkeley where I am studying Public Health and Global Poverty and Practice, I am continuing to reflect on the benefits of “Ensuring Insurance”. In the short term, it is wonderful—almost 500 children will experience immediate improvements to their health care. In the long term, however, will it create a cycle of dependence? Will families not value providing health insurance for their children, thinking that a foreigner will come and register them for free? These are questions with which I constantly grapple.

I am working with George and Richard, the director of Blue Med, to expand “Ensuring Insurance” in a sustainable manner that breaks the cycle of dependence. As our discussions and ideas begin to manifest themselves, I will resume fundraising.

Ensuring Insurance

As I wrote about in an earlier post, I have been working on a campaign to provide health insurance to children Hodzo Ga, a rural agricultural village near where I am staying in Ghana. Despite several days of struggling with technology, I have finally put together page that makes donating simple and transparent. I would appreciate any and all support in reaching my goal of providing health insurance to the 300 uninsured children in Hodzo Ga. Thank you in advance!

To learn more about the cause, donate or spread the word, click here

Getting Intense

I’m still reeling from today. Amelia and I got to see a much anticipated c-section. Waiting for the procedure to begin, I focused on deep breathing and preparing myself for a lot of blood and gore; to be honest I think I was more nervous than the soon-to-be mother, a 22 year old woman that for confidentiality reasons I’ll refer to here as Emma.

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Pre-op: so excited to finally see a c-section!

The actual operation was simple and quick, with a manageable amount of blood. It was the epidural that killed me, and almost killed Emma… Reflecting back on the situation, this may be a bit of an exaggeration, but while in the theater watching the nurses struggle with the epidural and the general anesthesia, Amelia and I were both convinced that Emma was going to die.

In Ghana, there is a shortage of doctors. At the hospital where I volunteer there are only 6; the majority of the work, including giving anesthesia, is done by nurses. In the theater today, three different nurses were attempting to give Emma an epidural. They stabbed her with a long needle, trying to find the correct nerve, for over 15 minutes.

Those 15 minutes felt like eternity. Emma was screaming in pain and the nurses were yelling at her to stop moving. I thought I was going to start crying or pass out. After they had missed the nerve for the 6th time, I went over to Emma, grabbed both her hands and told her to squeeze whenever it hurt. To be honest, this was as much for her benefit as it was for mine. I could not handle watching her in so much pain, with no one to comfort her, and not do anything.

After over 15 tries, the nurses finally go the epidural in the right spot. I began to relax, when all of a sudden something started going wrong with the general anesthesia. I’m still not exactly sure how or why it happened, but the nurses gave Emma too much nitrous oxide (laughing gas). She stopped responding, and I was positive they had killed her.

The nurses began to panic as well and rapidly stuck a breathing tube down her throat. They quickly realized this was a bad idea, since she still had a gag reflex, and immediately discarded it. Somehow, Emma finally started responding and I, in turn, began breathing again.

The cesarean itself went smoothly and I wasn’t too phased by the blood or by the surgery (this was the first surgery I’ve seen), since Emma was definitely alive, but numb to any pain. Another moment of panic occurred, however, when the doctor pulled the baby out. Wrapped in the umbilical cord, he was blue and not crying. After about 3 seconds of sheer terror, he gave a small whimper. I don’t think I have ever felt such a rollercoaster of panic followed by relief as I did in the 30 minutes leading up to the birth.

Once I had recovered from the fear of a still birth, I was able to appreciate the rest of the surgery. The doctor had pulled the uterus out onto Emma’s stomach and was carefully cleaning it out. He then stitched it up, put in back inside her and sewed up her abdomen.

After the surgery was over, I insisted on staying with Emma until she was safely taken back to the maternity ward. I was still terrified that something awful would happen to her, even though the procedure had been successfully completed. I’m going to go check in on her tomorrow, but I’m pretty positive that she is recovering well and enjoying the presence of her healthy baby boy.

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Post-op: feeling a bit traumatized

Getting Back Into It

Ever since Dr. Jonathon left, my time at the hospital has been very slow. I usually wander around the different wards with Amelia, another volunteer, looking for things to do. After a couple hours of talking to nurses and patients, reading charts and fruitlessly asking if any births or surgeries will occur, I end up going back to the hostel. 

Today however, things turned around. After inquiring about any imminent births or c-sections at the maternity ward, Amelia and I were presented with the opportunity to help bathe newborn babies! (And by presented with the opportunity, I mean I saw a nurse carrying a newborn, followed her to the labor ward, observed for a bit and then asked if I could help. I’ve discovered that I need to be a bit pushy in order to get involved.)

Washing the babies was such an amazing experience! They were so incredibly tiny, yet perfectly formed. Holding them made me forget the trauma of watching a birth, something I was sure would not happen for a quite awhile.

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A freshly washed, moisturized and wrapped baby!

After helping bathe, dress and wrap seven babies, Amelia and I decided to check up on the patients we had been following in the female ward. Unfortunately, two of our four patients had passed away over the weekend. At first, it was very difficult to grasp the idea that, despite the best treatment the hospital could provide, these two women had not recovered. I knew that both women were extremely ill and required costly treatment that the Ho Municipal Hospital could not afford. Yet seeing new patients in their cots was more shocking than I had anticipated.

Upon further reflection, I’ve begun to come to terms with their deaths. Both women were unconscious and suffering immensely. One was obese, hypertensive, diabetic and had renal failure. She badly needed dialysis, which is only available at a hospital in Accra (the capital of Ghana) and is prohibitively expensive. The other woman was HIV positive and had toxoplasmic encephalitis, a type of brain infection that can be deadly among those with HIV. Death was probably a welcome escape for both. 

The presence of a new doctor doing rounds in the female ward helped me take my mind off the two patients. I followed him around the ward (this has become one of my new hobbies) until presented with an opportunity to introduce myself. He was very friendly and seemed genuinely interested in explaining the thought process he went through in diagnosing patients. 

The new doctor, Dr. Akobo, is very young and has only been out of medical school for one year. He spends an extraordinary amount of time with each patient, particularly in comparison to some of the doctors. (One nameless doctor skims his patients’ charts, glances in their general direction and shouts instructions to the nearest nurse before moving on.) I’ve come to realize that the younger the doctor is, the more idealistic and focused on patient interaction he (all the doctors I’ve met have been male) is as well.

After an interesting and informative hour doing rounds, the day ended with us making a plan to continue shadowing Dr. Akobo, both in the female ward and in his consulting room. I’m so thrilled to have found another doctor! Dr. Jonathon was a great mentor and will definitely not be replaced, but I think shadowing Dr. Akobo will be a valuable learning experience as well. Can’t wait for tomorrow!

Getting Insured, a Project

The first patient I interacted with at the municipal hospital opened my eyes to problem of health insurance that is prevalent throughout Ghana. 

When I met her, Erica, an 8 month old who had arrived at the hospital unconscious and seizing from severe malaria, was a healthy, laughing infant who had been discharged for over a week. However, because Erica did not have health insurance, and her mother did not have the money to pay the 250 cedi hospital bill, Erica remained in the hospital for 3 weeks after she was discharged. During that time, she once again contracted malaria, a tragically common occurrence due to the large volume of both malaria patients and mosquitoes in the children’s ward.

Unfortunately, Erica’s story is a familiar one. Many children in Ghana, particularly in the rural villages, do not have health insurance. Terrified by daunting medical bills, parents are less willing to seek professional medical care for their children when they fall ill. Instead, they nurse their children with herbal remedies, which although successful at alleviating certain symptoms, have not proven to be an effective means of treatment. These children are then rushed to the nearest hospital when, as Erica did, they fall dangerously ill. Delaying professional care not only exponentially raises the cost of treatment, it also increases mortality.

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The bill from one of the hospital patients. I snapped the photo before the cost per item was written down, but you can get the idea of how expensive it would be

Lack of health insurance should not be such a devastating problem in Ghana. Unlike the US, the Ghanaian government is the sole health insurance provider. Through the National Health Insurance Scheme (NHIS), it only costs 4 cedi, the equivalent of $2 US, to insure a child for one year.

During the time I have spent at the municipal hospital, at community clinics and at rural outreaches, I have continually felt helpless to make a concrete change. I cannot do emergency surgery to save a woman bleeding to death from a ruptured ectopic pregnancy, I cannot convince the hospital staff to isolate a woman suffering from TB so that she does not infect the HIV patients with whom she shares a room.

Providing health insurance to children in need is something that I am able to do. With the help of my friends and family, I plan on providing health insurance to the 300 uninsured children in Hodzo Ga, a rural agricultural village near where I am staying in the Volta region.

This Friday, August 10, accompanied by a community nurse and an NHIS official, I will be going to Hodzo Ga to register children for health insurance. I am in the process of creating a fundraising website to provide a straightforward, transparent way for those interested to donate to the campaign. As soon as the site is done, I will post it here. In the meantime, I want to get the word out and encourage others to do the same. 

Malaria, unless proven otherwise

At all the wards I’ve been to at the hospital, malaria is by far the most common illness. In the outpatient department (OPD), where I’ve been spending most of my time shadowing Dr. Jonathon, everyone with fever and/or chills is immediately diagnosed with malaria.

In response to my questioning the frequency of malaria diagnosis, Dr. Jonathon responded, “Fever is malaria, until proven otherwise”.

He continued by explaining that during the rainy season, malaria is so common that any complaint of fever or chills is immediately diagnosed and treated as the disease. Often times, patients just have a case of simple malaria, which is characterized by fever, chills, weakness and frequently a lack of appetite and vomiting. Simple malaria is easily treated with a three day course of pills, usually Artemether/Lumafantrine or Artesunate.

I was surprised to discover how straightforward it is to treat malaria. From all the hype about malaria prophylaxis in the US, I was expecting treatment to be a grueling and drawn out process. Instead, malaria is so common, and its treatment so basic, that most people get malaria several times a year and recover by day two of their pill course.

However, if untreated, simple malaria can quickly become severe, and many complications can arise. A common cause of death in children under six, severe malaria is a general term that describes a variety of symptoms. On an assignment from Dr. Jonathon, I researched the different clinical and lab manifestations of severe malaria and discovered that there are about 20. Most common in the municipal hospital, and apparently throughout Ghana, are severe anemia (characterized by hemoglobin <5), cerebral malaria (where the patient’s brain swells and he/she often experiences seizures and loss of consciousness) and prostration (where the patient is too weak to stand or sit up).

In order to avoid an increased incidence of severe malaria, Dr. Jonathon usually prescribes malaria medication to anyone who has any of the illness’ classic symptoms as well as to anyone with a cold (since they are more susceptible to the disease) without a blood film test confirming the presence of the malaria parasite, p. falcipirum.  A very knowledgeable, patient and intelligent man, Dr. Jonathon explained to me that while drug resistance can develop by overprescribing medication, lab technicians often do not conduct an adequate blood film test, consequently incorrectly concluding the absence of the parasite. Therefore, he believes it is better to prescribe the medication, as side effects are minimal.

Dr. Jonathon has been a tremendous wealth of information, both about clinical medicine and about Ghana’s health care system. He not only patiently answers my incessant questions, but also quizzes me on topics he has previously explained or has asked me to research. Standing in for a doctor on leave, Dr. Jonathon had his last day at the hospital yesterday. I’m very sad to see him leave.

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Dr. Jonathon admitting a patient to the Children’s Ward from OPD

Genuinely interested in helping his patients and practicing good medicine, Dr. Jonathon is one of the few medical professionals I have met here who is not yet jaded by the health care system. Despite being restricted by administrative barriers and certain cultural practices, he does his best to advocate for his patients.

Two instances stand out the most in mind. The first occurred a couple of weeks ago with a girl who had hydrocephaly, an enlarged cranium due to an excess of water. Although the girl was at the hospital for a variety of other symptoms that turned out to be malaria, gastroentiritis and an upper respiratory tract infection, Dr. Jonathon was very concerned that nothing had been done about her hydrocephaly when she was younger. He prescribed her a variety of medication for her other complaints, and upon noticing she did not have health insurance and was struggling to make ends meet, gave her money for the prescriptions. He then instructed her to come back in a week, after she had recovered, so he could sign her up for health insurance. It was so touching to see this act of empathy in a hospital environment where many of the staff treats patients brusquely.

The second has been an ongoing battle with hospital administration. While doing rounds in the female ward a few days ago, Dr. Jonathon discovered that a woman with tuberculosis was in the same room as two HIV patients. As they are severely immunocompromised, the HIV patients had a high risk of contracting TB from their highly infectious roommate. However, the TB patient was no longer producing sputum, so although her chest x-ray displayed a very large granuloma, the diagnosis could be confirmed by a sputum test.

Dr. Jonathon has been arguing with the female ward nurses, the head nurse and the administrative staff to have the woman put into an isolated room, to no avail. Despite being told by other doctors that his battle was futile, he is still determined to get the TB patient isolated. The last time he was in the ward, he declared he would wheel her out himself if it came down to it.

Getting Touristy

The past two weekends I’ve decided to get my tourist on and visit other parts of Ghana. Besides getting my purse stolen by two guys with a knife this past weekend, the trips have been amazing. We’ve visited a monkey sanctuary, climbed the tallest mountain in Ghana, swam under a waterfall, gone on a canopy walk, touched crocodiles and explored a slave castle. Every part of Ghana that I’ve seen so far has so much character, even if it is a tourist location.

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Feeding a monkey at the monkey sanctuary. They were feisty!

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At the top of Afadjato, the tallest mountain in Ghana. Hiking the 2904 feet to the top was quite the challenge

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The waterfall near Afadjato

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Inching our way into the waterfall

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This picture was taken right before the crocodile started moving and I subsequently started screaming and running away

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The entrance to the male dungeon at the Cape Coast Slave Castle

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The view from the slave castle. Photo courtesy of Lin Li

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On the canopy walk