Heart to Heart
The ICHA Blog
Doing well with what you have |
There’s making do with what you have and doing well with what you have. The staff of the Elmina Urban Health Centre do much more of the latter.
Foregoing the excess packaging and attendant disposal requirements of individually wrapped band-aids, after a blood draw, patients are given a swab of unwoven cotton torn from a forearm-length bolt. Before their blood is even drawn, a piece of IV tubing suffices for a tourniquet. The plastic tubing offers an unintentional integrated safety mechanism. It snaps if pulled too tightly. For blood samples that must dessicate before or after staining, louvered windows, placed to catch the scant from a clinic courtyard, can be tilted to become a perfect drying shelf. For those serum tests, like typhoid, that must be rocked and checked for agglutination, a ceramic floor tile is an excellent tool. Its white surface provides a contrast with serum or whole blood, and its adsorbent surface assures neat mixing of serum particles. Economically placed, up to 35 samples can fit on a single tile.
In our home hospitals and clinics, with their myriad specialized gadgets, it’s easy to forget that things need not be purpose-made to be useful. Indeed, pressing everyday articles into sophisticated uses reflects and cultivates a versatility of mind that is priceless in any setting.
Doctor, heal thyself! |
As happens everywhere, health care workers share lifestyles with their clients. It's just one of the features of community health. Into the raucous joy of Ghanian life, are creeping some less healthy habits. Minimal exercise and fatty food additives are two main culprits.
Our visiting team has been treated to high fat, high salt snacks washed down with Coca-Cola after presentations of Preventing Heart Disease and Diabetes Mellitus 2. The irony isn't lost on us, nor is this counter-productive situation unique to Ghana--just look at the foods served at Western medical conferences, and the American Academy of Family Physicians decision to 'partner' with Coca-Cola to produce patient education materials on healthy beverage selection. The point is, often, patient education and community health improvement begins with the messengers.
Doctor, heal thyself! applies to both the Ghanian nurse covering her salad in dressing and the American doctor snacking on cream puffs at a Cardiovascular Disease conference. Addressing health care workers' choices are excellent starting points for changing the choices and health outcomes of a community.
Little Changes can make Big Differences |
The patients and staff of the Elmina Urban Health Centre reinforce the concept that happiness is found more in personal and community connections than in having things. This has a lot to do with how the staff at the health center were able to create and continue a sophisticated health system, complete with efficient patient flow through multiple care stations. At each step of their visit, patients are warmly welcomed--connected to their providers and this community center.
For someone who spends the majority of his professional time in patient consultations, I was very impressed with how the laboratory (typically, a faceless entity to Western doctors) contributes so much to patient care and community building. With early use of inexpensive point of care testing, lab personnel are ably to quickly and accurately diagnose malaria; enabling rapid treatment and decreasing unnecessary antibiotic use and subsequent malaria resistance. Malaria is a (likely, the) leading diagnosis at the Elmina Urban Health Centre, and simplifying the care process saves patients much time, enabling them to return to their daily activities and freeing the health care team to see other patients, a reverberation that decreases their waiting time too.
Little changes can make big differences. Those changes are happening now at the Elmina Urban Health Centre.
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A Meeting of the Minds |
With the support of the KEEA district, ICHA held its very first Heart Health Workshop. In attendance were 40 teachers, members of the district department of education, staff from the Elmina Urban Health Centre, a doctor from Kumasi, and champions for youth development in the community; essentially some of the greatest minds from the community that are willing to take the first steps of preventing heart disease in Elmina.
This workshop started well before the outreach. Much of it could not be possible without the coordination, assistance, and vision of Wilfred, the public relation officer at KEEA district, and his staff. The material (which was well received) came from many hours and revisions by a dedicated team within ICHA. And our three talented speakers sacrificed time from their busy schedule to come together and deliver a united message about 1) the importance of understanding heart disease; 2) how to prevent heart disease; and 3) why teachers are at the frontline of spreading this knowledge. For all of this, ICHA is immensely appreciative for everyone's efforts.
What has amazed me though, is the level of commitment, interest, and dedication from the teachers throughout the outreach. At times, I feel that we are all on the same page; what the teachers want are the same as ICHA's wishes. The three public secondary schools - Komenda, Edinaman, and Eguafo-Abrem - all welcomed us on to their facilities for a number of events. But it was the teachers that sat through and gave us feedback on our surveys, provided us insight on how to reach out to the students and enable them as ambassadors, and made the workshop a success with their presence and participation in discussion.
The teachers have not shown hesitation to express their opinions and ideas. They tell us when students might not understand this or suggest a better way to engage the class. But through and through, they tell us how necessary our program and organization is. The teachers are hungry for more - more material, more visuals, more activities, and more time with ICHA. And we think this is partially because they know their students are equally as hungry and enthusiastic for more.
So this Heart Health Workshop marked another milestone for ICHA. We have trained the teachers. They will share the information with students. And hopefully the message continues to spread, leading us to new ideas. A few great minds will turn into many - and this is how the community can keep Elmina safe from heart disease now and in years to come.
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Spreading the Message |
The youthful student body of Edinaman Senior Secondary School slowly filed into the large, 2 story assembly hall – all 1,000 as promised! This was the culminating event of our schools programs, and probably the one that had given me the most anxiety.
Taking a moment to reflect on the past week, I feel pleased with what we have accomplished. We started the week on Monday with the Teacher workshop, which could not have gone better (perhaps we could have started on time, but I can’t forget where we are). And we ended the week at Edinaman.
Though 1,000 high school students is not a crowd that either Vince or I have experience with, it went surprisingly well. I say “surprisingly” because I was, in fact, fearing the worst – laughter after every word we spoke in our funny American accents, or worse, blank stares! Thankfully, neither of these scenarios greeted us. Instead, the students seemed quite engaged, certainly shy when it came to volunteering for activities, but still interested and thoughtful. Because Edinaman is the only one of the three schools that has an assembly hall big enough for all of their students, it was the only assembly with the entire student body present.
I think in our favor (giving us a day to practice), we hosted a smaller assembly (for about 200 eager students) at Eguafo the day before. The assemblies included a brief interactive lecture, addressing the basics of heart disease and prevention – focusing on diet and exercise; with lots of activities throughout. The activities were the key. They included a rowdy fitness competition between students and teachers! The crowd loved this. Though young and mostly quite healthy, the students are important ambassadors to the community. The message they bring home to their families is taken as truth. Teachers are highly respected, so what they say is often heeded. So far, what we have seen is that the students are eager to learn and repeat the information, charged with good questions for us and their teachers.
We could not have pulled off these events so seamlessly without the help of the teachers and administrators. They have been committed to ICHA since we got here almost a month ago and we certainly appreciate their attention. We are counting on these leaders to remain involved once we leave Elmina. We believe the interest is there. We have planted the seed and provided the resources. Hopefully the message will take root.
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Meeting Expectations |
One of the things that I remember well from the last time I was in Elmina is the satisfaction after a good meeting. Sure, meetings are certainly full of cultural confusion which often means moments of awkwardness. But, overall, we all tend to agree with what needs to be taken care of and how. I usually learn quite a bit from these encounters and gain a new perspective, a new way to present our message; And certainly an extra spring to my step (which is especially obliging in this heat)!
Heart health, the reason we are here, is an easy message to share. It affects everyone – from children to seniors everywhere in the world! And everyone can do something to prevent it. It’s not a controversial health issue, and it’s so important. Thus, general reception of the issue is usually positive and supportive.
Today, Vince and I met with the Director of the District of Education for the KEEA Municipal. Though this was more of a formality than anything else, as we have been working with the PR officer since September 09, it was another satisfying meeting. He began by telling us that what he thinks we are doing is very good and explained why he thinks heart health is so important. To summarize, he expressed that “our heart runs our body - if our heart is not healthy, our body is not healthy. This is a problem that affects every human so it is a problem that is important to talk about. It is good to teach youth, the innocent, so they learn early”.
If I could record every meeting, we would have our package for the community. Most people we talk to understand the importance of cardiovascular health, can earnestly express the bigger picture and are eager to learn how to put it into practice. This puts us in a great position to move forward with the projects we have been working on and share ways to practice heart health.
ICHA will be hosting an all-day teacher workshop next week that, in collaboration with the District of Education, we have invited all Science, P.E., and Home-Ec teachers from the three public high schools. Along with guest lecturers from the clinic and the community, we will be presenting a heart health program to incorporate into the science curriculum. The week following the workshop, Vince and I will be leading interactive assemblies at the three high schools to engage students in the discussion of taking care of their hearts and their bodies. We will invite the students to initiate a Heart Health Club at their school, with hopes they will continue to participate in this discussion, at school and in their community, long after ICHA has left Elmina.
All the pieces are falling into place. Everyone we have worked with here in Elmina has been so accommodating and I think are as eager as we are for this project to lift off. We have great expectations!
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Fortune and Cookies |
“You will step on the soil of many countries.” These are the things I keep in my wallet – a collection of ambiguous messages printed neatly on a 6 x 1 cm piece of paper (yes, I measured…). In 99.8% of the cases, these messages never resonate much farther than an after-thought; cleared and disposed of with the dirty dishes. But for some reason, I knew this one was a winner; and it is the opportunity (and through lots of hard work) that I have been afforded through ICHA to do just this.
This is outreach #2. The expectations unbeknownst to Lyza and me, but we can imagine. Since the inaugural outreach, the team has been conceptualizing, arguing, and printing out a series of educational material for cardiovascular disease and health. The message is clear; audience interpretation and reception…not so sure. However, this is the fun part for me – to develop a concept and message, and then observe and listen. By working with the community of Elmina, I hope over time they can better utilize our message to raise awareness and prevention of cardiovascular disease.
Since I’ve never blogged before (hi world), I’m going to take up this space to thank the team (they know who they are) and my family/friends for their support. I’ve got a long list of things to accomplish – some personal, some for ICHA, and one about cookies (but more about that later…).
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Hope for the Future |
How to describe such an immense experience? I feel as though I have been through a lifetime and back, however still have not processed the experience fully. We achieved so much, extending beyond our expectations and yet there remains an endless amount of work left to do. Each step we took opened doors to a whole new set of opportunity and need.
The Doctor and RN shortage in Ghana is astronomical secondary to lack of relocation incentive packages and lack of local resources. Ghana only has three medical schools, one of which has yet to graduate its first class. As of now, Ghana only graduates an average, of about one-hundred medical students a year! Most of these graduates flock towards the big cities, leaving rural areas barren. At the Elmina Health Center, nurses and medical assistants may see up to one-hundred patients in one morning, leaving patient to clinician ratios unmanageable. It is under these conditions that we set out to make our impact on lowering CVD.
At first, staff was overwhelmed by our presence. It was too much for them to lengthen their rushed patient interview to ask additional questions and check more clinical values. We were frustrated at first, but then extremely encouraged by high lecture turnouts and gradual clinical change. Clinicians traveled from all over the greater KEEA area, during office hours, to attend our lectures. They did this with enthusiasm for two and a half weeks. Educational levels varied, so each student took away what they were capable. All took away an understanding of preventative CVD and Stroke measures, diet and exercise. Some were able to absorb all we presented and apply them to their own lifestyles and clinical practices. All yearned for more and begged our speedy return. As a parting note of encouragement, we traveled to a nearby clinic run by some of our students, where our teachings were in full application. I look forward to returning to Ghana and expanding to this second clinic. It is through return repetition and slow expansion that we will make an impact.
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Lessons from Elmina |
We went to Elmina to teach health workers about cardiovascular disease, and we left with new lessons for ourselves and our organization. One of the biggest lessons we took away from interacting with the health workers at Elmina Health Center was the enthusiasm and delight of learning something new or seeing things in a new light. The health workers at Elmina had such earnest interest in learning that it made the topics of cardiovascular disease even more exciting because of their energy. They brought insightful questions that made us realize that what seemed so concrete now has to be flexible enough to adjust to cultural interpretation. We realized that we could not simply say “You should not have salted fish and carbohydrates like cassava”. Since these are the main source of frugal nutrients, we had to stress moderation instead. One has to look at why their diet is composed of foods high in salt. If they had dependable electricity and refrigeration, they would not have to salt their fish so as to help preserve it. By this notion, we come to see how something as fundamental as electricity actually has a huge impact on the source of hypertension for many in Ghana.
Another lesson that we took away was the importance of taking care of others to your best capacity. Ghana has nationalized health care. Patients can choose to pay $15 a year to have health insurance. The insurance will cover for clinical consultations and medicines. Because infectious diseases are very prevalent in Ghana, one realizes that by providing medical care to others, they also are protecting themself from acquiring some of those infectious diseases. Therefore, one comes to acknowledge the value of providing healthcare to those who normally could not afford it. However, with more health insurance comes more patients. There has to be a system to encourage more health providers to work in villages and provide care in remote areas. The quality of patient care can be improved by decreasing the provider to patient ratio. If we increase the number of patients, we must also have ways of increasing the number of clinicians. These are lessons that seem very relevant in our out society as the health care debate continues.
Continue reading "Lessons from Elmina" » |
Exercise, Ghana Style |
Hold that jump rope
As an avid runner, before leaving San Francisco for Ghana I was trying to accommodate my running ‘habit’, and bought some helpful aids to maintain my cardiovascular fitness. I decided the main way for me to keep aerobic fitness was to bring a jump rope. Mostly I was really sure if opportunity and the specifics of the area would be conducive to running. However, on Tuesday morning I finally had my virgin run on the TransAfrica Highway. An early a.m. run before it got too warm and while there was still some early cloud cover allowed me to finish about 8 miles. I have had a couple of other shorter runs, including a set of 4 x 800s (roughly) and another 6-7 mile run on Friday. The diesel from the trucks and cars is pretty nasty to be breathing along the road, so that makes it a little unpleasant. And the other day running I saw goatkill… there are lots of goats wandering everywhere, and I suppose such an incident is inevitable with all the speeding cars.
World Heart Day in Cape Coast
We got up at 5 a.m. Saturday morning in time to join our partners in reducing cardiovascular risk from the Elmina Health Clinic to attend World Heart Day activities (mainly a walk) in the nearby city of Cape Coast. Hundreds of mostly young people sang the walkers through a loop of Cape Coast; including the locations where President Obama spoke when he visited with his family this past summer. The day was finished with some time at the market, a tour of Elmina Castle to learn more details about a central player in the gruesome Trans-Atlantic slave trade. The day finished on a more light note, sharing time with new friends (ICHA colleagues) and going for a swim at a great beach west of Elmina...
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About ICHA
The International Cardiovascular Health Alliance (ICHA) is a 501(c)(3) non-profit organization dedicated to promoting cardiovascular health in the developing world. ICHA works closely with local clinics and community organizations to provide knowledge and tools to prevent cardiovascular disease.
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