Heart to Heart

The ICHA Blog

I began my role with ICHA in the Records Office of Elmina Urban Health Center this week.  Countless green “Ghana National Health Insurance” folders and patient health record cards pass through this room. I have set up my laptop station and two friendly clinic staff members, Justice and Ernest, have generously been helping me find the patient charts over the last year so I can record information on hypertension. From this seat in the Health Center, I have gotten the privilege of a birds eye perspective – of what patients come in saying, of how their complaints are processed, of how they are diagnosed and treated, and of how their illness resolves (or evolves) over time. The flow of a clinic has emerged from this process of data collection. 

What it shows is a population of all ages experiencing a burden of the infectious diseases that we all imagine of a tropical, developing country.  However, I have been struck by the large number of high blood pressure readings I have seen in my own cursory glances at the data. It has not been uncommon to see a patient diagnosed with malaria and hypertension at the same time. This speaks to the “double burden” of communicable and non-communicable diseases that countries like Ghana experience. Hopefully, this data on hypertension will help shed like on the silent processes of chronic cardiovascular disease that lie below the surface of people’s daily lives.  One healthworker anecdotally estimated 5 new cases of hypertension/day in a clinic that sees an average of 150 patients per day.

What our time thus far in Elmina has also revealed has been a great generosity of locals inside and outside of the clinic.  The healthworkers that attend the 2-week ICHA training in Cardiovascular Disease greet us each day, and they are far from shy. Rather, they are engaged and can fiercely offer their opinions and questions on matters of diet, exercise, and pathophysiology.  Learning this new material challenges the statusquo of their roles as nurses, nutritionists and medical assistants in the community. Yet, I am struck by their willingness to take in new information and new workload – and balance a new priority of cardiovascular disease. One healthworker explained at the first session that it was difficult to find someone to cover for her as she attended our training sessions, but that she knew it was important for her knowledge and “for the betterment of her patients.”  To me, the best part of the training sessions – which have truly been facilitated as discussions rather than lectures by the 3 doctors on our team – has been the moments of honest sharing – where discussion yields pearls of knowledge about this local context which could never be written into our training manual or be understood by us as foreigners. For example, we learned that many people do not eat fruits or vegetables, or overcook them when they do, because they are worried about pesticides and chemicals from run-off and poor water quality.  I think that one of ICHA's invaluable strengths lies in the fact that it can help to facilitate dialogue on the realities of cardiovascular disease, and in doing so better understand local perceptions that will influence the success of prevention and treatment of cardiovascular disease.