Warning: There are some unpleasant pictures at the end of this post
Many chronic disease go undiagnosed and untreated here in Ghana. Diabetes and hypertension are two that are commonly seen. If patients come and are diagnosed, compliance with treatment is a big problem. With little resources at the hospital, patients are given only two months of medication at a time. They need to then come back to the hospital for refills. This can be difficult for patients that live in outlying villages. You can tell in the patient’s chart when the last time they received their medication was an often it is months before. They will always say, “It just finished,” as their BP is 210/100. It is hard to explain to them the importance of the medication because hypertension or diabetes is not a concrete disease you can see or feel, like say a rash. They don't feel sick. I have learned over my time here that unlike in America where we are nice and try to politely push our patients to make the correct decision, in Ghana you are expected to be a bit more direct and I feel they are much harsher in the way they speak to each other. During my first week at the BMC in 2012, I was shadowing Dr. Hewitt, one of the long-term missionary doctors. A saw in clinic a patient that was not taking his hypertension medications. Dr. Hewitt told the patient that if he did not want to take his medication he should just go to his village and dig a hole and lay next to it. That way when he had a stroke and died his family could just push him into it!! I was sitting there shocked with my jaw on the ground listening to this. I don't think I have ever said anything quite that harsh, but I have looked over and seen the wide mouth gasping shocked look on the face of a short-term volunteer after something I have said to a patient. I always chuckle to myself a little and remember back to my first weeks at the BMC. I have learned and changed a lot through my work at the BMC.
Many chronic disease go undiagnosed and untreated here in Ghana. Diabetes and hypertension are two that are commonly seen. If patients come and are diagnosed, compliance with treatment is a big problem. With little resources at the hospital, patients are given only two months of medication at a time. They need to then come back to the hospital for refills. This can be difficult for patients that live in outlying villages. You can tell in the patient’s chart when the last time they received their medication was an often it is months before. They will always say, “It just finished,” as their BP is 210/100. It is hard to explain to them the importance of the medication because hypertension or diabetes is not a concrete disease you can see or feel, like say a rash. They don't feel sick. I have learned over my time here that unlike in America where we are nice and try to politely push our patients to make the correct decision, in Ghana you are expected to be a bit more direct and I feel they are much harsher in the way they speak to each other. During my first week at the BMC in 2012, I was shadowing Dr. Hewitt, one of the long-term missionary doctors. A saw in clinic a patient that was not taking his hypertension medications. Dr. Hewitt told the patient that if he did not want to take his medication he should just go to his village and dig a hole and lay next to it. That way when he had a stroke and died his family could just push him into it!! I was sitting there shocked with my jaw on the ground listening to this. I don't think I have ever said anything quite that harsh, but I have looked over and seen the wide mouth gasping shocked look on the face of a short-term volunteer after something I have said to a patient. I always chuckle to myself a little and remember back to my first weeks at the BMC. I have learned and changed a lot through my work at the BMC.
Due to many chronic diseases, not being diagnosed and
treated, the complications of these diseases are often seen. Strokes from hypertension are always bad. There is little that can be done for the
patients. When a stroke patients leaves
the hospital to go home, you never know how they will be treated and that
always worries me. Will they be placed in a back room and forgotten, will they develop bed sores, etc? Peripheral vascular
disease from diabetes is often seen. In
America, if someone starts having leg pain or maybe a small non-healing wound
they will seek medical care. In Ghana,
it is often late when folks have very necrotic and gangrenous lower extremities
(sometimes even with a few extra bugs living there for extra grossness). Above the knee amputations is a very common
procedure here. Amputation is a very big
deal and I often get a lot of push back from the patient and family. What I love about their argument against amputation is that they always
say, “I won’t be able to work with just one leg!” They all want to get back out to their farms
to work and provide for their families, which is honorable. I just try to explain that they
can’t work the way they are now and they won’t be able to work if they are dead
either, so it is better to have the amputation.
Being handicapped in rural Ghana is a hard life. If the patient is lucky they will have
children that can care for them, but feeding a mouth that is not bring in an
income is difficult. It is not unusual
to have a patient sitting on our ward for a week or so getting dressing
changes, contemplating surgery prior to giving consent. In the end, although there is going to be
struggles, I believe most of them are happier once they have the surgery.
Warning: Gross pictures are below
Warning: Gross pictures are below
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