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Nurse in Charge
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Ghana, a country of over 29 million has just over 38,000 nurses, just one nurse to 739 people which despite exceeding the WHO threshold for developing countries leaves the country with a 50% deficit of nursing staff.
With poorly equipped hospitals, high patient numbers and attractive pull factors leading nurses to move overseas  the challenges are many, but Veronica is a phenomenal example of dedication and passion.
Through a partnership between the Royal Hospital for Sick Children in Edinburgh, World Child Cancer and Korle Bu Teaching Hospital, Veronica is receiving training in laparoscopy to help improve the provision of care for the estimated 1300 new cases of child cancer in Ghana each year. Treatment is very expensive and footed by the families which currently leads to a high level of care abandonment. The hope is that by using laparoscopic techniques to perform biopsies and surgeries, the procedure will be less invasive and the quality of care for children will improve.
“I’m originally from the eastern region, but did all my training in Accra and was lucky to be posted to Korle Bu Hospital. Though I have moved between departments, I am my happiest here as a peri-operative nurse. People keep telling me I need to specialise but I like being this kind of nurse as we know how to help with anything the surgeons need.
The hospital is run independently and that means that whilst I can move between departments, I can never be transferred out of Korle Bu. In other hospitals, you can be sent wherever they want you and it’s a problem for people with families, especially mothers, who say live in Accra and get posted to a district hospital far away in another region. It’s the reason why a lot of people leave the government services and the Ghana Health Service and choose to join private hospitals in Accra or in the main cities.
I look upon all my nurses like my children. It is no good getting angry when something goes wrong, we sit down and talk through the problem or mistake and we look at how not to make the same mistake again. After all it is people’s lives we are dealing with here and that’s the most important thing.
We have to improvise with what we have available. We often go to surgeons and tell them we don’t have a piece of equipment that we need, and we then look to find other ways of doing the procedure. We are always innovating and changing our practices as necessary. It is hard but we make it work.
Working in theatre can be challenging and one of the hardest areas is oncology. Patient numbers are very high but in terms of how many people are suffering they are low particularly among children. I think that fear and a lack of knowledge often prevents young girls from coming to the oncology department. They see other girls losing their hair because of chemotherapy and are scared as they don’t want to look like boys. Families aren’t aware that there are wigs that the girls can use and that their hair will grow back eventually. There is a lot to be done in terms of education for families but the team and I really enjoy working with them to help them understand the situation and that there are things that we can do to make the process less scary. Recently we were treating one little girl who was so sad when her hair started to fall out and her family could not afford to buy a wig for her, so we put our money together and bought her one and the smile on her face I will never forget. It is not our job but it is our pleasure to do this for our patients.
Despite the challenges, I love my job and I’m very excited by the prospect of laparoscopic (keyhole surgery) training. At the moment we use open surgery even for simple procedures and as a result there are high rates of infection and all the complications that go with it. Beyond the physical impact, surgery also affects the patients and families psychologically because it’s hard for parents to see their children with large dressings and imagine what we have done to them! With laparoscopy we use tiny plasters and the patients and parents see that it’s minimally invasive and the rates of infection are low. I’m hoping that it will improve the quality of care for all of our patients.”
In Ghana, stroke remains one of the top three causes of mortality and is a major cause of adult hospital admission. The Wessex-Ghana Stroke Partnership, which began in 2009, has created four multi-disciplinary ‘stroke-leads’ at the Korle Bu Teaching Hospital supporting the development of stroke-specialist clinical skills through delivering a training programme for hospital staff. The partnership also created a dedicated Stroke Unit in 2014 which has to date treated over 700 patients.
“Since my employment, I’ve worked in various departments in the hospital but I love working in the neurology department the most. Whilst working in the department, I met Dr Akpalu, the head of the stroke unit. Dr Akpalu, is a very lively person, he loves teaching and engaging, so I quickly fell in love with the ward because he makes you feel very comfortable and he always wants your views on how his patients are faring, which is rare for doctors in Ghana. You can discuss anything about the patient with him and he always goes the extra mile because he loves his patients.
The training we received at the stroke unit has given me the confidence to discuss and ask for different opinions on specific therapies for patients. I wouldn’t stand up in a group and talk, but now I am able to stand in front of 50 to 100 people and deliver training to new physios, interns and students. Dr. Akpalu has inspired others and every nurse and doctor who passes through here goes back to their department with a changed outlook and approach to work.
As a physiotherapist, I have learnt that the simple basic things such as how we handle patients make a lot of difference. The functional independence of a patient is so important, so we start training them from the ward, that way they don’t have to wear diapers. We support the patients to use the bathroom or a commode, which we place by their bedside and we teach them other non-verbal means of communication if they can’t speak, so they can raise the alarm when they want to use the bathroom. Even just small things like working with the patient on their swallowing technique can make such a difference and bring independence back to their lives. What has also been a great outcome of the training is the way we now work with families to teach them how to move and support their relatives.
I have been working most recently with a patient from Liberia who was flown in because they had heard of our stroke unit. In three weeks he has gone from being paralysed and losing the ability to speak to now sitting up and saying hello. His wife is so happy and it has been lovely to work with her to teach her muscle techniques for when they return to Liberia in a week or two. I think he really will make a full recovery – what could be better than this!
A huge challenge in Ghana is that the system requires patients to pay for physiotherapy treatments, which can be difficult for our patients because insurance doesn’t cover physiotherapy in the acute ward. Some patients’ relatives even refuse to let them have physio because they can’t afford it, which is sad, but we are doing our best to explain the importance of physio to the relatives and little by little we are seeing more patients paying for the therapy.
I hope for sustainability in the future. I believe that here at the stroke ward, we will continue to do our bit and train, and hopefully we can inspire attitudinal change in other departments so we can all be on an equal level as health workers”.
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