Lessons From Ghana: Medicine is Leadership in Communal Abrafu Odumase
Jul 9, 2013 1:00 PM
I wonder if we would have less systemic resistance to health care reform in the U.S. if our leaders and chiefs were also medical providers.
I wonder this because tomorrow we return to Salt Lake City, while today we are in Abrafu Odumase, a small village near the coastal city of Cape Coast, Ghana. The chief of this village, “Nana” (which literally means “chief”) is a medical provider, a physician assistant and graduate of the Kintampo College of Health. Over the past week, our predominantly Utahan contingent recently finished teaching several concurrent continuing medical courses at Kintampo. Working with Nana, it becomes clear to me that his leadership and the health of his community go hand in hand.
In this village, most of the homes are constructed with wood and concrete, protected by tin roofs. Homes are generally clustered around a courtyard in a rather communal organization. In the center of the village is a single central water pump from which residents may manually draw water for their homes. When we arrived in Abrafu Odumase, an assembly of 10 “chiefs” greeted us outside Nana’s quarters, referred to by all as “the palace” (see photo). The women are all dressed in brightly colored calf or ankle-length dresses—some in the more traditional Ghanaian prints, others using modern cloth. They frequently tote babies up to 3 years old secured to their backs in cloth. On the whole, this community looks healthy and reasonably prosperous by Ghanaian standards.
Today we work with Nana to support his community through screenings and consultations. We have 3 blood pressure cuffs, 200 glucose strips and a dozen well-supervised PA students. Our team has experience in creating order out of chaos—primarily, developing a functioning queuing system. First, all of our patients register with Nana who keeps their medical records in an orderly system of notebooks. He gives each a small scrap of paper with their name and age, on which we record our findings. Paper in hand, our patients then queue up for glucose testing, and then queue up for blood pressures, and finally, return to Nana with the details of their care and screenings.
In addition to the screenings, thanks to the presence of a few of our faculty and fellows, we offer some specialized consultations. We have a room that is divided in two with a brightly colored, hanging cloth. Behind our makeshift wall is a cushioned examination table draped with a white sheet—the “private” exam room. In the front of the room, a space about 12 ft. by 8 ft., chairs are clustered, forming three additional clinics inclusive of their respective waiting areas. One area is for dermatology, another for neurology, and the third makeshift clinic is for pediatric acute illnesses. Two men from the community function both as translators and as our “analog” public announcement system—rounding up patients for the dermatology and neurology clinics. Most of the community members speak English, but medical terms can be challenging. Post consultation, our cases are reviewed by Nana, as the certified medical practitioner. He also handles follow-up appointments and referrals.
In all, on this Monday morning, our team performed more than 250 screenings, identifying close to a hundred adults with elevated blood pressures. We’ve seen unusual rashes, a 14 year old with neurofibromatosis, an older woman with massively swollen feet and legs presumably due to filiariasis (elephantiasis), patients with migraines, seizures, and babies with fever.
When Nana first welcomed our group to perform a clinical outreach here, he urged us to make a good first impression to his community. I hope that we did. They certainly made one on us.
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