A ‘Deep Dive’ Into Our Operations
A ‘Deep Dive’ Into Our Operations
‘Mobile Clinic’ can sound very straight forward. Yet GNMC operates in anything but a simple or obvious setting. Here are some small word-pictures through which we want to share some of the daily realities our amazing team members grapple with and do their amazing work in:
- The setting: In keeping with local conditions and resources, the health posts in different locations are remarkably diverse. In one village without electricity or running water, the health center is a mud building with tables and chairs obtained from the local school. In this case, an abscess or skin tumor may be handled on an ‘operating table’ that is a wooden bench from school. In another case, the health post might be stationed in a primary health center, a concrete building with exam beds, medical instruments, midwives, gloves, gauze, etc. While there is running water, there may be no electricity.
- Time: To take into account holidays, rainy and dry season changes, religious obligations and harvests, the Mobile Clinic schedule is organized three months ahead of time and updated dynamically. Our team prints this out and on each visit to the health posts they give copies to the local contact people such as assembly man, medical assistant or nurse. Follow-up appointments for patients are scheduled with them verbally; we then give them a follow-up sheet with the next visit’s date (time is not feasible!). On the outreach day, the GNMC team leaves St Patrick Hospital with all their equipment and medications about 8am and according to the distance, condition of road/ season/ traffic etc. might arrive at about 11am. Then we unpack our equipment and patients slowly start to arrive. Outreach ends when all the patients have been treated, usually around 6pm. That is also because in Ghana the sun goes down consistently throughout the year at about 6pm, and you cannot see a lot in total darkness.
- Global teamwork, daily: The general surgeon at St Patrick’s Hospital is part of GNMC. He trains 4-5 House Officers a month; these are resident physicians and surgeons who are receiving further training in a medical or surgical specialty, while caring for patients under the direction of the general surgeon. Together they follow-up all postoperative care surgical cases. They are in daily contact with Britta in Israel as they manage the cases. A pediatric surgeon from the nearby university hospital is also available in case of emergency. When community health initiatives are initiated, as they often are, the international GNMC team is constantly involved.
- Responsiveness: When GNMC started its route, two of the health posts had no capacity to vaccinate babies. So every month we started taking public health nurses – together with their vaccination coolers – when we went for outreach to these villages. All the babies brought in for regular check-ups or treatment were then vaccinated, so in most cases there was no need to bring people in specially.
- Early Warning system: If our team sees more than three patients with the same disease, we inform the assembly man or the chief and discuss causes. An extreme example took place at one health post which is based in an orphanage managed by the Mother Teresa organization in the slums of Kumasi. Once we saw that 80% of the children suffer at least once a year from malaria, mosquito nets were purchased for every child’s bed and the frequency of malaria has reduced dramatically. When there was recently, in addition, the beginning of a cholera epidemic, the GNMC team instructed the nuns and assistants how to separate sick children and to use different towels for them; the outbreak was stopped.
- Communal dynamics: Some years ago, we identified a growing number of toddlers in one of the very isolated health posts suffering from malnutrition so badly that their growth was being stunted. Their families seemed to be trying to hide this situation. We found out that the children were “cursed” through a local Ashram, which had an impact through associated dynamics. We set about convincing the parents to settle their dispute in a different fashion and it worked. This worrying trend was reversed.
Gold and Public Health: Ghana is rich in gold. Apart from the official mines, illegal surface miners destroy flora and fauna and influence surrounding community health. In 2010, our team started to notice that in an area near one of our health posts such an illegal mine started to operate. Workers there cut down huge areas of forest, rinsed the soil to look for gold in a way that heavy metals (mercury, arsenic, copper) were flushed into the village’s water source. Horrified, we saw a rising incidence of babies born with malformations and skin infections as well as fleeting psychosis in adults. When we talked with the local chief and head of regional health, both questioned our observations. To pursue this further, we are now initiating research with the Public Health Department of a local university to establish this in an even more scientific, objective fashion.