Sam and I decided to do a follow up visit to Ridge Hospital, yesterday. Bridget was the PT Ridge sponsored to attend the course last week. Ridge is the Regional Hospital for Greater Accra. It would be the equivalent to a Level 1 Trauma Center in a major city in the US. However, the care you receive at Ridge is much much different than the care you would receive in the US!
We had an impromptu meeting with the PT director at Ridge. He helped explain to us how their department functions. Also, he discussed with us his frustrations of the PT education program in Ghana. He told us that the students are getting absolutely no practical training in school. The school expects the clinical instructors who oversee them at the hospital to give the practical training. This is a huge problem because many of the PTs who graduated 5 years ago did not have well trained instructors so they never learned how to be good therapists. Thus, therapists who are not well trained are expected to train the new graduates. It is not working at all!!!
In the US, about 1/3-1/2 of the curriculum consists of practical training, then on the clinicals you fine tune the skills you practiced on other classmates in lab at school. He said the universities are focusing on theory and not application of knowledge. He said the same problem exists for medicine. First year doctors do not know how to place a line or perform a physical exam since they did not learn any of that in school. I'm sure if you ask them to explain what meningococcal meningitis is they could do it without a problem, but would they be able to diagnosis someone with it is another story! Obviously, this is a much greater problem than I can solve on one trip; however, it is making me think about ways I can help influence the system or current PTs.
After meeting with the director, Sam and I helped out with some patients. I saw 3 interesting patients. I was able to help the therapists understand how to treat the patients a little more effectively from now on!
The first patient I saw was a person who had an incomplete spinal cord injury from an infection in his cervical spine. He was around 20 years old. The doctors had no idea how he got the infection. The director was working with him and so I did not have a ton of suggestions. The director was trained in Cuba and Holland so he actually is very knowledgeable. He said he just doesn't have the time every day to train his 4 interns at the level they need to be at! I did try and emphasize the importance of using a gait belt since they do not seem to use them ever! It would make their jobs so much easier with any patient who is not able to stand independently!
The next patient I saw was a man who was attacked. He suffered a shoulder dislocation. The doctors immobilized him for 5 months! That was way way too long! The doctors essentially created adhesive capsulitis or frozen shoulder from excessive immobilization. They have been trying to restore his range of motion. I learned that they have only been focusing on shoulder flexion. Their thought was that once they restore shoulder flexion then they could work on the other shoulder motions. I tried to nicely explain the poor logic behind that idea. Rarely do we move our shoulder in 1 plane of motion; thus, it is very important to stretch, mobilize in all motions that are missing! I did very aggressive PROM and stretching on the patient. Then I instructed him in AAROM wand exercises that he can perform at home. The intern was impressed with how much increased ROM he had at the end of the session. I explained that really the combination of our movements are needed to regain full ROM and that is why my treatment was more effective than what they had been doing.
I'm having a hard time explaining things without being condescending! I do not want to insult them because they are trying! They are doing the best they can with the limited practical skills they have. I remember learning and struggling to feel comfortable with my skills. I still question myself so I know if someone tears you down, it can destroy the learning process. I want to inspire these therapists to continue learning. I truly think the only bad therapists out there are the ones who quit trying to learn! I guess it can be said for any profession!
The last patient I saw was a lady who had a radical bilateral mastectomy in the fall. She has finished her chemo and radiation treatments. She ended up developing lymphedema in the left UE. The intern had no clue on how to treat this lady. I explained to him that she has lymphedema and how to effectively treat it. This was something I presented last week during the course so I told the student to ask Bridget for all of her notes. Also, Bridget should him how to perform the correct treatment at the next session. The patient had her surgery in Nairobi, Kenya where her daughter is working for the American CDC as a MD. (Since Kenya was under British rule longer than Ghana, their hospitals in the major cities are closer to American or British standards.) The patient actually had printed handouts from the American Cancer Society on lymphedema after breast cancer. Since her children are doctors in the US and she was a nurse, she was very knowledgeable on the subject, but did not know how to explain it to the therapists.
The medical system in Ghana is very patriarchal. As a patient, you do not question what they doctor, nurses, or therapists know. If you do question them, they often times will refuse to treat you. Obviously, this is another problem that I cannot tackle in one trip or by myself!
Anyways, I went on to treat the patient. I did manual lymph drainage (MLD) to her and then wrapped her with compression bandages. I showed the intern and another student how to perform MLD and wrap her arm. Hopefully, my crash course education session will allow them to help the patient with her lymphedema until she settles her affairs in Ghana and can see a lymphedema therapist in the US, when she visits her children.
My whole vision or goal for my trip has radically changed. Originally I thought my purpose of this trip was to train Celestine to be a pseudo-therapist. However, seeing how much help the actual therapists need who have had 4 years of book education makes me realize it is not enough time to train Celestine. Thus, I want to help the patients in Kpando as much as I can when I go back. I will still try and train Celestine, but I'm really going to try and push for the administration at the hospital in Kpando to hire a PT. If the government is soon mandating that PTs are licensed then they will not reimburse the hospital in Kpando if they do not have a real PT in place. Hopefully, that will be enough ammunition to get them to hire one. The next thing I will do, is travel to Ho and Hohoe to do follow up visits with 2 of the therapists from the course. Both towns are close enough to Kpando that I could spend a week with each of them. It would allow me to really help them to think like a therapist. I was impressed with both of these therapists so I think they will catch on fast!!! Lastly, I want to work with the various NGOs I'm affiliated with to help establish effective continuing education courses in the future. I do not know what the future holds for myself in terms of returning to Ghana, but I can help structure the process for future volunteers, that way the therapists of Ghana can learn to be effective!
I feel this trip has so much meaning! I am helping the sick and disabled of Ghana. Also, I feel I am truly helping shape or inspire the therapists of this country to continue learning in order to provide quality care to their patients! I know there are still many cultural barriers in the way that will keep me from impacting every therapist I meet. However, I really feel a few of the therapists I have interacted with are now better therapists because they had some training from Sam, Ken, and myself!! I think that makes this trip a success! Obviously, I have over 2 more months left so more can be done, but its just nice to know that at the 6 week mark we have accomplished something!
Love, Kari
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