Friday, June 18, 2010

Agroyesum: A Cutting for Stone Experience

Number of mangos consumed: 3

Number of mosquito bites: 1

I left Kumasi on Wednesday (June 16) to officially start my project in Agroyesum. I will be based out of Agroyesum for the next three weeks conducting facility assessments and interviewing physicians and administrators at St. Martin’s Hospital (Agroyeseum), St. Michael’s Hospital (Jachie-Pramso), and Bekwai Government Hospital. My research will specifically focus on the changes that have occurred since the arrival of permanent obstetricians at these district hospitals and compare these clinical and management practices as well as maternal mortality outcomes with district hospitals who have not yet received permanent obstetricians. I will also be designing a complications register to implement at Agroyesum and hopefully the 7 other sites I will be visiting this summer to help the Ghana Health Services collect data on the number and types of complications these hospitals see on a day to day basis. This complications register will help hospital staff and the Ghana Health Services strategically target areas for improvement in the quality of clinical care and clinical management of these obstetrical complications.

Agroyesum is about a 1.5 hour drive south of Kumasi. It takes about 45 minutes on nice paved roads, and then another very bumpy 45 minutes on rugged clay dirt roads to get to the district hospital. Stay tuned for videos! I really don’t know how the tro-tros (bus/minivans) make it out here. These road are also not lit, so if there is an emergency after 6PM, I don’t know how drivers can navigate these roads! Questions that I need to answer by the end of my assessment! I think Agroyesum is located at a higher altitude or perhaps just being far removed from the city and in the trees makes it feel a little cooler than Kumasi. The drive to Agroyesum, though bumpy, was breathtaking. It is so lush and green. The best analogy and probably embarrassingly most inaccurate analogy I can think of is the scenes from the movie “Mighty Joe Young”-- the movie with Charlize Theron and this huge gorilla. Just think of that, and that’s where I am!

Before moving out to Agroyesum, I was lucky enough to do a quick day visit last Friday (June 12) to get familiar with the facility and meet the entire staff. As I entered through the hospital gates, I felt like I was stepping into the book Cutting for Stone by Dr. Abraham Verghese. Cutting for Stone is a rich fictional narrative that follows the lives of Siamese twins, Marion and Shiva, set in Mission Hospital, a district hospital in Addis Ababa, Ethiopia. Like Mission Hospital, St. Martin’s Hospital is a Catholic hospital and the staff are managed by a Matron. The Matron at St. Martin’s hospital is Sister Helen. She is authoritative, maternal, and sweet. I feel so well taken care of when I am with Matron.

The hospital provides several different types of services and is much larger than I had expected. There are outpatient services with three consulting rooms, female and male wards, labor and delivery wards, two operating theaters, a pediatrics ward, physical therapy, lab facilities, x-ray facilities, a pharmacy, nutrition services, and they are expanding to create an emergency medicine ward. As Matron and I walked around the hospital, I couldn’t help but think about the characters in Cutting for Stone (I highly recommend the book and am thinking of sending St. Martin’s Hospital a copy). When Matron asked me what I thought of the hospital, I kept saying, “This was wonderful!” She just laughed at my enthusiasm. I then explained to her that I was a preclinical medical student, so just being in a hospital is a novel experience. She then promised that I’d be able to see all sorts of different cases that I could learn much from. I am so glad I packed some scrubs with me!!!

To tickle my imagination even more, I am staying at St. Martin’s Hospitals as a guest of the hospital administrator, who has the most adorable twin sons (picture pending). It’s like I’m guest at Ghosh and Hema’s house! The room I am staying in is very nice and has everything I could have asked for. I have a bed, a sink, my own bathroom with a flushing toilet and shower (cold water only), a ceiling fan, and plenty of room to spread my stuff out. The windows don’t seem to be completely reliable in keeping mosquitoes out, so I set up my mosquito net. After taking my cold shower, I kept seeing tiny bugs flying towards me, so I have taken refuge in my bed under my mosquito net. I look absolutely ridiculous, but at least I feel more at ease while sitting with my bare legs exposed. I’m sure my courage to sit outside of my mosquito net will build as the days go by.

Wish me luck with my continued goal of not getting devoured by mosquitoes and my first day of real work tomorrow!

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