Monday, November 21, 2011

New and Old Learning with Dr. Amin Davari and Dr. Nikki Webb

Dr Davari, in class at Bekwai Clinic
Dr. Amin Davari ended up in Ghana because of pizza.  The UCLA pediatric resident heard about a talk on International Health that was happening and thought it sounded interesting. He heard that they had pizza too.  By chance, he happened to sit next to Rebecca Dudovitz, long time associate of GHEI and coordinator of the many trips that UCLA residents have taken out to Humjibre.  While he enjoyed his delicious slice of pie, he heard from medical school students giving a recap of their time in Ghana, and Rebecca mentioned a chance to go to Ghana to support health service out there with GHEI.  

Several months later Dr. Davari was travelling down a shell-shocked road in Ghana, from Kumasi, in a rattling orange bus that wheezed dust as it motored to Bekwai, where he would continue on to Humjibre in a stuffy taxi probably blaring some great mid-90's adult contemporary music. Where he was going, there was no pizza… Meanwhile in Humjibre, Dr. Nicole Webb was already set up for the past two weeks.  Nikki had already begun many of their trainings as well making initial contacts with traditional birth attendants.  

There are three hospitals in Bibiani-Anwhiaso-District; there is only one that is public and affordable with (supposedly) one ambulance for an area that has a population well over a 100,000 and spans 837 square kilometers.  For a pregnant woman, making it to the hospital is not always likely, as it’s roughly a forty five minute taxi ride from Humjibre, when there’s even a taxi available.  There are midwives and nurses at clinics in some larger villages, but sometimes it is even difficult to get to those.  Most women are working up until the day that they give birth; many births happen at a cocoa farm.

In villages in Ghana just like Humjibre, there are women who deliver babies at home. Traditional Birth Attendants are these women, and they belong to a tradition that goes back generations and is a deeply rooted part of Ghanaian culture. Though the exact number is unknown, it is estimated that perhaps greater than fifty percent of babies born each year in Ghana are delivered outside of the health care system, many by Traditional Birth Attendants.  While the knowledge of these women's work is well known in the community, there isn’t a lot of interaction between the medical health services and them.  Amin and Nikki were here to meet these remarkable women though.  They heard the women’s experiences, got to know their technique, and formally established a relationship.

Dr. Webb training midwives
Amin and Nikki were also continuing the neo natal resuscitation training that residents like Beatrice Teatteh had provided in many clinics in the B-A-B district.   In the first few seconds after a birth, many babies cannot breathe, and response to this should quick and skilled.  The residents were here to show the midwives and nurses how.  Amin and Nikki with proper gear, including a dummy baby with lungs that fill with air and a chest that rises, spent several weeks bombing around the district in a string of sketchy taxis. They would arrive at clinics in clouds of dust, with smiles and an inflatable baby, ready to train.  

Some of their students were also coworkers, as Amin and Nikki also volunteered their time at the Bekwai Clinic.  Nikki and Amin, would see patients for a morning, and then bundle into a taxi in the afternoon and head off to a clinic in a far flung area of the district.  Or shoot off in the morning, and arrive slightly bedraggled (but still pretty psyched) for an afternoon in the clinic.  

I followed along and witnessed one of neo-natal resuscitation trainings at the Bekwai clinic.  I was a bit late, so I slunk into the back of the room and watched, as overhead fans mercifully roared away. 

“Is this a good heart rate for a baby?” Amin, with an assistant at his side and an imaginary stethoscope in his ears and on the plastic baby in front of him, tapped his finger on the table in a slow rhythm.  The answer was a resounding No from the audience.  “No, you are right.  This is much too slow.  What is the number one reason for a baby to have a heart rate that is not good?” Amin asked, in the particular cadence of Americans who are speaking slow enough to be understood by anyone not American.  A pause, and then an answer, “Yes, that’s right, because the baby is not breathing right.”

After training was done, Amin and I trekked up the dirt road back to Bekwai, when a car pulled off and invited us in.  It Mr. Anim, the Bekwai Clinic Senior Health Assistant, and as we got into the car I asked what he thought of the trainings, and he made a funny quip about his staff to the effect that they were allergic to learning, but on the subject of Nikki and Amin he said they were “splendid.” He said the example of their work, and the chance to work alongside them was improving the service of his staff greatly.

The hope is that one day, as relations continue to strengthen with the medical health services in the district, that better learning and sharing will take place between the traditional birth attendants and future volunteer residents.  In much of Africa, there can be a dynamic friction between the traditional and the modern, between the new learning and the old ways of doing things, this can be a difficult bridge to build.  The reality though is that the average Ghanaian is already a mix of new and old; they exist healthily within that tension, and the hope is that GHEI services can exist there with them.   GHEI is committed to the total health of the residents of the B-A-B district, no matter where the service comes from, old or new.

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