Wednesday, September 8, 2010
Other than the damaged Sequioa machine which Barbara and her entourage of Ghanaian engineers have worked on tirelessly, things have gone very smoothly. Our class size ranges from about 15 to 18 students from 6 hospitals and 2 private clinics. Some have had exposure to ultrasounds in their training, one or two do ultrasound on an irregular basis and for some it is the very first time seeing an ultrasound image or using a key board. We have two rooms for scanning. The physicians scan patients in one room and the NMWs scan in the other. Today we scanned about 35 patients, 10 GYN patients and 25 mostly healthy obstetrical patients. We found many fibroids in every size and location, one blighted ovum, 1 dermoid, one 17cm cystadenoma, an 8 cm posterior cystic uterine mass one year after myomectomy, one breech and one transverse lie fetus. A woman with a 19 week gestation looked perfectly fine. We asked how many babies she had. “Only one living,” was her sad reply. 3 pregnancies had been lost at 22 weeks. A decision based on this story was the made to do a transvaginal ultrasound. It showed funneling of the internal os of the cervix and a short cervix < 2 cm, both warning signs of cervical incompetence contributing to pretem delivery and possible death of the infant. The patient was admitted to the hospital for cerclage placement tomorrow. Hopefully the stitch in her cervix will help her maintain this pregnancy until viability.
After the day was over Dr Opoku, the Suntreso Hospital Director and a fellow obstetrician- gynecologist gave us a tour of the Suntreso Hospital. His tour was repeatedly interrupted by screams from the near by labor room. No epidurals here! Then there was finally silence and about 15 minutes later a young woman looking about 15 years old was lead by a nurse from the delivery room to the post partum ward. NMW do the majority of the deliveries. Physicians perform the cesareans and “difficult” deliveries. There are approximately 3,000 deliveries/year at Suntreso Hospital. Most patients stay only 24 hours before heading home. Unfortunately the hospital cannot provide food for their patients so family must bring some in. But care is free through the government health insurance plan. The open ward the new young mother was brought to was fully occupied. Earlier in the day even mattresses on the floor were occupied by other patients that had since been discharged. One large TV was on in the postpartum ward. I think the program was “Who Will Be America’s Next Top Model.”
Dr Opoku and Abeena, who is with the Millennium Cities Initiative (MCI), proudly displayed the very new and clean Mother Baby Unit on the oher side of the hospital.. Preemies and very ill babies are kept here. This is another large open ward currently only occupied by 4 mothers and their newborns who were receiving IV antibiotics for neonatal sepsis.. We subsequently toured the small library and large lab which was quite impressive. It even has a designated refrigerator for blood but with no blood available, chemical reagents are stored there for now. Suntreso Hospital has one operating theatre but it is far from L&D and awkward to get to in an emergency. Dr Opoku is hoping to raise funds to finish a half built theatre that was abandoned about 10 yrs ago and is strategically located right next to L&D. I wish him great success. Last but not least we saw the big generator and water purification system, all very critical components and necessary infrastructure for a successful hospital.
Being a Hospital Director in Ghana requires big shoulders and a wardrobe of many hats!