Babies babies evvverywhere!

After my post Monday, Keesha and I met with our mentor Dr. Adanu and spent our first bit of time in and around the medical buildings of Korle-Bu (pronounced coal-eh-boo). Kofi tells us that Korle-Bu is the third largest hospital in Africa, with somewhere around 3,000 beds. Things are hustle and bustle like on any University hospital campus—a mix of white coats, patients, and staff. A scattering of stands selling fruit and beverages dot the lanes between buildings and tired visitors lay on the ground in the precious shade. White sign posts with black letters and red arrows indicate buildings like “Central OPD” (Centeral Out Patient Department, which importantly also contains the Service Cateen where lunch can be found!), laboratories, and the Community Health building where our mentor’s office is located. The buildings are mostly old-looking cement structures, about half of which are only one or two stories, the others rising up as high as ten floors. Thankfully Keesha has a photographic memory for directions because the windy red dirt roads on campus turn me all around.

After our first fairly short meeting with Dr. Adanu, Keesha and I wandered into the street adjacent to campus. Little shops lined the streets, attracting us with tempting fruits, including apples (I LOVE APPLES!!... not cheap but it made my day) and more random plastic goods (buckets, brooms, etc). As we wandered further, the shops thinned and we found ourselves walking through a neighborhood sturdier than a shanty town, but nonetheless obviously impoverished. Living areas mostly consist of little courtyards with floors of red dirt with a rainbow of clothes flapping the breeze and an area with an overhang, with or without walls, amidst an array of buckets, tubs, chickens, goats, children, and general debris in a somewhat organized mess. I did a lot of smiling and waving a little kids who stare at me like I am the strangest thing they’ve ever seen. A few darted behind walls and popped back out to wave. At dinner the other night a brave little guy, maybe 6 or 7, marched right up to say hi and shook my hand. Too cute! I wonder how many I could smuggle back ;)
During our walk in the neighborhood next to Korle-Bu I learned firsthand where the bathroom is for these folks. The same cement rectangular ditches that line most roads in the city also lined these neighborhoods, mostly uncovered, with a few inches of putrid water baking in the bottom (umm malaria?). As I crutched along, a girl, probably 10 or so, out playing with friends, straddled the ditch, and without crouching, let loose, spraying herself and her skirt as much as the ditch. She continued chattering with her friends as she peed, and as soon as she finished they darted back to playing the street. A few blocks later a little dude in a uniform on the way home from school stopped for a similar potty break. There ya go. That’s how it’s done I guess. At least its efficient?

After I braved a bit more street food, this time something wrapped in a palm leaf, that was the consistency of jello and the taste of sour rice pudding, we called it a day and headed back to our side of campus (a few miles, or a 2 cedi taxi ride for yours truly the exhausted gimp!), to our new standby restaurant “His Place” a half mile or so from the hostel. Still no sick tummies!
Dr. Adanu realized during our first meeting that Keesha and I really only have study related questions in terms of logistics which involve seeing the study site and meeting the translators. Thus, there isn’t a ton of work for us to do on the project while still in Accra. Given that our plan for the week was going to consist of just a few meetings, I asked if we could go do a bit of shadowing on the obstetric wards in our downtime…
I have never seen so many pregnant women in my entire life—not in one place, nor in total ever. Everyone was bursting. The maternal block was mind blowing. First of all, I don’t think I saw a single male partner in the place (What’s up with that?! Potentially a space issue? Or privacy since everyone is practically naked?). Secondly, there were truly babies popping out left and right.

I ditched my crutches in the changing room (the frayed mental spikes that protrude where the rubber bottoms used to be, slide like ice skates on the hospital floor… I sat as much as possible and did a lot of standing on one leg, I’m doing my best to be good, I promise!), Keesha and I were given scrubs, introduced to one of the doctors, and let loose on the ‘complicated’ pregnancy floor—a U shaped lay out, with women in hall stretchers, on mattresses on the floor, and in a few small stalls separated by curtains. All the women were wrapped in a sheet or cloth, but otherwise naked. Sometimes there is a bit of an attempt to pull a curtain, but more often exams (cm of dilation, fetal heart beat with a tube shaped stethoscope) take place in plain sight. We spent the first morning in the ward rotating between the two obstetric theatres watching c-sections, on women who had had previous c-sections and were not good candidates for vaginal births, or had other complications. We’d walk into one theatre, watch the anesthesiologist numb the women up, the woman would swing her legs up, and the doctors were at it. In minutes, out popped a baby, handed screaming to nurses or assistants who cut their cord and suctioned their noises. They were then held up for the mom to see—the nurses spread their legs to show the sex, and then they were off to the hall, creating a chorus of wailing little ones. While all this was going on the woman was stitched back up and some had their tubes tied. The doctor finished their stitches, pulled off their sterile gown and gloves, walked out of the room, re-scrubbed, and walked into the second theatre where the next patient would be waiting. The second c-section we saw brought two bouncing twin girls (in separate sacs) into the world, during the third we saw what a polycystic ovary looks like, the fourth was following a myomectomy (fibroid removal), and the fifth was the women’s fourth c-section: all this in a few hours (literally 10 AM to 1 PM!), while other women with potential complications labored naturally outside the theatre doors. We asked one of the nurses how many deliveries they see in a day. She said the day before they had had 62. When I looked somewhat stunned and said that was a lot, she said “Why is that a lot? We have 3 shifts.” Oy vey! When we changed and left to head to our meeting the first day, a woman was laboring and near birthing, essentially naked, in the hall with a lone helper, in plain sight the women nearby on the floor and bed mattresses. Just an average day at Korle-Bu?
On day two we stayed out of the theatres, opting to stay on the laboring side of the ward instead. We followed the same physician, Dr. Atoatowa (?), a skinny largely soft-spoken physician who was more than a little busy with the 18 or so women laboring in the small hall (many of which were waiting for c-sections). At one point 5 women were sharing a bench by the door all waiting for a mattress to lie on. They were even shorter on beds than the previous day as one of the stretchers that we stumbled upon that was occupied by a woman who passed away earlier in the day.
We saw several placentas removed manually, one that hadn’t passed after her delivery at a smaller community hospital in the night, and another where the doctor waited and pulled on the cord for traction for a few minutes, and then actually said “I don’t have time for this, there are too many patients” and then manually reached in and removed it. In regards to time management, we learned that all women that aren’t in active labor (3 contractions of 45-60 seconds each every 10 minutes) and don’t have contraindications, are augmented into labor with oxytocin. When I asked why, the doctor told me there were just too many women-- Once women are here occupying a bed, the staff needs them to labor and get out, so that someone else can have the bed. He also noted that there is no food for the women, so if they stay to long they will starve.

While following the doc as he checked the waiting women’s dilation status, the “normal” labor floor above came to get him to help the midwives with a breeched vaginal delivery. The difference between the normal delivery floor and the complicated floor was unbelievable. It felt liked we’d walked into a completely different, much better funded hospital. There were far fewer patients, white washed walls, and actual delivery rooms. Apparently the local phone company MTN sponsored the renovation of the ward recently… I really wished some of the waiting women on the floor below could go there!

On the ‘normal’ delivery floor, I got to see a vaginally delivery for the first time! A pretty young woman labored with a breeched baby in the hall (there were empty rooms…). When we arrived the feet of the baby were out, toes all a wiggle. With a little help from the doc situating his arms and head, out he came. He had six fingers on each hand which the nurses quickly addressed by tying string around the extras to make them fall off… but otherwise, he was no worse for the wear. We continued around the floor and checked in with women… or rather a cart of instruments was rolled into their room, the doc measured their bellies, listened to the baby’s heart beat through the stethoscope, and then without any warning to the women, slipped on gloves and shoved his hand inside them to check their dilation, often reprimanding them if they yelled or moved.

Most of the conversations between staff and all of the discussions with patients went on in Twi, so we were largely at a loss, but let’s just say there was little regard for the woman’s input; Somewhat understandable given the chaotic conditions, but very difficult to witness and arguably quite degrading. Several nurses, understaffed and overworked, seemed to be fairly angry at a few women, particularly if they had been there a long time or if they yelled loudly when they contracted. One patient, who was yelling out in contractions frequently, but who was barely dilated, and in danger of rupture, was given several forceful and loud scoldings from one of the senior nurses in Twi. I have no idea what she was saying, but it didn’t sound very pleasant.

Pads, blankets, or whatever else the woman needed came from bags of goods that the laboring woman brought along with them for hospital care. The laboring women provided their own cloths to wipe the baby off after delivery, diapers, ect. A few times cedis changed hands, apparently to get a drink from the nurses.
Needless to say, in all the chaos and cramped conditions, Keesha and I mainly tried to stay out of the way. We offered to help in any way possible, but I frequently felt helpless: here’s where an MD and a truck load of money would come in handy! Women’s pleading eyes would catch mine—I’d do my best to help if I could—adjusting a mat, or holding a hand-- but beyond that I was as lost as they were.

That my friends, is a far too detailed summary of my last few days on the labor wards. My apologies to those with weak stomachs!

It’s hard to believe that tomorrow marks just one week. I’ve seen so much in the last few days that it seems like ages since I was in the states!

Gotta run (I mean hobble… ;)), a dinner of red-red awaits at the restaurant next door to the internet cafe!

Thinking of you all,
Much love from Africa,
Halley