A Ghanaian Healthcare Adventure

Michael safely transported me to the ISOS Clinic, a facility that provides primary healthcare to Newmont employees and their family.

I was met there by Dave and Dr. T, resident physician. After my meltdown with my husband, I sat down and answered a series of questions. Dr. T then had me get up onto the bed where she examined my wrist and leg.

 

My arm was swelling quite badly by this point, and it was very painful. The doctor did the usual tests on my knee (this is not my first knee injury). Based on her examination, she didn’t think I had torn my ACL. She felt the joint was pretty stable and wasn’t displaying the classic signs of an ACL rupture.

She then gave me a sling with which to wear to help hold my arm still and gave me a brace for my knee. Unfortunately, she only had two knee braces – large and small. The large was enormous, and the other, although too small, would work in the short-term. She had me move to a different room where she proceeded to give me a shot of pain medication (yea!). She was very careful administering the medicine as she said patients can react much differently. I quickly felt the medicine and the relief was fast. Unfortunately, it only lasted about 5 minutes, and then I was back to hurting pretty badly.

The IOSO Clinic is small, with very few employees. Dr. T served as both doctor and nurse. She arranged for transport to Lister Hospital where my wrist would be x-rayed and an orthopedic surgeon had been called. The ride to the hospital remains pretty much a blur to me, but I don’t think it was too far from the clinic. I was more concerned with keeping my arm as still as I could, while we drove over the always rough Accra roads.

I was about to find out how valuable Dr. T was going to be in this healthcare journey. Lister Hospital is fairly new, having been built in 2004. The waiting room was quiet when we arrived, with only a few other people waiting.

Dr. T had me sit down, got me the paperwork I needed, and went down the hallway to get the process moving along. As soon as I completed the necessary forms, I was taken to the x-ray room. Now, I’m guessing most of you have had an x-ray at one point or another in your life. This room was about as big as a walk-in closet. The walls were not filthy dirty, but I wouldn’t call them clean and sterile either.

Dr. T asked the x-ray technician if she should begin removing the brace and sling, but he didn’t want to discuss it with her. As Dave said, “He just wanted to be in charge.” We’re not even sure he realized she was a doctor. Dr. T and Dave finally went outside and he helped me to remove the brace and sling. Usually, when a patient gets an x-ray, they are covered (in part) with a lead apron, reducing the exposure to radiation. But, even more so, I would expect the technician to be wearing an apron – neither of us did. The room was so little he was basically standing right next to me when he took the x-rays.

I was then taken into a second room where there were two nurses sitting at a desk.

One of the nurses took my vitals and asked me a few questions. The most disconcerting thing was the way in which she “cleaned” the thermometer. She pulled out a tube that was filled with cotton balls. She took one of them and wiped off the thermometer. This was done without soaking the cotton ball with any kind of disinfectant. I was in a lot of pain and wasn’t thinking clearly, but I knew that I was NOT going to let her place that thermometer anywhere near my mouth. As it were, she put it under my armpit. I couldn’t help but wonder how many underarms that thermometer had been without a proper sterilization.

Next, I got into a wheelchair and was planted in the hallway in front of a door. Dave finally moved me out of the way as workers were running into me. I was then wheeled into a different part of the hospital.

We had to go up a ramp, which was outside, but covered. I was taken to a private hospital room, and was tended to by 2-3 nurses (I was getting personal attention, for sure). The smile was all for show. I was not what you would call happy.

The one nurse made a point of showing me how to turn the TV off and on, but I had no interest. She returned a few minutes later, and when she saw I had not turned the TV on, did so for me.

Dr. T had called a local orthopedic doctor to meet us at the hospital before we left the ISOS Clinic. Dr. Ocloo (oh-clue) was located at Korle Bu (core-lee-boo) Hospital and because of traffic would take anywhere from 1-2 hours. It wasn’t long before he came in, however, and affirmed that I had fractured my radius bone. Just this morning we heard about Louisville's Kevin Ware. He is the basketball player who suffered a compound fracture in yesterday's Elite 8 game against Duke. We didn't see the actual injury, as our TV did a WAWA thing, but we did hear about it. I am feeling more and more like a big wuss, and I can only imagine the pain that poor man is going through.

But, enough about him....back to me and my wrist fracture. Dr. Ocloo said that he would cast it the next morning at Korle Bu. A Lister doctor was in the room at the time and told him that they would be happy to cast it that night. Dr. Ocloo turned to him and told him that they didn’t have the proper materials. The doctor assured him they did, but Dr. Ocloo didn’t want to discuss it further.

Dr. T had evidently been corresponding with ISOS doctors in Paris (ISOS headquarters), and based on the x-rays she had sent coupled with the recent diagnosis of medial epicondylitis in my elbow, they recommended the cast be placed above my elbow. They also suggested the cast be in place for six weeks. Dr. Ocloo strongly disagreed with the Paris doctor’s recommendation saying that he would not cast the arm above the elbow as that would be cruel. He also said that the arm only needed to be in the cast for five weeks.

He then went on to examine my knee, moving it this way and that. He told me, “There is nothing wrong with your knee,” to which Dr. T said, “Do you think we should get an MRI just to be sure?” “No,” he answered. He told me that I could stay in the hospital overnight to which I emphatically said, “NO! I want to go home.” We were then wheeled back to the entrance in which we had arrived and Michael took us home. I think it was about 8 p.m. when we arrived home.

It had been a very long day for all of us, but mostly me. I had woken at 6 a.m. MST on Monday, March 11th. I stayed with my brother in Brighton, Colorado, and he dropped me off at the airport that morning. From Denver I had a direct flight to JFK in New York City, where I had a lengthy six hour layover. I was flying economy comfort overseas, and while I get a whopping four additional inches of legroom, sleeping is still not easy. I can usually get 4-5 hours of sleep, but for some reason had a more difficult time on this trip and estimate getting more like three hours of sleep. The last leg of the trip from JFK to Accra is approximately 10 hours in duration, so when I got home, all I wanted to see were the insides of my eyelids. As is typical for us, we only take short naps upon arrival, otherwise getting to sleep that night is difficult.  

As you can imagine, I was exhausted by just traveling. Add on the entire emotional and painful last few hours, I was hoping to get some good sleep. I took a pain pill and got into bed a bit later, but really couldn’t get comfortable all night long. If my arm didn’t hurt, my knee did. If my knee didn’t hurt, my shoulder did from being in a sling. Every time I felt myself dozing off, I relived the accident. I got up several times, and went out onto my recliner, hoping to pass some time by surfing the Internet or playing solitaire. It was one of the longest nights of my life.

The next morning Dave encouraged me to take a shower, even though I had no energy or ambition to do so. I was emotionally and physically spent. He reminded me that once I had my cast on, taking a shower would be a lot more difficult. As usual, he was right. Have you ever taken a shower with just one arm? If not, I challenge you to try it just once. It’s not as easy as you might think, especially when you have a bum knee and are nervous about falling and further injuring your as yet uncasted fractured arm.

Dave was a huge help in getting me in and out of the shower, drying me off, and in helping me put my clothes on (including my bra….try that one with one arm). However, he was sorely lacking in the “let me help you dry your hair” task. He tried, I’ll give him that.

Dr. T called Dave that morning and told him that the ambulance would be by to pick me up at 9:30 a.m. Dave assured her we did not need an ambulance and that Michael could get us to the hospital. Dr. T insisted, and would not take no for an answer. Right on time (VERY unusual for anyone or anything in Ghana), the ambulance arrived. In fact, they had to wait for me to finish getting ready. As I was climbing into the ambulance I was saying, “I can NOT believe I am getting into an ambulance.”

As I mentioned before, we found ourselves very grateful for Dr. T and her advice. What we didn’t know was that Korle Bu Hospital was located in downtown Accra. We were not only going to the heart of the city (the worst traffic ever), but we were also going in the morning, during hours long rush hour traffic. The ambulance driver turned on his lights and sirens. Dave got in the car with Michael and followed behind. We arrived at Korle Bu in a matter of about 20 minutes, opposed to what may have taken 1 ½ - 2 hours.

When I got into the ambulance, I laid down on the gurney, but was not strapped in. As we were weaving in and out of traffic, the gurney slid back and forth slightly. I knew that if he took a sharp corner, I would likely go tumbling. I sort of hooked my right foot under a bar to keep me from moving too much. Also, since I was lying flat on my back, I had no idea where we were going and what was going on outside. I’ll let Dave provide an account of the ride to the hospital.

Riding through traffic in Accra is normally an exercise in patience and frustration.  Not this time; it was time for Nascar; Accra style.  Usually, cars mosey along in the regular travel lanes with others moving around you into any available open area looking for any flat spot to fill hoping to get into the flow until traffic becomes completely jammed and comes to a grinding halt.  Occasionally, a military or police car will plow through everyone honking his horn and flashing his lights.  If he has a siren, he’ll use that too.  Everyone squishes up against the side ditch or car next to them to make a small opening for the “emergency” vehicle to pass and move quickly to wherever they are going (pastry shop or dropping kids at school most likely).  Ghanaians are very calm about this imposition and only get angry when the military car has a trailing vehicle that’s just taking advantage of having a guy with a siren in front of him.  I often kid Michael that he should flash his lights and honk his horn when the traffic is particularly bad; now was his big chance and he was clearly relishing the idea!  Putting Beth in an ambulance turned out to be a good idea; trying to keep up in a trailing car…not so much.  This was a nail-biting experience with lots of honking and near collisions as we bobbed and weaved through traffic behind the ambulance.  I never realized how quickly traffic closes in behind these emergency vehicles; especially when everyone assumes you are “taking advantage” and tries to cut you off.  We got lots of angry honks and finger pointing trying to keep up.  At one point, a police car started chasing us with his lights and sirens blaring.  Fortunately, he got cut off and we lost him in Accra Central traffic.  Smokey and the Bandit got nothin’ on us.

Ha Ha! I completely forgot Dave telling me about being chased by the police car! There were a lot of quick stops and starts.

The ambulance, like most vehicles on the roads here, had a standard transmission. So, as you can imagine, the stops and starts were that much more pronounced. I could see the tops of trees, and sometimes the blue skies. Mostly I noticed the mosquitoes flying around me.

When we arrived at Korle Bu Hospital, Dr. T told me to wait in the ambulance while she went inside to find the doctor. She wasn’t gone but a few minutes, at which time I exited the ambulance. Korle Bu Hospital is a public hospital and is located in Accra Central. There were lots of people milling around outside in the heat. As we entered the hospital, the first thing I noticed was the lack of air conditioning. Next, I couldn’t help but lay my eyes on all of the injured. There must have been 10-15 gurneys haphazardly scattered in the room. I don’t know if this was the waiting room, or what. Mostly, it appeared to be men on the gurneys. One guy looked as if he had been in a fight. His face was swollen and blood was everywhere. One patient, in particular, sticks out in my mind. He was lying on the gurney with his right calf all bandaged up. He had about ten 4” pins sticking straight out of the top of his leg, and the underneath part of his leg was soaked in blood. None of these guys were really moving, and many were sticking out in the walkway, so we had to walk around them. I would not consider this hospital sterile and clean, by any means. Dave told me that he wouldn’t have let me do anything but cast my arm here.

As Dr. T guided us through the hospital, we must have passed 100 people sitting in chairs, or standing in line waiting to be seen. I felt two things: 1) a tremendous amount of guilt for moving ahead of all of these people who had likely been waiting for hours; and 2) a tremendous amount of relief for being able to be seen quickly.

The area in which Dr. Ocloo was located was air conditioned, and it was full of young children and their mothers. He apologized and explained that it was “Baby Wednesday.” I saw several babies with casts on their arms and legs. There were three “bays,” and as soon as we walked in, Dr. Ocloo had his staff remove a mother and her baby from the middle bay and escorted me inside. Again, I felt much guilt and relief.

A number of hospital workers descended on me, all under Dr. Ocloo’s direction. They quickly (and roughly) cast my arm (boring old white one). As I was lying flat on my back on that gurney, all I could think was, “I can NOT believe I am here.”

 

This is the back part of the room. I didn't even notice it, but my trusty photographer did!

It was very painful, and tears were leaking out of my eyes. However, once they were done I felt instantly better as the arm was now stable and protected.

He had someone check a calendar and said that the cast would come off five weeks from that day. Dr. T asked Dr. Ocloo if he would be x-raying the arm to ensure that it had not moved in the hours since the last x-ray, and he refused….twice.

We walked out the same way we came in, and again guilt and relief were about all I could think about. As we were getting into the ambulance, Dr. T told us that she wanted to get an x-ray regardless, so she said we would be going to the Diagnostic Center, which is in East Legon, completely on the other side of Accra. The good news was we were still in the ambulance, so off we went. This time Dave drove with me. That's Michael behind us trying to keep up!

When we walked into the Diagnostic Center, it was full of people waiting….again. Dr. Tatyana did her “thing” and I was quickly taken back for an x-ray. The center is much cleaner than Korle Bu, and the x-ray was completed efficiently.

Next, Dr. T wanted me to have an MRI, against Dr. Ocloo’s recommendation. We waited for about an hour, and it was a long hour for me. I began to feel nauseas and hot. I was also SO tired, I could barely keep my eyes open. Finally, I was taken into the MRI room, where I expected to immediately change and begin the scan. However, there was already a lady lying in the MRI machine getting scanned. Dave, Dr. T, and I sat in the room with the MRI technicians and basically waited for them to finish. At one point, the two technicians got up and completely left the room, for about 10-15 minutes. In the meantime, the machine continued to make noises and the lady remained in the machine.  You can see the lady in the background in the MRI machine.

The technicians returned, got the lady out of the room, and told me it was my turn. The thing I was most grateful for at this point was simply a place to lie down. I didn’t care if it was noisy or uncomfortable, I just wanted to close my eyes, which I did for the next 25-30 minutes.

We got back into the ambulance and made our way back home (another quick trip through Accra traffic). As soon as we got home all I wanted to do was sit on my recliner, take a pain pill, and maybe sleep a bit. That night I slept at least eight hours, and would have probably slept longer except Dr. T called. She told me she had gotten the radiologist’s report on my knee. According to him, I had a torn ACL, MCL, meniscus, muscle, and significant fluid on my knee.

Dr. T recommended I travel to Paris to follow up on both my arm and knee. I told her I would have to discuss the issue with Dave, and that I would get back to her (he had gone to work). She told me, in no uncertain terms, “You are the patient. You must take control and make a decision.” I was taken aback, but then said, “I am mentally and physically exhausted and I am in no way capable of making a rational decision by myself. I will discuss this with Dave and get back to you.” I think she got the picture.

Dave and I were really not so much concerned with my arm as we were with my knee. Both Dr. T and Dr. Ocloo did not observe any obvious problems with my knee when conducting their examinations.  I partially tore my ACL about eight years ago while playing basketball, but had chosen not to have surgery. Rather, I rehabbed the knee through exercise. When I hurt my knee the first time, it was a much different experience than this injury. The first time I heard a pop, and when I was lying on the basketball court, my knee just burned. As I tried to walk to the sidelines, I had the sensation that my knee was going to fall off of my leg. When I fell off the ladder I heard more of a crack, not a pop. I watched my knee move to the left and then to the right. There was pain, but no burning sensation. It didn’t swell excessively, I was able to bend my knee almost completely, and the knee didn’t feel like it was going to fall off my leg. I could tell that something was not right with my knee, but I was not convinced it was my ACL.

We had a decision to make. Stay in Ghana and hope everything would be ok, or travel to Paris to get a second opinion. I always thought that going to Paris would be romantic….not painful.