Children's Ward

My heart is full. I just spent the last week in the children’s ward. I have been enjoying my days observing health care delivery in the maternity unit, and have felt connected in many ways to all that I have been learning in ANC and Labour and Delivery. But there is just something different about children. Women’s reproductive health is my area of educational interest, but children get my heart. I felt excited every day this past week to pop out of bed in the morning, take the tro-tro to the hospital, and join the doctors for rounds in the ward. I had sort of forgotten why I became so interested in international health and really, public health, in the first place. I studied abroad in Panama as an undergrad. My main interest and direction of research was on maternal and child malnutrition. Sometime during the trip, we visited an island off the coast of a major city in the mouth of the ocean called Son Cristobal. I remember pulling up to the dock, and stepping off the boat into a crowd of curious young faces; I was eager to learn about them, too. Most of the children had tattered clothing, pockmarks from parasites and decaying teeth. They had so many obtrusive health problems, but they were still kids. They played like kids, they laughed like kids, they were happy like kids. It’s the same at Camp Quality, too. So many of our kids are sick or have already endured so much, yet it seems at camp they have the time of their lives (as do we). If there’s one common theme about kids, near and far, it’s that they find time to enjoy the fun in life and certainly live life down to the very moment.

Most of the kids in the children’s ward are sick with malaria, diarrhea or suffer from malnourishment. There were a few HIV cases, but they were not in the majority. West Africa presents a very different picture from the Eastern and Southern regions of Africa. The prevalence of HIV/AIDS in Ghana is less than 4%. Certainly, HIV/AIDS is worthy of our attention, but thinking statistically, malaria and diarrhea in the child population are more outstanding health problems.

There are great things about Tema General Hospital, and I have to remember to focus on the good and not to get down about the gaps in the system. There’s a balance to be held, as we must also constructively critique areas of improvement. It seems that malaria is the glaring health problem especially for vulnerable pregnant women and children. Within three months at Tema GH, the children’s ward may see up to 6,000 cases. We asked the health professionals why they think this is the case. They told us that they educate, but nothing seems to stick. People know well enough that there are mosquitoes in this region and that they cause malaria, but still so many fail to take proper precautions. I wasn’t settled with that answer. There has to be more to it than that. Perhaps it’s that people feel that malaria is the norm and not a pressing health concern; sort of like chicken pox in the US. It’s true that a good portion of people living in areas of malaria contract it within their lifetime, but it can be dangerous, especially to children and pregnant women. Cerebral malaria can be fatal; it can also terminate a pregnancy. There are prevention measures against malaria in antenatal care. In fact, most of the women I saw were prescribed medication to prevent it. But with over 2,000 cases of children with malaria in one month, clearly something’s missing. I can’t settle with the idea that if there was education displaying the clear threat of malaria and if there was an affordable, accessible, and easy method to prevent this disease, that women wouldn’t adopt this method to protect their children. The latter is the ticket. Education alone is not enough to change behavior. This has been well understood in public health for some time now. You can throw education at a community all you want, but to really inspire behavior change, the social environment must also change. As a public health student, I see this disconnect as an opportunity. Malaria is preventable and with community education and accessibility to and availability of proper preventive measures, we can decrease the amount of people who get infected.

From my public health perspective, the population most vulnerable to malaria is the target. My clinical perspective, however, was concentrated elsewhere. We met Dr. Antwi for rounds on Monday morning. He is a young, handsome and charismatic pediatrician; not arrogant in anyway. He's definitely meant to be a doctor for children. I could tell by the way he examined his patients and joked around with them that he is well liked in the ward. He took the time to explain each case to us. When we approached patient 15’s bed, Dr. Antwi looked perplexed. He explained that the boy had come in with fever, vomiting, diarrhea, etc. He was also presenting signs of liver failure. With the combination of not being able to stabilize him quick enough and his family not having enough funds to afford basic labs and cultures, the boy ended up suffering several co-morbidities. He is now blind, deaf and possibly brain damaged. For an entire week, we watched his worried mother take care of his every need. When she wasn’t taking care of him, she was parked at his bedside, sometimes praying, sometimes with her head down just trying to catch a few minutes of sleep. When we met the boy on Monday, Dr. Antwi just sort of shook his head and said there wasn’t much they could do with their hands tied. We were all a bit unsettled at this. Katie and I spent a good portion of the evening discussing the need for palliative care if there weren’t any social services that could support this boy. We arrived the next morning, and headed straight for patient 29’s room, a baby we had all sort of adopted for the week. Katie scooped the five-month old into her arms, an action he was craving and needed. His mother brought him into the ward the Thursday before. She then admitted herself to the HIV/AIDS unit with chances looking slim that she would regain her strength. The father has abandoned them both, and soon the mother will pass. Instead of focusing on the questions of where this child will go, we focused on giving him the attention he needed most.

Not long after, a crew of doctors showed up for rounds. We again followed along. This time, Dr. “Boss” (I never got his name), the chief of Peds joined along. He walked in late, in the middle of another doctor’s presentation and took the lead from there. He is a small man, but his personality is big. I immediately equated him with Dr. D, the chief of Peds at Children’s Hospital in Detroit. Dr. “Boss” holds the same charisma, and scatter-brained intelligence.

Patient 15 was the last to be seen on rounds. We all crowded into his room, mostly somber knowing the situation. The doctors examined his vitals and checked for any progress. The three of us were wide-eyed, hoping for something positive. After standing around shaking our heads for about 5 full minutes, this speech from Dr. “Boss” emerged:

“So what should we do? Just wash our hands clean of this? This is a sad case, you know, a very sad case. The co-morbidities he’s suffering from, he’s so compromised, now. At the end of the day, is this our fault? Did we do this? His mother will now have to end up supporting him. And where’s the father? If there is a father, you know, before you know it there will be a divorce and the woman will be alone. She doesn’t have the money. Why does this always happen? It’s always the poor that are the sickest. What God would allow this? I guess when I get to the gate I have a few questions for God myself. So I’m asking, what should we do? We just walk away and go home? This is too sad, let’s just go have a beer and forget it. Come on. We have something to do with this, so doctors, what do we do?

Most of us stood with our hands tied behind our backs staring at the floor. Dr. Antwi, who is normally all smiles, stared off somberly, too. Finally, he lifted his head and spoke up.

“There’s a church group, you know. We could call a church group. There was one that brought in the boy, the HIV twin.”

The day before during rounds, we reviewed another abandoned HIV case. The boy, no more than a year of age, had been born to an HIV positive mother. He had a twin brother who was HIV negative. The sibling was clearly getting all of the mother’s nourishment through breastfeeding, which inevitably may result in another abandoned child with HIV. The twin brought in by the church group was near death from malnourishment. We found out on Wednesday that he hadn’t made it through the night.

Dr. Antwi’s suggestion jumpstarted the group from a moment of despair to thoughts of hope. Mumurs erupted through the group of doctors. Dr. “Boss” nodded along, but I could see by the look on his face, that he had a suggestion of his own.

“You know, there’s a Dutch organization, an NGO. Yeah, they’re doing great work. They have a sort of home for children with illnesses like this. If you go there, I promise, you’ll see every illness you’ve ever seen in your textbooks. Let’s connect his family with them, huh? I mean this is about quality of care right? We all know about palliative care. My mother, for example, she was diagnosed with cancer, two months to live. They put her on palliative care, she’s still cooking me meals. I mean, we can do this right? Let’s keep this boy comfortable; let’s let him have quality in his life. This is possible, and at least we’re giving some hope, right? I mean this is what it’s about. This boy is an example of the holes in our system, but let’s make this work, even if it’s just one case. We might not see things change in our lifetime, but if we can do something now and set things forward, it will happen one day. Hmm? I don’t know, maybe one day then we’ll be giving aid to the US.”

We all laughed. I was touched. I had lost sleep over this case the night before. I know better not to get too attached here, but I couldn’t shake the thoughts that this boy will not be supported because he now has disabilities that could have been prevented. I mean my Mom and sister make careers out of supporting children like this. So what does that mean then for children in Ghana? Where will this boy go? And what about his mother? I know that sad, unexplainable things happen all the time. But I too found myself questioning God’s role in all of this. What God would allow sickness and suffering with such limited solutions? It’s just hard to understand sometimes. Something in my soul needed this speech. I needed to feel chills; I needed to feel connected. It was the sermon that I needed to hear. It’s not that Dr. “Boss” said anything overly profound, but he gave us that small glimmer of hope. And if that’s all it was, then so be it. At least there’s hope at all! That small speech woke up a feeling in me that maybe sifting through all the crap in this world for the hope that within it there may be something good just might be worth it. In more literal terms, it means there are certainly health professionals here that get it, people that want to move things forward and make life better. It means there’s room for greater improvement in quality of care. It’s all very possible.