Doctor Doctor
on Anthony Lovat in Bolgatanga (Ghana), 19/Apr/2011 13:36, 34 days ago
It is VSO policy, I discovered recently, to fly a volunteer home immediately they become pregnant. This has happened to several volunteers in recent years - including, of course, our good friend Lindal (see Monkeygate blog). If Laura were the VSO volunteer, we would be forced to abandon our placement. As it is, VSO don’t really care what happens to a pregnant accompanying partner - in fact, they have cut Laura’s medical insurance. It has left us free to make an independent decision. If we had just started the placement, I think we’d be on the next flight home. As we have been here for some time, have builta tight network of close friends and feel quite at home, it has given us confidence that we can see our time through.It is quite frightening first leaving for a tropical country and reading the various terrible diseases that can strike you down. Malaria, typhoid, yellow fever, rabies, snake bite, scorpion sting, guinea worm, bilharzia etc. Some things, like yellow fever and hepatitis can be vaccinated against. Others, like rabies and malaria, cannot be. As with so many things, we fear the unknown. Now that we have come to know and understand many of these afflictions, we are imbued with a (perhaps false) sense of security.So I know that many people will think us irresponsible for having a pregnancy in Ghana. They may be right and I certainly hope that we will not live to regret our decision to stay here for the time being. There is no doubt that being pregnant in Ghana is more risky than being pregnant in the UK but we believe that we can manage the risk and complete our work.One of the first things we have learned is not to trust doctors. Most of the doctors in Bolga regional hospital are Cuban. Cuba sends thousands of medical professionals to deprived parts of the world partly to uphold its egalitarian and socialist principles and partly because it is an excellent propaganda machine in its continuing war of ideals against the USA. I am sure that many of the Cuban doctors sent abroad are skilled, professional and hard-working but the ones in Bolga regional hospital are anything but.Although the Cuban doctors say that they are doctors, they are, in fact, medical students. As part of their training, they are sent to Africa to practice. One inexperienced medical student claimed to be a surgeon. Ghana’s regulations being what they are, this student was able to practice his surgical skills in Bolga regional hospital on whoever he wanted. The poor and uneducated patients he treated trusted anyone in a white coat - particularly someone with white skin. It is not known how many people he killed before he was finally asked to leave.The Cuban doctors speak very poor English. Their patients also speak very poor English. It cannot be a good combination.When Christina brought a young boy with physical disabilities from her rural district to the hospital, she wanted a diagnosis. What is the boy’s condition? Can it be treated? The doctor took one look at the boy and immediately prescribed a cabinet full of drugs - all psychoactive stimulants. When Christina asked why these drugs had been given, she was told by the nurse not to ask the doctor too many questions. Doctors, like teachers andpriests, are to be obeyed and not to be questioned.So Laura was a bit wary when the doctor prescribed metronidazole - an antibiotic to stop her runny tummy. After all, this was a drug that she wouldn’t give to pregnant animals. Sure enough, when we checked later, this antibiotic can harm the foetus. These Cuban doctors need to check their revision notes. Of course, as with so many foreigners working in Ghana (myself included), there’s no one checking up on them.In the rural areas, sprawling family houses have a special hut for women giving birth. This small house, barely large enough to crawl inside, has a shoulder-high wall surrounding it beyond which men cannot enter. A straw mat is laid out on the ground for the woman to give birth on. In certain traditions, the woman must stay within the small hut until the end of her first period after having given birth. She is, of course, considered unclean during this time. A UN report from 2003 states that African women are 175 times more likely to die during childhood than their western counterparts.Nonetheless, we have been encouraged by the state of care Laura has received. Having signed up for national medical insurance, she visits the midwife every month for regular checkups, has blood, urine and faecal tests for every possible disease and has even been able to have the usual ultrasound scans (see picture). It is a Millennium Development Goal to reduce by three quarters the maternal mortality ratio from 1990 to 2015 and money has been given generously to help bring about this improvement. Interestingly, reading the 2008 Ghana report for the Millennium Development Goals, the Upper East Region has been making the biggest improvements in the whole of Ghana. The rate of maternal mortality has been more than halved in this region since 1992.Madam Mary was the first person we told about the pregnancy - just one day after we did the test and found out ourselves. She is the gregarious and matronly nurse who has been helping out with the TangaCulture AIDS concerts and is in her second year training to become a qualified midwife. The school of midwifery is an enormous building tucked directly behind the regional hospital. Looking at the number of students training, it is clear that midwifery is a health priority. Mary was able to advise us on where to register and get good professional care.Despite the Upper East Region making such heroic strides towards achieving this Millennium Development Goal, DFID reports that across the developing world, there were 450 maternal deaths per 100,000 births in 2005 compared to 480 in 1990. Considering how unreliable all numbers collected in the developing world are, this can be considered a disappointing“no change”. For Ghana specifically, the 1990 level was estimated at 740 deaths per 100,000, 503 in 2005 and 451 in 2008. This is still a long way short of the 2015 target - 185 deaths per 100,000.To put all this in perspective, there are 6 maternal deaths per 100,000 in the UK.So we are still taking a risk but we think it is a manageable risk. It being the dry season, mosquitos have virtually disappeared. Laura has booked her flight home for 13th June - three and a half months before the baby is due.Madam Patricia is the excellent and hard-working head of science at Bongo Senior High School. A young woman with a gorgeous smile, she beamed as she told me she was pregnant last year. As the weeks and months went on, I enquired after her health and she excitedly reported that everything was fine. Her belly grew and grew but she continued to work until the long August holidays when she looked fit to pop. Laura and I travelled over that period and it was September when I saw Patricia again. I immediately asked her how the baby was. It was the natural question. Patricia’s beautiful smile disappeared.The baby arrived early, Patricia told me. It survived for two days before dying in her arms. The nearest incubator is in Kumasi and is not covered by the national insurance scheme.“Do you have incubators in the hospitals in your country?” Patricia asked.In sub-saharan Africa, one in seven children die before they reach their fifth birthday. There is no way that Laura is giving birth here. That would be a risk too far.