Report by Margreet Sangers, The Netherlands
When I was studying to become a general nurse, I always knew I wanted to work for a while in Africa. In REVSODEP I found a good local NGO where I could both experience working in a regional hospital and doing fieldwork in the rural communities. I decided to go to Ghana for five months and in September 2008 I arrived in Accra where a member of REVSODEP was waiting for me at the airport. The reception was warm and it was good to have someone who took charge and arranged my guesthouse and some sightseeing in Accra as well, because I thought Accra was quite overwhelming. Together we traveled by bus to the north and in Tamale I was brought to my host family straight away so I could get comfortable and relax after all the new experiences and the long journey to the north.
Staying with a host family is a wonderful experience. It’s not always easy because there are many cultural differences but I soon found out that everything is open for discussion. Don’t keep it to yourself if there’s a problem, but discuss it with your host family in an open and friendly manner and there is always a solution. Personally I didn’t experience any big problems at all. From the moment I set foot in the house of my host mother, we got along fine and she accepted me as her daughter and treated me that way too. The hospitality of my host family was enormous; they would do everything for me and they really made me feel at home. For me my host family became a safe haven and we experienced so much together. I especially enjoyed the evenings with my host mother; we would watch television and talk and talk and talk! I learned so much about Ghanaian culture, family life and also about politics, because I was in Ghana before, during and after the 2008 presidential and parliamentary elections. If you are willing to adjust yourself to a different culture and if you are flexible and open in regards to your host family’s way of life and thinking, you will have a great experience. I still cherish my memories and have enclosed my host family in my heart forever!
After some difficulties in the beginning (the hospital thought it had to pay me and after it was clear I was volunteering everything was alright) I could start working in Tamale Teaching Hospital as a general nurse. I chose to work on different wards to experience as much as possible about nursing in Ghana. The first ward was the female medical ward, where women with all kinds of health problems, varying from malaria and typhoid to anemia and CVA’s were admitted. The ward was small, run down and the patients many, so a lot of patients where lying in the corridors in the heat of the sun. On the ward it was hot as well and the ward was ill equipped.
Working as a nurse in Ghana is in no way the same as in the Netherlands and although I thought I was prepared for this, I still found it very hard to adjust to this different way of working (and thinking). To summarize my experiences, I have to conclude that (most) Ghanaian nurses who work in the hospital don’t do a lot of practical nursing. They just sit around a big table in the middle of the ward and mostly yell at patients and their family. In the Netherlands I am used to having the responsibility over a number of patients and providing them with professional care in every aspect of the word and it was therefore very hard for me to do virtually nothing all day. On this ward the nurses just sat around the table, waited for the doctor to come, followed doctor’s orders and afterwards sat down again. The washing, the feeding, even the walks to and from the laboratory, all were done by family members of the patients. Reports were hardly written, only medication was written down and the names of the patients and their diagnosis were recorded on the patients chart. The nurses did not write their observations down, I even wondered sometimes if they really did observe patients at all. Only a few words were exchanged with the patients and their family members and mostly these words were quite hostile and aggressive, even if patients were obviously distressed or in pain. Everything is very hierarchic and it seems that everybody is focused on the group of people they themselves can boss around, to relieve some of the frustrations (I suppose) of being bossed around themselves by their superiors. Although my colleagues were very friendly to me and welcomed me with open arms, they didn’t really expect me to do much more than sit with them at the table and talk about nursing in the Netherlands and my personal life.
It really took me a few weeks to adjust and to be able to make my stay at the hospital a positive one. I learned that there were exceptions to the rule and I focused on my colleagues who were committed to give good patient care and who wanted to really learn from my experiences in the Netherlands. Together with an enthusiastic young male nurse I started to give clinical lessons, especially the student nurses on the ward were very eager to learn and seemed to enjoy these meetings a lot. The Ghanaian nurse taught about tropical illnesses, like malaria and typhoid and I taught about more western illnesses, that are starting to become more common in Ghana too, like diabetes, heart failure, CVA’s and other chronic diseases. That way I could contribute something and I didn’t feel as useless as I sometimes felt in the beginning, but still it was not easy at all!
On the second ward I could fit in more easily. This antenatal ward resembles somewhat a European consultation bureau. Everything revolves around mothers, pregnancy and babies and the atmosphere was relaxed and happy. The team of nurses worked hard and on this ward there was plenty of room for education as well, for example about child care, vaccinations and family planning. From the beginning I was totally accepted and they put me straight to work, which was a relief after my previous experience. They let me do everything, also vaccinations and if a woman only spoke dagbani (the local language) they would not take over but translate for me, so I could just continue my work. I enjoyed my time at this ward very much!
After working in the hospital, it was December and with the elections and Christmas it was quiet in the communities, so I worked at the REVSODEP office for a while. I had experienced some of their projects in the villages and was quite impressed by their achievements and their enthusiasm. I therefore decided to assist the staff with proposals for funding and together we brainstormed about possibilities for more educational projects. The people from REVSODEP were very friendly and I always felt that if I had a problem I could come to them and they would help me. The organization is growing and the staff is very committed to expand their activities to help the people in the northern regions in every way that they can. During my stay REVSODEP received people from the BBC for example and I was allowed to accompany them when they were filming in the villages, a very nice experience from which I also learned a lot!
The last period of my stay in Tamale I worked with the community nurse. Together we went on a motorcycle to the villages in the north to do fieldwork as part of an outreach program. We literally went from compound to compound and gathered all the people who were living there around us. The focus was on the pregnant women and the children under five years old and the emphasis of the work was on vaccination and education. It was a great experience for me, also because it gave me the opportunity to see how the people in the villages live and because I was able to communicate with them with the help of the community nurse who was always willing to act as a translator for me. The motorcycle rides through the beautiful rural landscape I will cherish forever, despite the dust and sweat I was covered with after every working day. The village people were really happy to see us and determined to get their children vaccinated, so it was a very rewarding experience. I can therefore deeply recommend this fieldwork to every nurse who is coming to the north!
Although it has not always been easy, I have enjoyed my stay in Tamale a lot! It has taught me so much about Ghanaian culture, about Ghanaian politics and about the Ghanaian way of working. But most of all I have learned a lot about myself. It is hard to be in a totally different culture, where you not only work under totally different circumstances, but where you also live in a family that is not your own and where everything is so different than you are used to. The people from REVSODEP have helped me to adjust and thanks to them I have had an experience I will cherish for the rest of my life!