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Reflections on Ghana: Karen T. Pardue

Interprofessional education (IPE) leads to Interprofessional practice (IPP):

From my lens, the work actualized through the Ghana Health Clinic provides an illustrative exemplar of what the World Health Organization (2010) means by interprofessional, collaborative practice.  

The Ghana Health Mission work actively engages participants to come together with a common purpose and meaningfully collaborate in an effort to deliver the highest quality care to the individuals and families presenting at the clinic. Such interprofessional practice ultimately aims to improve personal health outcomes as well as to strengthen communities and health care systems.

One powerful illustration of the benefits of an interprofessional approach is drawn from an 11-year old boy who presented in August 2011 at the rural Kansa outreach site. This child arrived all alone at the clinic and assumed his place in line. Nursing was able to first complete a thorough health history and a summation of this young boy’s current concerns, which included a description of general malaise, a low-grade fever, intense itchiness of his hands, and a 2-inch-by-1-inch open wound on the outer aspect of his right leg.  

The richness of the health history was made possible by the contributions of a community health worker who collaborated with the nurse in eliciting information. This local professional provided critical language interpretation and explained the family circumstances as to why this child presented all alone at the clinic. The student assigned for the day as the laboratory personnel completed necessary blood screening for malaria, and a volunteer rendered support and reassurance to this young boy during this process. The primary care provider confirmed a diagnosis of both malaria and scabies, and recommended that his leg wound be debrided. Nursing and the volunteer worked together to meticulously cleanse the wound and comfort the child during this difficult procedure. Pharmacy and the community health worker provided instruction and received teach-back on the medication regime recommended by the provider. Nursing expressed concern about the tightness and rigidity of the child’s right foot, so physical therapy became involved in assessing his foot and ankle range of motion. New sandals were provided, and physical therapy demonstrated exercises to increase strength, flexion and mobility in his affected right foot.  

The child returned the next day to the Kansa clinic, and the wound already showed signs of improvement. One month of dressing supplies were provided, along with a soccer ball for the child to enjoy once his wound had healed.

This narrative captures the benefit of an interprofessional approach to care. This child received high quality, holistic care through the expertise and contributions of a wide range of health professionals. This team interacted directly with the child, and collaborated actively with each other in designing and implementing an optimal plan of care. It is anticipated that this child’s individual health status will be maximized as a result of these interventions.  

This enhancement serves to lessen the associated stress for his family, supports his re-engagement in attending school, thereby strengthening his community. Such outcome upholds the aims and purposes for an interprofessional collaborative approach to health care.

Thoughts on the Concept of Time:

When reflecting on my experience in Ghana, I am struck by the stark contrasts that exist with respect to the concept of time. In the United States, time is a commodity that is both measured and precise. Great attention is dedicated to promptness, punctuality and speed. Timeliness is synonymous with conscientiousness and dependability. Being “on time” communicates great respect and unqualified consideration for the individuals present as well as the task at hand.

By contrast, the concept of time in Ghana is notably less structured. Dr. Kofi Awusabo-Asare, a distinguished population-health professor from the University of Cape Coast, acquainted us to the concept of “GMT,” better known as Ghana Maybe Time.  

Much of what unfolds in Ghana does so quite naturally and simply, thereby people (and clocks) do not force or push things to be. The hurried and often pressured rhythm of our Western day-to-day life was shed for a more utilitarian way of being. 

Clinics rarely started punctually at 9:00 a.m. and a dinner scheduled for 6:00 p.m. might fluctuate with little announcement to 8:00 p.m. This unfamiliar and foreign orientation to time challenged me to adjust my fairly rigid and ethnocentric perspective of time throughout the duration of my visit.

People in Ghana demonstrate unfathomable patience. They wait months, even years, for that which they might need or desire. The electrical power periodically and inexplicably goes out, the faucets suddenly stop flowing, and people calmly carry on and await the return of these basic necessities. 

A poignant example involves a man who returned to our August clinic, having first initiated contact with the UNE health outreach program back in March. He carried with him an alcohol wipe with the words “QUAD CANE” clearly inscribed with a Sharpie Marker. This notation was given to him back during the spring break 2011 clinic, when our UNE group ran out of quad canes. He was instructed to return in August, during our next scheduled visit, to see if then we might have an available device. He was elated as we fitted him five months later with his new equipment, and thanked us profusely for providing him with such assistance.

This paradigm of unstructured time and unbounded patience heralds both positive and negative facets. People interact unhurriedly with one another in an informal, thoughtful manner. They wait calmly and temperately for their turn, they form orderly lines, and demonstrate little evidence of impatience or incivility towards one another.  

In Ghana, it seems that waiting is part of living, and in so doing, they often wait a very long time to ask for help. In some cases, they wait too long in seeking help, as a number of health issues that we uncovered were quite advanced and thus required either complex treatment or had progressed beyond remedy. The many contrasts surrounding the concept of time greatly impacted me, and continue to encroach upon and stimulate my thinking even today.