I’d left some cheap scissors on my nightstand, the type you buy in a high street stationery store for £2.99, they came in handy for the times when I wanted to cut out shapes as part of my teaching prep.
That Monday morning, when the nurse picked them up, I thought it strange that he was using one of my office supply items rather than unwrap a brand new sterile piece of equipment from his medical bag.
I guessed that he was going to use them to cut the bandage that was soon to be administered to my, by now, four-week old wound. He moved to take off my existing dressing to reveal the blood soaked packing gauze and below that the still open wound, which not only stubbornly refused to heal, but alarmingly seemed to grow in surface area with every passing day.
I’d suffered the wound on a Sunday at the back end of a long tro-tro drive back from a weekend spent at the southern Ghanaian city of Cape Coast, when the hinged flip-seat at the end of the van’s bench seat had flipped down after a jolting encounter with one of the regular pot holes in the road.
An exposed metal pin-head on the seat edge, the size of a five pence coin and twice as thick, had penetrated my shin, as the seat fell suddenly and at speed from its vertical to a horizontal position and onto my outstretched right leg. As soon as it happened I felt foolish. With the benefit of hindsight already kicking in, I thought it was just so obvious that it was going to happen. “What an IDIOT!”
This introspection initially masked the pain that kicked in, though the impact left the wound area white, with shock, there was surprisingly little blood. Perhaps, I thought, this wasn’t going to be so bad.
Fortunately our journey was almost done and I was back in the volunteer house within about 40 minutes. Upon arrival I immediately dowsed my leg with the iodine that Meg had kindly lent me. She had suggested it as essential to sterilize the affected area. The aged and battered tro-tro’s was, after all, not the cleanest of environments.
Apart from some discomfort in walking, which continued into the Monday, the wound seemed to heal during the rest of the week and by the Thursday a scab had formed. “This was most encouraging”, I thought.
It was however to be a false dawn. I woke up the following Saturday in intense pain, shivering and with my lower right leg swollen to twice its normal size. An Infection had struck. The act of placing, even momentarily, weight on my foot led me to cry profanities for half an hour or more. Again hindsight kicks in… I curse myself, my pain, my luck.
It took some time for me to alert my local co-ordinators to my condition, such was my incapacity, though once informed they acted swiftly and purposefully to secure medical attention for me.
A nursing team was immediately dispatched to my bedside and upon arrival they quickly proceeded to a diagnosis.
Ignoring completely my distressed leg they soon established that I was infected with malaria and treated me accordingly.
Now, I’m fortunate in that I’ve never had malaria, it’s a nasty and potentially life threatening disease and you should take all sensible precautions to guard against it. I do, however, suspect that I’d have some idea if it was malaria that had struck me and the absence of any mosquito bites on my body, was for me a big, big give away.
At this point, with my tongue ever so slightly in my cheek, I should introduce you to the conventions and courtesies of healthcare Ghanaian style:
- The patient is clearly not concerned for their own welfare, otherwise they wouldn’t have put themselves into the spot where medical treatment is necessary.
- It follows from 1. That the patient will have no interest in the proposed treatment and will not understand the first thing about medicine, so communication with them is unnecessary.
- The welfare of the patient is secondary to the welfare of the condition being treated, and
- following on from 3. no amount of pain to the patient generally is considered to be too extreme to facilitate the treatment of the specific condition.
- A local anaesthetic is an unnecessary luxury.
- Hygene is not the be all and end of treatment, no matter that the patient is recovering from an infection.
- Finesse? What is finesse?
A needle was produced and thoughts of dread filled my mind. “Was this a potential carrier of hepatitis or HIV.” In my weakened state I protested that I had my own supply of needles. This was of course taken as an affront to my carer’s resources and diligence, but thankfully, the prospect of not depleting Ghana’s healthcare system of a needle and my insistence prevailed. Devoid of any energy myself to search my pack for the hypodermic (I’d left it on the unoccupied top bunk of my bed) one of the nurse’s came across an elegant solution and simply tipped the contents of the bag onto my bedroom floor!
I was told to roll over and I naturally therefore expected a jab in my arse, what I didn’t expect was that the jab would be administered with maximum brutality. The nurse’s hand, with loaded needle ready, was fully bent back so that it met his shoulder and thereby provided maximum leverage. This meant the poised implement of torture had a run up of at least a foot and a half (nearly half a metre for you metric kids) into my gluteus maximus.
Now I didn’t pay too much attention to mechanics during physics lectures, but hey in these circumstances I didn’t need to. I knew instinctively that this was going to hurt, but like the alert car passenger who can see that the crash is inevitable this didn’t help me one iota as I yelped in pain at the moment of impact.
This scenario was subject to further reiterations as a cannula was inserted into my arm for the first of many saline drips and intravenous antibiotics. Oh the joyful memory of it all.
Once these various treatments had been administered I was given a five day course of Clindamycin dacillin-150 antibiotic tablets.
Of course all of this would have been excellent if only I had been suffering from malaria, but I wasn’t. I had a gammy leg, that had formed to alien proportions, I couldn’t walk on it and it hurt like feck. If only I could have allowed myself to share my nurses pleasure that my malaria was being cured. To cheer HOORAY at the thought, but to do so I needed to be suffering from malaria and have sufficient energy to celebrate. Both of these vital ingredients were absent!
It would be two further days before I could entice the medical professionals back to my bedside. When they did appear they expressed surprise at the condition of my leg and chastised me for not bringing the wound to their attention earlier!
No, really, they did!
I was in no fit state to dissent, being at my wits end with pain, the kind that had me thinking every five minutes of any implement that I could use to saw off my leg.
The truth though was more fool me for even entertaining the thought that I was in pain. I hadn’t even begun to experience pain and fortunately I had on hand an expert sadist (Hello Nurse!) who was going to take me beyond my pain threshold. Yep, this was the point where the real pain began.
Taking one look at my tender ballooned leg, he elected to reduce the swelling by forcing and squeezing as much of the excess fluid out through my infected wound using his considerable African hands in a vice like grip to inflict maximum pressure.
Of course there was no forewarning of the pain that I was now subject to, as communication between health professional and victim – I mean patient – is strictly forbidden under section 8, sub section A, paragraph 5 of the Ghanaian health code.
Move a little closer reader, for I want to confide a deep shaming secret with you. This big Wandering Volunteer screamed the house down. I was reduced to screams and tears, all within earshot of my fellow housemate volunteers. No matter how I tried to hide my pain and I confess to hiding behind my sleeping bag and also stuffing my pillow over my face, I couldn’t suppress the yelps and screams as my dignity shrunk into a corner.
And there commenced a two-week period where the nurse would visit and repeat the squeezing, then dressing, and I would relive this almighty pain. I barely left my bed, during this period though I was able to erect a Heath Robinson (Rube Goldberg, for American readers) type ankle sling, made out of a spare bed sheet that I tied to the top bunk.
This was my cunning plan, by raising my limb I could reduce the swelling and curtail my reliance on the techniques of my torturer. “Haha!” I thought in the demented way that comes from enforced confinement. “That’ll show him.”
It was during this time that, with boredom an issue, I sought solace in Facebook. This had two benefits, I could catch up on news and events and also, during the day when my housemates were out volunteering, it meant valuable human contact with friends and family. When you’re spending days laying down in bed with your leg in a sling the entertainment options are somewhat limited.
I found myself entirely dependant upon others and at this point in this saga I want to thank all of my housemates through that period for their company and concern. As there were more than twenty of them they are too many to mention in their entirety, but it would be very re-miss of me not to single out a few: Jackie, Jess, Jess and Sophie for bringing me food and other supplies from Mpraeso, Leah for her iPod and chocolate. Meg, Lisa and Kathryn for offering the contents of their medical supplies. Chris, Andy, Kathryn (again) and Sarah for keeping me company.
By now friends back in the UK had been alerted to my condition via my facebook posts, among them two nurses, my sister in law, Kerry, and my future overland buddy Em. Private messages were exchanged where medical advice was offered and I was asked if I’d considered going home to get it treated? “Going home? Pah! What kind of wimp did these people think I was? Just because they had detailed medical knowledge, that didn’t mean they knew anything of my circumstances!”
I wouldn’t be going home, I was determined to resist doing anything but get better in Ghana.
I’d by now finished the course of antibiotics that were originally prescribed and not completely ignoring advice from home that suggested the continued use of antibiotics would help prevent any further infection, I requested a new prescription.
I thought it a little strange when I was given exactly the same medication (Clindamycin dacillin) for my leg as I’d received for the suspected malaria, so I decided to go online to check what this drug was all about:
So there you have it reader, my vaginal infection was worse than I ever suspected!
In amongst all this another family member sent an unusually serious message, basically saying ‘come home’. This pretty much went over my head and was brushed aside with a facetious retort. The seriousness of his remarks just didn’t register until a week or so later when an aunt commented to me that my brother ‘seemed very concerned’. “Oh, was he…”
Hygiene was now an issue, that was frightening me. Wherever you go in Ghana dirt and dust can be found and resources are stretched, so ideas of cleanliness and hygiene suffer. There began my battle to achieve sanitised conditions. Whenever my nurse produced a piece of equipment, like his hands or a knife, I would vigilantly dowse it with iodine. Frequently this resulted in a race between him and I, as I needed to get the iodine to whatever implement was going to touch me before it did. I ended up getting through bottles of the stuff.
The pressure from home was ratcheted up a further notch when Kerry printed off some of the photos I’d posted to facebook and took them to a ‘Tissue Viability nurse’, at the hospital where she works. This was a new job title on me and implausibility of it still makes me chortle…… The upshot of this latest fact finding was that word came back to me that this wound wasn’t going to heal unless I headed back west.
Apparently the bandages and dressings used in Ghana are less than contemporary and when coupled with the alien baterial environment I found myself in, the wound would continue to deteriorate. Yet I’m pigheaded with things like this and wasn’t ready to return home, as I saw it as ‘throwing in the towel’. Even if my experience with Ghanaian healthcare wasn’t inspiring confidence.
And so we come back to that Monday morning, the scissors and the sadistic nurse.
With my leg striped bare, the open wound revealed that the white poison like pus remained stubbornly festering, with the inadequate packing and bandages leaving it ‘wet’ and causing the surrounding ‘good’ skin to deteriorate further the nurse prepared to act.
Not for the faint hearted, but if you wish to see the gory detail then pictures of my wound can be found here.
I can only assume that I went into a deep speechless shock as I witnessed him pick up the cheap, rusty scissors and proceed to use them, initially as a scalpel, as he sought to scrape away the white yucky pus from the centre of the wound, for I was frozen and unable to demure.
Before I could come to my sense he changed his mind and turned his attention to the frayed perimeter skin, which he proceeded to attempt to cut back to a clean edge. Finding the scissors blunt, as well as rusty and cheap, he had no joy with the cutting action. On this occasion, however, he was not to be deterred for he simply decided to carry out this task by utilizing the scissors as pliers and began to yank at the frayed edges.
It was at this point that my weeks of anguish finally gave way to something more primal and this time it wasn’t just to do with the volume of my screaming, I found myself remonstrating angrily in, how should I say, rudimentary Anglo-Saxon language with my torturer.
This was my watershed, at that moment I realized that despite every hope to the contrary I was going to have to temporarily leave Ghana.
I didn’t wish to spoil the ending of the story, by thanking her earlier amongst my mentions of the others, but I can now add Bel, to my role call of thanks, for her part in accompanying me on the flight back to Heathrow.
Although the events portrayed above are factual, I have elaborated slightly in parts. The conventions and courtesy’s section are a fabric of my imagination as is my reference to the Ghanaian health code. I also very much doubt my nurse, Joe, was, or is, a sadist!
While my experience of healthcare in Ghana was certainly very different to that which I have been use to receiving in the UK, I have nothing but admiration for those dedicated to patient care in Ghana.
They work tirelessly in extraordinarily difficult circumstance with limited financial and material resources and equipment, despite this they consistently deliver the best health outcomes they can. The area where I volunteered was reputedly served by 3 doctors within a population hinterland of approaching quarter of a million people. By anyones standards that’s a tough gig.
What it does reinforce for me, and perhaps the real moral of this story, when travelling and particularly volunteering, is that you shouldn’t judge your experiences and the practices of less well developed places and countries through western eyes.
So I will finish this post by expressing my profound gratitude to Joe, without his attention, resourcefulness and care, I have no doubt whatsoever that my condition would’ve been a lot worse.