On a hot and clammy June day, a PA student, nursing student, recent graduate biology major, 15 osteopathic medical students, 2 physicians, and myself, a PA, arrive in Oworobong, a rural village in northeastern Kwahu, Ghana. During our 3-week stay here, three groups of students accompanied by a clinician will spend time at clinics in Oworobong and the village of Ntesso, a 2-hour drive away, which boasts a
general and obstetric clinic.
We set up our mosquito nets and mattresses before nightfall. Next, we tour the area and meet the interpreters and nurses with whom we will work. Outside, we see two pit latrines—one built by the clinic and the other a public one a few hundred feet away—and the water hand pump, both used by the entire village. Aluminum sheets enclose the shower area. "Akwabah," ("Welcome") the villagers we meet say, smiling. It feels good to be here after months of planning.
4:30 AM
I wake up to the sound of cocks crowing and goats bleating in the courtyard outside my room. The sky is pitch black, so I wait to rise until there are signs of sunrise. It's cool at the moment, but I know the low temperature won't last. I doze off and am woken again by the rooster. Now, the sky carries a faint blue hue—it's 5:30 am. With the light of my headlamp, I make my way out of the compound, across the dirt road, and past the clinic to the latrine with my bag of toilet paper and wet wipes in tow—essentials on this trip. A few women carrying buckets of water on their heads wander about, but for the most part, the place is deserted at this hour. We call out "Ethisen?" ("How are you?") to each other and answer, "Ehyeh, yoh?" ("I'm fine, and you?").
After I complete my ablutions, I return to the house where my colleagues, Dr. Ed Cho and Dr. Deborah Lardner, and I share several rooms with some of the students. I use bottled water to brush my teeth. Then I study the contents of my backpack and make sure I have my stethoscope, penlight, pens, ear, nose, and throat (ENT) equipment, note pad, snacks, water bottle, hat, sunblock and, of course, my Malarone tablets.
7:00 AM
After we spend an hour eating a breakfast of fruit, oatmeal, omelets, and Lipton tea with condensed milk, we discuss each faculty member's tasks for the day. Today, Group A, led by Dr. Edward Cho, will stay on at the clinic and organize more than 20 suitcases of supplies we brought along with us. Group B, led by Dr. Deborah Lardner, will go on a hike to one of the villages located about 6 miles away. She and her group of students will carry out various survey questionnaires for the four research projects we are conducting while on this trip. Group C, led by myself, will also remain in Oworobong today—we'll attend to the clinic patients.
On most days, the patients start arriving as early as 7:00 am. They may have walked for several hours or come by tro-tro [pronounced "cho-cho"] (bus). The students have set up a registration table, where they will record each patient's information, start a clinic card for first-time visitors, and record vitals. They also take a brief history before bringing each patient over to me in one of the two clinic rooms, one of which doubles as a laboratory. In the clinic room, I have a microscope, Accu-chek, urine dipsticks, malaria and HIV rapid test kits, and not much more. The second room, across the veranda area, holds all the medicines.
8:00 AM
The first patient is a 65-year-old woman who presents with chronic low back pain and leg pain for the past few weeks. She works on a farm with her husband and 3 children. Although she has had similar issues for several years, she states she only comes to the clinic when the pain occasionally flares up. The students and I examine her and determine the patient has lumbar scoliosis and osteoarthritis of the knees.
I encourage the medical students to perform osteopathic muscle manipulation. Afterwards, her pain has markedly improved and she expresses her gratefulness to us. We prescribe diclofenac for a few days and caution her about the potential side effects. We also educate her on the etiology, counsel her on lifting and carrying, and explain that although there is no permanent cure for her pain, exercise and better posture can help minimize the discomfort and prevent it from worsening. The majority of the patients we see have similar complaints: low back pain, upper respiratory infections, fever, and GI issues.