Zenab and the Snake: Adventures in the Tamale Teaching Hospital

I have been working along the edges of the health care sector in Ghana but I had not really experienced it until last week. While I was as staying and working in Wovougu I was told about a girl who had been bitten by a snake four days ago and was still sick. I visited her compound and found a girl who was unable to walk due to an extremely painful and swollen leg. She was also very weak and nauseas. It was obvious that she needed to go to the hospital but since it was late in the evening I decided we would undertake that the next morning, so I bandaged up the leg—the fang marks were gone but the skin was papery thin and one spot had already been picked at by a chicken while she was sleeping.

Following training the next morning Walisu went back into town to find a taxi. When this arrived we loaded the girl into it along with a neighbor lady who would look after her. It should also be noted that while Ghana has a “free” health insurance program almost no one in my village is a part of it. This is because there are 13 cidis worth of fees involved in signing up. Zenab did not have Health insurance.

Tuesday morning: Upon arriving at the Tamale Teaching Hospital we were met with a labyrinth of lines. Thankfully Walisu has a friend who works in the Hospital administration and he was able to fast-track us through the registration and triage lines. Triage was handled in a cramped room by a Ghanaian and a visiting Cuban doctor. This examination was done entirely with out speaking to Zenab or looking at the bite—Zenab does not speak English, the doctor did not speak Dagbani or Spanish, and the Cuban doctor did not speak English or Dagbani. After the doctors manage to write down the needed drugs and instructions we were admitted to the Medical Ward.

Since Zenab did not have Health Insurance the nursing staff does the bare minimum for the patient; IV’s and drugs, the rest is left up to the patient’s family. So after getting Zenab settled in we set off to deliver blood tests to various labs, buy all the needed drugs and to pick up two units of blood from the Blood Bank. Since we were also on the “pay as you go” plan all of these items also involved a visit to the accountant’s desk. 

First stop was the pharmacy where we were able to purchase the majority of drugs needed; all except the anti-venom that we would need to purchase at a pharmacy in town. Next we delivered the blood samples to the lab where we were given the instructions to come back later—we will also need to pick up the results. The most interesting stop of the day occurred next, the Blood Bank. Zenab needed a blood transfusion and in order to get two units of blood one needed to deposit two units. So along with a very hesitant Walisu I donated a unit of blood in a very run down government hospital in a developing West African country.  With this over I made a trip into town to visit the bank and to purchase a snickers bar and a carton of orange juice.

This was also a very interesting trip. Walisu had driven the motorcycle out to the village that morning and had not brought along a helmet, so when I followed the taxi into town with the bike I did not have one either. This only became a problem when I visited the town center. This is the one location of police officers in town and all they do is stop people for not wearing helmets. My plan was to avoid the main street and enter Barclay’s from there back entrance. This plan did not work I stopped and purchased some OJ at a small store and proceeded into town. There was a police officer in the Barclay’s parking lot. It was a really hot day, I had just donated blood and I was not feeling the best after a night in the village; needless to say I was not 100% at the time. Using his wooden club he flagged me down. And told me he was arresting me for not having a helmet. My attempts to explain were useless. The vast majority of police officers in Ghana are simply fulfilling their civil service requirement of school, so these types of stops happen most commonly around lunch time and are easily resolved with five cidis. During this process I had also opened my OJ and started drinking it. After informing him that yes, I could ride a motorcycle without a helmet where I come from I said the code words of “Is there anything I can do for you to take care of this here?” This was met with a reply of “20 cidis.” One wouldn’t think that you can haggle over a bribe but you can and after a few moments I had him down to five. And then as I was handing the money to a “friend” of his he said “Also you will not see your juice again.” At first this did not register in my slightly hazy brain but eventually I realized that my juice had become part of the bribe. Say what you will about bribing police officers but it was really the juice that made me upset about this situation.

After returning to the hospital I met up with Walisu and his friend and they went into town to purchase the rest of the drugs and I went to check on the blood tests and deliver the bags of blood up to the ward.  After this I was informed by the nurse that I would need to buy a variety of items. After several trips out to the road side  I had bought, a cup and bowl, a plastic pail for washing and another one to use as a chamber pot, soap, pillows, a sleeping mat, water and some dinner.

By five o’clock Walisu had returned and our work for the day was done. This had been a very hectic introduction to the health care system. I was left angry and frustrated and I even had help from Walisu’s friend. I can only assume that this experience must be overwhelming for someone coming from a village on their own and I can easily understand why many do not. Also the costs for day one were approaching two hundred cidis—a fortune in most villages. The health insurance would have covered everything but the anti-venom. The insurance covers hospital and doctor fees and most drugs as well as operations.

Wednesday morning: The next morning we delivered breakfast and then returned to the village where we finished up training and I quick fixed a bicycle. After this it was off to the hospital again. The security guard at the bottom of the stairs did not let Walisu up so proceeded up alone. Upon arriving I saw that the wound had still not been redressed or even looked at. So I decided to dress it myself. This was not received well and I soon had both head nurses and the doctor yelling at me, along with several other nurses. After some time I apologized and went off to purchase some more drugs and deliver another blood sample, the results of which I would pick up later in the afternoon.

This was general pattern for the rest of the week. Arrive at the hospital around 9 or 9:30 meet with the nurses and doctor and pick up any supplies that were needed. I would also return in the afternoon to check again and to pick up any lab results that I had delivered in the morning. During this time I did manage to get the nurses to redress the wound and had the doctor look at it. Nurses in Ghana do not receive much education and they appear to be rather lazy—this is confirmed by other volunteers who work in hospitals and spend a large amount of their day waking up nurses from naps—during her six day stay Zenab’s vitals were taken a total of four times. Also most of the nurses and doctors do not speak Dagbani so bedside manner was rather low. This also made it difficult when I visited without Walisu; I relied on a lady who was staying with the patient in the next bed to translate.

Throughout the week Zenab had been improving; the pain and swelling were reduced and her blood work was improving. And on Sunday morning she was discharged and I was thrown once again into the madding bureaucracy of the Hospital. This involved paying for all the fees accrued over the week. And since it was Sunday the only accountant was in the maternity ward and when we arrived he was at breakfast. He eventually did arrive and he began adding up the charges. I was rather apprehensive about this but luckily the Tamale Teaching Hospital is a rather cheap place to stay with the six day total coming seventy-five cidis. This along with the drugs, cab fares, and other items purchased brought the weeks total to three hundred and five cidis. After this it was another two hours of retrieving forms and receipts from around the hospital.

Zenab is back in the village again and appears to be doing better, she can walk now and does not feel sick anymore. There continues to be swelling in the leg and her skin is still blistered and stretched around the bite.  I am continuing to check on her every couple of days and hopefully she will soon be 100%. The first time I checked on her Monday morning I caused a bit of a scandal. Her parents gave me a rooster and a sack of yams and I said that I didn’t want them and that they should sell them and use the money to buy health insurance. A unhappy compromise was made when I “bought” them for thirteen cidis.