Improving Global Health Fellows. Week 5: Blood Pressures, Learning and all that Jazz!

The hard work continues on the Stroke Unit at Korle Bu. After a relatively quiet week with all the doctors on IMPACT training, the unit is now much busier and the patients are certainly keeping all the staff on their toes. I’ve never seen Aunty Faustina move so fast as when one of the patient’s got himself out of the chair and had a slight wobble on his way to his bed! Most are doing really well and engaging in the early stages of rehabilitation whilst preparing for discharge home.

The high percentage of haemorrhagic strokes continues – 6 of the eight patients most recently admitted have had a haemorrhage; and even one with an infarct has had a haemorrhagic transformation – so the doctors are busy working out the best forms of treatment. This week it has not been unusual to see blood pressures of 220/110, which would explain some of the bleeds!

The highlight last week was the really constructive multidisciplinary team (MDT) meeting we attended. The structured format allowed all members of the team to give feedback and be involved in the debate, leading to effective decisions being made about patient care. But it was not all about the clinicians – the thoughts, feelings and circumstances of the patients and their families were central to the discussion and led to some really patient centred care. This excellent MDT working continued afterwards as it expanded into a more managerial meeting and consensus was reached on how best to move forward a few things on the unit – again everyone had their say and contributed to the conversation.

It has also been good to see some really constructive discussion on the ward around a few topics that keep cropping up and this has led to some peer learning and therefore better patient care. One of the hot topics at the moment is cognition - how to assess it and how to differentiate a cognitive problem from a communication problem.  It would appear that as the Ghanaian population ages these cognitive problems (stroke related or not) are becoming more prevalent.

We ventured out to Akosombo this week too – we explored the Volta Dam – amazing scenery and quite a feat of engineering too!

Volta Region

After our weekend trip it was back to the Stroke Unit on Monday and a busy week with an average of 9 patients on the ward most days.  The variety of patients is as great as would be expected on a stroke unit in the UK, ranging from those with mild weakness and good rehabilitation potential to those who are very unwell and requiring nasogastric (artificial) feeding.

Nasogastric Feeding

It is good to see how many of the staff have now completed their competency logbooks and how many are nearly there. The willingness of the staff to learn new information is inspiring and hopefully our presence here is helping to consolidate some of the learning.

The weekly trips out continue! After an evening of live Jazz with Dr Akpalu and Dr Nkromah on Friday, we headed to the beautifully tranquil Botanical Gardens in Aburi on Saturday – a welcome change from the hustle and bustle of Accra.

Amelia Shaw and Debbie Bartlett (IGH Fellows)