This past winter, two students and two faculty members from the School of Nursing traveled over 5,000 miles from Buffalo to Accra, the capital and largest city of Ghana.
Olivia Cox, RN, Adult-Gerontology DNP '20 graduate, and Jessica Rachow-Pangrazio, RN, Adult Health Nursing DNP student, joined faculty members Carla Jungquist, PhD, ANP-BC, FAAN, and Mary Rose Guaghan, RN, MSN—along with individuals from the Jacobs School of Medicine and Biomedical Sciences and School of Management—on a multidisciplinary trip that taught them more about themselves and their profession.
On their first day, the group set up a clinic in the Agbogbloshie Market, a trading center situated on the banks of the Korle Lagoon, northwest of Accra's Central Business District. In one day alone, the clinic served more than 200 patients with health screenings and primary care.
“Everyone was very accepting and wanted us there,” Rachow-Pangrazio says. “I thought there would be some hesitation because we were outsiders, but we were able to get stakeholder buy-in before we got there. Dr. Dorothy partners with a group that has affiliation with the locals, and they worked with village chiefs, churches and senior community members to alert the general population.”
The trip to Ghana was arranged by Dorothy Siaw-Asamoah, PhD, clinical assistant professor and faculty director of global programs for UB School of Management.
“I was also surprised at the methods they used to attract people to the market,” Rachow-Pangrazio adds. “They don’t have a lot of resources, so they used a big speaker to blast music in the area. That’s how people knew that we were doing a clinic.”
The next day, the group traveled to Tema, Ghana, for a tour of Narh-Bita Hospital, which is a private hospital in the area.
“Doctors are sparse in Ghana,” Cox says. “They don’t pay them very well, and health insurance doesn’t come in on time. Typically, doctors are foreign-educated and then don’t come back. Because of that, nurses play a much large role in their healthcare system.”
Cox explained that while the country has made a lot of strides in its 60-year existence as an independent country, laws and regulations aren’t always enforced. This has caused a large problem in health care, which is why it can take anywhere from one to three years to pay health care providers (and sometimes they don’t get paid at all).
On day three, they went back to the Agbogbloshie Market, where they served over 200 more patients.
“It’s great that nursing students participate in this trip because they were able to just jump in and handle things,” Cox says. “The School of Nursing has been hands on since day one. In clinicals, you’re given a couple of minutes to come up with a care plan and then you need to implement it. That’s exactly what we did in Ghana.”
“Everything you’ve learned is put to this person right now,” she adds. “You can’t always go by the books because you don’t have every resource in every setting. You need to use critical thinking in real time, and the way the school educates nurses is well-suited for that type of setting.”
The next day, they toured and provided primary care at Nsawam Government Hospital.
“The whole maternity ward was run by nurses—there was no doctor in sight,” Cox says. “In many large facilities, there are maybe six or seven doctors, which is not a lot. Doctors also take turns going out and seeing people in the community, so that also affects their availability. Nurses play a huge role in keeping that place going from labor to recovery and the NICU area. They do it all with no assistance.”
In Ghana, nurses are able to pursue a two-year or four-year education. All nursing programs are authorized by the state government, and when students complete their education, they’re placed in position. Two-year nurses wear green scrubs, and four-year nurses (who often hold supervisor positions) wear white scrubs.
On New Year’s Eve, the group visited the Nsawam Government Hospital School Clinic, where they cared for Arabic Immigrants without health care.
“We saw so many different types of people throughout this trip,” Rachow-Pangrazio says. “There’s a big push for cultural sensitivity and including culture in the curriculum here at the School of Nursing, so I felt prepared for the experience.”
Ghana is home to roughly 29 million people. While English is the official language, it is a multilingual country in which about eighty languages are spoken.
“I even tried to learn a little Twi [a common language in Ghana] before I went,” she adds. I failed most of my attempts, but the patients were so excited that I tried to connect with them because they didn’t expect us to know anything about their culture. We see that same thing here in the U.S. If you try to speak Spanish to a Spanish-speaking patient, they appreciate that you’re reaching them that way.”
Later in the day, they were able to visit the Botanical Gardens for a sunset picnic.
On the morning of day six, they traveled back to Nsawam Government Hospital, where other participating doctors lectured on topics including stroke care, hypertension and quality management to the local health care team.
In the afternoon, they toured Graceville Medical Center, a new 32-bed capacity hospital located in Pepraw Junction. They ended their evening at the home of a fellow traveler Neneyo Mate-Kole, Jacobs School of Medicine and Biomedical Sciences student, whose family resides in the area.
The next morning, the group visited Kpone-Bawaleshie Clinic, where they performed health screenings and provided primary care for over 200 patients, mostly children.
“I was amazed by the number of children seeking health care on their own, even just for wellness checks.” Cox says. “We learned this was due to public health initiatives to increase children's access to hospital settings and vaccinations. It was a real generational shift. Many of the adults we saw had never seen a medical professional before, but the children empowered themselves to take advantage of these health care opportunities.”
There was a wedding going on simultaneously, so the group joined in on the celebration at lunchtime.
After a busy week, they were able to take a break to visit the area and explore its history on their own. They went shopping, visited Dr. Dorothy's home in Accra and visited the Cape Cost for some rest and relaxation.
Overall, Rachow-Pangrazio and Cox agreed the experience was both life-changing and eye-opening.
“Learning someone else’s perspective is always important,” Rachow-Pangrazio says. “You can do this by seeing where they came from, why they think the way they do. I left feeling gratitude for humankind and grateful for our privileges.”
“I came away from this trip realizing we’re all the same,” Cox says. “We have the same struggles. We all have to make money to pay bills and put food on the table. We all want to educate children and give them a better life. We may be in different stations in life, but at the end of the day we’re all the same. If you can go on a trip like this and see yourself in those people, you should be able to bring it home and treat your patients with the same compassion.”
“Global experiences, such as our trip, allow students to learn outside the box of the university setting,” Jungquist says. “They learn to be flexible and to use their basic skills for assessment. They also gain the perspective of respect for those less fortunate. Experiences, such as this one, feed the students’ souls and spirits, as well as their minds.”
“Traveling to Ghana gave me the opportunity to broaden my professional background and experience and love of nursing to the other side of the world,” Guaghan adds. It’s important to me personally to give back to others all the gifts I have been given to help others.”
Trips like these are made possible with support from the Carol S. Brewer Global Health Fund. To learn more and make a gift, visit our website.
Published June 25, 2020