2018 Ghana Mission Blog by Dr. John Parker

Throughout the 2018 Operation Walk New York mission trip, Dr. John Parker will be writing about the team’s experience.

November 3, 2018- Screening Day

It’s a hard thing to put a finger on, but part of the thrill of traveling is seeing the world through a different lens. In nations or cultures different from our own, things work differently. Road signs are different. Light switches are different. And the habits of communication are different. Experiencing these things, and figuring out how local systems work, are part of the challenge and excitement of being someplace new.

And, as a system, health care is indescribably complex. (“Who knew...?” We all knew.) And that system is always challenged to function efficiently in any culture.

So mixing these two elements together - trying to create a system that will allow the administration of a complex health care need like joint replacement, in a locale where every little thing is quite different - is a unique difficult undertaking.

Today is Screening Day. Working in four screening teams, we meet and examine about 140 patients, to assess their medical and orthopedic suitability to have a joint (or joints) replaced.

It’s on Screening Day that the exchange of information is most crucial, so this is the day where the differences between our cultures are most apparent. Communication challenges abound. Both we and the majority of the patients are all speaking mostly what we think of as English, but we commonly require the use of English-to-English translators.

And the Ghanaian voice, it seems, is commonly soft, and it’s often necessary to move in quite close to hear and understand what’s being said. In our American culture, it’s more common to step back, and speak up. This lends itself to a certain degree of cross-culture awkwardness (Except for Seth. Seth is a close talker).

Screening Day also makes an impression emotionally, when we see the pathology that these patients have been living with for so long. The easiest case of the week here is the hardest case in three months back at home. The degree of deformity and disability can be striking, and moving.

One 22-year-old presented with a dislocated right hip from a car accident, and his right leg was 10 cm shorter than his left. When asked when his injury occurred, he replied “7 years.”

Another young woman presented with two crutches and a ridiculous arthritic deformity in each hip for many years. And a broad smile. When we checked her age? 21.

In America, these extreme examples of orthopedic pathology are rarely encountered, simply because they get fixed way before they get this bad. But in Ghana, they are much more common.

Patient screening is followed by a long conference in which our entire surgical team reviews each case and discusses the appropriateness of surgery for each patient. X-rays are reviewed and patient comorbidities (malaria, sickle cell disease, hypertension, etc.) are reviewed. Surgical candidacy is narrowed down to a number that our resources can accommodate. Then a smaller team sits down and puts together the surgical schedule for the next four days.

While we screen patients, our OR prep team is working hard to create a small area of familiarity for us in the operating rooms. This is a crucial component of our success - surgically, we will do our best to play our home game. And tomorrow, as we move from screening into our first of four consecutive surgical days, running three rooms, we will pursue the actual surgeries with as much routine and normalcy as we can.

In Ghana.

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