Placement work and differences in practice:

To update from last week we actually got to do stuff! (Woo), after all of that palava. Our work mainly consisted of assisting occupational therapy sessions and working across 6 male and female wards. Occupational therapy is where individuals take part in interventions to improve their daily living this can be anger management, motor skills training and cognitive interventions. Occupational therapy sessions were so interesting the way games are designed to aid motor skills and cognition, we played pick up sticks and a strange hole game (no clue what the name was). The games were difficult to play but as we played the more we progressed and improved alongside the clients, I got very competitive I can’t lie.

While occupational therapy was client centred which was similar to the UK, the conditions and protocol of the wards were not.

Each person in the ward had a hospital bed and shared a room with 20 other beds. The wards were small and quite dirty and usually had nothing for people to do. Everyone who I spoke to said they didn’t want to be there or that they didn’t like it. However clients weren’t there long due to having to pay for healthcare in Ghana, people could only stay as long as they could pay the fees which was very expensive for majority of individuals. Individuals would usually have short stays of 1 week to a couple of months. There was only one exception: a client showed psychological issues after being hit by a car, he had no known family and no where to go so they allowed him stay at the psychiatric ward. The man was mostly paralysed, and the staff said no one could understand him as he spoke French, they then continued to tell me he had been there 20 years on the floor of the ward, which was a shock.  Despite having plenty of empty beds as he wasn’t paying for his stay he was forced to stay on the floor. As I knew a bit of french I tried to have a conversation with him and honestly I nearly cried, as his face lit up when I spoke some french to him. None of the staff had bothered to learn or even google translate over those 20 years leaving this man isolated. Alongside this I asked the staff for his diagnosis and they couldn’t tell me, they labelled it as just psychological issues, but I question whether their assessment was culturally appropriate as he did not speak English or Ghanian twee.

Speaking of staff, there were so many. In Ghana being a nurse or doctor is one of the only ways of getting out of the country (which most want to do) in order to work in the UK. But due to this there is unfortunately such a lack of passion and work ethic found within a lot of staff. There was  roughly 50 staff in the wards just sitting in the common room doing nothing but chatting and going on their phones. Due to this i spent a lot of time talking to the patients and educating them on the wards, many were so thankful for the interaction and advice for how they can make lifestyle changes to prevent coming back to the ward. Also providing psycho education as many individuals admitted they weren’t told what their diagnosis even meant, so I tried to educate on personality disorders and schizophrenia. Of course some completely denied having a disorder and in these cases I was more so learning about individuals, carrying out mental capacity assessments and observations of symptoms. However, others were grateful to actually understand why they were brought here and what medication they are on.

Although I have worked in healthcare before the male wards were intimidating at times being a white female in Ghana. There were a few times where i was grabbed or felt unsafe and i had to be vigilant in noticing changes in patients behaviours to keep myself safe as staff did not pay attention.

In the UK there is many risk assessments for each individual and possible situations in mental health units following this staff are provided training to deal with those outcomes usually with positive behavioural support (non restrictive strategies) and restraint training (restrictive strategies). However, the nurses and doctors there were not trained in either and instead were reliant on medication to prevent challenging behaviours. During our time in the wards, I assumed a leadership role, drawing on my prior experiences. This involved implementing strategies I had learned and making numerous decisions for our team. I was observant, paying close attention to cues and subtle behavior changes to inform our approaches or decide when to leave. I was appreciative of this experience to see the stark contrast in healthcare and it really showed me the mental health crisis Ghana is going through and that they not very equipped for tackling it. In response to this I did not only speak to patients but also staff, about the needs of individuals and suggestions of how they could improve treatment to feature more psychological interventions and be more personalised. To my surprise many staff did listen and took on what I was saying, which I did not expect considering I was younger and not a qualified nurse.

This week, I said goodbye to the incredible individuals in the Narcotics Anonymous program who are actively recovering. I had the privilege of working closely with many of them, building strong relationships and making significant progress together. I now wish them all the best on their continued journey.

Environment:

Trigger warning for all of the plant lovers and climate change activists. So when I got to Ghana I noticed there weren’t many bins…. and then realised there weren’t any at all. There’s no bins and no rubbish fairy, but there were pits. People fill the pits up with plastic and rubbish and burn it to compress it down (the smell was awful) or they would just throw it on the roads and fields. The amount of litter was painful and we felt so much guilt that we as volunteers were contributing to this litter as there was literally no where else for it to go. But fear not as i found a solution!! Which was to provide the occupational therapy unit with the plastic bags our water came in, allowing individuals to make bags and purses as part of their therapy. This initiative promotes recycling while enhancing motor skills, cognitive abilities, and teaching a trade that patients can use to create and sell products after leaving the hospital.

Driving:

I think I mentioned a few posts back about my life flashing before my eyes when driving around in Ghana. Yeah this hasn’t changed. Most cars just don’t have seatbelts over there, the amount of times I would go to grab a seatbelt and instead be grabbing thin air. But now that I have adapted I will probably forget seatbelts exist when I return to the UK. Also the roads (if you can even call them that) are genuinely like some sort of roller coaster ride because of how bumpy the dirt tracks are. I think Ghana cured my car sickness because of how much I was thrown around like a rag doll in the back seat and somehow I wasn’t even sick?!  Most people in Ghana don’t have a driving licence so whether it’s your driver or another driver it is terrifying, everyone drives so close and recklessly. There was also barely any traffic lights or road signs, the best way to describe it is that it is a free for all and you can just make up your own lanes. 

Language and tribes:

While being here I have tried my best to learn the language. Although there are many languages in Ghana used by different tribes there is the shared language of Ghanaian twee (pronounced “tree”). Here are some of  basics I forced myself to remember:

Thank you= Medasse

Welcome= Akwaaba

How are you = Eti sen

I am fine= Me ho ye

God bless you=  Mawu na yra wo

You are drunk=Atutu (don’t ask why I know this)

People of the Akan tribe (largest in ghana) also use something called “day” names where you are referred to as the day you were born and it is said to reflect your soul and personality traits. As I was born on a Saturday I am called “Ama” (easy to spell and remember thank god)

There are 5 main tribes/ ethnic groups in Ghana being the Akans, Guans, Ewes, Ga-Adongbe and the Mole-Dangbani.

Food:

As a past picky eater I didn’t know whether I would like the food or not. Food is a massive part of Ghanaian culture, not just the food itself but sharing the food and appreciating the people that cook for you. Somethings I did like were plantain, jaloff rice and tilapia, which is the local fish they cover in a very spicy seasoning. However, I did not like okra stew and banku which was a dish I tried multiple times, my attempts of being polite resulted in watery eyes and trying to hold back my gags.

One significant difference was the economy. I expected the rural villages I visited to be poor, but seeing the conditions firsthand deepened my awareness. This experience has made me more grateful for everything I have and for the chance to fully immerse myself in such a different culture. As I head into my final week, I am in high spirits and disbelief at how quickly my time here has flown by.

week 5 ✅