Sweat equity

Through heavy metal doors, I am led into a dark hallway lined with stretchers upon which lay the sick, injured and dying. Intravenous lines hang from rusty nails on wooden poles. Patients' eyes stare intently at me with a desperate plea for help. I am overcome by a smell I cannot place, but will never forget.

The small admission area is full of people who've been waiting for hours, perhaps the entire day, to see the few physicians available. They may walk away with over-priced antibiotics or be admitted and continue to pay for service. The lack of circulating air makes the sick feel sicker and the healthy feel helpless. Even now, with all that happened in those short eight hours, I still do not know how I managed to survive my first day in the emergency room in Ghana.

From day one of nursing school, being able to complete my senior practicum abroad was a primary goal – international health was something I planned to work toward in my career. Ghana, in West Africa, seemed to be the ideal choice. Where else would I gain first-hand experience about the concepts of primary health care and health promotion, two topics that are constantly ingrained in our minds during four years of school?

Despite seemingly endless hours of preparation, nothing could have prepared me for the 10 weeks I spent in Ghana. What struck me upon arrival in Accra, the capital city, were the heat, smells and the bitter poverty in a city where the average person makes less than $400 Canadian annually. The moment I stepped off the plane, I began to sweat. It continued until the day I left. A handkerchief became as much a part of my wardrobe as my developing tan. But while I could get used to the heat, it was the smell of raw sewage, rancid cooking oil and human closeness that I had the most difficulty with. It is not surprising that in a city of one million people, mouth-breathing and lack of personal space became the norm.

My first encounter with the poverty of Africa occurred on the car ride from the airport. My senses were in overdrive. The sight of locals living in slums next to open sewers was something I could not divert my attention from. Here I was, speechless and far from the everyday comforts of home, experiencing a developing country. But during my short stay, despite the lack of money, education and sanitation, these beautiful people displayed warmth, generosity, and a great passion for life - something I will never forget.

Adapting to a different country and an entirely different lifestyle took time and time seemed to slow down. There was no longer a rush to get from point A to point B; people actually took the time to get to know one another, and if something could not be done today, well...there was always tomorrow. Music always filled the air, smiles from children melted my heart, and taking the time to enjoy life was the most valuable experience of all.

Having the opportunity to work in emergency and the neo-natal intensive care unit of a major hospital, being on the front line in community clinics and taking part in a prevention program for AIDS and STDs sponsored by Health Canada truly shaped my outlook as a nurse. I quickly discovered, however, that acute care in Ghana was not my niche. Working at Korle-Bu Hospital was an eye-opener that amplified my appreciation for Canadian health care.

It was particularly difficult to see the many cases come into the emergency room, and know how much more could have been done if only we were in Canada. But despite the lack of resources, the staff was quite industrious in finding solutions. Primary health care delivery was almost text-book perfect at the Weija clinic, where our main focus was on maternal and child health. Most days were spent setting up field clinics for growth charting, immunization, nutrition and family planning. The daily turnout was never short of 100 mothers and their children, and the informality of the clinics made the nurse-patient relationship much more meaningful. I finally realized the importance and true meaning of community nursing. The opportunity to sit and speak with street workers as part of the West African Project to Combat AIDS and STDs, and to discuss concerns and collaborate with other colleagues on solutions, was a teaching experience that could never be found in a text book.

Nursing in another culture was a character-building experience. While I was always aware of the differences in Ghanaian and Canadian culture, I learned to appreciate these differences, as well as see the similarities that make us all human.

The experience of nursing abroad has broadened my view of cross-cultural nursing and different methods of health care delivery. But more importantly, being in Ghana opened my eyes to a new appreciation of other cultures and the realization that we all have the power and responsibility to help each other, no matter where we are in the world.

(Terry Te graduated this year from the University of Alberta with a nursing degree and is currently working in Edmonton as a home care nurse.)