“We don’t have”

Tumu District Hospital in the Upper West Region of Ghana has one practicing doctor to serve the needs of a population of over 90,000 people. Those 90,000 people rely on that one doctor, who also serves as the hospital’s medical director (an administrative role), to perform every procedure where a doctor’s care is needed, including cesarean sections and most cases of complications from unsafe abortion. Working virtually around the clock while shuttling himself between two health facilities, I dared not ask what happens if he is out of town, sick or otherwise unavailable.

I have spent the past week working with Pathfinder’s Reproductive Health Program Manager, Moses, and the Project Coordinator, John, on facility assessments for the Comprehensive Abortion Care project. Facility assessments are the first step after acquiring funding in implementing a project based at a hospital or health center. Pathfinder has ongoing CAC projects in the Upper East and Northern Regions and new funding allowed for the expansion of the project to the Upper West Region, considered the most remote and underserved region of Ghana. Our task was to assess the facilities ability to house Pathfinder’s CAC project, consider the communities’ need and determine the necessary level of intervention. Moses, John and I visited each of the four main hospitals in the region using an elaborate assessment tool to gather information relating to virtually every aspect of the hospitals’ workings: client volume and range of services provided; recent staff trainings and acquired skills; record keeping; up-to-date protocols, as well as the availability of various rooms, equipment, medicine and family planning commodities. The assessment tool includes a rating system where a mark of 1 means inadequate or not present, 2 means adequate, and 3 signifies good. At Tumu, it quickly became clear, as our pages began filling with row after row of 1s and most of our questions were answered with a simple, “We don’t have”, that this hospital was the most poorly equipped and the most in need of support.

The staffing shortages, in every corner of the hospital, are what struck me as the most devastating. There are five midwives to run the maternity, labor and antenatal wards for three shifts, 24 hours a day, seven days a week. There is rarely more than one midwife available at a time to see to the hundreds of women who come each month for services. The midwives of the hospital not only attend to all pregnancy-related health issues, including deliveries, they also act as the access point for the communities’ family planning needs as well as HIV/AIDS counseling and testing including prevention of mother to child transmission. There is one nurses’ aide to assist the midwives and no administrative workers for the entire maternity ward. In such an environment, it can be easy to give up. However, the midwives ability to forge ahead and continue the daily struggle of providing care for the women of their community is remarkable. Pathfinder’s CAC project relies heavily on the midwives to carry out four of the five components of the program (pregnancy counseling, family planning, treating the complications of unsafe abortion, and elective abortions); it’s possible to view the project as an additional burden for these midwives. And yet, the midwives understand, better than anyone, that the training they will receive and the comprehensive care they will carry out will save the lives of the women in their communities.

Also, the care and concern with which Moses and John, who are both nurses themselves, carried out the facility assessment was remarkable and no doubt contributed to the positive and hopeful attitudes of the midwives. Working from Pathfinder’s experience in the Upper East and Northern Regions, they collaborated to find ways to implement the much-needed CAC project in the context of this struggling facility. Where I saw pages and pages of 1s and heard “we don’t have” after “we don’t have”, Moses and John saw small successes where they could find them and innovative ways to overcome massive challenges. It says on the Pathfinder website that, "Pathfinder works in remote locations, under the most difficult conditions, serving the most vulnerable people." After traveling by dirt road, seeing women walking some 12 miles to and from the local market to sell their foods, and finally meeting the one doctor and 5 midwives serving over 90,000 people, I know this statement to be true. What I learned today is that Pathfinder is able to do this because the determination, creativity and hopefulness of its staff and partners who are able to seek out solutions and solve problems under the most difficult circumstances.