Lessons from Ghana

A pair of EvergreenHealth Monroe Pharmacy interns have visited Ghana two summers in a row to help address chronic conditions prevalent among vulnerable communities.

What they found was startling. Marissa Norton said in 2016 she and Justin Fernando, along with nearly two dozen other University of Washington pharmacy students, saw about 900 patients in three days. 

“From a health standpoint, high blood pressure really isn’t addressed,” she said. “These are in the lowest-income regions where they have little access to medical care at all because there aren’t even doctors in these regions.”

Inadequate access to services is coupled with the lack of resources that allow people experiencing an illness to travel to bigger communities, where the professionals are available, Norton said. It also explains why the students’ clinics were in such high demand, she said.

Norton said education was a key component of their efforts during both trips, but it became the main focus the second time around. The hope was to help create a self-sustaining system within the communities, Fernando said. This past summer intake was cut down to half as many as the year before, so students could spend more time with each patient.

“Where we live, it’s normal to have a blood pressure of 140/90. We screened roughly 400 patients in Ghana and found dozens had blood pressure well over 220/110, which was extremely alarming,” he said in an EvergreenHealth news release. “In some instances, patients had suffered strokes as a result of hypertension, but didn’t realize the seriousness of their condition...”

He recalled speaking with some patients who mentioned they had lost feeling on the left side of their body recently. Usually in the U.S. a hypertensive crisis, which can lead to a stroke, is when systolic pressure reaches about 180. That’s often when people need to go to the hospital. About three out of four of the people the group talked to were “living their normal day like that,” he said.

The first year, Fernando said, felt more like putting a Band-Aid on the issue. In addition to hypertension, he said patients were screened for diabetes and respiratory issues. He chose to go back this summer because he wanted to make a long-term impact.

The trip was the culmination of a quarter-long course at UW. Students spend much of the class planning and organizing the clinics, Fernando said. One person prepared protocol to hand off to nurses there before the group left, so they could carry out the diagnostic procedures themselves and treat their patients. 

The students went through UW’s Global Medical Brigades chapter, which is the world’s largest student-led global health and sustainable development organization, where international volunteer trips are arranged in various disciplines, according to the news release. Volunteers take vitals and patient history in triage, shadow licensed doctors in medical consultations and assist in a pharmacy under the direction of licensed professionals.

Fernando took the class because he wanted the chance to experience his chosen field in a different context. Fernando, who is now 27, said he originally wanted to be a nurse. Then each nursing school where he applied turned him down.

It took him a while to pick pharmacy, but he always knew he wanted to work in health care. It started when he was six. His father had developed a liver-related disease that kept him in the hospital for six weeks. The care given by those on staff inspired him to pursue the career.

Norton said she has always been interested in how chemistry works in the body. It wasn’t until she was studying biochemistry that she realized she wanted her job to include regular interactions with people. She had chosen UW in part for the opportunities to travel internationally, which are offered through the program.

“When I first went (to Ghana) I think I was really just kind of amazed at how well we were received,” she said. “Everyone was just really happy to see us, and everyone was working so that our clinic would be efficient.”

Norton said the experience gave her a renewed sense of why she is doing pharmacy. Manager of EvergreenHealth Monroe Pharmacy Kathy Arnold said she has seen the difference in Norton and Fernando since their travels to Ghana.

“I think that they have become more engaged in what goes on at the pharmacist’s desk rather than what goes on at interns’ desk,” she said.

Arnold is also a clinical instructor with UW. She said EvergreenHealth Monroe is not generally a teaching hospital. Because of their relationship with the Seattle-based institution, they hire pharmacy interns to work on the weekends for three-year stints.

She said the facility now has two people who have a global experience and can incorporate a new perspective into the local system of care. Arnold said she hopes by seeing the direct impact of education in prevention they can continue to emphasize the importance back here at home.