Tuesday 30 July 2013

View from a Habitat Team Leader: The full story of the fractured leg in Ghana.

View from a Habitat Team Leader: The full story of the fractured leg in Ghana.: I know, it's been a while since my last post. Well I have been busy with other things. House renovation, vacation, Yes, I do get one as...

The full story of the fractured leg in Ghana.

I know, it's been a while since my last post. Well I have been busy with other things. House renovation, vacation, Yes, I do get one as well as my Habitat Trips. I don't class those as vacations, they take months to put together and when they are over I need a vacation to recover. My last HfH trip to China was in April and to say the least, was not as expected. But I will tell all about that another time. I am not up to date yet with the rest of the trips. As you know I did not start posting blogs until recently so had a lot to catch up on.

I have decided that as they all retrospective I don't need to stick to date order. So this time I am posting my trip to Ghana Last year, 2011.  Well not so much a run down on the whole trip as most of it, well in fact all of it, I was sat on a plastic garden chair under a temporary awning to protect me and the dinning table from the rain, with my leg in a full cast. I have inserted pictures of my time spent under the awning so they are not actually relevant to that section of the story.

The girls in the team (100% female team) were amazing. 

 Meet the Ladies
They completed the project and ran around after me at the dinner table making sure I was fed and watered. They did a grand job, If I wore a hat, I would take it off to them. Even though they made sure I was eating, I still lost over 28lb in weight by the time I arrived home. Not a diet I would suggest to anyone else.

As I was not staying in a hotel but sleeping in a mosquito tent on the floor (it was not easy getting in and out of that) of a previously built Habitat house, it was not very comfortable to say the least, and I won't even go into the bathroom details, too much information as they say.

My home for the duration
The following is more a recount on my time dealing with the hospital and the ensuing problems of  breaking a leg in Ghana.

Ghana and the tale of the double fracture

It didn't get off to a good start from day one. I was due to be at the airport to collect team members arriving from the USA. Two flights were due in shortly after each other and the plan was to meet the first and hold them back for the second. I arranged with the hotel to have the driver pick me up at 19:00 hrs. He arrived at 19:30, he also collected another guest for transportation to the airport. We then stopped for fuel and finally arrived at departures over an hour later. 

I did hobble down to the build on one occasion, these are children of the partner family
I checked my phone and found an e-mail from Sonita who was due in at 19:30  it was now 20:30 and she was panicking because I was not there to meet her.  The traffic exiting departures was at a standstill so I left the vehicle and started to run down the ramp towards arrivals. That's where it all went wrong. I tripped and tumbled down the ramp grazing my arm and right leg. My left leg took the full force of the fall and was extremely painful.

On getting to my feet I found I could not put any weight on the left leg but had to hobble into the arrival area in the hope of finding Sonita. Luckily she had taken a seat by the coffee stall, I joined her and felt pleased that she was OK. It can be terrifying, a young girl thousands of miles from home, never been that far away from her parents before and there she is all alone, no one to meet her.

When the driver finally arrived I asked him to collect the next 4 team members on the next flight and bring them to the coffee bar where I was sitting. This he accomplished without a problem. 

I could hardly make it to the vehicle but with the help of a friendly shoulder to lean on, I got there.

Home owner
The following morning I realised the situation was worse than I had first anticipated. I had to accept the fact that I may have cracked  a bone in my leg. I called Naomi (affiliate GV co-ordinator) to my room and explained the situation. She was to take the team north to the village where we would be working. I would stay behind and go to the hospital and would catch them up later.

After following procedure and contacting Medex (HFH Insurer) they sent me details of which hospital to visit. I then took a taxi to the A&E at the Military Hospital in Accra.  This is where the fun started.

The taxi dropped me at the entrance and I hobbled in through the door. There was no reception and the first room was filled with people with various parts of their bodies bandaged or supported by temporary splints and dressings.  The doorway in front of me had a sign saying "Emergency Department" above it, so I hobbled through. An orderly saw my distress and immediately found me a wheelchair. Then the fun started. After I explained the problem I was taken in my new found form of transport to the accounts department where they took my details and issued me with a card in exchange for 30 Ghana cedies.

I was then transported back to Emergency and parked alongside two men lying on mattresses on the floor, both were attached to saline drips and one had bandages supporting his leg in a cardboard splint. The other just appeared to be in pain and curled in the foetal position. On a Gurney to the left of me was a guy with bandages around his waist and covering his arms, a saline drip was attached to his hand and to say the least he did not look comfortable. 

We got to meet the village Chief in his Habitat House
Eventually I got to speak to a doctor who informed me I was in need of an x-ray. Unfortunately the x-ray machine at the Military Hospital was not working and I would have to go elsewhere. At this point they ordered a state ambulance to collect me and transport me to another facility where there was a working unit. They also wanted to strap my leg and give me pain killers. The orderly told me what they would cost, I gave him some more money and off he went to get them. On his return they strapped my leg and gave me the pain killers. Apparently I should eat as I had taken the pill, I had had nothing since the previous evening.

The ambulance arrived and I was duly transferred to the stretcher and into the ambulance, (van with runners on the floor to hold the stretcher) Two other guys joined me and took their position on the double seat mounted next to the stretcher. One was the accompanying friend (apparently everyone should have one when going to hospital) the other was a car crash victim with dressings all over his face and what they suspected were damaged ribs. On the way, Max (ambulance doctor) got me a can of Guinness Malt, a disgusting drink that is apparently a food substitute.

On arrival at the hospital I assumed they were not used to having stretcher cases there because the doors did not accommodate them, but Max managed to get me in there. Max was to prove to be my saviour on more than one occasion during this exasperating day.  Once outside the x-ray unit door the radiologist wanted paying before he could continue. I didn't have enough cash as I had only exchanged a small amount at the airport when entering the country. Max paid the balance for me and the x-ray was completed. Max stayed in the x-ray room at all times, no lead aprons or protective screens to be seen here, and he was on the mobile continuously although the big sign said NO MOBILES.

Job done, Max informed me that I had a fractured Tibia.  On the way back to the Military Hospital we stopped at the ATM. I gave Max my card and pin number and told him not to book his holiday on it. He returned  to inform me that the card had been refused. I guessed it was a security problem. So there I am laying on the stretcher phoning the bank in England. Finally they clear security and free up my card. Max returned to the ATM and came back with the cash. I repaid my debt to him and paid for the ambulance. Hospital next stop.

The lovely lady in who's home I stayed during my time in Humjibre
Max wheeled me back into Emergency where I sat for a few hours watching the goings on around me. I was positioned on a gurney next to the operating theatre. A big sign on the door read "Operating Theatre No Entry" Perhaps the locals cant read but everyone and his friend entered that room at some point during my stay.

The idea of patients having a friend with them is so that they can run back and forth, paying fees, purchasing bandages and medicine from the on site pharmacy. You are charged for everything. Fortunately for me the friendly orderly took on that roll.

During my stay in the emergency unit, I had nothing to do but sit and watch the theatre performance going on around me. It was like a war zone. Bodies being brought in on stretchers, covered in blood, head wounds appeared to be the majority of cases. Motorcyclists with their feet hanging off, blood pouring from a head wound and a body covered in gravel wounds with the gravel still embedded in them. Another guy with a gunshot wound to his ankle, another motorcyclist with head wounds and a broken leg. He did arrive with a crash helmet so I'm not sure how he got the wound to the head.

They were all treated there on the stretcher right next to me, removed clothing dumped on the  blood soaked floor.  Cleanliness was not a high priority around here. I had no idea how long I had been there as the clock hanging from the ceiling was stuck at 11:20. The second hand was struggling to move, it kept ticking in a static position. I'm not sure if it was broken or if it was just the filth and grease stuck to it that was restraining the hand.

Beyond the emergency department was the emergency ward, here were patients who had been upgraded from phase one to the ward where they lay packed on beds lining the walls and packed so tightly with just enough space between them to enable the visitors and nurses to walk.  There seemed to be some kind of routine to visiting hours because every half hour or so, a stream of people walked through the area where staff were dressing the wounds of those damaged and bloody bikers, gun shot and car wreck victims.  All carrying food and washing items. It appears that you have to have your family feed and wash you, it's not part of the hospital facilities. I don't think I would have lasted long in there had it been necessary for me to stay in. 
My view from the plastic chair at lunch times
I had that thought too soon, I was told that the surgeon who needed to look at my x-ray and carry out any necessary surgery did not work on Sundays so I would have to stay until Monday. Seeing that this was not an option, I brokered a deal. I would get a taxi back to my hotel, although at this point I didn't have a hotel room, and return tomorrow morning.

With the help of Naomi who was at this time best part of the way through a 10 hour journey to the Habitat work site, I was able to secure a room at the Crystal Palm Hotel that had been used to house the team on the first night of their arrival. I also arranged for their driver to collect me from the Hospital and take me back to the hotel. 

With a room secured on the ground floor, I ordered a salad and then slept soundly until the morning. David the hotel driver was there on time and ready to take me to the hospital for another adventure into the health system of Ghana. He was very insistent that I was happy that he was on time. It was as if someone had mentioned that because he was late two days previously I had been placed in this situation. Not one that I blame him for, this is Africa, time is different out here. I still blame myself for running down a gradient, I should have known better. I was later to find out that Naomi had  had a word with the hotel about him being late.

On arrival at the hospital I entered the emergency room without a clue as to what to do or where to go. A guy in a short white coat requested the card that I had been given the previous day. On production of this he dropped it into a cardboard box at the end of a long table behind a clear perspex screen. I was then told to sit in a row of chairs which were fully occupied, and wait. 

Fortunately a young girl who had been sitting with an elderly relative, after being persuaded by the relative gave up her seat.  I had been sitting for a short while when I spotted a man raking through the cardboard box containing my card. He extracted a card and called my name. I hobbled across to him to be given my notes from the previous day. I hobbled back and sat down once again.

The kids wondering why this guy was sitting there with a cast on his leg
After a short while a door with the sign "consulting room one" opened and a number of people in white coats walked out and took a look at the rabble seated before them. This is a military hospital and there were a number of high ranking officers making there way back and forth through  the corridors and offices in view. Uniforms in camouflage, white, dark blue, the white ones looked really impressive. One of these uniformed medical staff stood outside the door and  directed the patients who were seated in the chairs, one by one into the room. It didn't mater who was first, he worked clockwise from the front right side of the double row of chairs.

It was not long before it was my turn. I hobbled into the room to be confronted by what appeared to be 2 male doctors and a female who I had seen the day before. I passed over the x-ray and the senior guy clipped it to the light board, pointing out the two fractures to my Tibia. He then proceeded to explain that I needed a cast and one of the other doctors present would find me a wheelchair (not an easy task in this hospital) and take me to the plaster room.

Once in the room with three, what I assumed to be doctors, I climbed onto the bed and they readied me for the cast. That was when one of them produced an invoice detailing the cost of bandages, plaster of Paris and a pair of crutches.  This all added up to far more than I had with me. So it was off the bed, back into the wheel chair with Kofi the doctor who had wheeled me there in the first place, now taking me to locate a Taxi. He summoned a hospital taxi as these drivers can be trusted (apparently). I squeezed into the front and with Kofi in the back we headed out to the ATM for a second time. The traffic was horrendous and it took quite some time to travel a short distance. After I extracted another 400 Cedies we headed back to the plaster room but not before stopping to pick up lunch for Kofi.

Back in the plaster room I settled the invoice and was duly plastered. Kofi wheeled me back to the taxi and I was free to go to the airport and fly up to Kumasi where a driver was to meet me for the three and a half hour drive to Humjibre in the western region. It had taken the team four hours to drive from Accra to Kumasi, the flight lasted twenty five minutes. I waited just over the hour for "Bright" my driver to arrive. We then headed out to the village arriving about 7 pm on the Monday.

 The Cast
I then spent two weeks sitting on a plastic chair under the awning set above our team table. Not sure I was of much use to them but at least I was able to give moral support and answer a few of their questions.

At the end of  the project and following the 10 hour drive back to Accra, I went back to the hospital and had the cast removed, thereby enabling me to fly home. Apparently most airlines will not let you fly with a cast or unable to flex the knee. Fortunately Kofi had written his name and number on the back of the x-ray envelope. I called and explained the situation and he asked me to meet him at the plaster room in the hospital. He then proceeded to remove the cast, We don't have a set charge for this he said, but we will take whatever you give us. I paid up and headed on my crutches out of the door and back to the hotel.

It rained a lot during my time under that awning and my crutches came in handy more than once
I spent that evening cast free sitting next to the pool with a beer in hand. The beer was to try and deaden the pain, it wasn't working. Next day at the airport, Virgin made a great effort to secure my comfort throughout the journey home, I certainly have no complaints as far as that flight was concerned.

Back in the UK, I was wheeled through the airport to be greeted by Moira waiting for me at arrivals. She whisked me off to the local hospital where we waited 5 hours over night to end up with a part plaster cast that was loose and disjointed and quite frankly, useless. At least Kofi in Ghana new how to put a cast on a leg. We then travelled back to Yorkshire and again checked into a local hospital in Doncaster. The story was so different there, you would not believe they were both NHS hospitals.

I then had a fancy contraption fitted, looked like one of those things kids with polio used to wear. (if you are old enough to remember those things). It was my new friend for the following 8 to 12 weeks. 

The calliper
Unfortunately it didn't stop there. Since returning home I was diagnosed with fluid on the lung, that  rectified itself with the use of antibiotics. An infection on the lung, Again rectified but left a scar. But worst of all is a blood clot at the back of the knee and a pulmonary embolism. So was put on Warfarin for 3 to 6 months. 

All the effect of fracturing my leg and flying back without a cast. Catch 22 I think, can't fly with a cast, DVT if you fly without one. But hey, there are many more out there far worse off than I.  And as they say, Life is the adventure.

Update:  
A few weeks after being home and settling back into life, all be it with a calliper on my leg. I received a phone call from a number I didn't recognise. It was Kofi calling from Ghana to see how I was getting on. Amazing, try getting that service from a UK NHS doctor.