By Rebecca Czekalski
Humanist Service Corps Volunteer
Medical errors are deadly errors. This is something that is ingrained in the consciousness of American nurses, and with good reason. Medical errors in the hospital are the third leading cause of death in the United States. According to the National Institute for Health (NIH), 98,000 people die every year due to preventable medical errors in the United States, and $19.5 billion dollars is lost because of medical errors. One of the major causes of medical errors is ineffective communication amongst the medical team. Hand off communications can be particularly tricky, and can easily lead to misinformation and deadly errors. A lack of access to updated patient records also contributes to medical errors, and is one of the main reasons behind the recent push in the United States to have computer documentation. I happen to be old enough to have survived that transition during my career. It was not pretty and we nurses hated computerized records at first, but they definitely save lives and prevent errors.
On the other side of the world, the village of Kukuo, near Bimbilla, lies in the north of Ghana. The residents are facing similar medical problems, but with far less technologically advanced record keeping systems. They also face their own obstacles of access and literacy that inflate the number of preventable errors and little study has been done on the impact such issues have on patient care in Ghana. Kukuo is a highly rural and impoverished village. Life there is a daily struggle to get money to live and to have enough water for daily needs. There is no running water in the village and women carry water on their heads from water pumps miles away from the village center, or up a very steep hill if they must draw from the river. Kukuo has a health clinic, which is staffed by two public health nurses. These nurses can treat minor issues, dispense medications for certain common conditions, and assess patients to determine if they need a higher level of care. However, as this is a health clinic in a remote rural village without the benefit of running water, most issues must be referred to the hospital in Bimbilla. In order to get to Bimbilla, a potential patient must be able to ride 45 minutes on a motorcycle, and that is if there is a motorcycle available and someone is available to do the transportation. To further complicate matters, Bimbilla is currently under a 6pm – 6am curfew, so the Bimbilla hospital can only be accessed by the people of Kukuo for 12 hours each day. Serious issues must be referred five hours away to the major hospital in Tamale. Patients are responsible for getting themselves to Tamale at their own expense. They must find family members to take them or arrange their own transportation. First they have to get to Bimbilla and then get the bus to Tamale. Many don’t get there.
Tamale Teaching Hospital comes to the village of Kukuo once every five years or so and does a basic health screening for hypertension, anemia, malaria, and diabetes, while also dispensing medications. This is done because Kukuo is a refuge for alleged witches, so ActionAid in partnership with Songtaba has set up these screenings. However, patients do not get a copy of the results of this screening. The Kukuo health clinic does not get a copy of this screening, nor are the nurses apprised of what medications the villagers receive. The medications from Tamale Teaching Hospital only cover the needs of one month, sometimes less if supplies are running low. For patients to get a refill on their medications they must either go to Tamale and get a prescription to refill their medications, or they must go to Bimbilla and convince a different doctor to write them a prescription. They also have the option of convincing a pharmacist to dispense their necessary medications without a prescription, but this is not technically legal or reliable. Health records are frequently lost, damaged, or inaccessible due to a filing system based only on an identification number given to the patient at the time of treatment. This is a consistent problem across the board in the Ghanaian Health System.
All of these issues put the residents of Kukuo at serious risk for unnecessary deaths and complications from preventable medical errors and failure to rescue scenarios. When the Humanist Service Corps decided to partner with Songtaba to help improve the standard of living in Kukuo, they asked the village elders for ideas about what kinds of improvements were needed, and where the biggest impact could be made. One theme that came from those meetings was the need for Kukuo residents to be more aware of their health and their health needs. Thus, the Kukuo Medical Records Project was born.
Shortly after I joined the Humanist Service Corps, program director Conor Robinson and I began to communicate about the idea of a medical project in Kukuo that would help residents become more knowledgeable about their conditions while also giving medical staff the best information possible for treatment decisions. Throughout several months of meetings with the Kukuo village elders, the Kukuo Health Committee, which is comprised of several prominent community members selected to represent community interests, and the Ghana Health Services, an idea for a comprehensive health screening and database creation began to take shape. Driven and guided by the people of Kukuo and the local public health nurses, I designed a medical screening form that would capture a comprehensive health history of the patient, while also gathering information on current medications, allergies, and vital signs. This tool also actively screens for malnutrition in children under the age of five, diabetes in those over the age of eighteen, malaria, and tuberculosis, while also reviewing available vaccination data for all children under the age of five.
This screening will be done in both English and Dagbanli, the local language. This is the first time that a health screening has been done in this area in a language besides English, as all healthcare and healthcare related issues are done in English only in Ghana. Unfortunately, only those who are educated can speak, read, and write in English, and many people cannot read and write in any language. This creates a large barrier for many people, especially elderly, the impoverished, and women, who make up a significant portion of the Kukuo’s population.
The Kukuo Health Committee, as well as the Kukuo health clinic nurses, who had a few recommendations for revisions, enthusiastically approved the health screening form. These revisions were made. It was then translated into Dagbanli by the language instructor for the Humanist Service Corps and submitted for final approval, which was again granted. A referral form was created to allow easy and safe hand-off communication between the screeners and the Kukuo health clinic nurses. A consent form was also created and translated into Dagbanli, so that everyone has the option of opting out of this screening, and only participates in this screening of their own volition while giving informed consent.
The Humanist Service Corps has employed and trained six young people from the village of Kukuo to carry out these screens. These six young people, four men and two women, have all completed high school, but are waiting to go to college, marry, or start a career. They are all bilingual in English and Dagbanli. I trained them in how to screen patients, how to sensitively ask questions to get the best health data possible, how to measure vital signs, how to do a diabetes blood test, how to do a malaria blood test, and how to use the screening tool. Training took three weeks of meeting for two hours, three times each week. All six recently passed a written test about common health conditions within the community, and demonstrated their skills in front of the public health nurses and myself by screening a young child and an adult. They have done an amazing job.
The health screenings were slowly rolled out over the course of ten days, with the screeners beginning with their own families and with each other. Questions were answered, and issues regarding referrals were clarified. As the screeners gained experience and confidence, the project has slowly begun to pick up speed. We are now in the beginning of our third full week of screening. So far, 138 screenings have taken place. Of those, 103 screens are fully processed – that is to say, they are complete in both English and Dagbanli, and copies have been made for the patient, for the Kukuo health clinic, and for Tamale Teaching Hospital. The originals, along with the consent form, are stored in a locking metal filing cabinet in the Songtaba office in Bimbilla. The patient receives English and Dagbanli copies in a waterproof folder. Tamale Teaching Hospital receives copies in English and Dagbanli, which will be stored in a locking metal filing cabinet. The Kukuo Health Clinic receives English and Dagbanli copies, which are also stored in alphabetical order in a locking metal filing cabinet on site. One of the pieces of data captured by the screening tool is the patient’s medical record number. This way, if the patient forgets their health card with the number, this information can be looked up alphabetically based on their name. This allows for the original hospital records to be pulled, when otherwise, there would be no way to access these records.
This project is already having a meaningful impact on the health of the community. Nineteen people have tested positive for malaria so far, and have started medication treatment at the Kukuo Health Clinic. Three people have been sent to Bimbilla for emergency treatment of severe high blood pressure. One woman went into labor while being screened, and was able to be referred to Bimbilla because the medical professionals assessing her, as a direct result of our screening, immediately knew about her high-risk pregnancy. She and her son are both healthy and doing well at present. Two children have been identified as being severely malnourished and have begun treatment with supplemental feedings.
So far, this project has had an impact beyond what I could have possibly imagined just a few months ago. In addition to this health screening and medical records database, we have also been asked by the Kukuo Health Committee and the local councilman to create a birth and death record, which is currently underway. We have also begun work on a complete census of the population of Kukuo, including age, date of birth, place of birth, occupation, tribal origin, and religious affiliation. These three things have long been a goal of the Nanumba district government and Kukuo is the first village in the Nanumba district to begin work on any of these goals. The local councilman is excited about these developments. If we are going to talk to every person in the village at length, we might as well record a census as we go along.
The Humanist Service Corps is partnering with Songtaba and the people of Kukuo to improve life in the village, while staying true to the guiding principle of HSC to work with, listen to, and teach any necessary skills to the local people, so that the knowledge base lies within the community, instead of with foreigners who will be gone in a short time. We are having a powerful impact with this medical records project. However, all of this costs money. Please consider supporting our work by signal boosting, liking our Facebook page, or even donating to this cause. We have a dedicated fundraiser for the Kukuo Health Screening Project at Razoo. You can also support the Humanist Service Corps generally. Any help would be greatly appreciated. Thank you.