REPORT ON A TWO WEEKS PRACTICAL ASSESSMENT AT THE PEKI – DZAKE HEALTH CENTER (SASNET-GHANA STROKE CENTER)
This report is a practical assessment by Deborah Nukpetsi, SASNET-GHANA rehabilitation Professional for Stroke Association Supportnetwork-Ghana (SASNET-GHANA) at Peki Dzake health Center/Stroke center in the South Dayi District V/R, under the supervision of Miss Juliet Anaglo, Senior Physician Assistant through the direction of Mr. Ad Adams Ebenezer, the Executive Director of Stroke Association Supportnetwork-Ghana (SASNET –GHANA.) The exercise began on the 18th of March 2020 and ended on the 31st of March 2020.
The idea behind this exercise, is to help assess the health conditions and understand the practical way of life of persons living with Non Communicable Diseases (NCDs) especially Persons living with strokes in terms of accessing health care at the community level and how this activities impacts on their health( improvements/ Quality of life) . From this practical assessments , it was deduced that, most of the health centers in and around the south dayi district records high rate of hypertension and diabetes on daily basis. And these two conditions are major factors causing stroke within the South dayi district and its surrounding communities. Therefore, interventions are much needed to curb these situation,such as scaling up education on causes of hypertension and diabetes which leads to stroke and/or premature death. Also, there must be measures by the government, thus the Ministry of Health, Non Communicable Disease Control Program of the Ghana Health Service (NCDCP-GHS) and Stroke Association Supportnetwork-Ghana (SASNET GHANA) to address the impact of stroke,thus on prevention, treatment and rehabilitation for that matter.
The practical assessment exercise commenced on the 18th of March 2020, through the direction of the Executive Director of Stroke Association Support Network (SASNET- GHANA) Mr Ad Adams Ebenezer with the support of the Volta regional Stroke Survivors Chairman Mr Samuel Sedodo , Mr Albert A. (organizer SASNET-VR) under the Supervision of the In-charge of the Center ,Miss Juliet Anaglo and Mentor Alexander Yeboah and other staff at the center .
DAY ONE (1)
There were cases at the Out Patient Department such as Malaria, Diabetes and persons with Stroke who were present at the center to have their Blood Pressure checked and to seek other forms of support at the center. A patient who visited the center was diagnosed with hyperglycemia and detained for treatment. IV ,normal saline was given during the initial treatment to neutralize the sugar level.
The acting Out Patient Department in charge assisted in handling the cases and in checking of vital signs such as Body Temperature, Blood Pressure, weight and as well as Fasting Blood Sugar and Random Blood Sugar test to ascertain the condition of the patients present.
Normal blood sugar level rages from (3- 5.8mmol/L), below normal sugar (Below 3 mmol/L (hypoglycemia), over (hyperglycemia)6 – 8mmol/L
In other emergency case, IV Fluid was administered to a diabetic patient who was brought to the center earlier that day although her condition was critical we were able to normalize her condition and she was later discharged.
DAY 2 – 5
Based on the first day observations which was coupled with large numbers of patients having elevated BPs, we continued with the screening of Blood Pressures, Body Mass Index (BMI) and body temperatures for patients who were at the center on that day, we mostly recorded high blood on the 2-5 day between 140-160 mmHg and 90-120 mmHg for patients between the ages of 21-55 and above.
DAY 6 & 7
Assessments continued with practical sections, we conducted various tests; that includes:
- HIV test; by using HIV test kit
- Malaria test; By using Malaria Test Kit
- Diabetes test; By using Glucometer
BODY MASS INDEX (BMI)
BMI = M/ (I)2
After collecting data from patients, we calculated
With Data of one patient as a rep. of a test case;
Weight = 74kg
Height = 1.63
- 74/ (1.63)2
- 74/ (1.63*1.63)
- 74/2.65 = 27.9
BODY MASS INDEX
Underweight = less than 18.4
Normal range = 18.5 – 24.4
Overweight =24.5 – 29.4
Obese = 29.5
From the above calculation, it means that, the person whose data was collected is overweight and needs advice on diet, exercise regularly to prevent hypertension and any other additional conditions.
On the 8th day, much assessments took place at the consulting room and together with the Physicians Assistant we diagnose patients and counseled those who have high blood pressure, stroke, diabetes and also the kind of medicine she prescribed to them.
Some of the medicines prescribedwereNifedipine, Amlodipine, atorvastatin, Losartan and Aspirin (for hypertension patient) and Metformin and Glibendclamine (Daonil) for Diabetic patient.
Education given to Diabetic patients to reduce sugar level in the blood most of which were due to diet includes;
- Choosing a healthy carbohydrate food such as, brown rice oats, fruit and vegetables, beans.
- Eating less sugar and salt
- Taking less red meat
- Using healthy oil in preparation of foods such as, olive oil, sunflower oil, avocados and many more
- Avoiding the use of alcohol
- Exercising regular according advice given at the center
Education given to hypertensive patient includes:
- Avoiding smoking
- Avoiding alcohol intake
- Exercising regularly
- Monitoring BP, thus regular check up base on schedules
- Eating balance food
- Reducing salt intake
- Reducing stress
At the Dispensary Unit, its was observed that, drugs given to the patients, the name of drug, quantity to be taken, number of times to take in a day, when and how to take it and also learnt the (FIVE Rs) which are very important to take note of and few abbreviations (Bd, Daily, Tds, ….) with regards to how patient needs to take their medications were explained to patient in the local languages, thus in Ewe and Twi.
THE FIVE Rs ARE;
- Right person
- Right medicine
- Right dosage
- Right route and
- Right time
ABBREVIATIONS interpreting how to administer drug by patients
- = 12 hourly – e.g. morning 6 am and evening 6pm
- Daily= 24 hourly e.g. Every 6am
- Tds or Tid= 8 hourly – Three times daily. E.g. 6am- 2pm-10pm
- Qid = 6 hourly- 4 times daily. E.g. 6am- 12pm – 6pm – 12am
- Stat= once
- Nocte= at night
- PRN= when necessary
- Suppository= to be inserted into anus
- Pessary = to be inserted into vagina
- Apply = to be apply on skin
- V = intravenous – into the vein
- M = intramuscular – into the muscle
Day 10 final day.
Our last assessments took place at the outpatient Department(OPD) and the maternity unit, there were interactions with midwife, on how they handle pregnant mothers who have High blood pressure, diabetes and or stroke.
Two forms of hypertension are recorded mostly at the center; hypertension in pregnancy is in 2 forms. 1. Chronic hypertension before pregnancy and 2. Hypertension developed during pregnancy which is called – PREGNANCY INDUCED HYPERTENSION (PIH). A pregnant woman developed high blood pressure due to the chemicals released by the placenta into the body and this result to a condition called eclampsia which can be mild, or severe. This condition has to be carefully monitored and if the condition become severe the baby need to be terminated, so as to save the mother’s life.
Another condition is diabetes which when developed during pregnancy can affect the baby in the womb (HYPERGLYCEMIA). Mostly those effected babies are big in body size and need to be fed often to maintain a balance glucose in the body, lack or less breastfeeding would cause the baby to developed hypoglycemia which could lead to death.
Majority of the patient handled have High Blood Pressure, calculating their BMI shows that majority are overweight. Which means they have check their food intake, reduce stress and monitor their BP and Sugar level
Since high blood pressure and diabetes are the major factors contributing to stroke and/or premature death, there must be measures by the government to address the impacts of stroke on individual or support Stroke Association Supportnetwork-Ghana (SASNET-GHANA) efforts and imitative that are geared to address these issues in the district, thus, by scaling ups actions on prevention on (hypertension, diabetes, stroke, etc), treatment and rehabilitation.
There must be an advocate in both health facilities and communities to educate people on issues with regards to causes of hypertension and diabetes since they are leading agents causing stroke and premature death. Compiled by Deborah Nukpetsi Rehabilitation Professional for SASNETGHANA