September 9, 2010

Well, that is all for my time in Ghana. If you read along with the blog, I thank you for your time.  If you have any questions feel free to ask by posting on the site or sending me a message on Facebook.

August 14, 2010

It is 8:40 Eastern standard time and I am currently in Washington, Dulles airport on a lay-over to Toronto.  It has been a long trip home (25 hours so far), but smooth, with no notable problems.  I have about 5 hours left till I reach Toronto.  I will use some of this time to reflect on my time in Ghana. 

Some important questions I can think to reflect upon include:

Do I still want to be a doctor? If so, what kind?

After working in the hospitals in Ghana, I want to become a doctor more than ever.  Seeing sick people in the hospitals, but not being able to do anything because I was not trained, made me desire more than ever to receive training as a doctor so that I can know what to do to best aid the patient.

Interestingly, although I had no strong interest in becoming a surgeon before my experience in Ghana, after seeing some surgeries, I now think I would like to become a surgeon.  As a surgeon you get to work a lot with your hands and get to see the results of your work (for good or bad) very directly, which I think I would like.  Because I am still very interested in the brain, right now I am thinking I would like to be a neurosurgeon.  Of course this could easily change as I get more exposure to different specialties however. 

What was my general impression of the development state of Ghana?

Compared to Canada, Ghana was obviously much less developed.  Even in fairly large towns such as Cape Coast there were major deficiencies in infrastructure, such as lack of clean running water, few paved roads, and absent sanitation.  School systems and health care were also far behind Canada (though less actually than I had imagined).  There were also many human rights violations I that I heard about in Ghana, such as people awaiting trial being detained for up to 10 years in prison.   

That being said, with money, you could easily find modern amenities, such as electricity, running water, and television.  This made Ghana seem much more developed than you may imagine a typical “African” country would be.  Ghana was also very safe (even for white tourists), which I think is an important difference between Ghana and many other developing countries.   

What were my general impressions of the Ghanaian people and culture?

Foremost, I found Ghanaians to be extremely friendly and willing to help others in need.  For example, if lost, most Ghanaians would go out of their way to help you find what you were looking for.

I also found the Ghanaian people to be much more open and direct with strangers.  After asking how my day was going, it was not unordinary to be asked by strangers if I was married, or what my religious views were.

I also found that Ghanaians have a very strong sense of family.  From talking to Ghanaians, it was never the case that somebody did not plan to get married and start a family. 

Additionally, Ghanaians all seemed to have a very strong sense of community.  For example, any time a Ghanaian was eating in a group, he or she would ask others around to share their food using the characteristic expression of, “You are invited”, while nodding at their food.

Ghanaians are also extremely religious.  Whether Christian, or Muslim, everybody I met attended church, and listened and watched to religious media.   A bit surprisingly, Christians and Muslims all got along well together.  Both groups seemed to hold a respect for the other for having faith in religion, which deterred any conflict.

A big shock to me about Ghanaian culture was how prominent traditional African beliefs in witchcraft and healing were.  Because modern information and communication tools (phones, internet, TV, radio, etc.) are fairly common in Ghana, I expected that Ghanaians would be more aware of up to date scientific information, which would dispel belief in fictitious traditional views.  Overwhelmingly, however, this was not the case.  Even young, scientifically educated people, such as the nurses from the Ankful psychiatric hospital, believed strongly in the authenticity of witchcraft and traditional healing practises.

What are some things I appreciate more about Canada after my time in Ghana?

After seeing severe poverty in Ghana, the largest thing I appreciate about Canada is how well even the poorest people have it compared to a lot of people in Ghana.  In Canada if you do not have money or family members to help you, government funded programs will ensure that you at least have something to eat and somewhere to sleep at night.  In Ghana, if you do not have money or family to help you, you do not eat and you die.  A chilling thought, is that Ghana is in the middle tierof sub-Saharan African countries as far as poverty goes, so I can only imagine how bad poverty may be in the lower ranking countries.

What experiences (good and bad) stand out most in my memory?

I will start with the bad, or difficult, experiences that stand out in my mind.  At the hospitals, I saw patients that I had come to know become sicker and sometimes die, which was difficult to experience.  Most prominently, the death of the young boy Abraham from cardiac failure is a painful memory that sticks out.  Another difficult experience was seeing people chained up and starved at the Edumfa Prayer camp.

The good experiences from my time in Ghana stand out far more clearly than the difficult however.  Watching Philip Kofi, a young boy who was very sick with malaria, get better and be discharged was a very good memory that stands out.  Getting to know the kids at the afterschool program was another great memory. Getting to know the other volunteers and going on trips with them was another enjoyable experience.  From the night-life in Accra, to the picturesque wilderness of the Volta region my weekend excursions with the other volunteers were definitely a highlight of my time in Ghana.

Did I see any of the “big African” animals?

No, I did not unfortunately see any of the “big African” animals (lions, elephants, hippos, rhinos, giraffes, crocodiles, monkeys, hyenas, antelope, snakes etc.).  Monkeys, crocodiles, antelope, large snakes, and forest elephants were found around where I was staying in Ghana, however, I was not lucky (or unlucky, depending on the animal) enough to see them.  The other animals are mostly isolated to the savannahs of East Africa.  Savannah elephants can be seen in Northern Ghana; however, I did not travel there, so didn’t see them.  

August 12, 2010

I spent today saying good bye to people around town and trying to do all the things I had been meaning to do, but had put off, such as visiting Kakum national park.  I said good bye to Doctors Kudoh and Kwarteng at the District hospital, as well as other people I had gotten to know there.  When saying goodbye to Francis, the medical student I had became friends with, I mentioned that I was going to Kakum later and he said he would like to come. 

Kakum national park is a rainforest reserve that is a 30 minute tro-tro away.  Kakum is well known for its Canopy Walk, in which visitors walk along platforms suspended 60 m up in the canopy of trees in the rain forest (Figure 35). 

The canopy walk was my main reason for wanting to go to Kakum, so Francis and I did that.  The platforms were a bit sketchy (Figure 36), but they held up and Francis and I had a great time (Figure 37).

Figure 35. Kakum canopy walk.

Figure 36. Sketchy platform.

Figure 37. Francis and I after the canopy walk.

For my last day at the after-school program I played games with the kids and gave out the remaining items I had left.  The kids seemed to really enjoy it, and so did I.  I am really going to miss the kids of the after-school program.  I gave Kojo a gift for himself personally (an American Eagle polo), to show my appreciation for his hard work. Kojo led the kids in a big thank you prayer for my time at the school and the kids all said goodbye (Figure 38). 

Figure 38. BCL kids saying goodbye.

    

It turns out Paige and Sossah, the program coordinator and director for Abusua, respectively, had received some praise from kids, parents, and other adults of the Kwaprow community about my work with the after-school program.  Because of this they decided to direct some Abusua funds into the after-school program for text books and classroom rent payments.  Paige also asked me to write a pamphlet guide for future volunteers who will work at BCL, so that future volunteers can pick up where I left off.  It is very satisfying to know that my work at the after-school program was appreciated and the program will continue to develop after I am gone.

August 11, 2010

For my last week in Ghana, I continued at the regional hospital.  Dr. Yamba, who I had followed the previous day and found to be a very good teacher, was working in the male and female medical wards, as well as the out-patient department, so I followed him to those places. 

On ward rounds, Dr. Yamba would ask me questions about each patient and guide me towards the correct asnwers.  While observing a patient with general sepsis, he quizzed me on how general sepsis presents.  After some help, I got that general sepsis presents with fever (as the bodies metabolic rate increases to fight the infection), high pulse and breathing rates  (to maintain the high metabolic rate), possible jaundice (from an over-active liver leading to malfunction), and possible ulcers (as bacteria degrades skin).

In the OPD, Dr. Yamba took me through the steps for a typical examination, with the aid of his patients.  First, the patient’s information  (name, age, residence, occupation, etc.) is recorded.  The principle complaint of the patient is then asked, followed by the order of onset for any symptoms.  Next direct questions are asked to help with a diagnosis.  For direct questions, the examiner probes the patients with questions to zero in on a correct diagnosis and treatment plan.  Next the patients family, social, and sexual histories are enquired about to get further clues for a diagnosis.  Current and past medications of the patient are also discussed, and any allergies of the patient are noted, to help in a diagnosis and treatment plan.

Next a physical examination is performed.  Dr. Yamba says you should always look, feel, and listen (in that order) during an examination.  In technical terms, it is said the examiner should: 1) inspect, 2) palpate (feel with hand), 3) percuss (tap the patient’s body and listen to the sound), and 4) ascutate (listen to body sounds with a stethoscope). 

Dr. Yamba also discussed important questions to ask a patient complaining of pain, which Dr. Kudoh had also previously told me about.  Questions for the patient include: Where is the pain? What are the characteristics of the pain (burning, stabbing, dull ache, etc.)? How severe is the pain is (scale of 1 -10)? How long the pain has has been going on for? Are there activities that reduce or aggravate the pain? Does the pain radiate anywhere?

I very much enjoyed the clinical training and experience.

August 8, 2010

I spent this past weekend travelling around the Volta region with some other Abusua volunteers.  The Volta region is located between Lake Volta on the west and Togo on the east and  is known for its beautiful landscapes of mountain, jungle, and waterfalls.

We left Cape Coast at 4:45 A.M. Friday morning (my birthday) and arrived at about 2:30 P.M.  We stayed at the Waterfall lodge, which overlooks the famous Wli (or Agumatsa) falls.  We got settled in the hotel (and had a few drinks to celebrate my birthday) then rested for an early start the next day.

We started on Saturday by visiting some well known caves up a mountain range, outside the village of Likpe Todome.   To enter the caves, we had to scale some sharp cliff faces with only a small guide-wire (or no wire at all) for safety (Figure 29).   The caves were worth the climb up though as they were very interesting inside.  Some even contained bats, which we took a group picture in (Figure 30).

Figure 29. Climbing to the Likpe Todome caves.

Figure 30. Inside the “bat cave”.

We also saw some great views from the top of the mountain (Figure 31), including the neighbouring country of Togo. 

Figure 31. Mountain-top view wiith Oli.

 On the way down we stopped at a beautiful, secluded waterfall (Figure 32).  All in all, the trek took about 3.5 hours.

Figure 32. Likpe Todome waterfall.

In the afternoon. We visited the famous Wli falls, which was extremely easy to access compared to the caves.  The waterfall was absolutely stunning (Figure 33).  I was able to swim at the base of the falls, which was very exciting (Figure 34).

Figure 33. Me in front of Wli falls.

Figure 34. Swimming at the base of Wli falls. Guess which one is me?

On Sunday we travelled back Cape Coast, which took nearly the entire day.  Overall the trip was a lot of fun and full of memories I will never forget.

August 5, 2010

Today I started at the Central Regional hospital (Figure 28), where I will be finishing off my medical internship in Ghana. The regional hospital is larger, more modern, and contains patients with more difficult cases than the district hospital.

Figure 28. Central Regional Hospital.

I started in the Accidents and Emergency ward.  I knew the house director (doctor fresh out of medical school, but who still does the work of a normal doctor), Dr. Yamba, from a previous orientation day, so I followed him around.  He was extremely informative.  He used the patient cases to teach and test me on clinical knowledge. 

 

Dr. Yamba led me through the diagnosis of a pregnant woman with pneumonia, urinary tract infection (UTI), and hypoglycaemia.  We diagnosed the pneumonia by listening to her lungs with a stethoscope (the right lower lobe had diminished air volume).  UTI was diagnosed from complaints of painful urination combined with the fact that UTI often occurs in pregnant women.  Hypoglycemia was diagnosed based on complaints of faintness and the womans report that she had not eaten in a long time.

There were also some actual “emergency” cases, which were very interesting to observe.  One man had a perforated intestine (hole in the intestine) and was awaiting surgery.  Intestinal perforations can be very dangerous because intestinal contents begin to leak into the normally sterile peritoneal cavity causing bacterial infection of the peritoneal cavity.  Unfortunately, the emergency surgical theatre was not operational, so the man had to wait for the only other theatre to become free.  The man was still waiting by the time I left about 4 hours later.  In the mean time, doctors pumped the man’s stomach with a nasl-gastric (NG) tube to avoid further leakage of stomach contents into the peritoneal cavity through the perforated intestine.

I also saw a man with suspected early stage hypertension-induced subarachnoid brain hemorrhage.  Due to the hypertension, an aneurism (weakening of the blood vessel walls) had formed and blood was now leaking through the weakened vessel into the subarachnoid space around the brain.  Blood in the subarachoid space was increasing intercranial pressure, which caused a hematoma (blood pool outside the vessels) to form underneath the sclera (white part) of one of the man’s eyes.  The man was becoming confused and losing motor abilities as blood flow to certain areas of his brain diminished. The man's wife and son were with him and seemed very scared.

A 17 year old girl in labour was also admitted.  It turned out the girl had not attended any antenatal (during pregnancy) clinics to check her or the babies health.  It turned out the girl was HIV positive and had a bacterial infection of the amniotic fluid.  It was now too late for the mother to take prophylactics to stop the baby from acquiring HIV.  By now the baby had also likely contracted a bacterial infection from the contaminated amniotic fluid.  There was a good chance the baby would not survive long.  Doctor Yamba was furious that the girl had not attended an antenatal clinic and the baby’s life was now at risk.

August 3, 2010

At the hospital, I asked Dr. Kudoh what he thought of Prayer camps. He thinks they are a big problem. The main problem, he said, is that people who need medical attention often go to the prayer camp instead of the hospital, causing their situation to deteriorate.

After talking, Dr. Kudoh and I went to the mortuary to examine the body of a patient who died in the ambulance on the way to the hospital. While at the mortuary I recognized the body of a former patient on the male ward. The body was just left on the floor in the middle of a hallway. In poast weeks, the man had been semi-conscious and bed ridden, but had been slowly improving in recent days. I asked Dr. Kudoh what had happened and he explained the man had died after being used as a patient for the nurses’ practical examination. The nurses tried to feed the man, but he choked and died. Dr. Kudoh was pretty furious at the man’s unnecessary death.  To have the man die in such an unnecessary way was a bit upsetting to me as well. Under Dr. Kudoh’s supervision I had used the Glasgow coma scale on this man each day and had been seeing steady improvement. It was disheartening to have the man die from such a careless act after seeing his continual improvement.

On a lighter note, the after-school continues to go well.  I am enjoying teaching the kids and they are learning quickly.  I am also gleaning some interesting information about Ghanaian culture from the kids.  Today, one boy asked me if I use Vaseline to make my skin so light.  I was very surprised by this.  After some thought however, I remembered that I have seen advertisements for skin lightening ointments all over Ghana.  It seems lighter skin is socially beneficial, and Vaseline is believed to be a cheaper alternative to the proper skin-lightening ointments.  I told the children I did not use anything on my skin, but was born with light skin.  The kids seemed quite surprised by this.