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.

August 2, 2010

Today I went to the Edumfa prayer camp, largely considered the most well known prayer camp in all of Ghana.  Edumfa was about 30 minutes away from Cape Coast.  On first view, the camp looked like a typical Ghanaian village. 

We met with the administrator, who told us all about the camp.  The administrator was extremely open about the practises that go on at the camp, seemingly because she believes what is done in the camp is right and she wants to spread the word. The camp holds about 6000 people.  People suffering from “psychiatric” illness or physical illness are admitted.  People of all religions are accepted.  Admitted people are called “inmates”.   Inmates can be admitted on their own or by family members.  Apparently, inmates pay a 5 Cedi “registration fee” and are not required to make any more payment.  Inmates can be admitted against their will, if others judge them to show psychotic symptoms.  People of any age can be admitted, even very young children.  Upon admittance the family members or the inmate must sign a consent form.

Common symptoms leading to admittance include: quiet behaviour, cold limbs, or a general change in demeanour.   No matter the symptoms for which a person is admitted, it is believed the symptoms stem from “demonic forces”.  If one is not Christian, they can be “worked against” by demonic forces.  It is believed demons may strike if a person is stressed, envious, or engaging in bad behaviour, such as alcohol or marijuana abuse.  As an example the administrator explained that if I was not a child of Christ and was envious of another person who was a child of Christ, whatever bad things I wished to happen to the child of Christ would instead happen to me because of demonic forces.

We were shown the housing areas for inmates and allowed to talk to the inmates. Inmates were housed in common areas with small foam mattresses to sleep on.  The housing was at least clean, which I was not expecting (though perhaps I should have because “cleanliness is next to Godliness”).   

All inmates, regardless of their camp-diagnosed illness, are treated with fasting and prayer.  The administrator says that fasting and prayer are the only effective treatment because modern medicinal drugs do not work. New inmates are made to fast (no food or water) for 3 days.  If inmates are uncooperative, they are chained inside to the floor or outside to a tree (Figure 26). 

Figure 26. Young man chained during fast at Edumfa prayer camp.

On the 4^th day, inmates are given tea made from the bark of a tree called Nyame-Dua (God’s tree).  I am not sure if the Nyame-Dua tree is a specific type of tree, or a tree that has been blessed in some way. The administrator claims God’s tree bark is a miracle drug that cures cancer, bareness (infertility), headaches, and any other illness.  The tea can be taken as a drink, or poured in the eyes or nose (to allow it to get to the head faster). Inmates are also given light food, and health tonics (yellow to treat fever, and red which creates more blood to improve strength).  

If the inmate does not improve after 10 days, fasting starts again.  An inmate is kept for a maximum of 21 days, after which, they are sent to Ankful Psychiatric hospital, where Dorota works (if they can pay).  At Ankful, anti-psychotic drugs are given (no matter the patient’s symptoms) along with a continued prayer regimen.  A person filters between the prayer camp and psychiatric hospital until they are deemed to be cured.

We were taken to a prayer service given for the inmates.  The service was given by the camp founder , “Aunt Gracie”.   Aunt Gracie told how she had started the camp 50 years ago after God instructed her to do so in a dream. She asked me if we would support their ministry when we got back home.  To be diplomatic and avoid an uncomfortable situation I replied we would try.  We were then brought to the front of the congregation to recieve blessings (Figure 27).

Figure 27. Being blessed at Edumfa prayer camp.

Overall, the experience was extremely disturbing.   The site of young children and adults chained to the floor and made to fast was probably the most immediately disturbing experience at the camp.  Also very disturbing was how strongly the workers, and even most inmates, believed what they were doing was right.

In my time so far in Ghana, and especially after visiting Edumfa, it has become very apparent that traditional views of witchcraft are still very prominent in Ghana (and likely most of Africa, as prayer camps are reportedly all over Africa).  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 witchcraft, as witchcraft goes against most scientific information.  Overwhelmingly, however, this is not the case.   

Even two nurses who work with Dorota at the psychiatric hospital and are in their final year of a BSc in psychology at UCC were very much in support of the prayer camp.  I was very surpised by this because the universities teach only legitimate science, and refute any belief in witchcraft and the practises of the prayer camps.  Consequently, the fact that both nurses were in support of the prayer camp, even after there scientific training, spoke very loudly for the deep root of traditional cultural practises in Ghana.

For anyone who is interested, Edumfa Prayer Camp has a website with much of this same information, which I highly recommend visiting:

http://edumfaprayercamp.com/index.html

August 1, 2010

I spent this past weekend in Accra, the capital city of Ghana.  I went with 2 other volunteers and we stayed at the house of the girlfriend of one of the volunteers.   Our formal reason for going was to give presentations on our volunteer experience at the Canada High Commission, along with other Canadian volunteers in Ghana.  Another large reason though was that we just wanted to see Accra. 

The presentations at the High Commission went well.  A common theme described by most volunteers was that work moves very slowly in Ghana, which I had experienced as well.   Even at the hospital it sometimes seems the nurses are slow to act on the doctors instructions,  sometimes at risk to the patient’s health, unfortunately.

From the presentations, I was able to gather some information about the major hospital in Ghana, Korle Bu, which one medical student was volunteering at.  Apparently, Korle Bu is nearly on the same level as some hospitals in the West.  Korle Bu has a CT and MRI machine, which are fairly modern diagnostic machines.  The hospital was not completely up to current gold standards however, as some of the diagnostic machines used were very outdated (i.e.: a radiology machine from 1965) and reportedly the CT and MRI machines are not functional more often than not.  TIA.

Accra is famous for its night life, which I saw much of on this weekend trip.  On Thursday night, I went with the other volunteers to a laid-back, local, live music dance bar.  On Friday, we went to a somewhat fancy live-music, dance bar.  On Saturday, we did a pub crawl around the area we were staying (Osu), ending at a popular local low-scale dance club, Container, which takes place outside on the streets.  It was also notable that we saw some amazing street dancers perform outside Container (Figure 23).  At these bars it became apparent that almost every Ghanaian (male or female) is an extremely good dancer.  It also became apparent that Ghanaians generally have a much easier time cutting-loose and having fun then we do in the West.

Figure 23. Street performers outside local bar.

Overall, Accra seemed very modern compared to Cape Coast.  There were small sky-scrapers, fast food restaurants, and even a large shopping mall.   I was even to able to find some products from home which I had been missing and could not otherwise find elsewhere in Ghana (Nutella and maple syrup).   My previous first impression of Accra as a hectic city, proved to be accurate.  Walking the streets of Accra I was constantly hassled by street vendors.  Additionally, Accra drivers have even less regard for pedestrian safety than drivers in Cape Coast.  That being said, I never felt threatened from malicious attacks. 

I also visited the Arts Center in Accra, a well-known market  in which local people sell traditional African items.  The common traditional  items sold included: tribal masks, Djembe drums (Figure 24), hand woven traditional Ghanaian fabric called Kente (Figure 25), and original canvas paintings.  I really enjoyed the experience.  If you do attend the Arts Center, however, be prepared to be swarmed by sellers pulling you into their stalls and trying to sell you their items.  Also be prepared to do some hard bargaining, as it is expected from the sellers and they start with fairly astronomical prices.

Figure 24. Djembe (traditional African drum) being carved at Accra Arts center.

Figure 25. Kente (tradional Ghanaian fabric) being woven at Accra Arts Center.  Note the Kente banner that says "Usher".

After a month in Cape Coast, it was like stepping out of Africa for a weekend and re-entering the modern world.  The trip to Accra was very refreshing, but I am glad to be living in Cape Coast rather than Accra, as I do not think Accra would offer a true “African” experience, which is a large part of my reasons for coming here. 

July 29, 2010

Today at the hospital, I returned to kids ward to visit some nurses I had previously befriended.  After being in the male and female wards for the past few weeks, I find the kids ward is the most emotionally challenging ward to be in.  There are always a lot of very sick children in the kids ward, which is difficult to see.  Also, I cannot help but imagine the kids of the after-school program becoming sick and ending up there, which makes the kids ward even more difficult to be in.

The children’s ward holds some unique rewards, however.  Unlike many adults, children show emotion easily and can easily be cheered up.  For example, after seeing me, the mother of one boy with third degree burns all over his body (due to hot soup) sang the Obruni song to get the child to stop crying. The Obruni song is sung to white strangers by Ghanaian children all over.  The song goes:

Bruni! How are you?

I’m fine, thank you!

The child immediately stopped crying and waved at me with a smile on his face, even though he was still covered in burns from head to toe.  It was nice to see the child so easily cheered up. 

At BCL, Kojo asked me if I could teach Science, in addition to English, to my classes.  We worked out a schedule in which I will teach Science two days out of the week and English the remaining three.

Back at the house in Cape Coast, Dorota, a clinical psychologist from Poland, told me about her placement at the Ankful Psychiatry hospital in Cape Coast. Ankful is a private psychiatric facility, in which admitted patients must pay or have family members pay for their stay. The hospital specializes in treating marijuana addictiction, which Dorota has been asked to take part in by giving psychiatric counselling to the patients. Dorota says marijuana use is treated like a mental illness in Ghana. Upon admittance the patient is immediately given anti-psychotics, such as chlorpromazine or diazepam, regardless of whether they are showing any psychotic systems or not. Patients are kept on these drugs indefinitely. There are no qualified psychiatrists associated with the facility; instead a person with only a BSc in psychology as well as student clinical psychiatrists direct the patient programs. Dorota says there are no treatment plans for any of the patients; instead patients are just given tasks to past the time. Dorota thinks the program is used more as a place to keep marijuana addicted people out of the way (because marijuana use is really looked down upon here), if the family members can afford to pay.

Dorota also told me about the infamous African “Prayer Camps”, which she has been hearing about at the Psychiatric hospital.  Prayer camps are very prominent in Ghana, with some at the hospital saying there are as many as 200 in the Central region of Ghana alone. In these camps, patients suffering from a range of illnesses, including both physical and psychological illnesses, are apparently held in prison-like conditions while prayed over.  Apparently the prayer camps are fairly welcoming to visitors, so we are going to try to visit a camp while we are here.

July 28, 2010

At the hospital, I was able to observe a surgery to fix a scrotal hernia. The surgery was very interesting. At one point the anaesthesiologist needed the patient to breathe through an oxygen mask, but the man was not co-operating because he did not trust what was being pumped through the mask. To get the patient to breathe the air, the anaesthesiologist told the man that “white man’s air” was being pumped through the mask. The man immediately began inhaling because, as the anaesthesiologist explained, Africans always want anything the “white man” has. Apparently this trick is used often with patients.

Things at BCL continue to go well.  My typical teaching routine has been to teach a lesson, assign some individual work based on the lesson, take up the work, then do dictation.  For dictation, I give small prizes (pens, pencils, beany babies, etc. that I brought from home) to the winners, which the kids really seem to enjoy.

July 27, 2010

Today at the hospital I observed a C-section for twin boys.  The surgery went smoothly, and both babies were healthy.

In the male ward, a patient was admitted with chronic liver failure.  Dr. Kudoh showed us the signs of this, which included jaundiced (yellow) eyes, and generalized edema.  Fluid build-up in the peritoneal cavity (ascites) was causing severe abdominal distension, so Dr. Kudoh relieved this by draining the peritoneal fluid through a canular inserted into the peritoneal cavity (a procedure called paracentesis).  About 2 L of fluid was removed!

July 26, 2010

Today I met with the Dean of the UCC medical school who told me about the Ghana medical school system.  To become a doctor,   Sstudents can enter medical school after secondary school (approximately age 18), or after a BSc is obtained.  If one enters directly from secondary school, an introductory year of basic sciences courses must be completed, after which 5 years of medical training is completed.  If a BSc has already been obtained, the year of basic science training is ommited and medical school only takes 5 years total.  Similar to Canada, students see patients in their 3^rd and 4^th years.  Unlike in Canada, students in the 5^th and 6^th years are trained fairly comprehensively in surgery.  Upon completion of school, students do a 2 year fellowship with an experienced doctor before they are fully qualified.  Once qualified, doctors must fulfill a government-enforced 2 year community-based practise program, during which doctors work in under-served areas.  The community-based practise program is supposed to allow doctors to give back to the community and learn cultural practises of different areas.  Doctors Kudoh and Kwarteng, who I have been shadowing, are in this stage (and not too happy with the program).  After 2 years of community-based practise is completed, doctors are free to practise at a hospital they choose.

As for cost of school, students pay about $4 000 CAN a year, which includes accommodations (very nice by Ghanaian standards).  During the community-based practise time, doctors are paid about $600 CAN a month (very low by international standards (think $7 200 CAN a year), but high for Ghana compared to other occupations (a secondary school teacher makes $75 CAN a month)).  Once a doctor is fully trained the wage is supposed to increase to about 3,000 Cedi/ month (still only $25 714 CAN per year), but in actual practise it seems the increase is less than this.

I was taken on a tour of the UCC med school facilities, and given a history on the school.  The UCC medical school just opened 3 years ago and is still being developed.  From what I saw, the UCC facilities and equipment were very modern.  The school has biochemistry, histology, anatomy, and clinical practise labs, as well as a mortuary, from which cadavers are obtained.  I was shown the cadavers used in the anatomy classes, which were held in formalin tanks.  It looked like the UCC students had been getting a lot of use out of the cadavers, as they were pretty hacked up.

At night, the volunteers and I went out to Oasis for dinner and drinks.  It was two of the volunteers last days, so we were wishing them farewell.  Sossah, the director and founder of the Abusua foundation came and I had a nice conversation with him.  He was born in Ghana, worked hard to put himself through university, then began the Abusua foundation when he was 24.  He is now 32, and has been running the Abusua program for 8 years.

Sossah told me some interesting things about the Ghana penal system.  In the penal system, it is fairly common for people to be held in prison while awaiting trial for 2 - 10 years.  Also, if someone (even foreigners) is caught with marijuana, it is an automatic 10 year imprisonment.  Sossah told a story of a mother and her teenage daughter from Europe who had been caught with a few grams of marijuana and  imprisoned.  They are currently serving out their sentence.  Nothing can be done by their embassy to get them out because they broke the  law of the country they were staying in.  The only thing their embassy can do is make their prison sentence more bearable by sending people to give the prisoners personal items (food, cleaning supplies, comfort items).  I will definately think twice before smoking up here.

Additionally, Sossah told me how dogs and cats are commonly eaten in Ghana.  I was a bit surprised by this at first, but after thinking about it, if you are starving, dogs and cats are just another source of food.      

July 25, 2010

This past Saturday, I and some other volunteers went to Ko-Sa beach for the day.  Ko-Sa is a beautiful beach about 30 minutes away from Cape Coast, which has rocky outcrops about 30 meters out in the water which blocks the rip-tide and makes it safe to swim (Figure 22).   We spent the day swimming and relaxing on the beach.   

Figure 22. Ko-sa beach.

After Ko-Sa, we went to Elmina Night club for some dancing.  From my experience so far, it seems that every Ghanaian (guy or girl, young or old) is a good dancer.  Ghanianas also seem to really be able to cut loose and have some fun, even if they are going through tough times.

On Sunday, I went downtown with Rob to get some fabric for a tailored shirt to be made (this can be done very cheaply in Ghana).  Later, I played a fun game of soccer with some of the Kwaprow village kids.