Final Thoughts

Wednesday: We started our day like normal and got to the resident office by 8am. One of the residents stepped out to check on his patient and told us he would be right back. We didn’t see him until 9, when he proceeded to tell us they were done rounding and he forgot to come and get us. We felt pretty bad that we waited for the resident to come back but instead missed all of rounds. On the bright side, there was only a few patients so it wasn’t much we missed as far as teaching principles go! The residents had a meeting to go over a presentation, and so our day ended early. We headed to the Cape Coast Castle to check out the art for sale nearby. I bought some wooden bowls and gifts for my family. I’ve said it before, but bargaining with the local shop owners is so much fun. Luckily, we convinced the owner to give us a good student discount! Next door to the castle is the Oasis Beach Resort, so we headed there next to get some beach time in. Uju and I were running into the waves and had a blast splashing around. I so badly wanted to swim out a bit, but the waves were a little aggressive and nobody else can swim, so I figured that could end poorly if I got swept out into the ocean. But I was certainly content sitting in the sand and water. After I headed home with my sunburn, we met with Caroline (the nurse) who gave us a presentation on common diseases and socioeconomic factors in Ghana. One thing that really got my attention was the topic of family planning. While birth control is available in Ghana, the culture puts men in charge. Women do not usually make decisions about birth control unless it has been discussed and approved by their husband. While this is not required by them, it is the standard cultural practice. As a woman, I could not imagine having to ask permission regarding my own health. Especially since women do all the work of pregnancy and child birth, it blows my mind that a man would still have the final decision. We also discussed socioeconomic factors in healthcare. I have mentioned before that medications and treatments need to be paid for in advance in Ghana or else that patient can not receive that treatment. Caroline discussed dialysis with us in particular. I learned that one session of dialysis is 190 cedis, and it’s typically required three times per week. For one month that is 2280 cedis. To put that in perspective, a resident makes about 1560 per month. And dialysis is not covered by insurance. So a hospital is asking a typical Ghanaian, who does not have a very high income, to pay MORE than a physician in training makes in a month. What?! And it’s not covered by insurance?! This means that patients who cannot afford dialysis are left to slowly decline until they pass away. I still can’t wrap my head around this. And the same goes for chemotherapy. To sum this up, patients die from life saving treatments because of financial reasons. And this is COMMON. I could rant about my frustration regarding this for hours! Anyhow, that was the conclusion of that night.

Thursday: We started our morning in the teaching center for the monthly mortality presentations with the residents. Each team makes a presentation about the number of patients that died that month, and continues to discuss each case. This is a way for all the residents to see how they can improve their diagnostic skills or treatments. It was really interesting and upsetting to hear each case. First of all, I saw that a handful of young (20-30’s) patients were dying of heart failure. How are these people ending up with these conditions at such a young age? I had a lot of questions. Also, I was getting very upset listening to the preventable causes of death, mostly due to resource related issues. As I stated in my Wednesday blog, many patients die due to a lack of finances and thus a lack of treatment. I heard about a man with kidney failure who died because he couldn’t afford dialysis- its awful. I also heard about a case of an 18-year-old boy dying from pneumonia. Not because it was severe and not because of complications… but because the ICU was FULL and there wasn’t an AVAILABLE ventilator. Again- my mind was blown! All I could think in my head was how horrible this situation was strictly due to a lack of resources and space. It’s completely unacceptable, however not necessarily uncommon in Ghana. There is certainly a lot of room for improvement in their healthcare system! After the meeting, we said goodbye to all the residents as it was our last day on the internal medicine service. That afternoon, we had plans to meet with the CFHI Program Coordinator for our trip, Dr. Charles Nwobu. He took us to a buffet for lunch and we discussed how our trip has been going and improvements that the program can make. It was an interesting discussion to say the least. The rest of the night was rainy (thank goodness) and so we spent our time outside, or sitting in the dark living room with flashlights while the power was out for an hour or so. I wouldn’t mind a power outage except that means the fans don’t work…. and no fans means more heat- ugh!

Final walk to the hospital
Classroom for the mortality lectures
Teaching Center
Last day!

Friday: That morning we went to the CHPS facility- the Community Health and Planning Services Facility in Ekons. We went with a nurse on some home visits which was really interesting. We saw a baby with malnourishment and discussed birth control with another woman. It was really nice to see these patients in their homes. It was also really eye opening as to some of the living conditions. In the last house, there was about 5 kids playing together. They were trying to nap on a cement floor with nothing but a thin blanket for all of them… yet they all continued to giggle as they covered up and snuggled together. I thought, these kids have close to nothing but you would never know it from their attitudes. They had dirty, worn out clothes… but they didn’t mind. It was really amazing to see how a family with so little could truly seem so content. It makes you really think about priorities in life. After those visits, we packed up and headed to Accra for the night. The bus ride was about 3.5 hours long and I was crammed in the backseat between a mountain of suitcases and Roland. Not the most comfy ride, but we made it. We went to dinner with Augusta’s father-in-law and I had some delicious beef jollof. We went back to our hotel and got ready to go out for the night. The bar scene in Accra starts at about 11pm and goes until 4-5am. It was also GG’s birthday (on Saturday) so we had to celebrate! We did a lot of dancing throughout the night and it was a blast. I’m glad we could have the whole family together! It made me realize how much I’ll miss our coordinators GG and Roland, and how much I love the nightlife in Accra- it’s another level of vibrant!

CHPS Facility
Nurse seeing a patient and checking for malaria
On the way to home visits with the nurse

Saturday: We had a very lazy morning. We had the whole family meet up for brunch (and by family, I mean Augusta, Amanda, Uju, GG, Roland, and myself) at Starbites. This is the restaurant with the amazing pancakes that we went to during our first weekend. The pancakes were just as delicious, and this time I got myself a latte. I miss coffee oh so much! After that we headed back to our hotel and hung out for a bit before heading to the airport. The rest of the day was rather boring- just lots of security checks at the airport and waiting, waiting, waiting. We left Accra at about 11:30 and headed to NY! Luckily, Amanda and I were on the same flight and sat next to each other. Amanda woke me up during the flight because there was an announcement calling for physicians or nurses on the flight. I was still half asleep, but Amanda told me that a young girl was having severe abdominal pains a few seats behind us. Conveniently, there was both a pediatrician and ER physician on board… what are the chances? The ER doctor had a portable, handheld ultrasound machine to evaluate her. It would have been neat to see what they were doing. When the flight landed, the girl seemed to be doing alright. And I was happy to have made it to NY!

L to R: Uju, Augusta, Amanda, Roland (RoRo), GG (Mama G), Me

Sunday: Getting through security again at the JFK Airport was not fun after a night of poor sleep. But I have finally made it to my gate and am waiting to board in an hour or so. Seems like a perfect time to wrap up my blog and reflect on my trip, right? I could probably write a lengthy blog on just my thoughts about my rotation in Ghana. But instead, I’ll just make some bullet points…

⁃ Ghana is a beautiful country filled with the most welcoming people and a culture that is so rich and vibrant

⁃ The healthcare system in Ghana is extremely frustrating and needs much, much improvement

⁃ Many people die or are left under treated because of financial reasons or lack of resources… and I find this completely unacceptable

⁃ Ghanaian food is delicious, particularly jollof, kenkey, stew, and kebabs

⁃ The nightlife in Cape Coast and Accra is unlike any other place I have been… dancing seems to be a second language to most

⁃ Air conditioning will never be taken for granted again

⁃ And neither will tap water for that matter

⁃ Actually… being in Ghana makes you appreciate most things we take for granted in the US. Air conditioning and tap water, appliances like washing machines and dish washers, paved roadways for our cars, big yards with grass (I definitely miss laying in the back yard with my puppy at home), malls/convenient stores/accessible grocery stores/etc, a shower with clean water, and a comfortable place to sleep. This is in consideration of Cape Coast where I was staying.

⁃ It also makes you thankful for our disease risks in the US. We don’t have to think twice about malaria or TB, and most don’t ever think about HIV… but these are all common in Ghana

⁃ Ghanaians are all so friendly… I was welcomed to the country more times than I can remember. And I was always welcomed to come back for a visit.

⁃ The view of healthcare in Ghana is much different than the US. Ghanaians only come to the hospital when they are very, very ill… whereas people in the US will go to the ER for a papercut (not really, but young get my point). It’s an interesting use of resources…

⁃ The Cape Coast Castle was an eye opening experience, and learning the history of slavery was upsetting yet fascinating. A very thought-provoking trip.

– Traffic and driving in Ghana is terrifying. I still don’t understand how people maneuver those streets…

– Bugs are much scarier in Ghana. Especially the millipedes and mosquitos.

⁃ Ghana is just beautiful for many reasons… thank you Ghana for my wonderful stay!

I think that about sums it up. Thanks for reading alongside my journey- I hope I could teach something both medical and non for those who have been reading. I am excited to be back in the US, but I’ll be looking forward to hopefully returning. Until then… the countdown to graduation begins!

Heading into Our Final Week

This blog will be rather short, as my laptop isn’t cooperating and I have to type this on my phone.

Saturday: We got up early on Saturday to head to Takoradi (Augusta’s mother-in-law offered to pick us up). We spent the day checking out some local beaches. We met up with Augusta’s family friend and had dinner at a chinese restaurant that night. They made the best calamari I’ve ever had! It was nice to again be in some AC and have a comfortable, relaxing day. We meant to venture out that night to some local bars, but we all decided it would be best to stay in and get some sleep.

One of the local beaches we went to visit in Takoradi

A hotel in Takoradi that we strolled through

Sunday: We had a very lovely, lazy morning. Augusta’s mother-in-law made us a wonderful breakfast and we watched Fear Factor until it was time to head back to Cape Coast. Once we made it home, we decided to go to Oasis (the beach resort) to play volleyball with some of Roland’s friends. They were all very good and looked rather annoyed that we wanted to play- they were taking the sport much more seriously than we were intending to. After we played a game of us girls vs the boys (which we lost 25-2), we decided to mix up the teams to evenly distribute our lack of skills among the guys. It was a lot of fun and the guys were very sweet trying to help us play. They were coaching us throughout and helped us understand our positions and how to serve the ball. And even with our frequent mistakes, everyone was very supportive. Augusta and I were on the same team, which WON! Sand volleyball was a great time and a wonderful end to the weekend!

Volleyball at Oasis

Monday: We started our last week here at the hospital! We spent the morning waiting for 2 hours for rounds to start (not entirely sure what we were waiting for). While waiting, we talked with the residents about salaries in the medical field. They said that in Ghana, a resident makes the equivalent of about $3600 USD per year, and a specialist makes about $41000 USD per year. Those are some jaw-dropping numbers compared to what doctors in the US make. Needless to say, they were also astonished to hear our future salaries. When we started rounds, we had a new attending that day. She specializes in internal medicine and is very intimidating. I’ve come to realize that all specialized attending physicians have a very strict, business-like attitude. They are intimidating, but usually in a good way. We luck out as visitors in the hospital, because the poor medical students in Cape Coast just get drilled with questions on a daily basis. But that day we only had about 3 patients, all of which brought out good learning points from the new attending. That afternoon, I adventured out to Elmina Castle with Uju and Amanda. If you read my previous post, this castle was almost identical to the Cape Coast Castle. The history was basically the same so I won’t repeat it. I did take a few photos however! We managed to still make it to the gym that evening which made my night!

The cell where rebellious captives were punished- they were left to die there

View from top of the castle
View from the top of the castle

Uju and I at Elmina Castle

Tuesday: That morning we decided to work a long day on the internal medicine service. We were excited because this meant we could wear scrubs! When we got to the hospital, we realized there were no formal rounds. We just sat in the resident office and waited for patients to come to the ER and need admitted to our service. Our only patient that came to the ER was a 32-year-old male with the complaint of diarrhea. He said he has had stomach pains for the past 4 months and diarrhea 8 times per day for the last 1 month. On exam, his liver was very enlarged and his stomach very tender. He was also jaundiced, meaning his eyes looked very yellow. This made us very suspicious for some kind of liver disease. I also brought up the concern for potential pancreatitis due to his alcohol use and diarrhea. We got to help the residents perform the exam and discuss which labs/imaging we needed to get. While in the ER, I also found a sign posted about which services are covered by insurance. I have been very annoyed with the health insurance in Ghana, as many services are still not covered even if a patient has insured. Most forms of imaging are still rather expensive as well. It’s difficult to watch a patient suffer because they cannot afford to pay the price of a medication or service before receiving it. Read the poster in the photo below! Anyhow, the rest of our day in the hospital was pretty uneventful and we headed home early. We spent our afternoon visiting the tailor yet again. He had finished everyone’s clothes (in record time) and we all tried them on. The girls who work with the tailor are SO much fun. They thoroughly enjoyed taking selfies with us and helping us try on our clothes. They said they will miss us visiting them! We ended our night with some kenkey and stew- delicious.

EKG from our patient with abdominal pain and diarrhea- this is a normal EKG
List of services covered by insurance
At the market yet again!
The girls from the tailor’s shop!
The tailor himself

I am off to finish my very last week of medical school here in Ghana- until next time!

Getting Educated about Medicine and Cape Coast

Wednesday: Half way through our first week on IM! Augusta and I were surprised to start rounds (kind of) on time today at about 8:30. We started in the ER and saw two different patients. One of them was a 39-year-old woman with end-stage kidney disease. She presented with recurrent vomiting for the past several months along with severe pruritis (itching). We gave her the likely diagnosis of uremia, which can cause vomiting, pruritis, lethargy, and confusion. It occurs when the kidneys cannot clear the urea out of the blood due to disease, and so it accumulates. We saw another patient who was a 24-year-old woman with end-stage kidney disease as well. She had the complaint of lethargy and palpitations. Over our time here in general, we have seen 3 patients under the age of 40 with end-stage renal disease requiring dialysis. I am interested in asking the attending more about the prevalence of kidney disease in young patients in Ghana, and what the common causes are. When we left the ER, we were also able to check up on our patient with neck pain from the day before. She looked so much better! She could lay back and say hello, and she also gave us a big smile when we walked over. We were so happy to see that she was improving! As we continued to round, we saw another patient with decompensated liver disease secondary to alcohol abuse, complicated by hepatic encephalopathy and anemia. In this condition, the liver is progressively damaged over time due to excessive alcohol intake until the function is no longer adequate. The liver can no longer filter the blood and help remove toxins. This causes a back-up of pressure in the vascular system resulting in ascites (fluid in the abdomen), portal hypertension (hypertension in the vasculature in the liver), hepatic encephalopathy (brain dysfunction caused by accumulation of ammonia in the blood), and several other symptoms. I personally am very interested in liver pathology, and so I found this patient to be a great discussion. We finished rounds and left around 11am. That afternoon I headed to the market with Uju and Augusta so they could get their hair done. The sky started to turn grey and a nice breeze rolled through- I was getting very hopeful that the 90 degree heat would get broken by a storm. Their hair took 2-3 hours and I just did some people-watching as work and school let out and people were passing by. The children get so excited when I wave to them- it’s adorable! We got home in time for dinner and some school work that night. It was a very easy-going day.

Sitting outside and getting hair done
More kebabs on the way home

Thursday: Rounding that morning started after the residents had their weekly meeting. While we waited for everyone to arrive, we were sitting in the resident office with the on-call doctor. A nurse came rushing in and asked us to come to a patient’s bedside as she was unresponsive. We hurried to the bed of an elderly woman lying there with no chest rise/fall and who was cold to the touch. We couldn’t feel a pulse and so the doctor started chest compressions. I was given the ventilating bag to assist with the CPR, but the doctor decided that this patient had been passed for some time, and that CPR would not help at this point. It was really frustrating that there were no monitors on this patient. Augusta and I were wondering, how long had this patient been dead before a nurse ever noticed it? In the US, most patients are hooked up to a monitor, and so if a heart stopped beating or a patient stopped breathing, the monitor would alarm someone right away. We learned that there are extremely limited numbers of monitors in the hospital. It is frustrating to realize that a lot of things are caused solely due to a lack of resources here. Once that situation was handled we saw an HIV patient that was presenting with HIV encephalopathy (brain dysfunction due to her illness) and chronic diarrhea. While her condition was very unfortunate she was saying some very amusing things. She continued to yell to all the residents and students to get their attention and sing- she loves to talk! We then headed to the adolescent diabetes clinic where we saw a few patients with the residents. In one office, there are 2 residents each seeing their own patient- so not much room for confidentiality. We mostly discussed refilling insulin, and I got to talk to the patients who spoke English which was nice. When we got home, Augusta and I decided to give the dogs a bath- I was SO excited (because they are covered in dust and lots and lots of fleas). The puppies didn’t quite enjoy their baths, but I’m glad I could take care of them even a little. It makes me so sad to see them covered in fleas, even though that’s normal here. After we cuddled the pups in a towel, I headed out to see the Cape Coast Castle with Uju, Augusta, and Amanda. This is a castle that was built by the English around 1662 during the peak of the transatlantic trade (which was between England, West Africa, and America). While goods from England were brought to the castle, Africans were held captive here until they were shipped to America for work. We went on a guided tour and learned all about the history of Cape Coast Castle. We saw the female and male slave dungeons- and they were awful. Imagine 200 people shoved into an underground stonewall room slightly bigger than a 2-car garage. They stayed there in shackles for 2 weeks to 3 months without leaving that room. There were only 2 small windows for ventilation and no form of bathroom. They had nothing to do but wait to be shipped out without any idea of where they were going. Our guide said that roughly 214 million Africans were held captive, 60 million made it onto the ships, and only 12 million survived to see America. Visiting this castle was so incredibly eye opening… I wish more people had the opportunity to see these castles firsthand. We left the castle and found some local art shops where I bought a drum (I’ve been looking for one of these) and some bracelets. Negotiating with the locals is always amusing!

There are tons of posters around the hospital- I particularly liked the dramatic nature of this one
Clinic office- 4 chairs for 2 patients and 2 doctors at a time
Clean little furballs
Cape Coast Castle
Ocean view of the castle
Plaque near the male slave dungeon
Taking advantage of the nice background for a photo
From the museum: map of the castles and forts in Ghana
From the museum: slave shackles
From the museum: diagram of the over-crowded slave ships that left the castle
From the museum: transatlantic trade
Entrance to the female slave dungeon which was 5 chambers that held 200 captives each, for a grand total of 1000 female captives
Inside of a slave dungeon (excuse the poor photo quality)
Some fishing boats near the exit of the castle- to the right is where the slaves were forced onto the boats and shipped out
Walkway from the main courtyard to the “Door of No Return” (name of the door where slaves were boarded onto ships)
View from a window in the governors room near the top of the castle
Climbing is what I do best!

Friday: We rounded again with the same team this morning (internal medicine is split into 2 teams to better cover the patients). We saw a patient with stage four congestive heart failure (the worst stage). To treat heart failure, a patient needs diuresis, or removal of fluid from the body. This is because when the heart becomes weak and begins to fail, it doesn’t pump blood very well. Fluid then moves from the vessels of the body into places like the lungs, legs, and abdomen. Think of it like vessels leaking everywhere since the heart is failing to pump. Regardless, diuresis is treated with what is known as a water pill, aka furosemide. However this patient was very restless due to her discomfort and kept pulling out her IV accidentally. She wasn’t getting the furosemide through the IV, and so her legs were incredibly swollen. Since the legs can only hold so much fluid, they begin to weep if they continue to swell. This patient’s legs were leaking fluid all over- I have posted a picture to see. I felt so bad because I am sure it is quite painful to have multiple open, leaking blisters. We also saw the woman with HIV encephalopathy again. Today she was calling our attending “soldier man” because “he leads the team”. She continued to yell soldier man even as we were out of the room- she had us all laughing. We saw another patient with asthma and had a lengthy discussion on the treatment of it. As doctors, we have to understand WHY were are implementing a specific treatment, not just know what the treatment is. And so we discussed not just how to treat an asthma attack, but why we use certain medications based on their onset of action, half-life (duration of action), systemic effects, etc. Lastly, we saw a patient with a STEMI (heart attack). I did not know this, but in Ghana there is no access to percutaneous intervention (when a cardiologist inserts a catheter into a patient’s coronary arteries to immediately open and treat the blocked vessel that is causing the heart attack). This means that they treat heart attacks only with medications regardless of the severity. I would love to get more information on the outcomes of heart attacks in Ghana with the limited resources they have. When we got home for the afternoon, we headed to the market to pick up some things for the house and pick up our clothes from the tailor. My shirts turned out great! That night GG, Roland, Augusta, Amanda, Uju and I went out to the local bars. It was a lot of fun having the whole “family” together. We ran into two of our attendings at the bar which was a little awkward, but a good time. I don’t think I have ever danced so much in a night- but I loved it! We stayed out until about 4am (which is normal there) and I was completely exhausted by then. It was an excellent start to the weekend!

Rounding with the team
Pitting edema with weeping blisters, caused by congestive heart failure
Hanging out with one of the puppies
At the tailor’s shop getting measured
From left to right: Uju, GG, Amanda, Augusta, me

New Cities and New Rotations

Saturday: We got up bright and early at 4am to get ready for our drive to Takoradi. Augusta’s family friend offered to drive us to the airport there so we could take a local flight to Accra. Public transportation here is not very safe so we wanted to avoid taking a bus to Accra. The flight was about 30 minutes and we were picked up at the airport by Fred (Augusta’a brother-in-law). He took us to a restaurant call Starbites for breakfast and it was delicious. We had the best pancakes I’ve ever had there, so it was definitely a good start to the day. Accra is a much nicer city (it’s the capital of Ghana), so there are a lot more restaurants and shops; it’s a nice change of pace from here in Cape Coast where things are more village-like. But after breakfast, we went to see the designer who is making a dress for Augusta. Fun fact, Augusta is getting married in June! She is getting a traditional African gown made for her wedding ceremony, so she was super excited to finally see it. We left the designer and then headed to a place called Osu (oh-sue) to check out some shops that Amanda was interested in. The shop we went to is a modern art/fashion boutique. The jewelry was nice but pretty expensive. Luckily, they had a tea/coffee stand inside, and I found a bunch of coffee grounds and beans for sale. They were all grown and roasted in Ghana, so I got 3 different bags to try (I am a coffee enthusiast, so I couldn’t pass up the opportunity). I am quite excited to try these when I get home… it has been 2 long weeks without coffee! We then headed to Independence Arch in Accra. This is a monument created as a symbol of Ghana’s independence- it is a big tourist attraction. One of the security workers there allowed us to walk the stairs to the top of the arch in order to get a picture with the star on top (refer to photos below) and see a nice view of the city. We then made our way back to the Airbnb to relax for a little before dinner. We went to Noble House, a Chinese restaurant that night. While I have been loving the food in Cape Coast, I was very happy to mix it up a bit. The restaurant was really fancy- it was fun getting dressed up to go out. We took a taxi from dinner to a place called Republic Bar. They had an outdoor DJ and I tried an interesting frozen drink with brown sugar, hibiscus, and mint. We watched a group of guys dance their hearts out which was very entertaining- they killed it! Our night ended with us going to another bar, Bloom Bar. This was a much nicer, up-scale bar. There was a long line to get inside and everyone was dressed up. The inside reminded me of a rooftop bar in a city- lots of couches, outdoor lighting, and fancy drinks. We tried our best to enjoy the music, but after being awake since 4am, we were definitely trying to hide yawns instead. Getting back to sleep in the AC that night was a blessing!

Boarding the plane for Accra
Gus and I at Starbites for breakfast
The best pancakes that Ghana has to offer
Waiting for the designer to fit Gus for her wedding gown
A local shop in Osu
Lots of fun accessories for sale at the shop in Osu
Independence Arch
The view from the top of Independence Arch (at the top near the star)
Posing for a photo on the top of Independence Arch
New drinks to try at Republic Bar
Republic Bar- they had tables placed all the way out to the street for guests
Roof-top views of Bloom Bar

Sunday: We got up that morning and headed to a place called Coco Lounge for breakfast. It was another up-scale restaurant in the city. The inside was adorable with feather lamps and a long bar with lots of decorations on the wall behind it. We all loved feeling a bit more at home in a restaurant like this. I tried the huevos rancheros and took a brownie home for later (which honestly didn’t make it more than 10 minutes in the car- delicious). The ride from Accra back to Cape Coast was a sleepy one for everyone (Augusta had another family friend offer to drive us). We got back to our little house in Cape Coast around 2pm and then decided to head to a beach for the afternoon. We took a taxi to Elmina Beach Resort (near the Elmina Castle). Amanda and Augusta stayed on the resort patio and I decided to venture down toward the rocks and the water. There wasn’t a sandy beach to walk onto, so I had to walk a little and get creative about how to get close to the ocean. I found a stretch of flat rocks and had a fantastic time just sitting there and admiring the water. It was so peaceful to just sit, listen to the waves, and watch all the crabs run around. After that, the night was quiet.

Coco Lounge- the most adorable restaurant in Accra
Huevos Rancheros (I sure love taking photos of the food I eat…)
Post-breakfast brownies
Elmina Beach Resort- not pictured are the countless crabs running around

Monday: Monday was our first day on the internal medicine ward. Starting new rotations is always stressful because there are usually little instructions. I end up waiting around and looking clueless while I try and find a physician/resident/student to help me find where I need to go. So that morning Augusta and I waited for quite a while (1.5 hours) until we were asked to join the other medical students for some teaching. One of the attendings was demonstrating how to do a very thorough, detailed respiratory exam. The patient we saw was dealing with bilateral pleural effusions (fluid in the lungs) and congestive heart failure. We had a great discussion about how to examine, work up, and diagnose heart failure. The attending actually asked Augusta and I questions directly, thank goodness. It was nice to be able to contribute (until she asked us what the size of a normal kidney is when we moved our discussion to kidney disease). We got done very early that day (around 11am) and headed home. We hung out at the house until our other friend arrived at the Cape Coast house. Our fellow classmate, Uju, arrived in Accra the night before. She is spending 3.5 weeks here in the ER and OR. She is a future ER physician who will be headed to Florida for residency. We were so excited when she finally got in! Roland needed to take her to exchange money and go to the market, so Augusta and I tagged along. We got more FanMilk (the ice cream in a pouch- I got banana flavored that I have yet to try) and some boughfrot (a fried donut-like pastry that is more dense and not as sweet). When we got back home, we headed right back out to the gym with GG (Amanda decided to stay home so Uju went in her place). We luckily escaped getting roped into another exercise class… we do our best to avoid the personal trainer when we are there. I love getting to do some weightlifting, but without much AC I leave the gym looking like I’ve gone swimming from all the sweat. On our way home we bought kelewele (pronounced like killy-willy; plantain that is seasoned with ginger, onion, and garlic spices and then fried) and lots of fruit. GG made us kenkey (fermented corn dough that it wrapped in banana leaves and boiled) and fried eggs for dinner- which was delicious to my surprise.

Boughfrot for sale at the market
Augusta, Uju, and I at the gym
Buying oranges at the market on the way home from the gym
Kenkey, fried eggs, fresh veggies, and shito

Tuesday: Getting started on the IM ward today was less stressful than yesterday. Usually everyone here runs on “Ghana-time” and things seem to start at least 30 minutes late. But today, the attending was waiting in the resident office at 8am. Each time a resident walked in, he would ask, “what time do rounds start?” and the resident would answer “they start at 8.” He would then continue to ask the current time (which was at least after 8:15) and yell at the residents for not stopping whatever they were working on to attend rounds at 8am sharp. He said he doesn’t like to round late because “he gets tired near the end”, and I found that to be a rather amusing reason to be on time. Things seem much more relaxed here between students/residents and attendings- back home attendings have very little patience and there are really no excuses that they will buy when you are late. Anyway, rounds were relatively quick. We saw a patient with hepatocellular carcinoma, aka HCC (liver cancer), due to chronic hepatitis B. It is interesting to understand the different causes of HCC between Ghana and the US. In Ghana, it is hepatitis B. In the US it is usually alcohol or hepatitis C. It made me curious about the rates of vaccination against hepatitis B here in Ghana. Unfortunately, this patient was looking at a liver transplant as his treatment option as long as his cancer had not yet metastasized. I would like to know more about transplants here in Ghana. Our rounds then took us to the ER where we saw a patient with DKA, or diabetic ketoacidosis. This is a condition where the body is not producing insulin to break down glucose, and so it resorts to breaking down fats for energy instead. This causes your body to produce ketones as a by-product of fat metabolism. However, excessive ketones can cause the pH of your body to become acidic- which is not a good situation to be in. Excessive dehydration is also seen, along with very low levels of potassium due to the shifting of electrolytes in the body. It is treated with IV fluids, insulin, potassium, and bicarbonate to help neutralize the acidosis. After we saw that patient, the attending took all the medical students into the office and we reviewed cardiophysiology for about 2 hours. This took me waaay back to the first year of medical school. We reviewed anatomy, direction of blood flow, electrophysiology, heart sounds, murmurs, and EKGs. We were fully participating in the review which was pretty fun; I was quite proud of myself for getting a few of the answers right (especially since I haven’t discussed cardiophysiology for well over a year). That afternoon, Augusta and I planned to work the evening duty hours from 1-6pm. We were told to hang around the ER and see patients that were to be admitted to the internal medicine ward from the ER. Uju was working in the ER as well, so the 3 of us all worked together. A 64 year-old woman came in with some difficulty breathing and the complaint of a sore neck/throat. She was sitting in the tripod position (leaning forward), had significant stridor (the sound of an upper airway obstruction), and looked very dehydrated. Augusta took the history, Uju helped take blood samples, and I checked the vitals. Her blood pressure was found to be 50/38 (normal is 120/80, and hypotensive is considered anything below 90/60). We got her some fluids and we had to manually squeeze the bags of fluid into her IV. She needed to get an x-ray of her chest and neck, but unfortunately she did not have insurance. So for her situation, she needed to pay for the x-ray before she could obtain it… I found this to be beyond frustrating, as this was potentially an emergent situation. We were concerned about a possible retropharyngeal abscess, epiglottitis, or peritonsillar abscess and a compromised airway. Luckily the patient was brought in by her daughter who was able to afford the imaging. We looked at the x-rays with the ER physician and the ENT specialist, and they both agreed that they looked fine. The final diagnosis was peritonsillitis complicated by anterior cervical cellulitis. Overall it was a really interesting afternoon. The ER staff are all extremely welcoming and they seem to be very open to letting students do procedures and help out. I am hoping to get some sutures and IVs in before I leave! That night, I went to the Oasis Beach Resort with Uju and Augusta which was great because Uju was willing to venture into the water with me (everyone else doesn’t like to swim so I usually go alone). It has certainly been a long, but very eventful day!

First time rounding with the internal medicine team (the attending is the one without a white coat)
The internal medicine service is split into a separate male and female ward
Waiting for patients in the ER- this is a typical set up for a patient’s bed
Actual x-ray of our patient with the neck pain- the physicians all cleared this image as normal
Buying chicken kebabs from a street vendor on the way home from Oasis
Peanut butter soup with a rice ball and chicken

Half-Way Point

Tuesday: In the pediatric ward on Tuesday, we learned a bit more about the healthcare system in Cape Coast. We spoke with Newton (one of our favorite residents) about insurance, medication coverage, and emergency treatment. He explained that in Ghana, the National Health Insurance Scheme (NHIS) was implemented in order to help more people have access to health insurance. It costs about 20 cedis per year (roughly 4 USD) and would cover just about all medical treatments. However, the problem is that some people in rural areas do not fully understand or believe the NHIS. He said that they do a lot of outreach to the community, and to those in rural areas in particular, to help spread awareness. For patients who do not take part in the NHIS, they have to pay for their medical treatment on their own. An example is the little girl with dehydration who needed to buy her own fluids for her IV fluid replenishment. We asked about emergency treatments when people clearly cannot purchase something in advance, and he stated that in those circumstances, the hospital will administer the treatment and then send the patient the bill afterwards. So overall it was a very helpful conversation to better understand how the hospital runs regarding insurance. When we were rounding, we also saw some great improvements in the little girl with dehydration- she was sitting up in bed and looked much stronger. That evening, we went back to the market again so that Amanda could meet the tailor and get fitted for her dresses. While Augusta and I were waiting for her to get measured, we decided it would be fun to get some clothes made too (it is very cheap to get clothes tailored here, and it makes for a great souvenir). And so we went back to the fabric shop in hopes of finding some fabric, but the shop was unfortunately closed. We headed back home with the plan to go to the market yet again the next day! When we got home, GG said she had to leave again for her mother’s house to get something. Augusta, Amanda, and I hung around at our house until GG returned in a taxi… WITH TWO PUPPIES! She said her mother has a few dogs and one had 4 puppies about 2 months ago. I about cried when she handed me the 2 dogs- they were ADORABLE! Naturally I sat outside for quite a bit that night and tried to play with them. They were very shy and mostly hid behind an aloe plant outside- instead of trying to play with them I just admired their cuteness and fought off the huge millipedes crawling by. Regardless, I was ecstatic to have puppies at the house!

Augusta and I waiting for Amanda to get fitted by the tailor
I like to call him Simba- he’s definitely the bold and spunky one
I like to call her Nala- she is much more shy and hesitant
Feeding the puppies is one of my favorite things to do!

Wednesday: That morning was exciting because we decided to change up our schedule and visit the ER for the day. At the Cape Coast Teaching Hospital, they call it the A&E, for Accidents and Emergencies. We started the morning by listening to a very long and detailed lecture about elbow dislocations and fractures. We identified anatomy on an x-ray, discussed complications, demonstrated treatment techniques, and reviewed management of different kinds of fractures and dislocations. We then attended a lecture on ATS, or advanced trauma support. The ER physician reviewed how to do a primary and secondary survey for a trauma patient. A primary survey is an exam that basically looks for anything that can cause a patient to die right then and there. You check the ABC’s in a primary survey: airway, breathing, and circulation. Once you know that all the ABC’s are stable, you can evaluate the patient in a more detailed, thorough way. She also demonstrated how to place a cervical collar and a pelvic binder (something that stabilizes the pelvis if you are concerned about pelvic trauma/bleeding). We also discussed some emergency conditions such as tension pneumothorax (type of lung collapse), open pneumothorax (another type of lung collapse), massive hemothorax (blood in the lung), and cardiac tamponade (excessive pressure on the heart from blood in the chest). It was a great review as a fourth year student! Unfortunately the lectures took most of our time, so we did not get to see any patients. We are planning to return next week to do some clinical work before our rotation is over. I am pretty excited to see what comes into the ER and how it is managed. That evening, we went back to the market so Augusta and I could buy some fabric. I decided on two tank tops and a dress (I couldn’t make up my mind, so I picked all 3). We headed to the tailor to give him the fabric and get measured. Both GG and I were pretty tired of going to the market at that point (this was the 3rd consecutive day in a very busy market), so we headed back home after that. Of course, I played with the puppies until it was time to get ready for bed. It has been difficult to play with them after dark, because the mosquitoes are relentless even with bug spray. My legs look like I have chickenpox from all the bites!

Morning lecture
Central nurses station in the ER
Print for my dress
Print for shirt #1
Print for shirt #2
Trying to teach her how to play
He likes to nap by my feet while I work on my laptop outside

Thursday: That morning we woke up to a lovely breakfast made by Roland. We have been teasing him all week about how he should cook for us, and we finally got our wish. He made omelets and toast for us- it was very sweet of him! After walking in the brutal heat to the hospital, we were back in the pediatric ward that day. We had more discussions about the different cases of mortality in the ward from February (they go over each case that involved the death of a patient). We then started to round with a new attending (who was very slow and talked quite a bit for each patient, making rounds last forever). We did see an interesting case however. It was a 5-month old patient that was admitted for a cough, was found to not be breathing well, and got diagnosed with a likely bronchopneumonia. On Thursday we found out he had a chest tube placed. A chest tube is placed through the skin and between the ribs until it reaches the pleural space. The pleural space is the area between the inside lining of the ribs and the lungs themselves. Think of it like the lungs being kept in a plastic bag- we call that the pleura. So all in all, a chest tube does not actually penetrate the lung tissue. They are used to remove fluid around the lungs. For the case of this kiddo with breathing trouble, he was diagnosed with bronchopneumonia that was complicated by empyema. Empyema is when there is pus in that pleural space, caused by infection. When we saw the patient, the chest tube had drained about 500mL of pus from around his lung- it was pretty impressive to see. Our last day of pediatrics is Friday however, so I am not sure that we will see how this kiddo improves before we leave. I wanted to take a photo of the x-ray (it was a great image of his pneumonia), but the lightbox wasn’t working. That afternoon, we all worked on various schoolwork and I also hung out with the dogs. They have been playing much more so I love sitting outside with them. That evening, we went to a gym! For anyone who doesn’t know, I love weightlifting. I was absolutely thrilled to be able to get in some exercise. I wasn’t expecting much, but it was worse than I had imagined. They gym had 3 (partially broken) machines, random dumbbells scattered around the floor, and one bench. It had a few treadmills and a boxing ring too. After we registered with the manager, we thought we were going to get a tour of the facility. Little did we know we were about to embark on a personal training session. After no exercise for two weeks, ab and leg work is definitely tiring- but we did it!

Rounding with our new attending (yellow dress)
We made it through the training session!
Post workout group selfie
Boxing ring at the gym
Stopped for roasted corn from a street vendor on the way home from the gym

Friday: Last day of pediatrics! I am a little bummed because I love kiddos, but I am looking forward to starting internal medicine next week. Augusta and I checked up on the baby with bronchopneumonia and empyema. I got him to smile, so we were glad he was feeling better. We ended our day with a lecture led by our favorite attending. We discussed causes of bloody and non-bloody diarrhea (sounds fun, right?) We thanked him for being such a good teacher and he told us to “make sure we go out”… advice that we will certainly take! I did some laundry when we got home and the puppies sat by the bucket and watched me wash clothes- these dogs are getting cuter by the day. We then had a nurse from the CFHI team come by the house to give us a lecture about the health system and insurance in Ghana which was very informative. After that, Augusta, Amanda, GG and I headed to Oasis (a beach restaurant). We had a drink and enjoyed the DJ while we sat by the ocean. It was quite a relaxing night to end the week. I would watch the waves all night if I could! Until next time!

Waiting for morning meeting in the resident lounge (with AC)
Medical record books kept by patients- it includes all kinds of information about the pregnancy and growth information about the child
Visiting our patient with bronchopneumonia- moments like this make me appreciate the opportunity to take care of kiddos as a future family doctor
Hanging out with the puppies while I wash clothes
Relaxing at Oasis

First Weekend in Ghana

Thursday afternoon: The rest of the day was pretty quite. I sat outside in the breeze and enjoyed my book for a bit. That evening, Roland (our local coordinator) invited Augusta, Amanda, and I to an outdoor bar called Hutchland. Even though we had to go to the hospital the next morning, we figured why not? The bar was basically empty but we still enjoyed some drinks anyways. It was fun to get to know each other a bit more.

Harry Potter while everyone else naps
Kiss is a cherry or strawberry cider. It’s always fun to ask the bartender for “a Kiss” haha

Friday: We started our day with our routine morning meeting at the hospital. This one was more lecture based, and the resident reviewed pediatric cancers/tumors. We discussed leukemia and lymphoma, bone cancer (osteosarcoma, Ewing sarcoma), eye cancer (retinoblastoma), and soft tissue cancers (rhabdomyosarcoma). It was a good review! Rounding that day was pretty interesting because we got to see a bit more about how the hospital functions. A little girl (I believe a bit older than 10) was admitted for dehydration due to vomiting and diarrhea. But this was severe dehydration- she was lethargic, her eyes were sunken in, and she was incredibly weak (almost unable to stand on her own to be weighed). The attending physician was worried because if she didn’t get enough fluid that day, there was a chance she could die overnight. According to the IV fluid calculations she needed based on her weight, she had only received a fraction of that since she was admitted. However, she was unable to get the fluids she needed. From what I understand, the hospital does not administer medications/treatments unless they are paid for in advance (I am unsure how this works for the ER, but I hope to find out soon). For example, if a patient needs antibiotics, the doctor will provide a prescription for the medication and have the parent go and buy it from the pharmacy, bring it back to the hospital, and then have the nurses/physicians use it. So for this little girl with dehydration, her grandmother couldn’t access/afford the fluids which is why her dehydration was so severe. The attending was outraged with this, as this girl could die, and he demanded that fluids be started regardless- thank goodness. But comparing this to the US, treatments are of course administered and then the bill comes after. While this leaves patients with unexpectedly high medical bills, they at least receive the correct treatments. It is really an interesting concept, and I hope to chat with some medical staff about it to learn more before I leave. When we got back home, Augusta’s brother-in-law, Fred, picked us up to go to his mother’s house in Takoradi. Her house was beautiful! It was so nice to be welcomed there! She made us dinner (chicken, jollof, and plantain) and then Fred took us for a walk around the city. Takoradi is much nicer than Cape Coast, and a bit cleaner too.

Mary’s house
The view from her porch (excuse my unsteady panoramic skills)

Saturday: We woke up that morning to Augusta’s mother-in-law making porridge for breakfast. We slowly got ourselves ready to visit her aunts and grandmother in another city, Axim. Augusta, Fred, Mary (mother-in-law), Betty (family friend), and I made our way to Axim that afternoon. Her grandmother’s house was also absolutely beautiful. She lived up on a hill, and so the patio area she had overlooked all of the trees and greenery. I tried to take a picture, but that didn’t do the view any justice. Again, her family was very welcoming and made us a huge lunch. I tried fried yams and fresh pepper which was delicious. We left after eating and headed to a nearby beach, Axim beach. This was by far one of the prettiest beaches I have seen. It was clean (unlike Da Breeze in Cape Coast which has a bit of littering), and there were so many palm trees and the water was amazing. Betty wouldn’t let me walk too far out into the water because she was scared I would get swept away haha. I was pretty sad to have to leave, but we had to head back to Takoradi before dark. Once we got home, we went to visit more family friends of Augusta, John and Gladys and their son Alfred. They conveniently live down the street from Mary. We sat and chatted with them at their house for a bit. When we were getting ready to leave, Alfred invited us to a local bar called Champs. So Augusta, Fred, and I decided to venture out again. The bar was just like home- crowded with loud music. However, we were excited to see that the loud music was from their karaoke night! We cheered on Augusta as she sang the last song for the night, and of course did a wonderful job haha. It was nice getting back and going to bed after such an eventful day.

Axim (it’s a fishing community)
Augusta’s family
Augusta’s grandmothers house- view from the patio
Axim Beach
Axim Beach
Axim Beach
Axim Beach

Sunday: We had plans to head back to Cape Coast that morning. Mary made us peanut butter soup and rice balls for breakfast, and then continued to pack container after container of food for us to take back with us. She is the sweetest woman! Fred drove us back and we returned to Cape Coast around 4pm. I sat outside and did my laundry in the front yard which took quite a bit of time. The rest of the night was very quiet, until it started to rain. I absolutely love when it rains here because it drops to about 80-82 degrees and there is a lovely cool breeze that rolls through. It made it much easier to sleep once it cooled down.

Monday, today: And here we are at the start of my second week! I have not been feeling very well the last couple days, so I was moving at the speed of a sloth this morning (I knew that getting some kind of GI upset while here was inevitable). But we went to the hospital and found out there was no morning meeting. We started rounding, but the attending doesn’t do a lot of teaching so it was mostly us trying to listen to patient management (which is difficult when there is a line of residents/students). I had a hard time paying attention since I wasn’t feeling well. We left rounds early to head over to University of Cape Coast. Augusta’s dad is a nephrologist in Dayton, but he went to medical school in Ghana and trained here. His medical school classmate is the current dean of the medical school in Cape Coast, and so we went to visit her. She was so friendly and even made calls to the Cape Coast Teaching Hospital so that we could spend a day in the ER at some point during our rotation. It has been so incredibly nice to have all of these connections through Augusta- it sure helps us get around! After we got home, we headed to the market with GG. We had a list of items to find; Amanda wanted to buy fabric for some custom dresses she wanted made, we needed food for breakfast and dinner, and Augusta needed more soap. The market was just as busy and chaotic as last week. I really love seeing everyone and all the items they have for sale. Enjoy the pictures of what we found!

University of Cape Coast campus
Visiting with the Dean of the medical school, Dr. Ivy Ekem
All kinds of fabric for sale
We brought home bananas, mangos, and a watermelon
FanIce, vanilla ice cream in a pouch… it’s delicious!
A pear-flavored drink
At the market
Snails for sale at the market
At the market
Hungry anyone?
At the market

Nearing the End of Week 1

Happy Thursday!

Tuesday evening: Our first day in the pediatric ward was certainly interesting. That evening, Augusta, Amanda, Georgina (our local coordinator that was call GG), and I went to the market to look for some food for dinner and some items Amanda needed to pick up. It was really cool to see. Personally, I love all kinds of markets. I especially love markets in other countries because I love seeing all the different things that people sell. We didn’t do much shopping since we had specific things to find, but Augusta and I have plans to go back on a weekend and spend more time looking around. They sell lots of fresh food, clothes, soaps and toiletries, TVs and electronics, and so many other random items. Since it’s a fishing town, there was a lot of dried seafood for sale which quite frankly looked gross (seafood is not my favorite to start), but it was still interesting to see. Augusta later got her hair done at this little salon, and so Amanda, GG, and I sat outside and talked with the hairdresser’s children. There was a group of little girls singing and dancing, it was adorable. Oh, and we got fresh coconuts too! I’ve been making a point to try everything, but I don’t think I will be drinking any more coconut water after that haha.

All of the commotion at the market
Fresh vegetables at the market
More food at the market
The market
Some seafood for sale at the market
Fresh coconut!

Wednesday: This was our second day at the hospital. We were so proud of ourselves because we walked to the hospital (about a 20 minute walk) since it was “only” 82 degrees and not miserable. We had a different attending physician to lead rounds that day, she was much nicer than the previous day. Most of the children were the same from the day before- a lot of jaundice, TB, and pediatric pneumonia. Overall, the cases were not too exciting. However, the boy I mentioned from my first day in the ward, the one with nephritic syndrome (the kidney problem), was still there. We found out that he will likely need dialysis for life due to his underlying kidney damage. It breaks my heart when I see him because he just looks so sad. You can tell that he is miserable in the hospital and just wants to play outside. I am really wishing I could bring him something to play with or do in the hospital! After work, we went to a beach resort area called Da Breeze. It was SO incredibly nice to be by the wind and water. The ocean water was relatively warm too which surprised me (not sure why since it is so hot here). But the beach was covered in a lot of trash which was a total bummer. We also invited two other students that we met in the hospital (Sarah from Scotland and Taylor from London) to join us. So we spent the evening walking around the beach and drinking Sangria from a box- it was very, very enjoyable. And to top it off, we had fried plantains with bean stew for dinner which was delicious! I am determined to come home with some of GG’s cooking skills.

Getting ready for the morning meeting
While the hospital does have an electric medical record system, they keep paper charts for vitals on the patients
Da Breeze
You can’t go to a beach without an artsy ocean photo
Happy as can be!
Enjoying the cool breeze and water for the afternoon (and the sunburn I noticed that night too… oops)
Our (surprisingly delicious) sangria

Today, Thursday: And here we are, almost at the end of the first week. The day at the hospital was very interesting. We started the morning with a discussion of pediatric mortality cases during the month of February at the Cape Coast Teaching Hospital- they had 20 reported infant deaths in just that one month. It is truly a shocking number when we think of infant mortality in the US. Yet, that number is not so surprising for this hospital. The residents went over most of the cases, and I found it really curious that for most cases, there was not a definite cause for death. The attending physician (the intimidating one from the first day) continued to point out how the medical care was not necessarily adequate. Especially regarding sepsis (an infection that affects the whole body), they would discuss how to treat it with antibiotics, but nobody seemed confident about where the infection came from. And so I am curious about the level of preventative medicine that is done at this hospital, and what precautions they use to prevent infections that can lead to sepsis. Once we started rounding we saw more TB, malnutrition, jaundice, and an interesting case of a liver cyst. This kiddo was a 6-week old male with a liver cyst that took up the space of almost half of his abdomen. Augusta and I were curious if it was caused by a parasite called Entamoeba histolytica (we were proud of our nerd moment when we could actually remember it). As of now, the other girls are napping, and I am hoping to head to another beach area soon. I have realized that the only way to beat this heat is to find water and a breeze!

Rounding with the team of 15-20 students/residents
Looking at x-rays for a patient with pleural effusions (fluid in the lungs)
Our scary (or more like sassy) attending leading our post-rounds discussion on patient communication
My favorite pack of goats and dogs that we pass on our way home

Arriving in Accra and Day #1 in the Hospital

Hi friends!

Traveling to Ghana: The journey here was not the most thrilling, but I am glad we made it. My flight time was about 26 hours total and included a layover in Boston and Amsterdam. We arrived at the Kotoka International Airport in Accra around 8:00pm. Since the drive to Cape Coast is about 3 hours, we stayed at a house owned by the CFHI (Child Family Health International) program. Our local coordinator, Georgina, picked us up from the airport and stayed with us at the Accra house. Luckily, we had air conditioning in our room (the average temperature in Ghana this time of year is 85-90 degrees). The next morning, Augusta’s future in-laws picked us up from the Accra house and drove us to Cape Coast. They live in Ghana and offered to take us instead of using public transportation, which was so sweet of them (a large, crowded bus with a bunch of heavy luggage and no AC did not sound very appealing haha).

Flying over northern Africa from Amsterdam

Finally in Cape Coast: We made it to the Cape Coast house on Sunday afternoon. All was well until we found out there was no air conditioning here. It sounds like something minor to complain about, but let me tell you… 90 degrees is certainly not a tolerable temperature haha. The constant sweating can get really uncomfortable. And since you can’t drink the tap water here, we have to make sure we have plenty of water on hand. I will likely continue to complain about the heat for the rest of my month here haha. Anyways, Sunday was just a day for us to get settled in. We had lunch with Augusta’s future brother-in-law at a beach resort called Oasis. We had jollof and chicken (jollof is a rice dish cooked in a tomato-based stew) while watching some tourists swim on the beach. On Monday we went to the Kakum National Park. We were able to take a guided hike and walk across some bridges that overlooked the tree tops of the park- it was beautiful! We made friends with our guide, Chris, and the other people in our tour group. It was fun trying to challenge each other to walk across the bridges (which were very narrow and extremely wobbly). On Monday night another student arrived- her name is Amanda and she is a 4th year medical student from San Francisco, originally from Nigeria, and has matched into an Ob/Gyn residency.

The Cape Coast House
Oasis beach resort
Jollof and chicken
Tree top view at Kakum National Park
Just leading the pack with my fearless bridge walking haha
Conquering the bridges (and heat) with Augusta
Just for fun: the cell phones we get to use to contact locals while staying here

First Day in the Hospital: Tuesday morning was our first day at the Cape Coast Teaching Hospital. It was a very sweaty walk to the hospital (there is nothing quite like wearing professional attire and showing up on your first day literally dripping with sweat- even though that it totally normal here). Augusta and I are both in the pediatric ward for two weeks, and then the internal medicine ward for two weeks. Some interesting things I noticed about the hospital: there is a separate male and female wing for the inpatient wards, there is no AC in the wards but there is AC in the various offices, there are not patient rooms but rather a large room with many beds in it for patients. Overall it is very different. We managed to show up just in time to round on the pediatric patients (for those unfamiliar, rounding is when the whole team of medical students, residents, and attending physicians see all the patients together as a group and discuss each case in detail, looking over the history, labs, images, and the plan for the patient- it is a great learning tool). There was about 6 medical students, 4 residents, 3 international students (including Augusta and I, the third was a girl from Scotland), and the head pediatrician. The pediatrician was pretty intimidating- he would ask the medical students all kind of questions and indirectly tell them they were doing a poor job. But we saw some interesting case; failure to thrive, possible tuberculosis (without isolation precautions which was strange), nephritic syndrome, Hirschprung disease, and some kind of pulmonary issue (not sure what this patient presented with because we couldn’t hear his story, but he had a chest tube in place). Another quick learning point: nephritic syndrome is a kidney problem caused by infection or some kind of kidney damage. It can cause swelling around the eyes, high blood pressure, and blood/protein in the urine. This kiddo was actually on dialysis for treatment. And Hirschprung disease is a condition where a child is born with nerve endings that do not work properly in the gut. This causes the gut to not be able to move and digest food, because there are no functional nerve endings causing the muscle to contract. It is usually corrected surgically. Aside from these kids, we unfortunately saw a ~1 year old need CPR after becoming unresponsive. The residents were performing the CPR without success, and sadly the kid passed away. The overall attitude about the CPR and death was very calm- in the US it would be a much bigger deal with lots of commotion and sadness around the loss of a child. My only thought is that maybe this is common? Regardless, it was a lot to see on our first day. I am looking forward to seeing more kids this week, however the lack of AC in the wards will definitely get the best of me haha.

Bracing the heat on our walk to the hospital
Where we will be working for the next 4 weeks!
Me, Amanda, and Augusta (all smiles because there was AC in the library!)
Attempting to see/hear rounds in the pediatric ward

Getting Ready for Ghana

Hello and welcome to my blog! My name is Kristin, and I am a fourth year medical student at Ohio University Heritage College of Osteopathic Medicine. I will be spending four weeks learning about medicine in Cape Coast, Ghana with my friend and classmate, Augusta Eduafo. I have a love for travel and meeting new people in new places. I am thrilled to have this experience and am excited to share my stories and knowledge that I pick up along the journey!

With my trip coming up in just 11 days, I am definitely feeling excited and nervous. The thought of packing for a month-long trip has certainly brought on some procrastination. While we have had a lot of communication with the local physicians, this experience well surpasses my other international trips and so I am still not sure what to expect. Augusta and I have organized this rotation through a program called Child Family Health International (CFHI). We will be staying together at one of their on-site locations with other medical students participating in the rotation (which I am unsure of at this point). I am really looking forward to working in the clinic/hospital, especially as a soon-to-be-doctor with a good amount of medical knowledge in my pocket (at least I hope so!)

I will be updating my blog about twice per week, so please enjoy my stories (medical and non-medical) along the way! I am looking forward to sharing 🙂