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!
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!
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!
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!