Life in the hospital

Sorry it’s been so long since I’ve written anything on here, it’s hard to find the combination of time and energy.

This last couple of weeks has been really challenging, both academically and emotionally. It’d be very easy to come on here and say what an incredible time I’m having and how I’ve been able to do so much awesome stuff. That is true… but it wouldn’t be a very genuine representation of my trip.

For example yesterday I got to put my first chest drain in (w a lot of guidance) – awesome experience, something I’ve never even watched in England, let alone been able to do myself. (It’s a tube, about the thickness of a finger, that you place between the linings of the lung to drain pus/fluid/leaked air).

The other side of the story, that doesn’t make for such an upbeat blog, is the reason I put the drain in in the first place. The patient was a muscular 30-something year old man with AIDS pneumonia. He had such damaged lungs that a leak had formed, leading to air filling his chest and crushing his lung. For about 6 hours after I put the drain in and released the air he looked great; he was breathing much better and he would thank me + Jim (who did it with me) whenever we went to check up on him. I was feeling so pleased. I thought he would live long enough for the antibiotics to have a chance to kick in. In the evening however he was looking as sick as he had that morning and when we went for rounds this morning his bed was empty – he died in the night.

Every morning I check certain beds to see if they’re empty, looking for patients who the night before have been on deaths door. About 50% are still there the next day.

For every tragedy though, there is the other 50% who make it through the night, and have time for the antibiotics/blood transfusion/fluids to kick in.

One of my favourite patients is a little 3 year-old boy on paeds. He saw our surgeon in clinic with a bulging fluctuance on his chest that felt just like an abscess. We took him to theatre and Lisa talked me through my first ‘I&D’ (incision and drainage). This is normally a very straightforward procedure involving a small incision and squeezing the pus out of the abscess. Once he was anaesthetised I made the incision and the pus came flowing out, and kept on flowing. In total we drained about 500ml from this tiny guy's chest. When the flow had slowed a bit it began coming out in little bursts as he breathed – it turned out the collection was coming from the lungs and had eroded forward to the skin. This was pretty unexpected, and he now had a sucking chest wound. Luckily Lisa managed to put get a chest drain in quickly and suture him up – so glad I wasn’t doing it on my own!

The next morning I went to paediatrics, half expecting to see an empty bed. Instead I found a well looking baby and a happy dad. As soon as the kiddy saw me he started screaming cos he thought I was coming to do another procedure on him. His dad thought this was hilarious, so now every time I go into paeds his dad always gets his kid and shows him to me. The poor little kid hates me, but me and his dad always laugh so much when we see each other. Draining the pus and fitting the tube saved that kids life, so I don’t feel too bad! (Having said that he’s definitely not out of the woods yet, but doing well considering)

There have been so many times over the last two weeks when I’ve really question all that is good in the world. There’s so much suffering here, so many young patients dying. But as Jim always says, you’ve got to remember the patients you have helped as well as the ones you couldn’t.

I’ve seen some pretty horrendous things here, but I’m not really sure how much you guys want to hear about that kind of stuff… As well as being a staff + resource poor hospital, it’s the only hospital for about a hundred mile radius, and so often only the really sick ones will travel that far, giving a disproportionate picture of health in northern Ghana. Before coming here my (half) Ghanaian friend Marie kept saying ‘why do you want to go to the North, healthcare is rubbish in the North’. Well that’s why I wanted to go to the North, and I’ve really experienced that, and some. Maybe that's not fair, but it's certainly very different.

The choir at First Baptist Church, Nalerigu

My friend Hamsa

All the women carry their babies like this and little kids carry the even smaller ones

Ghanaian church, babies + graphic pictures

The last couple of days have been good. On Sunday after rounds we went to a Ghanaian church in a village a couple of miles down the road. We drove in the back of a pickup truck, which was fun on the bumpy roads, except Jim (A&E doc who arrived on the w/e) kept reminding us to hold tight since there are no neurosurgeons in Ghana! The service was pretty good, except I spent half of it feeling like I was about to puke – I don’t think my malaria tablet enjoyed the ride (I’m going to take them at night cos they make me nauseous). Ghanaian church is definitely something I’d recommend experiencing – it seemed more like a rave than a church with everyone singing and dancing. I took a photo, but it doesn’t really show up very well (tried uploading, but failed like 4 times - really not worth it).

After the service we played with some of the local kids. I’d brought some bubbles and stickers, which was a total novelty for them. They all wanted the stickers on their foreheads for some reason. As soon as I got them out about a hundred kids suddenly appeared from nowhere and shoved their heads in my face. It was super cute until a couple of them started hitting each other for a sticker.

Mondays, Wednesdays and Fridays here are clinic days, while Tuesdays and Thursdays are procedure days. In the middle of clinic yesterday Lynn the OBGYN (I’ve gotten all American :p) came in saying there were two women about to deliver and did I want to go catch some babies. I got to help deliver one baby through a normal vaginal delivery and then suture up another lady’s episiotomy (cut to make the baby hole bigger) after watching her suction delivery, something I’d not seen before. There wasn't quite as much excited as the Royal Baby, but we were all pretty relieved when this little girl was born as the women had had a previous CS, putting her at higher risk, and was failing to progress.

This morning after rounds me and Jim did minor procedures. He’s been really great at teaching me lots and really getting me involved. I’ve probably done more practical stuff here in the last couple of days than I did in all of 4^th year.

Jim, Zato + I debrided this guys leg this morning – it’s this procedure where you scrape off the surface of the wound to help wound healing. He had a snakebite back in May and has developed this massive wound. I’ve seen so many wounds huge wounds here like this, it’s ridiculous. I’m not really sure why they develop like this, a lot of them don’t have a history of any trauma and type 2 diabetes is rare here.

Zato wearing a shoe cover as a hair net + a star (I have no idea how to rotate)

Zato works in theatres. He's the probably most friendly person I've ever met, he's great!

This is our snakebite kid. Most of the snake bits aren't open like this, but there are so many other wounds like this.

Uploading photos here is a bit of a struggle and only about 50% of them work. Martin or anyone else – how do you make the file size smaller? I tried changing it from .JPG to .tiff but that made it bigger…

Anyway I better go – a bunch of us are off to the river to see if we can find some crocodiles! 

Women washing

Baptist Medical Centre

First couple of days

At the request of various people I’ve decided to write a cheesy travel blog of my time in Ghana. This is my first attempt at blog writing, so sorry if it’s not great!

I’m here for 10 weeks on my medical school elective – for the first module of our 5^th year we get to organise our own placement anywhere in the world. I’m doing mine at the Baptist Medical Centre in Northern Ghana. http://www.baptistmedicalcenter.org/ The BMC is a mission hospital set up by Americans I think in the 50s (read the website if you want to know more, I don’t have internet at the moment, but it’s got all the details + pictures)

I’ve been in Ghana for about 36 hours so far and already it’s been a pretty crazy experience. I left England on Thursday morning, and got off to a good start – the plane was overbooked so I got a free upgrade from economy to club class. I spent the 6-hour flight on a fully reclining chair, with a 3-course meal, sipping free champagne! The flight attendant thought it was hilarious when I kept asking if everything was free and getting really excited when he said of course.

I got into the capital Accra at about 9.30pm local time and experienced the joy of Ghanaian baggage arrivals. That night I stayed for about 4 hours in a guesthouse that has links with the hospital, then left at 4.30am for my internal flight further north to Tamale. If I’d known it would be that quick a turn around I would have probably stayed at the airport, except the guesthouse had my ticket for the next flight that I needed to collect.

Breaking news: it’s hotter in England than Ghana! It’s rainy season at the moment, so although it’s really humid it’s pretty cool (maybe 25C?) which is lovely.

After the internal flight a man from the hospital named Dickie (?sp) drove me the 2 ½ hours further north to Nalerigu and the BMC. It’s a fairly small hospital (123 beds) but as we drove through the main gates there were hundreds of people milling around since Friday is a clinic day. I was pretty relieved to finally arrive, as this is my first time travelling on my own to a place I didn’t know anyone, and was a bit anxious of getting mugged or lost or something. But it all worked out drama free which was a relief.

I’ve not entirely figured out who works here, but yesterday I met 5 doctors (2 surgeons, 1 obs + gynae, 1 cardiologist and 1 GP) plus another medical student. Apparently there are also 2 Ghanaian doctors who sometimes work here. As far as I can tell that is it. And over the next week 1 of the surgeons, the cardiologist, the GP and the medical student are going, leaving a surgeon, an obstetrician and me (plus the 2 Ghanaians doctors who don’t seem to be around much) for the ENTIRE HOSPITAL. There are also Ghanaian nurses + midwives and this group called ‘medical offices’ who do a lot of jobs doctors would do back home. Actually I just remembered someone mentioned a an American doctor arriving some point in the next few days, but still my point is the ratio of doctor:patient here is insane.

After lunch we went to clinic. First impressions – clinic is mental! I was in with the 2 surgeons who run a joint clinic. This is nothing like a joint clinic back home where that means 2 specialists come together to treat one patient. This was a joint clinic where two patients are seen at once in the same room, sharing one translator. Confidentiality doesn’t seem to be a thing here. For a lot of the afternoon in this room, which is about the size of most GPs consulting rooms, had 2 surgeons, each seeing patients simultaneously (often with an entourage of family members), a translator, a nurse, one of the surgeon’s 6 year old son, at times her husband, and me sat in the corner. There were also various people using the room as a corridor to the consulting rooms next door.

I found the consultations really hard to follow. Not only were there two going on at once, with everything going through the translator but I’d had about 2 hours sleep the night before and was definitely flagging. We saw lots of interesting cases though, some really different from the things we see back home. There were a lot huge of tumours, many patients complaining of ‘paining in their waists’ (their way of saying abdo pain), some typhoid and lots of malaria. About half way through the morning we were called into to an emergency motto (?sp) accident (moped). People in England like to moan a lot when patients in A&E have to queue on trolleys in the corridor before being seen by the doctor. Here the corridor was the A&E department. So one of the surgeons and I saw this semi-conscious patient with a head injury from the accident in with about 30 Ghanaians crowding round wanting to watch. When I say crowding round, I mean literally touching the man, jostling for the best position. Investigations and treatment here are pretty limited. At home this man would have had a CT scan then sent to Derriford (Plymouth) via air ambulance to see the neurosurgeons. Here the nearest CT scanner is a 2 ½ hour drive back to Tamale, so the family had to decide if they could afford to organise a car to drive him there and if he would survive with the journey in the back of a car. I was pretty shocked that there wasn't any C-spine support (neck collars/blocks) but I spoke to one of the doctors after who said if they’ve broken their back they won’t survive anyway, so there’s no point in worrying about that. It’s all very different.

This morning we went ‘rounding’ as the Americans call it (ward rounds – seeing the inpatients). Saw about 20 female patients and a few kids. The most common complaint was snake bites, which has made me a bit anxious about walking around in my flip flops!

After rounds a spontaneous clinic started – there isn’t normally a clinic on Saturdays but there were so many patients yesterday that not all of them got seen, so they camped out overnight to be seen today. The cardiologist (Dr Heesh) I was with let me lead one clinic and the other student (Alison) led another in the same room, while he sat in the middle discussing management plans with both of us. Running clinics like this, with a translator, is going to take a bit of getting used to! I had a lot of uncertainty. If I’m honest I even felt uncertain about the history they gave – I’m sure some of it must get lost in translation and it’s impossible to build any rapport with the patients. It seems a lot relies on clinical examination as the only investigations available are some basic bloods, ultrasound scans and x-rays. There isn’t even a working ECG (heart tracing)! I found this pretty surprising, but the doctors said there aren’t many MIs (heart attacks) here since everyone works very physical jobs (most are farmers) and can’t afford cigarettes or fatty foods.

Sorry this is a bit of a long post, not really sure about this whole blogging business yet!

Anyway Ghana’s going to take some getting used to, but so far I’m having a good time, have met some nice people and I’m sure I’m going to learn loads. Hope you guys are all having a great time back home/on electives in other exciting places! It'd be good to hear how you're all getting on.

Love 
Alex