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