Louise Darvill - Medicine Electives in Ghana
My third year studying medicine at Southampton University had been very hectic. With non-stop clinical placements and intense revision for massive exams, by the end of the year I was ready for a change of scenery. The two months I spent in Ghana certainly provided me with just that!
When planning my elective, I aimed to observe healthcare in a developing country and hoped to be able to carry out practical medical procedures. I wanted to travel independently, to meet new people and to gain a real insight into the lives of the Ghanaian population, without the uncertainties of organising a medical elective on my own. As a result I chose to carry out my elective with Projects Abroad. I hoped that they would provide me with a fulfilling medical placement, the unique experience of living life the “Ghanaian way” and the reassurance of in-country support should I need it. I was not disappointed!
I left England a little later than expected following a week delay due to Lufthansa airlines temporarily terminating all flights to Ghana! Fortunately Projects Abroad were extremely accommodating regarding this and it was not a problem at all. As I left the plane on arrival in Accra, I was hit by the evening heat and humidity. Never before had I really understood the term ”culture shock”, but travelling by tro-tro from Accra up into the hills, that was exactly what I got. I found it hard to take in all the new sights and smells, the hustle and bustle of the evening traffic and traders selling their goods (plantain chips, water in sachets, and even toothpaste and batteries!) through the tro-tro windows at every opportunity. Arriving at my host family at about midnight, I felt a strange mixture of nerves and excitement about the adventure I was about to begin.
I spent eight weeks in Ghana, staying with my Ghanaian family about an hour north of Accra in the Akuapem Hills (which thankfully are a lot cooler and have many fewer mosquitoes!) The village where my family lived was also very rural, goats and chickens frequently waltzed in and out of the house, and at night the lack of streetlights and electricity in general (the power supply was variable, especially when it rained) meant the view of the stars was amazing.
My first four weeks of elective were spent in Tetteh Quarshie Hospital, a small and relatively poor district hospital. I then travelled in Ghana for two weeks before spending my last two weeks of elective at a rural clinic with two small male and female wards and a labour ward, in a small village called Larteh. The placements were much like those at medical school in England - the more I put into the placement, the more I got out of it - you certainly can’t expect people to tell you what to do, it is very much up to you to seek out opportunities and be pro-active!
The diseases I observed in Ghana were very different to the UK, and as I expected, there was a very high prevalence of malaria. In the hospital I also saw cases of pneumonia, meningitis and gastritis. I was surprised at the hugely high rates of severe hypertension, cardiovascular disease and diabetes, but having experienced traditional Ghanaian diet and lifestyle (high in salt, low in vegetables and exercise!) I could understand the cause of these conditions. I observed conditions that we rarely see in the UK, including typhoid and tetanus. I also witnessed cases of HIV, but due to the huge stigma that is attached to this condition in Ghana, I observed that testing was not at all common, and as a result, many more people have the condition than is officially recognised. I was shocked by how patients would leave it until the absolute last minute to attend hospital, and as a result I saw some very severe cases of anaemia and malnutrition, especially on the children’s ward.
At the hospital, I spent a week in the laboratories, a week on the medical wards, a week in outpatients and finally a week in obstetrics and gynaecology. In the labs, I was able to assist with recording patient details, carrying out blood sugar testing, and performing a variety of tests such as blood grouping and malaria parasite staining. It was a very interesting insight into how basic and unreliable the laboratory tests are in such a poor hospital. Despite malaria tests coming back negative, doctors would still prescribe anti-malarials on the basis that the tests were so unreliable, with no attention paid to the issues of drug resistance. It was certainly very different to my previous hospital placement experience in the UK!
On the medical ward, I observed a wide variety of cases on ward rounds and assisted the nurses with recording observations and dressing wounds etc. I was also able to take most of the bloods, which was good practice. I was most shocked by the real suffering I saw, and often felt annoyed by the lack of effort to make patients comfortable. Pain relief was minimal. Unlike hospitals in the UK, patient’s families carry out most of the everyday care and provide food and water during their hospital stay.
In out patients, I helped clerk patients and took blood pressures and temperatures. The style of clerking is very different to in the UK, and is basically a list of symptoms, with no attention paid to their onset, location, severity etc, or to the social or drug histories that we are taught to carry out at medical school in England.
I spent some time in the pharmacy, where patients are frequently given a long list of drugs, with no explanations as to why, and as a result leave without the faintest clue as to what their illness is and how they are being treated. Again, this was very different to what I was used to! I was able to observe several different clinics; general clinics, obstetrics and gynaecology clinics, where I was allowed to carry out speculum examinations, and ENT and ophthalmology clinics. I also helped in the antenatal clinic, where I observed ultrasound scanning, carried out antenatal palpation and was rather surprised at the compulsory singing of hymns at the start of the clinic! In Ghana, religion is central to many aspects of life.
My final week in the hospital was spent in obstetrics and gynaecology, where I attended ward rounds and was able to go into theatre. Here I observed C-sections and hysterectomies carried out at record speed, despite a power cut half-way through! I also observed women in labour and was shocked at the total lack of pain relief and general caring for the patients. The women were pretty much just left to it alone with no support from family or staff. Despite this, the maternal death rate was very low and most of the babies were fine, with breastfeeding second nature to nearly all mothers. I felt that despite certain inadequacies in the maternal care, the Ghanaian breastfeeding policy was something we could learn from in the UK.
Whilst at the small rural clinic in Larteh (basically the equivalent of our GP surgeries), I built up good relationships with the staff, and as a result I really enjoyed being able to participate fully in the delivery of the healthcare there. I observed and participated in patient consultations, eventually carrying out my own consultations (with the aid of the doctor translating from Twi, one of the local tribal languages!) and diagnosing and treating patients accordingly. In addition, I observed the child welfare clinics where I gained an insight into the immunisation programme in Ghana. I was also able to accompany the doctor on home visits in the local community. For one of the weeks I was at the clinic, the only doctor was away on a training course, so I was quite helpful in aiding the midwife in carrying out the clinics. I was also able to carry out all the practical procedures when patients were admitted to the wards. These included inserting cannulae, setting up drips and giving intramuscular injections.
On the small labour ward, I was shocked at one particular case where a baby became very ill, very suddenly, and needed to attend hospital. The family however, had not settled the bill for the labour, and could not afford to take the baby to hospital. I felt very annoyed by the situation, and helpless to do anything about this increasingly sick baby that wasn’t able to access the necessary healthcare, purely because of the costs of that care in the country he happened to have been born into. It was one of several cases I saw on my elective that made me appreciate that in the UK, we are able to treat all patients, regardless of their financial situation.
In addition to the time I spent at the hospital and in the clinic, I participated in some medical outreach sessions, which involved visiting local schools and administering basic first aid to the children. They often came along with quite nasty infected mosquito bites and cuts and grazes. As well as being a very rewarding experience - I was able to carry out some really practical medicine and the children thrived on the attention we gave them - it also gave me the opportunity to witness what some of the poorest schools in Ghana are like. It was a real eye-opener.
Staying with a local Ghanaian family was one of the best things about my elective experience and gave me a fascinating insight into the lives of Ghanaian people that I could not have achieved as a tourist simply holidaying in Ghana. I was made to feel very welcome by my host family, was looked after extremely well, and was really quite sad to say goodbye to them all when I left.
It was certainly not all work and no play though, with most weekends spent travelling with friends I made whilst in Ghana. In addition, during my two weeks travelling time, I toured Ghana, firstly experiencing a nail biting taxi ride (in the dark) along pot-holed roads to finally reach Mole National Park, where I was rewarded with witnessing elephants at close quarters. I was also able to visit the cities of Kumasi and Cape Coast, where I toured the castle and gained an insight into the appalling operations of the slave trade. I visited the canopy walks at Kakum National Park, and spent some time at a refreshingly original Eco-tourism resort on the beach west of Takoradi (Green Turtle Lodge - it was amazing!), before returning to the Akuapem Hills for my last two weeks of elective. During my free time, I also managed to visit a school that I had previously helped raise some money for whilst in England. It was really good to be able to see the results of our fundraising efforts.
I travelled to Ghana with an open mind, and as a result I thoroughly enjoyed Ghanaian culture both whilst travelling and in everyday life, and was continually pleasantly surprised by the genuine friendliness and helpfulness of the Ghanaian people. It was hugely refreshing to be able to ask for directions and to be led 10 minutes or so across a crazily busy tro-tro station to exactly the right tro-tro, purely because a local person had taken the time to do so. I never felt unduly threatened, I was never short-changed, I was always greeted with a smile, and I have great respect for the Ghanaian people, who despite doing everything in “Ghanaian time” (late, nearly always!) are such happy people, despite facing daily hardships that we would find intolerable. It gave me a fresh slant on the way I look at life, something that I would not have achieved had I not travelled to Ghana.
During my medical elective, I did not witness groundbreaking medicine, or get to carry out high tech procedures. I also did not learn a great deal of new medicine or receive any formal teaching. But that was not what I set out to do. What I did witness was the challenges of practicing medicine in such a cash-strapped society. Ghana has a newly implemented health insurance scheme, but even so, it is only those with money that can access healthcare. It made me feel very grateful that at home, as a doctor, I will be able to treat people regardless of their wealth. My elective experience also made me realise the value I place on being able to communicate and empathise with patients. One of the things that bothered me most during my time observing healthcare in Ghana was the lack of compassion shown towards patients, especially those in pain. It made me re-evaluate my reasons for studying medicine, and really appreciate that at home it is expected that doctors are compassionate towards patients.
I learnt a great deal about the things I value about practicing medicine, and I gained a lot of independence from carrying out my elective on my own. I made many new friends and built up a special relationship with my Ghanaian host family. All in all, I had a fantastic time and, if you are willing to embrace Ghanaian culture, I would thoroughly recommend Ghana as an elective destination. I have many amazing memories of my time there, and know that as soon as I have enough time and money, I will be off travelling again!