This July I had the amazing opportunity to spend 3 weeks in Kumasi, Ghana, living in a volunteer house with other young adults from all over the world and shadowing doctors at the local government hospital. Tafo government hospital is a relatively small hospital that mainly deals with routine and simple cases from the community, referring more difficult cases to the bigger university hospital. It has a labour, paediatrics, ObGyn, mental health, surgical department, emergency room and wards.
I spent most my time there on the wards (paediatrics, male and NICU) and mainly joined for rounds (discussion of the patients‘ treatment for the next 24h every morning) and new admissions.
In the first week Noa, a first-year medical student from Wales, and I, shadowed a paediatric doctor. We learned about the most common diseases treated on the paediatric ward including malaria which is responsible for the admission of more than half the patients on the ward at any point. As there is currently no Malaria vaccine and the disease is transmitted by mosquitoes found all over Ghana, most children get infected a few times in their childhood before developing immunity. Other common diseases were dehydration and malnutrition, sepsis, pneumonia and gastroenteritis. It was here that we first came into contact with the severe poverty in Ghana. Doctors would not always prescribe the most effective medication but the cheaper, less effective version as there is no centralised insurance, and this financial burden could make a family unable to pay for food.
We spent the second week in the NICU (neonatal intensive care unit) and the paediatric ward. The babies in the NICU often spend a week or more being treated there, so there were far fewer different patients than in the paediatric ward. During this time, we treated babies with hypoglycaemia (low blood sugar) due to a diabetic mother and a baby with a congenial heart condition where the chambers of the heart are connected due to a hole in the separating wall. Here again, the issue of poverty came up. The patient needed open heart surgery which was too expensive. Due to this, they will have to be on medications for the rest of their life. In paediatrics this week, we learned some more hands on skills such as how to take and present a history and perform a chest and abdominal exam; both of which we got to practice on patients. Additionally, we were trusted with writing up the notes, prescriptions and discharges that were discussed during rounds.
The third week was mostly spent on the male ward. A big issue that was highlighted this week is the huge stigma around HIV/ AIDS after a HIV positive man that had not been taking his medication presented to the male ward with severe AIDS symptoms. We tried to educate him on the importance of medication compliance. He was so afraid of losing his social status if someone found out and in denial that he refused to be properly educated. This issue is so big that staff in the hospital don’t talk about HIV/ AIDS but retro virus in order to protect their patients from the consequences of this stigma. We also witnessed a case of GI obstruction (an obstruction of the GI track that inhibits the normal flow of food and other substances through the GI system) and a GI bleed which are fatal if left untreated.
On our last day we had the opportunity to observe an emergency C Section due to the ambilical chord being wrapped around the babies head. This was definitely one of the highlights of my time at the hospital as it is just so interesting to see surgery and such a special moment to see a new life being brought into this world.
Overall, I really enjoyed my time at the hospital, I learned a lot and got several practical experiences, far more than when I previously shadowed doctors in an English hospital. It is however important to mention how bad of a condition the hospital was in compared to western standards. Everything was quite unhygienic as there was no disinfectant on the wards that was used between touching different patients. The wards were a tiny, not very well-ventilated room with 5 patients in beds next to one another. The toilets were completely unhygienic due to a water outage that lasted a few days. In addition to that the hospital was not very well equipped. People got send home with open wounds after car accidents as there were no bandages left in the emergency room. Despite this it has to be said that the doctors were aware of these issues and actively tried to battle them, striving for a better developed health care system.
This poverty could also be seen outside of the hospital. Already, on the 6h bus ride from Accra airport to Kumasi the streets were filled with potholes and many streets especially in the cities were only dirt roads. Living conditions in cities consisted of a lot of either very simple huts or unfinished, half abandoned buildings. In Kumasi, the running water and power for the whole neighbourhood would go of at least twice a day and not come back for up to 5 days. Conditions were even more deprived when we visited a community further north in a rural area that was still living in clay huts and therefore didn’t have any access to running water, electricity or proper health care.
Another significant cultural difference to Germany was the openness and welcoming nature of everyone around us. Everywhere we went we were warmly greeted and welcomed into the community. The native people living in the volunteer house with us instantly treated us like a part of the family and Ebenezer, a PA student from Kumasi we had met at the hospital promptly invited us to join him in the children’s church he runs for a service the next Sunday. This service was about 2 hours long which is quite short by Ghanaian standards where services can last between 4 and 5 hours. This is due to the huge influence of religion in everyday life. Ghana is mostly Christian and Moslem. On every other corner there was someone preaching the bible and a lot of cars and buildings have religious quotes on them.
Another (quite negative) difference is the corruption that exists especially within the police force. When we were going on the interstate roads during weekend trips to Mole National Park and Cape Coast, we would get stopped about once per hour at a police checkpoints to pay them off to be let through. These were some of the only moments in Ghana where I felt genuinely unsafe and scared. All in all, though, everyone felt safe most of the time especially in our neighbourhood in Kumasi.
To summarise, I’ve had an amazing time in Ghana. Not only was my experience at the hospital really eye opening and thought provoking and has massively reinforced my decision to go to medical school massively, but the people in Ghana have created such a welcoming and open community for everyone. Additionally, I got to meet a lot of awesome young adults from all over the world that were living with me in the volunteer house and who were also in Ghana to learn about the culture and help out in the community. I feel extremely privileged to have been able to go on this trip and get a view into a completely different culture and community of people that are a lot less privileged than almost all of us but still try their best to improve the situation in the country to the best of their ability and create a warm and welcoming environment for everyone, even foreigners.
I want to especially thank Dr Richmond Adjei Awuah, a (mainly) paediatrics doctor, for making the time every day to teach us so much and just going out of his way for us for the entire 3 weeks. My stay would not have been as good without him. Thank you.
Carla Hinterding
Recommendations + Tips
I would dearly recommend going to Ghana for your Auslandspraktikum. This have been some of the best weeks of my life. You get to meet some amazing people and get to know a completely different country and culture. At the hospital, you will definitely get to do more hands on than in Germany or other developed countries, though due to cultural differences and the condition of the hospital, you might spend a lot less time overall in the hospital (I was there from 8:30 until 12/2 o’clock). Also, there are other options than medicine such as teaching and childcare which might further your academic education, it will most certainly further your cultural and social one.
The company I did it with is PMGY, though there are many different ones. I think you just have to find the one that fits for you. About PMGY: They were definitely trust worthy and helped me out a ton beforehand for things like the visa (which can be especially tricky for underage people) and what to pack ect. Most things went very smoothly in the volunteer house and I definitely felt safe and taken care of. The one thing I would criticize is that there was not a lot to do in the hospital and Noa and me definitely got lucky for finding Dr Richmond. Others in the hospital had a very different experience and didn’t enjoy their placement as much.
All in all, if you want to go to Ghana for a hospital placement, I am more than happy for Herr Laupitz to give out my number and talk to you in more detail, but I would definitely recommend.