Language of exchange - English and twi

Period of exchange - 7 weeks

The hospital

Korle Bu Hospital, Accra:

I spent 2 weeks at Korle Bu working on a general medical team. This is a huge teaching hospital ( ive heard it is the 3rd largest in Africa!) and so it has a lot to offer. It has similar facilities to any western hospital though the difference is often finances result in the facilities being unable to be used. The only thing I am aware it cannot offer is MRI. Also, the expertise of the medical staff is of a very high level – similar to any teaching hospital. The obvious differences between korle Bu and my hospital back home in Cardiff, is that here they have a different approach to patient care and you may find it difficult to witness the lack of compassion some patients are shown. Patients are given no dignity – they do not even have curtains around their beds! And cleanliness is also not their biggest priority! The hospital grounds are huge and although you stay on site, this is still a good 20 minutes walk from the main hospital! Although fine in the mornings, at midday when its really hot, you might be tempted to take a taxi which only costs 1 cedi (about 50 pence or 1 US dollar.) The accommodation is really good as well. You would usually stay in a room shared with 1 other student in a hostel full of international students. Mostly these are from neighbouring African countries but there were a lot of American and European students there at the same time as me. The rooms are mostly ensuite although occasionally the water and/or electricity cuts out but bucket showers aren’t THAT bad! Theres kitchen facilities if you are inclined to cook (though cooking is expensive if you want to use familiar ingredients as they are imported!) We tended to live off pasta, noodles, take away and meals out (really not that expensive!)

Kwahu Governement Hospital: (5 weeks)

This is a much smaller hospital based on the top of a mountain near to Nkawkaw in a village called atibie.

There are 5 wards male/female/paeds/obs an gynae/labor plus outpatients, casualty and theatre. Theres probably about 100 beds but only 3 fulltime doctors (plus 1 who does 2 days a week.) All doctors specialize in everything! Their level of knowledge is amazing considering it is kept so broad! Everyone is very friendly and helpful and I felt they really appreciated our help where as we were more of a hinderence at korle bu!

You’ll notice HUGE differences between here and your smaller community hospitals back home! Everything is very basic and there are obvious lacks of resources. Due to resource and workload pressures, there is a very different approach to patient care which you might find hard at 1st.

There are lots of affiliated community clinics which you have the opportunity to spend time at. These are very very basic so when working here you will have to use your initiative and get used to adapting to the limited resources.

We lived on site in a students house, a 5 minute walk from hospital, which can house up to about 6 people (8 at a push.) We had rooms shared between 2, 2 bathrooms, a kitchen (but no cooker and microwave doesn’t work) a living area with TV and DVD player (you can get dvds with about 20 films on for about 2 quid!) There is only running water about 2 days a week so its bucket baths Im afraid! Even when there is running water you wouldn’t want to wash in it as its brown! But it does mean you don’t have to keep filling the toilet up everytime you use it! Meals are cooked for you by the hospital cook Felicia who is lovely. The meals are pretty spicey so tell her if you don’t like spice! Since I am not a fan of spicey food I did not get on with Ghanaian food as a result, however, I was told by the other students the food was really good! I on the other hand couldn’t taste much as my mouth was on fire! Be careful with the chicken though – a couple of times it was not fully cooked!

The specialty

Kwahu:

General medicine/surgery. We all did a bit of everything though I personally spent more time in the community as I felt this was where I got the most hands on learning opportunities. Expect to see everything you see back home plus a LOT of malaria! I also saw other tropical illnesses such as worm infestation, typhoid fever, schistosomiasis etc etc.

Korle Bu:

I was assigned a general medical team and saw all the usual medical conditions I see back home plus a few tropical conditions such as malaria and sickle cell. Everyone was very friendly and it was good to see a broad variety of diseases so I would recommend medicine. However, ive also heard really good stuff about anaesthetics and paediatrics. Obs and gynae and medicine are probably the most relaxed – I was invariably home by lunchtime!

The tasks

Kwahu:

An average day at hospital would involve a morning ward round ( you visit a different ward each day) followed by observing in OPD. Then after lunch, you can spend time working in casualty or have some time off! When your in casualty, you will be working without the assistance of doctors. We usually worked in pairs bouncing ideas off each other and using a lot of textbooks! There is a medical assistant to ask if your stuck or alternatively in theory, you should be able to contact the on call doctor (though this is sometimes easier said than done!) You can also spend time assisting in theatre or on the labor ward.

I spent 3 weeks in community clinics where I would run a clinic on my own. This is pretty scary at times though even my limited knowledge as a student is probably better than whats in place students aren’t there as often those prescribing have not had any formal medical training! You can still refer to hospital if your unsure but bare in mind they often wont go! During my time in the community, I also got involved with baby clinics, home visits, immunization clinics and health education in schools where I planned and delivered health lessons.

Korle Bu:

I worked alongside a team of final year Ghanaian med students so I did mostly what they did. Usually involved a ward round and teaching sessions each morning with the opportunity to clerk patients afterwards. Once a week we worked in casualty and OPD clerking patients. I also spent a day in the mortuary watching post mortems since the students had a 1 week rotation there.

The teaching

Kwahu:

There was less teaching at kwahu than korle bu but doctors are happy to answer your questions on ward rounds and in clinics.

Korle Bu:

They LOVE teaching at korle bu but be prepared to be quizzed a lot! The students really know their stuff and instead of giving 1 sentence answers to questions on a ward round, they more or less recite chapters from a textbook!! Teaching happens on ward rounds and in tutorials. Most of time in casualty is spent having bedside teaching – sometimes they would give an hours tutorial on every patient that gets clerked by a student!

Language difficulties

Kwahu:

Although less patients speak English in the rual areas, the language barrier was actually less of a problem as there is always somebody available to translate. Usually a nurse, nursing student or healthcare assistant. I also learnt more twi here so was able to throw in a few twi phrases here and there. I also learnt to say ‘take deep breaths’ which is really useful for examination!

Korle bu:

Some patients only spoke twi. Whilst I could ask another student to translate, I felt bad asking too often as the teams are so big so theres often not many patients to clerk once divided up amongst students! In this case, I would let them clerk the patient and I would read the patient notes, help with examination and then discuss the cases with the students afterwards.

Furthering medical studies

Kwahu:

I feel this was a great learning experience. Mainly because it taught me to have confidence in my own abilities and that if I didn’t know what to do, I could always fallback on textbooks and so it has made the prospect of qualifying much less scary! I learnt a lot about tropical medicine due to the huge amount of exposure to it. Therefore I will be less daunted if I have a tropical case back in the UK! I am also more comfortable with prescriptions and with GP conditions such as hypertension and diabetes.

Korle Bu:

I was really pleased to have spent some time at korle bu though I didn’t think it was that different to the teaching I got back home. However, im glad to have done it as it gave me the opportunity to compare rural and urban medicine and the tutorials I went to were really good!

Social life

Kwahu:

Since we were so busy in the days, we were content to stay in in the evenings which is good as theres not a lot to do in atibie! Most evenings would be spent eating dinner together and then reading or watching a DVD and occasionally playing group games like charades. There is a bar opposite the road with a pool table though its lacking in atmosphere a bit so we tended to just stock up on alcohol there then take it back to the house. Theres also a hotel halfway down the mountain which does good food though is quite expensive. We’d go there about once a week. Weekends were spent on day trips or going away for the whole weekend. We did a lot of village visits from here to see how kente cloth and bauxite beads are made. Would really recommend doing this!

Korle Bu:

I had a great social life for the few weeks I was based in Accra. An average Friday night would start off with a salsa lesson at aviators after which everyone dances salsa for a while and then heads to champs later for karaoke! There was always a large group of people to go out with – a mixture of locals and international/elective students. On quieter nights we would go out for dinner and there are lots of good restaurants in accra. If your craving some home food, try mama mias for really good pizza or afia beach resort (though the later is a bit pricey but worth it!) We often ate at pallomas which does a mixture of Ghanaian and continental food. Most people go away on weekends and its easy to get to lots of places from accra – cape coast is great for a weekend visit ( castle, beach and canopy jungle walk) or Kumasi (for the huge markets and beautiful lake bosumtwi.) Ive also heard Ada Foah is great though havent been there myself. If you have a long weekend off, try visitng Wli waterfalls in the Volta region.

Difficulties

Kwahu:

Sometimes you feel out of depth and it can be difficult to contact people for advice especially if you are out at a rural clinic! I would recommend having a Ghanaian phone and keeping it charged and with plenty of credit so you can ring other students for advice.

Korle bu:

As I was only there 2 weeks, when my team of med students went away for a week of it to the mortuary, I was left feeling a bit lost! I had the students numbers but not the doctors and so it was really hard to find where everyone was as ward rounds etc don’t follow a timetable! I also found it hard to get people to translate for me as everyone is so busy!

Good things

Kwahu:

The whole experience was amazing! I met some great people, experienced new diseases and got loads of hands on experience! Would recommend it to anyone! Other good things include, going on safari to mole to see elephants, relaxing at green turtle beach, seeing rural Ghana life, becoming part of the community in atibie, meeting many international and Ghanaian students, running my own clinic and feeling like a ‘real doctor!’ Oh and ‘gordons spark’ (gin drink) for the equivalent of 60 pence – its good stuff!!!

Korle bu:

Its great to live in accra for a while – it’s a really fun city! Though can seem kind of stressful when you don’t know your way around! It was great to get to know the local students and gave me a great insight into Ghanaian life! There’s always lots of elective students so you will always have a lot of fun! Its good to use as a comparison to rural medicine.

Improvements

Kwahu:

Often clinics and ward rounds did not start on time and sometimes our transport would not arrive for community week so more organization would improve matters!

Korle bu:

More structure so you always know where you can find the team! More help with translation. More hands on opportunities.

Advice

Try and learn some twi before you start your elective. It means you will feel like more of a part of the community and will help get you ‘on the patients side!’ And also because, people will find it hilarious that you can speak their language!!!

Korle Bu:

Spend some time here but base most of your elective somewhere more rural as you will get many more benefits!

Comments- Amazing!

Organization of the trip – brilliant – sefa was great. Really helpful and made things run a lot smoother!