My trip to Takoradi Ghana
Laura McCusker (Medicine)

Since my return from Ghana life is certainly a lot quieter. I can walk down the streets without every child I pass running towards me screaming 'Obruni! Obruni!'(white person), desperate to talk and play with you. When I need a taxi I have to phone or go out of my way to stop one in the street after eight weeks of every taxi passing you beeping its horn and pulling over, regardless of whether you needed a taxi or not. These are just a few examples of the welcoming and friendly personalities of the Ghanaian people and one of the things I miss greatly.

I travelled on my elective with three friends from Dundee and we were based in Takoradi, the capital of the Western Region of Ghana and the fourth largest city in Ghana.  During my six week placement in the Effia-Nkwanta Hospital, I shared my time between the Paediatric department, Obstetrics and Gynaecology and Accident and Emergency, in which I feel I had the opportunity to experience different aspects of the Ghanaian Health Service.

The Paediatric ward was a busy ward with a large nursing staff and a Consultant.  The Consultant had a fantastic rapport with the children and provided the patients with a great deal of health advice, even if sometimes a little brutally. He enjoyed teaching students and provided fantastic teaching on his ward rounds, allowing us to take histories and perform many examinations. Following the ward round he would take us to see interesting neonatal cases or would provide us with some teaching, frequently on X-Rays and common paediatric health problems such as Malaria, Sickle Cell Disease and glomerulonephritis.

The first morning of ward rounds in the Obstetric and Gynaecology department was quite a shock to the system. The wards were of an unbearable heat and there were beds and mattresses in any possible free area of floor. Mums and baby would be sharing a mattress on the ground that would have doors opening and knocking onto it.

In the post-natal wards, patients who had lost their child would be in beds beside those who had delivered healthy babies.  I came across five patients who had lost their child as a result of eclampsia.  This was commonly not picked up at an earlier stage as many patients are late bookers and therefore do not receive adequate ante natal care due to financial reasons.

All patients in labour were in the labour ward. We spent some time here helping to monitor the patients; timing contractions, performing vaginal examinations and listening for the foetal heart rate and documented our findings on a partogram. When due to deliver, the patient was made to walk out of the ward, down the corridor into the delivery room. Whilst in delivery, patients are not allowed to scream or make any noise as they believe this is bad for the baby. If a patient makes too much noise a nurse is usually at her side shouting at her or hitting her, ordering her to stop.

Caesarean sections were performed very similar to at home, although it was common practice for the anaesthetist to be unable to perform epidural anaesthesia on the patient due to lack of experience and as a result would have to use general anaesthesia. There would usually not be enough anaesthesia and as a result the mother would often wake up during the procedure.

The most eye opening experience was definitely the two weeks I spent in A&E. The one case which most demonstrates our different cultures was an incident in which a 25 year old male was taken into hospital covered head to toe in petrol, with many cuts and bruises. It turned out that he had been caught stealing and locals that had caught him, beaten him and tried to set him alight. The police arrived at the scene and had taken him into the hospital. When a member of staff was explaining to us the situation, they made a comment that he had 'unfortunately been saved by the police'. When we asked further about this it was explained to us how stealing was so badly looked upon that they would not think twice of someone who tried to kill someone they caught stealing. Due to it being such a rare occasion that a thief escaped an event like this the press showed up at the hospital. The patient was thrown in a shower naked to clean the petrol off, while reporters took photos of him. We were told it was likely he would be put in jail for about 20 years.

As Ghana does not have a structured general practitioner service, a large number of illnesses present to the accident and emergency department. It can therefore be exceptionally busy with minor cases when an emergency presents. Unfortunately there is no triaging service and often emergency cases are not fast tracked to the front. An example of this is when a 20 year old male nursing student was carried into the department by a group of his friends with excruciating groin pain. The doctor in charge was pre-occupied with a minor case of a child with a sore throat and did not make any effort to see the emergency patient. We took a history from the patient and examined him and were pretty confident that he was suffering from testicular torsion yet even when we had passed this message onto the doctor he made no effort to hurry. Eventually he came out and said that he was going to arrange an ultrasound scan, yet started to see more patients before arranging this. The patient was diagnosed as having testicular cancer, and fortunately received surgical treatment without further complications despite the delay in diagnosis.

One male patient presented who had fallen onto lead poles at work. One pole had pierced his left lung and another one had pierced the right side of his abdomen. In Accident and Emergency the only treatment this patient received was IV saline, whilst he was left in a room on his own perched off the side of a bed whilst waiting for a theatre space.

Other frequent presentations to the accident and emergency department included strokes, which were difficult to manage as there was no CT scanner and therefore it was hard to determine whether it was the result of an infarct or a haemorrhage. In order to make a decision, medical staff had to rely strongly on clinical findings.

Road traffic accidents were also common place- not surprising given the carnage we witnessed on the roads with speeding cars, frequently filled with up to 10 people and cars constantly pulling in and out of each other. Compound fractures were frequent presentations of road traffic accidents, treatment of which would be manipulation without any sedation or pain relief, followed by splinting of the fracture until a space was available in theatre.

Travelling with Work the World gave me the opportunity of travelling to a developing country with the benefit of having comfortable accommodation, a number of fellow students, great food and many points of contact so that I always felt safe. The Takoradi house could accommodate up to 16 people, so there was always plenty of people in the house in which I made some fantastic friends.