Case Notes:
Nick Heywood
(Medicine, Ghana )

I spent my time in the old capital, Cape Coast approximately 150km west of Accra split between the Central Regional hospital just outside the town, and the Ewim Urban Health Centre in the centre of town. During my first three weeks I was working in the Urban Health Centre, a complex situated on a hill in the centre of the town. Ewim offers consultations similar to those offered in GP’s in the UK, a maternity service with its own ward, a casualty department, usually for minor injuries not requiring the facilities of an A&E department, and also its own laboratory where simple investigations could be carried out. It also provides family planning services and a highly efficient post-natal programme.

My time at Ewim was spent with a fellow student, where we shared a consultation room and saw patients ourselves, taking histories, ordering relevant investigations & suggesting the appropriate treatment for common diseases, mostly malaria but also dermatological problems and some conditions rarely seen in the UK, such as schistosomiasis. We also spent some time visiting the other departments in the health centre, where we were exposed to the everyday workings of the complex itself. 

The next week and a half I spent my time at the Central Regional Hospital in the paediatric department. It has a 226 bed capacity and opened in 1998. The hospital itself is very different to the UK, and although the facilities provided are similar, it is very understaffed and under-equipped. Its 24hr emergency department and Intensive Care Unit are not what you would imagine them to be like, both are very small and often inefficiently run, but nevertheless provide important services for the hospital. There are also specialised departments such as ENT, Physiotherapy, and a dialysis facility. Although there are many departments available, only 6 of the doctors at the hospital are Ghanaian nationals, with many doctors from all over the world, many from Cuba, and also some European countries.

The paediatric ward is mainly run by the nurses, with the doctors spending little time on the ward except for the daily ward round. The average day in the paediatric department consisted of a doctor led ward round in the morning, followed by an outpatient clinic in the afternoon. I initially intended to spend 3 weeks at central regional hospital, but I having had such a wide ranging experience at the Urban Health Centre, I decided to return there to complete my placement for the last week and a half.

Differences in healthcare aside, the most significant difference between Ghana and the UK is health awareness in the population, with people having little understanding of severity of disease. Some patients would wait to see a doctor even with minimal symptoms for a small period of time, whilst others would leave it days or sometimes weeks before seeking medical advice. For instance, a 14 year old boy had badly broken his leg, but had left it over a week before seeing the doctor, so much so that it had begun to heal but in the wrong place.

Although some people in Ghana have health insurance and the scheme itself is on the increase, most do not, and therefore have to pay for their own health care, from each individual latex glove used, to the medication they require to be prescribed. If a patient is admitted to hospital in an emergency and cannot afford to pay for the treatment they have received, they are kept in the hospital, all the time still paying for each extra day they are there, until they can afford it, or some generous person or organisation bails them out.

There was plenty to do in Ghana when I wasn’t at my placement. I travelled widely with other students during the weekends – some of the highlights were undoubtedly the Nzwuelzu Stilt village in Beyin, Kakum national park, the expansive markets of Kumasi and an absolute highlight were the waterfalls at Wli.

The main way you will find yourself getting around, and I think the most fun way, is by tro tro. These are vehicles which range from the size of a VW camper van to a larger transit size van. The transport may not be the most comfortable in the world, but there are some amazing sights and one of the best things about travelling in Ghana is that the majority of people you meet are extremely helpful and, if you ask them, they will go out of their way to help you.

Overall I had an excellent elective and was exposed to many different conditions I may only see as rare occurrences back in Nottingham. It provided me with a broader understanding of healthcare in developing countries and showed a contrast between here and the UK.