For my first month in Ghana, I am working at the Tetteh Quashire Memorial Hospital in Mampong. It is very close to my house, about a five minute walk up a dirt road and then just across the highway. The set up for the hospital is definitely different than any hospital in Canada. The hospital consists of several buildings situated on a large piece of property. The administration building almost reminds me of a motel. It is 3 stories (I think) and has several rooms opening onto an open-air hallway on each floor. Aside from administration, the pharmacy, the laboratory, physiotherapy, and the media room is also located here. The main hospital building is 3 stories and is more typical of a hospital in Canada. The maternity, surgical, men’s, and women’s wards are all located in this building. The emergency room is a separate building, but is attached to the main hospital through a tunnel. There are also smaller separate buildings for each pre-natal care, adolescent reproductive counseling, and the mortuary.
Aside from these buildings, there is also the kid’s ward, where I am spending the next month. The kid’s ward consists of two separate buildings. One building is the actual ward, where children are admitted. At one end of the building there are 8 cribs for smaller children, and at the other, 6 beds for older children. Aside from these main rooms, there is also a room for newborns, an isolation room, pediatric intensive care, a procedure room, and a playroom. The other building is the pediatric clinic. It has a large waiting room (which is almost always packed), three offices, and a procedure room. The clinic stops accepting patients at 11 am and generally runs until 1, however, it regularly runs 1-3 hours late, depending on how many patients need to be seen. Many days, mothers start showing up with their children by 6 or 7 am.
The doctor that I am working with is Dr. Boaky. He is currently doing his housemanship, which would be the equivalent of being a first year resident in Canada. He is very nice, but still has a lot to learn. Because of this, I also spend a lot of time with Dr. Gyepi-Ate one of the more senior pediatricians working at the hospital. She is very nice, and very vocal about what the hospital is lacking. And to be honest, there is a lot to be vocal about. Although it is a rural hospital, it is the main hospital in an area of about 1 million people. Even though it is serves a population over the size of Winnipeg, it is still lacking in very basic equipment. In my relatively short stay here, this lack of medical equipment has already resulted in some needless deaths. On the day I arrived, while touring the hospital, I saw a baby in the neonatal unit just hours old. I found out when I got home that this baby died shortly after of hypothermia. He was 4 hours old. The hospital has an incubator to keep newborns warm, but it does not work. They didn’t even have hot water bottles there to use to try and warm the baby. Emma ended up running home and grabbing the emergency foil blanket out of her first aid kit to use to try and warm the baby up, but it was of no use. The next day I saw a child admitted in congestive heart failure, diagnosed previously with an ASD. He was one year old. He had pulmonary edema, and was extremely tachycardic with a heart rate of 220 beats per minute. They couldn’t give him IV Lasix, so they tried an oral diuretic (which isn’t as effective) to try to treat his pulmonary edema. They also couldn’t give him IV digoxin, and instead used a less effective oral treatment to try and slow down his heart. Neither treatment worked and he died around 11 pm that night. The next day I helped Dr. Boaky perform a lumbar puncture on a child with suspected meningitis. This child was the most cachectic child I have ever seen, nothing but skin and bones. He was 3 months old, but was the weight of a newborn. After performing the procedure, Dr. Boaky was explaining to me how they don’t have the proper needles to perform lumbar punctures, and because of that, if the child survives, he could have permanent damage from the procedure. With how that child looked, I didn’t even think he had a chance of survival, but thankfully, I saw him today (4 days later) in the intensive care unit, and he has already put on weight.
The clinic too is lacking in medical equipment. On Friday a boy came in complaining of ear pain and discharge. I asked Dr. Boaky if they had an otoscope, and they did not, so I went and grabbed my diagnostic kit from my medical bag. The child has some serous fluid build up, but Dr. Boaky, not having had much experience with otoscopy, double checked with Dr. Gyepi-Ate. When she saw my otoscope, she was very impressed, and has not stopped talking about it since. Today she said that she was going to find a way to raise the money for me to buy one for the clinic when I get back. I told her that if there was an issue with cost, I’d be able to find a way to raise the money for the equipment at home (I would have just bought it for them, but I wasn’t about to tell her that) but she was very insistent that the hospital raises the money on its own. Later, I told her that instead of buying one and having it sent back her (as they wouldn’t get it until December when one of the doctors comes back from a trip to the States because she doesn’t trust it being sent by mail) I would just leave this one here with them, and buy myself a new one when I get back home. The doctor was ecstatic to hear this (although I may still have to buy one for them, as now she’s talking about raising enough money to buy 2). But it’s nice to know that even if I do nothing else to help out here, the clinic will be better medically equipped when I leave than when I came.
It has been very interesting talking to Dr. Boaky about medicine and medical school, and the differences between Canada and Ghana. He’s always asking me questions, and always seems shocked to find out the answers. Like how pain management is an important part of medicine, and there are some doctors who devote their practice to pain clinic, or how the schools in Canada develop specialized programs for children with developmental and other disabilities in order to best suit their needs, or even how a child in a tertiary hospital will be immediately sent for surgery if they’ve perforated something in their abdomen. Needless to say, these differences are dramatic. But I enjoy working here, and hopefully as the doctors become more comfortable with me being here I will be able to do more procedures. If I don’t end up liking it in Accra, I may end up coming back here and spending my entire time in Ghana on the Kid’s Ward at the hospital here.
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