October 2015. The journey I have been looking forward to for a long time. Going to Ghana for 5 months, of which 18 weeks for my GEZP in Damongo. The first week, I met the Ghanaian culture and have visited the nature by public transport (read: crappy, old busses) by traveling from Accra to Tamale. Sieneke and Pearl (two semi-doctors who where there for a couple of weeks already) picked me up there to travel to Damongo. The next day, I immediately started in the hospital.
During a guided tour in the hospital, I was introduced to everyone and everyone let me feel very welcome by giving me a big smile. The first days, I have been watching Sieneke and Pearl to learn about the local possibilities in diagnostics and treatment. After those three days, they went on a holiday, so I had to do it by myself. Of course the doctors where somewhere nearby the hospital, but in general they only go with you if you ask for supervision. And it’s believed that you can handle the less complex patients by yourself.
The first blood transfusion for a very sick child, which is very rare in the Netherlands, was special for me. I woke up in the middle of the night, thinking about the procedure and that I didn’t forget anything. But soon I get used to prescribe blood transfusion, as well as diagnose exotic sickness like (complicated) malaria and ringworm.
One of the challenges in the hospital was the language barrier. Most of the patients can’t speak English. They speak on of the 13 other languages used in Ghana. You have to communicate via the nurses and family than. Thereby we had a lot of miscommunications and I missed lots of important information. On the other side, I hereby learned to trust my clinical experience: Is de patient looking sick? Are there differences compaired to yesterday? What is my physical examination telling me?
Another challange was the lack of diagnostic tools. Limited labaratory tests, and only an ultrasound and X-ray are available. Although, sometimes there are no more malariatests and halfway through my GEZP, they decided to charge a fee for some tests, because the hospital had no money left. Patients couldn’t afford it, so I had to diagnose and treat them without using the tests, while some medicins have very severe side effects. This was poignant to see.
For a more specialised diagnostics and treatment, patients had to go to the big city. However, most of the time insurances don’t pay, so patients decided not to go. This was also very poignang, for example an 8-years old patient with an upper-leg fracture who needed surgery. But because the family was not able to pay they choose to visit a traditional healer. It’s heartbreaking to realise that this kid probably will be crippled the rest of his life.
Other intense things where watch and check a defunct for the first time: a 14-years-old girl who died 15 minutes after I arrived in the hospital. The surgery of an 8-months-old baby with an intussusception, who stopped breathing before the surgery even started, but who survived in the end, although time will tell us if he will be totally healty again. The terminal patient suffering cancer, who despirately wanted to die at home, but the family didn’t want to take care so after a few weeks, she died in the hospital. The patient with a non-healing wound on his leg, who took the brave decision to amputate his lower-leg and left the hospital with tears of happiness in his eyes. To be called at 12am while you are having a fever as well, because one of the patients is getting worse very fast and they doctors are nog available. The pregnant patient who was raped by a family member. The 12-years-old girl with a positive pregnancy test, so you have to talk with her wether she had sex or was raped, but in the end the test appeared to be false-positive, and after this she hugged me while she was crying. The 2-years old patient with a cerebral palsy, but parents haven’t asked for help before. The young children with severe malnutrition and infected with HIV. I can go on like this for a long time.
But, an internship in Ghana is not only in the hospital. Together with Daniëlle, we bought a motorcycle, so we were less dependent of taxi’s and public transport. On Saturdays, we went to the market. Buying parts of a pork in the morning. We prefered to do it by our selves, because we had to make sure we were buying the good parts (no bone, no organs, and no ears!). I also bought a beautiful fabrics to make Ghanaian dresses. I also had my hair braided for 5 weeks, exactly like all Ghanaian girls do it. This resulted in a lot of compliments from the locals, because they really liked it!
We went to Mole National Park regularly to swim and watch elephants, or to Tamale to buy some Western food and eat pizza’s. We also went to a lot of parties where they danced like Ghanaians do (the boy behind the girl…awkward!) and I made local friends. We were meeting eachother to eat together or watch movies.
In Christmas Holidays, my family came to visit me. We travelled around for two weeks in Ghana. Also during my time in Damongo, I did two weekend trips to the north of Ghana.
This GEZP in Ghana was an unique chance, I have learned a lot, enlarged my limits, and above all enjoyed a lot. I’m convinced that this experience will make me a better doctor and I would definitely recommend it to other students. But I will miss my time in Ghana. It was easy to leave the Netherlands, because I knew I would return. It was much more difficult to leave my life in Ghana, without knowing if I can ever return.
Read more: Daniëlle van Gastel: Clinical elective