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February 23rd 2009
Published: February 25th 2009
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Donkorkram, Afram Plains.

An eight-hour trip from Accra via bus, tro-tro and ferry boat brought me to the Afram Plains. This region of Ghana is listed by the government as one of a handful of "underdeveloped" regions of Ghana. Historically this region's economy consisted mainly of farming, but the construction of a dam along the Volta River further south created the huge Lake Volta, which is actually a series of finger-like extension of lake. The Afram Plains is bordered on three sides by the Volta Waters, which has had an effect on the climate and agricultural productivity.

The Afram Plains region has one main city, Donkorkram. Aside from this town, and a handful of other villages coincidentally located along the electrical grid to Donkorkram, most of the region is without electricity. Donkorkram consists of two main streets, a handful of administrative offices, an orphanage, dozens of shops selling the same 10 items, one restaurant, one guesthouse, a school and a hospital.

Most of the homes (one is pictured) are constructed with mud walls and either thatch or tin roofs. These huts share communcal outdoor kitchens and latrines. There are a few upscale concrete, self-contained homes for the wealthier residents (e.g. the hospital staff). One day a week is "Market Day" where local farmers from across the Afram region bring their goods to Donkorkram. This is quite an event in the otherwise sleepy town and is well attended every week.

Don't be fooled into thinking the town is quiet. It's simple and not particularly crowded. But quiet... no. Like most other places I've visisted in Ghana, the moment anyone has access to a stereo or radio of any kind one is obliged to turn it on full blast at all hours of the morning, day and into the late evening. My daily meal at the otherwise empty restuarant every day, for example, was less relaxing than one might think with a fuzzy radio program playing at uncomfortable decibels through huge speakers next to my table.

The Orphanage.

The orphanage in town is home to about 20 children. It's run by three women, known as "the mothers". The orphanage is quite poor and relies entirely upon donations from the community. The children seem happy and relatively well taken care of by local standards... but all the same, they live in frank poverty and it was undeniably a sad place to visit.

Thanks to the generosity of Dr. Tom... I was able to deliver toothbrushes, toothpaste, floss and plenty of toys to the orphanage in town. There happened to be two other medical students (I'd not met them before, they're not from Accra) visiting Donkorkram one day during the week. I brought them along. We did a little lesson on brushing and flossing. Then we handed out plenty of toys.

The kids did well brushing their teeth. We tried to give little cups with their names on them to keep the toothbrushes separate... but we got the feeling things would quickly become a big bag of communcal toothbrushes to be shared among everyone. I don't know whether the mothers will be able to encourage twice daily brushing... but anything is better than nothing I suppose!

The kids went absolutely NUTS for the toys. It was like Christmas morning... but crazier. We had a nice time playing with everything. They especially loved the toy cameras, bouncy balls, toy gliders and the slap wrist-bracelets. Thanks Dr. Tom!!!

The Hospital.

The hospital in Donkorkram serves the Afram Plains, a rather large area, and people travel considerable distances to seek medical treatment. Until recently, the hospital was staffed by only a single physician and about 1/2 dozen nurses. Earlier this year, a second physician joined the rather understaffed hospital. Both physicians are in their "civil service" years after medical school and are approximately equivalent in training level to resident physicians in the US.

There is an operating room where simple elective and emergency surgeries are performed by the two physicians (they're not surgeons... just general medicine doctors who've learned to do a few simple surgeries during their training). Examples include hernia repairs and emergency appendectomies. There are three main wards (pediatrics, women's and men's) as well as a small maternity ward and a small emergency room (called "casualty ward"). The main pieces of technology are the autoclave (for sterilization), the ultrasound (for prenatal visits), a microscope and a lab machine that can perform complete blood counts (i.e. do counts of white/red/platelet blood cells). There is also a decently stocked pharmacy.

I was expected to see and treat patients independently. This was frightening (for me and the patients, I'm sure) as well as disturbing at times. It's a common topic in biomedical ethics discussions -- balancing the fact that while it's wrong to deliver substandard health care (i.e. my lack of training/experience) to vulnerable populations, the region and hospital is so understaffed (and the attending physicians themselves so junior) that there simply is no other option available. So I rolled up my sleeves, got my reference books handy and did my best. As it turns out... I feel pretty good about it now. I didn't do anything dangerous and if I had important questions, I could go into the OR to ask one of the physicians for advice.

The language barrier was difficult. Abour 20% of the spoke English, about 70% spoke Twi (the dialect I'm most familiar with) and the remainder spoke a separate dialect (Ewe) more common toward the East of Ghana. English I could deal with, of course. I compiled about two pages of useful Twi phrases and by the end of the week was able to diagnose really common diseases in Twi. The rest of the time I needed to have some the health care aides translate. I basically saw patients all day in an "urgent care" setting and then in the ER (casualty ward) at night.

The days were long... which was fine because there was nothing else to do in the town. I only brought one book on that trip with me and finished it on day 2. Oops!

All in all... this was the best week I've spent in Ghana. Very rewarding medical work and great to see a completely different side of Ghana... a rural village to contrast with the crowded chaos of Accra.

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