State of the Wards and Wards of the State

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February 6th 2009
Published: February 6th 2009
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Update from the hospital wards

This first week, I've been tagging along with the medical students from the University of Ghana Medical School. They are "junior" medical students and are doing pediatrics for the first time... so most of their patient interaction is geared towards learning how to take a history and perform a physical exam. The faculty here know I'm almost done with school and mainly allow me to do what I want and at times have me help teach basic physical exam skills to the students. My interaction with patients is limited, of course, by language (see below) as many of the patients and parents speak only minimal English and I speak even less Twi.

I've been able to distribute some of the toys Dr. Tom (thanks Dad!) provided. The kids are so excited about them!... the smiling and playing seems to annoy the nurses 😊 The parents are also excited... but they bombarded me the first day asking for more toys to take home to their other children who are not ill. Many of the mothers want the "slap bracelets" for themselves. Who wouldn't! The kids I did take some covert pictures (seen here) and although this wouldn't fly in the US (breaking HIPPA laws)... I did ask the parents permission and will not include info about names or illnesses.

I've been rounding on the pediatric ward in the hospital -- interviewing when I'm able, doing physical exams, reading charts to get a feel for typical medical therapies, etc. So far... the vast majority of patients have suffered from malaria, sickle cell disease, and various types of gastroenteritis (stomach "flu"). I've also seen tuberculosis and typhoid fever (enteric fever).

Medical tid-bits

Gastroenteritis is common here due to poor sanitation... and diarrheal illnesses are a leading cause of child mortality and morbidity in "developing" areas of the world. Some common pathogens here overlap with those seen in the US (e.g. rotavirus) while others are much more common here than in the developing world (e.g. cholera, shigella, salmonella).

Several children in the hospital have been HIV+. My understanding is that many people in Ghana do not know their HIV status despite recent public health efforts to educate the population and broaden free testing. Indeed, the most basic health concepts that we take for granted are absent from the public consciousness of lower and many middle-class Ghanians -- e.g. wildly inaccuarte or altogether absent knowledge about sex, birth control, sexually transmitted disease and, of course, santitation (but more on that to come).

Ghana does offer childhood vaccinations, although their program is new and not yet reaching all children. This is due in part to poor medical infrastructure and lack of access to primary care, but also due to cost. The government cannot afford the program and relies on foreign aid for the majority of funding for vaccinations. In addition, the "full vaccination" series ends by age 1 and therefore does not adequately vaccinate children against certain diseases which require boosters (e.g. measles).

Intro to Ghana

Language The official language in Ghana is English. However, the "primary" language of most Ghanians is their regional dialect. This is the first language they learn to speak, the language they speak at home and in daily life with one another and, usually, the language with which they are the most comfortable. In Accra and the surrounding area, the language is Twi (pronounced "Tree") and this is the dialect of the Ashanti people.

Borders. Like most African nations, Ghana's borders were decided by European nations (in this case, by colonial Britain). Generally speaking, the basis for most African national borders was European economic interests rather than commonality or relationships between the African people, cultures and tribes they encapsulated. Here in Ghana, this was mainly the Gold trade and, later, the infamous Slave trade. Modern day Ghana consists of ten regions, each with its own capital. Each of these regions contains what were once rather independent groups of people and today there are usually several languages spoken (though usually one main dialect used throughout that region). All in all... there are more than 45 African languages spoken within the country of Ghana (which is the size of the state of Oregon). Its easy to see why, given the many historical and present separations of the Ghanian people, the political word du jour (Americans, see: Change!) here is "Unity!"

Politics. Ghana obtained it's independence from the UK in 1957. Ghana has suffered many years of coup and countercoup. It's modern constitution (written by Rawlings, who himself seized power by coup twice!) was written in 1991. After serving his max two terms, the 2000 elections were historic in their
Making troubleMaking troubleMaking trouble

These two were playing soccer with the little soccer balls Dad sent. So cute... but the nurses got stern with them! :)
peaceful transfer of power from once party to another (Kufuor defeated John Atta Mills). This past January, John Atta Mills ran for president again and was elected by a small margin. This was just prior to my arrival and was a time of great anxiety and stress in Ghana for fear of violence and riots... but once again, power was peacefully transferred from one party to another.

Accra. Accra is a city of over 2.5 million and the capital of Ghana. It's around 90 degrees everyday. Like most large cities in the developing world, Accra is dichotomous. The lower class live in the deepest poverty -- sleeping in barely-standing-shacks in shanty-towns that sprawl accross Accra, urinating and defecating in the streets. The upper class live in homes surrounded by razor wire and drive cars nicer than any I've every been inside. The streets (traffic here is unreal by the way) in Accra are bizarre for their mixture of poverty and wealth. Cars honk their horns constantly and at nobody in particular, just to alert all others to their presence since since they have no intention of braking. At any given moment, children play near the open sewers that line each street, women walk by selling various goods (foods, fabrics, etc.) from huge baskets balanced on their heads, tro-tro's (shared-ride vans) drive by with double the passengers one would deem safe and Range-Rovers, Mercedes and Audi's cruise around reminding me of Sesame Street's One-of-these-things-just-doesn't-belong-here skits.

The people look amazing here. There's a pride in appearance that makes Americans look like full-on "W.T." Whether dressing in traditional Ghanaian garb or Western clothes... all but the poorest of people look immaculate and pulled-together. Also, the streets are lined with people who could be supermodels given the opportunity. I don't know how they manage because I stick out amonst them for being sweaty and dirty all the time (without air conditioning, a washer/dryer, a shower, etc.) Not that I wouldn't already stick out. People stare at me everywhere I go and the kids giggle and shout "Abronye! ("White Man").


15th February 2009

Jeff, your blog is fabulous! It's awesome to be able to track your experience. I'll keep following. Miss you.

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