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Ghana

Written by Peter Fox, 2003


Korle-bu Hospital, Accra

Ghana is a country in West Africa with a population of 20 million. Korle-bu Hospital is situated in Accra, the capital of Ghana, and provides specialist care for the whole country. Peter Fox, a final year student in 2003, spent one month studying Paediatric Surgery at Korle-bu Hospital.

Ghana is a vibrant equatorial country, with a rich culture, energetic people, and, like so many African countries, an abundance of poverty. My time spent traveling through Ghana was a lot of fun, since I met so many interesting people, and witnessed a beautiful land. However, the month spent in Paediatric Surgery at Korle-bu Hospital was incredibly sobering. I witnessed first-hand evidence of abject poverty and disease which afflicts so many developing countries. My involvement with the Medical Students’ Aid Project allowed me to appreciate that we can all make a difference.

Korle-bu Hospital is the only teaching hospital in Ghana. It is located in the coastal capital of Accra. This 1000 bed-hospital receives serious cases from throughout the country, many of which have been worsening for months prior to presentation. Unfortunately the Ghanaian government does not contribute much funding to health care, and therefore the patient burdens the majority of the cost. For this reason, most patients will be treated by traditional healers ('witch doctors') for weeks or months before they finally present to Korle-bu.




Poor Access To Health Care

A 6-year-old girl presented to our department with an infected, ulcerated exomphalos major. This is a congenital sac in the front of the abdomen which contains various contents of the abdomen. In this case, the exomphalos contained her liver, gall bladder and half of her small bowel. In a developed country, this defect would be corrected within the first few months of life. However, in this patient, the doctors had organised an operation after her birth, yet her parents were unable to afford the high cost. Now, six years later, she came back to the hospital with a life-threatening infection.


Common Conditions In Ghana

The common conditions that affect children in Ghana are infections. These include TB, malaria, gastroenteritis (especially typhoid) and meningitis. In paediatric surgery, we regularly saw typhoid perforations and entercutaneous fistulae (an abnormal connection between the bowel and the skin due to typhoid infection). Despite surgery and antibiotics, these children would spend weeks in the ward with chronically discharging wounds. Fortunately, HIV/AIDS is not a common problem in Ghana, compared to the epidemics which have swept over much of southern and eastern Africa. Even the highest estimates of the HIV rate describe it as less than 5%, and in theatre, the doctors took few precautions. Some common or unusual conditions I saw in Ghana include:


A Case Of Intesussception

As stated above, since many Ghanaian people are poor, 'western' medicine is seen as a last resort, and only when all other options have failed. Often management in the peripheral centres is not optimal, and patients are referred to Korle-bu in a bad state. For example, a 6-month-old infant presented to a rural health centre in distress, having not passes stools in several days. He was kept in the centre for several 7 days, before they revised the diagnosis as rectal prolapse. After his condition worsened, he was referred to our department at Korle-bu. After examining this child, it was readily apparent that the diagnosis was not rectal prolapse, but intesussception. The condition had deteriorated so far that his entire large bowel has formed an intesussceptum and been passed rectally, along with the classical 'red currant jelly stool.' This case was something that would never be seen in Australia, as it would be diagnosed and treated immediately.


How The MSAP Helped

Through the Medical Students’ Aid Project, we were able to provide equipment for the Paediatric ward which improved the quality of health care. Our major donation was a brand-new paediatric cystoscope, organised through N Stenning and Co. This piece of equipment, valued at over $5000, is used for investigating and operating on bladder problems in children. The most common use in Ghana is for posterior urethral valves, which block urine flow through the urethra and cause complications ranging from infection and hydronephrosis through to end-stage renal failure. Prior to the donation of the cystoscope by the MSAP, only open procedures were possible. The open procedure has a high complication rate, especially with scarring, and is more invasive. The paediatric cystoscope revolutionised the surgery, and was appreciated greatly by both doctors and patients.

The MSAP also donated a pulse oximeter for use on the ward. Prior to this, the only oximetry available in the hospital was in the operating theatres. Assessment of oxygenation is essential in the management of acutely ill patients. It was incredibly satisfying to witness the pulse oximeter being used on the wards, and making a difference to the management of these children. This photo shows us using the new pulse oximeter on the ward.

The MSAP also provided Ghana with an additional pallet (2.5 square metres) of equipment, including an otoscope, sutures, sterile gloves, syringes, needles, cannulae, urine bags, an autoclave, a glucometer, swabs, dressings, adhesive tape and bandages. The approximate value of all of our donations was in the vicinity of $25,000 to $35,000.


Exploring Ghana

The non-medical experience in Ghana was amazing. After having spent only one day in the country, I had already made friends who subsequently offered to accommodate me at their house for a month. Ghanaian people are incredibly giving and genuine, and attempt to make their guests feel comfortable. Since I was living with a local family, I had the opportunity to integrate fully into everyday Ghanaian life. Most afternoons, I would join the local neighbourhood lads to play soccer in the 'park' (a red dirt patch of ground).

The markets in Ghana were truly amazing. Having previously traveled through a considerable portion of southern Africa, I felt prepared when I arrived in Ghana. However, nothing could prepare me for the shock of the markets. Ghanaian markets are absolutely enormous, stretching further than the eye can see – often taking half an hour to walk across in both directions.

Ghana is a very cheap country to travel in. For $1, it was possible to buy 75 oranges. A typical meal costs $1 to $2. Catching the local minibus (tro-tro) to the hospital cost 10 cents. A five-hour bus trip on a weekend adventure was less than $5. However, Ghana would extend beyond many people’s comfort zone. Western luxuries are few and far between, dust gets into everything, the whole day is spent covered in sweat, and evidence of poverty is abundant. During my elective I became quite sick with malaria (despite taking doxycycline), which took over a month for me to recover.

Ghana had a tumultuous history, spanning from the slave trade to their independence in 1957. When the Portugese first landed in Ghana in the late 15th century, they erected a series of castles, which subsequently were used to store slaves before transportation. Elmina Castle is the most famous of these. I gained a lot from visiting the castles at Cape Coast, and learning of the slave trade. Ghana, despite a history of being ruled by the Portugese and then the British, was one of the first African countries to claim their independence, in 1957.

My elective experience in Ghana was with a doubt an amazing and inspiring experience. I have every intent, after gaining more medical experience, on returning to a developing country to work. Despite the lack of resources, it is a rewarding experience, and I would recommend it to anyone who wants to learn more about their world.


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