May 11th, 2022 by Cecile Dinh
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My first day at Ankaase Methodist Faith Healing Hospital was spent in the emergency department as I awaited further instructions on an orientation. In talking with the nursing staff while there, a phrase that one of them used has remained in my mind and likely will for the rest of my time here: “Anything is possible.”

One afternoon, the emergency department admitted a 67-year-old gentleman who was complaining of acute onset of severe abdominal pain that first occurred three days ago while he was out tending to his crops, and was worsening. He had since been unable to pass stool or eat without nausea and vomiting. He had a past medical history of hypertension and diabetes mellitus. The diagnosis of acute abdomen was made with a differential of mesenteric ischemia or complete bowel obstruction, among others. Given the hospital is a district hospital without resources such as CT scanners / MRI machine, or on-call surgeons, the decision was made to transfer him to the larger regional teaching hospital about an hour away for further management. However, I learned the following morning that he passed overnight while awaiting the transfer (which probably wouldn’t have happened for at least 24 hours after initial contact with the receiving hospital). Out here in rural Ghana, anything is possible, in the sense that literally anything could happen, for the better or for the worse.

While working in the antenatal clinic and labor ward, we encountered a patient who was referred to the hospital at early term due to size measuring smaller than dates and an ultrasound revealing oligohydramnios. A repeat ultrasound continued to show severe oligo with a total AFI of about 3. The patient was placed on the following day’s schedule for an “elective cesarean,” which I was able to assist with. Upon entering the uterine cavity, thick meconium fluid spilled out. Apgars were 5 and 6, and the baby was quickly whisked to the neonatal unit for further resuscitation. Had the hospital had the capabilities of health facilities comparable to the United States, an “urgent cesarean” would have been called with likely delivery that same day. The baby survived despite the circumstances, and it amazes me how much they are able to do with so little. Again, anything is possible here.

A few days after I arrived in Ankaase, I was stricken with gastroenteritis (presumably from some street food) on top of what I now believe was heat exhaustion/dehydration. I guess my body was shocked by going from dreary, cold Washington to the tropics. The weather is unbelievably stifling, even worse than New Orleans’ humid heat due to the lack of air conditioning, and I failed to keep up with drinking enough water. Thank goodness for working in healthcare, as I quickly was able to receive 3.5L of IV fluids and am slowly improving after having started ciprofloxacin that my PCP pushed on me before I left home. A blood test also confirmed that I did not have malaria. I finished a 20-gallon container of water by myself over 5 days and am happy to report that my urine is now pale yellow. Though miserable in the midst of my illness, I survived. No longer can I say that I have an iron stomach – really, I have not had more than a day of abdominal cramping here and there despite my years of international travel and eating whatever I wanted – but I guess here in Ghana anything is possible.

May 2nd, 2022 by Cecile Dinh
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I’ve made it to Ghana. I haven’t traveled this far since the COVID pandemic started, and while international travel still feels the same, it is noticeable that things take longer than it used to as various COVID regulations are in place depending on where one is traveling to. This is good for practicing my patience as I make my way back to the African continent, this time to West Africa, where things run at a much slower pace than in the United States.

To give a little more background about myself: prior to medical school and residency, I worked in the public health sphere with different African cultures. I taught HIV education to rural villages around Arusha, Tanzania, during the summer after my freshman year of college. I worked with a Somali refugee family who was settled in Tucson, AZ while in college at the University of Arizona. During public health graduate school, I did research with a group out of Emory University who conducted HIV studies in Rwanda and Zambia. After getting my MPH degree, I then lived in Lusaka, Zambia for two wonderful and glorious years while working for the same group. I left Zambia in 2013 to pursue medical school and residency, which now brings me to Ghana for a short trip to explore how I can effectively combine both my public health and family medicine training.

A couple similarities I have noted so far upon arrival and taking a walk down the street from the guest house I am staying at in Accra:

1. The scent. It sounds strange, but the smell of burning trash is nolstagic for me. It reminds me of my first trip abroad to Arusha when I was young and idealistic. I distinctly remember smelling it again when I stepped off the plane in Ethiopia on a layover in 2011, and feeling excited to be returning to live in Zambia for a couple of years. Today, I smelled it again on my walk, and it was an acknowledgement for me of how far I’ve come in my career.
2. The friendliness. I love being able to walk down the street and be able to greet everyone I pass with a simple hello and a smile, and have that greeting be returned in kind.

A couple of observations from today:

1. Kotoko International Airport has jetways. Many of the other African countries I’ve flown into in the past, with possibly the exception of South Africa, did not have jetways, rather had outdoor stairs that you walked down to get to your gate.
2. I’ve forgotten how to act like a local to get a better price. I accepted the services of the first taxi driver who approached me outside the airport terminal today. I bargained for a better price than what he initially offered, but still ended up paying about 4x what it should have cost, according to the guest house host.

I am excited to be in Ghana. My goals are to learn as much as I can about tropical diseases and to participate in as much obstetric care and newborn delivery as possible while I am here. A month is far too short for an experience like this, but hopefully, there will be many many more months to come after I finish residency and establish my own practice. Tomorrow, I am off to Kumasi and the Methodist Hospital in Ankaase!

April 22nd, 2022 by INMED
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Hello! My name is Cecile Dinh. I am a resident at Northwest Washington Family Medicine Residency, and I’m starting my INMED service-learning experience at Ankaase Hospital in Ghana beginning May 2022.