One word sums up this day: WOW. The other phrase that comes to mind is: trial by fire. Ok, from the beginning. We came to the hospital this morning with Cam, and he introduced us to everyone. People here are so friendly, and so welcoming, which makes the transition much more smooth than it might otherwise be. I’m sure it helps that we’re 2 of the only 3 while (albruni) people at the hospital, so we’re hard to miss! There’s a big teaching hospital in Kumasi, that sounds like it functions more like a european hospital, but this is definitely more rudimentary. We got a tour of the hospital, which didn’t take long, and I was amazed when Cam walked us right into the OR (theatre) with our street clothes on! Apparently that was ok since they weren’t operating that day!! Absolutely crazy. I’m starting to see how diseases are so easily transmitted here. Granted, Cam would make so many changes if he could, but his goal is to have this hospital function within the Ghanian system, and be self-sufficient and entirely run by Ghanians, so, as he says, he picks his battles. What I keep reminding myself is that even when things are so drastically different than the way things are done in the US, the way this hospital cares for patients is still 300x better than what they would otherwise have available to them: nothing. But I’m getting ahead of myself….
After our tour, we were basically cut loose. Now, for those of you non-medical types, here is how a 4th year medical student functions in the US: we see patients, come up with our ideas about what is going on and how we want to treat patients, and then run everything we want to do by our resident or fellow or attending before we even THINK about writing an order. Then, the nurses won’t even do anything we say unless we have the signature of one of those forementioned people. Well, things are a LITTLE different in Ghana. Picture this: Lisa and I (both 4th year medical students) sitting in a little consult room, maybe 4 feet by 7 feet, by ourselves, with one of the ‘helpers’ to translate what we say into Twi and vice versa, and the patient. Oh yeah, and we have a list of the medications that we have available to us, a couple little booklets from the US to help us with dosing and indications, and a prescription pad. WE’RE TOTALLY BY OURSELVES! At first, we’re trying to run things by Cam, like we would in the US, but it’s quite apparent from the very start that he is thoroughly confused as to why we are even talking to him at all. So we quickly figure out to just go with our guts, and only grab him when we really don’t know what we want to do. And that turns out to be whenever we think that the patient needs a much more extensive workup than they really do, or than is available to them or us, and Cam has to give us a quick lesson in the realities of Ghanian medicine. So we spend the entire day, glued to each others sides (Lisa and I), running our every decision by each other, terrified that we are idiots and going to kill these people who are convinced that they are getting the best care possible because we are albruni. We also learned quickly that, when in doubt, treat for typhoid and malaria. Most every complaint here (vomiting, diarrhea, nausea, headache, fever, etc) can be attributed to malaria or typhoid unless there is another blatanly obvious cause. By default, we are getting pretty adept at treating those conditions. That’s been a big mindset change. I’m convinced that I’m going to start residency with this compulsion to put everyone on malaria treatment, and the program is going to be questioning why they let me in!
Cam gave us our schedules today, and it turns out that we get to get involved with a bunch of community outreach opportunities, which will be such a great way to get out and see how these people live, and what are the things that affect them the most. There is a TB visit that happens on Tuesdays, when one of the pharmacists goes to see all the patients in the village with TB (not that many), to see how they’re doing with the medications, and if there are any side effects. They have to come into the hospital every day for their meds, but this is an additional kind of catchment system I think. Then there’s this ‘Community Health Evangelism’ program on Thursdays, where they go to several different villages and implement basic healthcare knowledge about malaria, diarrhea, clean water, healthy eating, when to go to the doctor, etc. That’ll be an awesome way to get out and see different villages, I’m sure. We each spend a day in the theatre, and a couple days a week in casualty, in addition to the rest of the time in the consult room, where it seems they need us most.
The staff does devotionals in the morning on Tuesdays and Thursdays, and Cam signed Lisa and I each up to do devotionals once. Yeah, again, for those of you who know me, I am basically terrified of this. 🙂 But, I can’t really complain, I prayed that I would be taken out of my comfort zone. What better way than to get up in front of a bunch of Ghanians, who barely understand me, and give devotionals! I’m scheduled for Tuesday, Feb 12th, so you can pray for me on Monday night (for you guys) that it’s going well!! Oh, my stomach flips just thinking about it…! They do a devotional time for the patients on Monday, Wednesday, and Friday mornings that is optional. We go, but it’s entirely in Twi, so I don’t know what they’re saying. After that, one of the nurses gets up and gives a talk about some health topic of her choosing, a kind of teaching session of sorts. This week, she’s doing breast cancer and cervical cancer one day, and TB another day I think. All in all, there are just so many great programs going on here.
Anne (through the donations of churches and people in the US) is having a library built in the village that is pretty close to being done. We went and saw it today, and it’s gorgeous! She’s getting books in English and Twi donated to use, and it should be open by August. What a great way to further educate these kids. You should see the schools here…they are mostly just cement buildings with some wooden chairs inside. It’s absolutely amazing to me that people live this way. But I’m sure you don’t even question it when you’ve seen nothing else.
The other commonality of African life we are getting accustomed to is ants. They are everywhere. Not the big ones like we get in the states, but the little tiny ones. If we don’t wash the food off our dishes, or fail to do the dishes at night, or leave anything out on the counters, we will have a line of ants to greet us in the morning. Pretty gross, but I’m sure it won’t even phase us by the time we leave.
I’m learning more Twi, and trying to use it as much as I can. They mostly laugh when I say Twi words, but I’ve been told that laughing is a sign of approval, so I’m hoping that’s true! The only bad thing about saying things in Twi is that people think I speak Twi, so when they rattle off with their answers, I’m totally at a loss! The other thing I’m learning is how to speak with a Ghanian accent so they understand. It’s amazing to listen to Anne and Kaylor speak with the Ghanians, because they sound just like them! I’m trying to learn it mostly because it makes it so much easier to talk to them! They can’t really understand my slurred speaking otherwise 🙂 Plus, it’s kinda fun. Lisa and I catch ourselves talking to each other that way, which always makes us bust up laughing!