April 19th, 2019

April 23rd, 2019 by Galit Rudelson
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Today was my last day as a medical student! Not just in Ghana but in general. I was feeling way too lazy to write about this week, but figured if I don’t do it now, I wont do it for a long time, and Ill forget. I leave for America tomorrow. I have already packed all of my things, and exercises one last time, and showered. Funny thing is, I still plan to shower 2 more times while Im here. I shower 2-3 times a day, but none of them last longer than 3 minutes. I have a morning rince off, since I usually sweat through the night through the power outages. Then an after work/exercise shower (my favorite because the cold water is welcoming then), and an evening shower if I have applied sunscreen or bugspray since my last shower. Anyways, that was off topic.
This week I was on pediatrics. I started every day in what they call the NICU. But it is different from the NICU you and I would be used to. This is one bedroom sized room. There are 7 baby beds and 3 incubators in the room. This is really for babies that need a little extra monitoring after birth. Some of them are on nasal cannulas, and a couple on antibiotics, but that is the extent of the intervention. They have the ability to intubate a baby, but no ventilator to maintain it. So no babies are intubated. The youngest baby I saw there was 36 weeks, but they said that they just discharged a 28 week baby that survived. The entire facility is proud of this, and I can see why. With limited resources it would be terrifying having a 28 week baby born. But it survived!
After rounds in the NICU, where we occasionally suction a baby, or change around antibiotics, we go to outpatient pediatrics. The inpatient pediatrics ward is mostly run by the physician assistant, and the doctor comes when help is requested. We saw a couple of inpatient pediatric kids while I was there. Many are there with malaria, pneumonia, or diarrhea.
Outpatient pediatrics was interesting. I had my hair braided this week at a salon. This definitely threw the kids off. They kept looking quizzically at the abruni (white person) with plaited (braided) hair. A couple were excited to play with me, but most were suspicious, and stayed far away. Most of the outpatient complaints were fever, cough, rash, or diarrhea. Any child with a fever was sent to the lab for malaria testing (which means almost every child was checked for malaria). If malaria testing could not be afforded (which happened a couple times) they just assumed malaria and treated for it.
It was interesting to see how differently the pediatric interviews were done. In the US it is stressed that if the child is old enough to talk, they should tell the story, and the parents could fill in. Here, no matter how old the child, even the 15 year olds, the parents did all the talking, while the child just sat there quietly.
The doctor finished working at 2:00pm everyday. I thought this was because he went to go do something else for the rest of the day, so I asked him what he does after he “closes” (how they say done working here.) He said he goes home and watches Game of Thrones and sleeps and eats! Until bed time when he just sleeps. This made me laugh. He was absolutely floored to hear how long our doctors work.
With that comes a close to this adventure. It has been a lot of fun. Ill do at least one more summary post, so I wont get too sappy now. I did take a lot of “last day of school” pictures today. Ghanaians will never just take one picture. They will always pose for a photo shoot, with several different poses. So I have a collection of last day of school pictures now!

April 16, 2019 : Mortality Conference

April 23rd, 2019 by Galit Rudelson
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Today I attended the neonatal mortality conference, and it was incredibly interesting. For starters, I should set the scene (this actually took a lot more typing than I realized, so if its boring just skip to the 5th paragraph, I don’t blame you). This conference was supposed to occur last week, starting around 10:00am. I was the first one there at 10:00am and people gradually trickled in for the next 45 minutes. Ghanians are very loose with their time, very relaxed about it. Around 11:00 it was realized that one of the main doctors was in an emergency surgery and would not be able to attend for a long while, so it was cancelled and moved to today at 7:30am.
I arrived today at 8:00am, knowing by now that 7:30 does not actually mean 7:30. I came to a room full of new nurses, starting at the hospital this month. They were doing some orientation thing. I waited outside of the door for 30 minutes, wondering if we were going to start after them. Every once in a while a doctor would rush up and ask me “weren’t we supposed to have a meeting today.” I told each one of them that I thought the same thing and was waiting to see if we were starting later. They all said “Ill make some calls” and walked away, so I never heard the result of these calls. Not that I am complaining. This is just the nature of being here. Be flexible and relaxed, adapt to the situation.
Eventually the meeting was moved until “later.” At 10:00am I was told it would start “soon, come now.” Hilariously the meeting did not start until 10:45! This is just a classic example of Ghanian time, happens all the time!
The room itself is on the second floor. All the windows are open (as barely any windows close in Ghana, there is no need, it is always hot enough to keep them open). Downstairs is the generator. The power has been off all day, so the generator has been working. It is incredibly loud. So imagine this meeting, in the heat, everyone sweating, and yelling just to be able to be heard over the generator. Ok that was a long set up.
The meeting was set up to discuss the death of 8 babies, either in utero or shortly after birth. They had a premade packet (which seemed to be used throughout all of Ghana) that asked for the details of the death. It started basic, name of mother, age, how many previous babies has the mother had, gestational age. Then it got into the details of the delivery. Was the patient referred, were baby heart tones heard and monitored. How long was labor. Was a c-section necessary. How long after decision to do a c-section did it occur. Then what were the complications of the pregnancy. What was the cause of death if intrauterine. If shortly after birth, what were the APGARs of the baby, and what interventions were done. At what age did the baby pass away.
All of this information is readily available in the US. The charts can easily be searched through on the computer, and everything can be done in a matter of minutes. Here, everything is paper charts. Things are recorded in many different locations. Some things are not recorded. Our first case took 2 hours to complete.
What was interesting to me is that this was clearly generated to do some sort of research off of it. It was made it what I would think is a very clear and straightforward method. So to me it was interesting to see where all of the confusion was coming from. It showed how difficult it would be to use this information in any sort of research, or to come up with any conclusions from it.
For example, a mother had pre-eclampsia (high blood pressure and some other side effects). A decision was made to take her to c-section. Between decision to go and the actual c-section was 4 hours. During this time the mother refused fetal monitoring (because it hurts. It is not like in the US where they just put a sticker on your belly. Here they press a baby fetoscope onto your abdomen HARD until they can hear. Not comfortable). Once the c-section occurred, the baby had passed away. So on the form there is a section of “cause of death.” There was a long debate: was it “pre-eclapsia” or “fetal distress” (and how can we say its fetal distress if nobody was monitoring the baby), or “placental insufficiency, since that happens in pre eclampsia” (“but we already said that the placenta looked normal on delivery, cant be that”). Or was it “unable to do adequate physical exam” (“no that is not it because it implies we did something wrong, but it was the mother that was refusing.”)
Point being, I can easily see that once the person collecting this data receives this information, he will simply add a tally to “pre-eclampsia” for example, and the rest of the picture is forgotten. Which makes for very inaccurate research. But what can you do?
The same type of thing happened for 5 hours. We got though 4 of the cases. 4 small data points for whoever will be reviewing all of this work. It seemed mind boggling.
I was also interested to see the outcome of this meeting. Everyone was identifying problems, and setting new goals for the maternity ward. The listed the mistakes made in each death, and thought of ways to correct it. Would be interesting to see how these go into effect long term.

April 14, 2019

April 23rd, 2019 by Galit Rudelson
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There was a power outage all night, and into the afternoon today. The lights just came back. Honestly, I am going to miss these power outages a little bit. I think they add adventure to life here. And it’s a fun comraderee for everyone to talk about how the power is off. Equally as fun to hear I quick whoop of excitement every time the lights come back on. Today I was showering when they came back, so I did not notice, as I had no lights on in the shower. But when I came out the fan was on in my room, and it was such a plesant surprise, I was excited.
Yesterday I went to lake Bosamtee (sp?), but I will write about that later. I am getting a little behind in my posts. So first I think I should cover my last week in the hospital.
Last week I worked in females wards. This is the inpatient females section of the hospital. The females have one large room, with about 20 beds in it. The males ward is right next door, also one large room with about 20 beds in it. It makes sense to divide them up, as these are not private rooms by any means. The women sleep there, change, shower, and lay ill in the ward. Therefore it would not make sense to have both males and females in the same room.
I began each day with rounds with the doctor. I arrived around 8:00am, and depending how busy the doctor was with other things that morning (I have no idea what he does in the mornings) we started rounding between 8:00am and 9:30am. The patients had various reasons for being inpatient, but some conditions were more common. Out of control diabetes and hypertension was there often. In Ghana hypertension is much more common than diabetes, which I do not completely understand. Their diet consists of mostly carbs, so logically they should also develop diabetes. Maybe it is the lack of fat and artificial sugar that makes it less common. But hypertension is everywhere. Again, unsure of how to explain this, or if its just as common as the US, just harder to control here. Therefore the secondary health concerns from hypertension and diabetes were common: stroke and DKA for example. In the US when someone comes in with stroke like symptoms they are rushed through a workup, including CT scan of the head, and you know your answer within 30 minutes. Here there is no CT scan on site, so they have to be transferred for scanning, up to several days later. So unfortunately the outcomes are not usually very promising from stroke.
Cellulitis, or infection of the skin, is also very common. The doctor asked me if I knew why it occurred so often. I ventured to guess it was because hygiene is difficult in the heat, and with limited water. Furthermore many of the women are farmers, so it is probably easy to cut yourself in the field and become infected. He said that was a good guess, but doesn’t explain why cellulitis happens much more often in females and not males (as they are farmers too.) He explained to me that many women here use topical steroid creams to help bleach their skin and make it lighter. The effects of this are dangerous: causes hypertension, diabetes, and weak skin. Many of these women have weak skin leading to infections, and hypertension that is so bad they have heart failure by their 40s. Kind of interesting that we go tanning until we have skin cancer, and here they bleach their skin until its falling apart. Nobody is every happy with their looks.
I also saw a couple cases of HIV/AIDS and the complications that arise from that (meningitis mostly). Some chicken pox in adults. This one was actually interesting, because I have had chicken pox, and it used to be so common in the US. But I realized that I have never in my working memory seen chicken pox rashes, and therefore had no idea what I was looking at when I first saw the patient. Vaccines are amazing things. Guess we shall see what this anti-vaccine epidemic does. I saw a patient tested for TB, but decided it was COPD instead. The doctor asked me what I thought, and I realized how unprepared I was to distinguish TB from COPD. I had my educated guesses, from all of my studies, but having never actually seen TB in a patient, I was not confident. Just shows that although we study similar medicine, there are vastly different focuses between the US and tropical medicine.
After finishing rounding I would accompany the doctor to outpatient general consultation for the rest of the day. These patients would arrive to the hospital as early as 6am. They would first go through admission to collect their charts (everything is paper chart). Then they would sit in a general waiting area and wait to be seen by a doctor. We spent between 3 and 15 minutes with each patient, depending on how difficult their complaints were. The doctor saw probably about 100 patients a day. He was exhausted every day, and I was too, despite not doing any real work.
Much of the same conditions we saw inpatient were common outpatient. There was also a lot of gastritis (stomach aches) caused by a bug called H. Pylori. Also lots of muscular-skeletal pain that we could do little about. I also saw 3 people come in with broken hips, which is sad, as even in the US with the best treatment, these are very difficult to deal with. Lots of pelvic inflammatory disease in females as well.
All in all, this was a completely different experience from my OBGYN and ER rotations. I felt that I learned a lot while on this rotation, saw diseases I would rarely see in the US, and in general felt comfortable with the way patients were treated

April 14th, 2019

April 23rd, 2019 by Galit Rudelson
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Double post day. The last one was very long, and this is a different topic, so I figured I would make a new post. Today is a very relaxing day so far, so I have had time to write both posts and catch up on my blogging. It is Sunday, most everyone has gone to church. As the church is in Twi, and I have already attended in other weekends, I decided to spend some time relaxing and on my own for a couple of hours. I took a very nice long walk this morning, exercised, and when the power came back on, treated myself (for the first time while I’ve been here) to a second cup of coffee. Now to write about my trip to the lake yesterday.
The hospital I am working at has a satellite clinic at this lake. Most of the time foreign students go to the clinic for half a day during their stay, and then enjoy the lake the other half of a day. As it is just me here, and not a large group, it was difficult to organize time at the clinic. But everyone was very nice and organized a trip to the lake for me none-the-less.
All of my closer friends went, which was very exciting and relaxing. Rachel, and 3 three children and one of their friends, Dorcas (my roommate), Fred and Mr. Franklin (who live in the mens section of our hostel), and Mr. Franklins friend Monica (whom I had not met before). Oh and the driver. The ride to the lake was a bumpy 3-4 hours in a van. The roads here are occasionally paved, but with many many potholes. Driving is a professional sport, swerving to different sides of the road to avoid potholes, passing cars, slowing down for unavoidable road wide holes, and not hitting pedestrians walking on the road. Truly impressive to watch the drivers. Also truly grateful to not have to drive myself! We passed through towns busy with market and bargaining, women walking down the streets carrying supplies on their heads. We also drove through many country sides, passing people working out in farms. We also passed lots of natural forest, which was beautiful. I sat in the back of the van with the window open the whole way, watching the countryside go by. It was almost as fun getting to the lake as being there.
Once we arrived to the lake we had to pay a fee to get to the water front. Despite the fact that the car was full of 10 Ghanians and myself, the gate guard charged us significantly more because I was in the car. He was not shy to explain that this was exactly why he had increased the prices. I am not sure how much we eventually ended up paying, as everyone in the car was bargaining loudly in Twi, so I heard many numbers being thrown around. But eventually money passed hands, and the door was opened, while Rachel sat grumpily in the car. I got the feeling we were still robbed of a bit of money to get in.
The lake itself was beautiful. Apparently it was all man made. It sits in a valley surrounded by many mountains. Rachel said 28 villages line its shores all the way around. As we arrived a child about the age of 10 ran up and asked if we needed any help. He explained that he is trying to collect money to buy a notebook to write stories in. Rachel gave him odd jobs throughout the day for a couple of dollars. He swepts the ground where we were sitting, helped carry supplies, brought us more water. A couple of his friends milled around us as well.
The first thing we did when we arrived was eat. We had brought food with us. As per usual, I was not able to finish my food. When I had first arrived to Ghana I felt rude not finishing, and would eat until I felt ready to explode, and still did not finish. Eventually it was learned that I simply cannot eat that much, and I was served less. Despite this, I could not finish my food. Rachel passed it off to the boy helping us out, and he and his friend happily split the left overs.
We then rented a boat for 15 minutes to take a ride. As there are not many places to swim, most Ghanians do not know how to swim. So everyone desperately clung to life jackets as we were in the boat, yet excitedly hooted as it started to go fast. It was beautiful on the lake, but almost as exciting to watch how happy everyone was to be there.
We spent the rest of the day swimming in the lake. I did not come prepared, not realizing that we were swimming there (silly mistake). But I was convinced to buy a swimsuit (for one US dollar) from a swimsuit shop there, and join in the fun. The water was incredibly warm. Everyone was very impressed with my swimming ability (again, since most people do not know how to swim). I showed them how to do a couple of handstands in the water, and everyone tried. We had some water fights, and sat by the beach as well. It was a lot of fun, but nobody had more fun than the children. They absolutely love swimming. Poor Rachel is not able to swim, so she kept yelling at her children to get closer to the shore. I understood her anxiety. Being children, they were eager to explore the deep part of the lake. But not being very good swimmers, this was dangerous. And as I was one of the few people there that could swim, it was nerve wrecking to watch them inch deeper, knowing there was nothing she could do for them. But luckily they listened when they were told to go more shallow, and everyone was safe.
It was a great day. I had a lot of fun. And of course the trip back was enjoyable for me as well. I love the scenery here. But this has been a long enough post. I will leave it at that!

April 10th, 2019 : Medical School in Ghana

April 23rd, 2019 by Galit Rudelson
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Title: Medical School In Ghana
Figured I’d give this one a title, since all I plan on talking about is the path to becoming a doctor in Ghana.
First, a quick summary of medical school in the US, for my non-medical friends. After college you go to 4 years of medical school. Traditionally the first 2 years are studying in books, and the next 2 are in the hospital. After that you graduate you go to residency, which can last between 3 and 7 years, depending on the specialty. After residency you either finally start practicing on your own, or choose to specialize even more within your specialty, and do a fellowship for several years.
Now onto Ghana. First of all, this is information I gathered to the best of my ability from talking to many different people. So my fair disclaimer is that I believe it all to be accurate, but I might have misunderstood parts of it.
Primary education (or our equivalent of K-8th) can be found for free. Of course, as can be expected, free education is often times not as good as paid for education. Furthermore, someone has to motivate the children to go to school. In households where both parents leave for work before school (such as farmers, as a majority of the community is), it is up to the children to get motivated enough to go to school. So just imagine convincing a 6 year old to walk to school on their own volition. Rather difficult.
Secondary school (or our equivalent of highschool) is much of the same. But almost all high schools are boarding schools. The children go for 3 terms, and come home between each term, and for a couple of months during the equivalent of “summer vacation.” No matter what school you go to in Ghana, everyone takes the same standardized high school exams. As I talked about in my previous post, I have met a truly impressive man that studied for these exams all on his own, and did very well. But I am assured that they are fairly difficult.
From secondary school future doctors apply right into medical school (none of this college then medical school like in the states). I heard from one person that you must have had the highest grade in all 6 subjects to be considered into medical school. The number of medical schools in the country are in the single digits.
School itself is 7 years. The first 4 are in the books, and the next 3 are clinical. During my time here there were three 6th year students here. Their knowledge level seemed very comparable to where a 3rd year med student would be expected to be in the States. I was also surprised to learn that they use a lot of the same resources, including Sketchy Micro!
Following medical school all graduated doctors become “House Officers” for 3 years. This is a twist on our residency program. The House Officers act as interns would, learning the ropes of the hospital, gaining responsibility as time goes on. But they rotate through all of the different specialties. This means that every House Officer learns how to do a c-section, abdominal surgery, pediatric care, and emergency care, for example. After House Officer my understanding becomes a little murky. They choose the specialty they go into, and I believe they start working under a specialist for a year, and then are on their own. Don’t hold me to that, it was confusing.
What comes out of this system is that no matter what specialty a doctor is in, he is able to be on call at night. He should be able to handle any emergency room patient that comes through, and any obstetrical emergency. They can all step in at any time to perform a c-section for example. The general medicine doctor I worked with today was tired because last night he had to come in to repair a ruptured uterus. To my non-medical friends, only OBGYNs would handle such an emergency, and aside from surgeons, nobody would know the first thing about performing surgery outside of their specialty.
This system also has some interesting consequences. Much of the grunt work is done by House Officers, like much of the grunt work is done by residents in teaching hospitals in the US. But in more rural areas, where any sort of specialist is a rare finding, House Officers maybe the only doctor a patient would be able to see. The doctor I worked with told me about how he managed chemotherapy for an ovarian cancer as a House Officer. He said “I like how Americans do everything because research proves that it helps. Here we try to copy the Americans. But then you end up in situations like that, where someone with no training in ovarian cancer is giving you your chemotherapy. And it becomes much more guesswork than research based.” In that story, his patient had come from 9 hours away to be seen by a doctor.
As interesting as this whole system is, I have made this far too long, so I will stop here for now! Thanks for reading

April 9th, 2019

April 23rd, 2019 by Galit Rudelson
Posted in Uncategorized|

We are currently in the middle of another large storm. This is technically supposed to be the tail end of the dry season, moving into the wet season. That being said, this is probably about my 12th storm since I’ve been here. One of the doctors explained to me that since climate change, there is no longer as clear of a demarcation between the wet season and the dry season. This also means another power outage, since the storm knocked out the power. So I figured might as well write about my previous weekend while we sit in the dark.
This weekend was my touristy weekend. We started by going to the town where Kente was invented. This is a traditional African weaving. The story goes, that two famous hunters years ago went into the forest, and saw an unusual spider. They said they wanted to learn how to weave like the spider. So they watched and learned. The first weaving was black and white. But at some point they started adding dye from the local plants to make brilliant bright colors. The weavers sit and use both their feet and hands to weave. Because they sit for upwards of 12 hours a day, women were traditionally not supposed to weave “because it ruined their hips and made them infertile.” Now, though, if a woman wants to weave, she is welcome to.
The weavings are brilliantly bright, and beautiful. They take 2-4 days to make (depending on how complicated the design is), and they sell for 6 dollars. This made me feel sad, that 4 days of work could go for 6 dollars. But it speaks to how Ghana is developing. They are definitely on the up and up, compared to other African countries. Yet their economy still is fairly week.
After the Kente we drove to Kumasi, the large town about an hour from my village. Specifically we went to the Kumasi mall. This mall is brought up often. Malls are a new concept in the developing Ghana. So they are very exciting, and people enjoy visiting them and talking about them, and showing them to visitors. The mall itself was fairly similar to one we would see in the US. But their child playground are much better. Multiple trampolines, ball pits, fun climbers. It reminded me more of our local Bonkers (but more fun). I also went to a grocery store and was suprirsed to see that most things there cost about how much they would in the US. After buying a fabric made over 4 days for 6 dollars, it was jarring to see a coke bottle being sold for 2 dollars, and chocolate for 3.
We spent the night in Kumasi at Rachel’s fathers house. Her father is the former Bishop of the Ghanian Methodist Church, and currently a pastor. We attended his service the next day. He shared some of his story, and later he and I discussed it together. He had an alcoholic father that was never around. He dropped out of high school to help his mother with funds. Later in life he had to beg on the streets for clothes, food, and money. He realized that he was always considered smart, and knew he was intelligent. He asked his friends who stayed in high school to donate their textbooks to him. He studied on his own, while begging. In Ghana all high school students take the same tests nation-wide. He took these tests and aced them, earning himself a spot at the University. He now has a masters, was the Bishop of the Methodist Church, and has countless accomplishments. During his time as Bishop he organized building a new health clinic, a computer education center, a library, and many other projects. Needless to say, he was a very interesting man to talk to. During our conversation we ate lunch. One of Rachels kids (his grandchild) refused lunch because he did not like what we were having. He pointed this out to me and said “isn’t it interesting what a difference two generations could make? At his age, I never knew when my next meal would be, and would never skip a meal.”
Church itself was fairly similar to what I have experienced in the states. The service I went to was the “chiller” service. The one afterwards had 2 hours of dancing as a part of it! Rachel said that she typically goes to that one, but as the first one is in English and the second one in Twi, she wanted me to attend the English one.
One last comment. Story telling is very big here (as the illiteracy rate is fairly high, story telling is the replacement to reading bedtime stories). Rachels three children constant asked me for stories. I had the brilliant idea to tell them about Harry Potter. My reasoning was that I knew those books by heart, so I would not have to make anything up, and I had an endless supply of stories, so it would last my whole time. This weekend my plan backfired. The children found out there are 7 books, and we were only midway through the 2nd. Therefore they wanted constant story time, to make sure we finished all 7 books by the time I left! They are funny, but I never thought that talking about Harry Potter would get exhausting!

April 7th, 2019

April 23rd, 2019 by Galit Rudelson
Posted in Uncategorized|

It is Sunday, and I have had a very long and fun weekend. But unfortunately I got lazy this week and did not write about my time in the hospital. So I will write today about the hospital, and tomorrow about the weekend.
As I wrote last, on Monday I was in the operating room, aka the “Theater.” The rest of the week I spent in the Emergency Department. This was a big adjustment for me. When I worked at the outpatient pregnancy I learned a lot, and was curious to see the differences from how we did things. But the differences were subtle, and in the end made a minimal difference on patient care. The ER is a different story. It is run significantly differently from what I am used to, so I had an interesting time adapting to it.
Let me be clear, a true, life threatening emergency is treated the same way. Lots of people rush over, vitals are taken, labs are drawn, a story is pieced together from any family or witnesses. The differences are in the non-life threatening emergencies. As many of you know either from medicine or from personal experience, the goal of the ER in America is to get you stabilized and out as quickly as possible. If you need further medical attention you get admitted and moved into the hospital. If you do not need medical attention, you are patched up and sent home. Here that is not the case. The ER is treated almost as a mini inpatient extension of the hospital. Patients who need more tests done, wait for the tests in the ER. If you need to monitor someone for a couple of days, they also stay in the ER. I was surprised to come back day after day to find the same patients in the beds. But that is just how it is done here. It makes more sense to redistribute the work load, instead of throw it all to the medicine doctors. Although to be frank, I am not sure when things end up in the medicine wards then. Im headed there tomorrow, so Ill update after.
Also, I should mention the general flow of the ER. Once a patient arrives, the nurses do the initial assessment, and call a clinician to let them know there is a patient. The patient can be staffed with a physician assistant, deemed stable, then wait for the physician to assess again later. The physician arrives around 10am every morning and does rounds. So this means that we had a patient come in with a dislocated shoulder, and sit with her shoulder dislocated throughout the night, until the physician came. Basically if you are not actively dying, you may have to wait to see the physician for over 12 hours. And afterwards you may stay there for a couple of days for observation. This seems like Im talking negatively about their system. This is not the case. They are making do with what resources they have. There are only 2 ER physicians for the entire region. Therefore it is not possible for the ER to be staffed 24/7 by a physician that is trained to handle any incoming case.
What was the most shocking to me though, was who cares for the patients. We are all used to the nurses taking care of us when we are sick. If we cannot go to the bathroom, the nurses help. If we need help changing clothes, we expect the nurses to help. This is VERY different from the expectations here. Here it is expected for the family to do everything. To change the patient, to bathe them, to help them to the bathroom, to change diapers if necessary for the elderly. Everything must be done by the family. If a patient needs to be repositioned every 2 hours to avoid bed sores, this is communicated to the family members! Again, it seems that I am talking negatively about the system. But in reality this frees up the nurses time to do all the initial evaluations on the patients, and other things that are handled by physicians in the United States. Making do with limited resources.
Of course, there are times when family members cannot always be present. In these cases the situation became a little dicey a couple of times. I have felt vaguely at ease throughout the culture differences, but this is one time I have felt uncomfortable. I have felt the need to do some of the “family responsibilities” and have in fact done some while family was not around. I still am not sure if I overstepped boundaries. But in my opinion we are all humans, and deserve to be treated that way. So if I have the time and ability to step in and help, I will do so.
All in all, the ER was a huge learning experience for me. This week I am moving onto the general inpatient wards, and looking forward to it!

April 1st, 2019 : In the OR

April 23rd, 2019 by Galit Rudelson
Posted in Uncategorized|

This one is for my medical friends! Non medical friends, feel free to read, but be warned it might get a bit outside of your comfort or interest zone.
Today I spent the full day in the operating room. It blew my mind on how simultaneously similar and different the experience was. Like the US, there is an emphasis on sterility in the OR (called the “operating theater” here). But the emphasis is much different than the US. To get into the Theater, you must walk through a common area, where everyone eats their food and relaxes between cases. There is a door leading out of this to the operating rooms, but it usually kept open. Within the same hallway is the bathroom, whos door can often times be open, meaning there are open doors ranging from where people eat, to the bathroom, to the operating room! And the scrubbing station is the same place that people wash their hands after using the bathroom.
The room itself is fairly similar to the US’s operating rooms, so I wont bore you with the details. There is a table for the patient, anesthesia stands at the head. Theres a scrub nurse (who’s also first assist) and a circulating nurse. The doctor explained that in bigger cities there is enough staff to have a first assist, a scrub nurse, and a circulating nurse. But here, rurally, they adapt.
I was surprised to see that the patient buys all of their own sanitary plastic for the bed (what they lay on) from the market across the street, and brings it themselves. On second thought though, although we do not buy these supplies from the market across the street, we still pay for it in our final bill. So I guess its not that different.
The patient climbs onto the bed themselves, and then are given spinal anesthesia, so they are awake throughout the case! The first case went very long, so they ended up having to convert to general for pain. But the last case the patient clearly was in pain towards the end, but did not complain to the anesthesiologist, so they did not convert to general.
A couple of interesting things that happened/ I noticed during surgery. First, they do not have unlimited packs of sterile water, like our hospital. So water from the tap is put into a water boiler (exactly like the one I have in my house), boiled, and then poured onto the sterile field into a bucket. Bloody lap pads are then dipped into it to rinse off. If sterile water needs to go directly into the body, then they open up a pack of room temperature water.
Second, the operating room is very hot. I would estimate the low 80s. The doctor is sweating through the whole case (rightfully so), but dropplets of sweat are dropping onto the patient! He stopped operating several times, and asked the circulating nurse to wipe sweat off of his face.
Third: the power. Now side story for a second. I happened to be in a room today that had the news on. They were discussing the frequent power outages going on right now. Turns out, they were fairly rare for the last two years. Only in the last 2 weeks have they become so common. The news explained that the energy comes from Nigeria, and is currently barely flowing in our direction, but they are working hard to fix it. Ok so back to the operating room. When the power goes off, there is a backup generator, but it does not kick in automatically. That means that we are left standing in semidarkness (there are closed windows in the operating room, but they are tinted so nobody from the outside can see in). Somebody runs to the generator to turn it on. But in the mean time, everyone takes out their phones, turns on their lights, and crowds around the table with their lights on, so the surgeon can see. He does not keep operating, but it helps him make sure everything is safe while we wait for the generator. The power came on and off 3 times throughout the first surgery. So we stood in darkness 3 times. Mind you, the patient is awake throughout all of this! In the background you could hear a rooster. A very different OR experience from the states.
And the surgeries done there are much different. Today was a “simple myomectomy.” This was the largest uterus I have ever seen, with so many fibroids. But the doctor explained to me that women will try everything before they will consent for surgery. Natural home remedies, prayer, herbs. Meanwhile the fibroids grow and grow. If this case was in the states, I doubt anyone aside from a Gyn-oncologist would try it. But here the junior house officers (that have been operating for 4 months) feel comfortable doing the surgery (with assistance of a senior OBGYN). They said that it is just so common that people let their conditions go. In fact, our first case was so large, they had to convert to hysterectomy. They consented the patient for it right in the middle of the surgery (since she was awake). Why not consent her before? Because she would not go for it! Cut the problem out, don’t cut the uterus out! They explained to me that some women believe that terrible things happen when you lose your uterus, to the point that they might even melt! The second case we cut out so many fibroids the uterus looked like a shredded rag. But the doctor was able to stitch it back together to resemble a uterus with apparent ease. Incredible.
All in all, they are able to do all of the same surgeries we are able to do. They try to maintain the same level of sterility, but it is difficult with the resources. And they work under some difficult circumstance, that are just every day occurrences here. I was very impressed.

March 31, 2019

April 23rd, 2019 by Galit Rudelson
Posted in Uncategorized|

Just wrapped up my first weekend in Ghana, and I am EXHAUSTED. It was a blur of interesting and fun experiences.
Friday morning I went to the OBGYN outpatient clinic as usual. We had a lot more patients than any other day. But I was finally in my comfort zone. I breezed through the vitals quickly. I was able to read off the patient names, and although they still laugh when I try to say their names, they at least understand who I am calling. I was able to small talk my way through vitals (and by small I mean SMALL, “Goodmorning”, How are you”, “I am fine”, “Where do you come from.”) Dorcas has been teaching me small talk phrases. Everyday in the middle of outpatient clinic, everything stops, and someone does a talk to the women about some topic. This weeks topic was personal hygiene. I don’t really know what they were saying throughout most of it, and the clinic took off at full speed afterwards, so I was never able to ask for a translation. But I was impressed with the apt attention everyone listened with, and the number of questions people asked. They seemed to be learning a lot.
On Saturday I had a jam packed day, as promised. First we went to a wedding. Rachel picked me up a little past 10:30, with her youngest child, Owua, in tow. Rachel was dressed beautifully, and seemed very pleased when I marveled at her dress and newly braided hair. We drove a couple minutes to the church. We were one of the first there for an 11:00am start time. The church was nicely decorated with clothes hanging on the celling, and Christmas lights blinking at the front. The groom (dressed in white), sat at the front under a white awning. There was live music playing, and ppl mingling in. The ceremony was filled with lots of singing, live music, and prayer. It was mostly in Twi, so I couldn’t not understand. But a portion about what made a good wife and husband was in English. I enjoyed listening to the reverend discuss positive qualities about both the husband and the wife. Not much segregation of sexes. Both had to be “reasonable people” and “know how to be respectful in society.” Near the end there was a procession to donate to the church. Loud music started playing, and everyone got up and danced in a line around the church, to the front, to drop a Ghanian Cedis (about 20 cents) into the bucket at front. This then transformed into a giant dance party. People were happily jumping up and down, spinning, and the music was blaring. I was pulled out to dance as well (which usually is my nightmare). But this dancing was so fun and easy (just jumping up and down excitedly). Of course, when the only Abruni (white person) in the village is dancing, everyone wants a video. So instantly every phone was directed me (with the flash on, because Ghanian skin is so dark, it is difficult to get good quality images without flash). I was very literally my nightmare come true, but for some reason I was very relaxed and had fun the whole time. Afterwards a large “Mr. and Mrs.” Wedding cake was brought out, and the couple ate the first piece, and the rest was shared with everyone else.
From there we stopped by Rachel’s home, and changed into our funeral clothes. I wore black pants and a black shirt. Rachel wore a nice maroon and black dress. She told me that when someone passes away, you have a one week celebration the next week. Then months later (even up to half a year later) you have the actual funeral. On Friday is the vigil, where people sit with the body throughout the night. On Saturday is the paying of respect, where everyone dresses in red and black. You go through a line of people sitting in chairs and shake their hands. Then you sit down in chairs. The people coming after you down the line then shake your hands as well. We sit there for about 5-10 minutes, then leave! The whole time I was sitting there I thought we were waiting for the funeral to start. But it turns out I was at it. Then on Sunday people wear black and white, and there is the burial ceremony and church service (which I did not attend).
Finally, in the evening we attend a party. For certain University degrees (such as nursing) you are required to do a year of service to Ghana (usually in your field). This weekend was the end of the yearlong nursing rotation that was at the hospital. So they threw a large party to celebrate. This was held in a hotel about an hour away. I was nervous to go because I have so much anxiety associated with dancing. Rachel said she would come get me at 7pm, since that is when the party starts. She arrived around 8 and we arrived to the party at 9. They said they were not ready, so Rachel and I sat in the car and talked for over an hour. She commented that “everything in Ghana runs on Ghana time, that if you say you are meeting at 8, you maybe waiting there for 2 hours for the person to come.” Then she offhandedly commented “you Americans are always on time. You are very strict with time.”
The party was a typical party. There was alcohol flowing everywhere. People were dancing (but I must say, much better than the dancing I see in our bars in America). But there was a couple added bonuses. Firstly: the music was not too loud, so your ears did not ring afterwards (and the music was fantastic, very upbeat, great for dancing). Second, nobody dragged me out on the dancefloor to dance. I was invited several times, but when I declined, nobody dragged me, which I was beyond appreciative of. It was much more enjoyable to be able to watch amazing dancers and relax. And lastly, there was A LOT of food everywhere, and people were sharing it. It was such a great atmosphere. We ended up getting home around 1am. At the end of the night Rachel said she would come by in the “late morning, around 8am” with her children the next day!
Although this is just Saturday, I feel that this was the best part of the weekend, and this post has been much too long already. Sunday was spent playing with the kids all day, although fun, does not make for great story time. So I will end today here.
Next week I am expecting to do one day in the operating room with the OBGYN, and then the rest of the week in the emergency department.

March 28, 2019

April 23rd, 2019 by Galit Rudelson
Posted in Uncategorized|

It has been a couple of days, so I will just tell a couple of stories from the days. I am currently writing during a storm. The thunder is constantly, quietly rolling in the background, and with each flash of lightning the lights dim for a second. There are a lot of power outages here. Today the outage lasted about 5 hours. It started while in the hospital. I did not realize how much of a difference the fans make. I never even feel them blowing, but when the power goes off, it instantly becomes significantly hotter. I find it interesting that despite the fact that this has happened all but one day that I have been here, the local Ghanians all complain about the heat. I would have thought that this is normal, but they all said that there has lately been a drastic increase in blackouts. For me, I think it is part of the experience, and vaguely enjoy them. Makes it seem like a bit of comradery.
We had a patient who needed a D&C (for miscarriage). The entire procedure was done in a room with no fan on and two windows open for the heat. It is an interesting experience to be doing a procedure, and hearing a rooster outside. For the procedure we wore aprons that kind of look like thick cooking aprons. We took our shoes off and put on rain boots. The bed the patient lays on is covered by a plastic sheet, which the patient is responsible for buying herself at the market across the street, and placing onto the bed herself. The entire procedure is done without anesthesia! Our patient was yelling (in Twi) “Im dying, Im dying” and the doctor asked her “How old are you, you are embarrassing yourself.”
This links with my point in last post, about how different patients are treated here. In the US I am used to us guiding patients through experiences with a soft hand and shoulder to cry on. Here everything is spoken plainly, as if encouraging an athlete to be tough. One patient had bleeding at 39 weeks pregnant, and did not come to the hospital, and her baby died. The doctor informed her that it is her fault her baby died. That she was counseled on when to come to the hospital, and she did not listen, and the outcome is a dead baby. I was surprised to hear this! And what was more surprising, the patient nodded solemnly, that she understood. This is just a natural interaction between doctors and patients.
I have made 3 new friends! They are Ghanian Medical Students, from nearby town of Kumasi. They are on their 5th of 6 years of training, doing their community research projects. I went over to their house today. They were just as curious about life as an American medical student, as I was about Ghanian medical school. I will probably write more about them as I get to now them better.
I should head to sleep, as it is 9:30pm, and the roosters start calling at 5:00am. Tomorrow is Friday, so I will get to sleep in soon! This weekend I am going to a wedding, funeral, and party all in one day. Dorcas and Rachael helped me pick out outfits for each. Then the next day we are going to church (also picked out an outfit). Very excited, although a little nervous for the party.