Akim Oda Government Hospital ( Elective Ghana ),
Clinical interest: General medicine
Why Ghana and OGH?
My choice of elective location was made with several considerations; I wanted to go somewhere different from home, outside of the developed world and in a resource-restricted culture. I needed to choose an affordable, safe, English-speaking country, with little chance of natural disasters. These criteria narrowed it down quite a lot, so we chose Ghana because of the welcoming reputation of ‘Africa for beginners’.
Next step: decide on a hospital. A quick search of The Elective Network and Google revealed that most of the placements in Ghana are best organised through Elective Ghana. My university strongly discourage going through any sort of company, but I thought Elective Ghana were fantastic. For a very reasonable price (180 American dollars) they liaised with the hospital on my behalf, picked me up from the airport, organised accommodation in the capital for the first three nights and gave me a tour round on my first weekend, took me from Accra to Oda, sorted out my visa renewal, and were just generally on the other end of the phone to help with any problems throughout the eight weeks.
I organised my elective around 15 months in advance, but this was far earlier than necessary. A visa for Ghana is ordered from the embassy in your local country, around 6 weeks (although double check this) in advance of your travel date. Other than that, I had no real planning to do because Elective Ghana did all the liaison with the hospital.
I have two top tips for travelling: buy a guidebook and ask for local advice. Ghana was filled with tourist attractions, some of which were amazing and some very underwhelming. Travel was cheap, but challenging and exhausting, meaning it is important to pick your location of study with the aim of reducing travel distances. Ho and Wli waterfalls was a fantastic weekend (although check the weather before travelling as it floods easily), as were Kumasi and Cape Coast/Elmina/Kakum. These were packed with culture and impressive sights. Other locations were more westernised and nice for some home comforts, for example Kokrobite and Accra, and Aburi and Keta were lovely, peaceful resorts. If feeling adventurous, you could even head up North for safari.
Travel is mainly by tro tro (local buses), there are no timetables or listings, but people will happily point you towards a stop and help you find the right bus. They depart when full (anything from 10 minutes to 3 hours!), and travel at night is strongly discouraged, so I would leave a whole afternoon to travel. You definitely want to avoid arriving somewhere new in the dark. I would advise carrying a little bit of cash (ATMs not the most reliable), although you can easily pick up food on the streets and at the bus stations.
The biggest challenge for me, having never really left Europe before, was the culture shock. You need to keep an open mind and expect to be treated differently as an Obruni (white person). It’s unavoidable to attract attention wherever you go, but mostly people were friendly and are really happy to help. Also expect to be charged more for being foreign, generally this isn’t much and you just need to accept it, but be careful and always bargain with taxis!
The clubs were so much fun, music and dance were so deeply embedded in the Ghanaian culture. I’d also make the most of the opportunity to get some dresses or a shirt made, a perfect momentum for your time away.
At the Hospital
I spent 8 weeks at Akim Oda Government Hospital (OGH), half in general medicine and half in obstetrics and gynaecology. Luckily there was a final year Dutch student staying at the same time as me – I perhaps wouldn’t recommend being the only foreign student, as we were given a lot of responsibility, and the culture difference was very overwhelming to begin with.
OGH is responsible for the health of 200,000 people in the Eastern Region of Ghana. The medical team consists of 5 doctors and 6/7 PAs, who together manage 4 wards (children’s, women’s, men’s and maternity), a theatre, casualty, drop-in clinic (like general practice) and specialist clinic! The medicine was a huge contrast from the UK, with presentations ranging from CHD, type II diabetes and arthritis, to malaria, snake bites and raging infections. Investigations were limited to bedside (BP, O2 sats, temp, RR, HR), bloods (Hb, platelets, urea, creatinine, HIV, Hep B/C and malaria screens, and occasionally LFTs and WBC), X Ray, ultrasound and ECG. However, limited equipment meant that although these were available, it was often a few days wait for anything other than urgent. This meant that you relied much more on history (challenging when you don’t speak the local language!), examination, and a lot of instinct.
I found that there being fewer doctors meant I got a lot more stuck-in than at home. We clerked in at casualty, ran clinics, made notes and had teaching on ward round, took care of ward jobs in the afternoon, observed and assisted in theatre, presented at meetings and taught younger students. The learning curve was immense. However, the huge quantity of work meant long days. It was often an emotional rollercoaster. Frustration also played a huge part, witnessing deaths which would have been entirely preventable at home. Although I struggled at times, I made friends for life and the lessons learnt were invaluable. The team welcomed us in and made us feel part of their family.
My skills have improved immensely, especially in terms of managing expectations of my performance, and dealing with acute scenarios. This is something students in the UK are almost never exposed to, and so has prepared me well for foundation years. On the flipside of this, I would recommend seriously considering your own limitations before taking on an elective at a rural, resource-restricted setting. You must be strong enough to say ‘no, this is outside my competency’, balancing what is necessary, and how you can help, with the potential to do harm by taking risks you wouldn’t at home.
I hope I’ve convinced you by now, but despite the ups and downs, my time in Ghana and OGH was an absolute rollercoaster of a summer which I’d recommend to anyone. The friendly, welcoming culture meant we made so many friends, and there was always people to help when things got a bit tougher at the hospital. I hope you all have an amazing elective!
Kakum National Park
Market in Akim Oda
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