|  | | | | | | Dr Almas Rehman spent her elective at The Korle Bu Hospital, Accra in Ghana and Al-Mowassat Hospital, Damascus in Syria between January and March 2002. Here is an edited version of her memorable trip.
We arrived very late at night, yet Accra was lovely and warm. For someone who was really dressed for the English winter that we had left behind, it was a little too warm! Our first day in Ghana was thankfully nice and relaxing, just getting used to the heat (mid 30’s) and the humidity which was the real problem.
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| "... the odd chicken and goat ambling around the grounds" | | |||||
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Korle Bu Hospital was like a small village. It had many different departmental buildings spread over a vast area with hordes of people everywhere. There was also the odd chicken and goat ambling around the grounds!
It is the largest hospital in the whole of Ghana and so patients come from all over the country. Although it is a government run hospital the patients have to pay for their treatment. They do however have funds available on the wards for patients who really cannot afford anything. This small amount is provided by the government and supplements any donations made from staff and the public. It was very touching to see the doctors having a whip round during ward rounds, particularly as some doctors told me that their salaries are quite low.
The doctors in Ghana are all very good clinicians - careful about taking a history and eliciting clinical signs during examinations.
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| "Rags hung in-between the beds as curtains" | | |||||
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The Medical Block was very old and the wards were merely metal beds with mattresses on them. Rags hung in-between the beds as curtains. These curtains were pulled across when doing internal examinations otherwise there were ignored. Hygiene and the concept of sterile procedures varied, although they were very good about using gloves.
It seemed to me that privacy and the patient’s autonomy were not really present. The patients were not enlightened to know or care about such things. They really believed that they had no right to question what was happening with their treatment and that the doctors would take care of everything. They had the utmost belief in their doctors and respected them a great deal. There was also an obvious hierarchy in the medical profession, with the nurses being very submissive to the doctors and the junior doctors being very submissive/respectful to the consultants and professors. It reminded me of the stereotype of the old British medical system.
The patients commonly arrived at the hospital with gross pathology of advanced disease. I was told that this was because religion was very important to them and that some try to cure the illness with the “power of prayer”. If this does not work then they go to see a herbalist. Post mortems are carried out routinely on the patients to find the cause of death, with those occurring within 24 hours of admission being referred to the Coroner.
They have many patients in either near comatose or comatose states and because facilities are very limited they are dealt with on the normal medical wards, as there is no real intensive care unit. There were also a few patients that had to be physically restrained as they were a danger to themselves and others due to their confusion. However, the nursing staff tried their best to take care of such patients and they do a good job.
There are other departments in the hospital, which looked like they had been transported from a big London teaching hospital. One example of those was the National Centre for Cardiothoracic Medicine. It is a beautiful place; air conditioning, sparkling floors, sharps boxes, oxygen tanks, ECG and ECHO machines and their own CT scanner. The whole place has been privately funded. One of the maternity wards was also privately funded and it is a great example of how a ward should look - safe and clean.
The medical and surgical emergency unit (MSE) was just a little more primitive. It was hot, noisy and generally chaotic. There is just one side room where you can have a little respite from the noise and privacy when seeing a female patient but it was rarely used. The place was heaving with people and the wards quieter in comparison.
I was just amazed at how well the medical staff coped and did such a fine job of treating their patients. The junior doctors take huge responsibility for the care of their patients and the working hours are quite different to the UK. The doctors have to see their patients every day, including the weekend. Their hours are from 8m-5pm and they also return in the evening to check on their patients. They have on-call duties every 4 days for 24 hours and they work the day after their on-call. It is a pretty intensive schedule.
The ingrained belief that prayer and the herbalist are more useful than modern medicine limits the doctors from helping significantly in many cases and the lack of modern facilities and money is very restricting but they are ever optimistic that things can change and they do their best to help. I shall be forever amazed at their doing so well.
As students we were very lucky, as their own medical students had just had their exams so we were the only ones around. We attended all the ward rounds, on calls and clinics for any of the specialities that we thought were useful, eg General Medicine, Dermatology and Neurology. We were allowed a great deal of hands-on experience, especially in the MSE - history taking, examinations, taking bloods, etc. The clinical signs that we were able to elicit were useful. Many of the patients on the wards had suffered strokes and a lot of young people were in heart failure due to cardiomyopathy. Similarly, there were a large number of patients with hepatocellular carcinoma (thought to be usually alcohol related), TB, meningitis and many people in Ghana suffer from hyperthyroidism.
And then on to Syria
My trip to Syria was very different. The population receives free healthcare and education. Everything is free and patients are able to have their conditions managed essentially without restrictions. The hospital was well stocked and very busy as it was the only big hospital with an emergency department in the area. It felt like there was little difference between the UK system and the Syrian system, except everything there was a little older. I was working in the orthopaedics and burns units with the usual case-mix of fractures, joint replacements, bone tumours, etc.
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| "They learn all their medicine in Arabic" | | |||||
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The Syrian medical system has been modelled on the UK system. They learn all their medicine in Arabic, unlike all of the other Arab speaking nations, which learn it in English. Many of the doctors complained to me that it made it very difficult for them to travel to any other country to study and work. It also made it very difficult for me, because the Arabic I know does not contain many medical vocabularies, so sign language was resorted to on many occasions!
Junior doctors in Syria are exposed to and have to have to deal independently with a great deal more than their British counterparts. Interestingly, patient discontent or litigation seemed not to be a major issue in Syria!
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