Hello everyone! I have thoroughly enjoyed my first week in Cape Coast and my third week in Ghana. Since I last wrote, I spent all of last week in the Pediatric department, except on Friday, when I worked in the Emergency Department. I have seen children with various conditions, like type I diabetes, bronchopneumonia, cerebral palsy, among others. The pace in Cape Coast is quite different than that of Accra, but I am enjoying more teaching and time spent with house officers and medical students. I also met some others from other NGO organizations that are volunteering in the hospital, and we ended up all going to Kakum this weekend, which I will discuss later.
On Tuesday, there was a morning talk about the management of preterm and low birth-weight infants. It was very interesting to get this lecture and then later in the week a lecture on the morbidity and mortality in the NICU. It is crucial to review those cases and reflect upon management to see if there is anything to improve upon in the future. Of note, there is a rate of 14.5% preterm births in Ghana in 2012, versus a 10% rate in the United States for comparison. Of the 111,500 preterm births in Ghana, the mortality rate was 7800. Often, in low-income countries, those born at 32 weeks or earlier often die, whereas they survive in more developed countries. The two themes that stuck out in prevention of mortality and management of very ill neonates is the need for infection control, including cord care, as well as close preterm follow up.
On Wednesday, I spent time going over the High Dependency Unit charts and then got a tour of the NICU with Dr. Bukarie. It was very interesting and eye-opening to see how they treat tiny babies without ventilator support or CPAP. They have the machines, but lack compressed air and continuous oxygen built into the walls, therefore, they treat the children with oxygen by nasal cannula. Also, there are 3 working incubators and otherwise used a heat lamp. We discussed how there might be potential with this sleeping bag looking device that is like an incubator. I am going to look into it further and see if I can get some donated or funded for Cape Coast’s teaching hospital. It is the simple things that make a huge difference in the outcome of neonates, especially preventing hypothermia in premature infants. I also have spare glucometers from diabetes camp this summer, so I will make sure at least two meters and strips go to Cape Coast and two to the Malnutrition ward at Princess Marie Louise in Accra.
On Thursday, I worked with Dr. Bukarie in the HIV clinic following rounds, which was very interesting to me. I have not yet had a chance to really see children with HIV in the US, let alone manage or treat them on any of my rotations. I realized that I need to learn the WHO staging of HIV and management. In addition, the psychosocial concerns would take a completely new blog post to write about (perhaps I will!).
After clinic, I went to the Cape Coast Castle guided tour, which is where the slave trade at its height, captured and tortured millions of Africans who were forcefully sent as slaves to the Americas. It was an intense experience to see and stand in the very place where so many perished even before leaving Cape Coast. It was also interesting to learn about the history of European competition for Cape Coast, which was first discovered by the Portuguese, but was later captured by various countries, including Sweden, Denmark, England, to name a few. It was chilling and remarkably uncomfortable to experience the history during the tour.
Friday, I spent the day in the Emergency Department, where I tested my diagnosis and management after doing physical examinations on the patients with the house officer. It was a good experience to be able to discuss patients we saw and what we think they may have, as well as what we will do next for diagnosis and management. I went out later that night with other students from the hospital and we socialized and got to know each other.
A group of five of us went to Kakum National Park on Saturday afternoon to stay in the treehouse and then do a 4:30 am nature walk. Before we arrived, we stopped off to see crocodiles and to see a monkey retreat, which was an interesting experience.
We later did a canopy walk on Sunday, which is a series of suspended bridges 1 plank wide often times 40 meters above the forest. I am afraid of heights, so it was a scary experience to say the least. The views were incredible, and I did end up enjoying myself, but did have some moments of intense panic 😉
Today, I started in Internal Medicine, where I rounded with one of the teams and then got a lecture on reading ECGs. It was great to have a review and to get certain topics covered that have confused me for a while now. This afternoon, I have another class in Family Medicine and then have a meeting at 5 pm with the Feb Foundation, a local NGO that works to improve health in the Cape Coast region.
I am at the hospital now, and must go to my meetings! I hope you enjoyed this post 🙂 Only 6 days left here in Ghana!