Part 8: Last week

As this is our last week in Ghana we did some more travelling and relaxing. We spent our penultimate weekend in Accra, where we went to the Arts Centre and some different restaurants.

The Arts Centre is an indoor market with rows and rows of small stalls. Many are pretty much identical. After what I had heard, I had expected it to be very loud with people shouting at us and telling us to buy things etc, but it was much more calm. Some sellers were pushy but used phrases like “please support me”, “just buy something small”, “prices are small, small” to try and get us to buy things. It felt a lot nicer than being at the trotro station for example.

We went to Zen Garden in the evening for food, which was nice. It had some live music for entertainment after 9pm which was very loud but enjoyable. I don’t think I knew any of the songs despite a lot being in english but the locals did – lots of them were dancing and singing at their tables.

We went to Pinnocios the following day which is recommended for its ice cream. It was nice.

We travelled to the north of Ghana on Monday. We took a flight from Accra to Tamale and then were picked up and taken to Mole national park (pronounced mole-ay). We did many tours here to see some animals. We emded up seeing:

• Antelope – “kop”
• Babboons
• Warthogs
• Crocodiles
• Mongoose
• Janet cat
• Patas monkeys
• Guinea fowl
• Elephants

plus many birds and insects (the flies were a nightmare!)

After being in Mole, we travelled back to Accra and had a couple of relaxed days. We went out for some more meals and got ready for our flight back to the UK.

For some reason this last photo is sideways haha. I can’t change it and now have to leave to get ready for the flight!

Part 7: Week 5-7

We wanted to try some community health this week and had been placed at the Health Centre down the road. This is a primary care centre so similar to GP. We spent some time in the family planning clinic and some in the child welfare clinic. They do have a small room for deliveries and a pharmacy but that seems to be it.

The family planning clinic gets many women coming for contraception. It is similar to the UK except the room has space for 3 nurses and a couple patients at once.

The child welfare clinic is a clinic which mainly does vaccinations. The vaccination schedule for children is similar here except they get yellow fever too and some of the timings are slightly different. They also don’t give mumps as part of the MMR vaccine (measles, mumps, rubella).

After the days spent here I became unwell and ended up in hospital. I missed our weekend trip to Cape Coast but recovered fairly quickly over a few days.

The following week I spent one morning in labour ward but nothing new apart from that. The labour ward is small with 6 beds. They had only one patient while I was there and in the 15 minutes we’d stepped out the room she had given birth. (Despite only being 6-7cm dilated at the time)

We spent the weekend of week 6 back at Kokrobite for a relaxed weekend. We got to see the Saturday night reggae event that they do weekly. The starting hour was more circus-vibes than reggae but it was really impressive with men juggling and standing on top of each other – At one point there were three levels of people with the top gentleman doing a handstand with his hands on 2 peoples heads.

We also tried food elsewhere and had some lovely food at a place down the road owned by some Italians. The pizza was almost normal and definitely the best so far. The other food we tried was across the road but this was very spicy.

The following week has been spent on labour ward and in theatre. It has been more relaxed with sorting out our sign-offs.

We also got some dresses made from some Ghanaian fabric. The fabric cost 60 GHS and the dresses 250 GHS each (in total it was about £20). Below is a quick photo we took as we were all really too hot and sweaty to be trying on dresses.

Part 6: Week 4

We went to the male ward this week. This ward seemed to have much sicker patients than we’d seen previously. Example diagnoses were hernias due/post operation, heart failure, chronic liver failure, tuberculosis, meningitis and sepsis.

We saw more how patient care was limited due to finances and limited resources. One patient needed a CT scan for their head but unfortunately relatives couldn’t afford the 750 Ghanaian cedis it would cost (£51.50 at todays rate), so treatment commenced without it.

We also saw many patients with low GCS scores – GCS around 3-4 – who were still on nasal oxygen and the priority seemed to be putting in an NG tube. (For the non-medical: patients were very unwell with low conscious levels and the priority of management seemed to be their nutrition rather than their breathing). This seemed to be partly related to costs but we were told oxygen face masks (the next step up from oxygen through the nose) were, at the moment, only available outside the hospital. In the UK patients with a GCS score below 8 are meant to be intubated and ventilated (their breathing done for them as they can’t control their airway) and the hospital does have an ICU here but I think the cost again is too high for relatives.

There also seemed to be some slow recognition of deterioration especially with regards to sepsis that we didn’t see in the female ward.

We also had many powercuts this week – every night we stayed in Nsawam. This was because of the storms. Sometimes when it rains it doesn’t cut the power but in a storm it always does. Sometimes this means our power (including most importantly our air conditioning!) is off until 6am even if it is a 5 minute storm.

We also had some coconut this week. I had some in Costa Rica and it was nicer over there. The coconut water tasted the same, but the inside was more bland than I remember (not that it had much flavour anyway).

Friday:

We woke up early to start travelling as we knew it was going to be a long day. The day before our administrator told us he wanted our house keys while we were away and this added another hour to the journey. (He wasn’t even at the hospital to recieve them despite saying he would be)

Our journey:

• Walk to hospital to drop keys 7:20am
• Left Nsawam 8am
• Nsawam to Accra circle
• Accra circle to Accra
• Accra to HoHoe (7 hours) arrived 18:00

We were exhausted by the time we got to Waterfall Lodge and covered in so much dust from the roads coming in through the trotro windows. Luckily we had ordered our dinner before we arrived so it was ready when we got there. The food was nice but more expensive here.

Our room had 2 fans and all of us together. It was nice. The bedroom was circular and had a double bed plus 2 singles. The bathroom was the cleanest we’d seen so far.

Saturday:

We had breakfast at 7am and I had some “oats with milk” as the other options contained egg. I had been having porridge last week for breakfast and was fairly sure this would be fine, but it was definitely more milk with oats.

We had ordered sandwiches to take with us. They didn’t have many options and I didn’t enjoy eating the sandwich I had on the hike.

We went to do the Wli waterfall hike. There are 3 different hikes that were available; the lower falls (easiest), loop to see upper and lower falls (steapest) and the Togo loop through Togo to see the upper and lower falls (longest). We did the latter.

In total the hike took us 7hours (8am until 3pm). It was long and tiresome and difficult. Most parts were steep and going up had little shade. I don’t think I have ever been as sweaty as I was then (and I do get incredibly sweaty day to day here).

The views however were stunning, the waterfalls were lovely and it is fun to say I have technically been to Togo as well. That said they only just make up for exhaustion.

For dinner we went to Miranda’s restaurant instead and that was lovely. We all really enjoyed the food and decided to come back for breakfast tomorrow.

Sunday:

We had met an external tour guide through recommendations of previous students. He hadn’t led us up the hike yesterday because of some disagreement with the people from Togo (better to let the official guides lead us) but had offered to take us to some places before we went back.

We had already wanted to go to the monkey sanctuary and this guide (Fred) was a trustworthy guy so we went with him.

He also suggested we went on another shorter hike to the highest mountain in West Africa and for some reason we agreed.

For this I had foolishly forgotten my inhaler with the thought of it only being 45mins-1hr each way and the thought that yesterday was fine for the 1st hour (I had obviously forgotten I had used my inhaler within that hour!). So obviously this hike was much more challenging for me and my lungs did not like it at all. It was steep, like yesterday, and I was very wheezy at the top. Thankfully I was mostly back to normal after a rest and the climb down was not asthma-inducing at all.

We tried the orange fruit on the right. We were told it was sour but it was more sweet for me so I was quite disappointed. Inside it has lots of white seeds and white flesh surrounding each.

After this we headed to get some bananas and then went to the monkey sanctuary. This was a fun experience and definitely one of the top 5 (possibly even the best) so far.

We were told to hold the bananas outstreatched and then the monkeys jumped from all directions to get them. We were told many times “with the banana the monkey is your friend. When there’s no banana the monkeys are not your friends” and that was true.

We started our journey back to Nsawam at 2pm. We had been told that it would be quicker on the way back and we would arrive perhaps just after sunset, but that was not true.

Our journey:

• Trotro to Koforidua
• Trotro to ?somewhere (we were too late to get a direct trotro to Nsawam)
• Trotro to Nsawam
• Taxi to the house

We ended up arriving back at 10pm and were starving so had some late night noodles and got to bed. At stations and stops there are lots of people selling plantain chips (crisps actually), bofrots, popcorn sometimes, drinks etc as well as other snacks and sometimes meals but when you’re crammed into a trotro in the heat appetite is often diminished.

• Just a note to say that almost all photos added here have been cropped/condensed to make the file size smaller so the real photos are better (and I do have lots and lots more + videos too that haven’t been added)

Part 5: 3rd week

This week (Monday-Thursday) Chloe and I spent most of our time in the female ward as, although we wanted to be back in paediatrics it was encouraged we went there instead.

The female ward has bays of 7, 8 and 10 beds and sees a wide variety of patients. Example diagnoses we saw were malaria, stroke, cellulitis, sickle cell related complications, heart failure etc. We found it interesting that so many patients with heart failure were aged 40-60 when in the UK you would expect patients to be much older when presenting with this for the first time. The answer given seemed to be related to patients typically stopping their medications (given for risk factors for heart failure like high blood pressure) when they ‘felt better’.

We were quizzed a lot. The staff here seem to have a much better physiology and textbook knowledge than we do. On Wednesday we joined another medical student teaching, but this time as more of a tutorial setting. The doctor leading the discussions had a habit of going on tangents and she started with checking the students knowledge of current football news and after some teaching on epilepsy, went into a discussion of religion, immigration and culture.

Chloe and I also went to the ICU (intensive care unit) on Thursday as we had been told to check it out, however there were no patients. The nurse said they get few patients and last month only had 2. The ward did have 3 beds and seemed to have good monitoring equipment.

After this we checked out ED (emergency department) instead. This was much less chaotic than the UK. They have 8 beds and at the time of being there they only had 6 patients (and one was just coming back for follow-up). The conditions here were mainly heart failure or stroke.

We were also told that although they do have an ambulance service in Nsawam, it has not been running for the past 2-3 years. The hospital can call an ambulance from elsewhere for patients to go get imaging or to be taken to a different hospital etc but it seems a patient here could not call one themselves.

We spent some of our lunches in the canteen and some at the house with homecooked alternatives.

Friday:

We took a trotro from Nsawam to Accra and then from Accra to Afienya (but stopped off at Apolonia junction). There we texted our hotel (Sleepeaze) to come pick us up. The hotel was nice but food took a long time to come. This has been the case elsewhere as often food is made fresh but because we’d been travelling we were extra hungry.

We spent most of the rest of the day relaxing.

Saturday:

We woke up with a plan to arrive at Shai Hills Resource Reserve as soon as they open so we had the best chance of seeing some animals. This changed, however, because of Ghanaian time obviously being different haha. We had an agreement to be picked up and taken at about 7:30 but this actually happened an hour later.

Our driver stayed with us for our time at Shai Hills and we were also joined by some other visitors. We got to pick between a one hour or a two hour tour and we chose the latter. We started off with a look at some ostriches and zebras that were brought up from South Africa as possibly part of a conservation programme. The other guests asked lots of questions including whether they could eat/keep the meat of an ostrich and whether they could ride an ostrich, which I found funny. (The answer to both was of course no)

We then went to the Shai Hills museum, which was really a couple of open rooms with displays of animal skins, bones, paintings and manmade objects from the people who used to live in the area. I also found it funny that the tour guide clarified that all the objects on the tables were bones except for a small wooden elephant haha.

After this stop we drove to the bottom of Mogo Hill. We saw antelope as we drove through and baboons on the side of the road.

We then climbed to the top of the hill using ropes that had been installed. The view from the top was amazing. It was way more impressive than can be captured in a photo.

We then were taken back to Afienya station and we took a trotro to Tema. We then took a trotro to somewhere else and then a taxi. We had booked this trip to Ada Foah very last minute as we hadn’t known Monday was a holiday until Thursday so had to ask lots of people where to go.

We were then taken to a boat and took the boat to Maranatha Beach Camp where we stayed 2 nights.

This place was on a small island, which was lovely. It had lots of palm trees and roaming dogs, goats and chickens. Our rooms however were not quite what we had expected. They had stand up fans rather than ceiling fans and one of the rooms didn’t lock properly. This meant the night became hot and sweaty as we couldn’t properly cool off.

Sunday:

We went on a boat tour this morning with the gentleman who took us to the island yesterday. We went to see the estuary, the mangroves and the crocodile island (which was actually a little zoo on one of the islands). There are 24 islands in total.

The food here had also been very tasty but similarly to Friday night, we had to wait a long time to eat. Last night we had to wait 2 and a half hours to eat, which was the longest so far. In particular the chicken had been cooked really well and the food hasn’t been very spicy at all! (They must have seen us and not put any in haha)

We went for a swim in the river in the afternoon and a walk in the evening. We tried to catch the sunset but unfortunately it was too cloudy to really see it.

After dinner we had some conversations with men who were proposing to us again. We have experienced this previously but it has not been at all this bad. I am grateful that I am married as they do seem to respect that and move on but for the others, the men are quite persistent and after saying no, want phone numbers or contact information.

Monday:

We ordered our breakfast and had a swim in the river while we waited. The sea was lovely but the current did feel very strong. We also seemed all to have gotten burnt yesterday so I didn’t stay in direct sunlight for very long.

We then packed up and made our way back to Nsawam. This time a boat drop off, taxi, trotro to Accra, then another to Accra circle (the main station), then another to Nsawam was how we made it back.

Part 4 – 2nd week of placement

Monday:

Chloe and I decided to go to the paeds ward today. The day felt hotter than last week and the paeds ward was even hotter. It has some ceiling fans but they are smaller than obs and gynae and really just over the beds.

I enjoyed the ward round. I felt like we saw a mix of children and had discussions about gastroenteritis, intussusception and hyperkalaemia (high potassium in the blood).

However, the paediatric head doctor did try and put a cannula into a small baby maybe 9 times and failed. It was sad to watch, especially as about half way into attempts an older child in the next bed was crying out for the same reason. (although it only took 3 attempts for him)

When we got back to the house we were in our rotation of showers when the power went out. Our meter had run out of credit so we had to wait for our administrator to fix it. We had to wait just under an hour as the house filled back up with heat, but all sorted now.

It seems this week has been photo deplete (can’t take photos in placement or during the day on the beach) hence have added pur watermelon from Monday and our walk on Wednesday despite not talking about that haha.

Tuesday:

I went back to the paeds ward and enjoyed it again today. We saw some of the same patients from yesterday but most had been discharged. A lot of the children had anaemia from an unknown cause and we ended up having a discussion about the effects sickle cell can have on kidney function.

Later on today our water ran out, which was quite annoying. We were told the doctor who owns this house would be back tomorrow and an electrician and gate person would be around today to have a look at those? It wasn’t very clear. Our administrator did come round to have a look and somehow we got onto the topic of us making him jollof rice tomorrow. He basically invited himself over with the excuse of “it’ll be a competition, 2 cooking this week and I plus one of you will cook next week”

Wednesday:

Today was a long day. Jess and I went to theatre today to see some more c-sections. The theatre environment was less friendly than last time and we were sure the nursing team were laughing at us in Twi (both generally at us not understanding and also about the UK in general).

So far my experience has been that the staff we’ve spoken to have viewed the UK through rose-tinted glasses. They often say they want to travel back with us because they’ll have money there or they think the hospitals have great staffing, pay, hours etc when in reality healthcare is very similar. The UK hospitals I’ve been placed at have more patients but similar staffing ratios and the hours doctors/nurses work seem to be almost the same. The staff here also seem much more relaxed about when meetings/ward rounds etc finish or start whereas time is pressured in the UK and I think it leaves staff more stressed.

After theatre we went for lunch at our usual place – the hospital canteen. We are always greeted by the friendly man who works there. He always asks us questions on how we are doing etc and today it was what music we like. We also had a conversation about the UK and how actually we do have a higher crime rate than Ghana which he was very surprised about. He was also surprised about the concept of having sunburn which was fun to explain.

Sadly though, they had run out of jollof rice so Chloe and I had to have some banku with okro soup. I didn’t like the flavour or the texture of the banku so ended up having a snack of yams and bofrot (like a doughnut but contains a lot of nutmeg) on the way home.

In the afternoon the new medical student arrived who will also be living with us and we prepared our jollof rice for the dinner party. Originally we had arranged for it to start at 6:30pm and we were ready for him around then, however he didn’t arrive until almost 8pm! (Despite saying he would be there soon at quarter to 7)

We did have a nice dinner despite the delay and learnt a Ghanaian card game that is similar to whist.

Thursday:

Chloe and I went to NICU this morning and saw a baby with mermaid syndrome, which was something I had not heard of before. It is not common here either.

After a short NICU ward round we went to paediatric clinic where they triage children with problems or review them. They see most children with sickle cell disease every 2-3 months and there were a lot of children with this in the clinic.

The room had one table and 2 clinics happening at once (doctor and patient at either end). There was also one nurse and one bed for examinations.

Friday:

This morning we took the trotro to Accra and then to Kokrobite and then to Big Milly’s. It was about 3 hours in total but the journey didn’t feel too long.

Jess and I had sausage pizza for lunch, which was nice because I had been missing cheese, however the pizza base was sweet and the sausages were hot dog sausages so it didn’t quite live up to expectations.

We then went for a swim in the sea and the waves/current was so strong it knocked us over a few times. It also meant we didn’t go out beyond standing height, but it was still lovely and cooling from the heat.

Dinner was a bit disappointing for all of us but dessert was so tasty! I had a brownie with ice cream and the vanilla flavour especially was really good.

Friday night here is culture night which meant some Ghanaian music and dancing. This was really fun to watch and listen to. The musicians and the dancers were very good at hitting quick beats and rhythms.

Saturday:

We woke up early this morning to try and catch the sunrise. While we didn’t get the sunrise exactly we still took some nice photos of the beach.

After sunrise we had breakfast and I had some delicious pancakes with syrup and a coffee. We had another wade into the sea and swim in the pool and then it was time to begin the journey back.

It felt longer on the way back and the first trotro we got in seemed to be held together by hope. (The front passenger door was only held shut with a piece of metal bent into a u-shape and the rest seemed made of mismatched metal and wood). The road from Accra to Nsawam is also extremely dusty which is why people wear face masks in the vehicles.

Sunday:

We went to try a Ghanaian church today. Our administrator had told us it would start at 7 but the sign outside said 8 so we had to walk back in the heat and wait half an hour.

We went to Winners International Chapel and the service was 2 and a half hours long (an hour longer than my home church) but it didn’t feel too long because everyone was so loud and enthusiastic! Some of the songs were the same as ones I’d sung before but there was a lot more energy and dancing in the worship than I was used to.

The sermon and the service in general also referenced a wide variety of bible verses throughout, but because they referenced them so quickly and they used KJV it was a little hard to keep up at times. They also at 2 points during the service asked us to stand up because we were new, but luckily no interview was involved haha. Overall it was a good service and I did enjoy the energy put into everything.

The rest of the day has been spent relaxing.

Part 3: 2nd weekend

Friday:

We woke up early to travel to Accra for a community outreach event. We had packed everything we would need into a rucksack each and took the trotro for the first time. It was cramped with 4 people per row and hot. We had to have our bags on our laps and the spaces between seats was small – we had our knees against the seats in front.

While we were waiting, a lady came on to preach very enthusiastically but we didn’t know what she was saying because it was in Twi. She only got off when we had started moving out the station.

The journey was extremely bumpy and not good for our knees, but there was a lovely breeze through the vehicle as we were travelling that meant it wasn’t hot anymore.

Once we had arrived in Accra we were picked up by our organiser to head to the event. Down a side street a local church had put up a canopy as the starting point for members of the public to have a health check. Then further down the street there was a room where the doctors would assess them and they could be given medication for free.

We got changed into scrubs and spent the morning helping with the initial check of blood glucose, malaria, typhoid and hepatitis B. The latter 3 were done from a single finger prick but each had a lateral flow style process.

We screened maybe 75-100 people with only one positive test of malaria, although by the end we had run out of malaria and hepatitis B tests so were only checking typhoid and blood glucose.

After around 4 and a half hours of helping we were very kindly given lunch on the roof of the building the local church congregate in. We were given jollof rice with chicken and plantain as well as water and a malt drink.

Above is the view from the roof.

After lunch our organiser took us to Kokrobite beach, which was about an hours drive away. We were wearing walking boots because we hadn’t planned to go to the beach and at one point walking along, the sea came in too fast for us to get out the way and it completely soaked our feet.

We then had some drinks before heading back to Accra to get ready for tomorrow.

Saturday:

We woke up early again to get a lift from our organiser to the trotro station. We got a trotro from Accra to Koforidua, which was about 2 hours. The journey was nicer than our previous trotro ride because it was just us 3 in the back.

We then spoke to the trotro driver and explained we wanted to go to Boti falls and he took us to a friend of his who was a taxi driver. Initially the taxi driver didn’t speak to us but he became very friendly and was very lovely. He became part photographer, part tour guide as well as driver.

When we arrived at Boti falls we had to wait in a long queue full of cars and mostly school buses. Our driver told us that because yesterday was the day they celebrate their independence lots of schools come to the waterfalls and people go to the beach/gardens to celebrate over the weekend period.

There were so many children once we were inside the grounds and most of them wanted us to wave at them or say hello. By the end I found it quite exhausting.

We also had what I described at the time as the worst social encounter of my life so far haha. There was a gentleman who had a microphone and was entertaining people by speaking inbetween the music that was playing. He started off saying things like everyone is welcome here including people from USA, Australia etc (no UK mention though haha). Then when you come to Boti falls it’s not just about the waterfalls, it’s about mingling etc and he was very clearly talking about us as we were sat on a bench away from other people (because we had been told to).

Some other people came up to him and then he was looking directly at us, continuing his waffling about mingling. Then he came over and interviewed us one by one. It was a short interview and some questions he asked us in Twi. I felt extremely awkward for not knowing what he was saying and especially because of the microphone. Then these guys that were with him were actually just wanting a picture with us so all of that conversation was merely waffle.

Anyway, we walked down to the waterfall and it was very lovely. It was quiet and although it was the dry season, the waterfall was still nice to look at.

Then we were told the guy who was supposed to take people to the umbrella rock (another attraction people come to see) was busy and that this walk would take an hour. He also told us he could drive round so we didn’t have to walk and that was the preferable option.

Once we got there we saw the three trunk palm tree. (The picture has been edited bottom right to remove some random people so the ground is a little inaccurate)

We then walked down to the umbrella rock. I had seen pictures of this before, but was pleasantly suprised by the amazing view from the rock. I would say that the actual rock looks more like a mushroom haha.

(above picture has also been edited bottom right to remove random people)

Nearby the rock was a tree with some fruit which we didn’t recognise. We asked our driver what it was and what it tasted like etc and then he went to climb the tree! He got some of the fruit down for us to try.

It’s the fruit of the parkia biglobosa (African locust bean tree). They are green and then dry brown and once dried they can be opened and the inside can be eaten. The yellow inside surrounds the seeds and is sort of powdery. It tastes sweet, almost banana-like.

We then made our way back to Koforidua to get a trotro to Aburi. This trotro was the worst so far. There were about 17 people in a 12 person space and it was very warm.

We were dropped off at the Aburi botanical gardens. We chose to just get entrance tickets and not a tour, so it was nice to stroll at our own pace but did mean we got quite confused due to the lack of signs/map.

It featured mostly trees, which were tall and impressive. Some had information in front of them but others didn’t.

We then walked to the trotro station to try and get a trotro back to Nsawam. We had to stand in a circular queue which was quite confusing as it looped round on itself and it was also slow. We ended up getting a shared taxi back instead.

Sunday was a quiet day with some needed rest after some long days.

Part 2: 1st week of placement

Started the day with some nutella-like spread on some bread – it was very nutty. Then ready for the day we were picked up by our administrator in a taxi to go to the hospital. Things then moved very slowly.

We spent most of the day waiting to be told or shown something. We were never given a proper tour of the hospital. Our day went like this:

• Waiting for the administrator
• Filling out some forms
• Waiting in the conference room for the clinical coordinator
• Watching some student presentations that the clinical coordinator was assessing (waiting for him to be ready to show us where to go)
• Waiting in the paeds ward for him to finish his meeting
• Waiting upstairs for the administrator
• Going on a tour to some of the wards by the clinical coordinator (which was actually so he could tell them they needed to use the computer system to admit patients)
• Having a discussion about malaria with the clinical coordinator
• Lunch at the canteen
• Then walked home

I have been coping better with the heat. Last night I actually found it too cold with the air conditioning on. However, walking back from the hospital was even more uncomfortable with the sweatiness.

It was interesting to see how the hospital differed from the ones I’d been to in the UK.

Paeds ward:

• 19 beds with no curtains between.
• Beds were rusty – most had sheets but in other wards some patients were directly on the mattress
• Oxygen was available for about every 2nd patient
• Notes were in English with the same acronyms and layout as the UK but most patients (I saw today) spoke Twi
• Doctors wore formal clothing with labcoats and nurses wore scrubs
• There were about 10 nurses for that ward
• No air conditioning, but fans on the ceiling
• On this ward they mostly see malaria, sickle cell disease and bronchopneumonia

For lunch we had jollof rice in the hospital canteen. The gentleman serving us was lovely and I have had jollof rice in the UK but it was much spicier here.

Tuesday:

We had been given the number of the taxi driver who drove us up yesterday to call this morning but he did not answer. We ended up trying to walk the shortcut instead and this was a much nicer walk. It was away from the busy roads and took us just under 20 minutes.

Our second day in the hospital was in obs & gynae. This ward was much bigger than paeds. We didnt go into the labour ward but they had a gynae bay ( 10 beds), antenatal (12 beds and then 4 beds), postnatal bays ( about 10 beds and another 10 bed bay). The patients in this ward had curtains but the rest was very similar to the paeds ward.

On the ward round there were lots of us (around 9) trying to fit between beds to see patients. The mix of ceiling fans and staff speaking very quietly meant we were unable to hear a lot of what was happening but we did also get quizzed by one of the doctors.

The presentations on this ward seemed to be similar to the UK; ectopic pregnancy, fibroids, pre-eclampsia, gestational diabetes etc

Because of the heat the ward round had felt very long. Around 12:30 it ended and we went for lunch at the same place as yesterday. The gentleman working there had made some “noodles” specifically for us.

Above are the “noodles” which was actually a mix of carrot, pepper, peas, beans, onion, various pasta and ?ketchup. It was a weird mix and only nice whilst I was still hungry.

We had decided to do shopping in 2 batches, some on the walk back and water/heavier items on another walk out. We had managed to find a small indoor shop right near our street selling a variety of things, which was great. However, it had started to rain and we got caught in the middle of a heavy downpour.

Wednesday:

We spent today on the obs & gynae ward again but split up to join the separate ward rounds today. I was in gynae. The ward round was much better today because it was just the doctor, nurse and me so I understood more of what was happening. Although, most of our conversations were more on the differences between the UK and Ghana

We walked back through the market today as it was on. There were so many stalls and people were very friendly saying hello/asking whether we wanted to buy what they were selling. We got some garlic and onion and also needed some bread. We asked one gentleman where it was and he took us back and down by the hospital to find it. We were a little sceptical on whether he knew what we were asking for because we had walked a fair way and previously he had confused bread with plantain and had asked if we wanted coffee as well. However, we found it. This time it was T-bread which was much more like English bread (not sweet like butter bread).

On coming back to the house (already pretty drenched in sweat) we found we couldn’t open the gate. The lock was stuck and we were locked outside. The administrator who had shown us in was at work and said he would call someone, but based on our experiences so far that could’ve meant in an hour or more.

Luckily a gentleman passing by stopped to help us and managed to get the gate open with lots of moving the gate back and forth. So we only ended up waiting about 50 minutes outside in the heat with no shade haha.

Thursday:

We went to try theatres this morning and discovered it was all air conditioned! So, after being allowed into the theatre (one of 2) we were able to enjoy the cool air. However, this had also come with mosquitoes – eek! Luckily we haven’t encountered many mosquitoes since Accra airport and since being in Nsawam I haven’t spotted any until today.

The surgeries we saw today were 3 c-sections and one surgical debridement (cleaning out a gunshot wound). I was also able to scrub into the last c-section which was fun! Here they wear wellies and an apron underneath their gown. They also have one normal sink for scrubbing in in an adjacent room.

Around 70% of births here are via spontaneous vaginal delivery and 30% via c-section. (Compared to 50:50 in the UK) They also don’t have a lot of anaesthetic doctors in Ghana so all the surgeries done here have anaesthetic nurses instead and the surgeries are less complicated than in Accra.

This evening we cooked our first batch of rice with a little jollof seasoning and veg. It was quite tasty.