David Holmes

I had initially spent a quite lot of time contacting various medical charities including MSF about the possibility of doing voluntary work with them. However none of them were enthusiastic about the prospect of having a 2nd year medical student on a placement (understandably). From there I stumbled across WTW which was pretty much exactly what I had been looking for. 5 weeks in Ghana combining medicine with travel seemed an excellent way to spend a summer and I wasn’t disappointed.

Placement

My placement was in Effia Nkwanta A&E for 4 weeks and then I spent my final week in Akwidaa village. Having had little clinical exposure in my first 2 years of medicine I was unsure exactly how my placement would go. However, for my first week in A&E, three of the other students were also on placement there. This proved to be a big help and I probably settled in more quickly into the department than I would have otherwise. Nevertheless, the staff are friendly and happy to teach you, especially when you make an effort with the local language. There are exceptions to this rule! As you've probably read elsewhere, be proactive. If you stand around waiting to be asked to do something you'll be standing for a very long time. Volunteer to do things, grab a cannula/catheter etc and ask if you can do it. Or if a new patient comes in, then reach for a pen and paper and take the history and record the vital signs. On that note, it's probably best to bring a few pens along for your own use. Searching for ones that actually work can sometimes take a while.

In reality, although your placement may be in a certain department, you're free to go wherever you want and whenever you want within reason.

It's flexible. Some wards may be more welcoming than others. Labour ward was always my next stop if A&E was quiet and the staff are really friendly. If you want to do a night shift in your department but don't want to stay all night then there is a hospital staff car available to take you home. Just ask one of the staff to call it for you. You could also get a taxi if you wanted but generally the staff will tell you it's not safe at midnight. I didn't have any problems though.

There will be many things that you may come across and be shocked by. Again, as you've probably read elsewhere, it's maybe best to accept most of these things if you can't change them. Feel free to offer advice and input by all means or ask questions. Just do it in a respectful way and bear in mind that ultimately you're a guest in their country. Having said that, if you're convinced something is in the best interests of your patient then always be their advocate. Should you visit the hospital mortuary or a psychiatric hospital during your time there then be prepared to be shocked. That's all. I could write a novel while trying to describe them and I still wouldn't have given a realistic impression. So I'll say no more.

Weekends etc

With regards to things to do, I was never bored. Before/after placement (depending on your shift) there's Africa Beach, internet cafe, Harbour View for souvenirs/carvings etc. There's also Pee's gym in the centre of town. Don't be expecting any treadmills though! At the weekends you can travel a lot further afield. Kakum canopy walk and Cape Coast were very good, Ezile Bay beach resort was really nice, Beyin beach and Nzulezo stilt village were also excellent. However my personal favourite was Wli waterfalls. The lower falls are pretty accessible, around 45 mins of walking on the flat. The upper falls are more challenging so bring good hiking shoes. I attempted it in Converse.  Which is fine as well, although you will slip and fall several times. (Or maybe that's just me.) It's quite impressive to look at really but for the full experience I can't recommend strongly enough that you need to go in and stand underneath the waterfall. Amazing feeling.

There may be other things that will come up unexpectedly. During a quiet afternoon in A&E a film crew arrived to shoot scenes for a Ghanaian love film. Still not quite sure how it happened but I ended up playing a nurse in the film. Memorable lines I delivered included the classics "Doctor!" and "You must leave now!" Obviously I've missed my calling in life and ended up in medicine by some unfortunate coincidence.

Village Experience

The Village Experience was another highlight. I spent my week in Akwidaa and loved every minute. Wisdom and Jeph (the nurses who run the clinic) are both great guys and everything is really relaxed which I also enjoyed. Be prepared to take charge of every consultation - you'll be left to do the vital signs, take the history, examine the patient, diagnose and prescribe what you think best. Either Wisdom or Jeph will always be there to observe you/ interpret for you/help you out. The vast majority of patients will have malaria so don't expect to see anything medically extraordinary. Focus instead on seeing the consultation through from beginning to end and appreciate the responsibility the nurses give you.

Village life

Students live with a family in the village. You'll have your own room consisting of a mosquito net and mattress and the house is a good quality one, not a mud hut. All you need really. Meals are cooked in the kitchen at the clinic and it's at the clinic where I spent most of my time. The host family have practically no English so it is quite difficult to have a conversation with them and get to know them better. I recommend taking Wisdom with you so that she can translate for everyone. Also they may invite you to have fufu with them one night during the week. Take them up on the offer. (All the other students seemed to hate fufu but I almost enjoyed it actually!) The rest of your meals at the clinic will mainly consist of bread, omelettes and spaghetti bolognese.
It becomes dark quite early in the evenings and, with no electricity, it limits what you can do. Make sure you bring a torch, preferably a head torch. Before darkness though there's volleyball and football on the beach. Also take one of the clinic motorbikes to see the lighthouse at Cape 3 Points. Definitely worth it. If you need to charge your phone etc, it's no problem to plug in to one of the generators in the village and you'll pay about 15 pence. With regards to reception, Tigo is virtually non-existent except at certain specific points in the village. I also had problems with coverage while travelling at the weekends. Much better to choose Airtel or MTN when you buy your sim in the first place as the coverage is a lot more widespread.

I think I've covered the main points. Ghana is an excellent choice for a first trip to Africa: it's safe, the people are friendly and English is an official language. Also, regardless of what stage you're at in your studies, whether first year or final year, don't hesitate to arrange a placement abroad. You'll apply what you know already and learn a lot more in the process.