Edward Moseley

My elective formed the last eight weeks of my final year at medical school. It took place after my final exams. Because of this I knew I wanted a really special experience to bridge the gap between life as a student, and life as a doctor. I wanted to really build on my independence, and so I decided to travel by myself, to push me to meet new people and get as much from the experience as possible. My Work the World trip to Ghana provided me with the independence I needed to make the trip my own, but it also provided me with the support to get as much from the experience as possible. 

I’d originally looked into organising my own elective, but after contacting a few different hospitals I found the planning increasingly complex, especially with my finals looming!  Many friends were also having similar trouble, and I saw a few hit complete dead-ends, even as the time for our departure drew near.

As a result, I took a look at the Work the World website. I’d heard some pretty positive things said about the company and I had a couple of friends who had already booked with them, and had commented how easy it was. The price was originally a little off putting, but in the end I worked out that, considering that accommodation and week day meals were included, as well as the organisational expertise and security, it wasn’t that great a difference to what I could find by myself.

Looking at the different trip pages, I settled on Ghana as my destination, because the page noted that it was an excellent place for infectious disease experience, which is something that I’m really interested in. I didn’t really know that much about Ghana at the time I booked, as it’s not an oft talked about destination – unlike Tanzania, for example – but it sounded like it offered exactly what I wanted from my elective.

After booking with Work the World, organising the trip couldn’t have been easier. The My Trip section of the website is really well laid out, letting you know what you need to get done and when, and the info pack is more or less invaluable. In addition to the website, the extremely friendly staff from Work the World are in frequent contact – both by phone, and by email – to make sure you’re up to speed, and to help you plan the structure of your placement. I have to say that they have an uncanny knack for knowing when you’re free to speak!

When I finally landed in Ghana, and strolled off the plane into the steaming humidity of a tropical land, it was 10 at night, and it was an unspeakable pleasure to be greeted by Ezekiel, the program representative as I came down the ramp from customs. He bought me a sizeable bottle of water and then we headed to the guesthouse in Accra for my first night.

I’ve travelled in developing countries before, but having someone to meet you as you arrive in a foreign land is extremely comforting, and had I been by myself, I fear I would have been a little overwhelmed to work out how to get from the capital to Takoradi. That first morning just traveling from the guesthouse to the bus depot was probably the definition of a culture shock.  I must have looked every bit the confused and puzzled British traveller as Ezekiel kindly lead me in the right direction!

Once we’d completed the four-hour bus journey to Takoradi (entertained along the way by some rather unique films!) we made it to the Work the World house where I was introduced to the extremely welcoming staff, and I began to settle down and find my footing. My new housemates gradually returned from their placements, and I began to hear tales of what to expect from my time in Ghana.

The next day was my orientation. Firstly, Joe (the local programme manager) took me for a tour of the hospital and introduced me to the staff I would be working with. I’d only just set foot in the clinic room and Dr Fahmi (one of the physicians) was already firing questions at me! After I’d recovered from that, Ezekiel took Harriett (who had also just arrived) and I for our local orientation, showing us around the main areas of the city and the spots we were likely to want to go to most. During my time in Ghana, I rotated around the general medical, paediatric and accident & emergency departments in the hospital. This gave me a fantastic overview of Ghana’s health service, and the opportunity to see diseases that you seldom see, or have only really ever heard about.

My main focus on my elective was general medicine and infectious diseases, and this was the area in which I spent the most time. Over four weeks I learned how the lack of any sort of family medicine or general practice, and the lack of health monitoring and promotion that comes with those services, has impacted on Ghana’s health, with many patients presenting for the first time with near end-stage disease. I regularly saw blood pressures over 220 systolic, and terribly controlled diabetes with all of its signs evident.

As well as these common things I also saw a huge range of other illness, from nephrotic and nephritic syndromes, ischaemic heart disease and heart failure, to primary hepatocellular carcinoma, and a myriad of infectious diseases.

Here we come to the part of my placement I enjoyed most. I find infectious diseases fascinating, especially in terms of how they impact on society and how they are managed. So to be able to see the systems in place for treatment of TB and HIV in Ghana was extremely rewarding, enlightening, and at times surprising.

[I] saw a huge range of other illness, from nephrotic and nephritic syndromes, ischaemic heart disease and heart failure, to primary hepatocellular carcinoma

Tuberculosis is rife in Ghana, as with much of Africa, both because of the HIV epidemic and the poor living conditions. And the cultural view of healthcare often impacts on its treatment.  In the first week I arrived, I saw a 12 year old (paediatrics only manages patients under 12 in Ghana) with Potts’ disease (or a tuberculous abscess in the spine), which had been progressing for 6 months, leaving him with paraplegia. His family had first tried treating him with herbal medicine. When that failed, they took him to a prayer camp to try and rid him of his illness. Finally, they took him to hospital, by which point it seemed unlikely he would ever regain full use of his legs.

The tuberculosis service in Ghana is a combination of well organised and poorly funded.  The hospital in Takoradi has what is called the “Communicable Disease Unit”. This is a separate group of small buildings that are supposed to house isolation wards for patients with TB and cholera. However this is now so run down that only the TB outpatient clinic is run from there. When I first arrived it was described to me as “a group of sheds in the middle of a field”, and it certainly more or less fills that description.The HIV service, by contrast is extremely well organised and funded. The hospital has just opened a new “Comprehensive Care Centre” for HIV treatment, and it is certainly that. On arrival, patients see nurses, dieticians, doctors and pharmacists, all providing support, advice and counselling.

The community support for both of these services too, impressed me. Community HIV screening has seen a surge in uptake with increased awareness of the illness, and the TB service couldn’t survive without its’ community sponsors – volunteers who encourage patients to complete their treatment.

Paediatrics, my second placement, continued my experience of infectious diseases in Ghana, with malaria being by far the most common illness diagnosed and treated in the department.  Whether the patients actually have malaria or not is sometimes debatable, but that it extremely prevalent and extremely dangerous, is not.  Paediatrics also gave me the opportunity to spend time on the neonatal intensive care unit, where I was even able to help take part in a couple of exchange transfusions for jaundiced babies.

My two week accident and emergency placement allowed me to see perhaps the widest range of health problems, covering any specialty imaginable from trauma and orthopaedics, to psychiatry, medicine, surgery, paediatrics and obstetrics. Here I saw things I never thought to come across.

One patient came in with severe facial acid burns, then re-presented the next day with acute alcohol withdrawal. Another came in with Stevens-Johnson syndrome – a very rare and very severe drug reaction.

My placements helped show me some of the major problems that the health service in Ghana experiences, namely the issues of poor resource availability, and the need to improvise because of this. Examples of this include the slightly terrifying “broken needle technique” used for taking blood from neonates, and the use of an iv cannula as a supra-pubic catheter.All my time spent on placement, however, was certainly no barrier to exploring the other experiences the country had to offer me. In eight weeks I saw eight out of ten of Ghana’s regions.  In the Western region I have had an incredible healthcare experience, but I have also explored Takoradi’s thriving Market Circle. I have seen its stunning beaches, and I have canoed to a lake and found a village on stilts, made of bamboo, where an isolated farming community still lives on after 500 years.In the Central Region I have seen the terrible legacy left behind by the colonial slave castles at Cape Coast and Elmina. I have also been uplifted into the canopy of a jungle and slept in a tree house at Kakum National Park. Finally, I have been immersed in local tradition by attending the annual Aboakyir Festival, where I saw tribes compete to present captured antelope to the elders.

In the Greater Accra Region, I have learnt about the history of Ghana’s independence at the Kwame-Nkrumah Memorial gardens and museum. I have gotten lost in Accra, and found my way back out again.

I travelled to the Northern Region, where I stayed in Tamale before going to the Mole National Park where I went on a safari, and tracked a bull elephant through the bush. On my way there I stopped in the Ashanti Region, where I paddled out onto the serene surface of Lake Bosumtwe, created by the violent impact of a meteor, and where I saw the city of Kumasi. I also passed through the Brong-Ahafo Region, where I saw the Cities of Techiman and Kintampo.

In the Eastern region, I stood on top of the Akosombo Dam, which feeds 60% of Ghana’s electricity, and gazed out over the Volta Lake, which extends for 2/3 of the countries length, and is the largest man-made reservoir by surface area. I went to Boti, where I saw two waterfalls sharing a pool, an “umbrella” rock, and a triple headed palm tree. I saw the botanical gardens at Aburi, where I also saw some truly beautiful craftsmanship.

And finally, I saw the Volta region. Here I rode on the back of a motorbike to find a village where monkeys climbed on me to feed from my hands at Tafi-Atome. I scaled a mountain to gaze out across the country and see the scale of the Volta Lake from on high at Mount Gemi, where I also saw the waterfalls at Amedzofe. I also survived the gruelling trek to the upper waterfalls at Wli, where I bathed under the tallest waterfalls in the country.

All this, and I feel that I really only scratched the surface of this amazing country. I can’t think of anywhere more diverse, or welcoming, than Ghana.