Last day at the clinic

Today I finish my time in the community, and it is a bit of a shame. I've found that it's been really useful. I am now getting to grips with the peculiar symptoms that everybody seems to have, such as waist pains (low back pain), general body aches (seems to accompany any fever and is usually treated with anti malarials). Another symptom that has been particularly problematic is numbness. It does not mean that they have altered sensation, but could mean anything from cramp pain to paraesthesia. Trying to distinguish between these is particularly frustrating as the interpreter often just translates it as numbness despite persistent questioning. Then when you ask them what that means they look at you as if you're stupid and make the somewhat ubiquitous symbol for numbness, grabbing a calf and making an anguished face.
As I have come to understand these symptoms however I have become increasingly frustrated by the very limited range of drugs on offer. Many conditions that are quite common simply can not be treated. Despite this it has been great to feel that for the first time I am actually treating patients and hopefully more often than not helping them to get better. On 3 of the days this week the medical assistant in charge of the clinic has disappeared leaving me to see all the patients. It is really great to feel that if I wasn't here that they wouldn't be seen. Although on the other hand it terrifies me that no one else will see them and correct any of my mistakes...

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Kumasi

This weekend we headed to the 2nd city of ghana, Kumasi. We arrived at rush hour and there was traffic everywhere. On roads made for 2 lanes of traffic there were three and every car on the road seemed to be changing lane at once. It was mental and made getting to the station take forever. Still when we got to our guest house it was definitely worth it. Ensuite shower, a twin bed and air conditioning. We got dinner then headed to a club we had been recommended by Dr addie. We paid our exorbatant entrance fee to get in only to find about 2 guys sitting in a dark room with a dj playing. We were not impressed at all. It was already 12 30 as we had been having a few bevies at the hotel. We decided to go in search for another drinking hole and come back later. Luckily there was one just down the road selling shots of gin for about 20p (the standard price in Ghana). We sat down at the table and suddenly he music was turned off and after a pause changed to 80s power ballads. Interestingly this is the second time this has happened to us. We must just give off an 80s vine or something. After a happy hour or wo we decided to head back to the club and it was now rammed! So if you're ever on a night out in Ghana you should remember noy to head to a club until 2!
The club was for some reason really dark but the hip life tunes were blasting out so we had a bit of a boogie (there are 2 main genres of pop music in Ghana, high life, a fusion of traditional African music and reggae, and hip life, a mix between high life and r'n'b). It turns out that ghanaian men are all amazing dancers, and dance with pretty much anyone indiscriminately whereas the women found a man she liked then stood in front of him wiggling her bum.
Next day we were all feeling rather fragile but ventured out to see the old fort which has been turned into a military museum. Ghanaian museums certainly leave much to be desired when approached in the same way as English museums. They are more a jumble of collected items thrown together into groups and not seemingly related to the other exhibits. In this case it was mainly a show of all the weapons ghanaian soldiers had captured, grouped by the country from whom they had been taken. Luckily we had a guide who whisked us through the exhibits at a tremendous speed explaining each cabinet with a single sentence before walking off to the next. It was great fun trying to keep up with what he was telling us whilst trying to get q good look at the previous items. My favourite object was a photo of the dozen or so brits who were trapped in the fort when the asante tribe decided to revolt against the British. There were about 3 or 4 soldiers looking like they were out of zulu then about 4 women and an assortment of men who looked as if they had no purpose at all of being stuck in a fort in the middle of Ghana in 1900. If only the picture could talk it would have been fascinating to find out their stories.
After the museum we headed to the hospital which was epic in proportion, being one of the 3 teaching hospitals in Ghana. From here we headed the market, said to be the largest in west africa. It was absolute chaos. People pushing past you in both directions whilst you were being shouted at by the people in the market stalls. It's like being in an incredibly stressful department store as the market was divided up into different sections which were packed full of loads of stalls all selling exactly the same thing for exactly the same price. It was madness, especially as far as I could see, the range of goods was no greater than what we have in our local market in mpraeso.
That night we were tired so we didn't go out and decided to have a lie in the next morning before heading to the palace to see the asantehene (the king of the asante people) we were very lucky to be about for this as every 6 weeks there is a festival where all the chiefs from all the different clans gather to say hi to the king. It was really interesting to see all the traditional dress (togas) and to see the king. We were also lucky enough to see the former president of Ghana who popped in to say hi.
After this we headed home and I'm back out in the community again this week although we've all changed round. I'll let you know about the new clinic later on this week.

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Community Clinic

This week when we eventually got back, we have been sent into the community. I have been placed in a clinic in near by obo. The community clinic works like a gp in England although it has less of a role in chronic disease management. Patients (called clients for some reason) visit the clinic when they feel like it. This is great for them but somewhat inconvenient if you're trying to fill a whole clinic. It had results in a lot of sitting reading for me (which is not necessarily a bad thing as the clinic has a lovely veranda under which to sit) waiting for patients to appear, and then suddenly its really busy and the nurse feels she should take over and stop translating. It can get quite frustrating.
The medicine practised is also unlike a gp because there are no investigations. Everything is done on history with a limited clinical exam if deemed necessary. Patients come in, get a diagnosis and leave with a bag full of drugs. Everyone gets all of these, which is hard to believe since no suspicions are confirmed by tests and the drug formulary is really limited. I suppose this in a way answers Mr Boles' question. I think more diseases are treated on less evidence rather than increased clinical expertise. I'm not saying that the level of the doctors here is any worse than at home, just that they have a much harder job. It's easy to sit in clinic questioning why everyone is being over treated but without the back up of hard evidence to the contrary on pretty much most diseases you can't be too hard on them for treating just in case.

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Agumatsu and the rest of the Volta region

We have finally made it home! After leaving on Wednesday night it has been a long weekend. In fact that means we have spent exactly the same number of days travelling as we have in hospital. This is all about to change though as we start community this week. I'll keep you posted.
This weekend has been great but also tiring and frustrating. We travelled to korforidia on the Wednesday night (which I think I have written about) where we dined in a fantastic 5 star hotel (the food wasn't 5 star but it was western), travelled to the boti falls and visited the bead market before a massive storm set in and we took shelter in a near by spot bar. This was great fun, and allowed us to try both the local gin and local cuisine, fufu and banko. Both of which were pretty horrible, gooey yam mashed to a pulp then either fermented (banko) and drowned in a spicy soup. Although fufu was slightly better (not fermented and nicer sauce) it was still pretty horrid.
Once the storm had died down we headed to Ho. Another nice town which thankfully offered up the traditional rice and chicken. Unfortunately we didn't have a great amount of luck in our excursions out of Ho. First we went to a national park which the guide book promised us had water buffalo and cobs but by the time apparently it was too hot and all the animals were hiding from it. We saw what the guide says was a cob in the distance, but it was really disappointing, especially as we were told there would have been hundreds of them milling around a couple of hours earlier. We then tried to get to xofe ecovillage. But when we got there we were told that it had shut down! Nice one guide book! All in all a poor day.
Next we headed to Ho-hoe and from there the agamatsu falls. These were spectacular. There were several different falls which cascades down from the hill which lies right on the togalese border. We trekked up to the top falls and went for a swim under the falls. It was a terrific day. Unfortunately it was so good we spent a bit too long there because we had to head back over the volta lake (the largest man made lake in the world) but by the time we got there it was too late and all the boats had stopped. Still we thought that's ok we can stay here and just head back early tomorrow. Little did we know when we got up the next day that there was in fact only one ferry that day and it wasn't until half 1! So we waited and turned up really early and were first on the boat. All going well so far (ish). When we got to the other side, because we were the first on, we were the last off. So by the time we got off the boat the one bus which was waiting for ppl was full and leaving. We thought that's ok another will turn up soon so we waited. And we waited. And we waited. Finally the same bus turned up again but it was clear this was the last bus of the day and we stopped for everyone! It was so slow that by the time we got to the next change point, donkorkrom, it was getting dark and was increasingly clear we weren't going to make it back tonight. So we stayed in donkorkrom and thankfully the next day we are now home. What a nightmare of a journey. Still Mr tiddei who organises our community placements seems to be fine with us not being back. It was v embarrassing though.

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Battle of the tro tros

Today we managed to get the day off (4 day weekend!) And headed to korforidua. We went to a really nice waterfall about 45 mins out of town (where we found the cocoa). All was going well until we got on a tro tros (basically a mini bus) going back to town. Soon after we got on we stopped pretty sharply to pick up another couple of passengers. Unfortunately another tro tros was following close behind and had to stop quickly. Something the driver wasn't so pleased about and let us all know by shouting as he drove past, slowing up so we could catch them and emergency stopping himself. Very mature. We then had a bit of a drag race where the other tro tros almost pushed us off the road! This really annoyed our driver and one of the passengers. So much so, that when we both next stopped they went and started throwing punches at the other bus driver. Not cool. The rucus died down after one driver had been hit in the face with a bag of water and the other a handful of sand.
It certainly made the journey more exciting! Less so when we made it back to the depot and it all started again. We made a swift exit and went to the bead market before the storm, which had been brewing during the journey hit (pathetic falacy?)

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Cocoa Pod

One for Matt. This is where chocolate comes from. Tried the seeds before they were dry and they are very bitter and purple!

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A Tough Day

A couple of days ago I had a particularly tough day. I watched a patient die after having a relatively straight forward procedure performed on them. It's the first time I've really noticed the inadequacies of the resources and procedures. The lack of resuscitation equipment almost certainly cost this poor lady her life.
I don't want to dwell on something quite so depressing, but we do take so many things for granted in the uk, like being able to call a crash team if someone deteriorates. Or even the simple availability of the most basic mask to deliver oxygen.
I think this event has opened my eyes because since then I've seen patients who have been denied life saving anti hiv meds because they did not meet the strict criteria and a patient who has to decide whether or not to pay for really expensive anti hepatitis b drugs which may or may not prevent him from developing cirrhosis in years to come. These are also patients who have the ghanaian health insurance. What chance do those who don't have? No wonder there is still such a popularity for traditional herbalists and quacks. Rant over.

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Kockrabite

This weekend we've jetted off to the beach. We've rented a hut in a resort set just back from the beach so that you can hear the gentle swell of the Atlantic as I write. The room is great and has a shower where water runs from a tap rather than from the bucket you pour over your head, which we have been thus far accustomed to.
Yesterday morning we went to a monkey sanctuary where we spent a couple of hours wondering about not seeing anything, until just as we were about to leave 3 monkeys came out and started grabbing the bananas we had left for them. My new binocculares worked like a dream.
Once we got back we organised a ghanaian drumming lesson, which was great fun. Based on a similar rhythm to Cuban drumming we were taught how to create a tone and a bass sound using a bongo type drum as well as treated to an in promptu concert. Today we head back to atibie, hopefully the roads will be less busy than yesterday.

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The walk to hospital

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The hospital

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The house

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2nd Annual General Meeting of Kwahu District Health Services

Today we had were really lucky and got to see the general meeting of the hospital and community services. It was really interesting to see what the roles of all the different services are and how they prioritise these. The nurses seemed to be particularly focussed on the wearing of correct uniform and also complained about the lack of night cup (whatever that may be, although it apparently is a great source of moral) and 8 years of no new uniform. Other interesting things I learnt were that the 5 electricians and plummers managed to fix 83% of the things asked of them throughout the year. Still we got a free lunch so it was worth it.

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Settling In

I've now had 3 days in Atibie, and feel I am settling in to some extent into the pace of life and am feeling more comfortable wondering down the street to buy groceries. It is weird having so many people look at you and call out hello when you walk past, although everyone we've met is really nice, it can be a little intimidating when all you want to do is buy some carrots. I feel I have also started to settle into hospital, it has been pretty boring so far due to being placed with a doctor who does not seem to like talking to people. He did not offer anything spontaneously today, apart from when we first asked questions. Hopefully I'll not have too many more days like that. More excitingly I am on casualty this afternoon and will be looking forward to talking to a patient for the first time!

Despite the disappointment with the hospital, it has been wonderful relaxing with a book in the afternoon sitting out the front in the shade. I really enjoyed watching the sun go down yesterday, something I can't remember doing for quite some time.