Where did you go for your elective? Why did you choose to go there?
I decided to undertake my elective at Effia Nkwanta Regional Hospital in Takoradi, Ghana. It is one of ten regional hospitals in the country, dealing with admissions predominantly from the Western region.
My goal with choosing Ghana was to see a completely different type of healthcare to the NHS. I wanted to learn how healthcare is run in an economically deprived and resource depleted area. Additionally, I was curious to see a different demographic of diseases.
What did you do in your elective?
I did 6 full weeks in main theatres where a range of specialties operated including orthopaedics, general surgery, ENT, MaxFax, Obs/Gynae, and ophthalmology.
I also attended wound clinics which furthered the scope of diseases and disease processes that I was exposed to as well as enabled me to learn homeopathic methods to treating these wounds alongside surgical remedies.
I also attended health care clinics run in the community for Ghanaians who could not make it to the hospital for a pleather of reasons.
We would do routine blood pressure checks, test for HIV, Malaria, and Hepatitis B in people of all ages, check their blood glucose levels, and run any other checks for conditions they might have.
I was able to explore a variety of surgical specialties to further reaffirm my interest in surgery and to hopefully help to narrow down that interest.
I was taught to scrub in as first assistant where I could work on my suturing skills as well as enhance my anatomy and physiology knowledge.
What did you learn from the experience?
I got to see firsthand how being innovative and resourceful these kinds of places need to be in order to survive and provide lifesaving treatments for patients coming from a range of financial backgrounds.
I was initially shocked at what seemed like a lack of empathy, communication and consideration for patients. They weren’t ever really acknowledged and would be left alone in compromising positions, often completely exposed.
Patients were not active participants in their health decisions and pain was a low priority, especially in theatres where we’d operate mostly under spinal blocks which would often run out before we’d finish.
I learnt that the reasoning behind this 'lack of empathy' isn’t coldhearted but rather they have a different set of priorities – namely keeping the patient alive. Bear in mind, these hospitals are dealing with patients who only present under dire circumstances, and have limited means to treat them. Pain, comfort, conversation, are all things that then naturally have to take a backseat.
I learnt how important it is to empathise with cultures and beliefs that sometimes feel a world apart from your own. I learnt the importance of approaching something with an open mind set, and not to come into an experience believing that the way things are done back home is the only right way to do things. Just because something is different, does not mean it is wrong.
On a more practical level, I was able to improve my surgical etiquette and learn how to communicate with patients who understood very little in English, and very little about their health. I learnt how to build a rapport and a community with the doctors and nurses, who also spoke little English and had very different cultural attitudes than my own.
I was able to learn about a different disease demographic included tropical disease like malaria (and its association with sickle cell), elephantiasis, and typhoid. I learnt the conservative approaches to managing these conditions as well as the surgical implications from some of these conditions. I also got to see the difference between amputations in our regional hospital versus private theatres and gain an insight to these two different approaches to healthcare in Ghana.
What did you enjoy about your elective?
My elective period was, without a doubt, the highlight of my time in medical school. It enabled me to become fully immersed in a vastly different culture and learn an incredible amount from everyone there, not just healthcare workers.
I was exposed to a wide variety of subspecialties in the surgical field which provided an understanding as to what a job as a surgeon might entail. Additionally, I met some of the most incredible staff who worked in the theatres and on the surgical wards.
On weekends, I was able to explore this beautiful country including Nzulezo, Cape Coast, Kakum National Park, Ankasa, Elmina, Wli Falls, the Volta Region, and Mole National Park. They taught me how to cook traditional meals over a coal stove, how to surf, how to tie a baby to my back, and how to walk alongside elephants in the wild.
I was so moved by the friendliness of Ghanians, their love of dancing and laughter. It was an experience that I will treasure forever.
How did your experience help shape your career aspirations?
This has been touched on above several times but my goal for my medical elective was to primarily assess whether surgery was the route I wanted to go down for my future career. If, through this experience, I could further narrow that down to a specialty, I would have considered that a bonus.
I was exposed to a wide variety of surgical specialties, both in the regional hospital and once in a private hospital, which allowed me to see what kinds of routine operations each specialty does on a given day.
I was able to assist in the majority of these operations which helped to build skills and enhance my knowledge which I will need now and in the future, regardless what field I end up in.
Are there any other highlights from your experience?
Something that may be less medically related, but an important takeaway for a life in healthcare, was the attitude Ghanaians had to stress and how to relieve it.
The house that I stayed at catered towards healthcare professionals of all kinds and at all stages of training. They insisted that every Thursday night was a BBQ and included a full-on dance party afterwards complete with both traditional Ghanian dances as well as classic styles from all over the world. The idea behind these dance sessions was to relieve stresses from that week’s work. They knew we would be exposed to traumatic cases, sometimes loss or maiming, and they knew it was toxic for us to hold onto these moments.
We were supported by a team if we needed to talk and process that way, but they made these Thursday dances to support us in a fun and releasing way too.
I thought it was a beautiful paradox of remembering these hard moments but also celebrating life and all its joys. I loved this mentality of dancing to let go of stress and hope that I can carry this mentality in some form into my future career as a doctor.