Wednesday, September 3, 2014

Life at the Baptist Medical Centre, Part 1

            I feel like I have been going through medical internship all over again, except this time with a lot more surgery. During the month of July, I was on 24-hour call every other day for the maternity ward and on call for the entire hospital every 4th night, on average. In July, the American obstetrician/gynecologist, Lynn, who will be here for another year, was on vacation for a month, and an American family medicine doctor, George, who had worked for 22 years at BMC, was here to cover for her. During his twenty-two year tenure, he had learned all sorts of surgeries and procedures, as well as recognition and treatment of common tropical diseases, so I gleaned as much from him as I could over that month. We have also had an ER doc from Texas and a general surgeon from Ohio come to help out for a few weeks. We were very grateful for their help!

Tim and George
Tim, Rebekah, and Jim
             While Lynn was gone in July, I started morning rounds in maternity ward most days and then went to the isolation ward (where there are patients with chronic wounds, tuberculosis, and other infectious diseases, such as hepatitis, meningitis, and chicken pox). Also, if I had admitted any patients from clinic or seen some on evening rounds while I was on call, especially those who had interesting cases or were sick, I would try to see them as well. Since Lynn has returned, I have been rounding mostly on the male medical ward and isolation ward (and sometimes on the male surgical ward, whenever we don't have a surgeon). I also take call for the maternity ward every other night and a 24 hour call on one of the weekend days.

   The following is a short list of some of the procedures that I have done/assisted on during the past 3 months: Skin grafts, EGDs (camera used to look inside the esophagus, stomach, and first part of the small intestine; looking for ulcers, masses, etc.), hernia repairs, exploratory laparotomies (for suspected ectopic pregnancy, gastric ulcer perforation, abdominal abscess, and typhoid ileal perforation), sequestrectomies (removal of dead bone from patients with chronic infections of their bone), AKA (above the knee amputation), oophorectomy (removal of ovary), wound debridements (cleaning dead tissue from wounds), incision & drainages for acute osteomyelitis (infection of the bone), mastectomy (removal of breast), and a suprapubic catheter placement (for a patient with urinary retention and inability to place a regular urinary catheter). I have also done numerous ultrasounds to help with management of patients (including OB, heart, abdominal, testicular and thyroid), paracenteses (draining fluid from the abdomen of patients that usually have liver disease), thoracenteses (draining of fluid from around the lung), Cesarean sections, tubal ligations, lumbar punctures ("spinal taps"), incision and drainage of skin abscesses, joint aspirations, laceration repairs, ileostomy bag/base changes, and many neonatal resuscitations, among others.

Large abdominal abscess


Air under the diaphragm in patient with stomach wall perforation

Necrotizing fasciitis after debridement, just before skin grafting

Chicken pox
Common conditions that I have seen here include the following: Malaria, typhoid fever, pneumonia, malnutrition, meningitis, chronic osteomyelitis, hepatitis B and C, HIV, chronic liver disease, nephrotic syndrome, cancer, snake bites, tuberculosis (pulmonary and extrapulmonary), hypertension, diabetes, congestive heart failure, stroke, gastroenteritis, fractures, chronic wounds, asthma, COPD (i.e.- emphysema), dog bites, peptic ulcer disease and road traffic accidents, among others.
Squamous cell carcinoma over previous burn site (Marjolin's ulcer)

Pulmonary tuberculosis
            There has been some changes in the doctors here over the past several weeks. Two of the previous doctors, the Nigerian ER doc (in ER residency training in Ghana) and the Ghanaian medical officer who is about to start surgery residency, have now left, but they were replaced during the month of August with two new Ghanaian medical officers, one straight out of housemanship, and one about to start surgery residency. These two new docs stayed until the end of August. What remains now are two Ghanaian medical officers straight out of housemanship, Lynn, and me (as far as long-term folks).

            I think that this would be a good time to stop and explain the Ghanaian medical training system (as best as I understand it) and some of the terms that are used, which I may use later. After graduating from secondary school (US equivalent of high school), students apply for medical school, which lasts 7 years. The first 3 years of medical school is similar to a mix of the US equivalent of college and the first and second years of medical school. The 4th and 5th years are similar to our 3rd year of medical school, where they rotate through the major areas (i.e.- surgery, OB/Gyn, Adult Medicine, and Pediatrics) as junior level students. In the 6th and 7th years, they rotate through the same areas as senior level students, where they are given a little more responsibility. These two years have a slight resemblance to our 4th year of medical school. During years 4 to 7, they are working and learning under house officers (explained next). After graduating from medical school, they move on to housemanship (where they are called house officers), which is two years of rotating again through the same 4 areas of medicine. This time, however, they are given primary responsibility of the patients. These years would most closely resemble US medical internship in each of the areas of expertise (or similar to what doctors in the US awhile ago used to do, which was complete one year of training after medical school, and then go practice as a GP, or general practitioner). After they graduate from housemanship, they then become medical officers and are assigned for at least two years to a hospital, often rural, in Ghana. Sometimes they may be the only doctor there and therefore responsible for seeing all types of patients and performing procedures and surgeries. For those who wish to specialize, they must complete at least two years as a medical officer, and then they can apply for residency in their area of interest (equivalent to US medical residency programs, which students in the US go to straight out of medical school). In the US, doctors must graduate from residency before they can practice on their own.

To be continued...


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