Telemedicine from the Gold Coast and I Still Can't Tan

My Return to Ghana and a Visit to the “Original” Gold Coast

alyxrosen — Fri, 07 Aug 2009 12:19:17 +0000

I returned to Ghana on Thursday July 15^th and was met by Mr. Mensah at the airport. I spent the morning at Auntie Ellen’s where she made me try on her wonderful hat she had made for David and Emifah’s wedding in August. It is quite beautiful. Later I met Jeff and Lauren in Osu for a not so relaxing afternoon in the arts market (a tourist’s worst nightmare!) On Friday we went to the school where we spoke with the nurse about how we planned to take the student health information that was gathered last week and begin to create a simplified medical record database for the school. The idea is that each term she will return to perform a general physical exam and help to maintain an updated record of the students. We also hope to create a checklist of vaccinations for all students under the age of 5 currently enrolled in the school or to be enrolled in the future. In the afternoon we left for Cape Coast and took a spacious Ford tro tro for the two and a half hour ride. We decided to spend the night at a place called Sammo Guesthouse. Because Lauren was feeling under the weather Jeff and I ventured out for some grub at another hotel along the coast. Along with dinner came an unexpected acrobatics and fire show by a local performer.

The following blurb is courtesy of Lauren:

Saturday, July 18, 2008

We wanted to make it to Kakum National Park early before the crowds came, so we ate a quick breakfast at Sammo’s Guesthouse where we were staying, and rode out to the park. The National Park is home to hundreds of species of butterflies, birds, and even elusive forest elephants that are rarely seen, except at night. We went for a small hike through the rainforest, and then to the hanging bridges. There are 7 suspension bridges at different levels in the canopy that we walked across and view different parts of the forest at various heights. The bridges were very narrow with ropes to hang on to. (I was obviously the only one who was scared, not of the height but of the narrow wooden planks with missing screws and wobbly rope – Jeff and Lauren were not making it any easier by shaking the ropes to frighten me.) After our hike, we took off to a Monkey and wildlife sanctuary that we saw a sign for on the roadside that looked pretty interesting.

It was such a great idea to stop at this sanctuary, we met a man and his wife from the Netherlands, who came to Ghana on vacation and loved it so much they decided to stay and start a sanctuary to rescue injured or abandoned, or illegally captive wild animals. (Actually the husband, Dennis, came on vacation to Ghana and loved it so much he went home and told his wife he was moving to Ghana and she could either come with him or stay-either way he was going!) He has a permit from the government to rescue animals, and has several monkeys that he rescued that were held captive and on a short leash and kept under really poor conditions. He has 11 monkeys, several wild cats that look like mini leopards called civet cats, antelopes, and baby crocodiles. He is building a small guest lodge where travelers can sleep in small huts around a campfire or in various camp sites around his 43 acres of property. He is also in the middle of building a small lake with an island where the monkeys can live and have more space to play.

For lunch we stopped at Hans Cottage, a hotel with a restaurant situated near a large lake full of crocodiles. We were lucky to get a table on a gazebo located in the middle of the lake that you access by a small bridge, and had lunch as we saw huge crocodiles cruising along in the murky waters. There were crocodiles sitting still on the banks of the lake, sunbathing, some of them with their mouths open! A staff member told us we could approach and touch the crocs if we wanted, so we faced our fears and touched a crocodile. I was really scared that it would snap an arm off, but the croc just opened its eye and looked at me as I pet its tail and leg.

The last part of our trip was to Cape Coast castle, and it was such a powerful and touching experience to be there. Obama came to see the castle during his visit to Ghana, and it is a vital part of understanding Ghana’s history. Ghana was colonized first by the Portugese, and then a succession of other European countries (France, Holland) before the British eventually gained control. Before the trade in slaves, Ghana was one of the major sites for gold mining, which is the reason for its old name, the Gold Coast. Cocoa is another major export from Ghana, and continues to be harvested today. With gold and cash crops becoming less profitable to the British, they looked for another source of revenue to support the enormous cost and burden of colonialization. They hoped that Ghana as a colony would become self-sustaining and they soon found another, more profitable trade- in slaves. For over a hundred years, Ghana and West Africa became a major site for the export of slaves to the Americas. Interestingly, only about 1/3 of the slaves were sent to North America. This was part of the Triangular Trade between Africa, Europe and the Americas. The slaves worked on plantations producing cotton, sugarcane, tobacco, coffee, etc, that supplied the European world, and the Europeans traded manufactured goods and weapons to Africa. At that time in history, Ghana was composed of many warring tribes who raided and captured enemies from other tribes and worked with the European slave traders. Africans were not united against the colonial rule, and African chiefs were responsible for the sale of Africans from all over the country to be sent away to slavery. The British brought these slaves to Cape Coast castle, where they were crammed into small dungeons under horrible conditions. The British separated men and women, and between 50 and 100 people were kept in a dark room smaller than the size of my apartment. People had to sleep and sit in their own waste and there was only one small window to let in light and air. They did not have a chance to shower the entire time they remained (which could be up to 12 weeks) before sailing across the Atlantic, and it was so sad to hear how the people suffered under such degrading conditions. The women who were allowed to bathe were those chosen by one of the British men before they raped the women. Our tour guide showed us around the male and female cells, and brought us through the “Door of No Return” the last door the slaves went through before they were loaded on the ships, never to return to their home country. With the abolition of slavery, and the recognition of the suffering and cruelty of slavery, a sign was created on the opposite side of the door that read “The Door of Return” to symbolize the freedom of the people and understanding of this tragic event.

Mallam-Kaneshi-HoeHoe-Wli = Stops on the Ride to the Agumatsa Waterfalls in the Volta Region

alyxrosen — Fri, 24 Jul 2009 12:14:42 +0000

On Friday we they arranged to have the nurse come to the school to do a physical examination on the students in the older grades. She would inspect their eyes for anemia (iron deficiency in their diet) by seeing how red the conjunctiva and asked them if they could see the board in class and hear the teacher to check their vision and hearing. She would then inspect their tongue, scalp, fingernails and body for general hygiene. We wrote down general information about each student as well as recommendations for doctor visits so that the school could send home a notice to the parents. Before this the nurse had never kept an individual record of the students. By the time we leave we hope to have a record for each of the students as well as a method for future medical data collection which will be necessary when the health clinic is finally up and running.

We decided to travel to the Volta region, to Wli, for the weekend which is known for its famous waterfalls. The five and a half hour tro tro ride there was less than comfortable and when we arrived at the lodge we were staying at we were greeted by two large spiders and a gecko in our room. Aside from the friendly creatures, the lodge was quite nice and run by this cute German couple. The food was delicious and in the morning after breakfast we got a tour guide to take us to the upper waterfalls which was about a 350 m hike. The falls were beautiful and although they don’t really compare in stature to Iguazu’s Devil’s Throat in Argentina it was still a great afternoon of hiking. After we made it back down to the village our tour guide, Anthony, took us to his family’s dwelling (in the words of Jeff) and had his brother get us a coconut right from the tree. I never knew this but there are apparently two different types of coconuts. The dark, harder ones (like the ones you see in the US) are the ones that we buy with our corn on the street. The other kind you find even more frequently on the street but people usually drink the coconut juice inside and eat the shell, which is much softer than the darker coconuts.

It was only when we returned to the Waterfall Lodge that I was able to use the house phone and get in touch with my family to hear the news of Grandma Bernice. I want to take this opportunity to thank Lauren and Jeff for their complete support throughout the night and the adventurous ride back to Accra and the airport to somehow manage to get me home to NY and to my family.

The Real Theater

alyxrosen — Wed, 22 Jul 2009 23:18:25 +0000

On Thursday we went back to the Police Hospital and I got to shadow another doctor in the Theater. When I got there the second OR was being used to perform a C-section that I caught the last part of. I saw the doctor deliver the baby and then watched as they cut the umbilical cord. The baby had more hair than you could possibly imagine. I then got to watch the surgeon remove infected sebaceous cysts from a patient’s arm and abdomen. The one on his arm was so extensive that it took her about an hour and a half to remove. The last surgery was an epigastric hernia on an 11 year old girl. It is caused by abdominal wall muscles that do not fully form and cause protrusion through the umbilicus (belly button.) I have seen several epigastric hernias (or what could also be umbilical hernias) including one of the girls at the school. These are not necessarily medical emergencies and do not have to be repaired however you can imagine what a 5-6in protrusion from the belly button looks like. When the doctor was finished repairing the abdominal wall there was a lot of excess skin that was left and I do not think that any attempt will be made to cosmetically correct the little girl’s abdominal appearance. I have seen some pretty funky looking belly buttons in Ghana. After work we went for lunch and then walked to the National Theater in Ghana in order to try and find a schedule of events for the upcoming weeks. The theater is quite large and looks really nice but just like a lot of things it is somewhat of a façade. There was no receptionist and we had to stumble into a meeting or sorts in order to get directed to someone who could get us a calendar of events. When we finally found a woman in charge she informed us that the schedule was only completed up until July 9th and a more extensive calendar would be available next week. Surprise, surprise, hopefully we will be able to see a show there before we leave.

Flash Floods and My Beautiful New Wardrobe for the “Theatre”

alyxrosen — Mon, 20 Jul 2009 01:42:36 +0000

Monday it rained really hard all morning and on our drive to the school there were flash floods everywhere. People were trudging through “oceans of water” (as Bismark would call them) up to their wastes or couldn’t even leave their buildings because of the water. Surprisingly a lot of the cars drive right through these huge puddles although there came a point where our taxi driver wouldn’t take us any further. Bismark came to pick us up and take us to the hospital near to the school where we will also be working and while he was driving we could feel the water under the floor of the car and all of the rocks scraping against the underside. People are so thankful when the rains finally stop because it can be incredibly dangerous especially for the little kids and older adults.

On Tuesday we finally got to start work at the Police Hospital in Osu. We will be going there about 8 times so we will shuffle through about 4 of the wards each. Lauren spent the day in the pediatric ward, Jeff sat with a Cuban doctor in the out-patient department seeing cases from Malaria and HIV to Diabetes and intra-uterine cysts. I got to spend the day in the Theatre or as Americans refer to the OR with Dr. Zakariah. He is a general surgeon who studied in Ghana but also did some of his training in the UK. The first operation I got to watch was a direct hernia repair. We talked about the fact that in the US hernias are frequently repaired with mesh rather than just sutures but that about 15% of hernia operations in the US are due to recurrent hernias. The use of mesh is also really expensive and Ghana does not have the resources to provide such a surgical option. However, Dr. Z explained that using stitches he is able to create a slight mesh-like design using sutures only. The second surgery I got to see was actually performed by an OB/GYN who was removing an ectopic pregnancy on a woman for the second time. While the sight would have appeared gruesome to most it was incredible to witness. The doctor was also able to salvage the woman’s fallopian tube so that she would still have a chance to get pregnant in the future although after two ectopic pregnancies her chances are very low. The final surgery I watched was a Cholecystectomy (where the gallbladder is removed.) The ultrasound showed numerous stones when the gallbladder was removed Dr. Z allowed me and this other doctor to open it up and remove/count the stones. During the operation he was quizzing me on the arteries to the gallbladder and it was so intimidating – guess it’s what I have to look forward to in the near future.

Because we did not come fully prepared with scrubs I borrowed a gown from one of the nurses, Wooda. Jeff thought I looked funny, hope you enjoy the picture below! After the hospital we walked to the National Theater in Accra. It is pretty difficult to find information online or get somebody on the phone so we tried to get a schedule of the July shows. Apparently the schedule is not yet complete, I guess that is Africa. Hopefully we will be able to catch a good show there before we leave. On the tro tro ride back to Dansoman I just had to try the boiled corn they were selling in the tro-tro station. It was my first adventure with street food and it was quite delicious.

Saturday in Aburi and A Bike Ride Never to be Forgotten

alyxrosen — Sun, 19 Jul 2009 20:32:59 +0000

When Ting was here she went biking at this place called Ghana Bike and Hike right near the Aburi Botanical Gardens. Saturday we decided to check it out and took three tro-tros and 3.5 hours to get to Aburi. Kofi, the owner of the place was great and fitted us with bikes and backpacks and Michael was our tour guide. While we were expecting a nice ride through the local villages and farm land that is not what the ride entailed. We rode on trails that were as wide as the bike tire, through corn fields and streams and by the end of the four hour ride Lauren and I could hardly walk. Needless to say it was a little bit more than we had expected. Bismark, one of the Japhet’s nephews, rode with us and even he was walking at the end. The view from Aburi, which sits on top of a mountain, was beautiful and in the tiny villages we rode through all of the little boys and girls shouted “abroni, abroni” “white person, white person.” I think we have kind of gotten used to it. Lauren and I left Aburi with way more scratched, bruises, and mosquito bites that we went with. On Sunday we went to the pool at a local hotel, its been pretty overcast so still no tans or burns here.

The Trio of American Med Students

alyxrosen — Sun, 19 Jul 2009 19:30:48 +0000

On Thursday morning after I moved to Dansoman we met with Dr. Nyarko at the police hospital to plan our schedule. We will be working in the police hospital two days a week shadowing through the different wards. After we went to this huge market in Accra where they sell everything from cloth to woodcraft and the sellers follow you from stall to stall in order to get to you even look at their items. We also went to the Kwame Nkrumah mausoleum and got a tour of the grounds. I believe President Obama will make a trip there when he comes to visit this coming weekend. The city is getting so excited about Obama’s visit but it doesn’t seem like the city is doing much to prepare. Apparently the slave castle at Cape Coast where he will visit was painted but even then they only painted the sides that he will see and didn’t bother to paint the back side. Inside the mausoleum the guide showed us all these photographs of Nkrumah meeting with heads of all different countries. The Ghanaians apparently believe that the UN was behind his murder since he seemed to be allies with conflicting sides like countries such as Cuba and the US.

On Friday we went to Adabraka Poly Clinic and also met with Dr. Yabani at the AMA (Accra Metropolitan Association.) He talked to us about the health care system in the 11 different districts in Accra. There were several hospitals, poly clinics, local health centers and throughout all of the 11 districts there are currently only two community health workers. They monitor things like cholera outbreaks in the various regions and had a wall full of data analyses compiled from all of the hospitals under their direction. The system appears organized and efficient but after experiencing the rural villages I question how truly effective the health care delivery is.

Friday night we met up with MartenLois (the diabetic nutritionist from Port Clinic) who took us out to Champs Bar at the Paloma Hotel. There was great karaoke all night and the place was packed with international people. Unfortunately we didn’t get a chance to sing Sweet Caroline, so maybe next time.

July 1st – Republic Day

alyxrosen — Sun, 19 Jul 2009 18:34:02 +0000

Wednesday, July 1^st, was Republic Day, a National holiday so most people have off from work. I had arranged to go to Port Clinic in Tema to attend their weekly diabetes education session. Lauren and Jeff, the two other medical students from UPenn who I will be working with, met me at the clinic. Dr. Ayerh asked that we discuss a bit about how patients in the US are educated about diabetes. There were about 20 patients that came to the education session where they were also weighed and had their fasting sugar levels tested and then see the doctor after the info session. Nurse Barabara and the Diabetic Nutritionist MartenLois coordinated the session and helped translate to Twi. We first had patients volunteer to tell us what they know about diabetes. There are pictures of some of the patients below. Then we had each patient come up to the front and explain to the group how they have changed their diet and lifestyle since being diagnosed with diabetes. It was incredible how people were able to honestly discuss their changes in habit as well as things they have yet to change, like cutting the local dish Fufu (which takes 12 hours to digest) out of their diet. We think it was incredibly helpful to have everyone address the group, form a support network and educate each other. I left Jeff and Lauren to meet a friend at La Palm Hotel pool and spent the rest of the holiday relaxing like a local! Auntie Ellen and I spent our last night together watching The Jacksons, An American Dream together. I will be sad to leave her tomorrow but am excited to head to Dansoman to meet up with Jeff and Lauren.

A Tribute to MJ and the Crazy Hat Lady

alyxrosen — Mon, 29 Jun 2009 23:44:07 +0000

Today I got up early and sat with Auntie Ellen as she prepared breakfast. We were supposed to go to the market to get her fresh vegetables but it rained so hard all morning and by the time it stopped the market would have been very muddy so we didn’t go. Instead I went to lunch with Achiamah, her Uncle Ed, Aunt Alice and their friends. We went to La Palm hotel, which was very nice and one of many hotels that are along Atlantic Ocean. (It is actually the Gulf of Guinea.) David, one of Auntie Ellen’s sons, is going to be married there August 1.The beach is covered with trash though and the water looks quite dirty so many people do not swim although there were a few people kite surfing today. The buffet had mostly traditional Ghanaian dishes but they were also roasting a full pig outside which I just had to try. I think that if I had not watched the man cut the meat right off the pig it would have tasted better. While driving we saw this whole community of workers who were building wooden furniture and goods. They moved from a small village and first set up on a road between Kumasi and Accra but now they have established themselves closer to Central Accra and their business does very well. The furniture is also really nice. I tried to take some pictures while we were stuck in traffic. We then drove through various districts including the Railway Station and Central Business Districts. The railways used to run through the bigger cities in Ghana but they are not functioning right now. Instead the area around the railway station is FULL of what people call petty traders that line the “sidewalks” and the streets. The old government (the NPP) worked so hard to remove the people from the area and succeeded in doing so, however, in order to try to get re-elected they allowed all of the people to return right before the election. The NPP ended up losing and now the new administration (the NDC – National Democratic Convention) is having a very difficult time removing the people from this area.

The best part of my day came later in the evening when we returned home to Auntie Ellen. She LOVES hats and has a lady that makes her all of these incredibly original hats. People even used to call her the lady with the crazy hats but she looks so good in them she can totally pull it off. So we had her do a mini fashion show. We then watched a very short tribute to Michael Jackson on TV while Achiamah acted out the dance moves. Everyone here loves MJ and on the news they interview people all over about his death. People here say the craziest things about his life and death and it makes them seen so naive. But everyone loves his music and we hear it playing everywhere. I was also so impressed when Auntie Ellen demonstrated her flexibility with her yoga moves. She does yoga for 30 min every morning. I hope to have her energy and strength when I am 73!!!

Plantains for breakfast lunch and dinner!

Ochronosis and skin lightening creams

alyxrosen — Mon, 29 Jun 2009 20:43:29 +0000

Thursday we drove to McCarthy Hill to conduct the study with Dr. Haligah at the Gha South District Hospital. We thought it would take about 30 minutes but it ended up taking an hour and a half. I am beginning to realize that everything takes so much longer than what Ghanaians say because you always have to factor in for traffic, rain, and just a blatant underestimation of the distance. We got there and Dr. Haligah was great! He had arranged with the medical director for us to work in a separate consultation room. Dr. Haligah brought in 15 new patients whom he had not seen before. He discussed with Achiamah his diagnosis of the patient and described the treatment that he would prescribe. We took pictures of each of the patient’s rashes that will be uploaded onto the TeledermAfrica website with additional information about each patient so that another dermatologist in Ghana can make his own diagnosis. We will then compare the two for concordance. There is definitely one skin rash that I can diagnose already. It’s called Ochronosis and is characterized by dark patches on lightened black skin. There is also the potential for internal renal and liver damage when using this skin lightening creams. A lot of women and some men in Ghana use these skin lightening lotion products and while this occurs in NY as well, Achiamah says that there is definitely a greater population of people in Ghana that what she has seen in Brooklyn. These beautiful women want lighter skin but they end up permanently damaging their skin and continue to use the cream for fear of their skin returning to its dark color. I now notice so many women, the poor as well as the wealthy, with this skin rash and there are some some pictures below.

I want to be tanner and these women only want to be lighter.

Dr. Osei-tutu x2

alyxrosen — Fri, 26 Jun 2009 21:12:23 +0000

Tuesday was a very successful day! In the morning we went to Achiamah’s uncle’s private clinic at the Mechanical Lloyd Building in Accra. Dr. Edward Osei-tutu is a general practitioner and was able to arrange for fifteen patients with skin “problems” to come to his clinic today to participate in the pilot study. Sorry to say dad that we have not seen extremely interesting cases just yet. Dr. Osei-tutu works at a private clinic and while some of his patients have National Health Insurance or private health insurance it was very unclear how much they paid to see the doctor. This is still something we have yet to figure out completely.