Letter from Anna

Subject: Akosombo


Greetings from Akosombo. I'm at a larger district hospital now at the site of the hydroelectric dam that provides 60% of the power for Ghana. The water level is very low right now, which is creating shortages throughout the country. It's a very strategic location for Ghana, and very well planned. There are alot of good jobs here, and it's evident when you look at the community I'm living in. We have paved roads, trash collection, and street lights. Most houses have cars parked out front, and it would easily pass for southern CA. It's amazing the difference in living conditions that exist within the country. Every morning I see the gardeners out "mowing" with sickles.

I'm staying in a student hostel with close to a dozen other Ghanaian students. Medical school here is like hitting the jackpot as far as education is concerned. There are only 3 schools in the country, and they graduate less than 200 MDs a year. Those few though are guaranteed stable futures either here or abroad. In the US, if you have the academics, you can be fairly certain of getting into medical school and you've got access to sufficient loans to get you through. That's not the case here. If your family can't support you through school, you can't go.

This is a referral center for the area, and has really great attendings who are limited more by technology that by training. We currently have a patient recovering from tetanus, a young man with renal failure of unknown origin, another with the largest spleen I've ever seen, a couple patients with complications from sickle cell, 2 with probable TB, and an older gentleman with AIDS. They are really sick, and there aren't many investigations we can get. We just sent one patients family to the capital in search of stronger diuretics. Dr Mills isn't sure if there are any in the country, but it's his best option given that dialysis isn't available. The nearest EKG is in the capital. In the US there's one in every family practice office.

Most of the docs have spent at least a few months working or training abroad, and they tend to know the physiology better than we do. In the US, physical exam is not really emphasized because we're going to order the entire panel of labs regardless of whether your suspicions changes from 20%-80% for or against a particular disease. Then depth and breadth of their knowledge is really impressive, but access to technology is very limited. Most docs seem acutely aware of that. The head surgeon spent a good 5 minutes on rounds talking about the failure in the public health system that lead to a case of active tetanus in this day. He's really interesting to talk to. He has a larger role outside the hospital that is not entirely clear to me. He talks about things like pest control measures near the dam and the snake that managed to get into the electrical systems and threatened to short out the main power plant for the country. He's also involved in bringing health care to the people living on the lake that was created by the dam. There's a perception that the dam brought Schistosomiasis which is partially true. (carried by freshwater snails, the exposure to which has increased as there became more people relying on fishing for their livelihood.) They built a hospital ship to go up the lake visiting multiple isolated communities with no land based access. It was supposed to go out this week, but it's delayed for unclear reasons. First they said there was a problem with the kitchen equipment, then the holidays, then the water level, then the engines, then storms. He wasn't been able get anything consistent from anyone, but unfortunately can't do anything about it. I have met some incredibly hard working people here, but they frequently come up against strong resistance when trying to implement ideas that will really make a difference. This hospital has been great in that there are a lot of motivated people here. It's really eye-opening though to see the reality of working within a developing setting.

Akosombo is beautiful. Lush spectacular mountainsides along the lake. We went canoeing this weekend, and out to a waterfall and amazing rock formations. I've also found some trails near the hostel that lookout over the mountains. Mangoes are in season, and they're great.

That's probably enough for now. I'll be back at the end of the month. Looking forward to Charlottesville in the spring.

Yours,
Anna