Brendan Payne

I'm a medical student from Melbourne, Australia and chose to do my final year elective in Ghana with Work the World. I spent 6 weeks at a regional hospital within Takoradi and my final week at Akwidaa CHPS, a rural health clinic.

I had planned to do my elective somewhere in the developing world for most of med school but didn't really know how to go about organising it.

I looked into a few things other students had done, contacted a few hospitals overseas but it would often be months before hearing back from different hospitals and nothing really came of it."

I had heard about Work the Work at a student conference the previous year, and, therefore, decided to look into it and was impressed with what they had to offer. It really was quite easy to sign up to the program and was reassuring knowing my placement would be well supported. The fact that accommodation and food were provided (all you really need) was a big plus too.

After I signed up they provided comprehensive information about the program and instructions for everything that had to be organised prior to departing; the UK office were very helpful and called several times to check that my visa, immunisations and other preparations were on track. I don't know what I would have done without Ezekiel when arriving at the airport (and at various points throughout the stay!). He was awaiting my arrival and dressed in his blue Work the World t-shirt. Public transport in Ghana is always an interesting experience, so it was great having Ezekiel to escort me to Takoradi on the first day and help settle me into the house. Luckily after the initial culture shock it doesn't take long to be able to find your way around and in my experience the Ghanaian people are very friendly and willing to help if you get stuck.

The house couldn't really be faulted, there is more than enough space, the beds are all equipped with mosquito nets and the food was a real highlight."

You'll get to try different local foods for dinner at the house; 'Red-Red' was one of my favourites. All of the staff are great and do their best to make the experience an enjoyable one for you. The other students in the house were good fun and you get to know everyone quite well. Most come from the UK; however there were some from Canada and one from the US. Having other students around is very helpful for getting a joint taxi into the hospital and having people to hang around with after placement. It also makes planning weekend trips so much easier and more enjoyable than travelling alone.

The trip into the hospital each day was an experience in itself. Large potholes, which were often very large indeed, were marked with long sticks poking out of them. Walking through Takoradi you will usually be the only white person or as the locals say 'Broni'. This is not a term of any disrespect, but it is odd, at least at first, walking down the street and having every second person yelling out 'Hello Broni!' There are dozens of different dialects across the country; the predominant dialect in Takoradi is called Fante. Nevertheless most patients at the hospital did not speak or spoke only very limited English, however all of the staff speak English and are generally happy to interpret for you. The population is highly Christian (up to 70%) evidence of which is literally everywhere. The majority of stalls/shops etc. will have religious themed names such as 'CHRIST IS THE ALMIGHTY GOD - Plumbing Works' or amusingly 'Mary's Immaculate Conception Fertility Clinic' in the capital Accra.

My rotation of 6 weeks was officially in paediatrics; however one of the good things about the placement is that it is quite flexible in terms of being able to spend time in most areas of the hospital such as emergency, general medicine and birth suite. It is really up to you how much time you spend at the hospital, although like any rotation you get out what you put in and I recommend making the most of it.

Generally patients do not present until the very last moment, which is even less ideal in an under-resourced setting like Effia-Nkwanta. There is a single X-ray machine but no CT. Simple blood tests such as U&E, FBE, blood films, LFTs, can all be done but typically take up to 2 days to return. Many basics drugs are unavailable or intermittently available. The lack of investigations and equipment lead to some interesting (and sometimes ingenious) practices, many of which, such as how a lumbar puncture is performed, must be seen to be believed.

You also encounter some pretty interesting presentations, for example in ED you'd get people coming in for the first time with a liver which you could see through their shirt from across the room. If you spend any time here you will soon become very familiar with malaria and sickle cell disease. Other cases I had never personally seen in Australia included Typhoid fever with a perforated bowel, a full-blown case of tetanus, Stevens-Johnson syndrome and elephantiasis.

Many of the doctors were excellent teachers including a highly eccentric Egyptian doctor who had been posted out to Ghana by the Egyptian government. I've never had a consultant spend so much time on teaching! During ward rounds, he would sometimes spend up to 60 minutes on one patient, teaching students. At the end of paeds rounds, one of the doctors would have a few patients set aside for you to examine and come up with a management plan.

My week in the rural village Akwidaa was a great experience. You stay with a local family and spend your day at the clinic, which is staffed by 3 nurses. This means that you are really looked at as the 'doctor' and assess each patient as they present. The nurses also cook a range of local dishes for you and organise cultural activities such as a bonfire and canoe trip.

"The head nurse is really trying to do his best to improve the service for the local people, at present resources are very limited and it is very difficult and expensive for patients with emergencies to travel to the district hospital at Dixcove (so they often don't want to go even when you diagnose a classical appendicitis!)."

Weekends were generally full of travelling; I managed to get to many areas of Ghana during my stay including seeing elephants up at Mole National Park, staying the night in a treehouse and doing the canopy walk at Kakum National Park, visiting several castles used in the slave trade (Ghana has a very interesting history) in Cape Coast, seeing some amazing waterfalls in Eastern Region and visiting Nzulezu, a village built entirely on stilts so that it sits just above the water during the wet season.

All in all I thoroughly enjoyed my trip, although one final word of advice whilst I recommend trying the local cuisine, you'd do well to stay clear of Egusi Stew. Just take my word for it!