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International Child Health Section: Articles
Accra, Ghana
Submitted by: Izabela Sztukowski
Earlier this year, I had the opportunity to spend six weeks working at the Department of Child Health at Korle Bu Teaching Hospital in Accra, Ghana. The Department of Child Health at Korle Bu and the Department of Pediatrics at the University of Alberta have an exchange program, which facilitates residents and staff physicians spending elective time overseas to learn from each other. My experience was eye-opening, educational, and very challenging.
Korle Bu is a large tertiary care hospital which sees hundreds of patients daily, in a huge hospital complex that consists of dozens of buildings. The residents, staff, and nurses at the Department of Child Health, like their colleagues throughout the hospital, are extremely busy, providing specialty care for the sickest and most complex patients in Ghana. There are approximately twenty pediatricians in a country of 20 million people, of which many are children and adolescents.
The challenges facing the population in Ghana are staggering. During my six weeks at Korle Bu, I helped care for numerous children with illnesses that I rarely see in Canada, namely malaria, tuberculosis, and HIV. Malaria is extremely prevalent, and I saw that it was common that children brought in for a fever would already have been started on over-the-counter anti-malarial medications by their caregivers. Sickle cell disease is also very common, and during my six weeks, I saw many children with osteomyelitis, anaemia, bone crisis, stroke, and other sickling complications.
Many of the children I helped care for at Korle Bu were severely ill, and, sadly, many died. Even illnesses that are common in Canada, such as gastroenteritis, can be deadly in Ghana, as children are often severely dehydrated by the time they present to hospital. Overall, the Department of Child Health faces a five percent mortality rate for all children admitted to hospital.
It never failed to amaze me that, despite these challenges, the pediatric residents and staff at Korle Bu remained positive about the work they do. Frequently overworked, the residents stayed well into the evening to see all patients presenting to the outpatient and emergency departments. They did this while teaching junior house officers, supervising and performing procedures, and counselling families. The residents frequently found ways to adapt to the challenges inherent in a low-resource system: clinical exam was a major diagnostic tool and lab tests were kept to a minimum. If absolutely necessary, bloodwork and diagnostic imaging tests were ordered judiciously. If the family could not afford the work-up, the residents would “pass the hat” to raise funds for the test.
The residents were also extremely inclusive to me, making me feel welcome and part of the team. In addition to clinical work, I had the opportunity to present a series of lectures on evidence-based medicine during morning rounds, sharing an approach to critical appraisal of journal articles. Even though the articles focused on malaria, sickle cell disease, and anaemia, the evidence-based approach was just as applicable in Ghana as it is in Canada.
Fortuitously, I was in Ghana on March 6, which marked the 50th anniversary of the country gaining its independence. The day, as well as the weeks leading up to it, was a major celebration for the country, which has so much to be proud of: a vibrant culture, close-knit family life, beautiful countryside, and hope for the future. It was a day that celebrated the achievements of the past, of attaining independence, but it was also a day that recognized the difficulties facing Ghana in the future, including the health challenges of malaria, tuberculosis, HIV, and early childhood mortality. I had the opportunity to work in an environment that faced those challenges each day, and came to appreciate the significant burden of disease affecting children in Ghana. I would like to thank the patients and families, and residents and staff at Korle Bu for making my experience so rich, and the Canadian Pediatric Society for helping make this elective possible.
Izabela Sztukowski
Pediatric Emergency Medicine program
University of Alberta
Posted: June 2007
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