Global Health Experiential Education in Ghana

Journal excerpt from week three:
“The morning rays begin to peak through the window beside my bed. Off in the distance, I can hear the wild goats beating and the rooster that seems to crow at all hours of the day. As I look around me, I can see the others in the room starting to stir. I pull on my scrubs and join them in the main room for breakfast. Brittney and Basil are already at the table with the other volunteers mixing together the water and condensed milk. The peanut butter and crackers are passed around the table, and the bags of Crystal Water are packed for later in the day. After a quick discussion about what hospital department we plan to shadow, we grab our bags and head out the door. It is only 7:30 in the morning, but the air is already a bit warm. After a few futile attempts with our handkerchiefs to dry off the sweat, we begin the walk to the hospital, which is a little less than a mile. We are all anxious to return to our patients and check in with the physicians we shadow. Along the way, we briefly review the concepts we were instructed to study, such as the names of the metatarsal bones or the modes of healing. We have only been here a few short weeks, but have already grown to love working here in the hospital. As I make my way to A & E (Accident and Emergency Department), I am greeted by smiles from strangers calling out “Akwaaba” (meaning welcome). The people here are so genuine, it’s hard not to feel at home.” This program is an incredible opportunity for students hoping to learn about global health and the medical field. I have never had the opportunity to witness such hard work, compassion, and expertise combined. It renewed my passion for medicine and gave me a completely differest perspective on medical care. The physicians I worked with were incredible about showing me the process ad explaining how certain procedures were performed. It was an opportunity like no other for a pre-med student like myself. The highlight of my experience at Cape Coast hospital was scrubbing in to see a C-section and a baby being born for the first time. It was something I will never forget!
Home is exactly what it became for me. Living here for five weeks, I became a part of their community. I wasn’t just the outsider watching them from a distance. In a way, I was one of them. I was working side-by-side with them, eating the same foods, drinking the same drinks, and (in small sentences) speaking the same tongue. I learned about their cultural values, family customs, social interactions, and even their medical approaches. I think one of the most symbolic moments in embracing their culture, was when my house mother took us to Church with her. We got to attend weekly Mass with the community and at the end, they had a “birthday into the community” ceremony for Brittney, Basil, myself, and a few of the other volunteers we were living with. We were given our Ghanaian names at that ceremony based on the day of the week we were born. I became known as Esi. From that point forward, I had an instant connection with all other Tuesday born Ghanaians. I enjoyed feeling a part of their community and learning from their example.
We also had the privilege of having two a few local coordinators, Augustine and Roland, from the FEB foundation. These two were not only key to learning about this new land, but they also became good friends. They were so welcoming and excited to show us around town. We were incredibly lucky to have them. With their help, by the end of the trip, we knew the words to a few of their songs and had a snap in our handshake like the rest of Ghanaians.
The trip as a whole was an experience that I will never forget, and one that altered me in ways I didn’t expect. At first, I was definitely challenged to adjust to the cultural differences, unique living conditions, and cuisine options. I needed to learn how to adjust to bucket showers, water shortages, and regular power outages. Although I struggled at first to figure out ways to wash clothing or communicate back home, I soon developed new methods and learned to acclimate myself. I discovered how to wash entire loads of laundry in only half a bucket of water and shower using only a bottle of water. I then learned to translate these water conservation methods to cleaning bedpans and towels to help aid the patients in the hospital. Adjusting to life in a developing country became a challenging, but an enriching experience. It changes your entire perspective and doesn’t leave you once you return to the United States.
Things like the careful use of resources and respect for others were vital aspects of the Ghanaian community. There have been numerous times already since I have returned, that I find myself thinking how resources are being allocated, or how certain actions could be perceived. Since coming back, I have felt a bit frustrated at times with the disregard for the struggle of others. There are so many people here in the U.S. that cannot think beyond their next Starbuck’s latte, never mind the people that are struggling just to access clean water. It makes me realize that I want to be careful in determining where my priorities lie. I don’t want to spend my life concerned with trivial matters when I could be contributing to the livelihood of others. It solidified for me my passion for continuing outreach and medical care.
When I stepped off the plane as a Global Medical Volunteer, I realized I might never look at healthcare or cultural differences the same way. During my first week as a volunteer, I met a young woman who was a patient at Cape Coast Hospital in Ghana. She had a tumor obstructing her airway, along with a case of pneumonia. With each labored breath, I could hear her struggle alone in her room. Concerned by her state, I went to check her vitals. As I unwrapped the blood pressure cuff, she reached up and grabbed my hand. I squeezed her hand in return to let her know I was there. She looked up at me, surprised, and a small smile crept across her once distraught face. It was the first time I had seen her smile and was determined not to let it be it her last. When the doctors asked someone to check her vitals and nebulizer every hour, I readily volunteered. To lighten her spirits, I made smiley face balloons from the rubber gloves. When she passed away, my heart dropped. I realized, however, that her story did not end here; her hands would continue to work through me as I care for those around me. In those five weeks, I was not able to eradicate malaria or even suture a wound; however, I know the people of Ghana will be forever imprinted on me as I go forth into the medical field. I will carry the sense of community and compassion shown me, and use that to guide me as a future physician.
I know that as a future physician, this experience will forever shape how I treat my patients, how I practice medicine, and how I extend that care to others. I watched the physicians in Ghana take the time to listen to their patients, make them laugh, and to offer them a kind word. I have never met such devoted and self-sacrificing individuals, who often spent even their “nights off” living in the hospital. They rolled up their sleeves and treated each patient with extraordinary care that often when beyond the walls of the hospital. I hope to follow their model, and cherish the moments that allow me to improve another person’s quality of life, whether that be in terms of housing, medicine sanitation, resources, or emotionally. I have learned from the people there that we all have great capabilities for doing good. In choosing to support one another, we build a community that strengthens itself. This has significant impacts on each individual both emotionally and physically. One of the physicians at Cape Coast Hospital once said to me at the end of his 48-hour shift, “If I look back on my life someday, and someone received a second chance because of me, then my life was worth something.” Those are words I will never forget, and I believe will guide me as I navigate my way through life.
I am extremely grateful for this opportunity to join a completely different culture, and understand how living with limited resources doesn’t need to limit you as a person. I have learned more in these short five weeks than I thought possible. I learned about myself and how to manage in extreme settings. I have become more conscious of my respect towards others, especially those who are my elders. I have discovered that reaching out and simply saying Akwaaba, or hello, can brighten anyone’s day. Most of all, I have embraced the idea that everyone is your brother (or sister) and that you have a duty to yourself and to them to bridge that divide.

My time in Ghana with CFHI was one of the most impactful components of my education in Public Health. This experience allowed me the chance to see the theories I'd learned playing out in a real-world setting, before my very eyes. Not only did I get to see these health challenges and disparities in person, I was also able to participate in efforts to counteract them through community outreach programs.
During my internship, I was fortunate that my schedule overlapped with another NGO in Cape Coast, and I was able to participate in a health clinic day in a rural village. This was one of the highlights of my time in Ghana, as I was able to meet the village elder and get a tour of her village, while she told me about the beauty and difficulty of the lives of those within her community.
I'd recommend CFHI Ghana to anyone looking to gain a better understanding of health and social disparities in a developing country. Entering into this program with an open mind and a willingness to expand your comfort zone will likely result in enjoying this program fully.

As a third-year pediatric resident who has some prior experience abroad, I came to this rotation with specific learning goals. The program and hospital staff were extremely hospitable and allowed me to tailor my experience to meet those objectives. At the same time I was given enough autonomy to see patients mostly independently (with appropriate supervision when needed, of course) and actually be useful instead of just being a burden to them. Housing was clean and more importantly safe, even though I was there alone for most of the month. The local coordinator did an excellent job of orienting me to the city and hospital.

Arrival was smooth and transition from the airport to Cape Coast was very easy. Only thing that was a little difficult to manage was contacting Augustine when coming out of the airport. I happened to use a taxi-driver’s phone number. Other than that, although it was exhausting to journey further after traveling for long hours, I think it was worth just heading to Cape Coast and resting once and for all.

The House
The house was very comfortable and had every amenity that is needed. My only suggestion is regarding the key. I think there is a way to make sure individuals can have a key so as to not have to ask someone to let them in (and thus disrupt their day as well). Solutions could be perhaps a lock box or asking individuals to place a deposit for a key so that in case it is lost, there are funds to replace the locks. The room was comfortable and I felt that after my initial adjustment to the heat, having the fan was adequate in staying comfortable at night. In terms of cooking, the house mother was not around, and this was not a problem for us because we all cooked in turns and helped out, however, I could see it being a bigger problem if individuals who come in the future do not like cooking.

Weekends
I think weekends were well spent. I would encourage people to take initiative to go places if they want to. Maybe a written guide could be provided? As someone who feels comfortable traveling alone, I wouldn’t have minded catching tro-tro’s or taxi’s if I knew where to catch them/directions.

Hospital
Most all people at the hospital were very welcoming. I had a fantastic experience on the internal medicine team and was fortunate to have individuals on the team who helped me a lot. I would have liked an overall orientation of the hospital and how different services worked on the first day, especially for things like the surgical suite, where the canteen is, lectures, etc. Nurses were helpful and so were house officers. I do think the issue of “having a letter” should be addressed early and students should be reminded to keep it at all times. The medical director’s secretary is not always available to start introductions with the chairs and the chairs of departments are not always available readily to give students an assignment. Most of the time the recommendation I was given was to just find a consultant since they are regularly around and join the team. I had some people who never asked for the letter and some people that did – it was kind of uncertain.

The CFHI Ghana experience was truly life changing. We were able to immerse ourselves in the Ghanaian culture while also gaining experience in a hospital setting. The Cape Coast Teaching Hospital allowed great flexibility in department rotations as well as a friendly learning environment. The doctors, nurses, and medical students never hesitated to seize a teaching opportunity. I hope to return in the future because this program inspired me to pursue a career in global medicine!

Our program was centered on understanding the many social determinants of health that are in place in Accra, Ghana. We worked primarily out of the Princess Marie Louise Children's hospital in Accra, working with the various departments to understand the types of patients that they normally see and with what conditions they normally arrive. The doctors and staff at the hospital were very helpful in helping me gain understanding of the types of disease burden the hospital normally sees, which is much different than what you would see working in a U.S. hospital. The program also allowed us to visit and learn from the many public health offices of the government, as well as USAID and the WHO.

This experience really opened my eyes to what was possible in a global health field and inspired me to continue working towards a career in global health. It also allowed me to learn about the people and culture of Ghana, which was really enlightening as well. I would highly recommend the program to anyone who wants to learn more about social determinants and global health!

I am currently a Pediatric resident in the US with an interest in practicing internationally in my future endeavors. I also have been on multiple trips with CFHI, including Oaxaca, Mexico and Córdoba, Argentina. I was the first participant to go to Ghana, a beautiful and welcoming country rich with a variety of languages and cultures. Being immersed in the hospital system as a 4th year medical student provided me unique opportunities to work alongside residents (medical officers) and attending physicians. CFHI and the local staff ensured that I was able to have the experiences I wanted. Specifically, I was able to accompany and administer vitamins on a national immunization campaign day. I also spent time cooking Ghanian food alongside mothers who were rehabilitating their malnourished children, learning how to properly balance meals to heal their children. Overall, this program met my expectations in allowing me to customize this program to my interests.

I had the opportunity to spend a month in Accra November 2016 and I absolutely loved it! As a pediatric resident , it can be difficult to find experiences abroad which fit your particular skill set and continue to allow for a safe learning environment. At Princess Marie Louise Children's Hospital, I was fully integrated into the inpatient and ED schedule with opportunities to also spend time in weekly clinics (sickle cell clinic, asthma clinic, developmental clinics, ect). I worked alongside dedicated physicians, house officers, and staff who all love to teach and were excited to involve me in the care of children without pressure to perform skills that I did not feel comfortable with. CHFI is also a large proponant of ethical standards and practices for global health rotations which is so important. I would highly recommend this program to anyone who is interested in pediatric global health!