IFMSA SCOPE Exchange in Accra, Ghana

~Akito’s Diary 2007 Spring~

1.Standing Committee on Professional Exchange (SCOPE)

2.The aim of SCOPE
3.General information about Ghana
4.Exchange in Ghana
5.Junior Clerkship in Kore-Bu Teaching Hospital, UGMS
6.Duty night!!
7.Community Health Training
8.Public Health Department in VRA
9.Doctors in Ghana
10.Health System in Ghana
11.Why Ghana is stable for 50Years?
12.Independence Day!!!
13.FGMSA Annual Congress
14. Hostel in Ghana University
15.Mass in Ghana
16.Flea market

1.Standing Committee on Professional Exchange (SCOPE)

The Standing Committee On Professional Exchange (SCOPE) is
the first created IFMSA Standing Committee. It constitutes the
largest exchange program within IFMSA and it has been running
since the organisation's foundation in 1951.

2.The aim of SCOPE

The aim of SCOPE is to promote international understanding and co-operation amongst
medical students and all health professionals through international exchange of students.
The exchange program offers students unique educational and cultural experience in
addition to the regular medical curriculum. It also helps to broaden the students
understanding of medical and social conditions in different countries.
Currently over 6 600 international exchanges are made every year, and 78 countries
throughout the world are taking part in SCOPE.
The Professional Exchange is defined and regulated in the Standing Orders of SCOPE. A
professional means an exchange of a medical student who undergo a medical practice in a
hospital abroad. This practice, named clerkship, is purely educational for the student and
he/she will not receive a salary for it.

3.General information about Ghana

The Republic of Ghana is a country in West Africa. It borders Côte
d'Ivoire to the west, Burkina Faso to the north, To go to the east,
and the Gulf of Guinea to the south. The word "Ghana" means
"Warrior King",[3] and was the source of the name "Guinea" (via French Guinoye) used to
refer to the West African coast (as in Gulf of Guinea).
It was inhabited in pre-colonial times by a
number of ancient kingdoms, including the Ga
Adangbes on the eastern coast, inland Empire of
Ashanti and various Fante states along the coast
and inland. Trade with European states
flourished after contact with the Portuguese in
the 15th century, and the British established a crown colony, Gold Coast, in 1874.[4]
Upon achieving independence from the United Kingdom in 1957,[5] the name Ghana was
chosen for the new nation to reflect the ancient Empire of Ghana that once extended
throughout much of western Africa.

4.Exchange in Ghana
Expenses: about 300EURO/month (exchange office covered accommodation and lunch)
Facilities: Room-share, Shower-cold and sometimes no water, Student’s Lunch-no
vegetables except for local food but fine, Computer- available, Internet-LAN and WiFi
available(I could use Skype!), TV-Cable TV available
Water: mineral water needed
Food: some good and reasonable restaurants near by hostel(You can eat vegetable there!)
Shopping: Small shops are in the university for your daily needed
Anti Mosquito: You can buy anything here except for Anti-Malaria Medicine
Security: Inside the university is very safe and outside also safe except for night
Weather: Basically hot in March but sometimes cold after raining

Clinical Training over view (Obstetrics and Gynecology ):

Monday: Clark and Physical Examination in Gyne Clinic
Tuesday: Observe operations in Theater
Wednesday: Clark and Physical Examination in Antenatal Clinic
Thursday: Ward round in Gyne Dep.
Friday: Ward round in Obst Dep.

Time line:
8:00~9:00: Morning Lecture all together
9:00~13:00: Clinical Training
Afternoon: Clark your own patients in Wards
+A duty in Delivery Theater / week
+Some Tutorials

Type to training:
You will join a group of Local medical students (6th year)

Events (My case in March 2007 )

1-Arrival
2-See Drama in Main University
4-Beach!!
5-Independence eve fireworks
6-Independence Day (50th anniversary in 2007)
12~16-Community Health Activity
17~18-FGMSA Annual Congress
22~23-Visited Private Clinic
24~25-Travel to Cape Coast and National Park
27-Visited Noguchi Memorial Institute and WACIPAC Office
30~31-UGMSA Annual Congress
31-Departure

5.Junior Clerkship in Kore-Bu Teaching Hospital, UGMS

We had clinical training in Kore-Bu Teaching Hospital which was located next to UGMS.
They have medical school for 7 years and 1st year, they studied basic science and before
2nd year they have exam to be selected as Medical Students or other College students. 2nd,
3rd and 4th year they study medicine in lecture room and 5th, 6th and 7th year are clinical
training finally (Junior clerkship training). They rotate 8 months/department and divided
to 8-9 students / group. They have morning lecture with all and then spread out.
My department was Obstetrics & Gynecology
department and I jointed with the 6th years
medical students’ group. At first I applied
Family medicine and Community health
department, but the department was small
and they suggested me to be the department.
In addition, I were also in part of Fever
Unit(HIV/AIDS, and other serious fever
patients there) , HIV Child Clinic( Unit for
Children who are infected HIV through mother), and Community Heath department.
The training we received were similar as Japan; physical exam, see and talk with patients,
present it to cuter or chief of the unit, lecture, and see delivery. The funny thing was that
the students’ behavior was also the similar as Japan!! For example; doctors asked us a lot
of questions very fast and we try to
answer but sometime no idea….and
doctors complain about that. They had
exam next week and really didn’t want to
go to the round and chief of the Unit
disappointed so much and say” I had
never be impressed with the group!!! And
students also complained that they didn’t
understand how exam was
difficult…something like that. Medical
students are the same all over the world.

6.Duty night!!
Our group had duty, “Toucyoku”in Japanese in Obsti & Gyne
Department. We stayed in Gyne Emergency room and Delivery Theater
whole the night to assist delivery. The room was more realistic
atmosphere than my teaching hospital in Japan. Pregnant women were
screaming, praying, some babies are miscarriage or abnormality,
horrible bloody smell, and only one operation room for Cesarean
Section (Teiou Sekkai)……here was the place that human live starts.
The biggest different here was that they didn’t use anesthesia, and because of the pain
they were screaming very seriously. The funny thing was that midwife gets mad and
beating pregnant women during the delivery but still pregnant women gratitude her and
gave some gifts.
Berth was very cerebrate event here and
people working here got high reputation
from patients and high income. That’s why
a lot of doctors wanted to chose Obst&Gyne
as their specialty in Ghana. This situation is
completely different compare with
Japan……they are not respected, low salary,
too much work, high risk (to be sued by
patients), and nobody wants to specialize
the department. It’s really serious problem
in Japan currently, because of the lack of doctors and midwives some hospital close
Obstetrics department and pregnant don’t have place to delivery. When I told the situation
to medical students in Ghana, they were surprised and wanted to go to Japan as doctor!!!

7.Community Health Training

I went to Aksomblo which was the middle
part of Ghana and near by Volta Lake. Since
all the 6th years’ medical students had exam
and I chose Community Health Department’s
activity in ARV Hospital for a week.
ARV hospital was a private hospital which
covers Alsomblo and cooperate with Kare-Bu
Teaching Hospital for Community Health.
The facilities and services of this hospital
were good quality and clean.
I stayed in Reproductive Health and Child
Unit and Public Health Unit for each 2 days.
In the RCH unit, we had weekly check of
pregnant women and school health. We
checked their urine for suger and keton,
general condition of infant and mother, and
gave injections. They had Maternal Health
Record Book, Family Planning Book, and
Child Health Record Book. They are kind of
Mother and Child Book,
“ Boshitecyou” in Japan. They had
such record books for a long time. I
was surprised that the health care
system in this county is quite good!!
2nd Day, I went to primary school to
examine school children. It was really
nice, because I hadn’t had such a
experience in Japan and it had a lot
fun to examine them. When I entered
into the classroom, their face looked really curious to see foreigner. The funny thing was
that when a nerse say “Good Morning and How are you doing?” to them, they replied just
like copy machine “ Good Morning” and “ I’m fine thank you and you?”. Yah, it’s typical
school students.
I examined as general systematic examination and found some patients; anemia, diarrhea,
abdominal pain, ear pain, and skin disease….etc We gave advices to them to come to our
hospital within a week. They were very quite silent when I examined and looked very
shye…and their English speaking ability were not so high at this moment. There was a
paper on the wall “Speak English!!” and if they won’t speak, they will get punishment. It
sounds serious, right?

8.Public Health Department in VRA

VRA is a Public Sector which covers around Volta river and
the dam. There were some departments in VRA and one of
it was Health Department. The health section were VRA
hospital, and Public Health Dep( lake side health unit and
environmental sanitation) The Public Health Department
in VRA deals with Aquatic need, Bilharzioma, Mobile
health services, Water pollution control, Disease vector
pesh control, and life style disease management. The
reason why they had these activities was completely
different environmental changes river side because of the
dams and they had responsibility to monitor and control
the side effect. They visited community around the river and if they fiound some problems,
they tried to solve them or gave advice to the community to solve them. Especially the
things I was interested in were mobile health and Disease vector pesh control. They use
ship and visit and provide medical treatment in very small villages which didn’t have
health sectors and give health lectures to villagers. It took for about 2 weeks and medical
students also joint the activities. (Unfortunately, I couldn’t have time to join this time….) I
felt that it’s exactly, community health activity.
Today, I went to the river side village to collect some samples of Bilharziosis (a parasite
disease). The parasites live on the small shells as intermediate host and it also contain
polluted water by the parasites. If you
drink it, you will get it and have some
kind of diseases. Since the parasite
makes serious damages to people living
there and also tourism around the river,
the prevention is needed. So we went to
some community to collect sample and
based on the result, give advice to go to
hospital or change the place to collect
water, and provide some health
education.

9.Doctors in Ghana
According to the paper of New England
Journal, a lot of Young doctors work abroad in
Ghana.(http://content.nejm.org/cgi/content
/full/356/5/440)
The number of doctors was not enough here
and young doctors abroad was one of the
reasons. I also thought that only 3 medical
schools was also the reason) I asked some
medical students in University of Ghana
Medical School why you want to go abroad. There are following reasons;
1. Low salary (Public Hospital)
2. Not enough facilities in the public hospital
3. Easier to get high position in Ghana after working or researching abroad

Main country they apply was U.S.A because of a lot of opportunities there. It was also a lot
of Ghanians in UK before, but because of some changes in the working condition it’s
getting very difficult to apply there now. Basically, they won’t think to work abroad all
their life and would back to Ghana around
10 years. Normally, they would apply
Private Hospital, Open the private clinic,
and position in teaching hospital. They felt
that they didn’t want to work all their life
abroad and desire to come back here with
high skills and a lot of money to start
working.
I also asked them if they were satisfied with
Medical Education in Ghana. They felt fine
as medical students, but as doctors they need more high facilities; CT, MRI, 3DCT…etc.

10.Health System in Ghana

We had party in one of the Doctor’s house.
The house was really huge and it’s just
amazing. I heard that doctors in private
hospital earned a lot in Ghana much more
than private hospital. Normally, private
hospitals were founded by European
Company. The quality of these hospitals was
much better as Europe and a lot of doctors
who came back from abroad to apply for
these hospitals.
I also heard that there was National Health Insurance in Ghana but there were some levels
of the insurance and it’s depend on how much you could pay for the insurance….it’s
different from Japan. I couldn’t heard more details and try to ask public health doctors to
explain more details about the Health system here later.

11.Why Ghana is stable for 50 Years?

It’s big question during my staling in Ghana.
You see around Ghana, these countries face serious poverty and unstable political situation.
(Of course unsafe!!). Compare with other African countries, Ghana is very safe, well
developed, very stable government, and stable local currency.

During my staying, I asked a lot of people about the reason and these are some answers;
* No conflict between tribes (possible to get marry with different tribe here and not strict
regulation)
* No conflict between religions (possible to get marry
with different religion even if he is Muslim!!)
* Strong Nationality (all of them love Ghana)
* Independent tendency (they want to solve problems
by themselves and not rely on others)
* A lot of good reader( Kofi Annan, ex-secretary
general of UN, is Ghanian and J.A.Kufuor, President
of Ghana is also chair parson of African Union)
* They prefer to discuss rather than fighting
* Not enough natural resources past 50 years(Less risk
to be invaded by others )
* The first independent country in Africa
* Only one English speaking country around this area(Prevent people living this area to
enter this country because of the language problem)
* The existence of river which is available for hydroelectric power generation and other
factories
****They are not from academic research and no responsibility on the contents......

The image of Ghana is completely

different than I have expected. It’s
stable and safe country. Although the
40% of National Budget of this country
rely on ODA and other Multi-lateral
funding, I hope this county will
develop and be a good leader of Africa
in the future….

13.Independence Day!!!
Ghana was independent 50 years ago (6
March, 1957) form UK and they had
independent day every year, but this
time was the biggest one.
We woke up 6AM and went to the
Independent Square and saw ceremony
of the anniversary. There were so many
people there and dusty…. as I could see anything except for people.……The President’s
speech should start at 9AM, it was too late and we just
decided to go back home. I putted on Ghanian Flag and
50th T-Shirts there and most of them also did so. The place
was filled with Red/Green/and Yellow colors. *
After going back to our hostel, I realized that almost all the
medical students were in the hostel and just watched TV.
One of my Ghanian friends told me that medical students in
this country were not so active and were prefer to stay
home.
*Their flag was red/yellow/green with Black star. The
meaning was a lot of fighting before
independent/Gold(Ghana produced a lot of Gold
before)/agriculture with hope of Africa.

13.FGMSA Annual Congress

We had FGMSA Annual Congress
(Federation of Ghana Medical Students’
Association) in Ghana University. In Ghana,
there were only three medical schools and
3 of them are active members of this
organization. Of course, this was the NMO
of IFMSA in Ghana. I wanted to see the
different style of conference from IFMSA
and IFMSA-Japan, I attended almost all the
events. We had Business Meeting (Plenary meeting), Debate match, sports games (Football
and Volleyball), BBQ party, and Mass( they
are Christian). In FGMSA, Ghana Uni Medical
students and Kumasi Uni Medical students
always competed each other in the plenary,
debate, and games…..Actually, they didn’t
have Standing Committees’ meeting and it’s
one of the disadvantage in this NMO. But
now they are very motivated to set up
SCORA (Reproductive Health inc’l AIDS) and
hopefully the make it.
14. Hostel in Ghana University
The hostel I was staying was the same as other
medical students in Ghana University. 90% of
them were in the hostel. The condition of the
Hostel was not enough compare with western
countries, but felt confortable and safe.
I set up mosquito’s net, mosquito’s coil,
mosquito’s spray, and take
Mararon(Anti-Malaria pill) in order to prevent
Malaria.
The electricity condition here was not good enough….it stopped sometimes and the most
worry thing was that hospital did’t have reserved battery. How are they doing if it stops
during the operation or using respirator……medical
students complain about that.
Water condition here was also not good enough….it
also stopped sometimes. So we had to collect water
in tabs and used it for bath. About drinking water,
of cause I bought mineral water for safe.
About temperature here, it’s the end of the dry
season and it’s really hot & dry. (about 36 degrees)

15.Mass in Ghana
I went to Church to have Mass. As you know, Ghana was a
colony of UK and 60% of people are Christian (Chatric and
Protestant) .
Ghanian Mass was a little bit different from Japanese
(and European) one, sounds like typical African’s!! The
order was the same and I thought the father’s lecture
was a bit long, but the music was really great. They
played local drums and sang songs very strongly. It’s the
good example of the style of religion is changed by the
local culture.
The content of his lecture was something about Love.
Between man and woman, and god and us. I heard the same lecture before in Japan and I
thought he cheated the contents somewhere.
16.Flea market
I went to the flea market to buy some staffs
for 50th Anniversary of Ghana independence’s
day. The market was very crowded and
smelled spice and fish. All of them said
“welcome to Ghana!!” I bought T-Shirts for
50th Anniversary and flag of Ghana. I think it’s
enough for 50th Anniversary.
About food in Ghana, they eat a lot of meat
and don’t eat enough vegetable. It’s not nice
for me and I missed vegetable. I thought they had so many cardio vascular diseases, but
not so much as I had expected. Maybe they had something good enzyme to reduce Cho….I
envied them.
About Foot ball in Ghana, they really liked it and they were all in TV room to watch it all
the time in the weekend. I’m sure football was the most famous national sport here.