The Rewards Of Being A Surgeon Northern Ghana

Top: The privilege of learning from bright, young doctors. Above: Local smocks given as gifts.

One receives much more than one gives in performing surgery in northern Ghana. Saving one life a week is more satisfaction than any other I can imagine. Sometimes saving patients lives is possible because they are young and their sickness is the result of trauma, infection, aspirating or ingesting coins, groundnuts or maize. A health worker has the feeling of contributing, of being worthwhile and the gratitude from the patients, staff and population is heartwarming.

A few days ago a woman thanked me for saving her life four years ago. Her chest was mostly scarred from the skin grafts which were used to cover her open wound after a deep chest abscess from an infected molar tooth. There are many examples of patients’ appreciation: an illiterate father returning with ten yams, an old, poor farmer giving me a guinea fowl, the boy who stopped his bicycle to say hi, the young woman with a baby on her back who kept smiling at me in the taxi and whom I later learned was the mother of the now healthy child we had saved the year before, the girl with the reconstructed nose who stuck her head in the door to say hi. These expressions of thanks make our day.

Working here has made me appreciate the goodness in all people. Generous donations given to me with no strings attached are truly appreciated and put to good use. Finally, there is the joy of learning that human nature is the same regardless of religion, dress or language. Sorrow over a loved one’s illness or death is universal. Interesting layovers over the years in Lisbon, Istanbul, Frankfurt and Manchester when going home for a family visit would have been compensation enough. I never dreamed of the many rewards which I do not earn or deserve.

Disease in Africa

The child with the congenital lymphatic malformation and the child with the scars from previous local medical man treatment.

Tamale Teaching Hospital serves the two million people of northern Ghana. Because of poverty and cultural beliefs, our patients come to the hospital late in their illness after being treated by the local medicine man. Last week, a child in severe respiratory obstruction was brought in by her step-mother. The step-mother said the child lived with the grandmother and had been sick for two weeks. However, the healed scars on the child’s abdomen signified a longer course of disease. The child’s respiration was obstructed by viral laryngeal papilloma which were partially removed allowing the child to breath. Unfortunately, viral papilloma will return as there is currently no effective treatment other than periodical surgical removal when breathing becomes obstructed.

Children with congenital abnormalities here do not have surgery because there is no specialist to perform the procedure. We currently have a backload of otolaryngology-head and neck cases which need surgery. One patient is in his sixties and has been bothered all his life with a condition which he has had since birth. Yesterday, we removed such a congenital neck cystic lymphatic malformation in a two year old in a five-hour operation. The case went well except for injury to the eleventh cranial nerve which rotates the head and elevates the shoulder on that side.  Another method of treating this condition, which we did not have available, is to inject a sclerotic drug into the cyst. We do our best and are saddened by any complication. The families are appreciative and thankful that we are caring for them..

Working In A Poor African Hospital is Challenging

Working in a financially deprived region has the reward of saving lives. The infected young or road traffic patients are able to respond to care, antibiotics and blood transfusions; however, not all survive. Patients are admitted in septic shock with deep neck abscesses from carious molar teeth. Recently, four have died from sepsis or hemorrhage. There are only three dentists in northern Ghana for two million people. There are four road traffic accident patients currently on the ward who have lost their scalp or face; one an 18 month-old child, another a 19 year-old boy whose injury also includes a facial paralysis and hearing loss. The young, risk-taking, helmet-less motorcyclists observe few traffic rules and the police do not have the capability of enforcing laws. Police are not in vehicles, seen only on foot. Road traffic accidents will soon be the major cause of death in the developing world, exceeding malaria. It is sad to see so many bright young people die needlessly.

Working in a poor hospital is difficult. It is often necessary to collect medications from discharged patients in order to supply new patients who cannot afford them or when the hospital does not have the needed drugs on hand. For the last two days, there has been no oxygen or water. Therefore, there is no sterilization of instruments, no bandages, no washing of linens and gowns and no surgery. The hospital is not functioning well.

Road Traffic Infant After Skin Grafting To His Scalp

Providing health care in a poor region in Africa

Providing health care in rural Ghana is challenging. Many of our sick patients cannot afford the CT scans, antibiotics, analgesics and Foley catheters necessary for their care. The hospital cannot afford to buy these supplies and does not have them available. The families, if they have the money, must seek out pharmacies in town to purchase the items. All this takes critical time in an emergency. I save medications which were not used on former patients for these poor patients. It occupies much of my time and effort to keep a supply. When the patients are admitted at midnight or on the weekend, when all the pharmacies are closed, I hope I have enough medications to keep them alive until the morning.

A 19 year-old boy needs urgent reconstructive surgery in Lubeck, Germany. Two months ago, a German Professor/surgeon removed his mandibular tumor, but the young man needs reconstructive surgery to prevent lifelong disfigurement and feeding problems. When the patient applied for a passport, the machine was broken. The former head of the passport department was removed for accepting bribes for passports. The family has finally obtained the passport; now the Embassy states he must apply in person for the visa. Many calls and emails to the embassy explaining the patient’s condition have not resulted in any response.

Progress is slow and difficult, but with much effort lives can be saved.

Having my wife here is good; with her doing the marketing, cooking, paying household bills, etc., it enables me to better cope with frustrations, freeing me to study and care for my patients.