Home With A Guilty Conscience

I returned home to the U.S. in March, 2020, when my concerned daughter purchased an airplane ticket for me, but I felt guilty leaving when there would be an increased need for a doctor during a pandemic. Since I was scheduled for a vacation and knew my family wanted me home, I thought I would take my vacation and then return. The border closed the day after I left and just recently opened. My colleagues at the hospital report that the people are healthy even though they are testing positive for COVID-19. There have been 50 deaths country wide among the 45,000 infected persons. If I returned and became sick, I would be a burden. There is only one working ventilator in our hospital. 

While home, I have been ordering medical equipment and we have just finished painting our house. I am getting to better know our two daughters-in-law and our four grandchildren, all under the age of six. Several family members have health problems which I also may be able to help. Returning might be possible early in 2021 after being vaccinated.

Encouragement to work in the developing world

As an American ear, nose and throat doctor practicing in West Africa since 2007, I encourage you to work in the developing world.The death rates for victims of accidents and women giving birth are fourteen times higher than in the developed world. Because there are few dentists to provide primary care, we have patients who die from septic shock caused by tooth infections. When we operate on our indigent patients, we often have to purchase medications for them.The hospitals in the poor regions of the developing world lack necessary funds, specialists, equipment, bandages, tracheostomy tubes, foley catheters and medications along with a consistent supply of water and electricity.

The developed world has so much while our brothers, sisters and children in the developing world lack medical care, sanitation, housing and transportation. Unable to afford a car, families rely on a motorcycle to bring their children to school. Accidents are frequent. I recall a five year old child who lost his arm when perhaps it could have been saved if there was a vascular surgeon on staff.

If you decide to work in the developing world, visit before going. You will learn what equipment you must bring. These rural facilities cannot afford to buy what you need, no matter what they promise. During discussions, they will tell you what you want to hear. Support is crucial - family, equipment, finances, maintenance, administration, assistance with customs and on and on. There are organizations and corporations who help, but it takes time and effort to locate and correspond with them. I am busy clinically, yet half of my time is devoted to repairing and requesting equipment.

The rewards are plentiful - experiencing a new language and culture, advancing in your chosen field and becoming friends with hard working, talented people.

The Difference Of An Ear, Nose and Throat Practice in New Jersey and Rural Ghana

My ear, nose and throat practice in a teaching hospital in northern rural Ghana is different than when I practiced in community hospitals in New Jersey, USA. My patients now are younger. The 2019 median age here is 21 years, in USA, it is 38 years. Weekly we remove tracheal and esophageal foreign bodies and see caustic ingestions and stridor in children. 

Another difference is how poverty influences patient presentation and treatment.  Because of their concern about expenses, the patients or their parents first attend a local villager who has a reputation for health knowledge and only after worsening of the sickness and obtaining permission from the village elders, do they come to our hospital in late stages of diseases and in septic shock. Resuscitation is necessary before definitive treatment can be done. There are three dentist in northern Ghana and septic shock and deep neck abscesses from molar infections is common. We now have a maxillofacial surgeon who will extract the carious teeth which we previously struggled at doing. Frequently the patients and the hospital cannot afford their antibiotics and we buy their antibiotics using donated funds.

Somewhat similar to the USA practice is the trauma caused from road traffic accidents, which here is the leading cause of adult deaths. The motorcycles and old imported cars along with inexperienced, risk taking, fast driving teenagers result in many deaths and injuries. The police have to do a much better job.

What are the benefits for a Board Certified American doctor
to work full time for twelve years in the developing world?
When I first came to the Northern Region of Ghana, I did
not foresee the numerous benefits.

Living in a different culture continues to be the biggest reward.
The people are polite, kind, thoughtful, religious and show
great respect for their dead. Like any society there are
exceptions, but they are few. Learning a new language has
been fun although it requires a lifelong attempt to master.
The food, rich in vegetables and fruit, includes dishes very
different from those experienced in the U.S.

As a doctor, I have grown and have been humbled by being
the only specialist for two million inhabitants when I first arrived.
Many patients present with illnesses that are already well
advanced. In addition to practicing my particular specialty of
otolaryngology, I must care for a variety of medical conditions
because of the lack of other specialists. A doctor in the
developing world has to be his/her own secretary, fundraiser,
purchaser, custom clearer and repairman.

Our medical visitors are a joy, even if I am left to care for the
complications their patients may have afterwards. On my trips
home, I have enjoyed Istanbul, Amsterdam, Lisbon, Cairo,
Rome and soon Cape Town.

Once in town a boy came over to say hello, his way of
thanking me. Many appreciate my work and I am content
in doing this needed healthcare.

  Ear, Nose and Throat Nursing Students

Child who had a groundnut (peanut) in the trachea 

is better after removal yesterday