Muslim custom unfortunate liability with the use of motorcycles.

Having been here ten years in a referral hospital, many interesting cases come to us. Sadly, several are in the late stages of their diseases and only palliation can be provided. The patients are poor and they first try to obtain a cure from a local healer. Only when in their final stages do they come to the hospital.

 A malnourished child was brought in with his left cheek and jaw necrotic. After being fed he looked and acted stronger. However, he needs the dead cheek and jaw to be removed and his rehabilitation will be far from perfect.

The traditional Muslim custom of the woman wearing a long scarf can become an unfortunate liability with the use of motorcycles. We are seeing accidents in which the scarf gets caught in the wheel and results in strangulation. Such a case presented recently in a woman with a total transection of her trachea from her larynx. Only an emergency tracheostomy saved her life. Her trachea was sewn back to her larynx and now she has a fair air passage. However, both vocal cords are not moving and her nerves may have also been transected with her injury. We are hoping at least one vocal cord will recover.

Because there is minimal dental care, we continue to see many cases of deep neck abscesses from infected teeth.

The custom of drying out groundnuts and corn (maize) on the compound floor allows crawling infants to swallow such items and these young children present choking with food stuck in their trachea.

 We have used our donated facial reconstruction plates on several patients with multiple rib fractures and they did well.

Malnourished child with necrosis of left cheek and jaw.

New form of Transportation

Tamale Teaching Hospital Doctors traveling for Awards

Poor, recovered child whose care was paid for by her doctors

Reflections and Recommendations After Eleven Years as an Otolaryngologist in Northern Ghana

After eleven years of working in the Northern Region of Ghana, a poor and largely rural area, I ask myself if the experience has been worth it? For the patients whose lives were helped and saved, yes. For my family enduring long separations, each of those members would have to comment. Personally, I have gained immeasurably in appreciating a different culture, enjoying other countries on home visits and improving immensely my surgical skills and medical knowledge.

While strongly encouraging foreign healthcare workers to live and practice in northern Ghana, the following  recommendations may improve upon one’s goals. If worthwhile things are to be accomplished, come with strong financial and administrative support to allow you to remain on site for many years. My days are spent with clinical cases, administration and teaching - all of which require more time than exists.  I spend a good portion of my time  purchasing supplies, clearing items through customs and repairing equipment. This is not what these people need from a medical surgical specialist. Too often after surgery, the physician, himself,  has to supply the antibiotics needed to keep his patient alive and this requires funds. A developing country can truly benefit from a specialist who will come for several years with modern equipment and teach the in country physicians new techniques. Medical training in Ghana lacks the availability of such tools and often does not include the instruction of more current methodology. As a result, Ghanaian doctors continue to do surgical procedures which could be better performed if the proper instruments were available.

The value of short-term visiting teams is questionable. One group came to teach a week-long course on middle ear surgery which requires certain microscopes and drills. However, if the visiting team does not leave the equipment necessary to do what they are teaching, little is accomplished because those instruments are not available here. The visiting cleft lip and palate teams come to correct patients’ deformities, but they do not allow the Ghanaian physicians to do the procedures under their supervision. Surgeons do not learn how to do an operation by observing.

Neck trauma causing a collapsed lung and airway obstruction.
This patient's life was saved.

Mosquito net. The mosquito bites are the most annoyance.

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