Ghana: November 2013
Heat. Odor. Pain. Body fluids. Work. Need. Reward. Learning. Lots of it.
I was prepared for our trip to be hard. I knew I would see death. They told me I would work harder than I had ever worked in my life, and yet our experience far exceeded anything I was prepared for. My 3 weeks in Ghana were the richest, most intense, best learning I have ever experienced. There are no work-hour restrictions in Ghana, and the work never ends. You spend any energy you have at the hospital. There are patients to round on, lacerations to sew, babies to deliver, medical mysteries to solve. You don't ever want to leave, for you're sure to miss something.
With such need, you can't help but gain experience. There're no specialists to call. When faced with a clinical question, you use the training you have and the books at your fingertips to do your best, and that goes quite far. When you can't get a CBC after noon, you learn to look in people's eyes, literally, and approximate their hematocrit. You learn your physical exam: how to feel a liver and a spleen, for example, first because it's actually palpable, second because it's an important part of directing your limited syndromic differential, and third because your exam is the most reliable metric you have.
While in Ghana, I was overwhelmed by the need. With barely time to eat or sleep, there was little time to gain perspective on the experience. Having returned, I'm often caught comparing my work here as a resident with my work there as a doctor. My life as a resident is so focused on counting hours and patients and procedures, and patient care is often dominated by the frustrations of faulty computer systems and insurance company demands. In this environment, my responsibility to the profession and to my patients can be obscured. Medicine, in its purest form, is providing care to relieve suffering. Three weeks in Ghana brought this responsibility back into focus. For when medical resources are minimal , and the frivolity of Western medical systems is stripped away, I find myself humbled by how little I know and how much hard work lies ahead, and yet determined to use and honor all I've learned as a healer thus far.