Wednesday, December 4, 2013

The finale

My time in Ghana was amazing. I am so blessed and grateful to have had this experience. I felt like I was really able to leave an impression on the people I worked with and they undoubtedly left a lasting impression on me. 

My first week was an eye opener. I have done mission trips before, but nothing like this. As a medical student, I went to mission trips to Dominican Republic, Jamaica, and Haiti. I went on each trip bright eyed and bushy-tailed, ready to make a difference in the world. Haiti was the best experience of my life; I have plans to return there.

But Ghana was different. I spent almost three weeks here learning. Learning the culture, the food, the people, the perspective, the hospital, the healthcare system. Witnessing (and relearning) how important the physical exam and clinical impression is; especially when it may be the only information you have to go off of and make pertinent life effective decisions. And also gaining a new fond appreciation for my training at NYU and access to labs, imaging, blood products, pumps, amazing nursing, ICU beds, etc. Each of these items have its own story.

This experience brought me back to my glory days; reminded me with very blatant examples of why I became a doctor in the first place. To fix the injustices of healthcare. The disparities I witnessed moved me to my core. In my almost four years of residency, we have had two maternal mortalities; one of which I was directly involved in. In Ghana, a maternal mortality was presented almost daily. In one day (my last Monday duty, aka 24hr call), I personally witnessed two. One arrived pretty much DOA and the second was a young 26yo P2 who I watched die right before my eyes. It was an excruciating experience. I felt helpless. 

She was admitted over the weekend, 2-weeks postpartum with a working diagnosis of pneumonia vs DKA. Her admission pulse was 150 with no O2-saturation documented. She had no labs sent, not even a UA or Udip to look for ketones. She has a CXR done which only one person on the team even knew about, and it was only reviewed just before she crashed. Pulmonary embolism was not written in any of the notes as a consideration for a differential diagnosis. The patient was only receiving prophylactic anticoagulation. When I met the patient, she was tachycardic, hypoxic and c/o chest pain. She was critical but in a bed on the wards. Thats when I learned there were only four ICU beds for the entire humongous hospital. As the patient rapidly fell into respiratory distress, a house-staff (an intern) and I ran her across the hospital to the OB recovery room where we could get her on a monitor, bag her, and get anesthesia assistance for intubation. She was pronounced dead approx one hour later. She was young and healthy with two children and she died. She didn't have to die...we should of been able to prevent this maternal mortality. But she was dead.

I sat down with the junior residents and we discussed the case, their working diagnosis when the patient was admitted, the differential, the missed events during her admission, the obstacles they ran into in delivery her care, why they thought she died. In summary, they thought she died because "we mis-managed her." We talked about how to learn from this experience, how to think about the likely diagnosis, and how to never forget the diagnosis they may kill the patient. She was dead and I can only pray to God we learned something.

The rest of the week was light. I had a wrap up meeting with the chairman. We talked about my experiences in and out of the hospital, my trip to cape coast, and a project I started with Dr. Oppong (reviewing charts of maternal mortalities related to PIH). The residents and fellow all gave me hugs and well wishes. They told me that they felt like I had been here for months because I integrated so well. That was the best thing they could of ever told me. 

I made some great friends here, professionally and personally. I learned about another culture and how to practice medicine within that culture. I felt so welcomed. Upon meeting Ghanaians, they would say..."welcome home." I was even given a Ghanaian name..."Ama" (Saturday born). And on my trip to Cape Coast where I returned from "the door of no return," I was adopted by a Ghanaian family who called me "Nana Hemaa" (Mother Queen). It was a humbling experience.

I feel like I have evolved to another level as a human and a physician that will allow me to deliver medicine on a higher level. I felt like I discovered another home away from home. I have some unfinished business there...I cannot live with the maternal mortality rate...and I will return there one day.

See you in 2015 Ghana...I will return home.