Wednesday, July 7, 2010

So Obviously Preclinical

Total Mangos eaten: 5
Total Mosquito bites: 14

Since I’ve moved out to Agroyesum, I have been traveling back to Kumasi for the weekends to visit Erika. Erika has moved from the Kumasi Catering Rest (where we were staying in Kumasi before I moved to Agroyesum) to the Medical Students Hostels (where I will be staying when I return to Kumasi). We’ve traded our modern comforts of air conditioning and consistent water supply including hot water at the Catering Rest House, for a decent wireless internet connection throughout the dorm and the good company of both Ghanaian and other foreign medical students. Even though it’s stressful to worry if there will be water the next time we want to shower, it is a very welcome change to be friends with people our age rather than the old security guard at the Catering Rest House who requests that we bring him bread whenever we go out for dinner!

The Ghanaian medical education system works like this. Medical school is a total of six years and starts right after high school. Three years are spent doing preclinical work: anatomy, physiology, biochemistry, pathology, histology, pharmacology, etc and the students earn a bachelors of science equivalent degree. Then, the next three years are spent doing clinical training. The fourth year is junior clerkships: medicine and surgery rotations and then the fifth year is spent doing OB/GYN and peds. Then, in the last year the students do medicine and surgery again in their senior clerkships. Most of the students in the dorm we are staying in are rising fifth year students and rising sixth year students. So, they are about the same age as me, but know so much more medicine than I do!

In the last two weekends I have been in Kumasi, I have tagged along with the KNUST Medical Student’s Association on their “mini clinic” excursions. Mini clinics are like the health fairs that US medical students busy themselves with except that in Ghana, the mini clinics have a different purpose. In the US, most of the health fairs are for targeted populations (underprivileged or at risk populations for specific diseases and conditions) with a health education and health screening purpose. The mini clinics in Ghana have the added component of raising funds for a specific cause. The mini clinics are hosted at churches on Sundays. A short five minute presentation is made about the campaign cause. Then after the service, the medical students provide BP (blood pressure) and BMI measurements for free and the mini clinic participants then can pay for HIV, Hepatitis B, syphilis, and blood typing blood tests. The tests are provided and interpreted by lab technicians of MediLabs (Ghanaian third party diagnostic test company like Quest Diagnostics).The tests are cheaper than they would be in hospitals (3-5 Cedi per test of 10 Cedi for all of the tests). The medical students also sell watches for 5 Cedi to help raise funds for their campaign cause.

This year’s campaign is awareness of club foot and other birth defects. The traditional view is that if a child is born with club foot, then he/she has been cursed by demons and that there is nothing that can be done about it. The campaign is to increase awareness that club feet can be treated and I believe funds are raised to pay for corrections too. Last year, the campaign was raising awareness about childhood malaria.

The mini clinics are primarily staffed by rising fifth year students because they are the only ones who have some “free” time during these few months. The rising sixth year students are taking and preparing for exams and the rising fifth year students are taking community health classes aka fluff classes. After a year of rotations, taking BMI and BP is busy work. The rising fourth year students are itching to do consulting (more hardcore diagnostics and treatment). As the only preclinical student in the bunch with another year of preclinical lectures ahead of me, I’m still very excited by the opportunity to take BPs since the number of times I’ve interacted with a patient can still be counted on my fingers. One of the rising fourth year students is an aspiring surgeon and has already begun to nurture his surgeon mindset by saying that he would not take BPs because surgeons will never have to take BP!

I’ve noticed that we take BP a little differently than they do in Ghana. After placement of the BP cuff, the Ghanaian medical students slowly inflate the cuff while feeling for the radial pulse in order to get a rough estimate of the systolic blood pressure. They then inflate the cuff only a little farther, release the pressure, and begin to listen for systolic and diastolic pressures. At Michigan, we were taught to inflate the cuff to about 220 and then slowly release the pressure while listening for systolic and diastolic pressures. Hm…anyone with a stronger clinical background want to comment on the advantages and disadvantages of the two methods?

I do feel a little uncomfortable at these mini clinics because I am the most inexperienced and I’m afraid the patients think I know much more than I actually do. I’m not even wearing a white coat, but perhaps my stethoscope wields a lot more power than I realize. I haven’t yet sensed that bring a obroni (corrected spelling) makes too much of a difference in interacting with the patients except for one drunk patient (what was he doing at church drunk?) who kept telling me that he wanted to die tomorrow and screaming “obroni” in my face as I tried to take his BP.

Despite my preclinical eagerness, I think I’d be ready to at least help interpret the BP measurements and turn them into some general health advice. The attitude of the rising fifth years is rubbing off on me!

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