Thinking...

So. Things at the hospital have been going well.

Today I gave a presentation to the Peds Department on electronic medical knowledge resources. Ostensibly, this was the purpose of my trip -- to come and do a brief project with the aim of improving access to and familiarity with available resources.

Physicians who work in major US hospitals, in addition to having (relatively) unlimited resources with which to practice clinical medicine, also have free access to a huge variety of online medical information, including journals, reviews, systematic databases, decision-support tools and so forth. Just ask any resident you know how often they use UpToDate. These resources, however, are not cheap, and are therefore not widely used in the developing world. There has been movement in recent years, however, to bully the major medical publishers into providing free access for free to those practicing in the developing world. HINARI is a program from the WHO which makes this access possible.

So, with the help and guidance of one of the Medical Librarians at the Yale Medical Library, I undertook it upon myself to find, catalog, and consolidate resources like HINARI in a way which made them easily accessible to the house staff here at Korle Bu Hospital. I did this by making a simple HTML page with one-click access to the major points of interest. The purpose of my presentation this morning was to review the available resources, distribute and explain the HTML access page, and give some tips on how best to navigate these resources.

The presentation was well-received, and was undoubtedly the first time that many of the staff present come into contact with some of these resources. Still, it takes far more than mere presentation of new information to affect clinical practice. Habit is a powerful thing. The integration of electronic medical resources into regular clinical practice requires personal interest and motivation, not to mention a certain baseline technical knowledge and infrastructure. Just ask the aging generation of physicians in the US, many of whom continues to struggle with some of these requirements.

Regardless, one must start somewhere. So consider it started here.

While having a coherent project plan (as above) was necessary to arrange an international elective, my personal interests were equally in clinical work and learning my way around the wards, which is how I have spent the remainder of my time. As with much of life, it has been educational, in that once again, I have learned how much I still have to learn.

There is this idea that a Western Doctor can show up in the developing world (even to a hospital well staffed with locally trained physicians) and be expected to provide better care than the local staff. Perhaps this is an obvious fallacy to some, but I doubt that it is to everyone. So let me put it this way:

Do you think it's easier to practice medicine in a resource rich or a resource poor environment?
Is it easier to practice medicine in a familiar environment or an unfamiliar one?
Is it easier to treat patients with illnesses that you see often or illnesses that you rarely see?

Exactly. Or how about this one:

If I am still very much a student of medicine at my home institution, will I be less of a student here?

So the initial idea is a bit off.

What, then, do I and my cohort of do-good Westerners have to offer? Not necessarily that much, initially. Still, there is a reason that the rigors of a US medical education are prized. The reason is not simply what you learn -- which in a foreign situation may be of little relevance -- but how you learn. Or more appropriately: how you learn to think. How to approach a problem and manage it's solution. This is a lesson that always serves you well. But form without content won't get you far in the hospital. You still need to fill in the blanks - the specifics of diseases, languages, treatments, and the politics of life and work in THIS place.

So, as always, there is still a lot to learn!
But who doesn't like learning?

More Chuck

This is a child who was running around the pediatric ward this morning. In case you can't quite read the caption: There is Nothing to Fear but Chuck Himself.

I'm Back

Hey All.

I'm back in Ghana. As per tradition, rather than updating via mass email, I will try to occasionally post a few thoughts here. Don't miss the links embedded below...

I'll only be here for the month of January. I am lucky enough to have gotten sponsorship from the new Yale Pediatric Global Health Track to do a quick project at Korle Bu hospital - the major teaching hospital here in the capital, Accra. In addition to spending time on the wards, I'm doing a quick project with the pediatric housestaff to improve access to and familiarity with available electronic medical knowledge resources. Basically, there are a variety of resources, such as electronic journals, databases, and decision support services which are can be obtained for free if you are a practitioner in the developing world. You just need to know how to jump through a few hoops to access them. Luckily, with the help of the Yale Medical Library, I have learned how to jump, and I plan to teach these skills. But more on that some other time.

First, because I believe that appropriate orientation is important for truly understanding your environment, I have put together a little google map with a few of the sites important to my life in Accra. Enjoy.

Here is the textual update.

Living situation:
There aren't a lot of places that rent rooms by the month here. As such I've ended up in a little apartment complex owned by a large Ghanaian woman named Auntie C, and occupied variously by her extended family, and a variety of Obroni. The expats here are an interesting bunch, working variously for the Korean embassy (he's Korean), a carpet business (he's Pakistani), the Goethe Institute (one guess...), a company that runs toll booths (he's also Pakistani), an NGO focused on fostering a transparent democratic process (also German), and their own start-up film-making business (brits). It's a nice little social spot, where not infrequently someone takes it upon themself to cook a big dinner and the crew sits together on the porch for dinner and a chat.

The hospital:
There will be more on this in later posts, so suffice it to say that Korle-Bu is the largest teaching institution in one of the most developed (though still very much developing) countries in West Africa. As such, it is characterized by the contrast between advanced pathology, scarce resources and leapfrogging technology (malnourished children with advanced cancers, payment required prior to lab work, sparse facilities for provider hand hygiene, Wifi access in part of the Pediatric Block, and a broken (but present) hospital MRI machine). As for interesting pathology there is plenty. Have you ever heard of Cancrum Oris? Neither had I. I was in the Emergency Room today -- which is, in fact, a room -- and I was impressed by the rather gory wound on the face of a wholly calm 2 year old. He had lost the majority of the soft tissue overlying his right jaw, with the exception of a twisted, blackened bit of lower lip, which exposed his lower arch of teeth and mandible. My first thought was electrical burn, given the charred appearance of the remaining lip. The resident with whom I was working found this to be a novel idea. It was, in fact, Noma - necrotizing stomatitis, not seen in the US or western Europe since Auschwitz. It was impressive. If you have a strong stomach, consider searching google images for "Noma". As the resident said - 'We see that here.'

Other tidbits:
I have to say -- the experiences that one has walking and running through various corners of the world never fail to entertain. For instance, you might think that I would have remembered past lessons prior to going running down the beach along the southeastern edge of Accra. Alas, I have been reminded.

Something one could never wholly prepare for, however, are the hilarious variety of reactions that one gets as a white man in Africa. Once, jogging down a farmer's path in the humid, hilly and verdant central Ghanaian Ashanti region, I so confused a local woman that she grabbed her small child and sprinted terrified off the path into the forest (I hope she found her way back). At other times, I've run with crowds of merry Tanzanian school children in tow. I've heard many a cat-call , and when my hair is long not infrequently been likened to Jesus. I was even once called Osama bin Laden - I have to assume it had to do with the long beard, although--let's be honest--the beard was bright red and attached to a really white guy.

But regardless, the media-fueled power of racially-based free-association never ceases to amaze, and I have perhaps never been as amused as yesterday when, walking the few blocks home from the local Tro-Tro stop, I heard the unmistakable, half-comical, gritty tone used to yell random things at foreigners, as a Ghanaian man called me:

Chuck Norris.