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Travel to Ghana _ppt_ - University of Michigan Health System

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					        Ghana




Alice Chi, Natalie Clark, Dipa
   Joshi, Christine Pipitone

     October 25, 2010
Travel to Ghana
           Before You Go

•   Getting permission
•   Visa application
•   Travel clinic for vaccinations and prophylaxis
•   Travel insurance
•   What to pack
         Get Permission from U of M



• Decide when you want to go, and keep track of
  period deadlines
• Inform Dr. Tim Johnson and Jennifer Jones (his
  assistant)
• Fill out the following forms:
   o M4 Elective Form for Outside Institutions (signed
      by Dr. Johnson):
      http://www.med.umich.edu/medschool/osp/forms/
      M4_outside_elective.pdf
   o Medical Student Acknowledgement
      Form: http://www.med.umich.edu/medschool/osp/
      forms/Med%20Student%20Acknowlegement.pdf
• Submit the forms to Cindy Murphy
• Cindy Murphy will create a dean's letter of good
  standing for you to submit to the UGMS
          Get Permission from UGMS



• Inform Kofi Gyan (kofigyan@umich.edu), the contact
  at University of Ghana Medical School, about your
  travel plans
   o Can also contact Samuel Acheampong for this
      information (academicaffairsugms@yahoo.com)
• Fill out the UGMS Elective Form (from Kofi or
  Samuel), submit to Kofi
• Submit to Kofi the letter of good standing that Cindy
  Murphy wrote
• Kofi will create a UGMS acceptance letter for you, as
  well as a course description, both of which you should
  also submit to Cindy Murphy
• Kofi will send you a letter indicating tuition and lodging
  fees
          Visa - $60 Single Entry


• http://www.ghanaconsulatenewyork.org/visa.html
• Supporting documents required besides 2 copies of
  the application:
   o Passport
   o Photocopy of biodata page of passport
   o Two passport-sized photos
   o Travel itinerary
   o Copy of student ID card
   o Copy of UGMS acceptance letter including dates of
     enrollment
   o Copy of permanent residence card if applicable
   o Self-addressed Post Office Express Mail Stamp, for
     return postage
• Once submitted, the consulate took 1-2 weeks
               Travel Clinic


• Follow instructions on U-M Travel Clinic
  website: http://www.uhs.umich.edu/travelhealth
• Common vaccinations recommended/required: yellow
  fever (proof of vaccination required to enter Ghana),
  typhoid, hepatitis A, polio, TDaP, influenza
• Cost will depend on coverage and how many
  vaccinations you need:
   o http://www.uhs.umich.edu/sites/webservices.itcs.
   umich.edu.drupal.uhs/files/uhsdocs/vaccines.pdf
          Malaria Prophylaxis


• Doxycycline: Start 1-2 days before travel, daily while
  traveling, daily for 4 weeks after return
   o Pros: cheap, protects against traveler's diarrhea
   o Cons: GI upset/reflux, photosensitivity
• Malarone: Start 2 days before travel, daily while
  traveling, daily for 1 week after return
   o Pros: better tolerated than doxy
   o Cons: much more expensive
• Although the hostel has screened windows, you might
  want to bring a net (e.g., Mobasa defender, a pre-
  treated net)
• 35% DEET insect repellent (100% not necessary)
            Travel Insurance


• http://www.uhs.umich.edu/tai/
• Required by U of M for any student traveling abroad
  for elective

• Costs $1.25/day plus $5 administrative charge
• Coverage: detailed on website, includes medical
  evacuation

• Cindy Murphy will purchase it for you - you are
  required to reimburse the university

• Or you can purchase it on your own, just inform Cindy
  ahead of time
               What to Pack


• For international flights you can have 2 checked
  pieces of luggage, a carry on, and a personal item
  (eg. Purse)

• Keep in mind that there's a 50lb luggage limit and if
  you exceed this, you can be charged up to $200

• Bring 2 smaller suitcases instead of one larger one

• Try to split up packing so that you and your travel
  mates are not packing redundantly
           What to Pack - Attire


• It is very hot and humid and there is no air
  conditioning, pack accordingly.

• Hospital Attire
   • Ladies: knee-length skirts, capris, light
     blouses, nice sandals

    • Men: slacks, collared shirt (can be short-
      sleeve), tie, dress shoes

•   Flip flops, walking/hiking shoes
•   Light raincoat or hoodie
•   Long sleeves and pants for national parks
•   Hat and/or sunglasses
          What to Pack - Hospital
                 Supplies


• MCard for ID (and student discount) purposes
• 1-2 pairs of scrubs
• OR masks, hats, shoe covers, reusuable eye
  protection
• OR shoes
• Stethoscope
• Penlight
• Latex gloves
• Small and large bottle of Purell
• Pregnancy wheel
• Pharmacopeia
• Basic OB/GYN book
        What to Pack - Electronic
                 Items


• International adapter(s)
• Laptop (you can purchase internet there for approx 60
  cedis - beware it is not fast)
• Camera w/charger
• If you have space, travel speakers and small fan are
  nice
• SIM card capable cell phone
• Flashlight and batteries
           What to Pack - Personal
                    Items

•   Toilet paper (1-2 rolls, you can buy more there)
•   Toiletries
•   Luggage and laptop locks
•   Ziploc bags
•   Alcohol swabs and/or wet wipes
•   Some cutlery (or you can buy stuff there - we had a
    Swiss army knife and plastic cutlery)
•   A string is helpful for hanging hand-washed clothing,
    although they have laundry services there for a cost
    (they will not wash underwear)
•   Medipore tape (helpful for blisters)
•   Duct tape (always helpful)
•   Fast-drying towel
•   Flip flops for shower
          What to Pack - Personal
              Items (cont'd)

• Sunscreen
• 30-40% DEET mosquito spray (you do not need
  100%)
• Earplugs!
• Eye mask
• Travel pillow
• The hostel provided sheets and a pillow for us
• Bradt Guide Book
• Pens, books, journal
• International phone w/SIM card capability (Kofi might
  have one for you to borrow, or you can buy one there)
• Granola/protein bars/snacks
          What to Pack - Cash


• At least $500 USD cash (if not more) for the first day
  to cover tuition, lodging, transportation
• Traveler's checks are not easily exchanged and not
  that helpful
• VERY few places take credit card, so bring a debit
  card (VISA only)
• You can exchange money at the airport or at a Forex
  bureau
• 1 USD = 1.43 cedis
         What to Pack - Meds


• Malaria prophylaxis (doxy or malarone)
• Cipro for traveler's diarrhea
• Ibuprofen
• Bandages
• Neosporin
• Benadryl (for mosquito bites, anti nausea, and sleep
  aid prn)
• Don't forget your personal prescriptions
                   What to Pack -
                    Paperwork



•   Passport and visa (with copies just in case)
•   Proof of yellow fever vaccination
•   Acceptance letter from UGMS
•   Travel health insurance card
             Communication


• Everyone communicates by cellphone in Ghana -
  having one is essential to get a hold of your travel
  mates and Ghanaian friends

• Bring a phone w/SIM card capability (or borrow one
  from Kofi Gyan or purchase one)
   o Can purchase local phones from Vodafone or Zain
   o Vodafone sells phones for 35 cedis (included in
     this is 10 cedis of phone credit)

• Vodafone phones receive phone calls and texts for
  free

• Internet cafes are all over Accra
• You can purchase wireless internet for your laptop for
  approximately 50-60 cedis from Zain or Vodafone - it
  is slow but we found it helpful to check emails
          Once You're There


•   Getting to the ISH
•   The first day
•   Costs
•   Clinical Teams
•   A Typical Week
•   Conferences and Curriculum
•   Sightseeing
           Getting to the ISH



• Travel from the Kotoka airport to the International
  Student Hostel at Korle Bu Teaching Hospital costs
  approximately 10-20 cedis in a regular taxi
• Kofi Gyan will arrange transportation for you that
  includes a stop to the grocery store and Forex bureau,
  however, this cost 60 USD
• Korle Bu Teaching Hospital is in the opposite corner of
  Accra from the airport, so, in traffic, the ride might take
  a while
• The ISH is very deep in the campus, and not close to
  the MD or local student housing, about a 20-minute
  walk from the wards (there is a morning shuttle that
  leaves daily at 7:45)
               The First Day


• At the ISH, you will receive a receipt for lodging
• Go to the Administrative building near the medical
  school, speak with the administrative assistant, who
  will ask for your acceptance letter, and your lodging
  receipt
• He/she will direct you to the cash office, where you
  will pay for tuition
• Go to the OB/GYN block to meet with Dr. Obed and
  his secretary to find out your team assignment and
  where you should meet your teams
                      Costs



• Lodging: 5 cedis per day in regular rooms, however,
  you will likely be offered the elective student room
  (10 cedis per day)
   o Regular rooms: public bathroom, TV or fridge not
     guaranteed
   o Elective student room: private bathroom, TV,
     fridge
• Tuition: <____> cash
Clinical Teams
               Structure of Clinical
                     Teams


• There are 5 teams, A-E
• Each team has ~10 medical students, ~3 house
  officers, ~1 junior resident, ~1 senior resident, ~1
  consultant, and ~1 specialist
   o Medical students: Start after high school, 6 total yrs
      of training
   o House officers: MDs that rotate through the major
      fields of medicine for 2 years prior to picking a field
      and applying to residency
   o Residents: MDs that have completed house
      officership and have chosen their field (e.g.,
      Ob/Gyn resident)
   o Consultants: like our attendings
   o Specialists: like our specialists
• Each team is assigned to a obstetrics floor, and round
  on their obstetrics patients every morning
   o Prior to this, they attend morning meeting where
      the cases in the previous 24h are discussed
• Then they attend the activity assigned to that team for
  that particular day
   o E.g., on Monday, Team B is assigned to take call
A Typical Week
         Day 1: Theatre (OR)


• Try to scrub in so that you may assist (you may
  need to be a bit aggressive, otherwise you will
  just watch)
• Air conditioned
• You may be provided scrubs but bring your own
  just in case, and bring OR attire (shoes, shoe
  covers, cap, mask, eye protection)
• When scrubbing, grab a rubber apron and put it
  on over your scrubs
• Follow your house officer's or resident's example
  when scrubbing
• Everyone is generally very nice to the med
  students in the OR, especially scrub nurses
• If you really want to go to the OR right when
  cases begin, follow a resident out of morning
  meeting, since house officers may spend much
  time rounding on their ward patients
• Types of cases: open, range from simple TAH, to
  myomectomy, to long gyn-onc cases
• The consultant or specialist surgeon does the
  majority of the case with assistance from another
  consultant, a resident, or house officer
                  Day 2: Call


• Rounds are quick
• One of the house officers will admit patients
  through the Emergency Department (or "Accident
  Centre")
• Another house officer will go to L&D and assist
  with cesarean sections (emergent and scheduled)
   o Your residents and consultants won't start
      performing c-sections until 5pm, otherwise they
      are done by the morning team
   o There is one OR for c-sections
   o The warden in this area will provide scrubs and
      lunch
   o Try to assist in c-sections
• A third house officer will go to prenatal/postnatal
  clinic
• Midwives perform all uncomplicated vaginal
  deliveries
   o Try to attend as many vaginal deliveries as you
      can, and try to observe breech and twin
      deliveries
• You are welcome to stay overnight on call, though
  you are not required to
               Day 3: Post-Call



• Your team will present at morning meeting, followed
  by obstetrics rounds, then gynecology ward rounds

• This is a good day to go perform and observe
  vaginal deliveries with the midwives

• Otherwise, this day ends early, and you can take
  your time to explore Accra or get errands done
  when there is no traffic.
             Day 4: Major Ward
                  Rounds


• Formal, extensive teaching rounds, where medical
  students get questioned extensively on patient-
  specific health topics (e.g., post-partum hemorrhage,
  sickle cell disease in pregnancy, etc)
   o This is kind of like "Reynolds Rounds" on gyn-onc

• You probably won't get questioned too much, and if
  so, the questions are generally about American
  medical practices
   • Very educational

• Afterwards, there might be inpatient
  procedures/biopsies to watch, or you can go to the
  labor ward with the midwives
           Day 5: Gyn OPD

• Gynecology Outpatient Department
• This is a day of clinic with both obstetric and
  gynecology patients
• Like usual, you will start out at morning meeting,
  then go to your floor to round, then you will attend
  clinic w/the house officer
• Although the official language of Ghana is English,
  most of these patient encounters will be in mixed
  English/Twi, and many patients may not
  understand enough English to complete an
  interview
   • That said, if there is a patient who is willing you
      can conduct the interview and do the physical
      exam
   • Otherwise, you can make the most of your day
      at the labor ward
• Usually clinic ends at 1-2 pm
Conferences and
  Curriculum
               Conferences


• Morning Meeting
  • Daily 8 am meeting going over previous day’s
     cases and deliveries

• Mortality Conference
  • Last Thursday of the month
  • Very different from our Morbidity and Mortality
     conferences
  • Incredibly eye-opening and educational; try to
     take notes
                 Curriculum


• The curriculum consists of daily clinical duties, and
  didactic lectures
• Professor Obed, the chair of the UGMS Ob/Gyn
  department, will lecture you on specific
  obstetrics/gynecology issues in West Africa
   o Take advantage of this valuable educational time
     with the department chair
• Residents may also offer review lectures to the
  medical students
Accra
             What to do in Accra


•   Kwame Nkrumah Memorial Park
•   National Cultural Center (shopping)
•   Osu for Ghanaian and international food
•   Lighthouse of Jamestown
•   National Museum
•   La Beach/Labadi Beach Resort
•   Local soccer match
Travel Within Ghana
Cape Coast
                Cape Coast
• 1st capital of Britain's Gold Coast Colony
• Castle
   • World heritage site, one of the largest slave-
     holding sites during the colonial era
   • Slaves traded to British by local tribes in return for
     EtOH and guns
• Great beaches
   • Oasis Beach Resort
   • Elmina Beach Resort-beautiful pool on the water
• Where to stay
   • Oasis Beach Resort: good food, on the water,
     near the castle
• Getting there
   • STC buses: 4 cedi, run daily, buy tix early
       • Awesome Nigerian TV shows
   • Tro tro: cheap, but less comfortable and more
     difficult to figure out
         Kakum National Park

• ~1 hour away from Cape Coast
   • Take a tro tro or hire a taxi (make sure the driver
     stays there and waits for you)
• Canopy Walkway: 40 m in the air, only one in Africa
   • Go early in the morning, less crowded!
   • Not if you are afraid of heights
• Forest walk
   • Medicinal plants, greater chance at seeing
     wildlife
• Museum
• Camping overnight on platforms available
• Animals you may see: forest elephants, monkeys,
  birds
Mole National Park
           Mole National Park

• Getting there
   • Flight to Tamale Antrak Air ($175 cash one way,
     book early)
   • Or…STC bus to Tamale via Kumasi
   • THEN Metro Mass bus from Tamale to Mole
     park
   • Best idea: get a driver from Accra via Avis
     (~$300/person w/4 people)
   • Along the way from Accra stop by
      • Kumasi
      • Tamale
      • Boabeng-Fiema Monkey Sanctuary (mona
         and black and white colobus)
      • Kintampo Falls
• Staying there
   • Mole Motel
      • Sits on a cliff with a restaurant and
         swimming pool overlooking 2 watering holes
           Mole National Park

• National park since 1971

• Ghana's largest wildlife sanctuary (4840 sq km),
  the best for game viewing

• There are 90 mammal species and at least 344
  bird species
   • Elephant, buffalo, warthog, antelop, monkeys

• Walking or 4X4 safaris

• Other things to do:
   • Mongori village
   • Canoe safari
Kumasi
                Kumasi

• The cultural capital of Ghana
• Visit the Ghana Cultural Center - includes a
  museum on Ashanti history and a large crafts
  center
• When we were there, Ghana was playing Sudan in
  soccer
• Palace
          Other Places to Visit

• Wli (Agumatsa) Falls
  o On Togolese border in eastern Ghana
  o largest waterfall in west Africa
  o within Agumatsa Wildlife Sanctuary with
     numerous straw-colored bats

• Volta Region
   o Theoretical ferry
   o Hippos!

• Boabeng-Fiema Monkey Sanctuary
                  Contact Info


• Ghana contacts:
   o Kofi Gyan: kofigyan@umich.edu
   o Samuel Acheampong:
     academicaffairsugms@yahoo.com
• Michigan contacts:
   o Jennifer Jones (Dept admin,
     Ob/Gyn): jjlynn@umich.edu
   o Tim Johnson (Dept chair, Ob/Gyn):
     trbj@med.umich.edu
   o Cindy Murphy (OSP): camurphy@umich.edu
• Us:
   o Natalie Clark: naclark@med.umich.edu
   o Alice Chi: amchi@med.umich.edu
   o Christine Pipitone: pipitone@med.umich.edu
   o Dipa Joshi: dmjoshi@med.umich.edu
                    References


Flag on first slide: http://think0.deviantart.com/art/Ghana-
Grunge-Flag-153462332
Briggs, P. (2010). Ghana: The Bradt Travel Guide.
Guilford, Connecticut: The Globe Pequot Press.

				
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