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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 (email@example.com), the contact at University of Ghana Medical School, about your travel plans o Can also contact Samuel Acheampong for this information (firstname.lastname@example.org) • 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: email@example.com o Samuel Acheampong: firstname.lastname@example.org • Michigan contacts: o Jennifer Jones (Dept admin, Ob/Gyn): email@example.com o Tim Johnson (Dept chair, Ob/Gyn): firstname.lastname@example.org o Cindy Murphy (OSP): email@example.com • Us: o Natalie Clark: firstname.lastname@example.org o Alice Chi: email@example.com o Christine Pipitone: firstname.lastname@example.org o Dipa Joshi: email@example.com 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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