2009 PFIG Recipient Emma O'Hara

Career Administrator

Emma O'Hara 
College of Arts & Sciences
Religious Studies 
2010 Graduation Year 

Internship: Central Regional Hospital in Ghana

Notes on the first week

My first week in Ghana has been absolutely amazing but a rollercoaster as well! After 24 hours of traveling to get here, the culture shock was definitely hard. We quickly realized though how unbelievably warm and open the people are here. I am settling into my home here, getting used to the lifestyle, and loving my internship.

I am at Central Regional Hospital , the largest hospital in Ghana and very modern by Ghanaian standards although very different from “modern” back home. I am going to be spending my first month in Physical Therapy and moving to a Pediatric Ward for July. The Physical Therapy unit has been so awesome so far and the therapists are really welcoming. There are two other volunteers, a physiotherapy student from Scotland and a licensed physiotherapist from Australia as well as two resident therapists. I spent the first half of the week observing the Australian, Laurel, and she is an absolute wealth of knowledge and has been wonderful! Now I am doing more things a PT Tech would do back home: taking vitals, applying electrical stimulation and TENS, massaging and supervising patients’ exercise programs. The majority of the patients are stroke victims and back pains although there are a lot of children with cerebral palsy whom I love working with since pediatric PT would probably be my focus. Hopefully being able to contrast a month in Physical Therapy with a month on a Peds ward will help me figure out what I want to do with my life!

Midway

It is amazing to me that I am already writing my halfway point journal! Friday marked the end of Week Five and my last day in Physical Therapy. On Monday I will start in the Pediatric and Neo-Natal Wards at Central Regional Hospital and spend the rest of my trip there. Time has absolutely flown by and I learned so much in the Physical Therapy unit. I enjoyed it even more than I thought that I would and will definitely be considering Physical Therapy as a career. I continued to serve a role similar to a Physical Therapy Technician but gained more and more independence as time went on. By the end, I had a handful of "my own" patients who would work with me exclusively after a quick evaluation by one of the PTs, which was amazing!! (All of my patients knew that I had received a grant to come to the hospital and would be writing a journal about my experiences. They all consented to the use of their names and pictures and were actually thrilled to be involved).

The cerebral palsy children continued to be my favorite patients because we would play for an hour! The children here are absolutely adorable and get really excited around "obrunis" (foreigners) so they would rush into the unit to give me a hug and start their treatment. It was hard to say goodbye to them! I was also surprised by how much I enjoyed learning about strokes and working with stroke victims. I found their improvements the most rewarding and I was so moved by how hard they worked. It was unbelievable to think back to Week One when I saw them for the first time and to realize how far they had come. When I first saw Lydia , she was completely unresponsive, could not sit unsupported, neglected the left side of her body and had absolutely no movement on the affected side. By our last visit she was awake and alert, aware of her left side, communicating fully with me, transferring from sitting to standing and from bed to wheelchair and was even walking a bit within the parallel bars – incredible!

My favorite patient was 9-year-old John who had a facial palsy and suddenly lost all movement on the left side of his face. He has been steadily improving but needed emotional support just as much as actual therapy. I can only imagine how hard it must be to be a 9 year old boy and unable to show emotion in half of your face. His dad told us that he was picked on a lot at school and completely stopped speaking even though his voice was fine and his annunciation normal. Unfortunately there isn’t a Speech and Language Pathologist at Central Regional but we tried to be creative in getting John to speak again. He was such a sweet kid and I just loved hanging out with him and watching his confidence increase. He bounded in at 8 am my last day to tell me about how he had come in first place in two of his classes that week – one of which was English and he had to read a story he wrote out loud. I was so impressed and warned him I would be popping back into the PT unit to make sure he was still talking loads after I was gone!

One of the most interesting patients I worked with was a 12-year-old girl named Lordina who was born with C1 C2 instability with a separation of 6.3 mm, which is nearly fatal. She had surgical fusion a couple of months ago but came in with zero strength in her lower limbs. She was gaining strength and was able to walk with the support of the parallel bars by the end of my time. Another interesting patient was Florence, a 21 year old involved in a road traffic accident in February. She has had two skin grafts since then to her right leg and 90% of the front surface is grafted skin. It took me a bit of time to get used to massaging the skin grafts and stretching them out but it was pretty remarkable! Laurel and I were also obsessed with Eric, a diabetic whose right leg was amputated below the knee. They don’t give prosthetics in Ghana so we were working towards getting his balance steady enough to use crutches. It was really hard work for him and he would joke that we were "physiotheorists" for making him exert so much effort. Eric was hilarious and we loved having him around; he was the only patient that made Laurel and I tear up saying goodbye.

I didn’t even realize how long this entry was going to be – I am still amazed at how much I have seen and learned in the past five weeks!! I am so lucky to have been placed at Central Regional and to have spent time in their Physical Therapy department. Everyone was so incredibly welcoming and Laurel gave me so much independence and support. I honestly loved my time there and although I am sad to leave, I am excited to see what the wards have in store for me over the next four weeks!

Final Reflections

My final four weeks in Ghana were just as incredible as I expected. I shadowed a Nigerian doctor who graduated from medical school last July, in her position as a Pediatric Physician. She was an absolutely incredible teacher and was so helpful in equipping me with knowledge about pediatric medicine. We would begin each day in the Neonatal Intensive Care Unit where we would do rounds on the neonates. She would assess all the new arrivals and would allow me to assess and monitor the more stable babies who had been in the NICU for a while. I was taught to look out for the most common problems especially dehydration and jaundice. After the NICU we would head to the Delivery Suite to assess all the babies who had been born in the previous 24 hours to make sure they were healthy before releasing them home to their mothers. I was able to perform my own assessments and reflex tests which I enjoyed.

The rest of our day would be split between Accident and Emergency and the Outpatient Department, depending on where we were most needed. I learned to recognize symptoms for the most common diseases, draw blood, prepare lab cultures, and place IV lines. Most of the children we encountered in OPD and A&E were unbelievably sick and it amazed me to learn the degree to which malaria is affecting Ghana. More than 75% of the children we saw were afflicted with malaria and their Hb and hydration levels were incredibly low. For financial reasons, many families are forced to wait until the last minute to bring their child to the hospital by which point it is too late. One in five deaths of children under five years old is caused by malaria. It really opened my eyes to the severity of the fight against malaria. The doctor and I spent a lot of time discussing how the Ghanaian government spends $760 million annually on malaria treatments which is money that could desperately be used elsewhere. The health clinic in Cape Coast has really kicked into high gear its community education about malaria prevention and twice a week I was able to participate in their medical outreach focused on prevention. The battle against malaria surprised but intrigued me and I would love to continue my involvement with the Voices Project (www.malariafreefuture.org).

My internship in Ghana was an unbelievable experience in shaping my future professional goals. I went into the summer questioning whether medicine was truly what I wanted to do and came out with a clear picture of my ideal future job. Although I enjoyed my time in pediatric medicine, I am more attracted to the hands-on nature of therapy as well as the repeated patient interaction. I am now looking at graduate schools for Occupational Therapy and I feel more certain of the direction I want my career path to take. This summer was an amazing opportunity and I am so thankful for the time I spent at Central Regional Hospital.