Wolverines Abroad: First impressions

Monday, October 1, 2018 - 3:54pm

“First impressions last a lifetime.”

“Go confidently in the direction of your dreams.”

These are the words of wisdom that led me toward my greatest adventure in medical school — an international rotation in Ghana. Pursuing my dream in another country created memories that will last a lifetime and inform who I am as a physician.

First Day in the Labor Ward

As I entered the labor ward at Komfo Anokye Teaching Hospital, I discovered a large room divided by thick concrete walls. Each section contained pleather beds covered in plastic tarps that patients brought from home. I found myself fascinated by the lack of equipment. There were no IV poles. The background noise was free of the familiar beeping monitors and inflating blood pressure cuffs. You would not find a large TV displaying continuous fetal heart tracings, but on each dividing wall, you would find a Pinard horn, a funnel-shaped instrument used to manually count fetal heartbeats. Intermittently, I would observe Ghanaian medical students place their hands on mothers’ abdomens to count the number and duration of contractions in a 10-minute period. The results would be entered into a pantograph, a paper chart that is used to track labor progression. Even without the lines and monitors, it was incredible to witness the level of medical care being provided within a limited resource setting.

As I continued my observations, I discovered that all patients go through “natural births,” predominantly due to the cost of epidurals. One might expect the ward to be filled with yelling and laboring mothers crying out in pain, yet it was surprisingly quiet. No one called out and no one screamed. Instead, I was surrounded by women snapping their fingers, praying and humming through contractions.

As I followed a mother’s progress through labor, I was taken aback by her final delivery process. In the “second stage” area, there is no coaching, privacy or family members, just the mother, her midwife and any medical students who decided to observe the delivery. Though it was her first child, the mother was not coached through her delivery. If she did not push adequately, the midwife would hiss in disgust. During the delivery, the midwife made an episiotomy, a surgical cut at the base of her vagina to aid in the delivery, but the patient, unfortunately, sustained a second-degree tear. While repairing the laceration, the patient would pull away due to pain. Each time the patient moved, the midwife would express her anger and displeasure. I struggled to watch as the patient writhed in pain. I desperately wanted to console her, but it did not feel like it was my place. With each unwanted movement by the patient, the tension in the room built. The midwife grew tired and at times, even pretended to give up on completing the repair entirely. Seconds felt like hours as the midwife worked to close the laceration and reunite the mother and her baby.

First Day as First Assist

“Can I scrub on your C-section case?”

“Yes, of course.”

The excitement that overcame me was palpable, as the idea of being first assist was merely a dream that I had prior to visiting Ghana. The resident took me through the scrubbing process, which entailed the typical personal protective equipment, rubber boots and a shin-length rubber apron worn over our surgical scrubs. We then scrubbed with pieces of pink soap left in a dish in the scrub room. As the foam collected on my hands, I found myself reviewing the steps of the operation, the patient’s medical history and any complications she was at risk for perioperatively.

As we entered the operating room, my heart began to race with anticipation. I gowned and gloved myself and then assisted with draping. We then made the first incision of the elective C-section for a fetus with a genetic disorder of bone growth called achondroplasia. When the baby delivered, his appearance was typical of achondroplasia: frontal bossing and shortened upper extremities. The baby was carefully placed on a nearby table, and then the surgeon’s technique took center stage. He prided himself on minimal tissue manipulation, leaving the uterus inside the abdomen during the repair and abstaining from exploring the uterine cavity for placental remains. We finished the operation and the only evidence of our presence was a small, beautifully closed pfannenstiel incision.

First Day Eating Ghanaian Fufu

“Are you free for dinner? We are going to try fufu.”

As a first-generation Nigerian American, I have consumed plenty of fufu in my life, including the batches that I personally struggled to prepare. Ignoring my familiarity with the dish, I enthusiastically accepted the invitation. My mind drifted over the possible variations of Ghanaian fufu. Would it be made of potato, yam or even plantain? Would it be hard or soft? Sour or neutral? Though fufu, a staple in Nigerian and Ghanaian cuisine, is essentially pounded starch and water, it can be made in numerous ways. I was excited to try this twist on a familiar dish.

We left the medical campus and began our journey to a restaurant called Confidence. When we arrived, we each ordered the fufu with groundnut soup and goat meat, a standard in Ghanaian cuisine. Within minutes, the server placed multiple large bowls of water and soap on the table and instructed us to wash our hands. The act heightened the experience, as I felt like a native Ghanaian eating in the proper way. The food came shortly thereafter, and as the bowl was placed in front of me I appreciated the nutty brown color and aroma of peppers and spices. Immediately, I reached into the bowl with my right hand to fish out a piece of the fufu ball floating in my soap. I flattened the fufu between my fingers while simultaneously scooping up the soup, and then lifting it to my mouth. The flavors were bold, yet balanced; new, yet familiar; and most importantly, delicious.

For any student traveling abroad, I encourage you to embrace the unfamiliar. If you challenge yourself to let down your guard and experience life in an open, curious and engaged manner, you will be rewarded with first impressions that last a lifetime.

Kiki Ogu is an M4 at the University Medical School.

To search for education abroad opportunities and register your travel visit global.umich.edu.