The medical system in Ghana.

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women's health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.

Establishment of a general medicine residency training program in rural West Africa.

Ghana, a developing country in West Africa, has major medical burdens in taking care of a large population with limited resources. Its three medical schools produce more than 200 graduates per year, but most emigrate to developed lands after training. Ghana is working to educate and retain locally trained physicians, but it is difficult to get them to work in rural settings where the need is greatest. This article details the establishment of a General Medicine residency at a 150-bed hospital in rural Ghana. Early training comprises 6 months each in Medicine, Surgery, OB/GYN, and Pediatrics; the hospital in Techiman also has a Surgery residency. House officers choose the program for more hands-on experience than they can get in larger centers. They perform many tasks, including surgery, sooner and more independently than do residents in developed countries. The training program includes a morning report, clinical teaching rounds, and rotations on in-patient wards and in the Emergency Department and clinics. Teaching focuses on history, physical examination, good communication, and proper follow-up, with rigorous training in the OR and some clinical research projects pertinent to Ghana. Trainees work hard and learn from one another, from a dedicated faculty, and by evaluating and treating very sick patients. Ghana's rural residencies offer rigorous and attractive training, but it is too soon to tell whether this will help stem the "brain drain" of young physicians out of West Africa.

A little known complication in an obstructed right inguinal hernia: five patients with afferent limb strangulation.

Within a period of 6 months five cases of afferent limb strangulation in patients with an obstructed right inguinal hernia were seen and treated in our institution and are described in this report. Recommendations to avoid pitfalls in the management of similar cases are reported.

Managing scorpion stings in the tropics: chloroquine as an effective drug.

We report on a fairly familiar alternative use of injection chloroquine in district hospitals in Ghana. Within a period of three years, pain control among six patients with scorpion sting was achieved successfully on an outpatient department basis with injection chloroquine at the Holy Family Hospital, Techiman, Ghana.

Fracture treatment by bonesetters in central Ghana: patients explain their choices and experiences.

OBJECTIVE: To understand factors influencing patients' decisions to choose either fracture treatment by a bonesetter or in the hospital and to explore patients' experiences with bonesetter treatment. METHOD: In-depth interviews with 46 patients with a radiological proven fracture in a district hospital in central Ghana. RESULTS: Traditional healers, such as bonesetters, play a substantial role in the Ghanaian healthcare system. Over a period of 3 months, 14 patients with a proven fracture left hospital for treatment by a bonesetter. The hospital is considered the only institution where emergency care can be provided and reliable, extensive diagnostic and treatment facilities are available for fracture treatment. Patients opting for bonesetter treatment are guided by the severity of the fracture, availability of the service, their financial status and past experiences. The healing methods used by different bonesetters are based on mutual comparable principles. CONCLUSION: Fracture treatment can serve as a model for respectful and efficient co-existence of traditional and biomedical medicine.