Following Dr. Albert Schweitzer
PROVIDING MEDICAL CARE IN GHANAThe New Physician
Prior to setting foot in the airport in Accra, Ghana, in the summer of 2000, I knew Africa mostly from watching Discovery Channel programs and those “Save the Children” commercials, in which the continent was treated as a single country consisting of little more than civil unrest and AIDS.
I wanted to make the trip so I could explore the visions of Dr. Albert Schweitzer—the Nobel Peace Prize-winning medical missionary—while searching for my own role in the developing world. I selected the most affordable volunteer program I could find and arranged to fly to the West African nation at the end of my first year of medical school.
Ghana is a beautiful and friendly country, where the people and the land reflect the deep roots of the culture. A proud leader of the African continent, the nation boasts the legacy of the Ashanti tribe and is the home of such familiar icons as the richly colored Kente cloth. A former British colony, Ghana is composed of a mosaic of different tribes, each with its own language, including Ewe, Twi and Fanti. Fortunately for me, I got by with English in most urban centers, and the Ghanaians I met were kind and eager to share their way of life to those willing to learn.
All of this occurred in the shadow of reminders of Westerners’ dark history in Africa. I had the occasion to visit an old fort once used as a center for shipping slaves to the Americas. One of the exhibits displayed a map of slave trade routes on which a long, arching, white line was drawn connecting the fort in Ghana to my medical school home of Charleston, South Carolina.
I was assigned to St. Paul’s Clinic, which is located in a small village south of Lake Volta. Still under construction, the clinic was already the most modern building in the village and housed one of the four telephones in the area. Living in such a foreign land, I enjoyed entering the familiar medical environment each morning.
The physician running the clinic was a native Ghanaian trained at one of the country’s two medical schools. Being one of only three physicians in the area and the only one trained in surgery, Dr. Dagbui was the Renaissance physician I dream of becoming. On a typical day, he would conduct a prenatal checkup and a tubal ligation before lunch, while occasionally being called for an emergency surgery.
Armed with good humor, practiced medical skills and a crate of medications donated by an Italian missionary, Dagbui set to work each morning on a long line of patients forming behind his office door. At his side, my medical student mind took crude delight in seeing the advanced stages of diseases: hydroceles, hernias of all kinds and typhoid fever. I even witnessed childbirth for the first time—twins, at that.
Even with these varied responsibilities, though, Dagbui spent the majority of his time doling out chloroquine. Malaria ran so rampant that many of the villagers had six bouts a year, with the infection usually lasting about a week. It was frustrating to add up the patients’ days lost from working the fields or attending school. And I became enraged when I realized the effect of malaria in a broader context—the total impact of lost profits, individual enrichment and progress on the developing nation just because of a single parasite. Sadly, I know that a malaria vaccine is not a priority for Western pharmaceutical companies.
I spent my afternoons and evenings playing games with the local children and trading postcards. The villagers—from old to young—worked hard and seemed happy. Even in the absence of modern conveniences and what in my eyes appeared to be meager means, the villagers displayed a wholesome dignity.
I found my work in the clinic rewarding and eye-opening. I learned a lot from one child in particular—Fatima. She was a dark-skinned girl with a pink flowered dress that betrayed her frail frame. Except for her aged countenance, she looked young for her 10 years. She came to the office with her father, who would gingerly place her in the examination chair. Fatima had sickle cell anemia and endured pain crises. At the times when she would have to go without pain medication—either because of cost or availability—her daily life was racked with aches so intense and chronic that she was just too tired to cry. Witnessing her alarming threshold for pain made me feel self-consciously weak. During one visit, Dagbui felt her forehead, glanced at her tongue and suggested I palpate her abdomen, which revealed an enormous, throbbing spleen. Her treatment was limited to saline IVs.
Even with Dagbui’s adjusted fees for the poorer patients, I knew that repeat visits were costly. The expense was even greater considering the income lost from not being able to work during peak farming hours. I once asked Fatima’s father about their family, and he said Fatima had six brothers and sisters, but she was the sole survivor.
This family’s story struck a chord in me. The father’s persistence in getting care for his daughter issued a challenge and purpose to medicine that could only be satisfied with medical skill and care matching his dedication. I prayed that I would someday perform at such a level for my own patients. But partnered with this inspiration was a paralyzing sense of heaviness. For even though a simple intervention like treating malaria was rewarded with the knowledge that a real impact was made on a person’s life, the dizzying vastness of the need made all efforts appear futile. Still, I resolved it would not diminish my goals.
As I prepared to return to the United States, the clinic was in the midst of constructing a bedroom for visitors. Dagbui hoped to have a partner to work in his busy practice one day or to host visiting physicians. In response to his offer, I humbly made a reservation for the year 2007, or however long it would take for me to complete my training.
A graduate of the Medical University of South Carolina, Ricky Choi will be an intern in the University of California, San Francisco’s Pediatric Leadership for the Underserved program.