25 Jul

We all slept well last night thanks to continuous rain throughout the night (and the cool breeze that comes with it).  Missing our morning runs in Ghana, we decided to exercise this morning, using a yoga video and yoga mat (brought by Rachel).  It felt so good to move and stretch, but we also realized how far we have to go once we get home to get into half-marathon shape by December (we are running the Dallas White Rock Half with Rachel’s sister, Jen).  It also spurred conversations about how our home on the ocean is going to need a fitness room, as running during the rainy season would be a complete joke (it POURS here, and has pretty much all day today).  We had oatmeal again for breakfast with fresh mango on the side.  We weren’t sure what the “programme” for the day would be since we had not talked with anyone since church yesterday.  But this is Africa.  And of course, there were 6 African pastors on our doorstep around 11 a.m., asking us what our “programme” for the day should be.

At our request, they took us to see the largest of two government hospitals in Conakry – Hopital National Donka.

We were able to see the pediatric ward and met with two pediatricians (Dr. Moustapha and Dr. Emmanuel) that work at the hospital who were kind enough to stop seeing patients in the middle of their morning to answer our questions.  They explained how the healthcare system is set up in Guinea and how the educational system works, and then answered our questions until Pastor Elijah graciously recommended that we allow them to continue their work (none of the pastors were quite as excited to be there discussing medicine as we were).  We learned that there are three levels of care in Conakry: primary, or large hospitals with the highest level of care available, such as Hopital National Donka; secondary, which seems to include smaller hospitals and clinics that would be equivalent to small private hospitals in the U.S.; and tertiary, or community clinics that refer patients to secondary or primary centers if needed.  Patients are admitted through the emergency room typically, but can also be directly admitted if they accidentally skip the E.R. and show up on the wards.  There are 70 beds in the pediatric ward alone – the entire hospital is very large and composed of several buildings, each housing different wards, labs, and imaging rooms.  Within the pediatric ward, they have a nutrition center and have recently opened a room dedicated to diabetic patients.  Dr. Moustapha trained in endocrinology in France and heads up the diabetes room.  He explained to us that Novo-Nordisk (a company that produces insulin to treat diabetes) started a program in 7 countries in Africa, including Guinea, that donates free insulin, glucometers, and supplies to patients with diabetes.  It is supposed to continue for 5 years.  Dr. Moustapha has been treating cases through the hospital since April of this year with the help of this program, and travels to villages around Conakry to identify new patients who need treatment.  He has also started giving seminars to hospital staff to educate them on the diagnosis and treatment of diabetes, specifically coma due to DKA (a serious complication of type 1 diabetes).  They are also airing commercials on the radio to educate the public about signs and symptoms of diabetes.  It was so exciting to talk with him about what he is doing at the hospital and to see how motivated they are to improve the care provided to patients here.  Both pediatricians discussed how they recognize the flaws and limitations of Hopital Donka, but that they are working toward improvements as best they can.

the building that includes the pediatrics ward.

the pediatrics ward.

We learned that the education of physicians is quite different than in the U.S.  Students who pass the national exam after 12th grade (see previous post about school system) can apply for medical school.  Those accepted study for 6 years and have at least some clinical experience scattered throughout that time.  They then must pass an exam to be considered “general practitioners.”  Some then go on to specialize in one of several areas, including internal medicine, pediatrics, OB-Gyn, surgery – pediatric or general, urology, neurology, and others.  This process takes an additional 4 years.  For those who wish to sub-specialize, such as in pediatric cardiology or gastroenterology, it is rare to have the opportunity.  They must either snag a spot in a program in France, or find someone who has been trained in a particular field in France and returned to Guinea to work.  For example, Dr. Moustapha happened upon an opening for pediatric endocrinology in France and travelled there for his studies.  Now that he is back in Guinea, he is going to train Dr. Emmanuel in the same field.  When we asked how difficult it is to get a chance to go to France to train, they almost laughed and said it is “by chance or luck.”

We then toured the laboratories and were impressed by the wide variety of tests available.  They have all basic labs in addition to cultures (identification and susceptibilities), viral serology, and even viral load for HIV patients.  The facilities are dirty and run down, but the lab appeared professional and organized, and the staff were clearly well trained.

our tour guide, the lab director (on the left).

the biochemistry lab.

rachel scoping out the microbiology lab.

Overall, the hospital appears to be “worse than a condemned project” (in Adam’s words), but we are excited by the opportunities that exist here.  In Ghana, we were often frustrated by the fact that the hospital was so limited and we were left guessing about many of our patients.  Here, because we are in a big city, it seems that we would have access to many of the same labs we use in the U.S. (even at the government hospitals – we haven’t seen the private hospital yet), which would allow us to practice good medicine and have the satisfaction of knowing what was happening in most of our patients.  Of course, there is A LOT of room for improvements, but that’s the whole reason to come.  And it is refreshing to see that the Guinean doctors are as excited about change as we are.

This trip has really been perfect.  We got to see a functioning hospital in Ghana and see what it would be like to work in that type of setting.  We felt rewarded by our work, and yet were not completely fulfilled.  We enjoy learning and teaching so much that we want to be in a setting with more opportunity for advancement.  Today, God reminded us that He has a plan for us, and likely in a larger city such as Conakry.  It’s exciting.

Thank you again for all of your prayers for us – God is clearly listening and working.

– Courtney & Rachel

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