By: Ethel Osei-Tutu, medical student, University of Cape Coast, School of Medical Sciences, Ghana
Editor’s Note: For more information on the Ghana–Michigan medical student exchange program, see “Perceptions of Ghanaian Medical Students Completing a Clinical Elective at the University of Michigan Medical School” by Abedini, Danso-Bamfo, and colleagues, published in the July issue.
The University of Cape Coast, School of Medical Sciences (UCCSMS) began a yearly exchange program with the University of Michigan (UMich) in 2012. Four final-year students from UCCSMS are selected each year based on merit to participate in the month-long clinical electives program. In 2013, I had the opportunity to spend a month in Ann Arbor, Michigan. I gladly accepted the offer because of my passion for obstetrics and gynecology and my zeal to learn from other cultures. I was hoping to experience firsthand some of the things I learned during my obstetrics and gynecology rotation that remained abstract because they were not practiced in my hospital (Cape Coast Teaching Hospital). My clinical electives program at UMich was in the obstetrics and gynecology department in August 2013. During this period, I did rotations in various subspecialties–labor and delivery, maternal and fetal medicine, and gynecological oncology.
Unlike my hospital, most of the surgeries I observed at UMich were laparoscopic. The most exciting one I observed was a total vaginal hysterectomy done with the da Vinci Surgical System. Being my first experience with a robotic surgery, I found the precision of the da Vinci Surgical System to be absolutely astonishing! These minimally invasive surgeries offered patients quicker recovery with minimum tissue injury and scars. It also reduced hospital stay, therefore reducing the risk of some post-op complications, such as deep vein thrombosis. I believe it will be awhile before laparoscopic surgery becomes established in Ghana, especially for obstetrics and gynecology procedures. The developing world has many more problems, and laparoscopic surgery is seen as a luxury.
Aside from the astonishing surgical procedures and equipment, I marveled at the high degree of patient-centered care that UMich offered her clients. As much as patient liberties and dignity was prioritized by the health personnel, patients seemed very proactive in seeking health care. I observed that patients knew their rights and most were well informed about their conditions even before coming to the hospital. They were involved in decision making–from the date for their surgery to little details such as the material for closing up their skin, i.e. staples or sutures. Some patients even declined an epidural because they wanted to experience “natural birthing.” Back in my hospital, there are very few options available and, even when given the options, most patients leave the decision making to the doctors, hoping for the best. Very few women here know about epidural anesthesia and, even if they did, it is hardly ever available.
Also, most of the procedures done at UMich, even the vaginal deliveries, were by an attending, and occasionally a resident under supervision. Some patients did not want even final year residents delivering their babies. In Ghana, there are very few doctors compared to patients so most vaginal deliveries are done by midwives. Sometimes these deliveries are done by medical and nursing students under supervision. This gives medical students here adequate exposure; many of us are able to do deliveries by the end of our training, sometimes to the detriment of patients.
The doctors I worked with at UMich were always ready to teach. My experiences were countless, and I hope to apply them to my future practice. My desire is to be able to offer women pain-free deliveries and minimally invasive surgery in the near future. I really enjoyed my stay at UMich, and I hope the UMich-UCCSMS program will continue so that other students will have the same opportunity my colleagues and I had.