University of Ghana

The University of Ghana is the country's premier university, and its main campus is in Legon, just on the outskirts of Accra. Students come from all over the country to study here, where they can get a 4-year degree or begin medical, law, nursing, or another professional course of study. My roommate Amma got her degree in Nutrition at "Legon" before entering medical school, and she encouraged me to visit. In fact, every alumnus of Legon that I've encountered at Korle-Bu has encouraged me to visit. They have a real nostalgia for the place! So I went off to see it for myself...

One of the main courtyards:



Courtyard in the middle of one of the largest dorms. Nice right?



Volta Hall, the all-female dorm:
(Note their motto, "Ladies with Vision and Style")




In contrast, check out the motto of the Male-Only Dorm:

(Note: my friend wouldn't let me go inside "Vandal City" because I was wearing a red shirt and according to him, "Red is their color. They'll go CRAZY if they see you in it!" hmmm......silly boys. Some things never change....)

Scenic spot at the top of campus where you can look over all of Accra. Students have been banned from this area because of some "nighttime revelry" here. Silly administration.....



Ah, hooray. This next picture from the food court area shows how Legon makes it easy for the socially awkward among us (*cough* me *cough*) and tells us point-blank where "nice people meet!"



Botanical gardens on the edge of campus:

Escape From Accra

Friday afternoon I left Accra with three visiting American medical students for Wli Waterfalls in the eastern Volta region of Ghana, near the border with Togo. The waterfalls are the highest in Western Africa, so we were pretty excited! There were some lessons on travel in Africa to learn though...

FRIDAY
3pm: Board bus. (want to avoid the questionable “tro-tro’s” here. They crash too much!) Our guidebook said that the bustrip to Wli would take approximately 3-4 hours. Should get there in the early evening….

9pm: Typical Africa. Just reached HoHoe, still 20km from Wli. Dark. Need taxi. I’m a pretty intense bargainer. When I tell a potential taxi that, “Listen we can just walk if you won’t give a fair price,” I get a few funny looks from my companions. (Hey! I did finish a half marathon last weekend.) Drivers do not call my bluff. Tactics pay off and we get a ride for half the original (inflated) asking price.

10pm: “Roads” were more like mud moguls. Slow going. Arrive at hostel. Very nice hosts. Soft beds. Running water. Ahhhh.

SATURDAY
8am: Breakfast at hostel, hooray. Set off on hike to falls.
(Pictured: view from hostel, wow!)



8:30am: Asked to pay for “guide” to falls. Not sure how much we’re being ripped off, but willing to support the community. Pay 9 cedi each. Oof.

10am: Guide fails to mention that hike is a direct climb up the side of a mountain. 75 degree incline at least. Beautiful hike, but could use rappelling gear. Guide starts giving us dirty looks for being “too slow.”

11am: Guide snidely remarks that he’s part of a business, that he makes his money by taking “several” groups up the trail each day. We’re costing him money by being too slow.

12:30pm: Reach upper falls. Beautiful! Huge! Guide glaring at us. Begin descent to lower falls.




2:30pm: Lower falls! Beautiful! Swimming! Woo!



3pm: Guide has left us in a huff. We refused his demand of 2 cedi each for “tip.” We’re not going to be ripped off again, besides he glared at us all morning. Head back to hostel.
(Pictured: guide leaving in a huff.)


3pm-10pm: Chill at hostel. Arrange taxi for 3am to make 4am bus (the only one!) back to Accra.

SUNDAY
2:45am: Waiting for taxi.

3:20am: Still waiting. Guard at hostel tells us he’s the only staff available, and he’s sure taxi will come. Tells us not to worry.

3:45am: Still waiting. Very worried.

4am: No taxi. Miss bus. Return to bed frustrated. Wonder if we’ll be stranded at hostel until next bus (on Tuesday). Don’t have enough money for that...

8am: Reign in temper while discussing situation with hostel host. He seems apathetic. Doesn’t know why taxi didn’t come. Assures us that we can pay 200 cedi to hire a car back to city. Great--now hostel thinks we’re made of money too.

9am: Germans staying at hostel steal taxi from us when we’re not looking. Blast you Germans!

10am: Get taxi to HoHoe. Find kind driver willing to drive us all the way to Accra for reasonable price (no where near 200 cedi).

2pm: Home!!

Lessons learned:

-Ghanaians think travelers are made of money. We will be overcharged by about 300-500% for most anything unless we make some hardlined negotiations. But we should carry up to 50 cedi emergency funds on trips, in case we get stranded somewhere...

-Funerals in Ghana are the most happening parties around. Despite a dearth of fellow travelers and no “nightlife” to speak of in Wli, there was a funeral that sounded like a rave raging from Friday night when we arrived to at least Sunday morning, 24 hours a day.

-Ghana has a beautiful countryside.

-Hiring a car/driver may be the most efficient and ultimately cheapest way to get around.

-Beware German travelers!

Morning Rounds 2

The patient is a 6 year-old male brought in by his grandmother for respiratory distress. Grandmother notes that he has been cyanotic since around 6 months of age, with repeated bouts of similar respiratory distress, but was seen only by traditional tribal medicine practitioners in the Northern Region of Ghana. He was never seen in a hospital before now. She brought him in because his distress is worse than it had been in the past.

She states that he never actually stops breathing, just that he seems to work very hard breathing. She has also witnessed “collapsing” episodes since age 1, and notes that he squats when he’s tired or exerted. She denies noticing any recent cough, wheezing, fever, or drooling. Denies any gastrointestinal symptoms like diarrhea or vomiting. Denies recent illnesses. Denies asthma or known allergies.

The patient was born via NSVD, with a “good” weight and nothing abnormal, but he has had poor weight gain his whole life despite a full diet. He lives at home with the grandmother. He started sitting/walking/talking/socializing at appropriate ages. Both parents died in their thirties of unknown causes. He has no siblings. He has never received any vaccinations. No surgical or medication history.

On exam, the patient appears acutely ill and in severe respiratory distress on O2. He is pale, cyanotic and prefers not to speak.
Vital signs: RR 28/min HR 98/min Sp02 95% on O2
He is normocephalic, no thyromegaly or lymphadenopathy. + conjunctival injection, + nasal flaring, + white scalloped areas on tongue, dentition intact, no swelling of the tongue; His lungs are clear bilaterally; a holosystolic murmur is loudest over the right subclavicular region and the left sternal border, with a gurgling quality, no sternal heave, no chest abnormalities on inspection. Abdomen is soft and nontender; Fingers and toes are clubbed and cyanotic; no skin rashes or lesions noted.

OK for you detectives…..what is it?




Based on all of this, I had a pretty clear idea of what was going on. The squatting spells really nailed the diagnosis of Tetralogy of Fallot for me. Nonmedical readers: ToF is a heart defect patients are born with where the heart vessels to the lungs and to the body don’t form correctly. Causes de-oxygenated (blue) blood to go out to the body. This leads to lots of complications…..Not good.

One of the most interesting things to review was his chest X-ray. I was looking at it thinking, “Hmm, big heart! Looks like an egg? No…more like a little boot. Aha! Boot-shaped heart!” Very fun when textbook descriptions jump out at you…..

I was still interested in the labs though, and will include them for you interested readers:

HgB 21.2 wow! Quite a compensatory mechanism here…..
Plt 159
WBC 5.1
ESR 2
Na+ 145 *
K+ 5.3 *
BUN 12.9
Cr 0.7


An echo confirmed the diagnosis, showing an overriding aorta and turbulent pulmonary artery flow. The boy was started on propanolol, antibiotics, and fluids, and referred for urgent cardiac surgery. Now I just hope he can afford it…..


(Pictured: a pilfered Google image of a bootshaped heart. My patient's heart was bigger than this, but it gives you the idea....)