A Short Journey Through Medicine
While as a child, I always wanted to be a doctor. No family member had ever been a doctor, but I suppose just like most children growing up, I also wanted to be a doctor. I have been trying to fathom why most children wanted to be doctors.
I remember most of the dreaded experiences of my childhood, not forgetting some of the encounters in the hospital. That peculiar hospital smell is etched into my mind's nostril forever.
It, therefore, seems quite irrational to want to grow up to work at the very place that one experienced those painful injections.
Could it be because we appreciated the fact that the doctors prescribed those painful injections for our good? Or maybe, it is a latent desire for revenge by inflicting the same pain on others.
It could also be for the simple reason that it is because of the respect and admiration that doctors enjoy from society.
Whichever reason that could be attributed to my desire to practise medicine, I pursued it diligently.
Admission to the medical school was and may be still very competitive since we had only two medical schools then with limited facilities. While submitting my application, I discovered then I had an interest in something else apart from medicine.
This was farming, so I took medicine as my first choice and agricultural science as my second option. Luckily, I made it to the medical school. After the playful first year, we plunged seriously into the second year, when we started learning about the human body in Anatomy.
In Physiology, we learned how the body worked. We were led on a spellbound journey into the amazing harmony of design and functionality of the human body.
Embryology gave us a peek into the process of how the human being is formed from the union of half cells. Histology was mainly bench work looking into cells and tissues of the human being.
In Biochemistry, we embarked on a thrilling journey to observe how the molecules that constitute the cell worked. I was particularly awed by the complex harmony of interaction between the molecules in the cell and got a glimpse into how mistakes occur in the process, sometimes with fatal consequences.
I was almost convinced at the end of the course to become a biochemist. In the third year, we learnt Pharmacology. We learned how drugs worked on the body and how the body also handled drugs. I believe the central theme of pharmacology was the interaction between the body or cell and the foreign substances we call drugs.
We also learned about small germs not visible to the eye and the kind of drug (antibiotic) that could kill or hold each type in check. In Parasitology, we learnt about small animals that attack us and feed on us and how to protect ourselves against them and to kill them.
I suppose what we were not taught was how to deal with big humans who feed on fellow humans through corruption.
Pathology is the temple of truth: Where all the actions and inaction of doctors are revealed.
The post-mortem is the principal tool used by the pathologist to bring out the truth. A post-mortem simply seeks to answer the question of what caused the death of the person.
Every doctor needs to know the cause of death or be able to give a fair and plausible reason to assign the death to, if the doctor thinks a post-mortem is not necessary.
For example, if an elderly hypertensive client suffers a stroke and dies after that, we can safely assume that that client died as a result of the stroke. Post-mortems are in these cases sometimes not done because of the distress to relatives.
This is more so for us Africans who see death as a transition to another world and so believe the dead are still alive in another form.
Whether an ordinary medical officer can perform a post-mortem is a subject which could be debated and I wouldn't want myself to be distracted by it in this short journey. I, however, think it would be a shameful waste of time to let medical students do six weeks rotation at the mortuary and do a lot of post-mortems under the supervision of a pathologist and then send them out to the district and not enable them to perform post-mortem on cases which are not the subject of litigation.
Clinical Chemistry is about the study of the composition of bodily fluids and how to look for diseases in the body by sampling and testing these fluids. This brings the basic sciences to an end and we start clinical work.
The clinical work takes us through the elegant field of Internal Medicine. We were taught how to communicate with clients by getting relevant information from them, examine them, conduct all the necessary laboratory tests and manage their illness without entering their bodies.
Surgery is more practical-oriented and manages illness mainly but limited to entering the body to fix the problem.
Obstetrics and Gynaecology took us on a tour of the reproductive system of the female; even though I am not sure we understood how the species in which these organs are situated actually functioned.
The community health department taught us about community entry skills and how to work with the people in a community to solve their health problems. Unfortunately, we did not pay as much attention to this very important course as I later realised we should have.
The department of Paediatrics was the most challenging because here, you had to learn how to manage babies who could not communicate their problems to you. You had to rely on the mothers who, most of the time, are not in the best frame of mind because of their anxiety over the sick child.
Of course, there is the mortuary rotation which was an ordeal to be endured. In Psychiatry, we took a rather quick peep into the glorious world of madness, where man is relieved of all the cares and responsibilities of this odious world.
I really wished to linger on further to learn some more but that was not to be, so I moved on. Then the final exam came and if you passed, you were sentenced to one year of hard labour (now two years) of what is called Housemanship. Indeed, it was a period of “houseboyship”.
I am sure most doctors would not want to recount the Housemanship years. So the stressful but useful years of Housemanship ends and you are let loose into the world.
For me, that was where the real learning curve started when I woke up to the realisation that I really do not know much about the unpredictable human being that I am supposed to fix, and that all I had was only a collection of educated guesses, suspicions and conjectures about what might be going on in the human body for which I seek confirmation and solace from laboratory tests/or investigations if they are available.
I am proud to have trained in one of the best medical schools in the world: The University of Ghana Medical School. My lecturers did their best to impart as much knowledge as they could to enable me to manage my clients.
There are, however, areas that I felt could be added to the training to enhance effectiveness and efficiency. I believe that a client is not just a sickness or a condition. The client is a human being with emotions who lives in a community with which he or she interacts.
This community has an ecological environment, an economic environment, political environment, social environment, a spiritual environment and the world of germs and parasites.
I believe that to be an effective and efficient doctor, one needs to be able to assist the client with advice on how to deal with and manage these environments.
Imagine an unemployed man who is going through difficult times coming to the hospital with malaria. Would I have managed him adequately if I just treated his malaria with drugs alone?
I should be able to do more than that. I think I should be able to advise him on avenues of earning some income, some moral support and if possible pray with him. I am not advocating spiritual healing.
I, however, think that the dominant western secular views that have held sway in medicine should be re-examined in the light of the incurable attachment the African has to religion.
It might be real or a figment of my imagination but I think the spiritual sentiments of our clients are not adequately attended to. Why else would our compatriots with mental health problems be subjected to inhumane treatment at the so-called prayer camps?
Should we experience any guilt about the recent stories of sexual abuse of women with child-bearing challenges?
Is it possible that they might have needs which we are unable to meet?
Or are our services not tailored to their needs? What I am advocating is total care which would empower the client to get back on his or her feet and contribute meaningfully to national development.
In a country like ours with a high level of illiteracy, it becomes imperative that the doctor, if he is to be effective and useful to the society, must be a teacher: An educator, not just a person who prescribes drugs.
The doctor should be able to advise his or her clients on their basic human rights and their responsibilities to the laws of the land so that they can achieve their full potential on earth.
I believe the health sector in this country needs a radical paradigm shift from seeing doctors as people who manage sick people to managers of people's lives.
Doctors should also likewise be able to appreciate that ignorance is at the root of most sicknesses and poverty. In this direction, I believe that the doctor that this country needs must have knowledge not only of medicine but also adequate knowledge about the law, sociology, administration, economics, religion and politics.
The African continent as a whole and Ghana in particular operates a neo-colonialist economy, where all our natural resources have been mortgaged to the Western colonial masters. (Yes, I have been reading Dr Kwame Nkrumah's book: Neo-colonialism, the last stage of imperialism).
The only asset we have to call our own if we ever get to the middle income status would be the bare soil (stripped of all minerals) and our people.
Education then becomes a requirement that we cannot compromise on and I think doctors have a crucial role to play in concert with teachers.
For is it not said that without knowledge a people perish? I hope this journey which is yet in its early days might turn out to be an odyssey reaching its epoch at a period when hospitals became schools.
By Dr Wisdom Amegbletor