We are American emergency medical providers working in a West African Trauma Center, Ask Us Anything!

What are the most common cases you guys end up treating?

Paramedic N: "Our group mostly works in the 'critical care' section of the ER, so the patients we see are the most sick or the most injured, so our experience is skewed toward that patient group. This is my polite way of saying 'most Ghanaians don't die from awful car accidents or traumatic injury, most illnesses around here can be attributed to combinations of long term, uncontrolled high blood pressure, untreated diabetes, or general ignorance about how to handle common illnesses among the very young or very old'."

Dr.G: "Yeah I might also add that we see treatable disease processes that have progressed through their natural history to the peri-Mortem phase by the time we see a lot of them - lots of infectious disease including sepsis, meningitis, orbital cellulitis; also ARDS and acute pulmonary edema are big ones that we could actually treat and hope to reverse. I think altered mental status must be our number one issue in red ward."

Dr.N: "Agreed."

I am naive of the situation, but is there anything practical that can be done to get more awareness/testing/treatment for the blood pressure or diabetes issues? Is insulin difficult to come by? I cannot imagine have to go through the starving death someone can go through.

I haven't heard of any Ghanaian's starving to death, though I'm sure it may happen from literal malnutrition due to poor dietary standards here. I'm also fairly positive its a massive contributing factor to the hypertension and diabetics. Practical help would be large scale human health classes at the high schools to help educate the general public generation by generation. Insulin is all over the place but very few physicians take time to adequately explain proper diet and why to people. That's not a complaint specific to KATH, that's a general issue explained to me by Ghanaians that I'll speak with at spots.

Hello! Thank you for what you're doing.

Would you consider the work you do to be dangerous, given the hazards of some overseas locations?

Paramedic N: Here in Ghana? No, this place is very safe in spite of some of the pictures in the imgur gallery. I think that as long as you know how to explore urban places and know how to keep your eyes out for trouble and your head cool in a conversation it's possible to keep out of real trouble. There are certainly dangerous places to be in or go to in West Africa but by and large, where we are in Ghana is quite comfortable and safe.

Dr.N: Depends on where you are. Here the work itself doesn't seem dangerous, but is only in the sense that you're exposed to everything that the local people are exposed to. This includes road traffic accidents, knowing that the medical infrastructure is such that if you are injured or ill you may not have the appropriate treatment available.

1) How did you get into the job and why did you decide to work in West Africa?

2) What are some things you have to struggle with everyday, regarding the different health care provided?

3) What are some of the differences in health care (e.g. First aid) we can't imagine?

Thanks a lot for answering :)

1) How did you get into the job and why did you decide to work in West Africa?

Paramedic N: I showed up. Honestly. I went into the hospital and asked how I could contribute as a volunteer. A month later I was working in RED and helping to direct some training for the nurses. Another month later I am here offering instruction for other hospitals as they develop their own emergency medical protocols.

2) What are some things you have to struggle with everyday, regarding the different health care provided?

Paramedic N: The system for treatment is pay to play. This means that as a patient is brought in the nurses will take vital signs, strip the patient, obtain IV access and maybe place them on a simple 3 lead cardiac monitor. If the patient needs additional medications or interventions they have to pay for them up front. If the patient is unconscious then the family has to pay for that up front. If the patient is awaiting further consultation (say, from the surgical unit) because they need X-rays, they have to pay for that up front. Otherwise, nothing will happen and the team will typically stand by idly, sometimes even until the patient codes. That's a pretty wild difference.

3) What are some of the differences in health care (e.g. First aid) we can't imagine?

Literally all of it. My personal favorite horror story is watching a doctor here make it a priority to provide a patient with a heart rate of 230+ motrin prior to even placing the patient on a monitor and assessing their electrical status, or even their blood pressure. For every mind blowing decision we've seen here, there are equal moments of really clever, cheap methods used to provide interventions.

The system for treatment is pay to play

Holy shit that's distressing. What would you say the cost is in terms of american or UK money?

Paramedic N: Its about 4 GHC to 1 USD now, and even then the drugs are generally dirt cheap. But the economy has been hard on Kumasi for about a decade now and money is tight everywhere. Most people are working with fractions of what they used to have.

How many people would you say are able to afford their care? How much does the least expensive and most expensive procedure cost?

Paramedic N: Most, I suspect. It's a matter of getting payment where it needs to be in time for it to matter. There are wildly effective nervous system procedures that are obscenely expensive and there are wildly effective cardiac emergency interventions that are pennies on the dollar.

Hi! I have a quick follow up question to this if you don't mind.

What happens if a patient is in unstable condition? Are you allowed to resuscitate without payment?

Paramedic N: Yes but no. We will provide chest compressions and obtain advanced airway interventions, but if the family did not purchase any additional pharmaceuticals (Epinephrine) then none of it really matters.

What's worse is in the rare cases when we do achieve ROSC and there are sometimes no additional meds to maintain that fragile stability.

This seems odd - advanced airways would surely cost more than a vial of adrenaline?

Also, what's the point of attempting resus if post-ROSC care isn't there?

Paramedic N: The stuff to the advanced airway stuff is already there and ready to be used, the adrenaline has to be purchased from the pharmacy outside of the ward and down the hall. There is post-ROSC care here, there are plenty of meds and pumps to execute post-ROSC care, but many of the doctors do not plan for it, i.e; they do not have the family proactively purchase those drugs.

they do not have the family proactively purchase those drugs.

I'm a paramedic in the US, and thought this sounded like a cool thing I might be interested in (I have some experience volunteering in Africa, but on IT projects). Having read this... Nope... Couldn't deal with the frustration of that.

Paramedic N: It's different on different days, man. Some doctors are really on top of their game, some are still learning.

What are some examples of the really clever, cheap methods used to provide interventions?

Paramedic N: I am so sorry I didn't see this question until 14 hours later.

For obvious femur fractures they will stabilize the entire limb in this wooden L shaped brace and wrap with gauze. It's extremely cheap and its extremely effective. Hospitals in the US would utilize one time use braces or gigantic equipment. Here they just manually pull traction and then splint in place and monitor for additional bleeds and assess pulse, motor, sensory function.

Because of the lack of IO access kits (needles), if a patient is a difficult stick the doctors are extremely good at obtaining jugular vein access and won't hesitate long to do it.

The Mad Max methods and ways in which some of the nursing staff are half tinkerers, half healers with regards to maintaining the hardware and life support equipment is inspiring.

Otherwise, nothing will happen and the team will typically stand by idly, sometimes even until the patient codes. That's a pretty wild difference

That's extremely fucked up, how does everyone sleep at night?

Paramedic N: Diazepam is only a buck.

It's also important to recall recent history. The past ten years have been a vicious grinding out of the economy and the Ghanaian government has been struggling to make ends meet all over the place as budgets loomed and issues bloomed. This hospital is trapped between trying to maintain an arsenal of advanced diagnostic tools, payrolls, and truckloads of consumable supplies that even under perfect conditions are sometimes wasted (same as the US). This has created a circumstance where it can be readily apparent how likely a negative outcome will be based on clinical presentation. Part of me wants to be angry with staff for not caring more, the rest of me understands that I'm only here for a couple of months, these guys are there for careers and have had to live this tough ground-hogs-day over and over again.

So why go to West Africa when America has working people who can afford medical help.

Paramedic N: I wouldn't have known if I'd never gone. Conversely I'd have ever experience or grown as a self reliant medic without the months spent here.

Hi there!

I'm a final year medical student in the UK. I spent 2 months working in Ghana last summer (Korle Bu in accra and Oda). I found A LOT of the doctors to be at best a bit incompetent and at worse dangerous (resting an unseated cannula needle in a pool of pus and then using it to cannulate! I could go on). I also found the nurses to be absolutely terrible. Cruel (punching and slapping women in labour or patients having their dressings changed) and dangerous (one nurse sat on a line giving blood to a 12 year old girl and pulled it out. The girl later died). The nurses spent more time abusing patients and playing on their mobile phones than looking after patients.

How has your experience of the local medical professionals been? Do you find it as frustrating as I did? I expected a resource poor set up and would never blame anyone for that, but that lack of pride in their work and compassion was heartbreaking to witness. To the point I would never return to Ghana. I've travelled extensively in Africa and Ghana is the worst country I've been to!

Good luck to you all

Paramedic N: I look forward to the doctors replying to you because their experience has been largely the same as yours. As has mine. I think you smashed the nail on the head:

I expected a resource poor set up and would never blame anyone for that, but that lack of pride in their work and compassion was heartbreaking to witness.

Paramedic N: My belief is that a lot of these nurses complete their training and are highly motivated to get out and make an impact and be good at their jobs but they run into these massive and already established hospitals and conform to these old guard nurses who are absolutely unqualified to provide medical support under any circumstance. Some hospitals have done better than others and my experience around Kumasi has shown that there are massive differences between hospitals and massive differences between nurses at different hospitals. Some people show a lot of motivation and drive but not a lot of critical thinking, some show absolutely no compassion or motivation and are just there for a pay check. I'm curious to see other African medical providers. Where should I go next?

This is a prevailing occurrence in third world countries. While they can find amazingly simple and cheap solutions to problems (the lack of resources forces them to), It's very common for nurses to be highly underqualified. Education focuses on the doctors, and even they can be incompent too. It's not so much the people, but the result of a poor educational system.

Paramedic N: I whole heartedly agree.

Hello! I am from Ghana and I was actually born in Kumasi. I would like to thank you for helping out my people. I know that the concept of emergency service in Ghana is not very well known to the people So i guess my question is do you receive many actual emergency cases? And what is the most interesting/bizarre case you have encountered? Thank you.

Paramedic N: Ete sen! We get real, very legitimate emergencies all the time in RED. For a patient to be sick enough to be distributed to our team they are pretty obviously ill or injured severely. That said, the most bizarre case we had was a young man brought in on a wheel chair. Allow me to set the stage.

We already had three patients with almost every nurse and doctor around them helping to keep them alive or monitoring the various drips or machinery and then this new patient is wheeled in. He had three friends or family with him and his eyes are wide open and he just sorta looked 'out of it', as though he were extremely drunk. I take a quick look with a pen light at his eyes and notice two quick facts.

1. His eyes are dialated and completely unreactive to light. Neat.

2. He is agonally breathing.

When I finally get the help of others to get the patient on the bed, striped, put on the monitor and a set of vital signs, it became real apparent real quickly that this fellow was essentially dead and moments from meeting his God. His spine was compressed, his abdomen was distended, his pressure was almost non-existent, his lungs were full of fluid, his heart rate was barely 30. When we finally got a sort of answer from the family they explained he was working on a building site and fell. His injuries looked like something I would expect from a fall from a three floor building, but then they told me the part that literally almost made me laugh out loud. The man had fallen three days ago and was only now being brought to the hospital.

He didn't make it, he coded about an hour later and that was that. I still try to figure out what the hell everyone was thinking with that guy. My theory is that his boss didn't want to get the blame for his fall death from lack of safety equipment (which is real common here) or some madness.

Me ho ye! Wow thank you for your reply. That is crazy. Especially waiting three days to take him to the hospital after the initial injury.

Paramedic N: Yea, for as much shit as I throw at KATH, the fact is that they're expected to execute a billion dollar mission with twenty bucks and a pack of gum. In short, they're doing the best they can figure with highly limited resource and insane conditions like a patient from a traumatic fall being brought to the hospital 3 days after the event. Like, even in the US that would be almost impossible to fix, if at all.

What is your daily schedule like?

Paramedic N: Wake up is usually around 0530-0630. Get into the hospital and set to work before the night shift transitions to the morning shift at about 7, the transition occurs at about 8. Work through until 3 and then head home to decompress. Each of us have slightly different home routines, eating habits, or home responsibilities like calling loved ones and such.

How do you find the time to write with such a busy life?

What is the internet like out there?

Is this a temporary work placement or have you got long term plans?

How do you find the time to write with such a busy life?

Paramedic N: I often dont find time to write. When I do I try and spill out as much brain goo as possible to the stories and sometimes I end up putting too much effort into some aspects and not others. By and large I think there is much more time in the day than we think about. You just have to figure out how badly you need sleep or beer drinking time.

What is the internet like out there?

Paramedic N: Almost everything is done through smartphones. Towers are cheap for companies to build and then its a matter of using the correct chip and the correct provider. For this region, MTN and Vodaphone are the primary carriers. For others there are others. So I pay about 30 USD for internet all month that's reasonable. I get my cat videos and email.

Is this a temporary work placement or have you got long term plans?

Paramedic N: I'm going to edit this response later as the others get back from their outtings today. For me, this experience is my chance to see what I can get done and what I can do to effect the area around me. The wife works with international development and I didn't really go to college, just the paramedic program at a local CC. The amusing part to me is that she seemed to have spent 6 years and a whole lot of money to get a degree that says she knows what she's doing while I just crash landed into this position and seem to be making a light and meaningful impact.

But we're just competitive that way.

I'm a medical student who wants to work in global health, how did you and the physicians get involved in this?

Paramedic N: I will pry the other doctors' brains open when they return from Kejitia, I got involved through an organization called Medics Without Borders. It's a little bit rag tag looking from the website because the founder is Ghanaian but his heart is in the best place possible and the connections we've made are phenomenal. Myself and a few others operate through their MOU's with KATH to work in RED team. There are other global health initiatives such as Medical Teams International, if you want to work in places other than Ghana. Again, if you're highly motivated to get involved, send me a private message and I will do everything I can to point you in the right directions.

If he would be interested in upping his website game, let me know.

Paramedic N: He is, you should contact him directly. It ain't me.

Do you have any sense of how often patients present with acute MI? What sort of troponin assay do you have access to - POC or lab-only? Is the Ghanaian ED system referral-only? What are prehospital services like in Ghana?

Paramedic N: I'm harassing the doctors but they're both out and about at the moment. I am making note to answer your question when they are both available. Here's what I've seen from my level, which has been working with the nurses on patient care.

Do you have any sense of how often patients present with acute MI?

Where we are, probably one a day enters the ED and one every 10 days is critical enough to come to RED where our particular group is.

What sort of troponin assay do you have access to - POC or lab-only?

Allow me to horrify you for a moment. While we can absolutely do lab-only troponin assessments, there is no cath lab. So there's no follow on care for the vast majority of those patients even after an MI is accurately diagnosed via 12 lead or sonogram.

Is the Ghanaian ED system referral-only?

I'm not sure, when the doc's come back I'll pry their brains open to sort it out.

What are prehospital services like in Ghana?

Do you mean ambulance services? The Ghana ambulance service is a thing but because there are few addresses and almost no accurate GPS location devices (they exist but are few and far between). The ambulances are generally well stocked but they really specialize in inter-hospital transfer. The majority of private ambulances are really just body moving devices and some even have local mortuary services as bumper stickers or advertising on their windows. As for peripheral facilities, the quality of care and efficacy of interventions will vary tremendously between them all. This is because of highly non-standardized qualifications between nurses and because of the wildly unreliable nature of working CT machines or other imaging tests.

What proportion of the cases you see are easily preventable with education or basic public health initiatives?

Paramedic N: I will harass the doctors to give a much more detailed reply to this question, but just guessing off the top of my head: More than half.

There is very little understanding of human physiology here and there is a deeply held belief that life is cheap and the after life is where the real party is at. That, paired with a culture that still deeply believes in voodoo (juju, here) and spiritual medicine, it's a perfect storm of explainable ignorance that generates a pretty massive problem.

More or less what I expected to hear. Are you as foreigners able to have any success in trying to educate your patients or their families? Do government officials or other local authority figures ever make an effort to address those things?

Are you as foreigners able to have any success in trying to educate your patients or their families?

Paramedic N: It's really difficult to measure the effect of lessons in the general public because of the massive generational language difference.

Do government officials or other local authority figures ever make an effort to address those things?

Paramedic N: I've not seen many government initiatives beyond some aggressive malarial protocols in the hospitals. There are a few private enterprises that have sought out MWB's instructors for first aid training among several different venues and businesses.

level-1 trauma ED RN here.

first off thanks for what you and the crew are doing; it sounds fascinating and at the same time compassionate (and frustrating! "pay to play," wow)

Q: What are your facilities/equipment availability like in comparison to a U.S. trauma center? E.g., in a U.S. level-1 trauma ED you have multiple O2 and suction setups, monitor, overhead X-ray, intubation supplies w/ video feed, central access equipment, rapid infuser, the whole sha-bang. I think we take it for granted but there's probably a million dollars worth of high-tech goodies in one trauma bay, and most big urban centers have at least 3 of them, plus half a dozen critical care rooms.

On your end, do you guys have anywhere near that level of available tech? Are you capable of monitoring all your patients or do you have to pick and choose who gets thrown on a monitor, etc?

Other Q: Does Ghana's emergency medical / ED system use an acuity scale like ESI? Do they use an overcrowding index like NEDOCS?

The doctors are actually going to be writing long reports about this when they return stateside and Im going to kick them in the shins like a good medic to get them to reply to your question as well. In the mean time, here is my paramedic answer:

What are your facilities/equipment availability like in comparison to a U.S. trauma center?

Paramedic N: Oh man. So There are no numbered beds or cots or anything in RED. Patients roll in as they come and take up position next to machines if they are available. We can have up to 11 patients in our zone at a time but we only have 5 functional 3 lead monitors and of those 5 we only have 2 with operational BP cuffs attached. We have no pulse oximetry attached to the monitors. There is one finger pulse ox machine for the whole ward. I thoroughly encourage the other volunteers to pack their own entire triage kit of stethoscope, BP cuff, pulse ox, thermometer, and shears. There are sometimes 4 working suction machines but usually only one works, there are no Yankauers, just half assed french caths that plug into the suction machines that have been used to the point of being only barely powerful enough to empty a cup of water. There is 2 working ventilators, which means that whoever is there first and has a paying family will get them and likely get to keep them. One operational ambu-bag for codes and one working blade for intubation. There are no constricting bands for IV access, we use infusion lines and a quick knot. There is no "code room".

No. I'm not making this up.

On your end, do you guys have anywhere near that level of available tech? Are you capable of monitoring all your patients or do you have to pick and choose who gets thrown on a monitor, etc?

Paramedic N: We arrived one morning to see an intubated patient who was both cold and pulseless but still attached to a working ventilator. The patient also had chest electrodes in place but somebody had removed the leads so the machine was off. When we placed the patient on the monitor we weren't too shocked to see that they were in fact in asystole (and probably had been for at least an hour, nurses do not round well). We work with the amount of tech we have and in accordance with the clinical severity of the patients, but there are also some inane protocols that are followed because its a government hospital and thinking outside the box can be thoroughly shunned.

Does Ghana's emergency medical / ED system use an acuity scale like ESI? Do they use an overcrowding index like NEDOCS?

Paramedic N: I'm gonna have the docs answer this question more in depth because I think they'll provide a better answer for you. So far as I understand it, the sorting of patients at triage follows the South African protocol guidelines via a scoring algorithm. I've not had any major issues with it yet other than that many nurses display a discouraging lack of critical thinking skills and will rely entirely on a binary algorithm instead of any clinical competency. Or perhaps I'm jaded, it's hard to tell some days :D

Good questions and it's awesome hearing from a fellow level one-er, thems were my EMT days before EMT-P!

How do you deal with the limitations you have? Example. Blood gases for a possible DKA or if someone needs blood is there a way you cross and match in this run down country.

How do you deal with the limitations you have?

Paramedic N: Case by case. As emergency medical technicians will readily explain, knowing how to do duct tape/MacGuiver medicine is one of the hallmarks of providing point of injury care. If the family isn't there to provide medicines for patients, we wont spend money out of our own pockets because of the massive issues it would cause. That's a different issue that I will get to later. The example of blood is fitting because the young man with the shotgun GSW to his legs was slowly bleeding out and needed blood. Because his family had gone back home over night we had to very gently provide normal saline so as to avoid over perfusing and causing rebleeds while we waiting for them to come back and provide money for more blood. Then, in order to get the blood it had to be a family member providing it. I don't know if the blood was ever tested for anything or even type. I do know that they charged the donor and then the patient for the draw and the application.

Pretty sweet, huh?

As for important labs, I'll pester the docs when they return. They've been showing us all a lot of secondary ways to look into symptoms and tell tale signs of decompinsation and the like. I'll let them explain in more detail.

What major issues would spending money out of your own pockets cause?

It creates a slippery slope for the providers that come after we leave and does not address the larger issue. I can afford 16$ to keep somebody alive, but can the next volunteer behind me do that? What happens when it's 50$? At what monitary value do I think to say "what's the return on investment?". What happens when I'm not there and folks were expecting the foriegn medic to just buy everything up front like he always does?

It's a very ugly circumstance to be involved in.

Have you had to make any significant changes in how you do things in Ghana as opposed to in the US? IE, changing certain procedures and treatments to fit what resources you have available?

Paramedic N: I want you to think of the sterile field. Get that image in your head. Get it thoroughly out of your head now. It's not possible here in the ED.

That sounds...utterly terrifying, actually.

Paramedic N: The specialists and doctors try very hard to maintain sterile field but it's just almost impossible given the setting. We all know what to do but it's often very difficult or impossible to do it.

Any room for pharmacists on your team? Or to better phrase it: What could a pharmacist do to help?

Contact me via PM if you're interested in coming out this way, but for the other pharmacists lemme 'splain:

Paramedic N: Generally speaking, the most meaningful thing any volutneer can do in these circumstances is to provide educational and professional guidance/ support to interested parties or general public. While there is almost certainly a real need to combat local pharmacists here to sell anything from herbal snake oil bullshit to pushing cough syrup for back pain, there's plenty of need for honest people to come out and help provide medical direction for the local populace.

There are dozens of needs for hundreds of kinds of professionals. If the organization I'm in can't use you or doesn't need you, we can send you where you are wanted and needed. Somebody someplace needs a pharmacist who cares!

How often, if at all do you see patients from smaller villages nearby Kumasi? I was in Ghana in the spring time, in the village of Boabeng roughly 2-3 hours north of Kumasi, the sister of one of our field assistants died suddenly on our last day. My entirely inexperienced guess was that perhaps it was a heart attack. Knowing that there is usually little to no ambulance service as we in Canada or the states would necessarily recognize especially in very rural villages, even if the people in the village knew the warning signs and symptoms for something like that, what do you think the chances of getting to a hospital, even as close as Nkoranza and surviving be? Or would there effectively be nothing really they could do in time given the lack of medial infrastructure?

This is a great question because it's got a lot of issues in it that are worth unpacking. I'll answer it first and then harass the doctors to stop playing in the streets and answer as well.

Paramedic N: The National Ambulance Services of Ghana is a very new establishment within the Ghanian health services ministry. There are a bunch of various growing pains as a result; who owns the trucks, who pays for maintenance, how to patients pay, do patients pay at all, who pays the drivers and EMT's? Who pays for their equipment and training? So on, so forth. Like in the US and places Canada (I suspect, I'm often wrong) it is generally very expensive to operate a full time fire/ rescue service so they are typically manned by a volunteer force. Volunteerism is an extremely foreign concept here. So for rural and far flung villages it is very hard for them to get ambulance services, such that the only people with body carrying vehicles in town are almost always the mortuary services who have a very clear conflict of interests with regards to patient transport.

That said, depending on the signs and symptoms of a patient and the amount of time it could take to get a patient with recognizable positive signs of accute cardiac issues, sometimes there's just nothing you can do. That's regardless of where you are on the planet. In the US I've seen people fall over, code, and die in Wal-Mart. It's not because the ambulance was too slow or because no one around knew CPR. It was because the patient was so sick so severely so quickly that there was nothing that could be done in the field. Now I don't know the circumstances with the example you have provided so I don't know if a different outcome could have been possible for your field assistant's sister. I do know that there is a very weak medical system in place to handle acute MI's where I am in KATH, and by weak I mean 'it doesnt exist'.

It doesnt exist such that there was no aspirin for a patient with obvious clinical signs of MI readily available in the RED ward.

This is a dumb question but I was curious after reading you mention the soccer match the other day: how's the sports culture in Ghana? I know that soccer is huge but what's an average "night out with the boys" like? (Example: wings and beer while watching American football) What's the average Joe drinking? If a huge loss/win occurs do riots ever occur? Any huge rivalries?

Football is a part of the culture, but it seems to vary quite widely among the places where I've seen games. I watched a Chelsea game and there wasn't an empty seat in the place and the whole crowd lost their mind when Chelsea scored. Conversely, for the first match of the Africa Cup, I was watching with EMT L and Dr.G and although Ghana scored against Uganda, I was the only one cheering. Apparently there was some tension with the Black Stars (Ghana's team) and that was later explained.

As for the internal Ghanaian teams, the local Kumasi club is heavily supported and when those games are going on the spots with TV's showing the games are packed.

An average night out with the lads will usually swing through a "spot" which is the Ghanaian equivalent of a little pub. Usually a shack with a massive ice-chest full of beer. The beers are 675 mL in size and are 5 GHC (Roughy 1.25$ USD), most beers are pilsners though there is a Castle Milk Stout and an Africa Guinness Special that are delicious. I've not heard of any major rioting or hooliganism from football matches but I know the Accra-Kumasi football club rivalry is real enough that cab unions arent allowed to display team stickers if the union is predominantly for one team over another.

Thank you for the great response! Between your fantastic work in the region, Galactic Tinder, and your appreciation for a good pint of stout, you're legend in my book. Even if you are a Chelsea supporter...(or are you? It doesn't actually say you are but being as I'm a Gunners fan I just thought it was implied above.)

I love when Arsenal, Chelsea, or Man U play. I love when they play because they're typically good matches.

And because I love being the only one in the pub rooting against them each time.

I'm from America, man, I haven't got a club I support.

What are some things (medically speaking) that we (living in the US) take for granted? What are some things that were shocking or "weird" when you started working in Ghana? Why did you decide to do this?

Paramedic N: The Pay to Play system of payment for treatment was and still is alarming and appalling. At the ED in the US that's just not how things are done. I came to Ghana to work emergency medicine in austere conditions and to see if there were any clever tricks of the trade I could pick up and learn from or conversely anything I could teach to help.

As I'm sure access to CT imaging is limited, what role does point-of-care ultrasound play in an emergent setting in Ghana?

Sorry for the delay in response, a block of questions got somehow skipped.

Dr. N: I've only been here a week so I don't believe I've 'seen enough' to effectively answer this question. Here's my take- without other resources, whatever we can see on a bedside ultrasound still has to be treated and that can sometimes not be readily apparent and available. It's a great adjunct for difficult to obtain IV's or in FAST application. Perhaps in a few more days I'll have a better answer for you.

Do you guys have any RTs (respiratory therapists) at your site, or will there be a future demand for some? What are some of the challenges of managing an airway and ventilating a patient outside a typical American hospital setting?

How could an RT get involved and help with what you do?

Paramedic N: Again, when the docs get back I will have them answer this question as well. For now, here's what I've noticed and certainly made several notes on.

Do you guys have any RTs (respiratory therapists) at your site, or will there be a future demand for some?

There are no RT's that I'm aware of. Certainly none in the ED, and they are desperately needed. Only the nurses SORTA know how to work the ventilators and most of the time they keep them on 100% O2 for literally days. It's a mess and something that the doctors have been cluing me into helping to combat some.

What are some of the challenges of managing an airway and ventilating a patient outside a typical American hospital setting?

Paramedic N: Supplies. We're always either out of supplies or rushing last second to locate supplies. Without this reply falling apart into me just being bitter and complaining, there is little to no oversight in how the RED zone organizes its equipment. This usually means that one or two people in the whole team of 10 will know where certain supplies are, this means you have anywhere from a 90-80% chance of asking somebody to find something for you that's TIME SENSITIVE TO HAVE and they either don't know where it is or say we don't have it because they don't know where it is. Assuming you can accquire the needed intervention tools to keep an airway and provide oxygen to your patient, unless you have your own pulse oximeter, you won't have that reading.

I tell anyone who wants to come out here to bring an entire triage kit for yourself because the floor will not have it for you or you'll always be competing with others for the limited tools available.

If you are interested in coming out here, and I would encourage anyone to come if they are, please send me a private message and I will get you in touch with the appropriate people. For as awful as some days can be, the rest of them are filled with learning opportunities and incredible moments that I will remember until I'm older and fatter than I am now.

Is it all voluntary? Do you receive a wage/expenses whilst on site?

Paramedic N: All volunteer. Another guy before me encouraged me to write short stories on reddit and beg for donations. Said it helped him half fund a clinic as well as remain fed during his stay in Ghana. The doctors are also here as part of their last year of residency and their electives. No pay, all play.

A little off topic but how do you feel about your current ems protocols back home and what would you change in regard to the current state of ems?

The conversation went like this:

Salo: Who the hell are you and what are you doing here?

Zigzag: I'm a paramedic from the US and I don't know what to do with my hands.

Salo: Me neither, come with me, let me introduce you to the clinical directors.

Hmm. Im not sure how the question and response got mixed up, lemme answer you better:

Paramedic N: I don't know where to start with how I would alter EMS work in the US. It's also wildly different town to town, state to state, department to department.

Are the many women who do what you do? Are there extra precautions for foreign women in West Africa?

Paramedic N: Are you asking about women who volunteer or Ghanaian women who work in emergency medicine? The volunteers we get receive a thorough on-boarding series of classes to help them understand general cultural differences and big no no's and red flag behavior. Ghana is wildly safe in comparison to, say, Lome, Togo, and as I stated earlier, so long as you keep your wits about you and you don't get drunk and wander down dark streets alone, you're probably gonna get home safe each night.

What kind of anesthesia machines and volatile gasses do they use there?

Paramedic N: We don't work in the "Theatre", which is what they call the surgical wards here. I don't know what they use but I can go up and ask when I work tomorrow night and respond later if you'd like. In the RED zone they'll just use a bunch of benzos or ketamine or propofol depending on the clinical presentation of the patient.

You are all proving such a great service and are all so selfless. Thank you, you are a great bunch of men!!

What are the most common, avoidable childhood diseases that you treat on a daily/weekly basis there that are extremely rare in the US because of vaccines?

Paramedic N: I've not seen any sort of consistent illness type that would make me suspect issues with vaccinations. A common childhood illness around here is malaria and there are aggressive treatment regimens in place to mitigate deaths by the illness.

Hi, do medical students ever come to you on electives?

Paramedic N: Both Dr. N and Dr. G are both last year resident students here in Ghana for a month each on electives!

Do you know u/salojin, reddit author, and fellow American working in Ghana's medical community?

Paramedic N: Yea, he got me involved at KATH and MWB!

[deleted]

When the docs and my other EMT return I'll have them answer as well because I think we've all seen something that eats at us in different ways. It's also important to understand that many of us have careers worth of "worst things youve ever seen" so there's not really ever gonna be one flat answer.

Paramedic N: The worst thing I've seen is the terrible disparity in those with money and those without. Here's the example: we had a 7 year old girl come into RED team with a traumatic head injury. There was exposed brain tissue and some other pretty damning clinical findings. However, because the family was quite wealthy we were able to get her labs drawn, a CT scan completed (at another facility, she had to be medically transported to another facility because the KATH CT scans are all down) and then on a surgical table in about 6 hours. Conversely, at about the same time we also received another fellow, perhaps 20 years old with a head injury. Same issue, slightly exposed brain matter from a motorcycle fall. He had no money. So he laid on the cot without any further care until he eventually deteriorated, coded, and died.

Pay to play is the most horrifying medicine I've ever witnessed.

Are you able to do any palliative care for him while he dies?

Paramedic N: There's not much to do with a brain dead patient but explain the issues to the family and keep them clean and warm and check vital signs, all while charting the inevitable decline. So, in that sense I suppose you can say we provided palliative care, though I feel that it was inadequate.

I'm a medical lab scientist interested in this type of work. Any need for lab folks where you are? What are the laboratory facilities like, and what tests usually need to be done?

Paramedic N: I'm not sure what the needs are for lab folks or other diagnostic professionals. I know there are smaller clinics that could really benifet from having a well trained member of staff around to help with day to day tasks, but that's about it. There are actually a massive number of labs scattered around the city that exist because of all the half-assed clinics that are also scattered around. Patients will go to a doctor, doctor will recommend some tests, patient will go to another lab somewhere else in the town and get the tests and then may or may not return to the doctor for further consultation. It's pretty strange.

There is a major private hospital that I'm helping to teach at that has a massive diagnostic center. If you have any interest in teaching or providing assistance I can certainly put you through to them. The major hospitals have very clean and professional looking labs but being a patient care guy, I couldn't really tell ya much more than that.

Here's me in a lab "Yep. There's that spinny thing. And yep. There's some microscopes. Huh...those look like test tubes...is that plasma or piss?"

I'll annoy the doctors when they re-appear.

Lol, most of the time I don't assume plasma/piss/shit/sputum or whatever else cause they can all resemble one another in a sick enough patient. So that's pretty cool that there some modern instruments/microscopes and such, although I love the idea of doing tests the old-school way. I saw in another comment you mentioned getting blood products for a patient, I do wonder about how much testing or safety is involved, especially since the products come from family members. One of the only ways I can kill someone from all the way inside my lab is by giving an incompatible blood type.

Paramedic N: Yea, so that happened back a few years ago in Fairfax VA, pregnant patient received a few units of the wrong blood type.

Whoops.

I believe there was a massive settlement from that too, I am wildly doubtful there would be any litigation of such an event where I am currently.

Thank you for doing what so many Americans can't/won't do. What was the moment in your life that made you want to go to a foreign country and help people? How much time did you spend in the states helping before you went abroad?

Paramedic N: I had the luck of being part of the Marine response to Haiti immediately after the earthquakes years back. Between that and seeing emergency medicine performed under other circumstances I knew that I wanted to be involved in that line of work. I'll ask the others what motivated them as they return.

Got a question for EMT L or Paramedic N. There's some range of differences state to state, for example an EMT in my state can administer 11 medications where I've repeatedly heard some states won't allow an NREMT-B certified EMT to administer so much as oral glucose. What's the difference between what you guys were allowed to do in whatever states you practiced first response in before, compared to what you are permitted to do at your current job?

Displaying levels of competency and providing copies of the medical protocols that you last operated under.

In your "us at work" album there's a man with 85% burns. Even in a US tertiary burn center with unlimited resources, that person would have at least a 90-95% mortality risk (rule of thumb = age + % burned = mortality) and require years of therapy and additional surgeries if he did survive. I would have imagined that he would be triaged to "unsalvageable" in central Africa. What is your triage process, and when are you deciding not to intervene on the severely injured?

Paramedic N: I find a lot of issues with that rule of thumb issue based off my experience with the military and working with burn wound wards from the wars. I won't disagree that it's an incredibly difficult injury type and I'll never disagree that it's almost prohibitively expensive.

Patients are triaged according to the South African Triage Scale which assigns numeric values based off clinical presentation. But yes, there's also a sort of unspoken rule about people that are typically too sick or too wounded to be expected to recover. The real problem is trying to see if the nurses and doctors are following that unspoken protocol every time or just lazy.

Thanks for the response. Don't forget, your military patients were young and extremely healthy, so if your results were better, it's probably a patient population thing. A 50yo Ghanaian man with an 85% burn isn't going to have the same outcome as a 25yo US Marine with an 85% burn.

Paramedic N: Devils advocate, I understand what you're suggesting but both of those patients were young men in great health who were essentially expected to die and treated as such. It was wildly frustrating.

Have you worked anywhere in conflict areas that were attacked or bombed by an airstrike while you were there?

Paramedic N: Yes. It was loud, we suddenly had more patients and less equipment. I don't recommend those environments.

So, I'm genuinely curious and I'm not trying to diminish your contributions. If anything, kudos for wanting to give back. That said, what % of your motivations are altruistic, and what % are "this would definitely look good on my resume"?

Paramedic N: I had to come to terms with myself a long time ago about why I was interested in emergency medicine. The conclusion I reached was because I hoped that somebody as motivated as I am to do emergency work is who finds me when my turn to have a bad day comes. As for the resume building, I hadn't actually considered that much, I was just looking for something to do for a few months.

What is your protocol if a suspected Ebola patient arrives at the clinic?

Paramedic N: Panic a little and then put on gloves. There is a protocol in place, I've seen the triage algorithm and such but I've never heard it drilled or tested.

Which public health agency would you contact? Seeing as you are Americans would you contact the CDC? I do not know enough about the Ghanese government to know how their public health system works.

Paramedic N: I'm not sure at all, actually. I'm going to ask about this for sure tomorrow. Also, Ghanaian*

Subspecialty surgeon here. For the physicians among you, are you employed by US medical centers? If so, tell me about the reception you received from the administrators when you decided to go to Ghana. I've thought about spending time at CURE in Uganda or maybe in Kijabe, but there is constant pressure from above to think about the impact it would have on RVUs. I'm curious how you're making it work with your employers.

I am specifically sending your message to the two docs now via Whataspp to hurry up a response. If you do not hear back in an hour, message here again and I'll find them and harm them until they respond. :)

Dr. G: "Well we are residents so its completely different for us. I assume you would have to work it out with your employer."

Still awaiting a response from Dr. N

Hi! What is the worst injury you have had to deal with? Have you felt prepared?

Paramedic N: Any injury that would be wildly survivable in the United States that is a death sentence here is the worst, in my mind. For example, in the imgur album are pictures of a fellow who received burns to 85% of his body. Although full thickness burns to that much of the body is a difficult to survive event, it's by no means a guaranteed death. But, for a confluence of factors here in Ghana, no one expected the fellow to make any sort of meaningful recovery and no one tried. So he eventually died a week after sustaining his injuries, for what amounted to reasons of apathy.

I've experienced patient care in austere or chaotic environments from disaster response to simply working in a crowded US, ED, but nothing will ever prepare you for when you know a patient is going to die because there simply aren't enough ventilators to use and no one wants to 'bag' the patient for hours by hand.

Why are you guys all white?

Paramedic N: I'm black where it counts.

What is the one thing you wish people back home who want to help West Africa through charitable endeavors knew?

Paramedic N: How corrupt most of the systems are around here. If I had 200$ worth of supplies mailed to a person here, the local post master would 'look the other way to avoid customs' for a 50 USD bribe, because the arbitrary customs fees he can legally attach could end up costing the value of the donated supplies. The best way we have of getting major supplies sent to us is in checked baggage, and the majority of supplies we need are simple things like vital signs equipment (Pen lights, BP cuffs, stethoscopes, pulse oximeters, thermometers, etc).

I'll harass the doctors for other equipment or donation recommendations. But honestly, another volunteer had a fair amount of money gifted to him by donators on reddit and he ended up losing an unhealthy chunk to crooked contractors and post masters.

How did Ben Linus infiltrate your team?

Ben Linus

Paramedic N: I Lol'd heartily.

Oh Bruni!

What precautions have you taken to protect yourselves from illness while in Ghana, and what did you think you should do before you arrived but in reality you aren't?

Have you dealt with any women's reproductive issues in your service?

Have you tried the yogurt from the kiosk on the UST campus?

Paramedic N: We take doxy for malaria and wash our hands and clean the veggies and fruits we buy at market before cooking/eating them. There are several different expats around us, no associated with the medical missions, that are here with education missions for schools and they have a reproductive education agenda. I've not personally had any issues or run-ins with womens reproductive issues here, though I know its a hot button topic. And yes, I've bought some of the yogurt drink for the little hut at tech. It mixes will with protein powder so I can be swol and stuff.

Why not take the team into lesser served areas of America like Remote Area Medical?

Paramedic N: I'll ask the other docs but I think the consensus here is that Trump is gonna make America great again or something.

I joke. Sorta. I'm still salty.

I came to Africa to see a different place and a different culture and a different setting. We all choose to volunteer in different places for different reasons, mine were purely for adventure. And frankly because I'm tired of the horror stories of Americans suing American's for nonsense. I'll ask the doctors their opinions when they re-appear.

Hey, guys! Y'all are incredible. Keep up the good work. It may be too late to run a question by you, but how wide is the scope of practice for, say, an EMT at your center? Are they able to really jump in and apply some more medic-level interventions, or are they still just, y'know, EMTs?

Paramedic N: So in order for the US EMT's to be utilized by KATH I had to show them the entire breakdown of capabilities and trainings as provided from literature from the National Registry of EMTs. If you are an EMT with ACLS training, you are expected to understand how to execute ACLS in the event that you are the ranking provider during a code. If you are an EMT with PALs, same game. If you are a Paramedic you can provide any and all interventions as trained and certified with your up-to-date EMT-P card. Ghana is still learning how broad the scope is for EMT's so truly its a matter of demonstrating skills to the clinical director for MWB who disperses medics to KATH and then not being an idiot and providing appropriate care and treatment for patients. Several MWB EMT's were Army or Navy combat docs first, so although they carry a simple EMT cert, in the event of traumatic injury its just inherently understood that they will take the lead until the doctor arrives.

I hope that answered you question!

1 - Favorite Ghanaian food?

2 - Have you been to Kumasi Central Market?

Paramedic N: Joloff with egg, veggie, and a bit of stew. And yes, fuck that place. The major construction to make the central market much more manageable is nearing completion and I think everyone in Ghana is gonna celebrate when it's done because jesus christ on a tricycle is that place intensely buggered up right now.

Ete sen?

Compared to other African countries suffering from civil dialogue, have you found there to be numerous patients that have come to your trauma centre as a result of civil war?

No. Ghana doesn't have that issue.

In fact, Ghana has the pride of being one of the few African nations where the previous president still lives in the country.

As for guys coming in with injuries because of fights or what not, that happens occasionally.

What are some cultural differences that make it hard to treat patients?

Paramedic N: I think the doctors will agree with me when I say very succinctly that there is a very very different value of work ethic associated with medical providers here and medical providers back in the United States. Now I've known some lazy nurses, I've known some slow moving doctors, but even the slowest nurse would run laps around some of the staff we have to corral into getting off their phones and helping freshly arrived patients.

When I was a Peace Corps volunteer in Madagascar I served as a translator for a group of American doctors and med students who were holding free clinics - some in rural areas, some VERY rural areas, and urban areas.

What is it like working with a translator? Was it more or less difficult than you thought?

Have you seen any extreme cases of alcoholism and/or pure neglect? Some of the craziest things I've seen were either from people drinking Malagasy moonshine, or letting something simple go unchecked, like schisto, and their testicle swelling up to the size of a grapefruit.

Thank you for all you do. You're saving lives.

What is it like working a translator? Was it more or less difficult than you thought?

Paramedic N: So, when a patient talks for five minutes and the translator gives me a single sentence reply, that's when I know it's gonna be a long day. I've learned to adjust my questions to be answered quickly and easily and if there are wide discrepancies between what I say and what is translated I know to ask why.

Have you seen any extreme cases of alcoholism and/or pure neglect? Some of the craziest things I've seen were either from people drinking Malagasy moonshine, or letting something simple go unchecked, like schisto, and their testicle swelling up to the size of a grapefruit.

Paramedic N: Constantly. Alcoholism is rife in the villages here and lots of easily survived illnesses are left to fester and to amazingly damaging things to the hosts. I haven't seen much schisto, but man we know it when we see it.

haha being on the other end of the translating, I can tell you that that person was probably going on and on about something completely off topic, like how long it took them to find a bus to get there and they ran into their sister in law on the way there, and how the price of bananas has dropped so they're having trouble selling their harvest, and they finally got on the bus but the bus broke down on the way there, so that's why they were late and can I please have some red pills because it burns when I pee.

The translator's response: "it burns when I pee."

Paramedic N: Yea that sounds about right.

Hey guys! First off, thanks for everything you're doing, it takes a very special person.

I'll actually be traveling to the Volta region, namely Ho and surrounding villages, for four weeks this May. I'll be studying any issues that arise when introducing improved sanitation, i.e. DIY composting toilets, in an attempt to make the transition as approachable and economically feasible as possible.

I obviously have some insight into the issue already but would be curious to get the point of view of someone working there, especially in the medical field. Assuming it's common in your area, my biggest question would be how people view inadequate sanitation/open defecation. Is it something so ingrained in many people that you'd expect a transition to improved sanitation to be difficult or do you see the potential and desire for improvement? Any other tips or words of advice on approaching this issue would be greatly appreciated.

Paramedic N: OH BOY! While you're out there you should climb up the Wli falls and explore the upper set and the lower set, its absolutely beautiful and the hike is an ass kicker. I really enjoyed my time in Volta and look forward to returning at some point for a few days. Sanitation here is pretty abysmal, most common folks dont know that toilet paper is flushable so they'll toss it in a trash can by the toilet. If they run out of paper it's common to use the hand and then wipe it on the wall and repeat. Children openly defecating is quite normal, adults openly pissing on the sides of the streets or against building walls is so common that there are dozens of hilarious hand written signs telling people to stop pissing on their houses.

You have an uphill battle my friend, and it all starts with the entire culture not really understanding the value of sanitation or the utility of good sanitation devices like toilets and functioning sinks with soap. Let me know when you come in with a private message, I'll try to give you some guidance if you want!

Hi, this is a question mainly to Paramedic N.

Given paramedics are typically work in Ambulances which are out-of-hospital, what is your role and what do your responsibilities entail now that you are IN-hospital?

Also, are you guys looking for additional paramedics?

Paramedic N: I'm essentially a turbo-nurse here. MWB, the organization I'm with, utilizes paramedics for just about everything at all times, you should reach out to the organization here:

http://www.mwbhealthsystems.org/Pages/default.aspx

What's the biggest misconception you think westerners probably have about West African medical care?

Paramedic N: That it's non-existent. There are great facilities and there are plenty of trained providers and supplies around KATH. It's just a matter of getting everything paid for in a timely manner, it seems.

Why don't they have their own first responders there. In Thailand they're untrained volunteers but, still they go scrape you up and take you to a hospital. What do they do when there are no Westerners around?

Paramedic N: They do have a first responder network and national ambulance service. It's new and still getting their feet under them and providing pretty intense support under pretty rough circumstances. They do just fine with us white folks around. We just like to help where we can.

Have you gotten the chance to get to know any of the locals?

Paramedic N: I live with them, yep. The guy who runs MWB is a Ghanaian born and raised outside of Kumasi.

Do you miss pizza delivery?

Paramedic N: Shockingly, there is a place that does pizza delivery here. Though it's not great, it's like a fun little treat.

What is your biggest worry being in West Africa?

Paramedic N: Suddenly getting diarrhea at an inopportune time.

Dr. N: Getting on Paramedic N's bad side. Or a trotro accident. That would be pretty bad.

Can Reddit do anything to help you?

Paramedic N: Not sure, I suppose help me if I get kicked out of the KATH program for doing this AMA :D

Do you miss Paperwork/EMR ??

Paramedic N: I can't hear you over how much fun I'm having not doing paperwork/EMR.

Are there some things that your new unit handles better than a US-based unit in terms of types of emergencies?

Paramedic N: I'm not sure I fully understand your question, could you be a bit more specific?

What do you like better jolof rice or red red?

Dr. N: Red red!

Paramedic N: Jolof

EMT L: Kenke

Is it true that you're allowed to do so many more things to the patient than u r in the US? As an EMT?

Paramedic N: Your question is asking if I do more with patients here in Ghana than I do with patients back in the US? If that is your question my answer is 'no'. I do everything as covered by the expectations and qualifications tested by the National Registry of EMT's. I will ask to learn new things from doctors as they offer and have demonstrated skills on cadavers, but that's really it. I'm already working with a pretty wide range of skills as a paramedic and I'm pretty happy with that.

Hey, thanks for this AMA! I myself have worked as a volunteer (nurse) in Ghana back in 2013 in Agona Swedru and Ho. Passed Kumasi multiple times, have you been to the market yet?

I have some questions:

1. Do you witness alot of 'holiday' volunteers? When I was there it was come and go of undergrad medical students and adolescents fresh out of high school. What do you think of them? Do they contribute anything?

2. How is the work relation with local nurses and doctors? Do you encounter any struggles?

3. What do you think of the NHS (National Health Scheme)? Does it work in your eyes?

Paramedic N: When the doctors come around I'll have them respond to your questions as well, for now here are my answers as a long term medic working in Kumasi.

Do you witness alot of 'holiday' volunteers? When I was there it was come and go of undergrad medical students and adolescents fresh out of high school. What do you think of them? Do they contribute anything?

We call that 'voluntourism' and it depends on the program they work with on whether or not there's any value in it. I think it's certainly an amazing experience for the EMT's and resident doctors as they roll through because there is nothing like this enviorment. As for their impact on the systems that they work in, no, I suspect they don't leave much footprint. I've been here a while now and I know the most impact I will have will be through teaching the major classes at other events and perhaps some of the quick on the spot lessons to nurses and doctors during specific events.

How is the work relation with local nurses and doctors? Do you encounter any struggles?

There is no rhyme or reason for who is extremely well trained and who isnt, who is highly motivated and who wants to hide away and make a free paycheck. The variation in work ethic and professionalism is wild and it generates different issues differently on different days.

What do you think of the NHS (National Health Scheme)? Does it work in your eyes?

Whatever the current system is that is currently employed by Ghana is not effective. I've pulled sheets over a lot of wildly recoverable patients because of the pay to play system in place here.

How do you guys support each other to work through things like compassion fatigue?

EMT L: I play football with the locals.

Dr. N: Excessive masturbation and drinking.

Paramedic N: We talk about it over beers with level heads in a non medical setting.

Is the purpose of this endeavor to donate your skills to other countries in need, or does this help you grow as an EMS provider in some fashion?

Paramedic N: Yes.

The host hospital certainly needs some of the guidance and educational support I can offer as well as my own drive to work patient care, but this experience has also deeply enriched my experience as a competent EMT. Most volunteering is a two way street like that, we want to get experience and we want to help, usually the experience helps us just as much.

Hello! First of all, thank you for the good work you have been doing. I have always wanted to work for 'Doctors without borders'. I have had a considerable amount of nursing experience but i am NOT a doctor. Is it possible for a person like me to enroll myself in the program?

Yes absolutely, please reach out to me in a private message and I will direct you to the next major steps.

As a heads up to others with this same question: It will cost you about 2-3K USD to hang out here for anywhere between 3 weeks to 3+ months. THe most expensive part of your trip will be plane tickets and costs in country are extremely cheap.

If I go to the ER in the americas for extreme back pain what would they normally do??? And no this isn't just back pain that I got randomly I have it all the time but right. Ow it is hurting severely. Thanks any response would help me out on if you guys think it's even worth going there or not!

Paramedic N: I mean, some random guy from across the world is going to have a hard time properly assessing you and helping you. BUT, most ER's will provide some level of pain management, imaging for assessment, and a physical examination from the doctor. If the pain is not manageable with simple over the counter medications and common sense self treatments at home, by all means utilize whatever help you can get. I had a roommate have their back seize with such strength that he had to get put on the stair chair and brought to a hospital for cortisol injections. Dude was 20 years old and healthy as an ox.

Hi there, fellas! I was a Peace Corps education volunteer in Ghana from 2008-2010. I miss it every day.

When I was in country, Ghana's emergency medical infrastructure was basically "Find someone with a car and drive as fast as you can to a doctor." What sort of things are you doing to help train Ghanaians in emergency medical work?

Paramedic N: So my approach has been with private hospitals and helping them understand how to do effective and fast assessments and triage. If the patient was brought in quickly, the faster we can figure out where to start and help, the faster we can start to help.

What kind of opiates do you have access to and how easy would it be to steal them?

Paramedic N: They see diazepam for almost nothing at every local pharmacy.

[deleted]

Paramedic N: I can't really answer this because Ghana is one small country in a gigantic continent. My sample size is quite small and my peer review group would beat me for suggesting I could generalize an entire people based off of one city in one nation on an entire continent.

How does the healthcare system work in Ghana compared to the USA? It's annoying having to pay close to $300/month for insurance and then having to do the leg work of finding a provider that takes that insurance. Then if it's anything other than the yearly checkup I have to pay out of my own pocket until I hit $6000 deductible.

Paramedic N: I actually can't seem to make heads or tails of the medical system here. THere is supposed to be a national, single payer system and there is certainly a national health ministry and health insurance card that I've seen patients carry but I have no idea what that gets them. I do know that the system here is terrifying and that I would never want to be hurt or ill in Ghana. In other responses I go into greater detail about the horrors of "Pay to Play" medicine.

Conversely, in the US, even if we get a heroin addict that we recognize because he's come through the ER so frequently we will still provide medical care and proper interventions for that guy. Even if we know he will never pay a cent. We do that because we know the hospital will still pay our pay checks and that we will still have a well stocked supply room.

If those two things weren't there, I don't know. I'd like to think we'd be good humans to one another, but I can understand why a system that's struggling would be so merciless.

I still don't excuse it.

And you won't ever here me say anything positive about the current american health care coverage system. It's a mess but at least you'll be alive and in permanent debt or something. Usually. God I don't wanna get cancer.

I misread as trump center and thought you were in D.C. Are you?

Lol, what? We are in Ghana, boss.

Some of us used to live there a long while back or passed through at some point, if that's what you meant?

http://imgur.com/OqKMZkw

Paramedic N: Fukken saved.