Most medical residents rarely see cases of tetanus, tuberculosis and polio beyond the pages of their medical books. But when three residents and two nurses from Johns Hopkins Bayview Medical Center went to Africa to lend a hand at a local hospital, they saw the pages of their text books come to life.
 
"We saw cases of malaria and meningitis that we might never have seen in years of practice in the United States," says Irene Dankwa, M.D., one of the residents who organized the trip. "We take so many of our tests and vaccines for granted, but they are luxuries rarely seen in Ghana."
 
In April of this year, the Hopkins Bayview medical team spent four weeks in Akwatia, Ghana, on the west coast of Africa. St. Dominic's Hospital, a 320-bed facility in rural Akwatia, is staffed by a handful of medical professionals who were grateful for the extra help as well as some donated supplies.
 
The idea for the trip was born when Dankwa and fellow resident Steve Solga, M.D., were on call during a quiet evening in Bayview's cardiac intensive care unit. Solga mentioned his interest in doing an international elective in Africa as part of his residency. Dankwa was willing, and with a little help from the Ministry of Health in Ghana and some time searching the Internet, they had selected St. Dominica's, a hospital working with a very tight budget.
 
Dankwa and Solga enlisted fellow residents, Jacob Mishell, M.D., and Kari Roberts, M.D., as well as nurses Julianne Bethea, CRNP, and Reginald Bannerman, RN, to go along. Hopkins Bayview and Johns Hopkins Hospital also donated medical supplies such as surgical gloves, gowns, masks, syringes, needles and antibiotics. The residents and nurses who volunteered for the trip paid their own travel expenses.
 
At St. Dominica's, the Bayview team spent their mornings seeing patients in the various wards of the hospital -- male ward, female ward, pediatrics, obstetrics and isolation. With so many patients and so few physicians, patients often saw a doctor only once or twice a week. Afternoons were spent in the outpatient clinics that were often filled with hundreds of people who waited, without appointments, to see a doctor.
 
"We all practice internal medicine, and seeing pediatric patients and scrubbing in for surgeries -- things we would never normally do in the U.S. -- was frightening at first," says Roberts. "But these people were so desperate for care that we just did everything we could."
 
The basic skills of the medical team also were put to the test. Without the availability of CT scans, MRIs and other diagnostic tools, they had to rely on their experience and education to help the patients. "There was one X-ray machine for the entire hospital, and the technician who knew how to use it went home at 5 p.m.," says Dankwa.
 
Adjusting to the economic realities of the area was also a challenge for the group. Supplies were precious, which led to tough decisions. Antibiotics, even for patients who had been admitted to the hospital, had to be purchased by the family from the pharmacy. If the family could not afford it, the patient went untreated.
 
While overcoming the economic and cultural differences was a challenge, the Dominican nuns who established and ran the hospital and the other medical staff made the Bayview team feel at home.
 
"The sisters fed us a wonderful lunch every day; they had a place for us to stay that was right on the hospital grounds -- running water, electricity and acres of farmland with fresh pineapples, mangoes and grapefruits," said Solga. "We're encouraging other Hopkins residents to take the trip. It was a wonderful learning experience."

Reaching Out to the World
In Our Own Backyard
 
When the physicians and staff at Johns Hopkins Bayview Medical Center are not traveling far and wide to share their talents with the world, their international expertise often comes in handy here at home. When international patients visit the Medical Center, our team goes into action to meet any special needs.
 
"Seeking health care in a new country can be frightening," says Sue Chong, coordinator for international services at Bayview. "We try to hold the patient's hand through the process."
 
Part of the "hand-holding" is informing staff members of a patient's specific customs. In some cases, it is as simple as preparing special foods, but it can get much more complicated. When a man from Jordan was treated at Bayview, the staff was informed that they would insult him if they called him by his first name or if people crossed their legs in front of him. The international relations department also provides interpreters and helps with any necessary paperwork.
 
Physicians note that taking special notice of international patients makes the staff more attentive to the needs of all patients. Joseph Carrese, M.D., assistant professor of medicine, who has studied the culture of the Navajo Indians, feels that the same approach taken with international patients can help physicians foster better relationships with the diverse populations in Baltimore.
 
"Taking the time to see each patient as an individual, to learn their background and unique story, makes us all better doctors," says Carrese.