A clinical year student from the University of Ghana medical school, Ms. Ruth Pokuah Appiah, has completed four weeks of sponsored elective placement in psychiatry at Ireland’s leading psychiatric hospital-St Patrick’s University Hospital. Ms. Appiah was one of two winners of the 7th Inter-medical schools public speaking competition to promote psychiatry to Ghanaian medical students.
The elective placement was fully sponsored by St Patrick’s Mental Health Services as part of the hospitals ongoing commitment to promoting global mental health especially in the developing world. So far the competition has sponsored 19 Ghanaian medical students on elective placements in Dublin.
The eight edition of the competition will be held on Friday the 2nd of November 2018 at the University of Cape Coast Medical School Auditorium from 11am. The topic for this year’s competitions is: “Child Sexual Abuse in Ghana: The extent of the problem, consequencesand proposed solutions”. The general public and members of the media are invited to attend.
Below is a report prepared by Ms. Appiah on her elective placement at St Patrick’s University Hospital.
REPORT ON PSYCHIATRY ELECTIVE PROGRAMME AT ST. PATRICK’S UNIVERSITY HOSPITAL, DUBLIN
RUTH POKUAH APPIAH
UNIVERSITY OF GHANA SCHOOL OF MEDICINE AND DENTISTRY
I had the opportunity to undergo a month long elective in July 2018 in psychiatry at St. Patrick’s University Hospital in Dublin, Ireland. This was the prize for placing first in the 7th Annual National Inter-Medical School Psychiatry Debate organized in October, 2017 in Kumasi, Ghana.
Though two students, Chris Kwashie and I, represented the University of Ghana School of Medicine and Dentistry in the aforementioned competition, I went for the elective alone because Chris had a few personal issues and had to stay back.
I arrived in Dublin on Saturday, 30th June, 2018 and with the help of the excellent directional instructions given to me prior to arrival by my contacts, Sinead Makk (Communications Administrator for SPUH) and the Psychiatry Debate Program CoordinatorProf Vincent Agyapong, very easily found my way to the hospital. I received a few documents and a stipend then went on to settle in my plush apartment, Steeven’s Gate Apartments, which was just a stone’s throw away from the hospital. I was to report to the hospital on Monday morning so I spent the weekend getting to familiarize myself with my new environment.
I was assigned to a different team each week for the 4week period and these were headed by the following consultants; Prof Declan McLoughlin with subspecialty Old Age Psychiatry, Dr. Connor Farren for Dual Diagnosis and Addiction Psychiatry, Dr. McDonough for General and Anxiety Psychiatry and Dr. Seamus OCeallaighfor Psychosis and Special Care Psychiatry.
Since this was my very first time studying psychiatry (I had not yet had my psychiatry rotation in school), I thought all four rotations were going to be extremely demanding with my having to do a lot of extra workpersonally to be able to learn as much as I needed but it was not. The members of each team I rotated on were all very eager to take me through some basic psychiatry and were never bothered by my incessant questions. I had an amazing time learning psychiatry and the experience has peaked my interest in this medical specialty.
I intend to follow in the footsteps of professionals like Prof Agyapong and Dr. Gilligan who have made it their life’s aim to ensure that psychiatry and the mental health system in Ghana becomes a well-establishedpart of our health system.
WEEK 1 – OLD AGE PSYCHIATRY
My first week was with Prof Mcloughlin and his team on Vanessa Ward. The key team members I worked with were Dr. David Weir (Registrar) and0 Grainne Dempsey (Team Liaison Nurse). Day 1 saw me sitting in some re-admissions and taking part in the Multidisciplinary meeting which lasted from 1.30pm to about 5.00pm. This meeting was true to its name. Present were the psychiatrists, a psychologist, a team liaison nurse, Occupational therapists and a Social worker. It was interesting to see all these people from the various departments contributing their bit to the care of each patient. It allowed for a holistic view of how well the patient was doing and enabled a truly individualized care plan to be drawn for each patient. We met the families of most of the patients and their views and opinions also helped to make the care plans much more suited to each patient. I observed a number of Electroconvulsive Therapies with prof McLoughlin on Tuesday and was amazed at how simple the procedure was – fast, painless, effective. I learnt a lot about the indications and contraindications for the use of ECT and how effective they were especially in cases of drug-resistant Depression. The rest of the week flew quickly as I shadowed Dr Weir, sat in some re-admissions and was tutored on Bipolar Affective Disorder, Depression and the nuances of Old Age psychiatry. Ijoined the ward rounds,took and presented some histories, went for the very educative audit reports presented by some of the registrars and took part in a Coping SkillsGroup Session for the Clinically Depressed with Grainne. I learnt about and administered a number of cognitive and/or frontal assessment tests like the ACE-III and MMSE too.
WEEK 2 – ADDICTION AND DUAL DIAGNOSIS PSYCHIATRY
I was at The Temple Centre this week with Dr Farren and his team, key of which was Roisin Nolan the team liaison nurse. There was no registrar on the team this week because the hospital had new registrars and these were in training. Here too, I sat in a very large MDT meeting, took and presented some histories, joined the major ward rounds, and sat in a number of Cognitive-based therapy sessions with the patients enrolled in the Addiction and Dual Diagnosis program. Most of these patients were struggling with Alcohol and/or narcotics. Sitting in these group sessions gave me the opportunity to observe how various psychologists and psychiatrists handled the concerns of patients and steered them onto the right paths and thought processes. I realized the group sessions were very helpful for the patients as a number of them came to realize that they were not alone in the fight against addiction and that help was available. Patients dissected and contributed to the recovery plans of others and generally encouraged one another to stay true to the sobriety. I also sat in a very informative Occupational Therapy lecture on Leisure. On the final day I went to the Dean Clinic at Sandyford for Dr. Farren’s Weekly Clinic Session there. I had a very good time there as welland, on our way back, I was tutored on psychiatry as a specialty.
WEEK 3 – GENERAL AND ANXIETY PSYCHIATRY
I joined Dr. McDonough’s team this week with the lovely Dr. Alison Leonard (Registrar) and Allie (Team Liaison Nurse) being the key people I interacted with. There was also Sunny, a nursing exchange student from China. After meeting patients on Monday, I sat in a CBT session for the patients on the Anxiety program with Dr McDonough and learnt the Imagined Exposure technique and a number of treatment types and experiments proven to help these patients whose diagnoses ranged from SevereObsessive Compulsive Disorder to Dissociative Disorders to Generalized Anxiety Disorders. They all tried figuring out various experiments which were to be performed the next day with the aim of helping them overcome various stages and aspects of their (worst) fears. Dr. McDonough gave them in-depth information about their various conditions and taught various techniques and ways to deal with them. It was refreshing to hear the questions of patients answered skillfully and see them gain a very good insight into what exactly was wrong with them, a phenomenon I hardly ever see in Ghanaian hospitals unfortunately. The rest of the week saw me interacting with more patients and shadowing Dr Leonard. I observed a long and very detailed primary admissions of a patient with a really interesting case of Dissociative disorder. Imet a lot more registrars and attended an MDT with a pharmacist as one of the team members (a first for me).
WEEK 4 – SPECIAL CARE AND PSYCHOSIS
My final week was spent with Dr. Oceallaigh’s team. I worked with Dr. Sean Naughton (Senior Registrar), Dr. Ruth Cullinane and Dr. Grainne Marie Murphy (Registrars) as well as Paula (psychosis Nurse Specialist). I did the usual – MDT (with Art Therapists present), Ward Rounds, Histories and presentations as well as a tutorial on psychosis and Schizophrenia. Though a number of the patients on the Special Care ward had psychosis and other similar conditions, they were all treated with absolute dignity and respect by each and every one of the staff and this was worthy of note. Never throughout my time in St Patrick’s University Hospital did I witness a patient’s human rights being violated.It was always loving respectful treatment with patient-centered care being the mainstay of all dealings. This last week went by very fast as I got ready to return home. I had really interesting times with these dynamic patients here on special care and also sat in the presentation of a very complex psychiatric case with the registrars and consultants.I later had the opportunity to meet the CEO of the hospital, Dr. Gilligan, and we had a lovely chat.I had really interesting times with these dynamic patients here on special care and also sat in the presentation of a very complex psychiatric case with the registrars and consultants.I also spent a lot of fun and educative times in the Hospital’s craft and art therapy rooms. I ended the week with my goodbyes and farewells.
Every aspect of my month’s stay there was marvelous.
My apartment was a very well furnished and comfortable 2-bedroom apartment and I enjoyed myself there. I was provided with a meal card which gave me an almost unlimited subsidy for my meals. I hence had an abundance of good food to eat at all times – kind courtesy the very helpful Ridgeways Cafeteria Staff.
All the hospital staff were very nice and wholeheartedly supportive, giving me helpful tips every now and then and all in all, ensuring I had a marvelous time in the hospital. My contact throughout the program, Sinead Makk, the Communications Administrator, was available to me 24/7 to clear any obstacles and smooth all hitches for a truly enjoyable stay. The patients were also very accommodating and cooperative and altogether allowed me to have a truly educative experience.
I had a lot of fun exploring the city of Dublin as well and realized that the Irish were very warm hospitable people. I was alone and had no friends upon arrival but by the time my stay was ending, I had a whole lot of Irish and Non-Irish friends. With my weekends and evenings I went to the Dublin Zoo, toured parks and museums, went on social and political tours, visited classic tourist locations and just engaged in a lot of touristy activities. There were lots and lots of tourists around every corner probably because of the season and the weather. The weather was generally very warm and felt like home, though the Irishmen described it as a heat wave.
I eventually met a number of Ghanaians through the contacts I was given by prof Agyapong and they all ensured I never got homesick.
After leaving Ireland on 29th July, 2018, I spent the whole of Monday, 30th July, 2018 in Dubai (sponsored by my Emirates flight ticket) and had an amazing time there just enjoying the sights and going on tours. I had the opportunity while there to get my first desert experience at the Dubai Desert and it was just marvelous. I visited other places like the world-class Dubai Mall, the Dubai Aquarium and Underwater Zoo, experienced the Dubai Fountain and saw the tallest building on earth, the BurjKhalifa – all in 24hours.
I experienced so much more that month than can be put on paper and the simplest and most lackluster way to describe it would be, “A Truly Wonderful Experience”. I appreciate all who made my trippossible.
I am first and foremost thankful to God who made this entire experience possible.
I am again wholeheartedly grateful to prof Vincent Agyapong who initiated this program and has seamlessly coordinated it up to this current day. He was always just a call or email away and ready to be of limitless assistance to us all the way from the time we won the competition to the time I returned from the trip. This experience would have been impossible and anhedonic without his input.
I am sincerely grateful to the CEO of St. Patrick’s University Hospital, Dr.Paul Gilligan, for sponsoring my trip and allowing me into his hospital to experience world-class psychiatry.
I am appreciative also to Sinead Makk the Communications Administrator for being ever ready to help at all times before, during and after my trip. I am grateful also to the other members of the Communications and Human Resource Team like Denise Kilmartin, Tamara Nolan, Emily Bowe, Amy Coyne and all the others who helped in my Visa Application and all the preparations that went into the trip from October when we won the competition till I finally arrived in Dublin, Ireland.
Dr. Alison Leonard (Grattan Ward), Thom (Ridgeways), Drs. Sean Naughton, Ruth Cullinane and Grainne Murphy (Dean Swift), all the consultants I worked with and the entire SPMHS staff, you contributed greatly to ensuring I had the time of my life at SPUH.
To Chris Kwarshie, Irene Appiah, Atsu Lartey, the entire UGSMD Debate Team, the UGSMD psychiatry Department and all who made it possible for UGSMD to clinch the most coveted 1stposition the debate competition, I will forever remain grateful for your initiative, input, effort and support.Id also like to thank UGSMD for this opportunity.
Finally, I am deeply appreciative to my family, friends and everyone else who contributed in one way or the other to make this the best vacation of my life.