Intro to Ghana Out of Programme Experience – start here!

11May10
Hello all,
I’m only a few hours now from leaving for Heathrow to fly to Ghana. In case you were wondering why I might be heading there, this is a letter I wrote to my family at the end of Janauary 2010 about where things were with the programme. Back then my blog wasn’t set up and I was somewhat helpless but thanks to my webdesigner, Rowan I now have this lovely site to make a mess over.  Hope this makes sense, it refers to a number of the people involved in the programme. Looking good to go – will likely next be reporting from Accra!
Dear Mom, Dad, Gary & Bruce
This week (30 January 2010) the Ghana placement has suddenly started to become more real. I’ve had a bundle of forms to complete and been swept up into email communications with a number of people who will be involved in my trip. I also met up again with three of the doctors who have been already and can feel myself being drawn into a club composed of those who share this experience and are consequently now bonded for life.
It’s been a while getting to this stage and I’ve kept open the possibility that it might not happen. You’ll know I was accepted on to the programme after my interview in August and had it been agreed earlier, I would have been ready to have gone already. In November I met with Clive Stanton, a week after he returned from his 3 month stint.  He said he was only just getting into the placement when he finished and that it was all set up for someone to take over from him but no-one was in place.
However, there still wasn’t any further news for me until December when I finally got in touch with Daliah Houghton from Challenges Worldwide (CWW). They’re an organisation that arranges the placements in developing countries with professionals in the UK and have developed this programme with The Royal College of Psychiatrists and my training programme at St. George’s medical school. She’d previously been away but was now pushing ahead with negotiations with my employers, Sussex Partnership, to agree for my release from my contract.
The money for my salary is actually paid by the London Deanery who supervise the programmes for all doctors in training.  The idea is that if the deanery agrees for me to have an Out of Placement Experience (OOPE), the Trust does not lose out as they are not actually paying for my work. What happens is that I agree to be paid for 2 of the 3 months I’m away, while CWW gets the third in order to fund their operations. Because of some other issues over how I get paid and as I’m the first doctor to apply from Sussex Partnership, it’s taken a while to confirm this but about 10 days ago it was at last agreed by all.
I’m now 6 months into my year-long post in Crawley but last week I arranged for my yearly review to be held with my supervisor, Glen Berelowitz. All of our time together has been friendly and complementary, with Glen summarising in my review that he feels I’m ready to take up a consultant post. Great  to hear though I don’t always feel that way – especially when its tough enough managing half of the 12 patients on our intensive care unit that I oversee. I don’t quite know how I’m ready to take on all of a consultant’s caseload with supervision of junior staff and all the other demands that will come!
During my training the one concern that has been raised is how I deal with stressful situations and my general interactions with other staff. It isn’t that I’m unprofessional but its been politely described by Glen as my ‘soft skills’ that need polishing. I would agree that I would like to be more relaxed and able to have friendly relations with all, though I prefer to prioritise getting things done for the patients and using my time for patient contacts or summarising in notes or letters. I’m pretty sure people respect my input and recommendations but it’s still somewhat hit and miss as to whether I get along with some of the staff.
Glen is something of a master at getting things done and being brief with people who don’t seem offended if he cuts them off when they pause in mid-explanation.  He’ll also often do dictation in crowded rooms, which emphasises what’s been decided before we move on to the next patient. I don’t see myself doing that so easily as I try to ensure I’m fair with all but I’m aware that my time demands are going to become even more pressing very soon.
Peter Hughes is able to achieve similar multi-tasking skills as during personal meetings he will simultaneously write stilted emails summarising all that’s been covered which he then copies to his secretary. He’s the programme director for Specialist Registrars under St. George’s and he sometimes visits London when he’s not doing humanitarian work around the world – at least that what his job seems to involve! I’ve had my two previous annual reviews signed off by him and we met again on Tuesday in London to discuss my latest review and the Ghana placement.
I was somewhat lucky to catch him as he’s due to go to Haiti this weekend for a month and probably longer with the International Medical Corps. When Clive was in Ghana, Peter supervised him by email from Chad and Somaliland! I will have similar supervision which Peter says he’ll do from Haiti if he can get internet access! By the way, he’s accepting donations for his trip here
Peter knows something of the concerns that have been raised about my interactions with other staff and advised me to remain aware of this, particularly with going to a developing country where there will be inefficiencies and corruption. He also warned about being a whistle-blower and what effect it could have on my career. I don’t see myself as much of troublemaker and think I can appreciate why things are the way they are. Again, Peter reminded me to be aware of the bigger picture and that I’ll be going to offer sustainable development of the infrastructure that follows on from those who have been and will be supported by my successors.
Clive was having his review with Peter just before mine and we went for a drink before going on to a presentation at the College. During the tube ride he shared his experiences and outlined his weekly schedule. As I’m due to based at the same hospital where he was, it’s likely I’ll be running a similar programme to the one he arranged. We’re still getting to know each other somewhat though we seem to have a lot in common with our interest in treating more than just a person’s “illness”.
We also seemingly share a significant personal interest in music. I had my usual difficulty in describing what I’m interested in before describing it as being in line with the diverse range that radio DJ, John Peel used to play. I was surprised to hear  from Clive that for someone so contemporary with an iphone, that his own musical interests consist almost entirely of guitar playing based on the blues. I tried to find common ground but he didn’t seem to know much of Jack White (of the White Stripes) but reckoned that he would like Seasick Steve. We therefore may have more to talk about in future than just our experiences in Ghana. Later in the week, Clive sent me his report to look over that confirmed much of what he had said and is likely to provide a blueprint for much of my own experience.
Also that night I met with Norman Poole who was the first doctor from our programme to go to Ghana. We worked together as part of the liaison psychiatry team at St George’s; I was in my last year as a Senior House Officer and he was the Specialist Registrar. I’d heard him speak about his time in Ghana before and his report is on the Royal College of Psychiatrists website
If Peter can’t get internet connection, Norman has agreed to give me supervision. We’re likely to keep in touch anyway as he started a research project in Ghana into the insight about mental illness among the population. Clive has developed this further and as I’m meant to spend one day a week doing research I would prefer to do something that’s already in progress than come up with something myself. I’ve enough to do in the month left before I go!
I’m starting to realise more of what I won’t have time left to do until I’m back from Ghana, if ever. All the books I won’t read, photographs to scan and upload to my website, CDs and records to arrange. At work too while there’s plenty going on in the day, I’m having to think I won’t be here to follow-up patients from the clinics I do in neuropsychiatry and maternal well-being. There’s also a locum consultant post becoming available next month in Crawley that I hear I would have been considered for. That would have meant promotion while continuing with my life much as things are without having to get packed. It’s tempting but the trip to Ghana is now taking ocean-liner qualities of inevitability.
I hear that I’ll be having plenty of time available in the evenings and weekends so I’ll be trying to do a weekly summary as the placement goes  along and turn into a blog. Here then was the first part!
Hope you’re all well and will keep you posted as things progress.
Much love,
Greg x
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