The Daily Beacon

The next three posts (Gap Year – Cause of War) are the articles I have written for my Beacon column, starting with the most recent.

Gap Year

The Gap Year. In the States, it’s a fancy term borrowed from the Europeans for those who want to “find themselves” before they go to college. Parents fear the words. If Johnny doesn’t go to college now, he’ll never make it. He might find something more appealing during that year, like eating frozen burritos and playing World of Warcraft. Students who had spent the last four years of their life building their resumes in the SGA and National Honors Society would never risk a gap year amidst the competitive atmosphere of college admissions. Now, however, with the help of a few of the top schools, such as Princeton, it is becoming an attractive option for college matriculates, even for those voted Most Likely to Succeed in high school.

There is a trend in the volunteers I’ve met here in Ghana. When I first arrived mid-May, I was one of the few Americans; most of the others were European gap year students. As finals were ending in the States, we began to receive the summer American influx, all somewhere in the middle of their college education. Now, as classes loom nearer, the Americans start to trickle away and the 08-09 gap yearers start to replace them.

It reflects the rush of American lives. If we took a whole year off, that would put us a whole year behind our peers, another whole year away from making the big money. In order to keep up, we opt for a gap summer, rather than a gap year.

It’s all too common for high school graduates to be herded on to college whether they know what they are interested in studying or not. It’s what you are supposed to do, or so says some middle-class cultural entity. Just as college is not for everyone, everyone may not be ready for college at the same time. Those who aren’t ready still likely proceed with their peers but end up spending more time exploring the strip than they do their professional interests.

So many people enter college with no direction in their lives. Upperclassmen wear their number of majors like a crown of glory. “I’ve changed majors eight times!” The academic advisors coax this into normalcy as they tell tales of these sixth year royals to the incoming freshmen. If you haven’t figured out why you are here after two or three years, maybe university isn’t the place it’s going to happen.


So if you’re starting to glue the jewels on your crown of eight majors worth of bragging rights, put the glue gun away. Stop doing what you’re “supposed” to be doing, and let yourself wander. Take a year and broaden the field of your search. Work, travel, just learn about life and yourself. Stop wasting your money, (or better yet, the governments) and do something productive. Experience life.

The Brain Drain

The Brain Drain. It’s a growing problem in the global health. It’s quite a clever name for such a threatening situation. What is happening is health care professionals in third world countries are choosing to practice in Western nations or to work for Non-Governmental Organizations (NGOs). Why? Money.

It’s a simple concept, really. The average nurse in Ghana makes about $100 a month. That’s $1,200 a year. Doctors, despite all their prestige, make a meager $12,000 a year. Yes, in Africa that’s much better than most make, but factored into the cost of living, it still doesn’t compare to Western salaries. Do you blame them for wanting more?

It’s the “American Dream”—in Africa. They all want the rags to riches story, and now they have the opportunity to write theirs.

As more NGOs are responding to the AIDS pandemic in Africa, they need more health care professionals to staff their field offices. Hiring from local sources works to the benefit of both the locals and the organization. It costs less for the organization to hire local nurses, and the organization gains the inside knowledge and experience of a person having lived in the area. On the other side of the handshake, the NGOs will be able to pay the health care providers more than they would be able to make working in a local hospital. This situation sounds win-win, right?

Not exactly. The majority of the NGOs that come to work in third world countries focus on specific problems. Some of the most popular targets are AIDS, malaria, tuberculosis, malnutrition, etc. Therefore, the nurses are being recruited to work in specialized clinics, leaving a dearth of nurses in the primary care environment. When people get sick with non-trendy illnesses, they have to wait long periods to see one of the remaining primary care providers. But if they had AIDS, they could walk across the street to the clinic and be treated promptly since those foreign clinics are adequately staffed with the health care workers they lured away from the primary care hospitals.

When laid out in such a fashion, it is easy to say that the locals should show loyalty to their cities and villages and not abandon the local clinics for the ritzy NGOs. A few months ago, looking at the situation through my nice 15-inch laptop screen, I wondered how these nurses could cave and be entranced by the jewels the NGOs have to offer. Part of me knew the answer. But I just wanted everyone to be a mini Mother Teresa.

The hard truth of survival remains. Everyone wants the same thing for their children—a good future. If the nurses see an opportunity to provide a better life for their families, they’re going to lunge at it. We should not blame them for wanting to better their situation and that of their children. Most of us would do the exact same thing.

However, that still leaves us with the swirling Brain Drain.

Do you know the cause of war?

“Do you know the cause of war?”

Last Wednesday, I was sitting with a group of about seven Liberian refugees in a camp outside of Accra, Ghana. I’d been hearing for the last few hours the effects of war. I’d talked to children who hadn’t seen their parents since they left for work on the morning of the day they fled Liberia. I’d talked to people who were beaten and tortured. I’d talked to people who had watched from the bush as their families were beheaded. I’d talked to people who had experienced things I could never even imagine witnessing.

The one experience that stood out most from that day was not the tales of atrocities or the pictures of bloody family members that a refugee carried in his briefcase. It was a question posed by one of the refugees, Mr. S, that captivated my memory.

After a pause, Mr. S looked at us and asked, “Do you know the cause of war?” My mind went directly to the course I am talking this fall entitled ‘The Causes of War’. How could this one man, sitting outside his brightly painted mud hut, tell me what I will be taking a 3-month course to try to understand in the fall? He had asked the question to lead to a single answer. One thing causes war. I was sitting on the edge of my seat as I waited through his pause. He looked at us. I wondered if I was about to hear some emotion fueled answer from a victim of war, or if I was going to hear a trinket of wisdom that comes only from those who have experienced such atrocities in life as had Mr. S. We locked eyes. “Poverty.” Poverty is the cause of war.

Initially, I thought this was a great answer. How many of the wars in Africa spawn from the perpetual state of poverty? The more I thought about it, however, I began to disagree. Poverty is definitely a significant contributor to the causes of war, but as I have learned, nothing stands alone.

Poverty is better attributed as a catalyst of war. Government soldiers in Somalia rob the citizens selling food in the market, not as a show of power, but because they are starving. Children will risk venturing into towns known to be inhabited by soldiers that will kidnap them because there is a chance they might find food there. People in impoverished areas have little to begin with, and what they do have is destroyed in the process of war. When in this situation, people are likely to cross the right-or-wrong line to stay on the favorable side of the life-or-death line.

In Africa, specifically, I’d attribute much of the conflict to Western colonization and the practice of putting a Sharpie outline around an aesthetically pleasing chunk of land. The chunks are occupied by several different ethnic groups and hundreds of different tribes, none who want to be controlled by another ethnic group. Viola.

As for the other causes of war? I guess I’ll find out this fall.

Experiencing Life

Life has been pretty busy since I last posted. In the past 3 ½ weeks, I’ve traveled essentially the whole of three countries: Ghana, Togo, and Burkina Faso. Although I initially didn’t plan on doing such extensive traveling, it has definitely been one of the best decisions I’ve made. I’ve learned so much in the past few weeks; I’m sure it’s more than even I realize at this point.

Northern Ghana

There are certain trends that history and modernization have carved out in West Africa. In general, the coastal south is predominately Christian and the north, Muslim. This is largely due to the path of European exploration and colonization. The Western Europeans, mainly Britain and France, came by boat along the coast, bringing with them their Christian teachings. The Muslims brought their teachings down with the caravans of salt through the desert from the north.

In Ghana, the capital, Accra, is in the middle of the southern coast. There are signs of modernization everywhere. At times, I even look out the window and think I could be driving along a road back in the States. Then I look out the other window and know I am definitely in Africa. People wear a combination of traditional Ghanaian fabrics and modern styles like clothes you would see in most Western nations.

Our trip throughout Ghana commenced with a 12-hour bus journey to the north. I watched as the landscape turned from the flat coast to the beautiful hills of central Ghana. Along with the landscape, the people and villages changed too. In Tamale, a larger city in the north, I noticed how many more women were wearing the traditional fabrics. Everywhere I looked my eyes filled with the bold colors and patterns.

Our first stop was Mole National Park, where we saw wart hogs (Disney took some liberties to beautify Pumba), antelope, and elephants. We stood about 30 meters from a group of five elephants. Later we toured Larabanga, a 100% Muslim village that sits right outside the park, and stayed at the Salia Brothers Guesthouse. One of the Salias won the opportunity to go to a leadership course at Columbia University in New York. He has done wonders for the village of Larabanga from building the tourism market in a dignified way, to settling disputes. He offered great insight on the effects the formation of Mole National Park had on the surrounding communities. Although the government drew the line on the national park right along the edge of Larabanga as not to displace the village, they still cordoned off their farmland. The people are used to going into their backyard to kill their dinner but are now told that it is illegal to kill these protected animals. Even though they did not have to leave their homes, the park had and still has great effects on the community.

On our way back to the south, we stopped at a place in Nkoranza called Operation Hand in Hand, which is a community for homeless disabled children. It sits on an expansive, beautiful piece of land behind the town’s hospital. It was started by three Ghanaians and one Dutch doctor. (The Dutch doctor is also the woman that introduced health care insurance to Ghana!) Hand in Hand was one of the highlights of my trip. It’s so great to see a community like this in an area where people usually discard children born with disabilities. Hand in Hand is set up so that one caretaker has from one to three children that they essentially parent. They become families, living with the children. They have a workshop where the kids make and string beads, and weave fabrics on looms. Their days adhere to a strict schedule to allow the kids they stability they need. There are game rooms, a siesta room, and they watch a movie every night at 7:00. There is a government-funded school on the premises specifically for the disabled children, and they have begun to take kids from the town as well. We stayed in the guesthouses that they have built as a way to generate income. They also sell the products the kids make in a shop.

Our next stop was Kumasi, the second biggest city in Ghana. They have a huge market with almost anything that you would want to buy. They had beautiful fabrics! I’m in love with all the different colors and patterns. Although I’m used to it, I still hate walking through the meat section of the market, with fish scales flying and raw meat covered in flies. If you’re one for people watching like I am, the market is the place to do it.

It was amazing to see the north and see the cultural differences throughout the nation. It’s so much more peaceful outside the bustle of Accra. At the end of it all though, it was good to be back home. For a day anyway.

Togo

One jollof rice and chicken dinner later, we were back on the road heading east towards Togo. Overall, I really enjoyed my time in Togo, but not being able to speak much French, I wasn’t able to talk to people much about their culture. I was just moving through a country and observing, rather than experiencing it the way I have been in Ghana.

We visited Togoville, Togo’s namesake, in the east first. It is known for its animist beliefs (Voodoo). Our guide explained many of the fetishes and how they are used. He mentioned that if someone gets a snakebite, they place him in front of a particular fetish and leave them for three days. I asked if they believe in/ use western medicine, but he never answered me directly. Dr. Paul Farmer said the in Haiti they might believe someone cursed them and made them ill, but they trusted western medicine to treat them. I was wondering how medicine was integrated into the Togoville community, but alas, could never get a straight answer.

In Tamberma Valley in the north of Togo, we visited the Tata villages. They are a very specific type of compound unique to the area. The people came from Burkina Faso long ago and settled here. The village was one of the most amazing things I’ve ever seen, but it is really hard to explain with out pictures of the compounds! I’ve been sitting here trying to figure out how to explain them but can’t seem to do them justice, so I’ll have to do it with pictures when I get back.

Burkina Faso

Because of the rainy season, much of what we planned to see in the southwest was going to be inaccessible due to poor roads. The capital of Burkina, Ouagadougou (pronounced Wag-a-doo-goo), is a very interesting city. Burkina is the third poorest nation in the world, and much of the old city reflects that. The current government, however, has come up with a plan to rebuild the city completely. They just bulldozed large portions of the city and replacing the old with new buildings, none less than four stories. This resulted in random sections of the city being piles of dirt, then an oasis of bright lights and shiny buildings. The main boulevard was so clean and the buildings so big, boasting their neon lights. It was incredibly nice, but it also felt incredibly out of place. (Especially the Palm Beach Hotel in land-locked Burkina)

The remainder of our time in Burkina was filled with the Gorom-Gorom Thursday market and camel rides in the desert. The market is famous in West Africa and very different from any I had seen thus far. Most of the men wore turbans, each different fabric representing their ethnic group. The Tuareg wear indigo and the Bella (the Tuareg’s former slaves) wear black. The Fulani men wear a two-toned blue/indigo turban, whereas their women are distinguished by their elaborate, colorful dresses and distinct accessories.

Back in Accra

Both Togo and Burkina were so different from Ghana, from the food, to the buildings, the transportation. This is largely due to the French influences versus the British influence. It’s been really interesting to see the effects of the colonization and modernization in different countries.

I know I’ve learned so much over my whirlwind tour through three countries, but I’m still processing it all.

Revisiting the Operating Room

I made an observation in my last post about how the draping, or lack there of, in the OR here allows the face to show. I said it brings the humanity back to the practice. But there was a part of me that held that thought and tumbled it around in my brain. Of course, there’s a reason other than being cold and heartless that we drape the face in the States. Ironically, a few days later, I was reading How We Live by Dr. Sherwin Nuland, and he addressed exactly that issue. Reading his description was like reading the words out of my mind, but he puts it so perfectly, I’ll let him explain: “There are reasons both medical and emotional that surgeons drape an incision site so closely that nothing else human can be seen, as well as hide their patient’s sleeping face behind a cloth screen. Those reasons go far beyond the prevention of infection, and the most critical of them is to maintain detachment from the intimidating reality of what they are doing to a man or woman made very much like themselves. The greater the danger, the greater the need for distance. Never is that more true than when we are fighting for a life.”

Next Up

A week from Saturday I will be going with a doctor that is coming over fro the States to help set up a clinic in a village outside of Accra. I’m really looking forward to comparing a rural medical setting to the urban, government hospital that I’ve been working at in Accra.

When I get back, I’ll have less than a week before I go back home. I can’t believe it’s almost over already!

The Daily Beacon

I’ve been given the opportunity to write an op ed column for The Daily Beacon, my university’s newspaper, this summer. It will be published every other Tuesday, and I will also be posting them here as well.

Obama in Ghana
“Obama is a hotcake,” a Ghanaian just told me. You better believe it. Last Wednesday all the local Ghana news papers were filled with stories of Obama’s victory over Clinton. On the streets, in taxis, in the media, all of Ghana is talking about Obama. Ghanaian music stars have concocted odes to Obama that beat from passing cars and roadside spot bars. “Obruni,” they ask me, “are you for Obama?.”

Although in the interest of time, I knew better than to ask a Ghanaian, “Why should I vote for Obama?” But because of the sheer insistence without any substance behind his democratic support, I couldn’t resist. Why? Unity. If America can elect a president with African descent, the whole world will realize we’re all one. It’s a step in the right direction, mate, but I’m afraid it’s not quite that simple.

Others have more honest, self-serving reasons why America should elect Obama as our next president. Our “hotcake” friend says an African president will draw attention to Africa. He would bring aid and support to the continent. An African as the president of a world superpower would be a great symbol to the world. Don’t forget Africa.

However, when I brought up the fact that the Bush administration, despite its flaws, has brought more medical aid to Africa by means of the President’s Emergency Plan for AIDS Relief (PEPFAR), than ever before in United States history, I was looking back onto a blank face. Although still barely making a dent in the African AIDS pandemic, PEPFAR has brought light and global support that is taking great steps in improving the state of health care in Africa. And that was by a white guy.

Increased African aid and a symbol of unity could potentially be nice side effects of Obama’s Presidency, but what about policy? I tried to explain to the Ghanaian preaching unity that, as citizens of the United States, we have a responsibility to consider the candidate’s platform. Will they support legislation that will improve our country? Are they strong enough to lead our nation? You cannot get these answers by looking at the color of one’s skin.

Although many Americans will try to argue that race is an issue of the 60s, this election has taken the awkward ugly step-sister out of the closet, given her a make-over, and thrown her a coming out party on CNN. No one can hide from the fact that race is playing a huge role in this election. The prospect of a black president has made Americans confront the fact that our nation never completely reconciled its prejudices and stereotypes. America just swept race under the rug along with the crumbs from the cookie mom told you not to have.

Africans shamelessly support a man because of the color of his skin. Is this true of Americans as well? I’d like to believe that more Americans vote based on policy than those who cast their ballot on appearance. I’d also like to be able to say that we as the voting population could focus on policy rather than on whether he’s black or white. However, whether the pundits are talking about it bluntly, or saying that we’ve progressed past the issue, the conversation still revolves around this election’s key word: race. Why don’t we just elect Michael Jackson? Then we’d have all our bases covered.

Wow. A lot has happened since I’ve blogged last. The main events that I’m going to try to hit on in this post are my experiences in the operating theatre, my first experience sitting down and talking with Liberian refugees, and my trip this past weekend to Boti Falls and Shai Hills Resource Reserve. And how badly I’m craving a Turkey Tom from Jimmy Johns…

It ended up being a little on the long side. It’s hard to limit what I want to tell everyone to a bearable length, but maybe you can grab a Turkey Tom and have a little lunchtime reading. Or you could forgo the awkward inspirational book on the back of the toilet this time and take my blog for a nice bathroom read. At least I’ve given you options!

The Operating Theatre

At my hospital, I have finally figured out that, outside of emergencies, they perform operations on Tuesday, Thursday, and Saturday. When I was in the surgical ward (pre-op surgical patients), we had a diabetic woman who needed her foot amputated. At the risk of sounding sadistic, I had been waiting to see the amputation for two weeks. It turns out they did it this past Saturday while I was out of town.

I am really glad I’ve had the opportunity to watch various surgeries in the States, because it has allowed me to make comparisons in surgical procedure here. I can’t decide whether it’s more similar or more different but I don’t think that distinction is really necessary. When I am in the OR, it is such a familiar feeling. Whether the surgeon is using decade old equipment and having to do invasive surgeries, or the surgeon is using the latest technology and doing a minimally invasive procedure, there is a commonality among it all. My favorite part about the whole experience is that we all look alike on the inside. Whether your skin is black or white, we all have the same pink organs.

The first procedure I saw here was an emergency ectopic pregnancy. This where the egg is fertilized and starts to grow in the fallopian tube rather than making it all the way to the uterus. You might imagine how this could be problematic. When the fallopian tube bursts, the woman starts bleeding into her abdomen along with other complications. In this surgery the tube had already burst, so they opened her abdomen and repaired the tear.

There are tons of significant differences between operating room here and back home in the States. To list them all would take a while, but it is very interesting so if you would like to hear more about it, I can send you a separate email. Notably, all the drapes and gowns used are cloth and they are reused. Whereas we use several disposable paper drapes per procedure at home, here they use a single cloth drape with a hole to expose the operation site. The doors hang off the hinges leaving me thinking about all the germs floating in and out throughout the operation. Overall, it just seems like they are operating a decade or so behind the times. Certain staple tools used at home are absent from the theatres here. However, what impacted me most about my first time watching a procedure here is not all the technology or procedural differences. When they drape a patient at home, there is a large drape that clips to two poles by the patients head so that their face is hidden from view to essentially all but the anesthesia personnel. Here there is just one drape, so you can stand back and is one glance see the face of the woman and the incision revealing her organs all at once. This really made an impression on me because it is so easy to view the case as a body part and not an actual person with a life story. This image brought the humanity back to surgery.

Liberian Refugee Camp

First, a little background on the camp and why there are Liberian refugees in Ghana:
There were two civil wars in Liberia, the first from 1989-1996 and the second from 1999-2003. When the war in Liberia broke out many fled to Guinea and the neighboring Ivory Coast. Ivory Coast had its own war around 1995 (I have not verified the date here, but this is what I’m assuming based on my conversations with refugees) causing the refugees there to flee to Ghana, the next country to the east. The camp is 19 years old and they are currently trying to close it down.

At the beginning of the year, the UN was offering a repatriation package of $5 per person and they were allowed to take 20 kg (or 44 lbs) of their personal belongings. Obviously, even in Africa, $5 is not going to suffice even for a week. Rent is averaging $25/month in Liberia right now. Many of the women’s groups in the camp gathered to protest and demand more money. While asking for $1,000/person, the UN conceded to give $100/adult and $50/child, but still only 20 kg of belongings.

In Ghana, you are supposed to ask permission from the government to protest. The groups in the camp did not do this, so the government looked at the acts and decided the Liberians weren’t appreciative anymore and wanted them to leave Ghana. Also, Ghana has presidential elections coming up in December and they don’t want the refugees causing any problems.

Last week when I visited the camp, I just sat and talked to a number of refugees. In the short time that I was there, I uncovered some interesting trends. Most of the people who were older or had arrived more recently wanted to return to Liberia. The exception was a little boy named Michelle who came up to me when I first got there that day. He was wearing a Camp Wesley Woods T-shirt; I asked him if he knew where it was (fully knowing that he didn’t) and told him it was in Tennessee, where I’m from. I went to that camp in 5th grade! He told me that he and his mom were going back to Liberia soon. I asked him if he wanted to leave, and he said yes. He was 7 years old, had been born in the camp, and even speaks the local Ghanaian language Twi. I thought this was interesting that he wanted to go “home” to Liberia, a place he had never been and knew nothing about. I concluded that this must be largely his mother’s influence. It’s interesting how much you can tell about an adult from their young child’s opinions.
In another area of the camp, I sat with some people who were less willing to leave. Most of them either had been in the camp since the early 90s or were very young when they left Liberia. A few of them who were around my age were talking about how they don’t know anything about Liberia. They know Ghana’s history, not Liberia’s. They have friends here; they’ll know no one in Liberia.

Another common theme was the importance of education and a proper job. One of the women who wanted to go back to Liberia said, aside from going to Liberia, the one thing she would like the most is a loan so that she could start a business. She said she didn’t think she would have any problem paying it back. Another woman was 23 years old in business school when she had to leave. Nine years later, she is still determined to return to Liberia and finish her education. Her life has essentially been on hold for the past 9 years. All of the people I talked to are very capable people. They were living normal lives until they had to start over in Ghana with nothing. They knew another life and then had to flee that comfort and come to a foreign land with no one and nothing and completely start over.

Although my emphasis is health care, that seemed like mute point here. There is an equipped clinic on the grounds. Anyone who needs treatment can go there—providing they have the money. They aren’t treated until they pay. It seemed obvious what the obstacle to health care here is: poverty.

As I familiarize myself with situations like these all over Africa, poverty is the common theme. It’s a vicious circle, and one single aspect such as health care cannot be isolated. We have to work together to build the infrastructure at once. If you lift a table from one corner at a time, everything is going to fall off. If you work together to lift all four corners at once, everything will stay in its place. You can’t fix the problem of poor health until you fix poverty.

Boti Falls and Shai Hills

This past weekend 11 others and I went to explore the amazing nature that Ghana boasts. The trip was interesting from the start since we had 12 people. We thought we’d never find one trotro with space for us all. It turns out 12 is the perfect number—we fill an entire tro! When drivers noticed this, they would allow us to essentially charter their tro to take us where we wanted to go. The only problem is that they saw the cedi signs in their eyes and paid no attention to the fact that they had no clue where exactly it was that we were going. However, Ghanaian men aren’t too proud to ask directions, unlike their American counterparts.

On Saturday, we went to Boti Falls. First, we hiked to Umbrella Rock. For most hikes in Ghana, you have to have a guide. The only problem is that these guides, in my experiences, have their speed set at turbo, so you’re rushing to keep up with them and not being able to enjoy the scenery. I enjoyed the hikes here more than back in the Smokies because they’re not as worn down from so many hikers. My favorite parts are climbing over roots and rocks. It did, surprisingly, remind me a lot of the Smokies though. All it was missing was a picnic by the river with my family and a turkey sandwich, Lays, and double stuffed Oreos.

Once we got to the rock, I noticed there was a scanty little ladder leaning up to the top of the rock. Our guide said for 20 pesawa ($0.20) we could go onto of the rock. Seeing a way to be adventurous and put my life in danger at the same time, of course I had to go up. You could see 360 degrees of the mountains—the first amazing view of the weekend. After Umbrella Rock, we went down to the falls. They are twin falls, and pretty big. When we were in the clearing by the pool of water, mist from the force of the falls hitting the water cooled us off nicely after our hike.

Saturday night we took another it-should-have-taken-one-hour-but-took-three-instead tro rides to Shai Hills Resort to ready ourselves for our early 5:30am rise to see monkeys. Sam, one of the other volunteers, is amazing at bargaining and was able to persuade the driver of a facility truck to drive us around the reserve for 35 cedi. We did two hikes in the reserve: one to a point 290 meters above the ground and another to the bat cave. (I ran into Alfred there. He said Bruce was out of town, but he let me take a spin in the Bat Mobile.) The first view, from the high point, was incredible! It is, hands down, the most beautiful view I have ever seen in my life. The land was so flat you could see for miles. I know at least 300 km because we could see the town of Tema in the distance. You could see small mountains come up out of the ground and then still see past them. It reminded me of looking out onto the ocean, how the horizon gently curves as it passes out of view.

The bat cave was interesting because a tribe used to live there and you could see where they fortified the area and put up traps to stop enemies. Other than that, I ended up way too close for comfort to a room full of bats I could only hear and not see.

On another note, my roommate, a couple friends, and I are making American pancakes for dinner tonight. I am extremely excited. Even more than a hot shower, I miss certain foods…What does that say about me?

It's "Ghana" Get Interesting

Sorry, I had to use that pun at some point. It's done now.

Sunday, June 1

Preface

I have been making references to what I am studying in my past blogs, but I have never explicitly said what I am studying or why I am here, in Ghana.

At school, I was just accepted into the College Scholars major. This is an honors program designed for "highly motivated and academically talented students who have clear goals for their undergraduate education, and who cannot attain those goals within the traditional requirements structure of the College." Essentially, it offers a student the opportunity to design their own course of study, working closely with a faculty mentor, and culminating their studies in a senior thesis project.

The program I have designed is entitled ‘Exploring the Relationship Between Conflict Zones and Health Care Delivery’. It focuses the consequences of war on access to health care, and looks at access before, during, and after violent conflict. It also focuses on African studies. I want to work as a surgeon in areas of armed conflict, predominantly Africa. It is imperative in providing optimal health care to understand the culture and society within which you are working.

To list all the reasons I wanted to come to Ghana this summer would take to long—perhaps a conversation best held in person. Primarily, I wanted to immerse myself in the culture and work in a medical context to be able to compare the practice of medicine here and to that in the U.S. I am also working at the Buduburam Refugee Camp in order to do research regarding my university studies. Talking to refugees and hearing their stories is a great way to learn about the effects of war.

Buduburam Refugee Camp

Last Wednesday I visited the refugee camp. The day went as most of my time here has been: One step back, two steps forward. I mentioned that I had met the director of PAC (Pan African Center for Peace) and arranged to meet with him at the camp. It turns out the organization is not yet a registered NGO but is a CBO (Community Based Organization). They focus on education and hold workshops in the areas of NGO management, Peace Education, Private Education (on how to teach), and Community Health. They had the Millennium Development Goals (MDG) hanging on their wall and when I asked, they said all their programs are aimed at fulfilling the MDGs.

They were excited that I was studying conflict and health care. What PAC had in mind for my involvement was for me to design and lead a workshop either in Peace Education or Community Health. I felt I was not qualified to lead such a workshop (especially not in peace education; I’m just starting to learn about that myself!), but I agreed to help inform PAC more about community health since they know essentially nothing. While talking to them, it was difficult to find a happy medium not letting them overestimate me, but without underestimating myself.

I was able to talk to some medical assistants and the head doctor at the camp clinic, which I believe is run by UNICEF. I was trying to figure out the health situation in the camp (i.e. - what the biggest problems/ diseases are) just to have a starting point. I was able to speak to the head doctor in the end. While trying to be polite to John of PAC, what I believe he was trying to tell me is that Pac is a CBO that doesn’t know anything about health care and it would be a much better opportunity and experience for me to piggyback on the campaigns that the clinic already ahs running in the camp. I’ll admit, this was a relief to me since this is more the type of opportunity I was looking for. I did not feel comfortable with the responsibility PAC was trying to give me.

I hope to gain insight to the health care situation in the camp and to have time to sit and talk to refugees; to hear their stories.

I don’t know if I’ll be able to go twice a week as I had hoped simply because it is quite a journey by tro tro to get there.

Friday, May 30

Medical outreach was cancelled today. I tried to sleep in since it was the first day I’ve had free since I’ve been here. I was awake by 7:00. I finally had an opportunity to meet with a friend of Dr. Hackett’s, Kwesi. He and his family were very nice. He is the Chief of his village and showed me the video of his installation as Chief. I wish I had time to watch it in its entirety; it was very interesting!

Saturday, May 31

Today was the end of the month beach party with Projects Abroad. It’s an all day party at Akwaaba Guest House on Coco Beach near where I live. Volunteers from all the different regions PA has placements come down for the day. There is food, drinks, games, drummers, dancers, etc. We played tug of war between the different regions (our Accra guys won!). We also had football (soccer) matches and I played with the girls. It was a punch in the face reminding me how out of shape I am!

There was a cultural group there with African drums and dancers. I love watching African dancing. Everyone always looks so happy. Not to mention that they can move in ways I didn’t think humanly possible! After dinner, they moved the drums down to the beach around a bon fire. But the festivities didn’t last long.

There was a group of four from another region that went swimming. The current here is very strong and the waves are really big. They got too far out and had to start swimming in. Two made it in on their own, and two of our guys were able to pull a third guy in, who was taken to the hospital. The fourth girl was still missing. It gets dark very quickly here so there was no way to see her. There are not effective emergency services here either, so there was essentially nothing we could do except walk the beach looking for her and wait. A little over an hour she came up on the shore right in front of where we were. She was still alive and taken to the hospital.

I just heard this afternoon that she did not make it. Please keep her family and friends as well as the other volunteer that was taken to the hospital in your thoughts and prayers.

Always choose bad news first; then you can turn it into good news.

Monday, May 26

Cape Coast

This past weekend I took a trip over to Cape Coast, a town about 2 ½ hours west of Accra. The town is best known for Cape Coast Castle and Kakum National Park, a rainforest les than an hour away. The game plan as we set out Saturday was to arrive in Cape Coast and find a place to stay. Sunday we were going to tour the Castle and see the town and then Sunday night Thomas and I were going to camp on a tree platform in the rainforest, while Amit and David slept in the comfort of the Oasis Inn another night. We would wake up early Monday morning and do the canopy walk before it got crowded when the park opens at 8:00am.
We had tried to call ahead to reserve a place to stay, specifically at the Oasis Beach Resort, however, no one would answer their phones. We arrived in Cape Coast and easily found Oasis. Luckily, they had one room, or bungalow rather, left for us. It was a very neat place. They had about 10 little bungalow huts along the beach front and a restaurant and night club on the grounds. The view from our window—from anywhere near the ocean—was gorgeous!
We went ahead and toured the castle on Saturday because we had time. Most of what the tour guide told us I had recently learned in Western Civilization, which made it of special interest to me. There’s a huge difference between learning about a subject via power point presentations and text books, and actually seeing the small enclosure that housed 200 men for 6 months. I couldn’t even fathom fitting 200 men in a single male dungeon chamber. I would love to talk more about the Castle and its history, but in the interest of your future bifocals (or current ones), I’ll let you email me if you want to hear more.
Since it didn’t take as long to see Cape Coast as planned, we decided to move up the trip to Kakum and wake early in the morning to go. (I’m here for 3 months, so I intend to return later to sleep in the rainforest. Who could pass up an opportunity like that?) However, when we woke up, it was pouring rain. So our rainforest trip got rained out.
Overall, Cape Coast is gorgeous!

Hospital News
I started my rotation in the ‘surgical’ ward today. I was really excited because I would finally be watching surgeries! I arrived at 8:00am, and sat in the office for about 30 minutes. Things usually don’t get started right at 8:00, so I wasn’t surprised. Then I followed a doctor and then some nurses for about an hour. At 10:00 am I helped the nurse take vitals in all the wards. As I think I mentioned before, the nursing students are doing their clinicals right now, so there are about seven of us following one person. They aren’t allowed to take blood pressure yet, so that has become my job just about anywhere I go. About 11:00am I was finished with vitals and sitting in the office again. Being used to early 7:30 starts in the Operating Room back home, I though surely by 11:00 they should have started some cases and maybe they had misunderstood my rotation and I was missing the procedures. I asked Rosie, an nursing assistant, when they do the surgeries. “On Saturdays.” La General Hospital only performs surgeries on Saturdays—my day off and a day I am usually out of town.
Since this discovery, I have talked with the assistant manager of Projects Abroad, Ellie, about possibly changing placements to a hospital that performs surgery more frequently. All the medical placements are full, but she might be able to move me for my last month here. I took the opportunity to make another suggestion as well. Rather than taking vitals for three months, I asked, “Would it be possible to only work at the hospital a few days a week and spend the other days at Buduburam refugee camp?” I thought this was fishing, but to my surprise, she said that would be fine! A discouraging situation has turned into one that might be even better. Now I will have more time to focus more on my area of study-- the consequences of conflict on health care.

Buduburam
My connections with the refugee camp came about in a very coincidental manner. Hollywood would probably call it fate. Last Wednesday I was riding in a tro and started talking to two gentlemen. When I told them I was a volunteer, the first question out of their mouths was, “Would you like to visit the refugee camp?” This caught me by surprise, since it is one of the main things I had been hoping to do since I started planning my trip! As it turns out, I was talking to the Director and Volunteer Coordinator of the Pan-African Center for Peace (PAC), a local non-governmental organization (NGO). The director is Ghanaian and the volunteer coordinator is actually a Liberian refugee. When I mentioned my area of study, they were very excited and invited me to come to their office to further discuss opportunities in working together.
I have arranged to meet with them and visit the camp this Wednesday. I hope I will be able to spend two days a week there. The tentative plan at this point is that I will spend two days at the hospital, two days at the camp, and then Fridays on the medical outreach trip with Projects Abroad.
I’ll keep you posted on what I work out!



Tuesday, May 27

In addition to being able to split my placement, I found out at work today that surgeries are performed during the week at times! Today I had the chance to watch an emergency etopic pregnancy case, a hysterectomy and cyst removal, and a C- section! It was very interesting to compare operating theaters here to those in America. I hope to write more about it later.

Hope everyone is having a great day!

"Obruni!...Ginger Snaps?"

I’ll start off with a humorous observation:

Being around my two British roommates, I have begun to think in a British accent, but not talk in one. Therefore, it is quite strange when what I think in a British accent comes out in an American accent. (I wondered why I did not think in a Ghanaian accent, but then realized that I’m still having trouble understanding it all the time. To not be able to understand your own thoughts would probably be a disadvantage.)


Saturday, May 17

Today was my first venture into town! We went into Osu, the area of Accra that is more touristy and also the location of the internet café I use most. We ate lunch in Osu at Tip Top Chinese Restaurant. “Chinese?” you ask? Why, yes! Apparently, Chinese and Lebanese food is very popular here. For those who know me better and question simply the fact that I ate Chinese—I was in a rather indifferent mood and that was the choice of the other two guys I was with.
While we’re on the subject of food, the food here is very good. Since I left Knoxville Tuesday, I had not had much of an appetite. I’m not sure why—this was very strange for me! But, thank goodness, my appetite returned to me on Saturday and I can properly enjoy the Ghanaian cuisine (or Chinese). My host mom—and her house helpers—cooks very well. She said she doesn’t put any peppers or hot spices in our food, for which I am very grateful! Today as well, I got to fry plantains with Abena. (Abena is one of the house helpers and is very sweet. I would guess her to be around 13 or 14. There is also a younger girl, who looks to be about 10.) Abena is a master cook—I think she was amused with my clumsy culinary effort. Mrs. Obiri told me if I wanted to prepare one of my American meals, to let her know and she would get the ingredients. I had to inform her that I was not the best cook….perhaps I’ll let Abena teach me a bit!

Sunday, May 18

I can tell I’m getting more comfortable here, because in four short days I was able to get back to my horrid habit of sleeping through alarms. I might have to revive my old phone to utilize its three alarms. Unlike when I would sleep half the day back home, oversleeping here was 9:00. I am usually up between 6:00 and 6:30. Where life is slower here, it is definitely earlier too. Last night I was in bed before 9:00. I don’t think that has happened since my parents gave me a “bed time”.
Today I learned that one of my housemate, Naomi, who was supposed to be staying another 2 ½ weeks will be going home tomorrow. Ellie leaves on Friday and the next girl does not arrive until a week later. Tonight we went out to have a last dinner with Naomi. It started raining just as we were leaving to go. The place that they wanted to go was closed so the only other option, while avoiding the pounding rain, was the food court next door. It was very Western—they sold pizza, burgers, chicken, “chips” (fries), ice cream, and a variety of other foods that one might see in a Western food court. It was strange to see something that looked so familiar in the midst of the unfamiliar.
I hate to change the mood quite suddenly, but the most poignant aspect of my day was my visit to the orphanage. We went to visit the infants. Upon entrance to the building where they stayed, I was surprised with the number of babies just lying on the floor. To walk down the hall, I was stepping over children. We helped to feed and bathe them. Well, I didn’t do any bathing—except for myself after a boy threw up all over me. I felt bad because there were so many children, (with just a quick glance in around my immediate area I counted close to 30) and I knew that the ladies working there simply could not give them all the love that they need. One child’s face will be etched in my memory forever.
The infant looked like an old man. He was so emaciated that his cheeks sunk in and the skin on his face was stretched tight against his skull. The skin on his arms and legs hung loose like an elephants. I could see where his tibia met his femur at the knee joint, and his hands looked grossly disproportionate to his body. He lied there, not crying along with the other children. Every so often, he would just roll on his side, reach his tiny, bony arm up and stare at the tiny baby girl lying diagonal from him. In addition to his malnutrition, he was sick, with vomiting and diarrhea. Looking down at the child, I felt as if he knew he had no hope.

Tuesday, May 20

I have completed two full days at Poly Clinic now. Here are the highlights of my thoughts while spending time there:

Privacy. Or lack there of.
Coming from working in a U. S. hospital where HIPAA (Health Insurance Portability and Accountability Act) is jammed down our throats from day one, it is quite different here. I have not found out specifics about whether or not there is a similar privacy act here, but I have not heard of such. The patient information is just left out on the table and I have heard no cautions against using descriptive information when telling others about certain cases.
Privacy is also negligible in other cases. The “Emergency Room” is a single small room in the middle of the waiting area. However, when emergencies come in—usually consisting of patients who are severely ill—they are treated in the open area. There is a rolling curtain that they use to try and conceal the patient to a point, but until they get that in place everyone in the waiting room (I’d estimate up to 100 people) is sitting there watching the proceedings. Also, where we check the vitals (temperature, weight, and blood pressure), there is a patient at each end of the 4 foot wide table and plenty others around to hear the vitals being reported. For instance if the patient is going to the AIDS clinic, they tell us at that point, and therefore anyone in the vicinity knows that individual has HIV/AIDS. Maybe it’s a culture difference, but I still feel individuals should be able to have privacy concerning possibly stigmatizing information.

Breast Feeding.
This stems from the privacy idea. I was surprised to glance over at one of the benches in the waiting area on see a woman sitting there breast feeding without covering herself. My first (American) reaction is that they should be able to do this in private. Then, on second thought, I decided that this was a very good thing. It encourages breast feeding, making it convenient, and normalizes the natural act. This is very good because breast milk is the best nourishment for the baby and such acceptance encourages the practice.

Efficiency.
I hate to venture into the subject since I am sure the hospital workers know much more about the hospital practices that I do. However, with 3-4 staff nurses at a time operating patient screening and the emergency area, it seems slightly inefficient for the entire staff to leave the screening desk to go tend to the emergency. Thus far, emergencies have not been anything dramatic such as someone coding, they are severely sick and weak people. The nurses just start an IV and take the person’s vitals and wait for the doctor to come see the patient. Meanwhile, the whole screening process which every patient has to go through before they can see a doctor is at a standstill. Again, I hate to comment on their procedures since I’m sure they have reasons for the way they do things, but I’m not sure where the line is. I don’t know if I’m being culturally naïve, or if there really is room for improvement.

People Watching.
A great past time—even better in a modernizing third world capital city.
I love to sit and look at the variety of people and attire in the wandering and sitting in the waiting area. There are people of all ages and all different classes. People are dressed in everything from very traditional attire to Dolce and Gabbana jeans. I like the women in traditional dress with Dior or Burberry scarves on their heads. We spoke of the effects of globalization in my Life Happens seminar with Dr. Rita Geier this past semester, and it’s very interesting to actually see it. I see women in business dress the equivalent of what you would see in the US, with a baby strapped to their backs in the traditional Ghanaian fashion. There are businessmen, traders, school children in their uniforms, young mothers, old mothers…the diversity is so interesting to take in!
I love to catch the eye of a small child or a baby. Many times they will just stare at me. Today there was a little boy who was looking at me, and whenever I looked at him he would “hide” but find another angle from which to look at me. Any time I caught him he would laugh.

Semi-Notable moments/ thoughts:

There is a spot on my journey home where the road narrows from two lanes to one. Of course, this backs up and slows traffic—to a halt during rush hour. Along this stretch of the beach road, vendors carrying everything from pure water and fried plantains, to mentos and toilet paper walk between the cars. Some of the vendors will notice me sitting in the window and stare me down trying to sell me something. “Obruni!... Ginger Snaps?”

On Monday I made my first successful solo trip from home to La Poly Clinic. Then I got a little courageous and even ventured to Osu to visit the internet café after work. Afterwards I made my way home, thus completing my first successful round trip by myself.

Noticing how much I stand out here made me think about the diversity in America. Everyone I pass knows I’m “not from ‘round here”. In America, however, we would never notice a foreigner simply because of their skin color. Culture and diversity are such interesting subjects. Here there is diversity yet such a strong shared culture. In America, the same exists, but in such a different way.

One thing I have learned about myself is that I am interested in the political aspect of medicine more than I previously realized. I am so used to having constant internet access back in the US and keeping up to date on international and local policy happenings, it is strange not having my daily perusal through the New York Times and CNN web pages. I was previously considering studying at Gulu University in Northern Uganda in the spring, but now I am thinking I might try for an internship in Washington D.C. I feel this would put me in contact with a variety of people and provide a more diverse experience concerning subject matter.

Fried plantains are amazing. I love the food here. It’s such a refreshing break from all the processed food back home. Especially since my diet was mirroring my mental crash near the end of the semester, consisting of mainly Cheesy Gordita Crunches and Micky D’s Sweet Tea. (My last “American” meal in the Detroit airport, as well, haha.) Fruit is so easily available! I went from never eating breakfast to having oranges or pineapples, banana, and bread every morning. Last night we bought a pineapple for 40 pesewa (about $0.40) and an orange for 10! For lunch today I had some form of a meat pie, fried plantains, and a Fanta—all for 70 pesewa!

My first days in Ghana

Wednesday, May 14
I arrived in Accra Wednesday night. My flight had been delayed out of Amsterdam so I was a bit late arriving in Accra.
As I stepped down off the plane, I was welcomed by the hot humid air. Having been in dry, air conditioned planes and airports for the last 25 hours, it felt pretty intense.
There were two other volunteers from America that arrived shortly after me and Nyame, who works with Projects Abroad (PA), took us each to our host families. Since I live the furthest from the city, I was last to be dropped off. I arrived at Mrs. Obiri’s house around 11pm. After meeting her, they showed me to my room and then we all went to bed.
I knew that Ellie from PA was to pick me up in the morning to take me on initiation, but other than that, I did not have any idea what I was to do in the morning. I distinctly remember wanting to take a shower since I had not bathed in quite some time. Now after only having been here less then three whole days, I think I might have been cleaner then. Because of the heat and humidity in combination with the sun block and bug spray, I always have a layer of something on my skin. I remember at first thinking I would never be clean again! But I’m already getting used to it.
There are two other volunteers staying at Mrs. Obiri’s house as well. Ellena and Naomi; they are both from England.


Thursday, May 15
I didn’t sleep very long the first night. The sun rises about 5:00 I think. I remember hearing the rooster crow…but that was after I was awake and the sun was up. I wasn’t sure what to do so I just lay in bed until about 7:00 when I got up and met Naomi in the hall. I learned that breakfast is served at 6:00 every morning. It usually consists of fruit and bread with peanut butter or margarine.
Ellie came and took me and two others that had arrived the night before on initiation. She first took us to the PA office, and then she showed us where the main tro tro stops were. We went to the post office, to change money, to buy phones, and to eat my first official Ghanaian meal. The food here is very good.
When I got home about 3:00 pm, I was already very tired. I took a nap until dinner was served at 5:30. Then sun sets early compared to TN—around 6:30pm. Therefore, I didn’t want to venture out in the dark so I just wrote some emails and finally got to talk to my family before I went to bed. It is rather expensive to call to the US; around 25 pesewa, which is about 25 cents, a minute.

Friday, May 16
Ellie from PA came to take me to my placement today. I will be working at La General Hospital, or more commonly known, it seems, as Poly Clinic. I visited the Administrator and then another woman and then ended up in patient screening for the day. I am still confused about what happened and how I ended up there. The administrator asked if I would like to go to the Pharmacy since he saw my pharmacy experience on my CV. I said my main interest was surgery. I thought that I was to sit down with someone and schedule which departments I would rotate through for the duration of my stay at Poly Clinic, but that never happened. Therefore, I do not know how long I will be in patient screening or where I will go next.
Patient screening is outpatient treatment. Where I was working, we took patient weight, temperatures, and blood pressure. From what I was able to gather, Ghana recently started a national health care plan. Those with insurance had booklets and those without had white cards. These, respectively, served as the equivalent of charts in America.
There was another volunteer working with me, Elsie. She is originally form Ghana but lives in Canada now. This was nice because she could understand the local language and knew a lot about the way things work in Ghana, but could also relate to and compare Ghana to the Western lifestyle.
I did not get to tour the facility or anything of the sort, so I cannot vouch for the entirety of the hospital. From what I’ve seen though, most everything is completely different. The patient waiting area is open air and the Emergency Room is a single room where (who I presume to be) the head nurse works. Projects Abroad told us to call them if we, personally, had an emergency because Ghana does not have an effective emergency department. I heard sirens go by the hospital while I was there, so I asked Elsie about the Emergency response. She said that most emergencies were brought in by family or friends and consisted of patients who were so sick they should have been brought in a week ago. I have only been exposed to the health care in Ghana for one day; so hopefully, I will be better able to explain it in the future.
Hopefully, I will also have pictures for my blog as well. I have been told not to “wave” my camera around, also I am not sure when and of what it is appropriate to take a picture. As I become more comfortable in my surroundings, I am sure that will change.

My Thoughts on Ghana Thus Far:
I have no clue what I am doing. As far as appearances, and physical attributes, I haven’t been too shocked by what I’ve seen. It feels like pictures coming alive. I remember the first night on my way to Mrs. Obiri’s house there was a police block where the police checked the cars. I looked out my window and there was the police officer with a rifle strapped across his chest. It actually took me a second thought to realize that this was the first time I had been a foot away from such a heavily armed officer.
The driving style here is certainly different! I mainly ride in tro tros. They are the cheapest form of public transportation. They are large vans with about four rows of bench seats, which run fixed routes. There is a driver and a mate. The mate sits by/ hangs out the window of the side sliding door and calls out the destination of the tro. For example, if the tro is going to Circle the mate calls something that sounds like, “Circ! Circ! Circ! Circle!”. Cars don’t necessarily stop at intersections and get inches away from other cars (or any object really, including people). Compared to America, driving is very aggressive here. While it seems somewhat chaotic, to me it makes more sense in a way. Traffic seems to flow more as one.
I had been told that I would, and therefore expected to be, called Obruni (white person) all the time. I have only heard it a few times, though. The first was when a beautiful little girl outside of the office said “Hello Obruni!”. Calling someone Obruni is not rude; it is just what Ghanaians call a white person. They do not know your name so they can get your attention by calling you Obruni.