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.