It is now one week since we returned home from Ghana.The adjustment period always takes a few days or week. Sleep can be problematic as our internal clocks have shifted aboutfive hours.I find myself dropping off to sleep in the early evening and then awakening much earlier than usual in my own bed.

I am not awakened by the the incessant roosters as I had been in Ghana but rather by some internal mechanism. When I awake I am still trying to process all the happened while we were in Ghana.

These BLOG entries cannot begin to capture the emotions and experiences but they are a start. Pictures will be added but that also involves some sorting of photos and re-sizing for web based applications. I have over 1500 pictures collected from my own camera and some of the students. Please be patient as I go through this process but I really want you to see some of the images.

I write this quick entry. I have been having problems getting my blog entries uploaded so I will have to wait until I get home. I have many more stories to tell so please check back and I hope to upload some photos. We are all safe and resting at a hotel pool for a few hours before we leave for the airport. We have so many stories to share. More later

Val

Today we get up early and drive to Kakum National Forest. We are told that this is only one of 3 National Forests that have a catwalk. I have done this attraction last year and I remember how arduous the hike up the trail was and I elect to stay below with Maura and people watch. The students make the hike up to the elevated platforms high above the tree line. The students expect to see animals but there are no animals in this part of the rainforest. It is the dry season and they have gone to other locations where the water is. Even if there were any animals they would not make an appearance with the screaming of the tourists as they cross over the roped walkways high above the floor of the forest. We have a few students who are afraid of heights but I am happy to announce that they all made it back in one piece. There is another group of white students who are also returning from the walkway. They are an assortment of students from various countries who are working on some humanitarian projects here in Ghana. When we see a group like that we always go over and see what they are doing. We are truly the minority in this country and the color of our skin binds us to these strangers.

We then travel to Elmina Castle which is one of the first castles built in this region. Originally it was a Portuguese trading site for gold and other items but very soon these traders realized the value of human trading. We have a wonderful guide who has been doing this for years and his name is Clifford. One important piece of information that he shares with me is the history of slavery before the adoption of that practice by the Europeans. The Africans themselves used slavery as a means to conquer other tribes and to use the prisoners of war during these conflicts as human barter. I think this is an important thing to hear. As a white American our history books focus on the role of the Americans during early slavery here in the US and ultimately the Civil War and abolition. I think slavery is a stain on all nations and that reparations and change in attitudes have to happen with all races and not just the white Europeans and Americans. We also need to modify our history books to reflect some of the origins of the slave trade.

As I tour this castle I am reminded of the comments I heard last year from out tour guide. This year we learn a bit more. He is trying to use words and stories to help us understand the emotions and fears of that era. We are locked in a small dungeon cell so that we may experience some of the sense of despair and fear that the African slaves felt. The stories of the rape and exploitation of the female slaves is especially troubling and when he talks of the separation of the families I start to realize the horror and lack of hope that must have been felt by these people. I am again appalled to see a Portuguese church sitting right on top of the dungeons and realize that the worship of God happened mere feet from the suffering of the slaves. There is a plaque on the wall and I am going to post the picture. Last year I gave a lecture at a church and I ended with that picture of the plaque in the hopes that it might generate some discussion. It was interesting that the audience did not want to discuss this. I think deep down we all know it was a horrible part of human history but it is easier not to talk about it. That is why we must continue to have dialogue about how these events have shaped who the white and black people today in 2010.

After the tour I am able to take some photos of the harbor at Elmina. It is like going back in time and I hope some of my pictures will help to demonstrate these aspects of the African fishermen. They carve out and build long boats from the local trees and each afternoon they leave their harbor to go out into the deeper water to catch fish. The boats have at least 10 men on them. We are here in the early afternoon and some of the boots are returning with their booty. These boats are lying low in the water and when other people in the harbor see these boats return there is a loud cheer and clapping. The returning fishermen are heroes to their community for bringing home the fish that helps to sustain the economy of this village. It is hard for me to imagine how monotonous this life must be but that is the only way that they can survive.

As we leave the castle we are mobbed by local vendors trying to sell us their trinkets. I do not need any of these items and I know that if my wallet comes out I will be swamped like blood to the piranhas. I hate to be rude but I push ‘my girls’ on to the bus and close the doors. The incredible poverty is overwhelming and it is wearing on us a bit. The students are anxiously awaiting a return to Coconut Grove resort for an afternoon of swimming. We have planned these last few days of relaxation and I think it was a good thing to do. We have worked so hard since our arrival and the students need some rejuvenation before they return to the rigors of their academic schedule upon our return. The pool is lovely and we pay a small per diem fee to use the facilities. The pool area is mostly empty and I think the addition of 10 beautiful young nursing students is something they do not see too often. I remove myself from their group and find a chair on the other side of the pool. Maura has left me for the afternoon to meet up with her son who ironically is also here in Ghana with Babson College and they are about an hour away at a competition about entrepreneurship. She leaves with Kwando to make the trip and I am with the students. They are having a great time but I need to maintain my distance a bit. I think it is important for them to be kids and for me (the mother and professor) need to be separate. I take advantage of a shady lounge chair and try to read but once I start to relax I find myself asleep. I am told later that the students came over and took some pictures of me with sleeping with my mouth wide open (not a pretty picture) and they jokingly said it is blackmail material for an A in their next class.

I meet 2 people that day at the pool. One is an American woman in her later years who travels around the world. She is in Africa and will be here for a few months. She travels alone and makes up her itinerary as she goes along. She tells me of her stories in India and Asia and I am curious about how she supports her travel because she stays at nice hotels along the way. She does not reveal her source of income. I also meet another man who is currently in Ghana doing some epidemiological research for a petroleum company. He does not get into details and I wonder if he thinks that a nurse would not understand the nature of his work. He is currently attending MIT Sloan School and has 3 degrees from Harvard. I do not recall his name but he has a former colleague who currently teaches at UML and I need to make a connection when I return. It is funny that when I am in my own country I usually do not walk up to people and start talking( well at least not all the time) but here in Ghana there is some liberty in starting discussions with people you know are from your own country.

The girls try to cajole me into delaying our departure and I give them an extra 45 minutes. We have a 3 hour trip home tonight to Accra and I am ready to leave. After a few posed pictures at the pool we leave. Out 3 hour trip turns into a 5 ‘ hour trip from hell. Actually the first 2 hours were not bad but once we approached Accra we sat in stop and go traffic for hours. At one point our driver took a short cut through some local neighborhoods and we were stopped at least 4 times at police roadblocks. I am angry to think that these Ghanaian police officers are stopping all these drivers but do not offer any assistance on the main roads to maintain some type of order to chaos on the roadways. Because our journey home is taking so long we must stop for gas again. I am amazed to find myself in a VERY clean store at the gas station and imagine my delight when I find some diet coke. I buy 4 for our last 2 days and I know Maura will be thrilled with my purchase. It is now Saturday night and we only have a few more days left. Tomorrow is our shopping day and I have planned a birthday party for tomorrow night. We have had 2 UML students have Birthdays during our trip (Allison and Jody) and I have ordered some cakes. We make an inventory of our remaining supply of American food and we realize that we have 12 packets of Easy Mac left between us. I have also hoarded some Starburst candy so I have planned a birthday feast of Easy Mac, Starburst Candy and Cake for tomorrow night. We are all getting homesick and are anxious to return home.

We have finally arrived at our day of rest. We leave our hotel in Accra and battle the traffic to get out of the city. They are doing a large construction project and the main road is being torn up. I think the attempt is to build a flyover to reduce congestion in the city but right now it is a mess. There are no traffic cones or overpaid state policemen directing traffic. It is a free for all. We are lucky that we are traveling in a larger bus because some of the smaller vehicles are yielding for us but it is a bumpy and stop and go process and it takes us over an hour to leave the city. Our journey to Cape Coast takes about 3 hours and along the way we see some of the affluence of Accra turn into the typical mud and grass huts that are the standard of living for many people in this country. I am reminded again of the extreme poverty of this nation. We are traveling to the sites where much of the slave trade occurred in Western Africa. Over 11 million Africans were carried across the ocean from the mid 15^th to the late 19^th century. There were no American forts but the Americans played a significant role in this terrible human tragedy. I urge you to watch Traces of the Trade which is the story of the slave trade that occurred in Bristol Rhode Island (available on PBS).

We are told that Cape Coast is the educational center of Ghana because it is the home of many fine schools and universities. It also used to be the seat of government many years ago but that has all moved to Accra. The buildings are very old. We see a 500 year old building. We drive down ‘stone house road’. Is it lined with very old brick and cement homes that were the original homes of the mulattos. The mulattos were the product of rape of the female African slaves and the British and other military soldiers in the 17^th-19^th centuries. These children were actually respected by both the white and black population so they served as important liaisons between the two races. They were usually not shipped off as slaves and enjoyed a different quality of life than their mothers and African family members. Many of them have Anglo names such as Taylor, or Williams. The city is very old and sometimes if you don’t look too close at the cell phone kiosks or the blaring of the taxi horns you could imagine yourself back in time. We arrive at the Cape Castle which was owned and operated as a slave castle (among other things) by various countries but it was last operated by the British. Our tour is very well done and it is amazing to be walking in the dungeons where hundreds of men and women were imprisoned. We see a mark on the wall which is about 2 ‘ feet from the floor. We are told that when they first started to prepare this as a historic site they thought the floor they were walking on was the original floor. It turns out that there was about 2 feet of dried blood, excrement and other fluids that had dried over the years in those dungeons and eventually the level of the floor rose. We can now see a groove around the perimeter and through the center of the room. It is the trough that bodily fluids are supposed to drain out of the room. I can almost feel the human suffering as I touch the dark cold stone. The lights are turned out and we are told that 500 men would be in this room. Many died from starvation and infections. If they attempted to attack their captors they were put in a cell in complete darkness and deprived of water and fresh air until they died. Their bodies were then shown to the other captives as an example. The heat in the dungeons is oppressive but there is no odor of dying but I sense the pain of those people. Outside the male dungeon there is a new plaque that was not there last year. It is a commemoration of the visit by Barack Obama. The visit to this Castle touches me in a way that is hard to explain. I can only hope that someday many of you will get a chance to see this site.

Our time is running short and we cannot visit Elmina Castle today but instead we decide to go to the Coconut Grove hotel for lunch. This is a very nice resort right on the ocean. We have a wonderful lunch in a gazebo overlooking the rough surf of the Atlantic Ocean. There are some American food items on the menu and everyone is happy. The UML students get to play in the surf and take some pictures. We buy some beaded jewelry from a Rastafarian student. The mood is high and we are looking forward to another fun day tomorrow. We are staying at a nice hotel (running water, AC and a TV that gets one American channel) and it is a relaxing night. I am sipping some Californian wine and realize that home is getting closer. I watch a bit of American TV and catch up on the news of the earthquake in Haiti. We feel somewhat disconnected to the world events right now. Last year the pilot landed on the Hudson River when we were in Africa. It is interesting how we have become isolated from the news due to lack of access to TV and newspapers. One interesting item is that last night while checking my email I find out that our meeting with the Ghanaian Minister of Health has been shown on national TV here in Ghana and also picked up on the internet feeds to international news sources. I am forwarded a copy of an article that appeared on the internet regarding that conference and the Minister is quoted discussing his goals for improved health in his country and then I am quoted discussing the need for compassionate and competent nursing care.

http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=175015&comment=0#com

The article also mentions UML and AFRICED as sponsors of the program. It is bizarre to have this email forwarded to me from the PR people at UML. I am proud to that we have made a positive impact while representing our university.

We arrived last night at Samartine hotel in Accra. Our hosts Sam and Martine are excited to have us return to their hotel. I am gladdened by their friendliness and feel very comfortable here. I did some laundry last night and ask her if I can hang my pants to dry on her line. She is very accommodating.

Today we had hoped to be done with most of our work but we are told that one more BP clinic is needed in the village that we first visited 2 weeks ago. It is near Ada and the name of the village is Adanor Kopeh. It is a very poor village. We were supposed to leave by 9 am but the bus does not arrive until 11 am and we have an hour drive (it actually turns out to be a 2 hour drives due to traffic). On the way we pick up Comfort who is a social worker from Accra who is from this village and has promised her people that we will return. I have no more BP meds and can only offer them some vitamins or Motrin or Tylenol. I really hate to do a clinic and not have any meds. The UML students are tired of working and we have been at this for 12 straight days now. When we arrive (late) at the village the people have left to go and work at their farms. Many of us need to relieve ourselves and are directed to a concrete box with a hole in one corner. We squat and relieve ourselves and dream about our clean USA toilets with toilet paper and privacy.

A loud bell is rung to announce our presence and the people start to trickle in. It quickly becomes an unmanageable situation. People are asking for any meds we can give them and are in a frenzy to get the remaining bars of soap, shampoo and conditioner that we have brought with us. This community is very poor and we again discuss the difference between greed and desperation. It is hard to distinguish at times. We realize that although we had promised to stay for an hour or so the situation was deteriorating and I needed to get the students out of there. We board the bus with such disappointment in the circumstances that lead to this disastrous day. A woman rushes to the bus. She heard the banging of the bell and wanted to come and see me. She received Tylenol and ranitidine (Zantac) 2 weeks ago and her stomach pain has gone away. She wants some more. I dig around in the box and give her some supplies. We board the bus and the kids are happily waving to us and the adults as asking when we can return. I am a bit ashamed of this shoddy nursing care and I know the students are feeling the same way but we had to stop the situation from becoming a bad situation.

As we drive toward Accra I begin to apologize to Comfort for the situation. She is not upset but rather wants to educate us about some of the psychology of the people of Ghana. She tells us that the people believe that we have magical powers due to the whiteness of our skins and the Ghanaian people will do anything to have contact with us. If all we do is assure them that they are healthy and need no meds then they will sleep soundly with the assurance that the white woman as told them good news. I find this interesting and also embarrassing. She tells us that there is a saying here that if a Ghanaian person is walking to church and they meet a white person on their way then they do not have to go to church because they have just passed God. This story is also embarrassing to me and I don’t know how to respond. There is much education needed here on this problem but it may take a long time to dispel. On the way home we stop at the Kasseh Health Center in Ada. This is the clinic where we visited on our first day and found the conditions in the maternity unit to be severely lacking. I have decided to take a portion of my church money to help them purchase some mattresses for the maternity unit. It is difficult to get a good quote but I hope that AFRICED can help me with this process. The nurses are appreciative of the large box of supplies that we leave with them. They are especially interested in the stethoscopes as they are rare item here. We have run out of BP cuffs and have none to offer to them. I had purchased 30 stethoscopes and 20 BP cuffs to bring with us and they were rapidly distributed during our visit. I wish I had brought more because giving these tools to the nurses will allow them to better take care of their patients. I am trying to think of items that have more long lasting value when contributed to the people of Ghana. They need so much but we (UML NSWB) need to more thoughtful about any future donations so we can maximize our efforts.

We journey back to Accra with the promise that all our hard work is over. I am sensing some negative feelings amongst the students. They are all feeling tired, missing home and frustrated by some of the circumstances of the day and also frustration with some of the changes in their envisioned experience. I make it a point to have a de-briefing discussion tonight that the students can verbalize their frustration or other emotions. I think we all recognize that the burn out factor is high and we need a break from the stress and continuous barrage of need. I am glad that we have a chance to talk but I still sense some dissatisfaction with some of our activities. There is such a wide variability in personalities of this group. I think it has been an incredible learning experience for these students. Some of the students are more flexible and are willing to go with the flow and others question certain aspects of the trip. I guess that this is just human nature and I need to give them time to vent. The physical and emotional challenges on a trip like this are monumental and I think we have all arrived at this point pretty much a changed woman. Personally I am not finding this trip as hard as last year and that has a lot to do with some of the changes I have implemented this year but also I had a more accurate sense of what ‘normal’ is here in Ghana. You cannot experience everything that we have done without expecting some internal change within yourself. I have tried very hard to document this trip so that I can look back on my words and try to make some sense of it all. I hope you have enjoyed reading this blog. The next few days will be a time of relaxation, reflection and evaluation. I am anxious to return home to my loved ones but also feel part of my heart is here in Ghana.

Today is our first full day in Peki. Last night we slept in a dormitory setting of a local school. The accommodations were sparse but there was running water. We had a nice spider visiting us in the shower but there was a cool breeze in the air and we did not seem to notice the lack of AC. As we are getting ready to board the bus I see a man run by quickly with a large bat and he is screaming. I had no idea what he was doing but as I rounded the corner I could see him poised over the quivering body of an animal in his last throes of death. The head was cut off but the nervous system was still twitching and blood was coming out of the hole where his head used to be attached. He is a grass catcher which appears to me to be a cross between a large rabbit and a hedgehog. They are very difficult to catch and supposedly quite a delicacy. Last year we say many bush fires and we were told that the men set fires to flush out the animals from their hiding spots. This animal is worth lots of money to them and our leader Kwadwo tells us that if he could he would gladly purchase this animal carcass and take it with us to Accra for his wife to prepare. It is a weird experience but reminds me of how easy I have it when I go to Market Basket to buy my prepared chicken and beef. Here in Ghana the women execute and prepare their own chickens. I think I would become a vegetarian.

We drive a short distance to the main village of Peki to have another meeting with the Chief. He is a very intelligent man who had a prosperous business career prior to becoming a chief. His goal now is to lead his village into an era of prosperity and modernization. He has established ties with some American Universities to develop some projects for his village. He is trying to get internet access to this village in addition to improved medical services and library and educational services. His son, Mawuli is in his final semester at the University of Ghana and he is one of the principals of AFRICED. I have had many conversations with him and I know him to be a very smart and dedicated man who aspires to improve the welfare of the people of his village but also the larger community of Ghana. I believe he will accomplish great things in his life along with the hard work and dedication of Kwadwo.

The UML students break into 2 groups to repeat their community health project. Maura supervises the Dental Health project. Instead of the expected 50 children there are 120 children and the program is carried out but there is an element of crowd control that was not seen with the previous demonstration. I am observing the HIV education program and the UML students excel again with this presentation. We are fortunate to be presenting in their classroom so we do not have the expenses of renting chairs and canopies that we had before.

A crowd of adults start to gather and I am told that we must start the BP clinic. I delegate the supervision of the HIV testing to Maura and it is handled very professionally and efficiently with not one positive result found which makes us happy. The BP clinic is not so smooth and we are inundated with people. They are requesting any medication that we can give them even if they do not require any medication. I give out vitamins and Tylenol again. We see the same high readings that we have seen at previous clinics and many people admit to being put on meds by a physician in the past but do not continue with the meds. Compliance with therapy is a big issue here. A local farmer brings us a basket of bananas as a token of appreciation and the nurses at the clinic also arrange for some bananas for us. We have enough bananas to feed half the village. We are in need of interpreters and the Chief himself sits with us and offers translation services. He is a great and humble man. A young mother brings her child to me for examination. His head is very large (about the size of my head which is big!) but they body of the child is the size of a 2 week old baby. The neck cannot support the head. I am told that the child is 3 years old and she has not taken him to a specialist. I do not know that the problem is but quite possibly a case of hydrocephalus which has obviously gone untreated and I doubt that there is any effective treatment at this time which will restore that child to normalcy. She is hopeful that I can do something and I feel helpless that I cannot offer any advice other than to have her try to get an opinion in Accra. It breaks my heart to know that had some measurement of head circumference been done at his pediatric evaluations then this problem might have been caught at an early stage.

We have to close the clinic. I am totally out of BP meds. I have purchased over 2000 BP pills to bring with me and I have gone thru them all and it is only a drop in the bucket. We make a donation of supplies to the nurse’s clinic and pose for pictures. Everything here is a photo opportunity.

We then hike up a small hill to the site of proposed orphanage. Currently there is a day program in Peki which helps to support orphans and other children that have been rescued from child slavery. There is a practice in this country that poor families will ‘lease’ their children to fishermen. They are taken at a young age and exploited because of their small hands and ability to help detangle the nets. They have no health care or proper food and housing but are slaves to these fishermen. Groups like AFRICED work to purchase back these children and acquire legal custody of the children. There is some hope to return some of them to their families if there is assurance that the child will not be re-sold but usually that cannot happen. These children are placed in community in foster homes but much of their expenses need to be paid. This is where non-profits like AFRICED come in. They are working to build a safe orphanage for these children and hopefully find adoptive homes for them. We visit the unfinished orphanage and realize that they need much more to complete this building. We have brought toys, clothes and vitamins for the children at the Peki orphanage and I intend to donate some of the money from my church to this orphanage and may consider sponsoring a child. Again my efforts are small in relation to their need but maybe some of my friends who are reading this will want to become involved.

We leave this village with some sadness. In less than 24 hours we feel so connected to this community. It is prettier than Kpando due to its location at the base of a large hill. There are cool breezes and green grass. The people do not know us but welcomed us as their daughters. We have our African names and our Queen Mother who will return with us to the US. We sincerely hope to keep the UML- Peki relationship going.

We now begin our long journey out of the Volta region and back to Accra. It is hard to believe that we have been here for 17 days. Our trip is almost over.