I begin my day with my usual breakfast, saltine crackers, peanut butter and strawberry jelly. Maura has managed to purchase some Diet Coke in Accra and I savor one every few days. We set up our ‘kitchen’ on our desk on our room and enjoy our breakfast. Lunch is usually something I can put in my backpack and I have some crackers and cheese that I eat at noon today along with my warm water. Supper today was at Cedes where I ordered toast and hot water. I added the hot water to my Easy Mac. It was kind of gross and I don’t know if it was the water or my preparation techniques. Obtaining food is somewhat of a chore. We have the restaurant but the service is VERY SLOW and a limited menu. Some of the girls have managed to obtain some local fruits. As we leave the restaurant I see a dead chicken at the end of our walkway. I am not sure how it got there or if it has any significance for us. I hope some critter comes and gets it tonight. I go the internet caf’ and have a frustrating time trying to log onto Comcast. Over 18 minutes and it still would not load. I switched to gmail which was a bit quicker so I have decided to use that email address for the majority of our trip. I have asked Jesse to help me post my BLOG entries to the internet so I hope you are reading this on the BLOG. I probably will not be able to read your comments until I return so if you need to send me a message you can send it to HYPERLINK “mailto:valkingnp@gmail.com” valkingnp@gmail.com.

I worked again at the clinic today and spent some time with Maria. She is the essence of what you want a good doctor to be. She is compassionate and loves to teach the patients and the nursing students. She discusses her curriculum with us and I think the nursing students are probably glad that they chose nursing and not medicine. It is a very rigorous program. She teaches so much to the nurses but I am also able to teach her a bit about primary care and our US healthcare systems, specifically managed care.

After the clinic we go to the Market. The market is a rotating day that features local merchants who sell everything from rice and beans to fabric to old dried out fish. I have so many pictures to share and I hope to post them upon my return but I cannot even attempt it here with the current internet access. I buy some fabric with the last of my Ghanaian money. I have plenty of US money but we cannot change it here in Kpando and I have to wait for our trip to Hohoe tomorrow. I have to bum some money from Maura to pay for my supper and my internet access. I have arranged to have a Bu-Bu made( ? spelling of that word). Think of a MU-MU and you will know what a Bu-Bu is. I figure it would be comfortable to wear around the house. Many of the students have bought fabric and will be going to Billy the Tailor to have some dresses made.

At the end of every working day we have a debriefing session. This is very important for all of us to discuss our daily experiences and to share thoughts or concerns. Some of the students describe some horrific conditions at the hospital. They describe horrible deep wounds being debrided without the aid of any pain medication. It is only after some of the UML nurses and Maura make some comments that the physician agrees to order some pain medication. There are dead bodies that are left in some of the wards waiting for the family to claim. The families are expected to play a huge role in the care of their loved ones. The nurses do not provide much personal care and often seem like they do not want to touch the patient. Blood from a wound and urine from incontinent patients are often left on the floor to dry. There does not appear to be any trained housekeeping staff to deal with biohazards. Women are asked at the clinic to bring cotton clothes with them when they go into labor so that they can be used to soak up their own blood. Babies are having respiratory distress and there is no oxygen and one mother is observed at her child’s bedside today with a look of resignation because it is highly likely that he could die. Infants are born and there is no suction if needed. The doctor whacks the baby with a towel and says it is ‘good for them’. Some patients are upset that their herbal folk remedies have not cured their hypertension which is no w in a very dangerous stage. The students try not to be too shocked by the conditions but it is hard. Lauren (one of the students) admits to forcing herself to look up at the ceiling to compose her emotions as she is so distraught over some of the conditions. The good thing is that there is a new medical director at the hospital who wants to make some sweeping changes at this facility. She is anxious to hear the impressions of the UML students. We hope to compile a report and present to her in a few days. I will be there tomorrow. It is a little out of my element as I am not a hospital nurse but I have been told by those who have worked at the hospital in the last few days that the deficiencies in the nursing care will be very obvious. There is much hope that our visit my have some lasting effect on the health care here in Kpando but I am not sure that that will happen. Change is very slow to happen and I think we have to be very careful how we voice our impressions. Continuing education is lacking here. There is no incentive to continue with learning new skills. I have decided to do a presentation on Thursday on a few topics to the nurses in Kpando health clinic. It was a spur of the moment decision and I hope they will want to come. Many of them cannot attend the nurses conference that we will be giving in Ho next week.

Tomorrow is another busy day. More stories to tell and hopefully no more dead chickens!