The craziest day of all – January 10, 2010

Today is a big day. This is the day that one of the UML groups will be doing their HIV program. Of course as with any of projects this year we are given a price of the items that we need for this program. We are using an inner courtyard of a home in the center of the town but we must hire chairs and a canopy for shade cover and also to provide refreshments for the participants. The students are not prepared for this expense so this is a cost I must cover. I am quoted 100 Cedes.(about 80 USD) I have no way to tell if this is accurate. I have no option but to pay. The students will be delivering a 2 hour educational program aimed at the 12-14. We see younger children in the crowd as well as older adults. We have to shoo them away. The content is too mature for the younger children and although the topic is ok for the older people we only have supplies for 50 and the activities are geared for an adolescent group.

I am again upset to learn that there is an expectation that the hypertension clinic will be happening simultaneously. I am needed at the HTN Clinic due to prescribing of meds but I am also needed to observe the students for their grade. This happened last year and I am frustrated by the lack of control I have over the situation. Maura and I work out a tag team approach to coverage of the clinic and supervision of the program. The program is conducted flawlessly and the students did very well. I believe it has been a wonderful learning experience for them. We have already discussed that they can repeat this program in another village but we would not be able to support the rental of chairs or purchase of food.

The hypertension clinic was pure chaos again. Some patients politely wait their turn and others simply step up to me even when I am in the middle of a patient exam and demand to be examined and demand there pills. I have to be firm with many of them and occasionally have to boot them out of my exam area. Patient confidentiality seems non-existent in this country. One child is brought to me because it is the mother’s hope I can cure her because she is mute. She is 5 and has never spoken a word. My exam is difficult and the room is loud and hot. I think she is deaf and there is nothing I can do. I advise her to go to Accra to be evaluated but I am not sure there is a solution for her. Another 4 year child is brought to me. Evidently she was walking fine until 3 months ago when she fell and ? injured her back. She does not have any reaction to sharp stimulus from me from her toes up to her diaper region. She cannot walk now and the teenage mother has not been given much information from the doctors. She is hoping I have an answer for her. I have none to give. Another 5 year old child is brought to me who has not walked at all since birth. I suspect some type of birth injury because there is a distinct absence of any muscle strength in her lower extremities. Deep tendon reflexes are difficult to assess as I have left my hammer back at the guest house. Even if I could assess the DTR I would not have any hope for this mother. I am amazed that they bring these severely injured children to me hoping for some type of miracle.

I am besieged by patients all with one ailment after another. I cannot even complete a rudimentary assessment before another patient barges in and starts asking for some type of help. After a few hours I tell our community leader that it is time to end the hypertension clinic. We have given out many medications. The people are not happy with their care unless they receive some pills before they leave. We have brought some vitamins so we can give out some of those but it bothers us that we are supporting their false assumption that good care = drugs. Patrick takes me on some home visits. These are some elder people who cannot make the walk to the center of town. It has been a long day and it is getting longer. Many of the people in Ghana have hypertension. We have tried to collect some data on our readings but due to the volume of patients we have not been 100% successful. My rough estimate is that 30-40% of the people tested are likely in Stage 2 or 3 hypertension and probably another 30% more are Stage 1. We do not see too many normal readings. Due to my short supply of medications I need to change my criteria for giving out meds. I am reserving my supply for the most severe cases of diastolic over 100 and systolic over 170. There is no lack of people with that reading and my supply quickly dwindles.

When I return from my home visits the students have completed their program and now we are offering HIV testing to the adolescents. We have made a big ethical decision today that some of the students do not agree with. Based on strong advice from the community leaders who know these people we have been advised not to announce that the test is for HIV. AIDS and HIV infected people are highly ostracized in this community. Families of patients with known HIV infection are shunned and often unable to earn a living. There is such prejudice against the HIV infected person. The HIV education program is intended to increase understanding of HIV and to help the young people develop safe sexual habits. The deception about the testing weighs heavily on my mind. I tell all the UML students that they have the option of not testing and three of them decline to participate. I admire their courage but also realize that some of the issues about this testing need to be considered in light of the cultural context. If our goal is to re duce the spread of HIV to others then we may need to use some deception to identify some of the infected persons. I know this decision will haunt me for a while. We have been assured by our leaders that this practice is common and that even the Margret Marquart hospital does testing on patients without consent and there is a code on the charts that indicate their HIV status. It is a difficult and tense period of testing. I am thrilled that we have not one positive result. We are fairly certain that most of the adolescents know that they are being tested for HIV due to the fact that they just had a 2 hour lecture on that topic. The youth of this country are much more open about this disease and hopefully will be able to dispel some of the prejudices.

The day has not ended yet but we leave Nkonya because we have more work to do in Kpando. After a brief rest at our guest house we gather a box of toys and clothes and deliver them to a nearby orphanage. We had originally planned on donating these items to Hardt Haven orphanage but we have met some resistance from the director. We then became aware of another orphanage in town that is equally needy. We go and make initial introductions at the facility, Missahoe Orphanage. The UML Students are enthralled with these children. The is home to about 30 boarding students and an additional 10 other students during the day. It is a very well run orphanage with evidence of an orderly organization that emphasizes the children’s health and well being. The director and staff members are loving and attentive and the children all appear happy and healthy. WE enjoy a short period of time playing with the children and tomorrow we will return to give them some of our donated toys and clothes. These children have nothing but they are so appreciative of any little toy or sticker that you give them. It is refreshing to see the young pre-teen boys ( 10-12) who actively seek out the coloring book pages and they color with great enthusiasm. An American boy of the same age would never be satisfied with the simple pleasures of coloring a page. These Ghanaian orphans represent an unusual stage of innocence not often seen. I am reminded again how fortunate I am to have healthy children and realize the vast differences in the childhood of my children versus that of a Ghanaian orphan. It is much food for thought .

Back to the Village Where I Spilled My Blood – January 9, 2010

Today we are schedule to go to Nkonya. This is the village that I fell at last year and suffered a nasty abrasion to my leg. It took a few months for the scar to go away but I remember that village very distinctly. It is extremely poor and has no source of regular medical care. There is a clinic that is almost completed but the government does not have the money to support staffing and supplies.

Today we are doing some preliminary work in preparation for our HIV education program and testing that will happen tomorrow. Every action we take seems to require a lot of preliminary work before we can begin. We must make our introduction to the community.

There is a funeral happening to day. The town is very active with families dressed in black and red (traditional colors for funerals). We break into 4 teams and the students are advised to give out condoms and any related teaching to the men and women and young adults that have questions regarding the condom use. We have been told that this community has a very high incidence of HIV. Because of the poverty many of the young girls are lured into being sex workers and often acquire HIV. They bring these diseases home to their community and then infect the men there.

There continues to be a huge social stigma for HIV. People do not want to know if they are HIV positive because once you are a known HIV infected person you are shunned from the community. It is not just you who suffers but your whole family suffers from the stigma. So what happens is that people refuse to be tested and often if positive will refuse treatment. Last year we conducted an HIV testing clinic and one woman was found to be positive I was the one who had to tell her that she was positive. I have learned today that she refused to acknowledge her diagnosis and would not take the antiretroviral medications. She is dead now for a few months. I recall her as a middle age woman with no other medical issues.

The UML students last year did an HIV program for the youth and this year’s students will be doing a similar program. It is hope that if we educate the youth then they may be more likely to engage in healthier behaviors but also serve as advocates for the people in their community.

I am lead by Patrick who remembers me from last year. He is a community leader and all of our negotiations have to go through him. He has also informed me that another patient that I told had likely advanced breast cancer last year has died. There is no such thing as regular mammograms for the women in this region. I am a bit heartened to hear that one of the patients that I saw last year with an enormous rectocele has been seen by a physician and she is much better. I don’t think she had surgery but she is in front of me and appears well. He tells me that she was inspired to see the doctor at the hospital because I told her to go.

We break into 4 teams and go into the village to distribute condoms and check BP. At every home they are desperate for any thing you can give them. I have some Tylenol, Motrin and vitamins that I give out if necessary. Even if they have no pain or hypertension they want medication. This is a real big problem here. They want to take the pills short term to solve the problems but are not willing to make the long term lifestyle and sanitation changes that need to be made for overall improvement in their health. It can be discouraging to see so much need and to realize that we are only making a very small dent in their existence.

Patrick has many needs and wants me to help him find a medical provider that will stay and work in their clinic. I struggle with the notion of foreign countries providing aid to these people when their own government needs to make sweeping changes to ensure that there are personnel and supplies available to provide care. I am taken from home to home to home and the story and the people are the same. We are supposed to meet with the chiefs but I don’t believe that will happen. They have had a big funeral today and many of them are at that ceremony.

As word gets out in the village that nurses are in town the number of patients amazingly increases about 10 fold. At every corner there is a cluster of patients wanted some of this ‘free medical care.’ At one point we have to physically be directed to our awaiting Tro tro to go home. Tomorrow we return to Nknonya for the HIV program and another stationary BP clinic. I am dreading that day because I remember last year and it was a mob scene.

January 8th

Today is the day that we make our presentations of goods to the health care facilities. We are welcomed with by both Margret Marquart Hospital and the Kpando Health Center. We have brought so many supplies and we are trying to divide the wealth a bit between all the health care settings. There is so much need and we question whether our small donations can make a difference in any significant way. Everything is a photo opportunity although I am not sure if these organizations would use the photo. We took all kinds of photos last year and I know I never was asked for copies. At least the UML website has used some of the photos.

After the donation Maura and I return back to the hospital to meet with the medical director, director of nursing and the hospital administrator. They are anxiously awaiting our report. In retrospect I am impressed with the report that we were able to generate for them. It contained very honest observations about the nursing care at the hospital. There were many areas that they had already identified as problem areas. They thanked us for our report that they will use in helping to make some changes. The new director is very anxious to make some positive changes. All 3 of them are professional and courteous to us. Part of me is feeling bad because we are delivering a not so great review but the director assures me that this is the type of information she is looking for.

We complete are little more time at the hospital or clinic and the get ready for one last trip to Torkor. My goal is to bring some items (glasses) that I had promised to one of the nurses and a lovely patient. We also have some soap and other supplies and clothes to distribute. When we greet the nurse I get a bit angry for the first time this week. She is quite upset that we have arrived ‘late.’ It is 3 pm and there day ends at 5 pm but obviously we have cut into their ‘down time.’ There are no patients in the clinic and she looks at me with disapproval (mind you, this is the nurse who needs the glasses that I have made a special trip to bring). I was very hot and tired and quite resentful of her attitude. I then said that I would be more than happy to bring my nurses and my supplies to another village if she did not want her residents to have any of the supplies. I think she saw my anger and then relented to let one of her medical assistants bring us around the village. We were able to visit about 60 people in a short period of time but to be quite honest I was happy to be leaving that village.

This is not the first time we have met some resistance to our overtures of donations and care. We also are getting occasional remarks from certain villages when they find out that we have been to other villages and we did not bring supplies to them or we did not do a presentation for them. There is so much need here any it appears at times that we are being pulled in many directions trying to satisfy everyone but at the same time leaving them wanting. It is tough thing to experience, especially when most of us are very hot and tired and running on empty (physically, emotionally and financially). Our nightly debriefing allows some verbalization of these feelings and I am trying to be available to the students for any issues or concerns. I think some of us can feel our time at Kpando coming to a close and there is some pressure in terms of time and resources.

I still do not have access to my UML blog site to post my entries. I have been able to have my daughter post some but it appears that some of my entries were not uploaded. I am working with UML to fix the problem. It is amazing how our lives can be disrupted by glitches in our technology and the people of Ghana live with such little technology, with the exception of the cell phone.

I would like to make a comment about cell phone use here in Ghana. In Kpando it appears that many people own a cell phone. It is like a 3rd arm or leg for these people. They come to our clinics with no shoes and in obvious need to some ‘free ‘ health care but many of them have their cell phones. What I find most appalling is the etiquette. Calls are received at any time and there is no attempt for the owner of the cell phone to excuse themselves from the ‘live person to person’ conversation that they had been engaged in prior to the ring ring. We observed nurses answering cell phones in the middle of patient interactions. They also tend to not offer a final goodbye when they end the conversation. Sometimes all you hear is a click. There are kiosks about every 50 feet on the main roads that sell minutes(or units) to the phones. There is a currently a few big service providers but VODAPHONE is the big guy in town and the company has saturated the village with signage to make their name a household name. Last year this company was not here and this year it is a huge business. It is interesting to see how much they have saturated the village with their branding.

In the early evening Maura and I journey down the street to the hospital and we hear lots of singing, drumming and horn blowing. People are dressed in vibrant red clothing and black. It reminds me a bit of Mardi Gras. I am told that on Friday nights the bodies are removed from the morgue and families arrive to take home their loved ones for a funeral in their home village. Funerals are big business here. People may not have the money to buy food or health insurance but they have money to support elaborate funerals. One by one the family groups go into the morgue with either a personal car or truck or a hired taxi. The body is wrapped head to toe in fabric and it is put in the back seat between 2 living family members. It is macabre to see these corpses sitting up in a car. We are told that they smell very bad and are sometimes discharging bodily fluids which then soil the inside of the car. This gives me the creeps knowing that some of the hired taxis that we have rented may have carried a body at one time. We are fascinated by these customs and watch for a while. Some of our own plans for clinics have been changed due to funerals being held in some of the villages.

Tomorrow is we are in Nkonya and our program that was scheduled for Monday has been moved to Sunday because of a local funeral.

“Pride and the American Nurse”

By Valerie King

Today is my first day at Margret Marquat Hospital. For those that know me this is not my area of
expertise. I am a community based nurse.
I am much more comfortable going from hut to hut than to try to serve a purpose
in an acute care hospital. I had hinted
at my desire to stay at the outpatient health center but Maura thought my
assessment of the nursing care at the hospital would be helpful.

We have been asked by the new medical
director, Dr. Lucy, to do an evaluation of our experience at the hospital. She wants to make some changes so our input
is solicited. We are treated very kindly
by the nurses but there are significant deficiencies in the nursing care that
goes against everything that we have been taught as an American Nurse. The contents of our report are too lengthy to
go into in this Blog but suffice to say patient safety, infection control and
issues related to competent and compassionate nursing care were some of our
biggest observations.

Later on this
evening I created with Maura and the students, a 4 page document that we will
use to present our findings to Dr. Lucy.
I am reminded of the comments of my teacher and friend Dr. Geoff
McEnany-Phillips when he taught me about evaluation. It is important to be truthful but we have to
be mindful of the stakeholders in this situation and try to present our
findings in a thoughtful and professional manner. We create the document over a
bottle of wine and with very insightful comments from the students. I am not sure how Dr. Lucy will use the
information but we felt it was our duty to be advocates for the patient but
also to help promote professional development of the nurses in Ghana.

To help
with our goal of professional development I gave a 2 hour lecture today at the
Kpando Health Center on a few topics. I
presented a lecture on the assessment of the geriatric patient and also
diabetes mellitus. The audience of
mostly nurses but some other staff seemed to be very much engaged with the
lecture. I had to slow my rate of
talking and to try to use appropriate and understandable terminology. I tried to lose my New England accent.

The time flew by and I was encouraged by the
thoughtful questions that were asked by the participants. I have truly come to respect these Ghanaian
nurses. They work with such limited
resources but have such potential for improved care if only they are given the
education. Throughout my lecture I keep
repeating that they have incredible power as nurses to make a difference in
their patient’s lives. I think the
nurses could play a larger role in the care of the patients but am limited in
their knowledge and sense of responsibility when it comes to patient outcomes. I pretty much told them that they are much
more important than the doctors (my apologies to my physician colleagues). I think there is a vast difference in the way
that Ghanaian nurses and American nurses are educated based on my

I would like to see these
nurses claim their autonomy and professionalism. Change comes slowly. I think having the UML nurses work with them
opens the door to comparisons, questions and emulation of behaviors. We have witnessed an obvious change in the
demeanor of the patients when the UML nurses address them with respect, touch
them and provide the level of compassionate care that is the trademark of the
American nurse. I have such personal pride in the accomplishments of the
student nurses from UML. We have had
many thoughtful conversations at night about the comparisons of the two
countries and their ideas for improvement.
I am proud to be a graduate of UML and I am equally proud to be a nurse
educator who will have a role in creating the future American nurses. I will end now on that positive note. There are still many more stories to tell but
again I am burning the midnight oil and tomorrow is another busy day.

“Tears, Smiles and Tears”

By Valerie King

Today we are scheduled to go to the Hohoe Christian
Children’s Home. Before we leave Kpando we have become aware of another acute
public health problem. We drive a very short distance behind the health center
and we are in a small village. We depart
from our Tro Tro (which appears to be held together by not much more than duct
tape and rust). We are visiting a
watering hole. We trek into the woods about ‘ mile along a rutted path and we
meet many people, mostly children, coming out of the woods with various water
containers on their heads. It is amazing that these people have to walk such
lengths to get their water.

Our true
shock comes when we come upon the watering hole. There are actually 3 holes. The first one can
only be described in one word. DISGUSTING.
It is a large hole in the ground filled with putrid green water. We do not see people collecting water from
this hole but we are told that people do use it if the other holes are low. We
come to the second hole. I have to tell
you that the next part is pretty gross.
If any of you have the seen the movie The Ring you will recall that
there was a deep well that a little girl was drowned in. Well this ‘hole’ is exactly like that movie
and the saddest part of all is that over the last year six children have fallen
in and drowned and only one body was recovered.
The other 5 bodies have sunken to the bottom of that well and supposedly
not retrieved. These families have to
continue to draw their water from this well.
Part of me doubts this story but if it is true I can only imagine the
anguish a mother must feel as she has to draw water for the rest of her
children from the very well that took the life of her other child. The third hole is quite active today and
surrounded by about 20 people who are drawing up the water using buckets and
ropes. You can see how a small child
could fall into these wells and if no one was around there is no way to climb
out. It is a pure vertical cylinder of
old stone. The village has been trying to get some funds to dig a bore hole but
the government is not listening to their request. They have asked for our help in this
project. We are unsure what we can do to
help them but we will be visiting them on Saturday for a demonstration about
boiling the water that they are pulling out of the holes before
consumption. We will see what the costs
are for a bore hole. This is a perfect
project for our engineering students at UML and I hope to bring this to their

our walk out of the woods we load back into the Tro Tro. We are like little sardines squeezed into a
small tin can. Hohoe is about a 30 minute drive down bumpy roads. We arrive at the orphanage to be greeted by
the loving arms and hugs of 30+ children. They are all so happy and
affectionate and give freely of their hugs.
One of the Community Projects is implemented today with the

The UML students are presenting
a dental health program today. They have
donated samples of toothbrushes and paste and have developed a whole program
that is flawlessly implemented for the attentive audience of children ages
3-15. It is interesting to note that
even the older children are interested in the coloring pages that are given
out. They do not consider them to be juvenile and my impression is that they are
sweetly na’ve to all the usual American teenage angst. I am joined at the hip by my new ‘son’
Francis. He has stayed with me all day
today and at our previous visit. The
founder, Nicholas is married to an Australian woman who is back in her country for
a Christmas visit. She is a white woman
and I think the children are missing their white mother. I am missing my own children so it is a nice
way for me to give and receive affection.

There is a cute little three year old girl named Lee and she has a very obvious bald spot on one side of her head that appears to be a healed burn. We ask for her story and it is the most tragic story I have heard yet. She is from the region of Tamale and has only been in the orphanage for about a month. She used to live in a village that was very superstitious. Her parents died, of causes unknown to me, but her grandparents believed that this little girl is a witch and she is to blame for her parent’s death. They chained her and starved her and burned her head with some type of hot metal to get rid of the witch. She was found by a census worker who rescued the child and gave her to a Peace Corp volunteer who in turn brought her to the orphanage. You can see the fragile bones of this dear child who appears to be thriving in this caring environment but one wonders about post traumatic stress disorder and what type of psychological issues will arise for her in the future. She is affectionate and loves the clothes and underwear that we have brought with us. This horrific story has me near tears.

The young boys seem to gravitate to Maura and me probably because we are mothers. They want to tell us about themselves and share their colored pages with us. My buddy, Francis is staying close to me and insists on carrying one of my bags. We take multiple pictures and I cannot wait to load them onto the BLOG site. Our Tro Tro arrives and the children hover around us. Francis is holding tight to me and crying into my shirt. It breaks my heart to leave him but I am not in a position to take him with me. I would like to continue to communicate with the director and hopefully Francis will write to me as he has promised he would. There are so many children here who need a home.

My day ends on a bright note. I have been able to use my own laptop in the internet caf’ and the access seems a bit quicker. I have been feeling a bit lost without communication from friends and family and I hope it will improve a bit. It is now about 11:30 pm and tomorrow will start early so I will go to bed now.

Polly Want a Cracker and Dead Chicken – January 5, 2010

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 “”

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!

“Slow and Fast” – January 4, 2010

Today is our first day of working in the clinic or the hospital. We walk the mile walk up to the Kpando health clinic because we are supposed to meet with the medical director before we start our day. We are told he was at the bank and then he was on his way to Accra. There is so much protocol involved before we can enter a clinic. We separate into 2 groups. Five students plus Maura go to the Margret Marquart Hospital. The other five students go with me to the Kpando Health Clinic. We are divided into 5 different areas. Two students are with the midwives in maternity clinic, one student is doing vital signs, another student is with the intake nurse, one student is with our friend, Maria who is a medical student from Puerto Rico. I am spending some time with Psychiatric nurse. She gives a daily HIV/AIDS talk in the waiting area. It is all done in Ewe dialect so I cannot understand what she is saying but I can tell that the patients are engaged in the lecture and are asking questions. The HIV rate is very high in this region and that is why we are doing HIV education programs as part of our community project. I then spend some time with this nurse, Margaret. She is doing an initial evaluation of a new patient with a history of some type of seizure disorder related to multiple beatings. He is also describing other symptoms which ( in his broken English) sounds like a Schizophrenic presentation. He has been on Haldol at a prior clinic and needs a refill. He is ok today but he is worried that he will get worse. It is interesting to watch her do her assessment. She does not ask the questions that I think are necessary and she makes no eye contact with the patient. One of the most interesting observations with the nursing care here in Ghana is the way that the nurses interact with the patients. They are very brusque and appear to be uncompassionate with their patients. There is very little touching and patients are treated more like a nuisance at times. It is vastly different than the way our American nurses are educated. We are taught the value the human interaction and that we , as nurses, have so much to give to our patients. We are told that there are many women who go into nursing for purely economical reasons. It is one of the highest paying jobs, about $5,600 per year. They seem to work at a slower speed than the American nurses. I quickly analyze the patient flow and can think of recommendations but I am not sure I am in a position to suggest changes. There are many other behaviors that are witnessed by our nurses and I will try to comment on those as I write other entries. The nurses are friendly enough to the UML nurses but not overly so. A few of them want to ‘further their studies’ in America but I do not know if they have the means to do that . I have some admission information which I share with them. I think some of them are surprised that I cannot sponsor them and pay for their education.

So now to the slow part of my day. The internet. The curse of my existence here in Ghana. I had such grand hopes of really staying connected to family and friends via my BLOG entries. The internet caf’ is run by a lovely young man called Eyram who was there last year. He does the best he can but the service is limited by dial up speed and very slow computers. I was in the caf’ for over 2 hours and left frustrated because I could not connect to the UML blog site but also had a hard time reaching friends and family. IF you are reading this I would love an email at””

I have now been here for about 9 days. I have 14 more days. This trip is much more organized than last year. We are getting so much done and our schedule if jammed packed. Stay tuned for more stories.

‘Sunday is a day of rest’

By Valerie King

After our lack of sleep last night we are a bit sleepy today and I think many of us could use the rest. We wanted to go and visit the Fesi Pottery and the Lourdes Grotto today but there was some confusion in our schedule and it never happened. We had also hoped to see the children drummers from the local church but that also did not happen. I did some administrative work for NSWB and around 2 pm we walked to the local carver, Papa Bones and Billy the Tailor. The students are buying and ordering some wood carvings and also getting some fabric for dresses to be made. The day is quickly passing and after a brief session at our meeting spot across the street we make the 1+mile hike to Shine and Bernard’s house. We have been invited to supper. The students are amazed that Maura and I made that walk every night in the dark. It is treacherous in the beginning due to the auto traffic and treacherous at the end due to incredibly uneven terrain. I am again amazed at the air quality here. It is such a poor quality due to burning and engine emissions. We are all feeling in our lungs and most of us have a dry cough. Our clothes and hair seem to absorb these smells and there is a huge drying effect upon our hair and skin.

We have a great meal of Pasta and Sausages which reminded me more of a spicy Pad Thai and fried Kielbasa. We are all very weary due to poor sleep last night. We leave and journey back home. I try to take some of the walking time to get to know some of the UML students a bit better. They are all lovely so far and I am enjoying my time with them. We walk past the dim and dirty shack where Hannah (age 6) Michael (age 10) and their mother Edith. We have gifts for them and we bring them to their home. They are so appreciative. Edith wants us to take pictures of her officially receiving the gifts. She is also talking about a plan that she would like us to set up a school in her village which is further away. We are constantly overwhelmed by needs that this country has but we tell her that we do not have the resources to start a school.

As I near our guest house I have one last stop. I must meet with my new friend Foster Dominics, who is trying to enroll at UML in the nursing program. I have given him some admission information and he has to wait now to take the SAT and TOEFL test. That will not happen until December 2010. Until then he plans on working and saving money for his dream to get a US education. I told him I can assist him with making connections in the US but I cannot be a financial sponsor of his education. He is a gentle young man that appears to have the intellect and desire for a nursing education. He has a twin sister, Fostine and his mother died about a year ago. I told him I will do whatever I can to help him with this processs.

As I type this my eyes are very tired from lack of sleep and also the effects of the smoke in the air. I am going to bed. Tomorrow is our first day in the clinic.

‘Smoke and dust in your eyes’

i>By Valerie King

We do not have any clinics planned today. We are going to make our first visit to the
Christian Children’s Home in Hohoe. This is a very well run orphanage we
visited last year and I am excited to return.
We have to rent a tro- tro to get us there. The cost is 10 cedis per student (under
$10). We will be using that
transportation to go to the Wli Water Falls also.

A tro-tro is a larger passenger van that
accommodates anywhere from 12-16 passengers legally but there are many
instances where there are many more people jammed into these vehicles. Occasionally you can see a goat tied to the
top of the vehicle along with multiple boxes and parcels that the passengers
are carrying. Some of the larger
transport vehicles will have 10-15 feet high of parcels and boxes. It seems top- heavy to me and that it would
not take much to topple the vehicle over.
The condition of the Tro Tros can vary from bad to very bad to very,
very bad. Usually they are very dirty
with ripped or taped seating and dirty and slightly rust interiors. We are all very glad that our tetanus is up
to date. Because of my motion sickness I
am usually sitting beside the driver on the raised seat in the middle. That is an advantage in that I can see out
the front window. It is a disadvantage
because my bottom is sitting directly above the engine and it is literally the
‘hot seat’. Seatbelts do not seem apparent
except for the driver. It is a manual
transmission so I must move my leg whenever he has to shift the tro-tro. It is very loud due to engine noise and all
the windows are open. There is no air
conditioning and the open windows let in all the dust from the roads. I am struck again by the air quality. It is now the beginning of ‘burning season’
and the farmers have begun to burn their fields in preparation for the next
growing season. The cars and other
vehicles would never pass any emission test in the US. They are frequently seen with a trail of
black exhaust. I do not know the
incidence of respiratory diseases here in Ghana but I am sure it must be an
emerging problem.

arrive at the Children’s Home and are again greeted by a throng of happy
children. They sign some songs for us
and I have captured some of video and will try to post on this BLOG. They are all extremely affectionate and run
over to hug me and the girls and grab our hands. One little boy, Francis offers to carry my
bag. I am a bit leery but then I am
reassured when he carries my bag but also does not let go of my hand. We are buddies for the morning. He gleefully shows me his schoolroom and
dormitory. The conditions are very
spartan but there is an attempt at cleanliness and orderliness that I did not
witness at other orphanages. I hug the twins that I met last year and I am told
that they are being adopted and will move to a family in Texas. There are about 40 children and 15 of them
are awaiting adoption. My heart wants to
take them all home with me but I know that is not realistic. I do want to contribute to their welfare and
will use some of the money that has been donated to me by my church for this
very worthy orphanage. Today is a
preliminary meeting for the children and the UML students. We will return next week with some of our supplies
(toys, clothes, medicine) and also will conduct a dental health teaching
clinic. We have received many donations
of toothbrushes and toothpaste and one of my Community Project groups will be
doing 2 dental health clinics at this and the orphanage in Peki. It is time to leave these children but we
have left them some coloring books and crayons and we will return.

We have negotiated for a lunch at a nearby restaurant. Everything here is about negotiation. I have agreed to a certain price for our plates of food and we are served the food which is jolloff rice (spicy red rice) and chicken and vegetables. It is a clean restaurant and all is going well until the proprietor comes with the bill. She has increased the price per plate, AFTER WE HAVE EATEN ALL THE FOOD, and now expects us to pay the increased fee. I am livid and I tell her that is unacceptable and that we had negotiated the price prior with her? husband or father. She states he did that without consulting her and he did not know the prices. Part of me wants to just lay down the agreed amount and walk away but I am hesitant to offend this establishment as they are somehow connected to one of our escorts and he has been very kind to us. It makes me angry and resentful of some of the Ghanaian people who assume that Americans are all wealthy and we can afford this price gouging. I again express my displeasure and state for all to hear that I am very unhappy with this treatment and it makes me want to take my volunteers (and our donation of time and supplies) to a place that we will not be gouged. Our escorts are somewhat embarrassed that we are treated like this but let me take the lead. My vow is to be much more aggressive with any expenditures of money. This is not the first instance of the ‘price changing’ that has happened. I realize that these people are only trying to survive but the whole premise of gouging has me angry and hurt.

We return to our tro-tro for a 30 minute drive to the Wli waterfalls. We are told that it is a very busy day here due to the holiday (January 2). I am not sure what holiday that is but the prediction is correct. We trek 45 minutes into the deeply wooded terrain and come upon the Wli waterfalls. They are magnificent and only pictures can describe. I will try to post some pictures. What amazes me on this trip is that there must be at least 300-400 people there. Mostly young men and women are in various stages of inebriation and celebration. There is much drumming, singing and dancing. We are the only white people there. We attract some attention but not as much as I would have thought. The air is charged with all this energy and I am slightly uncomfortable and feel the need to watch the UML students and our belongings very carefully. Most of the girls decide to go in for a quick dip under the cold waterfalls. They do attract some attention as they walk to the water in their bathing suits and I feel tense as I watch for any signs of inappropriate contact. They are accompanied by Kwadwo and Mawuli and I think that helps. After they return to our little pile of clothes and bags they are now approached by some of the Ghanaian men for their contact information. I ramp up to ‘mother ‘mode’ and gather them close and tell the med that they cannot share the information. He is not buying that. I then tell him that I am their teacher and if they give out any information they will flunk out of school. That carries a bit more weight and the men eventually leave. We decide to leave and I am a bit relieved. It has been a fun trip to the waterfalls but last year was more relaxing for me.

It is starting to get dark as we leave and we have a long journey back home. The road conditions alternate between smooth pavement and deeply rutted dirt roads. We are jostled in the tro tro and try to rest a bit but it is difficult. On the way we drive through many villages with young people gathering for today’s holiday. It is busy and loud and the tro tro must move slowly through the crowd but then our driver speeds up on the smooth roads so it is a very chaotic drive home.

We arrive back at our guest house find out that there is some type of event happening in our courtyard. There are chairs and later on it becomes a very loud ceremony/gathering of some sort. The PA system they use is scratchy and I cannot understand what they are saying although I believe it is in English. There is loud music. Now I hear a competing sound, on another scratchy PA system. It is hard to tell where it is coming from and I don’t really want to leave my room to explore. Unbeknownst to me it is beginning of a very long and loud gathering that will go on ALL NIGHT LONG. There is drumming and a repetitive chanting and ? singing that is not melodic to my ears. At midnight I hope it will end, it does not. At 3 am I hope it will end, it does not. At 6 am I hope it will end, it does not. Finally the roosters start crowing around 6:30 and the music seems to end but then the village awakens, the son is in my eyes and there is not much sleep to be had. We had hoped for a good rest last night but we did not get it. It is now January 3. We have been here for less than a week and so much has happened. We have 2+ weeks left and many more activities.

“It is a new year!” – January 1, 2010

By Valerie King

I stayed up until midnight to go and sit with the students for the New Year countdown. No big ball falling from New York City but the tiny glow of a cell phone and wrist watch that tell us the New Year has arrived. The students are happy and mellow, having spent a few hours relaxing at the Friendly Spot but we all return back to our room because we know we have a clinic to do tomorrow at Torkor. My sleep is interrupted last night by the local singing and dancing that is occurring into the very wee hours of the morning. The residents have returned from their church services and are ready to have a party.

After a breakfast of Crystal Light and peanut and butter crackers. I pack up my bag and medications and get ready for another clinic. We negotiate for a taxi ride (50 pesuas per person which is about 50 cents). The car is something that you see in our worse junkyards. Half way to Torkor the car stalls and the driver lifts up the hood and ties a plastic bag around some type of tubing under the hood. I hope it is not for the brake fluid.

We arrive in Torkor and it is much less crowded from yesterday. There are very few market vendors and it appears that half the town is sleeping. I think that is the case because we don’t have many patients the first few hours except for the small children.

They are fascinated with the student nurses and are very anxious to have the nurse, “touch them.’ We have been able to do some pediatric assessments. It is difficult because many of the young mothers do not speak English. It seems to me that in the poorer communities the young men seem to have some command of the English language but the young women not as much. We do not have as many interpreters today so some of the young men help us out with instructions to the patients.

The children appear healthy but we again are seeing the increased frequency of umbilical hernias. I do not know the reason for that. We have such limited tools. I do prescribe some penicillin for a young child who has some type of skin infection. I am able to demonstrate to the UML students how to do a scoliosis screening. At one point in the day the UML students engage the children in a clapping and singing game. It is a moment we catch on video. The children are always at first hesitant to come to the nurses but after a few moments they relax and are fascinated with the young girls and their cameras.

We see another ‘Ya-vou’ which means white person. We mimic what the residents have been doing to us when they see us walking down the street. A UML student yells ‘Ya-vou’ and this young white man immediately turns and comes to greet us. I cannot recall his name but I am going to call him ‘cute guy from Spain’ and his friend Courage who is a resident of Kpando but attends the University of Madrid with Cute Guy. They are in a PhD program and they study microbiology. They are touring Torkor today just out of interest but tomorrow they leave for the northern regions of the country (Tamale) to gather some samples for their research. They are collecting human and animal feces samples and will bring them back to their lab in Spain to research antimicrobial resistance and certain aspects of the microbes. We invite them back to the Friendly Spot tonight.

We have now been working for about 3 hours and it has been a steady but not crazy flow of patients. It appears that more people are coming now and I suspect that these are the people who are probably just awakening from their celebrations of the night before. We try to examine more patients for about an hour but we are starting to get tired and hungry. We close the clinic at 3 pm and we have to promise to return for another clinic.

This village is so poor and these residents are happy to have some access to free care. They need so much and we are only equipped to deal with a few health problems. Yesterday Alison, a UML student, took one of my big picture books that I use in my clinical practice at home and went out to the waiting crowd to show them pictures of the human body and where the organs are and specifically the organs affected by hypertension.

This is a totally unscripted educational program and I admire her for her ingenuity and ability to recognize that she had a teachable moment. She is knowledgeable and this is not the first time I have seen her jump right in and begin teaching the patients. She recognizes the value of educating the people here and wants to leave them with knowledge about their health. I find all the UML students very inquisitive and willing to learn something new. We have had some impromptu teaching sessions about various topics. Often these topics arise because of something we have witnessed. I am enjoying the process of helping them to consolidate some of their book learning into real life community-based nursing. I am very honest with them about my in inadequate skills in an acute care setting but I feel that I can help them so much with their community-based care.

We pack up our ‘clinic’ which is contained in a cardboard box and my Barnes and Noble book bag and off we go to get our Taxi back to Kpando. We become victim to a little price gouging when we try to arrange our taxi home. We were told it was 3 cedis each way per taxi but now they know that we are trapped in Torkor and they can up the price because we have no other options. We are now told it will cost 5.9 cedis to get home. I agree to the increase and I leave in my cab with ‘ of the group. The other half balked at the price and were ejected from their cab to go and negotiate a rate with another taxi. We are a bit upset that these people would take advantage of us after we have just given them 4 hours of free medical care. Everyone in this country is struggling to survive and the ‘ya-vous’ represent a revenue stream for them. This is the part of the trip I do not like.

After returning home we rest for a few hours. Maura is arriving today. Maura is the other ‘Mama’ who traveled with us last year and she decided at the last minute to join us in Ghana. I am thrilled to have a buddy and another RN who will assist me during this trip. We have arranged a meal of chicken and Yam chips (like French fries). Our cost is $5 for the meal. This food expense is something that was not built into the trip cost because we had no way of estimating it. It is a chore to decide on a menu and arrange to have it prepared by a local woman, Patience. She is a wonderful cook and I am very glad to help her with our money but for me it is tiring to be the ‘menu’ organizer and I hope to share that duty with the students.

Maura and I decide to walk to Shine and Bernard’s house (our hosts from last year). This is about a mile long walk which entails going thru the busy part of Kpando where the walking is treacherous due to auto and people traffic. We then turn onto a very dark and rutted road to continue our journey (about another ‘ mile) down into a residential section. The road and path conditions seem a bit worse this year and we rely heavily on our flashlight to guide our steps.

We meet with Bernard, Shine, 3 of their visiting friends, Mildred who is Bernard’s 4 year daughter and Maria, the medical student from Puerto Rico, who is staying with Shine for 2 weeks. We have a wonderful conversation about various things and we share our gifts to them. This is another aspect of our packing that I did not have last year. Last year I brought a hostess gift to Shine and I had some cheap t-shirts for Bernard and others. This year we return knowing so many more people that we feel obliged to bring gifts. My suitcase weighed so much but 1/3 was food, 1/3 was gifts and 1/3 was clothes. I am looking forward to a lighter suitcase upon my return home.

It is getting late and we are tired so we begin our journey home. Shine and Bernard accompany us ‘ way. The busy street has turned into a mob scene very similar to a Mardi gras atmosphere. There are hundreds of people in the street, loud music playing in local bars that spill onto the street and many, many people walking. We follow a walking street band for a while and get a photo of the group. We are a bit nervous in this crowd and Maura and I walk arm in arm down the street protecting our pockets. We are happy to return to the safety of Cedes Guest house.

The students are having their own little party over at the Friendly Spot with our new friends from the University of Madrid. I am introduced to Dominic who had contacted me via the internet a few weeks ago. He is very much interested in attending UML and studying nursing. He has brought his teacher from high school (who is Courage the student from U of Madrid) who wants to discuss Dominic’s credentials with me. I have come prepared with some admission material and I give that to a very enthusiastic Dominic. I do not know much about International student admission but I can connect him to the right persons.

It is getting late and I am totally exhausted. Maura and I chat for a while in our room and we quickly go to sleep. We are giggling a bit because our families have such a hard time comprehending the fact that we sleep together in one bed. The living conditions are so different here. We are not at the Hilton. I am thrilled to have a comfortable bed, a flush toilet, electricity and the best of all air conditioning. I go to sleep in my sheet snug sack I brought with me and the blanket I ‘borrowed’ from British Airways. Tomorrow is a full day and we need to get some rest.