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‘Another village, another clinic, another presentation’ – January 13, 2010

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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.

Hail to the Queen Mother – January 12, 2010

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I am exhausted right now but I must write a bit about what happened today. This morning was our last day in Kpando. Our plan was to have the large bus pick us up at 7 am for an 8:30 arrival in the city of Ho which is the capital of the Volta Region. We are scheduled be the main speakers at the first National Nurses Conference that is sponsored by AFRICED. Of course as usual we experienced a transportation glitch and the bus did not show up until almost 8:30 which put us very far behind. We load all of our suitcases and remaining boxes of supplies on the bus and leave Kpando. It is a bit sad for me because I don’t know if I will ever see this town again. The bus ride is very bumpy and this large bus is not as nice as our first one. I am worried about getting motion sickness of which I am very prone but as luck would have it one of the students beat me on that matter.

Upon our arrival at the hotel where the conference was being held I was immediately met but our friend Nicolas who informed me that the Minister of Health was due to arrive at any moment with his entourage and the national press. We are told to suspend our lectures until he arrives. There is so much protocol that must be adhered to. I am a bit anxious because the nurses from Ghana have been waiting for our arrival and now we are being told to wait a bit longer. To make matters worse there appears to be some financial concerns as AFRICED has been unable to procure private or governmental sponsors for this program and they do not have the funds to pay all the expected expenses of the day. I am a bit upset when I realize that there is no financial support from the governmental sector. On one had I am very happy to have the UML students and myself give our lectures( free of charge) but I am concerned that other bills for this program will not be paid. I have already obtained some financial support from Eta Omega Chapter of Sigma Theta Tau for a small part of the expenses. After some deliberation Maura and I decide to give some of our personal funds to help support the expenses. We are told that to cut costs we must speed up the lectures to 10 minutes each so the nurses can leave early and we won’t be responsible for feeding them. I understand that this is the first type of program that has been offered in this region but I am also disturbed that the program is being funded and subsidized by us and not the Ghanaian government. It is hoped that the minister will be happy with this program and consider supporting a similar program next year. The students excel in their presentations and make me very proud, although it is very hard to do justice to some of our topics in 10 minutes. The Ghanaian nurses are attentive and ask appropriate questions. I am very heartened to see Sister Magdalene from Margret Marquart hospital. She is such a kind and friendly soul it makes me glad that she has traveled the distance to hear us speak.

There were speeches by the Minister and then I was told I needed to give a keynote address. Well I had about 10 minutes warning and put together a decent speech. The national press was there and I can only imagine what my hair looked like but at least no one at home will be seeing my on TV. At the completion of our program we were able to give to each of the participants either a blood pressure cuff or stethoscope. I have purchased about 50 of those items as my donation to the nurses of Ghana. It is my belief that the nurses here need access to better education and tools and that my little token is one way of helping them provide good nursing care.

We conclude our program and after official pictures are taken we jump on our bus for the ride to Peki. After an hour we arrive in village that sites in the valley between some pretty decent hills (I would not classify them as mountains). It is typical of many of the other villages we have passed but the children are so excited to the Yo-Vo’s (white women). We check into our guest house which is adequate but a VERY far leap from the worse Motel 6 you would see in the USA. This is true Ghanaian accommodations. The floors are somewhat dirty, there is one light bulb hanging from the ceiling, there is a noisy fan (no AC), a toilet that doesn’t flush and a shower that has a trickle of water and a huge spider on the wall. But is has 2 beds and screens on the windows so it is fine. We are told we need to leave for the ceremony and we are intrigued. After a very short drive we arrive at the main village where the chief lives. It is dark now but there are some scattered lights. We can see that there is a huge crowd. It is hard to estimate the number but we are told that the population is about 1000 and I think that there has to be as least 500-700 people there. It is a sea of people comes to welcome the white nurses to their village. The children rush the bus and as we start to take pictures they yell in delight every time a flash goes off. There is no pushing or shoving but rather an appreciative and curious swarming of our group. We are ushered to a place of honor in the center of the village under a roof of palm leaves. I am again amazed at the number of people who are here. All eyes are on us. The drumming and singing begin and are amazement is just beginning. We are told that it is the Paramount Chief who is sitting across the large open area from us. In front of his seat is his Linguist which I am assuming is a person who does some of his talking. On either side of him are the other lesser chiefs. They are all dressed in various colored garb. No western clothing on these dignitaries. Perpendicular to him is the place where the Queen Mother sites. I see a beautiful and brightly clothed woman sitting in her chair and it appears she has her own assistant or linguist that sits in front of her. Now begins the protocol.

There is much back and forth between our side of the circle and the chiefs’ side. One of the AFRICED volunteers is Mawuli who is the chief’s son and speaks to another man who then is permitted to speak to the chief. If I was home in the US it would be a simple matter of a man telling his father ‘hey Dad, I have some people for you to meet’ but here all the correct protocol must be followed. After a while we are then treated to about an hour of performing. There is much drumming and singing and first a dance by a group of young women and a few young boys. I am struck by the fact that had it not been for the large fluorescent bulb nailed to the nearby tree one could imagine they were in an African village 100-200 years ago. There is no evidence of any modern elements except for the occasional flash of the camera and our western attire. The performances keep coming. We are treated to some lovely singing by a women’s group. It is more than 4 part harmony. It sounds like an orchestra of instruments and accompanied only by drumming. It is beautiful and I have a moment thinking of my dear mother in law who loved this type of singing and would have been thrilled to be sitting next to me. Our next performance is a series of short war dances performed by young boys. It is meant to be somewhat frightening and they have their symbolic ‘knife’ which is a stick and they make angry gestures to members of the audience. The younger children on the sidelines scream in terror when the dancer comes to them. The dancer does some facial contorting and has a look to his eyes which is meant to be menacing. It is effective in creating a sense of danger and war.

We were exhausted earlier but now we are running on adrenaline. We realize that we are experiencing something that not too many people from the US will ever see. The dancing and singing subside and we are then presented to the chief. He welcomes us as daughters to his family and we are given our African names. My name is Valerie Ami Aboagyewaah King. A woman ties a beaded string on our wrist and we must great the Chief and Queen Mother and are accepted into their family. We are all standing there except Maura and I am trying to indicate to Mawuli that she has been forgotten. Before I get his attention they announce that they are making Maura a Queen Mother of the Village. She is invited up and a group of women descend upon her and wrap her in a large heavy robe make of Kente fabric, jeweled sandals and a headdress. She is made to sit on a stool with her feet resting on an animal skin. Her arms and hands are powdered and she is positioned to sit in a certain way. Important words are said, applause happens and we (the UML group) must go and give our respects to our new Queen Mother. I am told that Maura was chosen over me because she is a few years older and it must be given to the older woman. She is then placed next to the Queen Mother to reign over the rest of the proceedings. I return to my seat and now the big drumming and singing begins. The students leave me with their bags and cameras and I am the photographer for the next 30 minutes of frantic and loud dancing. The young kids swarm my seat to watch me with the camera and I can no longer see Maura in the crowd. At this point the Ghanaian people all come to dance and many of them take the opportunity to dance with all the young American nursing students. There is much touching and at times the girls have to fend off wandering male hands but even the Ghanaian women touch the students. Then it becomes evident to me that they touch each other as well. It is a surreal experience but the UML girls stick together and seem to manage ok. They return back to me very sweaty but exhilarated with the experience. A woman brings a large bowl of palm wine to our table and we are told to drink. We repeat the customary sipping of the wine from the coconut bowl and then the remainder is dumped on the ground. There is some significance to this dumping and I can’t recall the meaning but we did it last year in a previous ceremony. The wine tastes like soured orange/lemon juice. Most of us are taking tentative sips being more afraid of germs from sharing a common cup than actually drinking the wine. We are hoping that the alcohol will kill some of the germs.

We have been here for 3 hours and we are very tired. Our UML Queen mother is being disrobed somewhere so we walk back to our bus. The crowd has slowly dispersed and many of them have to walk miles back to their own smaller villages. There are no street lights. Small children are walking along the road mere inches from the open sewer trenches. Our bus takes us to one more stop. We are dropped off at the home of Mawuli’s uncle and he serves us more palm wine. This wine is slightly better tasting than the other batch but there are multiple coconut bowls circulating around the room. I wonder if they expect us to get drunk on the palm wine but we are drinking very little. We are on a small porch and the men have left to go drumming and the children of the village surround us. I try to converse with them but they do not seem to understand our questions. They are staring and seem enthralled with us. Eventually the men return and we go back to our bus. Back home in our room we shower in the dark (no bulb in the bathroom… but the spider scurries away when the water starts. I am refreshed by the water but emotionally and physically exhausted but I must write this all down so I can remember. Tomorrow we will have a busy day in our new home of Peki.

“Time to Say Good-Bye” January 11, 2010

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Today is our last full day in Kpando. It is hard to believe that we have already been here for 13 days. We had hoped to do some more sightseeing in the Kpando region but we have been so busy working. We never made it to Fesi pottery or any church services. We did manage to make at least one big market day where fabric was bought and dresses were quickly sewn by the local tailors. We each have some Ghanaian clothing. I have had a Bu ‘Bu ( ? spelling) made. Essentially it is a large sack with armholes. It has a nice neck line and I have a matching piece of material to wrap my head in. I don’t know where I will wear this but it was something I had to wear. We have a meeting with the University of Ghana on the day we leave so I may wear it then.

We are expected in another Village today. It is Anfoega. We have been told that Lt. Col Mike Holly from the US embassy will be honored as a chief. We were hoping the ceremony was going to be today but details have not been fully arranged. Mike does meet us at Anfoega. He has traveled 3 long hours from Accra to meet us. This village is very smart. By making him an honorary chief they can assure themselves some visibility with the US and Ghanaian government. It is a big deal for Mike but the ceremony does not happen today. He is also joined by Jason Turner. Another US Army officer but I cannot recall his rank. Both men are very nice and from the Midwest. It is refreshing to hear American dialect.

We are impressed with the hospital at first glance. We had intended to do a repeat HIV education and testing program here but we find out that it is a Catholic hospital and that type of program is not really welcome here because part of our education focuses on safe sex and the use of condoms. There is a ceremony welcoming us. We are joined by some of the tribal chiefs and also the administrator and medical director. I am impressed with both of these people. The administrator is a young woman who seems to be personable and efficient and anxious to improve her hospital. The medical director is also a very impressive man. He is only 30 years old and he is the only physician at this facility of about 100 beds. He is on call 24/7. He does not have any mid-level providers working there( NP or Physician assistant) but he has established protocols for treatment and some of the more able nurses are able to manage a lot of the care that would normally fall on a physician. It some ways the nurses here have a lot of autonomy and in other ways I see them not fulfilling their potential due to lack of training and resources. I believe that some of the nurses have memorized some of the treatment protocols but may not understand the rationale or the physiology of their actions. It is hard for us to imagine working in these conditions.

We present our supplies to the staff and they anxiously inspect the ‘booty’. The tribal chiefs start to leave and I start taking BPs. A quick BP clinic is set up and we are swamped with mostly employees of the hospital and they are all looking for medications. This part of our efforts continues to bother me. There is a such a deep belief that pills are wonderful and if you are seen by a medical person you must receive pills. I am losing my restraint and start to go with the flow. Healthy men and women get some of the vitamins or Tylenol because this is all I have to offer. Sometimes we feel like the vultures are circling. I have experienced this type of frantic excitement for free items from all types of people here from the poorest of poor to the comfortable. Throughout our trip we are struck by the assumption of the people that we ( the students and myself) are rich Americans and our supplies must be endless. I think of the money it cost us to send these supplies and the hard work in obtaining donations and packing the 50 pound boxes and I wonder if our hard work has any impact if the non-vulnerable people want a ‘piece of the action’. It is something for me to discuss with the future groups that may travel to Africa. I do not want to be cynical but it seems like the same behavior is repeated where ever we go. There is so much need!

As I conduct the clinic with a few students a tour of the hospital is started. I cannot leave my position at the clinic. I am sad not to see the hospital and missed seeing the mortuary where the bodies were piled on shelves with no clothing and no plastic bags. I am told it is an eerie scene. We are treated to a lunch of typical Ghanaian food. We have become good at identifying the foods that we like( Jolloff rice, fried rice and chicken) and the foods that we do not like ( Banku, fish stew and baked WHOLE fish, with eyes intact). We are impressed with the generosity of our hosts and are very much impressed with this facility.

We return home to Kpando and begin our goodbyes to some of the people we have known to care for. We say goodbye to Eryram the young man who runs the internet caf’ and kept us connected to our loved ones, we say good bye to Pascalin who cooks for us at Cedes restaurant, we say good bye to Edith who must be the poorest but most appreciative woman we have met in Ghana and who gives us many blessings for our safe return to our home. We say goodbye to Shine who has been our dear host and friend last year and who remains my Ghanaian daughter. We say good bye to Patience our sometime cook and full time friend. We say good bye to Sam from the Friendly Spot who supplied us with our beverages after a long hot day. We say goodbye to the children of Kpando who are so poor but delight in getting a small sticker on their clothing and want to touch the ‘Yo Vo’s’ and have their picture taken. We say goodbye to Alfa, our young Ghanaian teenager who is on the cusp of becoming a man and needs so much but we encourage him to stay and excel in school. We say goodbye to a community that has welcomed us despite the color of our skin and our funny way of speaking. We are sad to leave but also realize that this part of our journey is over.

The craziest day of all – January 10, 2010

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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

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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

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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”

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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
observations.

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”

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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
attention.

After
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
orphans.

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

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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!


“Slow and Fast” – January 4, 2010

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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”mailto:valkingnp@gmail.com” valkingnp@gmail.com

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.