Day 8: ‘Mr Toad’s Wild Ride ‘ Part 3’

Each year I seem to have a Mr. Toad’s Wild Ride story and this year is no exception. Today Maura and I journey to Ho (1.5 hours away from Kpando) to visit our friend Shine who was our hosttwo years ago.

Shine is a special person to us and has just had a baby this year which she attributes to her American Mamas. We gave her a fertility statue the first year and we were hoping for twins but we shall be happy withbeautiful little Asher born in September 2010.

We are advised that we can catch a tro-tro from the lorry station (bus and tro tro station). As we approach the station a tro tro yells Ho and we quickly board. We ask if it is a direct route and we should have trusted our gut when they did not answer the question. The language barrier is a chronic problem.

Unbeknownst to us this tro to will stop and start about 20 times throughout the trip picking up and discarding passengers. We are crammed in like sardines into a rusty and clunky 12 passenger van that smells like rotten fish. People are practically sitting on each other. We know we are in for a wild ride. At one point our ‘ handler’ (not the driver) decides to take a leak right outside our door as he is waiting for the passengers to get settled. NO modesty about that.

We are dumped into bedlam in the village of Kpeve and told to disembark and load into another tro tro that is more crowded than the one we left. We wait a few minutes and another tro comes along and there aretwo seats in the second row. We sit next to a woman withthree small children and they are squished into the seats. Her middle child, who is about 2 years old, is slowly sliding under the seat so I hand my bag to Maura and pick up this child and cradle him in my lap. He immediately gets cozy and I find his little hand has snuck down to my breast. His mother is breast feeding his younger sister and you wonder how much cuddling time this kid gets. I don’t mind but I am secretly hoping he is potty trained as I hold him in my arms for the next hour.

We arrive in Ho which is a very large and confusingcity and unfortunately it is market day so that means the population has probably doubled. We find a cab and givethe driververy rough directions to a meeting spot which is the Catholic church near the police station. We are dropped in the middle of no-where and await someone to pick up us. We laugh about our predicament and within 30 minutes Shine’s sister picks us up.

We spend abouttwo hours with Shine and her family and it is time to go home. We dread the tro tro ride but know it is the only way home. We have (with the help of Shine’s sister) been able to securetwo seats in the front seat. The lorry station is a wild place with at least 200 vehicles awaiting destinations and passengers. Most of the vehicles are equivalent to our junkyard material.

Our tro tro has very little dashboard and there is a loud grating metal sound when the left side of the vehicle dips into a low spot in the road. There are another 15 passengers on board but I hesitate to look behind me as I will feel bad for their lack of comfort. We arethree across and they arefive across.

Fortunately this is a direct bus and we do not stop to pick up or drop off. We cross over a small mountain and that is a bit scary because Ghana has no guardrails. We can see some wild fires in the distance and are unsure if they are planned burning or accidental. Maura and Iare startled by a loud cackling or barking noise from behind us. At first it sounded like a dog but we soon realize it is the man behind us who hastwo live chickens tied up and sitting mere inches from us. We are startled and then laugh at the whole experience.

We arrive home about 7 ‘ hours after we left. We are filthy and tired but the students have had a good day. They were able to have some time in the clinic and hospital and then make a donation at the Missahoe Orphanage and were able to play with the children. Everyone is kind of chilling tonight which isa good thing. A few students go out and get a meal with Lorna who is celebrating a birthday today. Some have had a traumatic day watching a difficult birth at the hospital. I was not there but I heard the details and it was quite upsetting for some of the students. Our nightly debriefing session was held without us but I heard that there was some good discussion about what they saw.

I wanted to take a few moments to give you a description about some of our environmental challenges. In Ghana we are experiencing ‘Harmattan’ which is the season of hot and dusty blowing winds. The winds are bringing the sand down from the Sahara desert and the air is thick with the particles as well as the heat which keeps some of the air quality very poor. The multiple brush fires along with home fires add to the smoke and dense atmosphere. As we drive today we are lucky to see 1/3 a mile in front of us. Try to imagine the worse scene of California smog and multiply it times ten. We have not seen blue sky yet. The air quality is affecting some of the students who have asthma and I have found myself coughing this morning due to inhaled dust and now have laryngitis.

As the health challenges of the trip become more evident I am seeing a bit of physical deterioration in some of the students. The lack of proper diet is draining as well as the emotional and physical challenges. No one is complaining and I ask them daily about their status but from my perspective of someone who has been here before I can see the changes. They are learning to adapt.

We now consider ourselves fortunate if we get a trickle of water for a shower and don’t mind that it is cold. We look forward to our crackers and realize that the food will be challenge until we get home. We have all lost a little weight but the students are good natured about it and realize that our discomfort is only temporary and we will soon be back in our warm and safe American homes but the people of Ghana live this way every day. I findthe whole experience teaches us all about ourstrengths and how to survive. My first year I spoke about how the experience had to break me down a bit before it built me up. I suspect that this is a process that is experienced by many if not all of us.

We are looking forward totwo more days in Kpando with some busy plans for clinics at a few poor villages and one more orphanage visit. Our boxes are dwindling which is a good thing. We will travel much more lightly in a few days when we begin the last part of our journey which is more sightseeing and less work. We leave a week from tonight but there is still much to do and see.

Day 7

Today is our first day working in the clinic and the hospital in Kpando. It is also the first chance the students have to see Kpando in the light of day. I see some trepidation and concern in their eyes because this is a busy, dusty, noisy town with buildings that are ramshackle and lots of clusters of homes that appear very poor.

Our first week has spoiled us with nicer hotels. The UMass Lowellnursing students are excited to see some health care facilities. We begin our long dusty walk to the clinic where are supposed to meet with the District Chief.

This is the road that can be treacherous and I tell the students to walk single file to avoid getting hit by the many cars and trucks. We stop to buy some minutes for our cell phones and meet Grace the tailor regarding making some dresses and I point out Maxy’s Spot which is a run down derelict bar but it is the ‘in’ place to go.

The students don’t seem to impressed and if they decide not to go there then I will be happy. They seem totally happy with playing rummy and Phase 10 which Amanda and I have introduced them to. I am amazed at the different group dynamics every year with the students. We have a good group this year and so far no personality conflicts. We settle into life in Kpando.

The students quickly figure out where to buy water, where to buy carved wood, where the internet caf’ is and how all my warnings about crazy drivers were true. The are many very small businesses by the side of the road but mostly are small provision shops, casket makers and bars. There is also some tailors and beauty shops. So I tell Maura, we are all set; we can get beautiful, drink and have our body buried all in the same town.

I go to the outpatient clinic withfive students and Maura goes to the hospital. We have both found our comfort zone. Unfortunately many of the people I met last year at the clinic are not there so I must begin anew in establishing the relationship. It really is more of an observational experience than a working experience. I take whatever opportunity to ask questions and interpret (medically) to the students what is happening but it is hard for me to be infive places at once because I have distributed the students to five different areas.

They find the consulting area the most interesting because that is also my comfort zone and before long I am assisting the medical assistant (like a physician assistant) in his diagnosis and prescribing of meds for various problems. We see 83 patients that day and I would say at least 60 of them were malaria. The disease is so rampant here. Everyone always assumes that HIV is the prevalent disease but malaria is a more common disease with such death rates that are very high especially for the young children under 5. Seeing the prevalence has made our malaria project in Peki seem that much more valuable.

Time is short today so I will not write much. More to come tomorrow.

Day 5: ‘The Gifts: Education, Land and Experience (and lack of modesty)’

Today was our full day in Peki. Our plan is to implement the community projects that the students have been planning.

Last evening I had to make a public announcement to the attendees at the Durfur about our programs. We had hoped to have no more than 50 children for the Nutrition Program and about 20-25 mothers of young children for the malaria program.

Due to the exact time of both programs in different locations I have to rely on Maura to evaluate one of the programs. I evaluated the Nutrition program. This was a program targeted school age children and to teach them about healthy foods and the benefits of exercise.

Obesity is not a problem in Ghana but rather malnourishment is a problem. The children (and some of the parents) do not have an understanding of the various types of food. Although in this environment the children often eat whatever is made available to them we wanted to empower them a bit with some knowledge to help guide any decision making that they may be involved with regarding food choices.

The program was attended by at least 80 children along with a few mothers. The students need to use an interpreter to convey their message. Although English is spoken in the schools here in Peki, many of the children communicate primarily in their native dialect. The UMass Lowellstudents had prepared a craft project to coincide with their lesson but we had only enough material for 50 children.

Remarkably these children happily share the project with their friends. They did not know what a glue stick was but by the end of the program they had a paper plate with pictures of health food glued on them. We wanted the children to take the plates with them but the plates were collected by the clinic nurse (who was our interpreter) who felt that they would be good teaching tools for the mothers. I guess this logic makes sense because the mothers are the ones preparing the food. Each child left with a silly band bracelet and a smile on their faces.

The other project was a Malaria education program where the mothers received information about the signs and symptoms of malaria and how to take a temperature. The Nursing Students Without Borders club was able to purchase some thermometers and insecticide treated mosquito nets due to the generosity of the Lutheran church in Woburn.

We had hoped to give 30+ mothers a net when they left but we did not purchase enough. We have some additional church money left over to put toward our projects so we hope to purchase more before we leave. It was a great feeling at the end of the day when the students realized that their actions today have improved the health of so many in the village. It may even save the life of a young child who often die from malaria at young ages. It was a fitting way to repay the hospitality of this wonderful village.

After our programs we were treated to some cold water (actually they call them sachets of water which are the bagged purified water). The Chief of Peki asks to speak privately to Maura, myself and Jason. Jason is chosen because he is our only male student and the chief wants to recognize that and calls him a chief. We are offered some sweet red wine from South Africa and then followed by a small amount of a chocolate liquor called Takai. Both are quite good. And so begins the official discussion.

Land in Ghana is mostly privately owned and can be quite expensive and difficult to purchase especially for an outsider. Large amounts of land are controlled by the Chief. He is very pleased with the relationship between his village and the students from UMass Lowell and wishes to make a donation of land for our use. He would like to establish some type of building or structure(s) that would have lasting impact for the people of the region but also will bear the name of UMass Lowell. He encourages us to think about how this may take form.

He does not make this gift without much thought and I am proud yet concerned about being able to meet these expectations. This venture should not be entered into lightly because if done successfully could have lasting impact on both the people of Peki and future visitors from the USA. Maura, Jason and I leave this meeting with some trepidation but also with a sense of an important relationship that could transcend our national borders. This is an opportunity that will take some careful thought and planning but we do not make any commitments but express our appreciation of his trust and friendship.

Upon our return to our hotel we have a few hours to relax. This is the first time we have had some time to relax and it has not been after afive hour bus ride or after a 12 hour day. It is great to catch up on some rest because we will be working very hard for the nextsix days.

Our plan is to leave for Kpando tomorrow after we go a hypertension screening clinic in Peki. Tomorrow is Sunday so we must wait until after church and lunch are over before we can arrive in the village. Some of the student may go to church while others have decided to sleep late and enjoy the last few hours at this hotel.

I have told them that the accommodations at the next hotel are not as nice and we should expect more power outages and water problems. They are actually a bit excited about living a bit more rustic but I am sure that will wear off when they see a few bugs in their room or no internet because of power outages.

Every night we have a debriefing and talk about the day’s events. Tonight I could hear a difference in the students’ comments. I think they are finally coming to realize the enormity of what they are doing. I told Maura that I thought it was so brave of these students to take on this trip but she thought it was very brave for us (the Mamas) to take on this trip. I am not sure who is more brave but we all recognize that it is a truly remarkable experience that most of our friends and family will never experience and will only get a small glimpse of our adventures by looking at our pictures.

It is my hope as a nursing educator that this trip will make an impact in a way that traditional nursing practicums or lectures cannot even begin to compare. I believe that the students will develop an awareness of the blessings of their own lives at home in USA but also to become more acutely aware of the health and social disparities that are so prevalent beyond our borders and that they may now be empowered to address these issues at some point in their careers.

And to leave you all with a funny image rather than my soapbox comments. Two nights ago we made a presentation of new mattresses and some clinic supplies in the village of Ada. After enjoying some Fanta and Coke (no Diet Coke!) some of us needed to relieve ourselves before the long bus ride home. We were directed to the bathroom which was behind the clinic. Off we trot with our one little flashlight. We find the bathroom and Jason uses it first but reports back to us that is it quite disgusting, more like a small hole in the concrete. We take our chances outside rather than use the ‘hole’. I giggle when I think of my students merely 10 feet away in the utter darkness as their Professor King acts quite ‘unprofessor-like.’ Our daily struggles for the usual comforts of food, water and sanitation create a strange bond that many will never experience!

Day 3 ‘Americans in Ghana’

Today is our last day of sightseeing in Accra which is a good thing because I think we are all getting a bit anxious to start our work here in Ghana. We have never had this much time before our work started and although it is nice to see all the wonderful sights of Accra the students are anxious to get started.

We are due to see our American Embassy today and a few more sights in Accra. We leave the hotel around 11 but hit an enormous amount of traffic on the way into the city. The traffic here is like nothing you have ever seen.

Although the roads are paved and it appears that is should be atwo lane highway into the city it often resembles a large parking lot. I believe it is worse than even getting out of Fenwayor Gillette after a game. The roads are not lined and it can be like a giant game of chicken. There are many lanes of cars all trying to squeeze into a narrow road.

We are traveling in a larger bus but even the smallest of cars try to edge us out of our lane. There is lots of honking of horns and to complicate matters there are street vendors by the hundreds who are hawking their wares by the side of the vehicle. I cannot make eye contact with any of them or they will come over to the bus and tap on the window and offer their items. It seems cruel to avoid their gaze but it becomes necessary.

These people stand in the hot sun all day long trying to make a living. This type of occupation seems to be the largest employer in Ghana. There is an amazing abundance of hardworking people looking for employment and I am surprised that some of our US businesses who have outsourced their manufacturing to China or India have not considered Ghana.

Eventually we find out selves in at the Parliament Housewhere their legislators (Members of Parliament) are not in session. We are not permitted in the building but it is impressive. We are then taken to the Conference Center which is a huge building that is the home of large political and social gatherings. When President Obama came here to Ghana in 2009 he spoke from this building. We are given access to the VIP lounge where he awaited his time to speak. It is a large impressive room with many sitting areas . There is a large private office also where the Ghanaian president or other dignitaries can do some work. We are told that not many visitors get to see this area and we feel special.

Our appointed time is approaching and we must go to the US Embassy for our scheduled visit. It is quite the procedure to get into the building. All of our electronics (cameras, thumb drives, iPods, phones) needs to left at the counter as well as any liquids. We painstakingly go through the metal detector and bag scan. Only small groups at a time can enter into the Embassy and only with an official guide. We are joined byfive to six members of AFRICED so our entourage is large. As usual we are attracting lots of attention because it is not very often in Ghana that you seen a group of young white people like ours. The glances from the people of Ghana are never rude but rather inquisitive.

Upon entering the embassy we are directed to a large conference room. While we await the start of our program a young good looking US Marine comes into the room and starts to chat with us. He is a very personable young man who is excited to see a group of Americans and is anxious to invited us to a comedy night held at the embassy on Friday night. His name is Marcus and I wish we could spend more time with him because he is very humorous and gives us good insight into his life as an American in Ghana.

Our program begins with a welcome by Mary Drake Scholl who is the Public Affairs office. She gives us a wonderful description of what the US Embassy does in Ghana. I am amazed at the scope of their activities because I had always assumed there were in foreign countries just for American interests (security, passport problems, etc).

The US Embassy and their partners are involved with many initiatives like local and national health care, education and other activities that benefit the Ghanaians and American expatriates in Ghana. We then get a chance to talk to Susan Wright who is the deputy office chief of USAID/Ghana.

Susan is involved with many projects that are done to improve the health and welfare of the people of Ghana. She gives a great presentation on the prevalent health issues in Ghana (malaria being one of the biggest problems in this country) in addition to other social issues that are affected by the health of the people of Ghana. Her presentation dovetails wonderfully with the work the UML students have done in preparation for their community health implementation projects.

The students will be doing two projects, one is for malaria education and awareness for mothers of young children and the other is a nutrition education program for school aged children. They will be implementing their programs in a few days so all the information that Susan gives them validates their hard work and project purpose.

We then get to meet the heath care workers (a nurse and physician assistant) who are not government employees but rather are called ‘local hires.’ They work at the Embassy to provide health care to the embassy workers and their families and also have some responsibility for the other embassy posts in neighboring countries. It is interesting to hear their career stories.It seems that many people who end up in foreign jobs often begin their career with the Peace Corp. The working conditions that the PA endured in her previous job is incredible but it seems like her current job at the embassy is challenging but rewarding.

At the end of our program we are treated to a lively lecture by Dr. Fazle Khan who works with the CDC Director in Ghana at the Embassy. He has an interesting career story but it is his recall and insight into the health problems like AIDS and malaria that enthralls us. He is inspiring and has the utmost respect for nurses which is music to our ears. He gives some good career advice should any of the UML students desire to work in a foreign country like Ghana.

We are thankful for this interesting visit to our US Embassy which is a vast change from last year when our bus was bombarded by armed Ghanaian guards because some of the students took out cameras to take a picture.

We adjourn to a nearby restaurant for some cold drinks where we are met by a group of 10-12 people from AFRICED. We are presented with a souvenir t-shirt that says ‘University of Massachusetts Educational Tour ‘ Ghana 2011.’ The goal of our meeting is to spend some time with these hard working volunteers from AFRICED and to discuss their experience and concerns in addressing health issues in Ghana.

This exchange of ideas is strongly advocated by our coordinator Kwadwo. We need to learn from them and they need to learn from us. It is interesting to learn about the Ghanaian national insurance plan (costs a little more than $15 per person per year). It is financed by a tax. We have seen this tax on any item that we buy. Health care is available but there continues to be access issues such as proximity to a clinic or ability to afford even the $15 per year for health insurance (which is significantly less for children age 3 months -16 years). Pregnant woman and newborns are covered for free. This is to ensure improved health and maternal and neonatal outcomes which is a health care problem that is slowly improving but still a huge problem in a developing country like Ghana.

Maura and I share a lively conversation with Sherry (who also works on land disputes issues during the day and is going to school for her degree in business administration), Simon (who is a laboratory technician at the large Korlebu Hospital here in Accra) and Mustapha (who works in hospital accounts at Korlebu). Thesethree people maintain their full time jobs but also devote time to the social problems in Ghana such as child slavery/orphans and financially assisting families with many children to keep the families intact and functioning and not to sell their children into slavery to help the family finances. There are many other projects that AFRICED is involved with and they will be joining us intermittently this week to help us with our clinics and distribution of supplies.

After our debriefing on the bus (where the students are asked about the observations of the day), we then sit in traffic for nearly 3 hours to get back to our hotel. This is torture for us and I long for the rural roads of the Volta region where we have to dodge goats and not cars. Upon our return to the hotel we have a birthday celebration for one of the students (Kim), with Little Debbie brownies that have stashed in a suitcase. Chocolate is like gold to us now.

We spend about an hour organizing our supplies for the next day and counting pills. I have purchased some medications and the Nursing Students Without Borders club also purchased some OTC meds like Tylenol and multivitamins. My goal this year is to try not to make our trip about handing out pills but rather addressing some health education needs of the people of Ghana. If we teach someone about how to manage their hypertension that is much more sustainable than giving them 10 pills.

The students are anxious for our first clinic tomorrow.After a long day I retire to my room to discover that there is no water left to bathe.Some of the students have already showeredand used up all the water. I think we need to start a shower rotation schedule because I will be pretty smelly if I don’t shower for a few days. After a quick wet wipe cleanup we are in bed for some rest before tomorrow.

As I prepare for bed at 1 a.m.the rooster starts to crow again’ Does anyone have a muzzle?

Day Two : ‘Bugs, Buses and Beliefs’ By Valerie King

Today was a good day. I started with a cold shower but the toilet flushes and the AC worked all night. Some of the students lost their AC in the night and woke up to a hot room. The heat did not keep the lizards and bugs away but I am pleased to tell you that my most bug-phobic student is making great strides in conquering her fear. I told her it was well worth spending all this money to cure her bug fears!!

We had a day of touring the capital city of Accra. It is a very busy city with much traffic and congestion. It can be an interesting range of sites. We can be passing a shanty type community and 1/2 mile up the road pass by affluent gated compounds. The disparities in wealth are incredibly sad.

The UML students are amazed at the number of street vendors who sell anything by the side of the road. We see little children with large bowls of water bags on their heads who have likely been selling at the busy intersections since early in the day. No school for them. They are probably being used to sell items to help the family finances. The UML students payfive times what they need to pay for a small bag of water. The little girl does not know what to do with the extra money even when urged to keep the extra money to herself. It is sad to see how children are exploited in some situations and this child may never finish grade school because she is more valuable as a street hawker.

There are all kinds of merchandise on sale. Cheap toys, candy, fried chips, water, maps, jewelry. They are there just trying to make enough money to live another day. I worry about the small children by the side of the road and realize how easily a predator could scoop them up and drive off. The UML students seem subdued when they see these sights.

We were supposed to meet with the Minister of Education today but after waiting for him for about an hour we were told his schedule did not permit a meeting. We then proceeded to do some touring of the city and we ended up at Frankies which is a local restaurant that features American food. This is a treat I usually save until the end of the trip. We haven’t experienced any real hunger yet and here we were today at this restaurant eating American sandwiches and French fries. It is a welcome respite for the students because we are now approaching our busy time.

We hope to meet the Minister tomorrow and I will have to come up with some greetings on behalf of UML and the nursing students. I was asked if I had a ‘gift’ for the minister. As is customary, people often bring gifts when they meet the minister and last year I gave him some bottles of OTC medicine because that is all I had to give. That bothered me tremendously because those medications can be easily purchased by any person working in these government jobs and I felt it was depriving a needy patient of much needed medications.

This year we did not bring as many bottles of medication due to shipping costs so I had nothing to share. I told our coordinators that the Minister of Education was going to have to settle for the ‘present ‘ our of ‘presence’ in his country. That was kind of a snarky response but I have a real issue with inequities in health resources (in any country) and I am not going to promote those inequities because of the ‘custom’ of giving gifts. At some point in time a person has to stand up for their beliefs and this was in important issue for me. I know that I risk offending a very important politician but I think it is better to stay true to one’s own beliefs.

Tonight we returned home to our hotel and had our first debriefing session. This is such an important part of the day where everyone gets a chance to voice their observations, concerns or questions. I am proud to hear the comments from the UML nurses. They are absorbing so much and I can already see that this experience has begun to change their perception of social and health problems in a developing nation. UMass Lowell has taught them well.

Maura and I have a few glasses of wine and some peanut butter crackers and cookies for supper (we need to have some food to take our malaria medicine with). The wine is relaxing and I play a few rounds of a fun and crazy card game with some of the students while the other group is busy in their hotel room revising one of their assignments that is due for Community Project. Everyone is getting along well.

The marriage proposal count is at one. I told the students I will keep track of their marriage proposals and oneof the students was proposed to today by a Ghanaian military guard. I predict our marriage proposal count will go much higher when we get to Kpando. I will give updates on the proposals.

It is about 12:30 and time to go to bed. The rooster just crowed outside my window. He needs to have his circadian clock fixed. He woke me up at 3:30 this morning also. Tomorrow will be an interesting day as we have been invited to our American Embassy in Ghana to meet our Ambassador. Last year we almost got arrested for taking pictures and this year we are invited guests. Funny, how a year can make all the difference in the world.

Good night to all and come back to read some student blogging. I have been keeping them busy but hope they will start blogging soon.