‘Last blog entry ‘ Going home’

It is now January 31 and we have been home for 11 days. I had hoped to finish writing about the last few days in Ghana a day or two after we arrived home but alas here I am and February is here tomorrow. In summary, our last few days in Ghana were less work and more sightseeing. We had the opportunity to go to Cape Coast and visit the Elmina and Cape Coast Castles which were famous for the site of slave trading between the Africans and Europeans and eventually the Americans. This is always a very powerful experience for me but I have learned to understand that this is a sad chapter in the history of Ghana but the guilt is shared by many nations including Ghana itself . Slavery was not invented in Africa. It has existed for well over 2000 years dating back to the origins of our human history. Americans did play a role in the barbaric practice of slavery but also many other European countries were equally if not more of an importer of human beings for slavery. I am always saddened to walk through the slave dungeons but I am reminded that we must never forget this and strive for peace and good will to ALL humans no matter what their skin color, their politics, their religion, their economic or social status or other defining characteristic. We were treated to a evening discussion by one of the most well known curators of Elmina castle and it was a lively discussion of our perceptions of the slavery trade and our general impressions of the castles. These are the type of experiences that a class room can never duplicate. It is not nursing but it about the understanding of our mutual human connections.

The students were also treated to an elevated canopy walk at Kakum National Park. This is an exhilarating experience where there are ropes and plank and netted walkways high about the forest floor. I am sure that Amanda was looking for giraffes or other animals but any animals that were below were likely scared off by the delighted screams of the students.

Our departure from Cape Coast was marred by the theft of some UML student personal items at the Arafyn Hotel. The short version of this story is that the hotel manager ( who happens to be the brother of the owner of the hotel) was caught red-handed with some of the items except for the $500 Iphone. After much yelling and involvement by the local police the hotel owner agreed to pay $400 toward the phone. We left the issue of dealing with her brother, the thief, up to her. It is unfortunate to have this happen to us on the last few days of a wonderful trip to Ghana. What made this whole incident rot in my gut was the police detective asking me for a kickback for helping us solve the case. I was shocked and appalled and then I got steaming mad! I yelled at this detective in front of his staff at the police station telling him that that action is corruption and he was no better than the thief himself. In the USA our policemen do a good job because they are honorable and not thieves hiding behind a badge. I think the Ghanaian police officers are still talking about the ‘crazy American ‘ woman who went on a yelling rampage.

At this point my tolerance for being asked for money by many of the people I meet has gotten me quite discouraged. While I am fully and painfully aware of the poverty in this country, I cannot also be the solution to their pervasive social and economic problems. I am here to deliver nursing care and some supplies and I am not here to bribe policemen or politicians, or to put roofs on schools or dig drainage ditches. I try very hard to focus on the good that we have done and on the wonderful people we have met. If I concentrate on that and recognize all the good that we have done then I am happy but at the end of 16 long days it becomes harder to see the net result.

We spend one last day in Accra to do some last minute souvenir shopping. Everyone is down to their last few cedes( money). We have a last lunch at Frankies whish is the closest thing to a burger joint we have found. Our last treat is a tour of the renowned Korlebu Hospital. It is one of the largest hospitals in West Africa and much more advanced than the hospitals that we have visited in the rural regions but still much more primitive than our American hospitals. We are stunned that we are able to walk freely into the hospital units where new mothers are with their newborn babies or post surgical patients are sleeping in 36 bed wards that resemble a pre-1940 American hospital ward. We are grateful for this opportunity but realize that we would never allow a group of ‘sightseers’ to go through our American hospitals. I feel somewhat guilty but also am thankful of this opportunity.

We are then surprised with an impromptu party at a local bar where we are joined by 15 or more of our new friends who volunteer with AFRICED. These are the men and women who volunteer their time to work on projects that help the social, economic and health welfare of the people of Ghana, particularly the vulnerable women and children. The efforts of UML is brief but these are the people who care deeply about making their country a better place for all. We enjoy some beverages and some music. Speeches are made, photos are taken and friendships are cemented. This is such a brief party but one of my favorite parts of the trip. These people are so giving and genuine. I wish I had more to give to them but they are now my friends. Although I look forward to going home I am sad to leave these wonderful people.

Our next stop is the airport. We have re-packed some of bags by the side of the road and given our last goodbyes to our wonderful bus driver Ernest who kept us all safe and sound on the treacherous roads of Ghana and also to Mawuli, who does not come into the airport with us. We are assisted through customs by one of our friends, Nicholas. He has been such a wonderful help to us due to his position with the Ministry of Education. The students make it through security and Maura and I spend a few last minutes with Kwadwo. We have come to the point in our journey where we leave some of our funds to help promote AFRICED activities. The students have elected to give about $400 of their club money to help pay for health insurance for ALL the orphans at Peki in addition to purchasing some school supplies. I leave some of my own money as well and Maura does the same. We trust Kwadwo to use these funds for efforts related to the orphanage at Peki. That village is near and dear to our hearts and we are hopeful that these funds will help AFICED to provide services to 38 orphans.

We board our plane home. Maura and I have snagged our great seats just behind business class. There is a bit more legroom and we are anxious to get some sleep on the long leg of our journey home (12 hours until Washington DC). We are tired and still quite dirty but all in all it has been a productive journey. The students are equally exhausted but satisfied. They have done and seen things that many nursing students never get a chance to even imagine. This experience changes all of us for the better. We have survived the challenges, we have learned about another culture but also about ourselves.

Thank you to all the family, friends and colleagues who have supported NSWB during this journey. We could not have done this without you.

Day 6: ‘Pills, People and Problems’

Today is our last day in Peki. This village has welcomed us with such open arms we are sad to leave here. We pack up all of our belongings, 12 large suitcases, 12 other assorted smaller suitcases and duffles, backpacks, a few pillows and ten huge boxes of supplies.

Remarkably these items are all crammed intotwo tro tros which will take us back to Peki Adzokoe which is the village that our hypertension clinic is planned. We have to wait until noon to travel there as it is Sunday and this is a big church day for most of the people.

When we arrive shortly before1 p.m. we are met with a large group of people all dressed in their best church dayclothes awaiting a visit with the nurses. For some people this is a great event because they may not have health insurance and most people do not believe in purchasing the health insurance unless they have known medical issues or for a child This is like getting something free.

Preventative care is not a well known concept. We are again amazed at the readings we are obtaining. For those reading this blog who are not nurses, normal blood pressure is usually 120/70 or lower.Most people in the US will start medication if their blood pressure is higher than 140/90. We have had readings has high as 270/140. At home if we got readings like that we would likely be calling an ambulance because a stroke or heart attack could be imminent.

I have established a protocol for giving out some of the medicine I have brought with me. I will give out meds if BP higher than 160/100. I have brought about 2,000 pills that if I allocate a small amount (about 10 pills), then I can treat more people. Each patient is given a written page to go the clinic to get more medicine within the week.

Many people tell me that they have meds at home but ‘are done’ with them. They do not understand that this is a lifetime problembut treat it like an episodic illness. When the pills run out they stop taking them. Hypertension is a silent killer.

Their diet is not high in fat and there is not much obesity (maybe five percentor less). There is some smoking but not very visible like it is in Europe. I am not sure why we are getting such high readings but we experienced the same phenomenon on the lasttwo visits. I need to find out why hypertension is such a problem in Ghana.

It is great to see the students do the teaching, with the help of interpreters. I know that many of the nursing students felt tentative with their blood pressure skills but after doing 50 people in a row they have developed confidence and proficiency and also are interested to see the other advanced assessment skills that I am able to demonstrate to them. Whenever I get an opportunity I am quizzing them about drug classes and what they know about certain drugs. I think this trip is stressful for them in terms of clinical challenges but also allows them to experience a vastly different type of patient and most importantly it teaches them about community health.

We also have some vitamins and Tylenol. I have a few antibiotics but have not seen much infection which I find surprising. I save the vitamins for the older patients and the pregnant women. Tylenol (known here as paracetamol) is given to most of the older people because you can tell by their gait that they have a fair amount of osteoarthritis. I suspect one man was infected with guinea worm and I direct him to the local drug store also known as the ‘chemical store’ to get OTC meds for treatment and prevention of the worms. This is a disgusting disease that is quite prevalent due to the infected persons bathing and defecating in or near water sources and some people do not boil water before usage. Thus begins a vicious cycle of transmission.

After our clinic we take some supplies to the local orphanage. There is actually no physical building (yet) but AFRICED helps to provide care and resources for about 38 children. As I had mentioned earlier these are children who might be rescued from child slavery or orphaned by death of the parents. Sometimes the parents feel that their children might be better off in the care of an orphanage and will try to relinquish their custody over to AFRICED.

We are told that due to today’s donation the coordinators might see a surge in interest from these parents looking to get some advantage for their children and request that they be taken care of by AFRICED. As a parent I cannot imagine giving up my child but I believe that there can be such desperation for survival here that people do all kinds of things.

We have received a donation of about 200 Beanie Babies from Kelly’s grandmother and we have divided them into thefour orphanage boxes. There is a mad rush for the beanie babies and we see more than 50 children in line for a toy. I cannot distinguish between orphan and a child with a home but it is not up to me to decide who gets a toy. We also have some toothbrushes donated by Dr. Fadjo from Chelmsford and we can give those to the older children along with some books and videos donated by our friends and family back home. Our box seems so small compared to the need. The UMass Lowell students recognize that but also realize that we were hindered by high luggage charges. We will try to ship more items from home when we can find a vendor to ship barrels.

At the completion of our work day we are treated to a drink of palm wine which I did not like last year but this year it is nice and cold and does not taste as sour and fermented. Each person takes a sip (or more if desired) and then spills some on the ground and then one more sip. The UML students are hesitant but they do this. The pouring of the wine onto the ground symbolizes a recognition of the ancestors and reminds us that they are still present in our lives.

We have one last meet and greet with the Chief. He hugs all the students which is unusual because most people do not get to touch the chief. He is royalty to the people of Peki and certain protocols must be followed. He is kind and gentle man who wants the best for his people. He wants to maintain the beauty of his region but also is forward thinking and realizes that his community needs to advance and that can be done with collaboration with others.

We leave Peki and the students are a bit sad. They have grown to love this community but look forward to some new experiences. Kpando is about an hour away. It is a much busier town with more commerce, traffic and people. It has been home to Maura and I for the lastthree years in Ghana but the students are taken aback by the differences between the rolling country landscape of Peki and the noisy confusion of Kpando. We check into the hotel and we have been very spoiled by ourtwo previous hotels.

Cedes guest house is a somewhat dirty and poorly maintained hotel. I have not seen bugs but the mattresses and general cleanliness leave a lot to be desired. I am thankful that my silk dream-sack protects me slightly from whatever might have occupied my bed before me. It is unknown if the sheets have been washed. I find a pile of rags (or old clothes) in the closet and I immediately throw them in the hall. We are lucky to have a small refrigerator but it smells like something has died in there. We go to the front desk clerk and demand that the refrigerator be cleaned. Customer service here is not one of Ghana’s strong suits. Food service is very, very slow. I would not mind if I was eating at a 5 star resort in the Caribbean but when I am eating rice in a dirty room with one green fluorescent tube light and broken chairs I get a bit disappointed. I think my peanut butter and jelly crackers will be mainstay diet for the next five days. I havethree lovely oranges I purchased in Accra for $1.50 each and I am saving them for my breakfast for the nextthree days.

We are supposed to speak at the Nurses Conference on Friday but I still have not heard confirmation that they have a sponsor for the event. I again reiterate my concern that I will not be preparing lectures until I hear that it is happening and I need at least a few days advance notice. I do not think our coordinators understand how long it takes to prepare aone hour lecture and they have asked me to speak for at leastthree to fourhours.

Both the Ministry of Education and the Ministry of Health have refused any financial support. There is no such thing as big pharma here so commercial sponsors are unlikely. I have also been informed that nurses will likely resist paying for this conference due to their low paying salaries. I am not optimistic it will happen and I am frustrated by the lack of planning and decision making on this event. This, along with a new charge for transportation (which was not revealed on the original proposal) has me steaming mad tonight.

These unexpected financial burdens almost ruined my experience last year and I am holding firm to no new charges beyond this fee. I have very wisely retained 1/3 of the portion of our land fees until all charges have been established and we get a bit closer to our departure date. AFRICED is a new organization and has improved their services to us this year based on lengthy feedback from us but I have ongoing concerns with communication breakdowns. They are truly wonderful people who are trying so hard to improve the health and welfare of the people of Ghana.I am hopeful this is the only glitch in our otherwise wonderful trip.

Tomorrow we begin our observation and other clinical work at the hospital and clinic in Kpando. I am sure that there will be many stories to tell tomorrow but I must go to bed. We need to be ready by 8 am.I hope there are no roosters outside my window tonight.

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?

‘Is it night or day’ and hey.. where is my running water?’ Part 2 – December 29, 2009

We drive a bit through Accra but the hour is getting late and we are hungry, hot and tired. We are taken to Frankie’s which was the local restaurant I went to last year on my last day in Accra. It has wonderful American type food and I am thrilled because I know this will probably be my last Diet Coke for a while.

We are brought to a newly renovated hotel in Accra. We drive down a rutted dirt road and I am questioning the locale as safe destination but soon we drive into a courtyard with brick pavers and a hotel that has obviously undergone some recent renovations. We are surprised to be treated by private rooms for each student. The rooms are clean and new sheets, bathrooms and best of all, air conditioning. After carrying in our 44+ boxes and suitcases we retire to our rooms for a long awaited shower and rest. I guess the water fairy is not on my side again this year because I have a lovely bathroom with new tile and sink but no running water. I sneak down to a student room and after trying 3 different rooms I finally find one room with a trickle of cold water. At this point it feels like a luxury and I quickly shower. I hope this is a minor plumbing glitch that can be resolved in the morning.

Prior to my shower I start to give out some of my gifts to Kwadwo and his wife (who has joined us tonight). I have given him a used laptop for which he is very grateful for. It will help him with his work with AFRICED. I am feeling bad because it is a few years old and not too fast. If anyone has the inclination to donate a newer or new laptop to AFRICED I would be happy to arrange for shipment to Kwadwo. I will tell you more about AFRICED in another entry.

I reflect upon the day’s events that we have experienced. Some of the sights, sounds and smells are the same. A few of the roads appear better but then very quickly they deteriorate into a rutted dirt road. Ghana is making progress but it is sporadic in some areas. We are stopped by the local police at least 5 times as we travel to our hotel. It is a bit unnerving to be stopped at a roadblock with police in combat fatigues and large rifles on their shoulders. It is the Ghanaian form of police oversight but it feels a bit weird to be stopped and have the flashlights shinned into the vehicle.

I have had a conversation tonight with our new friend, Nicholas, from the Education Ministry( I think he is some sort of protocol officer). He is trying to educate me about the relative safety of Ghana but also some of the traps that are present for the obviously white tourists. I am encouraged again by the attention that NSWB has garnered from upper levels of government here in Ghana. There will be more to report on that later.

We also met a Ghanaian woman in the airport in London who is a nurse at Johns Hopkins hospital. She is home for a holiday and has invited us to come to her home. I am reminded of the friendliness of the Ghanaian people. This woman, who is a stranger to us has just invited 11 of us to her home. I also am reminded of the poverty as the people swarm our bus as we disembark and try to ask us to purchase little trinkets or just to give them some money. It is a bit of a shock for the students to have this so visible on their first few hours in Ghana. The students will have many more eye opening experiences and I can see them trying to acclimate to this type of human suffering that is not so apparent in their comfortable suburban life.

The halls are quiet. It is about 3 am and I need to wake up by 7 am for a 8 am departure. I am sure my body will crash sometime tomorrow. All the students are in bed and I am now going to sleep myself. Tomorrow will be a busy day and I will have a second entry later on tomorrow as long as I can stay awake to write it later tonight.