Tag Archives: Kpando

Day Nine: ‘Day Life and Night Life in Kpando’

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We begin our day loading in a tro tro that probably has more rust than metal. We are journeying to the Christian Children’s Home in Hohoe where we have been the lasttwo years to see the children.I have been communicating with then during the year and they have made much progress due to the generosity of some Americans and other international donors.

Our tro tro is a probably one of the worst I have seen. I can see the pavement through a crack on the floor, the roof is made out of plywood, there are bars between the first and remainingfour rows of rickety seats and there is a dirty bathroom rug covering the dashboard. Our driver smells as if he has not bathed in a while and Maura and I chew on cough drops to overcome the odor. The engine is below our seats and by the time we have driven an hour in the tro tro our buttocks have been cooked to medium well.

The visit to the orphanage was great. The UMass Lowell nursingstudents were able to repeat their nutrition project and I could see a vast difference in their confidence and delivery. They are becoming pros.

At the orphanage we deliver some toys, clothes and books. The children rush to me and call me ‘Mama Bell.’ I think they cannot pronounce Val. They remember me from last year and my friend Francis who is a cute 11 year old boy cuddles right up to me and appears glad to see me. We play with the students, tour the new buildings and then have to leave to journey back to Kpando (my backside was further cooked on the ride home).

Today is market day in Kpando and that is a huge event that draws in hundreds of vendors selling items ranging from lovely material to local produce and disgusting dried up fish. It is a sea of humanity and you just have to ride the waves. I am soon followed by another child, Michael, who becomes my quiet companion and guide. If I lose Maura, he knows where to find her. He helps me find fans and at the end of our expedition he leads us out of the market. Words cannot describe this place so I hope to post some pictures upon my return home.

Our plan was to have one quick cold drink before returning to our hotel. The UML students have invited us to dine with them at a local restaurant that they have found and seem to enjoy the food. We decline as we are anxious for some downtime and to catch up on our email. That downtime does not come because as we enjoy the last of our beverages we are joined by our friend Edith and soon thereafter we are joined by a steady stream of Ghanaian people who want to sit and chat with the Mamas.

There is a local football (soccer) team that has won today and everyone is celebrating. We meet some nice men associated with the team (the driver and the cook) and other people either connected to the soccer team or local workers. They are interested in us and we in them. They are impressed with Maura’s status as a Queen mother and mine as the Queen of Linguistics. To us these titles seem more honorary than actual titles but we are told of the significance of these roles and even to these people in Kpando are impressed with two Queens from another village (Peki). We are amazed at the long history of tradition regarding these important roles in the village royalty. These people are truly happy to be conversing with us and Maura even receives a marriage proposal. Nothing for me’ oh well! Our brief pre-supper beverage turns into afour hour ordeal.

The music is blaring from two large speakers and we await the return of the students from their supper so they can help continue with some of the communication. Day turns into night and we apply insect repellant to prevent risk of malaria. Our new friends are very interesting and are thrilled to be ‘hanging’ out with the Americans. They have all these places and people they want us to visit. Relatives in a different village, friends and family in Kumasi (which is another region aboutfive hours from Volta region that we had hoped to visit but we may run out of time), and local dignitaries right here in Kpando.Our friends buy us a bottle of brandy and we all take a sip and some of us spill a small on the ground in respect for our ancestors. The UML students do not like the brandy so I have no fear of drunkenness but most of them take a sip out of respect for the gift of friends.Music is playing and have a dance party out in the dark with all the UML students and our friends. Two more marriage proposals occur (not for me!).

After a long night of some libation, dancing, no supper and straining to understand the accented dialect, Maura and I walk across the street to have a quick cold shower and off the bed. Tomorrow is a busy day. Our last full day in Kpando.

Read about the students’ experiences

Day 7

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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 6: ‘Pills, People and Problems’

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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.

“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.

“It is a new year!” – January 1, 2010

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By Valerie King

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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