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Every Journey Begins with a Thank you! by Valerie King

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This is the first entry of my 2011 BLOG about Nursing Students Without Borders trip to Ghana. I wrote a series of entries last year and I think they are still available to view. There will also be a student BLOG written by a few students and I encourage you to read that at http://blogs.uml.edu/GlobalHealth/wp-content/uploads/sites/93/2017/09/students/ They will have a wonderful stories from a student perspective.

I must begin this journey by saying thank you to all of the people who helped us get to Ghana. Of course top on the list are the families of the students and my own family who have put up with multiple fundraisers and meetings. None of us could do this without the strong support of our families.

University of Massachusetts Lowell has been very supportive. It would take me many pages to write accolades about everyone but I wanted to specifically thank Chancellor Meehan, Provost Abdelal, Vice-Provost Pierson, Dean McKinney of SHE. Christine Gillette, Karen Angelo, Elaine Keogh, Jeanne Keimig, Shaun Sullivanand most importantly Dr. Karen Melillo and all the faculty of the nursing department. My colleagues have been very supportive of my efforts and those of all the students on this trip and previous trips. As the politicians say, “it takes a village to raise a child” but I would like to alter that and say “it takes a village to educate a student.”

My own church family at Central Congregational church in Chelmsford has been very supportive with prayers, encouragement and monetary donations to help further some of my special projects in Ghana. We have had other church donations and I would like to thank the Lutheran church (Redeemer) in Woburn as well as Tewskbury Congregational Church. These donations help us to truly make an impact on the people in Ghana.

I leave Massachusetts in a little more than 24 hours. I leave tomorrow with ten senior nursing students. We will be gone from January 2- January 19th. There is still much packing and preparation to do. I am again joined by my friend Maura Norton from Chelmsford who is a UML alumna and has made this journey with me the last 2 years. We have learned so much about the needs of Ghana but also how sometimes just a small little effort on our part can make such a huge difference in an individual’s life. We are truly blessed to live in America but I am fortunate to be able to travel to another destination and see another way of living and hopefully by my actions and those of my students be able to make some lasting impact in Ghana.

Stay tuned for more stories and updates of our travels. Sometimes the stories are joyful, sometimes they are sad. They are the story of our Ghana trip.

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

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

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

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

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

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

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

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


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


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


“Pride and the American Nurse”

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By Valerie King

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

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

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

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

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

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

“Tears, Smiles and Tears”

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By Valerie King

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

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

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

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

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

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

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

‘Sunday is a day of rest’

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By Valerie King

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

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

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

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

‘Smoke and dust in your eyes’

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i>By Valerie King

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

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

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

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

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

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

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

“It is a new year!” – January 1, 2010

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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.

‘Who has the right of way?’ – December 31, 2009

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By Valerie King

Today we have our first full day in Kpando. After a breakfast of peanut butter and crackers and water I prepare to meet the students for a walk to the District Commissioner’s Office for a formal meeting. This is the first day that the students will get the ‘walk the walk’ that I did so many times last year. Our guest house was chosen specifically because of its central location. I spent many hours last year at the internet caf’ and the small adjourning park that is across the street from our guest house.

This morning we are walking to the Kpando Health District offices which are about a mile away through the busy roads of Kpando. The roads are very busy and it can be treacherous to walk down the street with the many taxis, private cars and other vehicles on the road and every one of them think they have the right of way.

The students are seeing Kpando in the light of day and will learn to call this community home for the next few weeks. They will learn where to find the best pineapples and water and where to get a cold drink or where the children will rush up to meet you. There is much activity and not much has changed since last year. I am a bit dismayed to find the house where the little girl Hannah lived appears to no longer be occupied. She and her mother and (?) auntie were the first people of Kpando that I met last year and I have come prepared with gifts for them and they are not there. I have asked around and no one seems to know where they are. Their home was an unsafe shack before and I can only hope that maybe they have moved into more suitable living quarters.

We arrive at the District offices and have an official meeting with the Director. There is so much protocol that must be followed. We present our plan for clinics and interventions and anxiously await his approval. It seems strange that we could travel all the way here and then to have someone turn down our offer of help. Fortunately that is not the case. He is a lovely man and is appreciative of our efforts and also longs for a continuing relationship with the people of UMass Lowell.

After our meeting I walk to the next building to reunite with Shine. She was my host last year and I am her ‘mommy’. She shrieks and runs to me and we hug. She is such a wonderful person and I realize how much I had missed her and she missed me. I also am reunited with some of the other nurses from last year and it is comforting to see some familiar faces. We meet a medical student (3rd year) who is living with Shine for a while and working at the clinic. Her name is Maria and she is from Puerto Rico. She is excited to have some nurses working with her next week. She said she sees over 100 patients a day.

We gather the students and some supplies and we cram into a pickup truck and drive 4-5 miles to Torkor. This is the impoverished fishing village that we visited last year. Today is market day and the community’s population here has tripled. So as we ‘go where the patients are.’

A quick impromptu clinic is set up. Two tables, 6 chairs and some benches. I give out assignments. Five students for BP readings, 2 recorders, 2 medication sorters, and a roving photographer. My plan is to circulate throughout the stations and the students have been instructed which patients to refer to me for further assessment and medication administration. I was concerned that the experience was going to be too intense but I was very pleasantly surprised and proud of their adaptation to the circumstances. They were being asked to assess patients who did not speak English and to practice some of their assessment skills and critical thinking to determine which patients needed further intervention.

It was a crazy 2 hours. I have not counted the actual number of patients that we saw today but I would not be surprised if we saw over 100 in 2 hours. The incidence of hypertension is mind boggling. I know that my supply of BP meds is not going to last during this trip so I have to adjust my dispensing. I am only giving them 10 tabs and then instructing them to return to a local clinic. Many of them have no insurance and I am not sure that they will go but I cannot in good conscience let them leave the clinic without medications. I have also adjusted my threshold of what patients receive meds. I am only giving meds if the diastolic pressure goes over 100. We have so many people in Stage 1 hypertension but I cannot afford to give them meds. I am saving my meds for the more extreme cases and trying to supplement our intervention with lots of patient teaching. It is a difficult compromise for me to do but I am trying to make the best of the situation.

These people are the poorest of poor. They live off fishing and sales of goods. The clothing is tattered and worn. It breaks my heart to think of all the clothes I have at home in my closet and if I could get them here I would. One woman who was so appreciative tries to give me one cedis (this is equivalent to one dollar). I know that is a fortune for her. I cannot take her money and politely refuse but I realize that I may have offended her. One woman hands us a bag of oranges. Another man, whom I discussed his high BP and urged him to cut out salt, told one of our escorts that I must have heavenly powers because I told him the exact same thing a MD specialist told him. It is interesting to hear that and you wonder if hearing from a nurse from America helped to make a health behavior change for him. We return home to our hotel to get ready for our New Years Eve Feast. We have ordered some Ghanaian food from our friend Patience and she will bring it to our hotel along with some beer and Smirnoff Ice.

‘Hail to the Chief and Heathens’

We had a nice dinner. I am not a huge fan of Ghanaian food but Patience’s cooking was good and the girls loved the meal. We sat around our tables in the courtyard of the guest house. Our 5 small cocktail tables are illuminated by my Barnes and Nobles book lights (thank you Santa). After we finish we have a wonderful discussion with one of our organizers, Maule. He is from Peko which is a village we will be visiting in a week or so. He explained to us the chiefdom system that is the custom here in Ghana. He is the first born son of the Chief of Peko and someday he will be assuming this very important role. He is a personable and educated young man who has love of learning but also love of his village and a desire to return to Peki to make a difference in the lives of his people when he graduates this May from the University of Ghana. He has been incredibly helpful to us and is knowledgeable about local customs, dialect, and history.

We learn that New Year’s Eve is a religious holiday here. After dinner we cross the street to go to the Friendly Spot, local bar/shack that serves beverages and has an MTV type program on a portable TV on the grass outside the establishment. There are large speakers which at this moment are pounding with bass and music. As we sit there we notice many of the people of the town are passing us on the road and are dressed well and going to church for a 9 pm service. We are told that they stay until midnight to welcome in the New Year and then return to their homes and local bars to celebrate until the wee hours of the morning. I suspect that the Friendly Spot will be booming for hours to come. I think I may need to sleep with headphones tonight.

We are the heathens who instead of going to church are drinking and waiting for the New Year to arrive. I have left the UML students to enjoy some relaxation without the presence of the ‘Mama.’ I am enjoying the solitude but am sad that I am missing NYE with my husband and children. I want to call home but we do not have any minutes on our phone and the internet caf’ is closed. I wish all my dear friends, colleagues and family a very happy New Year and I will see you all in 2010.

“All Around Town” Part 2 – December 30, 2009

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After our meeting with the minister’s chief director we board our bus again and we began driving to our next destination of the Kwame Nkrumah Mausoleum. The traffic is stopped ahead and our driver who is following the lead of our truck in front of us, decides to go over the curb into the oncoming 2 lanes of opposing traffic. The passenger in the truck is frantically waving to the oncoming cars to get out of ‘our way’ so we can drive ahead to our destination. I was too busy watching my life pass in front of my eyes to take out my camera and get a video of this adventure.

Well, I am writing to you now so you must know that we arrived safe and sound at our next destination. We toured the Mausoleum which is a lovely tribute to the first President of Ghana when the country became a republic in 1961. Our tour guide tells us that he was removed from office around 1966 in a coup d’etat that was secretly supported by our own USA CIA. I don’t know if that is true but the fact that I see only one photo of President Nkrumah with JFK and multiple pictures of him with Fidel Castro then I suspect there could be some truth in this fact.

It is an impressive site that also contains the headless and handless statue of this president that was partially destroyed during the coup d’etat. It has some eerie resemblance in my mind of the statue of Saddam Hussein that was destroyed by soldiers during the invasion of Iraq. This Ghanaian president was obviously loved and respected and when he died his remains where brought to this park (that used to be a British polo field where no Blacks were ever allowed to walk on). We also saw his car, a bulletproof American Cadillac that sits out in the hot African sun. The display in the museum and the car are interesting but seem to be in dire need of some good museum conservation to keep the exhibit viable. There are signs of aging of the photos and not much appears to be done in terms of archival preservation. We also do a drive by of the Parliament and the massive conference center and parade grounds.

Kwadwo has rejoined our group and he has taken our personal funds and exchanged them for Ghanaian cedis. The exchange rate is not bad 1 USD to1.4 cedis. We finally have some money to buy some water and food. My task was to divide the over $3000 in Ghanaian money (mostly 1’s and 5’s) into even piles of $280 each. The one mistake I did was to count this money in the rear seat of a moving bus. For those who know me you know I am extremely sensitive to motion sickness, especially in the back of vehicles.

We arrived at our restaurant which was a bountiful buffet of all the Ghanaian foods that the students wanted to try. Some of the students love the food others are less than enthused but it is an opportunity to experience some of the culture. After a quick trip (thru the endless traffic of Accra) we go to the Mall to purchase a cell phone so the students can call home and some water for our day tomorrow. We will be journeying to Kpando and the students will leave the bustling city of Accra and see the rural area of the Volta Region. We are scheduled to work at 2 different blood pressure clinics tomorrow.

Everyone is weary so we head back to our hotel for a nice cold drink and a suitcase supper. A suitcase supper is made up of snacks that were brought by us to Ghana. Our land package does not include meals so we are trying to economize and eat some of our snacks as meals. Many of us are still full from the food we had earlier today. Back at the hotel we experience a blackout for an hour or so and we are told that this is a regular occurrence. All the students are prepared with flashlights. We now have running water and the air conditioner is working so life is pretty good here tonight. Jet lag has really caught up to us so we are going to bed a bit earlier today. Tomorrow will be a busy day!

‘All around the town’ Part 1 – December 30, 2009

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Today started with a loud tapping on my door at 6 am. Kwadwo’s wife Sylvia was waking me up about an hour earlier than I had expected. Oh well, guess I will function on 3 hours of sleep today. I was unsure about our breakfast arrangements so I finished my ‘ leftover turkey sandwich I had bought 2 days ago at Panera. I was hoping I would not get salmonella but if I did I rationalized that it was probably ‘American’ salmonella.

We all met at the hotel restaurant and I had a glass of OJ and the girls were very pleased that coffee and tea where available. The owners of this hotel called the Samartine Hotel are very friendly and accommodating. They have just finished years of work on this hotel and opened last week. I think we are one of the first guests. The sheets on my bed are brand new and the place is immaculate. It is a nice change from some of the previous hotels/guest houses we have stayed in and I would very highly recommend that you check out this hotel if you are in need of affordable, yet clean hotel rooms. Ok, enough of my commercial but the proprietors, Sam and Martine, are such lovely people I had to give them a shout out.

After breakfast we loaded onto our 25 seat bus (also a huge improvement in the Tro Tros that we used last year). Off we go for a day of sightseeing and a meeting with the Minister of Education. We had hoped to meet up with the University of Ghana students today but they are all on Christmas break so we will try to connect at the end of our trip. We drove through the campus. It is quite large and covers many acres of prime land overlooking the city of Accra. There are many academic departments and it is a frequent choice amongst students from neighboring countries.

The campus is impressive but we hear stories about the living conditions for the students and the UML students realize how good they have it at UML. Often there are 6-8 students sharing one dorm room with many bunk beds. We ask our friend Mawuli who is attending there in his last year of a BS in Social Work, how much the tuition is a year. He reports $500 per year. Ummmm’ I could save a lot of money and send Jimmy here.

After our drive through the campus we drive to the site where the Minister of Education works. He is a very important man and he has written an official letter of support for our group and that is not very often done. I believe he has interest in our trip and has agreed to meet with us. He was unable to meet with us so we meet with his Chief Director, Mr. Dannyo.

After brief introductions by all the students and myself we review our itinerary with the him. He appears impressed by the type of experiences we have planned. The students ask him some very relevant questions and we present him with one of our blue NSWB polo shirts and a copy of the UML Magazine article that was written by Karen Angelo last Spring about our trip in 2009. We also have given him some medicine that have brought with us as a sample of some of the supplies that we have carried into Ghana to deliver to the underserved people in our clinics. He is also impressed by this little ‘freebie’ gift of multivitamins, ranitidine, loratadine and Advil. He reports it is the first time he has ever gotten free medicine.