Entries tagged with “2010” from Nursing Students Without Borders

Home Sweet Home

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It is now one week since we returned home from Ghana. The adjustment period always takes a few days or week.  Sleep can be problematic as our internal clocks have shifted about five hours. I find myself dropping off to sleep in the early evening and then awakening much earlier than usual in my own bed. 

I am not awakened by the the incessant roosters as I had been in Ghana but rather by some internal mechanism.   When I awake I am still trying to process all the happened while we were in Ghana. 

These BLOG entries cannot begin to capture the emotions and experiences but they are a start.  Pictures will be added but that also involves some sorting of photos and re-sizing for web based applications.  I have over 1500 pictures collected from my own camera and some of the students.  Please be patient as I go through this process but I really want you to see some of the images.

 

We wake up early for our 8 am departure which turns into a 9 am departure.  This is typical of our trip and the alteration in our schedule is often frustrating for us. Our day begins with a visit by a few of the Nurses at the Kpando Health Center. I am sure due to Shine’s intervention that  they have traveled 3 hours to Accra to present us with a gift of appreciation to us for all of our donations and hard work in their community.  Each of us is presented with a length of fabric with the distinctive imprint of the Ghana health services logo.  Maura and I admired these last year. I think it is the hope that some of the UML nurses will make some nice scrub shirts with this material for our next trip tip Ghana. We are deep touched by their generosity.

   We have been told that arrangements have been made to meet with the University Of Ghana School Of Nursing.  I am somewhat disappointed that the dean has either been non-committal in her decision to meet with us or our leader has really not made the appropriate inroads in scheduling this event. We are told on our drive in that the Dean is very busy and is trying to gather some of her nursing educators but our proposed meeting with the student will not happen.  We drive through the University of Ghana for one last time.  It is actually a large campus. We are ushered into a room to meet with dean and few other educators.  I have brought with me a folder of information about UML and a gift of one of our senior textbooks.  Introductions are made and I explain that our purpose was to meet with them to begin a relationship that may be one of reciprocity with both Universities that that there is potential for future collaboration.   The dean seemed interested in our graduate programs specifically if some of her educators could get a PhD at our campus.    I will put her in contact with our departmental  leaders.  I had hoped for more dialogue with the UML nurses about their educational preparation but not too many questions are asked.  After our meeting we quickly use their washroom and go on a tour of their bookstore.  We see may interesting titles but I am struck by the age of the text books.  I consider purchasing a book about the health care system in Ghana but then I read that was first published in 1975.  It was “revised” in 2005 but all of the charts and statistics are from 1963-1980.  I find this unacceptable to be selling books to their students that contain likely outdated information.  They have an unusual assortment of textbooks in the nursing section. American paperback novels are available for a small fee but most are not recent editions and I wonder where they get their supply of books.  Many appear used.

We had also been promised a visit with Dr. Karl Kroman who is an infectious disease specialist who is working on a  malaria project.  Again somehow either he changed his plans to meet with us or possibly the plans were never finalized.  He is unavailable due to a meeting.

We are then treated to a very nice surprise. Lt Col Holly has arranged to have us spend an afternoon at a local hotel pool for swimming.  We are thrilled because the hotel has also given us a room for the day to use for changing and there is internet and a lovely restaurant.  I spend some time on the internet (thanks for all the communication from home).  Maura and I enjoy a nice club sandwich with more French fries and a diet coke on a lovely table with linen tablecloths and warm towels to wash our hands.  We can almost feel like home.  Our waiter is a nice man from the Volta Region and once he hears about our recent journey he lobbies me to include his village in our trip next year.   The request for visits by the UML nurses is growing and growing.  We have a nice concluding ceremony poolside as Kwando thanks us for all of our hard work and the statement that we have made such important impacts on the communities that we visited.  It is hard at times to believe that we have made a difference because logic would tell me that these people will have ongoing health and welfare issues long after our departure and it will take generations to solve.  For the time being I guess we have to be satisfied with what every little bit of care we can offer.

We return once more to Oxford Street.  I have told the students and Maura bout GLOBAL MAMAS and we return for one more shopping trip.  Some of the students did not eat at the hotel so we have our last meal at the place where we had our first meal in Ghana.   As was the case last year many of us are down to our last cede and there is much skimping. We manage to pay the bill and I take a few moments to offer my thanks to Nicholas, Kwawdo and Mawuli.  These men have the best of hearts and will work hard to ensure improvement in the health and welfare of the people of Ghana but more specifically the vulnerable women and children.  I applaud their dedication and I am so appreciative to have them as our leaders.

We arrive quickly at the airport and mass chaos happens.  There is a mad rush for carts and we try to stay together as we make our way to the long line for customs examination of our bags.  Nicholas is able to use some of his political power to get me to the front of the line and the officer in charge marks my bags. As long as the UML students follow behind me then that is a quicker way for us to navigate this process.  After an hour we have checked our bags and it is time for our African friends to leave us.  Hugs and kisses are given and we are left to maneuver that last few obstacles on our own.  We are becoming seasoned travelers and know who to stick together and make the best of the “hurry up and wait” mentality.  We are fortunate that it is a Monday night and travel seems a bit light.

I sit here and write this last entry on the British Air flight on the final leg of our journey.  I slept through much of the first leg.  The virtual map on my headrest indicates that I think I am somewhere over Eastern Canada.  Home is getting closer.  We land in less than 2 hours.  Our first order of business is a long hot shower and the next is a warm comfortable sleep in our beds.  The trip has been successful beyond my expectations and I hope to be a messenger for others who want to hear about the plight of the Ghanaian people.   I will be adding photos and possibly addendums to my entries as I start to remember more details.   Please feel free to contact me if anyone has any question or you want a presentation to your school or church group.  Well that is all for now.  

We have plans to sleep a bit later today as we have not had too many early mornings.  Maura and I enjoy our typical breakfast of peanut butter and jelly crackers and today we have cold diet cokes to go along with our feast.  We are compatible in our food likes and it has become our easy routine to set up our “breakfast table (a Sterlite container lid) on our bed and chat over our crackers.  We spend some time working on repacking our bags.  We also need to complete our 4 page evaluation for AFRICED and we want to carefully word our suggestions and comments.  We also need to have some private discussion about the distribution of our funds for various projects.  We have both come prepared with some money to help donate to some projects but we have questions about some of the quoted figures and we need to find a way to make our money be most beneficial.  We are somewhat taken aback that we received a text message from someone in Kpando inquiring about our “promised” plan to fully support their well project.   It is interesting that our tour of that tragic site left them with the impression that we were going to fully support this project.  Of course originally we were given a figure of $600 for a bore hole for a new safe well. This figure did not seem accurate to me.  Now are given an estimate of over $900 just to make the current hand dug well safer (i.e. concrete platform and a metal cover and gate to prevent children from falling in) and a rough estimate of a bore hole project that is about $4000.  We text back that the UML student nurses club is in no financial position to fully support this project but we will take under advisement how we may help them with this project.  It is important for us to see how much of their own funds from the community and their government that they themselves have tried to procure for this project.  We have also been told that the Kasseh health center is looking for us to purchase mattresses for their maternity unity.  Again, I will say again, there is so much need and many of the Ghanaian people have the hope (expectation) that visitors from USA will fund their projects and needs.  I would like to see how much governmental money is being used to help some of these projects also and I need to be assured that any donations made for these projects is safely and appropriately disbursed.  Maura and I come up with a plan of donation and we feel comfortable with our plan.  We hope to initiate other donations from our friends and colleagues in the USA.  We have trust in AFRICED that they will help to distribute these funds in a fair manner.  We both would like to see an organized sponsorship program for the orphans in Peki and ultimately a completion of the orphanage structure.  We have been given a rough estimate of $250 to support the living and school expenses of child in Peki for one year.  I would like to personally support one child a year and I hope some of my friends how are reading this might consider doing the same either independently or jointly with friends.  Please contact me if interested.

We are told that our friend Nicholas is here with a large bus for our needs for the day.  This was not a negotiated expense for our trip.  WE have planned to use taxis today.  I have told him that the BANK of VAL is closed.  I have subsidized various aspects of this trip and even our trusted organizers assume that our funds are endless.  I am conserving my funds for more charitable donations.   After some negotiation (everything here is a negotiation here!!!) we agree to pay for the fueling costs of the bus. I believe that the Minister of Education office may be subsidizing some of the expense because Nicholas works in that department.  He has been very instrumental in getting us through certain logistical hurdles due to his diplomatic status and I am very grateful.  On the other hand I believe that the presence of our group has also provided some political impact for him and our other leaders.  Our presence here in the country has been noticed by some of the Ministers and the media.  We are the model for future trips by nursing and other student groups.  We are taken to a local arts center where we once more face the lions of local commerce.  We have to negotiate every purchase.  They say 10 Cedes we have to counter with 3, they counter with 8, we counter with 4 and then the price ends of being 5.  I hate this process but some of the girls enjoy it.  Again, I feel like it is a feeding frenzy with the American tourists and I am anxious to buy my last minute souvenirs and re-board the bus.  

Nicholas takes us on a driving tour of the city and we see more of the local buildings.  We are dropped off at Oxford Street and told to walk the 5-6 blocks to visit some last minute vendors.  My Ghanaian cash is almost gone and I find a local Barclays Bank ATM.  I withdraw some money and for some reason I glance down a side street.  Because I am known as Mama Val my eye catches the sign of GLOBAL MAMAS.  It is a small shop off the main street and they sell Fair Trade products.  These are items that are made by women who are supported by some micro loans and the profit of their craftsmanship is again funneled back into their businesses.  Items are sold in this one location but I think is it like a consignment shop type of sales.  The items are somewhat standardized in that they use a lot of locally made products of beads and batik fabric.  They also sell items made out of recycled water bags and ice cream wrappers.  The designs are ingenious. I am happy to support these artists and I relaxed to know that I do not have to negotiate any pricing. 

                We board the bus and Nicholas takes us on a short drive past the American Embassy.  Unbeknownst to us the taking of pictures is prohibited and no sooner than we click off a few pictures our bus is stormed by angry Ghanaian officers demanding to be let on the bus to confiscate the cameras.  There is much shouting between our 3 Ghanaian escorts and at least 3 Ghanaian officers.  I do not see an American presence.  The door is open and I forcefully identity myself as an American citizen with proper identification and that as a leader of the group I am willing to take responsibility for any snapshots taken.  I think for a moment he considers taking me off the bus (and inwardly I am shaking but I must do this to protect my students).  Our Ghanaian escorts continue with their shouting and ultimately 2 cameras are taken (mine, which did not take any photos and one other student camera). Our escorts leave the bus and head over to the embassy.  We are all watching from the bus.  There is some fear but probably more indignation about the way we are treated.  The whole situation could have been simply solved with a normal tone discussion (and negotiation…. That word again) and erasure of the alleged photos.  We have the phone number of our new friend Lt. Colonel Mike Holly.  He is fortunately only a few blocks away. It is Sunday and he is not working.  He arrives to help calm the situation. Cameras are returned and we leave the area with the mantra “no photos, no photos, no photos”.

                I had made previous arrangements with our hotel to utilize their small kitchen to heat up of feast of Mac and Cheese and then our plan was to take the girls to a sports bar in town.  The proprietor of the hotel has had a change of heart and does not want to let me in the kitchen to boil water.  I do not even bother to negotiate with her.  I am disappointed with the hurdles to provide a feast for my students.  They are all low on cash and this was going to be a fun American comfort food feast.  Instead of staying there to have food and drink at the hotel I instruct the students to get ready ASAP for our journey to CHAMPS.  I eat one of my last packets of tuna because I have not eaten since my crackers from this morning.  I am dead tired but the students want to kick up their heels a bit and wear their new dresses.  I have no option except to join them. 

Champs is a non-descript bar that sometimes has fun entertainment like Karaoke but tonight is Sunday and it is movie night.  There are large screens with B-rate American movies and Arabic subtitles.  The sound system is right next to me and is blaring.  The students are all sitting together and the Mamas (Maura and I) nibble on beer, Smirnoff Ice, French fries and nacho chips.  When the bill comes 2 of our Ghanaian hosts do not offer to pay for their food.  There is this expectation that the Americans will pay for all.  The "Bank of Maura and Val "has to pay for this. Part of me does not mind doing this once in a while but the daily expectation for us to subsidize their food and transportation is tiresome.  We also do not receive appropriate words of appreciation.   After a while I urge the students to leave.  They have full bellies but we manage to go back to my room to have a birthday celebration with cake.  One more day in Ghana.   After we return to the hotel we pack up the last of our items in preparation for an early departure tomorrow. We have a very full day.  I need to do some more work on my evaluation and reports to Kwadwo.  I finally go to bed around 1:30 and I think about all the reading I was going to do on this trip and I have barely cracked open a book.  At 4:30 am there is an insistent knock on the door.  The proprietor’s wife is telling me we have to evacuate the hotel because of a radio announcement to the community about a potential earthquake.  We have all been on edge because of the earthquake in Haiti and it creates in me a few moments of fear but then common sense prevails I recognize it for the hoax it probably is but for the safety of the students I have to wake them up and evacuate them outside.  It is somewhat surely to be up at that time and hear the activity of the local neighbors. Everyone is milling around but I do not hear any warning bells or sirens in the distance.  I suggest to the owner that he turn on the TV In the restaurant but he is complying with what her perceives is the emergency plan and will not walk the 40 feet to his kitchen and turn on a TV.  I spot his car parked nearby and I urge him to turn on his car radio for any updates.  In the meantime I call home to see if my husband can see anything on the internet.  After about 30 minutes we find out there is no official order to evacuate and we return to our room.  My adrenaline is high and sleep (the remainder of my 90 minutes of sleep time) is hard to achieve.   Tomorrow is our last full day in Ghana.  Home is getting much closer and that makes me happy.

I write this quick entry.  I have been having problems getting my blog entries uploaded so I will have to wait until I get home.  I have many more stories to tell so please check back and I hope to upload some photos.  We are all safe and resting at a hotel pool for a few hours before we leave for the airport.      We have so many stories to share.  More later

Val

Today we get up early and drive to Kakum National Forest.  We are told that this is only one of 3 National Forests that have a catwalk.  I have done this attraction last year and I remember how arduous the hike up the trail was and I elect to stay below with Maura and people watch.  The students make the hike up to the elevated platforms high above the tree line.  The students expect to see animals but there are no animals in this part of the rainforest. It is the dry season and they have gone to other locations where the water is.  Even if there were any animals they would not make an appearance with the screaming of the tourists as they cross over the roped walkways high above the floor of the forest.   We have a few students who are afraid of heights but I am happy to announce that they all made it back in one piece.  There is another group of white students who are also returning from the walkway.  They are an assortment of students from various countries who are working on some humanitarian projects here in Ghana.  When we see a group like that we always go over and see what they are doing.  We are truly the minority in this country and the color of our skin binds us to these strangers.

We then travel to Elmina Castle which is one of the first castles built in this region.  Originally it was a Portuguese trading site for gold and other items but very soon these traders realized the value of human trading.  We have a wonderful guide who has been doing this for years and his name is Clifford.  One important piece of information that he shares with me is the history of slavery before the adoption of that practice by the Europeans.  The Africans themselves used slavery as a means to conquer other tribes and to use the prisoners of war during these conflicts as human barter.   I think this is an important thing to hear.  As a white American our history books focus on the role of the Americans during early slavery here in the US and ultimately the Civil War and abolition.  I think slavery is a stain on all nations and that reparations and change in attitudes have to happen with all races and not just the white Europeans and Americans.  We also need to modify our history books to reflect some of the origins of the slave trade. 

As I tour this castle I am reminded of the comments I heard last year from out tour guide.  This year we learn a bit more.  He is trying to use words and stories to help us understand the emotions and fears of that era.  We are locked in a small dungeon cell so that we may experience some of the sense of despair and fear that the African slaves felt. The stories of the rape and exploitation of the female slaves is especially troubling and when he talks of the separation of the families I start to realize the horror and lack of hope that must have been felt by these people.  I am again appalled to see a Portuguese church sitting right on top of the dungeons and realize that the worship of God happened mere feet from the suffering of the slaves.  There is a plaque on the wall and I am going to post the picture.    Last year I gave a lecture at a church and I ended with that picture of the plaque in the hopes that it might generate some discussion.  It was interesting that the audience did not want to discuss this.  I think deep down we all know it was a horrible part of human history but it is easier not to talk about it.  That is why we must continue to have dialogue about how these events have shaped who the white and black people today in 2010.

 

After the tour I am able to take some photos of the harbor at Elmina. It is like going back in time and I hope some of my pictures will help to demonstrate these aspects of the African fishermen. They carve out and build long boats from the local trees and each afternoon they leave their harbor to go out into the deeper water to catch fish. The boats have at least 10 men on them.  We are here in the early afternoon and some of the boots are returning with their booty.  These boats are lying low in the water and when other people in the harbor see these boats return there is a loud cheer and clapping.  The returning fishermen are heroes to their community for bringing home the fish that helps to sustain the economy of this village.  It is hard for me to imagine how monotonous this life must be but that is the only way that they can survive. 

As we leave the castle we are mobbed by local vendors trying to sell us their trinkets.  I do not need any of these items and I know that if my wallet comes out I will be swamped like blood to the piranhas.  I hate to be rude but I push “my girls” on to the bus and close the doors.  The incredible poverty is overwhelming and it is wearing on us a bit.  The students are anxiously awaiting a return to Coconut Grove resort for an afternoon of swimming.   We have planned these last few days of relaxation and I think it was a good thing to do.  We have worked so hard since our arrival and the students need some rejuvenation before they return to the rigors of their academic schedule upon our return.  The pool is lovely and we pay a small per diem fee to use the facilities.  The pool area is mostly empty and I think the addition of 10 beautiful young nursing students is something they do not see too often.  I remove myself from their group and find a chair on the other side of the pool.  Maura has left me for the afternoon to meet up with her son who ironically is also here in Ghana with Babson College and they are about an hour away at a competition about entrepreneurship.  She leaves with Kwando to make the trip and I am with the students.  They are having a great time but I need to maintain my distance a bit.  I think it is important for them to be kids and for me (the mother and professor) need to be separate.  I take advantage of a shady lounge chair and try to read but once I start to relax I find myself asleep.  I am told later that the students came over and took some pictures of me with sleeping with my mouth wide open (not a pretty picture) and they jokingly said it is blackmail material for an A in their next class. 

I meet 2 people that day at the pool.  One is an American woman in her later years who travels around the world.  She is in Africa and will be here for a few months.  She travels alone and makes up her itinerary as she goes along.  She tells me of her stories in India and Asia and I am curious about how she supports her travel because she stays at nice hotels along the way.  She does not reveal her source of income.  I also meet another man who is currently in Ghana doing some epidemiological research for a petroleum company.  He does not get into details and I wonder if he thinks that a nurse would not understand the nature of his work.  He is currently attending MIT Sloan School and has 3 degrees from Harvard.  I do not recall his name but he has a former colleague who currently teaches at UML and I need to make a connection when I return.  It is funny that when I am in my own country I usually do not walk up to people and start talking( well at least not all the time) but here in Ghana there is some liberty in starting discussions with people you know are from your own country.  

The girls try to cajole me into delaying our departure and I give them an extra 45 minutes.  We have a 3 hour trip home tonight to Accra and I am ready to leave.  After a few posed pictures at the pool we leave.   Out 3 hour trip turns into a 5 ½ hour trip from hell.  Actually the first 2 hours were not bad but once we approached Accra we sat in stop and go traffic for hours.  At one point our driver took a short cut through some local neighborhoods and we were stopped at least 4 times at police roadblocks.  I am angry to think that these Ghanaian police officers are stopping all these drivers but do not offer any assistance on the main roads to maintain some type of order to chaos on the roadways. Because our journey home is taking so long we must stop for gas again.  I am amazed to find myself in a VERY clean store at the gas station and imagine my delight when I find some diet coke.  I buy 4 for our last 2 days and I know Maura will be thrilled with my purchase.   It is now Saturday night and we only have a few more days left. Tomorrow is our shopping day and I have planned a birthday party for tomorrow night.  We have had 2 UML students have Birthdays during our trip (Allison and Jody) and I have ordered some cakes.  We make an inventory of our remaining supply of American food and we realize that we have 12 packets of Easy Mac left between us.  I have also hoarded some Starburst candy so I have planned a birthday feast of Easy Mac, Starburst Candy and Cake for tomorrow night.   We are all getting homesick and are anxious to return home.

We have finally arrived at our day of rest.  We leave our hotel in Accra and battle the traffic to get out of the city. They are doing a large construction project and the main road is being torn up.  I think the attempt is to build a flyover to reduce congestion in the city but right now it is a mess.  There are no traffic cones or overpaid state policemen directing traffic.  It is a free for all.  We are lucky that we are traveling in a larger bus because some of the smaller vehicles are yielding for us but it is a bumpy and stop and go process and it takes us over an hour to leave the city.  Our journey to Cape Coast takes about 3 hours and along the way we see some of the affluence of Accra turn into the typical mud and grass huts that are the standard of living for many people in this country.  I am reminded again of the extreme poverty of this nation. We are traveling to the sites where much of the slave trade occurred in Western Africa.  Over 11 million Africans were carried across the ocean from the mid 15th to the late 19th century. There were no American forts but the Americans played a significant role in this terrible human tragedy.  I urge you to watch Traces of the Trade which is the story of the slave trade that occurred in Bristol Rhode Island (available on PBS).

                We are told that Cape Coast is the educational center of Ghana because it is the home of many fine schools and universities.  It also used to be the seat of government many years ago but that has all moved to Accra.  The buildings are very old.  We see a 500 year old building.  We drive down “stone house road”.  Is it lined with very old brick and cement homes that were the original homes of the mulattos.  The mulattos were the product of rape of the female African slaves and the British and other military soldiers in the 17th-19th centuries.  These children were actually respected by both the white and black population so they served as important liaisons between the two races.  They were usually not shipped off as slaves and enjoyed a different quality of life than their mothers and African family members.  Many of them have Anglo names such as Taylor, or Williams. The city is very old and sometimes if you don’t look too close at the cell phone kiosks or the blaring of the taxi horns you could imagine yourself back in time.  We arrive at the Cape Castle which was owned and operated as a slave castle (among other things) by various countries but it was last operated by the British. Our tour is very well done and it is amazing to be walking in the dungeons where hundreds of men and women were imprisoned.  We see a mark on the wall which is about 2 ½ feet from the floor.  We are told that when they first started to prepare this as a historic site they thought the floor they were walking on was the original floor.  It turns out that there was about 2 feet of dried blood, excrement and other fluids that had dried over the years in those dungeons and eventually the level of the floor rose.  We can now see a groove around the perimeter and through the center of the room.  It is the trough that bodily fluids are supposed to drain out of the room.  I can almost feel the human suffering as I touch the dark cold stone. The lights are turned out and we are told that 500 men would be in this room. Many died from starvation and infections.  If they attempted to attack their captors they were put in a cell in complete darkness and deprived of water and fresh air until they died. Their bodies were then shown to the other captives as an example.   The heat in the dungeons is oppressive but there is no odor of dying but I sense the pain of those people. Outside the male dungeon there is a new plaque that was not there last year.  It is a commemoration of the visit by Barack Obama.  The visit to this Castle touches me in a way that is hard to explain. I can only hope that someday many of you will get a chance to see this site.

                Our time is running short and we cannot visit Elmina Castle today but instead we decide to go to the Coconut Grove hotel for lunch.  This is a very nice resort right on the ocean.  We have a wonderful lunch in a gazebo overlooking the rough surf of the Atlantic Ocean.  There are some American food items on the menu and everyone is happy.  The UML students get to play in the surf and take some pictures. We buy some beaded jewelry from a Rastafarian student.  The mood is high and we are looking forward to another fun day tomorrow. We are staying at a nice hotel (running water, AC and a TV that gets one American channel) and it is a relaxing night. I am sipping some Californian wine and realize that home is getting closer. I watch a bit of American TV and catch up on the news of the earthquake in Haiti.  We feel somewhat disconnected to the world events right now.  Last year the pilot landed on the Hudson River when we were in Africa. It is interesting how we have become isolated from the news due to lack of access to TV and newspapers.  One interesting item is that last night while checking my email I find out that our meeting with the Ghanaian Minister of Health has been shown on national TV here in Ghana and also picked up on the internet feeds to international news sources.  I am forwarded a copy of an article that appeared on the internet regarding that conference and the Minister is quoted discussing his goals for improved health in his country and then I am quoted discussing the need for compassionate and competent nursing care.

http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=175015&comment=0#com

The article also mentions UML and AFRICED as sponsors of the program.  It is bizarre to have this email forwarded to me from the PR people at UML.   I am proud to that we have made a positive impact while representing our university.

We arrived last night at Samartine hotel in Accra.  Our hosts Sam and Martine are excited to have us return to their hotel.  I am gladdened by their friendliness and feel very comfortable here.  I did some laundry last night and ask her if I can hang my pants to dry on her line.  She is very accommodating. 

                Today we had hoped to be done with most of our work but we are told that one more BP clinic is needed in the village that we first visited 2 weeks ago. It is near Ada and the name of the village is Adanor Kopeh.  It is a very poor village.  We were supposed to leave by 9 am but the bus does not arrive until 11 am and we have an hour drive (it actually turns out to be a 2 hour drives due to traffic).  On the way we pick up Comfort who is a social worker from Accra who is from this village and has promised her people that we will return.  I have no more BP meds and can only offer them some vitamins or Motrin or Tylenol.  I really hate to do a clinic and not have any meds.  The UML students are tired of working and we have been at this for 12 straight days now.   When we arrive (late) at the village the people have left to go and work at their farms. Many of us need to relieve ourselves and are directed to a concrete box with a hole in one corner.  We squat and relieve ourselves and dream about our clean USA toilets with toilet paper and privacy.

A loud bell is rung to announce our presence and the people start to trickle in.  It quickly becomes an unmanageable situation.  People are asking for any meds we can give them and are in a frenzy to get the remaining bars of soap, shampoo and conditioner that we have brought with us.  This community is very poor and we again discuss the difference between greed and desperation. It is hard to distinguish at times.  We realize that although we had promised to stay for an hour or so the situation was deteriorating and I needed to get the students out of there.  We board the bus with such disappointment in the circumstances that lead to this disastrous day.  A woman rushes to the bus. She heard the banging of the bell and wanted to come and see me. She received Tylenol and ranitidine (Zantac) 2 weeks ago and her stomach pain has gone away.  She wants some more. I dig around in the box and give her some supplies.  We board the bus and the kids are happily waving to us and the adults as asking when we can return.  I am a bit ashamed of this shoddy nursing care and I know the students are feeling the same way but we had to stop the situation from becoming a bad situation.  

As we drive toward Accra I begin to apologize to Comfort for the situation.  She is not upset but rather wants to educate us about some of the psychology of the people of Ghana.  She tells us that the people believe that we have magical powers due to the whiteness of our skins and the Ghanaian people will do anything to have contact with us. If all we do is assure them that they are healthy and need no meds then they will sleep soundly with the assurance that the white woman as told them good news.  I find this interesting and also embarrassing. She tells us that there is a saying here that if a Ghanaian person is walking to church and they meet a white person on their way then they do not have to go to church because they have just passed God.   This story is also embarrassing to me and I don’t know how to respond. There is much education needed here on this problem but it may take a long time to dispel.    On the way home we stop at the Kasseh Health Center in Ada.  This is the clinic where we visited on our first day and found the conditions in the maternity unit to be severely lacking.  I have decided to take a portion of my church money to help them purchase some mattresses for the maternity unit.  It is difficult to get a good quote but I hope that AFRICED can help me with this process.  The nurses are appreciative of the large box of supplies that we leave with them. They are especially interested in the stethoscopes as they are rare item here.  We have run out of BP cuffs and have none to offer to them.  I had purchased 30 stethoscopes and 20 BP cuffs to bring with us and they were rapidly distributed during our visit.  I wish I had brought more because giving these tools to the nurses will allow them to better take care of their patients.  I am trying to think of items that have more long lasting value when contributed to the people of Ghana.  They need so much but we (UML  NSWB) need to more thoughtful about any future donations so we can maximize our efforts.

We journey back to Accra with the promise that all our hard work is over.  I am sensing some negative feelings amongst the students.  They are all feeling tired, missing home and frustrated by some of the circumstances of the day and also frustration with some of the changes in their envisioned experience.   I make it a point to have a de-briefing discussion tonight that the students can verbalize their frustration or other emotions. I think we all recognize that the burn out factor is high and we need a break from the stress and continuous barrage of need.  I am glad that we have a chance to talk but I still sense some dissatisfaction with some of our activities.  There is such a wide variability in personalities of this group.  I think it has been an incredible learning experience for these students. Some of the students are more flexible and are willing to go with the flow and others question certain aspects of the trip. I guess that this is just human nature and I need to give them time to vent. The physical and emotional challenges on a trip like this are monumental and I think we have all arrived at this point pretty much a changed woman.  Personally I am not finding this trip as hard as last year and that has a lot to do with some of the changes I have implemented this year but also I had a more accurate sense of what “normal” is here in Ghana.   You cannot experience everything that we have done without expecting some internal change within yourself.   I have tried very hard to document this trip so that I can look back on my words and try to make some sense of it all.  I hope you have enjoyed reading this blog.  The next few days will be a time of relaxation, reflection and evaluation.   I am anxious to return home to my loved ones but also feel part of my heart is here in Ghana.

Today is our first full day in Peki.  Last night we slept in a dormitory setting of a local school.  The accommodations were sparse but there was running water.  We had a nice spider visiting us in the shower but there was a cool breeze in the air and we did not seem to notice the lack of AC.   As we are getting ready to board the bus I see a man run by quickly with a large bat and he is screaming.  I had no idea what he was doing but as I rounded the corner I could see him poised over the quivering body of an animal in his last throes of death.  The head was cut off but the nervous system was still twitching and blood was coming out of the hole where his head used to be attached.  He is a grass catcher which appears to me to be a cross between a large rabbit and a hedgehog. They are very difficult to catch and supposedly quite a delicacy. Last year we say many bush fires and we were told that the men set fires to flush out the animals from their hiding spots.  This animal is worth lots of money to them and our leader Kwadwo tells us that if he could he would gladly purchase this animal carcass and take it with us to Accra for his wife to prepare.  It is a weird experience but reminds me of how easy I have it when I go to Market Basket to buy my prepared chicken and beef.  Here in Ghana the women execute and prepare their own chickens.  I think I would become a vegetarian. 

                We drive a short distance to the main village of Peki to have another meeting with the Chief.  He is a very intelligent man who had a prosperous business career prior to becoming a chief.  His goal now is to lead his village into an era of prosperity and modernization.  He has established ties with some American Universities to develop some projects for his village.  He is trying to get internet access to this village in addition to improved medical services and library and educational services. His son, Mawuli is in his final semester at the University of Ghana and he is one of the principals of AFRICED.  I have had many conversations with him and I know him to be a very smart and dedicated man who aspires to improve the welfare of the people of his village but also the larger community of Ghana.  I believe he will accomplish great things in his life along with the hard work and dedication of Kwadwo.

                The UML students break into 2 groups to repeat their community health project. Maura supervises the Dental Health project. Instead of the expected 50 children there are 120 children and the program is carried out but there is an element of crowd control that was not seen with the previous demonstration.  I am observing the HIV education program and the UML students excel again with this presentation. We are fortunate to be presenting in their classroom so we do not have the expenses of renting chairs and canopies that we had before. 

                A crowd of adults start to gather and I am told that we must start the BP clinic.  I delegate the supervision of the HIV testing to Maura and it is handled very professionally and efficiently with not one positive result found which makes us happy.  The BP clinic is not so smooth and we are inundated with people.  They are requesting any medication that we can give them even if they do not require any medication.  I give out vitamins and Tylenol again. We see the same high readings that we have seen at previous clinics and many people admit to being put on meds by a physician in the past but do not continue with the meds.  Compliance with therapy is a big issue here.  A local farmer brings us a basket of bananas as a token of appreciation and the nurses at the clinic also arrange for some bananas for us.  We have enough bananas to feed half the village.   We are in need of interpreters and the Chief himself sits with us and offers translation services.  He is a great and humble man. A young mother brings her child to me for examination. His head is very large (about the size of my head which is big!) but they body of the child is the size of a 2 week old baby. The neck cannot support the head.  I am told that the child is 3 years old and she has not taken him to a specialist.  I do not know that the problem is but quite possibly a case of hydrocephalus which has obviously gone untreated and I doubt that there is any effective treatment at this time which will restore that child to normalcy.  She is hopeful that I can do something and I feel helpless that I cannot offer any advice other than to have her try to get an opinion in Accra. It breaks my heart to know that had some measurement of head circumference been done at his pediatric evaluations then this problem might have been caught at an early stage.

                We have to close the clinic.  I am totally out of BP meds.  I have purchased over 2000 BP pills to bring with me and I have gone thru them all and it is only a drop in the bucket.  We make a donation of supplies to the nurse’s clinic and pose for pictures. Everything here is a photo opportunity.

                We then hike up a small hill to the site of proposed orphanage.  Currently there is a day program in Peki which helps to support orphans and other children that have been rescued from child slavery.  There is a practice in this country that poor families will “lease” their children to fishermen. They are taken at a young age and exploited because of their small hands and ability to help detangle the nets.  They have no health care or proper food and housing but are slaves to these fishermen.  Groups like AFRICED work to purchase back these children and acquire legal custody of the children.  There is some hope to return some of them to their families if there is assurance that the child will not be re-sold but usually that cannot happen.  These children are placed in community in foster homes but much of their expenses need to be paid. This is where non-profits like AFRICED come in.  They are working to build a safe orphanage for these children and hopefully find adoptive homes for them.  We visit the unfinished orphanage and realize that they need much more to complete this building.  We have brought toys, clothes and vitamins for the children at the Peki orphanage and I intend to donate some of the money from my church to this orphanage and may consider sponsoring a child.  Again my efforts are small in relation to their need but maybe some of my friends who are reading this will want to become involved.

We leave this village with some sadness. In less than 24 hours we feel so connected to this community.  It is prettier than Kpando due to its location at the base of a large hill.  There are cool breezes and green grass.  The people do not know us but welcomed us as their daughters.  We have our African names and our Queen Mother who will return with us to the US.  We sincerely hope to keep the UML- Peki relationship going.

We now begin our long journey out of the Volta region and back to Accra.  It is hard to believe that we have been here for 17 days.  Our trip is almost over.

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

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

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

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

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

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

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

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 café 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.

Today is a big day.  This is the day that one of the UML groups will be doing their HIV program.  Of course as with any of projects this year we are given a price of the items that we need for this program.  We are using an inner courtyard of a home in the center of the town but we must hire chairs and a canopy for shade cover and also to provide refreshments for the participants.  The students are not prepared for this expense so this is a cost I must cover.  I am quoted 100 Cedes.(about 80 USD)  I have no way to tell if this is accurate. I have no option but to pay. The students will be delivering a 2 hour educational program aimed at the 12-14.  We see younger children in the crowd as well as older adults.  We have to shoo them away.  The content is too mature for the younger children and although the topic is ok for the older people we only have supplies for 50 and the activities are geared for an adolescent group. 

                I am again upset to learn that there is an expectation that the hypertension clinic will be happening simultaneously.  I am needed at the HTN Clinic due to prescribing of meds but I am also needed to observe the students for their grade. This happened last year and I am frustrated by the lack of control I have over the situation.  Maura and I work out a tag team approach to coverage of the clinic and supervision of the program.  The program is conducted flawlessly and the students did very well.  I believe it has been a wonderful learning experience for them.  We have already discussed that they can repeat this program in another village but we would not be able to support the rental of chairs or purchase of food.  

                The hypertension clinic was pure chaos again.  Some patients politely wait their turn and others simply step up to me even when I am in the middle of a patient exam and demand to be examined and demand there pills.  I have to be firm with many of them and occasionally have to boot them out of my exam area.  Patient confidentiality seems non-existent in this country.  One child is brought to me because it is the mother’s hope I can cure her because she is mute.  She is 5 and has never spoken a word.  My exam is difficult and the room is loud and hot.  I think she is deaf and there is nothing I can do.  I advise her to go to Accra to be evaluated but I am not sure there is a solution for her. Another 4 year child is brought to me. Evidently she was walking fine until 3 months ago when she fell and ? injured her back. She does not have any reaction to sharp stimulus from me from her toes up to her diaper region.  She cannot walk now and the teenage mother has not been given much information from the doctors.   She is hoping I have an answer for her.  I have none to give.  Another 5 year old child is brought to me who has not walked at all since birth.  I suspect some type of birth injury because there is a distinct absence of any muscle strength in her lower extremities. Deep tendon reflexes are difficult to assess as I have left my hammer back at the guest house.  Even if I could assess the DTR I would not have any hope for this mother.  I am amazed that they bring these severely injured children to me hoping for some type of miracle. 

                I am besieged by patients all with one ailment after another.  I cannot even complete a rudimentary assessment before another patient barges in and starts asking for some type of help.  After a few hours I tell our community leader that it is time to end the hypertension clinic.  We have given out many medications.  The people are not happy with their care unless they receive some pills before they leave.  We have brought some vitamins so we can give out some of those but it bothers us that we are supporting their false assumption that good care = drugs.  Patrick takes me on some home visits. These are some elder people who cannot make the walk to the center of town.  It has been a long day and it is getting longer.  Many of the people in Ghana have hypertension.  We have tried to collect some data on our readings but due to the volume of patients we have not been 100% successful.  My rough estimate is that 30-40% of the people tested are likely in Stage 2 or 3 hypertension and probably another 30% more are Stage 1.  We do not see too many normal readings.  Due to my short supply of medications I need to change my criteria for giving out meds.  I am reserving my supply for the most severe cases of diastolic over 100 and systolic over 170.  There is no lack of people with that reading and my supply quickly dwindles.

                When I return from my home visits the students have completed their program and now we are offering HIV testing to the adolescents.  We have made a big ethical decision today that some of the students do not agree with.  Based on strong advice from the community leaders who know these people we have been advised not to announce that the test is for HIV.  AIDS and HIV infected people are highly ostracized in this community. Families of patients with known HIV infection are shunned and often unable to earn a living.  There is such prejudice against the HIV infected person. The HIV education program is intended to increase understanding of HIV and to help the young people develop safe sexual habits.  The deception about the testing weighs heavily on my mind. I tell all the UML students that they have the option of not testing and three of them decline to participate.  I admire their courage but also realize that some of the issues about this testing need to be considered in light of the cultural context. If our goal is to re duce the spread of HIV to others then we may need to use some deception to identify some of the infected persons. I know this decision will haunt me for a while.  We have been assured by our leaders that this practice is common and that even the Margret Marquart hospital does testing on patients without consent and there is a code on the charts that indicate their HIV status.  It is a difficult and tense period of testing. I am thrilled that we have not one positive result.  We are fairly certain that most of the adolescents know that they are being tested for HIV due to the fact that they just had a 2 hour lecture on that topic.  The youth of this country are much more open about this disease and  hopefully will be able to dispel some of the prejudices.

                The day has not ended yet but we leave Nkonya because we have more work to do in Kpando.  After a brief rest at our guest house we gather a box of toys and clothes and deliver them to a nearby orphanage.  We had originally planned on donating these items to Hardt Haven orphanage but we have met some resistance from the director.  We then became aware of another orphanage in town that is equally needy.  We go and make initial introductions at the facility, Missahoe Orphanage.  The UML Students are enthralled with these children. The is home to about 30 boarding students and an additional 10 other students during the day.  It is a very well run orphanage with evidence of an orderly organization that emphasizes the children’s health and well being. The director and staff members are loving and attentive and the children all appear happy and healthy.  WE enjoy a short period of time playing with the children and tomorrow we will return to give them some of our donated toys and clothes.  These children have nothing but they are so appreciative of any little toy or sticker that you give them.  It is refreshing to see the young pre-teen boys ( 10-12) who actively seek out the coloring book pages and they color with great enthusiasm. An American boy of the same age would never be satisfied with the simple pleasures of coloring a page. These Ghanaian orphans represent an unusual stage of innocence not often seen.  I am reminded again how fortunate I am to have healthy children and realize the vast differences in the childhood of my children versus that of a Ghanaian orphan.  It is much food for thought .

 

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


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


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


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


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


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


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


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


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


January 8th

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Today is the day that we make our presentations of goods to the health care facilities.  We are welcomed with by both Margret Marquart Hospital and the Kpando Health Center.  We have brought so many supplies and we are trying to divide the wealth a bit between all the health care settings.  There is so much need and we question whether our small donations can make a difference in any significant way. Everything is a photo opportunity although I am not sure if these organizations would use the photo.  We took all kinds of photos last year and I know I never was asked for copies.  At least the UML website has used some of the photos.


After the donation Maura and I return back to the hospital to meet with the medical director, director of nursing and the hospital administrator.  They are anxiously awaiting our report.  In retrospect I am impressed with the report that we were able to generate for them.  It contained very honest observations about the nursing care at the hospital.  There were many areas that they had already identified as problem areas.  They thanked us for our report that they will use in helping to make some changes. The new director is very anxious to make some positive changes. All 3 of them are professional and courteous to us.  Part of me is feeling bad because we are delivering a not so great review but the director assures me that this is the type of information she is looking for. 


We complete are little more time at the hospital or clinic and the get ready for one last trip to Torkor.  My goal is to bring some items (glasses) that I had promised to one of the nurses and a lovely patient. We also have some soap and other supplies and clothes to distribute.  When we greet the nurse I get a bit angry for the first time this week.  She is quite upset that we have arrived “late.” It is 3 pm and there day ends at 5 pm but obviously we have cut into their “down time.” There are no patients in the clinic and she looks at me with disapproval (mind you, this is the nurse who needs the glasses that I have made a special trip to bring).  I was very hot and tired and quite resentful of her attitude.  I then said that I would be more than happy to bring my nurses and my supplies to another village if she did not want her residents to have any of the supplies. I think she saw my anger and then relented to let one of her medical assistants bring us around the village.  We were able to visit about 60 people in a short period of time but to be quite honest I was happy to be leaving that village.  


This is not the first time we have met some resistance to our overtures of donations and care.  We also are getting occasional remarks from certain villages when they find out that we have been to other villages and we did not bring supplies to them or we did not do a presentation for them.  There is so much need here any it appears at times that we are being pulled in many directions trying to satisfy everyone but at the same time leaving them wanting.   It is tough thing to experience, especially when most of us are very hot and tired and running on empty (physically, emotionally and financially).  Our nightly debriefing allows some verbalization of these feelings and I am trying to be available to the students for any issues or concerns. I think some of us can feel our time at Kpando coming to a close and there is some pressure in terms of time and resources.


I still do not have access to my UML blog site to post my entries.  I have been able to have my daughter post some but it appears that some of my entries were not uploaded.  I am working with UML to fix the problem.  It is amazing how our lives can be disrupted by glitches in our technology and the people of Ghana live with such little technology, with the exception of the cell phone. 


I would like to make a comment about cell phone use here in Ghana.  In Kpando it appears that many people own a cell phone.  It is like a 3rd arm or leg for these people.  They come to our clinics with no shoes and in obvious need to some “free “ health care but many of them have their cell phones.  What I find most appalling is the etiquette.  Calls are received at any time and there is no attempt for the owner of the cell phone to excuse themselves from the “live person to person” conversation that they had  been engaged in prior to the ring ring.  We observed nurses answering cell phones in the middle of patient interactions.  They also tend to not offer a final goodbye when they end the conversation.  Sometimes all you hear is a click. There are kiosks about every 50 feet on the main roads that sell minutes(or units) to the phones.  There is a currently a few big service providers but VODAPHONE is the big guy in town and the company has saturated the village with signage to make their name a household name.   Last year this company was not here and this year it is a huge business.  It is interesting to see how much they have saturated the village with their branding. 


In the early evening Maura and I journey down the street to the hospital and we hear lots of singing, drumming and horn blowing.  People are dressed in vibrant red clothing and black.  It reminds me a bit of Mardi Gras.  I am told that on Friday nights the bodies are removed from the morgue and families arrive to take home their loved ones for a funeral in their home village.  Funerals are big business here.  People may not have the money to buy food or health insurance but they have money to support elaborate funerals.   One by one the family groups go into the morgue with either a personal car or truck or a hired taxi. The body is wrapped head to toe in fabric and it is put in the back seat between 2 living family members.  It is macabre to see these corpses sitting up in a car.  We are told that they smell very bad and are sometimes discharging bodily fluids which then soil the inside of the car.  This gives me the creeps knowing that some of the hired taxis that we have rented may have carried a body at one time.  We are fascinated by these customs and watch for a while. Some of our own plans for clinics have been changed due to funerals being held in some of the villages.


Tomorrow is we are in Nkonya and our program that was scheduled for Monday has been moved to Sunday because of a local funeral. 


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 ¼ 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 naïve 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 café 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.

     I begin my day with my usual breakfast, saltine crackers, peanut butter and strawberry jelly. Maura has managed to purchase some Diet Coke in Accra and I savor one every few days.   We set up our “kitchen” on our desk on our room and enjoy our breakfast.  Lunch is usually something I can put in my backpack and I have some crackers and cheese that I eat at noon today along with my warm water.  Supper today was at Cedes where I ordered toast and hot water. I added the hot water to my Easy Mac.  It was kind of gross and I don’t know if it was the water or my preparation techniques.  Obtaining food is somewhat of a chore.  We have the restaurant but the service is VERY SLOW and a limited menu. Some of the girls have managed to obtain some local fruits.  As we leave the restaurant I see a dead chicken at the end of our walkway.  I am not sure how it got there or if it has any significance for us.  I hope some critter comes and gets it tonight.   I go the internet café and have a frustrating time trying to log onto Comcast. Over 18 minutes and it still would not load.  I switched to gmail which was a bit quicker so I have decided to use that email address for the majority of our trip.  I have asked Jesse to help me post my BLOG entries to the internet so I hope you are reading this on the BLOG.  I probably will not be able to read your comments until I return so if you need to send me a message you can send it to  HYPERLINK "mailto:valkingnp@gmail.com" valkingnp@gmail.com.

I worked again at the clinic today and spent some time with Maria.  She is the essence of what you want a good doctor to be.  She is compassionate and loves to teach the patients and the nursing students.   She discusses her curriculum with us and I think the nursing students are probably glad that they chose nursing and not medicine.  It is a very rigorous program.   She teaches so much to the nurses but I am also able to teach her a bit about primary care and our US healthcare systems, specifically managed care. 

After the clinic we go to the Market.  The market is a rotating day that features local merchants who sell everything from rice and beans to fabric to old dried out fish.  I have so many pictures to share and I hope to post them upon my return but I cannot even attempt it here with the current internet access.  I buy some fabric with the last of my Ghanaian money.  I have plenty of US money but we cannot change it here in Kpando and I have to wait for our trip to Hohoe tomorrow.  I have to bum some money from Maura to pay for my supper and my internet access.  I have arranged to have a Bu-Bu made( ? spelling of that word).  Think of a MU-MU and you will know what a Bu-Bu is.  I figure it would be comfortable to wear around the house.  Many of the students have bought fabric and will be going to Billy the Tailor to have some dresses made. 

At the end of every working day we have a debriefing session. This is very important for all of us to discuss our daily experiences and to share thoughts or concerns.  Some of the students describe some horrific conditions at the hospital. They describe horrible deep wounds being debrided without the aid of any pain medication.  It is only after some of the UML nurses and Maura make some comments that the physician agrees to order some pain medication.   There are dead bodies that are left in some of the wards waiting for the family to claim. The families are expected to play a huge role in the care of their loved ones.  The nurses do not provide much personal care and often seem like they do not want to touch the patient.  Blood from a wound and urine from incontinent patients are often left on the floor to dry. There does not appear to be any trained housekeeping staff to deal with biohazards.  Women are asked at the clinic to bring cotton clothes with them when they go into labor so that they can be used to soak up their own blood.  Babies are having respiratory distress and there is no oxygen and one mother is observed at her child’s bedside today with a look of resignation because it is highly likely that he could die.  Infants are born and there is no suction if needed.  The doctor whacks the baby with a towel and says it is “good for them”.   Some patients are upset that their herbal folk remedies have not cured their hypertension which is no w in a very dangerous stage.  The students try not to be too shocked by the conditions but it is hard. Lauren (one of the students) admits to forcing herself to look up at the ceiling to compose her emotions as she is so distraught over some of the conditions.  The good thing is that there is a new medical director at the hospital who wants to make some sweeping changes at this facility.  She is anxious to hear the impressions of the UML students.  We hope to compile a report and present to her in a few days.  I will be there tomorrow.  It is a little out of my element as I am not a hospital nurse but I have been told by those who have worked at the hospital in the last few days that the deficiencies in the nursing care will be very obvious.  There is much hope that our visit my have some lasting effect on the health care here in Kpando but I am not sure that that will happen.  Change is very slow to happen and I think we have to be very careful how we voice our impressions.  Continuing education is lacking here.  There is no incentive to continue with learning new skills.  I have decided to do a presentation on Thursday on a few topics to the nurses in Kpando health clinic.  It was a spur of the moment decision and I hope they will want to come.  Many of them cannot attend the nurses conference that we will be giving in Ho next week.

Tomorrow is another busy day.   More stories to tell and hopefully no more dead chickens!


   Today is our first day of working in the clinic or the hospital.  We walk the mile walk up to the Kpando health clinic because we are supposed to meet with the medical director before we start our day. We are told he was at the bank and then he was on his way to Accra. There is so much protocol involved  before we can enter a clinic.   We separate into 2 groups.  Five students plus Maura go to the Margret Marquart Hospital. The other five students go with me to the Kpando Health Clinic.  We are divided into 5 different areas.  Two students are with the midwives in maternity clinic, one student is doing vital signs, another student is with the intake nurse, one student is with our friend, Maria who is a medical student from Puerto Rico.  I am spending some time with Psychiatric nurse.  She gives a daily HIV/AIDS talk in the waiting area.  It is all done in Ewe dialect so I cannot understand what she is saying but I can tell that the patients are engaged in the lecture and are asking questions.  The HIV rate is very high in this region and that is why we are doing HIV education programs as part of our community project.  I then spend some time with this nurse, Margaret.  She is doing an initial evaluation of a new patient with a history of some type of seizure disorder related to multiple beatings.  He is also describing other symptoms which ( in his broken English) sounds like a Schizophrenic presentation.  He has been on Haldol at a prior clinic and needs a refill.  He is ok today but he is worried that he will get worse.  It is interesting to watch her do her assessment.  She does not ask the questions that I think are necessary and she makes no eye contact with the patient.  One of the most interesting observations with the nursing care here in Ghana is the way that the nurses interact with the patients.  They are very brusque and appear to be uncompassionate  with their patients.  There is very little touching and patients are treated more like a nuisance at times.  It is vastly different than the way our American nurses are educated.  We are taught the value the human interaction and that we , as nurses, have so much to give to our patients.  We are told that there are many women who go into nursing for purely economical reasons.  It is one of the highest paying jobs, about $5,600 per year. They seem to work at a slower speed than the American nurses.  I quickly analyze the patient flow and can think of recommendations but I am not sure I am in a position to suggest changes.   There are many other behaviors that are witnessed by our nurses and I will try to comment on those as I write other entries.   The nurses are friendly enough to the UML nurses but not overly so.  A few of them want to ”further their studies” in America but I do not know if they have the means to do that .  I have some admission information which I share with them.  I think some of them are surprised that I cannot sponsor them and pay for their education.   

So now to the slow part of my day.  The internet.  The curse of my existence here in Ghana.  I had such grand hopes of really staying connected to family and friends via my BLOG entries.  The internet café is run by a lovely young man called Eyram who was there last year.  He does the best he can but the service is limited by dial up speed and very slow computers.  I was in the café for over 2 hours and left frustrated because I could not connect to the UML blog site but also had a hard time reaching friends and family.   IF you are reading this I would love an email at  "mailto:valkingnp@gmail.com" valkingnp@gmail.com

I have now been here for about 9 days.  I have 14 more days.  This trip is much more organized than last year.  We are getting so much done and our schedule if jammed packed. Stay tuned for more stories.


“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.

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.

 

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 ½ 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 ½ 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 ½ 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.

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