Entries tagged with “Kpando” from Nursing Students Without Borders

Blog Day 11

Today is our departure from Kpando.  We make our final goodbyes to our friend Eyram at the Internet café, Sam at the Happy Spot bar and our special friend Edith( more about her later).   We have some donations to deliver and we make those to Margret Marquart Hospital and the Kpando outpatient clinic.  There is not as much as last year due to the increased cost of shipping.  Each box over our own 2 piece luggage allotment would have cost $200.  We had to leave some supplies at home. 

                Our big bus rolls out of town and it is a bit sad but I also look forward to the next part of our trip.  We make a quick stop at Anfoega hospital which is about 30 minutes away  from Kpando.  Last year our American Marine friends met us here and it was a more formal presentation.  This year it is a quick donation and back on the bus.  We are journeying to Accra which can take 3 hours on a good day but with our traffic luck lately that is most likely going to be longer.  The long times we spend in the bus is one of the negatives this year.  The traffic in the city seems much worse than last year.  Our journey takes us 5 hours.

                What I wanted to write about today is the role of the women in Ghanaian society.  As a woman I find this most interesting.  Women are highly regarded in the modern Ghanaian culture but there are still obvious divisions of labor and status.  I have observed woman to be much harder workers than the men.  The females are observed doing most of the domestic chores around the house and also the tasks to maintain daily life in the family.  The majority of the homes in the rural region are 1-2 room mud brick huts with a thatch or corrugated metal roof.  The floor of these homes is usually bare dirt but sometimes there can be poured cement.  Most people prepare the food outside on open fires or small briquette stoves.  There may be a public bathroom somewhere in the village but not usually in the home.  The bathroom usually consists of a 4 walled  structure with no roof  that resembles a animal pen. Within that pen is a pile of rocks in one corner and that is where the person urinates or defecates.  There is no soap or water to clean your hands.  In a few of the “nicer” public bathrooms we have had a toilet but many do not have water to flush unless you bring a bucket of water with you. Toilet paper is non-existent unless you bring your own.

                Water sources are not easy either.  Sometimes a village will be lucky and there will be well and a pump  centrally located.  Other times ( like in Tsakpe), there are open wells deep in the woods that must be accessed along winding paths.  This is one of the chores of the women and the children.  They must go to this well one or two times a day to retrieve water.  They pull the water up by hand in a rubber pouch or bucket on a rope and then fill their containers.  These containers are very large metal bowls, plastic buckets or jugs. Each container must hold at least 5-7 gallons if not more. After these containers are filled the women or the child will lift that up on his/her head and carry it out of the woods.  As we have traveled down some of the paved roads( highways) we have seen people at all hours carrying these water containers home from some nearby well.  Usually it is a woman or young female child. Often there is a small baby tied to her back with cloth.  This method of carrying the infants is very common and actually ingenious.  The infant spends much of his/her time bundled to the mother’s back in an interesting  use of material that is wrapped and tucked, actually not tied..  This is similar in concept to our American infant snugglies but the babies are on the back to allow the women to work.  The baby sits there comfortably while the mother fetches water, tends the fire, carries wood, cleans the house, mans the store or sells items by the side of the road.  The women in Ghana never seem to rest while the men in Ghana seem to have an easier life.  If not employed or working in a fishing boat or farm, they are often seen relaxing on long wooden benches.  I am not sure if there is a lot of sleeping or just sitting but I see more men in that position than women.  There are some businesses that men seem to gravitate to like spare metal parts, electronics, bar operators and casket makers.  The women seem to run the majority of the small stores and roadside stands that sell food.  They are usually there with their children if the family cannot afford to send the child to school.  Very often working long hours in the hot sun with a baby strapped to her back and other small children in tow.

                The Ghanaian government is making education of the females one of their priority initiatives.  We are told of a Ghanaian saying, “ If you educate a man  you educate an individual; if you educate a woman you educate a family”.  Although the women are respected in this culture my sense is that it is still somewhat of a 2 tier system and that the better jobs and educational opportunities are given to the men and boys. The politicians are mostly men but there are some women who are in the upper levels of the political world in Ghana so things are slowly changing.  Nursing is one of the professions that women are the majority but there are also Ghanaian male nurses.  If a woman has the resources to get an education  a nursing job is a very good job to have.  They work extremely hard and for poor salary compared to the US nurses but at least it is a job.  This week we have learned that some of the nurses regularly use mosquito nets at home to prevent malaria but when they get to work at the hospital there are pockets of mosquitoes under their desks and they regularly acquire malaria.  They recognize the symptoms and get treatment and go to work battling the side effects.    It is like the common cold to them.

                One amazing woman we met was Edith.  We actually met her on our 2009 trip and Maura and I have maintained contact with her. She was widowed early and according to her her husband was shot and killed by a Ghanaian police officer.  She was left to parent her child alone.   As she neared completion of her child rearing duties and well into her late 40’s or early 50’s she accompanied a pregnant friend to the hospital.  When the woman died in childbirth the doctors handed the baby over to Edith to raise.  Instead of complaining about this she turned to her religion and decided that God had a plan for her.  Since then she has worked tirelessly to provide for this child in addition to her nearly grown child. I was appalled when I first saw her house.  It was basically  four mud walls with a roof held up by large tree limbs.  The total square footage of this dwelling was about 100 square feet.  No electricity of plumbing or windows. She cooked outside on a fire by her front door and slept on a broken down army cot with no linen or other furniture.  Her primary piece of furniture are 2 plastic chairs which she places in front of her door.  Last year we saw her laboring in the hot sun removing corn kernels ( by hand) to send to the market.  She has some farm land somewhere in town and this is her means of financial sustenance.  When we met her we were struck by her friendliness and command of the English language. She is a self taught woman who prides herself on her intelligence and knowledge of the word beyond her meager surroundings.  She offers us a parcel of land so that we will be enticed to stay in Ghana and open a school or orphanage.  She talks very proudly of her sister who lives in the United States .  But above all of these characteristics I was impressed with her commitment to God and the belief that she is so blessed.  She is happy to meet us and does not complain about her lot in life.  We are humbled by her beliefs and personal strength.

                This year when I go to her home I am surprised to see the old mud shack is no longer there.  I am sad because it appears as if something has happened to her and someone has purchased her small plot of land and is building a 2 room structure.  To my delight she comes running toward me with such glee that her American friend has returned.  Somehow she has managed to build a slightly better structure although there still is no plumbing or electricity but she does have access to water and her home is without doors but she uses 3 plastic chairs to create a barrier.  She still sleeps on an old army cot with no linen but she has a small room next to her living space that she is planning on opening a small store.  These small stores which essentially are not much bigger than a childs playhouse are the lifeblood of so many people in Ghana.  The fortunate ones are the people who have 4 walls and a roof. The majority of people set up a stool and a blanket on the ground to sell anything from fish, to vegetables to used clothing.  Edith as bigger plans for a “Provision Store”.  She recognizes that she is getting older and can no longer support herself with the backbreaking work of farming.  I guess her age to be at least 60 but it is hard to tell.  She prays that God will help her with this new career. In the meantime she has applied for a job with ZooLion which is the local trash collector.    She  proudly states that she will pick trash up on the side of the road if it means she can support her family.  I am  amazed at her fortitude and resilience in surviving in the harsh world.   She remains forever grateful to God for her blessings and she is a joy and inspiration to know.

                When we leave Kpando today the we all gather  any extra clothes or supplies and donate them to Edith.  She is overcome with emotion as we bring her a large plastic tub of food items, clothes and other small items.  I use some  of my own money and some of the funds my own church friends at home have given me to help Edith in her efforts to open her own store.  She is the embodiment of the strength of the Ghanaian woman who works from dawn to dusk to provide for her family all the while maintaining a positive attitude and appreciation of the blessings from God.   As we drive away from Kpando we look out of bus window and see Edith surrounded by her new treasures.  She is proudly wearing my sunglass readers and pouring over a Suduku book.  I can barely do Suduku puzzles but I know that this smart and tenacious woman will figure it out, just like she has figured out all the other challenges in her life.   I will forever be amazed by my friendship and memory of Edith.

Blog Day 10

 This is our last working day and we have a lot planned. We load into 3 junky taxis and head to Torkor which is a nearby fishing village that is very poor.  The people there survive on fishing in the lake water that is heavily polluted. This is the one of the only sources of income other than selling items in a market.  We have been there before and although it is only about 10 minutes from Kpando the people are more poor and destitute. As we drive down toward the waterfront I compare my view from last year when I turned the corner and I could see a community along the waterfront and from a distance it could be a perfect location for a resort community.  This year as we wind our way down to the village we cannot even see the village due to the thick, dusty air.  The air resembles a thick fog that we have in New England. The visibility is about 300 yards at best but it is not cool and moist like at home. It is hot and gritty and occasionally smells of car emissions.  I have been battling some type of cough/laryngitis for days now due to the air quality and it may have turned into an infection. Some of the students (especially the asthmatics) are likewise affected. The taxi in front of me is spewing out black smoke and that adds to the air quality problems. We are all missing the clean air of home .

                We set up our clinic ( 2 stations) and the students work like a well oiled machine.  The need little supervision from me now.  They know the drill.  We are assisted by a few interpreters because English is not well understood in this poor village. We have identified communication and our inability to speak the local dialect as our biggest stumbling block to good care.  Maura and I have to do crowd control.  The people have heard that there is free medical care and they jockey and push ahead to get seen first. I finally get my first marriage proposal of the week but unfortunately it is from a drunk man. When he gets to the BP table one of my students, who in her normal fashion of friendliness, greets this man.  He leans over and licks her ear.  She is appalled but is able to continue acting professionally . We have Jason( our one male student) step up and tell this man that  Kelly is his wife.  My wedding band has served as a deterrent sometimes but the young and good looking students from UML are getting frequent marriage proposals.  I started to count at the beginning of the trip but lost count but I believe that each of them have 2-3 each.  Jason is a favorite with the older Ghanaian women. 

                Our BP clinic is successful and we pack up and return to Kpando to repeat the same activity in another village. This afternoon we are at Kpando Tpsake.  This is a poor neighborhood of Kpando and where we have our water well project.  Like the morning the students are able to set up quickly and everyone assumes a task. They feel very comfortable with this activity. As we near the end of our time there the crowd suddenly increases in size.  I move into a different mode and become a moving clinician in the crowd.  I grab 2 students, one is my recorder and one is my dispenser and teacher.  I work my way quickly down the line of people, taking BP, calling out readings and giving orders for med administration.  This has proven to be a fast way to work through the crowd but more people keep coming.  At one point we just have to shut down and turn people away.  This is hard for me to do but it can become overwhelming. 

We walk about 1/2mile into the woods to see the water project.  This is the site of multiple uncapped open wells that we visited last year. Due to financial donations from myself, Maura, my church, and some NSWB students we have paid for safety modifications such as a cement pad around the well and a metal cover that can be locked at night.  The area is heavily used but we are there during a slow time.  I do the ceremonial dipping of the water bag into the well to pour it into the community leaders water bucket.  The well has a new coat of paint and there is a written dedication to all the donors. It is nice to see that our funds have been used to help the people but there are still more wells to fix in this area. We are told that the trees surrounding the well cannot be cut down and this protects the aquifer.  I am appalled at the amount of plastic trash I see on the ground leading into the area and my comment to our coordinators is that the people of the village should be concerned about the long term health ramifications of the degradation of the plastics on the ground and how that can leach into their water system.  The issue of trash is a huge problem here and the practice of dropping anything on the ground is widely done by most Ghanaians.  To me this could be solved with education about the effects of pollution but they also need the infrastructure to remove all this trash.  They recycle old cars and bikes and TVs but they also pollute their environment with a resource( plastic) that may have some recycled uses.  I know this would take a huge solution but it all begins with a change in human behavior.

We debrief tonight and the students are very tired and look forward to washing up and some internet time and some food.   I am very weary myself and spend some time organizing our donations for tomorrow and then  fall asleep early.  Tomorrow we leave Kpando but we have donations to make to the hospital and clinic.

               

 

                This is our last working day and we have a lot planned. We load into 3 junky taxis and head to Torkor which is a nearby fishing village that is very poor.  The people there survive on fishing in the lake water that is heavily polluted. This is the one of the only sources of income other than selling items in a market.  We have been there before and although it is only about 10 minutes from Kpando the people are more poor and destitute. As we drive down toward the waterfront I compare my view from last year when I turned the corner and I could see a community along the waterfront and from a distance it could be a perfect location for a resort community.  This year as we wind our way down to the village we cannot even see the village due to the thick, dusty air.  The air resembles a thick fog that we have in New England. The visibility is about 300 yards at best but it is not cool and moist like at home. It is hot and gritty and occasionally smells of car emissions.  I have been battling some type of cough/laryngitis for days now due to the air quality and it may have turned into an infection. Some of the students (especially the asthmatics) are likewise affected. The taxi in front of me is spewing out black smoke and that adds to the air quality problems. We are all missing the clean air of home .

                We set up our clinic ( 2 stations) and the students work like a well oiled machine.  The need little supervision from me now.  They know the drill.  We are assisted by a few interpreters because English is not well understood in this poor village. We have identified communication and our inability to speak the local dialect as our biggest stumbling block to good care.  Maura and I have to do crowd control.  The people have heard that there is free medical care and they jockey and push ahead to get seen first. I finally get my first marriage proposal of the week but unfortunately it is from a drunk man. When he gets to the BP table one of my students, who in her normal fashion of friendliness, greets this man.  He leans over and licks her ear.  She is appalled but is able to continue acting professionally . We have Jason( our one male student) step up and tell this man that  Kelly is his wife.  My wedding band has served as a deterrent sometimes but the young and good looking students from UML are getting frequent marriage proposals.  I started to count at the beginning of the trip but lost count but I believe that each of them have 2-3 each.  Jason is a favorite with the older Ghanaian women. 

                Our BP clinic is successful and we pack up and return to Kpando to repeat the same activity in another village. This afternoon we are at Kpando Tpsake.  This is a poor neighborhood of Kpando and where we have our water well project.  Like the morning the students are able to set up quickly and everyone assumes a task. They feel very comfortable with this activity. As we near the end of our time there the crowd suddenly increases in size.  I move into a different mode and become a moving clinician in the crowd.  I grab 2 students, one is my recorder and one is my dispenser and teacher.  I work my way quickly down the line of people, taking BP, calling out readings and giving orders for med administration.  This has proven to be a fast way to work through the crowd but more people keep coming.  At one point we just have to shut down and turn people away.  This is hard for me to do but it can become overwhelming. 

We walk about 1/2mile into the woods to see the water project.  This is the site of multiple uncapped open wells that we visited last year. Due to financial donations from myself, Maura, my church, and some NSWB students we have paid for safety modifications such as a cement pad around the well and a metal cover that can be locked at night.  The area is heavily used but we are there during a slow time.  I do the ceremonial dipping of the water bag into the well to pour it into the community leaders water bucket.  The well has a new coat of paint and there is a written dedication to all the donors. It is nice to see that our funds have been used to help the people but there are still more wells to fix in this area. We are told that the trees surrounding the well cannot be cut down and this protects the aquifer.  I am appalled at the amount of plastic trash I see on the ground leading into the area and my comment to our coordinators is that the people of the village should be concerned about the long term health ramifications of the degradation of the plastics on the ground and how that can leach into their water system.  The issue of trash is a huge problem here and the practice of dropping anything on the ground is widely done by most Ghanaians.  To me this could be solved with education about the effects of pollution but they also need the infrastructure to remove all this trash.  They recycle old cars and bikes and TVs but they also pollute their environment with a resource( plastic) that may have some recycled uses.  I know this would take a huge solution but it all begins with a change in human behavior.

We debrief tonight and the students are very tired and look forward to washing up and some internet time and some food.   I am very weary myself and spend some time organizing our donations for tomorrow and then  fall asleep early.  Tomorrow we leave Kpando but we have donations to make to the hospital and clinic.

               


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

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

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

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

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

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

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

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

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

 

Read about the students' experiences

 

Day 7

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

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

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

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

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

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

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

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

 

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

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

When we arrive shortly before 1 p.m. we are met with a large group of people all dressed in their best church day clothes awaiting a visit with the nurses.  For some people this is a great event because they may not have health insurance and most people do not believe in purchasing the health insurance unless they have known medical issues or for a child This is like getting something free. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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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