Entries tagged with “Peki” from Nursing Students Without Borders
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.
Today was our full day in Peki. Our plan is to implement the community projects that the students have been planning.
Last evening I had to make a public announcement to the attendees at the Durfur about our programs. We had hoped to have no more than 50 children for the Nutrition Program and about 20-25 mothers of young children for the malaria program.
Due to the exact time of both programs in different locations I have to rely on Maura to evaluate one of the programs. I evaluated the Nutrition program. This was a program targeted school age children and to teach them about healthy foods and the benefits of exercise.
Obesity is not a problem in Ghana but rather malnourishment is a problem. The children (and some of the parents) do not have an understanding of the various types of food. Although in this environment the children often eat whatever is made available to them we wanted to empower them a bit with some knowledge to help guide any decision making that they may be involved with regarding food choices.
The program was attended by at least 80 children along with a few mothers. The students need to use an interpreter to convey their message. Although English is spoken in the schools here in Peki, many of the children communicate primarily in their native dialect. The UMass Lowell students had prepared a craft project to coincide with their lesson but we had only enough material for 50 children.
Remarkably these children happily share the project with their friends. They did not know what a glue stick was but by the end of the program they had a paper plate with pictures of health food glued on them. We wanted the children to take the plates with them but the plates were collected by the clinic nurse (who was our interpreter) who felt that they would be good teaching tools for the mothers. I guess this logic makes sense because the mothers are the ones preparing the food. Each child left with a silly band bracelet and a smile on their faces.
The other project was a Malaria education program where the mothers received information about the signs and symptoms of malaria and how to take a temperature. The Nursing Students Without Borders club was able to purchase some thermometers and insecticide treated mosquito nets due to the generosity of the Lutheran church in Woburn.
We had hoped to give 30+ mothers a net when they left but we did not purchase enough. We have some additional church money left over to put toward our projects so we hope to purchase more before we leave. It was a great feeling at the end of the day when the students realized that their actions today have improved the health of so many in the village. It may even save the life of a young child who often die from malaria at young ages. It was a fitting way to repay the hospitality of this wonderful village.
After our programs we were treated to some cold water (actually they call them sachets of water which are the bagged purified water). The Chief of Peki asks to speak privately to Maura, myself and Jason. Jason is chosen because he is our only male student and the chief wants to recognize that and calls him a chief. We are offered some sweet red wine from South Africa and then followed by a small amount of a chocolate liquor called Takai. Both are quite good. And so begins the official discussion.
Land in Ghana is mostly privately owned and can be quite expensive and difficult to purchase especially for an outsider. Large amounts of land are controlled by the Chief. He is very pleased with the relationship between his village and the students from UMass Lowell and wishes to make a donation of land for our use. He would like to establish some type of building or structure(s) that would have lasting impact for the people of the region but also will bear the name of UMass Lowell. He encourages us to think about how this may take form.
He does not make this gift without much thought and I am proud yet concerned about being able to meet these expectations. This venture should not be entered into lightly because if done successfully could have lasting impact on both the people of Peki and future visitors from the USA. Maura, Jason and I leave this meeting with some trepidation but also with a sense of an important relationship that could transcend our national borders. This is an opportunity that will take some careful thought and planning but we do not make any commitments but express our appreciation of his trust and friendship.
Upon our return to our hotel we have a few hours to relax. This is the first time we have had some time to relax and it has not been after a five hour bus ride or after a 12 hour day. It is great to catch up on some rest because we will be working very hard for the next six days.
Our plan is to leave for Kpando tomorrow after we go a hypertension screening clinic in Peki. Tomorrow is Sunday so we must wait until after church and lunch are over before we can arrive in the village. Some of the student may go to church while others have decided to sleep late and enjoy the last few hours at this hotel.
I have told them that the accommodations at the next hotel are not as nice and we should expect more power outages and water problems. They are actually a bit excited about living a bit more rustic but I am sure that will wear off when they see a few bugs in their room or no internet because of power outages.
Every night we have a debriefing and talk about the day’s events. Tonight I could hear a difference in the students’ comments. I think they are finally coming to realize the enormity of what they are doing. I told Maura that I thought it was so brave of these students to take on this trip but she thought it was very brave for us (the Mamas) to take on this trip. I am not sure who is more brave but we all recognize that it is a truly remarkable experience that most of our friends and family will never experience and will only get a small glimpse of our adventures by looking at our pictures.
It is my hope as a nursing educator that this trip will make an impact in a way that traditional nursing practicums or lectures cannot even begin to compare. I believe that the students will develop an awareness of the blessings of their own lives at home in USA but also to become more acutely aware of the health and social disparities that are so prevalent beyond our borders and that they may now be empowered to address these issues at some point in their careers.
And to leave you all with a funny image rather than my soapbox comments. Two nights ago we made a presentation of new mattresses and some clinic supplies in the village of Ada. After enjoying some Fanta and Coke (no Diet Coke!) some of us needed to relieve ourselves before the long bus ride home. We were directed to the bathroom which was behind the clinic. Off we trot with our one little flashlight. We find the bathroom and Jason uses it first but reports back to us that is it quite disgusting, more like a small hole in the concrete. We take our chances outside rather than use the “hole”. I giggle when I think of my students merely 10 feet away in the utter darkness as their Professor King acts quite “unprofessor-like.” Our daily struggles for the usual comforts of food, water and sanitation create a strange bond that many will never experience!
Today we finally leave Accra to the Volta Region. This is the part of the journey that is tiresome because we have to re-load out bus with all the suitcases and boxes. It is another hot and humid day and the bus driver is working so hard to tie our boxes to the top of our small bus. We have come to realize that the location of our hotel is not ideal. Accra is a huge city and most of our destinations have been on the opposite side of our hotel. We have traveled 2+ hours each way in the evening and the morning and that only gets us across the city. We travel for miles but often end up sitting at traffic lights trying to not make eye contact with the plethora of street vendors. I would go crazy if I had to deal with this traffic every day.
We are headed to a fairly new orphanage on the way to Peki. It was founded by a woman from Spain who felt compelled to open an orphanage and has been able to leverage some of her connections in Spain and beyond to help support this institution. It is an interesting orphanage that houses special needs children, orphans and children of families that can no longer afford them. It appears to be a well run organization with multiple smaller buildings and nearby mango tree fields that are harvested by villagers to help support the costs of the orphanage. We are met by an assortment of children who are so glad to open our box of clothes, videos, books, beanie babies, toothpaste etc.. We hope to make three other donations to orphanages in Ghana before we leave to return to the US.
We still have about 2+ more hours to drive to Peki. It is now 3:30 and we have been in the bus for since 10:45. We have had so much traffic today and this waste of time drives us crazy. We stopped for a while at the Kaneshie Market which was the scene of two episodes of the Amazing Race. It is a massive intersection with markets on all sides and throngs of people and cars. We idle but the side of the road while we wait for someone who has purchased insecticide treated mosquito nets for our malaria education program tomorrow in Peki.
Our hotel in Peki is very nice. We arrive with the instructions to be ready to leave in 20 minutes. Despite spending all day in a bus we feel very dusty and dirty but there is no time for a shower. Off we go to Peki for our Durbur with the Chiefs. A Durbur is a ceremony that involves drumming, singing, dancing, greetings from the Chief and myself, a blessing with palm wine and lastly the African naming ceremony.
We are surrounded by hundreds of people from the villages of Peki. It seems like there are more children than adults. The kids are thrilled to see the American students and pose quickly for an array of photos. The drums start and the chief processes into the open area and sits in his designated area surrounded by the lesser chiefs.
There is not Queen Mother today but Maura was made an honorary Queen Mother last year so she is recognized and sits on the left side of the chief. I am recognized and after my introductory remarks are made I am asked to sit near my “Queen Mother.” I joke around that I am her “lady in waiting” but she hear the Chief’s comments better than me and she tells me that because I am a teaching at a University I have been given the title of the Queen of Linguistics. I don’t know if that is true but I will confirm that tomorrow. I kind of liked being a lady in waiting!
The Durbur was very surreal and like going back in time. We are surrounded by at least 500 people from the village . I can sense the energy and excitement from the people. They do not do this ceremony very often. The children sing and the young boys are beating on the drum. The music is long and rhythmic. The drums beating heavily and there is some dancing. The dancers are dressed in traditional Ghanaian cloth and dance on the dirt and small rocks. There is a cloud of dust over everything. The people steal glances at us and the children encroach upon our seats so that they can get close to the Americans.
I have to tell the crowd why we are there in their village and it gets interpreted by the chief. We invite them to our programs tomorrow but I am fearful because I have told the students to prepare a program for 50 children and 25 mothers but there are at least 10 times that much in the crowd. We have purchased about 20 mosquito nets and we have another 12 that we brought with us so we can leave over 30 nets with them.
The people are so welcoming and kind. Tonight I have been able to try the pounding of the Fufu. This is a dough that is prepared with kasava root and plantain or yam. The women have to pound these vegetables into a mush and then it becomes a dough like substance when water is added. When complete it resembles a ball of bread dough but they eat it like that with a spicy soup. When we returned at night one of the students, Jason, ordered some banku to try. This is similar to fufu but it is derived from corn powder with some kasava. He did not like the banku but found the soup not so bad until he discovered the whole fish in his bowl, head and all. The next day his stomach is a bit upset. I wonder if that will end his food trials.
It is now Day 6 and I am preparing to leave for the village to observe the student projects. They are excited to do their projects and are happy for five days of getting to know the people because they had to modify their language in the program to match the phrases here in Ghana. Hot head means fever, waist pain is abdominal or back pain, catarrh is common cold etc. Time is short so I must go now. Thanks for your comments and emails.