Keough, Elaine: December 2009 Archives

By Valerie King

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

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

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

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

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

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

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

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

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

 “Hail to the Chief and Heathens”

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

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

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

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This page is a archive of recent entries written by Keough, Elaine in December 2009.

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