The students were also treated to an elevated canopy walk at Kakum National Park.  This is an exhilarating experience where there are ropes and plank and netted walkways high about the forest floor.  I am sure that Amanda was looking for giraffes or other animals but any animals that were below were likely scared off by the delighted screams of the students.

Our departure from Cape Coast was marred by the theft of some UML student personal items at the Arafyn Hotel.  The short version of this story is that the hotel manager ( who happens to be the brother of the owner of the hotel) was caught red-handed with some of the items except for the $500 Iphone.  After much yelling and involvement by the local police the hotel owner agreed to pay $400 toward the phone. We left the issue of dealing with her brother, the thief, up to her. It is unfortunate to have this happen to us on the last few days of a wonderful trip to Ghana.  What made this whole incident rot in my gut was the police detective asking me for a kickback for helping us solve the case.  I was shocked and appalled and then I got steaming mad!   I yelled at this detective in front of his staff at the police station telling him that that action is corruption and he was no better than the thief himself.  In the USA our policemen do a good job because they are honorable and not thieves hiding behind a badge.  I think the Ghanaian police officers are still talking about the “crazy American “ woman who went on a yelling rampage.  

                At this point my tolerance for being asked for money by many of the people I meet has gotten me quite discouraged.  While I am fully and painfully aware of the poverty in this country, I cannot also be the solution to their pervasive social and economic problems.  I am here to deliver nursing care and some supplies and I am not here to bribe policemen or politicians, or to put roofs on schools or dig drainage ditches.   I try very hard to focus on the good that we have done and on the wonderful people we have met.  If I concentrate on that and recognize all the good that we have done then I am happy but at the end of 16 long days it becomes harder to see the net result.  

                We spend one last day in Accra to do some last minute souvenir shopping.  Everyone is down to their last few cedes( money).  We have a last lunch at Frankies whish is the closest thing to a burger joint we have found.   Our last treat is a tour of the renowned Korlebu Hospital.  It is one of the largest hospitals in West Africa and much more advanced than the hospitals that we have visited in the rural regions but still much more primitive than our American hospitals.  We are stunned that we are able to walk freely into the hospital units where new mothers are with their newborn babies or post surgical patients are sleeping in 36 bed wards that resemble  a pre-1940 American hospital ward.    We are grateful for this opportunity but realize that we would never allow a group of “sightseers” to go through our American hospitals. I feel somewhat guilty but also am thankful of this opportunity.

                We are then surprised with an impromptu party at a local bar where we are joined by 15 or more of our new friends who volunteer with AFRICED.  These are the men and women who volunteer their time to work on projects that help the social, economic and health welfare of the people of Ghana, particularly the vulnerable women and children.   The efforts of UML is brief but these are the people who care deeply about making their country a better place for all.  We enjoy some beverages and some music.  Speeches are made, photos are taken and friendships are cemented.  This is such a brief party but one of my favorite parts of the trip.  These people are so giving and genuine.  I wish I had more to give to them but they are now my friends.   Although I look forward to going home I am sad to leave these wonderful people.

                Our next stop is the airport.  We have re-packed some of bags by the side of the road and given our last goodbyes to our wonderful bus driver Ernest who kept us all safe and sound on the treacherous roads of Ghana and also to Mawuli, who does not come into the airport with us.   We are assisted through customs by one of our friends, Nicholas.  He has been such a wonderful help to us due to his position with the Ministry of Education.   The students make it through security and Maura and I spend a few last minutes with Kwadwo.  We have come to the point in our journey where we leave some of our funds to help promote AFRICED activities.  The students have elected to give about $400 of their club money to help pay for health insurance for ALL the orphans at Peki in addition to purchasing some school supplies.  I leave some of my own money as well and Maura does the same.  We trust Kwadwo to use these funds for efforts related to the orphanage at Peki.  That village is near and dear to our hearts and we are hopeful that these funds will help AFICED to provide services to 38 orphans.

                We board our plane home.  Maura and I have snagged our great seats just behind business class.  There is a bit more legroom and we are anxious to get some sleep on  the long leg of our journey home (12 hours until Washington DC).   We are tired and still quite dirty but all in all it has been a productive journey.  The students are equally exhausted but satisfied.  They have done and seen things that many nursing students never get a chance to even imagine.  This experience changes all of us for the better.  We have survived the challenges, we have learned about another culture but also about ourselves.

Thank you to all the family, friends and colleagues who have supported NSWB during this journey.  We could not have done this without you.

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.

 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.

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

Shine is a special person to us and has just had a baby this year which she attributes to her American Mamas.  We gave her a fertility statue the first year and we were hoping for twins but we shall be happy with beautiful little Asher born in September 2010. 

We are advised that we can catch a tro-tro from the lorry station (bus and tro tro station). As we approach the station a tro tro yells Ho and we quickly board.  We ask if it is a direct route and we should have trusted our gut when they did not answer the question.  The language barrier is a chronic problem. 

Unbeknownst to  us this tro to will stop and start about 20 times throughout the trip picking up and discarding passengers.  We are crammed in like sardines into a rusty and clunky 12 passenger van that smells like rotten fish.  People are practically sitting on each other.  We know we are in for a wild ride.  At one point our “ handler” (not the driver) decides to take a leak right outside our door as he is waiting for the passengers to get settled.  NO modesty about that. 

We are dumped into bedlam in the village of Kpeve and told to disembark and load into another tro tro that is more crowded than the one we left.  We wait a few minutes and another tro comes along and there are two seats in the second row.  We sit next to a woman with three small children and they are squished into the seats. Her middle child, who is about 2 years old, is slowly sliding under the seat so I hand my bag to Maura and pick up this child and cradle him in my lap.  He immediately gets cozy and I find his little hand has snuck down to my breast.  His mother is breast feeding his younger sister and you wonder how much cuddling time this kid gets.  I don’t mind but I am secretly hoping he is potty trained as I hold him in my arms for the next hour.

We arrive in Ho which is a very large and confusing city and unfortunately it is market day so that means the population has probably doubled.  We find a cab and give the driver very rough directions to a meeting spot which is the Catholic church near the police station.  We are dropped in the middle of no-where and await someone to pick up us.  We laugh about our predicament and within 30 minutes Shine’s sister picks us up. 

We spend about two hours with Shine and her family and it is time to go home.  We dread the tro tro ride but know it is the only way home. We have (with the help of Shine’s sister) been able to secure two seats in the front seat. The lorry station is a wild place with at least 200 vehicles awaiting destinations and passengers.  Most of the vehicles are equivalent to our junkyard material. 

Our tro tro has very little dashboard and there is a loud grating metal sound when the left side of the vehicle dips into a low spot in the road.  There are another 15 passengers on board but I hesitate to look behind me as I will feel bad for their lack of comfort. We are three across and they are five across. 

Fortunately this is a direct bus and we do not stop to pick up or drop off.  We cross over a small mountain and that is a bit scary because Ghana has no guardrails.  We can see some wild fires in the distance and are unsure if they are planned burning or accidental.   Maura and I are startled by a loud cackling or barking noise from behind us.  At first it sounded like a dog but we soon realize it is the man behind us who has two live chickens tied up and sitting mere inches from us.  We are startled and then laugh at the whole experience.

We arrive home about 7 ½ hours after we left.  We are filthy and tired but the students have had a good day. They were able to have some time in the clinic and hospital and then make a donation at the Missahoe Orphanage and were able to play with the children.  Everyone is kind of chilling tonight which is a good thing.  A few students go out and get a meal with Lorna who is celebrating a birthday today.  Some have had a traumatic day watching a difficult birth at the hospital. I was not there but I heard the details and it was quite upsetting for some of the students. Our nightly debriefing session was held without us but I heard that there was some good discussion about what they saw.

I wanted to take a few moments to give you a description about some of our environmental challenges.  In Ghana we are experiencing “Harmattan” which is the season of hot and dusty blowing winds.  The winds are bringing the sand down from the Sahara desert and the air is thick with the particles as well as the heat which keeps some of the air quality very poor. The multiple brush fires along with home fires add to the smoke and dense atmosphere.  As we drive today we are lucky to see 1/3 a mile in front of us. Try to imagine the worse scene of California smog and multiply it times ten.  We have not seen blue sky yet.  The air quality is affecting some of the students who have asthma and I have found myself coughing this morning due to inhaled dust and now have laryngitis.

As the health challenges of the trip become more evident I am seeing a bit of physical deterioration in some of the students.  The lack of proper diet is draining as well as the emotional and physical challenges.  No one is complaining and I ask them daily about their status but from my perspective of someone who has been here before I can see the changes.  They are learning to adapt. 

We now consider ourselves fortunate if we get a trickle of water for a shower and don’t mind that it is cold.  We look forward to our crackers and realize that the food will be challenge until we get home.  We have all lost a little weight but the students are good natured about it and realize that our discomfort is only temporary and we will soon be back in our warm and safe American homes but the people of Ghana live this way every day.  I find the whole experience teaches us all about our strengths and how to survive.  My first year I spoke about how the experience had to break me down a bit before it built me up.  I suspect that this is a process that is experienced by many if not all of us.

We are looking forward to two more days in Kpando with some busy plans for clinics at a few poor villages and one more orphanage visit.  Our boxes are dwindling which is a good thing.  We will travel much more lightly in a few days when we begin the last part of our journey which is more sightseeing and less work.  We leave a week from tonight but there is still much to do and see.

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.

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.

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! 

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. 

We are due to see our American Embassy today and a few more sights in Accra. We leave the hotel around 11 but hit an enormous amount of traffic on the way into the city.  The traffic here is like nothing you have ever seen. 

Although the roads are paved and it appears that is should be a two lane highway into the city it often resembles a large parking lot.  I believe it is worse than even getting out of Fenway or Gillette after a game.  The roads are not lined and it can be like a giant game of chicken. There are many lanes of cars all trying to squeeze into a narrow road. 

We are traveling in a larger bus but even the smallest of cars try to edge us out of our lane.  There is lots of honking of horns and to complicate matters there are street vendors by the hundreds who are hawking their wares by the side of the vehicle.  I cannot make eye contact with any of them or they will come over to the bus and tap on the window and offer their items. It seems cruel to avoid their gaze but it becomes necessary.

These people stand in the hot sun all day long trying to make a living.  This type of occupation seems to be the largest employer in Ghana.  There is an amazing abundance of  hardworking people looking for employment and I am surprised that some of our US businesses who have outsourced their manufacturing to China or India have not considered Ghana.

Eventually we find out selves in at the Parliament House where their legislators (Members of Parliament) are not in session.  We are not permitted in the building but it is impressive.  We are then taken to the Conference Center which is a huge building that is the home of large political and social gatherings.  When President Obama came here to Ghana in 2009 he spoke from this building.  We are given access to the VIP lounge where he awaited his time to speak. It is a large impressive room with many sitting areas .  There is a large private office also where the Ghanaian president or other dignitaries can do some work.  We are told that not many visitors get to see this area and we feel special.

Our appointed time is approaching and we must go to the US Embassy for our scheduled visit. It is quite the procedure to get into the building.  All of our electronics (cameras, thumb drives, iPods, phones) needs to left at the counter as well as any liquids.  We painstakingly go through the metal detector and bag scan.  Only small groups at a time can enter into the Embassy and only with an official guide.  We are joined by five to six members of AFRICED so our entourage is large.  As usual we are attracting lots of attention because it is not very often in Ghana that you seen a group of young white people  like ours.  The glances from the people of Ghana are never rude but rather inquisitive.

Upon entering the embassy we are directed to a large conference room.  While we await the start of our program a young good looking US Marine comes into the room and starts to chat with us.  He is a very personable young man who is excited to see a group of Americans and is anxious to invited us to a comedy night held at the embassy on Friday night.  His name is Marcus and I wish we could spend more time with him because he is very humorous and gives us good insight into his life as an American in Ghana.  

Our program begins with a welcome by Mary Drake Scholl who is the Public Affairs office.  She gives us a wonderful description of what the US Embassy does in Ghana.  I am amazed at the scope of their activities because I had always assumed there were in foreign countries just for American interests (security, passport problems, etc). 

The US Embassy and their partners are involved with many initiatives like local and national health care, education and other activities that benefit the Ghanaians and American expatriates in Ghana.  We then get a chance to talk to Susan Wright who is the deputy office chief of USAID/Ghana.  

Susan is involved with many projects that are done to improve the health and welfare of the people of Ghana. She gives a great presentation on the prevalent health issues in Ghana (malaria being one of the biggest problems in this country) in addition to other social issues that are affected by the health of the people of Ghana.  Her presentation dovetails wonderfully with the work the UML students have done in preparation for their community health implementation projects. 

The students will be doing two projects, one is for malaria education and awareness for mothers of young children and the other is a nutrition education program for school aged children.  They will be implementing their programs in a few days so all the information that Susan gives them validates their hard work and project purpose.

We then get to meet the heath care workers (a nurse and physician assistant) who are not government employees but rather are called “local hires.”  They work at the Embassy to provide health care to the embassy workers and their families and also have some responsibility for the other embassy posts in neighboring countries.  It is interesting to hear their career stories. It seems that many people who end up in foreign jobs often begin their career with the Peace Corp.  The working conditions that the PA endured in her previous job is incredible but it seems like her current job at the embassy is challenging but rewarding. 

At the end of our program we are treated to a lively lecture by Dr. Fazle Khan who works with  the CDC Director in Ghana at the Embassy.  He has an interesting career story but it is his recall and insight into the health problems like AIDS and malaria that enthralls us.  He is inspiring and has the utmost respect for nurses which is music to our ears. He gives some good career advice should any of the UML students desire to work in a foreign country like Ghana.

We are thankful for this interesting visit to our US Embassy which is a vast change from last year when our bus was bombarded by armed Ghanaian guards because some of the students took out cameras to take a picture.

We adjourn to a nearby restaurant for some cold drinks where we are met by a group of 10-12 people from AFRICED.  We are presented with a souvenir t-shirt that says  “University of  Massachusetts Educational Tour – Ghana 2011.” The goal of our meeting is to spend some time with these hard working volunteers from AFRICED and to discuss their experience and concerns in addressing health issues in Ghana. 

This exchange of ideas is strongly advocated by our coordinator Kwadwo.  We need to learn from them and they need to learn from us.  It is interesting to learn about the Ghanaian national insurance plan (costs a little more than $15 per person per year).  It is financed by a tax.  We have seen this tax on any item that we buy.  Health care is available but there continues to be access issues such as proximity to a clinic or ability to afford even the $15 per year for health insurance (which is significantly less for children age 3 months -16 years).  Pregnant woman and newborns are covered for free. This is to ensure improved health and maternal and neonatal outcomes which is a health care problem that is slowly improving but still a huge problem in a developing country like Ghana. 

Maura and I share a lively conversation with Sherry (who also works on land disputes issues during the day and is going to school for her degree in business administration), Simon (who is a laboratory technician at the large Korlebu Hospital here in Accra) and Mustapha (who works in hospital accounts at Korlebu). These three people maintain their full time jobs but also devote time to the social problems in Ghana such as child slavery/orphans and  financially assisting families with many children to keep the families intact and functioning and not to sell their children into slavery to help the family finances.  There are many other projects that AFRICED is  involved with and they will be joining us intermittently this week to help us with our clinics and distribution of supplies.

After our debriefing on the bus (where the students are asked about the observations of the day), we then sit in traffic for nearly 3 hours to get back to our hotel.  This is torture for us and I long for the rural roads of the Volta region where we have to dodge goats and not cars.  Upon our return to the hotel we have a birthday celebration for one of the students (Kim),  with Little Debbie brownies that have stashed in a suitcase.  Chocolate is like gold to us now. 

We spend about an hour organizing our supplies for the next day and counting pills.  I have purchased some medications and the Nursing Students Without Borders club also purchased some OTC meds like Tylenol and multivitamins.  My goal this year is to try not to make our trip about handing out pills but rather addressing some health education needs of the people of Ghana.  If we teach someone about how to manage their hypertension that is much more sustainable than giving them 10 pills. 

The students are anxious for our first clinic tomorrow.  After  a long day I retire to my room to discover that there is no water left to bathe.  Some of the students have already showered and used up all the water. I think we need to start a shower rotation schedule because I will be pretty smelly if I don’t shower for a few days. After a quick wet wipe cleanup we are in bed for some rest before tomorrow.   

As I prepare for bed at 1 a.m. the rooster starts to crow again… Does anyone have a muzzle?

We had a day of touring the capital city of Accra.  It is a very busy city with much traffic and congestion.  It can be an interesting range of sites.  We can be passing a shanty type community and 1/2 mile up the road pass by affluent gated compounds. The disparities in wealth are incredibly sad. 

The UML students are amazed at the number of street vendors who sell anything by the side of the road.  We see little children with large bowls of water bags on their heads who have likely been selling at the busy intersections since early in the day.  No school for them. They are probably being used to sell items to help the family finances.  The UML students pay five times what they need to pay for a small bag of water.  The little girl does not know what to do with the extra money even when urged to keep the extra money to herself.   It is sad to see how children are exploited in some situations and this child may never finish grade school because she is more valuable as a street hawker. 

There are all kinds of merchandise on sale. Cheap toys, candy, fried chips, water, maps, jewelry.   They are there just trying to make enough money to live another day. I worry about the small children by the side of the road and realize how easily a predator could scoop them up and drive off.  The UML students seem subdued when they see these sights.

We were supposed to meet with the Minister of Education today but after waiting for him for about an hour we were told his schedule did not permit a meeting.  We then proceeded to do some touring of the city and we ended up at Frankies which is a local restaurant that features American food.  This is a treat I usually save until the end of the trip.  We haven’t experienced any real hunger yet and here we were today at this restaurant eating American sandwiches and French fries.   It is a welcome respite for the students because we are now approaching our busy time.  

We hope to meet the Minister tomorrow and I will have to come up with some greetings on behalf of UML and the nursing students.  I was asked if I had a “gift” for the minister.  As is customary, people often bring gifts when they meet the minister and last year I gave him some bottles of OTC medicine because that is all I had to give.  That bothered me tremendously because those medications can be easily purchased by any person working in these government jobs and I felt it was depriving a needy patient of much needed medications. 

This year  we did not bring as many bottles of medication due to shipping costs so I had nothing to share.  I told our coordinators that the Minister of Education was going to have to settle for the “present “ our of “presence”  in his country.  That was kind of a snarky response but I have a real issue with inequities in health resources (in any country) and I am not going to promote those inequities because of the “custom” of giving gifts.  At some point in time a person has to stand up for their beliefs and this was in important issue for me.   I know that I risk offending  a very important politician but I think it is better to stay true to one’s own beliefs. 

Tonight we returned home to our hotel and had our first debriefing session.  This is such an important part of the day where everyone gets a chance to voice their observations, concerns or questions.  I am proud to hear the comments from the UML nurses.  They are absorbing so much and I can already see that this experience has begun to change their perception of social and health problems in a developing nation.   UMass Lowell has taught them well.

Maura and I have a few glasses of wine and some peanut butter crackers and cookies for supper (we need to have some food to take our malaria medicine with). The wine is relaxing and I play a few rounds of a fun and crazy card game with some of the students while the other group is busy in their hotel room revising one of their assignments that is due for Community Project.  Everyone is getting along well. 

The marriage proposal count is at one. I told the students I will keep track of their marriage proposals and one of the students was proposed to today by a Ghanaian military guard.  I predict our marriage proposal count will go much higher when we get to Kpando.  I will give  updates on the proposals.

It is about 12:30 and time to go to bed.  The rooster just crowed outside my window.  He needs to have his circadian clock fixed.  He woke me up at 3:30 this morning also.  Tomorrow will be an interesting day as we have been invited to our American Embassy in Ghana to meet our Ambassador. Last year we almost got arrested for taking pictures and this year we are invited guests.  Funny, how a year can make all the difference in the world.  

Good night to all and come back to read  some student blogging.  I have been keeping them busy but hope they will start blogging soon.

Maura and I decided to upgrade for extra five inches of legroom. We wanted to see if it made a difference in our ability to sleep during the 10 hour flight from DC to Accra.  At Logan, all the parents were hugging their children and there were a few tears.  What a leap of faith these students and families take when they agree to go to Africa.  I know what to expect but it will be interesting for me to see their shock and reaction to this new experience.

Once on board our long flight we tried to con the very nice flight attendant, Jeannette, to upgrade us to First Class.  She could not do that but she was very respectful of our challenges and proceeded to give us some goodies usually reserved for first class.  We had some mimosas, wine, special dessert, vanity pack and large bottled water for our journeys. With our extra leg room and special treatment it felt a bit special and a some pampering before our upcoming  journey over dirt roads and hot temperatures.  We had a nice United Airlines angel watching over us.

We stopped at a mall in Accra to purchase cell phones and some last minute bottles of wine and water (hmmmm  I wonder which one we will like better after a long day!). One of the students said to me “Wow ... this is not as bad as I thought it was going to be.” I chuckled because I know there will be so many more shocks and adjustments yet to come.  The students are all happy and excited so I am hopeful it will be a great trip for them. 

We checked into a small hotel on the outskirts of Accra and I was pleasantly surprised to  have clean rooms with air conditioning and wireless internet.  As we were winding down for the night we heard some screaming and found out that we have other guests in the rooms (a few small lizards).  What can we do?  We are here and the lizards won’t kill them.  I am looking forward to going to bed in a few minutes and catch up on some missed sleep.
Tomorrow will be a busy day. 

Come back to hear more stories and check out the student blog that will have some entries soon.

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

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

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

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

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

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 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.