Ghana - January 11-13, 2010
Day 14: January 11, 2010
Today we returned to
Nkonya to conduct my Community Project group's intervention: HIV/AIDS
Prevention Education. We had slightly over 50 participants from age 12 to 18.
There were a few in the male group who were even a little older than 18 (early
20s) but we let them participate regardless.
Our program was designed to target adolescents from age 12 to 15 years of age, because we had identified the highest risk group for HIV infection being those aged 15 to 24 years old. We wanted to be able to educate the younger population, so when they reached the higher risk age groups they would be better prepared to protect themselves from HIV infection. Our original goal was to conduct this program in Kpando, but when we arrived we learned that HIV (while a problem in Kpando) was an even larger concern in Nkonya. The area is very poor and has minimal access to healthcare; there is a maternal clinic in the village, but the nearest full service clinic and hospitals are located in Kpando over 30 minutes away by car. Given the poverty in the area, education above a primary level is not common in the village, and many girls leave town for bigger cities (such as
I believe that our program was really successful in this setting. The participants were all voluntary and eager to learn about the topic. Our pretest indicated a huge need for further education. Many participants were unclear on what HIV even was, how it would impact their health, and even more had a very poor understanding of how HIV was transmitted. We handed out index cards so that individuals could submit questions they had about HIV, sex, etc. and because this activity gave the person anonymity we got numerous questions on each card. I worked with the female group, but when we regrouped later in the day to review how each group did I found that all of the questions the adolescents asked were intriguing:
-If I have sex with an HIV infected girl and she does not orgasm, can I get HIV?
-If I wear two condoms, am I better protected against HIV?
-Can I get HIV from a mosquito bite?
-If someone with HIV cooks for me, can I get HIV?
-Can I get HIV from deep kissing?
-If I am a student and I have sex, am I still at risk of getting HIV?
-Where does a condom go, how do I use it?
-Can a boy use a condom more than once if you do it more than once with him?
We reviewed all these questions at the end of the program, and I know that at least the girls were 100% when we conducted our post-test with them. They had a hard time choosing their favorite part, and did not offer us any cool feedback when we informed them that we were just trying to improve the program for the next group. I felt really, really good about what we did today. The girls were waiting to get their soda and biscuits during the break we provided to ask me individual questions. We had 5 immediate volunteers when I completed a condom demonstration and opened up the floor for others to try.
The only negative part of the day, for me, was HIV testing that was conducted following our education session. First off, I think those 15 to 25 should have been prioritized for testing because they are at greater risk of being infected, but the testing was opened up first to participants in our group. My other problem was that those being tested were being told that we had a test "for diseases of the blood" that they could participant in if they chose. The NSWB members were instructed not to tell people we were conducting HIV testing. Our guides and advisors at Africed said people will not willingly go for HIV testing in this area, and many areas of
I am a firm believer in patients' rights. I think women have the right to choose whether or not they want to terminate a pregnancy, I think a patient's end of life decisions should be respected (
The argument made for testing was this: HIV antiretrovirals are available to those who are HIV+ even if they don't have money. People are refusing to find out their status by getting tested. There is huge stigma surrounding HIV, and people would rather be ignorant than have their "life be over" when friends and family and coworkers learn that they are HIV+. In the meantime, the spread of HIV continues and is a huge problem in the area. It was a greater good for a greater number. Positive members would be counseled by local healthcare workers trained to deal with this kind of life changing news.
I can see both sides of the argument, but that was my ethical dilemma of the day, and I am glad I chose not to participate. At the end, when everyone turned out negative I reminded those gathered that just because they tested negative today for a disease didn't mean their actions tomorrow couldn't cause them to be sick. I also reiterated that we did not test them for every disease out there, so if they had a rash or a fever or some other symptom of illness they still needed to report to a clinic or hospital to be evaluated. I hope everyone there heard that part of the message.
Today we went to Anfoega to donate to
We received an extensive tour of the hospital, which was the cleanest I've seen since we arrived in
-The hospital is located about an hour from Kpando, but that is the only ambulance they have access to.
-There is no anesthesia machine in their "theatre" or operating room, so surgery, including c-sections, are conducted under conscious sedation!
-There is no blood bank refrigerator, so the hospital does not have blood banked for an emergency
-The lab had to conduct all its blood work without the assistance of a machine (that means manual counts on CBCs, etc under a microscope!) until a week before our arrival, when the new doctor (only doctor) at the hospital made sure a machine was purchased.
I give so much credit to the healthcare providers here in
In Anfoega, specifically, Dr. Alex Ackon has done incredible work. He has been stationed here for only 6 months and he has revamped their Pharmacy system, begun updating the Laboratory, ensured a more cleanly environment, and is working hard to get an X-Ray machine and updating the OR. He came from a teaching hospital in
Today we hosted the first (annual) National Nurse's Conference at
The day started off bumpy. Our bus arrived at quarter of 9 when we were up and waiting outside Cedes Guest House for its arrival at . The conference was scheduled to begin at , and we had an hour and a half drive ahead of us. Luckily, Zanele and Allison had gone ahead with Nicholas (the representative from the Ministry of Education we had been working with) and Mawuli (one of our escorts who works for Africed.) When we arrived, embarrassingly late, Allison was completing her talk on Pediatric Rehydration Therapy. Then we were informed that some important politicians were arriving with the media, so we had to put the conference on hold until they arrived. Politics is very big in
Pediatric Rehydration Therapy-Allison Geissert
Hypertension Diagnosis/Prevention/Treatment-Elizabeth Long
Stroke Prevention Education-Jody Roper and Lauren O'Keefe
Diabetes-Valerie King (she is a very engaging speaker for anyone who has her for Community Project this Spring!)
Congestive Heart Failure Definition/Treatment/Pharmacology-Renee Glennon and Stephanie Whippen
Breast Self-Exam-Zanele Denaro
At the conclusion of the lecture portion of the program we opened the floor up for more questions, and then every nurse was called forward to receive a BP Cuff (we had 18) or Stethoscope (35) and all were provided with a marker, highlighter, pen, and t-shirt we had made for the conference. The BP cuffs went first which is not surprising, given that oftentimes a clinic only has one (and it's mercury.) Everyone was very grateful and excited about continuing this tradition next year, but with even more participants.
After the conference we began the ride to Peki (Mawuli's hometown.) We were greeted with an elaborate, traditional welcoming ceremony. I have never experienced anything like it. When we arrived, the area was packed with people of all ages- there was some drumming and dancing already underway. As we got off the bus, children swarmed around us. They cheered and jumped and shrieked in delight whenever we took a picture; everyone wanted the opportunity to see their "photo."
We joined the dancing briefly and then were seated under a canopy of palm tree branches/leaves. Across the dance floor (an open dirt patch) sat the chief and his linguist as well as male elders of the community. All of them had robes of various African clothes wrapped around their waists and thrown over their left shoulder. To the chief's left sat the Queen Mother, her linguist, and drummers.
Our guides spopke to the chief on our behalf and presented him with a gift of Schnapps. They explained our mission in
First a group of 12 young people danced and sang for us (in their native tongue, Ewe.) The group had boys and girls of varying ages; they had cloth wrapped around their middle fingers that they twirled and utilized as they danced to an upbeat, hip swaying, rythym. Then young boys took their turns performing. Their routines involved sticks that were cut to look like small swords or spears. They made menacing faces; puffed out their cheeks, rolled their eyes upward until only the whites were visible, and bared their teeth. They spun and crawled and ran around, interacting with the entire circle of people; at times grabbing at or leaping toward the small children on the outer rim. Their "dance" incorporated defensive and aggressive moves, and seemed to be inspired by battle/swordplay/fighting.
Next up was a group of women in matching skirts and tops who sang a few songs; the first in their own language and then some religious (Christian) ones in English. The last piece of entertainment involved the Queen Mother and her linguist dancing around the circle. They pulled NSWB members forward to join them. It felt like she was showing us to the people. Those who were pulled from the safety of the canopy were: Whip (Stephanie), Myself (the Queen Mother told me I was "very good"), the Mamas (Val and Maura), as well as Jocelyn and Zanele. I've got pictures. They aren't as good as some others, as the dust and sand kicking up during the dancing came out as spots when our cameras would flash.
The entire affair was quite an event to witness. After all the entertainment concluded, our formal acceptance into the community began. The chief called each member forward and gave them their African names and two bracelets made of long strands of some kind of dried grass cinched by two traditional painted clay beads. These bracelets, we were told, represented our membership into the community as children of the Chief and Queen Mother (the word Royal was thrown around too.) Our African name is our first name, the day of the week we were born (in Ewe), and then our last name. Mine is Jody "Akousa" Roper, because I was born on a Sunday (my mom will have to correct me if I'm wrong.)
Maura Norton (being the eldest) received an even greater honor during the ceremony. She was crowned as a Queen Mama; as the community views her as "Mama" to our group. She received more beaded bracelets, a crown of woven/braided cloth, and special sandals. She sat on a stool beside the true Queen Mother, wrapped in a robe of Kenti cloth for the rest of the evening.
The dance floor was opened up to all participants at this time; so we danced. The welcoming session concluded with our group being offered palm wine, which was shared around our circle in a gourd bowl; you drink and then pour a small amount on the ground (I believe for your ancestors.) I have a phobia about sharing drinks, so I hung back a bit with the little girls I'd been dancing with and was passed over in the dark. I was told the drink was warm and bitter.
We loaded back on the bus, exhausted. We'd all been up since and the ceremony had lasted three hours. There was one more stop to make; Mawuli's uncle's house. On the well lit front porch a brand new bottle of chilled palm wine was opened for us. Many gourds were offered around our circle. I received a fresh "glass." It was fizzy and cool and delicious; though my tastes may have been influenced by the fact that I'd danced and sweat and been without drink for over three hours. It was a very unique flavor though, so I can't think of anything to compare it with at the moment.
Listed below are links to blogs that reference this entry: Ghana - January 11-13, 2010.
TrackBack URL for this entry: