Crystal North

Feb 25th

Well, today was the day of tourism fun! We got up early, so we could be at Kakum National Forest right when it opened at 8am.  We figured we’d get a taxi, it’d cost us like 10 Ghana Cedi, and that would be that. Well, turns out, since the taxis know that they have the tourists cornered out here, they charge 30 ghana cedi for the trip!! Highway robbery.  We make a deal with the driver to take us to Kakum, wait for us, and then take us to Elmina after that, all for 35 ghana cedi.  If for nothing else than convenience and ease of mind, it was mostly worth it….

Kakum was awesome! It is this national forest, which is obviously all rainforest. The canopy walk was built in 1994 by some people from Vancouver BC as a tourist attraction.  It stands about 20meters above the forest floor, and is a series of planks of wood connected between wood platforms built around tree trunks, all suspended with cables and ropes. Not for the faint of heart, that’s for sure! We ended up doing it with our own guide and a couple from Holland, which was a ton of fun. Encountered another Ghanian who wanted to know if we were married…par for the course! We got some excellent pictures too.

We then headed south to the coast, where we visited the Elmina castle. It was built by the Portugese, then captured by the Dutch, then captured by the British, then given over to the Ghanians in 1957, the year they got their independence from the British.  The history is absoutely flooring, and the conditions these people were made to live in were totally inhumane to say the least.  We got a tour of the castle, and got to learn about the history, which made the experience even better.  Plus, being on the coast, it’s just totally different here.  There’s a breeze (praise the Lord!), and it smells like salt water, and there are fishing boats (hand-carved) everywhere.  Again, we have some great pictures.

Then we caught a taxi over to the Cape Coast castle, which was more of the same (not that it lessens the experience, I just don’ t have much additional to say about it), situated in a little bit different of a setting.  We got to see the famous “Door of No Return” in that castle, and go through it and back into the castle again, which is pretty symbolic. Again, more great pictures, and more tales of just absolute torture that these people endured.  We learned today that the Ghanians that have more european last names are named thus because they are descendents of babies born to slaves who were raped by the colonists.  Those mulattos think of themselves as superior to the purely African people, and there’s a little bit of a hierarchy because of it.  So interesting, I never knew that.  We learned a bunch more about women in slavery, and different destinies for different women, depending on the mercy of the men, but I won’t write about it, for those of you who don’t want to read about it. Maybe you

We found out our next STC bus (oh the adventure) to Accra leaves at 1pm tomorrow.  We have to be at the airport by 930pm for our 1130pm flight to London.  You would think that was plenty of time, but as our experiences have gone thus far, we’re not so sure. It was either 1pm or 4am, and we figured it’d be better on our general senses of well being not to have pulled essentially an all-nighter before embarking on our London adventure! Seeing as we’re both people who don’t do well emotionally on little sleep, I’m thinking we were right! So you all can cross your fingers and pray that we don’t get delayed enough tomorrow that we miss our flight!! I’m sure that missing a flight out of Africa would be an adventure, but it’s not one that either of us is excited about embarking upon at this point… :)

Here’s to a relaxing evening (we’re going to eat at the restaurant at our botel, and there’s supposed to be this massive bird arrival to a tree right outside the open air restaurant), and a successful trip to Accra tomorrow.  Love to all of you!!!

Feb 24th, 25th

Well, for those of you keeping tabs, we are in Cape Coast, and have been since last night.  They have an “internet cafe” here (translation: bare room with a couple computers and a fan), so we’re taking the opportunity to do some emailing while we have the chance.  It’s actually pretty cheap too… 1 Ghana Cedi per hour (roughly $1).  So, to catch you up on the rest of the weekend:

Feb 24th (Sunday): Mostly packing in the morning and saying goodbye to Cam and Anne, and to Erica.  We were quite ingenious with breakfast, and used our brick of Starbucks chocolate covered espresso beans (that totally melted on the sweltering trip up to Ankaase) as a source of chocolate to make homemade chocolate pancakes. Delicious!  Needless to say, we were wired for the rest of the morning, since our bodies haven’t seen caffeine in about a month, so we found ourselves exceedingly funny.  And we tell ourselves that everyone else found us just as funny as we found ourselves… 

Now, here is where today’s adventure begins.  We have discovered that whenever you travel by STC, you should be prepared for the unexpected.  Which maybe means it should be the expected… We head to the STC (bus) station in a taxi, which was nice and event-free.  We get to the station about 2 hours before our bus leaves (you never know with Ghana), and sit around playing cards for a while.  Well, we attract quite the attention from a few local Ghanians with our card shuffling abilities, and we soon have a crowd.  One Ghanian, Benjamin, is actually willing to learn how to shuffle. The rest are too shy.  Benjamin proceeds to sit around and talk with us for the next hour, mostly about how we need to come back to Ghana again, and if we do, he will take us all around Accra, and pay for our food and lodging, and all we will have to pay for is our plane tickets. In the states, that would have been interpreted totally differently, but here, it’s totally normal for that kind of conversation to happen.  He was just chatting, not being flirtatious and forward, like US guys would be interpreted as being.  Granted, we have no plans to come back and visit him! At one point, he asked us if we were married. Another white lie: I told him yes! Then he started questioning us about why we weren’t wearing our wedding rings, and I said something about how I didn’t want to lose it in Africa, and quickly changed the subject. :)

Well, it comes time for our bus to be there, and we hear something overhead about our bus, the only part of which we catch being “the delay of your bus.” Lovely.  Sit back and relax folks, it’s going to be a long day.  Our bus ends up being about an hour late, which isn’t too bad in the grand scheme of things.  Sidenote: for any of you at UW with me, one of the girls we met today is Kyle Tubbs’ cousin! Small world!  Anyway, we get on the bus and take off.  We’re actually making good time, which is a nice surprise.  It’s amazing how much the landscape changed over the 3 hours of the trip.  What was a mixture of grasslands and beginning desert terrain turned into lush tropical forest.  The humidity also skyrocketed.  We felt physically sticky by the time we got to Cape Coast.  But I digress, there is so much that happened before we got to Cape Coast!

We’re trucking right along, and all of a sudden, we’re going up this incline and the bus slows down considerably, there is this strange LOUD grinding noise, and we are suddenly stopped without any power whatsoever.  Even better, we begin to roll backwards down the hill for maybe a couple hundred feet or so. Not sure of the status of the breaks at that point, I can say that the rolling made us quite excited about the whole situation.  Some kind of statement is made by the driver in Twi, that seems to have been the equivalent of “are there any mechanics around?” and several men get off the bus.  Interesting parallel: there is no idea of calling a tow truck, AAA, roadside assistance, or anything like that. If the vehicle breaks, you better fix it or get ready to sleep in it.  Well, as it’s becoming apparent that we’re going to be there for a while, people start getting off the bus to wait outside (let me remind you again of the humidity and heat and dust….lovely.) We’re standing around, watching them work on the engine, and a tro-tro drives up, the driver getting out to help. As it becomes obvious that people are bringing tools to help fix the bus, I’m absolutely amazed that these ancient busses don’t come with toolkits in them! This type of thing happens often enough that you would think that was a requirement!

Well, at this point, I decide it’s a good opportunity to take a picture to document this crazy turn of events. Unbeknownst to me, it is just dark enough to require a flash, so my handy-dandy camera automatically sets off the flash. Caught.  Have I ever told you that Ghanians don’t like their pictures taken without permission? They don’t. I’m immediately told in Twi (later translated for me) that I will make a good soup tonight. If I hadn’t heard everyone start laughing at that point, I would have become convinced that I was going to become Ghanian food, right then and there, on the side of some desolate road in the middle of the Ghanian landscape, somewhere outside Cape Coast. Excellent. Well, a little later, a Norweigen guy took a picture too.  Good, at least when they cook me as soup, he’ll be right there in the pot with me!

Eventually, just as we’re discussing the necessity of flagging down a taxi to take us into Cape Coast (mind you, we’re a mere 20 minutes outside of Cape Coast), we hear the engine start roaring.  Now it’s not the roar of a purring, beautifully maintained engine, but it’s running.  I would describe it more as the hacking cough of a man who has smoked his entire life and currently has pneumonia, but that’s just me.  And the grinding noise is still occasionally present, along with the occasional spark coming from some kind of belt type thing in the motor (yes, my knowledge of mechanics is second to none…). Having no other options, we all get back on the bus.  Lisa and I decide that this is an opportune time to have a small conversation with the Man upstairs about keeping us safe as we make our way to our motel, seeing as it is now pitch black outside and we know the name only of the place we are going.  Well, about 10 minutes after we begin going again, the bus suspiciously starts to slow down again, the grinding noise returns full force, and we are again stopped with no power whatsoever.  Lisa and I had decided that if the bus broke down again, we were going to attach ourselves to the Ghanaian and Norweigen men sitting in the seats directly behind us, since we knew they both spoke English, and that is exactly what we did.  We found them outside the bus, told them we wanted them to help us get a taxi, and then grabbed all our bags off the bus.  Some car stops, and we run to it, and decide that he will take us all to Cape Coast. So the 4 of us pile in the taxi, with all our bags, and take off. Praise the Lord!! We are so ecstatic to be off that God-forsaken bus, especially when we learn that they have called for a new bus to come get everyone, and that it is coming from Takoradi, a town about 90 minutes away, ironically also the destination of the bus we have just abandoned. We make fast friends with the guys who helped us (David and Atla), and ride together to Cape Coast, where they get out and let us take the taxi to our place, about 20 minutes north.  We get to our place (Hans Cottage Botel…can anyone tell me what a Botel is??), and get checked into our minimalistic room, and heave a huge sigh of relief!  This place looks like it was in it’s prime during World War II, it feels like we have stepped right out of one of those movie scenes with all the military men at the hotel, with the loud music and all the people everywhere, but since that time, has been in some dire need of some TLC.  There is a restaurant over the water, which is kind of fun, so we went and had Fanta and FanIce (pop and ice cream) for dinner. 

So, that was our adventurous day!  Tomorrow, we will go to Kakum National Forest to do the Canopy Walk, then down to see the Elmina slave castle, then to the Cape Coast slave castle.  It’ll be our day of playing tourist, and we’re pretty excited about it. Although we’ve already discovered that things marketed to tourists are much more expensive than they should be. Things are much more expensive than they were in Ankaase.

Until next time… Crys

Feb 22nd

Oh, another day of memories.  Morbidity and Mortality was quite lively, maybe because all of the prescribers were there to give their input.  ‘All’ includes the two Cuban doctors, which is no small feat to get them to show up, so that’s a small miracle.  I gave a talk about diabetes to the patients today after patient devotionals, and it was…interesting. :)  I had to have one of the pastors translate, since most of them didn’t understand English, which adds it’s own difficulties and halting nature to speaking.  When I got to the part about diet modification, and began telling them the foods that had a lot of sugar in them (cassava, plantains, cocoa yam…..the only foods most of them eat), the pastor turns to me before he even translates what I’ve said and says incredulously ”but those are our staples!!”  Well, most everyone starts laughing at this point, and there was nothing for me to do but laugh right along with them. If you can’t beat them, join them, right? In my own defense, I proceeded to tell them that I knew they couldn’t stay away from those foods, and so to try and eat a little less of them and maybe a little more of more protein-containing foods, or to try and eat the same amount of food each day, so it would be easier to control blood sugar levels. I’m not sure how much of my message got to them, since I’m sure I was viewed at that point as this crazy obruni who was telling them not to eat the only food they had access to. Oops :)  Lost in translation I guess! Live and learn…

This being our last day, we took a lot of pictures and did very little medically useful work. We did, however, see a stroke patient in casualty who had an impressive case of anhydrosis (one side of the face does not produce sweat), which is the only time I’ve actually seen that.  Very memorable.  He had had a stroke, so was largely unresponsive, but he did respond to pain.  You can imagine what that did to my IV placing abilities.  Picture Lisa, putting her whole weight on this man’s arm (he’s really strong!) to keep it still, and me trying to get the IV in veins that are less than ideal in less-than-ideal locations since the good veins have already been used for previous blood draws.  Long story short, this man did not get an IV placed. Because it is important for a later story, I will also say now that we did a Babinski (nerve test) on his feet with a pair of surgical scissors (upgoing bilaterally, for those who care…).  We do not have CT scan capabilities, so he had to be transferred to Okonfo Anokye in Kumasi anyway for further workup.  His family couldn’t pay for an ambulance, so about 4 men ended up coming into casualty and just picking up this comatose patient, putting him in the back of their car, laying across 3 of them, and driving him to Kumasi.  With all that said, he got there quicker that way, since the ambulance didn’t show up until about 90 minutes later.  Oh, medical care in rural Ghana…  When it comes down to it, even if he had gotten to the hospital much sooner, the chances of him regaining any abilities are pretty small.

Lisa and I hung around with the girls in casualty for a while after work today.  One of them was making Kenkay (corn maize based dish), and wanted us to try it.  We figured that we had made it this far without getting some horrible form of dysentery, so the chances are that we would be okay… So Gladys (the girl making the Kenkay) proceeds to mash up the corn maize with her very UN washed Ghanian hands (which are a whole different ballgame than American unwashed hands).  She does this for a while, and then adds a bunch of water to make a porridge-like mixture.  I tried to ensure that the water was truly bottled water, and they said it was, but I can only hope that was truly the case.  When I asked, the girl actually busted up laughing and said “you are afraid of Typhoid?”  I said “of course!!!” :)  After that, still mashing with the unwashed hands, they add a bunch of sugar and some milk.  Well, the milk was in a can, and there isn’t really any such thing as a can opener here, at least not among non-obrunis.  So they take a pair of surgical scissors and use the tips of them to puncture a big hole in the can (oh yes, remember the story earlier? go back and read it if that statement doesn’t make you instantly vomit).  So now, the scissors that were drug along the soles of that man’s feet, the feet that had obviously seen neither shoes nor soap and water for at least 20 years, had inoculated the milk we were about to ingest.  Let me just stop to tell you that there are plenty of tropical worms that enter the body through piercing the feet.  Well, Lisa and I are already committed, so there’s not really any turning back.  They try to give us huge heaping spoonfulls, and we use the excuse that we are eating dinner later (which we WERE) to say that we could only take small spoofulls.  We each ended up eating two spoonfulls of the Kenkay, which actually tasted pretty good, all things considered.  If I drop dead from some nasty infection, you’ll all know why now. :)  No one can tell me I’m not adventuresome!

We had dinner with Cam and Anne again tonight (FuFu again, yum!!), and ended up watching Amazing Grace after. It’s a movie about the man who helped to end the British slave trade.  We got to talking afterwards about the movie, and Anne shared with us that she recently learned that Ankaase was one of the slave posts in Ghana during that time.  In fact, the Ashanti King (we are in the Ashanti region of Ghana) became quite rich off of conquering surrounding tribes and selling the people as slaves to the Americas and Britian.  The Ashanti people have a reputation for being pretty ruthless in the whole trade.  It struck me that I am in an area where their history is on the completely opposite side of the slave trade disgrace.  In the Americas, our ancestors were the people to buy and utilize the slaves from Africa.  Here, these people’s ancestors were the ones who conquered and sold the people to the highest bidders.  Unless they are from the northern regions of Ghana, then their ancestors were the ones sold into slavery.  It’s quite the paradigm shift.  We are going to tour the two slave castles in Cape Coast on Monday, so I’m pretty anxious to see what that experience is like.

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Alright, I have to go. We’re having Cam and Anne, and Erica (missionary teacher we have grown to love) over for dinner tonight and I have to go help Lisa cook.  We are leaving Ankaase tomorrow morning, taking a taxi to Kumasi, where we will take a bus down to Cape Coast.  We’ll spend Monday doing the castles in Cape Coast and then doing the canopy walk a little farther north in Kakum National Forest. Tuesday morning, we’ll get on a bus from Cape Coast to Accra, where we’ll meet up with a missionary we met a couple weeks ago who lives there. She’s going to take us around for a few hours, until we have to be at the Accra airport Tuesday night to catch our plane up to London.  We’ll be in London from Wednesday morning until Sunday morning, when we fly to Chicago.  I’ll be back in Seattle on Sunday night, March 2nd.  Although, Africa time, it’ll feel like Monday morning.  Jet lag, here I come! :)

Love you all!

Feb 21st

The kindness and generosity of the people here was shown to us tenfold today.  We had been talking to Phillip (the hospital administrator) yesterday, and told him that this was our last week.  Well, we are sitting in devotionals this morning and time comes for the announcements. Phillip begins to talk about how this is our last week, and how much they will miss us, etc. After he’s done saying what he wants to say, he looks at us and says “now you will say something to us.”  Kind of like, give a speech, and you don’t have the option of saying now.  It just made me laugh! So I said a couple sentences of thanks.  Then he looked to Cam and told him to tell everyone how much he appreciated us and how he’ll miss us.  Get that! Cam was told to give a speech, and exactly what to say! Again, hilarious!  Phillip then presents us each with a wooden statue of San Kofa (a bird symbol that means “back to your roots”, roughly), a necklace with the same figure, and a bracelet with the colors of the Ghanian flag on it. We were so shocked! I’m going to miss those devotionals.  They have a special place in my heart, especially since it was there that I led my first devotional.

The other thing we were asked to do, on the spot, is to recite three Twi words or phrases we had learned.  Luckily, we both passed the test with flying colors, and the whole room erupted into laughter and applause after each of us finished.  Who knew there would be a test at the end of the time? I would have studied harder. ;)  As the weeks have gone on, it has become apparent that the people, especially the older women, are not merely greeting us in Twi, but rather are testing our abilities to learn new phrases.  It’s hilarious! For example, it will be the middle of the day, we will have greeted any given person a couple of times by then, and had been at the hospital for hours. All of a sudden, out of the blue, they will say “Akwaaba” to us (welcome).  Well, the appropriate response is “Yeasong” (phonetically spelled, I’m sure), which roughly means “received.”  All they’re doing is seeing if we know what to say! Such sneaky old Ghanian ladies….  It’ll be interesting to see how much I retain.  Here’s what I’ve learned:

Maa Kye– Good morning;  Maa Ha–Good afternoon;  Maa Kyo–Good evening; Me daase–thank you; Wo ho te sen–how are you?;  E te sen–how are you?; Me hoye–I am good; Eye–I am good; Debe–no; Akwaaba–welcome; yea song–received.

I think that’s about it. :) 

I’m going to miss this place. I’ll miss the peculiarities of the delivery of medical care here (well, SOME of the peculiarities anyway), but moreso I’ll miss the people. Lisa and I have both said to each other that if we get sick and need medical care, we want to be flown to Europe or the States!! And if we need to go to the OR, we want the other person to be present, overseeing everything. :)

My man with the huge belly and high potassium is doing much better. Turns out he has massive cardiomegaly, for all of you dying to know.  What probably happened is that he was admitted (NOT by me, thank you very much!), begun on diuretics before lab data came back, got the crap diuresed out of him, which produced some electrolyte problems, that we identified and fixed by stopping the diuresis.  Electrolyte problems being caused by over-diuresis in the setting of failure to check laboratory data before starting the medication…..imagine that…. :)

Feb 20th

I got up early this morning to do my Bible study, since I haven’t done it for like a week or so, and re-discovered what an amazing way that is to start the day! You think I’d know that by now, at 26, but apparently I needed a little reminding. :)  I also discovered that it’s a better way to spend the morning than cursing the Ghanian deejays.  There is some radio station based out of Kumasi that they broadcast in the morning, which is all well and good.  They do things like have announcements that I’m sure are very informative to people who speak Twi.  And I’m sure that the dialogue happening between the commentators is all very interesting, again to people who speak Twi.  HOWEVER, to those of us who are used to sleeping in until we absolutely have to get up, having the radio station absolutely BLARING at 5am is not our idea of pleasant.  Let me just say that if they were within range, they would have several pair of tennis shoes being thrown at them every morning.  God bless the first morning in London, when we don’t have to wake up to a Ghanian radio station at 5am!! :P

I was in casualty (the ER) today with Kingsley (one of the providers, who I’ve grown to adore), and I learned a bunch about Ghanian culture from him.  He was telling me that they have two proverbs about strangers in their midst.  One is that “A stranger is like a child”, meaning that they need to be looked after and cared for more so than other people.  The other saying is that “A stranger has big rolling eyes, but does not see,” meaning that they do not know what they are looking for or where they are going, so they need to have help from other people to do what they need to do.  And those proverbs totally describe our experience.  Everyone is totally willing to drop what they are doing to help us, no matter what it is we need help with, and are always so totally welcoming to us wherever we go.  Kingsley and I were also talking about how strange he thinks it is that we (in the states) have to be wary of strangers, while in Ghana, people let their children run up and talk to whomever they want, and they don’t worry.  They even discipline each other’s children at their own discretion!  Such different cultures, and I think the Ghanians have one up on us on this one.

I’m SO excited about donating the extra money I raised to the hospital! They badly need (among other things) a new maching to do blood counts, and I would love nothing more than to facilitate that for them.  Well, “I” being all of you who donated money to this trip! I think that the best thing to do is to give them the money, and let them decide how best to use it.  I trust that Cam will know where the money needs to be spent, whether that be on lab equipment or not.  I wish I had so much more money to give them! They also need more beds for patients, money for construction so they can accomodate more patients, money to hire more nurses, money to develop a blood transfusion system (right now, it’s all reliant upon family members being willing to donate for the patients), and many other things I’m not even thinking about right now.  But even within all that need, big strides are being made as the hospital grows, and it’s been so exciting to watch for the last 3 weeks.

Feb 19th

My patients are all still alive, praise the Lord! I rounded with the other Cuban doctor today, and my opinion of him slightly improved as well.  Maybe part of it is that I’m rounding on the adults now, so I don’t feel so much like a fish out of water when it comes to my own knowledge base.  Well, that might be part of it, but they were genuinely delivering sub-par care last week.  I think part of my dissatisfaction is that they are doing things the way they have learned to do them in the Cuban healthcare system, while I am wanting things to be done the way they would be done in the American healthcare system, all the meantime while we are trying to take care of patients within the Ghanian healthcare system.  Sounds like a complicated set of interactions, doesn’t it?!

There was a group here from California today, doing dental and auditory checks on some people.  They are spending 2 weeks travelling through Ghana, doing the same in other small villages throughout the country.  They are all very nice people, and I was able to have lunch with them at the team house today (which I didn’t even know existed until today!).  I came away from the day with them, however, almost ashamed of being an obruni and being associated with them.  That sounds harsh, I know, so let me explain myself a little.  There is probably (Ok, I KNOW there is) a large portion of my own pride issues in that feeling, thinking that after 2 weeks, I’ve mastered how to interact and fit into the Ghanian culture and they have not.  And maybe there’s a little bit of feelings of ownership, like I want to be one of the only obrunis around. How selfish am I?!? But, on the other side of the coin, I definitely had the distinct impression at one point in the day, that we were on this African safari, and the little African children were the animals. We were driving by a couple of the schools, and the children were all crowded around the van screaming “obruni!” like they always do, and here are a group of women, all hanging their cameras out the windows, taking pictures of them. As I type that, I realize that it doesn’t sound like something totally insensitive to do, but at the time, all I wanted to do was to jump out of the van and run from the situation. It just felt so wrong.

Maybe another reason for my reaction to the people from CA was the fact that a few of them were pretty stinking dolled up for being in Africa. One of the women had her hair perfectly done, her makeup perfectly applied, her fingernails and toenails perfectly french-tipped, and her bracelets and necklaces and earrings and diamond rings all sparkling and matching.  Now, there’s nothing wrong with looking nice, but I just think that when you’re coming to work in the midst of a poverty-striken village, wearing all of that is kind of like flaunting what you’ve got in front of them. It just struck me as highly inappropriate. 

Then I was talking to a couple of them, and saying something about how friendly everyone in Ghana is, and how impressed I’ve been about that overall. She proceeded to say how her experience has been that people are very pushy and rude about getting people into their shops, and force them to buy things, and yell at them when they don’t.  It just shocked me, because all of that was such a misinterpretation of intentions! They talk loudly, they even talk loudly to each other; they’re never yelling like we interpret yelling. And yes, they are very excited to see people who are going to buy something, so they to what they can to get you to go in their shops.  But if you politely refuse, they won’t get upset.  And if you don’t buy something from them, they are almost always still exceedingly nice to you.  So, what a sad experience for them if they’re interpreting everything so negatively!! We’ve had the advantage of having Cam and Anne to process through things with, so maybe that’s where we have been blessed to understand motives and intentions a little better these past few weeks.

And then, at lunch, a couple of the Ghanians (that I’ve come to know) served us the whole time, while we just sat around.  It felt so wrong that I was completely anxious for lunch to be over, so there wouldn’t be this difference of roles anymore. I tried to get up and help them serve at one point, but they had already got everything ready, so there wasn’t anything for me to do. I just feel like we’re supposed to be coming in the name of Christ to these people, and befriending them, and livinng in their culture, and that having them cook,clean, and serve us propagates thsi master/servant relationship.  We’re these rich obrunis that they’re waiting on.  Now, I’ll be the first to say that it’s nice to have the woman who cleans clean our apartment, and to have them make us meals sometimes, don’t get me wrong.  I’m just curious as to what that does for the relationship or the view of the Obrunis by the Ghanians. Maybe nothing, who knows. I’ve thought similar things when I watch the watchmen at the house open the gate for us to drive in with Cam, or the women at the house doing the ironing and cooking.  But maybe it’s never hit me like that before because I’ve never been put in a direct situation of being physically waited on.  Again, it just doesn’t feel right.

Went into the surrounding villages again this afternoon to do more of the health survey that the community health program is conducting, and again was just struck with the level of poverty these people live in.  Words just can’t do the situation justice, so I won’t even try. I now understand how diseases are transmitted fecal-orally, and how people get diseases from flies, and how animal to person disease transmission happens, let’s just leave it at that.  I had this thought, though, later in the afternoon, that it would be so awesome to be able to come back and do clinics in some of the more remote villages.  Maybe I could be based out of the hospital here, and utilize some of the staff for translation and nursing, but then do week-long clinics in 4 or 5 different villages throughout the region.  How totally rewarding would that be!!! Something I’m tucking away, for a time when I have more freedom with my schedule than residency will allow…..!

Feb 18th

I have to admit, I actually came away from rounds with one of the Cuban doctors harboring just the ever-so-slightest bit of respect for his medical knowledge.  I was asking him a lot more questions today (I’ve learned to be much more aggressive with my management decisions and orders), and he actually impressed me.  He was looking at the whole picture of the patients, rather than their individual chief complaints, and doing things like checking blood sugars, blood pressures, adjusting medication dosages, etc.  I questioned him on the logic of double antibiotic coverage for one of our patients, and he actually gave me an answer that satisfied me (nevermind that Cam later totally blew his theory out of the water, but at least he had reasoning to be hitting this lady with the equivalent of the antibiotic kitchen sink).  Maybe, just maybe, I was a little too rash in my writing-off of their capabilities as physicians….maybe. We’ll see how the rest of the week goes. The higher likelihood is that I found a bright spot today… There are a couple of patients that I want to keep a closer eye on this week, so hopefully all goes well with them.  One of them is a man with ascites (huge abdomen), hyperkalemia (think: possible heart problems), and elevated liver and kidney function tests, whose wife put a curse on him 3 months ago. I’m determined not to let this man’s potassium be overlooked, so that he doesn’t end up dying like the last man.

I’m continuing to become more confident in my knowledge and skills as the weeks go on.  Granted, I’m still learning a ton about management and disease presentation in Africa, but I’m no longer terrified of sitting in the “consult room” (basically, clinic) by myself, ordering tests and making diagnoses and treatment plans by myself.  Not that I’m necessarily competent enough to be doing those things in reality, but you get the picture.  Like one of the doctors says, whenever things don’t go like they ideally should, “It’s Ghana” (said while shrugging your shoulders) :)  This just really goes to show that you need at least a month in any one place to really begin to function independently and understand the system and how to work within it.  Just goes to show that we should have given ourselves more time here. Oh well, I’m sure London will be a blast!

Feb 17th

Today was our last church service, since we’ll be headed into Kumasi next Sunday morning.  There was a funeral last week, so almost everyone at church was dressed very traditionally in black and white fabric.  I am totally intrigued by the way they do funerals here.  They are a week-long event, with a TON of loud music.  The first part (or all?) of the week, everyone is dressed in this beautiful black fabric, some of which has a sheen to it, almost all of which has a very faint pattern in it.  The other color they wear is red. Bright, blood red.  I haven’t figured out who wears black and who wears red, or if there is any rhyme or reason, but that’s what they do.  So everyone is in black and red all week.  Interestingly enough, I haven’t seen anyone come to the hospital in the funeral clothing. Maybe they’re not supposed to? Maybe it’s considered poor form? Maybe it’s no big deal, and no one attending those events has happened to need to see a doctor? I have no idea. They have this huge event on one of the days (I don’t know which one), where everyone gathers at a common location. There are rows upon rows of plastic chairs all set up to face a table with a picture of the deceased person on it, with the table being quite ornately decorated.  There are these tarp-awning (sp?) type things that are set up over the chairs  (like we had at the K5 pool), probably to shade them.  On either side of the table with the picture are these towers of loudspeakers, from which the aforementioned music is blaring, mostly around the clock.  By my western standards, the music seems to be quite upbeat for the occasion, but who am I to judge??  You can see these people dressed in black and red all throughout the surrounding villages, so you always know when a “celebration week” is going on.  I wish I would have had the opportunity to attend a funeral while we were here.  Granted, I wouldn’t have understood a blessed word, since the whole thing would have been in Twi, but it would have been an experience to see all the tradition.  Anyway, Sunday is the day of celebration for the person’s life, and everyone dresses in this white fabric with different black patterns all over it.  I walked into church today to this sea of black and white, and it was so beautiful. I wanted to take a picture, but figured that would probably have been poor form. :)  The only people not in that clothing were us obruni’s, in our American wear, in the middle of the church.  When I’m not watching the clock, and actually absorbing the service itself, the 2 1/2 to 3 hours actually go by pretty quickly! I’ve been told that the services we’ve been to have all been on the short side of normal. They typically run between 3 and 4 hours. I think I might have to draw the line there! But there is so much singing and dancing, that it’s hard to get bored. They even dance down the aisle when giving the offering.  It’s just this week that I’m starting to recognize some of the songs, and at least kind of sing along.

Other than church, and a bunch of mass emailing (the fruits of which were all the posts for last week…), a  pretty laid-back day.  Almost done with my 600 page book! :)

Feb 16th

So today’s Saturday, and we got up early so we could go into the cultural center in Kumasi with Erica, to do some perusal and general souviners-type shopping.  We got a LOT of great stuff, and I finally got my cloth for an outfit! It’s absolutely gorgeous cloth, and I can’t wait to take it to the seamstress tomorrow in Ankaase to get it made.  So, now seems like a good time to talk a little bit more about general Ghanian culture, since it’s fresh on my mind from our trip today…

We rode a tro-tro into Kumasi, that we caught in Ankaase right by the hospital. It only cost us about 45 cents each, amazing.  Tro-tro’s are everywhere, and in a lot of ways, the easiest way to travel.  They’re these white, VW-type van things, originally designed as 16 passenger vans, but converted to seat about 25-30 people, depending on the day.  Kids sit on their parent’s laps, there is no idea of pesonal space, sometimes there are chickens and such riding alongside you. It’s quite the experience! They kind of look like clown-cars when they’re totally full, people bursting from the seams. Same idea, for those of you who have been to Honduras, as the collectivo there.  There’s this guy who sits at the door, who seems to dictate who gets on an doff by these hand signals and certain taps on the bare metal interior of the tro-tro.  I’ve tried to watch, to see how this guy knows what one of the people (in the midst of the sea of people standing around) on the side of the road wants a ride, but it’s an absolute mystery to me.  It can get pretty claustrophobic, smelly, and hot inside one of those, especially considering that there is no such thing as air conditioning in them, but my two experiences thus far haven’t been too bad.   Maybe I’m being lulled into this false sense of security, about to be awakened by the worst tro-tro ride of my life. Bring it on! :)

The idea of retail and stores are definitely different hear (shocker, I know).  With the weather being so hot, most everything is open-air style.  Even the houses in the villages, as run-down and sad as they are, have these open air spaces in the middle of them around which the rooms are organized. The stores consist of these small rooms, with almost ALL their merchandise sitting on the dirt or street in front of the room.  I’m talking rows of tires, old TVs, car radios, fridges, car engines, mufflers, the works.  And each store is dedicated to one type of retail. There are stores, like in this village that is wholly devoted to wood-carving products, where you do go inside the small room to look at their goods.  Those places are especially interesting for an obruni (I’ve been spelling that wrong, by the way. It’s not albruni, it’s obruni).  They immediately surround you, even in each other’s shops, and start asking what you will pay for what they’re holding.  IF you show the slightest interest in something on a shelf, they will grab it, dust it off, and start asking what you will pay for it.  If you say you’ll come back later, they will follow you, and ask if you still want whatever it was you were interested in before.  You’ve got to have a pretty strong resolve to be in a situation like that, or you end up buying much more than you intended, and spending a ton more money! I really like bartering with them, so I have fun with it. It can be pretty exhauting though, if you’re there long enough.

In Kumasi (big city about an hour’s drive away), people like the streets with their goods they want to sell.  They will sit side by side in the dirt by the road, or on the pavement if the sidewalk is big enough, lay out a tarp or two, and have all their goods arranged on top if it.  All varieties of veggies, clothes, shoes, sunglasses, cloth, you name it.  The sidewalks are absolutely packed.  A lot of places will also have peeled oranges and friend plantains for sale.  I stay away from those….I’d rather not feel the ill effects of eating them, if you know what I mean….!  There are also women and men walking aorund with amazingly heavy loads on their heads, perfectly balanced.  They do that all over, and it never ceases to amaze me.  We saw a little boy the other day with a huge bag of charcoal balanced on his head, walking to the next town over.  When I say bag of charcoal, think large bag, previously used as a flour bag, probably containing 15-20 kg, filled with the charred remains of something they use to burn fires.  Young women with bowls of water bags, plantain chips, etc. will stand on the roads and go up to the cars, tro-tro’s, busses, etc to try and sell their stuff.

Something else fascinating to me is what happens if you refuse to buy something from someone.  They are still as nice to you as they were before you said no!  I refused to buy something from someone today, and he wished me a good day and said God Bless.  Even in rejection, Ghanians are the nicest people ever! Now granted, we have had plenty of over-friendly people talk to us too! I had one guy come up to me in the tro-tro station in Kumasi (utter chaos, through and through), and ask me if I loved him. Before I could reply, he said “I love you, do you want to love me?” and repeated this over and over until I just smiled and walked away.  How endearing….!  And another guy who I bought a little figuring from asked me if I was married. I must admit, I told the smallest of white lies and told him that I was. It was just easier than dealing with the consequences!

I’m almost done with my 600 page book (Woman in White, for those of you who care….an amazing, suspensful book!), if that gives you any indication of the laid-back atmosphere of life here.

I can’t believe that we leave a week from tomorrow!  It’s way too soon.  We actually looked into changing our plane tickets, so that we would be in Ghana longer and London for less time, but turns out that it would have cost us about $650 each in order to do that. Hardly worth it.  I guess we really do have to leave.  I wish we were here for a few more weeks at least.  I also have this not-so-fleeting wish that I could change my ticket from London to Seattle to something more exciting like London to somewhere-else-in-Africa.  I’d totally look into it, except getting a visa this last minute would be a headache, especially living in a remote village like Ankaase. More adventures will just have to wait I guess…

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Alright, internet access is done for me for now. Lisa’s sitting here, anxious to get her turn on the computer, and I’ve taken more than my time already. Love to all of you, keep sending the emails, keep praying for me!  I’ll try to get online again next weekend and give you all another week’s worth of updates :)

Feb 15th

Happy Birthday Rachel!!

We experienced another Morbidity and Mortality meeting today.  One of the patients talked about was one of my patients, a 98 year old man who had pneumonia and renal failure with high potassium levels.  He ended up dying last weekend, no one knows why, but it is exceedingly likely that he had a heart attack from the high potassium levels. This one is especially frustrating for me, because being one of the patients I was involved with, we had identified his kidney problems and made some changes to try and bring his potassium back down.  True to form, one of the Cuban doctors came along the next day and decided that his kidney failure did not need to be aggressively pursued, and so did nothing about it, didn’t even check another potassium level to see what it had come down to from what we had done the day before.  It’s hard because if we had continued to see him, continued to manage his kidney problems, he probably wouldn’t have died. His pneumonia was getting much better, and he was actually getting pretty close to discharge. It wasn’t like the states, where the pneumonia was obviously going to be the cause of death. I was shocked to hear he had died. People here are amazingly healthy for their ages, and so this man, being 98, looked closer to 65 or 70.  Once again, if we had stayed involved, this man would likely still be alive. I wish I could reach into the Cuban doctors’ brains and give them a little shake, and knock some caring into them.  Or maybe, in a more compassionate manner, do something to make them feel less isolated and alone. Unfortunately, neither are within my powers to do. 

I saw, for the first time, Ghanian men getting quite worked up about the standards of care that aren’t being met. I guess I had just assumed that the air of apathy that seems to be present among other staff members also translated to the rest of the staff, but I was wrong.  Changes that need to be made to protocols and such need to be initiated and carried to fruition by Ghanians, otherwise they won’t have much staying power.  So it’s encouraging to see that those seeds have been planted and are growing nicely.

As we’re here longer, I’m really beginning to see the clash of cultures surrounding healthcare.  Naturally, I bring my western approach to medicine with me, my hurried approach to situations (as in ‘do things quickly’), my addiction to diagnostics, and my need for order and hierarchy.  Almost none of that exists here, mainly because it is not a hospital that is modeled after an American system.  It is designed to be fully led by Ghanians eventually, and hopefully will one day soon.  (They just hired a general manager that is Ghanian, but received a doctorate in hospital management in the states, which is just so incredibly exciting for the future of the hospital!) In this culture, relationships come before all else.  Also, they do not seem to have the same views on death and dying.  Cam says that the culture of death is more related to the animistic, fatalistic ways of the tribal religions and cultures, in that death is this inevitable event that cannot be prevented, try as you may.  I don’t think this is a matter of who’s right and who’s wrong, Ghanian versus American culture. I think both have valid points, and that both cultures may take their ideas to the extreme. Ok, I don’t think I’m making any sense right now, so I’m going to stop! I think all of that is to say that some things need changing (like the concept of an ‘emergency’), but many things are just cultural differences.

Another first tonight: first time cutting hair in Africa! My hair is entirely too long for the tropics, and Erica (a missionary here who we’ve become friends with) wanted her hair cut, so we all had a hair cutting party! Erica was very brave, and let Lisa and I try to layer her hair. She showed Lisa how, using me as an example, and then we went for it! I’m proud to say that we did an excellent job.  Rachel, I’m going to need some fixing when I get back! :)  One regret: not getting my hair cut before I left the states. But then, I wouldn’t be able to talk about the time when I let my friends cut my hair in Africa!