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April 18th, 2008 Posted in Uncategorized | 1 Comment »THE PHOTOS ARE UP. SEE PHOTOS PAGE.
ALSO, IF YOU ARE NEW TO THIS BLOG, START READING AT CHAPTER 1.
FRED PFENNIGER
Chapter 12 – Goodbye Ghana ???
Last week went by fast. I attended a presentation for a malaria drug by a drug company. That was an experience. I walked out of the room with a handful of gifts – a ruler, a pencil sharpener, a flashlight, some drug samples.
In a place where people do not have much I question this approach. A bigger impact would have been made by doubling the drug samples and giving them not to the nurses and doctors, but the hospital pharmacy with the directive of giving them out free to people unable to pay for their medications.
The rest of the time I spent doing clinic – outpatient and pre-natal and the nights doing my presentation.
Diagnoses are varied, as they always have been – chronic sinusitis, malaria, head laceration (required 8 stitches), routine physicals, pregnancy, chicken pox, impetigo, measles, folliculitis, worms, dementia, obesity, pre-eclampsia (BP 250/150 – patient refused hospitalization), hypothyrodism, ovarian cyst.
I had both good and bad days. Good days mean diagnosis / plan of action were solid. Bad days mean I struggled with what to do next. Areas that need improvement … many. Areas I would like to focus on … eye problems and rashes.
Dr. C and Dr. A are very good here. There confidence in dealing with the variety of problems is impressive. It is something to strive for. Do not get me wrong; I have met other doctors here that do not give me the same feeling.
I reflect on the idea of what kind of doctor I will turn out to be. I question myself … will I become competent? Can I become competent? Medicine at times feels like a game of chance. Best guess on symptoms and history. And always part company with a statement such as “if these symptoms get worse” and or “reasons to come back to the clinic”.
I know with out a doubt that I wish to practice a broad base type of medicine. However I question the ability to become competent is such a broad field. Will time give me the skill and the competency?
I would also like to continue doing oversea missions. My experience in Ghana says the ideal oversea doctor is a broad based doctor with some surgical skill … c-sections and hernia repair.
But what does a mission doctor actually achieve? My time here in Ghana tells me very little. As a mission doctor I feel all I am doing is reacting to a need. I am not dealing with the problem and or problems at hand. However the manna mission is.
Ghana is a great country with spirit and potential. What it needs is structure and systems like garbage disposal, roads, and education. This can be achieved either through a top down approach i.e the government and or through a bottom up approach through organizations like the manna mission.
Whatever path is used, success will be dependent on reaching the people and affecting / empowering there lives directly i.e. waste disposal systems, education and housing. I would caution that this does not necessarily mean the need for capitalism. Capitalism has the negative affect of making people helpless through the re-distribution of wealth away from an area. I would argue it makes the immediate area poorer. Ghana does not need this.
A Wal-Mart in Teshie would result in the closure of the hundreds of the roadside stands selling products. From a capitalist point of view, i.e. efficiency, it may make sense. From a culture stand point it does not. To put a Wal-mart in Teshie would mean a standardized solution to a common problem … poverty. It would also mean standardized measurements of success i.e. yearly income, GNP, etc. To chase these measurements would mean a change to the present way of Ghanaian life. I think this would be a mistake.
What Ghana needs is an improvement in its infrastructure that will encourage the present Ghanaian way of life / spirit. There is a great book out there by Tracy Kidder call “Mountains beyond mountains”. It is a story about Dr. Paul Farmer and his impact in Haiti.
How is that for a rant?
Anyways, it has been fun. I enjoyed writing this blog. I hope you enjoyed reading it.
I will post pictures during the first week of June.
I will be home soon. From there, I will be driving from Vancouver British Columbia to Edgewood Kentucky with my dad (40 plus hours). Edgewood Kentucky will be my home for the next few years … I am looking forward to my new job with high expectations. I am looking forward to settling down and building some roots.
Yours truly
Fred
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Chapter 11 – The poem
The Ghana Story
An international elective
I thought
But who, where
And what would be taught?
“I .. N .. M .. E .. D, can you help me?”
I ask
“Yes” they said
“Ghana and the Manna Mission is your task”
I did arrive
The Monday of week one
By the time I saw OSU, Teshie and the clinic
It was done
Arrive with a bang
Did week two
I spent my days asking
“How is your poo?”
Travel I did
During week three
Castles, towns and Ghanaians
I did see
With clinic and a presentation
It is now week four
I am left to wonder
Can I do much more?
Close at hand
Is week five
Sad I will be
To say bye-bye
So without delay
I say
Thanks you
On this May Day
Fred
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Chapter 10 – Day 17 / 18 / 19 / 20 / 21 – Back to The Clinic
We arrived back in Teshie at 7:30 am. 1 hour to shower and eat. 8:30 am to clinic we go.
At clinic I see and present patients -> malaria, pregnancy, upper respiratory infection, swollen eye lid, diarrhea. It was tough today. Lots of eye problems among other things. I do not like eyes. I struggle through the day. I think I am tired.
Paul has been complaining of chills / fevers for 4 days now. A blood test is run. He is diagnosed with malaria. We laugh at his diagnosis. I hope he does not go jaundice, else I owe him 10 CDs. ((((To encourage ourselves to eat and try the local foods, Paul and I have an ongoing bet to see who is the first to get hepatitis A with jaundice. Loser has to pay 10 CDs to the winner … the person who gets hepatitis))))
I leave clinic at 3:00 pm. To bed I go. I sleep for 12 hours.
I get up early Thursday morning to do laundry. Laundry here is done with a buck, water, soap and close line. Reflect I do on my previous days clinic. I am not impressed. I failed to follow my standard format of investigation.
Medicine is not rocket science. It is about standardization. You ask a set of questions. If there are negative the patient is healthy. If any of them are positive, a new set of standardized questions should be asked. From here one of two things will happen. First a diagnosis will be made and treatment of the diagnosis / symptoms will be started. Second no diagnosis will be made and more tests will be ordered and or treatment of symptoms will be started.
I think at times I either get lazy / tired or annoyed. And instead of asking the questions patiently and doing the analysis, I jump to conclusions. Today will be different, I think.
8:30 am clinic starts. It looks like it is going to be busy. I tell the nurse I am ready to see patients in exam room 4 and request English speaking patients only. My first patient is sent to me. “Hello” I say. “Hello” he responds. “My name is Fred, what brings you to clinic today” I ask.
The patient goes on to tell me that he has been having chest pain, which occurs with activity. Outside of that, he is also having constipation problems. After establishing that these are his only two problems, I go on to investigate his chest pain.
“Can you point to where it hurts” I ask. He points to the middle of his chest. “Is it a sharp pain” I ask. “No” he replies. “Is it a throbbing pain”. No he replies. “Have you ever had this problem before” I ask. No he replies. “When did it start?” I ask. “One week ago” he replies. “Do you take any medications regularly” I ask. “No” he replies.
I continue on in my line of question for about 15 minutes. At this time there is a knock on the door. “Come in” I shout. In comes a lady, carrying a plastic bag, who introduces herself as his wife.
“Welcome” I say. I then go on to introduce myself. I start to explain to her and her husband what I think the problem is.
Well I do not even finish my first sentence when the wife jumps in and says “Chest Pain? He is not having chest pain. He is having shortness of breath. Also, he takes about 6 different medication and suffers from diabetes, hypertension, atrial fibrillation.” I become lost for words and angry. I get up and ask a fellow medical student if he can re-interview the patient.
My day goes down hill from here. My questioning is all over the place. I struggle to make diagnosis. I am glad to go home at 5:00 pm.
Friday turns out to be a better day. I spend all day in clinic. Clinic becomes quiet. My mentor, Dr. A, assigns me a presentation topic -> BUGS / DRUGS / EMPERICAL TREATMENTS. This is big presentation. I hope to start it this weekend.
By 4:00 pm, I go home. I spend the night reading and playing cards with our house missionaries and Paul.
Saturday is fun. Paul and I sleep in. We head off to town to search for gifts. The sites, sounds and smells have not changed. Vendors remember our names. “Fred, Paul come look at my shop!!” The guys are good. We arrive home in afternoon, and sleep. We play cards with our host missionaries.
Tomorrow is Sunday. In the morning we will be going to church. In the evening, Paul will be heading back to England. I am sad. Paul has been good company. He is, as I have told him, atypical male ak metro-sexual. And with his British accent he is what the girls are chasing here. Beyond that he is a good clinician. I have learnt a lot from him. On a lighter note, Paul is not his real name. I changed it from Mark to protect his identity.
The host missionaries will be leaving on Wednesday. I will miss them. They remind me of an Italian/Canadian friend and his wife. The mannerisms are almost identical. I will be alone for 8 days. But I will have lots to do -> clinic and presentation.
Fred
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Chapter 9 – Day 15 / 16 – The trip
Monday April 12 – Leave the house at 6:00 am. Hire a taxi to Accra bus station for 7 CDs. Arrive at 7:00 am.
Paul and I purchase tickets to Cape Coast (156 km north west of Accra) for 3.50 CD. Bus to leave at 8:00 am. Sit and chat we do. A local Ghanaian tells me I have to check in my carry on luggage. Paul tells him we need the stuff in my bag. He leaves us a lone. We meet M&M, two Canadian girls heading to Cape Coast for 5 weeks and 3 months respectively. They will be volunteering at a regional deaf school.
This has been our second encounter with “Missionaries”. Missionaries are, as I have come to learn, people who go over seas to work with NGOs and or volunteer. It is a broad term. I initially understood missionary to mean those who go over to preach. But this is not the case. Whatever it is, I must say I am very impressed with the overall mindset of missionaries. Their desire to work outside of their comfort zones, to try new things and there understanding of issues beyond their countries of origins is impressive. And for the record, there appears to be more female missionaries than men.
Arrive at Cape Coast at 11:00 am. We exchange phone numbers and part company with M&M. Our first goal -> accommodations. We check out two places. In the end, we end up at the Red Cross for 7 CD a night. The room is simple, two beds, a fan, and a bathroom (sink is broken, toilet works, shower works).
From here, we head off to Elmina to visit the Elmina Castle and to learn about the slave trade. And learn we did. Facts about the slave trade
- Slaves were the by-product / prisoners of local tribal wars in Western Africa (Yes, African were themselves, throughout the history of the slave trade, involved in the trade of slaves. There were in essences, as I understand, the providers of the slaves).
- Prior to the arrival of the Europeans on the West Coast of Africa, there existed a trans Africa slave trade. The route, going from West Africa to the Middle east, supplied slaves to the Muslim world.
- Portugal established a trading port in Ghana for three reasons:
- To stop the spread of Islam
- To access the gold supply of Western Africa
- To spread Christianity.
- Other European countries (Sweden, UK, Denmark) soon established their own trading ports along the coast.
- With the increase demand of labor in the New World (North America, South America, Central America) … slave trading became popular. The New World provides large new markets.
- Between 12,000,000 and 25,000,000 slaves were traded over a 200 years period. Of these, 1/3 went to Brazil, 1/3 went to Central America and 1/3 went to North America.
- England was the first country to ban the trade of slaves.
More impressive than the facts was the castle and the living conditions of the slaves. The slaves were kept in tightly cramped, poorly ventilated rooms. How any of them survived is amazing. And according to our tour guide many of them did not. To top it off, there was a Christian church build in the middle of the compound. The slaves and their voices would have been heard in both directions, going to and coming from the church. In seeing all this, my thoughts were of two things:
- What bible were these early Christian studying from?
- Can you imagine what the world would look like today if the “church” had did it correctly from the beginning?
After the castle, we walked the town of Elmina. The sites, sounds and smells were very similar to that to Teshie (the area around Manna Mission). Granted there was a few more larger, completed building. But in between these building, as in Teshie, it looked like a bunch of teenagers were let loose to build forts from tin, cinder blocks, sticks and plastic.
Guiding us through the town was a paved road with a drainage gutter on the right and left hand side. And as we walked the children call out “Obruni” and the shops call out “Friend come look in my shop”.
The beach was no different … garbage everywhere. As we explored the beach, we saw a group of children playing soccer. We walked. We talked. We watched. We passed the children.
“Watch out” Paul said. I looked down on the sand and adjusted my stride. “Thanks Paul”. “There must be some healthy dogs around” I said. We laughed. We looked around and we saw no dogs!!! And as we later found out, this was by far not an isolated incident.
During a walk on the beach near Cape Coast, we encounter a stretch of beach, approximately 150 meter long that should have signs posted.
From Elmina we went to “Mabels Table”, a restaurant half way between Cape Coast and Elmina. We walked the 4 km distance, drank some beer and ate some burgers. On the way back to Cape Coast we encounter “6 sisters” aged 32 to 19. Within 5 minutes of the encounter they were asking Paul and I to take them to Canada / UK. We became afraid. We leave.
The rest of the evening was uneventful. We watch some children street dancing. We had a few more beers. A few more Ghanaian merchants hounded us. We went to bed.
Tuesday April 13.
Wake up at 6:00 am. Catch cab at 7:00 am to Kakum national park. Our objective for the morning -> canopy walk and salt flats.
Kakum national park is located approximately 30 km north of Cape Coast. The cab ride costs us 30 CD. We arrive at the park at 7:45 am. Tours of the canopy do not start until 8:30 am. The canopy walk consists of 350 feet of bridges suspended over a valley. Highest point is 40 meters. The canopy is used by scientist to study creatures / insects of the canopy. It was fun to walk. No animals seen. Lots of misquotes. Would I pay 9 CDs again … probably not.
On the way home we stop by Hans cottage to see some alligators feeding. It was free. Would I go to Hans cottage again … definitely.
To the salt flats we go. Harvesting salt in Ghana is a very labor intensive, but simple process. When the tide comes in, the valley is flooded. The water is then trapped and not allowed to recede. From here, and through the use of a number of lagoons / flood gates, the water is directed in to 100 feet by 100 feet ½ inch deep cement lined lagoons. From here, and with the help of the sun, the water is evaporated away. The net result, coarse salt. The salt is shoveled by the men and carried by the women to the storage shed.
To tell you that this is a clean process in Ghana is to tell you a lie. As like any other place in Ghana, the salt flats / adjacent areas were littered with garbage. I kid you not. I have a picture. I will post it once I return to Canada.
We returned to Cape Coast around 12:00 noon. Our objective this afternoon -> visit cape coast castle to learn about the slave trade. And once again … learn we did. The story was very similar in nature to that of Elmina. However cape coast is a larger castle and the church was built right over the dudgeon where the slaves were held. Again I am left in amazement at how the slaves were treated and the fact that Christianity was practiced in the midst of all this. Impressed I was by the tour guide who answered the question of responsibility for the slave trade with the simple words “we all are … African / European / American / Muslims”.
We return to the Red Cross hostel at about 2:00 pm. We sleep for a couple of hours. Paged we get by Pauls phone. M&M have returned a text message. They want to know where we are. We reply. 7:00 pm -> dinner at Castle restaurant. Happy we are. Laugh we do. Shower we do. Act like to teenagers … no, but smile we do.
Head off to the restaurant we do 1 hour early. We stop off at the adjacent resort for a beer. Guess who we meet - a local businessman who know us from the night before. He tried to get us to purchase some of his seashells. We did not. And even prior to sitting down, he is trying again.
It is driving me nuts. I tried to ignore him. “Friend, friend can you help me. I have malaria and I need some medication!!!!”
Conversation we have with another Ghanaian. He works at the local university. His outlook is not so good. His pay varies from month to month. There are not too many jobs and as such it is very hard to find another one. He says that in order to survive in Ghana one needs to make 15 CDs (15 USD) a day. National health insurance cost 70 CD a year. Rent cost 40 CD a month. He gets paid anywhere from 50 to 150 CD a month. A carpenter will make 6 CD a day in Ghana, and a bricklayer 8 CDs. He says corruption / poverty is a big problem in Ghana. Surprised I am not. Disappointed yes. Ghana has so much potential.
6:45 to dinner we go. Meet we do two cousins C&M. They have been traveling for 6 months and 10 months respectively. They drove from England through France, Spain and Northern Africa. A very interesting story they had. Impressed I was.
M&M arrive. Good looking they are. Conversation we had. Food we ate. The night ended too quickly.
10:30 pm … at the red cross-shelter we are. Tired we are. Awake we must be at 3:00 am to catch the bus in to Accra. We must be at clinic at 8:30 am tomorrow. I wish I could stay a couple more days …
Fred
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Chapter 8 – Day 12 / 13 / 14 – The Weekend
Friday April 9 – Only spent ½ day at clinic. Happy I am to go home at noon. It has been a tough but fun week. Paul and I head to Osu via the trotro to exchange money. We are planning to head to Cape Coast on Monday / Tuesday. I am looking forward to the trip. I go to bed early … sleep for 12 plus hours I do.
Saturday April 10 - Slept in until 7:00 am. What a nice feeling. Did laundry. Paul headed off to clinic but returned within 15 to 20 minutes. No work for us today. Very happy I am. Our house managers, S&R take us to the tourist markets in Accra. The markets consist of a bunch of local citizens trying to pawn off local goods. It was interesting. No purchases made. Had lunch / beer at a local Irish pub. Conversation / company was excellent. It was a nice afternoon.
Sunday April 11 – Go to church. Spend the afternoon reading two novels … the Generals Daughter and Dying for a Drink. It was an enjoyable afternoon / evening.
Fred
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Chapter 7 – Day 9 / 10 / 11 – When will it stop
This is crazy.
Clinic on Tuesday is just as busy. Hours are longer. Patients more varied. The young, the old and the ugly. Malaria to cellulites to pregnancy to assault to the out right funny.
A Ghanaian lady comes to the clinic at 10:00 am for a cough. I examine her at 5:00 pm. After examining her I diagnose her with upper respiratory viral infection. Treatment -> multivitamin. She then requests if she could get an excuse from work because she was at the hospital all day. I respond by telling her I will write one for today.
It is at this time that her attitude changes. I ask her what is wrong. Sheepishly working around the issue, she indicates she would like a work excuse for a “few days” and not just one. Trying to clarify the issue, I ask “how many days would you like off work”. To this and in true Ghanaian fashion, she replied “As many as your heart would like to give!!!” She got 2 days off.
Ah to be Ghanaian.
Wednesday was tough. One doctor, three students, 4 examining rooms and 12 hour shift. Patients appear to be multiplying in the waiting room. Must talk to the clinic about getting separated male / female waiting rooms.
We process patients at a rate of about 11 an hour. Lots of kids. I make a 2 year old pee his pants in the office. I feel bad. By the end of the day I am either getting better at dealing with kids and or the kids are not as afraid. One 13 year old girl asks for my phone number. Why thirteen, I think … why not 26.
Clinic stops taking patients at 5:00 pm so that we could clean up the backlog by the start of the night shift at 8:00 pm. We finished at 8:30 pm. It was a good day. I am starting to feel like a doctor.
M a physio-therapist / soon to be doctor, invites Paul and I for dinner. Go we do. Very nice house, solid and simple. And get this, it is finished. It has to be the first I have seen completed. Granted it was missing a light bulb here and or there and a light fixture. Well maybe not 100% finished.
Eat, talk, laugh and watch House we do. At 11:00 pm we leave. Arrive home, shower, bed … 12:00 am.
Thursday morning comes too quickly. Paul and I attend prayer meeting. I ask to hang out with the midwives. I get assigned to pre-natal assessments for the morning. My goal is delivery. My task is to determine baby position (cephalic, oblique, transverse, engaged, non engaged) manually and to measure fundal height and heart tones of each pregnant lady.
I am happy for the change in scenery / pace. This happiness is short lived. 10:00 am … 12:00 pm … 1:00 pm … when will this stop. I swear the women are getting pregnant in the waiting room.
The examining room is hot. 1:30 pm -> lunch I must go. Plate of rice, fish and some salad. I drink 1.5 liters of water. Sweating I am.
I reflect on my experience -> a multitude of normal uncomplicated pregnancies, a couple of pendulum pregnancy (I am not sure if this it what it is called, weak abdominal wall), fundal height of 37 inches for a 29 week pregnancy (large, large baby -> mother given instruction to decrease food intake and to eat more fruits and vegetables), one pregnancy with fibroid (36 weeks, present fundal height 31 inches (cephalic and fixed) … past fundal height 34 inches (free))) and a pregnancy (36 weeks) with the baby in a transverse / breech position. The clinic delivers 100 plus babies a year. I think the midwives like me. New goal -> turn a baby in the womb.
1:45 pm return to clinic. The afternoon is slow. A few visits and one emergency. I meet my first two suspected Ghanaian alcoholics.
Alcoholic #1 - a woman complaining of abdominal pain, positive past history of alcohol abuse and positive past history of typhoid. Paul and I are responsible for the patient. Blood pressure 100/60, heart rate 92 (low), glucose 4.4 (low) and alert and oriented. We order an D-5 IV, with Bco (thiamine) to be started and labs to be drawn (FBS, BF, UA, Typhoid). After 500 ml of D-5 IV, blood pressure 120/80. Got a history from the patient. Discussed patient with doctor. Must r/o malaria and typhoid. Order malaria medications and typhoid medication. Patient admitted for observation.
Alcoholic #2 – a man complains of intermittent dizziness for three days. Dizziness occurs only, I said ONLY, while walking to work. It does not occur at night, in the morning when the patient gets up, with activity and or when walking home. The man denied alcohol use. His wife confirmed it -> daily times 5 years.
I leave clinic at 6:30 pm. Head to a local Baptist church to hear a medical student give a presentation on typhoid fever / enteric fever”. Church is fun here. Very simple, very positive, very up lifting. I love African gospel music (something so simply, beautiful voices).
Arrive home at 9:00 pm. I am tired. Must try to write a blog. Unsuccessful. I fall asleep.
5:00 am -> I am up. Room is warm. Air-conditioner is off. Power problems last night. Surprised I am not. Power problems happen weekly here. Itchy I am. I look at my hands. 1,2,3,4,5,6,7,8 … oh shit. The mosquitoes got me last night. Hopeful I am that my malaria medication works.
Malaria here is like the common cold / flu in North America. It happens all the time. Some people are afflicted with it every 2, 4 or 6 years. Some, every other week / month. It symptoms are also similar -> general body / joint ache, dizziness, headache, slight diarrhea, cough and weakness. Both can result in serious complications.
Weekend goal -> pictures.
I love you Ghana. I really do.
Fred
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Chapter 6 – Day #7 / 8 – Obruni
Sunday morning, 8:30 am, Paul and I head off to church. The church service was amazing. Unlike my church experiences in Canada / USA which focus on sin, punishment and atonement, this church in Ghana focused on hope, miracles and life.
The preacher, who is also a Doctor and the founder of the Manna Mission, talked for about 2 hours. His message was simple … in the beginning there was God. “Begin” he said. “Do not worry about where it will end. Begin”.
He then went on to give examples of success stories. He talked about a man who came to the manna mission and only spoke in tongue. He talked about how this man never held a women, how he gave this man a job polishing his shoes. He talked about how this man never had a car, and or a home. But he began … he got a job, then a home, then a woman (by this time the congregation is alive with cheers).
He then talked about poverty and said “dress good, look good … begin. There was a man here at the mission. He was a poor man. He dressed good. He looked good. We gave him a job. He learned to become a bookkeeper. Now he is a business man” (the congregation is alive once again).
He talked about miracles. About how there is a miracle here for somebody. He talked about how there should be a place for people who are sick to go. He talked about how there should be a place for people to make a request for help in time of need. He listed the salvation army and the YMCA as North American examples of places people go in time of need. His presentation was powerful / hopeful / inspiring.
After church, Paul and I decided to explore the neighborhood once again. Our first attempt was done on Wednesday of last week.
Heading out of the manna mission gate we passed a couple of girls. One speaking Ghanaian beckons us to come with her. We smile. We do not understand what she is saying. Her friend, speaking English, quickly interrupts hers saying “she wants you to come with her”. Our smiles get bigger. We tell her friend that we are heading the other way. And that we hope that they have a nice afternoon.
At the junction we head left with the idea of walking towards Accra. Our journey is, as already explained earlier, amazing. The incomplete houses, the smell, the garbage, the cinder block homes, the gutter, and the people. We hope to get some good pictures.
As we pass, the children look, wave and call out “Obruni”. Paul explains to me that this is a term of endearment. Translated it is like calling us “white”. Some of the children cross the street to shake our hands and give us five. Paul takes their picture. They are happy. They look at their picture and run away. We laugh.
We attempt to take some pictures of the neighborhood. This is not well received. People shout at us. I am unsure why. I put my camera away. Further down the road, I attempt another picture. Again, some shouts. One lady standing at the doorway of her unfinished house screams “why do you take the picture?”
I decide to go to her. I say “Hi”. “Hi” she responds. “Where are you from?” she asks. “Canada” I respond.
“Where are you staying?” she asks. “At the manna mission” I responded.
“If you take my picture you must pay me some money” she says. “How much money” I ask. The man standing beside her responds “whatever your heart desires”. The lady laughs and say “enough to finish my house”.
“How long have you been building your house?” We ask. “11 years” she responds. “What more must you do?” “We must finish the outside with cement, hook up electricity, and finish the tiling”.
Peering over the women shoulder at the house I am sure that this is far from a complete list. We shake hands and part ways. I did not take her picture in the end as I am sure the 1 CD I would be willing to pay would offend her, where as paying the money she requested would have offended me.
We continue our journey. Again the landscape is interesting -> the garbage, the smell, the shacks and the gutters.
We do not take the road to Accra, but instead decide to head back to the mission. We take a left turn at the cross roads, and a left at the next junction. We pass a make shift “out-house” built over the gutter. Just past the outhouse and in the gutter is a chicken pecking away at who knows what. I wish I got a picture of it. I will try again another day.
The children for the most part continue to yell out “obruni”. The braver ones cross the road and give us five. The younger ones hide. One or two cry.
We return to the mission hospital laughing / smiling about our experience. We spend the night cooking. We are low on food. Another night of rice, mushrooms, corn, tomatoes, garlic and onions.
Tomorrow is Monday.
I sleep like a log Sunday night. The night is not long. It is short 9:30 pm … 6:00 am. Where has the night gone.
8:00 am to the hospital we go. No doctor to be seen. We sit. We talk. Nurses pass us by. Many say “hello Paul”. “Hello Fred”. We only know a few. One of the nurses reports to us that she has talked to the mother of “The baby”. “The baby” is still in hospital, but is no longer in ICU. We are happy.
8:30 am … the doctor arrives. We start seeing and presenting patients. The clinic is busy once again. 10:00 am … 12:00 pm … 2:00 pm … 4:00 pm … 6:00 pm … 6:30 pm. Cases are varied. Malaria to chicken pox to inguinal hernias to sickle cell to peptic ulcer disease to head lacerations to diabetes to hypertension. We even have a case of allergic reaction. A man comes in with utercaria (swelling). After a serious of question, our diagnosis becomes allergic reactions. We ask the man if there is anything in particular he eats / drinks / does when the swelling occurs. He thinks a while and then says “I have been thinking about that. I think it occurs whenever I drink this sweet type of beer and eat cat.” We chuckle a bit and instruct the man to say away from cat and the sweet beer. I did better on this day than last. Medications have become more familiar. Routine has become more familiar.
I go home at 6:30 pm. I am tired. Very little food in food in the fridge. I am craving a burger / steak with all the toppings.
Fred
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Chapter 5 – Day #6 - The baby
Once again the night is long … 1:30 am, 2:30 am, 4:00 am, 5:30 am. Awake at 6:15 am … eat, shower, dress … 6:45 am.
8:00 am. Paul and I head to clinic. No doctors to be seen. We talk. We decide to head to the Pediatric ward to check on a case Paul was involved in -> A young boy who was admitted with a HB of 2 (very anemic). This is all I know. We do not find him.
A nurse, at the nurses station, holds a baby. The baby looks sick. Questions are asked. The nurse tells us that the baby is 3 days old and that the baby has not eaten anything for 3 days.
When the mother brought the baby in this morning, the baby felt cold. We listen to its heart, lungs and belly. The baby is breathing fast. The baby’s heart rate is 152 (no murmur). No palpable organs. Temperature feels normal. The baby is lethargic / appears thin and frail. Meconium is noted.
The nurse asks us what should she do? We are afraid. We respond with the obvious. “The baby looks dehydrated. He needs an IV”. The nurse ask “Should I start an IV?”. We respond “We are medical students, we can not give orders”. It is a cowards response.
We leave the ward in search of a doctor. No doctor to be seen. We sit. We talk. The condition of the baby disturbs us. We run through the 11 systems of the body. Focusing in on the neurological and digestive systems of the body, we come up with a differential diagnosis. Among the top thoughts are esophageal atresis, and hypoglycemia. Sepsis passes through our minds. But with no temperature reported, it is low on our list.
Still no doctor to be seen. We decide to go back. We decide to do a complete history and physical.
Enter the pediatric ward we do. The baby is on an adult size bed in the pediatric ward, IV has been started. Mother is bedside manually expressing breast milk. Nurse is bedside attempting to feed baby with 10 ml syringe. We see all this from the door-way of the pediatric ward.
“excuse me” we say, moving towards the third bed. The peds ward is a 10 by 40 foot cinder block room with 8 beds (all full) and a fan or two, I think. I do not remember. There is enough room between the beds and between the ends of the bed and the wall for one person to walk. No curtains.
We introduce ourselves to the mother, to the nurse. We tell them we are medical students and that we would like to do a complete history on the baby. The mother, squeezing her left nimble and attempting to draw milk is happy to see us. She says she will answer our questions. Caught off guard at the scene, we tell her we will wait until she is done. The nurse instructs us that she will move the baby to another room for some privacy.
To the birthing room we go. A physical is done. Eyes – pinpoint, slow to react. Temperature – feels normal. Fontanel -> depressed. Respiration -> fast (45 plus). Heart -> 152. Abdomen -> soft. Limbs -> decrease tone, decrease resistance. IV ½ NS, 2.5 % dextrose. Absent rooting / sucking reflex. No deformities noted. We ask the nurse to check the baby’s temperature / glucose.
To the mother we go. The mother came to the Manna Mission on Tuesday to deliver her baby. Because of the baby’s position, the mother was considered a high risk and transferred to a hospital in Accra. Labor started some time on Tuesday. The mother delivered spontaneously and vaginally on Wednesday morning. The delivery was attended to by one nurse / mid-wife.
An attempt was made to feed the baby shortly after its birth. The mother reports the baby latched onto her breast, but that she was unable to express milk. Baby was shaking at birth. Short thereafter, the mother started to bleed. The mother stayed in the hospital for another 24 hours prior to being discharged. Baby stopped shaking prior to discharge. No other attempts at feeding were made.
Friday, mother started to express milk. Friday night is the first reported successful feed. Small amount taken in. Baby unable to latch onto breast. No vomiting reported. No crying, at any time reported.
Back to the baby we go. Blood glucose 11.3 (normal 4-10). Should have done a blood glucose prior to starting IV. Temperature -> normal. Re-check the baby. The baby is improving. A change is tone is noted. Baby is not as cooperative to our exam. This is good.
In search of a doctor we do go. A doctor we find. Report we make. Discussion we have. Learn we do that hypothermia in babies can be a sign of infection. Back to the baby we go. Baby has improved. Tone is good. Eyes reactive to light. Baby does not like the light. Doctor orders CSF, blood and urine culture (to rule out infection). Antibiotics to be started after cultures draw. Additional glucose to be added to babies IV bag. Baby makes a sound. We smile. The baby continues to improve throughout the day.
So what do medical students do? With humility, I will tell you not much. We may from time to time affect the timeliness of an event. With pride, I will tell you we affect lives and change worlds. I think, though, the truth lies somewhere inbetween.
Fred
Follow up note -> prior to church on Sunday, Paul and I visit the pediatric ward in search of “The baby”. We learn that the baby had continued to improve throughout the day. However, because it had no rooting / sucking reflex, the baby / mother were transferred to a larger hospital.
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Chapter 4 - Day # 3 / 4 /5 - The Clinic
I am anxious for clinic to start. I roll over. The clock reads 1:00 am, then 2:30 am, then 3:15 am, then 5:30 am. This night seems to drag on forever. I am up at 6:00 am, eat, shower, dress … 6:15 am. Time in Ghana passes slowly.
I arrive at the hospital at 8:15 am and wait. My attending for the day will be Dr. A. Today I will be observing and learning. I am happy for this role.
The day passes quickly. We see over 30 patients in a matter of 6 hours. From the doctors point of few, patient flow is excellent. We sit in a room. A patient comes in with their file. We examine her / him. We write our notes and treatment plan. We discuss our findings with the patient. We send the patient away. We ring the bell for the next patient to come in. Flawless. If we require labs, we send the patient to the lab with a request. Once the labs are done, the patient returns and waits in line with the lab results. Again … flawless.
Our cases overall are numerous and range from Malaria to Malaria / Pregnancy to Malaria / urinary tract infection to Malaria / Typhoid to cellulites to fungal infections to chicken pox to suspected uterine cancer to bells palsy to fibroid to pre-natal routine care to hypertension to diabetes to obesity. My mind is a buzz. I am happy to go home at three o’clock.
The next day is no different except I work with a Dr C. Our cases again are numerous and range from Malaria to cellulites to routine pregnant care to HTN to DM to minor wound repair / surgery to fungal infections. I am told my color scares the children. A child is given ketamine so that two stitches can be put into her chin. A 6 inch cut on a patients forearm is stitched up. I am again happy to go home at three o’clock.
The next day is different. My morning is spent working in the treatment room with the nurses. I change bandages for three hours. The patient range in age from the young to the old. Their injuries are cuts – surgical and other (fall, collision with a bicycle, knife, hammer, glass) - ranging in size and in location. I think the nurses like me. They asked me too many questions. They want to give me a Ghanaian name. One takes a picture of me and shows it to me. “Handsome” I thought.
My afternoon starts as soon as I leave the treatment room. Lots of patients standing around. 1 doctor. 1 medical student is seeing / presenting patients to the doctor. I decide to tag along with the medical student. Now two medical students seeing / presenting patients. Cases are numerous. Measles, Malaria, pregnancy, tinea corpis, malaria / diarrhea, obesity, HTN, candidia, muscle strain. We see patient after patients. 1:00 pm. 3:00 pm. 5:00 pm. When will this stop. The cases are too varied. Malaria versus infectious diarrhea, when to treat one or the other or both. I feel uncertain about everything I do. 6:00 pm. I had enough. I must get out of here. 6:15pm I leave. Still lots of patients hanging around. Nothing I can do.
I arrive home. Air-conditioned room. Happy I am. Knock. Knock. “Come in” I yell. It R. “Hello Fred” she says. “Hi” I respond, just wanting to be alone. “My Husband has been vomiting all afternoon, can you come and take a look at him” she asks. Bad words I think, “Yes” I respond. Questions I ask. To the hospital I go. Medicine I fetch. Injection I make. Vomiting stops. Maybe I do know something after all.
7:30 pm. Air-conditioned room I go. Happy I am. Reflections I make.
The Ghanaian is a happy person. They are a grateful people for what they have. There is not longing for what they do not have. They do not complain about the challenges / trials put before them. Despite their environment and its condition, they are not poor. Today Ghana has taught me poverty is a condition of the soul, not the environment. If I thought Ghana could learn one thing from North America, it would be structure / leadership. If I thought North America could learn one thing from Ghana, it would be there state of being.
Tomorrow is Saturday, clinic I must go.
Fred
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Chapter 3 - Day #2 - Teshie / Accra
Day two was spent with Paul. Our goal for the day, tour the manna mission, find food and exchange US currency for CD (Ghana currency).
Our day started about 8:30. Prior to leaving the house we became aware that two of the tires on the mini SUV were flat. Cause unknown
Our first stop the Manna Mission Hospital. This is, for the most part, a one story, cinder block white building. I would estimate between 15,000 and 25,000 square feet. The first floor consists of a maternity ward, a pediatric ward, and an adult ward. Also contain within the first floor are a receptionist area, 4 examining rooms, a treatment room, the pharmacy, the operating room, the administration offices and the pathology lab. Today is Tuesday. And as with Thursday, Tuesdays is maternity days. The hospital is packed. The women are stunning.
Paul takes me around to meet some of the staff. Names are a blur. The locals speak quietly. It is hard to hear what they say.
The next stop - the “cafeteria”. This building is a stand alone building approximately 20 by 40 feet. According to the ladies it serves about 100 people a day. Paul informs me that we will be having lunch here today.
We visit the X-ray lab next which consist of a fully working X-ray machine (I think) and an ultrasound machine. It is a two story white building similar in size to the cafeteria.
Next we locate a taxi to travel into / back to Osu (a suburb of Accra) to exchange some money and buy some groceries. Paul informs me he is not so good at bartering for price. I say nothing. We hire a taxi for 6 CD’s (approximately 6 US dollars), 1 less dollar than the taxi driver wanted.
Again, as with the drive from the airport to the Manna Mission Hospital, the view is beyond description. From what I can see Teshie and Accra have become one city, separated only a three military bases / training facilities. Teshie is a collection of shacks put together by cinder blocks, sheets of metal, sticks and plastic. Garbage is evident everywhere.
We pass a garbage sorting area contained within a residential area. The smell is very distinct. Also what becomes more evident is the number of unfinished houses / projects within the residential area.
Later I come to understand that owing properties is very tricky in Ghana. Landowners will sell a piece of land to a multiple of buyers. As such, in buying a piece of land, it is very important to build something on the land to mark it as being owned. Also, the interest rates are high. People only build when they have money. A house as such, may take thirty plus years to finish.
Arriving in Osu is uneventful. I exchange money with no problems. 200 US dollars for 194 CD. Paul is less fortunate. He forgot his passport at the Mission. They will not exchange his travelers checks without his passport. We decide to walk around the city.
We do not get far. People are hounding us to buy things … shinny new necklace, personalized wristbands, wood carvings, etc. This attention makes me feel important. We turn everything down. But I am intrigued. I continue to shake the hands of everyone who approaches me. It is at that this time that I meet “Black Africa”.
Standing about 5 feet 8 inches, he is a lean fellow. He is dressed in a green USA airforce shirt from what appears to be the Vietnam era and black shorts. I would guess he is in his early thirties.
“Hello” he says. “Hi” I respond. “Where are you from?” he asks. “I am from Canada”. “What are you doing in Africa?” he enquires. “I am volunteering at a local hospital”.
“Who are you ?” I ask. “I am Black Africa” he responds. “It was nice to meet you” I say, attempting to leave.
He will have none of that. He goes on in a conversation to tell me how we are meant to help each other, that he is an artist and that I can help him. He shows me his painting and asks me to pick my favorite one. I smile thinking this guy is good.
I tell him politely I am not here to buy. He response is eloquent “I do not want to sell you anything” he says, “You help Africa, and I want to help you”. By this time, Paul has a big grin on his face. Mine is no smaller as I think, this guys is really good.
I respond by telling him that our meeting has helped me, as I will be smiling for the rest of the day. I also hoped that he got as much as I did from our meeting. He responds by saying “Do not pity me!”. This guy is really, really good.
In a matter of minutes, he not only made a personal connection with me, but made attempts to appeal to the many facets of my humanity – the good, the bad and the ugly - to purchase one of his paintings.
Our meeting end shortly after this with a friendly handshake, no sale and me taking a closer look at him wondering which MBA school he graduated from as he clearly was no amateur.
The rest of the day is very uneventful. We continually got hounded to buy things. We did not purchase anything but groceries. However I got lazy. In response to one request to purchase some merchandize, I responded by saying “I am poor, I have no money!”. To this the Ghanaian, politely and rightly so, responded “Sir, you are here in Africa. Do not tell me you are poor. Tell me you have no money, but do not tell me you are poor!”. Ghanaian 1 Mr Pfenniger 0.
We hired a taxi for 5 CDs to take us back to the Mission. Upon arrival we sorted our groceries and went to the cafeteria. Following that we walked the area immediately around the Mission and was taken in by a fellow medical student into his uncles’ Ghanaian home. The theme was familiar. His home, surrounded by a cinder block wall, was built over a thirty-year period and was incomplete. Garbage (plastic and all) was buried in the backyard as there was no local reliable service.
We watch a Ghanaian made film that was impressive. Unlike American films, which are high on acting ability and low on morality, the Ghanaian film was high on morality and low on acting ability.
Needless to say, my feelings are mixed … are these people poor? Are they happy? I am looking forward to clinic tomorrow.
Until next time
Fred
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I do not know what to say or where to start. My trip so far feels like the start of a great novel …
Chapter 1 - The Novel
The flight to Ghana was uneventful but long. I boarded a plane Saturday night in Vancouver BC at 8:00 pm. I arrived in Accra Ghana at 8:00 pm on Monday night. 11 hour layover in Boston. 7 hour layover in London.
I arrived at the airport and dis-embarked on the tarmac (from a Boeing 777). My first impression … hot, Ghana is hot. I entered the airport, passed through customs and then waited for my baggage. The carrousel was small. Something you would find at a small airport in Canada (Abbsford, Fort McMurray). The people were many (Boeing 777) and the luggage was many. We were stacked 5 deep around the carrousel from its point of entry through the cinder brick airport wall, along its U-shape track, to its exit, through the same wall, 20 feet away. The luggage, stacked side by side, came through the 6 feet by 6 feet opening in the wall at an impressive rate.
After a few “excuse me”, “sorry” … I retrieved my luggage, passed through customs once more and then proceed to the exit all the while thinking, “what do I do now?”. Looking around the small crowd of people that had gathered to meet loved ones, nobody looked familiar. Granted why should they? I was new to this land! My closest relatives were miles away. Then I saw it … a white piece of cardboard measuring about 12 inches by 12 inches with the words “FRED PFENNIGER” written on it. Where these the people I have been looking for?
“Hello”, I said, “I am Fred Pfenniger”. The middle aged, slight overweight female holding the sign, smiled and beckoned me to the near by exit. Follow I did. “Sir … sir, do you need a taxi?” … “No” I replied “I have a ride” not knowing for sure where this lady was taking me. “Sir … sir, do you need a taxi?” “No” I replied thinking the Ghanians are very friendly people. “Sir … sir do you need a taxi” “No” I replied thinking that is odd. Why is everybody offering me, and not my fellow passengers a taxi ride. Then it hit me, easy money. Here I look like the tourist.
Making my way through the crowd, I tried to keep an eye on the middle aged lady dressed in blue. Does she know I am behind her? She must. I hope I do not lose her. I follow her to a parking lot and am met by a man. Afraid I become. “Hello” I said, “I am Fred Pfenniger”. “Hello” he said “ I am J” as he grabs my hand. His hand shake is firm, but his stature is small. I have a fighting chance I thought, if things go wrong. “Please, come over here?” He directs me to a blue van. I am once again put at ease for not only is the van a van very similar to the one I drove on Saba for 20 months, but there written on its side and back are the words “Manna Mission Hospital”. Home I am.
The drive from the airport to the Manna Mission Hospital passed quickly. J is an orderly at the Manna Mission. He has work there for many years. He has three children. His first wife died suddenly 5 years ago. At 60 years of age, he says he is too old to marry again. His English is good.
The middle aged lady is the head of the cleaning department at the Manna Mission Hospital. Her name eludes me. She is in her mid 50s. She lost her husband 2 years ago. She lost her eldest son 3 months ago.
The terrain is something I have never seen before. I have no vocabulary to describe what I see. It is like a thousands of young boys and girls were let loose to build thousands of forts from cinder blocks, wood, plastic and whatever else they could find. I am speechless. Is this poverty? Or is this the Ghanian way of life?
The road we travel is single lane with no markings and a drainage ditch on the right hand side. Ghanians line the street. Some try to sell food and other items to the passing cars, while others occupy the road-side shops. Memorized I am.
“Are you married?” J asks. A moment passes. What do I say? If I say no, will he try to set me up? If I say yes, and he finds out I lied will I lose a new friend. “No” I replied.
Turning off the main road, the road changes suddenly. Pot holes replace the pavement / packed road topping. Garbage is everywhere. Happy I am I got all my shots.
Chapter 2 - “Manna Mission Hospital – Turn Right”
“Welcome to Manna Mission Hospital” said J, as we drive into a walled compound. “You residents is near the back. I will drive you there”.
Manna Mission Hospital is a 32 acre lot, surrounded by an incomplete 3 to 7 feet high cinder block wall. Located within itself is a hospital clinic with a pediatric, maternity and adult ward. It has a pathology lab, a cafeteria, an operating room, an X-ray lab, multiple of examining rooms, and a pharmacy.
Also located on the property is a church, a private school which educates 400 plus students, a prayer tent and the foundations of multiple uncompleted buildings.
“Here we are” said J. Looking to the left, I see a two story building surrounded by a 7 foot high cinder block wall.
“Nice” I reply. “Your house managers are two missionaries from the USA, S&R. Also staying with you is Paul a student from London” said J as we drive into the compound.
“Hello!?” … “Hello!” … “Hi, I am S, how was your trip?”. “Long” I replied.
“Hi, I am Paul, can I help you with your luggage?” “Thanks” I replied. “Let me show you to your room”.
“You must be tired” asked S”. “I am” I replied asking “Am I able to take a shower?”
“Yes, the bathroom and showers are over there. Tomorrow you do not have to work. Paul will take you around to sort out your groceries and stuff. On Wednesday you will start in the clinic”. “Thank you” I replied.
Putting my suitcases down, I reach for my towel and headed to the shower. Refreshed I was to become. Tomorrow will be a new day
Fred
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Mes amis
How are things? I am doing fine. I am two days away from leaving and I still have a lot of little things to do.
So what do I have done. Packing. I am bringing with me about 75 kg of stuff for 4.5 weeks. Not bad hey.
Outside of that, I am a little nervous as I do not know what to expect. How will Ghana be? Will I be able to diagnose malaria, yellow fever, chicken poxs? Will I get malaria, yellow fever?
And what about the culture? Having been raised as a Swiss-Canadian, I am left to ponder how my ”get-r-done” attitude will fit in Ghana. From my friends in Fort McMurray (the Zims) I have come to understand that this may not fly in Africa.
Whatever it is, I am looking forward to it. And I will keep you posted as best as I can.
Yours sincerely
Fred
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