October 30th

Our plan this morning was to have another formal meeting with Chief Nana and elders regarding the clinic. We spent some time in the evening preparing our gifts for them, had Edward purchase Schnapps to present to the chief and wore our foundation shirts.

When we arrived in Kwekwewere, plans changed. Chief Nana was at another meeting regarding temporary coverage for another chief of a broader collection of villages. We did, however, plan a time to meet with the architect and review our building plans and expectations.

On our way out of the village, we stopped by the primary school located on a main road. The children were in their lessons, taught in an open air room under a tin roof, reciting English phrases, discussing "information technology" and basic science. We were somewhat of a disruption; the children all gawked as we drove up. They mostly wanted to be in pictures and share hellos.



On the side of the road, there was a few men selling coconuts and our driver, forever seeking to entertain us, pulled over to buy some for us to try.


I like coconut, but a whole one was more than I could drink or eat. We briefly dropped by the hotel to clean up and change heading out with Daniel so he could show us his church and a school it funded.

Our next stop, was in a village on the other side of Kumasi. This school was a bit nicer in appearance than the first, though the basic structure and lessons seemed to be similar.




I loved the alphabet pictures on the side of the building. Each letter being represented by a word/picture familiar to the Ghanaian children (oranges there are green and papaya is called paw paw and HECK yeah there are queens!).



Instead of ice cream cone cupcakes, they had sugar cane for snack time. They kindly shared with our group.






We next stopped at a Kumasi craft market. In retrospect, I should have bought a few more things there, but without the option of bargining with the shop keepers, it did not have much appeal to me at the time (knowing in Accra I could wheel and deal to my heart's content). Mom bought some nice baskets. And, we saw some fruit bats in the trees surrounding the shops.

After an unexpected morning of new experiences, it was time to head back towards our hotel for lunch.

Oct 29th Part Two

We left Kyekeywere and met for lunch at the Beauty Queen. Over lunch, Mom, Chris and I discussed and drew up a rough idea of what we thought was realistic for an initial clinic/hospital building allowing for plenty of expansion.

Roughly, our plan included a labor room, delivery room, postnatal ward, observation ward and a few sites for outpatient visits including one where short, bedside procedures could be performed.

After lunch, I returned to my room to shower. Having been invited to Pastor Ben's family home, I anticipated this might be a more formal visit.

With our driver, we traveled to Pastor Ben's home. His father was a rather jolly man who chatted with us in their living room for a brief time. His mother sat to the side mostly silent as I guess she was not proficient at English. He appealed to us to build a clinic near their church.

We next traveled with Pastor Ben to meet another Nana from anther village to again talk to use about building this clinic near their church. They referred to him many times as a Doctor. I was expecting a medical doctor, but it turned out that he was an Engineer trained in Switzerland.

Finally, it was time for dinner and a visit to an internet cafe. After several days with no contact, I was eager to contact a few people. Naturally, their internet connection provided little to no service on that particular day.

Dinner was at an out door restaurant near the cafe. Music boomed from the pa system. The phenomenon of too loud to be appreciated seemed to be common. I tried a native dish called Fufu in chicken soup. The fufu is a paste made from cassava and plantain. The soup had a tomato base and the chicken included all parts (liver!). I was not a huge fan as I really enjoy crunch and texture, but I felt like a champ for trying.

English Breakfast Day Two (part one)

October 29th.

My nights quickly already acquired a pattern. Sleep at 10ish, awake at 3ish and back to sleep at 6ish. I had Sookie Stackhouse vampire novels and Al Jazeera to thank for keeping me sane while awake for three hours a night.

We awoke to another breakfast of beans, toast and meat (one day it was eggs, perhaps it was this one). Our plan for the day was to visit a Seventh Day Adventist hospital in a nearby village.

After some confusion about our plan (initially Chief Nana was going to accompany us, but due to scheduling conflicts he did not) and a quick stop in Kyekyewere, we headed to the hospital.

There was a wall surrounding the land and we had to pass through a gate to gain access to a parking place nearby the hospital. The gentleman who ran the hospital had been informed of our interest in seeing the facility by Chief Nana. Touring the hospital required first meeting this gentleman and explaining who we were and why we were visiting. This seemed standard enough.

We entered his office. Mom told our story and explained that she intends to build a clinic/hospital in Kyekyewere, etc.. The response from this gentleman was in this medically underserved nation utterly bizzare. An odd mix of welcoming and warning. He basically told us that we could not do anything as spectacular as his place and boasted about their lab and surgical suites.

After sitting there for way too long (by my impatient, western estimate), we were finally assigned a tour guide and took a walk around the hospital. Think single story, concrete, mostly open air and tons of people (very few elderly) waiting patiently on benches for a turn to be seen.


This is a photo taken by Chris White. We are talking with a head nurse.


We inspected the lab. This was a single approximately 10 x 10ft room with four or five people, a microscope and centrifuge. Nothing like the insanely huge high tech lab and pathology department at my academic hospital. We then moved on to the surgical suites. Nothing much to them. There were also a few ward beds for post operative, new mothers and other medical cases. Unfortunately, out of respect, I did not photograph at this hospital.

We finally met the one physician working full time at the hospital. He was a hairied thirty-something with very little time and a huge burden of responsibility. Not only did he have to round on all inpatient wards three times per day, but he also saw a steady stream of outpatients. I am not sure how these visits were distributed between the doctor and various midlevels. I couldn't fathom what drew him to his profession (seemingly an entirely different one from mine) being that it seemed he had to give up all hope of a life outside of work.

After leaving the clinic, we stopped by Kyekeywere to inspect some new habitat construction and briefly met a group from Northern Ireland working on two houses.

Ok. We are STILL on First Visit 10/28 part FOUR

Having sanitation as a focuse made for some rather amusing albeit distressing photos. Our next stop before finally leaving Kyekyewere was at the city "dump" and waste facilities.

Scampering about the trash and human waste were a few adorable and lively barefoot children. Illustrating one of our largest concerns; the ease of disease transmission where education and sanitation are lacking.

Below are my final photos of the day with a few comments.




Above is the "dump" located a short 100 or so yards from the chief's compound. This area was not fenced off or demarcated by signs. The human waste facilities are just down a short path about 50 yards away. While offering some attempt at basic sanitation, I cannot imagine what might draw a person to utilize said facilities. When ones only other option is to pass waste freely wherever whenever, while not recommended, it clearly seems preferable.


Don't miss the tiny face peaking out from the bottom of the doorway into the women's latrine. I didn't intend to catch anyone in a private moment... really.






So excited about the camera, sister forgot to pull up little one's drawers for the photo op.

Providing better, more attractive and functional septic sewage facilities to the village is so important for the villagers and their health. Improved sanitation has a huge impact on rates of diarrheal illness, water/foodborne diseases and ultimately a populations survival. Only 62% of the world's population has access to basic, improved sanitation according to WHO/UNICEF definition of such as of 2008. This is up only 8% in the past 20 years. Clearly, this is only one of many things we can impact directly this small population.

After an enormously educational/eventful day, we were exhausted and retired readily to the comforts of the Beauty Queen.

First Visit Part Three

After leaving the clinic, we headed over to see some homes built for villages by Habitat for Humanity and its volunteers (mom being one). These homes were typically four rooms. One for cooking, one for a "bathroom" and the other two were used as living/sleeping space.

These homes are typically made of concrete bricks made at or near the building site. And, metal roofs.

Included below are pictures of some of the homes villagers live in who do not have the resources to purchase a habitat house. There is also a wandering population of the village who works at farms by day and stays in either partially built, vacant homes at night or where ever else they can find shelter.








This is the floor of a typical bathroom (basically a hole in the floor, a few water buckets and a little straw brush to push in refuse). The imprint of a lizard in the concrete amused me so I took the picture.

At this point, we had a chance to visit with my mother's friend Lydia who she met during her prior trip and who we saw the night we arrived as she walked, in pain, to a nearby clinic. She primarily had abdominal pain, nausea and vomiting for a few days. She showed me the prescription given to her at the clinic and there were twelve medications on it. Basically, they had four different antibiotics (covering, I suspect, H pylori and almost any other infectious diarrheal illness) as well as medication to relieve heart burn and diarrhea. A shotgun approach. Lydia had not filled said prescription nor had any intention to do so. She did not have the money to cover this multitude of medications. Her symptoms slowly seemed to resolve on their own.

First Visit Part Two

After a minor amount of confusion about who was to pile into what car, we and the village elders left to survey the newest drinkable water source and the site of land being donated for the health clinic. During our meeting, they showed us a lay out of plots in the village. Our potential site is centrally located and has a power line running nearby.

First to the water source. Basically, a pump that went to deep enough potable water and a reservoir. There was a single spout. Many women, while we were there, visited to fill their bowls and carry them away on their heads.







Next, we visited the site of land donated for our clinic.


Nearby was an electric line.




It looks amazing. And hopeful. There is a lot of space (approx 2 acres) to expand if and when we are able to do so.

Next, we visited a nearby health clinic run by two nurses in training and a midwife.




They mostly see pregnant women and follow up primary care issues like hypertension (though the patient would need to get those medications at a hospital). They do prenatal counseling and some testing (HIV). Women are able to have their first child at the clinic. About twenty births a month occur at the clinic. Subsequent babies are had in the home. It was unclear to me whether the midwife would attend those births, but given that there is only ONE midwife, I suspect there is simply not the manpower to offer such a service.


Birthing room.



Scale to weigh the newborn




Postnatal Ward




Medication room (this is about all they had)

There were many posters offering information on tuberculosis, prenatal care, immunizations and evaluating chronic diarrhea. I could not help but wonder how helpful those were to the frequently illiterate villagers. Especially, given the high number of women we encountered who could not speak English.

The nurses and midwife lived in a dorm near the clinic. I took several pictures of their dorm, goats and the sanitation site for the clinic/dorm. They were fortunate to have a septic system of their own.

Our first visit to Kyekyewere: Rapid Cultural Immersion Part One

We awoke the next morning (October 28th) to our first of many breakfasts consisting of some variation of meat, beans and toast. Instant coffee instead of brewed. Canned condensed milk for creamer.

We left our hotel with our driver around 9am. The village chief had sent his gold mercedes and a driver, but we opted to keep our driver (who we are now affectionately calling Eddie) around. The drive to Kyekyewere was not far and on mostly dirt road once we left the main vein on which our hotel was located. The picture below is of this dirt road.



The housing along the roadside was mostly concrete with tin roofs and did not appear to contain more than one or two rooms. Goats wandered freely.



We stopped at a centrally located building where Chief Nana Yaw lives with his family designated by the village as "the palace." Here was a large room where our first ceremonial discussion occurred. Below is the door to the palace. On the door are Adinkra symbols. The meanings of each are not a single word, but relate to a proverb. The top symbol has something to do with "The great panorama of Creation" and that only God can see the begining/ending of things. The bottom has a meaning similar to the biblical phrase "eye for an eye." The middle, as I was informed, had no specific meaning.






Our meeting included village elders, Chief Nana Yaw, our driver and my mother's friend, Daniel in addition to us. We sat in a circle of plastic chairs in the palace. Before conversation could occur, we conducted a round or two of hand shaking (right hand only) and were given "water" from the chief (this was really coca cola and fanta).

Talking to Chief Nana had to be done via a second party. Although, sometimes for simplicity, he broke this rule and spoke with us directly. Mom did all speaking from our party. Essentially, she confirmed her intention to raise funds to build a clinic in the village. Chief confirmed his intention to donate land for this cause as he felt it would be good for the village on many levels. He envisioned a much larger "hospital" and I began to sense that with any endeavor like this, there is always more one could do, but being realistic and setting limits is the best way to actually get anything done.

We left the meeting as a group to see the site and to visit a clinic in a neighboring village.

The Trek

The flight from JFK to Ghana on October 26th was somewhere around nine hours. After meeting my Mother and her partner, Chris at JFK we waited several hours for departure. The flight was over night and although sleep was difficult, it did come.

We landed in the captial city Accra at about 7am. From the plane window, the red dirt left a striking first impression. The airport looked to me like a military bunker with a colorful welcome message painted on the side. AKWAABA!

The customs officer who reviewed my passport informed me that he would pray for my speedy return to Ghana to do medical work. So, no problems there.

We exited the airport to a throng of Ghanaians. Several begging for money, but most looking to retrieve passengers. Our car service manager stood patiently to the side with a sign and greeted us warmly when we identified ourselves. We then met our driver, Edward, and loaded the car for our journey to Kamasi, an approximately five hour drive. Thank god for air conditioning or it would have been unbearable.

Driving out of Accra on a DIRT road was chaos. Vegetable stands on the street sides, people shuffling to and fro in traffic and cars minding no road rules made me repeatedly gasp. I am a terrible passenger at best and this most definitely forced me to rethink the amount of energy I could invest in worrying about the ride. Ha.



After the dirt road was one of the most pot hole infested paved roads that I have ever rode upon. There were again no lines demarcating where the north and south bound traffic should be contained. Many wrecked trucks (one in a building) and cars lie at the side of the road. Additionally, many folks were actively working on their broken down vehicles (dude, probably not best idea to lie under car with legs extended into highway).

We reached Kumasi and our hotel around 1 pm and took a leisure afternoon. The hotel was called The Beauty Queen. And while my room was generally clean, the bathroom kind of skeeved me out (think ants/shower). Ants or not, I showered (drops of cold water from shower head) and rested.





We received a visit from Mom's friend (a Habitat employee) from Kyekyewere named Daniel. He and a woman Lydia dropped by on their way to a clinic (Lydia having severe abdominal pain, more on this later) to say hello. We discussed plans for the next day. The contents of this discussion and what actually occurred the next day began a trend of communication/planning mishaps that characterized our future interactions.

Introduction

Background-

My mother, a nurse and pharmacist, has done several trips with Habitat for Humanity. Her most recent, last year, was to a small village outside of Kumasi, Ghana called Kyekyewere. While there, she observed the living conditions of villagers and was impressed by their need for basic healthcare, sanitation and clean water. Upon returning to the United States, she decided to create a foundation whose goal is to build a health clinic in the village to provide a sustainable point of care as well as additional clean water and sanitation.

My blog is to retroactively share my experience as a first time traveler to Ghana and first time involvement with any international health project. Ideally, I could have blogged from Ghana, but due to poor and infrequent internet connections, I am doing so from home afterwards. I wrote about 50 pages in a journal that I am using for reference.

This, like most good things, is an ongoing learning experience for us all. Any input is greatly appreciated. Thanks for reading.