Monday, July 19, 2010

Happy Birthday to Me!!

July 19

• My actual birthday
• Kumasi reunion
• Cape Coast Castle
• Journal disaster
• My new home

My actual birthday…

was fine. I didn’t sleep well the night before and I woke up to my phone ringing. It was Kwadwo (my Accra version of Sabina—he’s a doctor who is specializing in Obs & Gyne and will finish next year). He said, “Hi Erika, I’m really sorry but I won’t be coming in until 10:00 today. You don’t need to come to the morning meeting because I won’t be there and won’t be able to get you any interviews until after 10. I’m really sorry.” I tried to contain my excitement at getting 2 more hours of sleep and told him that was absolutely OK. When I told Keesha it was my birthday, she made me breakfast (oatmeal with brown sugar). I got to work at about 10:30, deciding I was allowed to run on Africatime on my birthday. Kwadwo came in around 10:45 and stammered breathless apologies. I told him that it was a perfect birthday present. He was so excited that it was my birthday, and he said, “I need to buy you lunch.” So he went to the gyne ward rounds (while I read Middlemarch in the Doctor’s Lounge) and came back an hour later. We took a taxi to a really nice restaurant and he bought champagne and a piece of birthday cake (sugar, flour, butter, plus a hint of banana that could easily have just been because it was sitting next to a banana or something). It didn’t have frosting on it but I took the leftovers home and it was pretty good with Nutella on it. After lunch, I went home (no interviews that day…) and the American girls in the hostel and I went to Keneshie Market and walked around. I had fabric that I bought in Kumasi and I found a seamstress to make me a dress and purses out of the cloth. I’m pretty excited about them, especially since my current purse is really not doing so well. I am going to pick up my clothes sometime this week. We came home and drank the champagne out of Styrofoam cups. I went to bed. Not very eventful, but I don’t think your 22nd birthday needs to be all fireworks and excitement. I wasn’t expecting anything, so the day was full of pleasant surprises.

Kumasi reunion…

was great. The University of Ghana School of Medical Sciences (Accra) and the Kwame Nkrumah University of Science and Technology Medical School (Kumasi) both took buses to Cape Coast this weekend. We arrived late Friday night and left on Sunday afternoon, and it was so great to see Shy, Eva, Ernest, Nelson, and Edwin again. Lots of hugging and screaming. When I first got there, Eva told me that Shy was in the shower and would be out soon. About 10 minutes later, he showed up behind me, saying “happy birthday” and holding a birthday cake. I can’t really describe how amazing and loved I felt. It said, “Happy Birthday Erica” on it (not their fault—they supposedly spelled my name right when they talked to the cake person) and the pink frosting was totally smushed on one side. Cakes are really hard to come by in Kumasi and it sounds like they really had to hunt and plan to pick up the cake and transport it. It sat on Shy’s lap for the entire 4 or 5 hour trip from Kumasi to Cape Coast. I am so incredibly lucky to have such great friends in Kumasi. They were so humble about it and really acted like it was no big deal. SO AMAZING.

Cape Coast Castle…

should really have its own post, but I really don’t have time to elaborate on it very much. My med school apps are being pushed aside for this long-due update, and I’m sure my interviews wouldn’t mind being transcribed tonight either. Anyway, the castle was one of the huge portals for the slave trade. I really can’t remember most of the facts from the tour and the museum, but I’m sure you internet-savvy Americans can just google it and read. It was really massive and I can’t really describe the feeling I had when I was there. I felt like I should feel guilty because my country was founded on slave labor, but I really just felt guilty and could not believe that humans could do such cruel things to other humans. It’s not a matter of race or nationality—it’s this human code that was violated for hundreds of years. You can’t enslave other people. We stood in the male dungeons where there were 200 men packed in a ~40 x 30 foot room for 3 months. They pooped, peed, vomited, stood, sat, and ate on the same floor. (In the women’s room, they also bleed on that same floor.) There were 3 windows that were about 30 feet high, 1 x 2 ft. All the body excrements and food became packed on the floor for years and years until 3 researchers cleaned up and excavated the floor. They left a part untouched to retain the feel, and at one point the guide told us, “you are now standing on flesh, vomit, sweat, blood, and feces.” Again, I still cannot believe that we humans did that to other people.

One scary part of it was that the British built the church directly over the male dungeons. It was very easy to hear talking and footsteps above us when we were in the dungeons, and the guide really stressed that there were men dying below while the slave traders were learning to ‘love they neighbor as thyself.’ It gives you goosebumps, doesn’t it?

Journal disaster…

was really a disaster. On the first night in the hostel, the IFMSA exchange coordinator needed to borrow some paper and a pen to write the dinner orders so he could run out and grab them. I volunteered my notebook for the task. They left the notebook at the dinner place. They were busy planning the welcome party so I didn’t ask about my notebook until late the next day. The exchange coordinator immediately said, “oh. we left it at the restaurant. i’m really sorry.” I told him how important it was to me, as it has all my observations from the hospital, research notes, rough draft secondary essays, and phonebook, not to mention my daily journal entries. He said that we would pass by there that night on the way to a beach restaurant/bar. We didn’t. Finally, when we had been at the restaurant for a little while, I approached one of the guys and said, "I don't care that it's dark out, Depali (my new Norwegian friend) and I are going to go see if the notebook is at the restaurant" and the guy replied, "no way. The store isn't open anymore, it's no biggie, we'll look for it tomorrow," and I started to get really frustrated and replied, "you just don't understand how important this is to me. it has med application essays, research stuff, phone numbers, and all of my journaling for this trip!!" and I tried really hard to just accept it and go with the flow but then my eyes started tearing up. I was trying my hardest to avoid crying and was doing pretty well until they saw that I was really upset. When they said, "OH MY GOSH PLEASE DON'T CRY!!!! I'M SO SORRY. I DIDN'T DO IT ON PURPOSE!!!!" I lost it. (This is still at the outdoor bar/restaurant/club.) Then they offered to buy me a new one which is like beyond ridiculous because it really was never about the $3.99 college ruled 3-subject Mead notebook. I just kept thinking about all the notes that I’ve taken and all the soul I’ve poured into it (I didn’t think about it at the time, but it’s kind of like a Horcrux, for any of you Harry Potter fans), and it was just a really bad and emotional night. They promised me to get it the next day and then bought me a drink. I pulled myself together and went on with the rest of the night. The next morning, we went to the beach and it as awesome. The waves were enormous and very very strong. I had a great time. When we left the beach at 2:00, we stopped by the place where we had gotten food the first night. We found the notebook right away. Even though it was almost a non-issue, I still felt justified by freaking out. All through the disaster, I was glad that I had such a strong reaction for something so inexpensive. I really don’t think that I would have been that upset if I had lost $200. It was not flattering to throw a tantrum (and I really tried so hard to avoid it), but I think it was a good validation of my priorities. I know I could journal on my computer, but it is so different and more organic when I handwrite in my notebook. I have gotten to writing most of my thoughts down because I’ve looked at my entries from Kumasi and I have already forgotten so many things from my time there. I don’t want to forget anything from Ghana. I’m thinking about dictating my thoughts to save time and save my fingers from hurting (transcribing is hard and very stressful for my fingers!! They talk so fast!!), but now that I have a roommate, I’m not sure that’s such a great idea. That brings me to my next topic.

My new home…

is at the medical students’ hostel. It is about 5/6 of a mile closer to the hospital than the international students’ hostel and already has much more charm and personality, even though the water is out here, the floors are way dirtier, the bathrooms are far away, and there aren’t any sheets on my bed. I just couldn’t stay at the international hostel for a whole month without any friends. The Cape Coast trip was great because I got to know all the exchange students and the Ghanaians involved in IFMSA, and now I will be involved in a lot of the events that are planned for the IFMSA students. My roommate is fantastic and I’m really excited for the next 2 weeks. They leave in 2 weeks, and I’m not sure what happens after that.

Wow, I’m so sorry for the long entry. I try to keep it under a page (with very adjusted margins) but this one was 3 pages!! Anyway, if you’re reading this blog, chances are I love you, so xoxoxo!!!

Ghanaian proverb for the day: When the cock is drunk, he forgets about the hawk.

Struggles

July 1, 2010 – edited July 15

Time is flying. I love it here. I really love Kumasi and I don’t think I’ll ever be able to articulate how good I feel here. (Here, now, in this setting, time of life, body, group of people, I don’t know what it is but it feels easy and natural to be content). I think this is partly an apology for junior year because this is as good as junior year was bad and the happiness permeates everything I do. Anyway, all the international students are noticing huge gaping holes in the system here. Before I go on, I want to make it clear that it is really a luxury for my conscience that I am not here to help with anything. I must observe. I am not burdened with guilt that I’m ‘not doing enough’ or that I’m ignoring atrocities because I’m not supposed to be doing service work, I’m supposed to be an observer. This is because of 2 reasons: 1. I am here doing research. I am not an MD, not close to being an MD, and for me to treat someone would be unethical and totally unreasonable. That is not why I’m here. That would be pointless and even if I had the skills, it would be completely unsustainable. (Side note: sustainable is one of the buzzwords in public health. More to come on this later, but I think it’s something that most people doing ‘international service work’ ignore.) 2. Systems need to change from within. It doesn’t make sense to force new fetal monitors on the doctors when they don’t want them. They won’t use them; they aren’t asking for them. They have seen healthcare in the US or UK but they don’t implement the same patient safety systems we have. I want to know what their reason is, but I know that the reason isn’t because they lack resources. I think saying that doesn’t give Ghanaians enough credit. If they want something, they’ll do everything they can to get it. I know the western world isn’t better in all aspects, and I think that with the amount of resources that we have, we are doing a pretty bad job of promoting a healthier world and being good people, but I can’t help thinking the phrase “don’t crowd out the important for the urgent.” That’s the basic theory behind time management and an appointment schedule. You make time for things that are important to you. Here, if you have 45 women and one is bleeding out or giving birth, you will pay attention to that woman. Then you neglect to see other women who are not at risk yet, but become at risk because they didn’t get proper treatment in the first place. Then they are the women bleeding out or giving birth prematurely. That is unsafe and irresponsible and crowding out the important for the urgent. Not good.

I might be naïve but why can’t all the ob/gyns take 1 day/month and work at a district hospital? There are 30 doctors, so that clinic (hopefully staffed with nurses) could see patients every day. Why can’t the doctors without anything to do see the hundreds of patients that are sitting and waiting all day, just a few feet away from this incredibly concentrated center of educated individuals? Why can’t midwives give weekly lectures on safe home birth practices? Or nurses give safe sex talks? Or secretaries distribute condoms? Or a group of med students take blood pressure and distribute hypertension drugs? Or tackle trash distribution? Nutrition? Warning signs in pregnancy? I guess this question won’t ever be answered, and I won’t be satisfied unless everyone is taking measures to reach their full potential and be incredible doctors.

Ghanaian proverb for the day: When a man is wealthy he may wear an old cloth.

Thursday, July 8, 2010

“I’m a reverend. You will be a doctor. We need to get married.”

Thursday, July 8, 2010

Willemien got here yesterday. When I was finished with my work, I stumbled my way back to the hostel (making a few 180 turns on the way) and we went to get lunch. The only restaurant that I know of is called “His Place” and it is a few blocks away from the wall surrounding the hospital grounds. The day before, I had made a friend there named Stella. She is 23 and not married. She is about 5 feet tall and is super cute and friendly. We talked for a while on Tuesday night, and she invited me to come to church with her this Sunday. She attends a Pentecostal church, so that will be really interesting. She is very gracious and complimentary, and puts her hand on my shoulder when she talks to me. Every time I order something, she says apologetically, “Erika, I will be right out!! Don’t you worry! I will be back fast! Your order!” and then scurries away. When she does that, I almost want to introduce her to the Erika-style, “I CAN DO THINGS!!” mantra, but she’s already so peppy that I think that her coworker might kill her if she started saying that.

Anyway, Willemien and I passed a nails salon (okay… ‘salon’ in the least formal of terms) and we got our nails painted after we ate. I asked for light pink and the girl brought out a neon orange color but I definitely love it. I’m pretty sure that Christina (or any 11 year old girl) is a much better nail-painter than this girl (and WAY nicer), but we couldn’t resist since it was 2 GhC for fingers and toes ($1.40). The women painting the nails were chattering in Twi so Willemien and I couldn’t understand what they were saying (I REALLY need to learn Twi!!) but I am pretty sure it wasn’t anything nice. When Willemien told them her name, they put on this really high-pitched voice and repeated it over and over. They also mocked me when I asked for “just polish, no fake nails.” That is consistent with the impression I have been getting from most of the Ghanaian women here. For whatever reason, they are really hard to get to know, be friends with, hang out with, everything. Even at the student hostel in Kumasi, only half of the girls said hi to us and we were able to have a conversation with only one girl. Whenever we went to clubs in Kumasi, we would go with a group of 4-8 Ghanaian guys and see more that we knew at the club, but there were no Ghanaian med students there. We’ve askd the guys about that and they’ve given us 2 different answers: 1) the Ghanaian med students go to different clubs, and 2) the Ghanaian med students like to date residents and not other med students, so they don’t want to hang out with Ghanaians their own age. Whatever the reason is, they were way less outwardly welcoming and social than the guys. Mom, I know you’re thinking to yourself, “of course the guys were really nice—they like hanging out with pretty white girls,” but the guys were incredibly friendly toward the Obroni guys also. It’s still a mystery, but the fact remains that I have 100 Ghanaian guy friends and 1 Ghanaian girl friend. This makes me appreciate Stella even more.

The title of this post is what a guy said to me yesterday in the internet café after talking at me for a few minutes. In his head, it made perfect logic. When I fired back with the logical, “I don’t know you so I can’t marry you,” he fired right back with, “We will become friends! Our marriage starts here in Ghana and when I come to the United States, we will be married in your Presbyterian church!” How can you argue with such a reasonable man??

Ghanaian proverb of the day: Let not what you cannot do tear you from what you can do.

“Where everybody knows your name… And they’re always glad you came.”

Wednesday, July 7, 2010

I had the theme song from Cheers stuck in my head all last week. I was singing it in my head as I walked down the hall of the GETFund Hostel in Kumasi, and I realized that the song should have been the hostel’s theme song. Even during the short walk up the stairs and to my room I was greeted by 3 smiling Ghanaian guys who all said, “hello Erika!! How are you today?” I know I had met them before, but I have forgotten at least 80% of the people who said hi to me every day. But they ALWAYS know your name!! And they’re always glad you came!! I thought it was so ironic when Ueli, Shy, and I went to a bar called Cheers after dinner one night.

Anyway, I’m not in Kumasi. Ueli is back in Switzerland and I haven’t found a Cheers bar here in Accra. Willemien is in Accra for two days before she goes home to the Netherlands (to watch her country beat Spain in the World Cup final). So far, Accra is very different from Kumasi. I am staying in the International Hostel associated with Korle-Bu Hospital and the majority of the students there are white Americans. Because Ghana’s only international airport is in Accra, many businessmen come to Accra for meetings and fly right back, never getting to see the rest of the country. This means that the gradient of white people increases as you go south. I see about 20 white people a day. Additionally, it seems like the University of Ghana has a stronger relationship with other countries (esp. the US) than Kwame Nkrumah University of Science and Technology (the university in Kumasi). I have heard the term ‘obroni’ only a few times since I got here, and kids are much slower to smile at me when I smile and wave at them. I think my pale skin (yes mom, I’m using sunblock) and blue eyes are much less of a novelty here in Accra than they are in Kumasi. Another difference between the two is that I stayed in the hostel with Ghanaian medical students in Kumasi. Me, Shy, Kjersten, Willemien, Ueli, and Eva (and later, Margrit) were the only white students – okay, maybe not Shy, but he’s still an obroni – in the dorm. There was a huge TV room with a snack bar and a ping-pong and pool table, and making friends was totally effortless. Here, I think it’s a little harder because all the US students have their own cliques and friends, and we’re not a novelty living among Ghanaians. Also, we’re in the subregion “Korle” right now, which is on the very southwestern corner of Accra. I haven’t found very much stuff within walking distance from our hostel. Anyway, Willemien knows the Student Exchange Officer here and even though he doesn’t live in the International Student’s Hostel, we are hanging out with him tonight and hopefully he’ll be able to show me the ropes and include me in some of their activities here.

Other than the disappointing reception to Accra, things are going well. I have completed 4 interviews (only 51 more to go!!) in the past 2 days, and I have a guy named Kwadwo (pronounced Kujo) who is assigned to help me. He’s no Sabina, but he’s really fantastic and helpful. When I got here, he had already obtained 50 of the 55 phone numbers for me. I wonder what would have happened if I hadn’t had a counterpart assigned to me in Accra. Kwadwo and I run around from the operating theatre to the Head of Department’s Office to the gyne clinic to the prenatal care clinic and when we catch people, they say, “oh just call me tomorrow sometime before 3.” If I were totally in charge, I would demand a time and place, and make it clear that I don’t mess around with things like that. Kwadwo seems thrilled to get a vague estimate, and he is optimistic that we’ll finish with our 13 Korle-Bu obstetricians by Monday. We shall see!! Regardless, I’m going to Cape Coast next Friday, so that will be great to see so many people who know my name (even if I don’t know their names).

Ghanaian proverb of the day: If there were no elephant in the jungle, the buffalo would be a great animal.

Culture Center: the new Obrofuo hangout

June 28, 2010

There are no appointments in the hospital that I’m working in. The closest you can get to an appointment is having a doctor tell you, “come back next Tuesday.” How frustrating. All patients need to block out an entire day to go see the doctor. Hopefully I’ll remember that when I’m annoyed with someone for making me wait. Many more people would come to the hospital, but they can’t pay the 1 Cedi ($0.70) to get to the hospital via taxi or tro-tro. Hospitals that are less than a mile away from Komfo-Anokye are called “district” hospitals because they serve a population of people who can’t get to Komfo-Anokye.

Anyway, the new Obrofuo hangout is the National Culture Center. The prices are super cheap and the quality is fabulous. Initially we made friends with this guy named Hector. He’s absolutely totally sketchy. He wears sunglasses all the time, has 4 gold teeth in the front, and wears suits that are outrageous. He’s a total gangsta, in all the meanings and connotations of that word. Hector makes his living by making friends with painters, buying the painters’ paintings, signing his name at the bottom, and selling them for 2 or 3 times the amount that he paid. He hangs out at the Culture Center and traps Obroni visitors, and then pressures them into buying a painting that he did not paint. We’ve always been wary of him, but when we found out that he was claiming other peoples’ work as his own, we decided not to buy stuff from him. When we walked around the Culture Center, we made friends with most of the owners of the stores, including two painters named Philip and Bernard. It turns out that Philip is the one who paints many of the works that Hector sells. Philip is a soft-spoken, extremely modest guy in his mid-20s. Shy invited him over to his room in the student hostel and he brought all his sister’s jewelry and his laptop with pictures of his work. He sat with us for about an hour as we sifted through everything and marveled at his paintings. Willemein chose 3 paintings that she loved and he encouraged her to give him suggestions about the colors, shapes, size of the canvas, etc. Kjersten decided to buy a huge picture of an elephant (with Lion King colors, not real-life colors, although he does do real-life ones too). A few days later, we came back to the Culture Center and sat and commented on the painting. He tweaked it until Kjersten was satisfied with every little detail and deferred to every comment on his painting. Normally paintings that size would be about 80-100 GHc ($60-70), but he gave it to her for 60 GHc. In response to questions about Hector, he shrugs and brushes off any rude comments that we make about him. I know it’s probably good for Philip to have different people selling his paintings, especially because he sits in the Culture Center every day, but it is so frustrating for me to hear Hector say, “do you like this picture of a lion?? I can make you one. I’ll paint you one and it will be even better than this one. You can personalize it. Do you want different colors? More grass in the background? I will paint this lion for you.” We didn’t want to get Philip in trouble with Hector, but I guess he told Hector that we had been buying things from Philip and Hector became very territorial to Shy.

There are so many beautiful works of art in the Culture Center and they would probably be sold for at least 5 (probably 10) times that amount if they were sold at the Ann Arbor Art Fair. The artists make intricate wood carvings for 10 GhC and beautiful paintings for 15 GhC. Needless to say, I bought a lot of stuff but it is all gorgeous and high quality. I bought 12 paintings from Bernard, who is another incredible artist at the Culture Center. He does a lot of paintings with women carrying baskets on their heads. I went with Shy, Kjersten, and Ueli and hung out at his booth for an hour the first day we met him. After gushing over and buying 5 paintings, we promised to come back soon. The next day we headed over to our hangout spot and visited him again. This time, I bought 2 larger paintings and 5 small ones. I think he thinks that I worship him, but I don’t care. His paintings are absolutely stunning. (NB: If you want to check out his works, go to his website: yessy.com/kwaboama) Later that week, we stopped by his booth, but his apprentice was the only one there. As Willemien bought a wood carving from some other vendor, the apprentice’s phone rang. It was Bernard. They discussed business and everything, and then the student (frustratingly named KOFI, like everyone else here!) handed the phone to me. Bernard said hi and that he was so sorry he couldn’t have been there that day but he was at his studio painting (probably to replace the 40-some paintings that the 4 of us bought from him). He said he would see me soon and apologized again for not being at the Culture Center to talk to us in person. He is in his early/mid-40s and has 3 daughters, a fact you can identify right away in the way he acts to girls. Maybe it’s his humble personality or his discomfort with attention, but he is so accommodating and fabulous to us, especially the girls. Willemien bought two of his paintings at one of the art galleries in the Center, but she had to pay 15 GhC and couldn’t bargain them down. Since we only needed to pay 5 GhC when we bought them from Bernard himself, he approached her the next day and quietly told her to pick out 2 more paintings because he felt bad that she had spent so much money on paintings. I thought that was so incredibly nice and discrete and fair and generous.

I’m in the bus back from Tamale to Accra and I’m falling asleep so I’m going to stop typing. Today I move to the International Student Hostel in Accra at the Korle-Bu Teaching Hospital. I’m excited to start my work in Accra because I have about 55 interviews there (I only had 30 interviews in Kumasi) but I already miss Kumasi. It is such a busy city and I had made friends at the hostel, both Ghanaians and international medical students. I was prepared to be on my own, and Eva’s presence over the past few weeks was just an added bonus, but now I’m a little apprehensive about starting over in a new place. I think I’ll try to visit Kumasi at least once before Eva and Shy leave (August 14). The medical students are organizing a trip to Cape Coast from Kumasi on July 16 and I am definitely going with them. I need to do an interview or two in and around Cape Coast, so that should work out perfectly. All in all, I’m excited for Accra and exploring but I really would like to be in Kumsi, especially since Eva moved back in the hostel today. I will need to travel a significant amount for these Accra interviews, and I’m not looking forward to that. I don’t enjoy traveling very much and I wish I could just have Accra as my permanent home base. Oh well. I guess I’ll seem much more of the country than I would have if I wasn’t forced to travel.

Ghanaian proverb of the day: Two men in a burning house must not stop to argue.