Final (maybe) Post

September 19, 2010 - October 7, 2010 (this post took a while to write)

I have been getting requests from some uber-faithful readers to wrap up this blog in a neat and tidy way. I’ve also been so incredibly busy (or maybe scattered would be a better word) that I haven’t been willing to sit down and write, especially because I am scared of not doing justice to my time in Ghana. To force some order on my still-swimming head, I’ll bullet-point thoughts, feelings, and any comments that I have.

• The biggest culture shock of my experience was the Atlanta airport. I got off the plane and went to find my connecting flight’s terminal, and no one made eye contact with me. I had spent 3 months getting used to being stared at. The staring was always so welcoming and friendly, though, and it was weird to feel totally [opposite of individual]. There are 23 million people in Ghana, but I never felt like I was just a number—not once. I got off the plane in Atlanta and immediately lost all sense of community. It was weird, eerie, and suddenly very lonely. I know that airports are like shopping malls and hospitals—very impersonal and built for people-trafficking, but this felt different… Most Ghanaians aren’t used to being stared at like my blonde-hair, blue-eyed self, so I’m not sure if they sense the difference as much as I did. In my conversations about America, I can tell that there’s just a different aura, even when they talk about it. It’s this awe and reverence for the United States combined with the realization that they would just awkwardly disappear into their workplaces and neighborhoods and not automatically achieve nirvana and perfection if they moved there.
• Speaking of America, I just want to note something about MY attitude towards the homeland. I went in to this trip thinking that I would still be just a number (I don’t like saying that because I don’t think it’s like a number, per se—it’s kind of like how you can say, “hi. How are you. I’m good, how are you. Fine, thank you. Have a nice day.” in a total monotone, without realizing that the true question requests that someone reveals how they are doing – what’s bothering them, what’s on their mind, if their parents are healthy.) That monotone ‘exchanging pleasantries’ is what I became conscious of in the Atlanta airport. Anyway, please don’t think that I’m down on Americans. I am NOT. Let me continue. So. I thought I would learn all these terrible things about America and would be disgusted to be an American. Thank goodness, that’s not what happened. First of all, I wasn’t concerned with America when I got to Ghana. I was concerned with finding my way around. I tried to learn as much of their culture in the first few days. When I got to Kumasi and started having conversations with the international students, I started to realize how incredible America is. The country does get criticized for being too proud and arrogant, and I agree, at times, we are ridiculous. But, if you take a second to think back to the origin of the country—fighting for our freedom, questioning authority, following our conscience, succeeding against the most powerful navy in the world, organizing ourselves into a comprehensive government—I think we have a right to be proud. I don’t think we have 2 separate words for it in English, but there is a huge difference between pride resulting from comparison between two things and pride resulting from an inward view of an accomplishment. Ghana, all the way from an individual person to the country’s view of itself, has an incredible amount of the latter kind of pride. It’s almost like self-confidence. Anyway, I felt that when I was in Kumasi, talking to European students about differences in all aspects of culture. It wasn’t because of anything bad the Europeans said, but I really felt proud to be from a country with a “think for yourself” attitude. (Again, not that other countries don’t have that, it’s just that we are so focused and centered on independence and autonomy and that’s kind of cool.)
• These interviews are KILLER to transcribe. They lure me in and make me think that I can use half my brain to sift through the accent and the other half of my brain to look out the window or daydream. Then I have to rewind the recording and listen to it again, even though I successfully typed about 90% of the interview. I’m about 65% done with the interviews and I’m going to try to power through them this week (Drs Anderson and Johnson-- I’m doing my best!!).
• I’ve been working on my budget and trying to match up the real expenses with the proposed expenses and I’m so proud of myself for cutting almost all of my expenses in half (except for my housing, which turned out to be about 25% of my projected costs). The other medical students kept calling me a spoiled American for having all my stuff paid for by UofM, but here are my objections and defenses:

1. I was so incredibly responsible with money, it was unbelievable. The IFMSA students got 'free' meals with their payment, so every time I bought food (mostly cookies), they would say, "oh you spoiled American". Finally they realized that eating 50 pesewa Indo-Mie (Ramen) Noodles was probably the cheapest thing you can do.
2. I took tro-tros. Granted.... I could have taken way more tro-tros instead of taxis, but I genuinely believe that would have interfered with my productivity and efficiency. The cost of a taxi is about 10 times more than the cost of a tro-tro (usually about 3 cedis versus 30 pesewas -- $2.50 vs. $0.25), but there are a few inconveniences of taking public transportation (tro-tro).
1. The added walking time (tro-tros don't usually drop you off at your destination unless you're a clueless white girl and they are nice and the van is empty because you accidentally rode it to the last stop).
2. Feeling bad about holding up the entire tro-tro by asking the mate exactly where they are going 10 times before you get into the vehicle.
3. Being sat on by sweaty people (somehow, I never had to sit on sweaty people. I was always the sitee-- not the sitter).
4. Not having someone to talk to -- the taxi drivers were usually pretty talkative but tro-tro passengers were mostly women who had already had a long day. Plus, it's hard to have a conversation with someone who is sitting on you.
3. The IFMSA students were all on vacation and I was there on business. OK maybe not business, but I was there doing work. Although.... if “work” means that I have that much fun all the time, bring on the work!
4. I was kind of stunned by the international students’ attitudes towards research. I’m thinking that it was largely affected by the groups of people I was with, but most of the people were totally apathetic toward research and were stunned that a university would invest “so much money” in research. They would die if they saw UofM’s yearly research budget!

• Anyway, I don’t really know what else to say. I had an entire blog series (like a sermon series) planned on the topic and issue of water-- getting it, drinking it, peeing, swimming in it, fishing in it-- all that, but I’m not sure how useful it will be. I’m already seeing things that I learned slipping away from me-- trying to remember where the hospital entrances were, what time I would get up, how dirty I felt the whole time, the sounds, smells, tastes related to the food...

I do really miss Ghana. I can’t wait to go back. I would strongly encourage anyone and everyone to go visit this country. The friendliness of everyone taught me so much about myself. I realized that the American default of closing ourselves off when we are uncomfortable comes off so unfriendly.

CHIM!!

August 21, 2010

Last night, I went with Catherine to the labor ward. She has been desperately trying to catch a baby (I absolutely can’t stand that phrase. They ooze out, they don’t shoot out like cannonballs). I won’t go into all the details of seeing my first birth, thinking about all the incredible physiological changes that need to happen at the right time for the baby to be born and healthy, imagining the agony that my mom went through, knowing that some of the women have had 5 or 10 kids and don’t know about, don’t want to use, or are prevented from using contraceptives. Any of those topics could fill up 15 pages of blogging but I think I can reflect on that later—those are all things that are universal. The one that I want to think about is the fact that the women aren’t allowed to have anyone else in the delivery room. Kwadwo supplemented my knowledge today in the van on the way back from Koforidua but I think I have a lot of reading to do if I want to understand the culture surrounding pregnancy.

(Aside: The trip is a 2.5 hour drive and I really wish he was more talkative because I could have talked about it for hours. I’m usually pretty good at figuring out how to get people to talk but Kwadwo is kind of an enigma. Maybe my human radar only works on Americans.)

I’m very glad that I went to the labor ward so that I could see what I’ve been researching, but it did not seem as relevant to my research as I thought it would. I really just can’t believe that the women can’t have someone with them. I felt AWFUL standing in my scrubs with my privileged white self just staring at women screaming. I couldn’t even talk to them because most of them didn’t really speak English. One woman only spoke Ga and the staff had a hard time communicating with her.

(Aside: I would have expected that in Kumasi because that region is mostly Twi-speaking, but here in Accra, many people speak Ga… it’s almost like Twi is the second language here and English is the third. School is taught in English, but that is a disaster that I’ll think about later.)

So I just felt awful. I think I would have felt almost fine if I could have communicated with the women but I felt like they were thinking that I was really judgmental or something because I just stood silently in the corner of a room. I stood with Catherine and 3 other medical students (they are all required to catch 13 babies and see about 20 deliveries during their 5^th year), and there were times when we just stared at the naked woman’s exposed vagina.

So Kwadwo said that the traditional culture was/is very strict about women and their vaginas. Women aren’t supposed to cook or be around other people when they have their period. Periods are messy and I understand why they have been historically associated with uncleanliness. He also said that it was typical that the man would go out of town when his wife was giving birth. The woman was supposed to go to her mother’s house and stay there for the end of her pregnancy, giving birth at her mother’s home. The husband shouldn’t see the woman in labor for a few reasons: don’t want to see their wife in pain, or at least in a pain that they can’t control or ease, the husband might not get turned on again if he sees the woman giving birth, and sometimes the husband hasn’t seen the woman fully naked and that would be inappropriate.

Also, Kwadwo mentioned that the labor ward is not set up for individual births, it’s set up for community births, but not community as in, “it takes a village”. More community as in, “you don’t have a right to privacy and you should deliver the baby soon”. So I guess I’ll just go from the beginning:

The women enter with their personal belongings and sometimes a friend/family member. They arrive moaning. About half of them were in wheelchairs. The doors are VERY heavy and I saw two people get totally pegged with the doors as they were wheeling in laboring women. Talk about the potential for lawsuits… They are told to put their things on the shelves and that the companion is not allowed to go any further. Then they stand there while the nurses talk between themselves and, in one case, argue whether her labor should be induced or whether she could stay on that floor with the uncomplicated pregnancies. During this time, they are standing and moaning or rocking from side to side. A nurse leads the way to a room, and the woman is forced to waddle as fast as she can to follow the nurse. Then, I think they just check her BP, HR, dilation, temp, etc. They are either led to a room or the hallway—not sure what the difference is, and then they are told to get on the bed. The “beds” are about 2.5 feet off the ground and they need to use a wobbly wooden stool with legs like this /---/. The nurses do not help them get up. The women then labor right there, in the hallway. They roll around in pain on the “beds”, which are like the black cushioned examining tables that we have in the USA. The stirrup-like feet-holders were broken, and when the women tried to put their feet in them, they would spin around and her leg would kick out and off the table. There aren’t any side rails and I pulled a Karen Gardstrom when I gasped and reached out my arm every time a woman decided she would thrash into a new position. So then when they start actually delivering, they are made to get off the (very tall!) table (using the faulty stool) and walk to a bed in a room. They lay on the bed and then they are forced to get up again and go into a similar black-cushioned thing; this time it’s more of an upright chair than a table. One woman I saw last night was using the bed on wheels to get up on the really tall chair. The nurses didn’t really help her except for holding her IV bag and yelling what I’m assuming could be translated to, “you NEED to get on this chair. Just do it. STAND UP.”

Actually, I know they said “stand up” because I know Twi!! It is pronounced like, “sahr – rie” (or “sorry”—appropriate!).

I know our midwife teacher told us that we should be moving around while we’re in labor and stuff, but this just doesn’t seem safe. It’s not like the baby fell out of her on the way over but the head was definitely ready to pop out while she moved. And there was no assistance!!

So that is the thing with the beds. Now for the partners. They are not allowed. No one except the mother-to-be. I couldn’t tell how the women felt about it. I think they probably were in so much pain that they didn’t have the energy to be angry at us. Now I understand why the doctor with the super nice practice isn’t coming on Wednesday. Oh wow. I have no idea where that came from. I just fell asleep and kept typing. Anyway, what I meant was Now I understand why the doctor with the super nice practice was talking about introducing the concept of a doula. They wouldn’t be with the woman for the medical stuff, but they would know the woman well enough to know the normal parameters of skin color, actions, feelings, etc. Kwadwo said that most people ignore the women’s screaming, but he tries to pick up on how it sounds at the beginning and stay finely tuned to any changes. Other than that, the women labor alone, with very little encouragement from the nurses or doctors.

I guess it is understood that pain always accompanies labor and childbirth. The process is what makes you a real woman and apparently women who have had C-sections are not considered real women. I’m pretty sure it’s not as harsh as that sounds, but that’s the way he explained it to me. I’ve heard this before and Kwadwo repeated it: the nurses and doctors will say, “Be quiet. Who are you screaming for? There’s no one here to help you.” That was not more harsh than it actually is. Apparently the women obstetricians are more dismissive than the men when it comes to pain management. Only people who have been exposed to Western culture will ask for pain relief or permission for their husband’s company. (I get the sense that the only people who would ask pain relief are the ones who are wealthy and have a high enough social status that they have husbands and not boyfriends or ‘partners’.)

Anyway, this is scattered but the bottom line is that I can’t imagine going through so much pain without anyone there with me. Some people say the birthing process is beautiful and I’m not sure that’s the adjective I would use. I think it’s absolutely miraculous, but I think the first part of giving birth is really about the mother. Since the father is not physically involved in the whole process, I think it is so important that he is there to support the mother. Also, speaking of relationships and stuff like that, after the babies are born, they are put in those portable cribs instead of with the mother. I am definitely not up to date on my maternal-natal bonding within the first hours of life, but I think that the research really supports physical contact as soon as possible. It’s interesting because at Komfo-Anokye, all the women were lying with their babies. I assume that’s similar in the postpartum ward at Korle Bu, just not for the first hours? Not sure. All the kids in Ghana haven’t died, though, so I’m pretty sure that it is okay that they are not with their mothers right away. Oh, and the title of the post refers to what the nurses say. ‘Chim’ means ‘push’.

Ghanaian proverb of the day: It is a child who has never traveled who says that only his mother prepares tasty meals.

“Yes the police are very strict. Getting a ticket is awful, not because it’s expensive, but because you have to wait all day while you try to pay it."

August 18, 2010

Two weeks ago, I called the head of the department at Kumasi to ask him when he wanted me to come and present my research to the department. When I interviewed people in Kumasi, a few of them expressed frustration with how long it takes for research to be written up and effect any change. I heard “how will this benefit me” from more than one person. While I think it is a legitimate question,

(Not-so-irrelevant aside: Formal research is not very common here. There is very little incentive to publish findings, and only 2 or 3 people out of 70 physicians that I interviewed reported getting funding for their research. Most of them said angrily, “the research that I do is funded by myself and it takes up even more time in my busy schedule.” The professors are required to do research to get/keep their status as a professor (as opposed to a lecturer or senior lecturer) but I have met very, very few people who were excited about research.)

Anyway, most obstetricians are not very exposed to research and consequently don’t understand that research doesn’t always (or usually) benefit the person involved in the study. That’s another reason why I love research so much—it takes so long for stuff to get done that you are usually working to benefit the next generation, not your own. It’s kind of altruistic in a way. So… “how will this benefit me” – I usually say, “This research will help inform international policy and will benefit other countries by supporting the founding of a similar postgraduate training program and other similar partnerships like the one between the University of Michigan and the two universities in Ghana,” they seem unconvinced that it is worth their time.

(Not-so-relevant aside: Any resistance that I receive initially usually dissipates within a few minutes of starting the interview. Like many things in life, the hardest part is convincing them to agree to do the thing. I think if I weren’t as sensitive to people’s reactions, I wouldn’t notice half of the resistance that I’ve encountered. None of it has been offensive or posed a problem to my research. The nuances in people’s attitudes were really insightful into Ghana’s medical field, its relationship with nonmedical people, and Ghanaians’ attitudes toward abrofuo and western culture.)

ANYWAY, I called Prof. O-A and he said, “oh, we are going to be administering examinations all next week, so why don’t you come up to Kumasi and do your presentation at tomorrow’s morning meeting?” I scanned my mental list of commitments and asked myself if I could handle 6 more hours in a car/bus/tro-tro, since last week we drove to Takoradi (10 hours in a bus and car in one day), Ho (3 hours in a big tro-tro, 2 more hours in a taxi), Tema (1 hour in a tro-tro) for work and then 6 hours to and from Hohoe over the weekend. I decided that I could probably handle it, esp. because Kwadwo was unavailable this week so I was not expecting to schedule many interviews this week. Within an hour, I had eaten and packed and was at the VIP station to buy a ticket to Kumasi. With the help from a Ghanaian guy and his mom, and amusement provided by a Ghanaian guy who, upon learning that I was from the United States, whipped out his American passport and said, “THE UNITED STATES? I LIVE IN COLORADO!”, I was on my way to Kumasi. I sat next to a guy (forgot his name—gave him my email address though, so we’ll see if he ever emails me) and he owns a laboratory and talked about how we can develop a partnership and I can buy things for him in the USA and he will pay me back. They showed 3 Nigerian movies, 2 called True Love (the first and the sequel), and something like Church Swapping or something. The first 2 were pretty funny—True Love #1 was about a girl who lived with her retired military father. Her mother had died in childbirth, and the dad was ridiculously protective of her, so when her fiancé came to visit, the dad put him through all kinds of absurd trials.

(Aside: They also watch a lot of Spanish/Mexican (?) soap operas translated to English. Why are some countries so into absolutely awful television entertainment when other countries like France are super artsy and classy??)

The second one was WAY worse—the dad decided to remarry a girl who was the same age as the daughter. The fiancé (now husband- he passed all the trials!) cheated on the daughter, and the dad’s new wife turned out to be marrying him just for his money when he died. She was also cheating on him. The third one was the best—

(Disgusting aside: Apparently tomato paste and tomato sauce aren’t the same things. My dinner of Ramen noodles (without seasoning), tomato paste, and boiled carrots is really not as awesome as I was expecting. Why does 1) it get dark so early?? It’s like I’m grounded every night unless I can get a boy to go find food with me, and 2) Ya not have her shop open on the weekends? I’ll answer that… she plays mother to everyone in the hostel and cooks lunch and dinner for everyone every day. I think she lives in the hostel, and she is ALWAYS in “Ya’s Place”, the little shop in the hostel. Eeek. I’d need to get out at least once a day if I were her!!)

The third movie. Husband and wife. The husband meets this woman who falls in love with him. She’s a sorceress. Whenever he does anything she doesn’t like, she kills someone close to him. He is forced to allow her to move in with him and his wife, and she is always trying to make out with him. She makes the wife cook her food and stuff, and when the wife’s friend tells the wife to stand up for herself, the friend gets zapped and dies. Throughout the whole movie, everyone is screaming and hand-drawn neon blue light shoots out from the sorceress’s hands when she kills people.

I thought I’d post something a little lighter after the drunk driving post, so I decided to continue the transportation stories. The title of the post is what Sabina (my helper in Kumasi) said as she made an illegal U-turn and then ran a red light. She wasn’t kidding either!! I think she goes by Christina and my rule: there are 4 colors on a traffic light—green, yellow, red, and scarlet. Here in Ghana, red is like a warning that scarlet is going to come. There’s a 5-second delay after the light turns red before it is deemed an illegal scarlet. Then, you might maybe one day get pulled over, although I’ve never seen a police pull someone over here. They just stand at the police checkpoints and stop cars as they slow down to go single-file through the police barriers. The police have flashlights and they take about 4 seconds to scan each car. If you have a sticker that says your father is a member of parliament (a HUGE deal here), the police are not allowed to pull you over. I think they are more lenient with abrofuo and I was in a tro-tro that got stopped and (I think) randomly selected to go through a check – all the passengers had to get out. I was sitting in my normal princess place in the middle in the front, and the guy next to me (obviously upper-class by his dress and attitude) said, “ahem, excuse me.” The police officer came over, said, “oh I didn’t see you in the car. I’m sorry. Have a good day!” and then told the people to get back in the car. I asked the business guy if he knew the police officer and he said that he used to work with him, but it definitely seemed like a boss/subservient relationship to me. The guy wasn’t wearing fatigues or anything military-style, so I’m wondering if he was some sort of a minister or member of parliament or something.

Ghanaian proverb for the day: Do not follow the path. Go where there is no path to begin a trail. (HA. HA. HA. Is that referring to Ghanaian roads?)

Transportation Frustrations

August 16, 2010

Today, I experienced drunk driving. I guess I’ll just describe the schedule of the day because it all added up to the end result in the taxi. (sorry, I’ve already ruined it… now you know that I survived the drunk driving.)

8:00 – morning meeting

9:00 – called the various doctors that I have left on my list, sent some emails, worked on med school apps, etc.

1:15 – headed back to the medical students’ hostel for lunch

2:00 – tried to catch a taxi to Tema, which proved harder than expected. Tema is only 40 km away from Accra, and should only take about 30 minutes to get there. However, with the Accra traffic, it usually takes about an hour and a half, and sometimes can take 2.5 hours. Since my interview was at 3:00 (way to plan ahead, Equia), I opted for a taxi instead of a tro-tro. The first guy just laughed and said, “I don’t go to Tema” so I was left to find another taxi. One came soon and we agreed on 18 cedis. (Taking a tro-tro would have been 80 pesewas which is like 55 cents.) It was probably too much, but I couldn’t help thinking of the hurry I was in and the fact that my budget allowed for very luxurious traveling. I quieted my conscience by telling myself that I would attempt to take a tro-tro on my way back.

2:35 – we had only moved like 10 km. The driver slowed down his car and pulled over to the side of the road and then stopped the car. His English was really shaky and all I understood was, “broken.” I’m still not sure if he had a flat tire or if he saw smoke coming out of the hood or something, but we stood at the curb and waited for another taxi to come by. Of course, this was the one time there weren’t millions of taxis driving past, and I only had 25 minutes to find this doctor’s private practice in a city that was still 30 km away.

2:45 – found another taxi. Explained to the driver that I didn’t know where I was going, only that it was in Tema and I will call the doctor when we got closer. He suggested like 20 cedis and I got it down to 15. I didn’t have to pay the original taxi driver, which was nice. While I was bargaining, I tried to say, “but we’re already halfway there and I was only going to pay the guy like 15 cedis.” The driver was more amused than offended or bothered and smiled at me, saying, “oh. we are definitely NOT halfway there.”

3:30 – called the doctor who gave the driver directions. We found the hospital/clinic without ANY problem (absolutely incredible) and I was shown into the waiting room.

4:15 – (now can you see how my days just get wasted here?? What have I done all day? Nothing!!) Began the interview. The doctor was very nice. His mother was Swiss and his father (an obstetrician) was Ghanaian and he was working at his father’s practice. The place was a private nongovernmental nonreligious hospital and it was really, really nice. He was really excited about the interview and showed a clear understanding of my research because he asked me a few times, “what are you trying to get out of this answer? Do you want me to talk about what I have done since I came here? Do you want to know the improvements that I’ve made since being here?” I have started to have 2 distinct kinds of “good” interviews: the people who give really good answers for data crunching purposes (i.e. “there was no ultrasound, fetal monitor, laparoscope, or any other technology before I came—I was directly involved in buying them”) There are also good interviews for the verbatim purposes. Some people say exactly what I want to write in the paper, and it’s so great to have those. The last paper had quotes written on the middle of the page, and there were some good ones. I’m glad I’ll have great comments that are, for the most part, representative of the majority of the interviewees. He gave me a pamphlet-book that he had written and then showed me around the facility. It was really great. Last week, I interviewed a doctor who had, with his wife, an absolutely incredible practice in a very beautiful facility. (resolvegh.com) At first, I thought that private practice doctors were selfish because they treat mainly wealthy women, and they receive a much larger salary from their practice than the government workers. After seeing these two clinics, I have decided that they are actually really positive things for Ghana. They prove that quality care is available and possible in Ghana, and I think they hold the other hospitals to a nicer standard. At the clinic last week (the one called Resolve), they even go so far as to say that the birthing process is great and should be as comfortable for the women as possible. I’m pretty sure they don’t have Jacuzzis and birthing balls at Korle-Bu.

5:30 – get in a shared taxi to go to Community One, which is what one of the main Tema tro-tro stations is called. Have a little difficulty trying to find the actual tro-tro station because Community One is, like most stations, a big market also. The people weren’t super excited to help me, but I was persistent enough to ask, and the ones who knew where to find an Accra tro-tro. One guy grabbed my hand and said, “I’ll take you there.” Since the tro-tro was nowhere near full, we stood outside the car and chatted for a while. I gave him my email address and stood my ground in the 5-minute argument about whether I would give him my number. I finally got in the tro-tro and sat for about 5 minutes. The car wasn’t filling up and my friend came in the car and grabbed me and said that he actually is a tro-tro driver and would love for me to come in his car. I had already paid the 1 cedi and knew that he was going to Circle, which isn’t as direct a route for me as the one I was going in. But, it hadn’t filled up and I knew I’d have to take a connecting ride anyway so I decided to go with him. He gave me first priority and I sat in the front of the tro-tro, sharing a seat with the mate. The seat tipped when the mate stood up, and I’m not sure the car had ever had seatbelts. The driver drives silently for about 5 minutes and then picks up his phone and starts dialing a number and talking on the phone. Apparently he is looking out the window because we were picking up speed and the big white construction vehicle in front of us was not moving forward. He noticed it about 2 seconds early enough and swerved the car to the left, slamming on the breaks. This elicited a loud shout from the passengers in the tro-tro and I felt really bad for the driver, even though I was struggling to get back on my seat. A few more close calls, but none as bad as that one. He still did not put his phone down.

6:20 – the car dies. The battery light is flickering and he can’t turn the car on. We are in the middle of the road and it is dark now. Everyone starts shouting and getting upset and the mate steps out of the car. He leaves the door open so I jump down, and the rest of the tro-tro follows me through the front seat door. When they go to reclaim their 1 cedi from the driver, they realize that he is so drunk his eyes can’t focus. He tries to brush it off like it was nothing, but all the passengers yell that they are going to get the police and stuff. I’m stunned that he was that drunk (and that I didn’t notice or think twice about the slight smell of alcohol on his breath when he was talking to me earlier). I’m clutching my purse, knowing that it could never get stolen in such a large group of people (esp. Ghanaians) but realizing that I had already made one stupid mistake in trusting the guy and knowing that I would feel stupid and be in huge trouble if someone stole my purse. I tagged along with a few of the Ghanaians who had gotten their money from the drunk driver and were going to get another tro-tro at a nearby station. We walked along the highway / sewer for a while and found the station. The people that I followed were very nice and made sure the mate of the new tro-tro knew that I was getting off at Accra Mall. They told me 3 times where I was supposed to get off, and when we neared the station, the guy behind me kept poking me in the back and saying, “this is where you are going! do you know to get out here?” So we get out, and Sam, one of the guys I met on the tro-tro helps me cross the two 3-lane highways that separate me and the Accra Mall. I talk to him for a while, give him my email address, and go into the mall.

7:30 – I enter the mall and look for a camera. The cheapest one was 250 cedis and the store only takes debit cards (not credit cards) and I only had 30 cedis in cash on me. This is so frustrating. I really need to remember to ask someone for their camera for a day, although I don’t know who would want to lend a camera to the girl with the broken one. And knowing my luck and skill with electronics in Ghana, I’d break it.

9:15 – I meet up with the rest of the Accra group and we buy tickets and get popcorn and Coke and go to the 8:40 showing of Inception. I thought the movie wasn’t well developed and the dialogue was a little cliché, but it was fine. It would have been nice to see the beginning, but I guess I was able to follow the story okay (i.e. better than mom would, but not as well as Karl would).

11:15 – the movie ends. We walk down (and cross 1 of the 3-lane highways) so we can get a better price for taxis. The taxi drivers know that abrofuo (sp? means white people) will always pay more so they charge 3 or 4 cedis extra to white people, especially near the mall. We find one for 6 cedis and pile in.

11:50 – we get back to Korle-Bu. I had met up with the whole international group and that included a Ghanaian girl who was studying medicine in Germany and was here on exchange. She is staying at the International Students’ Hostel which is a little more than a mile away from our hostel. We drop her off and the driver says, “You need to give me 2 extra cedis because I’m dropping you off at an extra place.” I got into a very heated argument with him. I was NOT about to let that happen on such a bad-luck transportation day. I finally told him that we would get out of the car at the junction leading up to our hostel and then we would pay 6 cedis. He agreed but on the condition that I gave him 7 cedis. It finally became a matter of principle and I told him that I would not pay a price higher than what we agreed on before we got in the car. We ended up walking to our hostel from the junction. He was very, very angry.

Anyway, now it’s 1:20 am (that means in the morning, Dipali) and I’m TIRED. I’m not sure whether I’m going to the morning meeting tomorrow. I really enjoy it but today I was almost dozing off, which is something I don’t usually do. Maybe I have malaria. I did get about 10 mosquito bites last night—I guess the mosquito net and repellent are effective. I think I’ll use them tonight since I can’t handle a replay of last night.

Ghanaian proverb of the day: Fire and gunpowder do not sleep together.

Another Scattered Post

August 15, 2010

Hi Bloggies!
I wish I could be like Eva and have a central theme for every post but I am not that organized. This entry will start out talking about the beach and I’m not sure where it will end up. I’m giving myself from 5:45 until 6:15 to write and then I’m going to keep pounding at med school secondaries. So much personal, contemplative thinking—it really is exhausting!! Anyway, today I called one of the doctors I had to interview and he told me to come to a clinic so I took a taxi to go see him. He was very nice. I can always distinguish the doctors who have either studied in the United States or worked with a lot of Americans because they are able to keep up with my pace and they understand my accent so much better. This doctor works in Akwatia, about a 2 hour drive from Accra, and he is the only obstetrician at the hospital. They have about 3000 deliveries every year. He is permanently on call. He didn’t seem too stressed out—not sure why. I think I would be either trying my hardest to get out of the situation or working nights to recruit all the Ghana College graduates to come help out or try to set up community education so that I don’t get so many emergency and eclamptic cases.

So after that, I put on my brown sundress and swimsuit top and Lisanne and I went to the beach. On the 10-minute walk there, we were greeted by about 10 groups of men and 2 or 3 groups of women. The greetings ranged from “hey sexy” to “OBRONI come here!”. We ignored most of them, but the entrance of the beach “resort” is always a little hard to get through. There are almost always Rasta guys there, and they always are much more persistent in getting to know you. While Lisanne was talking to a guy who happened to be going to Holland with his wife later this year, a drunk guy came up and tried to kiss me.

(note: I’m making Spanish rice from a box that Ella’s parents brought her when they came to Ghana and I just put the butter in the boiling water. It did not melt. I would hate to see what Blue Band ‘bread spread’ would do in my stomach. Oh, also about food: I ate a salad at a restaurant 2 nights ago and I didn’t even feel sick. Who says you can’t eat salads in countries with unsanitary water?? Awesome.)

Anyway, the drunk dude isn’t important. In fact, I think that I’ve had that experience in the Diag in Ann Arbor, so it really shouldn’t be on this blog that’s supposed to be about Ghana. So. We got through there and through the resort place and I bought a goat kebab. Personally, I think that the goat kebabs are overpriced—they are 1 cedi (roughly $0.70) and there are like 5 pieces of meat on them, separated by onions. They are covered in this spicy breading and oil and are grilled over a few small coals. You can get them all over the place, and although the Ghana FDA is probably not involved in their production, they all taste pretty similar. I was lucky—only one piece of goat had skin on it. As all you science people know, there’s a layer of fat directly under skin and nonscience people know that skin is tough and rubbery. The gray color doesn’t help either. Other than that, I don’t mind the skin. I am a vegetarian when it is possible and healthy (i.e. in Michigan but not in Ghana) and the wandering goats and (really loud) chickens serve as a reminder of what we are eating. I think people should eat meat only if they are comfortable with actually thinking about where the food came from, and if they would be comfortable killing the animal themselves. I think that would force a lot of people to become vegetarians (thus contributing to a more sustainable food industry). We’ll talk about that later. SO we get down to the beach and I spread out my 2 yards of kente-patterned printed fabric on the beach.

(note: Kente is a word that describes a kind of cloth. It must be woven in strips that are about 5 inches across. The strips are then combined to make a cloth that can be as wide as you want it, depending on how many strips you connect. I haven’t bought any real Kente cloth because I don’t like how it looks when you combine the individual strips. Sometimes they aren’t lined up properly and then they don’t look very good. I’ve bought cloth with the typical Kente pattern but ones that have been woven continuously across for about 15 inches. I like them better.)

So the beach. It’s dirty. I waded in the water a few weeks ago and did not enjoy all the plastic bags floating up and wrapping around my ankles. There are diapers, forks, Styrofoam bowls, you name it.

ARGH it’s 6:25p and I need to go contemplate how I will add to the diversity of the University of Virginia School of Medicine. I’ve tried to explain the United States’s obsession with diversity and how for undergraduate applications, “diversity” is used to refer solely to skin color. Ghana, more so in Kumasi than Accra, is a very homogenous place and it is pretty ridiculous to sit in the medical students’ hostel and think about the makeup of my future classmates in the United States.

(note: today’s proverb hits a little too close to home… I can’t believe I’m going home in 11 days!! SAD.)

Ghanaian proverb: By the time the fool has learned the game, the players have dispersed.

Quickly Waiting

August 4, 2010

I think it has been a while since I’ve posted. It’s hard to remember what I’ve written about and what still needs to be covered. I’ll bullet-point because this is probably going to be a boring entry:

I only have 22 days left. Things I need to do before then:
o Finish all interviews (25 more).
o Analyze results.
o Create a powerpoint and hopefully get it approved by Dr. Anderson.
o Go to Kumasi to Komfo-Anokye to present to the obstetricians I interviewed
o Present to the obstetricians at Korle Bu in Accra.
o Go to the West African College of Physicians and Surgeons and try to find the answers to questions I didn’t know I had.
o Go to the Ministry of Health to get annual reports and ask more questions that I don’t have yet.
o Talk to the Ghana College of Physicians and Surgeons and try to understand the relationships between the GCPS and the WACS. Amazingly enough, this really can only be done in Ghana, in person. There isn’t enough literature on the internet to learn the stuff and everyone has a very different perception of the differences and goals of both programs. I’m looking forward to hear what the founding members have to say about the Ghana College.
o Get my debit card in the mail so I can take out money to pay my 2 assistants (Sabina in Kumasi and Kwadwo- pronounced ‘Kojo’ in Accra)
o Figure out what kind of going-away presents I need to give and who I need to give them to… I don’t think the Ghanaians would appreciate a strip of Kente cloth or a djembe (drum) as much as my American friends…


More things that are time sensitive but won’t get done before I leave:
o Medical school applications. I’ve submitted 4 and have quite a few more to do.
o Transcribe interviews: it takes about 3x as long as the real interview to figure out what the interviewee is saying and type it out. Almost all of the interviews have been about 20 minutes long. My interview on Monday with one of the women was AN HOUR AND SIX MINUTES. That will take me 3 hours to transcribe. That will NOT get done while I’m in Ghana!!
o Learn Twi. The Accra Ghanaian boys are starting to get annoyed with my trying to learn Twi, but it is SO satisfying to say something, even if it’s just one word, in Twi and then wait to see the smiles on the Ghanaian faces when they realize that I am trying to speak their language. I have a Twi booklet from the University of Ghana and a recording of learning Twi from the Ann Arbor Public Library. It’s hard for me to learn because (1) I really don’t have much time. Between med school apps, interviews, traveling, etc. I really have only a few hours every day to do what I want. (2) There are many pronunciation issues. For example, the combination “ky” is pronounced “ch” – as in, “Komfo-Anokye” is pronounced “Comb-fo-a-no-chay” and like I said above, “Kwadwo” is pronounced “Kojo.” (3) The boys just get frustrated and then try to make me say things. They keep telling me that it means, “I love you” but I know their sense of humor and I really doubt that’s what they’re teaching me. I wish I were back in Kumasi because the boys didn’t get sick of Eva and me asking millions of questions. Accra people are more impatient.

OK wow, this entry was actually way more boring than I had expected. I’m sorry, faithful readers. If I have time later tonight, I’ll write another one to make up for the lack of content in this one.

It’s pretty amazing to think that I am planning on running from place to place for the rest of my life. It’s definitely part of the medical school → residency → doctorhood, and I plan on fully embracing this aspect of medicine. Meanwhile, on Monday, I sat on a bus for 4 hours to Takoradi (the most beautiful place in the world) and then 4 hours later (after waiting for 2 of those 4 hours), I sat in a car for 4 hours back to Accra. On average, everyone waits at least 3 hours every day for various reasons. Today I called a doctor who works a little outside of Accra and she said that she could meet me because she was coming to Accra. I met her at the Ministry of Health where she was going to have a meeting. She told me that because she didn’t know when the meeting would end, we could meet before her meeting. She was about 50 minutes late to arrive at the Ministry of Health (traffic), and then I took up about 35 minutes because she gave detailed answers. We were sitting in the hallway and by the end, everyone who was going to meet with her kept walking past saying, “Hello Sylvia.”
Anyway, I just find that ironic—that medicine is such a fast-paced, totally packed profession, and that I am (and everyone in this country is) always sitting here waiting for something. I also think it’s so ironic because I have SO much to do but I’m always waiting. I can’t do my applications because I really don’t feel comfortable flashing my computer around at the patient waiting rooms, and my presence is required as a physical reminder that the doctors have an appointment with me.


In other news, most of my mosquito bites are starting to ooze clear water when I squeeze them. Eeeeek!!! I hope I didn’t get any worms from my gash on my foot!! There’s like a yellowy/orangey ring around where I cut my foot, but other than that, it should stop oozing in a few days. It’s definitely a lot easier to walk on it now but I’m glad that I won’t be hiking in the mountains until Friday or Saturday.

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.