Eh-heh

October 11, 2012

Kasoa

Eh-heh.

I stand corrected; that is actually how they say ‘uh-huh’ here. Sometimes though they do say ah-hah as I have previously observed. Given my tendency to copy people’s way of speaking and acting after observing them for prolonged periods of time, I have on several occasions stopped myself from saying eh-heh.

I went to work on my own today! Yay to me. I hailed a tro-tro using the hand signal (index and middle finger turned down) that means ‘I’m going to Kasoa Junction.’ W taught me two other hand signals to signify your destination (a particularly important know-how since tro-tros here do not give clues to their terminus): index and middle finger bent to your right (‘I am going to Accra’) and bent to your left (‘I am going to Kasoa’—that is if you’re coming from the side of Accra). I thought these were cool to know. It made me feel more street-savvy.

I did not have a difficult time traveling to and from work, even if it involved a significant amount of walking (snaking, is the more apt term) through crowded areas in the market. Only once did I hear someone call out to me, ‘China!’ as I walked past. I was pretty surprised that no one bothered me. I guess it helped that I walked fast and purposefully (as if I so knew where I was going), dodging approaching bodies as I did and always looking up. It almost, almost felt like walking through the 168 area in Manila again.

They must have told me and I just missed it, but apparently on Thursdays and Fridays the HIV unit does not normally see patients. I was reminded of it when G told me. Since I made the plucky effort to go to the hospital anyway, I asked if I could instead go to one of the consulting rooms and work with the HIV specialist (who also saw general IM and Peds cases). So I walked up to Room 5 and waited a few minutes for Dr W to arrive (she did ward rounds first).

She after all was amiable. I didn’t think so the first time I met her. Then, she hardly looked up from her paper when I was introduced. And she had hardly smiled. But today was different. I saw all sorts of patients with her—ranging from those who had difficult to treat HIV, to those who had HIV and who were feeling sick; from rashes to um, rashes (fine, so there were benign fungal infections but we had a fair share of scabies and folliculitis); from rule out malaria to rule out malaria. We had some run-of-the-mill hypertensions. We also had one lady who looked so surprised after testing positive for pregnancy. Our first patient was an elderly woman whose skin was sloughing off (she had improving SJS from nevirapine) and whose eyes were so red. I felt so bad for her because she was old, has acquired a lifelong disease and was sick from her medicines.

The most nasty wound I saw was of a young man’s (~20? Yup, that shows my age). Apparently he was having someone take off his old tattoo when an unknown chemical was poured on the area—resulting in a caustic burn. What I saw was red, beefy, degranulated, weeping tissue surrounding what looked like an eschar (or maybe it was the tattoo that was still, unfortunately for him, glaringly present). I can take blood, but not a wound like that. Even after more than ten years of being exposed to such, it takes all my will to control my facial muscles to keep a neutral expression. Luckily though, this wound didn’t smell a smudge as bad as a rotting diabetic foot.  I thought the lessons for this man would be: 1) don’t have a tattoo you may later on regret (i.e., a significant other’s name, because in time this other will be insignificant), 2) don’t have a tattoo taken off crudely and 3) live in the States where you can at least sue the person who poured the chemical.

Most of the patients we saw were I assume on the lower SES. Some of them were on NHI (National Health Insurance), which means free consultation and more often than not, free medicines as well. A non-free consultation with a non-specialist costs 10cedis (5 dollars) and 12 cedis (6 dollars) with a specialist. Since not all of the patients we saw had NHI, there were those who paid out of pocket. Although the fees do not sound significant, I can imagine how it must be a gigantic leap for them to even come see a doctor, when they earn an average of less than 2 dollars per day. Imagine: 2 cedis for transportation,12 cedis for consultation and say 20 cedis for medicines (and I’m being very conservative with this, because I saw that a steroid lotion cost 26 cedis). Holy cow, that would be 34 cedis! Already a week’s worth of your salary! And we’re not counting the lab and xray requests yet. It is no wonder then that even here or should I say especially here, people don’t voluntarily go see a doctor until they feel unwell or are dying.

And with this I confess that I have not seen my primary care doctor since 2009 when I was um, acutely ill. One thing you have to know, doctors make the worst patients. I have done worse than not seeing my doctor, like going out of the hospital to have dinner with a friend---name badge on my wrist and all-- while I was supposed to have been admitted for a knee surgery the following day. Like hiking soon after a knee surgery and not going for physical therapy until just standing on my legs for 10 minutes really started hurting. Like sneaking something to drink while I was ordered to be NPO as an appendicitis rule out--- why should I, when I knew for sure that it wasn’t what I had? Like asking if I could just walk home after having conscious sedation for a breast lumpectomy, because I thought I didn’t have friends or family available to pick me up and I didn’t want to postpone the surgery anymore.

Here in Ghana though, I have been good. I take my multivitamins every single day and pop my anti-malarial every night –on a full stomach, as I have been instructed. What did I say before—living in a different space changes you.

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Today marks my 1^st week here in Ghana. It feels longer than this, and I think it is because my days here lack monotony and predictability. (After all, don’t we lose power and water at unexpected times?) We like knowing what’s going to happen, but it’s the tiny shockers that really build you up from within. I wonder if this is why I gravitate toward the edge—because really, why would anyone not want to know what is beyond?

I had a conversation with F, our country coordinator (who was sleeping on the night I arrived, but everything’s forgiven) one night. We talked about giving our blessings forward. A relative apparently helped fund his education in the university, which in turn opened up opportunities for him. Today he helps fund a girl’s education. It’s the only way I can give back and give thanks, he said.

I gave him a part of my story. I recounted how the sacrifices of my parents and a very generous aunt supported my long education. And how without them, I would not be where I am now, doing things that I love and that make me grow in love. Once while I was swimming in a pool, something I absolutely love doing, I thought about my father with such extreme gratefulness that I thought water seeped into my goggles only to realize that it was my own tears I was blinking. When my brother and I were much younger I remember him insisting that we must learn how to swim. He enumerated several reasons, as he always does, why knowing how to swim mattered. It didn’t soften his heart when I would in panic grab the arms of my much more skilled brother in the pool because I was so scared to swim on my own.  He was tough on this one, my father, the same way he was tough on making sure we polished our school shoes every night (which my brother and I faithfully did, until we learned how to nicely ask our helpers to do it for us). I guess with swimming it was harder to cheat so I just showed up for our swimming lessons, begrudgingly at first until I not only learned how to swim on my own but also realized with some surprise that I actually loved it.

What I grasped in the pool is what I grasp again today—that no one in this world makes it on her own. And that the ‘useless things’ we do, the meandering roads that seem not to make sense, the bizarre strangers we meet in these meandering roads; the loves we have had, and the loves we have had to let go, our injuries and our blisses ---- they really do amount to something.