Hearting Ghana

October 30, 2012

Kasoa

On a night w/o power nor water

I am almost getting tired of having both power and water outage. Especially when this means melted ice cream packs and stinky bathroom. U said it is hard to tell if she is dehydrated because of all the accumulated urine in the toilet. I suggested that she watch the stream of her urine instead.

But moving on. I watched with bated breath, the unfolding of Hurricane Sandy back home. I am happy that DC (where my plane will land), MD (where my parents are) and PA (where our Filipino house is) were all spared from destruction. Since I am aware of how ‘lucky’ I can get with transits, I am also hopeful that my flight out of Frankfurt will not get pushed back (as it is I already have an 11 hour lay over during which I cannot leave the airport because I have no German visa) and that by the time I arrive in PA we have both power and water (because I need a break).

I still find it hard to believe that I am now tangibly talking about departures and flights and such. Having only 2 full days left here in Ghana, I feel the nostalgia seeping in. Now every place I have frequented, every habit I have acquired, every food and drink I have ever consumed since coming here have attained a certain finality to it. Today was the last time I would go to Country Side Orphanage. Today might have been the last time I would buy chocolate at Mama Joyce’s. Today was the first and last time I would carry 15L of water on my head. Tonight might have been the last time I would receive lessons on Azonto dance under the moonlight. Yesterday might have been the last time I would eat red-red. And who knows, tonight might be the last time I would not have power nor water (power of positive thinking). And pretty soon I will say, today was the last time I rode a trotro.

Today for the second time I played doctor to the children at the orphanage. It was refreshing to talk to teenagers and tweenagers this time around, because they could talk and tell me if they had health concerns. My favorite was a 15 year old boy whose concern was not being able to wake up at the time he wanted. He said he would like to wake up at 4am but has difficulty doing so and wakes up 1 or 2 hours later. I asked why he would want to wake up at such an hour, and he said it was ‘for learning.’ He puts me to shame, this boy. It must have been at least 7 years since I last woke up early in the morning to study. The closest I have come to this is staying awake during a night call to study. I don’t think it counts, because with this you don’t rouse yourself from one of human’s most satisfying delights. You just stay awake; you do not awaken yourself. It turns out that he sleeps late at night (10pm). I explained that his body needs at least 8 hours of sleep each night and that waking up at 6 when he slept at 10 is just his body’s way of saying --- I am the boss, listen to me let me sleep.  I then asked him if he was good in class (I hoped he was, to give justice to his efforts) and he said yes. His classmates corroborated this. He said he would like to be a medical doctor when he grows up. I chuckled and said he was starting early; indeed, I said, doctors are sleep-deprived.  He apparently is the top in his class, but he did say that he and his friend compete with one another so that sometimes he is second to him. He said it so lightly, I had the feeling that for him learning is a fountain of fun and play.

Another favorite is a 16 year-old girl who was complaining of having menstrual cramps. I asked her what she takes when she has it and she said, ‘banku.’ (mashed cassava and corn)

Again I was amazed at how nice their teeth were! None of them had bad teeth. None. Like I said I think it is because they don’t eat candies nor drink a lot of soda here. Though their diet is carb-heavy they themselves are not heavy. Today was the first time I saw an obese teenager. He stood out. It took every ounce of my will not to stare at him.

With Joyce (nurse), Uncle Joe, Mama Emma, Uncle Anes

Ordinarily in the States I would talk about sex with my teenage patients. Here though it seems odd and out of place to do so. They all seem so unadulterated. As an example, our helpers reportedly asked one of the girls if you can get pregnant by swallowing sperm. They also wanted to know what the color and taste of it was. I think this might have been when they read parts of Fifty Shades of Grey that one of the girls brought here before.  I don’t know if they also asked about S&M stuff, which I think the book is heavy on.  If they did, it would be like getting a PhD before getting your high school diploma.

Condoms here are referred to as romantics. I think this name is too presumptuous. It assumes that all sex are motivated by romance.  But at any rate, can you imagine summoning a romantic in the middle of sex? Saying it is too long and tedious. I wonder if it’s one reason why condom use is not common here. I remember one female patient with HIV whom I spoke with. She confessed that she had not informed her partner yet about her HIV status (can you imagine; it is almost criminal to withhold such a thing).  Initially she said they always used condoms. Finding this hard to believe (I know that patients lie. I know the fail rate of condom use), I quizzed her again and again. Later she admitted that maybe sometimes they didn’t. It makes my head spin, how people can be so stupid and imprudent.

___

Unbeknownst to me until tonight, the Azonto is a dance style that Ghanaians have popularized. It involves a twisting movement of your feet and legs while gyrating your hips. In the meantime, your upper body remains free to rave in different combinations; sky’s the limit. My favorite one at the moment is the Azonto style they rendered on ‘Chop my Money,’ Akon and P-square’s hit and hip single that is so catchy everyone here’s into it.   So tonight to while the time away I asked J to teach me the steps. J is the girl who lives with us and whom F sends to school. And so in the darkness of power outage, the two of us were dancing in our front porch to the music blaring from P’s cellphone. I tried hard, but in the end I felt like a white dork next to J who looked very cool.

By now I think you might have sensed how I have hearted Ghana already. Ghana, the land of trotros, Azonto, romantics and plantains; of peace, easy brotherhood and religiosity; of haggling and colorful fabrics; of beautiful smiles and straight spines.

It will be difficult to leave.

  

Doctor for Kids

October 29, 2012

Kasoa

Having finished my hospital work last Friday, I have this week free to do other types of medical volunteer work.

And today I played doctor for kids.

The location was at Country Side Orphanage, no doubt the best orphanage I have been to in Ghana. It is located on a 28-acre property, bordered by lush virgin forests and run by well-hearted individuals (Mama Emma and Uncle Joe, and another Uncle Anes) for whom I have high respect and admiration. It has dormitories (clean, non-cramped), classrooms, kitchen, wash area, library (well-stocked, quiet, conducive to learning) and best of all—a health center with a good stock of essential medicines and equipment as well as 3 big beds where sick kids can take their respite. This alone beats the HIV (non)unit at Ga-South Hospital where I worked. My next favorite place was the animal farm where all profit goes to the orphanage. It had a poultry, a piggery, a goatery (? Haha, I don’t know how you call it), peacockery (?) and a tilapia pond. Though I’m not a fan of four-legged animals, I must admit that I found everything charming. Including the pigs. I enjoyed observing the different animal behaviors: how the peacocks ‘gackak’ the moment you direct sound to them (almost like mirroring); how the lambs just herd together—walking in one direction, turning their heads at the same time and gazing at the same aim; and how the pigs just act like pigs—smelly and pink, gross and fat. Oh the piglets were so cute with their curly tails!

Pig tails!

Look at them gaze in one direction

The tilapia pond

After touring the facility, Uncle Anes helped me settle down in the community gazebo. This was where I was going to play doctor to toddlers. It was adorable how they were lined up so neatly on the benches. None of them with a mom. Aww, I thought, my little patients!

Look how good my little patients are seated

My mini patients waiting for their turn

With all the shrieking, I had to close my eyes to shut out the noise

I was going to see only the toddlers, but the next thing I knew older children started lining up too. I don’t know how many I actually saw, because at some point my scriber left. It was at least 40. 40 in 2.5 hours. See how much a doctor can do without the burden of documentation? It was awesome.

I was expecting to see a lot of skin infections, scabies and maybe even lice. I only saw 2 serious tinea capitis (fungal infection on the head) cases, 1 contact dermatitis and maybe 5 or 6 hyperkeratoses of the extensors. I listened closely to the ones who were having runny nose and were coughing, making sure they didn’t have some crackly sound in their lungs to suggest something more serious. Clear lungs all.

I mean sure they had big bellies and were generally small for their age -- an effect of micronutrient deficiencies and playing chronic hosts to parasites—but they were pretty healthy. Even their teeth were white and surprisingly free of caries. I thought they had better teeth than the kids I have seen in the States. I think it is because Ghanaians do not have a sweet tooth. Meaning, they drink less soda and eat less candies.

As I would examine their genitals, those who were either waiting for their turns or had their turns already would mill around and above me, hoping to get a glimpse of their friends’ privates and then giggling and shrieking endlessly when they did. I don’t remember as a child getting at all excited about seeing my playmates’ things. I think maybe bathing with my brother (which I did until both of us started to be aware of our differences) was enough to desensitize me to the mystery of the pototoy. And then of course I had my own, which enough said, bored me already. But I guess it can be funny watching your playmates and friends look uncomfortably self-conscious. Until it is your turn and then it isn’t funny anymore. When the older boys started to take their turns, they asked me to tell the girls to go. Of course, the girls stayed. I would have stayed too, especially if those same boys stayed and watched for my turn.  But this is coming from someone who as a child raced on foot and bikes with boys, climbed trees with them and who often came home with fresh wounds. As a young child I would not be outdone.

___

Tomorrow I will again go to the orphanage and see more children. I am excited. Truly, I am Med-Peds through and through!

I love my work. I really do. And I adore the spontaneity and innocence of children--- and the runny noses, boogers, shrieks, clinginess and dirt that come along with them.  

Revelations

October 29 2012

Kasoa

It’s late afternoon. It’s my almost-favorite time of day here in Ghana, when the cool breeze meets and greets the warm afterglow of the sun. I like to sit and lounge at our front porch at this time. Right now there is on my right the young round moon that has risen. I have a feeling it is going to be a bright night. If we lose power tonight, I suspect the moon will radiate enough light to illuminate our street.  I bet you tonight is also a night of brilliant stars.

We do not usually see the sun set from here at our home base, and I think it’s partially because we do not seek it. Living in a city sometimes makes you think less of these ‘usual’ revelations of nature. And although Kasoa is not as big as Accra, it is still riddled with the price of city living: traffic, noise, dust. Distractions. Today though I did see a glimpse of the sunset when I went to examine the patch of land that is now teeming with plants of cabbage and yam, where W only a couple of weeks ago planted their seeds. I didn’t see the half arc of the orange sun as it was sinking, but I saw a suggestion of its descent: the silhouette of an unfinished building with stairs that led aimlessly to an unsupported landing. With the sun behind it, the contours of the building stood out more—as an unfinished structure.

Unfinished. It strikes me now why I chose this word. In describing the building, am I also describing our selves here? Am I describing myself and how, even with the tiny revolutions that have taken place within me since I got here, that I am still unfinished? The thought relieves me, because in the state that I am in I would be aghast if I were already finished, and if all my questions were already answered. We each have our own stories here— where we came from, why we came to Ghana, the things we know about ourselves, and the many more things we don’t know and what comes after Ghana. None of us know for certain: L may or may not go to Tanzania and who knows what after that; Lu does not know what to do after Ghana and Australia; what he knows for certain is that his previous job was just a job and it was time to move on (I have to applaud him for his daring); U will go back to school but is unsure of what she will end up doing, And I?  At my core I think I know what to do and it is more a question of gathering courage to do it than being certain.

___

Today, M, a new volunteer arrived. F said she is older than any of us (how refreshing for me, who until now had been the oldest in this household).  Before she arrived, we were all curious about her--- what does she do? How old is she? Where is she volunteering? Will she keep to herself? Is she fun? Questions that I am pretty sure U and L also asked before I came. I didn’t want to share my room (I am territorial this way), especially with all of my things strewn all over. But when F asked if I could share the room, I said yes. What is one to say anyway? Truthfully though I really do not mind it, except for the fact that now I cannot just undress and scatter my mess. I guess it’s to prepare myself to go back to the Filipino house where food, bills and mess are shared among four. In the meantime our questions about M are still unanswered. She has been sleeping since the time she arrived. I think it’s jet lag.

P, though she has not met M yet, has been worried about her since dinnertime. She has asked us countless times now why M has not awakened yet, and if she’s not hungry. ‘But she must eat!’ I asked P if she wakes up at night because she is hungry. She said no. I offered the analogy, but it left an impression for only 2 minutes and it was again back to her ‘but she must eat!’ In the end, to abate P’s worry I composed a note to M saying:

‘M—P is worried that you might feel hungry when you wake up. Your dinner is on the kitchen table. It is yam and cabbage stew. It is very good. There is also pineapple in the fridge. It is on a plate. It is all for you. P hopes you eat. By the way, P is one of our cooks. You will meet her tomorrow. 

                                                                                                -Ross and Una
                                                                                               -Portia                                                                               
P.S. (I add this when P hands over a bag of water to me)
This water is for you. This is how we drink water here. There is more in our room. Feel free to take some. 

P seemed happy with this note, but then she started to worry about M not seeing it if the power would go out. Exasperated, U suggested to her that if she wanted she could keep a vigil by the dining table and wait for M to wake up. I added that should power go out, that she should shine a light on her face using my torchlight. You know, just to be sure M sees her.

The only thing I have said today to M was hello I’m Ross, because I and U had to go back to the hospital. Last night as we were leaving Aburi, U started to feel symptoms I thought were very suspicious for malaria. When she had the fever last night and again this morning, there was no question about it: all my plans for today (which included meeting up two acquaintances in Accra and going to Church for the first time this month) would have to be put on hold especially since everyone was going to Church.

The first hospital we went to was Kasoa Health Centre. It was a government hospital with a system that was similar to Ga-South, where I have been working. So first U had to buy a folder for registration. What’s peculiar about the folder was that on the first page, most of the spaces were left blank save for U’s name and age and her religion which the clerk assumed was Christian --- the clerk didn’t bother with U’s contact info, emergency contact person, status and insurance. The second step was to pay for the consult fee. The third step was where it gets cloudy: one sits down on one of the benches outside to wait for BP/Temp/HR screening; there is no specified order – there is no one who calls your name, there is no number to track. Patients have to keep track of their place in the sequence by themselves. Once you succeed in this step, then you queue to be seen by a doctor (though in U’s case there was no doctor). If lab work is ordered, then you go to the lab (in U’s case there was lab work ordered but no lab service available). If medicine is ordered, then you go to the pharmacy (in U’s case the medicine was not available).

Because neither the doctor nor the lab was available, we decided to walk to the private hospital nearby. It was not much better. Doctor was not in yet, and so was the lab technician. We were told to come back 3 hours later, when the lab tech was expected to be in. Ayayay.

Anyway, U’s blood smear did not show evidence for malaria but as a precautionary measure she is getting treatment for it. This of course makes me paranoid--- though I dislike putting on that darned spray, I have been applying it liberally nevertheless. Just in case. I counted my malaria pills tonight and realized that I missed one pill. It should not kill me. Again, like I said--- doctors make the worst patients!

__

Yesterday, three of us (U, Lu and I) went to Aburi. It is a hilly town in the Eastern Region just one hour from Accra. We got there by taking a tro-tro from Tema Station. On the way we rode with other obronis, all of them girls. U and I suspected that they have not been in Ghana for long, judging from how they hesitated to go into the tro-tro and took time to decide where exactly to seat themselves.

Aburi has two popular spots (and by ‘spot’ I don’t mean bar, like how they mean it here): the Aburi Botanical Garden and the Rita Marley Foundation/Studio 1. Unknown to us, the gift shop of the RMF was brought down by fire several months ago and is now closed. This brought down the spirits of Lu, who is a staunch fan of Rita Marley’s deceased husband, the ever famous and influential Bob.

The Aburi Botanical Garden has impressive flora. Upon entering the compound (5 cedis for Non-Ghanaian adults), you will see a line of tall trees standing straight along the main walkway. There were at least a hundred more trees and plants that looked foreign and interesting, but of course I didn’t bother to know their names (I never liked botany). It was enough for me to look at them from afar and appreciate their beauty.

After eating lunch we rented mountain bikes from Ghana Bikes, a company that rents out bikes and offers different tours in Aburi (and beyond). They also offer hiking. It is located very near the South entrance of the garden. We almost missed it had we not seen their sign. There was no discernible store where the sign was. Apparently the store is on the second floor of the house next to the sign. It was being manned by I think, a husband and wife (and child) team. They do not own the store however.

Since it was already past 2pm, we decided to take a short route with reasonable terrain. We all declined to wear helmets, a decision I would somehow later on regret as we were going down almost-vertical roads and seriously rocky tracks. I and U barely managed to bike the terrain. I think half of the time (I am exaggerating) we just carried our bikes until the ground was more flat and ergo, manageably safe. When we reached a swamp we left our bikes. There was a small bridge that we all  were able to luckily traverse without falling. On the other side were cocoa trees. Our guide, who all this time was wearing black pants, black shirt with gray vest (totally appropriate for the weather and the occasion), reached for a semi-ripe cocoa and opened it for us to see. It opened up like a lobster. The meat was white. It almost tasted like guyabano, nothing like the chocolatey taste I have come to know and become addicted to. Whoever thought of making sweets out of cocoa was genius. I suspect it was borne out of accident though, as most discoveries are.

Our well-dressed guide

Cocoa

Stopping at a village

The track we used on the way back was more manageable than the one we took coming. We had to go through a small river crossing with our bikes and thankfully my Vibrams held steady. Some leaves would often get stuck in between the toes of my Vibrams though. By the time we reached the road, all of us were drenching in sweat and screaming in thirst. I wanted to pour the cold water all over myself, but instead I just drank it with so much greed. After this stop we had to power through the almost-vertical road again. On the first part I carried my bike up (no shame in that), but on the second part I was able to gather up enough will, muscle and lung power to bike up, catch up with Ludo and go past him. The reward was looking back at how far we have come. And of course the freshly cut pineapple prepared for us by the storekeeper at the end of our trip was another reward.

The queue for the Accra-bound tro-tro was long and it took us almost half an hour, maybe more, before we found ourselves in front of the line. Being in front of the line didn’t matter, because when our tro-tro came the people behind us muscled their way through and went ahead of us anyway. The conductor directed me to go to the front seat. As I was hoisting myself up and Ludo was getting ready to follow me, a man told us, ‘only one!’ My eyebrows shot up. Tired of all the s***^, I said no, there’s two of us and we were first, so we take this seat. Argh. We should not have to do that. But again, when in Rome you do as the Romans do! That is how you survive.

When our driver crashed our tro-tro against a cab that was parked in front of us, I was not surprised. The way that he impatiently careened in and out of traffic and honked at other cars, it was bound to happen. So first hand we were witness to how a Ghanaian car accident is settled: it’s almost comical. First our driver goes down angry, shouts at the cab driver for being parked improperly. Then the cab driver shouts back (if you ask me, our driver was at fault). Then our driver gets something (a bottle and a towel) from the tro-tro and then starts wiping the cab’s damages (really? You could wipe off a rear light crack?). Our conductor comes around the tro-tro and opens the driver’s door. At this point both L and I thought he was going to start driving the tro-tro as a compassionate gesture, but instead this is what he does: he changes the radio station. L and I started bawling with laughter--- surely, changing the radio station was the most important thing to do in the scheme of things!

__

We did lose power tonight, and I was right: it turned out to be a bright night with a full moon in the company of brilliant stars against a dark velvet sky. In the company of the giggly Kasoa family, this was perfection.