We really are the only white people around. I think in the entire time I've been here, I've only seen two other white people, and they were at the tourist spot - the waterfall. I saw one Asian man, as well. He was just driving down the street.
It seems weird to me how racially homogeneous Ghana is, but there just aren't people here who aren't African. In the US, you have people from everywhere and different colors are common. In Ghana, if you aren't black, you are out of place.
We have had two different types of responses to our presence. In the city, taxis honk at us and men holler after us "I want you to be my wife!" in a way that I can't tell if it's taunting or sincere. I can't tell if the city men think we are beautiful, or just plain silly. And, of course, I really don't appreciate the hollering either way.
In the rural villages, the response is very different. People just stare. Pretty much every person you meet on the street follows you with his or her eyes until you pass. Everyone wants to say "good morning" to you - often the only English they know. But the most striking response we have had is from the beautiful Ghanaian children. Everywhere we go, we acquire a massive following of small children. They are just fascinated by us. They go crazy with blushing and smiling if you wave at them, and if you learn a few words of Twi or Ewe to say to them, like "memahmooasi" which means "good morning" in Twi, or "indi" which means "good morning" in Ewe, they get so excited! I've taken so many pictures of adorable masses of children, because they also love cameras. If you show them your camera and take their picture, they LOVE to see the picture you've taken. They laugh and smile until you can't help but laugh too! Even when we work our clinics at local churches, so many children commune to sit by the doors and just watch us. Sometimes our clinics can last all day, from 8:30 AM to 5 PM, and the children stay the whole time. They just watch, fascinated. They don't get bored, they don't talk too loudly, and they don't interfere until you address them first. They just watch. It was a bit eerie at first, but now it's just cool. And even thought I've found that many of the children know no English, a smile can go so far with a child. Smiling and waving can just make them giggle and giggle and giggle. Plus, at one place where we worked, the children were so excited to help us move all the chairs back after we had finished. They sprang up and ran to be helpful. Then they loved it when we shook their hands and said "akpe" or "thank you."
Another thing about Ghanaians that has really struck me is the sheer beauty of the women. Every Ghanaian woman wears some kind of dress or skirt made of beautifully colorful patterned cloth. The little girls have their ears pierced and wear beautiful cloth as well. The women are simply elegant. They have perfect skin and stand up very straight. And many of them have stunning smiles. I can't imagine why the Ghanaian men holler at the white women when they have gorgeous Ghanaian women everywhere who I think are FAR more beautiful.
Another cool thing about the women is how they carry their infants. They use a piece of cloth to put under the baby's bum, and then they tie the around their torsos. Again, here is a pretty good picture of the set-up that I found on the internet: http://farm1.static.flickr.com/155/394136715_9cee5977fe.jpg?v=0. I'm sorry for all the internet pictures, but I think they help me convey some of my thoughts that I'm not articulate enough to paint a mental picture of for you. And although this baby doesn't look very happy, so many of the babies that I've seen are perfectly serene. They seem to be so comfortable against their mothers' warm backs, that they often just snooze. Women are also not afraid to nurse in public. In fact, we have had one or two women nursing while we conducted their eye screenings.
Its hard for me to describe what I think about the Unite for Sight program so far. There are wonderful aspects, and there are aspects that trouble me. In particular, one of my greatest frustrations is the huge problem of the language barrier. Sure, many of these people have a few words of English, and sure I can say hello and count to five in Ewe, but that doesn't mean we can really communicate. I know personally that when I am a patient being cared for, I must know what is being done to me and why, and I must receive constant feedback, or I become very frightened. With these people, I can't imagine that they fully understand what many of us are trying to tell them, and the reasons that they are receiving glasses and medication are a mystery to many of them. We only have one guy on our team who speaks Ewe, and he doesn't have the time to explain every malady and every medication to the people because we are often so swamped that we don't have time to see everyone as it is! Although I think it's amazing that we are able to give these people eye glasses, medication, and surgeries, I am so worried that we are not telling them enough.
In terms of what this means for my views on medicine, I realize that I need to become fluent in Spanish. Right now, I am competent, but I want to be fluent. If I am going to be an effective doctor in the States, I need to be able to communicate with all my patients, not to the exclusion of the large Latino populations in so many cities. Being able to speak the same language as your patients seems invaluable, and it hurts me to not be able to give many of the people we see here the feedback they deserve.
Okay, okay. Again, I grow verbose. Of course I'll have more to write later, but perhaps I should spare you the trials of reading every single though that comes to my mind. I head out to Tema tonight to stay for a week. Tema is about an hour from Accra, and I don't know if there will be internet available, so perhaps you will be spared my rantings for another week. We'll see :)
Sunday, June 28, 2009
Tourism!
Okay, so I can't just be working all the time. It's about time I told about the one touristy thing I've done so far, and about the prospect of another touristy adventure.
On Thursday of our visit to Jasikan, we had a very slow outreach day. We showed up around 8:30, and there were only about 50 people convened in the church where we were going to host the screenings. Considering that we've done more than 150 on some days, 50 seemed tiny! We were able to close the clinic at noon when there were no people left, and then we decided to drive to Hohoe and see the tallest waterfall in West Africa.
The drive was about 2 hours, but it was SO worth it. We met a tour guide when we got there, and he took us on a 45 minute hike up the side of the mountain. One the hike, he stopped to show us cocoa that was growing along the path. Later, he stopped us to show us a coffee tree as well. He also pointed out the edible little white mushrooms along the ground. We went over 9 different footbridges across the river on our way to the falls, and then, we were suddenly there! The falls were . . . the only word that really works is majestic. I took a few pictures with my camera, but I don't know how to put them on my computer, so I've found an adequate picture of the falls online. They look like this: http://image40.webshots.com/41/1/20/57/2830120570067495964bUyVCe_fs.jpg. We were allowed to wade in the water at the base, and we could just feel the forceful spray of the water that had fallen so far down the mountainside. In fact, in this picture, you can see a tiny little person standing right where we stood. It was AMAZING.
As we were leaving, our tour guide told us that some people come to the falls to do a three hour trek up to the top of the falls, where they camp for the night, and then hike back down the next day. He said that when you get to the top, you are no longer in Ghana, but in the neighboring country of Togo! And not only that, but near the top of the falls is a village of people who speak French, the national language of Togo. Usually, the guide said, people who hike up the mountain are greeted very enthusiastically by the people of the village, and they invite the hikers to celebrate with them all night. So, of course, a few of us are dead set on doing this. We all just need to coordinate a way to drive us up to Hohoe, 4 hours away, and get back the next day. We'll figure it out, and we'll go. We must!!!
On Thursday of our visit to Jasikan, we had a very slow outreach day. We showed up around 8:30, and there were only about 50 people convened in the church where we were going to host the screenings. Considering that we've done more than 150 on some days, 50 seemed tiny! We were able to close the clinic at noon when there were no people left, and then we decided to drive to Hohoe and see the tallest waterfall in West Africa.
The drive was about 2 hours, but it was SO worth it. We met a tour guide when we got there, and he took us on a 45 minute hike up the side of the mountain. One the hike, he stopped to show us cocoa that was growing along the path. Later, he stopped us to show us a coffee tree as well. He also pointed out the edible little white mushrooms along the ground. We went over 9 different footbridges across the river on our way to the falls, and then, we were suddenly there! The falls were . . . the only word that really works is majestic. I took a few pictures with my camera, but I don't know how to put them on my computer, so I've found an adequate picture of the falls online. They look like this: http://image40.webshots.com/41/1/20/57/2830120570067495964bUyVCe_fs.jpg. We were allowed to wade in the water at the base, and we could just feel the forceful spray of the water that had fallen so far down the mountainside. In fact, in this picture, you can see a tiny little person standing right where we stood. It was AMAZING.
As we were leaving, our tour guide told us that some people come to the falls to do a three hour trek up to the top of the falls, where they camp for the night, and then hike back down the next day. He said that when you get to the top, you are no longer in Ghana, but in the neighboring country of Togo! And not only that, but near the top of the falls is a village of people who speak French, the national language of Togo. Usually, the guide said, people who hike up the mountain are greeted very enthusiastically by the people of the village, and they invite the hikers to celebrate with them all night. So, of course, a few of us are dead set on doing this. We all just need to coordinate a way to drive us up to Hohoe, 4 hours away, and get back the next day. We'll figure it out, and we'll go. We must!!!
Jasikan
As I mentioned before, I was incommunicado for a few days because I went on an overnight outreach to the village of Jasikan. Getting to Jasikan takes about 5 hours through the pothole-ridden muddy streets of rural Ghana, so in order to see patients in that region, we had to stay there overnight. Just to give you some idea of where everything is that I'm talking about, here's a map of Ghana: http://www.web-translations.com/resources/country_guides/Ghana/map_of_ghana.gif. The primary location were Unite for Sight is stationed is in Accra, where the star is. Then, the Jasikan region is on the far East side, along the border of Togo, and near the indicated mountain. Tomorrow, I am going to go live in Tema, near Accra, for a week. Then, after that I will spend two weeks in Kumasi, which is about 5 hours northwest of Accra.
But I digress. This week, we were in Jasikan. We arrived on Tuesday, worked outreaches on Wednesday, Thursday, Friday, and Saturday, and drove back to Accra on Saturday night. This meant that we spent a lot of time driving in our van. We mostly tried to sleep, told riddles, read, chatted, or listened to Ghanaian reggae. One girl on the trip, Barclay, had bought a CD of Ghanaian reggae, and most of it was great! Some of it got really angry and political and there were songs about "shame on the politicians," "the great sins against the black man done by Satan's disciples," and "abortions bring FIRE, FIRE FIRE FIRE!!!" When the crazy rasta man started screaming about fire, we were all pretty surprised. Some of the reggae was just laid back and happy, though. We listened to that album on repeat a lot. Plus, sometimes we caught some American music on the radio. We heard some Backstreet Boys, Vanessa Carlton, and Michael Jackson (en memoriam I suppose). We also listened to crazy Ghanaian radio announcers who try to talk above loud music and end up being pretty much unintelligible. It was fun.
During one particularly long drive, I was trying really hard to sleep, but was way too uncomfortable. But then, a miracle was sent. We passed by a pillow vendor! Along the road, a woman was selling pillows she had made for 2 Cedi, so we all bought big pillows. And the best part of all - my pillow is covered in pictures of Pokemon! Everyone else just has pretty patterns, but I have Polywrath. I'd say I win :)
Okay, well the Jasikan region was much more rural than Accra. In Accra, there are gas stations, many cars, tons of people, and a good amount of commercial business. In the Jasikan region, there is almost nothing in terms of technology. No TVs, no internet anywhere, no AC. People live very simply, and everything is very very inexpensive.
We stayed at the local Catholic Diocese of Jasikan for about 4 USD a night per person. Our rooms were full full full of bugs - moths, ants, mosquitos (don't worry, I have malaria medication), geckos, and of course HUGE SPIDERS. Good god. HUGE. FREAKING. SPIDERS. One night, I got up to go use the hole in the ground, and saw a spider about 2 inches in diameter near the sink. Of course, I couldn't squash it, and the other girls were asleep, so I just crawled back into bed. I couldn't sleep a wink that night for fear that that damn thing was just going to leap into bed with me. I never found it again even though we were there for 3 more days. *Shudder*
In Jasikan, much like in Accra, chickens, dogs, and goats are free to roam. Our car has to dodge a number of goats on every drive, and we are woken up by stray roosters every darn morning. I don't know why there seem to be so many stray goats and chickens, because these are valuable animals! I asked someone in Accra how people know who the animals belong to, and he told me that all the animals know to go home at night. They graze around the city by day, but go home to their owners to sleep. I don't know how that could possibly be true, but it's what he said. Meh.
I'm also happy to see that there are a few more traditional Ghanaian dishes other than the classic rice and chicken combo. A few things that are prominent and delicious are banku, fufu, watche, and goat meat kabobs.
The goat meat kabobs don't need much explaining. You can buy a skewer of meat at a street vendor for 50 Gd (about 30 cents). Although, I learned the hard way that you have to ask for "meat" and not "the parts." The first time we had goat meat, it was very tender and delicious, but the second time it was chewy and flavorless. Our driver Bismarck told us that was because we had gotten the lower quality kabobs the second time - they were mostly fat and pieces of organs. Blech! And I had eaten all of it!
Watche is a yummy dish that is only served in the morning, and it's spicy and made of beans and a delicious sauce. You eat it with your hands. Only your right hand, though, to not offend anyone.
Banku is very interesting. The jury is still out on whether I like it or not. It's a two-part dish. One part is like the consistency of silly-puddy and is made of corn meal and cassava leaves. The mixture has been fermented and crushed until it's doughy. Then you dip the fermented dough into a soup made of fish or chicken. The dough is sour from the fermentation. This is another dish you eat with you hands, so you have to be pretty careful not to make a huge mess.
Fufu is very similar to banku, only it is made with crushed plantains and cassava leaves. And it isn't fermented, so the dough isn't sour. I think I like fufu better then banku :)
Okay, this post is getting long, so I'm going to munch on some leftover rice. I'll be back.
But I digress. This week, we were in Jasikan. We arrived on Tuesday, worked outreaches on Wednesday, Thursday, Friday, and Saturday, and drove back to Accra on Saturday night. This meant that we spent a lot of time driving in our van. We mostly tried to sleep, told riddles, read, chatted, or listened to Ghanaian reggae. One girl on the trip, Barclay, had bought a CD of Ghanaian reggae, and most of it was great! Some of it got really angry and political and there were songs about "shame on the politicians," "the great sins against the black man done by Satan's disciples," and "abortions bring FIRE, FIRE FIRE FIRE!!!" When the crazy rasta man started screaming about fire, we were all pretty surprised. Some of the reggae was just laid back and happy, though. We listened to that album on repeat a lot. Plus, sometimes we caught some American music on the radio. We heard some Backstreet Boys, Vanessa Carlton, and Michael Jackson (en memoriam I suppose). We also listened to crazy Ghanaian radio announcers who try to talk above loud music and end up being pretty much unintelligible. It was fun.
During one particularly long drive, I was trying really hard to sleep, but was way too uncomfortable. But then, a miracle was sent. We passed by a pillow vendor! Along the road, a woman was selling pillows she had made for 2 Cedi, so we all bought big pillows. And the best part of all - my pillow is covered in pictures of Pokemon! Everyone else just has pretty patterns, but I have Polywrath. I'd say I win :)
Okay, well the Jasikan region was much more rural than Accra. In Accra, there are gas stations, many cars, tons of people, and a good amount of commercial business. In the Jasikan region, there is almost nothing in terms of technology. No TVs, no internet anywhere, no AC. People live very simply, and everything is very very inexpensive.
We stayed at the local Catholic Diocese of Jasikan for about 4 USD a night per person. Our rooms were full full full of bugs - moths, ants, mosquitos (don't worry, I have malaria medication), geckos, and of course HUGE SPIDERS. Good god. HUGE. FREAKING. SPIDERS. One night, I got up to go use the hole in the ground, and saw a spider about 2 inches in diameter near the sink. Of course, I couldn't squash it, and the other girls were asleep, so I just crawled back into bed. I couldn't sleep a wink that night for fear that that damn thing was just going to leap into bed with me. I never found it again even though we were there for 3 more days. *Shudder*
In Jasikan, much like in Accra, chickens, dogs, and goats are free to roam. Our car has to dodge a number of goats on every drive, and we are woken up by stray roosters every darn morning. I don't know why there seem to be so many stray goats and chickens, because these are valuable animals! I asked someone in Accra how people know who the animals belong to, and he told me that all the animals know to go home at night. They graze around the city by day, but go home to their owners to sleep. I don't know how that could possibly be true, but it's what he said. Meh.
I'm also happy to see that there are a few more traditional Ghanaian dishes other than the classic rice and chicken combo. A few things that are prominent and delicious are banku, fufu, watche, and goat meat kabobs.
The goat meat kabobs don't need much explaining. You can buy a skewer of meat at a street vendor for 50 Gd (about 30 cents). Although, I learned the hard way that you have to ask for "meat" and not "the parts." The first time we had goat meat, it was very tender and delicious, but the second time it was chewy and flavorless. Our driver Bismarck told us that was because we had gotten the lower quality kabobs the second time - they were mostly fat and pieces of organs. Blech! And I had eaten all of it!
Watche is a yummy dish that is only served in the morning, and it's spicy and made of beans and a delicious sauce. You eat it with your hands. Only your right hand, though, to not offend anyone.
Banku is very interesting. The jury is still out on whether I like it or not. It's a two-part dish. One part is like the consistency of silly-puddy and is made of corn meal and cassava leaves. The mixture has been fermented and crushed until it's doughy. Then you dip the fermented dough into a soup made of fish or chicken. The dough is sour from the fermentation. This is another dish you eat with you hands, so you have to be pretty careful not to make a huge mess.
Fufu is very similar to banku, only it is made with crushed plantains and cassava leaves. And it isn't fermented, so the dough isn't sour. I think I like fufu better then banku :)
Okay, this post is getting long, so I'm going to munch on some leftover rice. I'll be back.
Mass
At 7:30 this morning, we caught a crazy taxi and drove over to Our Lady of Assumption Catholic church in Accra. It was the most beautiful building I've seen so far - okay, it's in a close tie with the hotel Villagio near the Accra Mall which is where I hear President Obama will be staying when he comes to Accra on July 11. But still, the church is surrounded by dirt roads and extremely modest houses, but it has beautiful stained glass windows! Plus, everyone wears his or her best clothes to church, so everyone looks very glamorous. In fact, many of the people in the congregation who are members of different church organizations have a shirt or a dress made of fabric that has a pattern saying the name of the organization! The organization gives them the fabric, and then they have it made into any piece of clothing to wear.
It's amazing how halfway across the globe, there are just so many things about a Catholic service that never change. Two of the other volunteers who went to church with me were Catholic, and they knew exactly what to say when and where. It was pretty cool!
This Catholic church was slightly spicier than I'm used to, though :) Their choir was SO GOOD, and I read in the program that they had about 8 different choirs, and this one wasn't even the most prestigious. Plus, accompanying the choir were a few marvelous drummers! The choir would sway and belt, and the drummers would beat those drums to death. During the offertory, people would dance up the aisles to put a few Cedi in the pot. Then, after the conventional offertory, they had a REAL offering. Many many people had brought food, and they processed up the aisles to put bread, and eggs, and bananas, and any other food they could make up to the alter. One of the other volunteers thought that the food would later be donated to charity.
Finally, near the end of the service, they asked for people with birthdays and anniversaries to come to the front and be blessed. Then the choir sang a beautiful arrangement of the birthday song! The Father then came over the small children with the microphone and asked them how old they were turning. The kids loved it, and they were so so cute!
Weirdly enough, we also ran into Robert, the ophthalmic nurse I've been working with all week, at church. It was a cool surprise! I'm definitely going back to church next Sunday :)
It's amazing how halfway across the globe, there are just so many things about a Catholic service that never change. Two of the other volunteers who went to church with me were Catholic, and they knew exactly what to say when and where. It was pretty cool!
This Catholic church was slightly spicier than I'm used to, though :) Their choir was SO GOOD, and I read in the program that they had about 8 different choirs, and this one wasn't even the most prestigious. Plus, accompanying the choir were a few marvelous drummers! The choir would sway and belt, and the drummers would beat those drums to death. During the offertory, people would dance up the aisles to put a few Cedi in the pot. Then, after the conventional offertory, they had a REAL offering. Many many people had brought food, and they processed up the aisles to put bread, and eggs, and bananas, and any other food they could make up to the alter. One of the other volunteers thought that the food would later be donated to charity.
Finally, near the end of the service, they asked for people with birthdays and anniversaries to come to the front and be blessed. Then the choir sang a beautiful arrangement of the birthday song! The Father then came over the small children with the microphone and asked them how old they were turning. The kids loved it, and they were so so cute!
Weirdly enough, we also ran into Robert, the ophthalmic nurse I've been working with all week, at church. It was a cool surprise! I'm definitely going back to church next Sunday :)
Good Hygiene
I just stepped out of the shower. Of course, another trickle of cold water. And this shower was my third shower since I've been in Ghana (a week and one day). I bet you can guess how good I smelled before I washed off :) On top of that, I realized a few days ago that if I want to have clean clothes, I'm going to have to hand wash them in the sink or the shower! Sooooo, I've been wearing dirty dirty clothes a lot. Pretty much any clothes are fair game as long as they don't look dirty. That means that I've probably worn some of my dark articles of clothes for at least three full days each, and they are getting to smell rank. Things get dirty quickly here because, well, the environment is dirty! We spend all day working in churches with dirt floors, walking around on dirt streets, and sweating like dogs. I have never been quite so unclean in my life, but since everyone else is gross too, it's not really so bad. That doesn't mean it doesn't feel glorious to be clean right now, though!
I also haven't been able to brush my teeth for a day or two because I ran out of water! Of course, the local water is un-drinkable, so we have to go out and buy huge bags of 28 smaller water baggies. The primary way that people here drink sanitary water is by buying these small 500 mL baggies of sanitary water, biting off the corner of the bag, and sucking the water out. These little plastic baggies are probably the primary piece of trash that you can find on the streets, but overall, people are reasonably good about throwing trash out. "Keep Ghana clean," is what people cry when they see someone litter.
Another interesting thing about litter is how sodas are dispensed. Coke, sprite, and fanta are the common sodas around here, and if you ever buy one of them from a vendor, you are expected to stick around and give the glass bottle back when you are done. They then send the bottle back to be refilled, and so glass bottles are recycled perfectly! It's a pretty cool idea, and encourages you to hang around and talk to the store owners while you drink your soda.
Oh yeah, and I've decided to break blog posts down into smaller piece that pertain to different topics! That way I won't just write one giant post today :) As you can tell, this post was about things pertaining to sanitation. Sweeeet. Oooo, and it just started raining outside my window. Ah, a lazy rainy Sunday.
I also haven't been able to brush my teeth for a day or two because I ran out of water! Of course, the local water is un-drinkable, so we have to go out and buy huge bags of 28 smaller water baggies. The primary way that people here drink sanitary water is by buying these small 500 mL baggies of sanitary water, biting off the corner of the bag, and sucking the water out. These little plastic baggies are probably the primary piece of trash that you can find on the streets, but overall, people are reasonably good about throwing trash out. "Keep Ghana clean," is what people cry when they see someone litter.
Another interesting thing about litter is how sodas are dispensed. Coke, sprite, and fanta are the common sodas around here, and if you ever buy one of them from a vendor, you are expected to stick around and give the glass bottle back when you are done. They then send the bottle back to be refilled, and so glass bottles are recycled perfectly! It's a pretty cool idea, and encourages you to hang around and talk to the store owners while you drink your soda.
Oh yeah, and I've decided to break blog posts down into smaller piece that pertain to different topics! That way I won't just write one giant post today :) As you can tell, this post was about things pertaining to sanitation. Sweeeet. Oooo, and it just started raining outside my window. Ah, a lazy rainy Sunday.
Monday, June 22, 2009
First Outreach
Again, my darling father has been asking questions, this time about the weather. Well, we are currently in Ghana during the "rainy season" which lasts from about June to August. It seems like Ghana weather has two options 1 - hot, 2 - hot and rainy. In the sun, the heat is pretty much unbearable, and in the shade, it's a tolerable version of stifling. During our outreach today, it was hot and sunny up until half an hour before we left the village, and then it started to rain. The rain really cooled things down and felt incredibly nice. Also, rainy season doesn't seem to mean that it rains a lot, just that it rains sometimes. I imagine in "non rainy-season," it doesn't really rain at all.
Well, today was my first day on the job, and it was very interesting. We went to a village in the Volta Region, about three hours away, called Wute. Our van left around 9 AM, we were in the village a little before noon, we worked until about 4:30, and we were home around 8. I was warned ahead of time that a good portion of the workday is spent commuting, so I brought a book for the drive. We have to commute a good distance to get out of the city because the city is HUGE and traffic is insane. We probably spent much of the commute time just getting to the outskirts of Accra.
When we arrived in Wute, there were about 90 people sitting outside a small building waiting for us. They had been told we were coming and that if they had any problems with their eyes, they could come to be examined for free. We ended up seeing 84 patients in a little under 4 hours, and I'll try my best to explain how it all went.
Luckily, Jerome, who is a member of our team, spoke the local language called Ewe, so he did the introductory health talk. Since I couldn't understand what he was saying, another volunteer told me that he told the people about common eye conditions, about how to adopt good eye health habits, about the treatability and non-treatabilty of certain conditions, and about the falsity of many of the local myths surrounding eye surgery. It is very very important to dispel fear about surgery so that if some patients are referred for procedures, they actually show up. At this village, one man stood up and asked if it was true that for eye surgery, he must have his eye removed and then returned to its socket. It was so so so important that Jerome help him understand that eye surgery was far less invasive and terrifying than that!
There were six of us on the job in Wute, and we each had an assigned station. Ben ran registration, I did the preliminary visual acuity screening, Robert the ophthalmic nurse did the eye examination along with Andrew, a medical student, and Ashley dispensed eye glasses and medications with Jerome.
First, the patient would sit down with Ben and translator who knew English and Ewe. Ben would speak directly to the patient in English, and the translator would relay Ben's questions. He wrote down the patient's name, age, and chief complaints. It was very interesting to see that many of the patients did not know their ages, but many of them had IDs that told their birthdays, so Ben found himself doing a lot a math.
After the patients were registered, they came to me to get their vision screened. First, I introduced myself to the patients and found out if they could read letters. A good number of the people we saw were illiterate, so instead of using the traditional Snellen's chart we had to use the "tumbling E chart." Both of these can be seen at this link so you know what I'm talking about http://i1.allaboutvision.com/i/eye-charts-358x338.gif. If we used the tumbling E chart, we simply asked them to point in the direction that the tines of the E were pointing. I would progress down the chart until the patient couldn't read the letters, and then I would record their acuity. If the patient could not see the chart at all, I would ask them to count my fingers at progressively closer distance. Acuity could be recorded by the distance at which they could count fingers. If they couldn't count fingers at a distance of one meter, I would simply ask them if they could see my hand waving if I waved it slowly. Finally, if they could not see my hand waving, I would shine a pen light back and forth across the eye to see if they could perceive light. If they could not perceive light, there was a good chance that glaucoma had made the patient completely blind, and the blindness caused by glaucoma is due to damage of the optic nerve and is irreversible.
After the patients saw Ben and then me, they went to be examined by the ophthalmic nurse who would dilate their eyes and diagnose their pathologies. He would determine which prescriptions of glasses, which medications, or which surgical referrals each patient would need. Then he sent each patient to the referral station where they were given free eyeglasses and very inexpensive eye medication. The patients were asked to pay the equivalent of 2 USD for eye medications just to make the medication more valuable to them. Unite for Sight has found in the past that if the medication is given away for free, the people do not think that it will be effective, and they do not use it. Making them pay a small amount for the medicine makes them value it much more. Plus, 2 USD is about all they can afford.
We saw a number of patients today who had one eye in which they had no light perception, and quite a few who could only perceive hand-waving. We saw a congenital cataract in a 4-year-old, a cataract due to trauma in a teenager, and many cataracts in the elderly. There were quite a few people with damage due to glaucoma, and a good many who had simple refractive errors. A disease you've probably never heard of, but that is pretty common in Ghana is pterygium, seen at this link - http://www.eye.com.ph/images/Pterygium1_300.jpg - where tissue grows over the eye and impairs vision. Many patients with pterygium showed up at the outreach today. I think, in total, six patients were referred for surgery, most for cataracts and one for a large growth on the eyelid. Many patients were given eye glasses, sunglasses, or medication.
Then, we drove home. When we got back, it was already dark and four of us went out and bought some spicy steak from a cart on the street. Good food at the end of a good day.
Okay, this is another super-long post, but I figured I would write a lot because from tomorrow to Saturday, I will be away from my computer. Five of us are going to stay over-night in a village called Jasikan to do three days of outreach and one day of sight-seeing at the highest waterfall in Ghana. I'm sure I'll have lots to write about when I get back from that!
Good night!
Well, today was my first day on the job, and it was very interesting. We went to a village in the Volta Region, about three hours away, called Wute. Our van left around 9 AM, we were in the village a little before noon, we worked until about 4:30, and we were home around 8. I was warned ahead of time that a good portion of the workday is spent commuting, so I brought a book for the drive. We have to commute a good distance to get out of the city because the city is HUGE and traffic is insane. We probably spent much of the commute time just getting to the outskirts of Accra.
When we arrived in Wute, there were about 90 people sitting outside a small building waiting for us. They had been told we were coming and that if they had any problems with their eyes, they could come to be examined for free. We ended up seeing 84 patients in a little under 4 hours, and I'll try my best to explain how it all went.
Luckily, Jerome, who is a member of our team, spoke the local language called Ewe, so he did the introductory health talk. Since I couldn't understand what he was saying, another volunteer told me that he told the people about common eye conditions, about how to adopt good eye health habits, about the treatability and non-treatabilty of certain conditions, and about the falsity of many of the local myths surrounding eye surgery. It is very very important to dispel fear about surgery so that if some patients are referred for procedures, they actually show up. At this village, one man stood up and asked if it was true that for eye surgery, he must have his eye removed and then returned to its socket. It was so so so important that Jerome help him understand that eye surgery was far less invasive and terrifying than that!
There were six of us on the job in Wute, and we each had an assigned station. Ben ran registration, I did the preliminary visual acuity screening, Robert the ophthalmic nurse did the eye examination along with Andrew, a medical student, and Ashley dispensed eye glasses and medications with Jerome.
First, the patient would sit down with Ben and translator who knew English and Ewe. Ben would speak directly to the patient in English, and the translator would relay Ben's questions. He wrote down the patient's name, age, and chief complaints. It was very interesting to see that many of the patients did not know their ages, but many of them had IDs that told their birthdays, so Ben found himself doing a lot a math.
After the patients were registered, they came to me to get their vision screened. First, I introduced myself to the patients and found out if they could read letters. A good number of the people we saw were illiterate, so instead of using the traditional Snellen's chart we had to use the "tumbling E chart." Both of these can be seen at this link so you know what I'm talking about http://i1.allaboutvision.com/i/eye-charts-358x338.gif. If we used the tumbling E chart, we simply asked them to point in the direction that the tines of the E were pointing. I would progress down the chart until the patient couldn't read the letters, and then I would record their acuity. If the patient could not see the chart at all, I would ask them to count my fingers at progressively closer distance. Acuity could be recorded by the distance at which they could count fingers. If they couldn't count fingers at a distance of one meter, I would simply ask them if they could see my hand waving if I waved it slowly. Finally, if they could not see my hand waving, I would shine a pen light back and forth across the eye to see if they could perceive light. If they could not perceive light, there was a good chance that glaucoma had made the patient completely blind, and the blindness caused by glaucoma is due to damage of the optic nerve and is irreversible.
After the patients saw Ben and then me, they went to be examined by the ophthalmic nurse who would dilate their eyes and diagnose their pathologies. He would determine which prescriptions of glasses, which medications, or which surgical referrals each patient would need. Then he sent each patient to the referral station where they were given free eyeglasses and very inexpensive eye medication. The patients were asked to pay the equivalent of 2 USD for eye medications just to make the medication more valuable to them. Unite for Sight has found in the past that if the medication is given away for free, the people do not think that it will be effective, and they do not use it. Making them pay a small amount for the medicine makes them value it much more. Plus, 2 USD is about all they can afford.
We saw a number of patients today who had one eye in which they had no light perception, and quite a few who could only perceive hand-waving. We saw a congenital cataract in a 4-year-old, a cataract due to trauma in a teenager, and many cataracts in the elderly. There were quite a few people with damage due to glaucoma, and a good many who had simple refractive errors. A disease you've probably never heard of, but that is pretty common in Ghana is pterygium, seen at this link - http://www.eye.com.ph/images/Pterygium1_300.jpg - where tissue grows over the eye and impairs vision. Many patients with pterygium showed up at the outreach today. I think, in total, six patients were referred for surgery, most for cataracts and one for a large growth on the eyelid. Many patients were given eye glasses, sunglasses, or medication.
Then, we drove home. When we got back, it was already dark and four of us went out and bought some spicy steak from a cart on the street. Good food at the end of a good day.
Okay, this is another super-long post, but I figured I would write a lot because from tomorrow to Saturday, I will be away from my computer. Five of us are going to stay over-night in a village called Jasikan to do three days of outreach and one day of sight-seeing at the highest waterfall in Ghana. I'm sure I'll have lots to write about when I get back from that!
Good night!
Sunday, June 21, 2009
Lazy Evening
Times zones are odd here. I'm not exactly sure why, but it gets dark around 6 PM and light around 4 AM. We are only 4 hours different from Eastern time in the US, but we are aligned with the Prime Meridian which denotes a 6 hour difference in Europe. So . . . that means that it's 8 o'clock and already very dark outside! Weird, but I guess I'm going to get into a schedule of early to bed and early to rise.
My adoring father alerted me to the fact that I misspelled the word "sacrifices" in my last post. I indeed apologise for any future misspellings, but I don't apologise too much because I find spelling pretty irrelevant. I'll run spell-check on everything else from now on.
Sooooo, when I last left you, I was headed off to orientation. At orientation, we learned about our upcoming schedules for the week, reviewed a little bit about what our jobs are going to be (although I really get the sense that we'll learn pretty much everything on the job), and met the Accra area Unite for Sight coordinators. They are very, very cool guys. Robert, Kartee, and Dannis are the three ophthalmic nurses affiliated with Unite for Sight, and Jerome is the coordinator of everything else, like sight-seeing.
We were lazy for most of the day, just exploring the area around the Telecentre. Today is Sunday, and since Ghana is so heavily Christian, Sunday is truly a day of rest. Most shops were closed and lots of people were playing loud music and hanging out on the streets. This meant that we really had to search for places to be open so we could eat at them.
It's funny, but there definitely seems to be a common-denominator in Ghanaian food. For the two meals that I've bought so far, I've odered the exact same thing without even knowing it - Jaloff rice, fried chicken, and pseudo-cole slaw. This seems to be THE standard Ghanaian meal. Good thing that it's good! Jaloff rice is particularly good, since it's fully of savory vegetables and you can often get it with a spicy sauce that makes it taste a bit like Asian rice. I like it, but I hope I can find some other things to eat too :)
Accra, the city where I am staying, is the capital of Ghana. It is quite a city. It's huge, and it's raw. People drive like maniacs down dirty roads, and its amazing that they don't kill all the pedestrians that walk along the sides of the roads. Only main roads are paved, and very near the Telecentre there is a place called ABC Junction, a local landmark. Here, about 5 different roads converge in a dirty lot. Essentially, its a free-for-all for traffic arriving from 5 different directions and the poor pedestrians who want to walk across it. Cars and vans weave around each other and honk, and pedestrians run for their lives!
Women walk around carrying baskets and loads of goods on their heads, and many of them are dressed very beautifully. In fact, much of the traditional dress worn by men and women is gorgeous. We walked past a joyous ceremony today and learned that is was a "one week" celebration, meaning a celebration that happens one week after someone's death. At least 100 people were in attendance and they were wearing gorgeous outfits of only black and white. We learned the the black and white dress indicated the the deceased lived to a ripe old age, and the celebration was joyous to commemorate a long-lived life. However, if someone dies young or dies suddenly, people wear red and black to the ceremony.
Ghana reminds me a bit of Latin America. Every thing is open-air. Loud music is playing from all the little shacks along the sides of the road. Men aren't afraid to hassle you, especially of you are white - "obrunni" is the semi-derogatory word for white people that gets hollered at you. And everything is cheap! I bough about 15 liters of water for less than 1 USD and enough food for lunch and dinner for about 4.50 USD.
Also, although I have a great wireless internet connection here, I think that between June 23-27, I won't have any internet at all. Three other volunteers and I are doing an overnight outreach trip to a rural village called Jasikan, and the chances of internet are very very slim. We are staying overnight at this village because it is very far away (probably 6 hours) and because Unite for Sight's connection with the village is relatively new. I guess I'll just have to write about that when I get back.
Tomorrow should be an exciting day because it's my first day on the job. We are doing a day-long outreach to a village about 3 hours away. We will get picked up around 8:30, arrive in the village after driving all morning, spend about 5 hours seeing patients, and then drive home. I'm going to learn a whole lot tomorrow by simply getting thrown into my job. I'll probably have quite a lot to say tomorrow night.
Okay, this is a pretty long post, so I'll leave you along for now. Hope all is well!
My adoring father alerted me to the fact that I misspelled the word "sacrifices" in my last post. I indeed apologise for any future misspellings, but I don't apologise too much because I find spelling pretty irrelevant. I'll run spell-check on everything else from now on.
Sooooo, when I last left you, I was headed off to orientation. At orientation, we learned about our upcoming schedules for the week, reviewed a little bit about what our jobs are going to be (although I really get the sense that we'll learn pretty much everything on the job), and met the Accra area Unite for Sight coordinators. They are very, very cool guys. Robert, Kartee, and Dannis are the three ophthalmic nurses affiliated with Unite for Sight, and Jerome is the coordinator of everything else, like sight-seeing.
We were lazy for most of the day, just exploring the area around the Telecentre. Today is Sunday, and since Ghana is so heavily Christian, Sunday is truly a day of rest. Most shops were closed and lots of people were playing loud music and hanging out on the streets. This meant that we really had to search for places to be open so we could eat at them.
It's funny, but there definitely seems to be a common-denominator in Ghanaian food. For the two meals that I've bought so far, I've odered the exact same thing without even knowing it - Jaloff rice, fried chicken, and pseudo-cole slaw. This seems to be THE standard Ghanaian meal. Good thing that it's good! Jaloff rice is particularly good, since it's fully of savory vegetables and you can often get it with a spicy sauce that makes it taste a bit like Asian rice. I like it, but I hope I can find some other things to eat too :)
Accra, the city where I am staying, is the capital of Ghana. It is quite a city. It's huge, and it's raw. People drive like maniacs down dirty roads, and its amazing that they don't kill all the pedestrians that walk along the sides of the roads. Only main roads are paved, and very near the Telecentre there is a place called ABC Junction, a local landmark. Here, about 5 different roads converge in a dirty lot. Essentially, its a free-for-all for traffic arriving from 5 different directions and the poor pedestrians who want to walk across it. Cars and vans weave around each other and honk, and pedestrians run for their lives!
Women walk around carrying baskets and loads of goods on their heads, and many of them are dressed very beautifully. In fact, much of the traditional dress worn by men and women is gorgeous. We walked past a joyous ceremony today and learned that is was a "one week" celebration, meaning a celebration that happens one week after someone's death. At least 100 people were in attendance and they were wearing gorgeous outfits of only black and white. We learned the the black and white dress indicated the the deceased lived to a ripe old age, and the celebration was joyous to commemorate a long-lived life. However, if someone dies young or dies suddenly, people wear red and black to the ceremony.
Ghana reminds me a bit of Latin America. Every thing is open-air. Loud music is playing from all the little shacks along the sides of the road. Men aren't afraid to hassle you, especially of you are white - "obrunni" is the semi-derogatory word for white people that gets hollered at you. And everything is cheap! I bough about 15 liters of water for less than 1 USD and enough food for lunch and dinner for about 4.50 USD.
Also, although I have a great wireless internet connection here, I think that between June 23-27, I won't have any internet at all. Three other volunteers and I are doing an overnight outreach trip to a rural village called Jasikan, and the chances of internet are very very slim. We are staying overnight at this village because it is very far away (probably 6 hours) and because Unite for Sight's connection with the village is relatively new. I guess I'll just have to write about that when I get back.
Tomorrow should be an exciting day because it's my first day on the job. We are doing a day-long outreach to a village about 3 hours away. We will get picked up around 8:30, arrive in the village after driving all morning, spend about 5 hours seeing patients, and then drive home. I'm going to learn a whole lot tomorrow by simply getting thrown into my job. I'll probably have quite a lot to say tomorrow night.
Okay, this is a pretty long post, so I'll leave you along for now. Hope all is well!
A True Exercise in Ghanaian Punctuality
So . . . we were told that we had an orientation at 9 AM, and we do. Our guide just hasn't show up yet! It's 10:30, and we are sitting in the lobby of the Telecentre Bed and Breakfast watching very dramatic Ghanaian soap operas.
We were warned ahead of time that Ghana works on a different theory of time than we are used to. In America, we have schedules and things happen at planned times. People are the slaves of the clock. But in Ghana, time is much more flexible and fluid. Deadlines are never exact and it is not considered rude to tell someone you will pick them up "around 9 AM" and not show up until 11. So, here we sit, trying to remind ourselves that our tour guide is not simply being rude. He's just being Ghanaian.
Oh, and today is Father's Day! Daddy told me that he is going to read my blog, so here is shout out the most amazing father anyone could ever have - STEVE ISRAEL! Daddy, I love you so much, and I appreciate all the sacrafices you have made for me and all your hard work to help me succeed. <3 <3 <3 <3
I guess for now I can attempt to describe our accomodations. They are better than I had expected. We are staying at the Telecentre Bed and Breakfast in Accra, Ghana. The city is by far the largest in Ghana. The Telecentre has a bizzare mix of luxuries and deficiencies. For example, we have air conditioning and screens! Air conditioning for goodness sake! And the screen protect us pretty well from mosquitos (although I still slept under my mosquito net like I was advised). Also, one night at the Telecentre, with breakfast included cost 23 Cd, the unit of Ghanaian currency, and one USD is worth 1.44 Cd (at least is was yesterday at the airport, haha). You would never find somewhere this cheap to stay in the US. However, an interesting deficiency in these accomodations is the fact that ever shower we take is in COLD WATER. For the next two months, I will never know the caress of a warm water shower. Plus, the water pressure here is horrible, so a shower is more like standing under a cold trickle. It's actually pretty unpleasant, especially in the air-conditioned room.
Ah! Our guide is here. Bye!
We were warned ahead of time that Ghana works on a different theory of time than we are used to. In America, we have schedules and things happen at planned times. People are the slaves of the clock. But in Ghana, time is much more flexible and fluid. Deadlines are never exact and it is not considered rude to tell someone you will pick them up "around 9 AM" and not show up until 11. So, here we sit, trying to remind ourselves that our tour guide is not simply being rude. He's just being Ghanaian.
Oh, and today is Father's Day! Daddy told me that he is going to read my blog, so here is shout out the most amazing father anyone could ever have - STEVE ISRAEL! Daddy, I love you so much, and I appreciate all the sacrafices you have made for me and all your hard work to help me succeed. <3 <3 <3 <3
I guess for now I can attempt to describe our accomodations. They are better than I had expected. We are staying at the Telecentre Bed and Breakfast in Accra, Ghana. The city is by far the largest in Ghana. The Telecentre has a bizzare mix of luxuries and deficiencies. For example, we have air conditioning and screens! Air conditioning for goodness sake! And the screen protect us pretty well from mosquitos (although I still slept under my mosquito net like I was advised). Also, one night at the Telecentre, with breakfast included cost 23 Cd, the unit of Ghanaian currency, and one USD is worth 1.44 Cd (at least is was yesterday at the airport, haha). You would never find somewhere this cheap to stay in the US. However, an interesting deficiency in these accomodations is the fact that ever shower we take is in COLD WATER. For the next two months, I will never know the caress of a warm water shower. Plus, the water pressure here is horrible, so a shower is more like standing under a cold trickle. It's actually pretty unpleasant, especially in the air-conditioned room.
Ah! Our guide is here. Bye!
I have arrived!
And sadly I only have about 5 mintues to type before orientation starts! I promise to write more later in the day since the only thing we new arrivals HAVE to do is go to orientation. Just wanted you all to know that I'm alive :)
Monday, June 1, 2009
Adventure Pending
Good Afternoon Ladies and Gentlemen!
Now begins my adventure to Ghana. Ok, I mean 19 days from now begins the adventure, but 19 days is negligible on a cosmic time scale anyway.
I probably won't be saying much before I head out, because my life in the states for the next 19 days is going to be pretty mundane. Glorious, but mundane. I'm going to lie in the Michigan sun with Aaron, sleep, and eat. And since you don't want to hear about any of that, I won't write about it :)
In case you don't already know, I'm spending this summer working for an NGO (non-governmental organization) called Unite for Sight. I will be primarilly stationed in Accra, Ghana, but will be working in local villages during most days. This blog is going to be mostly about my experiences working in the field, providing inexpensive eye care. In later posts, I'll be talking about exactly what that means.
For those of you in the band, I will not be alone in Ghana. The glorious Ben Long will be with me about half of time, when we are working in the same regions. Hopefully I'll be able to convince him to write a few posts :)
I'll hopefully be talking to you all much more frequently in about two weeks. Take care 'till then.
- Puffer
Now begins my adventure to Ghana. Ok, I mean 19 days from now begins the adventure, but 19 days is negligible on a cosmic time scale anyway.
I probably won't be saying much before I head out, because my life in the states for the next 19 days is going to be pretty mundane. Glorious, but mundane. I'm going to lie in the Michigan sun with Aaron, sleep, and eat. And since you don't want to hear about any of that, I won't write about it :)
In case you don't already know, I'm spending this summer working for an NGO (non-governmental organization) called Unite for Sight. I will be primarilly stationed in Accra, Ghana, but will be working in local villages during most days. This blog is going to be mostly about my experiences working in the field, providing inexpensive eye care. In later posts, I'll be talking about exactly what that means.
For those of you in the band, I will not be alone in Ghana. The glorious Ben Long will be with me about half of time, when we are working in the same regions. Hopefully I'll be able to convince him to write a few posts :)
I'll hopefully be talking to you all much more frequently in about two weeks. Take care 'till then.
- Puffer
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