Our last few hours in Accra were strangely enough spent at the Accra Mall. Kofi was trying to juggle a morning of shuffling MHIRT students around, and Keesha and I needed to do a big grocery shopping trip to stock up on essentials before heading to Akwatia—thus, Kofi dropped us at the mall, whose main feature is a ShopRite grocery store. In addition to the grocery store, the mall contained a handful of small very expensive clothing realtors with an African twist—at places like “Woodlin” one can pick out their own fabric and have an outfit from the mannequins made. The other shops included a few Nike-like shoe stores, fine china and silver shops, cell phone networks, a video arcade, and a food plaza. I could do without the rest of it, but much to my excitement there happened to be a coffee place—the closest they could come to real coffee was espresso with cream, but I was stoked nonetheless-- Definitely a step up from the Nescafe packets I’ve been rationing! We also purchased a wireless internet USB through the phone company, in hopes of having occasional internet access in Akwatia for work and play. (Unfortunately, it only sort of works sometimes, as the signal is weak or non-existent here… but it’s better than nothing! (Sorry Mom and Dad for missing all of your calls… weak internet through the phone company also means weak cell signal!)) Kofi told us he’d be back in an hour and a half, but amazingly, we’re learning how things work around here, and weren’t surprised when we showed up four hours later. It gave Keesha and I more than enough time to fill a grocery cart at ShopRite and further indulge in an American summer treat we’d been jonesing for and had not yet found: ice cream cones! It wasn’t Washtenaw Dairy, but it definitely hit the spot.
Well stocked with toilet paper and tummies filled, Kofi returned and we headed out to Akwatia—North through the San Francisco-esque house-spotted hills of Greater Accra, then veering Northwest through villages and rolling hills that look similar to the green mountains images rendered in Chinese artwork. I chatted most of the way with Kofi, curious about his eclectic background. I learned that he was born and raised in Ghanaian—one of six children, to his father’s first of three wives. Polygamy is practiced in Ghana, but as Kofi explained “the economy just isn’t good enough anymore to support multiple wives” so it’s become less commonplace. Raised catholic like most Ghanaians, Kofi went through primary school and on to a Franciscan Ministry secondary school. The first nine years of schooling (through middle school) are compulsory and free here; secondary school is optional and tuition based. He made friends with a visiting scholar, and ended up using those connections to find free housing in Boston for university, leading him to campaign within the church for funding to attend Boston College. He had always been drawn to animals and badly wanted to be a veterinarian—a rare occupation in Ghana. He ended up transferring to Pennsylvania from Boston College, and later attended Penn State for a DVM specializing in large animals. After four years of practice in Africa and some time working as a veterinarian for USAID, through a fluke he attended a maternal mortality conference in place of his boss. The speaker captivated him with a speech that equated the current maternal mortality rate with a large airplane full of pregnant women crashing every four minutes—99% of those deaths occur in the developing world. That conference changed his life. He went to Korle Bu to review the Ghanaian statistics and was shocked—thought about medical school, and was encouraged to do an MPH instead. Thus, he arrived at the University of Michigan, where he completed his MPH and met Tim Johnson, who in 1986 had started an OB/GYN residency program in Ghana, in an attempt to stop the brain drain and keep more trained OB/GYNs in Ghana. Dr. Johnson was in need of a study manager, and the rest is history. Kofi has spent his time ever since jetting back and forth from Ghana to the United States, and has been absolutely essentially in exponentially expanding the collaboration between Ghana and Michigan. There’s talk of breaking ground on a ‘Michigan Center’ as a home base for research and visitors in downtown Accra on land donated by the University of Ghana. In the time we’ve been here Kofi’s been back to Michigan, spent a week at the ACOG conference in California, came back to Ghana, and is now in Uganda! Utter craziness, but very handy guy to know in Ghana—we’re definitely lucky to have him!
Most of the trip I was fairly engulfed in learning about Kofi’s background, and asking random questions about Ghanaian culture—like why do so many people have straight line scars across their cheeks? (answer: tribal marking traditionally- different slashes for different tribes, and on younger generations because an anti-seizure medication to seizing babies is given through the cheek!) Or, what food are people making on their front porches pounding tall wooden bats into wooden buckets (think the action and strength of post-hole digging)? (answer: Fufu- they are pounding cassava and plantans together into a dough called fufu which is then dipped into stews). A few miles from Akwatia, we saw a scene that needed no explanation. On one side of the road, a tro tro tipped over, on the otherside a busted up taxi cab jutting into the overgrowth on the roadside. A whole pile of people where standing around, having piled out of the tro tro. The accident had obviously happened just minutes before. As far as we could tell no one appeared seriously injured, but the scene was a sobering testament to the dangers of driving in the developing world.
Just before dusk we secured the keys to our apartment, and settled in for our first night. The doctor who lives in the flat next door invited us over to watch a big ‘football’ match. After settling in, and when the cheering through the wall was sufficiently loud, we wandered over, hoping to make friends. We found a group of eight or so Ghanaian men, and three German high school exchange students (who unfortunately left the next day!) utterly engrossed in the game. The room was a hilarious mix of English, Twi, and German—lots of yelling and emphatic fist pumping, while Keesha and I just did our best to figure out which team was which We didn’t really get to talk with anyone amidst the intense football watching, but we’re one step closer! Actually, we have made some very friendly and lively friends since moving in… they’re fun, energetic, and always up for a party! They happen to be 4 and 5 years old… but hey, ya gotta start somewhere right? Hehe. These two little kids, brother and sister: Kevin and Obi, live on the top of our three story apartment building. Keesha and I met them yesterday on the back stoop and they’ve latched on. Throughout yesterday afternoon, and again this evening, we’ll hear low knocks on the backdoor and excited voices yelling, Obbbrunie! Hey miss Obrunie!! Yesterday they picked us flowers, and had far too much fun with the digital recorder and microphone we are using to record interviews. I think the only English song they know is “We Wanna Wish You a Merry Christmas”… but they are definitely not afraid to sing it!
Almost as exciting as the small children, was our first official day of pseudo work! Yeah! We took the hospital bus that comes at 7 AM into work this morning, where we spent our first morning in the antenatal clinic. The clinic already had a good twenty women waiting at 7:15 when we arrived. Women sat on rows of benches under the shelter of the open air clinic. A handful of nurses and ward assistants trickled in to set up the clinic for the day—they set up a large table with a nutrition and bp station, and sorted the women into sections of benches for antenatal and post-natal 2 week check-ups. All of the post-natal mom’s were easy to spot both from their baby in toe, and because they wear traditional white gowns to symbolize the strength and success of their recent birth. By the time they were sorted out the benches were filled with forty or fifty women waiting for their check up. As Doris, a midwife and our translator, explained, the day always starts with a prayer. All the women stood and sang and clapped to a joyous song, to praise God, and bless the start of the day. After singing a more solemn prayer is said, and then the women take their seats for a talk. They were addressed by Janet, who appears to be a head midwives at the clinic, and had also led the singing and prayer. Doris explained that Janet, addressing the whole crowd of women, was talking about the importance of antenatal care, what lab tests are done, what the midwives are checking for during the exam, that abnormalities are referred to the doctors, the importance of coming to the hospital first rather than a spiritualist in a village, and then the list of what women need to bring with them for delivery (including a plastic pad, a razor, and pads). When all this was done, the actual clinic started.
Our goal today was to pilot test the survey—trying out the questions with a few women, making sure our recorders were working correctly, and giving the translators a chance to practice translating back and forth. We did two practice interviews, which went far more quickly than we anticipated. Not wanting to drain our resources for the actual study (by interviewing too many of the local women in their third trimester for practice), we wrapped it up after two, and were out of the clinic by 9:30 AM! Keesha and I are really itching to actually get started on the study, now that we’re here (with nothing else to do!) and everything is in working order. Unfortunately, we’re still jumping through University hoops. Although our study is IRB (Institutional Review Board) approved at the University of Ghana, the University of Michigan is still hemming and hawing about a few requested changes. Last week we found out they wanted the consent form translated into written Twi. I wasn’t that surprised, but also had no idea what a feat translation would be. It seems that everyone speaks Twi, but no one writes it—not our mentor, or either translator. It sounding more and more like the translation and final approval from the University won’t come until next week. Dr. Adanu had planned to come out to Akwatia today to check in and bring us the final copy of the forms, but we just found out that instead he is coming tomorrow, and will not have the forms with him, as they aren’t translated yet. Trying to be patient! We knew things moved slowly here and that this experience would be an exercise in patience, but it’s easier said than done! Keesha keeps joking that it’s a good thing my leg is broken or she might not be able to keep me tied down. I just hate sitting around like a bump on a log—especially here where I really want to be able to do something remotely useful! Oy! One day at a time I suppose.
After our short morning of work, Doris took us to the local market. Mondays and Thursdays are ‘market days’ when the fruit is fresh. The market is only a mile or two from the hospital. The Akwatia market was much much less intense than those in Accra. The vendors are set up in a cluster near the roadside, in makeshift stick stalls, in loosely defined rows, filling a space comparable to Kerrytown Market in Ann Arbor. Doris greeted many of the vendors who are well known to her, and helped us exercise our limited Twi vocabulary. We found a frying pan and knife, much needed additions to our mini-kitchen set up. Doris also helped us pick out the items needed to parse together a Ghanaian dish—tomato and fish stew with boiled plantans. Realizing that we were clueless when it comes to Ghanaian cooking, she accompanied us back to the apartment for a cooking lesson. It didn’t turn out to be anything fancy, but it definitely tasted like Ghana. She sautéed some onions in the frying pan, then added tomato paste, water, pepper, salt, some little packets of spice with pictures of fish on them, and chunky tuna-like fish canned in tomato sauce. When that was simmering she boiled raw plantans in another pot until they were golden brown and then added cold water to stop them from cooking. And wala! Tomato fish stew? We thank her profusely for her lesson. Apparently the next lesson is ground-nut stew. Sounds fairly similar except instead of tomato paste you add ground nut paste (essentially unsalted peanut butter… which we’ve adopted as peanut butter). Far more familiar to our taste buds, was the pasta with an attempt at cheese sauce (without cheese…) that Keesha fabricated for dinner.
In case the elaborate recount of our cooking doesn’t give it away, besides entertaining small children, we’ve been fairly starved for excitement. We’ll see what comes of Dr. Adanu’s visit tomorrow—if it sounds like prospects of being able to actually start work are bleak for the rest of the week, we may try to bust out of town and do some exploring for a few days. Until then, I’m channeling patience and learning to sit still and smell the roses, or banana trees.
Monday, May 24, 2010
Friday, May 21, 2010
An Introduction to Rural Africa
This week I had my first taste of the rainy season. Thankfully, I haven’t been caught out in one of the torrential downpours yet, but I’m sure it’s only a matter of time! Since we’ve been here the sky has been mostly cloudy, always dangling the possibility of rain. I can’t imagine what the temperature would be if it was regularly sunny… yikes! Monday, the clouds stopped threatening and got down to business, with a few hours of pelting rain. When the rain started I was in the doctor’s library with Ella, when it subsided and we ventured out to find food, we discovered that the carpet of red dirt had turned into an obstacle course of pot-hole puddles and dangerously slick clay. Add crutches, one flip-flop foot, and trying to get to a canteen that’s a good 30 yards off the road (beautiful sidewalk for 15 feet outside the door and then dirt the rest of the way to the road) and you’ve got yourself a hot mess! Somehow I managed not to fall outright, but I might as well have. By the time we got home (half hopping, half taxi) we were both so covered in red clay that we had to take our shoes and my cast off outside the hostel and washed them before coming in. The manager came out to check on us, and gleefully informed us that the rainy season had started! No kidding! She was really cute about it—she was sure we’d be thrilled, as the daily rain reduces the temperature a bit. I gotta say, sitting covered in mud, washing my cast and then confined to my bed for the rest of the day while the cast dried, I can’t say I was that stoked about the rainy season!
The big outing this week was a visit to Akwatia, where Keesha and I will be doing our research. We move to Akwatia for good on this coming Saturday (May 22nd), but Dr. Adanu wanted to take us out to scope the place out, and be introduced before we make the move. We left Accra Tuesday early afternoon. Keesha unfortunately had her first taste of the infamous stomach problems we’ve all been warned of. She spent the ride trying to sleep to avoid puking in Dr. Adanu’s car. I sat up front taking in the scenery. We headed out of town initially on the same route we’d used to head to Kokrobite. Outside of Accra, as you move North of the coast, the landscape turns to rolling hills. The hills just North of Accra are smattered with an array of houses, creating a scene that from a distance looks oddly like the ticky-tac houses on the hills outside of San Francisco. The crowds of Accra thin slowly—the city is sprawling, and with traffic, takes a good 30-40 minutes to escape. Every set of loosely obeyed traffic lights, for the first 10 or so miles outside of the dense part of the city, serve as a conduit for a swarm of hawkers and often a larger market that sprawls on the four corners of the crossing. My toothpaste tube is almost sucked dry, so I had my eyes peeled for a toothpaste hawker (I saw one last week and failed to jump on it!)… but alas, no toothpaste on this trip.
At one the lights we turned off the main road, and headed out on a sometimes dirt, sometimes pavement, intensely pot-hole ridden road. I have no idea how anyone gives directions or figures out where anything is. As far as I can tell, there are no maps and no road signs. I asked Dr. Adanu how he knew where to go—he said you get taken there once and just remember… or get lost and ask people where whatever you are looking for is. Pretty quickly off the main road, roadside stands gave way to rolling hills of tall grass, banana trees, green baby coconuts, and torturously ripe mangos. We sped along, interrupted frequently by stomping on the break or swerving around pot holes. The tall grass made every curve a blind turn. Tro-tro drives frequently risked coming into the outcoming ‘lane’ around the turn to miss a pothole, and passing uphill doesn’t seem to phase anyone but me. Every few miles at first, and less frequently as we went, a little village would pop up: mostly a short stretch of houses build snug against the road, with a few houses depth of clearing behind them, dirt plots with roaming goats, and a few roadside stands. Some structures were cement, most where semblances of wood and rock, and more than a few were mud huts with thatched roofs in a variety of conditions. We passed through one sizable town, Asamankese, with an active market, just 15 miles from Akwatia.
As we drove there was almost always a pedestrian or two in sight, either an adult carrying a heavy load atop their head, or children walking home from school in matching uniforms. Multiple kids walking in the opposite direction saw me and screaming ‘Obrunie!!’ jumping up and down and pointing as we sped by. It was pretty funny. From the look on some of those kids faces, I’m pretty sure I’m the first white person they’d ever seen.
After two hours of slaloming around pot holes on country roads, we reached Akwatia. We didn’t really venture into the actual town, which we could see on the hillside opposite the hospital. We spent our 24 hours in Akwatia getting acquainted with the hospital grounds and staff. The hospital was founded 50 years ago by German nuns, who still preside over it. The grounds were actually quite beautiful. Everything was freshly painted following the recent 50th anniversary celebration. One of the features that stood out most to me was the entrance guarded by gaits. Outside the gaits there is a little covered section of benches under a sign that reads ‘Visitors Lounge’. The hospital has strict visiting hours: a few early in the morning, at lunch, and again in the late afternoon. Family members ride in on tro-tros from neighboring villages, and sit waiting in the visitors lounge (with the occasional goats and chickens) until the gait open for visiting hours. Then the drive up to the main building is flooded with women in colorful African wraps, carrying basket lunches to their loved ones in the hospital. The hospital is a cluster of single story buildings, painted yellow, with dark trim, and interspersed blue arrow signs indicating the purpose of each building “Children’s Ward” “Casualties” (?) “Dispensary”. We’ll be working with women at the antenatal clinic, which is actually a row of benches under a roof, but otherwise open air. There is a cubicle of walls behind which the midwifes and nurses do there exams. Otherwise women sit in the shade, and open air, awaiting their check up on a hillside overlooking Akwatia. Health work, while being outside? Now that’s something I could get into!
Keesha and I spent an interesting night on the hospital campus. The cute, well-maintained campus includes housing for many staff members, and backs up to a catholic school and well groomed soccer field. I ventured out and explored as much as I could on crutches while Keesha crashed and tried to get her tummy behaving again. Dr. Adanu left to spend the night with friend in a neighboring village, but a broken drive shaft brought him back to Akwatia. The part had to be brought out from Accra in the morning (no one travels on those roads at night!), and Kofi ended up having to come out and pick Keesha and I up. Keesha and I stayed the night with Dr. Adofo, the head OB/GYN at St. Domic’s. We thought we were staying with him and his family, but his family is now located in Accra, where the schools are better for the kids. Thus, Dr. Adofo had a spare room for us in his hospital provided home on campus. I had grand (dis)elusions of eating dinner with a family and maybe even learning to cook a Ghanaian dish. But alas, instead Keesha and I went without dinner or breakfast, as they simply never materialized. Starving children in Africa? Around noon the following day, we confessed to Dr. Adanu that if we find food soon we’d be sacrificing him first!
With a bit of food onboard, we met our translators, and summer companions, Doris and Joyce. Both are hospital employees on vacation, who have been hired to work with us during their off time. Doris is motherly in age and demeanor. She’s a midwife who works in the labor ward, and seems very interested in the research. She offered to teach us Twi while she translates too! Joyce is a little quieter but also very nice. She is a community health nurse, who was born and raised in Akwatia. They’ll be with us during the interviews and will be helping us to translate the interviews into English afterwards. We learned an interesting fact too, which hadn’t crossed my mind. Everyone here speaks Twi, but no one writes it (almost all signs are in English—Ghana was a former British colony and English is the government language). Thus, actually getting our consent form translated into written Twi is a bit difficult, as very few people actually write in Twi—Dr. Adanu and our translators do not.
The last bit of business we had in Akwatia was sorting out our summer housing. Dr. Adanu had been under the impression that we would be staying on the hospital grounds-- an idea I was pretty stoked on. However, the head nun informed us in a German accent, that that would not be possible. Seems like they don’t reeeally believe that you are coming until you arrive and show your face in Africa… it seemed like they were really hashing out having us there as we arrive. Oh well, that’s the way it works here! Once housing was settled on the ‘estate manager’ drove us to it—St. Dominics recently built a few condos to house staff a few miles from the hospital, away from town. Keesha and I will have run of a gorgeous ground floor flat in one of the small cluster of condos. The apartment is actually lovely—the nicest housing we’ve seen! There are two separate furnished bedrooms and bathrooms, a dining and living room, and a kitchen, with basic utensils, a half size refrigerator, and gas-camping type stove (no ovens here). My only worry is that it’s not within walking distance to anything except banana fields. Apparently a hospital bus comes to pick up workers at 7AM sharp. The manager was less clear on the buses to take us home, and said a taxi should cost 2 cedi. It will take a little trial and error but I’m sure we’ll figure out a reasonable routine, and access to food somehow
Though in the back of my mind I knew it was a possibility, both Keesha and I swallowed hard when we learned that Akwatia has no internet cafes nor does the hospital have any internet access. Dr. Adanu joked, that though the place is well-kept, it’s run by old German nuns, what use do they have for internet? Touche! So my dear followers… if you’ve read this far my posts may get far far more sporadic. We’re looking into a wireless plug-in internet connection, that charges by the minute, like a phone call. We’re hoping one won’t be too costly, so we can at least check in periodically! If nothing else, we’ll be making occasional trips in to Accra (if we can figure out the rural tro-tros!), and will be sure to update then! I promise I’ll do my best to check in as much as possible!
So this is it! Off to the rural region I go!
Hugs and love to all.
The big outing this week was a visit to Akwatia, where Keesha and I will be doing our research. We move to Akwatia for good on this coming Saturday (May 22nd), but Dr. Adanu wanted to take us out to scope the place out, and be introduced before we make the move. We left Accra Tuesday early afternoon. Keesha unfortunately had her first taste of the infamous stomach problems we’ve all been warned of. She spent the ride trying to sleep to avoid puking in Dr. Adanu’s car. I sat up front taking in the scenery. We headed out of town initially on the same route we’d used to head to Kokrobite. Outside of Accra, as you move North of the coast, the landscape turns to rolling hills. The hills just North of Accra are smattered with an array of houses, creating a scene that from a distance looks oddly like the ticky-tac houses on the hills outside of San Francisco. The crowds of Accra thin slowly—the city is sprawling, and with traffic, takes a good 30-40 minutes to escape. Every set of loosely obeyed traffic lights, for the first 10 or so miles outside of the dense part of the city, serve as a conduit for a swarm of hawkers and often a larger market that sprawls on the four corners of the crossing. My toothpaste tube is almost sucked dry, so I had my eyes peeled for a toothpaste hawker (I saw one last week and failed to jump on it!)… but alas, no toothpaste on this trip.
At one the lights we turned off the main road, and headed out on a sometimes dirt, sometimes pavement, intensely pot-hole ridden road. I have no idea how anyone gives directions or figures out where anything is. As far as I can tell, there are no maps and no road signs. I asked Dr. Adanu how he knew where to go—he said you get taken there once and just remember… or get lost and ask people where whatever you are looking for is. Pretty quickly off the main road, roadside stands gave way to rolling hills of tall grass, banana trees, green baby coconuts, and torturously ripe mangos. We sped along, interrupted frequently by stomping on the break or swerving around pot holes. The tall grass made every curve a blind turn. Tro-tro drives frequently risked coming into the outcoming ‘lane’ around the turn to miss a pothole, and passing uphill doesn’t seem to phase anyone but me. Every few miles at first, and less frequently as we went, a little village would pop up: mostly a short stretch of houses build snug against the road, with a few houses depth of clearing behind them, dirt plots with roaming goats, and a few roadside stands. Some structures were cement, most where semblances of wood and rock, and more than a few were mud huts with thatched roofs in a variety of conditions. We passed through one sizable town, Asamankese, with an active market, just 15 miles from Akwatia.
As we drove there was almost always a pedestrian or two in sight, either an adult carrying a heavy load atop their head, or children walking home from school in matching uniforms. Multiple kids walking in the opposite direction saw me and screaming ‘Obrunie!!’ jumping up and down and pointing as we sped by. It was pretty funny. From the look on some of those kids faces, I’m pretty sure I’m the first white person they’d ever seen.
After two hours of slaloming around pot holes on country roads, we reached Akwatia. We didn’t really venture into the actual town, which we could see on the hillside opposite the hospital. We spent our 24 hours in Akwatia getting acquainted with the hospital grounds and staff. The hospital was founded 50 years ago by German nuns, who still preside over it. The grounds were actually quite beautiful. Everything was freshly painted following the recent 50th anniversary celebration. One of the features that stood out most to me was the entrance guarded by gaits. Outside the gaits there is a little covered section of benches under a sign that reads ‘Visitors Lounge’. The hospital has strict visiting hours: a few early in the morning, at lunch, and again in the late afternoon. Family members ride in on tro-tros from neighboring villages, and sit waiting in the visitors lounge (with the occasional goats and chickens) until the gait open for visiting hours. Then the drive up to the main building is flooded with women in colorful African wraps, carrying basket lunches to their loved ones in the hospital. The hospital is a cluster of single story buildings, painted yellow, with dark trim, and interspersed blue arrow signs indicating the purpose of each building “Children’s Ward” “Casualties” (?) “Dispensary”. We’ll be working with women at the antenatal clinic, which is actually a row of benches under a roof, but otherwise open air. There is a cubicle of walls behind which the midwifes and nurses do there exams. Otherwise women sit in the shade, and open air, awaiting their check up on a hillside overlooking Akwatia. Health work, while being outside? Now that’s something I could get into!
Keesha and I spent an interesting night on the hospital campus. The cute, well-maintained campus includes housing for many staff members, and backs up to a catholic school and well groomed soccer field. I ventured out and explored as much as I could on crutches while Keesha crashed and tried to get her tummy behaving again. Dr. Adanu left to spend the night with friend in a neighboring village, but a broken drive shaft brought him back to Akwatia. The part had to be brought out from Accra in the morning (no one travels on those roads at night!), and Kofi ended up having to come out and pick Keesha and I up. Keesha and I stayed the night with Dr. Adofo, the head OB/GYN at St. Domic’s. We thought we were staying with him and his family, but his family is now located in Accra, where the schools are better for the kids. Thus, Dr. Adofo had a spare room for us in his hospital provided home on campus. I had grand (dis)elusions of eating dinner with a family and maybe even learning to cook a Ghanaian dish. But alas, instead Keesha and I went without dinner or breakfast, as they simply never materialized. Starving children in Africa? Around noon the following day, we confessed to Dr. Adanu that if we find food soon we’d be sacrificing him first!
With a bit of food onboard, we met our translators, and summer companions, Doris and Joyce. Both are hospital employees on vacation, who have been hired to work with us during their off time. Doris is motherly in age and demeanor. She’s a midwife who works in the labor ward, and seems very interested in the research. She offered to teach us Twi while she translates too! Joyce is a little quieter but also very nice. She is a community health nurse, who was born and raised in Akwatia. They’ll be with us during the interviews and will be helping us to translate the interviews into English afterwards. We learned an interesting fact too, which hadn’t crossed my mind. Everyone here speaks Twi, but no one writes it (almost all signs are in English—Ghana was a former British colony and English is the government language). Thus, actually getting our consent form translated into written Twi is a bit difficult, as very few people actually write in Twi—Dr. Adanu and our translators do not.
The last bit of business we had in Akwatia was sorting out our summer housing. Dr. Adanu had been under the impression that we would be staying on the hospital grounds-- an idea I was pretty stoked on. However, the head nun informed us in a German accent, that that would not be possible. Seems like they don’t reeeally believe that you are coming until you arrive and show your face in Africa… it seemed like they were really hashing out having us there as we arrive. Oh well, that’s the way it works here! Once housing was settled on the ‘estate manager’ drove us to it—St. Dominics recently built a few condos to house staff a few miles from the hospital, away from town. Keesha and I will have run of a gorgeous ground floor flat in one of the small cluster of condos. The apartment is actually lovely—the nicest housing we’ve seen! There are two separate furnished bedrooms and bathrooms, a dining and living room, and a kitchen, with basic utensils, a half size refrigerator, and gas-camping type stove (no ovens here). My only worry is that it’s not within walking distance to anything except banana fields. Apparently a hospital bus comes to pick up workers at 7AM sharp. The manager was less clear on the buses to take us home, and said a taxi should cost 2 cedi. It will take a little trial and error but I’m sure we’ll figure out a reasonable routine, and access to food somehow
Though in the back of my mind I knew it was a possibility, both Keesha and I swallowed hard when we learned that Akwatia has no internet cafes nor does the hospital have any internet access. Dr. Adanu joked, that though the place is well-kept, it’s run by old German nuns, what use do they have for internet? Touche! So my dear followers… if you’ve read this far my posts may get far far more sporadic. We’re looking into a wireless plug-in internet connection, that charges by the minute, like a phone call. We’re hoping one won’t be too costly, so we can at least check in periodically! If nothing else, we’ll be making occasional trips in to Accra (if we can figure out the rural tro-tros!), and will be sure to update then! I promise I’ll do my best to check in as much as possible!
So this is it! Off to the rural region I go!
Hugs and love to all.
Monday, May 17, 2010
More babies and obrunie beach adventures!
Keesha and I spent 2 more days observing in the hospital after my last post. Thursday we returned to the labor ward for the third time. It was packed as always with women ready to pop. I can’t say I really felt any less overwhelmed or helpless the third time! Soon after arriving the power went out-- the staff carried on without missing a bit. It happened again several times throughout our day, leading me to realize why the surgery sweets had large windows. C-section in the dark anyone? The power outages weren’t too surprising, our hostel has them frequently too, but what I couldn’t get over was the water outage. The water went out for the entire day! The doctors were scrubbing in for surgery using buckets of water kept on hand for outages. None of us could wash our hands or flush the toilet… and there definitely isn’t any hand sanitizer to be found. I think partially because of the power outages affecting the wash, the ward had also run out of scrub caps for us to wear in the surgery theatre. Have no fear, the resourceful Ghanaians had a backup plan for this too. The nurses took the paper wrapping from used sterilized instrument packages and wrapped them around our heads like a bandanas. When I fumbled trying to fasten mine, she laughed, and said “you’ve never done this before?! Don’t you know how to make a hat?” Silly me, eh?
With our puffy baby blue paper hats, we settled in for more surprises in the obstetric theatre. We saw two more c-sections, neither of which went smoothly. One of the women was a bit overweight, and the anesthesiologist couldn’t get the spinal anesthesia in… there was a lot of laughing and talking, and blaming the woman for not staying still enough… I really felt quite uncomfortable. Everyone was feeling rushed, as the other theatre had broken equipment and was out of commission, backing up the line for c-sections even further. So, after 10 minutes of failed attempts, they intubated this woman for her c-section. They proceeded to intubate the next patient too, when her spinal wasn’t completely effective. I’m really unsure of how this type of thing is handled in the US, but regardless of the choice to intubate, I felt like there was a huge lack of communication and respect for the women. I can’t say, without knowing Twi, but I really don’t think the women knew they were being intubated, and I know they weren’t consulted about the risks or options.
Struggling to take in all the challenges of the ward, Kogo, one of the residents, shared his thoughts. Kogo stood out as one of the most compassionate of the medical team—he is really great with the women, pulls curtains to protect privacy, and talks to them more than I’ve seen anyone else do. He said when his residency is done he wants to get out of Accra and go to the states. When I asked why he said that this- indicating the ward- isn’t the practice he wants to do. I probed for more detail, and he said, this wasn’t the way medicine was supposed to be practiced, there were too many women, too few resources, too many compromises in quality. This is the not the type of medicine he wanted to be affiliated with. He wants a better outcome and circumstances for his patients. It’s a catch-22. I completely agree with what he’s saying, but at the same time his services are needed so badly here. These women need help! He sees the task of caring for these women, and the overwhelming odds stacked against him in his attempts. If you came to work day after day set up for failure and hardship, would you want to stay? How do you keep those with the skills that you need, when they feel like they are eternally constricted by their surroundings and resources? As much as I wish he wanted to stay and work to improve the situation, hypocritically if I was in his situation, as horrible as I feel admitting it, I might be just as tempted to leave. The task of working toward improving the situation is so much bigger than the problem of space and resources in one ward—the multitude projects needed to ban together is overwhelming the public health campaigns, infrastructure improvement, education, sanitation, family planning, funding—and on and on.
This is not to say that Korle-Bu is bad. The hospital offers invaluable services to a huge number of people in Greater Accra. The teaching hospital is improving steadily and has a number of collaborating institutions. It is my understanding that obstetric residencies here are relatively recent, and since implementing residencies here in Ghana the majority of OB/GYNs trained here have stayed here, whereas when they used to go overseas for residency, they rarely returned.
Our final day of observing was spent in the antenatal clinic on the ground floor of the maternity block, just below the labor ward. (Power at the hostel just went out again…) At first glance the place looked like a mad house. At 8 AM when we arrived, there were rows and rows of pregnant women sitting on benches waiting to be seen, with a handful of nurses and women roaming to and fro. If I had to guess I’d say that in the wide hallway that serves as the main corridor for the clinic, there were 150 women, all hot and pregnant. Dr. Adanu introduced us to one of the nurses, and asked her to show us the ropes, and then he headed off for the day. I think we really lucked out having him as a mentor—not only is he supportive of the work we’ll be doing in Akwatia, but he is incredibly accommodating, and clearly an influential figure around the hospital. Cheryl, our mentor from U of M, tells us he’s being groomed to be the Dean of the Medical School. Fancy!
The nurses and midwives of the antenatal clinic were amazing. They had organizing the chaos down to an exact science. Women came into the clinic and were directed to the first nursing station behind a curtain, where, if they were visiting for the first time for this particular pregnancy they were given a Ghana pregnancy booklet, which would stay with them throughout the pregnancy as their pregnancy record. The first nurse filled out the basic information with them, asked background medical history, and covered one or two of the ten or so topics in the ‘education’ section of the booklet, checking them off as she went. The nurse explained that by the time the woman goes to deliver all of the educational sections are supposed to be checked off. She said they ask women to come at least 6 times for antenatal care—ideal once every two weeks until 28 weeks and then once a week after that! I can’t imagine! Visiting the clinic is a four or five hour affair on a good day!
From station 1 women are sent to sit in the section waiting for station 2 where their height and weight are recorded in their book. Then they head to station 3 in groups for HIV counseling. We sat in on a few sessions, run by an inspirational midwife. She was so passionate, so talented at engaging the women, making them as comfortable as possible, and doing her best to make sure the vital information about transmission got across. After the group discussion, each woman did a rapid HIV test. The test involved a glucose-check type finger stick drawing a drop of blood which was placed on a small plastic one-use instrument. A drop of developer was added and in 10-20 minutes you had your results. Results were given by the midwife one-on-one with the women. We were privileged to sit in on a few of these sessions as well. The educator would tell them they were negative (all that we saw were) and then would ask what the women were going to do to maintain their negative status. The women would mumble and blush and laugh and consistently said “I will take care of myself”, the midwife would chuckle and ask for more detail. Though the women knew exactly what she was getting at they were painfully shy and couldn’t even start to say anything about sex or protection. How could anyone possible negotiate for protection or talk about monogamy when they can’t even mention the subject matter! The shyness was consistent and strong, woman after woman blushed and squirmed, knowing exactly what the nurse wanted them to say, but feeling far too shy to say the words or broach the topic! They were all pregnant! Obviously they’ve had sex! Their reactions to the topic in a supportive setting, alone with a compassionate woman, were shocking. The nurse told us afterwards that day after day this is what she experiences. She encouraged the women to bring their partners in to be tested (for free). She said many can’t convince them to come and get tested and are trained to not bring up the subject anyway—so instead she would suggest that the women just tell the men “the doctor wants to see you” just to get them in the door.
One of the tests we saw was unfortunately positive. Ghana has relatively low rates of HIV compared to other African countries. But, unfortunately, we were told that virtually none of the women who test positive go to the HIV clinic for follow up help after being counseled to do so… again, a result of denial and stigma. The midwife told us that last year 106 of the women they saw for antenatal care were positive. Shockingly, at least too me, was that of those women, 80 of their partners were coerced into coming in, but only ONE of those men tested positive, suggesting that the majority of these women got HIV from a previous partner or via another method. I guess that really speaks to how much easier the disease is to transmit male-to the male’s partner.
Anyway, back to the clinic flow. After counseling women go to station 4 where they pee in a cup which is immediately stick tested from protein and glucose (to test for pre-eclampsia and diabetes), the results of which are recording in their book. At station 5 blood pressures are recorded. And finally as station six they see a doctor. The examining rooms were something like 9 by 6’ and included a metal stretcher (no pad), a card table, and four plastic chairs. Two doctors worked with two patients in a room at a time. The women sat back to back in two of the chairs, next to the table where the doctors sat facing each other adjacent to the women. They looked through the nurses’ charting, asked a few questions, and then had the women jump up on the stretcher to have their belly measured and the fetal heart beat checked. Sometimes they would write for an ultrasound or prescribe some meds. The patient would then leave and the next patient would file in to fill their seat. An amazing, efficient, ‘herding’ method, that I’d venture to say is a fairly ingenious way to manage the limited resources. The nurses we met in the clinic were inspirational: skilled and compassionate educators who connected with every woman, no matter how shy or quiet they were—I left feeling really good about what these care providers were able to do with a bare minimum of resources. If they can accomplish this much on the ground floor, maybe there is hope for the labor ward!
After a positive clinic experience, a tasty pile of fried rice for lunch, and my first skypable internet connection (courtesy of sneaking into the doctors library and hacking our way onto the internet…)—we called it a day and wrapped up our week of observing at Korle-Bu. (Power just came back on!)
Despite the fact that Kofi (our go-to guy) is back in the States at the moment, the Michigan group (MHIRT students + 3 SPHers) decided to reconvene in Accra Saturday morning to head out on a weekend adventure. There are beaches near downtown Accra, but we’d heard rumors of some fabulous beaches a little further off the beaten path where we might be able to escape some of the hustle and bustle of the city. Having never ridden a tro-tro before, we headed out with vague directions. The plan was to meet up (some of the other students are now stationed outside Accra) at Kenashie market. Getting there wasn’t hard. Almost all of the tro-tros that pass by the ‘hole in the wall’ that leads to our hostel yell “Kenash! Kenash!”-- indicating their destination. We flagged one down and piled in, smushing ourselves in a van with a dozen or more other people packed like sardines in the back of a speeding death-box, that swerved to avoid pedestrians, pot holes, and oncoming cars, and honked at every passerby to ask “do you want a ride” until ‘capacity’ was reached… we survived! For 20 cents, we were dropped wide-eyed at Kenashie. As far as the eye could see the streets were packed with vendors, hawkers, shops, street food, taxis, busses, bolts of fabric, cans of nails and pins and bolts, cell phones, donut balls, soccer jerseys, piles of socks, clocks, toothpaste, fried fish, piles of mismatched sandals, coconuts, and anything else you could possibly dream up. If you could find it in the maize, you could buy it. The area of the market we stood in was only half the craziness, two pedestrian bridges about a half mile apart, connected the side of the market we were on to a continued expanse of craziness on the other side of the four lane thoroughfare. Miraculously, in the madness, after a handful of phone calls and bad directions, we connected with our group. A happy reunion of our little eight person Ghanaian family!
Within minutes, Alex and Nick’s aptly named friend, Wisdom, had us on a tro-tro headed to Kokrobite. Alex and Nick are working in a lab in Monpong 45 minutes from Korle-Bu. Wisdom is a young guy who does IT in the lab. He has taken them under his wing—teaching them to cook some Ghanaian food, playing soccer with them, and now, insisting on accompanying all of us to Kokrobite, just to make sure we didn’t get lost! The eight of us, plus Wisdom, filled the better part of a tro-tro, and headed North out of the city, before cutting west to the coast. For 70 cents, after a 40 minute ride, we were watching waves wash the sands of the African coast. We pulled off the main road onto a windy dirt road that took us hairly up a dirt, pot-hole ridden lane, over a steep hill for the overloaded bus, and then down the coastal plain, through roadside villages to the ocean. In the hills we could see larger houses, mostly grey cement block buildings, some finished, many half built or crumbling. Along the roadside little arrows indicated various beaches and food stops. Roadside stands spotted the drive, interspersed with garbage, beautiful views of the beach, shanties, children, and a smattering of goats.
We were dropped at a dirt road junction, 30 yards from the water, shaded by palm trees ripe with coconuts, and sided by a few cement buildings with lodging, and a sign that read “Big Millie’s Backyard” pointing down the lane that ran parallel to the ocean. Our plan had been to get to the beach and then find a spot to stay for the night. With Wisdom’s help we secured a few rooms at the “Dream Hotel”, breaking the bank at 13 cedi a person for the night. If we had explored further we could have probably stayed in a less touristy type place (though as far as we could tell there wasn’t really anyone else staying at our hotel…), but for our first outing, we were content with this place… plus we all just wanted to hit the beach!
The hotel was actually made up of outbuildings painted pink, reminiscent of Spanish styles, hidden in a garden behind the entrance. Each villa contained a few rooms, each outfitted with three single beds, a toilet (which sometimes flushed and had no seat), a shower, and a fan! As with all beds we’ve encountered in Ghana, there is a fitted sheet covering the mattress and a pillow—but no other sheets—not that you would want them in the heat! We were more than pleased with the place. Outside the rooms there were monkeys in the trees! At first glance we were stoked… before realizing that the monkeys were shackled to the trees, clearly on display for the visitors. It was later pointed out that none of the monkeys made noise and had probably had their vocal cords cut. I contemplated cutting them free… but decided that probably wouldn’t end well for me or the monkeys.
The sun was high, the beach was gorgeous, and with the ocean breeze we experienced comfortable temperatures for the first time since arriving. We staked out a spot, not a challenge on the spacious sands. A little further east 30 or so people played in the water, at the beach front of a hotel with trinket stands that sprawled onto the sand. We settled between a row of hardy wood fishing canoe-like boats and a little wood hut with rasta-men and the more than occasional smell of pot in the air. The beach was heavenly. Within minutes Nick and Alex had drummed up an intense game of beach soccer with the rasfa-dudes. We laid out towels and spent the afternoon lounging, playing in the bathwater ocean waves, and watching the action on the beach. I couldn’t help but cave to the lour of the water, and delinquently removed my cast, and was helped to the shore where I happily sat in the waves. Water therapy?!
Two guys and a young boy practiced an acrobatic routine nearby for hours—doing flips in the sand, standing on each other’s heads, whirling around with impressive balance preparing for a performance that evening. A group of nine or ten year old boys chased around after soccer balls and ended up stark naked running on the beach, kicking the ball and flipping into the water, surfing on old water jugs, and having far too much fun. A few chickens wandered on an off the beach at their leisure. Occasionally women would walk by with drinks or snacks balanced on their heads—unlike the men, they don’t solicit their sales (so much more pleasant!). They sold me my first ‘bag water’ which was intensely chemical flavored, to a degree that keesha’s crystal light powder couldn’t mask—unpleasant enough to dump out despite being thirsty. A pair of jewelry makers stationed themselves behind us, and we sat for a while sorting through their necklaces and bracelets of glass and stone hand painted beads. Once the soccer game wrapped up there was a fairly constant stream of rasta-dudes coming over to chat us up—asking about my leg, and telling us to come back later to hang out. The majority of Ghanaian men are so forward… “Hi, what’s your name? You have eyes as beautiful as the sea. You come later? We hang out!” Ummm no. Did you really think that line was going to work for you?!
At one point a scruffy little puppy, no more than 6 weeks old wandered onto the beach. He had patchy black fur, and clearly was in serious need of a mom and a vet, but he was playful as could be. He came loping clumsily across the sand, and I couldn’t help but pick him up! (I promise I washed well after and didn’t bring him anywhere near my face). He was sooo friendly. When I put him down and walk away he came running after me, jumping on me when I laid back down. He then joined a little boy playing near the bead lady. The boy totted him around and fed him parts of his donut ball snack. At one point he wandered over to the rasta men, and one of them picked him up by the ears and carried him whimpering back to the edge of the hotel… maybe that’s his dad? Poor puppy! There is a completely different mentality towards animals here—from the puppy, to the goats we’ve seen dragged on the street, to the monkeys tied to the trees. Sad.
After beaching it up, and pricing out the two close-by food options (annnd the power is out again) we chose to eat at our hotel. We seem to be fairly slow learners. We sat down starving, ignoring the fact that nothing happens fast here, particularly food. I’m fairly sure that when we order in most cases the cook then goes and starts the meal—I mean it makes sense, they can’t have a whole bunch of premade food kickin’ around. Plus, we were the lone diners at the outdoor hotel patio, in sight of the beach… table lit with my headlight. About an hour after ordering, and then gorging on dinner, but walked over to “Big Millie’s Backyard” where the place was hopping with a number of “Obrunies” (The word for “white people”). Their accents sounded Australia, South African, and American accents—obviously a tourist spot for 20 or so lucky folks. A word that sounds like o-bee-bee-nay means black person—Alex has taken to responding with o-bee-bee-nay when little kids point at him surprised and yell oooobrunie! Apparently the shock is double when he responds in Twi!
At Millie’s I had my first African beer: “Star” ‘Ghana’s favourite beer!’ according to the bottle. It tastes like America’s favorite beer, Budwiser. We sat under an outdoor bar with a grass roof. Christmas lights illuminated signs hanging from the roof with prices “per tot” (shot?). (Power is back) The local gin was 50 peswaes a ‘tot’… thankfully none of us wanted to try it. We hear it’s seriously potent and sometimes dangerous stuff. It was a chill night—we each had one beer, and sat chatting in a big circle tiki hut within ear shot of the ocean under a blanket of the first stars we’ve seen since arriving (first clear night). By 10PM we all moseyed the 100 yards back to the hotel to collapse into bed . Now that is my idea of a night out!
I spent Sunday morning reading on the beach, and was out early enough to see the fisherman paddle their bulky wooden boat through the surf on their return from the morning catch. It took seven men to get the boat up on the beach. These guys had the routine down. They placed a large tube under the front of the boat, grabbed the sides and together rolled the boat forward over the tube, repeating this process until the boat was in the proper place. Then they hauled out there nets. I sat a few feet away and watched them sort through enough crabs and crawfish to fill a laundry sack!
We capped off the stay with “Obrunie Breakfast” at Big Millie’s where we happily had omelets, crepes and coffee (!!!) for a few cedis each. Here, traditional breakfast food is the same as traditional lunch and dinner food—lots of rice, platans, chicken, and spice—so it was a treat to get breakfast food and coffee! We expertly tro-troed it back to Accra, and for less than a cedi fifty were back in the urban sprawl. An all around successful first outing and a wonderful weekend break!
Sending tropical rays to all of you.
Much love!
With our puffy baby blue paper hats, we settled in for more surprises in the obstetric theatre. We saw two more c-sections, neither of which went smoothly. One of the women was a bit overweight, and the anesthesiologist couldn’t get the spinal anesthesia in… there was a lot of laughing and talking, and blaming the woman for not staying still enough… I really felt quite uncomfortable. Everyone was feeling rushed, as the other theatre had broken equipment and was out of commission, backing up the line for c-sections even further. So, after 10 minutes of failed attempts, they intubated this woman for her c-section. They proceeded to intubate the next patient too, when her spinal wasn’t completely effective. I’m really unsure of how this type of thing is handled in the US, but regardless of the choice to intubate, I felt like there was a huge lack of communication and respect for the women. I can’t say, without knowing Twi, but I really don’t think the women knew they were being intubated, and I know they weren’t consulted about the risks or options.
Struggling to take in all the challenges of the ward, Kogo, one of the residents, shared his thoughts. Kogo stood out as one of the most compassionate of the medical team—he is really great with the women, pulls curtains to protect privacy, and talks to them more than I’ve seen anyone else do. He said when his residency is done he wants to get out of Accra and go to the states. When I asked why he said that this- indicating the ward- isn’t the practice he wants to do. I probed for more detail, and he said, this wasn’t the way medicine was supposed to be practiced, there were too many women, too few resources, too many compromises in quality. This is the not the type of medicine he wanted to be affiliated with. He wants a better outcome and circumstances for his patients. It’s a catch-22. I completely agree with what he’s saying, but at the same time his services are needed so badly here. These women need help! He sees the task of caring for these women, and the overwhelming odds stacked against him in his attempts. If you came to work day after day set up for failure and hardship, would you want to stay? How do you keep those with the skills that you need, when they feel like they are eternally constricted by their surroundings and resources? As much as I wish he wanted to stay and work to improve the situation, hypocritically if I was in his situation, as horrible as I feel admitting it, I might be just as tempted to leave. The task of working toward improving the situation is so much bigger than the problem of space and resources in one ward—the multitude projects needed to ban together is overwhelming the public health campaigns, infrastructure improvement, education, sanitation, family planning, funding—and on and on.
This is not to say that Korle-Bu is bad. The hospital offers invaluable services to a huge number of people in Greater Accra. The teaching hospital is improving steadily and has a number of collaborating institutions. It is my understanding that obstetric residencies here are relatively recent, and since implementing residencies here in Ghana the majority of OB/GYNs trained here have stayed here, whereas when they used to go overseas for residency, they rarely returned.
Our final day of observing was spent in the antenatal clinic on the ground floor of the maternity block, just below the labor ward. (Power at the hostel just went out again…) At first glance the place looked like a mad house. At 8 AM when we arrived, there were rows and rows of pregnant women sitting on benches waiting to be seen, with a handful of nurses and women roaming to and fro. If I had to guess I’d say that in the wide hallway that serves as the main corridor for the clinic, there were 150 women, all hot and pregnant. Dr. Adanu introduced us to one of the nurses, and asked her to show us the ropes, and then he headed off for the day. I think we really lucked out having him as a mentor—not only is he supportive of the work we’ll be doing in Akwatia, but he is incredibly accommodating, and clearly an influential figure around the hospital. Cheryl, our mentor from U of M, tells us he’s being groomed to be the Dean of the Medical School. Fancy!
The nurses and midwives of the antenatal clinic were amazing. They had organizing the chaos down to an exact science. Women came into the clinic and were directed to the first nursing station behind a curtain, where, if they were visiting for the first time for this particular pregnancy they were given a Ghana pregnancy booklet, which would stay with them throughout the pregnancy as their pregnancy record. The first nurse filled out the basic information with them, asked background medical history, and covered one or two of the ten or so topics in the ‘education’ section of the booklet, checking them off as she went. The nurse explained that by the time the woman goes to deliver all of the educational sections are supposed to be checked off. She said they ask women to come at least 6 times for antenatal care—ideal once every two weeks until 28 weeks and then once a week after that! I can’t imagine! Visiting the clinic is a four or five hour affair on a good day!
From station 1 women are sent to sit in the section waiting for station 2 where their height and weight are recorded in their book. Then they head to station 3 in groups for HIV counseling. We sat in on a few sessions, run by an inspirational midwife. She was so passionate, so talented at engaging the women, making them as comfortable as possible, and doing her best to make sure the vital information about transmission got across. After the group discussion, each woman did a rapid HIV test. The test involved a glucose-check type finger stick drawing a drop of blood which was placed on a small plastic one-use instrument. A drop of developer was added and in 10-20 minutes you had your results. Results were given by the midwife one-on-one with the women. We were privileged to sit in on a few of these sessions as well. The educator would tell them they were negative (all that we saw were) and then would ask what the women were going to do to maintain their negative status. The women would mumble and blush and laugh and consistently said “I will take care of myself”, the midwife would chuckle and ask for more detail. Though the women knew exactly what she was getting at they were painfully shy and couldn’t even start to say anything about sex or protection. How could anyone possible negotiate for protection or talk about monogamy when they can’t even mention the subject matter! The shyness was consistent and strong, woman after woman blushed and squirmed, knowing exactly what the nurse wanted them to say, but feeling far too shy to say the words or broach the topic! They were all pregnant! Obviously they’ve had sex! Their reactions to the topic in a supportive setting, alone with a compassionate woman, were shocking. The nurse told us afterwards that day after day this is what she experiences. She encouraged the women to bring their partners in to be tested (for free). She said many can’t convince them to come and get tested and are trained to not bring up the subject anyway—so instead she would suggest that the women just tell the men “the doctor wants to see you” just to get them in the door.
One of the tests we saw was unfortunately positive. Ghana has relatively low rates of HIV compared to other African countries. But, unfortunately, we were told that virtually none of the women who test positive go to the HIV clinic for follow up help after being counseled to do so… again, a result of denial and stigma. The midwife told us that last year 106 of the women they saw for antenatal care were positive. Shockingly, at least too me, was that of those women, 80 of their partners were coerced into coming in, but only ONE of those men tested positive, suggesting that the majority of these women got HIV from a previous partner or via another method. I guess that really speaks to how much easier the disease is to transmit male-to the male’s partner.
Anyway, back to the clinic flow. After counseling women go to station 4 where they pee in a cup which is immediately stick tested from protein and glucose (to test for pre-eclampsia and diabetes), the results of which are recording in their book. At station 5 blood pressures are recorded. And finally as station six they see a doctor. The examining rooms were something like 9 by 6’ and included a metal stretcher (no pad), a card table, and four plastic chairs. Two doctors worked with two patients in a room at a time. The women sat back to back in two of the chairs, next to the table where the doctors sat facing each other adjacent to the women. They looked through the nurses’ charting, asked a few questions, and then had the women jump up on the stretcher to have their belly measured and the fetal heart beat checked. Sometimes they would write for an ultrasound or prescribe some meds. The patient would then leave and the next patient would file in to fill their seat. An amazing, efficient, ‘herding’ method, that I’d venture to say is a fairly ingenious way to manage the limited resources. The nurses we met in the clinic were inspirational: skilled and compassionate educators who connected with every woman, no matter how shy or quiet they were—I left feeling really good about what these care providers were able to do with a bare minimum of resources. If they can accomplish this much on the ground floor, maybe there is hope for the labor ward!
After a positive clinic experience, a tasty pile of fried rice for lunch, and my first skypable internet connection (courtesy of sneaking into the doctors library and hacking our way onto the internet…)—we called it a day and wrapped up our week of observing at Korle-Bu. (Power just came back on!)
Despite the fact that Kofi (our go-to guy) is back in the States at the moment, the Michigan group (MHIRT students + 3 SPHers) decided to reconvene in Accra Saturday morning to head out on a weekend adventure. There are beaches near downtown Accra, but we’d heard rumors of some fabulous beaches a little further off the beaten path where we might be able to escape some of the hustle and bustle of the city. Having never ridden a tro-tro before, we headed out with vague directions. The plan was to meet up (some of the other students are now stationed outside Accra) at Kenashie market. Getting there wasn’t hard. Almost all of the tro-tros that pass by the ‘hole in the wall’ that leads to our hostel yell “Kenash! Kenash!”-- indicating their destination. We flagged one down and piled in, smushing ourselves in a van with a dozen or more other people packed like sardines in the back of a speeding death-box, that swerved to avoid pedestrians, pot holes, and oncoming cars, and honked at every passerby to ask “do you want a ride” until ‘capacity’ was reached… we survived! For 20 cents, we were dropped wide-eyed at Kenashie. As far as the eye could see the streets were packed with vendors, hawkers, shops, street food, taxis, busses, bolts of fabric, cans of nails and pins and bolts, cell phones, donut balls, soccer jerseys, piles of socks, clocks, toothpaste, fried fish, piles of mismatched sandals, coconuts, and anything else you could possibly dream up. If you could find it in the maize, you could buy it. The area of the market we stood in was only half the craziness, two pedestrian bridges about a half mile apart, connected the side of the market we were on to a continued expanse of craziness on the other side of the four lane thoroughfare. Miraculously, in the madness, after a handful of phone calls and bad directions, we connected with our group. A happy reunion of our little eight person Ghanaian family!
Within minutes, Alex and Nick’s aptly named friend, Wisdom, had us on a tro-tro headed to Kokrobite. Alex and Nick are working in a lab in Monpong 45 minutes from Korle-Bu. Wisdom is a young guy who does IT in the lab. He has taken them under his wing—teaching them to cook some Ghanaian food, playing soccer with them, and now, insisting on accompanying all of us to Kokrobite, just to make sure we didn’t get lost! The eight of us, plus Wisdom, filled the better part of a tro-tro, and headed North out of the city, before cutting west to the coast. For 70 cents, after a 40 minute ride, we were watching waves wash the sands of the African coast. We pulled off the main road onto a windy dirt road that took us hairly up a dirt, pot-hole ridden lane, over a steep hill for the overloaded bus, and then down the coastal plain, through roadside villages to the ocean. In the hills we could see larger houses, mostly grey cement block buildings, some finished, many half built or crumbling. Along the roadside little arrows indicated various beaches and food stops. Roadside stands spotted the drive, interspersed with garbage, beautiful views of the beach, shanties, children, and a smattering of goats.
We were dropped at a dirt road junction, 30 yards from the water, shaded by palm trees ripe with coconuts, and sided by a few cement buildings with lodging, and a sign that read “Big Millie’s Backyard” pointing down the lane that ran parallel to the ocean. Our plan had been to get to the beach and then find a spot to stay for the night. With Wisdom’s help we secured a few rooms at the “Dream Hotel”, breaking the bank at 13 cedi a person for the night. If we had explored further we could have probably stayed in a less touristy type place (though as far as we could tell there wasn’t really anyone else staying at our hotel…), but for our first outing, we were content with this place… plus we all just wanted to hit the beach!
The hotel was actually made up of outbuildings painted pink, reminiscent of Spanish styles, hidden in a garden behind the entrance. Each villa contained a few rooms, each outfitted with three single beds, a toilet (which sometimes flushed and had no seat), a shower, and a fan! As with all beds we’ve encountered in Ghana, there is a fitted sheet covering the mattress and a pillow—but no other sheets—not that you would want them in the heat! We were more than pleased with the place. Outside the rooms there were monkeys in the trees! At first glance we were stoked… before realizing that the monkeys were shackled to the trees, clearly on display for the visitors. It was later pointed out that none of the monkeys made noise and had probably had their vocal cords cut. I contemplated cutting them free… but decided that probably wouldn’t end well for me or the monkeys.
The sun was high, the beach was gorgeous, and with the ocean breeze we experienced comfortable temperatures for the first time since arriving. We staked out a spot, not a challenge on the spacious sands. A little further east 30 or so people played in the water, at the beach front of a hotel with trinket stands that sprawled onto the sand. We settled between a row of hardy wood fishing canoe-like boats and a little wood hut with rasta-men and the more than occasional smell of pot in the air. The beach was heavenly. Within minutes Nick and Alex had drummed up an intense game of beach soccer with the rasfa-dudes. We laid out towels and spent the afternoon lounging, playing in the bathwater ocean waves, and watching the action on the beach. I couldn’t help but cave to the lour of the water, and delinquently removed my cast, and was helped to the shore where I happily sat in the waves. Water therapy?!
Two guys and a young boy practiced an acrobatic routine nearby for hours—doing flips in the sand, standing on each other’s heads, whirling around with impressive balance preparing for a performance that evening. A group of nine or ten year old boys chased around after soccer balls and ended up stark naked running on the beach, kicking the ball and flipping into the water, surfing on old water jugs, and having far too much fun. A few chickens wandered on an off the beach at their leisure. Occasionally women would walk by with drinks or snacks balanced on their heads—unlike the men, they don’t solicit their sales (so much more pleasant!). They sold me my first ‘bag water’ which was intensely chemical flavored, to a degree that keesha’s crystal light powder couldn’t mask—unpleasant enough to dump out despite being thirsty. A pair of jewelry makers stationed themselves behind us, and we sat for a while sorting through their necklaces and bracelets of glass and stone hand painted beads. Once the soccer game wrapped up there was a fairly constant stream of rasta-dudes coming over to chat us up—asking about my leg, and telling us to come back later to hang out. The majority of Ghanaian men are so forward… “Hi, what’s your name? You have eyes as beautiful as the sea. You come later? We hang out!” Ummm no. Did you really think that line was going to work for you?!
At one point a scruffy little puppy, no more than 6 weeks old wandered onto the beach. He had patchy black fur, and clearly was in serious need of a mom and a vet, but he was playful as could be. He came loping clumsily across the sand, and I couldn’t help but pick him up! (I promise I washed well after and didn’t bring him anywhere near my face). He was sooo friendly. When I put him down and walk away he came running after me, jumping on me when I laid back down. He then joined a little boy playing near the bead lady. The boy totted him around and fed him parts of his donut ball snack. At one point he wandered over to the rasta men, and one of them picked him up by the ears and carried him whimpering back to the edge of the hotel… maybe that’s his dad? Poor puppy! There is a completely different mentality towards animals here—from the puppy, to the goats we’ve seen dragged on the street, to the monkeys tied to the trees. Sad.
After beaching it up, and pricing out the two close-by food options (annnd the power is out again) we chose to eat at our hotel. We seem to be fairly slow learners. We sat down starving, ignoring the fact that nothing happens fast here, particularly food. I’m fairly sure that when we order in most cases the cook then goes and starts the meal—I mean it makes sense, they can’t have a whole bunch of premade food kickin’ around. Plus, we were the lone diners at the outdoor hotel patio, in sight of the beach… table lit with my headlight. About an hour after ordering, and then gorging on dinner, but walked over to “Big Millie’s Backyard” where the place was hopping with a number of “Obrunies” (The word for “white people”). Their accents sounded Australia, South African, and American accents—obviously a tourist spot for 20 or so lucky folks. A word that sounds like o-bee-bee-nay means black person—Alex has taken to responding with o-bee-bee-nay when little kids point at him surprised and yell oooobrunie! Apparently the shock is double when he responds in Twi!
At Millie’s I had my first African beer: “Star” ‘Ghana’s favourite beer!’ according to the bottle. It tastes like America’s favorite beer, Budwiser. We sat under an outdoor bar with a grass roof. Christmas lights illuminated signs hanging from the roof with prices “per tot” (shot?). (Power is back) The local gin was 50 peswaes a ‘tot’… thankfully none of us wanted to try it. We hear it’s seriously potent and sometimes dangerous stuff. It was a chill night—we each had one beer, and sat chatting in a big circle tiki hut within ear shot of the ocean under a blanket of the first stars we’ve seen since arriving (first clear night). By 10PM we all moseyed the 100 yards back to the hotel to collapse into bed . Now that is my idea of a night out!
I spent Sunday morning reading on the beach, and was out early enough to see the fisherman paddle their bulky wooden boat through the surf on their return from the morning catch. It took seven men to get the boat up on the beach. These guys had the routine down. They placed a large tube under the front of the boat, grabbed the sides and together rolled the boat forward over the tube, repeating this process until the boat was in the proper place. Then they hauled out there nets. I sat a few feet away and watched them sort through enough crabs and crawfish to fill a laundry sack!
We capped off the stay with “Obrunie Breakfast” at Big Millie’s where we happily had omelets, crepes and coffee (!!!) for a few cedis each. Here, traditional breakfast food is the same as traditional lunch and dinner food—lots of rice, platans, chicken, and spice—so it was a treat to get breakfast food and coffee! We expertly tro-troed it back to Accra, and for less than a cedi fifty were back in the urban sprawl. An all around successful first outing and a wonderful weekend break!
Sending tropical rays to all of you.
Much love!
Friday, May 14, 2010
Pictures on facebook!
http://www.facebook.com/profile.php?id=646615061&ref=profile#!/album.php?aid=419774&id=646615061&ref=mf
Wednesday, May 12, 2010
Babies babies evvverywhere!
After my post Monday, Keesha and I met with our mentor Dr. Adanu and spent our first bit of time in and around the medical buildings of Korle-Bu (pronounced coal-eh-boo). Kofi tells us that Korle-Bu is the third largest hospital in Africa, with somewhere around 3,000 beds. Things are hustle and bustle like on any University hospital campus—a mix of white coats, patients, and staff. A scattering of stands selling fruit and beverages dot the lanes between buildings and tired visitors lay on the ground in the precious shade. White sign posts with black letters and red arrows indicate buildings like “Central OPD” (Centeral Out Patient Department, which importantly also contains the Service Cateen where lunch can be found!), laboratories, and the Community Health building where our mentor’s office is located. The buildings are mostly old-looking cement structures, about half of which are only one or two stories, the others rising up as high as ten floors. Thankfully Keesha has a photographic memory for directions because the windy red dirt roads on campus turn me all around.
After our first fairly short meeting with Dr. Adanu, Keesha and I wandered into the street adjacent to campus. Little shops lined the streets, attracting us with tempting fruits, including apples (I LOVE APPLES!!... not cheap but it made my day) and more random plastic goods (buckets, brooms, etc). As we wandered further, the shops thinned and we found ourselves walking through a neighborhood sturdier than a shanty town, but nonetheless obviously impoverished. Living areas mostly consist of little courtyards with floors of red dirt with a rainbow of clothes flapping the breeze and an area with an overhang, with or without walls, amidst an array of buckets, tubs, chickens, goats, children, and general debris in a somewhat organized mess. I did a lot of smiling and waving a little kids who stare at me like I am the strangest thing they’ve ever seen. A few darted behind walls and popped back out to wave. At dinner the other night a brave little guy, maybe 6 or 7, marched right up to say hi and shook my hand. Too cute! I wonder how many I could smuggle back ;)
During our walk in the neighborhood next to Korle-Bu I learned firsthand where the bathroom is for these folks. The same cement rectangular ditches that line most roads in the city also lined these neighborhoods, mostly uncovered, with a few inches of putrid water baking in the bottom (umm malaria?). As I crutched along, a girl, probably 10 or so, out playing with friends, straddled the ditch, and without crouching, let loose, spraying herself and her skirt as much as the ditch. She continued chattering with her friends as she peed, and as soon as she finished they darted back to playing the street. A few blocks later a little dude in a uniform on the way home from school stopped for a similar potty break. There ya go. That’s how it’s done I guess. At least its efficient?
After I braved a bit more street food, this time something wrapped in a palm leaf, that was the consistency of jello and the taste of sour rice pudding, we called it a day and headed back to our side of campus (a few miles, or a 2 cedi taxi ride for yours truly the exhausted gimp!), to our new standby restaurant “His Place” a half mile or so from the hostel. Still no sick tummies!
Dr. Adanu realized during our first meeting that Keesha and I really only have study related questions in terms of logistics which involve seeing the study site and meeting the translators. Thus, there isn’t a ton of work for us to do on the project while still in Accra. Given that our plan for the week was going to consist of just a few meetings, I asked if we could go do a bit of shadowing on the obstetric wards in our downtime…
I have never seen so many pregnant women in my entire life—not in one place, nor in total ever. Everyone was bursting. The maternal block was mind blowing. First of all, I don’t think I saw a single male partner in the place (What’s up with that?! Potentially a space issue? Or privacy since everyone is practically naked?). Secondly, there were truly babies popping out left and right.
I ditched my crutches in the changing room (the frayed mental spikes that protrude where the rubber bottoms used to be, slide like ice skates on the hospital floor… I sat as much as possible and did a lot of standing on one leg, I’m doing my best to be good, I promise!), Keesha and I were given scrubs, introduced to one of the doctors, and let loose on the ‘complicated’ pregnancy floor—a U shaped lay out, with women in hall stretchers, on mattresses on the floor, and in a few small stalls separated by curtains. All the women were wrapped in a sheet or cloth, but otherwise naked. Sometimes there is a bit of an attempt to pull a curtain, but more often exams (cm of dilation, fetal heart beat with a tube shaped stethoscope) take place in plain sight. We spent the first morning in the ward rotating between the two obstetric theatres watching c-sections, on women who had had previous c-sections and were not good candidates for vaginal births, or had other complications. We’d walk into one theatre, watch the anesthesiologist numb the women up, the woman would swing her legs up, and the doctors were at it. In minutes, out popped a baby, handed screaming to nurses or assistants who cut their cord and suctioned their noises. They were then held up for the mom to see—the nurses spread their legs to show the sex, and then they were off to the hall, creating a chorus of wailing little ones. While all this was going on the woman was stitched back up and some had their tubes tied. The doctor finished their stitches, pulled off their sterile gown and gloves, walked out of the room, re-scrubbed, and walked into the second theatre where the next patient would be waiting. The second c-section we saw brought two bouncing twin girls (in separate sacs) into the world, during the third we saw what a polycystic ovary looks like, the fourth was following a myomectomy (fibroid removal), and the fifth was the women’s fourth c-section: all this in a few hours (literally 10 AM to 1 PM!), while other women with potential complications labored naturally outside the theatre doors. We asked one of the nurses how many deliveries they see in a day. She said the day before they had had 62. When I looked somewhat stunned and said that was a lot, she said “Why is that a lot? We have 3 shifts.” Oy vey! When we changed and left to head to our meeting the first day, a woman was laboring and near birthing, essentially naked, in the hall with a lone helper, in plain sight the women nearby on the floor and bed mattresses. Just an average day at Korle-Bu?
On day two we stayed out of the theatres, opting to stay on the laboring side of the ward instead. We followed the same physician, Dr. Atoatowa (?), a skinny largely soft-spoken physician who was more than a little busy with the 18 or so women laboring in the small hall (many of which were waiting for c-sections). At one point 5 women were sharing a bench by the door all waiting for a mattress to lie on. They were even shorter on beds than the previous day as one of the stretchers that we stumbled upon that was occupied by a woman who passed away earlier in the day.
We saw several placentas removed manually, one that hadn’t passed after her delivery at a smaller community hospital in the night, and another where the doctor waited and pulled on the cord for traction for a few minutes, and then actually said “I don’t have time for this, there are too many patients” and then manually reached in and removed it. In regards to time management, we learned that all women that aren’t in active labor (3 contractions of 45-60 seconds each every 10 minutes) and don’t have contraindications, are augmented into labor with oxytocin. When I asked why, the doctor told me there were just too many women-- Once women are here occupying a bed, the staff needs them to labor and get out, so that someone else can have the bed. He also noted that there is no food for the women, so if they stay to long they will starve.
While following the doc as he checked the waiting women’s dilation status, the “normal” labor floor above came to get him to help the midwives with a breeched vaginal delivery. The difference between the normal delivery floor and the complicated floor was unbelievable. It felt liked we’d walked into a completely different, much better funded hospital. There were far fewer patients, white washed walls, and actual delivery rooms. Apparently the local phone company MTN sponsored the renovation of the ward recently… I really wished some of the waiting women on the floor below could go there!
On the ‘normal’ delivery floor, I got to see a vaginally delivery for the first time! A pretty young woman labored with a breeched baby in the hall (there were empty rooms…). When we arrived the feet of the baby were out, toes all a wiggle. With a little help from the doc situating his arms and head, out he came. He had six fingers on each hand which the nurses quickly addressed by tying string around the extras to make them fall off… but otherwise, he was no worse for the wear. We continued around the floor and checked in with women… or rather a cart of instruments was rolled into their room, the doc measured their bellies, listened to the baby’s heart beat through the stethoscope, and then without any warning to the women, slipped on gloves and shoved his hand inside them to check their dilation, often reprimanding them if they yelled or moved.
Most of the conversations between staff and all of the discussions with patients went on in Twi, so we were largely at a loss, but let’s just say there was little regard for the woman’s input; Somewhat understandable given the chaotic conditions, but very difficult to witness and arguably quite degrading. Several nurses, understaffed and overworked, seemed to be fairly angry at a few women, particularly if they had been there a long time or if they yelled loudly when they contracted. One patient, who was yelling out in contractions frequently, but who was barely dilated, and in danger of rupture, was given several forceful and loud scoldings from one of the senior nurses in Twi. I have no idea what she was saying, but it didn’t sound very pleasant.
Pads, blankets, or whatever else the woman needed came from bags of goods that the laboring woman brought along with them for hospital care. The laboring women provided their own cloths to wipe the baby off after delivery, diapers, ect. A few times cedis changed hands, apparently to get a drink from the nurses.
Needless to say, in all the chaos and cramped conditions, Keesha and I mainly tried to stay out of the way. We offered to help in any way possible, but I frequently felt helpless: here’s where an MD and a truck load of money would come in handy! Women’s pleading eyes would catch mine—I’d do my best to help if I could—adjusting a mat, or holding a hand-- but beyond that I was as lost as they were.
That my friends, is a far too detailed summary of my last few days on the labor wards. My apologies to those with weak stomachs!
It’s hard to believe that tomorrow marks just one week. I’ve seen so much in the last few days that it seems like ages since I was in the states!
Gotta run (I mean hobble… ;)), a dinner of red-red awaits at the restaurant next door to the internet cafe!
Thinking of you all,
Much love from Africa,
Halley
After our first fairly short meeting with Dr. Adanu, Keesha and I wandered into the street adjacent to campus. Little shops lined the streets, attracting us with tempting fruits, including apples (I LOVE APPLES!!... not cheap but it made my day) and more random plastic goods (buckets, brooms, etc). As we wandered further, the shops thinned and we found ourselves walking through a neighborhood sturdier than a shanty town, but nonetheless obviously impoverished. Living areas mostly consist of little courtyards with floors of red dirt with a rainbow of clothes flapping the breeze and an area with an overhang, with or without walls, amidst an array of buckets, tubs, chickens, goats, children, and general debris in a somewhat organized mess. I did a lot of smiling and waving a little kids who stare at me like I am the strangest thing they’ve ever seen. A few darted behind walls and popped back out to wave. At dinner the other night a brave little guy, maybe 6 or 7, marched right up to say hi and shook my hand. Too cute! I wonder how many I could smuggle back ;)
During our walk in the neighborhood next to Korle-Bu I learned firsthand where the bathroom is for these folks. The same cement rectangular ditches that line most roads in the city also lined these neighborhoods, mostly uncovered, with a few inches of putrid water baking in the bottom (umm malaria?). As I crutched along, a girl, probably 10 or so, out playing with friends, straddled the ditch, and without crouching, let loose, spraying herself and her skirt as much as the ditch. She continued chattering with her friends as she peed, and as soon as she finished they darted back to playing the street. A few blocks later a little dude in a uniform on the way home from school stopped for a similar potty break. There ya go. That’s how it’s done I guess. At least its efficient?
After I braved a bit more street food, this time something wrapped in a palm leaf, that was the consistency of jello and the taste of sour rice pudding, we called it a day and headed back to our side of campus (a few miles, or a 2 cedi taxi ride for yours truly the exhausted gimp!), to our new standby restaurant “His Place” a half mile or so from the hostel. Still no sick tummies!
Dr. Adanu realized during our first meeting that Keesha and I really only have study related questions in terms of logistics which involve seeing the study site and meeting the translators. Thus, there isn’t a ton of work for us to do on the project while still in Accra. Given that our plan for the week was going to consist of just a few meetings, I asked if we could go do a bit of shadowing on the obstetric wards in our downtime…
I have never seen so many pregnant women in my entire life—not in one place, nor in total ever. Everyone was bursting. The maternal block was mind blowing. First of all, I don’t think I saw a single male partner in the place (What’s up with that?! Potentially a space issue? Or privacy since everyone is practically naked?). Secondly, there were truly babies popping out left and right.
I ditched my crutches in the changing room (the frayed mental spikes that protrude where the rubber bottoms used to be, slide like ice skates on the hospital floor… I sat as much as possible and did a lot of standing on one leg, I’m doing my best to be good, I promise!), Keesha and I were given scrubs, introduced to one of the doctors, and let loose on the ‘complicated’ pregnancy floor—a U shaped lay out, with women in hall stretchers, on mattresses on the floor, and in a few small stalls separated by curtains. All the women were wrapped in a sheet or cloth, but otherwise naked. Sometimes there is a bit of an attempt to pull a curtain, but more often exams (cm of dilation, fetal heart beat with a tube shaped stethoscope) take place in plain sight. We spent the first morning in the ward rotating between the two obstetric theatres watching c-sections, on women who had had previous c-sections and were not good candidates for vaginal births, or had other complications. We’d walk into one theatre, watch the anesthesiologist numb the women up, the woman would swing her legs up, and the doctors were at it. In minutes, out popped a baby, handed screaming to nurses or assistants who cut their cord and suctioned their noises. They were then held up for the mom to see—the nurses spread their legs to show the sex, and then they were off to the hall, creating a chorus of wailing little ones. While all this was going on the woman was stitched back up and some had their tubes tied. The doctor finished their stitches, pulled off their sterile gown and gloves, walked out of the room, re-scrubbed, and walked into the second theatre where the next patient would be waiting. The second c-section we saw brought two bouncing twin girls (in separate sacs) into the world, during the third we saw what a polycystic ovary looks like, the fourth was following a myomectomy (fibroid removal), and the fifth was the women’s fourth c-section: all this in a few hours (literally 10 AM to 1 PM!), while other women with potential complications labored naturally outside the theatre doors. We asked one of the nurses how many deliveries they see in a day. She said the day before they had had 62. When I looked somewhat stunned and said that was a lot, she said “Why is that a lot? We have 3 shifts.” Oy vey! When we changed and left to head to our meeting the first day, a woman was laboring and near birthing, essentially naked, in the hall with a lone helper, in plain sight the women nearby on the floor and bed mattresses. Just an average day at Korle-Bu?
On day two we stayed out of the theatres, opting to stay on the laboring side of the ward instead. We followed the same physician, Dr. Atoatowa (?), a skinny largely soft-spoken physician who was more than a little busy with the 18 or so women laboring in the small hall (many of which were waiting for c-sections). At one point 5 women were sharing a bench by the door all waiting for a mattress to lie on. They were even shorter on beds than the previous day as one of the stretchers that we stumbled upon that was occupied by a woman who passed away earlier in the day.
We saw several placentas removed manually, one that hadn’t passed after her delivery at a smaller community hospital in the night, and another where the doctor waited and pulled on the cord for traction for a few minutes, and then actually said “I don’t have time for this, there are too many patients” and then manually reached in and removed it. In regards to time management, we learned that all women that aren’t in active labor (3 contractions of 45-60 seconds each every 10 minutes) and don’t have contraindications, are augmented into labor with oxytocin. When I asked why, the doctor told me there were just too many women-- Once women are here occupying a bed, the staff needs them to labor and get out, so that someone else can have the bed. He also noted that there is no food for the women, so if they stay to long they will starve.
While following the doc as he checked the waiting women’s dilation status, the “normal” labor floor above came to get him to help the midwives with a breeched vaginal delivery. The difference between the normal delivery floor and the complicated floor was unbelievable. It felt liked we’d walked into a completely different, much better funded hospital. There were far fewer patients, white washed walls, and actual delivery rooms. Apparently the local phone company MTN sponsored the renovation of the ward recently… I really wished some of the waiting women on the floor below could go there!
On the ‘normal’ delivery floor, I got to see a vaginally delivery for the first time! A pretty young woman labored with a breeched baby in the hall (there were empty rooms…). When we arrived the feet of the baby were out, toes all a wiggle. With a little help from the doc situating his arms and head, out he came. He had six fingers on each hand which the nurses quickly addressed by tying string around the extras to make them fall off… but otherwise, he was no worse for the wear. We continued around the floor and checked in with women… or rather a cart of instruments was rolled into their room, the doc measured their bellies, listened to the baby’s heart beat through the stethoscope, and then without any warning to the women, slipped on gloves and shoved his hand inside them to check their dilation, often reprimanding them if they yelled or moved.
Most of the conversations between staff and all of the discussions with patients went on in Twi, so we were largely at a loss, but let’s just say there was little regard for the woman’s input; Somewhat understandable given the chaotic conditions, but very difficult to witness and arguably quite degrading. Several nurses, understaffed and overworked, seemed to be fairly angry at a few women, particularly if they had been there a long time or if they yelled loudly when they contracted. One patient, who was yelling out in contractions frequently, but who was barely dilated, and in danger of rupture, was given several forceful and loud scoldings from one of the senior nurses in Twi. I have no idea what she was saying, but it didn’t sound very pleasant.
Pads, blankets, or whatever else the woman needed came from bags of goods that the laboring woman brought along with them for hospital care. The laboring women provided their own cloths to wipe the baby off after delivery, diapers, ect. A few times cedis changed hands, apparently to get a drink from the nurses.
Needless to say, in all the chaos and cramped conditions, Keesha and I mainly tried to stay out of the way. We offered to help in any way possible, but I frequently felt helpless: here’s where an MD and a truck load of money would come in handy! Women’s pleading eyes would catch mine—I’d do my best to help if I could—adjusting a mat, or holding a hand-- but beyond that I was as lost as they were.
That my friends, is a far too detailed summary of my last few days on the labor wards. My apologies to those with weak stomachs!
It’s hard to believe that tomorrow marks just one week. I’ve seen so much in the last few days that it seems like ages since I was in the states!
Gotta run (I mean hobble… ;)), a dinner of red-red awaits at the restaurant next door to the internet cafe!
Thinking of you all,
Much love from Africa,
Halley
Monday, May 10, 2010
Greetings from Ghana! It’s been an amazing and humbling journey already. We arrived in Accra on Friday May 7th, after a 9.5 hour flight from JFK. I got my first glimpse of the dark green African foliage and red dirt from the plane, Akwaaba (Welcome!) to Africa! We disembarked the plane 7:30AM Ghana time (3:30AM Michigan time) and were hit with the heavy 100+ F blaze of the equatorial sun. The heat has stayed with us day and night since—my 100 SPF sunblock is getting a work out!
We were met in the airport by a few men holding a U of M placard up. They were sent by our on the ground person Kofi. Having never met them before, and still very much disoriented, we followed them out into the street to their van. As we walked an increasing number of men joined our group, each pressing in next to us asking to carry our bags, and though we refused, telling us that we needed to tip them—they almost convinced another student to give them 20 cedi (1 USD = 1.41 Ghana cedi), before we were shoved into a car by Kofi’s drivers; the beginning of a continuing and overwhelming experience with poverty and inequity.
We drove out of the airport into the heart of Accra, the capital of Ghana. The streets were lined with people selling items from razors, to bags of water, to TV antennas, in between the clogged lanes of the most chaotic traffic I have ever seen. Cars pull out in front of one another with no clear pattern of right of way, and eventually someone yields or swerves—a large game of car “chicken” that somehow gets people where they want to go, when it doesn’t end in an accident. Many people travel in tro-tros—vans that pack a dozen or so people in, operated by a driver and another person hanging out an open side door yelling their destination to passerbys who might want a ride (40 paeswas (.4 cedi)). We’ve yet to ride one, but I’m sure we’ll work up the courage soon-- that’s definitely the cheapest way to get around. The ones going by where we are staying mostly yell “Kaneshie! Kaneshie!” as they are headed to a major transportation hub and market in an area of the city called Kanesh. The back of the vans and taxis are fairly comical. Most have strange biblical references pasted on the back windows in large letters, things like: “PASTOR!” of “I SIN NOT!” and many more which make far less sense. In all honesty though, you’d have to have a lot of faith to be a driver in that traffic! Plus, if you go off the road you either hit people or the foot wide cement ditch that lines many roads. Needless to say, we’ve seen several used tire-sales places!
The trip from the airport to the hostel took 45 minutes in the notoriously bad Accra traffic. I wish I had internet access that would allow me to upload the videos I took of the Accra streets—I don’t think my descriptions can do the place justice. All along the streets there are makeshift vendors, with random goods like those sold between lanes of traffic, as well as traditional foods (from ball shaped donuts to dried fish), and fruits. Women strolled along in the heat with heavy loads balanced on their heads—carrying baskets of bagged water (10-20 paeswas for a softball size bag). Some were in bright typically African dresses and wraps, while others were in western style clothes. Along the dirt sidewalk, people lay in the shade, and small children darted in and out playing in the dirt, or riding in wraps strapped to their mother’s backs. Shanty towns popped up left and right, clothes hanging out to dry along the street side, an occasional goat trotting through the buildings, old Guinness posters cut into slats to make hanging doors on shacks. Pre-teens played an intense game of soccer bare feet in a half finished, half demolished building foundation, while a younger troop scuttled in an empty lot. We passed by the Atlantic coast line, but this particular view was clouded by factory smoke from the distance, and rubble and garbage heaped high on what would have been the beach. We’ve heard rumors of some great beaches and coast line… but definitely not this particular spot! Word on the street is the La Beach is the best beach in Accra, so we’re aiming to try that out when we can… though I’m not sure I can feasibly crutch on a beach… minor details.
We turned off the main roads from the airport into Korle-Bu Teaching Hospital campus. Dirt drives off the campus road lead to one story bungalows with open doors and signs indicating things like the “Nursing Quarters” and “Regional Prevention of Maternal Mortality Program”. Some of the main roads have names (though I’ve yet to see a road sign), but most directions are given by general area (like Kenashie, or “the road after the sign post that says X” which makes it a big difficult to navigate as a newbie. After a mile or so on the medical campus, we reached the University of Ghana Medical School International Students Hostel, flanked by barb wire and a dirt field (later used by the boys for an intense game of international soccer) and bordered by a bungalow house with numerous small bare-foot children peaking around the corner at us and playing in the field. I later tried to make friends with them, telling them I couldn’t play soccer with the big kids, but I could sit in the dirt and build castles… They weren’t having any of it.
Our hostel houses visiting medical students, and international students that attend the University of Ghana. My roommate, Bukky, is a third year medical student from Nigeria (as are all the other African students I’ve met). For Keesha and I this is temporary housing for a week or two before we head to Akwatia. The hostel has two person rooms, with screens on the windows and ceiling fans. At night the fan makes the room sleepable, but during the day it’s blazing despite the air flow. We have the luxury of running (non-potable) water piped from a basin outside that collects the rain water. We have thoroughly enjoyed the cold showers and flush toilets (though they are BYO-toilet paper). Wash buckets line the halls along with hangers for drying clothes. I’ve been washing my clothes in the shower with me, and hanging them to dry. In this heat things get so sweaty that after a day they definitely need to be washed! Around 6 PM the sun sets and sweating subsides. Still adjusting to the time change and heat, I’ve been fast asleep soon after it gets dark! By 6 AM it’s light and the Ghanaians are up and about, smartly getting things done before the sun is scorching.
I’m learning about Africa time, and realizing that things are going to move very slowly here. Kofi appeared Saturday morning for the first time (he’s great—telling us, call me anytime, “While you are here I am your mother, your father, your sister, your brother”). Already we’ve realized that people don’t always show up when they say they will, and if they do it’s likely at least an hour late. He told us that we’ll be able to meet our mentor Dr. Adanu at Korle-Bu on Monday, and we’ll be able to work on final preparations for our work in Akwatia—things like translating surveys and finalizing our methods for the week or two while we are here (no one really knows the details). Kofi just popped in moments ago to take some other U of M School of Public Health Students (Katie, Megan and Ajab) to their site in Tamale (45 minutes away). Apparently at some point later today he’ll be back for us—that’s the most detail we’ve had yet! I’m sure it’ll work out though, and I’m really looking forward to meeting Dr. Adanu and seeing the hospital.
Being on crutches is incredibly frustrating—I would love to go explore, but I have to carefully ration where I can physically manage to hop to in one day. As much as I want to pitch my crutches out the taxi window, I’m trying to be good and yet not to let it slow me down too much. By Sunday I had completely worn through the rubber stoppers on the bottom of my crutches (not cool on the slick floor of the hostel hall!). I’m building a bit of stamina (that’s what exhausted arms mean right?) and sweating buckets. I stick out like a sore thumb as a white girl, with blue eyes, and crutches. People stare at me on the street and many yell from taxis or stands, “Sorry! Sorry!” while pointing at my leg. It’s quite a trip to have an impoverished person, laying in the dirt on the street yell “sorry sorry!” pointing at my leg. I haven’t figured out the correct response yet, for now I’m sticking with “medasi” (thank you).
The local Ghana dishes are delicious (no sick tummies yet!)—my favourite so far is red-red: a very filling plate of fried plantans, beans (black-eyed peas?), and chicken. As the locals have explained, people here do a lot of manual labor, so the dishes are made to be dense and filling. If you though portion sizes were large in the US… come to Ghana—finishing a meal of local grub is a challenge. Last night I had plantans and palava sauce (onions and greens in a stew like mixture that is sppppicy!) with a drink for 3.7 cedis and was absolutely filled to the brim! Yesterday while hopping around the outside of campus in search of water and fruit, we ate our first street vendor food, purchase from a young man biking along with a box of baked goods. The item I had, for 20 paeswas, was called something that sounded like “rock-pie” and looked and tasted like a delicious corn meal muffin. After we’d all finished buying what we wanted that young man pulled out another “rock-pie (?)” and handed it to me for free, acknowledging my cast. So generous!
In order to have some food here at the hostel, Saturday Keesha and I decided to venture on our own to the grocery store, as the driver Kofi sent never showed up to take us. My roommate Bukky told us what to tell the taxi driver and what a fair price for the ride was—that’s something I definitely haven’t adjusted to yet. Buying anything involves intense bartering, especially as a foreigner. Bukky helped up bargain for the first taxi, as there was no direct tro-tro, and she thought the tro-tro would be too difficult with crutches. For 4 cedis we got a ride through Accra to the district of Osu, where we were told to go to a store called Koala for groceries. We’ve now realized that folks tend to send us to “foreigner” restaurants and stores. Koala had a sample of what we have at home, but at high prices, as one might expect: Corn Flakes for 10 cedis, etc. We found a few things, that we really needed, including water which we had completely run out of (we’re drinking 3+ liters each a day in the heat and have to buy it in bottles) and made a pact to try not to shop at “white-people” stores for the rest of our stay. That said, the rice and beans Keesha cooked up using her roommates dishes were very yummy! If I had known more about our housing situation I would have packed a bit differently—I could kill for a bowl, real silverware, and a camp set of cookware, as we are on our own for that stuff at the hostel! I’m sure we could buy those things somewhere here, but we’ve yet to find it, and when we do find things we’re looking for the prices are astronomical—we could barely stifle a laugh when one street vendor told us a bath towel was 30 cedis. She had of course inflated the price for us (Kofi said we should pay no more than 5) and we passed on the offer, but on the flip side, in doing so we also failed to buy the things we were looking for, like dishes. We’ll keep looking!
Having gotten up early to avoid too much hoping in the heat, and made what is hopefully one of my only “long hops” today to the internet café, I’m heading back to find more water, and recharge my arm energy at the hostel before our meeting with Dr. Adanu.
I’ll do my best to update again soon!
All the best to all of you! Hugs!
-Halley
We were met in the airport by a few men holding a U of M placard up. They were sent by our on the ground person Kofi. Having never met them before, and still very much disoriented, we followed them out into the street to their van. As we walked an increasing number of men joined our group, each pressing in next to us asking to carry our bags, and though we refused, telling us that we needed to tip them—they almost convinced another student to give them 20 cedi (1 USD = 1.41 Ghana cedi), before we were shoved into a car by Kofi’s drivers; the beginning of a continuing and overwhelming experience with poverty and inequity.
We drove out of the airport into the heart of Accra, the capital of Ghana. The streets were lined with people selling items from razors, to bags of water, to TV antennas, in between the clogged lanes of the most chaotic traffic I have ever seen. Cars pull out in front of one another with no clear pattern of right of way, and eventually someone yields or swerves—a large game of car “chicken” that somehow gets people where they want to go, when it doesn’t end in an accident. Many people travel in tro-tros—vans that pack a dozen or so people in, operated by a driver and another person hanging out an open side door yelling their destination to passerbys who might want a ride (40 paeswas (.4 cedi)). We’ve yet to ride one, but I’m sure we’ll work up the courage soon-- that’s definitely the cheapest way to get around. The ones going by where we are staying mostly yell “Kaneshie! Kaneshie!” as they are headed to a major transportation hub and market in an area of the city called Kanesh. The back of the vans and taxis are fairly comical. Most have strange biblical references pasted on the back windows in large letters, things like: “PASTOR!” of “I SIN NOT!” and many more which make far less sense. In all honesty though, you’d have to have a lot of faith to be a driver in that traffic! Plus, if you go off the road you either hit people or the foot wide cement ditch that lines many roads. Needless to say, we’ve seen several used tire-sales places!
The trip from the airport to the hostel took 45 minutes in the notoriously bad Accra traffic. I wish I had internet access that would allow me to upload the videos I took of the Accra streets—I don’t think my descriptions can do the place justice. All along the streets there are makeshift vendors, with random goods like those sold between lanes of traffic, as well as traditional foods (from ball shaped donuts to dried fish), and fruits. Women strolled along in the heat with heavy loads balanced on their heads—carrying baskets of bagged water (10-20 paeswas for a softball size bag). Some were in bright typically African dresses and wraps, while others were in western style clothes. Along the dirt sidewalk, people lay in the shade, and small children darted in and out playing in the dirt, or riding in wraps strapped to their mother’s backs. Shanty towns popped up left and right, clothes hanging out to dry along the street side, an occasional goat trotting through the buildings, old Guinness posters cut into slats to make hanging doors on shacks. Pre-teens played an intense game of soccer bare feet in a half finished, half demolished building foundation, while a younger troop scuttled in an empty lot. We passed by the Atlantic coast line, but this particular view was clouded by factory smoke from the distance, and rubble and garbage heaped high on what would have been the beach. We’ve heard rumors of some great beaches and coast line… but definitely not this particular spot! Word on the street is the La Beach is the best beach in Accra, so we’re aiming to try that out when we can… though I’m not sure I can feasibly crutch on a beach… minor details.
We turned off the main roads from the airport into Korle-Bu Teaching Hospital campus. Dirt drives off the campus road lead to one story bungalows with open doors and signs indicating things like the “Nursing Quarters” and “Regional Prevention of Maternal Mortality Program”. Some of the main roads have names (though I’ve yet to see a road sign), but most directions are given by general area (like Kenashie, or “the road after the sign post that says X” which makes it a big difficult to navigate as a newbie. After a mile or so on the medical campus, we reached the University of Ghana Medical School International Students Hostel, flanked by barb wire and a dirt field (later used by the boys for an intense game of international soccer) and bordered by a bungalow house with numerous small bare-foot children peaking around the corner at us and playing in the field. I later tried to make friends with them, telling them I couldn’t play soccer with the big kids, but I could sit in the dirt and build castles… They weren’t having any of it.
Our hostel houses visiting medical students, and international students that attend the University of Ghana. My roommate, Bukky, is a third year medical student from Nigeria (as are all the other African students I’ve met). For Keesha and I this is temporary housing for a week or two before we head to Akwatia. The hostel has two person rooms, with screens on the windows and ceiling fans. At night the fan makes the room sleepable, but during the day it’s blazing despite the air flow. We have the luxury of running (non-potable) water piped from a basin outside that collects the rain water. We have thoroughly enjoyed the cold showers and flush toilets (though they are BYO-toilet paper). Wash buckets line the halls along with hangers for drying clothes. I’ve been washing my clothes in the shower with me, and hanging them to dry. In this heat things get so sweaty that after a day they definitely need to be washed! Around 6 PM the sun sets and sweating subsides. Still adjusting to the time change and heat, I’ve been fast asleep soon after it gets dark! By 6 AM it’s light and the Ghanaians are up and about, smartly getting things done before the sun is scorching.
I’m learning about Africa time, and realizing that things are going to move very slowly here. Kofi appeared Saturday morning for the first time (he’s great—telling us, call me anytime, “While you are here I am your mother, your father, your sister, your brother”). Already we’ve realized that people don’t always show up when they say they will, and if they do it’s likely at least an hour late. He told us that we’ll be able to meet our mentor Dr. Adanu at Korle-Bu on Monday, and we’ll be able to work on final preparations for our work in Akwatia—things like translating surveys and finalizing our methods for the week or two while we are here (no one really knows the details). Kofi just popped in moments ago to take some other U of M School of Public Health Students (Katie, Megan and Ajab) to their site in Tamale (45 minutes away). Apparently at some point later today he’ll be back for us—that’s the most detail we’ve had yet! I’m sure it’ll work out though, and I’m really looking forward to meeting Dr. Adanu and seeing the hospital.
Being on crutches is incredibly frustrating—I would love to go explore, but I have to carefully ration where I can physically manage to hop to in one day. As much as I want to pitch my crutches out the taxi window, I’m trying to be good and yet not to let it slow me down too much. By Sunday I had completely worn through the rubber stoppers on the bottom of my crutches (not cool on the slick floor of the hostel hall!). I’m building a bit of stamina (that’s what exhausted arms mean right?) and sweating buckets. I stick out like a sore thumb as a white girl, with blue eyes, and crutches. People stare at me on the street and many yell from taxis or stands, “Sorry! Sorry!” while pointing at my leg. It’s quite a trip to have an impoverished person, laying in the dirt on the street yell “sorry sorry!” pointing at my leg. I haven’t figured out the correct response yet, for now I’m sticking with “medasi” (thank you).
The local Ghana dishes are delicious (no sick tummies yet!)—my favourite so far is red-red: a very filling plate of fried plantans, beans (black-eyed peas?), and chicken. As the locals have explained, people here do a lot of manual labor, so the dishes are made to be dense and filling. If you though portion sizes were large in the US… come to Ghana—finishing a meal of local grub is a challenge. Last night I had plantans and palava sauce (onions and greens in a stew like mixture that is sppppicy!) with a drink for 3.7 cedis and was absolutely filled to the brim! Yesterday while hopping around the outside of campus in search of water and fruit, we ate our first street vendor food, purchase from a young man biking along with a box of baked goods. The item I had, for 20 paeswas, was called something that sounded like “rock-pie” and looked and tasted like a delicious corn meal muffin. After we’d all finished buying what we wanted that young man pulled out another “rock-pie (?)” and handed it to me for free, acknowledging my cast. So generous!
In order to have some food here at the hostel, Saturday Keesha and I decided to venture on our own to the grocery store, as the driver Kofi sent never showed up to take us. My roommate Bukky told us what to tell the taxi driver and what a fair price for the ride was—that’s something I definitely haven’t adjusted to yet. Buying anything involves intense bartering, especially as a foreigner. Bukky helped up bargain for the first taxi, as there was no direct tro-tro, and she thought the tro-tro would be too difficult with crutches. For 4 cedis we got a ride through Accra to the district of Osu, where we were told to go to a store called Koala for groceries. We’ve now realized that folks tend to send us to “foreigner” restaurants and stores. Koala had a sample of what we have at home, but at high prices, as one might expect: Corn Flakes for 10 cedis, etc. We found a few things, that we really needed, including water which we had completely run out of (we’re drinking 3+ liters each a day in the heat and have to buy it in bottles) and made a pact to try not to shop at “white-people” stores for the rest of our stay. That said, the rice and beans Keesha cooked up using her roommates dishes were very yummy! If I had known more about our housing situation I would have packed a bit differently—I could kill for a bowl, real silverware, and a camp set of cookware, as we are on our own for that stuff at the hostel! I’m sure we could buy those things somewhere here, but we’ve yet to find it, and when we do find things we’re looking for the prices are astronomical—we could barely stifle a laugh when one street vendor told us a bath towel was 30 cedis. She had of course inflated the price for us (Kofi said we should pay no more than 5) and we passed on the offer, but on the flip side, in doing so we also failed to buy the things we were looking for, like dishes. We’ll keep looking!
Having gotten up early to avoid too much hoping in the heat, and made what is hopefully one of my only “long hops” today to the internet café, I’m heading back to find more water, and recharge my arm energy at the hostel before our meeting with Dr. Adanu.
I’ll do my best to update again soon!
All the best to all of you! Hugs!
-Halley
Thursday, May 6, 2010
En Route!
It's official-- I'm on my way!
For those of you who haven't heard the details, here's a quick recap: The MHIRT (Minority Health and Health Disparities International Research Training) Program at U of M sponsors students doing international health research. This year I am one of six students sponsored by the program to go to Ghana for the summer to do research. The six of us are split into three groups doing different projects in several locations around the country. I'll be in the town of Akwatia (http://en.wikipedia.org/wiki/Akwatia) with my partner in crime for the summer, Keesha. At the moment Keesha, myself and three of the other students who will be stationed in Ghana (Nick, Alex, and Ella) are enjoying our last moments of fast internet at the JFK airport, before jetting off to Accra(the capital of Ghana) where we will be working for the first two weeks .
In Akwatia (a town 2 hours outside of Accra) Keesha and I will be interviewing pregnant women in an antenatal clinic about their needs, wants, and intentions for the delivery of their pregnancies. Despite numerous attempts in developing nations to decrease maternal mortality by increasing skilled birth attendance, over the last thirty years little improvement has been made-- More than 500,000 women die every year from pregnancy related complications. While many have hypothesized about the types of interventions that are needed to combat this issue, few have directly asked women what decides where they deliver. My hope, and the idea behind our research, is that by giving these women a voice we can better understand the circumstances that determine their delivery locations, and empower these women to help craft interventions that are more effective and culturally attuned.
So that my friends is the game plan... We'll see how it pans out! More exciting updates to follow :)
Hugs to all!
For those of you who haven't heard the details, here's a quick recap: The MHIRT (Minority Health and Health Disparities International Research Training) Program at U of M sponsors students doing international health research. This year I am one of six students sponsored by the program to go to Ghana for the summer to do research. The six of us are split into three groups doing different projects in several locations around the country. I'll be in the town of Akwatia (http://en.wikipedia.org/wiki/Akwatia) with my partner in crime for the summer, Keesha. At the moment Keesha, myself and three of the other students who will be stationed in Ghana (Nick, Alex, and Ella) are enjoying our last moments of fast internet at the JFK airport, before jetting off to Accra(the capital of Ghana) where we will be working for the first two weeks .
In Akwatia (a town 2 hours outside of Accra) Keesha and I will be interviewing pregnant women in an antenatal clinic about their needs, wants, and intentions for the delivery of their pregnancies. Despite numerous attempts in developing nations to decrease maternal mortality by increasing skilled birth attendance, over the last thirty years little improvement has been made-- More than 500,000 women die every year from pregnancy related complications. While many have hypothesized about the types of interventions that are needed to combat this issue, few have directly asked women what decides where they deliver. My hope, and the idea behind our research, is that by giving these women a voice we can better understand the circumstances that determine their delivery locations, and empower these women to help craft interventions that are more effective and culturally attuned.
So that my friends is the game plan... We'll see how it pans out! More exciting updates to follow :)
Hugs to all!
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