Settling Into Akwatia

We’ve completed our first real week of work and are starting to settle into a routine here in Akwatia. Each morning we wake up at 6, greeted by wet red dirt, inevitably watered by the evening rains. Even at 6, the air is humid despite the rain. I boil a cup of water in the tin mug we found in our cupboard, use a towel to pick it up off our two burner gas counter-top stove and then add a coveted packed of Nescafe to make a mixture resembling morning coffee. After a quick meal, often groundnut paste (peanut butter –ish) on toast or eggs, we’re out the door to meet the bus to the hospital campus, which leaves at 7:05 sharp. We ride into the hospital with a mix of staff that stays in the St. Dominick’s ‘staff village’ where we live, as well as a bunch of ridiculously cute tiny children dressed in their school uniforms—yellow shirts tucked into green shorts for the boys, and yellow dresses for the girls. Each school has their own bright and distinct uniform, so as we drive into town we’re met by a collage of children- some in pink and purple, other in checkers, heading one way or another, depending on their level in school and destination.

Our apartment is surrounded by what I thought were forest like orchards of limes- turns out they are oranges in lime’s clothing—they don’t turn orange, but are a pinky color inside. After a few minutes, life other then the jungle and oranges builds slowly. The sky is well lit by the time we’re headed to work but morning fog still hangs over the jungles that rise up to our East. Aside from the homes and road side stands scattered on the road, just beyond the road the surroundings fade quickly into dense jungle- no clearings aside from what touches the road. A valley falls to the East of the road, giving us a beautiful view of a horizon of rising hills, appearing wild and untouched from afar, covered in a cascade of wild palm trees, eucalyptus trees and rich green foliage, soaking up the daily rains of the rainy season.

To the west, the forest is thick, but without a valley our view is limited to the roadside. We pass a sign in a clearing that says “Ghana Diamonds Consolidated” marking a path leading to a gate, beyond which are the small hills containing the Diamonds that brought Akwatia into existence—making some foreigners or government officials wealthy with money that the average citizen from Akwatia will never see. We hear the mines aren’t running at the moment. After dropping the troop of children at a school on the edge of town where structures start to cluster along the road, we enter into the town of Boudoa (pronounced Bode-dwe-ah). Boudoa flanks the hospital grounds to the East, sandwiching St. Dominic’s between it and the slightly more populous Akwatia, a mile or so to the West. Boudoa is really just a T junction—our bus turns West at the T toward St. Dominic’s, whereas if it continued Northward in 5 or so miles it would run into the town of Kade, a larger town with a market we’ve visited. Like most towns we’ve seen, larger than villages reached only by footpath, or clusters of mud huts, Boudoa’s structures line the road for a block or two on either side of the T junction. Homes and vendors are short ground level buildings made of scrapped together wood, or cement blocks, with well rusted patchy sheet metals roofs. The doors are barely a stone throw from the road, sunk down in the red dirt, a few feet below the level of the road. The edges of the structures are eroded away by strong rains, separated from taxi’s and tro tros by only a cement ditch. We pass a few spots where old cars or taxi’s are being worked on in lots, a shop where four or so women sit at sowing machines under an overhang hard at work, and some building that have obviously changed hands—like ‘God’s Grace Beauty Salon’ painted on the ledge below the overhang of a roof from which greasy auto parts hang.

At 7 am a number of people are out and about—kids off to school, vendors settling up shop, adults loitering on stoops, fixing taxi’s on the roadside, balancing bundles of wood on their heads, and heading off to work. We pass a small gas station at the T, a rough and tumble bike repair shop, with twenty something age boys sitting on crates surrounded my old tires, patched tubes, and well greased and gunked spare parts. I keep threatening to buy a bike, but without a helmet for hundreds of miles, and given the road conditions, I should probably steer clear of that as I don’t really think I can stand to be on crutches again! Past the bike shop, there is a little worksite on one side of the road with piles of a brown substance that people shovel into big cylindrical grates which are then spun… from the looks of it, the churning goat droppings…. I’m assuming for use as fuel?

We turn West at the T, and continue another half mile or so, up a gentle incline, to the hospital entrance, poised at the top of the hill. Across the road from the hospital entrance women line the road, manning our version of grocery stores. Stalls with shelves with a scattering of canned goods, buckets of loose rice and beans, bottled water and minerals (pop), and the typically smattering of plastic buckets and odds and ends. Just outside the hospital gait, a cluster of tro tros clutter the roadside, dropping off visitors and patients, and shouting out their destinations to pack their seats on the way out. An overhang next to the gait is clearly labeled “Visitors Lounge”—aside from the strict visiting hours a few times a day, the lounge is filled with waiting relatives. Mostly women, clutching small baskets, covered in towels, carrying food for their loved ones at the hospital. Goats and chickens weave in and around the waiting crowd, stealing scraps from the pregnant woman who peels watermelons and pineapples next to the roadside… she gets a lot of business from me! Our bus, honks and the pedestrians slowly saunter out of the way, as the guards open the gait to the hospital—only a few vehicles are allowed to actually drive onto the grounds.

We’re dropped just inside the gait at the entrance to the main hospital building. Most wards are separate free standing buildings—most probably 60’ by 100’ or so in size. The antenatal clinic is off the main road, behind the children’s ward, in front of the overflowing nursery school- throughout the day and on some of the recordings you can here shrill voices singing “this is my neck, this is my nose, this is my stomach! Etc”. The clinic is open air on the two long sides of the building, with walls, and two cubical style rooms at either end. Wooden benches line the middle open air portion, where women sit waiting their check up. When we arrive at 7:15 there are always a good 15 or 20 women already seated. The nurses, midwives and ward assistants set out their things—wiping off the large main table at one end of the clinic, covering it with plastic, and setting out biscuits and bagged water for purchase, as well as the clinic record books. The women carry their antenatal pregnancy booklets with them—their records from each visit are kept in identical red booklets, containing a bit of information about pregnancy and notes from each check up. The women stack their booklets, and one of the nurses sits and makes note of each women in attendance. Each morning starts with a sing song prayer, led by a nurse, then a silent prayer, followed by an educational talk on some aspect of antenatal care, and then a chance for the women to buy the various supplies they are expected to bring with them for delivery. Through all of this Keesha and I sit in our little cubical area, observing the routine, offering to help set up, writing, attempting to get our USB internet stick to cooperate (which it does relatively frequently), and setting out our things for the day. The women are called up one by one to be weighed, and on Monday’s the throng of post-natal women line up to weight their 2 week old naked babies in a hanging sling suspended from the doorway. A table in the corner acts as the vaccination station, which one of our supposed translators (who is in theory a nurse on vacation, but is definitely working) sits at giving women and infants shots, just outside the door to our cubical. The women are at the clinic for hours—many arrived well before 7 AM, and at 9 are just starting to be weighed. They are called one by one to each station, seeing a midwife for a physical exam, then being sent to the lab for urine and blood tests. Midwives can write referrals to a medical doctor or to the dispensary if they detect a problem, but a medical doctor is not on hand and typically women have to come back in a day or two to see them if they are not admitted.

We work in our little room, with cement walls and windows on two sides, our window shutters oscillating between wide open hoping for a breeze, and shut in an attempt to drown out the noise that muffles our tape recordings of the interviews. Our room doubles as a storage space, houses the freezer with vaccines, a pile of old records, and I think normally serves as an education station. Instead, while we are here, when a women more than 27 weeks pregnant finishes her physical exam, she is funneled toward our room, where she is asked to take part in an interview—often by the time women start funneling toward us it’s well after 9 AM. The women come in quick succession, much faster than we can interview them, frustrating our translator who struggles to understand that we want to have quality interviews, where we take our time and really hear all that the women have to say, not just as many interviews as possible. The back to back interviews, in our little room, without a fan, heating as the sun continues to rise, go until around 1 PM, when we try to call it quits to avoid decreasing quality with increasing exhaustion and hunger!

We leave the clinic, picking up water or any needed and available groceries outside the hospital, catching a taxis back to the apartment for 2 cedi. The afternoon usually involves a much needed shower, while the cold water still feels good on our sweaty selves! A break for some reading or writing, and then a few hours of transcription work: re-listening to the day’s interviews and typing them out. By 9 or 10 I’m flat out in bed!

Aside from a few outings to the markets that pretty much sums up the week! Aside from accidently telling an old lady selling fabrics “I love you” when pressured by Doris to converse with her using our four sentences of Twi, the outings were fairly uneventful.  We’re spending this weekend in Akwatia, saving a bit of money (things in Ghana are cheaper than at home, but it’s adding up!) and catching up on a bit of transcription. Hopefully next weekend we’ll be off and about. My only venture out today was to go into Boudoa to get water, as we were down to a liter between the two of us. Given that we live in the boonies, separated from town, it’s a bit of a challenge to catch a ride from here. The tro tros and taxis that go by are typically packed full—they don’t leave a town until all the seats are taken, so unless someone jumps ship before the major drop off, there isn’t room for an extra passenger. I stood out at the roadside for a good 30 minutes today to no avail, and finally hitched a ride when someone in the staff village who has a car drove past me with an open seat and offered me a ride on his way in! In addition to flubbing up my attempt to greet the watermelon lady in Twi, I was able to pick up four large bottles of water, a loaf of bread, 4 eggs, a paw-paw (papaya), and half a pineapple at the roadside stands—should do the trick until the weekend is over!