Abstract:
Over 10 million children under the age of five will die each year (Ghana Heath Service). Up to 42% of those deaths are of neonates (Feresu et. al.). The leading cause of neonatal death is prematurity. One million preterm infants die annually, accounting for 27% of neonatal death (Lawn et. al.). This study was conducted at the Kintampo Municipal Hospital in Kintampo, Ghana. It attempted to; implement a systemic way to evaluate newborns, collect data on neonates, and evaluate the hospital workers knowledge of prematurity. At the time the study commenced, there was no primary document dedicated to newborn screening and care at Kintampo Municipal Hospital. Therefore a Newborn Assessment Sheet was created to facilitate data collection and basic care for infants. Along with the Newborn Assessment Sheet, a Neonatal Care Survey was created to interview healthcare personnel regarding preterm birth. It was found that a lack of knowledge about prematurity fostered largely inadequate care for infants. Educational interventions were recommended to boost both awareness and knowledge of overall infant care, and care related specifically to preterm birth.
Background:
Worldwide approximately four million infants will die before one month of life. They are part of the over ten million children who die before reaching age five; accounting for 38% of childhood mortalities (Ghana Health Service). While under-five mortality rates in sub-Saharan Africa have declined by 22% since 1990, there has been little progress in addressing the mortality rates of newborns (Millennium Development Goals). These deaths primarily occur in low and medium income countries, where access to health care is difficult and data collection on newborn infants is minimal or non-existent. Other reasons for the predominance of neonatal death in low-income countries include; lack of systemic estimates for the prevalence of preterm births, lack of accurate estimation of gestational age, and lack of simple care and quality health services for mothers and newborns (Lawn et. al.).
Complications of preterm birth are the single biggest risk factor for neonatal death and increased morbidity. Prematurity accounts for up to 27% of the almost four million neonatal deaths every year, from both direct and indirect causes. The challenges a premature infant faces include, but are not limited to; respiratory distress (respiratory distress syndrome, brochopulmonary dysplasia, apnea of prematurity) in 93% of premature newborns, late onset sepsis (sepsis occurring at 3 days of life) in 36% of premature newborns, intraventricular hemorrhage (IVH) in 16% of premature newborns, and necrotizing enterocolitis (NEC) in 11% of premature newborns (Lawn et. al. and Mandy et.al.).
To begin to explore the risks associated with prematurity, it is necessary to define it. Preterm birth includes any infant born before 37 weeks of gestation and has gradations of moderate (33-36 weeks), very (28-32 weeks) and extremely (less than 28 weeks) preterm. These gradations of prematurity are important because survival rates increase with increasing gestation. A study of newborn infants in Nigeria found that for a gestational age of 31 weeks the survival rate was roughly 53.3%. By 35 weeks there was a substantial increase in survival to 96.6% (Owa et. al.). Along with gestational age, the weight of a newborn is often considered an important tool in determining prematurity. An infant is considered low birth weight when they are less than 2500g, and very low birth weight when less than 1500g. However, low birth weight is not necessary a product of prematurity. It can also be the result of processes like intra-uterine growth restriction. Therefore gestational age is a better indicator of preterm birth (Mandy et. al.).
Despite its influence on neonatal mortality, preterm birth lacks visibility and political backing in low-income countries. Issues such as lack of human resources, poor funding, and improper facilities make the care of neonates difficult (Victora et. al.). On top of lacking the resources to provide appropriate care, places with the highest risk of preterm death currently have the smallest amount of recorded information available on it. This presents a large problem for neonatal care, because the neonatal mortality rate depends on the place of delivery. It is related to the supplies available and the expertise of the staff. Thus each obstetric unit should establish their own gestational age-specific mortality rates contingent on the care they provide (Owa et. al.). This can only be done if the quantity and quality of information on neonates can be improved by seizing opportunities to add to ongoing hospital data collection (Lawn et. al.).
Kintampo Municipal Hospital is among the many rural district hospitals that lack accurate data collection and assessment of newborns. Steps need to be taken at Kintampo Municipal Hospital to raise awareness about both the prevalence and risks of prematurity. Assessing healthcare workers understanding of and clinical skills surrounding prematurity would help to make targeted interventions effective, thereby improving care.
I am apolitical. I leave that world to my father and my boyfriend who relish in unsolvable philosophical talking points. But today I found out that Osama Bin Laden was killed. At first I was frightened…because I thought Osama was Obama. Can you imagine? I can, which frightens me. Maybe I shouldn’t keep reading Malcolm X’s autobiography before bed. When I realized it was an s not a b, I was skeptical. Was he really killed? How could they do DNA tests in the first place…who had his DNA? Why did they bury him in the ocean? Who saw his body? I remain skeptical…but optimistic?
I found it amazing that the American political scene had reached Ghana. Not only that, but people here cared to talk about it. I started talking to another American at the Beach Hotel about Osama…save for he spends 75% of his time in Ghana and only 25% of his time in the United States,so maybe he’s more Ghanaian than American. He spoke fondly of the US. Many things I’ve heard others criticize about America, he saw as its strengths. In particular he lauded over our sense of individualism and constant desire for change. He likened our thirst for more and better to increased self-esteem and creativity.
Ghana is more traditional. People hold onto old technology and old beliefs. There is an adrinkra called Sankofa…in western terms it means that you learn from the mistakes of your past…but for Ghanaians it also means that you should not abandon stalwart tradition. So Ghanaians believe in voodoo, herbal medications, spirits…these things are real to them. These beliefs keep them rooted to an ancient practice and past, but at the same time stop them from evolving. They are caught between a vibrant flame of cultural identity, and a tank of gasoline gearing them up to drive to the future…it's a society that could explode at any minute.
Why doesn’t Ghana blow up like so many African nations around it? I’m not sure. There are some hints that it might…for instance if you steal, even if its a loaf of bread, an angry mobs will hunt you down and kill you with their bare hands…justice or violence? Again, I’m not sure. That is the allure of Africa. It's muted tensions, its struggle to define itself, the ebb and flow of life...it's so...human.
I mentioned that we made friends with Christian missionaries yesterday. Because we hit it off, at dinner last night we were approached to look at the eye of one of the young girls in the group. It was swollen shut, with purulent discharge fusing together her eyelashes, and dripping down her face. When she pried it open for us the eye was an angry red, and a white opacity clouded her iris…we couldn’t even see her pupil, and she couldn’t see.
Even though she was using antibacterial eye-drops, it appeared as though she had a raging infection. We agreed to take her to the hospital in the morning. We found each other at breakfast, and another scholar and I took the Christian’s white van to the hospital. It was a ghost town. The usual groups of brightly clad patients sitting outside offices were nowhere to be found. Instead empty benches and a wandering goat greeted us. We woke Dr. Tengan from sleep, and he consulted with her.
The eye was still swollen shut. It looked like it hadn’t gotten any better overnight. The doctor confirmed my worst fear – that this was a periorbital cellulitis. While it can be life threatening if the infection spreads to the skill, the biggest complication is a loss of vision. I can’t imagine being 17 years old and blind in one eye.
So he prescribed IV (intra-venous) antibiotics, to be given every 8 hours. We walked her from the out patient offices to the woman’s ward to get an IV inserted in her arm. What followed was a comedy of errors. The nursing student fumbled with the needle, dropping it on the floor several times. She sprayed antibiotics on herself and in my face. When it was clear that she was incompetent, a senior nurse took over. The senior nurse could not insert an IV. She tried two times before she was able to get one that was working. Then she pushed medication outside of the vein into the poor girls skin – infiltrating her with antibiotics that could cause skin necrosis. So a third IV had to be put in the opposite arm.
It’s hard to understand if you’re not in the medical profession how dangerous it is to push large doses of medication into someone’s veins…and then watch that medication leak out into their skin…all while observing un-sterile practices. I think in the states we can be too cautious about patient care (after all, it’s only a matter of time before you get sued)…but I think what I saw today could be classified as negligence. In the states we would have hung her medication to be delivered over several hours, given her a CT scan to see the scope of her infection, and made her stay in the hospital overnight…
What the healthcare system in Ghana needs…more than supplies, more than money, more than improved facilities…is education and training. It would make a world of difference if the staff could see what quality care was.
I had an Indiana Jones Experience today, ten times better than the ride at Disney. Since the hotel owner was leaving Axim for Accra, he took us on a morning excursion to Fort Anthony. Like all 14th Century forts on the Ghanaian coast, this was an old slave-trading hub…otherwise know as a human dungeon.
It was small in comparison to the one at Cape Coast, and having been built in 1520 was the second oldest fort/castle in Africa. What made it particularly unique was that slaves were shoved into a tunnel and forced to walk under the ocean to a deserted island where they were loaded on ships to the new world. The passageway is blocked, but in the fort you can see the door and the chute they would push people through and down.
A nice Christian man was touring with his group of Western missionaries at the same time we were in the castle. He asked if we wanted to join his group of 7 to head to the deserted island in the ocean and see the other end of the slave passageway. We agreed, and walked over dead fish and sharks to board a small wooden boat rocking precariously in the waves. After boarding the vessel, we headed through the surf to the island. We were accompanied by 4 Ghanaian fisherman…one of whom I think had cataracts, but he was only 10 years old!
When we arrived the shore was lush with mangrove trees. We jumped off the boat and into the jungle. Through a canopy of banana trees we walked up a staircase that reminded me of the entrance to a Mayan temple – big sand-colored stone stairs with a flat walkway in the middle. It lead to a violent rocky sea cliff that waves angrily crashed against. At the level of the surf you could see the exit of the slave passageway, being highlighted by the foaming sea. The island teemed with life – insects, mangos, coconuts, birds…but even the bustling paradise couldn’t over shadow the human atrocities committed there.
I spent several minutes staring at the turbulent surf. We didn’t find any archeological treasures, or life-threatening situations like Indiana Jones would have…but I still felt like an adventurer.
I can’t tell if I’m hungry. Today we went to the canopy walk in Kakum National Park. It’s one of five canopy walks in the world! And it’s the largest!
What is a canopy walk? It is a series of bridges between trees in the canopy – or highest part – of the tree. So we were 130 feet off the ground walking between the treetops. They were originally intended for research, but now are a source of tourism.
We spent 8 hours in the car getting to and from our treetop hike. I spent most of those eight hours feeling nauseous from the ups and downs of an unpaved road. I had rolls for breakfast, and spaghetti with beef for lunch, and even though it has been hours since I ate I can’t tell if I’m up for dinner…maybe it was that heavenly Twix bar I scavenged from a gas station today. Ghanaian’s don’t like sweets…so the once every 2 weeks I can lay my hands on a piece of candy is a joyous day.
Ghanaian food has started to get to me. It’s very repetitive. I’ve eaten every combination of rice and protein you can image – rice and fish, rice and chicken, rice and beef, rice and goat. Not to mention rice balls (banku). I’ve also eaten more plantains in more combinations then I can remember – fried, roasted, broiled, thinly sliced, thickly sliced, with beans, and of course…with rice.
What I realized about the states that I hadn’t before is that we have a lot of good food. So many cultures come from so many places to provide a dizzying amount of cuisines! Well, for now I’ll feast on my rice-plantain-meat creations…
Obama came to Ghana in 2009. But from the looks of things, he never left. His image is as common as Starbucks in NYC. It’s on billboards, small posters, keychains, t-shirts…there is even a brand of cookies called “Obama Biscuits” in a red and white striped wrapper.
People speak very fondly of him here. I encouraged one of my fellow scholars who is an avid photographer to document all of the times we’ve seen Obama’s image…she is going to collage it together for us at the end of the trip.
I remember once when I traveled to Italy and stayed in a hostel in Rome…it was during the Bush years…the bartender was very anti-American and went off on a rant about how all Americans were devils. I listened politely. Then he stopped, looked angry and said, “Are you an American?” I went with being a Canadian…it seemed appropriate given his level of aggression. But here in Ghana, I’m proud to be an American. Obama, you make me so happy.
I thought that a lot of the things I would see in these tropical, African, resources poor hospitals would be diseases I had only imagined of in textbooks…but what I’ve come to find is that the things I see aren’t wildly exotic. It’s not like I haven’t seen dramatic things – horrible meningitis, disfiguring car accidents, typhoid fever, babies dying left, right and center (though a lot less die in Axim…). And a lot of what I see are exaggerations of diseases at home – ecclampsia (prenatal care is not the best here), ganglionic cysts that have grown so large people can’t move limbs, advanced cancers of blood and bone and other places….
But the number one disease that I see constantly is malaria. Everyone’s either got it, or had it at some point. Dr. O says he gets malaria up to three times a year. He’s so used to the signs and symptoms that he will just take medication without testing himself when he thinks he has it. He gave us a three-hour lecture on malaria yesterday, and now I feel ready to treat it! Except…that I’ll basically never see it at home. Especially in children, who don’t tend to go to developing countries on their own.
There was a cholera outbreak in a village two hours away from Axim…Dr. O went, and I was really conflicted about going. On the one hand, it would have been interesting to see. I’ve never been in the middle of a cholera outbreak, and I’m not sure when the next opportunity I have to go is. However, they had special boots and scrubs and didn’t have any my size…and you have to take good precautions when walking into a cholera zone. Plus, I’m not the most comfortable with IVs to feel skilled enough to be inserting them in very sick people with very dried up veins (for those who don’t know, cholrea causes a watery diarrhea so severe you get massively dehydrated, lie on a table with a hole cut under your bottom so you can poop constantly…and can die). So I sat this one out.
Maybe next time I’ll go. For now, I’ll master malaria.
Today we arrived in Axim on the former gold coast. It is a beautiful beach...a little marred by thoughts of the slave trade…but I can’t compare it to Kintampo. Doing that wouldn’t be fair to landlocked, bush-filled, poor Kintampo...but what can I say I grew up on the beach (that's right, Long Island has amazing beaches!).
I took this weekend off from doing work on my research project…but not from thinking about Baby Ray. As I sit in my new hotel room with the sea breeze blowing through the window...I’ve been thinking. Most of my thoughts revolve around Stephanie and my last conversation with Dr. Buckle.
Dr. Buckle views The Life of Ray as a campaign or a seed project. It’s a nice little one-year development plan…but he wants us to think bigger. He says we should take the first six months of our project to learn what development is about, and the next six months to define what it is we want Baby Ray and his mother to symbolize…
Our original impulse was to help Baby Ray by allowing him to stay with his mother. We inadvertently entered into supporting the mother as well. So this didn’t become a project to save orphans, but a commitment to helping an entire family…an exercise in sustainability. (Note: the Ghanaians don’t have a word for orphan in any of their languages…that’s a western concept…in Ghana is you don’t have parents communities will often assign you them…but the traditional aspects of the culture are fraying…).
For it to be sustainable, do we buy Ray’s mother everything her heart desires? Do we up her standard of living, pull her out of a state of poverty? I asked Dr. Buckle that…and he automatically worked to alter my thinking. Poverty is subjective, just as happiness is. We can’t “pull her out of poverty” because she is surrounded by a certain living standard. The key becomes having her adjust to life meaningfully in her environment...and out of that comes the concept of social risk protection…providing people with the basics of life – food, clothes, shelter – so that they don’t have to worry…and can think and dream of planning a future.
So I’m taking some space to breath now…and imagine how in the future I can change the world.
The last two days in Kumasi have amount to a shopping frenzy. We went to the largest open-air market in West Africa, side-street vendors, and the cultural center of the city to shop.
It was at this cultural center that one of the other scholars got a massive statue. It almost goes to my chest, but is made of a lightwood and easy to carry. It costs $40 US, a steal considering it was first said to be $250...now that’s what you call a bargain! (Remember, that as a foreigner in Ghana you are always quoted a price that is maybe 2/3s more than the item is worth...so bargaining is allowed, and a useful skill!)
It is of a woman. She is naked with a necklace that extends her neck, exposed breasts, and a beaded belt carved into her waist. We all thought she was a fertility statue. Here in Ghana they sell statues of women that are supposed to get you pregnant. Being a bunch of woman living together, our cycles have synced. We collectively enter a baby craze around ovulation, which started today. However, the logical non-hormonal part of my brain was pretty freaked out by sleeping with a large statue that wanted to get me pregnant staring at me from the end of the bed…
Luckily, the woman statue that has now become a fixture in my roommates and my room isn’t for fertility. When I say that “we” thought she was a fertility statue, I meant the scholars, not the Ghanaians…they always knew she was a puberty statue.
Which begs the question…what is a puberty statue? With her staring at me will my voice get deeper? Maybe I’ll grow a few inches?
We asked our Ghanaian friends, who informed us that she was a tool used in a puberty ceremony. Traditionally, Ghanaians wouldn’t allow sex before puberty. If you had it, your family was fined a large sum…so parents would educate their kids about sex using these statues and other ritualistic maneuvers that kept early pregnancy rates down. But now the culture is changing, and a lot of the traditional values are being lost. So puberty statues are just for tourists…and the teen pregnancy rates are as high as 60%.
Maybe I’ll get a puberty statue too…she might just be the best form of sexual education for my own children…after a fertility statue finds me.
Today was the mid-term review for my program, led by Dr. Gilbert Buckle. The review took nearly the entire day (with a break for shopping…I’m now 20 cedis poorer, or rather 3 African masks and 3 beaded bracelets richer).
Part of the day was taken up with The Life of Ray Charity Fund. Dr. Buckle was very enthusiastic about the project and my fellow scholar and I have a meeting with him tomorrow night to discuss the advanced structure that our charity can take on. We have already raised nearly $1,000 in just three days! Thank you so much everyone! To all the family and friends who have donated, those who are thinking about it, the people who have sent me emails, and everyone who let this crazy dream be possible. It truly does take a village, and I’m so happy with the village of people I live in. If you are reading this or have read anything in my blog I am so proud to have you in my life.
Dr. Buckle anticipates that we will be makes hundreds of thousands of dollars in the future (really Dr. Buckle???) and must plan wisely. Given that we are making Ray’s mother work for her money he is impressed with our eye on sustainability…I hope we can keep it focused in that direction.
Dr. Buckle also spoke eloquently of Ghanaian culture, particularly funerals. The Ghanaian funeral has even been a hot topic in the NY Times. An article on Ghanaian funerals was sent to me by Danny (my boy) through Conor (some guy) - http://www.nytimes.com/2011/04/12/nyregion/12funerals.html?_r=1 - I joked with Dr. Buckle and said that I wanted to attend the ceremonies with him. He laughed and explained how funerals were a person’s life insurance…and the premium that someone earned was in how good a person they were during life. If people liked you and respected you, your family made money during your funeral. If not, your family went into debt. People would come to eat and drink and dance and party and either pay or not pay depending on how upstanding an individual you were. How good a person you were in real life determined how much you made in the afterlife…I hope one day people are dancing on my grave with hundred dollar bills.
So Dr. Buckle…if that invitation to the funeral real I need to know two things:
a) how many cedis should I bring?
b) should I eat breakfast beforehand?
In the Ashanti capital of Ghana…the second largest city. We are staying in a wonderful hotel where the shower is warm and has pressure…heaven!
We are here for our mid-term reports where we will be discussing our projects and I’ll get to present both my half-completed paper on neonatal care and the Life of Baby Ray Fund. I’m excited and exhausted.
The girls who were on the beach in Axim keep talking about what an amazing experience it was. I can’t wait!
More about Kumasi tomorrow. Don’t forget about Ray! www.lifeofbabyray.wordpress.com.
Rain means it’s a bad day. Sure they tell brides its good luck on their wedding …but I always thought that was just to make them feel better. It gets dark, its cold, its wet…it’s the same here in Kintam po.
I was holding Baby Ray in Mama Florence’s house. Saying goodbye…when the rain started.
I knew it was the last time I would ever craddle Ray, the last time I’d see him as a baby. What does it feel like for a mother to know her moments with her infant are far from forever? The only sounds were my thoughts, the rain…and the Jackie Chan cartoon blaring on the TV. It was surreal.
Kintampo, I loved you…I know I loved you because I hated you at times. I couldn’t understand your poverty, I didn’t always appreciate your people…but you showed me the power of the human spirit. I watched individuals from your community unite behind an abandoned baby boy. I saw you accept the ideas of crazy American girls who wanted to help. Dr. Damian said that even if we couldn’t raise the money that Ray’s mother is thankful that we cared enough to think about her, to do something.
Even if we don’t raise anything (though we already have $20!)…I’ll never feel like it wasn’t worth trying…
The rain stopped. The relentless heat that devoured us during the day slept. The sun came through the clouds…and we walked away from the hospital and left baby Ray.
I copied and pasted the contract for our agreement with Akua Yakubu (Ray’s mother) and Ray below for you to read…we all signed it…but Ray’s mother doesn’t know how to write (so she stamped it with her thumb)…
The Life of Ray Charity Fund
www.lifeofbabyray.wordpress.com
Official Contract Between the Life of Ray Charity Fund and Kintampo Municipal Hospital Regarding Raymond Adam Yakubu
This is a contract between the Life of Ray Charity fund run by Joanna Jean Parga and Stephanie Renee Staples and the Kintampo Municipal Hospital. For the purpose of this agreement, Kintampo Municipal Hospital specifically refers to the Medical Director, Dr. Damien Punguyire, the social worker, Mr. Okyeve Heuaku Godwin, the head midwife, Ms. Florence Atiah, and Ray’s mother, Ms. Akua Yakubu.
This contract outlines the agreement between said parties regarding the appropriate allocation of money raised from the Life of Ray Charity Fund. All funds raised will be sent to Kintampo monthly via wire transfer in an account at Ghana Commercial Bank opened under the name of Raymond Adam Yakubu. Upon the creation of the bank account, all information regarding this account, including but not limited to the account number, account balance and transactions, will be provided to Ms. Stephanie Rene Staples and Ms.Joanna Jean Parga. Dr. Damien will be the signatory to the bank account. Dr. Damien’s signature will be required for all transactions, including but not limited to deposits and withdrawals pertaining to the account. Ms. Florence Atiah will be listed as a second name on the account, and will therefore have access to all information regarding the account. Both Dr. Damien and Ms. Florence will be required to ensure that Ms. Akua Yakubu receives an appropriate salary subsidization from the charity funds.
Though entitled to the money raised by this fund up to 3,600 Ghana Cedis, Ms. Akua Yakubu should not receive this money as a lump sum. Instead, the funds should be dispensed as a monthly salary. This requires that the aforementioned parties (Kintampo Municipal Hospital) can ensure employment for Ms. Yakubu.
Should Ms. Yakubu default on the agreement and decide not to work, she will no longer be entitled to the funds raised by the Life of Ray Charity Fund. Instead, all funds will be diverted to Ms. Florence and under the supervision of Dr. Damien Punguyire and Mr. Okyeve Heuaku Godwin for the care of Raymond Adam Yakubu.
If fundraising is successful, she will receive 300 Ghana Cedis (approximately $200 US dollars) per month from the Life of Ray Charity Fund for the period of one year (May 2011-May 2012). This will total 3,600 Ghana Cedis, roughly $2,500 US dollars. Any amount exceeding the 3,600 Ghana Cedis guaranteed to Ms. Akua Yakubu will be distributed to the Kintampo Municipal Hospital for the funding of educational endeavors (subsidizing workshops, travel to training sessions, etc.) and purchase of supplies. If fundraising is unsuccessful, Ms. Yakua Akubu will be entitled to all of the funds totaling less than 3,600 Ghana Cedis for the care of Raymond Adam Yakukbu.
Allocation of these funds is contingent upon monthly updates provided in the form of e-mail with attached photos of Raymond Adam Yakubu, his mother and the hospital.
The Life of Ray Charity Fund looks forward to a successful relationship.
Maria Berenice Nava
Joanna Parga
Anne-Lise Paisble
Stephaine Staples
Dr. Damien Punguyire
Ms. Florence Atiah
Mr. Okyeve Heuaku Godwin
Ms. Akua Yakubu
I thought Darwinism only had to do with lizards and turtles living in Ecuador. That was until today when one of the emergency medicine room doctors told me that it was futile to keep premature babies alive in Africa. He said that the only reason they survive in the United States (where we both hail from) is all the supportive care that they are given…and the services their parents can afford. He said babies with developmental problems here couldn’t survive, that it was “survival of the fittest” and “when was the last time I saw a child with mental retardation here?” When I told him I wanted to be a neonatologist who worked in developing countries he scoffed at me. “Maybe its best the babies just die.”
I can see where he is coming from. It’s true. There are limited resources here, and people are forced to make due with little. Yet I can’t help but say – HOW DARE YOU EMERGENCY ROOM DOCTOR! HOW DARE YOU TELL A YOUNG STUDENT THAT IT’S FUTILE TO FIGHT FOR HUMAN LIFE, NO MATTER HOW SMALL! WHERE IS YOUR COMPASSION MAN!
I’m sorry if somewhere along the lines you stopped believing in miracles…I’m sorry if it hurts you to see babies die every day, and now you think that its not worth saving them…I shouldn’t have yelled…I feel bad for you that you can no longer see that it’s worth it to improve neonatal care. That you think the only solution is money and to hell with ingenuity. That you don’t think these babies can be saved. I’m sorry you lost your faith in the perseverance of the human spirit, and in the resilience and love for each other these Ghanaian people show…especially a mother looking at her child. They want better care, they don’t want to see their people sick, they want the technology, they want their children to survive…and they don’t want us to lose faith in them…because they know our wealth and experience can help.
So I will be back as a neonatologist here…even if you think it won’t accomplish anything. Because I know you are wrong. I will work to find cost effective ways to save newborn lives…because I believe that’s its not just ventilators and expensive medications that can save…I believe in creativity and heart. I believe in these babies…and don’t you DARE tell me not to.
First off – Baby Ray book series (see the post The Life of Ray) is in full swing. Look out for our kickstarter page! My fellow scholar Stephaine and I (www.mariposabutterfly.wordpress.com) are helping him pen his autobiography as we speak!
Today, one of our many visitors…and the most important one…was one of the chiefs of Kintampo – Nana. I don’t think that’s his real name…do you know any guys named Nana? He was a friendly older gentleman…dressed in a bright orange Canada shirt. I wasn’t expecting a more traditional African outfit, but chiefs can dress however they please. He talked about the history of Kintampo, and how his main job is settling disputes. For instance, if someone stole my goat and I didn’t want to go to the police I would go to the chief…and if after we talked it out we had a really great handshake…it would mean everything was settled. I accidentally harped on the fact that there are multiple chiefs in Kintampo, so and how did he deal with not being the only one in power? Well…mistake, you shouldn’t ask a chief what its like to have his ultimate power threatened.
I got a talking to by Dr. Damian after the meeting…but now I know never to question things like that. A boss is a boss in Ghana. But I don’t think its my fault for being confused! Ghana has an intricate power system with kings, paramount chiefs, sub chiefs etc. that I don’t fully understand. And technically being a chief is not a political position, so the government of Ghana has even more division and subsections…it’s dizzying. Or maybe it’s just the pito (aka fermented corn) that is making my head spin.
3 more days in Kintampo hospital. Then its bye to Baby Ray L.
First off – Baby Ray book series (see the post The Life of Ray) is in full swing. Look out for our kickstarter page! My fellow scholar Stephaine and I (www.mariposabutterfly.wordpress.com) are helping him pen his autobiography as we speak!
Today, one of our many visitors…and the most important one…was one of the chiefs of Kintampo – Nana. I don’t think that’s his real name…do you know any guys named Nana? He was a friendly older gentleman…dressed in a bright orange Canada shirt. I wasn’t expecting a more traditional African outfit, but chiefs can dress however they please. He talked about the history of Kintampo, and how his main job is settling disputes. For instance, if someone stole my goat and I didn’t want to go to the police I would go to the chief…and if after we talked it out we had a really great handshake…it would mean everything was settled. I accidentally harped on the fact that there are multiple chiefs in Kintampo, so and how did he deal with not being the only one in power? Well…mistake, you shouldn’t ask a chief what its like to have his ultimate power threatened.
I got a talking to by Dr. Damian after the meeting…but now I know never to question things like that. A boss is a boss in Ghana. But I don’t think its my fault for being confused! Ghana has an intricate power system with kings, paramount chiefs, sub chiefs etc. that I don’t fully understand. And technically being a chief is not a political position, so the government of Ghana has even more division and subsections…it’s dizzying. Or maybe it’s just the pito (aka fermented corn) that is making my head spin.
3 more days in Kintampo hospital. Then its bye to Baby Ray L.
The Life of Ray Foundation.
Two orphans become one family.
There were four strangers sent to Kintampo, Ghana to live, learn and work in a rural hospital. Despite differing culture backgrounds, hometowns, colleges, and medical schools, the four women found many things in common. Fast friendships developed, whose bonds are woven from the finest kente cloth. They would never unravel and would form a sisterhood…a family in a foreign country.
It was this family that found an abandoned baby boy, wrapped in a cut up potato sack in the back of a rustic maternity ward. At the time he was an orphan, and they accepted him into their brethren, naming him after a father whose spirit was strong. And so Ray was born, and he lives to tell his story.
“My name is Ray. I am waiting on a tribal name. My last name will most likely be Yakubu, after my mother. I don’t know my father. I don’t know much. I’m only two weeks old.
What I know, what I can share with you is my story. My two weeks of life have been filled with heartache and adventure.”
As four foreigners, we want to let Ray tell his story because we know that we can’t do it justice. Ray needs us to know about his life, and he needs our help to keep on living. Ray doesn’t just want to tell his story once, he wants all the children of the world to know what it is like to be an African Boy. So he needs our help to feed and grow and to become the author of a series of children’s books about himself and Ghana. All the money raised in starting this book series, and all the profits from this book series will go to Ray and the town of Kintampo. It will be used to make sure that Ray’s mother can support him. It won't be given in a lump sum to her, but will be used to subsidize the job she will get to support herself and her child. That way Ray doesn’t need to be sent to an orphanage. If we can raise $2,500American dollars, we can support a baby and his mother in Kintampo, Ghana for an entire year AND we can launch a children’s book series that will support the people of Kintampo for a lifetime. Let’s tell stories and make dreams come true.
Read Ray’s story, and invest in a future and a life.
“First I want to tell you about my mother. Her name, as I said, is Yakubu, Akua Yakubu. I don’t know much about my mother. That is because my mother and I have not known each other for very long. Just a few days.
She is not from Kintampo where I was born. I am not sure what region of Ghana she was born in. When she came to Kintampo she was running away from Accra. Accra is the capital of Ghana. It is a big city, maybe as big as any. But I’ve only heard Accra from my mother’s womb and never saw it. I was too young to have eyes.
My mother won’t tell me why she needed to run away from Accra. She was working with a woman who made Ghanaian tea. She was making money. She met a man, my father, and they had sex. I was conceived. My father is gone. He left. Some say he went to Libya. I worry he died in the war there. Others say he is still in Accra. He got lost in the crowds because he didn’t want to be found. I was too much responsibility. I think I am the reason my mother had to leave the city.
She had no support for her pregnancy, for me. Her parents, my grandparents, are both dead. My mother is an orphan.
My mother is an orphan, and she left me to be an orphan. I don’t understand her, but I am not mad anymore. I cried when she left me. I was wrapped up, placed on a stranger’s doorstep. I cried. I didn’t know what else to do. I was alone. It was cold. A man opened the door and saw me. He took me inside. He took me in his car. He took me to Kintampo Municipal Hospital. I wish I remembered more. He saved my life. I would have died outside without him. It was cold.
They called me abandoned baby. Mama Florence took care of me. She bought me pampers and milk. She dressed me in clothes. She bought me girls dresses to wear. I didn’t mind. I like to eat. When I can’t eat I get hungry. I cry when I am hungry. I was not cold with Mama Florence. I had no name. No one could decide. I am abandoned baby.
Stephaine and Joanna came to visit. They found me. Ann and Maria came to visit. They found a baby with no name. They found an abandoned baby. They knew it was me. I met them. I slept. They held me. I cried for milk. I like to eat. Stephanie called me Ray. She had a father. Her father was never lost. I live in his name. I am Ray. I was found. She found me a name.
My mother found me. She didn’t mean to. They made her come, the police. They felt bad for me. I am happy. I was angry and cold. My mothere is warm. Where did you go mom? She is back. I remember her. She gave me her breast. It is better than the bottle. I am happy. I will grow. I tell you this story to remember. I want to know why they call me Ray. I don’t want to forget.”
Tattoos aren’t big in Ghana. I haven’t seen a man with a woman’s name stamped on his forehead, or a lady sporting a “tramp stamp” on her lower back.
What I do see are small black lines on a person’s face. They could be on one cheek or two, close to the nose or far, on the forehead, trailing down the neck...any number of shapes and sizes. Even though these marks resemble the thick black lines of an ink tattoo…but they aren’t tattoos, they are tribal marks.
Some of the marks aren’t inked in, some are scars…when people are too young to remember their faces get cut…the marks can be small lines or long jagged trails…and by looking at them you can know a person’s tribe, if they are royal, their profession, and a host of other things I’m sure I don’t know. The ritual scarring is strange to me, I notice it, I remember it and I’ve started to look for it on people. I’ve heard 60% of people in Ghana have them. If they aren’t on the face, then there are marks on the body (chest, side) each uniquely tailored to a particular tribe.
My hometown on Long Island never took itself so seriously…that is one thing I admire about Ghanaian culture. The togetherness, the community, the belonging.
My morning started by walking in on a dead baby. It was just lying in the back of the ward. I’m only writing about it because it should have been traumatizing, considering it was a dead baby, but I see a few of those a week so I was able to brush it off...is that even more disturbing than dead babies?…regardless…there was good news!
Ray’s mother came back to the hospital [Ray = orphanged child left on a porch]! It was the talk of the maternity ward. People thanked Jesus, prayed, we all smiled…Ray was going to be with his mother…well…that’s what I thought…
I went to the eye clinic to check on the head midwife who had an eye infection and she insisted on taking me back to her house to meet Ray’s mother. We acknowledged each other, but didn’t talk much…because she doesn’t speak English and my Twi is sub par. But I held baby Ray and as I was sitting there in came a social worker to figure out what should happen to the reunited mother and son…
The mother didn’t come back voluntarily, she was found by the police staying at her “uncle’s” house. All her closest relatives were dead so she was forced to give birth with a close family friend she called an “uncle” on his farm…an orphan giving birth to another. The father was some fling she had in the capital (Accra) and had disappeared. She didn’t have the money to care for a baby, and she cried speaking of her hardships…it was decided that Ray may still go to an orphanage…unless the mother can find a job...trouble is she’s never been to school and has no working skill…except in making tea…so the social worker asked me what I would do…what would you?
After leaving the social work scene I walked through the open-air hospital to collect my thoughts and consider what could be done to keep mother and son united. That’s when I saw a little girl…around 5 or 6…pooping outside of the children’s ward. She was massive diarrhea in public. Poop in her underwear, poop on her dress, poop in her shoes, poop down her legs and on her butt. I was the only person to stop and stare… I went inside the children’s ward to see if I could get her help…the nurses came out and looked and laughed, promising they’d locate the mom…I watched her for a few more minutes and I said to myself, “now there is a chick in a ditch.” I laughed.
I know I mentioned in another post that in Kintampo, Ghana we are famous…but did I also mention we are rich?...Filthy rich. Now, mind you, in the states I’m one of the poorest people I know, but here I might as well be Bill Gates! I’m an American, which means I live the easy life and swim in pools of gold coins ala the old cartoon Ducktales.
Yesterday while I was working on screening neonates in the maternity ward one of the researchers who worked in the laboratory beside the hospital spent a half an hour telling me how lucky I was to be from the United States. Compared to Ghana, we live like kings, and he wanted to make sure I knew that…and that I thought of him and brought him back with me. A lot of people talk longingly of the American Dream…the one my family lives right now…
It’s hard, because I’m not wealthy…but when you see the poverty here it is devastating. It holds people down, it makes those with any intelligence and wealth want to flee. And can you blame them? Dirty, unkempt dust roads, decaying buildings, rampant disease…things in Kintampo can look pretty bleak. The poverty rate is 30 – 40%, and poverty here means living with electricity and running water, little sanitation, scrambling for food, living off the earth.
Yet, the people are happy…the material concerns we have about needing things don’t seem to be as important to them…then why do I feel so guilty? Why when they live and laugh and dance? I’ve been told that it’s best not to ask why in Africa…so maybe the better question is how can I be happy with the little I have?...and how will this experience change me?
Baby Ray is the orphan infant in the maternity ward who all of the workers are convinced we should take with us to America…if only. He’s adorable. But today when I was staring into his cute little face I noted that he was also cross-eyed. His left eye was deviated outward. The scholars and I informed one of the head midwives and what followed was a hospital wide help Ray campaign. We traveled to the eye clinic where the optometrist saw the eyes and said that he would make Ray a mini-eye patch (very pirate chic), but first we had to treat Ray’s eye infection (which none of us budding Western doctors noticed). So then it was off to the pharmacy with Ray where we were given free medications and asked countless times how it was possible we gave birth in Ghana when we had been there for such a short time…
Which lead me to think, would I give birth in this hospital in Ghana? I think I would be scared to. First of all, there is no anesthesiologist so you can forget an epidural (ouch). Next, the sanitation is not up to Western hospital standards…a lot of that is because of the lack of funds to get up to date supplies (gloves, scalpels, fetal heart rate monitors, uterine contraction monitors)…and lastly, I’m just not ready to have a baby! Taking care of Ray is hard enough, and the whole hospital staff is there to help! It takes a village…
Ok, it’s not really that long…every morning we walk 15 minutes to the hospital. It should really only take 5, but when you factor in the intense heat it slows things down. What makes the walk feel so long – aside from the melting part – is that in Kintampo we scholars are mini-celebrities…
Being a brown-eyed, brown haired chick with tan skin I fit into most places I go. It’s easy for me to blend inconspicuously with the crowd, and I prefer not drawing a lot of attention to myself. Kintampo is not like most places. Here I am an oddity…the color of my skin might as well be highlighter yellow. With my unique appearance comes a lot of responsibility. I have to say hi to EVERYONE I walk by, and not in English, in Twi…otherwise I risk offending someone by not gracing them with my strange accent and skin tone.
While it’s nice that EVERYONE is so friendly, some of the attention can be unwanted. The marriage proposals, the declarations of love within 5 seconds of meeting, getting photographs of people’s wives, being asked to find white women for the townspeople to marry, the children screaming and following you, making babies cry, being told you are rich and need to give money…the list goes on. And it all starts with my 8am walk…
My glaring skin doesn’t stop attracting attention when I’m inside the hospital. While watching a woman in labor one of the nurses slid next to me and asked, “do white women feel pain when they give birth?” I almost laughed, “Of course! It’s the same for everyone!” She looked pensive and said, “I guess we were all made by the same God.” I didn’t know what to say back, so I nodded.
It makes friendships hard…sometimes you don’t know if people see just your skin color…do they care to see you? Do I look like a giant hundred dollar bill to them? Sometimes I can’t tell…but I trust the people…I think I will leave with a lot of true friendships.
