It Takes a Village.

My typical day consists of waiting in the maternity ward for babies to be born to include in my study. While I’m there I chat with the nurses (the conversations are always interesting…I was warned by a midwife yesterday that if I didn’t have children by age 30 that I was at risk of birthing a mongol…I informed her that the risk increased after age 35 and that we don’t use the term mongol anymore…just Down Syndrome), I deliver babies when they come, and most importantly I mother baby Ray.

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…

The Long Walk.

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.

Chick in a ditch.

Today another scholar and I saw some baby chicks caught in a ditch. The ditch I speak of is actually a drain…maybe it’s a sewer? I can’t tell. Anyway, it runs along the side of every street and is open on the top so people and cars can fall in if they are not careful. Occasionally there is something that looks like sewage (it’s green, glumpy and gross)…but oftentimes there is grass growing in it, and goats and sheep will jump inside to graze.

But today a whole bunch of baby chicks fell into the ditch, and there was no way for them to get out. The mother hen did seem concerned, but best she could do was cluck from street level and strut around hopelessly. I thought it was a good metaphor for life – don’t become a chick in a ditch – because if you do who will get you out?

Today was another crazy day at the hospital. A baby was born with its umbilical cord wrapped around its neck and not breathing. So we had to use a bag-valve mask to do a neonatal resuscitation on the infant. It was scary. We rushed it to critical care (ie. the emergency room) and got it some oxygen. The mother had not gotten any prenatal care, this was her sixth child…so if he died she had five others she needed to look after. Even after getting oxygen and some dextrose in his veins the baby still didn’t look good. We will see how it looks tomorrow. The maternity nurses were also far less concerned then the scholars and I about the state of the baby…they seemed to think we shouldn’t have given oxygen and just left the baby next to its mother…I still disagree with them…but its hard to go against a culture and a people and their way of doing things even if you think you are right. But I was afraid that by not seeking care…the mother had left her chick in a ditch.

On another note – my project is going ok. People are not excited about adding paper to the chart (I created a new neonatal assessment sheet)…but I’m perfecting my sheet so that each baby has a record of being.

Let's give it to God.

It was the first day I introduced my newborn assessment sheet to the maternity ward. Previously there had been nowhere to record any infant data in the ward…but I’m hoping with the addition of this sheet to mother’s charts that the nurses will begin to collect information on the newborns.

However, it’s a tricky proposition. In Ghana, children under one year old are not considered human beings. They don’t have funerals (which are a big deal in Ghana…lots of people get together…you are forced to pretend to cry or you owe the family a goat…serious stuff), and their death is not considered as painful as an adults. When a baby dies they don’t say the baby is dead but that “he has gone back” (back to God presumably…) and the phrase “lets give it to God” is also common when discussing infant death. It’s a country-wide issues…and it’s also an issue of needing more personal, space and motivation from staff to take care of the babies.

So I’m hoping that my interventions at least make people start to think about life differently. I wonder how pro-choice advocates would handle Ghana…though I’m sure none ever come! I lead a teaching group today with the nurses…we collaborated and they made suggestions on how to make the form better. Fingers crossed they use it.

Aside from the constant drama of the hospital we made a very good friend in town – Matilda. She is from Kintampo, and she sells us fabric and sets us up with tailors to get dresses made. It’s an extravagant relationships because the dresses we are having made are of bold patterns, and wild fabrics. But she is a very caring person and amazing tour guide and showed us the whole of Kintampo after work. It’s an enormous town! We bought a bag of mangos off the street for less than two dollars and practiced walking through the streets balancing them on our heads like Africans do.

Church and Monkeys

This morning we woke up at 6:00am to catch a 7:00am service at the Roman Catholic Church – St. Joseph’s. It was an interesting experience, so many people came they couldn’t fit us all inside the church! So we sat on wooden pews we moved outside the door…it was nice to be outside…but I couldn’t really hear the service and spent the whole time admiring the town of Kintampo in their Sunday best. All the woman wore elaborate colored dresses, little boys were dressed in suits, and little girls had so many frills on their skirts you couldn’t see their faces through them.

After church, we drove out with one of Dr. Damian’s friends to the monkey sanctuary. It is a very touristy place…but Dr. Damian taught us well and thus we never paid full price for anything. One interesting aspect of Ghanaian culture is bargaining. Everything is worth only one-third of the price they will quote a foreigner…and everything is negotiable. Even the price of admission to a game park. I’m not the best bargainer because I feel guilty about it…but the other scholars are good. So we get discounts on everything! I also got some great

First day in Kintampo without hospital duties.

Another scholar and I woke up at 6:30am to do an exercise class with the locals. It was in a large field that was behind the hospital. So we joined a circle of Ghanaians as the only “obruni’s” or “white people” there.

I’m surprised by how many obese people are in Ghana. They are calling it an epidemic. There are also increasing rates of hypertension and diabetes. It’s fascinating. Dr. Damani says it is because they have been exposed to a Western diet and now fry everything. I can see that. They love to give us mounds of fried chicken and plantains. My stomach is a little queasy today so it hurts to think about!

Before my stomach pains (a normal part of traveling in Africa…) the workout was good! It lasted a little over an hour and we stretched, jogged, did push ups and stairs…did it remind me of a workout class at Crunch gym in Brooklyn, NY? No, not at all. Some moves I’d never seen before and there was clamping and chanting in a local language I couldn’t follow. But it was fun. There was a sense of teamwork and community that make it endearing. Though I still think it would be funny to get an American aerobics teacher in that field blasting music…it would be a culturally insensitive nightmare!

Ray

Let me tell you about Ray. Ray is the opposite of a dead baby…he is vibrant, active, chubby and always hungry. He is the happy healthy infant that mothers dream about…but he’s an orphan.

His mother was from a neighboring village and came to deliver at the hospital. She didn’t have any relatives accompany her to come to visit her, which the staff knew was a bad sign…it meant she had no support. She also gave a different history of where she was from every time the hospital staff asked. They were happy when she was discharged in 24 hours and left with the baby….

Happy until they a day later someone showed up with Ray at the hospital. They said he was left at their doorstep, and they could not care for him…so they dropped him off at the Kintampo Municipal Hospital. He was called “abandoned baby” until my fellow scholar and I named him after her father – Ray.

The nurses were joking around that he was a blessed baby because we were going to take him to America with us. I wish we could. He would have such a different life if he could come on the plane with us when we return in May. But instead, he will go to a local orphanage where he will be raised with other African children. He will not remember the Americans that cared for him at birth and he will always wonder why his name is Ray. I hope the story of his name follows him throughout his life…because I don’t think Ray’s story is sad…

…he is one of the lucky ones to have his health and be given a chance at life.

A Call to be a Neonatologist

Today I held a dead baby in my arms as I ran to the emergency department, which also doubles as a “critical care” unit.

We had seen the infant on morning rounds and she did not look good. She was breathing fast and had a temperature of close to 39 degrees Celsius (102 F). She was somnolent and Dr. Damian (again, the only doctor in the hospital) ordered ampicillin, gentimicin, and fluids for her.

I didn’t think to check on her all day...in the afternoon the nurses brought her limp body to the back of the Maternity Ward, which doubles as a nursery. When I saw them carrying her I knew she was very sick...and a sick thought crossed my mind that she was already dead. I came to help them assess her and watched her take one last deep breath….afterwards I couldn’t get a pulse rate or hear a heartbeat with my stethoscope. There was an eerie silence in her chest.

I started doing compression on her while the other student went to tell the Emergency Room doctors visiting from Columbia who had assisted in two neonatal resuscitation that week. They asked me to bring her to the emergency room and I did while another student did compression on her in my arms. We tried CPR for a few minutes but blood started oozing out of her mouth and her nose...I think she was already dead in the nursery.

I’ve never seen a dead baby, I’ve never held one…but I won’t soon forget it.

The mother was crying when we told her, but I was told that in Ghanaian culture we leave them to grieve with family and friends. Being that I only know 5 words in her language – Twi – I felt helpless at consoling her.

I changed by project to looking at the growing and much needed field of neonatology in Ghana. I want to focus specifically on identifying prematurity with the Dobowitz-Ballard Exam and comparing the gestational age found with that to reported maternal gestational age…and also to describe the risks of prematurity to new mothers.

Kintampo Municipal Hospital

Today was the day we first started working in the hospital. We meet Dr. Damian who walked us back to our guest lodge and over dinner talked about religion, medical school, and funerals in Ghana. It was a heavy conversation, and I gained a new and appreciation for an astonishing man.

The hospital itself was wonderfully different than anything in the United States. It was open air (which was troublesome during an ENORMOUS rain storm) with green grass and red soil making for a powerful landscape. Goats, dogs and chickens roamed freely around the hospital grounds. The facilities were very basic. There were more patients then there was space to keep them inside. As customary of Ghanaian women they wore bright colorful clothes with larger than life patterns. All of the hospital staff was so gracious and welcoming and so excited to have us there with them. We were introduced to everyone…half of their names I can’t remember…and I spent the majority of the day working with an HIV/AIDS adherence counselor.

It turns out that my project with cell phones is not feasible at all. The people do no have them, the hospital does not collect numbers, and they already had their own system in place for tracking down people for appointments…it was based on cultural values and a close-knit community. I thought about doing a project on the stigma surrounding HIV/AIDS…how people with it are considered dead even though they are alive…until I saw a c-section. It was for a woman who claimed to be 38 weeks gestation, and she gave birth to a beautiful baby boy. It was then I KNEW I wanted to try to do something with infant mortality. The pediatrician in me came out in full force. So I am going to try to alter my work to include something with them…

Today was a travel day. We went all the way from Accra to Kintampo…it was an eight hour journey over paved and unpaved roads. We didn’t get a chance to see the hospital at all, but we did get to experience our luxurious guesthouse with queen sized beds and single rooms! Our team decided to start our community assessment for our group project tomorrow, and I am also going to try to get my independent project started. We were informed there were emergency medicine residents from Columbia here as well so we are excited to meet fellow American colleagues and get their experiences.

The most interesting story of my day was one the driver – Alex – told us on our long trek from Accra to Kintampo. It was when we first entered the Ashanti kingdom and saw the statue of Yaa Asantewaa. She was an Asante Queen who when the British tried to take over her kingdom was the only one of a tribe of elders (that was mostly men) to stand up for her kind and her country! Here's a famous quote:

"If you, the men of Asante, will not go forward, then we will. We, the women, will. I shall call upon my fellow women. We will fight the white men. We will fight till the last of us falls in the battlefields." She is one of my newest inspirations!

I can't wait to meet the doctors at Kintampo tomorrow to find more muses!

PS - the internet is slow and doesn't let me upload pictures...I have one of Yaa Asantewaa...but for now just trust me she's cool, or google her!

Create Wealth Through Health

Today was orientation day! And sitting in a room having to learn about a country, culture, and new health system on top of coming up with an independent research project is exhausting. So I’ll summarize for you so you don’t fall asleep reading this:

Highlights from orientation:

- “create wealth with health” – Ghana plans on stopping people from getting sick so they can work and boost the economy!

- 30% of Ghana’s health care money comes from investments from foreign countries, they are not happy to be that dependent on foreign aid…

My hypothetical project:

- looking at attendance at rural clinics and seeing if sending text messages to people before their clinic appointments makes patients more likely to come – note that only around 50% of rural Ghanaians are literate, and only 37.6% have cell phones

The most exciting part of the day was the market. I attached some pictures so you can get a feel for what it looks like. But the hustle and bustle isn’t captured in these photos. Each shopkeeper aggressively tried to make you buy his goods, and since its rude to say no in Ghana a foreign traveler is forced to come up with a more polite excuse. Mine was “Since I’m just traveling I hardly have any room in my suitcase!”

I’m curious how Accra this vibrant, colorful, loud, dirty, traffic and live filled city compares with the rural Kintampo I will be traveling to tomorrow to complete my hypothetical research project. One thing I do know is next time I am in the markets I am going to buy an African mask for my boyfriend and my new apartment in LA (Danny they are so majestic you will love it!).

Accra

I am in my accommodations in Accra...it is a hostel...it looks like more of a house. But once I found out I had internet I wanted to post something quickly before I explored the whole space. My room is big and airy with an air conditioner and running water...so I'm happy.

The plane ride was also without any problems. The plane was a half an hour early, and the pilot encouraged us to remember that next time a United (soon to be Continental) flight ran late. I was in the middle seat in the middle aisle next to a Ghanaian man and a Nigerian man. Neither of these gentlemen was too keen on giving me any arm rest room...but I fought hard and managed to fall asleep on one of them...

I was exhilarated coming out of the airport. There were bright billboards that said "This will change your life." They were for a phone company, but I just assumed they were for me and the National Medical Foundation. There were so many cultures and people in the airport that while it had a distinctly African flavor I was amazed by the diversity. The car ride to our hostel was through poor and rich neighborhoods...the most eye opening to see where the "slums" on the side of a major road. Rows and rows of corrugated cardboard houses held together with a spiderweb of powerlines.

And lastly, Jackie, one of our hosts taught me some Twi:
Eti sen - How are you
eye (pronouced e - yeah) - I am fine
mi pa wo joe - please
bra - come
ko - go
ye fre mi ... - my name is...
me di... - my age is...
mi fri New York - I am from New York
kakra - small/little
mi ye dokita - I am a doctor (eek)
mi pe Ghana papa - I love Ghana a lot
papa - lot
mi da ase - thank you

She says these will all be helpful. I am in the process of memorizing.

Leaving New York City

Today I am leaving for Ghana. As a part of the program I need to keep a weekly journal. So I decided to start blogging. At least once a week (if the internet access allows!) I will update this blog with pictures and words.

Right now I'm conflicted about going. Leaving Danny has been much more difficult than I ever imagined it would be. He describes me as "a kid going to summer camp" who "throws a fit when they have to leave"...and then "throws another when they have to come back. " I hope he's right, and I'll conceded that he general is about this sort of thing.

I have to get back to my pre-trip checklist...at least I get to cross off start blog!