A Loss of Vision.

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.

There's Now a New Way to Donate to Ray!

Check out his blog for details:

www.lifeofbabyray.wordpress.com

Raiders of the Lost Ark.

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 14^th 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.

Food.

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…

A Personal Post.

Could I come move to Africa for a year? Maybe two? A lifetime?

I think Ghana is an amazing country. I've been learning so much about myself and doing work I never dreamed I could (like by finding a way to support baby Ray...). And while I've gotten over my tropical disease (aka common cold) I'm still a little sick from the things I'm missing at home. Weddings, friends, friends weddings, graduations, my boy...starting a new life in Africa would be hard, because that would mean leaving behind a life I already love.

So while for now I'm here with my head in my work...my heart is in the states. See you in 11 days America!

Do you understand what I'm saying?

In Ghana, English is the official language. But, its far from the only one. There are close to 80 tribal dialects spoken. Twi, Ga, Nzema, Ewe, Hausa and Fanti...those are the few I've heard of. As far as I can tell they have no relation to each other...

I learned some Twi in Kintampo. Enough to say good morning and introduce myself. People responded either by looking confused, or by laughing at me. I like to think the laughter was from the joy of hearing an obruoni (white person) speak the language...but it might have also been how I pronounced things like Eti Sen? (How are you?)

Even though most Ghanaians speak English, communication can be difficult in our shared language. The English they speak is more British than American. And I can't tell if its the speed at which I talk or my accent, but many things in my conversations will get lost in translation. Consider this encounter with a pregnant Fanti woman I took to ultrasound:

Me: Do you speak English?
Her: Small, small.
Me: First baby?
Her: ::no answer::confused look::
Me: First baby? ::waving hands over stomach::
Her: You know if its a boy or a girl?
Me: No...
Her: Its a boy?
Me: I don't know...Do you want a boy?
Her: Where are you from?
Me: United States. You?
Her: Central Region ::incomprehensible town name::
Me: Ok.
Her: ::silence::
Me: So...first baby?

While I did get her to ultrasound...and while I was able to communicate the baby looked "ok"...I felt lost by not speaking her language. I didn't know if she had any questions or complaints. I couldn't tell if she wanted advice about having a baby. We spent most of the time regarding each other in silence so we didn't have to force a conversation in broken speech.

To know your patients...you really have to speak their language. As many Ghanaians will ask when they finish chatting with me - "do you understand what I'm saying??"

Sounds of Africa.

Somehow this Easter weekend - between partying and rainstorms - I managed to catch a cold. It started with a sore throat, and has moved on to become a relentlessly runny nose. Am I scared I have some horrible tropical illness? Yes. Is that likely? No. I'm just curious how I could have caught a cold while staying in the tropics where I spend 99.2% of the day bathing in my own sweat.

So because I just took some benadryl to help me sleep...and my brain is slowly shutting down...I present to you as a post some musical treasurers.

Let's start with stereotypical African songs:

http://www.youtube.com/watch?v=D-XldXGxqDk&feature=related

http://www.youtube.com/watch?v=apEuFdzP5ZU

These always play in the touristy hotel restaurant.

But if you want to listen to some REAL African music:

http://www.youtube.com/watch?v=qw5-Dj_ReaY - I LOVE 2face...but he's Nigerian and not Ghanaian...

http://www.youtube.com/watch?v=qryWRyMZwOA - THIS is Ghanaian hiplife...it's like hop-hop Ghana-style. This particular singer is an ex-football player...infamous for missing a world cup goal (ouch).

Enjoy the sounds of Africa.

Axim Beach Hotel.

I've stayed in countless hostels. From the best to the worst, in Europe and in Africa. Now I'm at Axim Beach Hotel - http://www.aximbeach.com/default.html - enjoying my ocean view in my last two weeks in Ghana.

I didn't want this post to just be me bragging about staying in a gorgeous chalet with a straw thatched roof, beautiful winding beach and a dolphin look-out gazebo...I wanted to talk about the owner, J. He's an artist, he built the entire hotel complex (its a collection of small quaint red houses all with the same straw roof and intricate rock and shell detailing in the cement). It was his vision, one that he keeps perpetuating. Today I got to walk around the facilities with him and ask him about his inspirations...it was touching and creative...he is a Ghanaian. That shouldn't come as too much of a shock considering where I am. But many of the hotel owners are foreigners with money who are using the former Gold Coast to make fortunes off a land that is not there own. Have you ever considered such a thing as evil ecotourism? So its nice to see a man who is from here pull himself out of the surrounding poverty and make something so beautiful.

I might have to always stay in places like this. Don't get me wrong...I think 5 star hotels are great. You can't beat the services, the luxury...but there is something about a hotel built by a spiritual man that roams the grounds and tells you his dreams that makes me want to stay in hostels and budget joints forever. This isn't technically a hostel, but it has that upbeat traveling spirit. It's in these small home made corners of Ghana that I find the heart of a people and a country.

Obama in Ghana.

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.

Malaria.

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.

Adinkras.

One thing unique to Western Africa that I love is the adrinkra. They are symbols imbued with particular meanings. The most common one is gye nyame. This stands for “except for God” and represents the supremacy of God. It's on chairs, napkins, buildings, screen savers, everything! The one that dominates the Axim Beach Resort that I now call home is sankora meaning “return and get it,” a sign that reminds you to learn from the past. For a full list of adrinkas check out this link - http://www.adinkra.org/htmls/adinkra_index.htm.

I can’t decide which I think is my favorite, but I think it might be osram ne nsoromma…as I’m always looking up to the night sky.

Axim Hospital.

Today was our first day working in Axim Hospital. It reminded me of Kintampo…but there were big differences. The first is that no one speaks the language Twi…they speak about 3 other tribal languages that I’m not sure I have the energy to learn. I did however get a Ghanaian name – Yaaba – it means Thursday born...it’s custom here in Ghana for your name to represent the day of the week you were born on. Was June 27th, 1985 a Thursday? I’m not sure, but I needed to just pick a day of the week, and I like Thursdays. I know you are thinking I should google it…but the internet is so slow that just getting this post up today was difficult. So for now, I am Thursday born.

Dr. O, our new attending, is very different than Dr. Damian. He’s just as charming and sweet and has the same sincere desire to make this experience the best it can be! But even though he’s 10 years older than me, he has so much more energy! He had us running around the hospital…and then Axim…and then through the far reaches of Axim. All to show us the coast and his own private ultrasound centers and other projects. I’m not sure I can keep up!

So this post will be short as I recover and listen to calming sounds of the sea. I wonder what Baby Ray is up to…

Space to Breath.

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.

Puberty Statue.

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.

A Premium in People.

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?

Kumasi.

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.

Leaving Kintampo.

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

LifeofRay2011@gmail.com

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

Donate to the Life of Baby Ray!

www.lifeofbabyray.wordpress.com

Dog-Eat-Dog.

For the first time a baby I resuscitated survived overnight! It was so exciting! I didn’t see one dead baby today! So I won’t write about babies (skip next paragraph to avoid medical mush about a toddler I treated).

Paragraph for doctors: I did see a 2-year-old code after doing an LP on her. I did the LP by myself (one-stick wonder)! I was scared because I thought I made her herniate…I mean…we didn’t do a CT scan first (there is none here)…but there was a low opening pressure…we didn’t check the opening pressure, I just think that cause the CSF didn’t come out forcefully…after some CPR she her heart was beating again...fingers crossed she survives. Her WBC count was 74.

Despite the life or death dog-eat-dog world Ghana can feel like, there was a little puppy that made me realize how socially minded Ghanaians are... He was the cook’s dog, no more than a few months old, tied to a mango tree by the food tent. I know I’m not supposed to pet the dogs (parasites, rabies, fleas, etc.) but this puppy was so darn cute I got up close to baby-talk it and scratch its ears (I washed my hands afterward! Swear!) The pup wasn’t playful though; he looked at me with big sad puppy dog eyes and quietly wagged his tail. I thought it was just the raging heat, because at 1pm when I’m outside all I want to do is nap in the shade too. But the cook looked over and saw me harassing his dog and said, “Eh, the dog, he was just castrated.”

Castrated? Really? Here in Kintampo? How…thoughtful. With all the chickens, goats (I’ve gotten really good at identifying when a goat is pregnant from at least 100 yards away), feral cats (some are in heat outside my window, chilling with my 4:30am crowing rooster) and sheep (very hard to tell the difference between a goat and sheep) I see roaming the street… …it just never occurred to me a man would think to neuter his dog. But it makes sense, there is no shortage of stray dogs running around…and female dogs with all their nipples engorged searching for food to support their pups. They can be aggressive…

I wonder if they spay…

Survival of the Fittest.

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.

All Hail the Chief.

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.

All Hail the Chief.

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.

I Do.

Today I was invited to TJ's (not his real name) wedding in Sunyani, the capital of the Ashanti region of Ghana. Am I friends with TJ? No, we just met last week...honestly he annoys me. Why did I go to the wedding? Because he wanted light skinned people there as a status symbol. How does it feel to be the only foreigner in a wedding where you don't speak the language?...about a 10 out of 10 on the awkward scale (10 being the highest).

It started with a bus ride in a mini-van going close to what felt like 100mph without good brakes. The van sat 14 people comfortably, so the 21 of us in there were crammed. At some points on the road it felt like a roller coaster ride...except for its not as exhilarating thinking of what would happen if the car you were in did flip upside down...I think from now on I'll stick to Six Flags in the states.

Scary drive aside, the wedding pushed me far outside my comfort zone. The ceremony started with speaking in tongues and dancing...then went on and on from there...I almost fell asleep so I'm fuzzy on details. It ended, and we took the roller coaster van into a village where we were given water and food. Never any alcohol...the bride and groom never danced (or smiled)...when we got our food we didn't stay to eat it...we left! I thought there would be more dancing! Sigh.

Throughout the service and the wedding I must have been in 100+ pictures. I'm told it will be a point of pride for the family to share them and be able to say a white person was there...it was certainly unforgettable.

The Life of Ray.

The scholars and I have a genius idea...one that could really help baby Ray. I wrote a story about him that I'm posting below...let me know what you think! I'm counting on my faithful blog readers to point this budding non-profit in the right direction. Look out for a kickstarter (www.kickstarter.com) in the coming week...

And as a note - Ray is the name of one of the scholar's fathers who passed away from a brain tumor when she was a teenager...

Here's the story I wrote:

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.”

Life Not Lived.

I've seen a dead baby about every other day. It's gotten to the point where the sight of a lifeless infant sitting in its own blood with white lips and a fresh cord dangling from its abdomen doesn't faze me. The body will be in the room, usually encased in the one mechanical incubator the hospital owns...and it will sit there...a fly on the wall. A life not even lived.

The worst part, the thing I can't get over, is watching the baby die. I had to go into the hospital tonight to interview a midwife as a part of the neonatal care study I am conducting. I have interviewed all but one of the maternity ward midwives, grilling them about their knowledge of prematurity - the number one killer of infants in Africa. I haven't had time to analyze my results, but it is alarming how little the midwifes know about premature infants...and the almost complete lack of care that is afforded to them.

But how can you provide an infant with care when you can't afford to buy a watch to take the babies pulse? A premature infant was born this evening, 30 weeks gestation (normal is over 37)...his eyes were fused, his testicles shrunken, his skin transparent and fragile, and his body blue. Once he emerged and the cord was cut, he was left for dead in a plastic crib. But this baby boy refused to accept its fate...he cried a pathetic gasping cry, struggling to inflate his underdeveloped lungs. It was able to turn most of his body pink...meaning he was taking in some oxygen...but his legs remained an abnormal and dusky blue. While another scholar placed the baby in an incubator I ran around the hospital trying to get him oxygen, or pressure support for its lungs...something...anything! We found steroids, but we couldn't find a vein in the baby...so eventually I wound up just shooting the drug into the baby's leg.

As far as I know the boy left for dead is still alive...I don't know if he will be in the morning...or next week...if he were born in the United States he could have survived...

Tonight I watched a baby struggling to live, but knew in reality I was watching him die.

I wish I could save his life. I'll never stop wishing.

Cock-a-doodle-doo.

Every morning at 4:30am sharp a rooster crows outside of my guesthouse window. I know this because that means every morning at 4:30am sharp I’m awake listening to said rooster. My revenge is that I know when I walk down the street and see roosters cawing and hens clucking…I will probably be eating them for dinner.

I know this is true because today I watched them slaughtered goats outside of another scholar’s window. When goats bleat it sounds like a small child crying, so I heard this goat crying and crying and went to investigate. The other scholar has these large one-way windows that look out onto the backyard…you can see out, but the people in the backyard can’t see in. So there were these two goats tied with a rope on their neck to a tree, bleating away…then a big strong man wrestled with one of the goats…they struggled, the man won and tied the goats legs…then one of the women from the kitchen brought a machete to the goat…then…

You can imagine. I ate goat for dinner. Another time outside the same window there was a little girl eating chicken…then throwing some chicken to the chickens who were also eating chicken…then she threw her chicken bone down to the ground and the chickens raced for it…chickens are cannibals, who knew?

I’m learning a lot about livestock here. They have overrun the hospital (in fact one of the goals for 2011 here is to pen the animals so they aren’t roaming free about the wards) ,so I see them everyday at work. And even though all the animals seem wild, they all go back to the same house at night to sleep…even if that house slaughters them during the evening.

Looking forward to my 4am wake up call…

Tribal.

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.

Lost and Found.

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.

Mole National Park.

Dear Followers,

Sorry to leave you hanging yesterday, I know how upset you all must be. But not after I tell you about my experiences at Mole National Park (pronounced like guacamole...without the guaca part).

It is one of the biggest game parks located in Northern Ghana...a mere five hours from where I am staying in Kintampo. We stayed at a beautiful resort (tourist trap) where we had some good old fashioned American food (overpriced french fries). We went on a morning safari where we saw 8 kinds of animals (baboon, some type monkey, warthog, and 5 types of antelope)...but unfortunately no elephants which are my spirit animals (http://en.wikipedia.org/wiki/Power_animal)...

However, it's not about the destination...it's about the journey. And what a journey! The reason getting to Mole takes 5 hours isn't because its super far away...it's because for 2.5 of those hours the road is an unpaved dirt path. Even the pickup truck we were in couldn't handle it. We stopped just outside the park to pay a toll and the truck refused to start! Thus, all four scholars got out and pushed like we had never pushed before...until our stick shift car rolled to a start. Luckily on the way home it started, no problem (no problem = a popular Ghanaian phrase)! Also, the lack of air conditioner in the car made it so we were all caked with a thin layer of red dirt by the time we got back to our hostel. I've never appreciated my no pressure, swatting shower as much as I did this afternoon.

Am I sad I didn't see elephants, leopards, hyena and the like? A little...but being the spoiled traveler that I am this was my third African safari (others were in Botswana and South Africa)...so don't feel bad for me...but I do recommend visiting Southern or Eastern Africa to get your big 5 fix (http://en.wikipedia.org/wiki/Big_Five_game).

Lifestyles of the Rich and the Famous.

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?