Home at Last

Our last day in Accra was spent doing tourist stuff; that is, buying more stuff to get rid of our cedis that the European money changers won't exchange. We also spent quality time at the KLM office to make sure Chris and I could fly home on the same planes. After two visits over several hours, we were successful! The eight hour layover in Amsterdam was a nice break, and we took the train into town for chocolate pastries and coffee at a cafe, followed by a visit to the Anne Frank House. Yup, the slave castles and the holocaust in the same trip. Party on.

We had a nine hour flight from Amsterdam to Minneapolis, complete with triple bag screening and being wedged into the very middle seats of a DC-10. We thought we had less than hour to get through customs and to our flight to Salt Lake. We managed to get through quickly, only to get to our next flight and sit on the tarmac for over two hours while a rescuse slide was being repaired. 35 hours after arriving at the Accra airport, we arrived home, and I sleepily wondered how many cedis we would be charged to stay in this nice guesthouse.

And now it's time for a shower and some Ambien.....good night.

Final Days

We said goodbye to Kumasi this morning and took the first-class bus to Accra. The first-class bus, since you asked, includes A/C, and on-board washroom (not working today), and video screens featuring the best of Nigerian cinema. The teen romantic drama was worth a few laughs: boy meets girl, boy's best friend gets girl pregnant, boy pays for girl's abortion, boy sees girl hugging best friend after he apologized for his actions, boy runs off in anger and gets hit by a car. Credits roll. This was followed by a murder mystery whose plot I couldn't follow, despite the high volume at which it was played. It involved a lot of women screaming and crying, and men in their underwear hitting each other. I was glad I had my earplugs. Chris was not so lucky.

Paying three times too much for a taxi from the bus station to the hotel has left us all in a foul mood. We recieved the classic obruni treatment: three cabs next to each other that each refused to negociate, claiming it was "traffic time," a bald-faced lie and we knew it. It seems silly to get worked up about an extra dollar, but the principle that you pay more based on the color of your skin annoys me.

So, on my last full day in Ghana, and feeling about ready to leave, I've been reflecting on what I will miss from here and what I miss at home:

Will miss (a very brief list):
-pepe sauce
-fresh African pinapple (none of this Hawaiian crap)
-people randomly saying "Akwaba/Hello" on the street
-groups of small children yelling "Obruni!" and waving
-diversity of flora
-monkeys
-"brother" and "sister" as a standard way of greeting someone
-red-red and fried plantains
-Fan Ice

Will not miss:
-Nescafe
-canned milk
-paying obruni prices
-everyone else yelling "Obruni!" at me
-two-foot deep sewers
-humidity
-mosquitos, botflies, tsetse flies, termites, ants
-foam mattresses
-Ghanian pop music, plus repeated playings of "African Queen," "Mr. Lonely," and old Backstreet Boys songs.

When we get home, I plan on having a large salad with a glass of wine, and washing my clothes using the washing machine and dryer. In the morning, I will have brewed coffee and cereal with REAL milk while reading the newpaper. I will then go to the gym, where I plan to not be drenched in sweat after two minutes. I will then take a shower standing up, without having to turn on the water heater 30 minutes ahead of time. I will not apply bug repellent prior to leaving the house.

Not to imply that being in Ghana hasn't been a positive experience. I've learned a great deal about tropical medicine and about delivering care with limited resources. Almost everyone here has been very welcoming. The food, despite its reputation, has been delicious. And although I've gained appreciation for much of the excesses of American society, I'm a little homesick for those excesses right now.

Secondary characters- CJW

John always beats me to the punch and writes entries about the amazing places we've been to together. So, I guess I'll treat this blog as I do with pictures from our trips with Doug-- beautiful landscape portraits are taken by others, and I'll supplement with point and shoot snippets of people.

If I were to write a book about Ghana, I'd like to include the following people we've met here in my story. Like Anne (the mother who is also staying at the guesthouse) these are just passing acquaintances but I found them to be fascinating. Hope you do too.

Marba- Marba is an orphan at the King Jesus Charity Home. As John described, we were swarmed by orphans as soon as we stepped out of the truck. Things settled down eventually, as Pastor Kofi led us on a tour and sent the kids back to class. The children were divided between four classrooms, grades 1 through 6, and although the kids were more interested in what we were doing, they dutifully sat at their desks, with one ear cocked to their teachers and the corners of their eyes following us instead. It was while listening in on the grade 3 glass that Marba approached us. She was singing to herself and pulling at her clothes. She instantly came up to me and hugged me, then put her arm around my waist and curled against my shoulder. Pastor Kofi said that she has a "mental illness" but it appears to be more severe mental retardation. Pastor Kofi said that she cannot go to school and can't do chores, so she does nothing all day. She recognizes her name and readily repeats it (if you say it right). When I asked Pastor Kofi if anything could be done for her (and explained how in the US we try to find meaningful activities for people with disabilities), he said that there is a government run school that could try to teach her but he has no money to send her. For now, she wanders by herself through the yard, softly mumbling to herself as the other children do their studies. I hope there really is a school to send her to, and not just the home that I read about where they seem to isolate children with mental/cognitive disabilities.

The Kids from Damango Secondary School- When we came back from our morning walking safari at Mole National Park, we found a crowd of local teenagers crowded around the hotel's pool. They were taking pictures and talking excitedly about it, hoping that they could find the money to pay for the non-guest fee for swimming at the pool. Soon, a boy saw our table and asked if he could take a picture with us. This triggered a string of requests from others, each taking turns sitting at our table. We happily complied, even if we did feel like characters in costume at Disney World. Some stayed at our table to chat. One young lady bobbed and swayed rhythmically while she talked, as if constantly grooving to some music that played in her head. She explained that they were all from nearby Damango Secondary School and that this was a weekend excursion of their Wildlife Club. They had been out on the morning walk as well, and you could hear their excited chatter about the elephants near the hotel. However, I think they were more fascinated with a different wildlife site-- the rarely seen (in Ghana at least), fat, old German man in a speedo as he performed his ritualistic wading in the pool. Rather than repulsing them, the kids crowded around this site and it seemed to increase their fervor to jump in!

Andy- Andy is a young man from Aberdeen, Scotland studying politics and has been working an internship with a Ghanain newspaper this summer. We met Andy at Mole and when we found out that he needed a ride back to Kumasi, we sold him a seat in our overly spacious, air conditioned van. Andy has been writing about the coal mining trade in Ghana, how it's somewhat exploitative of its workers, and (surprise surprise!) funded by American investors. In his short 5 weeks here, Andy's come down with malaria and been in a horrible tro tro accident (the main source of public transportation here) when the drunken driver sped down a dirt road at night and veered off the road. Consequently, Andy was our protector when our van driver was driving a bit too fast for our comfort. Andy sat up in the front seat, showed him the picture he'd taken of his tro tro accident, and coached him on the proper speed to take on the dirt roads leading us out of the monkey sanctuary. Hopefully, we'll see him again when we get back to Accra on Wednesday.

Philip and Gladys- Finally, there's Philip and Gladys, cousins that we met while walking home from the internet cafe last Thursday. Philip introduced himself to us first. He's twelve years old and lives at the guesthouse next door to ours. His cousin Gladys's father runs the guest house. Philip lives there with him so he can go to school at the university's junior secondary school-- his mother lives 153 km away in a small town. Philip sees her when he takes the bus home on weekends. Philip made me think of my own parents, particularly my mother, who left her parents at a fairly young age to go to school in the states. Philip is such a bright young man, and we had fun asking him questions and answering his, particularly when he asked us if it's true what he heard: that to go from Salt Lake City to Philadelphia, one has to take a plane! This question humbled us a bit as John realized that the closest distance analogy he could think of would be to go from Ghana to Kenya or to the Sudan.

Most recent local food: When John ate kenkeye, I ate boiled cassava and plantains in palova sauce. The sauce was a bit fishy, and it was not my favorite, but it was pretty tastey. Mostly filling. I only was able to eat about two pieces of plantain and one chunk of cassava before being totally full. Our waiter was very hurt, assuming that I and the others at our table didn't like our food, but he perked up and gave us a lesson in local ingredients, including yam leaves (the leafy green that we think was in the Black Star dish) and the small pepe pepper that gives some heat to most Ghanain dishes.

Best Non-religous local business name: Marvin Gaye Spot and Communication Center

Mole

No, not the delicious Mexican dish...Mole National Park in northern Ghana.

We traveled there this weekend because, despite the talk of cultural awareness, people come to Africa to see wildlife. Determined to see elephants, we made the 400+ kilometer treck in an overpriced rented van. Then van had "Blessing" written across the top of the windshield, and the driver indeed drove as if he thought he was protected by God.

Mole lived up to expectations. We were greeted by baboons at the front gates, and warthogs wandered around the pool as we ate dinner. We took a tour the next morning with a park ranger, who was armed with a 22 gauge rifle that would just bonce bullets off most of the animals there. We saw elephants right away that morning (indeed, just 50 yards from the hotel). The rest of the tour brought us various different hooved mammals whose names are becoming a blur, and closer looks at elephants after bathing. That afternoon, baboon swung in the trees above our head as we read on the platform overlooking the balcony. One baboon snuck up 6 feet behind me, but just stared at us for a minute and walked away.


There is also an almost 600 year old mosque 5 kilometers from the park, the oldest extant building in Ghana. Roma and med student Chris (not Wong) rode bikes to see it, but I was laid up in my room for the afternoon with my first case of traveler's diarrhea for the month. Fortunately, Cipro works quickly! And more fortunately, we had brought enough snack food that we didn't have to order dinner at the hotel's restaurant that night. Apparently my mistake was the desire to try guinea foul.

This morning, before leaving, we got to see the same elephant herd bathing in the watering hole. On the way back to Kumasi, we stopped at a monkey preserve. I was surprised to learn that most monkeys in Africa have been hunted extensively, and the only ones remaining are in perserves. This particular preserve was near two villages that consider the monkeys there to be sacred. They even have funerals for dead monkeys and bury them in coffins. The local legend is that the an ancient fetish priest turned some humans into the mona monkeys (for reasons that aren't entirley clear to me), then died before he could change them back. Sacred or not, we got to walk alongside and underneath families of monkeys within the rainforest, which made the white-knuckle ride to the preserve worth it.

Recent Overly Religious Sign: "Jesus is Coming Upholstery"

Recent Local Cuisine: I will not go into further detail about guinea fowl. However, a few days ago I tried kenkey, which is fermented maize (similar to banku) that is cooked in a banana leaf and has the consistency of polenta. It is quite good, but quickly filling. I was told that I was taking too small of a bite; apparently one is supposed to wolf it down.

"What is you name?"

We both went to the orphanage today, partly so I could do some screening medical exams on some of the kids. The orphanage doesn't have enough money to keep the septic tank from draining through its courtyard, much less to regularly take the children in for medical care. Pastor Kofi wanted me to essentially triage who needed further evaluation.

We were greeted at the car with packs of children, each asking "What is your name?" and in turn telling us theirs. I promptly forgot most of the names, as it is tough to keep track of 100 children who are all in school uniforms. Pastor Kofi then gave us a tour of the orphanage, including the classrooms, the dorms (4 to a bunk bed), and the new bathrooms which they hope will have running water soon. We also saw the lovely septic tank, which has to be emptied every 2-3 months. They know it is full when the drainpipe starts leaking, which causes a small stream running down towards the classrooms. Pastor Kofi hopes they will soon have the 4 million cedis (about $430) to have the pipe extended away from the main buildings. We also saw the fish pond Pastor Kofi built to help feed the kids, and to use as a side business to raise money.

As I wanted to mainly see the kids who seemed sick, I asked Pastor Kofi which children he wanted me to see. He identified several from one class, and sat me down in front of the classroom had had me start examining them. A few children turned into a crowd after one of the teachers asked the kids, "Who else is sick?" Suddenly, everyone had a headache or abdominal pains.

Unburdened by charting or long discussions with parents, I was able to see about 30 patients in an hour and a half. The kids who were just looking for attention were easy to spot, but there was some interesting pathology. Only one child had to go to the hospital soon for an abscess under her fingernail. One teenager from Togo had a fever but was already taking antimalarials (she was also excited when Chris and Anne spoke French to her). A lot of the pathology was the usual well-child stuff: growing pains, plantar fasciitis (in one of the teachers), Osgood-Schlatter Syndrome in a 12 year-old boy who liked playing football. Sadly, there were a few children with conditions that would get prompt treatment in better circumstances, but there just isn't the money to pay for it. A teacher brought over one young girl who was hard of hearing, and she had bilateral chronic otitis media with effusion (In English: fluid behind the eardrum). I could only tell them to take her in to get evaluated at the hospital when the funds were available. I'm not even sure how oftern PE tubes are put in over here. Another boy complained of 2 years eye pain and sensitivity to light, and had very mild corneal clouding. Ideally I would have him see an opthalmologist to screen for cataracts, but again, that will have to wait. But for now, I could try the medicine of laughter, which I inadvertently gave after trying to say a few phrases in Twe to the kids.

All of the kids serenaded us with several songs before we left, and waved the bags of soap and toothbrushes that Chris and Diane had brought. And before everyone asks, this particular orphanage does not adopt out its residents, so Chris is not sneaking anyone back inside her trenchcoat.

Recent Good Local Food: Well, Funky's Pizza is not really local fare. But the pizza was baked in a woodfire over, and is an excellent dish to have with Club beer. Club is a local lager that is the closest thing to Budwiser in Ghana. Thus, I won't be trying it again.

Recent Bad Local Food: Meat pies, often purchased from street vendors and which sound good in theory. Mine had an overly buttery, crumbly pastry with a small dollop of sausage in the middle. The species of animal contained within the sausage is still a mystery.

Why Don't They Sell This in the U.S.?: Mango Fanta

Overly Religious Sign: "God Time is Good Gas and Metal"

Ghanains with Disabilities

I've had limited, but informative opportunities to learn about the disability culture here. At one of the orphanages which we visited, the pastor who directs the facility said that they had very few orphans with disabilities and he proceeded to name one child who did not have a left hand and another child who was abandonned when his parents discovered that although he is a boy, he did not have any genitalia. I asked him about people with mental illness, and he said that they did have a couple of kids who had mental problems and many mothers with mental illness who abandonned their children to them. We talked a little about how difficult it can be for people with disabilities to find a job. In fact, on most occasions, I've seen that the people who are truly begging for money and not hawking souveniers or snacks to us have had disabilities. This includes a young man who kept tapping on our van window at the Elmina castle, making a sign that he wanted food. At first, we ignored him as he was lost among the boys who were trying to sell us shells with our names written on them. Thankfully, it appeared as though the other boys accepted him too.

I wonder if people here have problems assessing cognitive or developmental disabilities. A member of our group said that she spotted at least two children in an orphanage at a village to the north of us who may have had some mental retardation, one due to cerebral palsey. They weren't getting any treatment for it. I don't know if it's due to an inability to get treatment or if it's just accepted.

We were joined for two days by Wendy and her translator, Michelle. Wendy is a resident at the U's pediatrics program and John was her senior resident on a rotation. She and Michelle have been working with a group from Utah that has been teaching ASL and volunteering at Ghana's School for the Deaf. She told us how the Ghanains basically use ASL but with regional versions of signs. Many of the children are abandonned by their families there. In fact, school is supposed to end for the summer in a couple of weeks and it is anticipated that many families will not come to pick them up. This group that Wendy is working with has tried to develop little cards with basic ASL info. on them to give to parents as a means of encouraging them to communicate more with their children.

She also said that most of the students there were not born deaf, but may have become deaf when infected with meningitis at a young age. It doesn't sound like there's much of a Deaf culture here and hearing aids are widely accepted and sought. One group has managed to secure hearing aids on a sliding scale, as cheap as 65 dollars for the students at the school.

Perhaps most sad of all is that there is no help for these students for finding a job on graduation. In other words, they go through years of education and will ultimately end up as beggers on the street.

I guess I really can't think of a "best" category to follow up this entry. Sorry if this was depressing!

The Children's Home

I revised my last entry since I realized that just complaining about my flight here was not very interesting. Hopefully, it's a little better now!

Yesterday, while John worked at the hospital, Dianne and I went to our first orphanage play date. We spent the morning making small packets out of some of the supplies that you all kindly donated. We made 70 packets, each containing a crayon, a pencil, a bar of soap and a fun little thing (like a sticker or a hair clip).

We were joined by Anne, a lovely woman who is also staying at the guesthouse. Anne was born in Ireland and now lives in Eastern Tennesee. She is a teacher by trade who has spent many years teaching in foreign countries, sometimes funded as a Fulbright Scholar. She has the nicest lilt to her voice, her Irish and Southern accents melded together. Anne is here visiting her daughter who is researching a poisonous fungus that grows on the corn here so she was looking for a way to spend her time while her daughter was working.

We went to The Children's Home, an orphanage that has some government subsidy but is mostly run on private donations. (I think the social worker who is our contact there first warmed up to us when I told her that in the States, we must rely more and more on private donations to support our nonprofits as well!) Most of the older children were in public school so we were greeted by the little ones who are all aged 4 and under. The children were so excited to see us, screaming "Obruni!!!" as they came running up and immediately clung to my legs. Some asked me to zip up their sweatshirts, despite the 80 plus degree weather, just to have the contact. Others made gestures to be picked up and would immediately settle their heads against my shoulder.

We took turns singing songs to one another, then sat down in smaller groups and read stories. The book I used is a nonsensical story to help teach the alphabet, so the children had fun identifying letters for me and repeating the refrain, "Chicka Chicka Boom Boom." Most were content to sit quietly and play with my hair or touch my cheek.

It's mostly hard to think about what hard lives these little ones lead. Walking the streets in Ghana, you see mothers everwhere with their children slung low on their lower backs, constantly in contact with their mother's bodies, and cradled by an extension to their dresses. I suspect that these children aren't just fascinated with my foreigness, but are instantly loving out of a desperate need for the natural contact that their otherwise denied. Furthermore, a teacher told us that they are all awoken at 5:30 in the morning, eat breakfast at 7 and aren't put to bed until 8 at night. When asked if they get naps after lunch, she laughed at the idea of that! It's also a little difficult to watch teachers herding the children into better behavior using switches or ignoring the fights that would break out between the children.



Anyway, it'll be interesting to see if there's a difference in treatment when we go to an orphanage this afternoon that is run entirely on private donations from two foreign doners and the labor of the pastor who founded the place. John will be coming with us to medically evaluate the children. We think it's dangerous that the two of us will be there at the same time as we might not be able to resist bringing home a little one with us. It is a bit amusing to think of what would happen, living in Utah as an interracial couple with a Ghanaian child!

Best recent advertisement: Sambrosa Olive Oil: for Anointment and Good Health

Catching up/ CJW

It's my first ever blog posting. I'm sure it won't be nearly as interesting, well written or funny as John's, but I'll try.

My plane trip has been more harrowing than any travel around Ghana so far. What started off as an early arrival in Detroit (which led to thoughts of trying to get on an earlier flight to Amsterdam to spend time in the city) turned into a 7 hour ordeal. Our flight was redirected to Detroit due to lightening strikes at the airport. We were circled twice then had to land in Grand Rapids for refueling. For some reason, the fuel trucks kept coming over to our plane, only to fuel a plane nearby then leave. The pilot and crew kept telling the angry passengers that we were next in line to be refueled and would be on our way only to be proven wrong time after time again. Some angry customer remarked that it was like the boy who cried wolf and she would never believe the pilot again. I say that's analogy is slightly off-- I'd liken it more to the network t.v. coverage of a presidential election. An earnest call made too early.

Anyway, we had a brief reprieve with the flight to Amsterdam during which the flight attendant gave me a double gin and tonic for free (international flights rock!) But the flight to Accra was also delayed and we got in two hours late, made all the worse by the hour and fifteen minutes it took for our luggage to arrive.

But the next morning, we got an early start to the Cape Coast. (See John's post about that.) The troubled travel continued as I had my first introduction to the frequent police stops to check your car for appropriate licenses. It's a little intimidating when a man walks up to your car with a big machine gun, even if he's standing next to a sign that has "Police Stop: Foam Rubber, Your Partner for Life" on it. At our first stop, the officer tapped our luggage and asked what was inside. Our driver told him it was our personal items, but the officer asked us at least 2 more times. Had he opened it, he would have found suspicious looking medical supplies such as syringes and catheters, and I'm not sure if an international incident would have been on our hands. Our driver was very upset by the experience, saying that we should not have been hassled because all of our paperwork clearly indicated that we were tourists going between two hotels. He insisted that this was an indication that the officer was looking for a bribe.

Other than that, the only other interesting incident of note was when I was hit on by a smelly, vaguely European tourist at our hotel at the Cape Coast. While waiting for the front desk man to help John and me with our internet connection, my solicitor asked for his room key, greeted me then promptly asked me for my room number. I made up some response that I was staying in the "R" building. When he asked for clarification, I said that my HUSBAND and I were staying in the R building. He quickly backed off then. The next morning, we saw him and his buddy with a woman who was quite clearly a prostitute. I can either feel good that I drove him to this desperation, or worry that he thought I was his 'ho for the evening.


I spent my day Monday going around with Dianne and establishing contacts with the agencies that we'll be volunteering with this week and finding people on staff there who can be contacts for future U of U medical groupies such as myself. A very moving day, but you'll have to wait until I have more time to post on that.

Most inadvertently disturbing religious sign: Thy Will Be Done Licensed Chemicals

A weekend of contrasts

First of all, Chris has arrived! Woo-hoo!

This weekend we decided to travel to the Cape Coast Region, specificly the town of Elmina. Cape Coast is a popular tourist resort destination for Ghana, and has beautiful beaches lined with palm trees. It is also infamous for being the center of the slave trade.

Driving to Cape Coast from Kumasi took us through some of the poorest villages in the area, particuarly the mud huts in the fishing villages. We stayed at the Coconut Grove resort, a posh (by Ghana standards) hotel, where we ate dinner under a canopy three feet from the beach. After a lengthy breakfast and the arrival of Chris and Diane, we traveled to Elmina Castle. This was the main castle used by the Portugese and the Dutch for their slave trade. The English castle is in Cape Coast proper. We were led through the dungeons were hundreds of slaves were kept standing for months at a time, to the "Door of No Return," were they were led out to the beach to be loaded on ships.

We then enjoyed a soft drink at the hotel and drove to Kakum National Park. They have a "canopy walk," which is composed of rope bridges connecting seven trees that lead you through the forest, 120 feet off the ground. We then enjoyed another dinner by the beach.

My white liberal guilt was indeed in full gear this weekend. Not that it prevented me from drinking a pina colada by the pool after we drove through such poverty. Nor did it move me to actually purchase something from the hawkers who stood just outside the hotel property, trying to lure us with necklaces and hats. Our tour guide at the castle repeated pointed out that it wasn't just Europeans driving the slave trade. The Ashanti kingdom did much of the rounding up of villages to feed it. But one does not stand at the principle site of one of the worst events in world history and not feel reflective.

But, like the true obnoxious American tourist I am, I felt better the next morning, after another prolonged beachside breakfast and my fourth cup of Nescafe.


In other events, when we came home today was were greeted with a large swarm of ants and termites crawling over the walls of our ground-floor at the guest house. Yes, for those of you who have read it, our lives are starting to imitate "The Poisonwood Bible." We used enough African-strength Raid to send Chris running out of the building with an asthma attack, and were moved to a room upstairs. All is well.

Recent Religious Sign: "'If God Says Yes, Who Can Say No?' Pork Products."

Recent Advert: Sign at the entrance of the hospital: "Vasectomy - Give Yourself a Permanent Smile!"

Recent Local Food: Black Star (the restaurant's name for it), a concoction of greens, spicy pepe sauce, meat, and some sort of grain, served with fried plantains. Mmmmmmm...

In the Village

Today was a break from the hospital for a visit to a few of the outlying villages with the public health group. They have an impressive community health system set up in this area. A team of public health workers visits each village once a month to weigh babies, give immunizations, and do basic preventative health education. They also keep records of births, deaths (including neonatal and maternal), and incidence of diseases like meningitis, malaria, and diarrhea. Each village also has a designated health worker who has a decent supply of chloroquine for malaria. If anyone has a fever or any signs of malaria, they have quick access to medicine that will treat the most common cause of fever in these villages. There is a problem with resistance to chloroquine in Ghana, but as the physician who was guiding us explained, "If you have a medicine that will treat only 80% of the people with that disease, that is much better than not having medicine, and treating no one."

As many parents in Utah do not want their children vaccinated, I asked one of the workers what the vaccination rate in his area was. "100%" was his reply. I don't know if I believe this, but when I pressed him about it he insisted, "no exceptions." He explained that in Ghana, the government can and occasionally will intervene if a parent refuses to get a child vaccinated. Dr Brown, our physician guide, said the rate probably isn't 100% but that parent refusal is a rare problem.

One of the side benefits was interacting with everyone at the villages. We had to follow protocal and meet the chief and elders of each village, and ask permission to leave. Ghana seems to be the only place that is more friendly than Utah (and less creepy about the friendliness). In particular, the school-aged children were excited. In the first village we visited, a small group of kids were gathered near the road. When they spotted our van, they all yelled "OBRUNI!!!" in and started running, en masse, behind the van. They loved seeing pictures of themselves in the viewfinders of the digital cameras. And they always followed behind the van as we left, waving franticly and saying "goodbye" in a slightly musical way that reminded me of the "Goodnight" song in "The Sound of Music."

The roads themselves were a little, well...rustic. We were in a 4WD vehicle from the WHO (much to the excitement of the public health students), and the ride was bone-shaking. But, we passed several taxis overloaded with goods going into town for the market. Most of these taxis are Opel hatchbacks. Many had one or more flat tires, and two were so overloaded that there was a person sitting to the left of the driver. I'm not sure how these cars made it, but somehow they did.

Recent Local Food: EBA, a stew with fish and okra. Served with banku, and apparently to be eaten by hand as it came with the required bowl of water for washing hands. I used a spoon for the broth, though.

Overly religious sign: "The Power and Eternal Life in the Blood of Jesus Christ Church Welcomes You to Kumasi."

Glad I recertified in advanced life support

We had a rather disturbing moment at the hospital today. We a working on a research project on cerebral malaria in children, and had enrolled the first patients yesterday. As one of the medical students and I were standing at the foot of a child's bed, discussing how to obtain a urine sample, his mother began screaming and ran from the room. I checked on the child and he was in end-stage "agonal" breathing, but still had a pulse. The Ghanian resident ran in with a mask for ventilation (which I hadn't even realized they had), and started what I can only describe as half-assed recussitation. Not that more could have been done. The child needed to be intubated and put on a ventilator, but that just isn't feasible. They have one ventilator in the hopspital, in the operating room.

Enough of that. Aside from the frequent power outages today, I am still impressed with the care they are able to provide here, even with limited resources. And the resident's skills at IV insertion put mine to shame.

Today we visited the carving village, which is really just a suburb with a street of carving shops. Obrunis are quite popular there, but the vendors are less pushy, so it was almost enjoyable. However, histrionics still take over when you are bargaining. I am getting meaner. I still think I was overcharged a little for some things, but didn't pay more than $9 for any one carving. These are pieces that could go for $30 or more if purchased in the US, so who can really complain?


Recent tasty local cuisine: A stand in the hospital sells these delicious balls of fried dough, which are slightly sweet. I finally found out today what they call them..."doughnuts." Hmm.
Also, Castle Milk Stout. This is a local brew which, as the name implies, is like a Guiness, only a little less creamy. (Get it?? Milk stout??)

Recent Religious Business Name: "In Him is Light Chop Bar and Communication Depot"

First Weekend

I spent Friday at the hospital in the pediatric HIV clinic. As there is quite a social stigma about HIV here, the clinic is tucked away in an unlabeled section of the "Chest Clinic." The resident working that day, while walking to the clinic, said, "I know a shortcut." He led me through a ward full of emaciated, coughing people. Realizing this was the tuberculosis ward, I pointed out that maybe this wasn't the ideal shortcut!

This clinic itself is quite well-run, despite limited resources. They have 5-6 drug from which to choose, as they don't give kids the newer protease inhibitors. They have two labs they can order, for the most part: a CD4 count and a CBC to check for anemia. That day, the lab had run out of reagent for the CD4 counts, so the patients have to come back in a couple of weeks to have their counts checked. Most of these children came to the clinic with grandmothers or aunts, as their disease was diagnosed only after their mothers had died under circumstances no one would discuss. Not a pretty picture, but it was fascinating to look at their growth charts to see how much they had improved after therapy was started. I'm learning a lot at the hospital, but after that clinic I was ready for the week to end.

This being our first full weekend in Kumasi, we decided to spend it exploring the area around the city. A group of medical and public health students who are doing public health research arrived Friday night, and we all loaded ourselves into a rented tro-tro and headed to Lake Botsumtwe on Saturday. It is the largest natural lake in West Africa, and I think its coolest feature is that it is a crater lake, formed by a meteor strike.

It is considered a sacred lake, so the locals aren't allowed to boat on it, but are allowed to fish by floating on plain slabs of wood and paddling with their hands. Inexplicably, though, tourists can be taken on tours on a motorboat. Hmmm. At any rate, afterwards we visited Bonwire, a village that specializes in weaving kente cloth. While it is amazing to watch the weavers in action, the constant attempts to sell stuff to the obrunis is aggrevating.

Each of us had 2-3 people crowding around us at any one time. We had trouble getting back into the tro-tro, as vendors were surrounding it and shoving their arms inside, showing us their pieces of cloth, personalized woven bracelets, and kente backpacks. I didn't buy anything, as the haggling was getting fustrating and I knew prices were about the same in the city without as much obnoxiousness. A small child wanted to trade me a bookmark for my chapstick. I consider chapstick too valuable a commodity, but he accepted a pencil instead.



Today was spent relaxing, eating Indian food (yup), and visiting the Ahanti royal palace. The Ashanti king is just a figurehead now, similar to the British royalty. The public section of the palace was underwhelming, composed mainly of the king's old furniture and pictures of him with Queen Elizabeth and the pope. On an upside, there were peacocks wandering the grounds, and I think I will need peacocks when I have my large estate.

Recent overly religious business name: "'Blood of Jesus Fast Food' - Rice & Beans" Yummy.

Recent delicious local dish: Banku, a pasty dough made of fermented casava (fufu is casava and plantains). It is less messy to eat, and I had it with grilled tilapia and spicy sauce.

Obruni

Another evening finds me in the internet cafe...such is campus life.

I have never had "hey, white man!" shouted at me so much, at least not since I lived in East Cleveland. We went to the main market in Kumasi this afternoon, and we seemed to attract special attention from the merchants. Usually it was with the Twe word used to refer to non-Africans, "obruni." This doesn't seems to have a benign connotation to it, either. Despite that, it is cute when groups of small children see you and franticly wave, yelling, "Obruni! Obruni!" until you wave back.

For those of you who have been to Cleveland, the Kumasi market is a bit like the West Side Market, with the following excpetions: the meat is rotting, there is dirt everywhere, the aisles are about 2 people wide (not including a basket on one's head), you haggle for everything, and an obruni can't pause without someone pouncing, trying to get you to buy something.

I have also found ice cream! It's at Vic Baboo's, an infamous expat joint downtown.

Today's best religious product name: "Pray" toothpaste

We become entrenched

We are now settling into the swing of things at KATH, although the language barrier keeps Roma and I from doing everything we would ordinarily want to do. After years of feeling like we don't accomplish anything if we we're not overworked, it's hard to get used to mainly observing.

Seeing how medicine (well, pediatrics at least) is practiced here makes me feel both confident in what I've learned so far and utterly ignorant of what is seen here. In the peds emergency department, ALMOST EVERYONE has malaria. Even the kids who come in for ear infections and asthma exacerbations have malaria. Of course, this is the main teritary care center for northern Ghana, and the kids who are sent there has already been seen by other doctors and determined to be ill, so the sample is skewed. The management of their other issues is pretty rountine; in fact, with a few technical and pharmaceutical limitations, it's a lot like the US. But it seems everyone has to get started on antimalarials in addition to the two antibiotics they are getting for meningitis or the drainage of their abscess.


As others in the group have observed, we are also getting accustomed to the extreme poverty around here. Perhaps the is because the hospital has arranged for a driver to take us from the guest house to the hospital and back. So, after being served breakfast by someone whose annual salary is probably less than my monthly salary, we a picked up in a Land Rover with A/C and driven past communities composed mainly of shacks. The contrast is striking. We also worry that a taxi driver who charges us 40,000 cedis to take all of us across town is cheating us, when that's about $4.

On a side note, why do the keyboards in Ghana have a dollar sign?

More nonlinear updates:

Best Recent Food: Red-red, a concoction of beans, grilled meat, and onions, with fried plantains on the side. I could eat this three times a day.
Complemented nicely by a Star beer, the local lager that is actually decent (and the restaurant near our place has 20oz bottles for 9,000 cedis - about 1$!)

Recent Overly Religious Business Name: "Finger of God Communications"

Homesick Moment: No decent coffee to be found, only Nescafe (I have to go back to the US to drink brewed coffee from Africa? Although the instant stuff is from Cote d'Ivoire)

Update for Rich: Wine seems to be hard to come by, although Johnny Walker Black runs in abundance. I'll keep you posted.

First of all..

...the campus of Kwame Nkrumah Univ of Science and Technology (KNUST) looks like Lewis and Clark College, only set in an African rainforest and with more cement 50's era architecture. The student center also sells Lime Fanta and scotch, both of which one would be hard pressed to find at most student unions in the US. The internet cafe is a nice walk down tree-covered streets, and the nighttime walk is a good reminder to take your malaria prophylaxis.

Today was our first day at the Komfo Anokye Teaching Hospital (KATH), and it seems most of the people there didn't know what to do with us. We've been assure things will seem more coherent in the next few days. My day in the pediatric emergency unit started with a group of students who thought I was also a student, ("Have you seen seizures before?"), and ended with the death of a child who was admitted for severe malnutrition. The mother was making quite a scene about her grief. The resident working at the time expected me to be shocked that none of the staff we comforting her. I was a bit surprised, but I figured it was because the place was so busy. The resident later confided to me that the mother had not been feeding the child as a form of punishment, and the staff really didn't feel much sympathy for her.

On a lighter note:
Best advert seen today: "Foam rubber - your partner for life"
(Almost all of Ghana's mattress are faom rubber blocks, which are actually rather comfortable)

Best overly religious business name: "God is God Clothing."
No, that wasn't a typo on my part.

Best local food recently: Fufu, a sticky casava-based lump of dough that is covered with sauce or broth. Sounds gross, I know, but it actually doesn't have much of a taste (it takes up the tastes around it), and it fills you up nicely. In Accra, mine came with goat meat and a spicy palm-nut broth.

Worst "local" food recently: Malta, a nonalcoholic malt-based beverage made by the Guiness company that tastes like drinking runny molasses.