Hello everyone! Sorry it’s taken me a while to post. It has been quite the busy week. Last time I wrote was last Sunday.
On Monday, I ate Tom brown porridge, which is made of roasted maize, served with milk and brown sugar mixed in. I enjoyed it, but it also came with two rolls and a sandwich, which was frankly too much food. From there, I went to the hospital and worked in the emergency room and the high acuity ward with Dr. Naiza. She is such a nice pediatrician who allowed me to review they patient charts ahead of time and examine the patients. She also talked to me about how bronchopneumonia is empirically treated, common pathologies seen in Ghana, including asthma, malaria, HIV, and malnutrition. She also commented about how it is often difficult to communicate with patients from other regions. The most common languages spoken here are Twi, Ga, and Houza. Despite English being the official language, it is definitely important to try to learn at least a little Twi since most everyone can speak it regardless if they originally grew up speaking a different language. I immediately asked to be taught expressions so that I could speak with patients who often don’t know much English or who at the very least feel intimidated by speaking English. I learned how to say the following expressions: how are you? What brings you in today? Your child is beautiful, numbers up to twenty, and body parts. I also learned that since I was born on a Friday, my Ghanian name would be Afia Julia.
After clinic, Nora came to pick me up and we ran some errands at the Makola Market. For one, I wanted to get a few dresses to have during the trip. We walked around and I tried on some dresses on the street. I ended up buying two of them, both are long and flowy. That day, I went to buy some groceries for dinner that night. I bought some oranges, pasta, spaghetti sauce, and lentils at the main grocery store and then picked up garlic, green peppers, onions, and curry packets as the local store near my house. The funniest part of that experience was the lady cutting the curry packets with a machete. I wish I had a photo for you because it was just overkill at its finest. That night, I made a lentil curry with vegetables, and Nora tried lentils for the first time in her life. I realized then and later that if food isn’t local, usually people have not tried it before. For example, fresh milk and butter are not common there, as in sold at local stores. You probably could get it from the farmer himself in a village, but it isn’t typical in Ghanian cuisine. Also, there are no strawberries or blueberries. What they do eat is a lot of yams, wheat, casava root, rice, meat, spices, and fish.
So on Tuesday, I woke up at 6 am, which normally is a bit of a challenge for me in the states. I typically fall back asleep and hit snooze on my alarm, but in Ghana, even if I do that, the people already up and ready to start the day singing, yelling, roosters going crazy. So finally you also feel ready to wake up, so as to not feel left out. I definitely could use this morning motivation when I go back to the United States. It probably helps that it is so hot here, so the mornings are nice and cool, a good time to get things done.
Dr. Charles had brought me a hearty breakfast of slices of a type of chocolate and white bread with fried eggs sandwiched in between with a hot chocolate drink called milo. This was my favorite breakfast so far. This day in clinic, I worked with one of the junior officers, which, in the Ghanian medical system, is a physician that is doing the equivalency of internship that lasts 3 years instead of 1 year. They have 6 month rotations in various areas, so she is in her third 6-month rotation, doing pediatrics. After this, she will do 6 months in surgery. Once they are medical officers, they can do that and practice forever or they can do a specialty, like family medicine, pediatrics, or surgery. I saw a variety of cases this day, where most were bronchopneumonias, malaria cases requiring blood transfusions, acute tonsillitis, and severe malnutrition. I later worked again with Dr. Neizer in asthma clinic, which takes place every Tuesday. Just like in the US, there is a high need to educate families on prevention, the nature of asthma being a chronic disease that needs to be well-controlled, and how to manage day-to-day medical regimens.
After clinic, Nora and I walked around and went to Kwame Nkrumah Mausoleum, Kwame Nkrumah is the first Ghanian president, liberating Ghana from British rule in 1957. We then headed over to the Trust Clinic, which is the clinic Dr. Charles works at doing locum tenens work. This is the clinic that CFHI students would use if they were to get sick. I took some pictures of the clinic. From there, Dr. Charles and I went to a gym, where I ran for a while and lifted weights. After that, we headed over to a bar called Champs Sports Bar and played trivia. It was only Dr. Charles and I on a team, so we lost haha. The most important thing is we had fun!! Someone from Iceland approached me and said I looked just like someone else she knows that is here in Ghana.
On Wednesday morning, I had wheat porridge, which has been my favorite porridge so far. Dr. Charles and I went to the Morbidity and Mortality meeting, where all the patients on each floor the prior month are broken down by age, gender, and type of medical condition. They then review all the cases where children died and discussed if there was anything to improve upon to prevent precipitous deaths. I then went to work with Dr. Mensa on the medical ward and then in the malnutrition ward. Some of the children there have never seen a white person, so they were very scared of me and cried. I felt so bad and tried to get them to warm up to me. The diagnoses they had were severe acute malnutrition or SAM with or without edema. Some of you may know Kwashiorkor, which is total protein malnutrition, versus marasmus.
I learned a lot about the protocol of how to treat malnutrition, starting with ensuring the child is not hypoglycemic and also that they are hemodynamically stable. If they are hypoglycemic, you give 1 teaspoon sugar in 3 tablespoons water. We then treat children with either a 50 mL bolus or F75, which is a special formula to gently stabilize a child’s nutrition status. If the temperature is 35.5 degrees Celsius or lower, you can feed every 3 hours and keep the child warm. If they are dehydrated, you replace the water with oral rehydration solution called ReSoMal (rehydration solution for malnutrition) between feeds and after loose stools. There is a lot more detail if anyone is still curious, but I will stop for now.
After clinic on Wednesday, Nora took me to get a hat, and we tried roasted plantains and ground nuts (peanuts), as well as a coconut. I also bought ground nut butter and donuts, which were delicious. Nora had also gotten these nuts called tiger nuts or attadwe. My big adventure that day was getting a haircut. I am a bit nervous about haircuts in general, and I was afraid they may not be used to cutting a white girl’s hair. They cut it while it was dry first, which made me nervous. I noticed that a few strands were uneven, so I was kind of funny and asked to borrow the scissors to fix it. Man! I sound like a total jerk 🙂 anyway, they fixed it for me and gave me a good wash and dry. I feel so much better with the horrible split ends off that felt like straw and made my hair impossible to comb. I will get it styled when I am back in the US. I was so full from lunch and all the things we tried, so later that night I wasn’t planning on having a large dinner, but then Dr. Charles asked me what my dinner plans would be and I said maybe I would make my pasta, but that it’s too much for just one person, so we decided to eat that and he went out to buy us tilapia. I know that I love tilapia, but don’t normally eat a whole fish. When when returned, I was a little intimidated, but decided to dig right in. I ended up doing a pretty decent job if you saw they pictures on my Facebook 🙂 I also can say that I have tried a fish eyeball, which is one of the weirdest things I have ever eaten. I didn’t like it that much and gagged when I ate it, but mostly it was the thought of eating a fish eye.
On Thursday, Nora and I went to the Art and Culture center and Jamestown community. Jamestown is an old fort, but later became a prison after Ghanian independence. Since it hasn’t been in use, anyone can live there so there is a fishing community that lives there. They fish out at sea and this is the main profession. The women are fishmongers and the men are fisherman, where 80% do fishing and have no education past primary school. Also, there is a school started by a Canadian nonprofit Volunteer Abroad. They really stress going around to gather the students to put in school, especially the girls, because otherwise the parents don’t really mind if their children are educated. I didn’t have my camera that day, but I am going to try to go back and get some pictures.
On Friday, they brought me Hausa koko porridge which I didn’t really like. It was sour and wasn’t for me, so I had an orange prepared the Ghanian way, which they take the peel off the skin and leave the membrane on and squeeze the orange to drink the juice. I also had koose, which is bean curd patties that have been fried that you put in bread to make a sandwich. At the clinic, I worked with the Nutritionist Stella Opare, where I learned about outpatient management of malnutrition. This department actually is responsible for several campaigns, which includes vaccination campaigns, encouragement of exclusive breastfeeding, feeding techniques, food hygiene, and family planning.
In the afternoon, I bought a converter, some shea butter, fabric to make my dresses at the Woodin shop. She is going to make two dresses, the first of which will be ready on Monday afternoon from Sister Baaba, but she is called babs pronounced (BAH-bs).
Okay! This was my week. I will expand upon some areas in future posts, which I think will be more interesting to hear about instead of me chronicling all he details. I will also post pics tomorrow in a separate entry.