Weeks three & four: Damongo, Accra, and Elmina

In the Northern region of Ghana, it is customary for new visitors to the village/town to be introduced to the Chief. We were all unsure how the meeting would go, and to be honest I felt kind of nervous! Pastor Abraham suggested we bring a gift for the Chief, recommending a few bottles of Schnapps. So after a quick stop at the store, we were on our way to the Chief's Palace. Upon our arrival, we found the Chief sitting in a plastic lawn chair, and a few other individuals sitting on hides on the ground beside him. The men on the ground would kneel down and touch their heads to the ground as a sign of respect. We sat in plastic chairs across from the Chief and talked with him in English for 15-20 minutes. Our conversation varied, but we mostly stayed on the subject of the differences between Ghana and the US. We learned that chieftancy runs in the family, and that a man cannot become Chief if he is missing any of his toes, eyes, or fingers (especially the thumb and the ring finger)! The Chief gave us a blessing for our stay in Damongo and wished us well for our time spent in the hospital. 

We spent 8 days in the West Gonja District Hospital, dividing our time between the Children's Ward, the Maternity Ward, and the Outpatient Clinic (OPD). The West Gonja Hospital is similar in size to the Mampong Hospital, however at West Gonja there are only two physicians for the entire hospital. Dr. Kubio (Medical Superintendent) and Dr. Romanus, both Ghanaian, work around the clock to meet the high demands of the hospital. Dr. Kubio spends most of his time with administrative work and Dr. Romanus works in the wards seeing patients and operating in the theatre. According to Dr. Romanus, in Ghana there is only one doctor per 9,000 Ghanaians. He also told us a big problem with new Ghanaian doctors is that they leave the country to practice medicine in Europe or the US, leaving Ghana with a severe physician shortage.

On the wards, we were able to assist the nurses with minor procedures, wound dressings, and medication administrations. We rounded with Dr. Romanus and observed him in several C-section surgeries. In the OPD, we were able to assist the hospital staff with interviewing patients, conducting physical exams, collaborating on a diagnosis & plan of action, and writing prescriptions and ordering lab tests. A day in the OPD was very tiring since patients would begin lining up in the waiting area hours before clinic began. In a day the OPD sees between 75-150+ patients. 

   

Administering medication

Medical records, all on paper

Children's ward

Dr. Romanus (left) performing a C-section

Patient being wheeled to the theatre

Patients waiting in the OPD

Looking for malaria parasites in a blood smear

We were fortunate enough to be treated to a fantastic drumming and dancing performance by the Tahma Culture Troupe. And if we didn't draw enough attention to ourselves already, we were pulled up from our seats to dance with the dancers. What roars of laughter we drew from the townspeople watching! Lesson of the day = obronis (foreigners) cannot dance.

As the trip was coming close to an end, we drove from Damongo to Tamale (the capital of the Northern region), spent the night in Tamale, and the following morning hopped on a flight to Accra. After spending the past three weeks in small towns and villages, it was a bit of a shock to get off the plane into the hustle and bustle of the big city. Accra is a chaotic and modern city. We explored the Center for National Culture and the old buildings along the coastline. 

Tro-tro adventures

So happy to discover the 
Rooftop Spot in Accra

So after three and a half weeks of volunteering, we were able to take a few days to relax before heading back the US. Elmina is a small town located a 3.5 hour drive west of Accra. We stayed at a small beach resort called Stumble Inn...a slice of paradise! It was so nice to unwind on the beach and explore the coastline a bit. We walked up and down the beach, wandered through some small beachside villages, and stopped to watch some local fishermen pull in their nets full of fresh fish.

Elmina beachside village

Beach boys

Sunrise...our last morning in Ghana

Cultural Immersion. Service and Community. Simple Living. Our time spent in Ghana wholly embodied these pillars of Project CURA, and in the end, I am so grateful for this experience despite the frustrations and emotions that some days would bring. Over the four and a half weeks in Ghana, we all learned that it's really not so hard to live without running water and electricity. We learned about the importance of affordable and accessible healthcare in a place where malaria is as common as a cold. We learned how, even when there is a language barrier, a friendly smile and a respectful greeting goes a long way. We learned to give more and take less, and to always be thankful for what we have.

Recently, I stumbled upon this quote from Albert Pine: "What we do for ourselves dies with us. What we do for others and the world remains immortal." While our group of six soon-to-be second year medical students did not change the world during our time in Ghana, we know that our time and efforts left indelible impacts on the people we encountered. Through compassion, smiles, laughter, prayer, support, sensitivity, respect, and partnership, we formed a special bond with these people, and that is something that we will always cherish and remember for the rest of our lives. ■  

Project CURA Ghana 2014
Gary, Lauren, Janae, Ryan, Patrick, and John

Week two: Nsuto, Mole National Park, and Damongo

Under the direct supervision of local doctors and nurses, we spent three days working in the Mampong Government Hospital in the various wards. The Mampong Government Hospital is the only hospital in the area, serving a population of over 88,000 people. The hospital has 98 beds in the general wing and 56 beds in the maternity wing, with the most common patient admissions being for malaria, anemia, pneumonia, typhoid, hypertension, and diabetes. Many Ghanaians strongly believe in the powers of spiritual healers ("witch doctors"), and so for patients who are admitted to the hospital for a curable disease, by the time they come to the hospital, it is too late. The hospital also has a 14 bed emergency ward and a clean, modern surgical theatre and laboratory. We were surprised to find that even though the hospital supposedly has a back-up generator, the power still went out quite frequently in the general wings...causing the wards to get very hot and stuffy in the middle of the day.

The Mampong Government Hospital is staffed by four Ghanaian doctors, two Cuban doctors, anesthetists, medical assistants (PAs), nurses, nursing students, pharmacists and midwives. Interestingly, Ghana and Cuba have established a medical service and educational agreement: Cuban doctors work in Ghana for four years to support healthcare delivery in the country and Ghanaian medical students travel to Cuba to be trained as doctors. The two Cuban doctors we met at the Mampong Hospital, Dr. Anya and Dr. Eric, were both near the end of their four-year service. It was evident they were both extremely burnt out due to the immense work load they faced each day. Dr. Anya rounded on patients in the Children's and Men's ward, while Dr. Eric rounded on patients in the Women's ward. After rounds were finished, they both would see over 75 patients in the OPD (outpatient clinic) in a day. They both spoke broken English and Twi - so it was sometimes difficult to understand and follow their (very short) patient interactions. In the OPD, patients would come in to the room, be interviewed by the Cuban doctors (with the help of a translator), a physical exam may or may not be performed, something would be scribbled in the patient's chart, and the patient would be diagnosed and sent out with a list of medications, lab orders, or admission instructions. This entire ordeal lasted 2 minutes or less per patient.

Patient beds at the Mampong Government Hospital

Almost every patient we saw in the OPD had malaria. Or if their lab test showed they didn't have malaria, but they had the symptoms, they would still receive malaria treatment (quinine). Headache, stomachache, fever, cough = malaria. A test kit for malaria is available over the counter for the equivalent of $1, and the malaria medications cost around $10. Due to lack of education and lack of money, patients flood the hospital's OPD since they don't understand how to test themselves at home, or they simply cannot afford it. Anemia is another extremely common diagnosis in patients at the hospital due to their diet that is high in salt and lacks iron. Rounding in the Children's ward, we learned that anemia is diagnosed by inspecting the conjunctiva (inside of the eyelids) - it will appear white instead of a normal pink color - and by palpating the abdomen - the spleen is extremely enlarged. In fact, I remember back in Omaha in one of our physical exam lectures the MD said that she has never felt a spleen before and that it's very difficult to palpate properly. Well, in the children with severe anemia, you barely had to push on the abdomen before you could feel a rock hard spleen. In most cases, the treatment for severe anemia is a blood transfusion. Because of the unreliable electricity, the hospital's blood bank is in a constant shortage of blood. The way the hospital works in Mampong is that if a patient requires a blood transfusion, they will receive it, but they are not allowed to be discharged from the hospital until they "repay" what they were given. Thus, the patient (once fully recovered) or a family member is required to donate blood back before they leave the hospital.

We spent a lot of time in the maternity wing of the hospital, where most of us got to witness several Cesarian sections and vaginal deliveries. We practiced giving APGAR scores to the newborns, we learned about all the surgical instruments, we refreshed our female anatomy, and wore some cool outfits in the OR :)

Observing C-sections

Overall, the experience working at this hospital was, while at times very difficult, very rewarding. We were introduced to the Ghanaian healthcare system and how the hospital staff manages the enormous amount of patients every day. The hospital administrators welcomed our large donation of basic medical supplies, and I know they will be put to good use in the wards. The three days we spent on the wards opened our eyes to the incredible amount of need there is in this part of the world, and how important it is to serve an underserved population.

Before our time in Nsuto/Mampong was up, we squeezed in one more community health outreach. For this outreach, we visited three schools in Nsuto and screened children's vision. Thanks to First Sight, a non-profit organization in Omaha, we brought with us a vision screening kit that included 100 glasses frames and 200 lenses. Most of the children we examined had nearly perfect 20/20 vision! We ended up fitting around 20 children with glasses that corrected their myopia (nearsightedness). We took time to explain to the children how to take proper care of their new glasses, and we tried to show the kids that wearing glasses is cool!

Gary fitting a girl for glasses

After a fun goodbye party with our host family, we bid farewell to Nsuto. We all agreed that staying with a host family was a really great experience...we miss them already!! Our next stop was Mole National Park, a short break before we start our next two weeks in the West Gonja District Hospital in Damongo. The drive north from Nsuto to Mole National Park took around 6 hours. We broke up the long, bumpy journey with a stop at the impressive Kintampo Falls. According to the locals, the waterfall is home to a band of human dwarfs (whose existence has not yet been proven...) and a large aquatic snake. Needless to say, we did not see either of the two mysterious waterfall dwellers, but the falls were very beautiful!

Kintampo Falls

Mole (Mo-lay) National Park is Ghana's largest wildlife sanctuary, with significant populations of elephant, hippo, warthog, and antelope species. We stayed in Mole Motel, which is located inside the park's boundaries. Because of this, the hotel staff constantly has to shoo away wild baboons out of the restaurant and pool areas, and warthog families constantly graze at the grass right outside your hotel room! The hotel was located at the top of a cliff that overlooked a watering hole. From the viewing platform we could see for miles around the park. We spotted elephants bathing in the watering hole and herds of antelope grazing in the field. Our group set off for a guided safari on foot early in the morning. Almost immediately we encountered a group of elephants in the bush, making their way toward the watering hole. Our guide was very knowledgable about the elephants, and allowed us to get very close to them for taking pictures! The walking safari lasted around 2 hours. While the elephants were by far the coolest animals we saw, we also spotted lots of antelope and birds, and we saw buffalo tracks in the ground. Some of the group went on a night safari later that evening, where they ventured deeper into the park by jeep. 

Creighton takes Mole National Park

Our guide for the walking safari

After a restful few days in Mole, we packed up and made our way to Damongo, a small town just 30 minutes outside of the park. While in Damongo, we would be working at the West Gonja District Hospital and volunteering at the Redemption Children's Home Orphanage that is run by the same man who offered us a place to stay the two weeks. Redemption Children's Home was established by Pastor Abraham Saaka in 2004 and now he currently has over 50 children that range in age from small toddlers to teens. We spent many afternoons at the orphanage...at the beginning, I was expecting to feel heartbreak and sadness for these children, but every day we spent with the kids we saw them playing and running around with huge smiles on their faces. It was evident the way they clinged to us when we arrived for the afternoon that they all share the same need for attention and love. Pastor Abraham (or "daddy" to the children) and the aunties that work at the orphanage have the kindest hearts and treat the children with love, trust, and adoration. We spent a lot of time playing soccer (ahem, football) with the kids, letting the young ones braid our long hair, snapping pictures with our "sistahs", and so much more. 

Giving the girl's dorm a fresh coat of paint

Sistah let me braid your hair!

      

Week one: Accra, Cape Coast, Kumasi, and Nsuto

After two long flights, we landed in Accra, Ghana's capital city. The plan was that we were going to overnight in Accra and then drive to Kumasi (a 5 hour drive north) the following morning. Unfortunately not all of our bags made it, so we were forced to spend an extra day in Accra to wait for the bags that would be arriving on the next flight in. Spending one more day in Accra actually worked out well, since we were all able to have a little bit more time to adjust to our new surroundings (and get over a little jet lag). We decided to take in some sights and travel west to Cape Coast (3 hour drive). As the name suggests, Cape Coast is a small coastal city that has a rich history in the European slave trade. We visited the Cape Coast Castle, one of the largest slave-holding sites in the world during the colonial era. Seeing the claustrophobic dungeons and the "door of no return" was a sobering experience.

Cannons at the Cape Coast Castle

Fishing boats in Cape Coast

The following morning, we were off to Kumasi. The first 10 days of the trip, our group partnered with a non-governmental child-based organization called Light for Children. Light for Children works in several areas of Ghana to promote a healthy development for vulnerable and disadvantaged children. Light for Children has many projects that volunteers can get involved with, including a Preventive Child Sexual Assault Program, a School Health Program, and programs that provide opportunities to  teach English in local schools and care for HIV-positive children in orphanages. Our involvement with Light for Children was focused mainly on providing public health education on the topics of hand washing and oral hygiene to school children, and conducting several community health screenings in small villages. Light for Children also coordinated for us to spend three days shadowing and assisting the medical staff at the Mampong District Hospital, a government-funded hospital located about an hour  north of Kumasi. More on the hospital later!

The major language spoken in the Ashanti region of Ghana (Kumasi being the capital of the Ashanti region) is Twi. It was a lot of fun learning some Twi phrases, and the locals absolutely loved when we spoke to them in our broken Twi. Here's a quick little lesson in Twi:

Good morning. Maa chi.
Good afternoon. Maa ha.
Good evening. Maa jo.
Thank you. Medasi.
How are you? Ete sein?/Wo ho te sein? 
I am fine. Eh yea.
What is your name? Wo din de sein?
My name is... Me din de...
Foreigner. Obroni. (A favorite name we were called by little children!)

Seems like we could get by with just fine by only knowing those few phrases! Greetings are very important to Ghanaians in the Ashanti region. We learned that if you fail to greet everyone when you enter a room, the other people in the room will be insulted. So we got the hang of this very quickly!

We began our work with Light for Children by visiting the village of Jansu. This small village contained a primary school that was built by Light for Children several years ago. The school had around 62 students and 4 teachers. We visited the classrooms and demonstrated the proper way to wash your hands, stressing the importance of soap and running water. In some of the classrooms, the teachers had to translate from English to Twi for us, as we wanted to ensure that the children really understood what we were explaining to them. We explained that it is important to wash your hands properly before and after preparing food, before and after eating, and after using the toilet. We then sang a song with the children to help them remember how long they need to scrub their hands!

(To the tune of Frere Jacques)
Soap and water! Soap and water!
Wash your hands! Wash your hands!
Rub them both together. Rub them both together.
Clean them well! Clean them well!

With some of the students and staff of the Jansu Primary School

While we had the kids' attention, we also taught them about how they should be brushing their teeth. In Ghana, we saw toothbrushes and toothpaste being sold in the markets, but a lot of people in the smaller villages use "chewing sticks" to clean their teeth. They chew on these short pieces of a special type of wood containing antimicrobial properties. We distributed small toothbrushes and toothpastes to the children, and informed them of the benefits of toothpaste and how a toothbrush can clean your teeth very well. Due to the young age of the children, we didn't go into much detail about gum disease, gingivitis, or plaque...but we got the message across that it's really fun to brush your teeth twice a day! 

Ryan teaching the kids how to brush their teeth

During our time in the Kumasi area, we also got the opportunity to explore some of the city. We stopped into the Kumasi Culture Center, where we got to watch people carving drums out of a block of wood, weaving kente cloth, and making batik clothing. We also traveled out to Lake Bosomtwe, Ghana's largest natural lake. It was absolutely gorgeous!

Wearing Kente cloth at the Kumasi Cultural Center

Sunset over Lake Bosomtwe

After a few days in Kumasi, we traveled about an hour north to the village of Nsuto. We were based in Nsuto for 8 days, where we spent time in the Mampong District Hospital and went on medical outreaches to villages in the surrounding areas. While in Nsuto, we stayed with a host family. We really didn't know what to expect as far as accommodations went, but when we arrived to the house we were completely blown away by the niceness and hospitality of the family. The house was very simple and basic, with semi-reliable electricity but no running water. The house was arranged in a square with a large open courtyard in the middle where most of the cooking and eating occurred. The host family we stayed with was very large, with a lot of extended family also living there. At first it was a bit overwhelming with so many people in the house, and it was a bit hard to adjust to the lifestyle. But after a day or so, we became immersed in the simple living, and it actually was very refreshing to experience a new side of daily life. The electricity would go out quite often, so we spent many nights in the courtyard eating dinner by headlamp. With the lights being out all across Nsuto, the star gazing was incredible!

Our host family's house in Nsuto

Lauren learning how to make fufu

Hanging out with our host family's children

Fun times with the kiddos!

Doing laundry (in scrubs...the only clean
clothes we had left!)

Dinner time

One of the many highlights of our time in Ghana was the health screenings we did in several rural villages. At each location, we set up several tables and chairs and organized ourselves into three stations: a vital signs check (blood pressure, pulse, respiratory rate), a blood sugar check, and a consult area. Many of the patients we saw expressed their sincere gratitude for our presence, as the villages are so rural that it is difficult for them to get to a hospital. Each day we saw around 75 patients. The most common things we saw in the patients was hypertension, arthritis, dehydration, body pains, headaches, and minor cuts and rashes. While we could not directly treat the patients we saw with high blood pressure, we were able to consult with them about monitoring their diet (the local staple food fufu is loaded with salt and lacks any good protein). We also encouraged patients to go to the hospital if their current state of health dictated a doctor's visit. It was incredibly moving to see some of the patient's faces light up when we were able to inform them that their blood pressure was normal and their blood sugar was good! We also brought with us several medications that we were able to use and distribute to patients - including ibuprofen, pediatric pain reliever, antimicrobial wound cream, anti-itch cream, anti-fungal cream, etc.

Blood pressure and blood glucose screening

Treating children for a fungal infection

During our free time in Nsuto, we got to experience many cultural things! We attended two funerals (you would think this would be a strange thing to do while traveling, but in fact this was one of the most interesting events!), church services, and played football (aka soccer) with the local kids at the town football pitch. In Ghana, a funeral is a huge celebration where everyone from the town attends wearing red and black. The event is very festive with a lot of music, dancing, gift-giving (goats, food, drinks). When you arrive at a funeral, it is customary to go around and greet everyone. Even though there was a language barrier, we learned that a smile and a head nod go a long way. The first funeral we visited we introduced ourselves to everyone in attendance, and then it wasn't long before a group of women approached us and invited us to have a drink with them at their house. Out of courtesy, we agreed and ended up enjoying our nice, cold coke with the extremely kind and friendly women. The second funeral we attended was the same drill - shake hands, sit and watch the performers, get invited to a house. This was at the time that the World Cup was just getting started, so it was easy to find some common-ground with complete strangers. Everyone loved to talk about football, especially the upcoming Ghana vs. USA game!

Football...balls generously donated by 
HappyFeet Soccer Club, Omaha

The kids were so excited to have a
ball to play with!

We're leaving on a jet plane...in one week!

What do 100 eye glass frames, 200 lenses, 15 soccer balls, 3 huge suitcases stuffed full of medical supplies, and 6 newly dubbed second year medical students have in common? Oh yeah, we're all going to Ghana in one week from today! 

Supplies piling up in Janae's apartment

Medical supplies that will be donated to Mampong
District Hospital and the Saboba Medical Centre

It's the final countdown, folks. After months of preparation, this trip is finally starting to feel like reality. 

Our group has been very busy these past few months. We spent a lot of time in the Clinical Education and Simulation Center at Creighton University Medical Center, where we learned, practiced, and refreshed ourselves on how to do blood draws, conduct physical exams (adult and pediatric), identify signs and symptoms of infectious diseases endemic to Ghana, and the process of labor and delivery.

Now that classes are all done for the year, I've been able to put down the Neurology textbook and pick up Phillip Brigg's travel guide to Ghana. In his words, Ghana is "Africa for Beginners: a country of immense natural diversity and renowned hospitality ideal for newcomers to the continent and seasoned travelers alike." Needless to say, I am very much looking forward to being immersed in the rich culture, and to try new things. There will be days in the hospital that will push us to our limits, but that's all part of the adventure that awaits us! This trip is not only an opportunity for us to see a new part of the world, but also an incredible opportunity for us to put our passion for service and medicine into practice in ways that will make a difference in the lives of others.

We hope to update this blog during our trip as much as internet access allows us! It's Ghana be a good summer, so check back in on us once in a while!

From bucket showers to sweating buckets...it's Ghana be a great time!

Less than 2 months to go!

There are now less than two months until we bid farewell to the US and set off for Ghana! Here are some updates to our upcoming trip:

• A huge THANK YOU to all of our friends & family who have generously contributed to our trip's funds. With your support, we have raised over $1,550 - all of which will go toward the purchase of medical supplies we will bring with us to use and distribute to patients during our community health outreaches in the Ashanti region of Ghana. 

• Omaha non-for-profit organization First Sight has generously donated an eye exam kit to our group. This awesome kit contains 100 eye glass frames, 200 different types of lenses, and all the equipment needed to conduct an eye exam so we can fit children and adults with a pair of glasses (all in less than 15 minutes!). The First Sight kit contains all the necessary tools to help correct average vision problems for people who have minor single farsightedness, nearsightedness, or astigmatism. Check out First Sight's website, with more details on the kit we will be bringing with us here: http://www.firstsighteyeglasses.com/product/

• We have arranged two days in Ghana where we will partner with NGO Unite for Sight (http://www.uniteforsight.org/) to provide eye care in remote rural villages. We will be assisting Ghanaian ophthalmic nurses and optometrists to take patient history, test visual acuity, observe & conduct eye examinations, distribute medication and eyeglasses prescribed by the eye nurse, and provide eye health education. We will also get the chance to observe sight-restoring surgeries provided by the ophthalmologists at Friends Eye Centre in Tamale, Ghana.

• We have also organized a tour of the Korle-Bu Teaching Hospital in Ghana's capital city, Accra. Korle-Bu Hospital is the only tertiary hospital in the Southern part of Ghana and is affiliated with the University of Ghana Medical School. We are very much looking forward to the opportunity to learn how medical education is conducted in Ghana, and to compare our experiences to the Ghanaian medical students!

• Our group is also in the process of designing a research study investigating the high prevalence of Typhoid fever in Saboba, Ghana. In previous years, there have been attempts to reduce the incidence of this disease by providing the medical staff at the Saboba Medical Centre with educational tools to teach their patients about the risk factors of typhoid. Our group is interested in continuing this study in order to learn if these educational tools are still being used by the medical staff, and if so, to what effect typhoid education is having on the incidence and prevalance of this disease in Saboba. There is a lot of work still needed to be done designing this project - but we hope this research will lead to a better understanding of how public health education can be beneficial and effective in a community.

• Lastly, Project CURA's primary fundraising event, Savor the Flavor, was a great success! We had an attendance of over 200 Creighton students, faculty, and community members! Each trip prepared a dish local to the cuisine of the country they will be traveling to this summer, and the food was outstanding. Our group made fried plantains, a popular Ghanaian snack, and the buffet line was full of other delicious foods including red-red stew (Ghana), chicken curry (India), spring rolls (Vietnam), goulash (Romania), and more. Project CURA also was able to raise funds through an extensive silent auction & raffle, which included items such as Creighton Men's Basketball season tickets, hand made crafts & jewelry from around the world, gift certificates to Omaha restaurants and businesses, and much much more! Our group put together a poster board with information about our trip, and we were able to talk to many attendees about what we will be doing.

The group in front of our poster at Savor the Flavor