Ghana Live the Simple Life

Again… warning! Very very detailed blog below! I tried to categorize it to make it easier to breeze through, but I admit, it’s rather lengthy! As you see, had lots of time on my hands (I pre-wrote this before I finally had good internet access to send it)! Also again, the blog site is not letting me do paragraphs, which makes it look especially lengthy. Sorry about that, but I've really tried everything and it just won't let me add spaces. Grrrr. I tried to make it easier to read by bolding sections... hope that helps a little.

Well, I decided that I'm going to sell my home, my possessions and move to a 3rd world country like this and continue to volunteer my services and just live a good simple life from those proceeds. Hmm.... Okay fine, that briefly crossed my mind, buuuuuut it is amazing how one can quickly adapt to a new, very different, environment. Working toilet, what? No power/water shortages? Eating salads or foods with fiber or protein? Mmmm... sounds good. Washing machine and no hand washing? What a luxury! Granted, I was able to handle a month of this simple lifestyle, and probably could do a couple more, but that's about. I admit I'm spoiled and have too many unnecessary things and really, a good detox of all that really will do me some good. I always have these great ambitions to do a “possession” cleansing after big trips. But then when I get home, I fairly easily convince myself I really do “need” 4 bikes and a good 40-50 pairs of shoes, etc. Ha ha. What can I say? :-) Anyhow, below I tried to outline my experience here in with physical therapy/medicine and the other stuff I've been up to during my month here. My physical therapy experience at the hospital: Overall, I would have to say my experience volunteering was awesome! It definitely made me think more creatively, and how far PT has come in the States because I'm sure it started just how this has. Basically, a friend of mine (who used to work for the same PT company in Chicago) had come here 2 years ago to volunteer for 6 months and found her 2nd home here. Being that there wasn't physical therapy at this local governmental Catholic hospital or anywhere within an hour's drive, she literally single-handedly started a PT clinic at the hospital where I'm now volunteering, the Margaret Marquart Hospital.

In doing so, she found someone that was interested in it (a high school graduate that was here helping out) and trained him to do PT. So everything he knows is from her, and he pretty much is keeping the PT at the hospital “alive.” Although by our standards, Emmanual is an Aide running the show, he just now interviewed for nursing and physical therapy, and hopefully he will be accepted to be more than that. He is sooooo eager and passionate about helping and learning and it's been a great pleasure to work with him. I have to admit, I have been impressed with his basic knowledge (good work Sarah!), I especially admire his work ethic and that he is so noble, he does way more than what he “is paid to do” (I'll explain that later) out of the goodness of his heart to help people. It actually has made me feel invigorated with PT again to be his mentor just because he is so excited about it. What's also nice here is that the PT is very open and free. The clinic also had recently expanded from a 4x4 room (ha ha, well, almost), to this nice big spacious room:

The patients just come when they want, there are no appointments, “I'll come sometime next week.” Which, really, for the most part, has worked out, especially with the both of us being there (I feel bad leaving!). The only problems have been the language barrier sometimes for me and sometimes we just ask them to come back at a later time or date and/or depending, have them wait if we are busy (people here are super patient). Hence, to help with my PT, I’ve learned a few basic words in Ewe, the local language, like: “bod-e-me” = relax, “Jo” - straight, like “straighten it,” or “Ai-ko” or “Wil-a-gy” for good job, or keep up the good work.

There is somewhat of a referral system. The Orthopaedic MD comes one Friday a month and we are definitely aware of that because we get super busy with referrals then, i.e. “physical therapy.” We definitely don't have MD referrals in inpatient because we literally “find” patients to treat, we usually ask the nurses who they think would benefit from it, or sometimes people see us and seek us. We then do something of a brief chart review, but really just confer with the nurses. I can see patients whatever time I feel is appropriate and necessary (no “units” here), some have been 20ish minutes, some an hour and half. I decide if I want them to come back or not, and if so, how many times a week. Again, if it is written in the chart or we get a referral, our “prescription,” if you would call it that, just says “physical therapy.” Sometimes we get a diagnosis like, “shoulder pain. See PT.” Sometimes patients just come in, like a walk-in bases.

Besides the free flow of patients, I've definitely had to be creative with evaluations/examinations and treatments with the basic supplies (thanks again Sarah!) that we have and also in treating cases I haven’t seen since grad school. We saw a lot of neuro cases, like stroke

and even a SCI (spinal cord injury), some orthopaedic (which is my comfort zone), and some just random, “what the?” cases. The ortho stuff was fun for me, a lot of farmers with shoulder problems.

The neuro stuff, I actually felt that Emmanual knew more than I did because he sees it so much more, ha ha. People I’ve noticed have difficulty describing their pain, which isn’t all that new to me, but they can be extremely vague. I don’t know if it’s because they physically have to grow up quickly and endure a lot that when things finally creeps up, they just don’t know how to deal with it? Hmm.. I dunno. I’ve gotten a lot of “waist pain,” which I finally deciphered to generally be back pain. Or they will say, “it hurts here” and with their hands will go through the whole body. Eh? I think this experience has taught me great patience and persistence to try and get to the source of the pain, while using simple wording nonetheless. Throughout the day, we go through 3 PT disciplines, outpatient,

the ward (inpatient),

and home health. In inpatient, there are a lot of diabetes complication patients, and there are a lot of ulcers and wounds.

Seeing some of these patients, walking around freely but yet are “inpatient” is definitely different than the US (what happened to “get ‘em in and out?” Ha ha). The family of patients bring the meals, and because typically in Ghana the people are very open and accepting of others, it’s literally a matter of minutes before the family of patients and the patients are friends with everyone else in that ward. For example, if we are working with a particular patient, it is not a surprise when a family member from across the room will laugh with us, interject, put in their input. To be honest, I found it fairly amusing and didn't mind. For the most part, it has been helpful. Again, in America we are so private and enclosed. All the people here live like a big open family, neighbors, friends, etc. and I think it’s kinda nice to have such a big support group, ya know? What I can say is that people in Kpando especially are sooooo appreciative and grateful and nice, and are genuinely happy to see us (besides the fact that sometimes I feel they ‘get better’ just because a white person worked with them, ha ha). The other thing that always amazes me is how the people that have the least, give the most. I’ve noticed that in other 3rd world countries, and here is no exception. Several times patients have given me little trinkets to say thank you and it is not something I can deny, and it is really heartwarming. I have 1 patient in particular, “grandma” Johanna that I'm seeing in home health. She will just sit in the foyer all afternoon until we get there (which, here, they are very used to waiting and definitely different than the States. They NEVER complain and are SUPER patient, and again, grateful), and is eager and motivated to exercise. Sarah, the previous volunteer who referred me here, worked with her consistently after she had a stroke 2 years ago, and people here call Sarah the “miracle lady” because she got Johanna from a wheelchair to walking with a 4-point cane. They think she is a god, and it is soo cute! Grandma will just keep going and going, even if she is tired, because she is just so grateful and doesn't want to let us down.

In the picture above, Prince (who helped me out when Emmanual was out of town), Grandma Johanna in the middle, and Emmanual to the right. Again, working with her was so rewarding and it has made me love what I do even more. They cannot say “thank you” enough, even when I feel I haven't done enough. At home in the US, soo many people have posture problems from sitting at a desk for hours at end, but here, since there are hardly any computers or “desk jobs,” most of them are always moving around and carry everything on their heads (literally, everything),

they have posture that would make any model or dancer cringe (but all is not perfect in that aspect because they have major anterior pelvic tilting posture).

BUT, what they do have is horrible bending techniques, they bend right from the waist, and it make me cringe everytime I see it.

But then again, inflexible hamstrings is common with low back pain patients, but here, since they bend from their waists and stay there for prolonged periods, they have excellent hamstring length. I've tried to educate this horrible posture, but that has been extremely challenging because that is the only thing they know – they bend over to do everything, from cook, to wash clothes, to cleaning and sweeping, to farming.

The farmers are the most challenging to educate because they literally have to bend over to hoe and do their farmwork, and they’ve done this since they are were little, and as we all know, habits are hard to change. I've really tried to be creative with how I communicate with them and try to educate them. Although frustrating, it became amusing when I would spend ample time on showing/teaching someone how to bend with the knees, they are super anxious to please, will do it, thanking me many times, saying “the pain has reduced” and literally I will turn around to leave, turn back, and they are back to bending from the waist again. Darn it! The experience has been a great insight to “direct access” PT. There have been times when I love it that anyone can just walk in and I can treat them, and there are others when there are some random/bizarre “complaints” that I really have no idea what is going on. Sometimes by default in the States if there is something that is questionable, I say, “maybe you should get a MRI?” But here, especially in the small town of Kpando, there is no MRI (I don't even think they know what it is) or they would have to go to a larger city, like Ho. Once we saw a spinal cord injury patient (SCI), which I hadn't seen or even thought about since grad school, and I was a little jumbled. At home I could easily consult other PT's, refer them to neuro specialist (which we ended up doing, there are just a couple of hospitals that have Rehab specialists in the country) or pour through my notes from school or search the internet. I tried my best without all of those sources, and I think we managed okay considering. Speaking of, what has been the best is that I have had minimal to no paperwork. Talk to any PT, and they will say what they like least about our job is the paperwork. In the ward and home health I do none, in the outpatient, very short and brief, and sometimes not anything if they don't have a chart or insurance form. The “paperwork,” when it does happen, is pretty much is a reminder to myself what I did when I see them later on. There are no charts, they bring a folder with their written (obviously not computerized) chart and we write our brief note in there and give it back (they keep their charts home with them). Actually, it made me realize how much B.S. is involved with our paperwork and what we do just for insurance reimbursement (saying the right things so that insurance will reimburse or just to “protect” ourselves). Oh, and I love wearing whatever I want to work, flip-flops, shorts, tank tops. Nice. Ahh... gotta love the little things in life. Medicine in Ghana So yes, the medical system is.... basic at best.

It's the good 'ol, “too much demand, little supply” of doctors, many of whom don't work on weekends, by the way. At this hospital they don't have eye doctors, just eye technicians. For serious eye problems, you have to usually travel to Accra, 3ish hours away.

I guess there also are only a handful of cardiologists, in the country! So as you can see, there are many funerals here (which by the way here is celebrated with joyous singing and dancing all night. Also, it doesn't seem to be such a great deal like in the States when a close relative dies, i.e. “my sister just died” and yet she is in therapy and appears okay). No joke. Anyhoo, because Emmanual is not trained/specialized (meaning gone to PT school), he technically cannot bill for his services. I'm still unsure about how that all works because I know he is getting paid (sporadically at that) and that we have “charged” insurance for some outpatients, but I really have no idea what the reimbursement is.. not just PT but for other disciplines. For example, on the insurance form we write “Physical therapy – knee exercises,” or whatever we did with them (i.e. back exercises, abdominal strengthening). It's interesting and complicating. When he gets paid, he gets paid about $70 USD a month, which here isn’t so bad considering that he pays $7 USD/month for rent. The hospital accepts both uninsured and insured patients. Either way, no matter what, you have to “register” when you come.

If you are insured, you get a stamp that you “registered” and off you go to whatever specialty. If you are not, then you pay about $2 USD and then are free to go wherever. What I’ve seen, the “registry” process is a big pain, you can wait for hours just to get this little stamp.

I learned that specialty schools cost around $1500-$2000USD for something like nursing or PT. The starting salary for doctors I learned is $30,000USD and of course is more if you are a specialist. At the hospital where I am volunteering, there are several Cuban doctors here because I guess even though Cuba has one of the most up-to-date medical facilities in the world as far as education, they get paid very very low so they come to these 3rd world countries and get paid a lot more. When I was talking to them (in Spanish! Yea!). I still find it hard to understand how the salary in Ghana can be that much more, but whatever. And of course here they are more than willing to take foreign doctors because they are so short staffed. Weekend trips/excursions: Since I had such limited time with Emmanual, I opted not to invite myself along when the other volunteers when they went to Keta for 4 days. Instead I did a day trip to Wli Waterfalls and took 3 kids from the orphanage. It supposedly the highest waterfall in Western Ghana at 50m, but that too is under debate (there always seems to be great debate over the 'biggest' or 'highest' with waterfalls, like Victoria Falls, for example).

I think both the kids and I just had fun being outside of the “compound” and Kpando (we went on my 3rd weekend here, and I had not left the town at all before this trip), and it was good getting to know them better. I finally had a chance to ask them what they thought of the doubling of the orphanage and how they were getting along with the “new” kids and I what I would have expected as a response, some of the new kids are “stubborn” and the other ones are nice. The older ones especially can see this because they are almost like parental units here and discipline the kids, and some of these new kids do not respond to discipline, even I’ve seen that. Most of them however do really listen and look up to the older kids, especially the ones that have been around for awhile (i.e. Grace and Wisdom). Which on a side note, the names that the kids adopt, Christian names, are so funny to me: Love, Patience, Queen, Comfort, Confidence (the boy in picture below), Favor, Forgive, etc.

What makes it even more amusing is that many of these names are very applicable to their nature. For example, Love is one of my favorites because he really is loving, super affectionate, and a total cutey!

Anyway, back to the falls… I also treated them to a “fancy,” i.e. sit down restaurant, lunch and that was funny also. I don't think they had ever been “served” before and didn't even know how to react. It was cute. I felt bad because obviously the other kids were jealous (it was “mama’s” decision on who I took) of our little excursion. That's the tricky thing about this orphanage of 40 kids. Obviously we all have our favorites, but you can't single them out with treats or goodies because they will immediately brag and tell the other kids, and then you get all of them begging you for a treat/goody and they get jealous. So it literally is all or none. Side trip #2: Elmina I left the hospital and the orphanage a few days early to spend a couple of days to go near the well-known Cape Coast, to Elmina and then from there to Accra and the airport! My last hurrah in Ghana, sniff sniff. It was funny, within not even half an hour of arriving to Accra, me and this other volunteer simultaneously said, “we miss Kpando.” Not only is it MUCH cheaper (Accra is probably like x3 more expensive), but the people are much more friendly and … we just liked the simplicity of life. Oh well. We spent the day meandering around town, ate pizza (we had to indulge! Normal food!) and then the next day parted ways. I took off for my journey to Ampenyi, and quite the journey it was! I had not yet experienced a tro-tro, which is pretty much a crammed old-school mini bus that is the main mode of transport here. You hop on, wait till it fills up, which sometimes could be one minutes, sometimes ½ an hour, and then you go off. The seats are small and uncomfortable, and they stuff every last ounce of space with people. To say the least, what probably would be more or less 2-3 hours if there was a simple direct route took 6 hours and about x6 tro-tro transfers.

I liked the adventure, but was happy when I finally got there safe and sound. I stayed at a nice beach resort that was literally just a few yards from the beach. The little clay-hatch cabins were damp, but cute. Pretty much the whole weekend I lounged by the beach and got burnt and did some good quality pleasure reading. I read 2 of the 3 Stieg Larsson books, “Girl with the Dragon Tattoo” and “Girl Who Played With Fire” (great books, by the way). These were the chairs that had indents of my butt for sitting so long!

The food was delicious and I finally tried gari foto, or the African version of cous cous with vegetables… yummy. I wasn’t completely lazy (well, almost). I finally ventured one day to see Elmina and the St. George’s Castle, which was built in 1482 by the Portuguese. Because it has been so extensively rebuilt, it is still in pretty good condition. It is also celebrating 500+ years of existence, and is said to be one of the oldest colonial building in the sub-Saharan Africa. Slavery plays a big part in Ghana’s history, and the “Castles” at Elmina and the Cape Coast were both hubs for slave trade for all of Africa. We learned that when the Portuguese came, it was they that derived the name Costa de el Mina de Oura (The Coast of Gold Mines) for the easy access and acquisition of gold, which later turned into the name Elmina.

Because it is right on the harbor, Elmina 1st was busy as a trade route of salt, merchandise, etc. That soon turned into slave trade, which continued once the Dutch took over. It wasn’t until the early 1900’s that slavery was abolished and the British took over that it finally ended. It was quite a morbid experience to walk through it knowing how many people suffered and died. It was almost disgusting to learn how the slaves were treated. Hundreds cramped in a small unventilated room where they had to sleep on the hard cement, use the toilet on the same cement and get “fed” barely edible food.

Many refused to eat and opted to die rather than suffer those conditions. I think they said that there were about 600 men and 400 woman, and 1/3 of those did not make it. The slaves would wait for up to 3 months for a ship to come and then were sent to various African countries as slaves. Blech. Sometimes its hard to understand how these atrocities could even take place, it is just so inhumane.

Next to the Castle is the fishing market, and although the distinct smell of fish sometimes can make me gag it is so potent, it was cool to see how the whole market operates and the life that locals live.

In Kpando, the life is farming. Here at the Coast it is definitely fishing… and more fishing.

Soo… that was about it for my quick weekend getaway. Spent my last day back in hanging out in Accra, and also re-packing and organizing… again. Lastly, my impressions of my experience in Africa Overall, I survived 10 weeks in Africa and I have to say, now that I’m leaving, my impression is nothing but positive. Both in South Africa and Ghana the people have been extremely friendly and genuinely nice. I think spending so much time at each place made me really appreciate the culture and the traditions. I also loooved the volunteering experience and if I had it my way and didn’t have to work to make money, I would devote my time just to volunteering. I hope that I can be like my mom, who goes every year, sometimes twice a year, to Honduras to do volunteer eyecare/surgery, and go to 3rd world countries and volunteer my PT skills. It’s something I really hope to keep up with. Although there were some hurdles in the road coming to Ghana, I am so glad that I had this experience. If anything, I REALLY appreciate the things that I have and also am happy I chose the career I am in!!! Can you help? YES! Although you should get a reward if you actually made it this far in my blog, anyone that is actually still reading should get their own reward. BUT, if you have ANY donations, kids clothes, games, toys, book, toothbrushes, pencils, etc, and also any extra PT equipment, hehe, please let me know! I hope to be active with helping the orphanage especially, but also with getting the PT here going and I would be happy to package and send things. And I have connections of regular volunteers that go there that are even more eager to help. Please let me know! Where to next? Where in the World is Ellen? So yes! Next stop.... Europe for 2 months! Serbia 1st and then around Scandinavia, particularly Norway. This time I’m taking a backburner and doing shadowing/observing at different hospitals in both Serbia and Norway to see how PT is there. Should be interesting. I’m excited though because I’m going to meet my parents and my brother in Serbia for several days 1st and then off I go on more adventures! Stay tuned!