to the icy north

After a long recovery, Kale and a girl we'd met from UFS named Molly (who had planned to travel alone, bad idea), set out for Tamale, the major hub of Northern Ghana. We were told to head out an hour early to catch our bus at the downtown circle. We found a cab, told him 5 Ghana Cedi and were on our way. About 10 meters later however, he was asking for 25, which is completely absurd. We got out on the side of the road, now only 30 minutes before our bus and waited for another taxi.

Another one finally came, and we trudged through the morning traffic. We got a phone call that we were missing check-in for our bus and had to go to a different station. Fortunately this driver knew of the other station as well and we back tracked and did end up getting there early enough to sit around for our bus for an hour (kind of inconsistent with the early check-in requirement and late buses...)

We splurged on a kind of nice bus for our 12 hour drive to Tamale. It had big seats that were still partially covered in plastic, air conditioning, foot rests/reclining capabilities, and of course some resident mosquitos--one I squished with someone's blood all over everything, gross!

The bus also had a TV and a nice sound system, unfortunately. They blasted awful Ghanaian soap operas the whole ride at maximum volume. Return of the Ghost 1, 2, and 3 among many others were instant classics, combining romance, infidelity, cash, and "humor." They only took a break to play one real movie--The Ghost and the Darkness--a film about man-eating lions in Africa, well-played!

For what might have been a 10 hour drive, we stopped every 2 hours at rest stops that were waiting for us with hawkers literally jumping up and running to the doors at the sight of us. They also had fees for the bathrooms at these stops, and when I finally had to give in, I had to choose between a communal female urinal (a trough where about 15 women were using it together) or a foul smelling, fly infested hole in the ground. I went for the latter and tried to hold my breath, plus no TP even for 40 peswas.

We met an Obruni on the bus named Anna from Holland, she was returning to visit an orphanage she was a teacher at in Tamale a year before. People are incredible.

As we got farther North, the huts became more round and plain with thatched roofs and unpainted mud walls. There were more mosques (the North is primarily Muslim), more cows and goats, more bikes--and bike lanes! the only ones in all of Africa, higher termite mounds, and more severe punishment for theft (ie death--the UFS students in Tamale witnessed this as a man accused of stealing was thrown off of a rooftop bar).

We heard walking at night was dangerous, so we got a cab to a hotel that looked like an abandoned haunted house, and immediately upon sight of this, headed to a different hotel.

The next morning, bright and early we took a cab to the Metro Mass Transit "station." I put that in quotations because there wasn't much of a station: there was a small wooden box from which you could buy tickets and rows of seats outside in the dust surrounded by goats.

We spent the rest of the morning exploring Tamale. We found what our map called a 'palace' which was really several of the circular huts connected by low, mud walls. We then searched for a long time for the Zongo leather tannery, asking many people for directions and getting many answers.

We finally got there and it was slightly disappointing. Just some skins hung up to dry and a bunch of people sitting around. Kale clicked a photo. We got called over and yelled at for taking a picture without asking, and then offered the full tour for 10 cedi each. That's a lot. We really had no interest.

We stopped by the STC bus station to get our exit tickets for Saturday to Kumasi. We saw they actually had an afternoon bus on Friday and wanted to get out of Tamale as soon as possible. The woman said the bus might not go, we kind of wondered how it was that you could buy tickets to a bus that might not exist. Every time we tried to verify this with her, we got different answers. She didn't appreciate all of our questions.

We then went to explore the market since I wanted to get some souvenirs. The market was filled with cow carcasses rotting in the heat, which don't make for the best gifts. It took 4 people to find someone who could understand what I was looking for. A young man offered to lead us there. We followed him for a very long time and started growing wary of where he was taking us. Molly asked what I was expecting, the thin passage to open to an art oasis? And then it did. Hah.

Then back to the hotel and off to the Mass Metro bus.

There was lots of yelling at the bus station, and with the varied accents and many languages, we weren't sure when or if ours had or would be called, especially when the ETD is somewhere around 2pm.

We found some other obruni volunteers from Canada and the Netherlands and between the 5 of us were able to determine when our bus was leaving. Let me tell you about this bus. You walk on and the seats look as if they were all mauled by tigers, there is dirt everywhere, no air conditioning, our bags were not latched below because the latch was broken but secured by a thin string, AND to top it all off, the middle aisle folded into another line of seats, so when the bus was full, there was no way to exit in case of an emergency....

We bumped along for 5 hours as the sun set, stopping several times including once at dusk to pray. We finally made it to Mole National Park later that night.

ghana clubbing and BABOONS

On Friday, after our last outreach, Jerome and Bismarck (the ophthalmic nurse and the driver with Crystal Eye Clinic) decided to take us out for a night on the town. We all went to Highway View--a chill, outdoor bar blasting Ghanaian hits--while we waited and I tried the infamous "Digestive" drink which is Brandy, lime, and another unidentified alcohol.

Then Jerome and Bismarck pulled up in the big, clunky UFS van and drove us to a club.

The music started out American and then transitioned in to Ghanaians hits, it was perfect since we knew all the words to both after hours spent in the van listening to the same songs over and over again.

The whole time all of the girls were getting grabbed at by Ghanaians, and not subtly at all. They would literally grab your arm with boths hands and pull, as if physical force would make dancing with a sketchy stranger that much more appealing. We had to put Kale and Vu on protection duty. They would surround the girls as best as possible and intervene everytime someone got pursued by a stranger. It was a full time job. Jerome also occasionally would tap a guy forcefully on the shoulder, whisper something in his ear, and the guy would leave us all alone for a bit. You don't mess with a ~400 lb Ghanaian.

Some dancers there were ridiculous. There was one girl who danced bent over at the waist and moved her feet so fast to the beat that I don't know how she remained standing. Kale and I tried it, great thigh work out, but we looked like tools.

I think part of the reasons the dancers were so good is that they spent half their time dancing in a line in front of a mirror. I attempted this and within 0.5 seconds I was so uncomfortable that I had to turn away. Better left unseen.

When we left, our ears were still ringing and our clothes reeked of cigarette smoke.

We hopped in the van, got back at 3, slept for an hour, and were ready to go at 4:45 am. Kale could barely stand up. We got in the Telecentre van regardless and headed to the Volta region for a day of monkeys and waterfalls.

As usual in this country, the ride started out with an almost doubling in cost. Nothing ever seems to cost the original quoted fee. The van itself was pretty trashy too. We tried a/c with windows closed until Danielle nearly suffocated in the back of the van, then we had windows open with fresh, unfiltered exhaust blowing in our faces for the rest of the day. It was so bad that I had a sore throat afterwards.

I tried to sleep in the car regardless, but every time I succeeded, the driver poked me to point out something else mildly interesting along the road. I think he was lonely.

We arrived at the monkey reserve before 8am to make sure they weren't taking their afternoon nap to avoid to heat. I was hoping to see at least one monkey swinging through the trees, to my surprise an entire crew of baboons came out from the trees to play with us. We fed them peanut brittle (too fast) and peanuts (just right).

The way they ate the peanuts was very precious, they'd grab your hand open with one hand and take each peanut individually with the other. I was cool with this until mine decided to lick the crumbs up, then i was hand sanitizing and photographing the others.

The alpha-male refused to eat from us no matter how hard Kale tried, but the mothers with their babies swinging from the chest were not too proud to be fed.

FYI baboons' butts are disgusting. They are nothing like Rafiki's from the Lion King (my primary source on African wildlife) with his blue butt. Instead they are pink and look almost as if the skin decayed away. Not sure how this evolved.

We then paid an additional fee for the guide to take us to the antelope reserve. We followed him on a very long walk through the mud, with a few casualties, only to see antelope so far in the distance they might as well not have existed. Not to mention, all of us were on the verge of being ill.

Then we took a longer-than-expected drive to Boti Falls. There was another price debacle and then we took the 250 stairs (hardly a 'hike') to the twin falls, male and female.

The water beneath them was an inviting chocolate milk color, so naturally Chelsea went for a swim. I couldn't believe it when she submerged her head...

We all tried cocoa from a cocoa-nut (?). You are supposed to suck on the pods which tasted surprisingly like the 'apple' we had eaten (sour apple flavor) with the same texture (goopy, squishy, stringy), and the bitter cocoa remained inside the pod, unfit to taste.

We then had a long drive back with the engine overheating to dangerous levels and barely got out of bed for the next two days.

finishing up with UFS

Yesterday's outreach was in the hills near Accra. First time I've increased altitude my whole stay! Needless to say, the ride was beautiful and the winding highway, surprisingly safe, was dotted with ripe mangoes in massive quantities.

The outreach was kind of hectic because it was split on two sides of a parking lot, which is kind of difficult to cross if you're blind.

Danielle made an 8 month old cry during visual acuity, because of her "color" -- blond hair, blue eyes, white skin... hilarious.

*Disclaimer: this is a different girl.

On the way home we passed a bunch of coffin shops. We've seen a lot of these so we asked Ernest about funerals. Turns out they're huge businesses in Ghana. When people die there is a big party and lots of people go and give lots of money. To demonstrate the importance of funerals Ernest mentioned a UFS patient referred for cataract surgery that didn't come because he couldn't afford the 20 cedi transportation cost to Accra, but spent 60 cedi to go to a funeral even farther away. Sometimes people will even steal corpses to fake a funeral and bring in donations.

That night after outreach, I was reaaaally ansty. If you know me well, you know I can't go more than a day without exercise, and I've been going weeeeeks. No one wanted to run with me at night though, so I did it on my own. Used my headlamp, which worked amazingly. I could see the ground AND cars totally thought I was a motorbike and did everything they could to avoid me (which they definitely don't do for pedestrians). Naturally everyone I passed shouted out to me, but only one kid tried chasing me in flip flops.

Today's outreach was super long, and we didn't finish until well after the sun set. This complicated glasses-fitting so we had to use flashlights to test if the glasses that were prescribed actually worked.

The next day which I guess would be tomorrow at the time I started this entry, but is now two days ago. Was my last outreach. We went to a coastal village in the southern volta region. Danielle and I saw ocean and immediately wandered in that direction while the intro speech was being made. We had to wander through the village and by mud huts to get to and cross the swampy grasslands to reach the ocean. It was a gorgeous tropical beach with only minimal trash. There were fishing boats and a few Ghanaians staring at us, some with clothes and some without.

We couldn't stay long since we had to help with the outreach, so we headed back. We passed a group of people preparing cassava on the way back and I asked if I could take a picture, they said ye ye ye so I did.

The outreach was a manageable size and we powered through it. It was my last time on visual acuity. I had one patient, in their mid-20s, who was having some (understatement) difficulty figuring out what to do. I tried all my different sign language attempts of putting one hand on one eye, short of covering his eye myself. Every attempt got him showing me his watch or taking out his cell phone or holding his hand horizontally in front of his face and several inches away or just nodding and smiling, but none with his left hand occluding his left eye. This happens often, but usually doesn't take quite as long and I just couldn't contain myself any longer. I know it's not professional, and I did turn away, but I started laughing so hard I nearly cried. This is even before we had to explain how to point in the direction of the symbols on the chart...

When we were wrapping things up, I brought out my ball to kick around with the kids who were watching us through literally every window of the church.

As I was leaving, again they asked if they could keep it. This time I said yes. I hope it is used well!

Now that my UFS work is done, I get to play and travel for my last week in Ghana.

This also means I should reflect on this part of the experience:
Awesome things:
-getting sincere thank yous from patients
-knowing that we've made a significant change in someone's life
-overcoming barriers to care in a resource-scarce setting
-working with a wide variety of med/pre-med/ghanaian med people
-identifying and treating eye pathology that has gone untreated for too long
-earning patient's trust and understanding across cultures
Frustrating things:
-language barrier
-cultural barrier
-repetition of tasks
-not getting to see the transformation from blind to not blind
-people taking advantage of our services
-people lying
-people referred for surgeries choosing not to go
-lateness
-6ish hours drive round trip on bumpy, smelly roads every day

Overall I think it was a great experience. I think my biggest contribution to the Ghanaians we treated was the fundraising and collection of eye glasses, but we also helped to deliver the care by running stations that don't require a medical degree. I didn't come in with too many expectations, so I think I am satisfied. By the end, doing the same tasks day after day with the same frustrations became tedious, but that just makes me more excited to get to the point where I am doing the treating. I know when I do, the skills I have developed here working without language or cultural commonalities will help me to be a more effective physician when those same obstacles come up.

last week of outreaches already!

Today we drove in the direction of the Volta region in the east. The drive was flatter and it looked like you could see for miles and miles and miles.

This outreach was the smallest yet. I'd say under 100 people total. We breezed through visual acuity. I decided it was ball time again. The weaker ones got weeded out and eventually I was in a juggling circle with about 6 boys from 12-18 (I think). They loved that I could juggle, and my name went from Ms. Great to Lady Ronaldo. I'm really appreciative that I have skill that allows me to interact with people all over the world regardless of language. So cool.

Naturally, they asked me again to keep my ball. I wish I had a bunch to give away, it's so so hard to say no each time. The last group we see will be a lucky one!

On the way back to Accra we passed a very wealthy suburb. After seeing shack after shack for days it was so bizarre to see three-story, modern houses with multiple garages.

Makes you wonder how they escaped the poverty. We also went to a mall. A real mall! Like for a second I felt I could've been back in the US, there were even a bunch of obrunis! There was also a normal grocery store in the mall and I looked longingly at the fresh vegetable produce. I'm not sure if that is even safe, so I got beans/rice instead, but man, I could sure go for some broccoli.

The next day I got to go to the eye clinic. UFS requires that each sponsored surgery be witnessed and signed off by a UFS volunteer. Kale and I were supposed to go at 8, around 9:30 we headed out (you'd think I'd be used to this by now) and sat around the clinic until around noon. Then we saw 43 UFS cataract and/or pterygium surgeries in a row, with a few private patients sprinkled in between.

The OR in this clinic was nothing like the OR's in the US. The room had two beds, one with the patient being operated on, and the other with the patient on deck getting ready to go. The 2nd and 3rd patient were also chilling in the OR in chairs, waiting their turn.

The ophthalmologist, Dr. Clarke, went back and forth from table to table doing surgeries all day. Kale and I watched and asked lots of questions.

It was a very different procedure than I observed in the US as we've done away with it. It involves a larger slit and the cataract is popped out whole through the slit. There are no ultrasound vacuums or folded lenses that pop open inside.

The cataracts looked like little brown m&ms. Many of them had these for years and years without treatment.

Unfortunately that moment I had my heart set on witnessing, when the bandages would be removed and the blind patient would see did not occur in front of me. Bummer.

Also I had to take off my sneakers in favor of OR flipflops. Pretty ridiculous. Goes against years of closed-toe protocol and freaked me out since I was afraid the tools might accidentally drop on my toes and infect me with some unfortunate illness. I did get sprayed on my feet a few times when the doctor turned towards me to answer a question with a tool still spurting some unknown solution.

Also the people in the OR wore the same masks as us, but neglected to cover their noses--which kind of defeats the purpose. And sterile procedures kind of didn't exactly exist. My surgeon did change his gloves with each patient (unlike another site where the gloves were just sprayed with some disinfectant), but no one changed their sterile smocks and the assisting nurses changed nothing. They also reused many tools and only washed them with boiling pots of water... not quite as effective as an autoclave. The OR was hot and the AC barely cooling down the room, making it a great environment for bacteria to prosper.

I could go on and on, but you get the idea.

clubbing and cape coast adveture

After sitting Friday's outreach out (due to continuing GI issues). I got to meet the new set of volunteers that arrived, and I realized how far I've come in the past 2 weeks. I'm definitely a lot more comfortable here, which I hadn't realized until I saw how uncomfortable they were. They also made me appreciate this experience more. One girl, Tina, kept repeating "I can't believe I'm in Africa. This is so cool." And it is. Just wish I wasn't tied to the bathroom anymore.

I went out Friday night as planned, but didn't drink since I wasn't feeling well. We started at a chill outdoor bar with loud music and friendly waiters. Then we went to Osu where the nice restaurants are and me and Shriya went off to check out a live band. They were okay but it was awkward and smelly people (the world really needs to embrace deodorant) tried to dance with me.

Then we tried to get into a club called Bella Donna. We were denied. Apparently flip flops aren't accepted in clubs, even in Africa. But seriously, they should be happy I was able to borrow a nice outfit--all I brought were techwick shirts and EMS pants and bug spray.

Then we had a long and drawn out search for an alternative club, and more and more Ghanaians kept following us, trying to lead us places and sell us stuff.

Eventually, after failing, half the group went home and the rest of us took a cab to Afrodisiac. They also tried to turn us away for our shoes but in desperation we begged, "We came here to VOLUNTEER not to PARTY, PLEASE this is all we have." They took pity on us and let us in. The inside of the club was beautiful--a classy club--with plush couches, dangling lights, cool effects, and well-dressed people. We jammed out to classics from the '90s like backstreet boys... but would have preferred the Ghanaian hits. clap clapclapclap AWAY!

We got in just before 3am and again I wasn't able to stay in my bed through the night. The next morning (an hour or so later than planned) I organized a day trip to the Cape Coast region.

I thought the drive was only 2.5 hours, but it was actually over 3.5. We stopped for bananas in one market that had giant live snails and no good bananas. Instead I got grilled plantains later, which were delicious, but were man-handled by the woman making them and given to me wrapped in a piece of typed up computer paper. Resourceful? We also got kenke which is mashed up corn wrapped in plantain leaves that apparently tastes awful (I'm still avoiding most street food).

We hit Kakum national park at about 3pm (our next destination closed at 5pm and was over half an hour away...) for the notorious canopy walk.

There are a set of planks suspended by rickety ropes on trees high above the rainforest canopy. I was kind of nervous, I'll be honest. You never know about safety in developing countries... and it was really rocky! and the wooden planks were sometimes loose! By the 5th or 6th bridge, I wasn't scared anymore but there were only 7 bridges, so boo. Would've probably enjoyed the experience/scenery more if I had gotten over the fear sooner.

Then we zoomed (slowly through traffic) to the cape coast slave castle. Ghana was the gateway to West Africa during the slave trade, so there are castles like this dotted all along the coast. It was really eerie being there. We had a great tour guide that brought us into the depths of the slave dungeons and talked us step by step through the process and experience of the slave trade at Cape Coast.

There were several tiny chambers underground, with small slits for light and air to pass in, but nothing else. 200 men (or women in the female dungeons) would be sardine-d into these rooms for a holding period of about 3 months. They would defecate, vomit, urinate, and often die in these dungeons. There were markings on the wall of how high these bodily fluids would rise, and it was a solid 3 feet off of the ground. I couldn't imagine living squished in the hot, oppressive dark surrounded by people and various fluids up to your waist...

On top of the dungeons, ironically, was the First English Church "heaven above and hell down below." I learned a lot on the tour. It was much much more real than the abstract references to the slave trade in high school history class.

A somber rain started to fall as we left.

Elubo! Part 2

Elubo outreach day 2:
This time our outreach was right on the ocean, next to a bunch of fishermen carving boats out of logs of wood, sewing fishing nets together, and setting out to the rough sea in these less than stable looking boats. It was so hectic out there. So many people running around getting the boats ready, and our crew of obrunis with cameras really stood out and in a really negative way. I felt rude to be taking pictures of these people doing their work, no one comes to the US to take pictures of me, they come to the US to take pictures of the Grand Canyon and the Statue of Liberty. We also were in an area devoid of obrunis, and it was just a very uncomfortable experience all around.

We headed back to the stifling-ly hot church for the day’s outreach. I helped Ernest again, kind of, by doing a pre-screen for reflexes and mature cataracts. They’ve become so easy to spot! Of course it helps that most of the pathology we see on outreaches is ridiculously advanced, it’s really very sad. One woman had such bad pterygium that it covered her entire cornea, requiring surgery to hopefully restore her vision. Another boy, only 25, had cataracts in both eyes so bad that he was fully blind (also sent for surgery).

I spent the second half of the day helping with dispensing. I had one patient try to bargain prices with me—they are set by UFS and only nominal fees. I had another girl try to get me to give her reading glasses even though she had no prescription, “I forgot to tell the doctor that I have trouble reading.” It was hard to say no, but I was certain she was bull-shitting.

Another bizarre thing during dispensing was that a lot of older women in traditional cloth outfits kept their money wrapped in cloth within the folds, and one even reached as deep as her underwear… which kind of made money-handling really disgusting, but don’t worry more than enough hand sanitizer is being used.

Day 3:

This day's outreach, ever farther and farther west, was in a surprisingly nice church. The town itself was as run down and poor as usual, but the church had stained glass windows, polished wooden benches, and a statue.

Again Alex and I were at visual acuity. People were doing well with the instructions because a lot of them were watching the ones before, but I also think some were able to memorize the beginning of the chart by their turn. Tricky. Also, the ones who showed up late had no idea what to do even when people came to help translate which was fairly frustrating.

At the hotel that night we watched a video on couching. I was wrong in an earlier post, it is a traditional healing procedure for cataracts, not for glaucoma. A needle is stuck in the eye (with no sanitation or anesthesia) and the lens is dislodged from its position and shoved into the vitreous fluid of the eye, rendering the person's vision irreparable. It was a pretty tough video to watch and it's sad that it's still fairly widely practiced here.

Day 4:

In stark contrast to the beautiful church yesterday, today's church was tiny, dark, dirty, and right on a smelly roadway. We stopped to get breakfast at a street vendor. I got a styrofoam container (with napkin, spoon, rubber band, and plastic bag as usual) filled with rice, beans, shito (spicy), tomato-y sauce, pasta, and a hard boiled egg. I don't know if it was that or the array of fruits from the night before, but something didn't sit well with me. To make matters worse, the only toilets were out in the open in front of a billion kids staring at us and the urine made a nice layer on the floor and it smelled of manure. Needless to say I did not use that bathroom and the day was quite painful.

On top of that, the dispensing station was outside the door and kids were crowding us and people from the street thought we were selling the eye supplies to anyone who happened to walk by like all the other vendors. We had to have the translators continuously back them away from us so we could have spaces for ourselves and the patients.

The highlight of the day, however, was when I was able to translate an interview. Some people

choose to do research projects while they are here, which I considered but I'm here for such a short time that I thought it wouldn't be worth it. The research usually involves interviews with the patient through a local translator. This time, since we were so close to the border with Cote D'ivoire, there was a family or two who had fled from their country due to the ongoing civil war.

I was able to help them all with instructions and medication use, and for one family I was able to translate their entire interview for Jonathan who was doing the research.
It was very interesting. They had fled for fear of being killed, and yet they were so happy and outgoing, it was hard to believe that they were going through such a tough time in their family.

We've learned a lot from the interviews in general as well through those doing the surveys. The toughest question for people to answer is how many people live in their home, they have to sit there and count it out. Not something most people in the US struggle with. They also mostly have corrugated steel roofs, lack electricity, and have never seen an eye doctor before--and if they have they used a hospital through their national insurance plan and were referred to another hospital that was too far away for them to access. These are answers from those at the outreaches, not necessarily representative of the city-dwellers.

Before our 5 hour drive back to Accra, we stopped for some street food and I got jollop which is spicy rice with fried plantains and chicken. Not sure what I was thinking since I was already sick...

Elubo! Part 1

Six of us trekked off to Takoradi, a city about 5 hours west of Accra, this week to do an overnight outreach for the Elubo people. We drove west along the coast most of the way to Cote D’ivoire. The coast is a tropical paradise on the ocean side and cluster of poverty across the street. We got to our hotel late last night which is super cool, made of white plaster in an outdoor maze. Chelsea and I opted to go all out and get the expensive air conditioned room, because Elubo has a lot more bug-age than Accra. Well worth the $15 USD per night. Plus, everyone else came knocking to escape the heavy heat.

After breakfast at the hotel, where Chelsea found little worm larvae in the sealed oatmeal she bought at a shop, we headed off to our outreach. This one took place on top of a hill with a great view, and right next to a massive cell phone tower. Not sure that’s super safe. Anyone know?

Our site was an unfinished cement building (there are many all over Ghana) that lacked windows, doors, and half of the second floor—easier for the goats and children from the mostly outdoor school next door to come play with us.

Today I was doing visual acuity with Alex, and fortunately a local boy stayed with us the entire time to translate the instructions. We use charts with E facing different directions, and you’d be surprised how much explaining it takes for each patient to cover one eye only and point in the direction of the 3 legs. Like, really surprised.

There were many patients that couldn’t see the chart at all or hand motion right in front of their face or sometimes not even a penlight shined into their eyes.

Every time I used a Twi word all of the waiting patients clapped.

The chief also told me I was fancy and offered me a husband.

We saw the younger kids in class outside and had them sing for us. It was adorable and one song was even one we grew up with! “The more we do together the happier we’ll be, ‘cause your friends are my friends and my friends are your friends… “ all while hugging or swinging arms.

When the kids were hanging around the outreach site later they loved my name, they had so much fun shouting Jenny-fah! How ah you! So when my soccer ball was punted out after school let out, all hell broke loose. The ball was gone in seconds and I was being pulled at and even pinched by dozens of school children.

One of the teachers came over, and I was sure I was in trouble for starting so much ruckus. But instead she asked me to give my ball to the school, so they could have it. I had to say no since the ball’s purpose is to be shared with all of the outreach communities, but it wasn’t a good feeling.

I had one little boy get the ball back successfully, and the kids turned to Chelsea with her blond hair and started petting it and pulling on her. Then they sang her their national anthem. It was pretty entertaining.

After 8 hours of visual acuity, we waited around for Ernest to get through all of the patients. Then we headed out for some true Ghanaian food. I had fufu for the a first time, which is a pan-african dish that is a little different in each country. Mine was a ball of mushy, gooey cassava in a spicy-tomato based palm oil broth with half of a tilapia (skin, bones, and all) slapped on top—this cost a lot extra and I did not know that. You eat this dish with your hands, well with only your right hand, by tearing off a piece of the ball in the soup and dragging up some soup and meat. It’s very messy. Very tasty. I’ll probably be sick soon though…

Tonight we walked near the hotel to get some fruits. Little kids in underwear were running all over the street in the dark, calling at us obruni obruni obruni. Still so weird to be called hey white man! over and over.

trip to the beach...

Today is our last day before a few of us go on a week-long overnight outreach to the Elubo people in Takoradi. Since it's Saturday and we have weekends off, I was determined to take advantage of the free time. I rounded up a group of six to check out a really nice beach resort called Bojo Beach.

The super friendly Ghanaian from our hotel walked us to a major junction to help make sure we got a fair price on a taxi (there is always a special obruni rate and they often resist attempts at bargaining). We convinced him to squeeze all 6 of us in a 4 person car (one in the trunk with the bags) and bounced our way along towards Bojo.

Or so we thought. An hour later our cabbie took a U-turn and pulled to the side. Here you are! With no ocean in sight, we were pretty sure this was not Bojo Beach. The Twi language barrier didn't help things, but he eventually found someone who'd heard of it and eventually we got there.

It was a beautiful beach on a sandbar that requires taking a boat to get to. There were palm umbrellas and waiters and fancy stuff. It was beautiful and relaxing. I went for a run and had a few Ghanaian males join me, read, got sunburnt, etc. Then we left when the winds started up and headed down the road we'd come from to find a taxi willing to take all 6 of us back.

We found one although he was nervous about getting arrested for driving too many passengers--as if rules are enforced here. We squeezed into his car that had a broken windshield/rear view mirror/headlight, almost no roof, and smelled awful. We bumped slowly along toward our stop at ABC junction in Achimota. It started to rain, hard. He pointed to the left "There is Achimota!" and kept driving. "I am out of petrol and engine oil, I leave you here." We were not okay with that, we had bags and it was pouring, we didn't know where we were, and we had made a deal! So he kept driving. Until his tire popped. We pulled to the side of the road in the rain in the dark.

The driver was swearing in Twi as he looked for his spare tire. Eventually he tried flagging us a taxi . We got out of the car and finally got one by using someone's flashing red light. We split up in 2 taxis and made it back. So frustrating though! What should have been a 30 minute trip in 1 taxi took 3 hours and 3 taxis.

I'm now up to 1 witnessed accident, 1 experienced accident, and 1 broken down taxi. Kale is in the lead with 2 accidents, 3 police stations (one of which tried to sell him a crazy monkey on a leash), and 1 broken down taxi. (Most of those police stations are because accidents don't lead to tickets, but rather to arrests in Ghana). Great transportation here, I'm telling you.

reaching out!

Now getting down to business. On our second day here, we started outreaches. Outreaches overcome geographic barriers to care in that we bring eye care to the communities that lack access. This first trip was to a monthly site west of Accra called Tishi. It was a gorgeous drive along the ocean with plenty of extravagant buildings surrounded by a lot of barbed wire. Oh! Before that on the highway we saw a naked man standing the road. Good way to start the day.

There were 11 of us packed into a van, bouncing around on the less than ideal roads. We passed a group of children running to school in their tan and brown uniforms. Some with backpacks (how Western!) and some with back packs balanced on their heads (how confused!). All of the school girls have very short hair the same length as the school boys and I think they have to do that until they get older and can grow it out.

We arrived on site at a church next to a grade school. The church was a large barn-esque building with brightly painted walls. Hundreds of people were already occupying it by the time we arrived (we had planned to leave at 7am Ghanaian time which meant we left at 9:30am after waiting around in the lobby fort the 2.5 hours). The routine introductory speech began in English by one of our ophthalmic nurses, a Ghanaian named Dennis, and was translated into Twi by a villager. He went through the process of the eye screenings and how they could expect medication and glasses for only a nominal fee--to make sure they attribute value them--or surgery completely free of charge.

That's when he addressed us who were also on stage saying that we had collected the money to make the free surgeries possible, and everyone clapped. They really really need it. Many of them will get it thanks to all of you guys.

Dennis also attempted to dispel rumors and traditional practices that are detrimental -- ie no urine, salt, or breast milk in the eyes, no couching to relieve pressure (pushing a pin to the back of the eye for glaucoma) and during surgery the eyes are not removed from the head, worked on, and then replaced. Also no anesthesia for the surgeries, so no temporary death involved. These are commonly held beliefs in this country and are also barriers to care and can be an unfortunate cause of blindness.

After we introduced ourselves, we set up registration, visual acuity, opthhalmic nurse screening, and medications/glasses dispensing stations. Unfortunately we had way too many people at this outreach and didn't have a whole lot to do at the dispensing station that day. I did get to fit a small girl for sunglasses who stood unmoving, patient, and trusting as I tried on different sizes for her. Nothing like the spoiled kids in the US squirming around and whining.

We spent the entire day there until well after sunset, and believe it or not people sat there patiently the entire day waiting to be seen. Without a single complaint. Imagine that in the US where people get mad after sitting around for 15 minutes!! They were so appreciative.

Meanwhile, the school was having a big graduation next door. 15 year old boys were commissioning as cadets for the military while drums played and girls wore bright colored cloth dresses. There was music and loud speeches with lots of qualifiers -- 'the best teacher, well you are all the best teachers but the best of the best teachers is...' It went on all day.

Before we were given a delicious lunch of spicy rice and fried chicken as a thank you from the village, my friend Naima and I went on a walk. Dennis said we could take breaks to go see the ocean. We left the school together and walked towards the beach. It was covered in trash and tires and goats eating the trash and tires and harsh looking people. We were called back by someone and told that it wasn't safe, that they are bad people and would steal our stuff. He offered to walk us through the village to the other side where the safe beach was. How long we asked? 7 minutes he said.

10 minutes later we had found out that he was not with UFS and had just brought his father to the clinic and followed us out (sketchy) and the village was super poor. With me being the only obruni of the three everyone in the village was calling me white girl in 5 different languages. 10 minutes and we could finally see the ocean and it was at least 15 minutes more away, so we asked him to head back and he accused us of being scared... well, duh!

After seeing several hundred patients, we started packing things up. I went and played soccer with the villagers--all males about my age with another girl. They were reluctant to let us play, but once they did everyone got into it. I wish I understood Twi. I love showing boys in other countries that girls can play sports too.

The next day, the outreach was a bit farther. A 3 hour drive each way on really rough roads. We made it there and there were about 130 people waiting patiently in a much nicer, tiled church (the church tends to be the nicest building in the village, even if the rest of the buildings are all broken down wooden shanties with rusted tin roofs).

We did the same intro, this time without English, and got started. We were better balanced this time, and I asked that day's ophthalmic nurse (the ophthalmologists are saved for the surgeries mostly) if I could sit with him at the screening station--still regret not bringing my ophthalmoscope. He agreed to it for me and an English optometry student. I offered to do a pre-screen for pupillary reflexes (afferent and direct) while looking for mature cataracts (severe clouding of the lens) and pterygium (a tissue growth on the sclera).

I saw some ridiculous eye pathology; really advanced eye problems that never ever would have gone that far untreated in the US. I saw a traumatic cataract which comes from injury that had gone untreated so long it was unfixable, much of the iris would also have to be removed and it would be unlikely that the eye would be able to recover--I'm not sure what the prognosis would be with the medical care we are used to. I saw a little girl with a corneal ulcer from a herpes infection. I saw really advanced pterygiums. I saw a school-aged girl making up her poor vision/need for glasses. When the nurse pretended he was refracting but used a clear lens with no prescription, she said she could read what she had claimed to be unable to see before.

On a lighter note, there were a few well-managed cases of glaucoma, a few cataract referrals, and the girl with the herpes was to be sent for immediate emergency care.

On an even lighter note, I ran down the street to buy a soccer ball, well kinda, a ball that looks like one and will be used as one even though it's made of plastic. Best part of the ball is the "JESUS SAVES" on it, who knew he was a good goalie on top of all that godly stuff.

I brought the ball back to the outreach and kicked it to a little boy in the grassy/dirty/flat area next to the church. Then there was a about 5 people I was passing to. Then about 20. Eventually there was about 70 kids and I was no longer the passer. They were running around shouting with happiness, and chasing the ball while a little boy next to me called me Jesus in Twi.

One of the kids playing was a boy with one shoe (naturally the shoe was a total 90) and for a 5 year old he was very good at soccer. When I took the ball to put it away to get back to work all the kids stood there staring at me with the saddest eyes.

We wrapped up the clinic as the rainy season downpour began. The car wouldn't start. We were 3 hours of bumpy road from the city and there wasn't much of a chance for jumper cables in this village. I was starting to set up camp for the night in the church. Some villagers helped push the cars (while we watched a safe distance from the rain) and eventually we got it going Little Miss Sunshine style.

I sat behind the back wheel of the van on the way back. The holes in the road had gotten deeper with the rain. Our driver wanted to get back to catch the end of the Ghana v Congo soccer game so he was bombing across the roads. I don't get car sick. Well, I never have, but the guy next to me had them stop the car because I went totally pale and felt really ill. Had to move up to the middle. Weak.

beginnings

Hello!

Thought I'd do one of these blogs to fill y'all in on my wanderings! Internet's kind of iffy here, but I'll do the best I can and I hope it's semi-interesting !

After 24 hours traveling from Boston to Frankfurt and Frankfurt to Accra with Kale, we arrived last night. Entering the airport we saw a sign saying "Welcome" so I figured compared to my jaunt in Indonesia (sign said: "All drug traffickers will be executed.") we were off to a good start. Then we had to wait for our cumulative 1100 pairs of eyeglasses and other luggage to make it through. We traveled with the glasses in large boxes to avoid an extra suitcase and this drew attention. After being ignored while several Ghanaians were ushered ahead of us, the officer had us step aside to open our boxes. We were handed a large knife and had to wait awhile until the officer came back.

We stood beneath a sign that announced the criminal penalties for bribes as she fumbled through Kale's box. She found a pair she liked and then asked us for it, I was like yes yes take as many as you want! anything to get the glasses through customs... and she let us pass without anymore problems... no corruption there at all. (Am I going to be arrested for posting this?)

We then entered the main room of the airport where lots of people were milling about and there were drivers holding up tags with people's names. We had had some issues arranging our ride and had expected to wait from 7pm till midnight alone in the airport to be picked up. Fortunately, a driver with 'Unite for Sight' on a sign was there. We were a little wary because this guy could really have been anyone that figured out UFS students come every 10 days. Nevertheless we followed him to the parking lot where many other Ghanaians surrounded Kale and tried to carry his stuff even while he refused them.

Turns out it was the right guy, but we were going on blind faith (must admit I got nervous when we turned off a main highway onto a dark and unpaved road for awhile).

On our ride I got begged for money through the window by a girl without legs, sold fried plaintain chips from someone carrying them on their head, and learned the beauty (heavy sarcasm) that is Accra's traffic and terrifying driving.

The next morning we began by just walking in the direction of the Mokola Market. We had something resembling a map, but with no street names on the actual streets, it was pretty useless. Everyone advised we take a taxi or tro-tro (van/bus), but we really wanted to walk and kept asking for directions and kept getting the same reply "pick up a tro tro over there"). People were everywhere in the hot sun on the dusty, dirty roads.

Walking along the road turned out to be pretty terrible between the sun, the dust blowing, and dark black exhaust coming from the many cars scrambling up and down the road in no real order.

We realized after 2 hours that they were right and it actually wasn't walkable. We took a taxi (obviously the back seatbelts dont work with the crazy drivers) to the market. This market is absolutely insane. There are narrow paths through bundles of cloths, piles of pans and knives, fruits and vegetables surrounded by flies, raw meat also surrounded by flies (this includes pig hooves and other highly appetizing meats) through which many women are bustling with large

items balanced on their heads. Kale and I stood out like a sore thumb. We couldn't walk past a single seller without being grabbed at by our arms or clothes and asked to look and buy something from them. It was pretty overwhelming. All at the same time we tried not to touch the meat rotting in the mid-day sun and not to bump into anyone with something on their head while being grabbed at and called "obruni" or white person.

We bought some water and some very ripe mangoes, and headed out. We wandered from there to the ocean. We somehow made it into a very nice hotel and sat out on their patio eating mango while watching the enormous tide from a safe distance. Very messy, but totally worth it.

Then we wandered along the trash-covered beach to Independence Square. It is a Russian-looking flat, paved area with some monuments and giant McDonald's arches.

We tried to cross the square of independence and were stopped by military (irony!). He made us walk around the outside, while all the non-obrunis were walking straight thru, discrimination is no fun.

We had a few more run ins with the military like when we tried to see a castle that turned out to be the president's house and when we tried to go to it's beach, etc etc.

Then I REALLY had to pee, like drinking water all day but not wanting to use a bathroom in the streets really. We hurried up to try to find a place just as a group of six Ghanaians approached us and started hand shaking and chatting and insisted we come see their friends play drums. They ushered us to an area and into their shop. I wanted nothing of it, I needed a bathroom. Long story short a man in the library tried to charge me to use his, then asked me if I only wanted to urinate and then let me go for free when I said yes.

Eventually we got a cab back to the hotel (which, by the way is pretty snazzy for a developing country - a/c and some internets!), which took an hour and a half because we were in stop and not go traffic, literally--our cabbie would turn off the car for about 15 minutes at a time. We were even rear ended by two 14 year old boys on a motorbike without helmets. The cabbie yelled at them in Twi for a bit and they drove off between the unmoving cars.

When we got dropped off at a nearby junction it was dark already--boo equator during summer. Then we had to figure out how to cross this same 7 lane highway. It involved climbing a ladder and running between moving cars with my hand raised (as if that would be effective). We made it to the other side and then got really really lost in the dark as my cell phone battery was dying and Kale's was already dead. Fortunately, Page tracked us down and we went to Fingalix with the new volunteers. Loooong day!

Outreaches start tomorrow!

(p.s. expect a time lapse on all of these entries)

Thoughts on Ghana/Ghanaians/Accra:

friendly people!

terrible drivers

no need to grocery shop--just sit in traffic awhile and food--among other things-- comes to you!

military polices everything

the coolest things can't be photographed

Accra has a huge clash of poverty and relative wealth and traditional and Westernized culture

beautiful cloths!

great fruit

lots of hand holding

I stand out.