Ghana day 10

Today hasn't been a great day. I went to bed early last night because my legs were hurting, and woke up to even worse pain. I gave work a go, but left early because I was having difficulty walking. Joe, our programme manager, managed to source me some morphine for 125 cedi (about £30) from somewhere: either it's an OTC drug in Ghana (which I could believe, given the crazy healthcare system), or he's got 'contacts'. Either way, it's in the same packaging as it would be in the UK with an intact seal so I'm not going to worry about which drugs trolley it may or may not have have fallen out of.

I've spewed up everything I've eaten today, including the chocolate spread on toast Ophelia (our official house cook, and unofficial house mummy) made for me. There are two positives to this: firstly, if I keep on emptying my digestive system all traces of Michael's chips will soon be gone and, secondly, I had a legit reason to miss the infamous Tuesday night Fante lesson with the scary 'Fante Master'.

The only interesting thing I've done over the past couple of days is visit Circle Market again to get some D&D sunglasses to replace my lost Ray Bon's, and mastered the art of hand washing clothes. Tomorrow a group of us are visiting the orphanage: I'll be taking all the donations you guys gave, and the other girls are taking food - which is apparently in very short supply at the moment. 

I'll leave you with this photo. Only in Ghana would you find a sign stating the bloody obvious, below a figure of the Mother of Christ, behind a statue of a naked boy wearing a Santa hat. I'm glad it's been clarified though... I wasn't sure what the rules were before I read it.

Love Emily x

Ghana day 8

I've now turned into an inter-continental sick note. I thought I'd got off quite lightly with tummy trouble, but since eating Michael's chips I've been suffering. Cheers, Michael.

I've had fun picking up fabric during the week, and I've taken it to a seamstress who lives next door to us, and makes made to measure clothes. I've already got a custom maxi skirt, and she's currently making me a dress to replace the ones from last year which I'm now too fat to wear.  

I've got nothing interesting to say today, so have a photo of a typical Ghanaian vehicle.

Love Emily x

End of my first week in Ghana

Thinking about writing this post has made me realise how poor my life choices have been this weekend, but also confirmed my strong belief that bad decisions make good stories.

After having an early night (my digestive system doesn't like Michael's chips) we were up bright and early for breakfast. There was slightly odd selection of food (you could have cold toast, a fried egg and coconut on the same plate), but it was nice all the same. We dropped our bags off at the reception and walked to the main road to flag down a tro-tro. As far as I've seen, there is no public transport system in Ghana. Your options are walk, hail a taxi, or flag down a tro-tro. A tro-tro-tro is a 12 seater minibus, often complete with a nutter behind the wheel, which follows no fixed route - if it's empty it'll go wherever you ask it to, but it'll stop along the way to pick up more roadside passengers if their destination matches the driver's intended route. Basically, it's paid hitchhiking, but the price depends on how many people are on board.

A tro-tro-tro came crashing along pretty quickly, we agreed a price of 7 cedi each, and set off for Kakum National Park. As an undergrad I can remember laughing when a part of Queens Road in Leicester collapsed leaving a 1x2m pothole but in Ghana that's just par for the course. We were rattling around in this decrepit minibus being badly driven by two strangers down a road which was more pothole than surfaced mud. We arrived at Kakum and the driver asked us for 70 cedi, and subsequently started an argument. The co-driver admitted he had given as a price of 7 cedi each (35 cedi in total), but still the driver demanded 70. If that happened in the UK I would have paid the agreed price and walk away, but these two men were blocking the way off he minibus. These men's English was about as good as our Fante, so they called over a Kakum employee to do some translating. She was really helpful, and kept spelling out that we were willing to pay the agreed price. I think this pissed the driver off so he upped his price to 700 cedi. The Kakum employee said something to him in Fante, and he then lowered his price to 40 cedi. We paid an extra cedi each (about 25p) and escaped from his vehicle. 

Kakum National Park is huge and covers hundreds of square miles, but the main attraction of he part we visited is the canopy walk. It's a bit of a trek up a hill to reach the top, but the views were worth it. The canopy walk itself had 7 tree-top platforms, linked together by 8 rope suspension bridges over the top of the rainforest, 40m in the air. Having skydived, micro-glided and climbed up the millennium dome I hadn't expected to find this pant shittingly terrifying, but I did! After you reached the first platform you had he choice of completing the full course of 8 bridges, or doing a 2nd which took you straight back to terra-firmer (in Rushden, otherwise known as 'doing a Megan'). As tempting as the shortcut was I finished the long route, with the words "Bon - BEHAVE!!!" echoing through the jungle. Along the way there had been a photographer snapping us all. Thinking it was going to be a rip-off comparable to buying photos at Alton Towers we reluctantly let him show them to us, but I'm really glad he did! Not only had he taken some great photos; he only wanted 3 cedi (under £1) for each print! We later found out there used to be 2 jungle rope suspension bridges in Ghana, but Kakum is the only one now because the other fell down.

The thing which amuses me most about Ghana (or enrages me, depending on how hungry I am) is their approach to restaurant service. It starts off fairly sensibly: you sit down, you're given a menu, you order your drinks, and when your drinks arrive you order your food. The problem seems to be they cook the meals one at a time, but bring each one out as soon as it's ready. We all ordered pizza for lunch: Ellyn's arrived first (an hour after we ordered) and it was another 20 minutes until Kristy's came out. It was another 20 minutes before Sam and Bon's came and then, finally, mine arrived 1hr 45min after ordering. In the UK I'd be seriously annoyed and demanding a discount, but in Ghana it's just how things are - the the extent that waiting staff aren't remotely apologetic. 

After everyone watching me finish my lunch we ambled back to the main road to flag down another tro-tro. We saw a snake, and I tried to take a photo, but the locals seem to think we should pay them for photos which aren't of them, or taken by them, just near to them. A tro-tro skidded to a halt and we squished 5 of us into a tro-tro making the total passenger number 15 (plus a baby). Initially a Ghanaian turned around to us and said something along the lines of "you are white, I do not like the way you talk, you must be quiet on this bus", but then an 82yr old man got on and loved us because I let him try on my glasses, and the driver only made us pay the agreed 4 cedi each.

We arrived back at Hans Cottage to collect our bags from reception which was unmanned for the 20 minutes we sat waiting. Luckily our bags hadn't been stolen, we picked them up, and trundled back to the main road to wait for Frank (our lovable plonker of Work the World staff) to pick us up in his minibus at 2pm. I should know by now that if a Ghanaian, or Colin, says to me "see you at 2" then I've got until at least 3:20, and unsurprisingly this was no exception. We picked Donna and Claire up from their luxury hotel, made our way back to Takoradi, and hand washed our clothes.

A weekend in Ghana (cont.)

Today we escaped from Fespa hotel... their breakfast looked no better than our room, so most of us chose to go without! Sadly our group of 7 shrunk to 5 - Donna and Claire were so traumatised by Hotel Fester they booked themselves into somewhere luxurious and left us kids to do our studenty thing. After this we set off for Cape Coast castle, another fort used to detain and transport slaves. Taxi drivers in Ghana have no issues with 5 passengers in one car, so we stuffed ourselves in and headed off.

 We opted for he guided tour, and the group we were with was half black and half white. None of us even picked up on this until the tour was underway, we were standing in a dungeon used to house slaves, and a black man angrily started asking the guide questions and heavily implying white guilt. It was a really interesting tour, and by the end of it he seemed to have warmed to us slightly. He insisted on this photo being taken: I got off lightly with him just holding my arm. I initially thought he wanted me to sit on his lap.

After the tour we tried to get a taxi to take us to Hanns Cottage, which is where we stayed on Saturday night. In Ghana approximately 80% of cars are taxis (seriously) so you just stand by the road, stick out your arm, and something will come hurtling along pretty quickly. 3 cars pulled over and quickly realised we needed a maximum of 2. They all started shouting at us, and then each other, so we jumped into the ones which were charging 20-40 cedi, not the one which wanted 800. We got to Hanns cottage and were pleasantly surprised. The accommodation is not dissimilar to Fespa, but there's a pool, a bar, functional wifi and we don't have to walk down an unlit donkey track to have dinner. One of the major features of Hanns cottage are the crocodiles which are apparently 'friendly' and tolerate being stroked. I've never seen a crocodile off their tits on midazolam before, but I'm fairly certain I did today. They were laying with their mouths wide open, and so still we questioned if they were even real. Every now and then they would have a myoclonic jerk, but otherwise were completely unresponsive to noise, touch or movement. We kept asking the lady who 'looks after' the crocodiles if they had been sedated but she said "no, they're just sleepy because I've fed them a big chicken". Sounds legit.

A weekend in Ghana

Yesterday 7 of us were set to head off for Cape Coast for our luxury weekend treat. Our hotel specification was fairly modest: we wanted hot running water, wifi, a pool/beach, and alcohol. A week in Ghana has taught us that locals see/hear us abrunis coming a mile off, so we delegated the task of booking a hotel to one of the Work the World staff, Frank. Somewhere along the line wires got crossed, and at 4pm Friday afternoon we learned Frank had booked us our luxury hotel - but in Axim. We then set him the task of finding us a similar hotel, along Cape Coast, to accommodate 7 with a few hours notice. Unsurprisingly, all that was available was ultra-high to ultra-low budget stuff, and the middle ground places were fully booked. We chipped away at our specification and budget expectations and at 5pm eventually agreed on a hotel with no pool and no beach, but with hot water, wifi and a bar. Happy days.

After a 2 hour trip on a tro-tro (minibus) we were ready for our little bit of luxury, and pulled up at Hotel Fespa. Initial impressions weren't amazing, but we were ready to be wowed by this African rough diamond. We got to the rooms (via 4 flights of stairs) and saw we'd been given 3 doubles, not the 2 doubles and 1 triple we asked for... and even the correct number of beds wouldn't have compensated for the cleanliness and comfort of the rooms. Luxury this was not. The hotel manager's response to the bed situation was chucking what looked like a sunbed cushion on the floor in one of the rooms. We were fairly unimpressed, but it still had hot water, wifi and a bar. We tried hooking up to the wifi to research alternative hotel arrangements for Saturday night, but predictably it didn't work. "Oh well", we thought, "let's just go down to the bar and have some food, drink some drinks, and make the most out of staying in a shithole". We headed downstairs, discovered the restaurant and bar advertised on the front of the hotel didn't exist, and our only evening entertainment was the hotel security guard chasing away a fox.

Seriously unimpressed at this point, we enquired about our dining options and were given directions to a nearby petrol station which served pizza. Ghanaian driving is terrifying as a passenger, but even more so as a pedestrian. Walking along the side dual carriageway because there is no path. In the dark. With only a phone torch for illumination. We found this garage, but they had stopped serving food by this point. We asked a man where the nearest open restaurant was, and he pointed at a dirt track across the road, and told us to walk down it. It briefly crossed our minds that perhaps we shouldn't trust the directions of a complete stranger, in a foreign country where us 6 white girls are extremely conspicuous, which take us down "the dark road"... but our hunger overrode that little concern, and we headed down the dirt track wondering what could possibly go wrong?

At this point we met 2 men. Being 6 white girls in an unfamiliar country, late at night down a dirt track, we tried not to hang around for too much of a chat. This is when one of them grabbed my arm and started chastising us for disrespecting him in his country. Take me to any village and within the hour I will have found their resident nutter, and this bloke was no exception. He said his name was Michael and he owned the bar we were trying to walk into. We ordered some beers, and spouted some Fante for him, and ordered some chips - which made him pipe down. 20 minutes later he came up to our table, said we weren't drinking our beer quickly enough, we'd been there for 3 hours and we weren't letting him show us traditional Ghanaian hospitality. He kept on repeating that we would be offending him if we didn't let him know what he could do to make us comfortable, but somehow it didn't feel appropriate to say "well, you could start by fetching us those chips we ordered half an hour ago". 

The chips arrived, and we noticed Michael sitting at the bar, paying for drinks. At this point we considered the possibility that he might just be a mentally ill bloke with delusions of owning a bar, so we tried to quietly get the attention of a waitress so we could pay up and escape. Michael noticed this, and came over again demanding to know what he could do to satisfy us. I handed my camera to the waitress, asked her to take a photo of us all with Michael, and then hastily retreated out of the (his?) bar. 

We legged it back to the hotel, further pissed off the manager by asking for 2 top sheets (he refused), and enjoyed our first hot shower in a week.

Ghana day 6

As horrible as it sounds, today has been the first day of working in Ghana which I've enjoyed. The BBQ last night really cheered me up, and I went to Kwasimintim this morning with enthusiasm (and a slight hangover). A labouring woman came in and Ellyn and I looked after her. Her baby's heartbeat was a bit slow, and staff were willing to cannulate and start IV fluids. Short of starting a CTG (certainly not available at Kwasimintim!) their management of the situation was exactly as I would have done in the UK. Whether that's a positive reflection on them or a negative one on me is for you to decide. The baby came far quicker than any of us anticipated, and as I was the only one wearing gloves I delivered (#48, if you were wondering). As the baby came so quickly the woman had quite a nasty tear. Watching this being repaired was horrible - especially as it was being done with no anaesthetic. I could see a 10ml vial of 1% lidocaine, and tactfully suggested we used it. "Okay" said the midwife, "get me 1ml". Ordinarily I'd use 10ml, so I didn't expect this 1ml to go far. She infiltrated half of it, and commenced suturing again. Unsurprisingly 0.5ml of local didn't really touch the sides, and I persuaded the midwife to give the other half as it had already been drawn up, and couldn't be used on another patient. As awful as this was to watch, I knew it didn't happen because any member of staff was being deliberately cruel: it happened because that 10ml of lidocaine had to last for many other women too. Today, I felt everyone tried their hardest with the available resources - for the first time since I've been here. 

The lack of effort and care in Ghanaian healthcare terrified me on a personal level. I was diagnosed with transverse myelitis in November 2014, and assumed cold British weather worsened my symptoms. As they improved as the weather became warmer I took this as causation and not correlation. Having been in Ghana for a while I've learned extremes of temperature - be it hot or cold - trigger pain. I hadn't expected to be needing analgesia stronger than codeine whilst I was out here, and got quite worried at the thought of needing morphine: from what I've seen of African hospitals so far, I'd rather return to the UK to get it. I mentioned this to Joe, our project manager, and he told me not to worry because there is a local hospital which will only treat ex-pats. Hearing this completely confirmed my opinion of Ghanaian healthcare: this is the place where staff sleep in front of patients, staff collect vague 'fees' at outpatient clinics which are then pocketed, and every ward has a staff television but can't provide bedding for patients. 

I think the biggest lesson I can take from Ghana to my own midwifery practice is how not to do things.

Love Emily x

Ghana day 5

Today has been my third day at a Ghanaian hospital, and it's been as head-bangingly frustrating as the others. Ellyn and I arrived at 8:25 (Ophelia, our housekeeper served breakfast at 7:45 instead of 7:15) but no-one had noticed, never mind cared! I am now accepting this as 'the Ghanaian way'. As soon as we arrived we saw there were no labouring women. With Work the World's advice of being proactive in our minds, we went to theatre to ask if there was an elective caesarean list running that day. "No", we were told, "but there will be an emergency case soon". We legged it back to the staff room to put our theatre kit on, and went back to theatre hoping we hadn't missed it. The doctor (who is awesome) told us to wait in the corridor and we'd be told when the woman was brought over. We waited for an hour, and again thought "this is just the Ghanian way". After another half an hour I asked a nurse when the woman was coming. "We've just had a phone call", she said (bollocks; we didn't hear a phone ringing) "we'll do it tomorrow". How big an emergency was it?!

Another biting-tongue moment came later on in the day when a para 4 (woman giving birth to her 5th baby, for the civvies!) came in, and Ellyn and I suggested she stood up to use gravity to help her baby descend. The midwife in question replied "no, we don't allow that because when the baby is born they'll hit their head on the floor". We mentioned that in the UK we have 1:1 care in established labour, to which the response was "we don't have the resources for that". I tactfully replied that there were presently 5 midwives staring at this poor woman (2 of which had previously been kipping on patient beds), and perhaps we could deviate from their normal practice on this occasion. They were fairly insistent I VE-d (vaginally examined) this poor woman, and couldn't accept that just because she wasn't fully dilated at the last examination doesn't mean we might not be now, and no, it's not okay to shove your fingers in on an ad hoc basis with no warning or consent.

After the day at work and a big debrief a group of us braved Takoradi's circle market. If there are any GoT watchers reading this: think Flea Bottom. For everyone else, try to imagine the smell of rotting fish being a welcome distraction from the stench of the open sewers running alongside each pavement, and rats. Lots of rats. The people living in the inner-city had no issues with grabbing us and steering us towards their stall. Children were grasping us and shouting "abruni!" and "osei!". The passageways were so narrow we were walking single file, and even that was too hard at times. Walking through that market was the closest I've come to feeling unsafe here: the residents could see we were the only white people for quite a way, were trying all tactics to get us to buy from them, and got fairly irate when that didn't happen.

Patient and marketplace assault aside, I think I'm getting the hang of other aspects of Ghanian life. I've woken up to find I've been sharing my bed with a lizard. I've become an expert at negotiating prices for EVERYTHING. I've managed with no running water for 2 days. I've chosen fabrics and am having them made into custom clothing. I've stopped bracing each time a taxi swerves off the road to avoid hitting a goat. I now dance slightly less like a white woman.

After we all returned from work we had a house BBQ with lots of alcohol and dancing. The stereotypes unfortunately turned out to be true; the black men were dancing like pros and us white girls were sort of shuffling 2 beats behind.

This weekend a group of us are heading to Cape Coast to do the canopy walk at Kakum forest, stroke some crocodiles and stay at a hotel with running water, and hot running water at that!

I can't wait.

Love Emily x