the purple elephant: twenty one days

Becoming fearless isn’t the point. That’s impossible. It’s learning how to control your fear. And how to be free from it.”

There’s a purple elephant in the room. One that I promised I would address. The twenty one days are up.

Though there was anticipation in the Canadian customs line…

November 7, 2014 006

We were welcomed back to Canada with only a few curious questions and a raise of the eyebrow. “So what were you doing in West Africa? You were volunteering in a hospital?

There was no forced isolation. It was Ghana, not Liberia, Sierra Leone, or Guinea. We were about the distance between Vancouver and northern Saskatchewan. When there was a SARS outbreak, did we leave Canada? Vacate Saskatchewan because we were ‘near’ Vancouver?

A friend shared that her preschool son was praying we wouldn’t get Ebolum. Cute. Whatever you call it, it’s nasty. I will tell you all now that I wasn’t the face of courage.

I know you all were worried, or ‘wondering’ at our choice. It was the looks on the faces, the questions, or the ‘discussions’ in the OR and hospital wards. If you don’t know me, then I’ll tell you, I’m not the picture of fearlessness. I might appear confident, but it’s learned–because like more than enough people, I’ve fought a planeful of fears. The words, West Africa, caused a few mini-meltdowns for me, no matter how close or distant it was.

I’ve been watching this epidemic unfold since last winter, before most people knew it existed. It was all over the news. I knew I was going to WEST AFRICA. I didn’t think bringing my family of six into Ebola territory was such a clever idea, even if we were relieving pressure of some seriously busy third world medical staff. Even if we made a commitment over a year and a half ago. Even if our lives were meant to be spent living, and sharing, and not whiling away in luxury. I’m not an extremist looking for a suicide mission. I hoped, and expected, the Ebola epidemic would decline–not spiral internationally. (And I might have been quoted to say that it wouldn’t land in the US. I politely clear my throat…I was wrong).

I might not have let on that I was ‘concerned’. A small handful knew. It wasn’t just a discussion with my husband. I think I can confidently suggest I’ve had an argument with my husband that most haven’t. I did more than argue it out with him a handful of times. Mini-meltdowns that he had to accept–I didn’t instinctively think that heading closer to the flame was a great idea. Not everyone is as instinctively brave, and rationally-minded, or as confident in gloves, masks and handwashing techniques, or calm, cool and collected under pressure as he is.

We prayed a lot, occasionally for perspective, definitely for courage. Coded prayers with kids, and many prayers without. We didn’t tell them much about Ebola. We told them too much about cholera and malaria, since we were definitely heading into a cholera outbreak, and heavily-saturated malaria zone. I thought it would be useful to show them a couple animated YouTube videos, get them serious about not walking outdoors without long sleeves and a full-body cover of DEET. We hadn’t left Calgary before our five year old was requesting long sleeves for bedtime. Later, the long sleeves in plus 40 slippery sweaty heat was a bit much to handle. The bedtime mosquito nets were suffocating for some.

October 31 002

And the super high DEET concentrations I now own cannot be purchased in Canada. My oldest declared this bottle to be her African best friend…

November 1, 2014 003

World Health Organization expected first spread transmission to enter Ghana, not Spain, not Mali, not the States, primarily because it is the regional airport hub in West Africa–Accra, Ghana’s capital city. I wondered if I would see an empty airport waiting room–the six of us on a plane by ourselves. Nope, not so.

Teresas ipod 678

Did I take a few deep breaths as I walked through the extra KLM security check? Yes.

Teresas ipod 683

Hesitated before I stepped over the plane’s threshold? Uh huh.

Teresas ipod 686

Seven hours later, we landed, blasted by the heat as I stepped over the threshold again. I expected to see the signs when we first arrived at the Accra airport. But when I actually saw them, I had to take a deep breath, (illegally photograph them), and move into the temperature scanning line-up.

Teresas ipod 690 November 3, 2014 006

There might be talk of Ebola on North American television, but we weren’t in North American hype-ville anymore–the land of CNN, MSN, and tweeting feeds; instead, there were signs for handwashing, bottles of hand sanitizer, and people in medical uniforms and masks welcoming us (no it’s not airborne–this is more a statement of the country’s public health training).

We landed in West Africa’s destination airport–a travel artery that collects folks from all over that zone and sends them on to other international destinations. And this Airport was doing what it could to prevent it from entering their country. If you think eye temperature checks are a useful prevention strategy (it really isn’t), well, each of us patiently waited to be checked.

There’ll be no bathroom breaks in this Airport, no bottles of water purchased, no snacks at the snack bar, no stopping to touch anything. Keep your hands in your pockets. Don’t breathe heavily. Don’t brush past people’s jacket sleeves. Dorothy, we are not in Kansas anymore. Okay, I exaggerate, mildly. I’m sure you’ve been told that the disease is transmitted by visibly sick people, not healthy, handsomely dressed travelers toting a piece of Ralph Lauren luggage.

Oh, you say, but what about that fellow who flew to Dallas? Yep, there’s that exception. That one out of two million Monrovia, Liberia residents exception that found his way onto North American soil. The many thousands of others infected couldn’t imagine purchasing a taxi ride, let alone a plane ticket. At a buck a day income for much of African slum citizens, a plane flight is an unobtainable purchase.

I won’t say that I’m thankful that Ebola found its way to the States. That wouldn’t really be what I think. Affecting and infecting many people on American soil isn’t a good thing. Affecting and infecting and killing thousands of West African people isn’t a good thing either. But now that it’s in the States, you can guarantee that whatever can be done will be done to change the tsunami wave of Ebola infection.

Jim was worried that our family couldn’t handle the seven hour flight from Amsterdam to Accra, then only sleep a few hours and take another hour flight to travel three hours to Nalerigu. I was just happy to get out of that West African hub.

Bye bye Accra.

October 31, 2014 067 November 3, 2014 021 October 31, 2014 065

Despite driving three hours north from the center of the country in the hospital’s Land Rover, I felt awfully safe wandering into the nether regions of Ghana. I felt relieved when we drove past farms and farms and farms and small towns and more small towns. It made you realize how VERY far away we felt from the potential of Accra, and the difficulty it would be to travel that far north for almost everyone.

So when we settled into our three week location, it unnerved me to hear a discussion about potential Ebola transmission travelling through the northern border Burkina Faso, despite Cote d’Ivoire’s closed border, to this well-known, reliable hospital.

Jim's iPhone 093

It also unnerved me to hear that earlier in the summer a threat of hemorrhagic fever, query Ebola, created panic and induced volunteers to leave suddenly. It definitely unnerved me to hear that only weeks before we arrived, another threat of hemorrhagic fever forced one of the doctor’s and his wife, baby and toddler, into isolation in the capital city. Query, Ebola? It wasn’t Ebola. The mother of those two kids questioned whether the hospital would be equipped to deal with Ebola if, or when, it came. I know what I think. A resounding no. Two American doctors can’t maintain sterile procedure for the entire hospital. It did not help my frame of mind to see the state of the hospital. That hospital wasn’t clean, smears of different colours covering the walls, sterile fields optional, gloves optional.

Jim performing a lumbar puncture, gloves brought from home…

Jim's iPhone 069 Jim's iPhone 086 Jim's iPhone 084

It unnerved me when we were told the recently visiting American doctors were on isolation for three weeks from their work back at home, just in case, despite not being exposed to Ebola. It unnerved me when a nighttime knock on the door, two nights before we were to fly home, we were told that our flight was grounded. Were we even going home?

Need I say that I wouldn’t share that information with family and friends when I was there? Why let them know that we felt threatened, recognizing that the potential was larger than originally expected?

So despite my being there, feeling awfully close, there’s still that discussion: Should African borders be closed? My response: Do people know how large Africa is? It isn’t a country. It’s a continent, with presently fifty five countries. A continent that swallows North and South America easily. Should we close the borders to North America now that Ebola is in Texas? We wouldn’t just be preventing the illness from travelling, but not bringing any essential protective gear, food, medical assistance from the western-able world? Shutting down already faltering, fragile African economies? It would be like a cruel military strategy to starve it out. Cruel.

November 19, 2014 008

In the end, you could call it crazy or risky. You could call it worthwhile and helpful. We wanted to follow through with our commitment we’d made over a year earlier, especially as we were one of the last volunteers in that area willing to still go despite the Ebola threat.

I’m certain it was helpful. I’m certain it was an adventure. And I’m certain that by looking into the face of my fear, sometimes it’s the fear itself that I’m most afraid of.

I learned that courage was not the absence of fear. But the triumph over it“. NM

 

reverse culture shock?

If I’m honest (and when am I not honest?) I haven’t gone through reverse culture shock. Instead, reverse culture relief!

Within an hour of landing in Canada, we were at McDs. We almost never hang out here, but the kids requested, and we were eager to please and return pounds to their tinier frames.

The look of love is in their eyes…

November 7, 2014 010 November 7, 2014 012 November 7, 2014 014 November 7, 2014 016

When I tell people that this was a most challenging experience, not the vacation-like experience many might think we should have had, some are disappointed. Yup, I hear ya! In our part of the world, everywhere we intentionally set to go should be a fantastic, exhilarating experience.

I did have a pretty good sense what I was heading into, since I have been third world before. I wasn’t naïve. We went to share, and where better to share than a place that actually has needs? One doc to ten thousand, instead of one to one thousand here. We didn’t head to Africa to soothe ourselves in leisure and comforts. But I also wasn’t prepared to see a harsher reality of this part of the third world (and yet I’m certain there are much, much harsher realities still).

I quickly missed stuff from home…

1. Luxury items: clean, running tap water and public safe sanitation. I can turn on my tap and fill my glass, or swish my toothbrush, without fear of intestinal cramping or potential death.

And if you think three and a half weeks is really not that long away from these things, well, I dare you to try;)

2. My cappuccino maker…the gal living in our Canadian home during our trip told me she was sipping on a cappuccino while she read I was missing my machine…I thought of her in Ghana. Even the touch of the coffee beans grinding under my hand that first afternoon back was thrilling. Yes, thrilling.

3. North American climate. My Caucasian, four season-trained exterior didn’t know what to do with that tropical humidity. I like being outdoors. But not outside in plus forty degrees, with a sweat-slicked body,  no thanks! I was still sweating like a pig an hour into my air conditioned flight home.

4. Coffeeshops…and my favourite second-home, John Ward…

November 19, 2014 112   November 19, 2014 215  September 2014 547

5. Food variety and availability. The only truly surprising aspect of our culture is the incredible variety, and really, excessive variety. I stared in amazement at the eight dollar flavoured toothpicks at a gift shop last week. Obscene. Though I won’t judge you for your purchase (I’m sure some of mine might look excessive to you); just don’t offer me those toothpicks for the next month. This time I didn’t have a manic moment in Superstore, but I did slump over in overwhelm and then gushed in tears when I saw my ‘bare pantry’. Before I left, I thought that I’d ‘cleaned it out’–now I saw its abundance.

Whether one is ‘western wealthy’ or not, availability is ubiquitous.

Have you seen the fruit options?

November 19, 2014 104 November 19, 2014 103

Those fifteen dollar, make your laundry smell good, but not wash them, beads? Seriously?

November 19, 2014 211

Nutella snack packages…they should pay me for this…

November 19, 2014 210

I said it before, but ‘eating in season’ is a North American modern notion. The rest of the world does it by default.

6. No sense of food scarcity. Packaged meat was a twelve hour drive away. Powdered milk was as challenging to find as saffron here. There was no whole grain anything, except rice if that qualifies. No pasta. No cheese. No stuff in cans. We had what we needed. I don’t want to suggest otherwise. There were the basics. But we were very aware that our options just become seriously limited.

Really, do we need to stock our pantries for a month? Do we really think that our bean and rice availability will dry up if the end was near? We might miss citrus, or feta cheese, or fresh pasta, but we’ll always have an abundance of food.

7. Premium Healthcare. I wasn’t personally missing it. Though I wasn’t eager to be treated in-hospital when dealing with malaria. Yikes, the uncleanliness.

No one here is worried about babies dying in our doctor’s waiting rooms. That would make the news, an inquiry, a College investigation. No one is worried about our hospitals running out of narcotics. Or that the OR would forget to call for a burn patient dressing change. Or concerned that sterile fields and sterile gloves wouldn’t be available for a lumbar puncture. Or that you couldn’t  afford a dollar a day hospital admission, or a ride to the specialist two hours away for your typhoid-induced abdominal perforation.

And I can be certain that many would come to our rescue if the city of Vancouver (similar size of Monrovia, Liberia) were overrun by a freakish nightmare like Ebola…they wouldn’t consider shutting down borders and isolating millions to end their existence in a horror-like state.

I am now keenly aware of things that I should be thankful for.

The ordinary is extraordinary. You want to really see what you have? I recommend taking it away temporarily. Don’t know why the human spirit is trained under unpleasant circumstances, but I am certain it is.

I am thankful that our government, imperfect as it is and always will be, doesn’t concern itself with potential military coups, like Ghana’s neighbouring country of Burkina Faso, an hour away from where we were at the beginning of November.

What we are probably missing within our western culture…

…a keen awareness of who we really are minus our entertaining distractions and perpetual comforts.

…and subsequently, understanding what’s really important in life. Call me opinionated, but insisting that we stand apart as individuals, distinct, competitively asserting that we are better, more important, popular, have people acknowledge our greatness….a waste of our life. We’re all important. And call me loudmouthed, but aspiring to wealth and fortune is a waste of energy. Comforts are good. Oh yeah, baby! But teaching our spirits to enjoy the little things, being content with simple, that is the greatest luxury.

…a deeper awareness of communal community…yeah, I know those words have the same root. But community is an exponential experience where community is required. Perpetual handshakes and personal involvement are part of the African culture for a reason. They need each other more often. Our western independence is a sign of our privilege. But is it always a privilege?

Yes, I know this was an adventure of a lifetime. And I am deeply grateful for the life transitions it has pushed me toward. I was delighted to encounter so many interesting Ghanaian people, privileged to share our gifts and skills. But I am really, REALLY thankful to be home.

out of africa

Gearing up for our redeye tonight, I didn’t sleep last night. That wasn’t as planned. Thankfully, three out of three of us have had an afternoon nap (not me).

On our last day of Africa, we spent it unconventionally. With availability of resources, we bought ourselves twelve dollar pedicures, scrubbing that terracotta muck off our toes, threw away our shoes and stopped at the gelateria for lunch. Not how you see Africa? Ya, me neither.

November 2, 2014 005

Some of us found the pedicure tickly…

November 2, 2014 012

I’ve never had a more effective foot scrub. I can recommend a pedicurist if you’re ever in these parts.

Zach bounced on the lonely bouncy castle. Not a lot of people in this modern mini-mall.

November 2, 2014 008

 I debated suggesting elongating our morning out by driving by the Gulf of Guinea. I like to collect the sand from waterways around the world, the Arctic, the Pacific, the Atlantic, the Adriatic, the Mediterranean and the Caribbean, are checked off my list. I didn’t make it to the Indian Ocean on our way through Kenya last time either. But I hear this oceanfront is sewage-filled so I’m not missing much more than a garbage-beached view.

Cappuccino is tasting closer to home, possibly Tassimo inspired. Milk coming from South Africa, a long ways away. No dairies in these parts.

November 2, 2014 018

The FroYo was delightful. White pineapples from Tamale. Bounty chocolate bars, yum, my fav. Dark chocolate syrup. Papayas and other tropical fruits.

November 2, 2014 015

I’ve taken my final African tepid shower, avoiding water running into my mouth. I imagine the cold of the Netherlands will whip me into shock, but I will be so thankful for the bug-killing temps. It’ll take me a while to not ‘swat away’ bugs, aka falling hairs from my heads or people that brush past me.

We’ll get to put away the Steripen and stop buying water everywhere we go, drink from public taps, not squatting over toilets, not worry about being run over by traffic (not even in European cities), and not have to dodge public defecators, animals and humans alike. I’m even going to wear jeans and sneakers to the airport.

I am super grateful for the opportunity we’ve had for the month in Ghana. As I have written, it has taught us much, and we came to share, and we did indeed do that. But I am thankful that we’re just four hours from being out of Africa.

 

accra, by day–the other part of Africa never discussed

I had hoped to take a tour of Cape Coast on our travels to Ghana. President Barak and his wife recently shed tears here too. It was the major trading location of slaves in the 1800s, transported to Hispaniola. This would have been a fascinating World Heritage Site to explore, ripe with Ghanian history. Curiously, Jim’s and my first date was to see the movie, Amistad. I recall him saying he didn’t want to watch a movie that was too deep. Funny, I didn’t get that then. Still don’t;)

Just as useful in really seeing a major continent’s travel hub is seeing its shopping district. No, not the one just for tourists, but for the people in the community. Just like our experience on African airplanes yesterday, our day today affirms that we westerners have oft-repeated misapplied stereotypes to Africans. They are not all in poverty. Some of them are stinkin wealthy folks. I’d be presently living near those folks, the ones with the administrative, governmental money. They are the stereotypes that don’t commonly get talked about… There is a great divide between wealthy and poor here, but the wealthy do exist in significant number.

We stood at the edge of our 34 Joseph Bros Tito Guesthouse compound and summoned two taxis. Ten cedis each…approximately $3.50 per taxi.

November 1 064

We studied the map with Jim before we left. He had already been introduced to the frustrated cab drivers…they want directions where you need to go, where you are staying–we have to manage a two million person populated city that we’ve never been.

November 1 003

Following Jim, Zach and Hannah…

November 1 006

So we headed to this place…ShopRite…aka a local grocery store.

November 1 008

Entering the doors, I felt I was in a modern shopping center, equipped with air conditioning.

We first entered the Bata store and updated our shoe choices at a third of the expected price…our new shoes were worn out after three weeks in the terracotta dirt.

November 1 009

Then we went upstairs to check out the grocer.

November 1 011

No wonder no one is buying yoghurt in this urban center…the price is ginormous to even us. That’s about $15 for six lunch-sized yoghurts.

November 1 018

The tasteless cookie of Africa, Digestives…almost as ubiquitous as cornetto in Italy. But the kids love them…

November 1 017

Trying to find sage for the missionary family that is temporarily at the Guesthouse from Nalerigu. They’re also Samaritan’s Purse doctors with two little girls from the States who plan to prepare sausage for dinner. Gotta have sage.

November 1 014

Feeling another hypoglycemic attack (malaria induced?), I headed to buy water and a frozen ice cream similar to Ben & Jerry’s Raspberry with chocolate. YUH UM. Looks like a Canadian toonie…actually is a Ghanian cedi coin…worth thirty three cents.

November 1 019

There’s a reason there are so many taxis. You have to avoid walking over these cesspools of potholes dotting your ‘sidewalk’ in front of businesses.

November 1 058

We’d be fine to do so if we weren’t also having to avoid these…Vehicles a foot away from our pedestrian selves. And traffic on Osu was considered light today.

November 1 061

I made up a joke yesterday: Why don’t Africans have roller coasters? Because they have roads!

Oh, and why did the chicken cross the road? To get slaughtered by a motorcycle for dinner.

Okay, so I won’t start blogging my jokes…

Can you see the vehicles just to the right of Jim, a foot away? Holy smokes, dangerous.

We were looking for this…Frankie’s. When we’d asked around, we were told THIS restaurant was famous for its burgers, falafels and it was guaranteed to be open, even on this “Clean Your House–Cholera Prevention Day”.

November 1 025

And it DID deliver…

November 1 040

YUH-UM. Haven’t had cow for a month.

Some of us were going from famine to feast. “Make your own African famine” by five year old Zachary. Despite having neighbours dying of starvation, he was still having issue with cabbage slaw and casseroles at House Six. So he was hungry.

November 1 043

November 1 047He’s a bear coming out of hibernation…

And has been “first world starving” since we got here…a term I happily accept from my children now. “I’m starving” was hard for me to hear, but  “first world starving” is kosher with me;)

And I’m a North American woman coming off my coffee addiction with my first cappuccino…kinda salty…

November 1 033

But it did the trick. After my coffee, my “malaria” headache resolved. Haha, might have been a misdiagnosis.

The kids will miss regular soda consumption…

November 1 037 November 1 038

Etched on the table was a quote from Joe E. Leni–“I went on a diet, swore off drinking and heavy eating and in fourteen days I lost two weeks”. I’m not aspiring to heavy eating, but I feel his pain. And maybe five pounds…from each of us.

“Mom, behind you is the Eiffel Tower!” Madelyn was right. There it is!

November 1 026

We had to stop at the bank because we aren’t eager to readily use our credit cards.

November 1 020

November 1 022

Can you see the sign? Next to the Pizza Inn and Chicken Inn signs…Wash your hands to protect from Ebola and Cholera. And bring six bottles of hand sanitizer for your three week stay in Africa. The KFC was just a hop skip and a jump ahead of these signs. There are many interesting signs: the Hilarious Services (advertising passport photos and laminating services), the El Elyon Hotel, the Two Legs Haircut, and Boyz2Men (I think it was an art gallery).

November 1 059

The kids enjoyed a half hour on a bouncy castle nestled on the second floor of a shopping center, while we took our only view of the Gulf of Guinea.

November 1 052

We checked one other grocer for the sage we couldn’t find, and discovered the incredible numbers of North American food offerings nestled on the corner near a traffic circle. M&Ms, skittles, chocolate of all sorts. No, we’ve been carbed up plenty, so we’re not hankering for more. At least Jim and I aren’t. The kids got a reasonable bag of “Halloween candy” last night, as they each chose a chocolate bar for me to keep. Turns out, Zach even dressed up in his “Super Secret Agent” pajamas.

November 1, 2014 008

I didn’t see much to bring home from Ghana, but I did see a potential Christmas gift for Jim in the Koala grocer…a George Clooney Cologne;)

And that was all our Family of Six could tolerate for this day in Accra, till we headed back home for afternoon siesta.

November 1 063

There won’t be an Accra by night post…we’ll stay out from the mosquitos, the traffic and the “safety” of Accra.

almost as scary as Halloween

If you have trekked this far with me, and are still sticking around for more, I say “ompusee“–thank you in Mampruli. At times, knowing that though few are with us in physical presence, many are with us in spirit, has been an incredible encouragement. I wish I felt safe enough to open my laptop sooner in the Tamale airport earlier…the messages would have been wind beneath my sails, or should I say currents beneath my airplane wings?

We were awoken two nights ago to a message that our airline was landed by the government of Ghana. We would not have a flight out of the remote town. With the help of the Accra Guesthouse, our flights were switched, but it would cause considerable delay. We initially expected to leave by four in the morning. Now we could leave at 8. Sounds like it would be helpful with four kids, and me in day four of malaria.

We were packed and ready to go, left soccer balls for the neighbourhood kids, responded to neighbourhood petitions for money, and said our goodbyes. We drove the rough road for nearly three hours in a white land rover, Jim volunteering to sit in the hatch of the vehicle with the three youngest, quizzing them in mental math and otherwise entertaining them, while I convalesced with Hannah, and the driver sat with a TB clinic employee who was delivering TB samples in his Coleman cooler.

October 31, 2014 014 October 31, 2014 019

October 31, 2014 038 October 31, 2014 030 October 31, 2014 032

We assumed we would go in to Tamale for lunch. Rather, we were left outside the Tamale Airport with six backpacks, six luggage, to wait for another three hours. There’d be a snack bar inside if we needed lunch. By snack bar, he was referring to pop and digestive cookies. Great, another gluten-free, low-glycemic “meal”.

While Jim chatted at the ticket counter, I rummaged in my bag for a Cliff Bar (absolute must-have on international flights). When he got back, he told me that he had news: the flight will be an hour later! So four hours trapped in a ten by ten space with fifty people and an air conditioner. Nowhere to sit, nowhere to stand, nowhere to store luggage. Just stand and wait. For four hours.

October 31, 2014 055 October 31, 2014 057

While I attempted to braid the girls’ hair again, a lady from behind tapped me on the shoulder and suggested she do it instead…twenty minutes of free time!

October 31, 2014 046 October 31, 2014 049

Jim and I have had a lot of practice travelling with kids, so we know that when these moments arrive, it doesn’t matter that we’re totally spent from a three week sojourn into discomfort and personal stretching, we’re going to have to buck up ANYWAY, and entertain the quadrangle for a solid four hours, whether hypoglycemic, malaria-ridden, willing or unwilling.

Do I need to tell you that the plane wasn’t on time? Naturally… Half an hour late, but to my amazement, they turned that plane around like it was moving through London’s Trafalgar Square…no time to waste (and likely no time to fuel or to clean–Hannah didn’t use the toilet for six hours, avoiding airports and planes–wow, you go girl).

It was then just an hour flight to the capital of Accra. We were fed with another bag of Digestives (aka bland Arrowroots) and watered down orange juice boxes.

With all the hubbub of flight changes it didn’t dawn on us that our airport driver to Guesthouse wasn’t contacted. The only other Caucasian woman on the flight smiled at me across the walkway and said, “Are you Teresa? Have you just come from Nalerigu?” Surprised that this German stranger could identify me, I was taken aback. She told me she was to look for a Canadian family of six who would be on the same flight to Accra: “The driver will meet us all at the airport when we arrive!”

October 31, 2014 065 October 31, 2014 066 October 31, 2014 069

And after she called him, he eventually did arrive, took us on a ten minute drive past palatial Embassy estates, cutting through traffic as only African drivers passive aggressively do, no one buckled, naturally, with five people sitting in a three person backseat, naturally.

And we arrived early enough for Jim to attempt finding a taxi to an unknown location, “a local supermarket please”, where he spent a hundred dollars in cash purchasing food for the weekend, as no one will be preparing meals because of the local cholera outbreak–the Government has mandated a “clean up” day.

So we will nestle in for the weekend, recharge our SteriPen (an absolute must-have for third world travelling) and neutralize cholera bugs. Don’t you wish you were here?

kids thoughts from the hospital

A partial strike at the hospital this afternoon again. Yes, I’m serious. A strike. Nurses and translators want to invest their pensions without the government doing it for them. But I wouldn’t know what was going on for the last couple days because Jim has been treating me for malaria. My head still swimming in artesunate, I will attempt to blog.

For the last few days Jim has suggested the kids not come with him to peds, because there’s just too much illness going on there…and too many people not covering their mouths. How he has made it through so many years without frequent illness, I will never understand. He says he washes his hands. Like a surgeon. Religiously.

The kiddos and I have had an interesting crash course in hospital care and tropical medicine over the last three weeks. An education that we aren’t allowed to experience in Canada, unless we’re in nursing or medical practicums. Perhaps some of us one day will, and some of us won’t. I’ll bet you can decide what they think…

Rachel, nine…

October 22, 2014 085

I got to sit on dad’s chair in pediatrics. Dad was sitting too. Women were lined up with their babies. The worst thing I saw was this little baby who was pale white and her arms were in the air. But then she sat like this in her mother’s lap and somehow when she was born she had white skin instead. She was one year old and the size of my heads and arms together.

Dad was so concentrating because he really doesn’t have time to tell me what’s going on. Some of them are old but mostly they’re new people that came in to the hospital. There’s more and more and more people that came into the hospital today.

It wasn’t very fun. The smell was bad. I’m not allowed to touch anything. It was kind of disgusting.

 

Zach, five…

October 22, 2014 103

I saw this guy who had fillings that looked like mustard and ketchup. It goes on his arms and places because he got hurt really a lot. Here, here, here and here and a little on his chest (the man with burns–the ‘ketchup’ was blood, the ‘mustard’ was iodine).

One of the different people I saw couldn’t breathe.

And two people couldn’t walk. But we didn’t do one of them because one person was sleeping, but one of the people we did wake up.

Some of the people couldn’t walk or breathe. That’s really all I saw.

I thought it was scary at the last person. The last person was the bloody one. The one with the fillings. (aka burn dressings)

So what’s pediatrics like?

It’s essentially like clinic but it’s more to the details and people waiting on the side.

A couple people on the back wall, babies crying. Waiting for Tim (another Samaritan’s Purse doctor) to come around and check them and you keep walking and go to the right. There’s a couple seats and a table where the African people do something with the folders. There are many people waiting for dad to come.

There’s nothing I really like about it. I get to learn what illnesses people have.

What do you not like about it?

I don’t like the smell. There’s a fan except in the back room, but it wasn’t on.

Do you like dad’s work?

No. It’s not very cleanly.

Some of the people asked what my name is and what my age is. They asked if I was related to dad.

So that’s pretty much it, you’re going to go into medicine.

No. I never want to go into medicine. Sorry. Probably cause it’s not very cleanly and it’s not very fun. I would love to get paid to watch him though.

 

Madelyn, eleven…

October 22, 2014 084

We got through four patients, that’s all.

Why?

One of the ladies took us a long time because the guy couldn’t find scissors. Dad was trying to cut a bandage off this ladies foot and it hurt her too much so he admitted her to the ward. Dad also saw a lady. She was in the female ward. Big blisters on her lips.

What was it?

They think that one of the drugs she was taking was the cause.

I also saw a guy that had blood all over his finger and forearm and he said that he fell on the road. So dad got him to get some bandages.

So why didn’t you stay?

I just got tired and dad will probably be there till dusk. It was really busy. Dad let me look through another patient’s ear. Her left ear was fine, literally white, which dad said was white. And her right ear had plaque. She said it was hurting.

It was a little gross sometimes. Different. When dad prescribed a medicine, he wouldn’t just say ‘Give it to him’. He would say, ‘Give it to him if we have it’. That was different than what we do in Canada.

How is clinic different than Canada? different illnesses?

Three doctors in a 7×7 room. Nine or ten people, counting me, in that room.

I would say it is sad, but it’s very interesting at the same time. Some things are also disgusting. Other kids you see that are sad and you just feel sad for them. But to wrap it up in three words, I would say “Interesting. Depressing. Compassion”.

 

Hannah, thirteen…

October 13, 2014 008

You walk into a huge rectangular room. There are beds all along the edges, filled with sick kids and their moms who are either sleeping or watching the little TV in the far corner of the room. You are directed to sit on a wooden chair in the middle of the room. You share this seat with your Dad’s medical bag. You are sitting beside your Dad and beside your Dad is a nurse and then there’s another nurse beside the first one, but this one looks like he doesn’t need to be there, he’s just interested in the girl nurse. And then, of course, sitting beside him is the translator.

The translator’s name is Veronica, old and has a mean edge to her. Now all the people that I just described are in a semi-circle in front of us in a small desk, and before that is a line of stools that goes horizontally through half the room. About 20 adults are sitting on the stools and their sick children are sitting on their laps.

The next child’s mom puts her son’s folder on the table. My father looks at it and asks if the child has been vomiting, a common question. The lady says something in Mamprulli and the translator says “Yes, the child vomited three times yesterday”. My father asks the translator if the child has a fever. The answer again is “yes” and then the questions continue until my father is absolutely sure that the child has malaria.

The people move up the stool methodically and my dad is presented with the next case. This goes on for about 30 minutes when I get bored and start to look around. I look behind me and see a bed with a child laying still, a man with white gloves is applying CPR to the boy. Doctor Tim, a doctor from the US, is watching. There are about three other nurses–one is pumping air into the boy and the other two are just watching.

I hope that the boy lives, but it’s pretty clear he’s dead. When I turn back, I see almost all the parents on the stools watching the resuscitation. I decide to turn back again. One of the male nurses is wrapping the dead body in the sheet that was covering the mattress. The body is stiff.

You turn around again to see a lady with a boy on her lap shielding his bum while he pees on the ground, and also her feet. She’s looking in all directions trying to act innocent. But you know she doesn’t want to have to leave the line so her child can go to the bathroom. The room has been gradually getting hotter, but now it’s unbearably hot. Luckily my Dad asks if I want to leave–I do. He wants to stretch for two minutes and to top it off, I don’t know how to get out of the hospital without getting lost.

It’s nice to go to pediatrics, for the experience. If I had a big list of jobs I would check “Doctor” off the list right away.

Home Office: Top 10 Medical Facts Dr. Jim has Learned

I spent the summer of 1995 in the Greater Toronto Area on an internship for a corporate comprehensive health organization project.  I rode the subway, went to the Skydome and visited Stratford for King Lear.  But the highlight of my summer was visiting Wahoo, Nebraska.  I drove the Trans Canada there and decided to go home via Denver to sight see a bit.

Wahoo you say?  Or Wahoo you knew!  I am 43. I grew up thinking a certain late night host was amusing for his acerbic wit.  He’s grown old, I have grown old and the schtick got tired.  But in 1995 the home office for Late Night with David Letterman was in a small Midwestern town in the USA so I detoured off I-80 to visit.  As the joke with his home office went… there was nothing except a road sign and a slice of middle Americana.  The home office was a figment of imagination, just a place name to drop every Monday to Friday night at 2355 hours or so right before the TOP 10 list (the comedy gold for the night – better than his monologue for sure).

So from the home office in Nalerigu, Ghana, tonight’s Top 10.  The category tonight is top 10 Medical Facts Jim Learned While at Baptist Medical Centre….

#10.  Malaria isn’t funny.    Don’t get me wrong, I didn’t laugh about Malaria before but I have had a crash course in a boat load of outpatient and inpatient cases.   One of the few lab tests we have at our disposal here is a blood film where the lab tech looks at red blood cells to try to identify malaria parasites in the red cells.  But if the clinical story fits, you treat for malaria whether the test is positive or not.  Sometimes a repeat test helps but regardless, malaria or the secondary infections that coexist with it can be lethal especially to kids less than five.

Jim's iPhone 091

#9.  Pott’s TB isn’t funny either.  OK, OK I promise not to have ten items that go ‘X isn’t funny’ .  But TB spread to your lower thoracic spine and then possibly forming a big abscess nearby is an ugly way to be sick.

#8.  If you’re an old man and your prostate is big you might have problems passing your urine.   Actually not a big surprise cause I see that in Canada too, except we have more options in Canada for treatment. Here people often wait until they are retaining urine and obstructed and then need a suprapubic catheter through their abdominal wall.

#7.  If you are a young man and you have problems passing your urine it ain’t your prostate – it’s schistosomiasis.  Google away people – its a bug found in water and crosses your skin barrier and winds around until it blocks your bladder from the inside.  Fortunately, treatable with Praziquantel, a medicine.

#6.  Typhoid fever in a youngster often leads to intestinal perforations requiring surgery.  What else can I say?  Don’t ignore typhoid fever…don’t drink untreated water and the tummy pain might not just be cramps.

Jim's iPhone 090

#5.  We in Canada take for granted our diagnostic options on hand at home.  I saw two cases today that would be simple to diagnose precisely and fix if I had availability of certain lab tests.  We will treat on clinical ‘best guess’ grounds and it should work out but we are blessed in British Columbia.  Of course, people could travel to Tamale and Accra for the same availability but lack of $ limits and that kind of travel is beyond the reach of most.

Jim's iPhone 086

#4.  There is nothing like seeing and doing instead of reading.  Reading about cases matters but you get wise and comfortable treating and diagnosing by seeing lots.  I appreciate the opportunities here to help and do.

Jim's iPhone 088

#3.  Infant and toddler mortality is high.  Sad.  Many are saved, all are not.  Convulsions and neurological troubles often result from cerebral malaria.  Each week there are deaths from this.  Probably 90% are fixed but when 10-20 kids a day get that diagnosis…..you do the math.

#2.  In the outpatient clinic the most common presentation is “generalized body pain, headache, dry cough and nausea with fever”.  Malaria until proven otherwise.

#1.  Cerebral malaria isn’t funny.

Sincerely, Jim

orphanage of Nalerigu: a person’s a person no matter how small, Dr. Seuss

“If we are to teach real peace in this world, and if we are to carry on a real war against war,

we shall have to begin with the children”

Ghandi

October 23, 2014 003

We are on our way to the orphanage a half an hour walk across town. It is stinkin hot. The kids don’t care for the walk at all but I tell them we’re working on our tan in October. We are silky sweaty when we finally arrive at the lean-to behind the Nalerigu Assembly of God Church.

October 23, 2014 014

Elizabeth helps to run the orphanage–an afterschool program–for kids that do not have parents, but do have somewhere to live, with their auntie or grandma or relative.

October 23, 2014 066

For an hour Tuesdays to Fridays, and three hours on Saturdays, the forty kids play card games, woola woola, and other wide games in the blasting sun.

October 23, 2014 021

Here the kids play “China Wall”. Funny to hear them playing China Wall in Africa, but hey, I think they’ve played it in Canada too.

October 23, 2014 063

Some kids play with their toys instead. A tire will suffice. I have seen many kids play with these, both here and in Kenya.

October 23, 2014 060

October 23, 2014 025

October 23, 2014 067

Many of the kids ask me to “snap me”. And I will oblige, because this is my opportunity for photos. It is frowned upon to photograph without consent. They get a real kick out of seeing themselves on camera.

There are many kids everywhere we go. The littlest ones yell from the security of their huts, “hello”. Since we’re the only English speaking folks that understand that word, we know that we’re the ones they’re calling. Occasionally they come to greet us…thrilled that they’ve shaken the hand of the westerner.

October 18, 2014 085

Surprisingly, we are cool and comfortable underneath this shelter. The kids had a horribly yellowed and moist UNO game–they deal just four cards. As I put the 2+ card on the pile, it ripped, so I found them a newer version on the compound. And a bunch of other card games. They are especially fond of “Wooly wooly”…a game I recall being explained was southeast Asian. Twelve little holes dug out of the ground, four smooth stones inserted into each one and each person gets to choose a hole of rocks to move around the rectangular “game board”. A game out of natural sources–always resourceful.

October 23, 2014 015

I brought my book from home that shows pictures of where we live and answered questions about Canada. So many interesting discussions that came from this book. With this crowd, snow was a constant question, as no one is familiar. Imagine me, boasting about snow. Soon, we will relish in its grandeur as we land in Canada…flip flops here, winter jackets waiting in the airport parking lot.

October 23, 2014 059 October 23, 2014 064October 23, 2014 042 October 23, 2014 055October 23, 2014 057 October 23, 2014 053

What game is this, you ask? Why, duck duck goose, of course. Playing with forty kids, taking turns, sliding into terracotta dust with our sweaty bodies–why that’s a mother’s dream game. It was awfully fun watching my thirteen year old daughter play it again. May childhood never end.

These Ghanian kids are truly beautiful. So open to share, connect and welcoming us to be with them.

When a few hours sitting under this simple shelter, we had nothing else to do, they asked if I would show them math problems. So on the plastic table, I used a piece of chalk to explain place value from the Math-u-See curriculum. Here in an African orphanage, Place Value Street has been taught. Teaching math in Africa–them there’s something I never thought I’d do.

October 18, 2014 084

For six months, these German girls, Teresa and Charlotte, have been staying in a local woman’s home assisting the orphanage. Brave girls.

October 23, 2014 046 October 23, 2014 068

“Children are the hands by which we take hold of heaven”. Henry Ward Beecher

 

postcards from West Africa–animals and plants of Ghana

Where’s the chicken? Can you see his red wattle and white tail feathers? She would be tiptoeing through the sewer. Lives up to our notions of free-range chickens…or does it?

Teresas ipod 836

These are one of those gigantic size pots of “tropical” you might see at the WalMart greenhouse.

October14,2014 007

A baby goat sitting beside a path.

October 22, 2014 010

Something similar to Karl Vorster grasses…apparently they’re agricultural feed here.

October 22, 2014 009

Many wandering Eeyores. I have seen them wander the countryside and pull carts too.

October 22, 2014 014

If you can give me a botanical name for six of the following plants, I’d be glad to send you a postcard from Ghana…

October 12, 2014 149

October 12, 2014 153

October 12, 2014 154

October 12, 2014 158

October 12, 2014 162

October 12, 2014 175

October 12, 2014 167

October 12, 2014 178

October 12, 2014 180

October 12, 2014 182

I have yet to see the crocodile at the creek, but the local kids swear there is one.

This would be one of the half dozen cows pasturing in this area. Whoever owns them is mighty wealthy. I’ve been told the milk is hard to get used to. Even finding powdered milk here is tricky. Must get it a three hour drive away.

October 22, 2014 016

It’s maize harvesting season. Looks an awful lot like corn, doesn’t quite taste as sweet. Roasted on a fire it can be a great snack though.

October 22, 2014 047  October 22, 2014 101

We’ve seen three meter high millet grown here too.

This particular dog belongs to the missionary kids. Her name is Susie–a very mild bush dog.

October 22, 2014 006

I saw a baboon forty five minutes outside of town. It was adopted as a lady’s friend. These are not a common sight here though. Apparently Gorillas do exist not too far away.

October14,2014 013

It’s not a rainforest, and its not the sahel, but there are plenty of trees.

October 17, 2014 023

The dawa dawa that produces huge pods.

October 12, 2014 160

The shea butter tree that produces the stuff in many lotions. It might be on one of the pics above, I’m not sure.

Probably not how I’ll grow my pullets two springs from now…Africa has had a grasp on free-range for quite some time though.

October 23, 2014 071

I wish I could show you the lizards. They’re hanging outside my back door. But they’re too fast.

Haven’t seen bacon, but we were invited to a good old fashioned, stick him on a spit, PIG ROAST. Mighty fine chops he had.

October 23, 2014 069

You say goat, I say sheep. The difference between a goat and sheep here is in the tails. A long tail denotes sheep. I’ve been told the kids don’t understand the rhyme: Baa baa black sheep, have you any wool…cause they don’t have wool. (and who would need it with this heat? I was told today that this isn’t hot, +48 is hot–I’m sure it would be, I will not be around long enough to find out. +38 with a humidex is hot enough for this Canadian).

October 22, 2014 134

These are the goats. And they are the most common animal of Africa?

October 23, 2014 005

What? You thought it was lions and giraffes and monkeys? Wildlife, congregated at your local zoo, or wildlife parks around Kenya, Tanzania, Uganda or sub-Saharan Africa. Camels in the north. Gorillas in the Interior Mist. Eland (like deer with horns) all over. Monkeys in the forests. Africa is a big big BIG continent.