August 2, 2010

Today I went to the Edumfa prayer camp, largely considered the most well known prayer camp in all of Ghana.  Edumfa was about 30 minutes away from Cape Coast.  On first view, the camp looked like a typical Ghanaian village. 

We met with the administrator, who told us all about the camp.  The administrator was extremely open about the practises that go on at the camp, seemingly because she believes what is done in the camp is right and she wants to spread the word. The camp holds about 6000 people.  People suffering from “psychiatric” illness or physical illness are admitted.  People of all religions are accepted.  Admitted people are called “inmates”.   Inmates can be admitted on their own or by family members.  Apparently, inmates pay a 5 Cedi “registration fee” and are not required to make any more payment.  Inmates can be admitted against their will, if others judge them to show psychotic symptoms.  People of any age can be admitted, even very young children.  Upon admittance the family members or the inmate must sign a consent form.

Common symptoms leading to admittance include: quiet behaviour, cold limbs, or a general change in demeanour.   No matter the symptoms for which a person is admitted, it is believed the symptoms stem from “demonic forces”.  If one is not Christian, they can be “worked against” by demonic forces.  It is believed demons may strike if a person is stressed, envious, or engaging in bad behaviour, such as alcohol or marijuana abuse.  As an example the administrator explained that if I was not a child of Christ and was envious of another person who was a child of Christ, whatever bad things I wished to happen to the child of Christ would instead happen to me because of demonic forces.

We were shown the housing areas for inmates and allowed to talk to the inmates. Inmates were housed in common areas with small foam mattresses to sleep on.  The housing was at least clean, which I was not expecting (though perhaps I should have because “cleanliness is next to Godliness”).   

All inmates, regardless of their camp-diagnosed illness, are treated with fasting and prayer.  The administrator says that fasting and prayer are the only effective treatment because modern medicinal drugs do not work. New inmates are made to fast (no food or water) for 3 days.  If inmates are uncooperative, they are chained inside to the floor or outside to a tree (Figure 26). 

Figure 26. Young man chained during fast at Edumfa prayer camp.

On the 4^th day, inmates are given tea made from the bark of a tree called Nyame-Dua (God’s tree).  I am not sure if the Nyame-Dua tree is a specific type of tree, or a tree that has been blessed in some way. The administrator claims God’s tree bark is a miracle drug that cures cancer, bareness (infertility), headaches, and any other illness.  The tea can be taken as a drink, or poured in the eyes or nose (to allow it to get to the head faster). Inmates are also given light food, and health tonics (yellow to treat fever, and red which creates more blood to improve strength).  

If the inmate does not improve after 10 days, fasting starts again.  An inmate is kept for a maximum of 21 days, after which, they are sent to Ankful Psychiatric hospital, where Dorota works (if they can pay).  At Ankful, anti-psychotic drugs are given (no matter the patient’s symptoms) along with a continued prayer regimen.  A person filters between the prayer camp and psychiatric hospital until they are deemed to be cured.

We were taken to a prayer service given for the inmates.  The service was given by the camp founder , “Aunt Gracie”.   Aunt Gracie told how she had started the camp 50 years ago after God instructed her to do so in a dream. She asked me if we would support their ministry when we got back home.  To be diplomatic and avoid an uncomfortable situation I replied we would try.  We were then brought to the front of the congregation to recieve blessings (Figure 27).

Figure 27. Being blessed at Edumfa prayer camp.

Overall, the experience was extremely disturbing.   The site of young children and adults chained to the floor and made to fast was probably the most immediately disturbing experience at the camp.  Also very disturbing was how strongly the workers, and even most inmates, believed what they were doing was right.

In my time so far in Ghana, and especially after visiting Edumfa, it has become very apparent that traditional views of witchcraft are still very prominent in Ghana (and likely most of Africa, as prayer camps are reportedly all over Africa).  Because modern information and communication tools (phones, internet, TV, radio, etc.) are fairly common in Ghana, I expected that Ghanaians would be more aware of up to date scientific information, which would dispel belief in witchcraft, as witchcraft goes against most scientific information.  Overwhelmingly, however, this is not the case.   

Even two nurses who work with Dorota at the psychiatric hospital and are in their final year of a BSc in psychology at UCC were very much in support of the prayer camp.  I was very surpised by this because the universities teach only legitimate science, and refute any belief in witchcraft and the practises of the prayer camps.  Consequently, the fact that both nurses were in support of the prayer camp, even after there scientific training, spoke very loudly for the deep root of traditional cultural practises in Ghana.

For anyone who is interested, Edumfa Prayer Camp has a website with much of this same information, which I highly recommend visiting:

http://edumfaprayercamp.com/index.html

August 1, 2010

I spent this past weekend in Accra, the capital city of Ghana.  I went with 2 other volunteers and we stayed at the house of the girlfriend of one of the volunteers.   Our formal reason for going was to give presentations on our volunteer experience at the Canada High Commission, along with other Canadian volunteers in Ghana.  Another large reason though was that we just wanted to see Accra. 

The presentations at the High Commission went well.  A common theme described by most volunteers was that work moves very slowly in Ghana, which I had experienced as well.   Even at the hospital it sometimes seems the nurses are slow to act on the doctors instructions,  sometimes at risk to the patient’s health, unfortunately.

From the presentations, I was able to gather some information about the major hospital in Ghana, Korle Bu, which one medical student was volunteering at.  Apparently, Korle Bu is nearly on the same level as some hospitals in the West.  Korle Bu has a CT and MRI machine, which are fairly modern diagnostic machines.  The hospital was not completely up to current gold standards however, as some of the diagnostic machines used were very outdated (i.e.: a radiology machine from 1965) and reportedly the CT and MRI machines are not functional more often than not.  TIA.

Accra is famous for its night life, which I saw much of on this weekend trip.  On Thursday night, I went with the other volunteers to a laid-back, local, live music dance bar.  On Friday, we went to a somewhat fancy live-music, dance bar.  On Saturday, we did a pub crawl around the area we were staying (Osu), ending at a popular local low-scale dance club, Container, which takes place outside on the streets.  It was also notable that we saw some amazing street dancers perform outside Container (Figure 23).  At these bars it became apparent that almost every Ghanaian (male or female) is an extremely good dancer.  It also became apparent that Ghanaians generally have a much easier time cutting-loose and having fun then we do in the West.

Figure 23. Street performers outside local bar.

Overall, Accra seemed very modern compared to Cape Coast.  There were small sky-scrapers, fast food restaurants, and even a large shopping mall.   I was even to able to find some products from home which I had been missing and could not otherwise find elsewhere in Ghana (Nutella and maple syrup).   My previous first impression of Accra as a hectic city, proved to be accurate.  Walking the streets of Accra I was constantly hassled by street vendors.  Additionally, Accra drivers have even less regard for pedestrian safety than drivers in Cape Coast.  That being said, I never felt threatened from malicious attacks. 

I also visited the Arts Center in Accra, a well-known market  in which local people sell traditional African items.  The common traditional  items sold included: tribal masks, Djembe drums (Figure 24), hand woven traditional Ghanaian fabric called Kente (Figure 25), and original canvas paintings.  I really enjoyed the experience.  If you do attend the Arts Center, however, be prepared to be swarmed by sellers pulling you into their stalls and trying to sell you their items.  Also be prepared to do some hard bargaining, as it is expected from the sellers and they start with fairly astronomical prices.

Figure 24. Djembe (traditional African drum) being carved at Accra Arts center.

Figure 25. Kente (tradional Ghanaian fabric) being woven at Accra Arts Center.  Note the Kente banner that says "Usher".

After a month in Cape Coast, it was like stepping out of Africa for a weekend and re-entering the modern world.  The trip to Accra was very refreshing, but I am glad to be living in Cape Coast rather than Accra, as I do not think Accra would offer a true “African” experience, which is a large part of my reasons for coming here. 

July 29, 2010

Today at the hospital, I returned to kids ward to visit some nurses I had previously befriended.  After being in the male and female wards for the past few weeks, I find the kids ward is the most emotionally challenging ward to be in.  There are always a lot of very sick children in the kids ward, which is difficult to see.  Also, I cannot help but imagine the kids of the after-school program becoming sick and ending up there, which makes the kids ward even more difficult to be in.

The children’s ward holds some unique rewards, however.  Unlike many adults, children show emotion easily and can easily be cheered up.  For example, after seeing me, the mother of one boy with third degree burns all over his body (due to hot soup) sang the Obruni song to get the child to stop crying. The Obruni song is sung to white strangers by Ghanaian children all over.  The song goes:

Bruni! How are you?

I’m fine, thank you!

The child immediately stopped crying and waved at me with a smile on his face, even though he was still covered in burns from head to toe.  It was nice to see the child so easily cheered up. 

At BCL, Kojo asked me if I could teach Science, in addition to English, to my classes.  We worked out a schedule in which I will teach Science two days out of the week and English the remaining three.

Back at the house in Cape Coast, Dorota, a clinical psychologist from Poland, told me about her placement at the Ankful Psychiatry hospital in Cape Coast. Ankful is a private psychiatric facility, in which admitted patients must pay or have family members pay for their stay. The hospital specializes in treating marijuana addictiction, which Dorota has been asked to take part in by giving psychiatric counselling to the patients. Dorota says marijuana use is treated like a mental illness in Ghana. Upon admittance the patient is immediately given anti-psychotics, such as chlorpromazine or diazepam, regardless of whether they are showing any psychotic systems or not. Patients are kept on these drugs indefinitely. There are no qualified psychiatrists associated with the facility; instead a person with only a BSc in psychology as well as student clinical psychiatrists direct the patient programs. Dorota says there are no treatment plans for any of the patients; instead patients are just given tasks to past the time. Dorota thinks the program is used more as a place to keep marijuana addicted people out of the way (because marijuana use is really looked down upon here), if the family members can afford to pay.

Dorota also told me about the infamous African “Prayer Camps”, which she has been hearing about at the Psychiatric hospital.  Prayer camps are very prominent in Ghana, with some at the hospital saying there are as many as 200 in the Central region of Ghana alone. In these camps, patients suffering from a range of illnesses, including both physical and psychological illnesses, are apparently held in prison-like conditions while prayed over.  Apparently the prayer camps are fairly welcoming to visitors, so we are going to try to visit a camp while we are here.

July 28, 2010

At the hospital, I was able to observe a surgery to fix a scrotal hernia. The surgery was very interesting. At one point the anaesthesiologist needed the patient to breathe through an oxygen mask, but the man was not co-operating because he did not trust what was being pumped through the mask. To get the patient to breathe the air, the anaesthesiologist told the man that “white man’s air” was being pumped through the mask. The man immediately began inhaling because, as the anaesthesiologist explained, Africans always want anything the “white man” has. Apparently this trick is used often with patients.

Things at BCL continue to go well.  My typical teaching routine has been to teach a lesson, assign some individual work based on the lesson, take up the work, then do dictation.  For dictation, I give small prizes (pens, pencils, beany babies, etc. that I brought from home) to the winners, which the kids really seem to enjoy.

July 27, 2010

Today at the hospital I observed a C-section for twin boys.  The surgery went smoothly, and both babies were healthy.

In the male ward, a patient was admitted with chronic liver failure.  Dr. Kudoh showed us the signs of this, which included jaundiced (yellow) eyes, and generalized edema.  Fluid build-up in the peritoneal cavity (ascites) was causing severe abdominal distension, so Dr. Kudoh relieved this by draining the peritoneal fluid through a canular inserted into the peritoneal cavity (a procedure called paracentesis).  About 2 L of fluid was removed!

July 26, 2010

Today I met with the Dean of the UCC medical school who told me about the Ghana medical school system.  To become a doctor,   Sstudents can enter medical school after secondary school (approximately age 18), or after a BSc is obtained.  If one enters directly from secondary school, an introductory year of basic sciences courses must be completed, after which 5 years of medical training is completed.  If a BSc has already been obtained, the year of basic science training is ommited and medical school only takes 5 years total.  Similar to Canada, students see patients in their 3^rd and 4^th years.  Unlike in Canada, students in the 5^th and 6^th years are trained fairly comprehensively in surgery.  Upon completion of school, students do a 2 year fellowship with an experienced doctor before they are fully qualified.  Once qualified, doctors must fulfill a government-enforced 2 year community-based practise program, during which doctors work in under-served areas.  The community-based practise program is supposed to allow doctors to give back to the community and learn cultural practises of different areas.  Doctors Kudoh and Kwarteng, who I have been shadowing, are in this stage (and not too happy with the program).  After 2 years of community-based practise is completed, doctors are free to practise at a hospital they choose.

As for cost of school, students pay about $4 000 CAN a year, which includes accommodations (very nice by Ghanaian standards).  During the community-based practise time, doctors are paid about $600 CAN a month (very low by international standards (think $7 200 CAN a year), but high for Ghana compared to other occupations (a secondary school teacher makes $75 CAN a month)).  Once a doctor is fully trained the wage is supposed to increase to about 3,000 Cedi/ month (still only $25 714 CAN per year), but in actual practise it seems the increase is less than this.

I was taken on a tour of the UCC med school facilities, and given a history on the school.  The UCC medical school just opened 3 years ago and is still being developed.  From what I saw, the UCC facilities and equipment were very modern.  The school has biochemistry, histology, anatomy, and clinical practise labs, as well as a mortuary, from which cadavers are obtained.  I was shown the cadavers used in the anatomy classes, which were held in formalin tanks.  It looked like the UCC students had been getting a lot of use out of the cadavers, as they were pretty hacked up.

At night, the volunteers and I went out to Oasis for dinner and drinks.  It was two of the volunteers last days, so we were wishing them farewell.  Sossah, the director and founder of the Abusua foundation came and I had a nice conversation with him.  He was born in Ghana, worked hard to put himself through university, then began the Abusua foundation when he was 24.  He is now 32, and has been running the Abusua program for 8 years.

Sossah told me some interesting things about the Ghana penal system.  In the penal system, it is fairly common for people to be held in prison while awaiting trial for 2 - 10 years.  Also, if someone (even foreigners) is caught with marijuana, it is an automatic 10 year imprisonment.  Sossah told a story of a mother and her teenage daughter from Europe who had been caught with a few grams of marijuana and  imprisoned.  They are currently serving out their sentence.  Nothing can be done by their embassy to get them out because they broke the  law of the country they were staying in.  The only thing their embassy can do is make their prison sentence more bearable by sending people to give the prisoners personal items (food, cleaning supplies, comfort items).  I will definately think twice before smoking up here.

Additionally, Sossah told me how dogs and cats are commonly eaten in Ghana.  I was a bit surprised by this at first, but after thinking about it, if you are starving, dogs and cats are just another source of food.      

July 25, 2010

This past Saturday, I and some other volunteers went to Ko-Sa beach for the day.  Ko-Sa is a beautiful beach about 30 minutes away from Cape Coast, which has rocky outcrops about 30 meters out in the water which blocks the rip-tide and makes it safe to swim (Figure 22).   We spent the day swimming and relaxing on the beach.   

Figure 22. Ko-sa beach.

After Ko-Sa, we went to Elmina Night club for some dancing.  From my experience so far, it seems that every Ghanaian (guy or girl, young or old) is a good dancer.  Ghanianas also seem to really be able to cut loose and have some fun, even if they are going through tough times.

On Sunday, I went downtown with Rob to get some fabric for a tailored shirt to be made (this can be done very cheaply in Ghana).  Later, I played a fun game of soccer with some of the Kwaprow village kids.

July 23, 2010

Things at the hospital this past week have continued to go well.  I visited a former patient, Paul Kwesi, from the paediatric ward who had been very sick with malaria and he is doing much better.  Paul had been semi-conscious for 3 weeks prior, but now was able to walk and eat on his own.  It was a very uplifting feeling to observe his improvement.

My typical schedule has been to observe rounds with Dr. Kudoh in the male ward, follow Dr. Kwarteng in the female ward, then observe a surgery in the early afternoon.  Dr. Kudoh continues to be a great clinical teacher.  This week from Dr. Kudoh, I have learned to rank a patients level of consciousness using the Glasgow Coma Scale.  He also taught me the steps to take in first examining a patient, and questions to ask a patient complaining of pain. 

The surgeries I observed were: two C-sections, and a lymphoma removal.  All operations were successful.  Dr. Kwarteng asked me and Rob today if we wanted to assist in a C-section.  He may have been kidding, but I am pretty sure he was not.  We told Dr. Kwarteng we have no training and could not ethically do this.  The assistant plays a large role in the surgery (helping to open the abdominal wall, cut tissue, wipe blood).  If anything were to go wrong, I would not know what to do.  I was not comfortable with that responsibility, so I declined, even though it would have been pretty interesting. 

Dr. Kudoh and Dr. Kwarteng also told me about the Ghana health care system from a doctors point of view.  It seems the Ghanaian government plays a very large role in determining where each doctor will practise.  Both doctors Kudoh and Kwarteng were assigned to CCDH to fulfill a required community-based practise program.  This would be fine they said, however, at these rural hospitals they are expected to perform duties they are not adequately trained to do.  For example, Dr. Kwarteng has been made the resident gynaecological surgeon at CCDH, although he does not have any specific training for this.

At BCL, things continue to go very well.

July 19, 2010

Today was my first official day in the female ward, with Dr. Kwarteng.  Dr. Kwarteng was also the doctor for the maternity ward, so I followed him there as well.  In contrast to Dr. Kudoh, the approach Dr. Kwarteng takes with teaching us interns and the nurses is much less student-teacher and more friend-friend. 

Things at the afterschool program continued to go very well.  A few days back I had asked the kids to write a paragraph on anything they wanted, to help me gauge their writing levels, which many of them had not done.  Today, one student, Collins, brought the assignment in. His paragraph was about how he really looked forward to coming to the after school program because he liked me so much as his teacher.  I was very touched by the paragraph. 

Back at the house, dinner was rice and some sort of sauce, as per usual.  It was pretty tasty I guess, but not very satisfying, as I am getting pretty sick of rice.

July 18, 2010

This past weekend was pretty relaxing.  On Friday, there was a BBQ/party at the house with all of the volunteers and invited friends (Figure 20).  Saturday was raining in the morning, so I and the other volunteers watched a movie until it stopped, then went downtown to shop for fabric to get shirts tailored.  On Sunday, we went to Elmina Beach Resort and swam in a beautiful pool overlooking the ocean (Figure 21).  It was very nice to party a bit and relax after the busy work week.

Figure 20. Abusua house BBQ.

Figure 21. Pool at Elmina Beach Resort.

July 16, 2010

Today I was able to observe a C-section surgery.  This was performed by Dr. Kwarteng, the doctor for the female ward.  Dr. Kwarteng told me that all doctors in Ghana are trained in basic surgical procedures, which they routinely perform.   The surgery went off without a hitch, and a beautiful baby boy was born.  

For a C-section, the patient is anaesthetized by a spinal tap and the abdominal area is sterilized.  The surgeon makes a small (approximately14 cm) horizontal incision through the integument (skin), underlying adipose (fat) tissue, and abdominal wall to expose the uterus.  Any blood vessels are clamped shut to stop bleeding.  The aforementioned tissues are stretched to accommodate the size of a typical baby (this is done very forcefully!).  Tissues are stretched as opposed to making a larger incision because stretching avoids cutting of blood vessels.  The uterus is raised out of the abdominal cavity, then cut open and the baby removed head first.  The umbilical cord is clamped on both the mother’s and baby’s end, then cut in the middle.  The placenta is removed from the uterus, and the uterus is sutured up and put back in the abdominal cavity.  The surgeon ensures there is no sustained internal bleeding, then the abdominal wall, adipose tissue, and integument are sutured back together.  

All in all the procedure took about 30 minutes.  I was surprised at how short it was.  I was also very surprised at how rough the surgeon can be on the patient’s body (stretching skin, stuffing the uterus back in the abdominal cavity), without causing damage.   

C-sections are much more common in Ghana than Canada. Dr. Kwarteng explains that this is because in some younger woman, the birth canal is too small for the child to pass through.  Since pregnancy commonly occurs in younger girls in Ghana compared to Canada, higher rates of C-sections are performed in Ghana compared to Canada.

Nothing too exciting was occurring in the male ward, so I went to visit Rob in the female ward as Dr. Kwarteng did his rounds.  Dr. Kwarteng and Rob showed me a snake bite victim who was in bad condition.  The lady had been bitten on the leg last Friday, but did not come to the hospital till Monday, by which time her condition had worsened significantly and treatment was not being effective.  When the lady was first brought in, her leg was swollen and discoloured, but she was otherwise alright.  By Friday, she was in a coma and struggling to breathe.  Dr. Kwarteng suspected the snake venom was acting as a neurotoxin, causing the woman to fall into a coma, as her brain systems became impaired.  Dr. Kwarteng predicted that the woman would die shortly, as the venom inhibited the woman’s vital brain systems (temperature regulation, respiration, cardiac function).  The women died two days later, as Dr. Kwarteng predicted.

Dr. Kwarteng and Rob also showed me two patients who were HIV positive and suffering from secondary infections due to their weakened immune systems.  This was the first time I had seen HIV patients.  The girls looked extremely weak and disoriented.  Dr. Kwarteng ordered a CD4 count to be performed to determine the stage of HIV of each girl.  He suspected they were in stage 4, the stage just before full blown AIDS. Dr. Kwarteng said the treatment course for the girls would be to send them to HIV clinics, where they would be placed on ant-retro viral drugs for a time, until their symptoms became manageable. Dr. Kwarteng said HIV positive patients were sent to a separate clinic because there is still a large social stigma surrounding HIV positive people.

July 15, 2010

Today at the hospital a 17 year old boy named Abraham died.  I had been overseeing Abraham for the past week.  He had previously complained of coughing and severe weakness.  The palms of his hands were white (compared to the pink hands of others), which Dr. Kudoh said indicates anaemia.  Based on these symptoms Dr. Kudoh diagnosed Abraham with severe malaria and secondary anaemia. 

When I arrived in the ward, Abraham was having convulsions and had bloody sputum blocking his airways, likely from a bacterial infection in the airways.  The nurses were trying to aspirate off the sputum and give Abraham oxygen.  Because Abraham was anaemic, oxygen levels in his tissue were already low.  Abraham’s breathing was wheezy, and the nurses believed he likely had fluid in his lungs (acute pulmonary edema).  With the fluid in his lungs, the little oxygen that could be brought to the tissues now had to pass through fluid (as opposed to air) which further decreased his tissue oxygen levels as fluids have a much higher resistance than air.  Consequently Abraham’s tissue oxygen levels were becoming dangerously low. 

Dr. Kudoh had not yet arrived because he was away at another hospital.  The nurses injected Abraham intra-muscularly with 5 mL quinine to reduce any symptoms caused by the malaria parasite.  Amoxicillin, an anti-bacterial, was given to try to clear some of the bacteria that were likely infecting the airways and causing the bloody sputum, which was blocking his airways.  The nurses kept Abraham on a slow-drip, intravenous dextrose saline.

I looked at a chest CT scan of Abraham from earlier in the morning, and saw that the heart was extremely enlarged, just like the previous patient (Thom Johnson) who had died of cardiac failure.   

I checked for pitting edema in the legs, which had also occurred in Thom Johnson, but found none.  A good sign, perhaps? I listened to Abraham’s heart beat, and it sounded very irregular.  The nurses gave Abraham 100 mg of hydrocortisone dissolved in saline I.V., and checked his vitals.  Temperature was 32.7 (very low), blood-pressure was 110/70 (low for this patient), and his pulse was too feeble to count.  The nurses continued to aspirate off sputum and give oxygen.  Two other doctors who I did not know came in, and said to continue aspiration and oxygen delivery, and wait for Dr. Kudoh.

When Dr. Kudoh arrived he confirmed that cardiac failure was occurring using his stethoscope. He also found that acute pulmonary edema was occurring, and showed me how to distinguish between the sounds of a fluid filled lung filling with air (distinctive crackling) and a normal lung filling with air (smooth sound).  Dr. Kudoh said to continue aspiration and oxygen delivery, but told the nurses to remove the I.V. saline immediately, as the added fluids were only increasing the work-load for the already failing heart.  He also told the nurses to prop-up the patient as much as possible, which allows blood to circulate the body more easily.  Dr. Kudoh gave I.V. lasix, a diuretic, to help pass fluids and lower the workload of the heart.  A catheter was inserted to allow excretion of the extra fluids.  Dr. Kudoh said that this was all that could be done for the boy, and we just had to wait.  Two hours later Abraham died.

Abraham’s death hit me a lot harder than any of the other deaths I had seen.  Abraham had been in the male ward since I started 4 days ago.  He spoke English and I had talked to him a few times about soccer, which he loved to play.  He had appeared relatively healthy in those first 3 days, and his sudden cardiac failure came as a large surprise.  After the experience, more than ever do I want to train as a doctor, so if I am ever in a situation like that again I will know what to do to best help the patient survive and recover. 

At BCL, I read a story with the kids and pointed out different grammar things we had learned previously as we went, which the kids seemed to really like.  At the end of class, the kids asked me to do some dictation (like a spelling B), so we did that.  After the difficult day at the hospital, teaching at the afterschool program really cheered me up.  I took a picture of my classes (Figures 18 and 19).  I have now agreed to teach 5 days a week from 4-6 P.M.

Figure 18. BCL class 5 (younger class).

Figure 19. BCL class 6 (older class).

 

July 13, 2010

In the hospital today I checked vitals in the male ward, then observed Dr. Kudoh on rounds.  Doctor Kudoh was again very informative. 

A 24 year old patient who suffered from severe malaria, vomited so forcefully that his esophogus and stomach tissue was torn (severe gastritis), causing him to vomit blood and tissue.  Apparently, vomiting after food or water intake is common in severe malaria cases. The doctor calmly instructed the nurses to inject two saline IVs, and wait for a suitable donor (family members) for a blood transfusion.  Dr. Kudoh also pointed out fine, closely spaced scars on the chest of the patient, which he explained were remnants from a traditional healer.  The healer would slice the skin, then apply topical poultices, which could now enter the blood.  Dr. Kudoh said that if the young man had been brought immediately to the hospital when he first turned symptomatic, he would be in much better condition.

Dr. Kudoh showed me a post-mortem chest CT scan of Thom Johnson, which showed an extremely enlarged heart.  Dr. Kudoh said an enlarged heart is a classic indicator of cardiac failure, and he diagnosed Mr. Johnson’s cause of death as cardiac failure based on this information.

I finished early at the hospital, so I decided to teach at the afterschool program, though I was not scheduled to do so.  I had not yet collected the homework assignment designed to gauge the childrens academic level, so instead I taught from the beginning of the text to ensure that the basics of grammar were covered.  This seemed to work fairly well.  It turned out that only a few students had done the written paragraph assignment, but those that had did not seem to have a great handle on basic grammar.  I think I will continue with the grammar basics and move on to more advanced topics if the students seem bored by the basics.

Additionally, I learned from the house cook that the average wage for a working person in Ghana is about 90 Cedi per month.  I spent about 90 Cedi in my first week, I cannot imagine how the average Ghanaian gets by with a 90 Cedi/month wage.