Acceptance. Tolerance. Flexibility. Patience.

I came to Ghana with these four words in mind. I’ve repeated them like a chant since. As I said earlier my goals are two fold, for others and for myself. As my time here dwindles I find myself thinking: ‘What have I truly gained from this experience?’ However, each time I come to the same conclusion: I won’t truly know until I leave here.

When I think of the four words I think I can say that each has increased, some more than others.

I think of the sick 4 month old we saw in October. I pleaded the family to go immediately to the hospital one hour away. One week later we found out they never went. We, as a team, visited the family at home three times over the last month. I thought about taking medicines to the home and giving it to the family. But I decided otherwise. Dr. Rettig’s words echo: “These families know their child is sick. If they wanted to they would have come in earlier, but they chose not to. There are so many sick children and limited resources, we must focus our resources on those with the families invested in caring for them.” I have accepted my limitations in helping this child. Everyday I pass by the mother’s food stall and greet her. I can only hope she brings her child to the clinic, but there is nothing I can do by force.


I also accepted that I am “fat” here and that, may actually be a compliment. Within my first week of arriving an older woman slapped me on the ass and said: “I like you. You are fat. I consider you to be like my youngest daughter.” I still don’t understand how to put those three sentences together, but I like to think they mean something positive.

“Obruni coco mache” (white red person) is yelled, no, sung by children near and far everytime I pass through the village to go somewhere. I have become tolerant of my label and that I in someone else’s eyes am seen as “the white person.” On most days I not only tolerate but welcome 7 children yelling in chorus “obruni coco mache,”
“Obruni. Obruni. Obruni. Obruni. How are you?,”
“Obruni coco. Obruniobruniobruniobruni Where are you going?”
I think of myself as the Miley Sirus or Mickey Mouse of Buamadumase. I too would be excited every time Micky Mouse walked through my neighborhood if I was four years old.

I am sure that I have become flexible figuratively and literally, as I have been doing yoga a couple times a week. But I certainly am not as bendy as I used to be (again figuratively and literally). Somethings feel like they are pushing my limits until that thing is taken away or, in some cases, added on. The water tank seemed far away until the rainy season ended and now I have to go further away to the pump to fetch my water. I miss the tank full of water. On the other hand, I thought sitting four in the back seat and three in the front of a taxi was a lot. But the other day, while we were waiting for the taxi to fill up, I heard the “baa” of a sheep. Sheep are as common as people in the village, but this one seemed awfully close. I looked, but to no avail could I find her. Finally the car filled and we rolled out, the “baa” followed us. Alas, I realized she was with us all along…sitting in the trunk.

As for patience, I have two words: slow internet.

Rising and Setting With the Sun

Off the Accra to Kumasi road begins a paved road towards Boumadumasi. The pavement is deceiving; for once you reach the top of the first bend a dirt road awaits you. The taxi ride with four people in the back seat always gives my insides a good shaking as we hit the potholes and water puddles on our ride to Bouma. In fact, my body has begun to resist, opting rather to take the two-mile walk on foot. The walk is a peaceful one: Plantain trees and corn crop tower far above me, occasionally making way for the scenic landscape in the distance.

Walking into town at 7am makes me feel late and lazy. Children skip energetically in their bright yellow uniforms. Storeowners sweep vigorously, sending the dust back to the road it came from. Vats of water are carried atop heads to their respective homes, vegetables are neatly arranged into piles for selling and oil is heated to start frying yams. If I didn’t know better I would think it was the middle of the day.

I am now more synchronized with the village; I rise and set with the sun. In a place where electricity comes and goes at its leisure and water is accessible for all at a central pump, the sun is more than your friend; it is your protector, caretaker and provider. Now my eyes open at 6am and start to droop around 7pm.

As I hit the two-month mark in rural Ghana, I realize and have come to respect my own limitations. Reluctantly I admit that I am an American, raised in a comfortable environment with all amenities available at my fingertips. Never have I had to fetch the water I use to wash my body, the dishes and my clothes. For each drop fetched I sweat a couple more. A sink is so commonplace that I never once stopped to appreciate it’s worth. To think, all these years I just stacked my dirty dishes in there, spit my toothpaste out in there, rest my soap conveniently next to the handle. I can’t do that now and I miss the sink. And, of course: electricity. Thank you Benjamin Franklin if it was, in fact, you who discovered it flying a kite. To have light at night, a computer to type on, a phone to call family to has become invaluable to me. Once again, I never anticipated a life without these things.


From these reflections begs the question as to why I’ve come here. Why I have opted for a circumstance so extremely different, no difficult, compared to mine. My thoughts are two fold: one for myself and one for others.

I don’t care what explanation someone gives for volunteering, there is always a selfish component. It is there so I think it is worth acknowledging. In this case my selfish gains are perspective on the world greater than myself and appreciation for so much I take for granted in day-to-day life. Beyond these things, is hearty nourishment for my soul from being surrounded by such enriching company. In simplicity lies truth, there isn’t enough “stuff” to hide behind or distract one’s self with. You see real people, talk a real talk and are forced to acknowledge and accept the environment around you. I do spend time with the stray cat, countless chickens and corn crop everyday…brushing my teeth.

The second part is for the work. The education we go through to become a doctor compared to how we are utilized (at least as Pediatrician’s in the US) are so incongruent. It is hard to justify that giving someone cough syrup or convincing a parent a child doesn’t need antibiotics is the richest career I can have. Coming to rural Ghana has reignited this drive to figure out exactly how a snake bite is treated or what not to miss when treating Malaria. Additionally it pushes me to expand my medical knowledge for a greater purpose: education, education, education. Educating communities on having healthier children, on decreasing Malaria and controlling their hypertension seems to have a much larger and satisfying impact than treating sniffles (unless, of course it is Syphillis…I’m a nerd, I know). Not to mention that the clinic closes at 3pm (a perfect working day finish time).

As the three remaining hours of sunlight last, we wrap up our daily duties. Knowing I have no where to go, no one to report to or any TV shows to watch, I accept my current reality and prepare to shut down not too long after the sun sets.

Tro Tro Queen

Flies and I have become friends. We shit in the outhouse then walk to clinic together every morning. Initially their incessant buzzing in my ear had me waving my hands around like a mad woman. But their persistence wore me thin and I have just come to accept them as a constant companion on certain pathways and in certain parts of the home.

Tro-tros and I have also become good friends. Tro-tros are the (at least my) staple form of transport between towns in central Ghana. They are mini-vans that putt down the main road from Accra to Kumasi picking up and dropping off passengers en route.

“Kumasi. Kumasi. Kumasi. Kumasi. Kumasi. Kumasi.” You’ll hear the mate hang out the van door and shout. It is just impossible to miss your ride.

My favorite part: the price is just right. Average cost: 70 pesawas = $0.50. You don’t need to know me well to understand how happy that makes me. But I have other favorite parts. The mate is always a point of intrigue. Much like the way you stare at your teacher’s shoes, blouse and twitches in her face while watching her all day long, I watch the mate.

Each tro-tro has a driver and a mate to accompany him. The mate does the shouting, seating and collecting money. The driver and the mate are a dynamic duo: young men spinning their wheels, cruising the main road and making a dime in the process. They communicate without ever talking. A bang on the side of the door means stop, another bang means go.

The tro-tro extends beyond the mate and driver though. Each country and culture has its idiosyncrasies , this is one of them. Everyone moves with a quiet understanding and this system that looks haphazard and crowded actually is hardly at all. A good 12-14 of us pile into the car, you fill the back most seat first. Time to time we stop at some random roadside, from a little corner emerges a town you may have passed by a hundred times and never noticed. Someone in the back second road will deboard. Then we all will reshuffle ourselves to fill the empty spot and leave room up front for the next passenger.

Everyone on board works on the honor system. You just pay the mate and he never bugs you again. When in the back row, you just tap the passenger in front of you on the shoulder and they pass your money up to the mate and your change passes back down the same chain of people. There really is very little haggling or doubt in the whole process.

When stepping on board the passenger next to you often greats you: “Ete Sen?” (how are you) or a “Good Afternoon” in the crisp Ghanian English accent.

Bring your suitcase, bring your wood, bring your chickens, it is all welcome on board here.

Another idiosyncrony I have come to appreciate and admire really is the efficient use of the head. It is essentially a third hand that I never knew about, but somehow every Ghanian does. When I traveled to India in the past I would, time to time, see a woman carry a ceramic dish on her head. But in Ghana it is a different story all together. You name it, it can be carried on your head. A plastic bag with groceries, a couple books, a suitcase, a board holding sunglasses ready to sell, a bucket holding 20 buckets ready to sell, a sewing machine, a crate of chickens! Now if a few did that, then I would, like with a magician, be convinced that it is a talent that only a few are skilled enough or committed enough to accomplish. However, when I see 4 year olds to 94 year olds all doing the same task, turning their head to talk to each other, grabbing their baby to pick them up, reaching down to scratch their leg without flinching or hesitating about the stuff on their head, I wonder why the rest of us missed the boat on this.

So the other day it started to rain, I used that as my justification to walk around Kumasi with a bag on my head. At first I held it hesitantly on my head, using my right hand as my training wheel and eventually I was hands free. ‘Try and look normal Mona,’ I told myself. I am sure I looked like the Obruni (Gringo) trying to be an African. But now, more importantly, I can say I did it.

At the risk of making a overgeneralization, I feel like the tro-tro and head carrying system exemplify something I have noted in Ghana: a lot of common sense and efficiency. I have only been here going on one month now, so there is still a lot more to learn. But I don’t find myself fighting battles to do little things or having to talk to six different people to get a straight answer. Above all, I really feel a lot of genuine intrigue in who I am and concern for my safety. There is a certain level of peace I am able to obtain here that I was lacking back home. Escapism? Life minus LA traffic? Preoccupation with sweeping and washing and fetching water? Who knows, but all I can say is that I am enjoying my time out here.

Martha

The complaint that brings a patient in often masks something more serious. That was the case with Martha. Martha is a beautiful Ghanian woman. She bears the leather lifelines of 60 years of relentless farming, though they somehow decorate her face nicely. Her dress bestows the essence of Ghanian wear: a headwrap is neatly packaged on top of her head with an ornately, brightly patterned blouse and full-length skirt to match. Underneath this demeanor shines the spirit of a survivor; you see it in her eyes.

Today she comes in complaining of falling twice in the last week. It is hard to imagine a woman with a lifetime practice of balancing her merchandise on her head and walking two miles to simply trip. In fact, that is hardly her case. She describes herself as having “weak knees.” But when you look closer you see a cloudy haze covering those expressive eyes. Like many her age in Central Ghana, she is beginning to have cataracts. Upon asking we find out that she can barely see me sitting right in front of her. For the first time in her life she learns that she is hypertensive with her BP at 160/100. Arthritis, cataracts and hypertension are extremely common problems that plague our elderly, farming population in Ghana. There was no brilliance necessary in realizing that arthritis from 70 years of wear and tear on her knee joint along with her developing cataracts leaves her at risk for one mighty fall and a hip fracture to follow suit.

As horrendous as hip fractures in the elderly in the US may be, we rely on hip replacement surgery, well-trained anesthesiologist to handle the complications of elder age and months of physiotherapy to nurse them back to baseline. If Martha has a fracture, she, with her uncontrolled hypertension, maybe able to get surgery, but she will no longer have an income and become reliant on someone to care for her through months of recovery, hence losing a second income.

This foresight has the head nurse, MaVic, and myself worried for her. We prod her to please, please go to Agogo Hospital’s eye clinic. After all, she has free health insurance from the government (provided for the elderly). Her eyelids sag under the weight of her problems. She can’t afford to miss a day of work, nor can she afford the fare to Agogo Hospital: $ 0.75. The more we tell her go, the heavier her eyes get. She looks away, shortly after she checks out of the conversation.

We play out all the potentially dangerous prospects that lay in her immediate future. “What will you do when you can’t see?” We ask.
“Then I’ll just die,” she says.

Ok, that was not the direction I was hoping the conversation to go. Martha’s eyes are calling for help. But how much hope can you ask a person who has spent a lifetime fighting to put food in her mouth; who has spent a lifetime farming and selling vegetables at the expense of her body?

We find out that she has a daughter who lives nearby. She too will have to take a day off work, she too doesn’t have fare for transportation, but she can take her. Now her eyes dance with uncertainty and a tinge of despair. In this aspect, Martha was more of a guilty mother than anything else; an older mother who strives to be independent of relying on her children. She really doesn’t want to ask for help. Personally, I hate asking for help. So, perhaps only on this level, I understand her angst. However, Martha, MaVic and I talk through it. Martha agrees to ask her.

Certain things in life cross all boundaries; they hit at the core in the most fundamental of human ways. Despair is universal, it is a feeling we all recognize. It is an uncontrollable situation; loss of control. My heart sunk under the weight of her increasingly cloudy eyes. I do not understand why God would bring her into this world under these circumstances and I under my “American” circumstance. Even under these circumstances she came bearing vegetables for the clinic. “Why is it the people with the least amount always want to offer whatever they have and those who have more hold on tighter?” asked MaVic.

There is so much I don’t understand, but this I do: life is much greater than myself and the visible world around me. I am grateful, if only for a brief period in time, to bear witness to that.

Looking Beyond the Surface

Half Way There Still is Not Enough.
October, 18, 2009

Sitting down to see patients in whatever community it may be, grants an unparalleled privilege. For this week I have gained access to the inner workings of the villages buried off the main road from Accra to Kumasi in Ghana. One can only see and know so much in week, I cannot claim to know anything more than that.

A few simple reflections: People are the same wherever you go, it is there expectations that change. It seems that poverty in Ghana, Mexico, India and US alike lowers one’s expectations, inversely increasing gratitude to the care received. The gratitude here is immense, for that I am grateful. However, the poverty, limited access, limited resources and lack of education have proven to be far more challenging than the illnesses I see.

Within my first day I learned that Malaria is rampant. There are four different types, we learned in medical school. Falcipurum is the kind you never want to have, it will break down your blood and penetrate your brain. That is the one they have here. My first patient: vomiting and fever. Diagnosis: Malaria. My second patient cough and fever. Diagnosis: Malaria. My third patient: headache and fever. Diagnosis: Malaria. You get the picture.

We sat down with the community health educators this week and learned about the non-scientific science behind the persistent, rampant spread of malaria. For it is not the parasite itself that is as pervasive as the lack of education. “The government provides mosquito nets and mosquito repellent at a small cost. Most of the families have them.” MaVic (the head nurse here) informed me. “They all sit around there homes unused.” I was caught by surprise and it really didn’t make sense at first glance…until we spoke to the community workers:

“Some don’t know how to put it up,” one man said.
“They don’t know what time of day to use it,” a woman added.
“A lot of the nets are old and have holes in them,” a third voice piped up.
“When our kids sit inside the net, they want us to sit with them, but we have to cook dinner. Then what do we do?” a man inquired.
Okay now we’re getting somewhere.

Like the available access to mosquito nets, I was surprised and impressed to learn that the government provides insurance for everyone at low cost. Ah ha, Ghana accomplished in 1989 what we resist, scream and bark about in the US today...
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A 24 year old came into see us early this week.
“My stomach and chest hurts,” he explained in Twi. Hawa, one of the nurse’s assistants, translated for me.
So we run the gamut of chest pain, abdominal pain questions English to Twi; Twi to English. This chap sounds very anxious I think and explain to him.
“…and I have pus coming from my penis.” He adds.
Okay. I don’t have computer screen with seven red blinking patients waiting for me in rooms. I can take my time. I take a deep breath. We run the gamut of sexual activity questions.
“I would like to treat him for UTI, Chlamydia and Gonorrhea,” I explain.
“Doctor, we have Doxycylcine and Ciprofloxacin.” Hawa explains.
“Great. What about Ceftriaxone to treat the Gonorrhea?” I ask.
“That we don’t have. He will have to get it from the pharmacy.” Hawa says.
“Ok, will his insurance cover it?” I ask.
“He doesn’t have any.” Hawa informs.

I take a step back. We have a government that insures, mostly subsidized and still we have uninsured patients? The 24 year old male is not the only one. There are many that follow after him. I am once again scratching my head. So I ask the nurse’s assistants to explain:
“They can only go on Fridays after they get paid from the Friday Market.” Says Hawa.
“Even then, they have to take an unpaid day off work and pay for transport to Ejisu (the town thirty minutes away). When they get there they don’t know what to do.” Jan adds.

Our chap came back with the ceftriaxone so we could give the injection. I asked to check him for HIV more out of habit than anything: “where one STD lurks often do many,” we were always taught in Adolescent Fellowship.

“Doctor, his test came back positive. I checked it twice.” Kingsley, the “labman” informed.
My heart sank, as did MaVics. We brought him in to talk to him. MaVic did the talking in Twi. “I have asked him why he is so worried,” MaVic informed. “He says that he completed secondary school, but has no money to go to college or learn a proper trade. His family cannot provide the support he needs.” She said.

She went on to tell him the results of his test. I sat and watched, not understanding what was said. I watched this young 24 year-old man engage in MaVic’s discussion, then I saw him breath rapidly, then I saw him disengage. “He is asking for water. Please fetch him some water.” MaVic Asked.
Our, already, anxious young man’s world just darkened. All we could do was inform him of it, refer him and hope he goes.

I am grateful for MaVic as the her name (Mama Victoria), the position she holds in this clinic and the presence she commands creates the ethereal community Mother many of the patients need. She will be the mother that the 24 year old chap needs right now as we continue to follow him.

I asked MaVic about the stigma attached to HIV in this community.
She informed me that it has improved tremendously with the onset of better and cheaper treatment (much due to Clinton’s Global Initiative). “The men no longer immediately divorce their wives or wives divorce their husbands as they once did,” MaVic informed. “They know that they can still go on to have a full life.”

The cases are so many, every patient that walks in has so much to teach me. This week I go to a nearby town, Agogo, to follow and learn about local disease and treatment in Agogo Hospital. The best part about it: internet access baby!

Landing on Two Feet In Ghana

Once in a rare while has life presented a moment where I step back and think, “Wow! This is happening to me.” Two days ago I felt that.

I departed Accra (the capital of Ghana) by bus en route to Huttel Clinic. I was told that if I follow the map to the nearby town, Duampompo, it will get me within a 5 minute taxi drive of the clinic. It wasn’t on the map.

Rest assured the bus driver guaranteed he would drop me off there. Who am I to doubt him? I said a long hard prayer to God that morning with a little reminder, “I am in your hands today.”

My bus was quite cozy. I got a seat by the window with the seat next to me open for my excessive things to unravel and breathe for a minute. It was not long before I saw the bus piling up at our next stop. My things reluctantly resumed their condensed positions back in my backpack; my backpack reluctantly resumed its position on my lap. Low and behold, just the largest lady took that open seat next to me. Not only was my spare seat gone, but part of my own seat as well.

“Patience. Flexiblity. Openess. Acceptance.” I repeated to myself.

“Good afternoon,” she told me.

I concurred.

We exchanged a few kind words. I was quick to disclose my journey to this remote location off the typical Accra to Kumasi route.

“You are new here? Welcome to my country!” she proclaimed.

What a sweet woman! She could share as much of my space as she liked. At points our bodies nuzzled into each other; one nudging elbow permissive and relaxing towards the other. I had to, in fact, hold back from leaning on her shoulder and nodding off.
I asked her if she spoke Twi. “Yes, of course!”

She did not hesitate to start teaching me Twi. “Go on, say Medasi (thank you) to the driver when you get off,” she said.

We were 4 hours into the bus drive and I was just finding my comfort zone when the bus halted. I looked around for any identifiers: No city. No town. Just farmland.

I looked up. The driver was looking at me. “This is you,” he said.

I hesitated to depart from my new best friend. I looked at her longingly. “Remember to say Medasi!” she smiled and chuckled.

The driver unloaded my embarrassing, ginormous pile of bags on to the dirt road. Around me gathered three women. They were clucking in Twi and I was staring at them with my eyes crossed and probably the dumbest smile across my face.

So I was dropped in the middle of rural Africa. I stood there thinking: ‘Wow, this is actually happening to me.’ There was only one thing left to say: “Medasi.” Smile. “Medasi.”

One of these kind women read my mind and fetched me a taxi. I, being MonaVarsh and being a Puri, found myself negotiating a cab fair with no leverage, 4 bags, no clue as to where I was nor how far I needed to go. I quickly realized- his price was the right price. We drove about 32 seconds before we pulled to the side and four men piled into the back seat. With a Twi vocabulary of one word, I hugged my backpack tight and sent God a reminder “Medasi for looking out for me today?” Two miles down a bumpy, dirt road we pulled into a pink clinic.

I would be lying if I didn’t say there was an element of shock to what I had enlisted myself for. The clinic is small and basic compared to the luxuries we take for granted at home. However, the love and intent with which it was built was apparent on first glance.

My room is in humble conditions though it has shaped up quite nicely. I will take bucket baths, use an outhouse style toilet and wash my clothes myself. What actually pulled me out of my state of shock are the people with which I live. I look around and see my neighbor, Jan. Not only did she quietly, but dutifully arrange my room and bed for me when I arrived, she cooks and shares her food with me on a daily basis. Jan wakes up daily, preps herself very respectfully and is timely for work. Every time I pass her room I notice that it is maintained in a very tidy fashion. Her sandals are religiously removed prior to stepping into her room. Why, if Jan can live in these standards comfortably, should not I? Especially when realizing that the standards of the clinic rooms are significantly better than the poorer surrounding villagers.

Today I busted out the old school India squat and broom and swept my place clean. I squatted and, probably rather inefficiently, washed our dishes. Before I could huff or puff to myself I looked up to see Jan carrying a bucket of water retrieved from the well on her head for us (she did this three times by the way)!

It is strange how perspective changes so quickly. But my room is cozy now. It is dust free now. It is mosquito, cockroach and bug free! I have my host of books (including a Cecil’s and Nelson’s), a comfy little couch to lay on, space to yoga it up and, of course, Jan as my neighbor.

Jan is one of the four nurses assistants who work at the clinic along with MaVic, the very gracious nurse in charge. I will be speaking Twi before I leave primarily because they won’t be speaking to me if I don’t. These five ladies are just wonderful. They greeted me and continue to receive me with open hearts, generosity and authenticity. They only make me reflect on the kind of world I have been living in that I expect the opposite. A world devoid of contempt, animosity and competition has a calming effect on the soul. Granted I am three days in, we’ll see what 6 weeks down the road has in store for me…

Next up patients, population and providing care in limited resources.

Why Africa?

I had a chance to eat that final delicious Indian meal with the family (in Fremont, of course), prior to taking off. "Why are you going to Africa?" my 16 year old cousin asked. 

        "To save the starving children," I responded. Just kidding. So on my 24 hour journey, I have been simmering over how I landed up en route to Ghana for 3.5 months.

My first trip to Gujarat, India wet my travel palate. I realized how much I would like to do, how limited my capacity as a premed student was and how tranquil a life away from the bustle of everyday life in the US could be. 

I saw the opening for potential travel, unpaid, abroad this year. Afterall, I am not locked into a relationship and do not have children...so seize the opportunity. Monisha is my primary motivator to travel to an African nation: "You can come to India anytime," she said, "but when are you going to have the time and energy to see Africa for an extended period of time." 

She (as always :) was right. Little did I know that my younger brother, Munish, would beat me to it and make it out to South Africa this summer. "What is with Africa? Why is everyone going to Africa?" my mom remarked.

She wasn't incorrect, as my brother's girlfriend, Andrea had been out here the summer previous to him. How grateful I am for that as she has made my transition into Ghana a very smooth one: "We have a package for you Miss Puri," I was greeted by the hotel host. 

Wow! Who travels to Ghana and has a package waiting for them?

I think I imagined myself just stepping off a plane with a stethoscope draped over my shoulder. "Thank God I am finally a doctor. For sure I will be in high demand!" I would think. As any great adventure, that statement proved to be of utter ignorance and over confidence. Finding a well structured, non-religious, medical project in an African country proved much harder than initially anticipated. 

However, I am grateful to have landed with Foundation Human Nature . This organization funds and runs two clinics: one in Ecuador and one in rural Ghana. They picked up this clinic, as it was not being efficiently run before, about 5 years back. They have since educated and trained a lot of the full time staff and created a solid structure to provide health care and education to the surrounding 8000 villagers in the Ashante region of Ghana (about 5 hours north of Accra, the capital). 

I have yet to arrive, but I came prepared to sit, to listen, to observe prior to working (much easier said than done for me). I have come prepared to study those foreign diseases we just don't see in the US. Lastly I have come prepared to occupy my time without the benefit of the TV, friends to go out with on a whim and, my greatest addiction, the internet!

I hope to see and learn interesting things and keep you posted as I go every couple of weeks. I so appreciate you reading my blog as it is so meaningful to make this connection with so many out there!

       To great adventures, new experiences and meeting new people! Mona-Varsh