The End Is Just The Beginning

I've struggled for many days with what to write in this last post. I have no clue how to capture how I felt and what I learned while in Ghana but...I'll give it a whirl.

Before leaving for Ghana, I had certain expectations for what would play out during my time there, some of it based on what we were told by people who had been before. I expected to encounter heartbreaking situations in the hospitals and have a greater appreciation for health care and life in Canada. I expected to be challenged emotionally and to experience the phrase "the highs are high and the lows are lows". I expected to be challenged by normal things in daily life like the food, uncomfortable living arrangements, and the intense heat. I expected to love the children I met. I expected to feel sadness about the sickness and health conditions I would see. I expected to get home from work with the question "God, why?!" running through my mind. I expected to be speechless at times. I expected to want in my life, some of what I experienced in Ghana and detest some aspects of my Canadian lifestyle. I expected to immerse myself in the culture and enjoy fellowship with the Ghanaians. I expected to experience some sort of insight regarding whether or not relief work/development work is something I'd like to do long term.

I didn't expect to experience all those things in the way that I experienced them. I am so much stronger because of what went on during my 7 weeks in Ghana. I learned so much about myself, both good and bad. My patience was challenged most moments of every day, my acceptance and tolerance of others was challenged. My view towards the nurses and hospitals was challenged - trying to maintain a positive attitude towards their work as I observed what they did and cringed, was very difficult. I enjoyed making friends with the Ghanaians and miss the nurses who played football (soccer) with us everyday after work. I loved the pace of life, the no-rush mentality, and the many opportunities I had to just sit, and be.

I gained a greater understanding of the different factors that impact the health care system such as culture, resources, and education level.

I witnessed first hand the statistics that we hear about and they hit me so much harder. I always knew they weren't just numbers, but when you spend those last moments with a beautiful babe just before she slips away....nothing can prepare you for the emotions that come along with it. I always knew the illiteracy rate would impact so many things in any given country, but while in the rural town of Gushegu, I witnessed this and it impacted me in a greater way. I worked with pregnant women who were asked their age and had no idea how old they were, the nurses were handing out prenatal education pamphlets that were covered in pictures, instead of words. Sometimes I would just sit there and think about how it would feel to be illiterate - the feeling of exclusion and being removed from the rest of the world.

To be honest, after being so welcomed by the Ghanaians, I was not expecting the hospital staff to treat their patients in negative ways. Watching nurses disrespect patients and walk away from them when they needed someone to help them, was not something I was expecting. I longed to just *be* with the patient, sit there, hold their hand, be present, but I needed to recognize the ethical side of things which meant that I couldn't always do just that.

In a way, I thought the hospital staff would be more receptive of us and what we had to bring to the table. I think it was ignorant of me to think that. These people were used to doing things their own way, and who am I to waltz into their hospital and expect them to want to hear what I had to say? It was easier to share my knowledge with the younger staff and they reciprocated their ideas to me, but with the senior staff it didn't happen. I also experienced the importance of creating relationship and positive rapport with the staff in order to create a channel for me to share my knowledge with them, and for them to share their knowledge with me.

I have a better understanding of how to make change in a health care system similar to the one I worked with in Ghana. I so badly wanted to be able to help with the needs of the patients in the moment, and I thought we might be able to do this more; I thought we might be able to create change in the ward and change the prognosis for the patients. In reality, the change is incredibly long term and it starts with all the behind-the-scenes work; I always knew this was the case, but being there made it more clear to me. We had an opportunity to make presentations to the nursing students, and the change that this might create would be more sustainable than anything else we did.

I walk away from this experience with a greater confidence and security in my nursing practice here in Canada. As a new grad, I can be encouraged in that there are so many specialized staff members in the hospital that I can ask for help - this is not the case in the Ghanaian hospitals I worked in. I am also more aware of the knowledge that I do have; when as a new grad I might feel like I don't know very much, I probably know more than I think I do. I also have a greater confidence in our health care system and the fact that you can confidently go to the hospital here, and know that you will most likely be treated well, and will be able to receive the necessary treatment - this is not usually the case in Ghana.

I've been called to re-evaluate my life and the way I choose to spend my time. This includes the time and effort I put into relationships, and meeting face-to-face. Many Ghanaians greet every family member every single morning, and we were included in this! Sometimes we would get phone calls from our Ghanaian friends because they wanted to make sure we were okay and said they "wanted to know where you are in the country" and would then ask us to phone them again later to check in. This wasn't in any sort of controlling way - it was just because they cared about us. The value they place on relationships, and family, seems to exceed the way that most of us value these things in Canada. Genuine contact, genuine 'how are you's', and the desire to be in relationship with everyone they meet and greet everyone they pass on the streets. Even amidst all the hurt and despair, there is so much joy. I can definitely learn a lesson from the Ghanaians! I have a desire to slow down my pace of life here after being on Ghanaian time for seven weeks. Not packing every minute of my day full of 'stuff', but taking time to 'just be'.  I hope I can remind myself of this frequently enough  because it is so easy to get back into such a busy lifestyle.

I am so thankful and feel so blessed to have had the opportunity to go to Ghana. I want to thank all of you for your support and prayers for our team while we worked there.

We had our very last meal in Ghana in a restaurant that had painted on their wall, "The End Is Just The Beginning". I thought that was so fitting. I don't know where I will go from here, but I can say that the end of my time in Ghana is just the beginning of so much in my life. Finishing school, finding a new job, most likely re-locating, and longing to make relief work/development work part of my future in one way or another.

I'm eager and anxious to find out what the future holds. While I plan to be situated in Canada for a while, I left a piece of my heart in Africa and hope to return there one day.

Photos and a quick update

Pictures:

1) the gifts we bought for the Project Grow Village that our school supports
2) the women at the village dancing and showing their gratitude (note their Project Grow t-shirts!)
3) a child at the village
4) how I've spent much of my time here at the resort
5) the streets in Tamale
6) the view from our porch here in Cape Coast

It almost feels wrong to put these picture side by side, but I can't get internet often enough so that's how it goes!


Life continues to be fabulous here in Cape Coast at the Coconut Grove Resort. Yesterday we went on a one hour fishing boat tour through the harbour and into the Atlantic Ocean. Such good times! The boats are surprisingly solid - they told us they wouldn't tip, but I wasn't convinced, but sure enough, the boat pulled through just fine. It was basically a big solid canoe with a motor on it. We brought our iPod and speakers and the Ghanaian men on the boat loved it!

Yesterday night we had a nice dinner here at the resort. We got all dressed up and enjoyed a nice meal. Today we spent the day at the beach and pool and my skin is suffering some pretty intense sun damage...blisters aren't fun. The African sun is HOT. Shawna and I just enjoyed an hour of horseback riding along the beach at sunset here! It was so nice, except that I was not-so-kindly reminded that I'm allergic to horses!

Tomorrow we are taking the bus to Accra where we will spend the next day and a half until we fly out on Monday night at 1145 Ghana time. We will have a 10 hour layover in London where we plan to quickly see some sights before we get back on the plane, head to Calgary, and arrive in Kelowna at about 9pm on Tuesday.

Thanks to everyone for all your thoughts and prayers and for following me along this journey. I hope to post something a little more reflective within the next little while - likely won't happen until I get to Canada though.

Take care all.

Good-bye Tamale, Hello Vacation

It's been a few days since I posted last...I'll do my best to remember what we all did. Saturday was a lazy day for us, hit up the market and just lazed around. Sunday we had a class from 1pm-4pm where we talked about our experiences and debriefed about what we had seen during our clinical experiences. We all spent 2 weeks working in Tamale hospital, but for the other 2 weeks we were in groups of four in different areas of the country so it was interesting to hear stories from the other groups.

Monday we had another class from 9am-12pm and talked about transitioning back into life and nursing in Canada. I am nervous about the culture shock that I'll experience when I head back home, and I have a feeling it'll be difficult to transition back into the Canadian lifestyle. I am definitely more grateful for everything I have back home and will never forget the things I've seen here. So much of me wants to return one day. I feel like I am leaving a piece of myself here, and I definitely have a desire to come back.

Monday night we had a thank-you/going away party at the Bigiza hotel (one of the few places that has a swimming pool in Tamale). We invited all the friends we had made over the last few weeks, and some of the hospital staff that we worked with. One of our friends from Gushegu (2+ hours from Tamale) was in Tamale for the weekend so he came to our party too. So nice to have all our friends and support network people all together.

Tuesday called for a long day on the bus. We woke up at about 530am and headed over to the bus station for a thirteen hour busride from Tamale to Cape Coast. Thankfully we were on an STC bus (these, unlike the metro's, do not oversell tickets so it's not super crammed, and they have air conditioning!). While 13 hours on the bus is a long time, it flew by for all of us. There is so much to see all around us and I really enjoy that. As we made our way from Tamale to the coast, everything became more green and lush - so nice! Tamale and northern areas are so, so, so dry and brown, and here on the coast everything is green. Love it. Interesting story...at one point on the bus ride there was a semi truck that jack-knifed on the dirt road that we were traveling on. The only way we could get past was if we took a village road around the accident. The people in the village were not too keen on this idea and decided to block their road off with tractors and wood. After a long discussion between the bus driver and the village people, and some money paid to the village folk, the tractors and wood piles were moved and we were back on our way! This is Africa!

Eventually we (the six of us who chose to vacation here) made it down to the Cape Coast bus station and made our way off the bus. Here's another quick story for you...we were collecting our bags and finding two taxi's to bring us to our resort and as usual, there were quite a few people trying to help us get taxi's and load our bags in (then they often ask us for money in response to their favour). We thought one of the men helping was the friend or assistant of one of our cab drivers, so when he got into our cab with us we didn't think anything of it. Meanwhile, the cab driver thought he was our friend. When the man started asking us questions about where we were from and what we were doing in Ghana, the cab driver became suspicious of the man. He said "do you know this man?" and we innocently responded with "no...not at all". He pulled over instantly and kicked the guy out. He then explained to us that sometimes guys will find random tourists, go along with them in their cab, follow them to their destination, and possibly rob them of their things. Thankfully this driver was on the ball :)

So, now we are on the coast staying at a GORGEOUS resort. I cannot believe how wonderful it is. When you walk through the gates you forget you are in Africa. The six of us are in a family suite with two bedrooms, a kitchen, living room, running water that always works, power that does not go out, and air conditioning! It's wonderful. We are so blessed. The Atlantic Ocean is just steps outside our door and the waves are crazy big. We all spent a LOT of time in the sunshine yesterday and today and our skin colour definitely shows it. The African sun is hot...and very capable of burning...

Tomorrow we are going on a fishing boat for an hour and it'll take us from the harbor out into ocean. There are so many fishing boats that go past here. I'm not exactly sure of what we're doing...the other girls arranged it. Should be interesting. Then we might hit up the golf course here at the resort...even though I dislike golf.

The plan was that we would stay here until Saturday, then head to the Volta River until Sunday, and then stay Sunday night in Accra and then fly out on Monday night. But...we are so in love with this place and not in the mood for another 4 hour bus ride, that we might not go to the Volta River. Not quite sure yet...

I've spent so many hours poolside and oceanside and have spent some of that time reflecting on my experience here in Ghana. I've also been reminded time and time again of how amazing our God is and have thought about where I'll be in the future. Although I will be leaving this incredible country on Monday, I am quite certain that I will not be leaving Africa forever. I don't feel like I can walk away from what I've seen... I need to come back.

I plan to post a reflective entry and some pictures within the next couple days.

Cheers.

A Full Heart (photos below)

Since arriving in Tamale it's been pretty busy and somewhat sleepless! I was hoping to get a decent sleep on Thursday night after being up since 3:30am but that didn't happen. My roommate came down with something pretty rough and vomited the night away so we were both up the entire night. On Friday we were supposed to go to Bolga to see the village that our school is supporting but someone needed to stay behind with my roommate. Shawna ended up staying back, and did some pretty good nursing care! My roommate was so ill we ended up starting an IV on her, and getting antibiotics etc from the pharmacy (you can buy whatever you want without a prescription from the doctor, weird but so good for us!). We trust our own care better than the care of the hospital. So long story short, after being incredibly lethargic, really confused, glazed over eyes that were unable to focus, and barely speaking, some antibiotics and anti-nausea injections and IV fluid changed this girl into her almost normal self. Woohoo!! (ps. for those of you who were wondering, I am no longer sick. 3 days of antibiotics cleared up whatever I was sick with :))

Yesterday we headed up to Bolga and it took about 3ish hours to get there. We went to a village that our school supports through a project called Project GROW which was initiated by a Ghanaian named Vida. She grew up in this particular village, ended up in Nursing school, and eventually came to UBCO where she did her masters degree. For her masters project, she wanted to work with the women in her home village to determine what they needed to improve their health and the health of their children. One of the most important things they expressed was the importance of having their own money. The men were generating income, but rather than using the income for their family, they would often drink it away, leaving very little to support their family. Vida's project called "Project GROW" stands for Ghanaian Rural Opportunities for Women, and basically works to empower the women and provide them with the necessary resources for them to generate their own income. The men were very hesitant at first to allow anything like this to go on in their village, but now, the atmosphere in this village is so different from the other ones we went to, as a result of Project GROW - the men have a greater respect for the women, the rapport and relationship between the men and women is much improved, and the women were even sitting on benches when we arrived and these benches are usually saved for the most important people.

There was a ceremony that went on for a few hours and we were SO welcomed! The people see us as huge lifesavers and are so thankful for any of the work/fundraising that we've done for them. It was so awesome to be a part of such a great celebration of women and community. We gave them goats and donkeys with carts which will help them tremendously - the donkeys/carts will enable the women to take the things they make to other villages to sell them and generate more income.

There was lots of dancing and some speeches, and because some of our fundraising money also went to support a girls school in the village, the schoolgirls were there as well. One of the leaders of the project did a speech to these girls encouraging them to not give into the men so that they would not get pregnant and would be able to continue going to school. SO many girls get pregnant so early, drop out of school, and then run into money problems later on. My heart felt so full after being in the village all day! The thankful hearts of the village people were contagious - as a thank you for us, the women made all of us really nice purses. So nice, so, so nice. I believe that this is an example of true sustainability where they are not just being given money or resources, but are also being trained to better themselves and improve their life and their health. One interesting thing is that now that the women are making money, they have expressed a huge interest in becoming more literate, or at least being able to read numbers so that they can manage their money better and make sure they aren't being ripped off (ie. when they go to the bank). Hopefully there will be someone to help these women with that.

Tomorrow we have a final seminar type of class where I'm assuming we'll be talking about our experiences and transitioning back into life in Canada. Then on Monday we're having a going-away party at the Bigiza hotel (the only place we've found that has a swimming pool!) and we've invited all the friends we've made/hospital contacts we had. Then on Tuesday we're busing all the way to Cape Coast which I think is around 12 hours - will be a long day!

And then...

We will spend 5 days on the coast (CLICK HERE) and then 2 days at the Volta River. So excited. I first had some guilty feelings about taking a vacation and spending money on it after seeing and experiencing all I've experienced here in Ghana. But on the flip side, we are in Ghana, this place is not only heartbreaking but also gorgeous, and I think that spending time relaxing after this is also necessary. So, that we will do.

Hope life is grand!

Back to Civilization

So we arrived in Tamale this morning at around 9am. We woke up at 330am, packed up the last of our things, and got to the station around 430am. The bus was supposed to leave at 5am but of course that didn’t happen, haha. We were finally on our way and there was about 85+ people crammed into a 60 passenger bus. Needless to say it was a squishy ride, and the sleep I was hoping to get, didn’t happen. Once we got back to the Catholic Guest House (the same place we were staying in Tamale before we went to Gushegu), we went to the restaurant there and ordered REAL food for breakfast. So wonderful. So, so, wonderful. You really don’t know what you have until you don’t have it anymore. So thankful and so blessed to be able to eat healthy again. The next plan was to SLEEP but unfortunately mine and Erin’s room wasn’t ready yet so we had to wait, and wait, and wait. Finally around 12:40pm we got our room, and then the power decided to go out so the fans stopped working, meaning sleep was impossible. So…I’m tired. Haha.

The last few days in Gushegu were alright. It totally helped me that we had made friends with the nurses who were working there so that we could at least be occupied for a little while each day playing football and card games with them. Last night brought up a bit of a scary situation! I was walking back from the shower (you have to go outside to access it) and came across a snake along the path. I sort of freaked out, called Erin to come see it, and then calmly walked around it. It was green and looked like a Canadian type Gardner snake. Later on we told our friends who said “you didn’t kill it?! If you see it again call us we’ll come kill it”. We thought it was long gone, but a little while later Erin nearly stepped on it and so we called the guys over. They informed us that these snakes kill/bite toads and frogs and take the venom out of them and then bite humans, aka, if we got bitten we would’ve been admitted to the lovely Gushegu hospital. I’ve had many patients who were admitted due to snake bites, so it’s definitely not unusual here in Ghana.

I/we have been talking a lot about what we encounter in our clinical experience and why we tend to get so frustrated about what goes on. Personally, I don’t think it is entirely about a lack of resources and knowledge. It wouldn’t be farfetched for me to say that the nurses do not do very much, and even the knowledge that they do have, they don’t usually put to good use. Watching TV from 8am-9am until the doctors decide to start their rounds isn’t exactly right. That’s when vital signs and morning assessments should be done, but at the very least, you must look at all your patients to make sure they are okay. The mindset is so different here. Urgent situations are not seen as urgent, people nearly dying isn’t seen as a huge issue, and I guess they don’t have the legal issues to worry about if/when something is done incorrectly, like we do in Canada. Obviously we can’t waltz into these hospitals and expect anything to change. We can only do our best to advocate for our patients in the best and most polite/respectful way we can, and try to teach the nurses some things as our education level is much higher than theirs. Really, it’s ultimately about the patients and it’s tough for us to see them in such sick situations even when things CAN be done about it yet no one is taking initiative.



Tomorrow we are going to Bolga to see a village that our school has been supporting. They have focused on supporting the women because the husbands tend to take all the money and not leave enough to support the women and children. So our school has helped them to get their own income that they can claim as their own, in order to help support the children. We are also going to give them goats. Apparently it will be a long, long, long day with singing, dancing, drumming, goat giving, speeches, etc. We’ll see how it goes! It’s about a 2 hour drive north, and we are coming back in the evening.

Saturday is Independence Day here so we’ll likely spend time at festivals/parties around town. On Monday we are having a going away party where we invite anyone who we have met/made friends while we’ve been here. Then Tuesday morning our VACATION starts and we’ll be making the long bus trip down to the coast where we will get to sit on the beach, and relax. So excited!

That’s all for now!

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I can't seem to type on the picture post below so here's a quick description
1) Kintampo Waterfalls a couple weekends ago
2) Gushegu: The child health outreach clinic where we hung the scale from the trees and weighed the babes
3) Gushegu: me and a sweet patient I worked with on pediatrics
4) Gushegu District Hospital
5) Jaimee, Shawna, and Erin on our bikes in Gushegu
6) Us all ready to watch the mens gold medal hockey game which we didn't end up watching because we couldn't get the channel!! :(
7) Gushegu: two of our patients at the hospital. Twins who were very malnourished, they are 3 years old! The bigger one was still malnourished (huge belly showing protein insufficiency) and the smaller one was much more malnourished. So heartbreaking. So sad. So, so, sad. Their poor mother was basically raising the children alone and could not provide for them. Broke my heart.

Lifesavers

Since we’ve been in Gushegu we have noticed a few things that have saved our life. The first being our kettle that we bought in Tamale – one of the most important purchases of this trip. This allows us to have oatmeal and a boiled egg for breakfast and sometimes lunch since there’s hardly any food in this town (I did not know you could really boil eggs directly in the kettle…but you can). It also allows us to have our Nescafe instant coffee (I cannot WAIT to have real brewed coffee). Another thing that saved our life was our bike rental idea. We go into town a few times a day for a coke and water and sometimes manage to find more food like bread and Mr. Noodles type food (yet these are expired). A third thing that has saved me and helped me pass the time in this boring town is the Sudoku book I got in my Christmas stocking a couple years ago…Mom, that was a good idea. I have done SO many of these. The last thing that we are so thankful for is the wonderful hospital laundry lady! She volunteered to wash our clothes for us. Let me tell you, none of us are very good at handwashing our clothes so they were never actually clean post-washing, until Thursday after they went through the heavy duty laundry machines. Wonderful. And it only cost us $3 Canadian to get ALL of our clothes/towels/bedsheets washed. So great.

Sleeping is still a difficult task. The heat here extreme and we just have to grin and bear it. Sure it gets hot in Kelowna and occasionally in Vancouver, but…the heat can be escaped. A/C in cars and houses, going to work in a cool environment, being able to get cold water whenever you want it is also nice. None of those things exist here. We do have fans which are wonderful when the power is working.

On Thursday and Friday Shawna and I worked in the medical ward. Thursday began quite stressful. Our shift began and I walked into one of the rooms to find all the nurses/students around a patient’s bed chatting. I took one look at the patient and noticed that he was have a very very difficult time breathing. He was definitely in respiratory distress yet nothing was being done. Shawna and I came over and we asked the nurse if he had a bronchodilator ordered that we could give him to help open his airways and the nurse said “no he doesn’t have one ordered” and just stood there (there is no urgency in these hospitals…the patient was VERY unwell). Shawna and I kindly yet sternly told them to call the doctor to get something ordered. In the end, the doctor came and agreed with us and we right away sent the patient to the OR in case he would need to be resuscitated (that is the only area in the hospital that has the necessary equipment for resuscitation). Sure enough, he got intubated and ventilated. Sometimes it’s just a bit irritating to see something going so wrong yet nothing is being done about it! But...this is Africa, folks.

For the most part though, the hospital here is run much better than Tamale. It’s small and modern, and the communication between the staff is quite a bit better. None of the doctors are from Gushegu – there are 2 from Cuba and 1 from southern Ghana.

On Saturday we were asked to do a presentation for the Ghanaian Nursing students who are also doing a practicum here. We were asked to tell them what Nursing in Canada is like (the differences are endless) and our perceptions of Nursing in Ghana. This went over pretty well and the students were really receptive.

We have had some serious issues with getting food here. We have been told not to eat in town and there are very few non-perishable items there. We’ve been told that the kitchen that provides the meals for the nurses and Ghanaian nursing students will provide meals for us, but…this hasn’t been happening. It has been frustrating. I haven't had fruits or vegetables for a LONG time and none of us feel healthy at all. Not fun.

Today I was on the pediatric ward and I'm back there tomorrow as well and in the afternoon we’re doing another presentation for the students, Wednesday I’m in the OPD (outpatient department – aka emerg…sort of), Thursday we head back to Tamale, Friday we go up north to Bolga to see a grassroots project that our school is supporting there and then come back to Tamale the same day, spend a few days there, and then we’re off to Cape Coast for a VACATION!! We’ll also be hitting up the Volta River for a night or two which is south-east Ghana.

Hope you Vancouverites enjoyed the Olympics!! We tried to watch the gold medal game last night and got all dressed up in Canadian stuff/red and white but we couldn't get the channel on the TV at the hospital. Such a bummer. Gotta head out though! Dinner and football (soccer) time!

To those of you who have commented/emailed/facebooked me, thank you very much, but I can't respond for the next little while because I can't get on the internet very often. Sorry!

Take care all.