Final Update from America

I know that this is long overdue, but I have been busy. I did not account for any free time in my summer. I left 3 days after finishing finals and I started work less than 18 hours after I landed back in the US. This past week has been exhausting to say the least.

When I came home, my parents greeted me at the airport with flowers and a card. At home, our family friends joined us for dinner as a welcome home treat. After the short celebration, it was back to the reality of life in the US and the fast pace that I had somewhat abandoned in Ghana.

Before I left Ghana, I was able to spend my final day going through Accra and seeing many of the tourist sights that I put off for the last day. This included the Art Center, Independence Square, and the beach. After a long day in the city, it was time to say goodbye to the amazing friends I made in Ghana. I had the chance to work with amazing interns from the US and incredible Ghanaians. I made a special family over there-Eric, Douglas, Angie, Jen, Meghan, and Grace. Thank you all!

National Theater

Me, Eric, and Jen at the beach

Independence Square

Dancing Azonto with Angie

My attempt at dinner-Abandoned Noodles

Me near Independence Square

My last friend at the clinic

Survey Says...

In recent years, Ghana has improved its national infrastructure to achieve some of the Millennium Development Goals set forth by the United Nations. Inside Accra, Ghana is just like any other country, particularly regarding the healthcare. Korle-Bu, the teaching hospital inside Accra, has sophisticated machinery that one would expect inside a 21^st century hospital. There are also private practices that cater towards the upper class. Outside of Accra, the healthcare system is very different than the healthcare system within Accra. Inside Buduburam, a Liberian Refugee Camp, there is a hospital called St. Gregory’s Catholic Clinic. The hospital has two doctors, two medical assistants, numerous nurses, and numerous pharmacists. The education requirements for each of these positions differ greatly compared to the education requirements in the United States. Doctors in Ghana must attend school for six years and after those six years, they are allowed to perform surgery. Medical assistants were created for the sub-district level to fill the position of doctors. They go to school for four years and perform the same duties as the doctor except surgery. Nurses and pharmacists both go to school for two years.

In addition to the education requirements of each of these positions, the general function of each of these positions differs greatly compared to the United States. The doctors would come to work for about four hours a day. He would go on rounds through the different wards and perform any procedures that needed to be performed. Afterwards, he would go to his office and occasionally take a few patients. Majority of the patients saw the medical assistant. The medical assistant usually saw around 45 patients a day, but on a single day, he saw as many as 110 patients. Each visit is rather short, lasting around 4-5 minutes. The medical examination is merely a medical history, checking the eye for anemia, checking the skin for fever, and occasionally feeling the abdomen or listening to the lungs depending on the symptoms. The nurses, like nurses in the US, are the ones who interact with the patients the most. Some of the procedures that they perform in Ghana, however, are traditionally performed by doctors in the US.

I found that at times, the doctor was rude to his patients. In the US, most patients choose a doctor and establish a trusting relationship with their doctor. The doctor is rarely rude to the patients because if the doctor is rude, the patients will transfer to a different doctor. I concluded that since the patients do not have a choice regarding their doctor, the doctor does not have repercussions for his poor attitude around patients.

Compared to the US, the facilities at St. Gregory are from the 20^th century. Records are kept in composition books. The IV is not attached to a sophisticated machine that monitors every bodily function of the patient. The patients have bed pens rather than catheters. Majority of the conditions in the hospital are unlike conditions that would be found anywhere in the US. The wards hold about six beds for patients and the ward generally smells like urine. Compared to the technology and availability of space at hospitals in the US, the hospitals here are lacking. The conditions only get worse as you go further from the city. In more rural areas, the facilities are less accommodating than St. Gregory and the patients have to travel greater distances.

When thinking about the healthcare system, it is easy to assume that NGOs are improving the situation in Ghana. In Ghana, there are 500 NGOs in the Ghana Health Coalition, which operate under the Ministry of Health. Majority of these NGOs focus on education rather than the improvement of the healthcare system. Because the NGOs are not run by healthcare professionals, the NGOs do what they can to improve their communities through education, such as malaria education, nutrition education, and sanitation education. Y Grow, an NGO in Kasoa, has worked with USAID on the BCS project, the behavior change support project. According to the founder of Y Grow, the Western world helps the job because of the reception that a foreigner will immediately receive. The most effective role that the Western world can play in Ghanaian medical NGOs is by sending health teams to feel the “plight of the people.”

The Ministry of Health estimates the number of doctors in 2007 at 2,026. A recent census found that about 24 million people live in Ghana. According to some predictions, by 2025 the population will reach 32 million. If Ghana wants to achieve a doctor to patient ratio of one to one thousand, it would require 32,000 doctors. Many believe that the government cannot fund such an endeavor due to funding the education and employing all these doctors. Due to the lack of funding from the government, many have called for the privatization of healthcare. The Aureos Capital Group recently created the African Health Fund to invest in commercial healthcare in small and medium enterprises. They plan on investing in markets that provide care to the disadvantaged, hoping that these areas have a greater potential for growth from which Aureos will regain their investment. The World Bank Group has also pledged to engage in the private health sector.

Compared to education in the US, tuition at university or medical school in Ghana is not expensive. Although allowing the private sector to invest in Ghanaian healthcare might be beneficial, it does not address the real problem. Even with that investment, there will still be a shortage of doctors in the near future. The hospital I worked at only had two doctors. In the US, there are more than two doctors in any given practice. Without an investment in the education of these doctors, the population will continue to grow without a steady growth in the number of physicians. In my eyes, this is the most staggering aspect of healthcare in Ghana. Yes, their facilities are different than facilities in the US and so are their education requirements, but they both get the job done. Without an investment in the future, an investment in future doctors who seek to help their nation through healthcare, Ghana will fall behind. I think that this is where the Western world can do more, in partnership with NGOs in Ghana. The NGOs here focus on education and, with healthcare professionals from the Western world, they can help educate more doctors so that Ghana does have to rely on the generosity of doctors from more developed countries. This is what I believe has to happen in the future. Our current model of NGOs falls short on creating a sustainable solution to the problem.

The journey of a lifetime

Four weeks ago I set out on a journey to Ghana with the support of my family, friends, the Cheerful Hearts Foundation, and the Notre Dame Kellogg Institute. When my dad left me at the airport, he told me that if this became more of an endurance test than I was expecting, to push through it and do good work. I did not think it would be an endurance test. For me, coming to Africa was a dream because, as my friends know, I have an obsession with the continent. It was a life experience, but it did indeed become a bit of an endurance test.

My goal was to use my experience working in the St. Gregory Catholic Clinic as research regarding the role of medical NGOs in Ghanaian healthcare. St. Gregory is supported by the National Catholic Health Service and Point Hope. In addition, it receives interns from Cheerful Hearts on occasion. I am really thankful to all who helped me. In the end, there are a lot of valiant efforts to improve healthcare in Ghana. All the NGOs are trying to do this. They have a desire to help others just like our moral culture teaches us. This is evident by the mere number of NGOs. Ghanaians see the plight of their fellow man and understand that it needs to change. The problem is that as you spread the resources between the NGOs, very little gets accomplished. There are 500 medical NGOs at the national level in the health coalition, a country the size of Oregon. This is a staggering number and even more want to start NGOs. It seems like everyone has an NGO or wants to create an NGO. I was stopped on the roadside on multiple occasions by Ghanaians who wanted my help starting an NGO (as if I know anything about it). Another eye opening experience is seeing how difficult it is to improve healthcare. Where do you start? In my mind, I thought the solution to improving healthcare was educating Ghanaians in Ghana to build up the infrastructure rather than relying on more developed countries to provide medical missions. I realized during my time in Ghana, however, that there are deeper problems than educating the next generation of doctors. It is hard to make improvements to healthcare like this when the main cause of most medical cases in Ghana is due to improper sanitation. It is hard to provide proper sanitation when the roads are difficult to drive. It is hard to provide paved roads when the funds are not available. In recent years, more developed countries have been investing in Ghana to build the infrastructure, but according to one Ghanaian, the government takes cuts from the deal and this has negatively impacted the development of infrastructure. None of the NGOs that currently exist can see their intended impact when there is so much to be done. I do not know what the solution is, but I do know that Ghana can become more developed if people gave the time and effort to do so.

I have wanted to become a doctor since a very young age. As I have grown up, I have realized that my gifts need to be shared with others. I am not the smartest or greatest, but I do have many things that many would be envious of. When I was deciding which college to attend, I wanted to go to a school that would help me expand my ability to serve others. In high school, I was taught to “Be who you are and be that well.” To me, that means sharing my gifts by serving others. That was the main reason I decided to attend Notre Dame. A professor cried during class last year around Holy Thursday because every year she is reminded how special Notre Dame is. She said that more than any other school, we take the passage of washing others feet and serving others to heart. As I grow up and decide on medical school, there are three options. I can live a comfortable life in the US, serve others elsewhere, or do a combination of the two. I have realized that while serving others is very rewarding, I love my amenities. I had a difficult time living without air conditioning, clean water, and a washing machine.

I hope that my blog has not only enlightened you about my voyage, but also about life in Ghana. It is a lovely country with very friendly people. I know that people care either about me or about Ghana because this blog has gotten over 700 hits in the past month. Thank you for all of your support over the past four weeks. I have had the experience of a lifetime and I hope you have enjoyed reading my blog.

Fin

Today was my last day at work. I took 60 patients with Oppong. The most interesting case was an old woman, whom I have seen 3 times over the past month. When she originally came, I diagnosed her with pneumonia and gave her antibiotics. Since then, her lungs have gotten worse. She was admitted earlier today, with the hope that being in the hospital might help get rid of the pneumonia. Aside from that, it was a long day filled with lots of goodbyes. I got a quick Azonto lesson from Vida before I left for home. My final cry count is 5, but I made an adorable friend today which makes up for the crying kids.

Red-red night was awesome, as usual. I bought some ingredients to make spaghetti tonight. Jen bought cake for the celebration tonight. I am really excited about celebrating my final night in Ghana in the company of close friends. I am also excited because Meghan is coming back just in time for the celebration. Tomorrow we are going into Accra for the day to see more sights and drop me off at the airport. Prayers for a safe flight home.

I have more photos that I will upload when I am back in the US for the final post. Thanks for all your support. Have a good weekend!

Thursday...Rebecca Black's new "Friday"

Today was my second to last day in the clinic. I started the morning dressing wounds with one of the nurses. Afterwards, I took patients with Oppong. There was an interesting case regarding a possible sickle cell disease patient. She has a twin sister who is ss, but she tested negative. Oppong says that her features are characteristic of sickle patients and he does not believe that she is negative.This girl has an enlarged spleen and Oppong originally thought it was a result of her sickle cell disease. Oppong gave me some videos for Azonto. I think I have to practice tonight so I can impress everyone tomorrow.

Tonight is the last meal Angie is going to prepare for me. She told me she is going to make red-red, my favorite. I promised her a few weeks ago that I would make something American for the last night. I know that spaghetti is technically not "American," but it is really easy to prepare considering the kitchen I will be cooking in.

I finally have some pictures from work. I hope you enjoy! Also, HAPPY 30TH BIRTHDAY MOM! (You get 20 years off for good behavior.) I am really excited to go home very soon, but I am sad that I am going to be leaving some great people. I have made numerous friends here and it is going to be hard to say goodbye to them

Dressing a wound

Oppong and Me

Exhausted after a long day

It is the final countdown

Today was the last hump of my trip. At work, I took patients with Oppong. We saw 64 patients before 2pm. I was supposed to learn how to dance Azonto from one of the nurses, but we were too busy for dancing lessons. Nothing exciting really happened at work today. You know it has been a long day when the most exciting part of the day was when a street vendor sold me a water bottle with a leak in it.

Last night, we watched X Men. I slept during the movie because I was exhausted. We had noodles and vegetables last night. I am hoping that we eat red-red soon. As I get closer to my departure, I am becoming more anxious about leaving. As most people know, I like packing. I have slowly started packing all my belongings because I am excited about leaving for home. It is going to be hard to get through the next two work days, a day in Accra, and 21 hours of traveling.

I declare today a holiday

Today I woke up just like any other morning, but there was one big difference-the sky was very dark. Eric started singing the rain song and shortly after his song, it started to storm. I still needed to get ready for work, so I went into the shower during the storm. During my shower, we lost power. Jen, Grace, and I decided to have a holiday today and only work in the office because when it rains in Ghana, life usually stops. During bad storms, children do not have to go to school and most people do not expect you to go to work.

Last night, after spending a few hours in the office, we decided to head home for dinner. On the way home, we met some little children shouting Obruni at us. I decided it was the perfect photo-op, so I attempted to talk to them in Twi. They were really excited, particularly about the touchscreen on my camera. When we got back to the house, we indulged in some American television from Grace's laptop. I have never been so excited to watch an old episode of Modern Family.

A high five is the key to any new friendship

My newest friends

Go Irish translates into any language

Just another Manic Monday

Today was my last Monday in the clinic. Mondays are very busy, so I was happy to survive the day. I sat in the consulting room and received patients with Oppong. We saw 72 patients by the time I decided to leave at 2:30. For some odd reason, the kids were loving me today. I did not make any children cry and I made tons of friends. I should have known that today would be a good day when I met a little girl on my walk to work. Her name was Mary and she asked if I could walk with her for the rest of the week. After work, I caught the end of  a malaria presentation at a local school. Jen and Grace have been working on public health in Kasoa and so they have been giving presentations at the local schools.

Last night, Angie prepared "red-red," my favorite meal. I ate all of it, which is a rare occasion. Afterwards, Eric played on the keyboard. He sang the Amanda song, which asked me if I was tired and sleepy. Just like at home, I am known for being sleepy and sleeping a lot. It is a weird thought knowing that I will be back home in a week and starting work at 8am next Monday. Hopefully the work week flies by at just the right pace, fast enough that I do not become too anxious to get home and slow enough that I can savor my last week in Ghana.

Red-red

Eric playing for us

I ate all my food-Angie was very happy

They are "listening" as Jen and Grace give a presentation on malaria

Adding to the gang

Yesterday we decided to go into Accra rather than explore Volta. Transportation can be complicated and tiring, so we decided to hit the city instead. At noon, a new volunteer from the US came. Her name is Grace and she is a Cornell student. After picking her up, we went to lunch and then decided to see the National Museum. The National Museum is not very exciting, but there was a malaria exhibit that Jen really wanted to see before it left. The malaria exhibit was interesting, but the rest of the museum was not up to the expected quality of a "national museum." Additionally, a man came over to me and told me that if I wanted to take pictures, I had to pay 20C-more than 3 times what I paid to even enter the museum. I told him that I would put my camera away because I didn't want to pay the money. We were going to see other sights in Accra, but we were too tired.

We went home and relaxed for a bit. When we wanted to go out for dinner, a storm came. I hate the storms because they turn all the roads to mud, but I do love the cool air that they bring. We went to dinner at XXX, a restaurant near the Liberia camp. While we were at the restaurant, they broke news regarding the cargo plane crash in Accra. It was weird to know that we had been in that part of the city a few hours before the crash. My prayers go out to all those who lost their lives in the crash and their families.

As I enter my last week, I find that I need to get sentimental about doing certain things for the last time. Earlier today, I did my laundry by hand for the last time, which was a very nice feeling. I miss the washing machine. I have also started to compile a list of things that I want for when I come home (Mom and Dad, I am giving you fair warning.)

1. I call the washing machine for when I get home

2. I want a tall glass of water from the tap

3. I want to take a nice long shower

4. I want to use a fully functional toilet and toss the toilet paper in the toilet

5. I want the A/C on full blast

6. I want something very American for dinner on Sunday-burgers or steak

7. I want a welcome home party with a bonfire and ice cream

8. I want everyone to welcome me at the airport in 1 week.

I hope everyone had a great weekend. Cheers to starting my final work week.

Tro-tro

A storm approaching

Tired intern-Grace

Let it rain!

Douglas and Jen-this sums up their relationship

Angie making jollof

Cheerful Hearts interns-Me (Notre Dame), Grace (Cornell), Jen (Yale), and Meghan (Tufts)

Me and Douglas

Stools in National Museum

Traditional Cookware

Traditional Kitchen

"No Shaking"

Cheers to the Weekend

Today was a pretty typical day at the hospital. I went on rounds with Oppong today. The most interesting case was a young boy who came in yesterday with malaria three plus. He was having convulsions and coming in and out of consciousness. Today, he is doing much better. In the consultation room, an emergency came with a woman puking everywhere. She was puking bile and was admitted for gastroenteritis with severe dehydration.

Outside of work, I tried to watch the live feed of my little brother's graduation. Unfortunately, I missed majority of it because I was at work and the connection was not fast enough for the link to work. I am sorry Patrick! I am very proud of you and am sending my love from Ghana. This weekend is my last adventure. At first, Jen and I were going to head out to the Volta region to see some natural sites like the Wli Waterfall. I decided earlier today that it might be better to go to Accra because Jen wants to see a malaria exhibit at the museum and the exhibit leaves on Tuesday. Additionally, I need to buy a few more gifts for my family. Eric will be going into Accra to get another intern named Grace. We still have some time to decide, but I think Accra is the better choice.

I hope everyone enjoys their weekend. CONGRATULATIONS PATRICK!