Back in Edinburgh

"So, what's it like being back?" is often the next question. The first is usually "How was Africa?", to which I respond "fine thanks": Wiseman's 'Hand of Thole' is very much alive in my life! As you can imagine, this doesn't really cover it, but the true answer should probably come with the warning: 'you may have developed pressure sores, wrinkles and grey hair by the time I finish - are you sure you want to know?'

I had fully intended to close this blog at the last post until I was reminded that the narrative isn't really complete without the return back home. Which is something that many people consider to be sufficiently traumatic, as to warrant careful consideration and preparation. I neither considered nor prepared for my return home, and so it was that I flew in on Sunday morning and returned to work on Monday, with perhaps a not particularly clear head. 

However, it was a good week at work which passed uneventfully enough. In fact, save for six weeks worth of e mails, there was so remarkably little to catch up with that I may as well have never been away. It is a bit depressing to find that one's absence is so insignificant!

 It is an unusual thing for me to receive comments regarding how 'un pale' I am. It is all relative of course and I have just spent six weeks answering to 'white person' in Ghana, where everyone is darker than me - even my fellow white people :o( I guess anyone might change colour a bit if you put them in the sun (lots of it) for long enough - even me! But it came as a surprise since I had been entirely unaware of this until I arrived back home. 

I plunged straight back into life in Scotland without much pause for thought. I was even on call on Tuesday night (rotered on for Monday, but quickly swapped at lunchtime with a friendly colleague who took pity on me). The weather was beautiful (though this only lasted a week) and I relished the fact that I'm not sweating all the time  or caked in suncream and I have fewer potholes to swerve around than I have grown used to. I would like to emphasise the relative aspect of this - not to let Edinburgh council off the hook for all those that will start to bug me again shortly.

I experienced no significant reverse culture shock the first week, and was relieved to find myself quite un-phased by the contrast in environment and way of life. It took a week or so actually,  before I noticed the flatness that always seems to accompany an anticlimax, and the sense that something is missing. Maybe it is the sun: I find nearly anything can be blamed on the rain if you try hard enough!

But I went out to buy pineapple anyway, just to be sure that that wasn't it - I had to wait a week before it even began to resemble what I have learned pineapple should taste like, and it didn't make me feel any better after all. So I set about catching up and concluding the blog and posting my photos to facebook. This is something that I must confess is a first for me, preferring normally to leave it to everybody else and then to steal their photos.

I should possibly also confess to being ever so slightly disgruntled by the absence of friendly (non parental) comments in response to all my journaling efforts. I discover this week that I could have altered the settings to make commenting a bit easier, but console myself with the righteous thought that if you were determined enough it could have been done, and checking or changing settings while the technology was so slow wasn't an appealing prospect. Or wouldn't have been had I thought of it!

My mood is not improved much by my persisting tendency to be awake by 6am at weekends, regardless of how long I have or haven't spent sleeping by this time. And particularly when this is not the case during the week. However, week two got better eventually and it is now 9pm and still light outside, which doesn't happen in Ghana. I bought a new camera last week, while I was still remembering how much I needed one (!) and followed that up this week by replacing my mountain bike which died back in November (while I was some distance from home, having just watched the rest of 'team gym' drive off into the distance). 

I had a fight with my computer this weekend. This is not unusual in itself: what is noteworthy is the fact that I won, though this was was probably due to the less than technical nature of the fight. Despite sustaining a few injuries and coming out feeling as though I had just beaten AQ on the rower, I eventually overcame it and knocked it out (with the help of my long lost hammer) by about lunchtime. It spurred me on to actually getting my new camera out of its box and learning how to use it. There has been, I believe, a commendable lack of procrastination recently!

So, to answer the question......."what's it like being back?"

"Fine thanks"

:o)

Coming Home and final thoughts.

The taxi left our house in Hohoe around 15.30 on Saturday since it can take nearly 4 hours to get to Accra and my flight is at 22.40. There may have been few people around to see me off but  Ghana was very sad that I was leaving: she cried so much at my departure in fact (loud thundering sobs) that I seriously hoped Prosper was wearing special X Ray contact lenses and could see the road better than I could. 

The whole trip was otherwise fairly uneventful - which is probably the best way for a long trip to be. There were the usual familiar and tedious safety announcements: I usually try to ignore them (I might be sorry one day when my plane runs into trouble), but today, like traffic updates, they keep cutting across the movie I am trying to watch and I have little choice but to grumpily pay attention. I am also slightly intrigued by the air hostess' accent which seems to be a slightly odd combination of Irish and cockney. 

It is an overnight flight butI have as much trouble getting myself to sleep as my dad used to have when I was two - he used to resort to feeding me whiskey apparently, when all other sleeping aids and medications failed. I am usually quite good at sleeping but not for extended periods and not when I am forced to do it vertically. My dad, incidentally, who I like to blame for my travelling insomnia, is an anaesthetist....

We are served breakfast at around 5am and I nearly get tricked by what I suspect was a piece of chocolate cake disguised as malt loaf: it's sneaky stuff, chocolate. Still, I am excited to be back and the relief of getting off the plane to Scotland's natural air conditioning (as opposed to Ghana's overwhelming heat) is huge. It seems incredible that in 12 hours I can live in two entirely different worlds, separated only by a bad nights sleep.

One of the biggest personal challenges I faced in Africa was the slowness of pace and the vast amounts of free time. I am, on the whole, quite happy to have free time to myself, but that is when I have plenty of options for filling it. If you have ever been subjected to my random ponderings (which I suppose you have if you have been following for the last 6 weeks) you might appreciate how daunting for me was the prospect of a large amount of thinking time. Which I took the time out to seriously worry about, even before leaving Edinburgh!

Time takes on a different meaning in Ghana: it is not a commodity to be traded or guarded and I found my own attitude to what I was doing, and how much time it took, adapted significantly. I was more prepared to wait longer for something to happen, with no idea when this might be, and I would find myself stopping for extended periods to pass the time of day with somebody I didn't know, or shrugging off the inconvenience caused when things or people didn't run to time or amenities failed, making prior arrangements impossible. Maybe because I had no choice or was not really told about said plans in the first place, or maybe because I simply had nothing better to do. It was a very different perspective on life for me and in many ways, knowing that it will be unsustainable at home, I will miss it.

It is my approach to time that normally prevents me from keeping a journal (I am extremely bad at it): I resent the time it takes me to stop what I'm doing today, to write about what I did yesterday (though this of course, reduces the amount of stuff I will have to stop to write about tomorrow!). In Ghana however I have been glad of the project that this blog presented (and the time it filled) and I would like to thank you for giving me reason and motivation to persevere with it. Even if you weren't reading it - I didn't know that, after all. Thank you especially if you took time to comment on it (mum, you earned many brownie points) or otherwise e mailed to encourage me. As much fun as it all was, there was much at home that I missed and I was grateful to hear from you. 

But my African adventures are over - for now - as is the marathon documenting of them. There is still post-travel stuff to be done: things to think about and learn from, fondly remember or relish not having to do anymore, photos to try to recover from my stupid camera, which might as well have stayed lost, and recovery of some semblance of fitness which has probably all ebbed away from lack of exercise. Better close and get on with it then.....

Reflections

Personally, I don't tend to watch a film twice, because I prefer not to know what is coming next. But I should, since it is often only on the second or third viewing that I notice the interesting and amusing details that I missed before, while I was concentrating on the plot. And so it is with my six week 'viewing' of Ghana: the longer I stay, the more I notice (or have pointed out to me)....

I have learned that the left side of the face is not particularly accident prone after all, and the scars are tribal markings, carved into the person's identity as an infant. I notice the teddy bears that are tied onto children's backs in imitation of their mothers (much as a child over here would push a miniature pram). I know to expect the crowd around a tro tro when it stops and how to attract their attention (other than simply being white) and I don't worry about the fact that the door is tied on with string since I haven't known one to fall off yet. 

I know the difference between a greeting and a beckoning wave and when it is or is not a good idea to respond. I am no longer surprised when I see a child wandering around with a whopping umbilical hernia (I still ponder the practicalities of wearing clothes over it though). I am used to the sky flashing like a christmas tree and know that when the road starts flying into the sky I have only a few minutes to run for cover. 

As my time in Ghana was drawing to a close, I found myself reflecting on the experience - good, bad and challenging, and contemplating my return home. When I was planning the trip I was told "come with as few expectations as possible", and it was true that I really couldn't picture what I was going to find. There were, however, things that I had been warned about and was prepared for....

I was not surprised or shocked by the comparative lack of facilities, the temperamental nature of running water and electricity, by the poverty and poor hygiene or caution required in assessing things for edibility. I had anticipated the heat and been warned about 'Ghana time' which doesn't involve schedules (hours may as well not be divided into minutes), and where lateness is so expected that it doesn't even merit an apology.

I also knew that I would be a novelty, sticking out like a sore thumb for the duration, and I wasn't even hugely taken aback by the not infrequent and unceremonious marriage proposals! Despite being a happy nation on the whole, many Ghanaians people believe that all their problems will be solved by money and a ticket out of Ghana, something that we Yevus apparently represent. I will not, I have to say, miss most of these things!

I came prepared for a culture shock and possibly to find the circumstances difficult, but in fact the only thing that I found truly shocking and had not anticipated was the attitude of many of the staff in the hospital: their detachment from those in their care, and their lack of empathy and compassion. Life is expendable, and death is expected and allowed when it could be so easily postponed. Maybe it is just that suffering is so commonplace and people are simply desensitized to it, or that life is valued less and death feared less. Since attitudes to life and death are not easily comparable entities, I will probably never find out.

More widely than health care though, innovation and initiative are not employed that often - many people don't think within the box, let alone, outside of it. Team work is not an important part of the school curriculum, with the result that within hierarchical structures people can be fairly inflexible and maybe have less ability to take another perspective or stand in somebody else's shoes. Can't blame them really - feet over here can be quite disgusting I have discovered - even mine :o)

In schools, children are taught to recite facts and figures but do not understand their context or significance or learn how to apply them. This they take with them into adulthood, in many cases, where they carry out their duties and fulfill their job requirements but often with no recognition of social graces or courtesy. There are some elaborate customs defining social interaction, many of which I would find most daunting left to myself, but much behaviour, even to other Ghanaians, is simply rudeness. Or ignorance, and I will not miss this at all. Particularly since I will also find it at home.

I will definitely miss, however, the other side of the coin, which, I would like to stress, is bigger. The longer I stayed in Ghana the more I encountered the Ghanaians' warmth and hospitality: they will generally do anything for their friends (and they will readily include you among them), or in fact anyone they meet. It is not uncommon to see them drop what they are doing, at a minute's notice, to help a stranger move house or personally chaperone somebody asking for directions, some fair distance, to his destination. 

I have had many an in-depth and insightful conversation with the locals in Hohoe, often huddled under canvas shops, sheltering from a downpour I have just been caught in. Or with people who had accompanied me all the way home, just for the chat. I found myself discussing the country's religion, business, politics, education or health care, and exchanging e mail addresses, with people I had met moments before. 

I will miss the amazing scenery, surrounded by mountains and thick with palm and coconut trees and other leafy greenery. I came to like the familiar rough mud tracks and obscure routes into town - and frequently challenged myself to do them in the dark by forgetting my torch - sometimes even on purpose! I will miss the spectacular flashing skies and incredible 'instant thunderstorms', though I might not miss the dust clouds and power cuts that accompany them, nor the cavernous pot holes in the roads or the monstrous speed bumps, or the uncomfortable feeling that I take my life in my hands whenever I get into a tro tro or cross the road.

I will miss the staff at the home base: Alpha's  long drawn out welcomes for example ("Helloooooooo feeleedah from Edinbeeerrg...."), Makafui's "Ehsssellent" enthusiasm, Akos' dry humour, Joe's passionate anti smoking campaign and Atsu who regularly scored me on my Ghanaian handshaking skills (usually with a resigned shake of the head). I will no longer be able to help Roberta scoop all the water out of the large porch with a dustpan and brush, or watch as she sweeps the lawn with her grass - broom, and I am disappointed I will have no more 'carrying water on my head' lessons from Rebecca. I never really got past the first one actually but that might be because she tried to start me on a full bucket! I also shouldn't forget the CCS van that had so many cracks in all the windows that autoglass would have had a field day, but which Dela lovingly cleaned and dusted every day anyway.

I will miss the local seamstresses, Roberta and Beatrice, and particularly Beatrice's grandson, Calvin, who used to launch himself at me as I arrived and point out all the things I had 'forgotten' to bring with me. I'll miss the kids next door who played cards with me and taught me how to count in Ewe, among other things, as well as the physiotherapy staff and patients who did their best to understand my broken Ewe and teach me new words or, failing that, enter in good spirit, into another frustrating game of charades.

I will also miss the animals: the enormous pigs, tied one to a tree, on the road by the hospital, and the sheep and goats which roamed everywhere, bleating noisily as though they had just got lost in the supermarket. I won't forget the baby goat which got stuck in the gutter: we stood there stupidly wondering how to help as it launched itself at the sides, until one of the locals jumped in to rescue it. Stupid Yevus!

I loved the enormous gobbling turkeys (I'm not sure I've met one before in such close proximity - during it's lifetime at least) and the mornings will seem quiet without the cockerel which crows reliably early, in a most un- Ghanaian fashion. I will particularly miss the lizards scuttling about: I never got tired of watching them but sadly never succeeded in catching one or even getting close enough for a decent photo. And the frogs which made the evenings as noisy as the cockerels did the mornings. The animals made themselves as much at home in the hospital as they did everywhere else however, and I doubt they washed their hands on the way in!

Life will not be the same without the chicken and beans and pineapple, and I might have to go hunting for some plantain when I get home. I would also miss John's omelettes if it weren't for the fact that I am so much enjoying having cornflakes again. Cereal was not a popular option considering the difficulty of keeping milk. Or finding it in the first place even: Maybe I should have spoken nicely to the sheep and the goats.

Quite apart from cornflakes, I am enjoying the speedy and readily available internet, wearing a sweater, sleeping past 6am, using a washing machine rather than hauling water out of the well, and being left to shop in relative peace without having to justify at length not spending my money on something I don't want. Possibly what I missed most while in Ghana (apart from all of you, of course) was my anonymity in a crowd, and I'm happy to have left my celebrity status quite firmly in Africa.

Happy Easter from Accra

I decided that over Easter, and my last full weekend in Ghana, I should make an effort to see a bit more of its capital. I also have a friend in Accra, Valerie, whom I knew through Pantygwydr, my church in Swansea. I had not realized she had returned home to Ghana until the week before I came out here and we tend only to chat on facebook these days, but she invited me to stay with her and her family for the weekend.

My tro tro catching experience was quite painless: I didn’t need to catch it at all in fact, since it came and found me before I had even reached the station. I wondered whether I had inadvertently had 'Going to Accra' stamped across my forehead, but I wasn't complaining. Apparently there were so few people traveling to Accra from Hohoe at Easter that it was setting off almost empty and looking for passengers on the way. Two people work on a tro tro – one drives and the other collects passengers and fares. When you are not in Accra, the fare is paid sometimes at the start of the journey and sometimes at the end: maybe the certainty of arriving is not always sufficient to induce people to part with their money before they receive what they are paying for.

So I had a comparatively comfortable ride – in a physical and spatial sense of the word at least (I had leg and head room). In an auditory sense it was less comfortable due to the worship songs playing for most of the trip. They were not offensive in themselves, and were even the kind that DC would approve of (well below the MP1000 mark). Like me however, he might have been less enamored with the volume at which they were played: AQ's quote for DC could feasibly have been adapted to 'this traditional music is hurting my head'! 

I must also remember to tell the music team that Hazel and Jody are being underused in Bellevue, since I have never heard these hymns played with quite so much bass. I am not sure I am going to get used to it, but as I barricade my ears with earplugs I remember that bass is fairly immune to them. The peace returned a few times when the radio lost its range but unfortunately it soon recovered.

Valerie's parents have built their own home (in fact they are still building it) with a bakery attached, and I woke the next day to the sound of the dough mixer bashing the dough around with it's huge pincer like forks. I watched as it got squashed in the roller system and then was allowed to join in the 'moulding it into bread shape' stage. This is finished by about 8.30am and the rest of the day is spent baking it - up to about 75kg worth of flour. Not by us though - Valerie and I went into town, starting at Korle bu Hospital which is the biggest and most specialist in Ghana and to which patients get sent when no-one else has the facility to treat them. Cindy (one of the physios in Hohoe) met us unexpectedly at Korle bu and gave us a tour around.

After parting from Cindy we wandered through the market and stopped for coconuts: they cut the end off with a machete and you drink the juice, you can then give it back for them to slice in half and cut you a coconut skin 'spoon' so you can scoop the flesh out. We took a tro tro out past the presidential residence and various other important landmarks which I have forgotten about, and ended up at the beach for a while before heading home.

 The crowds and the traffic were fairly chaotic and I was glad that, being Easter, it was 'unusually quiet'! I am also glad I do not need to regularly get about by tro tro: the fare will be taken for a given destination but the driver may change his mind en route and decide not to go there at all. Sometimes the only option is to get off and walk to your destination, or to the nearest tro tro station to try again, and there was understandably much frustration and heated argument when this happened. Which Valerie most obligingly and entertainingly translated for me.

These were not the only heated arguments I was treated to on tro tros. Many passengers who were offended by the conductor (and this happened often) simply walked off to board the next tro tro going the same way. It's not really in the tro tro's best interest to insult a 'yet to pay customer' and most annoying to the others on board who are waiting for it to fill up and get going. Passengers also found plenty to fight about amongst themselves - on one short trip, a good five minutes was spent by half of the tro tro occupants, bickering about who was sitting where - to the great amusement of the other half of it's passengers.

Back at home we had soup for dinner, served with fried fish and fufu. Fufu is a traditional West African starch made by boiling things like cassava, yam, plantain or rice and then pounding them on the floor with a large wooden pestle until they turn into a glutinous mass. It looks like a large blob of dough sitting at the bottom of the soup and is designed to be eaten with fingers (yes, even in the soup): you scoop it out using a 'finger against bowl' technique which I didn't really master. We didn't stay up late since most of the household was aiming to get up around 5am the next morning to get ready for church. We were going, thankfully, to the service held from 9am - 11am, in English (rather than the Ghanaian dialect one from 6am - 8am, or the English/ French version from 11am - 1pm).

The service, though much bigger and definitely livelier, was otherwise very similar to church services that I am used to back home. The hymns were familiar and I was not left wondering what was going to happen next, something of a relief since it is not easy to sink inconspicuously through the floor when you get it wrong. Traditionally many people here wear white to church on Easter Sunday to acknowledge the ressurection (just as they wear black on Good Friday). I did not manage this bit and Valerie and her mum very kindly didn't either - don't know whether that was on purpose or not. 

The welcome team take you into the visitors corner after the service if you are new, sit you down, hand you a drink and quiz you on what you think and how you felt about the service. I told the nice lady quite genuinely that I had really enjoyed it. And followed that up with saying I would be very unlikely to return any time soon!

We had lunch and then headed back to the tro tro station: there was an empty tro tro there destined for Hohoe but there was only one other passenger and nobody else seemed to be arriving, so the driver decided he wouldn't go to Hohoe after all. It was lucky Valerie and her family had not yet left me there and we went off to try another tro tro station. Thankfully we found a nearly full one which was definitely going to Hohoe, and there ended my Accra experience and my Easter break.

Religion

At home, despite the fact that, on the whole, christian values are accepted by many people as a good way to live, the majority do not regard the bible as truth or accept it's teaching. I found myself living in an entirely reverse situation in Ghana where the scales are firmly tipped, publicly at least, from the secular towards the sacred. 

The country is overtly and loudly christian, and people, places, buildings and businesses all seem to be named or labelled to reflect this. Signs are posted up everywhere declaring Gods word and it is unusual not to be attending church on a Sunday: In fact if you don't look as though you have been to church at around 'church time' you might even be asked what your excuse is and given an impromptu sermon on the subject.

This was the experience of several of my fellow volunteers who, with Darwin on the side of science and evolution, were most definitely opposed to Creationism, and whose views were not culturally popular. Personally I didn't enter into any debates on the subject: it would have been a bit like trying to convince the Scottish or Welsh to support an English football team. Against anyone!

So it was a funny two sided world that I lived in: worship songs blasted from everywhere, most days of the week, most hours of the day (crucifying my favourite songs until they were almost unrecognisable), while Gods name was regarded with a degree of contempt in what was, for six weeks, my home. It struck me that, despite our differences in culture and background, experience and view of the world, I may have had more in common with some of the Ghanaians that I met, than with some of my fellow volunteers. 

However, even without the presence of foreign volunteers, Ghana has its inconsistencies and doesn't always seem so sure of its values. Patients in hospital, for example, suffer and die needlessly whilst the staff who are paid to care for them are busy watching programmes on TV about the love of Christ; it is unusual to see anything given freely unless there is a large audience (most people simply didn't believe that as volunteers we gained nothing financially from our trip); and 'the extra mile' is as yet, a road almost untravelled. 

There are of course many exceptions and there is much middle ground, but the contrasts in values that you see everywhere, living side by side, are striking. 

Last week in Ghana

I returned to Hohoe from Accra on Easter Sunday in order to go to work on Monday this week. It is a holiday but I am free to go into work if I want to, so I do. The kids with burns on the ward would definitely qualify for an on call service at home but of course there is no such thing here and they have barely moved since last week. I do as much as I can to remedy this, whizz around the other wards and leave a bit early, just as the dust is whipping off the road and around the sky, warning of an imminent downpour.

Said downpour only takes a few minutes to arrive and leaves me sheltering sociably in several different stalls with the locals on the way home. I try to use the internet but the electricity keeps going down, which is bad for business when you run an internet cafe, so after a bit of starting and stopping, Godwin, the manager, shuts up shop for the day, and I go home.

On Tuesday we went to the children's ward armed with i pods - for dancing to, play dough - for our new found 'play dough elephant' craze and lots of noisy activities which possibly lead the staff to believe we have lost the plot altogether. Some things, for the family at least, are a bit cheerier but I didn't hang around for the dressing changes.

Wednesday is visiting Likpe caves day again and I decide to go along, partly for the exercise and partly because the 29 year old stroke patient (from Likpe) who has yet to regain any real function, was discharged home last week with no wheelchair and no follow up with physio. I am not convinced she will attend the loose arrangement to reattend the hospital in a couple of weeks so I am hoping to visit her at home to at least give her a firm appointment and see how she is getting on. 

It is slightly more challenging than my usual home visit in that this patient has no phone number, she doesn't know I am coming and her 'address' consists of 'Asorkor's house, Likpe Todome', so I have to hope I meet somebody who knows her and will take me there. Amazingly enough I do, but after a bit of investigation I discover that my patient has been sent to prayer camp where she might stay for several weeks or months. Prayer camp is a long way away and I can't visit it :o(

It is a good job that I didn't go into the hospital on Wednesday in any case, since the previous day the dispute that Kristina and Julianna had been having with the nursing staff and medical director over the burns kids, reached a climax of bad feeling and unpleasant exchanges resulting in them being banned from the children's ward - dismissed from their volunteer posts! Unfortunately for me, the director's relationship with 'volunteers' is now such that, by association, I also find myself evicted, leaving me with two days remaining and no placement to attend.

I have agreed to meet Cindy in physio so I sneak into the hospital in the afternoon. I am perhaps overly nervous about the prospect of being spotted but I realize, as I glance around furtively, that since I have never met the director I have no idea who to be avoiding. It is, sadly, not safe to go across to visit the kids and I feel disgruntled :o(

On Thursday I go to the Christian Orphans Home with Becky to help teach the kindergarten and P1 how to count to five. Which proves more challenging than I might have believed six weeks ago. The orphanage is better equipped than most  and we spend quite some time watching a dvd on the laptop, of the kids acting out the crucifixion (recorded during the many hours they spent on Good Friday marching around Hohoe). In many ways it was nice to go somewhere else, to experience school in Ghana, and see for myself what the other volunteers spend their time doing in the mornings. 

As much fun as all this was though, on Friday I decide to abandon work altogether (feeling somewhat disobligated to anywhere in particular) in order to visit Ho. Ho is the capital town of the Volta region and a place that somehow I have never got around to seeing. So I said my goodbyes to most of the other volunteers, who would be spending the weekend in Accra (and gone by the time I returned) and caught a tro tro which got me there by about midday.

My confidence in Ghanaian driving is never improved much by the frequent burnt out and bashed in cars that we pass at the road sides. It was particularly not helped today by the large tanker lying on it's side, with people dancing around trying to transfer whatever it was carrying to another tanker, which is blocking a good deal of the rest of the road. We passed it again, lying alone, on the way back: I wonder how long it will stay there.

Having been escorted (quite some distance) from the tro tro station to a recognizable central point by a friendly local, I wandered off in one direction looking vaguely for the ever elusive ice cream and some souvenirs. I eventually took a break for a while at an awesomely large and speedy internet cafe before going off to explore the other side of town (which was remarkably similar to where I had been earlier). 

Things were livelier back at the tro tro station: I watched as one tro tro ploughed through a space that really wasn't big enough for it, taking the door of another tro tro with it and almost ripping it off completely. It moved on with much shouting and shaking of heads as the tro tro waiting behind blasted it's horn impatiently at the delay. At least there is entertainment to pass the long wait to go home.

Waterfalls and monkeys

Time is whizzing by and the new volunteers have arrived so we are on my second round of activities and excursions. African drumming was first and I thought I would get some decent photos this time around. I was carefully manoevring myself towards a good vantage point, trying not to get in the way of anybody elses photo, when I stepped on a loose plank of wood. After falling unexpectedly into the ditch I recovered myself to see that Rebecca, who was sitting on the other end of said plank of wood, had been catapaulted right out of her chair, onto her knees on the concrete. Not such a good start then....

The new volunteers by the way are called Amber and Jamie. Amber is American, in her early thrities, married (and has an amazing wedding story to go with this) and is in Ghana for three weeks. Jamie i2 23, from Perth, Australia, and staying for twelve weeks. They are both working at Happy Kids.

The Wli (Agumatsu) waterfall trip was next. It is about a 40 minute drive out to the bottom of the track from where you walk another 40 minutes or so to the bottom of the falls. The waterfall is the highest in West Africa and you can wade across the shallow water to stand underneath it, though you have to walk towards it backwards for the last 5 metres or so because the force of the spray is a bit blinding. You also can't stay under for too long since it feels a bit like somebody has turned up the knob on your power shower to 'blast the dirt off with no need for soap' level.

In the interest of amusing tourists like myself, somebody periodically comes along to frighten the bats out of the cliffs, where they are flapping about minding their own business, by whacking a large stick against a metal barrel. They swoop indignantly around the sky for a while until the noise stops and we all breathe a sigh of relief (or at least, I do).

After your 'swim' you get to walk soggily back down to the van, which I nearly had to do without shoes this time, because Akos had stolen and hidden them. This was not the only deja vu moment I had: there are nine bridges to cross on the way up (and down) and I found an exciting alternative route across the river at one of these on the way back. I resisted the urge this time though before I got to the part where I am properly sitting in the river and wondering how exactly I got there.

Julianna's family were here visiting last week and joined in with our excursions. Doting Ps, it seems you have been slacking in your parental duties! They also went independently to visit the monkey sanctury and, having conscientiously missed my monkey sanctuary trip in favour of staying at work, I tagged along with them. We went armed with plenty of bananas, which we stopped to buy on the way. We were nearly charged a fortune however, possibly because the stall owner, like many Ghanaians, didn't understand the currency, or possibly he thought, as many people do, that yevus are stupid enough to pay it. 

We met the guide at the office and he led us along a trail through the rainforest, stopping (obviously), once we found some monkeys. This can take a while since many of the monkeys will settle nowhere near the tracks, but we were fortunate and found some after only a few minutes. They come and snatch banana quite brazenly from your hands (the whole thing if you don't hold tight) and leap about, squabbling amongst themselves, for a while until the bananas run out. The others were going on to Accra to catch their flight home, so I had to take a tro tro home - but it was definitely worth the risk.

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Orphanages

The good thing about having scheduled work only in the mornings is that we can use the afternoons for other projects or activities. I spent some of my afternoons visiting the schools and orphanages with the other volunteers when they went back in the afternoons (many of us frequently chose to go back to work after lunch if there was stuff to do). I visited 3 different orphanages: 'Happy Kids', 'Eugemot', and 'The orphanage for the mentally challenged'.

First I went to 'The orphanage for the mentally challenged' (I think I have 'politically corrected' this from what it might commonly be known as) to spend the time after lessons playing with the kids. I didn't see too much of the living arrangements because the stone building split into its three classrooms, which is where we spent our time, is set a bit apart from the main orphanage. The kids were easily entertained - they are happy just to have your attention and sing insy winsy spider over and over (and over!) again. It was the first orphanage I visited and it was striking how little the children have (both materially and emotionally) and how basic are their requirements. If they fall over for example, they just bleed, rub a dirty finger in the wound and move on - there were many needless scars around from previous such incidents.

The next orphanage, 'Happy Kids', is perhaps the most shocking in terms of living conditions. There are 15 - 30 children living there (really not sure how many since some just attend for school) varying in age from a year or so to over 16 years. They all sleep on the stone floors of 2 rooms,  each about 7 - 8m squared in size, and school classes are run in the semi open section in the grounds (covered with a roof of straw and shrubbery). I think it gets a bit soggy when it rains. We would always get mobbed the minute we arrived outside the gate, with kids shouting their welcomes and running over to relieve us of anything we might be carrying.

A group of us spent an exhausting afternoon at Happy Kids one day, scrubbing the walls so that they could be repainted. I had to give up on any idea of perfectionism since I discovered that pulling out the tissue paper from the gaps between the wall and ceiling only meant that the roof started to fall through, covering your newly washed wall with earth and dust. It was most distressing!  The kids as usual were fascinated by our activities and some of them attempted to join in. I began to go off this idea once they had skated around the floor for a bit, fallen over the broom a few times, with varying amounts of resulting blood, and used the bleach to wash their faces :o(

Eugemot is bigger and slightly better staffed and equipped. The children sleep in bunk beds in their dorms (though I'm not sure how many kids, or bugs, each bed might be expected to sleep). There are also several different classes so the kindergarten do not learn with the 12 year olds as they might at HappyKids. Kristina came along on this particular day to spend the afternoon cleaning and dressing infected wounds, most of which had been growing rather than shrinking for quite some time. It also provided much entertainment for all the other children who watched, mesmerised and not getting at all bored, as infected wound after infected wound was painstakingly poked and sterilised and bandaged up with the usual firm and unheeded instructions not to coat it with dirt again. 

I learned the hard way that any game you begin will not be over quickly and find myself playing wheelbarrows and spinning games endlessly, and dizzily, or doling out suncream (to kids who never get sunburned!) just for the 'pleasure' of rubbing it in, smelling it and enjoying how our skin now feels all greasy. And there was I, discontentedly taking for granted the delights of the sun cream ritual. 

 

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Don't feed the cat!

'Do not EVER feed ANY cat' reads the notice on the board, adapted no doubt from previous less emphatic but equally well ignored instructions to refrauin from encouraging the cats. Akos does not like cats and there is a family of cats resident in one of the neighbouring houses. The mother had kittens, possibly a couple of months ago but remains one of the skinniest feline creatures I have ever seen.

She comes to our table every meal time because Brenda feeds her chicken bones. Brenda freely admits to feeding the cat and has no intention of obeying the orders to stop, while the rest us tend to do our best not to let the food near the cat, or near Brenda when the cat is around. The cat, incidentally, does not appear to have a name and is referred to simply as 'the cat'.

There are 4 or 5 kittens, one of which has an infected eye which doesn't appear to be responding well to the conservative treatment of doing nothing. The housemates worried for some time that 'mom' was trying to abandon it and set out to make this as difficult as possible for her to do, rescuing and returning it to her like an unwelcome boomerang. All of the kittens seem to have a bit of a death wish though - they have been plucked from the drain, or released from under the ramp or the top of the wall on numerous occasions and will need more than their allotted 9 lives if they continue this way.

The cats are not allowed in the house and there is proper reproach when they flout this rule. However they do sometimes enter by special invitation when Akos is not around. I doubt this is compensation for being swung around by their tails, blasted with the fans or poked with the stick that I would swear Joe keeps for this purpose. Apparently one of the volunteers coming in the summer has an allergy to cats, something that Akos does not seem upset about - I wouldn't like to be a cat any time soon....

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The wards

'Warning

Man on Fire

His word burns in my heart like a blazing furnace'

Not a particularly unusual caption to see written on a t shirt around here. What made us look twice was the fact that it was worn by the relative of the 2 kids in hospital with burns following a gas explosion! They arrived in Hohoe hospital on Friday with fairly significant burns - probably up to about 50% body surface area, and by Monday were still waiting to receive any treatment at all.

You may have spotted a problem by now but the staff on the ward did not think there was anything wrong with this. So I spent all day on Monday helping Kristina to clean and dress them (with much faffing as the family were sent out to buy the appropriate painkillers) because nobody else seemed to be available.

I am on the wards for my last 2 weeks in Ghana, supposedly in designated areas but it doesn't seem to matter where I go: people don't question who I am or what I am doing so I just float and find stuff to watch or do. Physiotherapy really is the nicest part of the hospital that I have visited: the wards are fairly primitive and the pace of work is if possible even slower than in physio. So slow on night shifts in fact, that the nurses on duty just sleep in the next room, and it's not extremely unusual for them to wake up to find that a few of their patients have died overnight.

Families pay per day for relatives to be held in the morgue and a lengthy stay with drawn out funeral arrangements is apparently an effective way of demonstrating wealth. A funeral incidentally is a big event - with procession, singing, dancing and celebration (of the deceased's life rather than their death, presumably).

I discussed the kids with the physio staff and Nancy duly came to see them with me. We are however having problems with getting either of them to move much since they are in so much pain. The nursing staff have just changed their dressings, ripping off much healthy skin along with them and making their burns much worse. The rationale for the lack of pain relief (being risk of addiction) is confusing in a country where you can buy valium over the counter!

Kristina has been jumping around trying to get them analgesia, appropriate dressings and transfer to the burns unit in Accra (where there are no beds). She eventually contacted Shriners, a burns charity who will apparently fly them to America for treatment. I found myself in a quandry: Appalled as I was by the lack of humanity shown, I remained (as I usually do) less shocked or emotionally involved than my American colleagues (though admittedly I didn't personally witness the brutal dressing changes) and mindful of the fact that change needs to come from within the service and cannot be forced.

This is true regardless of how I feel about working practices or the treatment of patients and has stopped me from intervening on many occasions. I wondered uncomfortably if this time, for the sake of the individual, I could have tried harder to change the situation but am wary of the cultural differences and relationship with the volunteers and I know that the same dilemma will arise again, and the approach will be no different because the staff themselves don't recognize any need to change anything.

I find myself adopting the phrase commonly used here (often by Ghanaians themselves) to express frustration (and often resignation) about the way things are:

Oh, Ghana!

The bone setter

If you are a physio, imagine the kind of sinking feeling you have when your patient tells you they are, or have been, seeing an osteopath or chiropractor 'to have their bones and joints realigned' and multiply that by quite a lot and you might start to understand the trepidation with which I have come to regard the bone setter. If you can get a history from your patient it might sometimes include a visit to the bone setter, but despite considerable effort, I never managed to uncover any more detail than this from any of my patients. So I decided last week to pay him a visit myself.

The morning got off to a slow start because the bone setter was off burying a relative (I don't think he was responsible on this occasion for their need to be buried) so I sat around with all the patients for an hour or so before we started, pretending to watch a video about their work. They have several stone buildings partitioned into rooms - some small, some big - that patients stay in if they are unable to walk; otherwise they are seen as outpatients - daily or weekly.

Some people end up seeking further help at the bone setter once they have been discharged from the hospital, unable to walk and without follow up while others bypass the hospital completely and bring their fractures to him directly. I asked whether patients had X Rays - I didn't really find out the answer but was told that X Rays tend to discourage patients and something about the outside of the bone not showing up on X Ray. I hoped this was a language related misunderstanding.

I may be grossly generalizing but essentially the treatmens offered by the bone setter comprise acupuncture (I did not witness this but understand that there is, alarmingly, a element of electricity involved), herbs, and mobilization (or immobilization). Leg fractures (radiographically diagnosed or otherwise) are strapped into a wooden case - they may be 'tweaked' first until the legs look straight - and then patients are instructed not to move at all for 3 weeks. After 3 weeks they are instructed to get up and start walking as able -which is not usually very able. Funny, that....

Herbs are applied to the site of pain, covered with a leaf and taped into place:

"What do the herbs do?" I ask
"They help the fracture heal"
"How do they do that?"
"They make the pain go away"
"Why does the pain go away?"
"Because the patient gets better"

...and so on, goes the circular conversation that follows most of my questions. My observations of patients demonstrating (albeit in an agonized silence) what could only be described as a true 10/10 on a visual analogue scale, as the bone setter yanked their body parts into the desired position, did not do a lot to convince me.

Coming out of one of the rooms, I went flying down the steps which are really not designed for anyone who isn't looking where they are going (or might have a mobility impairment for example!). I recovered my feet, noting that I must be more careful considering that this was possibly the very worst place to sustain an injury.

So anyway, I spent the morning watching herbs and leaves being put on, first the outpatients who had queued all morning to sit in the painful hot seat, and then those housed in the various annexes, through which we marched (armed with our herbs and leaves). All ailments appear to qualify for herbs: fractures, soft tissue injuries, muscular aches or whatever else. I am not sure that the bone setter really knew what 'whatever else' was, and I began to feel, as Julianna had warned me before I went, that I really had entered the twilight zone.

The calm after the storm

And so physiotherapy returns to normal and it is my last week in the department. I wonder whether I should have stayed so long in one department but was keen to see some of the patients from the previous week followed up, some goals and plans written, organise the store cupboard and try to encourage some note writing. Not sure about the rest but there is now an inventory of all the archaic items in stock, which will either sit there forever or will be used and recycled until they disintegrate or melt.

In sympathy with their lack of resources I attempted a rescue mission on a tatty old splint but unfortunately (or otherwise) the prognosis was poor and it met a wet and sticky end. I wish I could have said the same for the 50 or so boxes of cement mix, bunch of hair accessories, 2 years worth of old newspapers and other interesting artefacts whose purpose can only be guessed at. I discovered plaster shoes that must have been made for a yeti, several moon boots (which bring back painful personal memories), and decrepit old wheelchairs with various essential components missing. I write it all down so that I do not remain the only one with a thorough knowledge of the hospital's stonework and current hair fashions.


I also visit my first inpatient this week. She is my age and seems to have suffered a stroke a few days after giving birth to her third child. She has been lying on a mattress on the floor in the ward for nearly three weeks. We get her up onto a bed (don't ask how), carry out an assessment and find her a chair to sit in - it does the job if you jam it against the wall and ignore the footplates - they would adjust if we had tools, but we don't.


I also take my opportunity this week to suggest firmly to Manuel that it might be a good idea to write some notes every once in a while - especially for the occasions when he burns his patients with the hot pack or causes them to fall, bashing their head on the parallel bars on the way down! Manuel's explanation that 'I am not such a good writer' despite his claim to agree entirely with me, perhaps explains why treatments don't change much regardless of the patient's needs, or why he is never so sure about whether a patient has actually improved or not.


Manuel is Cuban and about three quarters of the way through a 2 year contract here. He apparently qualified and worked as a physician before going on to study physiotherapy, and came to Ghana in the hope of working as both. He has remained in heated debate with the hospital director, who won't let him, ever since he arrived. I must say, I am relieved. However Manuel was most welcoming towards me and allowed me to treat his patients whenever I wanted to, even when I disagreed with his approach to them and his treatments (and changed them) which was most of the time!

The department is led by a Ghanaian lady called Nancy, originally a nurse who retrained in physio about 4 years ago. Her family live in Accra and she hopes to set up her own practice there in the future. Nancy was also happy to work with me, allow me to watch (or lead) and ask my advice about things at times.

I could say much the same about Cinderella, the other Ghanaian physio in the department. She is a few years younger than me, from Ho and has been at the hospital for just over a year. She is happy to just let me join in and teach me about what she is doing and learn anything useful I may have to share with her. I visit Cindy at home sometimes - for dinner, to play scrabble or sing songs (I have made it my mission to teach her a new repertoire of songs from the Bellevue supplement for the kids at her church).


I have really enjoyed working with Nancy and Cindy. I am not always convinced about their assessment of patients or their choice of treatment or documentation (which doesn't happen all that regularly, if at all in some cases), but over the last 4 weeks I have developed a lot of respect for them both - for the work they do within the difficult climate of Hohoe hospital, and their attitude towards their work. I sincerely hope I stay in touch with them.

Tro tros and mountains

I caught my first tro tro this weekend. A tro tro is basically a minibus taxi and the Ghanaian form of public transport. The advantage they have over all our british forms of public transport is that they never run late or fail to keep to schedule. This is because there is no schedule and no timetable: it simply goes when it is full. To catch a tro tro you go to the tro tro station and hope that the one going your way is nearly full - otherwise you can wait a long time for it to fill up (it is quite possible to wait several hours), the only way of speeding up this process being to pay for the extra empty seats.

Thankfully I waited only about an hour on this occasion before we set off. The interior light in the tro tro reminded me of the fan in our hotel in Cape Coast: it was swinging by a few wires from the ceiling and I was glad it was daytime and there was no need to test it. I am also glad it was a short trip - if you are over about 5'3" you can expect to experience a significant amount of discomfort since 'full' really means full in Ghana. I do begin to wonder however as we speed up and begin to kangaroo along the road, whether the obligatory wedging of knees into the seat in front is actually a strategic way of preventing heads from hitting the ceiling too hard.

The tro tro is taking me to a place called mountain paradise, a fairly basic but clean lodging in the most beautiful location, way up the mountain and surrounded by tropical greenery. I am staying only overnight and have come by myself because there is a shortage of obliging housemates wanting to travel this weekend. Being without company though, I discover, is difficult to achieve - as soon as the 'situation' is noticed, somebody invariably does their best to remedy it. I am unfriendly and unsociable enough to not always be grateful for this.

So the tro tro stopped in Fume, at the bottom of the mountain where the sign post says it is 4km to the top. There is a taxi waiting at the bottom and I am beckoned over by a man who tells me that it is too far to walk and the taxi will cost 10 cedi. I decide it is not too far to walk (even when the price drops to 8 cedi) and set off up the hill, this after all, being what I came here to do.

There are no sign posts after the first one at the bottom and I hope that there are going to be no decisions to make regarding direction. I walk and walk, with really no idea of distance or time (or unfortunately, when I last put on suncream!) with only my ipod and some noisy frogs for company, and I am slightly taken by surprise when I eventually arrive at my destination. I was enjoying myself and did not regret my decision to walk, particularly at the point that I passed a sorry looking and caved in taxi at the side of the road.

Finding myself with a lot of spare time, I set off for another walk, which is not uneventful.... First I am accosted by the resident dog (looking incredibly healthy compared to the dogs I am used to seeing in Hohoe) who wants to play and bites holes in my t shirt. Then a car stops so that its occupants can debate with me at length why it is that people come to visit Ghana. Despite my best efforts I fail to convince them that their country is beautiful and well worth a visit, and we part amicably, agreeing to differ. I pass through a small village and arrive at a school (an open stone building, partitioned linearly into 3 separate classrooms) where I stop to watch the goats who are performing acrobatics but aren't really sure what to make of me.

I leave as a thunderstorm threatens and make it back shortly before the heavens really let rip. (whatever the weather decides to do, it doesn't ever do it by halves). My plans for spending time with a book, and food, are hampered somewhat by the powercut - the interim kerosene lamps do not really provide much light.

I meet the resident cat (also looking very healthy) which doesn't seem to get on very well with the resident dog and I am entertained as they fight (like cat and dog) all around the dinner table, breaking every now and again to beg shamelessly for food. The light eventually returns and I manage to get dinner. I have the usual ordering difficulties (the lack of food available that is, rather than the decision making) and am requested to hurry up eating because the dishes need to be washed!

As the weather gets wilder I wish for the first time since arriving in Ghana that I had brought a sweater with me and somebody would have provided a sheet to sleep under. I take my chances with a blanket that I pinch from an adjacent room, preferring to not think too hard about whether or not it has been washed recently.

The following day I go for my guided hike before heading down the mountain and flagging down a tro tro back to Hohoe. It is full but they make room for me - there don't seem to be restrictions regarding passenger numbers as there are at home :o)

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Wheels for the world

I am sitting in the middle of the physiotherapy gym engaged in conversation with a man who is telling me about the spinal cord injury he sustained in a car accident a few months ago. The man has limited English and I am not sure about his interpreter either: the answers I am receiving do not seem to be in response to the questions I have asked.

I shuffle sideways in order to avoid the wheelchair heading my way, driven inexpertly between all the mats, chairs, cushions and random bits of metal lying on the floor.

I learn that he had spinal surgery (no other details known) that he is unable to stand or move himself about and is unable to go out because he does not currently have a wheelchair. He tells me that he believes his leg is broken, something he realized himself after going to visit the herbal doctor. This 'revelation' does not appear to have been acted upon.

A few illegal manoeuvres later, my friend is sitting in his new wheelchair, lovingly taped together with duct tape and waiting to see the pastor for the 'evangelism slot' while I embark on a similar kind of conversation with an elderly lady whose registration card reads (name) (age), diagnosis: 'old age'. If it were not Friday, I might have been a bit taken aback but I have just spent a week working with 'details' like this. It appears she was unwell about a year ago and has not stood or walked since. She doesn't know why or what her illness was and has not seen a doctor about it.

Once her new wheelchair has been rattled and hammered into submission and she appears reasonably comfortable, I am washing my hands (under the tap - it is afternoon so the water is running again) when Louanne hands me a couple of crutches, 1 short, 1 tall, and asks me to go outside and reassure the man who is returning them that he should use them. I am so bemused by the request that I forget to laugh at what is really a very comical scenario (once you have accepted the equipment situation).

The man is quite right : the crutches are entirely different sizes, but with one at its shortest and the other at its tallest, I discover they are almost the same size and after checking that this really was the only option, I set about convincing him of this. It is not easy: he would like the holes to match up please...

Leaving him with his original 'set' of crutches, I go back inside to admire the spectacular method a 40 year old man is using to get in and out of his wheelchair. He has been unable to walk since breaking a few bones in a car accident 30 years ago and has perfected this performance: it is incredible but I'm not sure I shall be teaching it back at home.

There is a photo shoot going on so I join in: a 10 year old girl, with significant hypertonicity is being fitted into her first wheelchair - one that has been elaborately (if primitively) custom redesigned for her. This involved sawing off the back, chopping half the side out and joining the ends by screwing in some metal tubes fashioned from zimmer frames. I am impressed.

So what is all this madness about? An American group from 'wheels for the world', a subgroup of the 'Joni and Friends' charity has donated a load of wheelchairs and walking aids and is spending the week with us, fitting them to people who can come to the department for assessment. So the gym is transformed - wheelchairs and walking aids are packed at one end, the workstation takes up the other end, and patients and therapists squeeze into the space that is left in the middle.

People in increasing numbers queue outside to be registered and then, in theory, work their way through wheelchairs/ walking aids, vision and blood pressure check, chat with pastors and then wheelchair training if required. It was a change from the usual laid back atmosphere in the department and gave me opportunities I would never have had otherwise.

Home visits for example! On Thursday there was a lull in the afternoon so the team packed the generator, a bunch of tools and a selection of wheelchairs and sticks into the van and set out for a nearby village where they had heard there were several people needing help but who were unable to travel. I was invited along for the ride.

Most of the village congregated along the side of the main road where we had stopped and people were brought to us from everywhere. So we began our clinic, interspersed with an impromptu gospel message and worship songs. There were also people who couldn't leave their homes so we set out in small groups to visit them at home, bumping a selection of chairs along the dirt tracks in the hope that one will fit when we get there.

If there had been an accommodation officer to appeal to I would have done it on the spot but like so many other things, it doesn't exist and that is all there is to it. It was certainly a variation from my usual community visits!

The blood bank

There is currently something of a competition amongst the housemates to donate blood to the bloodbank. This is not a random whim but a response to what we have recently discovered is a desperate shortage of blood. People die at Hohoe hospital at an alarming rate, partly because people ignore their symptoms for so long that their condition becomes critical, and partly because the staff do not know how to properly treat and assess emergencies, and hygiene is not quite what we are used to.

And then when patients arrive (and staff wait a few days before realizing the seriousness of their illness and then spend a while deciding what to do about it and the patient becomes even sicker to the point of needing extra blood), there is no blood to give them. None at all. The poster on the wall outside reads 'A blood bank without blood is bankrupt' and sadly this particular bank is in much the same state as most other banks around the world at the moment.

Our current obsession with blood began a week or two ago when Kristina came home telling us about a baby in the ward with malaria who would not survive without a transfusion and for whom there was no suitable blood in the bank. So a group of volunteers rushed over that afternoon to try to donate before it was too late. They didn't make it: only 2 had haemoglobin levels above the required threshold (13) and they were not the right type. The baby died later that day, reflecting a story that repeats itself at the hospital on a regular basis.

So anyway, I joined the most recent group of hopeful donors from our house for a long afternoon last week, camped outside the bloodbank. The process of blood donation is similar to what would happen at home, though on a smaller scale. And slower speed - we were there for about 3 hours, and there was barely a queue! We got our blood tested for Hb (don't worry mum: I watched the needle come out of its sterile packet) before testing for blood type / screening for disease etc. Now I am blessed with good veins - about as easy to spot as I currently am in a crowd - but there was still a fair amount of scrabbling around and I felt for Tim, who was the only one to pass the stringent haemoglobin test, and whose veins are something of the proverbial needle in a haystack.

There was a student nurse there - he came to donate blood because his patient was haemorrhaging and needed it: his sense of responsibility for the situation humbled me as I considered the infrequency with which I give blood back at home. Unfortunately this was a rare incident: this kind of initiative (or in fact any kind) is not hugely prevalent and people do not appreciate what they personally can do to help, even when it is within the remit of their job!

The idea of blood donation is alien even to medical staff it seems: Julianna arrived home one day last week in the usual state of appalled shock because the doctor in A+E spent the morning hunting for the person who had donated blood to one of the deceased malaria babies so that the baby's father could pay them! Julianna suggested that anonymous donations were free, to which one of the nurses argued that if they were to go to a store to purchase blood they would have to pay, so therefore the donor should be paid. Another nurse worried about where the donor would get more blood to replace the blood they had donated. The local convenience store it seems (!)

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Predictably irrational

This post has absolutely nothing to do with Africa - it will not add to the chronicles of Ghana and consequently does not really belong here. However, it is my blog so I believe I can break the rules if I want to.

Well aware that there would be a reasonable amount of time in which there is no scheduled activity and none of the usual methods that I use to waste my time at home, I had crammed quite a few books into my luggage. Having finished my packing however I reflected on the volume and weight that my books were contributing to my allowance and carefully selected one to leave behind. Only to replace it with 2 more bought impulsively at the airport.

The first is called 'Elephants on acid' and is a collection of anecdotes about crazy experiments that have been carried out in the name of science, with or without reasonable rationale. The second book is the title of this post.

Many who know me might suggest that this is a very fitting book for me to read. And much as I hate to agree with those who would question my logic, they would be right. It is an excellent reflection on the way we make decisions and on what influences them. I see myself in so much of the irrational behaviour and reasoning that is described in this book so I thought I would share some of it's wisdom with you.

The author, Dan Ariely, describes with amusing anecdotal and experimental evidence how we can be manipulated into purchases according only to their value relative to an arbitrary similar item; how, like goslings, our first impressions and subsequent decisions become inextricably imprinted on us; how zero cost is overrated and how incompatible are social and market norms. Particularly pertinently for me this year there is a chapter on procrastination. I appear to be doing well in recognizing my tendency to procrastinate but according to the rest of the chapter, not so well in addressing it. Oh well, the next chapter tells me to put all my eggs in one basket and shut a few doors so maybe I could soon have less to procrastinate about.

According to the book I should approach my character makeover optimistically since our expectations appear to be self fulfilling. And if I am to be honest about my achievements I should add direct monetary value to them. Any bets on the outcome then?

Church

I attempted church again this Sunday, in fact I went to two. It was not intentional but I was curious - I should know better by now! I had arranged to go to the International Central Gospel Church with one of the pastors, Adolf, with whom I spent last week working on a project at the hospital. I confirmed this the night before, borrowing Marcella's phone to do it, unfortunately not realizing that poor Marcella would receive a wake up call at 6.20 am just to wish me a good morning. She very kindly didn't wake me up to relay this message.

I was to meet Adolf at 8am close to our house and in true Ghana style he arrived in the taxi around 8.30, probably (I have given up carrying the time with me since it is so elastic anyway). There was an errand to run en route so we took a detour - this was fine though I did start to question the logic during our second complete lap of the town. Once we arrived, I was directed to a seat, unfortunately near the front where I sat most conspicuously and was deprived of my opportunity to watch what everybody else was doing.

The service started with a time of worship. The choir - about 5 singers with microphones - was accompanied by a keyboard, regular drum kit (if you are a drummer and there is no such thing, then please excuse me), african drums and electric guitar. The worship alternated between congregational songs (thankfully with fairly repetitive lyrics) and the choir singing for us. I started to wonder whether the speakers and worship group were paid by the decibel: the babies managed to sleep soundly throughout but my ears felt as though they had been thoroughly assaulted.

Since the service was in both English and Ewe. there were 2 speakers, both shouting - into their microphones! I decided that I wouldn't like to be shouted at for 2 hours every Sunday: the emphasis that it might give is lost a bit when there are no interspersed quiet bits. Maybe my communication problems here have nothing to do with the language and I am simply not speaking loudly enough. The service was similar in many respects to what I am used to, with allocated times for prayer, sermon, worship, notices etc. Probably won't be seeing so many waving white handkerchiefs or dancing on the stage or in the aisles at home though.

I walked home, passing many other churches on my way - it is relatively unusual for people not to be going to church on a Sunday here - and as I got closer to home I decided to poke my nose into one of these, whose service was still going on. I had no intention of actually going in but somehow I got pushed through the door and cajoled into a seat. Which was not quite as near the back as I would have liked. There I got pounced on, in fact almost literally sat on, by a large and very friendly lady called Benedicta who should really be adopted into our welcome team at Bellevue - people certainly wouldn't be rushing away.

Benedicta beckons another man over who wants to know why I am there and tells me I must meet the pastor. This now leaves me with the choice of sitting there significantly longer than I had anticipated, listening to a service conducted entirely in Ewe, probably missing my lunch into the bargain, or quite certainly offending the pastor not to mention my welcoming committee. So I wait, hoping that there will be a point where I can meet the pastor quietly and then be allowed to slip out. Sure enough I am soon hustled up towards the front, but it is anything but quiet and inconspicuous. As if being the only white person, and quite possibly non Ewe speaker, in the building isn't enough to damage my chances of blending in, my meeting with the pastor is followed by public introductions to the congregation who chant 'Way-zor' (not the right spelling but don't know how to make the keyboard write Ewe consonants) to which I respond 'Yo'.

I console myself that at least now I will be able to leave when..."Miss Phyllida, I want to talk to you at the end...." I find myself grumpily wondering how the door which is so close (and open) is suddenly so far out of reach and I must confess that as prayers were commenced, mine were much more along the lines of 'please let this finish soon' than anything more edifying. Still, I am entertained by my new companion as she gives me a slightly less than whispered lesson in Ewe and a commentary on the public handing over of money to the 'pastor's house' fund.

However I haven't found myself so relieved to be reciting the familiar end of service blessing for quite some time - 4 hours of church in a morning is quite a lot, and I didn't appear to be the only one to think this, considering the number of sleeping people lying in the pews! The pastor tells me the church will now stay in touch with me and since I don't feel able to refuse or give him a false address, I scribble down my e mail. I just hope he doesn't do house calls.

Meet the housemates

Sounds like a line from 'Big Brother' but there are certain similarities: random bunch of people taken out of their usual habitat and living in each other's pockets for an extended period of time. The results are generally worth a mention. So, who are they?

Ali is Canadian, from Toronto, arrived at the same time as me and stayed 3 weeks. She is 27 and works in Human resources for a food company. She makes the snappiest decisions ever and can end up spending quite a bit of money in the process. Sometimes she regrets the decision almost immediately but never stews over it. Ali loves children and worked in an orphanage while she was here. She would have adopted all the local kids if she could.

Becky also started the programme at the same time. She is American, from somewhere near New York. She is 19, between semesters at university and had to put in some effort to convince her mum it was safe to come over here. I bet her dad didn't make flippant lion jokes!

Rebecca is Canadian, also from Toronto and was my room mate for my first 3 weeks until she left. She didn't snore, or at least I couldn't hear her over the noise of the fan. She is 18 and about to go to university to study political science. She had lots of pairs of flip flops, all of which broke in one day leaving her stranded in various interesting places. She looks great with braids, African style, and I have some fairly wild hair pictures from when they came out.

Emma is 26, originally from Wigan but defected across the pond to California some years ago. She got bitten regularly by the resident beasties and responds by swelling up impressively. Emma worked at a school while she was here.

Kristina is a critical care nurse back home in Boston and is working in the emergency care ward in Hohoe Hospital. She is totally appalled by their lack of hygiene or sense of urgency. She has taken it upon herself to teach the nurses the basics of emergency medicine and has rallied various members of the homebase to go and give blood since there wasn't any to save lives with. Should we tell our cook most people were turned away due to low iron levels?

Robin is from New Jersey, she is studying special education at university and is working in a school for learning disabilities in Hohoe. The kids, most of whom need 1:1 attention are in a class of 30 with one teacher. Robin sometimes plays scrabble with me but has been known to try playing 'words' like 'e-i-e-i-o' so needs to be watched.

Tim is 19, from Ottawa and has just been accepted into Toronto university to study economics. He is friends with nearly all the locals and knows all the short cuts into town and all the best places to go out. He has had the most exciting multicoloured hoodies made during his stay here.

Rik has also mastered the wearing of exciting hoodies. And bargaining for large and interesting souvenirs. He is 20, from California and hoping to set up his own business. He daydreams about the possibility of creating miniature animals and ponders the genetic implications of such a thing. I wonder whether his malaria pills are adversely affecting him.

Julianna is from Massachusetts and is studying nursing. She is actually working at two different placements - one in the labour ward at the hospital and one at an orphanage 'happy kids'. She is currently trying to 'renovate' or at least clean the kids rooms in her spare time - quite an exhausting task as I discovered at the weekend.

Marcella is 30 something, from Glasgow but would live in Ghana were it not for the temperature. She works in finance but is here working at an orphanage and teaching. She extended her stay for 2 weeks because she couldn't bear to leave the kids and is currently dreading the prospect of leaving Hohoe next week. It has been nice to have a friendly scottish accent around - even if it is from the west.

Brenda is also 30 something and is Canadian. She is a pig farmer and often uses her experiences as ammunition to bring the conversation downwards at mealtimes, possibly to ensure we don't all eat too much. She has the most exciting sleeve like tattoo on her arm and plans on getting another to match.

In true Big Brother style, housemates are evicted (well hopefully not, but they finish their programmes and leave anyway, albeit very reluctantly). and others are introduced - on a monthly basis. So, wait until next week for the sequel.....

see photos

Atoto bibi!

This is the most commonly used Ewe phrase in the homebase. It means 'pineapple is delicious' and alludes to the almost never-ending supply of fresh pineapple that is laid out for us - and really is delicious. As is nearly everything that we are served. Our diet, you might have picked up, is a little unvaried but probably one of the most healthy and balanced I have eaten for ages.

The lunch and dinner menu (there is no distinction) consists of:
Beans - nearly always
Chicken - nearly always, sometimes substituted with beef or grasscutter (a large rodent) all of which I have eaten without asking too many questions (the level of shock you experience may depend on how well you know me).
Fried plantain = often
Yams or potatoes - often
Pasta - occasionally
Rice - usually
pineapple - always
Watermelon - sometimes
Apples - never :o(

This last ingredient is possibly the only thing I miss - I have not seen an apple in Hohoe yet, although we did stock up on our way through Accra last weekend.

So there is an exhaustive list of what we eat. It is of course possible to buy other safe (packaged and tinned) food and even sweets if you look hard, which I do. There are no large food stores locally but there are market type stalls and small grocery shops - packed from floor to ceiling with an assortment of convenience food. One of these stores is called 'affordable', ironic considering that while prices in Ghana are normally very low, here you can pay the equivalent of twice as much as you would pay at home for a few familiar groceries.

On the whole, Ghanaian food is something to be wary of, mainly due to its preparation. The regular sickness is understandable when you see food sitting in the sun all day or the meat, a distinctly rotten looking kind of blue, waiting to be added to the grill. The food at the homebase can be entirely trusted (John has to be the most vigilant cook going) but we are advised not to eat out unless a restaurant has a good track record. The safest option is probably vegetarian (if cooked) - more rice and beans then!

Orientation

"Go right out of here and over the raised stones, past the huts on your left and across the open space. The Geduld (hotel) is on your left then take the path towards the back of the houses and out by the water pump. Turn left onto the main road - pass the bank and sewing shop then turn off onto the mud track opposite the banana stall and round the trees where the goats were the other day. Stay to the left of the washing lines and go straight until you get to Miss Ghana . Take the main road on your left and keep going until you see it"

This apparently is how you get to the market! I should explain a few terms:
'straight on' usually means winding your way (not straight) between small huts and shacks where there are lots of options for 'straight on' and 'left' and 'right' are almost never firmly left or right. Landmarks are often quite camouflaged into the surrounding landscape and can easily be mistaken for a similar looking 'hut' or 'pile of stones'. Landmarks may also be mobile and can therefore not be trusted to be where you left them (there's a fairy tale in there somewhere) and missing one may leave you wandering around in the heat for some time. Thankfully the Ghanaians are a friendly bunch and will usually put you back on the right road, if not personally walk you to your destination (which may be some distance away).

Miss Ghana is the exception to the ambiguous landmark rule - she is a large gold statue standing at the junction of 3 main roads in Hohoe. The main roads are actually reasonably straight and recognizable as main roads despite being dirt tracks. They were resurfaced soon after I arrived - this did not leave a nasty tar smell or newly painted white lines, it just meant that huge piles of extra mud kept appearing on the roads like magic (totally destroying my main road landmarks) before being eventually rolled down onto the road and presenting the local kids with a great skiing opportunity in the meantime. It left us creeping along the sides of the road for a while, risking our cleanliness with the chance of falling into the gutter, in order to avoid getting stuck (literally) in the middle of the road.

Paving does not exist at all in Hohoe so anything big or fast moving will leave you spluttering your way through a cloud of dust: it's not at all great for contact lenses. Maps also do not exist, and neither do road names - I would love to see what a modern GPS system would make of it.

Physiotherapy in Ghana

I have procrastinated (yeah yeah I know..) in writing this post. I am nervous about portraying inaccurately or with bias, a hospital, department or health service that I don't fully understand. However I am writing to document and share my experience and here it is.

Like any service, physiotherapy is dictated by the needs of those it serves and by the resources that are available to it, and the physiotherapy department here (3 physiotherapists and a secretary) is meeting the needs of it's community in the best way it knows how to. However the staff are aware that this falls far short of what is really needed and a 'postcode lottery' doesn't even begin to describe the barriers to decent health care that many people face. Physiotherapy is only one example but in terms of accessibility and equality of provision it is probably fairly representative of most health care services.

Referrals are received from the hospital and local clinics. Patients may present to a doctor soon after an injury or onset of symptoms, or it could be days or weeks later. This is true for major traumas (such as open fractures or partial amputations) as for minor ones. The doctor may refer for physio or they may not. They often are not aware of what physiotherapy could offer, not a problem unique to Africa. The physiotherapy department itself does not have a waiting list: all patients are seen within a week of referral. This would be a fantastic situation at home - here however it simply reflects the gross under use of a department which is unable to reach the people that need its services.

The patients that are referred to physiotherapy present with many conditions common to us: a lot of stroke patients for example, though usually months or years down the line when neurological recovery is most unlikely and they are dealing with the effects of previous poor management. They also have children from a local special needs school come to use the facilities for exercise. The school has no name other than 'school for the mentally retarded and handicapped' ! Many of these kids also have a physical disability - the two I have seen both had a hemiplegia but I have no idea about the others as none of them had databases, problem lists or goals. Or notes in fact.

There are also a lot of patients with musculoskeletal problems: arthritic joint pain, neck or low back pain - as we see at home. The causes and aggravating factors vary a bit though. You probably wouldn't see on an assessment at home: "patient reports pain when carrying water on her head". Most of the patients are outpatients, although (according to the book at least) there are between 1 and 6 patients a month treated as inpatients.

The actual treatments are, on the whole, aimed at symptomatic relief and the conditions usually are chronic - many patients are not referred until a long time after initial onset of symptoms. Commonly used treatment modalities are heat treatments and massage, gait and stair practice, carried out routinely (reassessment is less frequent than I am used to), many patients attending twice a week. Active exercises are also given - usually using pulleys and the gym equipment available. Only 60% of the population are literate and many don't speak English so my prowess in stick men diagrams which require no explanation is being pushed to the limit.

Function is addressed but often the physical and functional requirements of a task are not really broken down so compensatory mechanisms are practised until they become established. As it was put on my recent Bobath course "if you take something away, you have to give something back": these patients unfortunately are often struggling fruitlessly to obey a command which is impossible for them.

The problem for many people is distance - they may be required to travel long distances to attend physiotherapy and there is no alternative - physiotherapy is not offered in local centres and there is no community outreach. People who are fortunate enough to have wheelchairs at home usually do not bring them into the department as they have no means to transport them - they tend to be carried in from the taxi. The proportion of non ambulant patients is small - I imagine we just don't see the majority.

Facilities and staffing obviously present difficulties: ferrules on the whole are worn through, wheelchair brakes don't work, there are no specialist seating systems, standing frames, splints or basic materials. However the biggest need in this community is probably education. People don't understand their own health conditions, they don't know when to seek help or where to go; even within hospitals emrergencies are not treated with urgency and preventable morbidity (and mortality) is not prevented. Socially, a physical disability in childhood is seen as a curse on the family and usually the child is kept hidden away in the home. Last week an 8 year old girl, who is unable to sit or stand independently, was brought into the department - nobody in her community knew she existed and she was not known previously to the health service.

The Ghanian physios are lovely to work with: they are happy to answer my questions and ask for my advice and input. It is still a difficult line to tread though, being a volunteer and working within your own profession where decisions are made very differently and where sometimes you do not agree with the choice of treatment. I am given a lot of freedom to treat patients as I wish but I am mindful that my way of doing things will not necessarily transfer practically to another culture. Not would it be accepted easily or quickly. As we are all reminded on beginning the programme, I am not here to change the world, only to share experiences and promote understanding and respect across cultures.

Internetting

The world today is an amazing place. In a town that often has no running water and where many of the houses lack roofs or walls and washing machines are unheard of, you can still walk 20 minutes down the road and login to find out what the rest of the world is up to. It is one of the few activities I can do here that is at all familiar - even sleeping, showering and laundry having taken on new meanings (I have never before had such neatly ironed underwear or spent so much time at the well).

You do need plenty of time however: my own internet connection at home invariably doesn't work as fast as I'd like it to but here it is not uncommon to wait 30 minutes for a page to load (or not load at all). Best to go armed with a book. Emmason, the internet place, is a room with over 20 computers in it and a small office. It is very cheap - about 1 Ghana Cedi (approx 60p) for an hour, but you don't achieve much in that time.

If you do get onto your chosen site, typing becomes the next challenge: the keys are usually sticky and do not always produce the expected effect. They frequently swap places with other keys and this week my apostrophe disappeared completely. I had not appreciated how handicapped you can be without an apostrophe!

There are a couple of fans on the ceiling which cover quite a few of the work stations but if it is not working or you are at the wrong computer you just have to sweat it out. There really is considerable dedication required!

Most excited to find free internet available last weekend at our hotel in Lake Volta I hoped to catch up on a few e mails without having to watch my money as well as my time slip into the cybervoid. However, after maybe an hour of enduring the small electric shocks that jumped from the computer when you got too close to it, several episodes of shutting itself down when the plug was jiggled too much and waiting at least twice as long as you do at Emmason even, my enthusiasm was waning.

The weekend in Cape coast was more fruitful internet wise -there was a cafe next door to our hotel which advertised fast internet. I went on Saturday morning to enquire about opening times.
"we open at 2pm"
"great, and what time are you open until?"
"we are open 24 hours"
!
It was indeed open late though and my scepticism was unwarranted - it was excitingly speedy: every page loaded within a minute and the only hiccup was a solitary power cut!

Trip to Cape Coast

"Are you taking the tro tro?" Akos asks. "You should take the van"
I explain that the equivalent of 100 pounds each for a taxi for the weekend was a bit steep so we had decided to rough it instead (and tro tro is the ultimate in roughing it transport wise). Sounding increasingly worried she reminds me that 11 people died in the tro tro last weekend on the road that we are about to take. And that this wasn't an isolated incident. Having deliberated at length about it previously we were reluctant to rethink our financial priorities and change our plans, but much as I like Ghana, I would like to keep my chances of returning to Edinburgh as high as possible. I was not alone so, wallets feeling decidedly lighter, we stayed in our spacious air conditioned van (we had accompanied Emma, who was leaving, as far as the airport in Accra) and as we crawled through the traffic, were already starting to feel the benefits.

Unfortunately the van doesn't do anything to make the traffic any better and it took us a good 2 hours to get out of Accra and on the road towards Cape Coast. Had we chosen to we could have used the time to do a spot of shopping: people walk up and down between the rows of traffic selling food and drink, clothing and even shoes out of the boxes on their heads. They seemed to get most of their custom from the tro tros which don't stop for comfort or refreshment breaks, but we also had a lot of people approaching our windows. Mostly we just smiled and waved at them, unhelpfully buying nothing.

The van doesn't make the roads any better either. It may be that its suspension is better than that of the tro tros (which I have yet to travel on) but it still has some monster potholes and speed bumps to contend with. In fact (and you may empathise or snigger depending on who you are) if you are female and planning on travelling in Ghana any time soon, I would recommend a decent sports bra! And possibly a helmet.

We eventually arrived at our hotel late in the evening - about 9 hours after leaving Hohoe. It was basic but clean enough (just) though worryingly the large fan hanging over the beds, when switched on, appeared to be about to swing itself violently off the ceiling. I am also not sure that the loose and exposed cables hanging out above the shower would pass their safety check back home. The following morning, as we walked along the small street outside our hotel, we met some of the locals, one of whom was wielding some large knives and looked about three years old!

We started the day with a canopy walk and a short stroll through the rainforest, and spent the rest of the day (amidst numerous classes of schoolchildren and other tourists with the same itinerary) learning about Ghana's participation in the slave trade at Elmina and Cape Coast castles. We also attempted to explore the local surrounds though this wasn't easy as we were accosted frequently by people attempting to sell us things we didn't want or demanding money for one cause or another. The smell of fish and the heat were quite overpowering in Elmina and it was a relief to retreat to the van.

Back in Cape Coast we stopped for dinner and took a walk along the beach to work up an appetite first (I'm fairly sure it did not serve this purpose). The first hundred metres or so of beach contained a few budget hotels and some boats (the touristy bit!) and was followed by a stretch about the same distance which would have looked idyllic (sun, sea, palm trees etc), had it not been absolutely strewn with rubbish and screaming of the poverty that is typical of the area. It was inhabited it seemed by a family of pigs wandering freely in the sand and foraging amongst the waste.

The children on the beach mostly swimming in their underwear, though some swimming fully clothed or wearing nothing at all, came running over to talk to us or demand we take their photo. It was around this point that the sea pounced and we spent the rest of the evening soaking wet. And smelling of fish - yuk!

Sunday was spent en route back to Hohoe. We drove through the university before heading back - it seemed a bit out of place with its manicured lawns, smart buildings and smartly dressed students on their way to the on- campus church. Anyway, we arrived back in Accra a few hours later where we went to the market and spent more money than we had intended to. It is a very un- british way of shopping: you find yourself literally chased or dragged into the various stalls (unless you run fast in the other direction) by people overly anxious to rip off the tourists, who they will not accept are not loaded with spare cash.

"Just come and look at my shop...I want to show you something..."
"No thank you" I repeat firmly. 'Looking' is turning out to be expensive.
"Not to buy, just look....it is free...I give you a good price...I want to give you something to remember you by..."

There must be some kind of inter- stall etiquette since whilst you are looking at one, you seem to be relatively safe from other attacks, but once you leave you are immediately pursued again. I became more accomplished at bargaining as time went on: the trick I learned is to not care too much about the thing you bargain for and be prepared to walk away. Also to start with as ridiculously low an offer as they start ridiculously high. Not foolproof though: I fought hard for some material to what was a fairly good price and then found the guy shortchanged me in quantity. The hazards of being a white tourist :o(

We also stopped at the shopping mall which felt a bit more like what we are used to - especially when we wandered up to visit the cinema and food complex. Until, that is, the electricity failed and everything shut down. That wouldn't happen at home!