Immersion Nonpareil

October 22, 2012
Back at Kasoa
I had quite a culturally interesting morning today. It involved a slow and large bus. An author. A butt and an armpit.
Had I taken a few more steps to find a tro-tro to take me to Accra/Kaneshie, I would have missed all of the above.  But, since impatience and curiosity won out I boarded an almost empty bus. It was my first time to ride such a bus. It was huge; it was almost as big as the long-distance bus we rode from Kumasi to Accra. Contrary to my assumption, the bus ran at a turtle’s pace. It stopped every minute (I am not exaggerating) on the road to get passengers on board. At first I didn’t notice how slow we were running, until I realized that my hair was almost sticking to my neck. Normally after passing the Kasoa Junction my hair would go with the wind owing to the speed at which the tro-tros and taxis run (fast).  The moment I was hair-aware, I knew for sure that the bus was crawling at 30kph. All other vehicles were speeding past us. I was jealous. This was the part of my trip that I looked forward to the most and I was being denied of it.
After the bus got filled, the man who was previously sitting innocuously on the side of the bus suddenly rose up from his seat. He stood up in front of the bus, just behind the driver’s area and just so proximate to me that one more step to his right and I would have said hello to his crotch. Thankfully, he stood firm where he was. Then with a penetrating voice he starts speaking. He spoke in Twi so I didn’t understand 98% of what he said. I think he might have prayed with the crowd in the beginning because after a pause everyone (with the exception of the lone passenger who didn’t understand Twi) said ‘Amen.’ I thought he was a preacher of some religious persuasion, and had he been I would not have been surprised as I am now well aware that Ghanaians wear their faith on their sleeves and their business names and even toothpastes (one toothpaste was called ‘Pray’).
A breath after the crowd said ‘Amen,’ he turns to his right and gets something from a plastic bag. He gets a bundle of small books. I was able to make out ‘Letters for Primary and Senior High School Students’ as he was pulling out the book from the bag. I did my best to keep a straight and disinterested face, as I did not want to be the subject of marketing discrimination.  I assumed he was the author of these books because later on I heard:
‘What I like and don’t like. What I eat and don’t eat. What I love and what I hate.’
(Ah, he’s selling a biography? was my thought)
Then to confuse me he says,
‘Cat. Dog. Cobra.’
(WHAT?! Where the heck did those animals get plucked from?)
Then later on he makes a smooching sound as he says,
‘Kiss Kiss Hug.’
So what I think is, gathered from all these excerpts, he was the author of a book that teaches primary and senior high school students how to write letters. I still can’t explain the animals though. To my surprise, after he finished talking the crowd started pulling out bills of 1 cedi and 2 cedis. Oh my gawd, they were actually paying for the book.
It didn’t end there. The next thing he started selling was African history book. More legit subject, and although I didn’t hear the end of his discourse I was pretty sure people pulled out some bills from their pockets to reward this author/marketer for his racket. I don’t understand Twi but I bet you if I did who knows if I might have pulled out a bill myself.
Immersed like this in another people’s culture, my senses really perk up and I start taking note of things. Such as how it suddenly got so crowded that now the seats are at a max (3-2-3-2; I was on a seat that could accommodate 3) and now there are people standing. And such as how the butt of the woman standing on my right was grazing my right shoulder—forward backward, inward outward – it all depended on the direction the bus went (go stop, left right). My eyes widened in disbelief when I realized that the ridge I was feeling? It was her butt crack. To add to the incredulity of things was that my left shoulder was likewise rubbing against the sweaty armpit of the person sitting next to me. Until today I didn’t expect that save for the obligatory rectal exams I sometimes do at work, that I would engage in intimacies with another person’s ass, though rather unknowingly.
Incredible. I hate it and I love it.
___
Allegedly Mondays are markers of fresh starts but today utterly felt like an annex to last weekend’s undeniably rich and authentic cultural entanglements, about which I will shortly write.
And as a preview it involves rides of different varieties: goat ride, boat ride and motorbike. And of course, the ubiquitous tro-tro. How we learn to have patience and pack up spontaneity and keep it as our company.

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Rest Days

October 19, 2012
Kasoa
Rest days. We need them. Today and yesterday were such days.
Yesterday I woke up with such tremendous muscle aches that even giggling a little hurt. I immediately brought the back of palm to my forehead to check if I had a fever. I wondered if that was the kind of myalgia you get from malaria. Dammit, I thought, I should have been less flippant about that nasty DEET lotion. I barely got out of bed. I felt as if I had a day-long massage from a hard knuckled masseuse. I knew that it wasn’t a day for Insanity, and I felt bad that I would ditch my work out buddies. But, as it turned out they too were feeling the same way. The charming thing about it was that regardless, we all got up at the same time we did each morning (~0600).  L said it first—I can’t work out today. Then U said it too. So it was sealed. It was going to be a day of rest. So there we were, with one solid hour before breakfast—already spent. We each took a sofa; I on the one nearest the dining area, L on the one against the wall and U on the one nearest the door. U made it back to her bed. L and I didn’t and we both slept where we already were.
Today I woke up with a start. There was this time, something grumbling. I rushed to the restroom quick. Two times. This time I thought I was getting the cholera. Dammit, I thought, I should have washed my hands 10 seconds longer! But, as it turned out L was also having the same issues (and 8 hours later, U became another sympathizer). Though I found enough resolve to go through another P90x video with U, my yafunu (stomach) was still very uneasy. Scared that this might be my day’s annoying stalker (and agitated at the thought that if and when I would have the urge, that it would be when I’m stuck in traffic in a trotro), I deliberated on missing work. My fear of uncontrolled stomach urgings won out and I stayed home. I felt terrible for not going to work today. I was gonna go to a hospital where an HIV unit was just recently built by the NACP (National AIDS Commission Program), to inspect how it looks like and how it is run. And I was going to get the revised blueprint and quotation from the construction company.  But I just couldn’t risk it. L and I looked back on what we ate yesterday. I was convinced it was all the Ghanaian chocolate I ate along with the cupful of Sangria I pleasingly drank last night. L said it couldn’t be, because we didn’t eat much. Well, she didn’t but I did.

Made in Spain, this Sangria is excellent!

Ghanaian chocolate, so yummy

Working out, oh yea!!
There is comfort in numbers. Knowing that all three of us have been sharing the same symptoms in the same temporal sphere makes me less paranoid that what I have is malaria or cholera. Or dengue. Or some other nasty illness worthy of a Masters of Medicine presentation (‘Presenting a female who initially presented with myalgia; past social history significant for recent travel to Ghana…’). I have been wanting to drink a hot chocolate drink (they have MILO here, yay!), but I know that if I do that would be my undoing.
I don’t know why my stomach would not now withstand food challenges. It used to be, that I could eat fishballs dipped in a publicly shared sweet and spicy brown sauce without getting sick. It used to be too, that I could avidly consume taho(soft, sweetened tofu) from our good old manong,  as well as gobble the pansit (noodles with vegetables) that the store at the corner of Dapitan Street was selling (the name escapes me, but it was where the men who were preparing the noodles were naked from the waist up, beads of sweat and all). Now my stomach is such a weakling. I need to rev it up.
Red Red on the left, gari (dried cassava) on the right– an attempt to add some roughage as a leverage to the oil 

Hey, I have been trying. Lunch today was Red Red (beans cooked in red palm oil, partnered with plantains), which I consumed entirely despite knowing that when you’re having diarrhea oily food should have to wait. (Ok, so that might have been careless.)

I almost forgot to talk about the Fish and Chips we had in Lake Bosumtwe last week. The waiter at the resort said they only had beef and fish to choose from. Naturally, I chose fish. Yes!, I thought, something familiar for lunch. Difficult to mess up.

The infamous Fish and Chips with the eyes 

Well, here’s what I was served: well-fried chips (in fairness to the restaurant it was good) and um—fried whole fish. Now, now— I know how to eat fried, whole fish. In fact, that is what we in the Filipino household cook on lazy nights; but, I thought it was hilarious how they called it! Freakin’ ‘Fish and Chips.’ And poor L, she didn’t know how to eat it! (L: ‘What the?! How do I even begin to eat this thing?!’) U, who ordered beef, said ‘oh hey look it still has its eyes!’ Good thing L was hungry enough to give the fish a chance, although she did have to cover its eyes. I didn’t realize eating a fried whole fish was an acquired taste.

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As today was Market day and we happen to live conveniently close to the Kasoa New Market, L and I (as soon as we felt our stomachs calm down a bit) decided to look for some fabric. We were going to decorate our drab living room. I was also going to buy one for my mom (orange and yellow, something bright she said) and maybe again, for myself. Upon arriving home from the market, we taped the fabric onto the wall with whatever tape I could find (a medical tape, designed to tape tubes and such on skin). For only a few minutes the fabric on my room held out, as did the fabric I taped on one side of our living room. The one L put up on the wall lasted there for maybe a couple of hours before entirely limping out and collapsing on the floor. It would have been beautiful on the walls. Now they are folded neatly, tucked in a black plastic bag that I am going to take home with me.

How my room looked like for 30 minutes or so

P showing off L’s fabric. This is the one that held the longest.

__
2 solid weeks left. Argh, I am having separation anxiety already. I have been practicing how to say ‘I will miss you. God bless you’ in Twi for when the day comes (November 2) so I can say them to D and P (our helpers in the house who hug me when I get home from work, who feel sorry if they aren’t able to serve me my hard boiled egg each morning, who offer to look for the ice cream I crave for, and who hold out my flashlight while I hang my clothes outside at night to dry).  I will say that to W too, because he never fails to ask me how I am and who is just so sincerely concerned (he also loves my curry and garlic rice). I never liked goodbyes, even though I know that all of life is a cycle of goodbyes and hellos, and that hello leads to goodbye and goodbye leads to hello.

P and D helping me cut veggies for the curry

But, the glass is always full isn’t it? I have 2 more weeks left, that is true; and you know what, each of the following days will be a celebratory party for friendship and extreme blessedness.

Visions

October 17, 2012
Kasoa
The track pad on my laptop is undoubtedly on its way of ruination. It has grayish spots now, which I take as signs of corrosion from my almost 100% DEET lotion. I am so lazy to spray the nasty lotion on me so at night I just wear long pajamas, socks and sometimes, even a light jacket. In the African heat, that is no small feat. But I cheat by having an electric fan blast on me less than a foot away. During the day it’s not so much of a problem, so I take it for granted. I guess even mosquitoes take a break from the day’s heat.
Yesterday we went to Good Shepherd Orphanage and International School (by ‘International’ they mean that students learn at least one language other than their own) where another volunteer was working (he is from the French-speaking part of Switzerland, so I get to practice my pidgin French). It was so refreshing to see that that they had a computer lab with quite the modern equipment! Apparently in this school they are taught French and English. Quite an education. 

‘President Obama is my best friend.’

Mardi. Tuesday. 
Traveling to and from work has been less of a hassle now that I absolutely know where to go and what to say. I still get confused though with how much a tro-tro and a shared taxi (cheaper to be on a shared taxi than not) should be, so I feel like I still get cheated by roughly 10-20 cedis at a time. I don’t mind it that much; in these cases I just try look at the bigger picture and make room for some generosity. I try to copy what the locals here say. For the past days I’ve been practicing how to say ‘stop here’ (i.e., ‘para’in Philippine lingo) in Twi. It sounds like ‘mesi ha.’ Then if I add ‘please,’ it would sound like, ‘mesi ha mepa wo chow.’  I think a little courtesy goes a long way.
Since we’re on the topic of shared taxis — the funniest thing happened to us two days ago on our way home. It was the last leg of our trip from Kumasi and we were on a taxi. As there were only three of us, we could still make room for one more person. As the driver continued on, we saw a mother of three hailing a taxi.  One was a baby (hugged close to her back by a fabric, as almost all babies here are), one looked like she was 6 and the other maybe 4? Clearly, we didn’t have space for three space-occupying persons.  The driver did stop though, despite this vision (perplexing). After realizing whom he stopped for, he scratched his head and said, ‘ay!’ After some shuffling, the 6 year old sat with me on the front. The 4 year old sat on L’s lap, and the mom with the baby pasted on her back sat on the only remaining space. I thought it was the most amusing thing. We shareda taxi alright!
Today in clinic I saw a patient with HIV.  He was there for follow-up. I asked him how he has been and he said he’s been fine; he really doesn’t have any complaints and he was just there to get his medicines. I asked anyway: do you have headache-dizziness-cough-trouble swallowing-vomiting-stomach pain-diarrhea-rashes. He said no, no nothing like that. I am fine. And then mid-sentence he stopped. He said well actually I do have a problem. I said what is it? He said, I have black skin.
I locked eyes with him (in my head I wondered if he actually said what he just said). I said with much deliberation, soooo….do you mean that your skin is darker now? He looked so concerned, but I didn’t know what to say to him. I wanted to ask if he wears sunscreen and if he was always exposed to the sun. These never made it out of me; I thought they would sound silly once said out loud.
I have been seeing more patients in clinic on my own now. Of course, this is if they speak even just a little English. I get excited each time! I miss work. There are only a few things besides doctoring that fills my gut with real gratification. The more I do what I do and share with others what I know, the more I recognize how truly blessed I am. Not everyone can lay claim to have a job that isn’t just a job, but one that enables them to make a fairly bountiful living while serving others and making a difference one human life at a time. Each encounter I have with a patient never fails to make me feel that the ‘wasted’ moments of my prime years that I have spent studying, worthwhile.
I came here with the intent of discerning what truly resonates within me. I am still en route; I am still in the making.  I still have burning questions that are yet unanswered. But at some undefined point during my trip here in Ghana, I felt a growing desire to do more. More. Isn’t that such a Jesuit thing to want?  (Eleven years after graduating from a Jesuit school, the Magis continues to have a home within me.)
So yesterday I decided to take it on. I talked with the hospital (Ga-South Municipal Hospital) administrator and advocated for a dedicated HIV unit within the hospital grounds. The HIV/AIDS team in this hospital has been, for the past 2 years now, pushing for this. They have always been promised something more. None have materialized. I know a large part of it was a funding issue, but I also suspect that HIV/AIDS patients here are an afterthought. What they were planning was to construct a new building that would house all five General Medicine and Pediatrics consulting rooms and some other rooms including the records area and pharmacy (which currently are located in the same building as the HIV ‘unit.’ ) The plan was that if and when this new building was finished, that the decongested areas could then be used by the HIV unit. Wow.
This was not a plan. This was wishful thinking. I asked what the timetable was for this new building and how far along they were in getting funds. The administrator in so many ways said, in an attempt to make the words more palatable, that they have not gone far. Sensing that this was the weakest link to their argument for not wanting to build a dedicated HIV unit, I offered an alternative and several reasons for this alternative:
When the HIV unit was set up in 2009 there were only 72 registered patients. The latest census this year 2012 has recorded 703 patients. The numbers are not expected to decrease soon. If at all, it will only go up. And exponentially at that. In the days that I have worked here, we have seen an average of 20 patients a day. We have squatted in different places in the OPD/Consulting room: the office of the Medicare head; the Male Ward; the hallway. This set-up does not lend itself to privacy. Nor is it an acceptable way to take care of patients, regardless of what standard you hold. The filing cabinet is filled to the brim. There are folders that are in boxes and on the floor. Records get lost. (I almost said that the office of the Medicare head, which we occasionally use, also function as her kitchen.) 
I said, while constructing a new building with new consulting rooms to decongest other units is a noble idea, I said: my heart is not in it. I hope you understand.
I said I was willing to help them build the HIV unit, find sponsors and such. I reasoned that it would be easier to get funding for a more specific end, rather than saying: please help fund a renovation for the HIV unit that may be vacated by other units if and when a new building is made, at some point in the future.
The message got through. I got the go signal to start. Shortly after the administrator showed me the land where the unit can be built. (So they had it after all!) Today we got a quotation for the building. As we made some revisions today, I said we should allow for some fluidity in the planning stage. In the next few days I will review the blueprint and the quotation with F, our program coordinator who has some know-how in engineering/carpentry.
I am excited, can’t you tell.  I have surprised even myself that I have gotten this far and bold in dreaming. I have always believed though that is only in teasing our life with bold choices that we can make good (excellent) with whatever faces us and whatever fazes us!
I have been praying about this in the past days and you know what, it resonates. This dream, it reverberates. In my heart I hear the words: ‘if God brings you to it, He will bring you through it.’
It has held true in every single moment of my life. Should I have doubts now?

Kumasi Adventures

October 14, 2012
Back at Kasoa
Oh, what a weekend we had.
We three girls went on a grand trip. (Grand: not to mean ‘luxurious’ in this context, as you will understand when my story unfolds.)
As a background:
Kumasi is Ghana’s 2nd best known city. According to Google Map, it is 229 km from Kasoa. It should take, again according to Google Map, roughly 3 hours to traverse it. However as you know because of the incompletely cemented and asphalted roads here, the actual trip is expected to be between 4-5 hours. Again, part of the famed ‘GMT’— Ghana Maybe Time (a coined term of one acquaintance).
As we later on quite painfully learned, 4-5 hours is being optimistic.
First Saga: THE RIDE.
Ours lasted 6 hours, almost 7. Looking back, we all agreed that this is most likely due to the fact that instead of taking a bus (less stops, more technically reliable) to Kumasi we took a tro-tro. The night before our trip we intended NOT to take a tro-tro,but that is where we found ourselves being escorted to on Friday morning. There were many things that were wrong in so many ways with this particular tro-tro but there were also some things that could have gone wrong but didn’t. Like how many people were allowed to be seated per row. On an ordinary short-distance trip (i.e, within the city or less than 2 hours) in a smaller tro-tro, there would be 4 people in each row; however during our trip there were only 3 per row. I thought, oh what a treat. I was so pleased with this small indulgence that I neglected the space between my knees and the driver’s seat. I also overlooked the stiff, non-cushioned seat that was going to be my butt rest.
One mistake I did: I didn’t pee before going out of the house after downing 750ml of water. This was a blunder that I was going to pay for so dearly. I knew it had to be the case even before our tro-tro left the station when I stared feeling the subtle promptings of my bladder. There was no way though that I was going out of the tro-tro though and start looking for a restroom in the station that was already teeming with an unbelievable number of human bodies. To be able to understand why I could not do it, one has to know what a tro-tro station here is like.
First, the human factor as I have already alluded to. Like ants scattered about in search for sweets, passengers and conductors and drivers and scalpers and hawkers mill about, in and out, shouting, talking loud. And as you know, when you don’t understand a certain language it always seems annoyingly blaring.
Second is the factor of place. Or the sense of the place. Let us start from the ground up. Orange. Orange is the color of their earth here. There is something about this color that moves my gut funny. Perhaps it’s how it is allied with the dust emanating from the shuffling of human feet, the reverberation of tires, the scattered litter. Add a few puddles of murky water and mud, and orange turns brown— almost like the color you get on your palette when you mix colors too clumsily.
There are also the colors white and black. Gray if you add them together. Almost always, white tro-tro. Black tires. Black skin. White teeth.
Then of course there’s the swarm of the dark and bright and light and deep colors of women’s dresses and head wraps, assembled in a motley of designs almost none of which are exactly alike. They are all nauseatingly beautiful.
Third factor is the distinctness of odor. There’s the whiff of fried food and orange and pineapple. There’s the reek of the unmistakably salty fishness of dried marine life.  There’s the lingering sweat that has overstayed its welcome in armpits and groins and feet. There’s the newly organized puddle of murky water. There’s the smoldering smell of smoke spurted by exhaust.
So in the face of all this gut-smacking assault to my senses— I decided that my bladder’s suggestions would have to retreat and be set aside. Surely, my skill at withholding these things have been honed throughout my medical training (fondly remembering how we would assist on a surgical procedure for hours on end; how we do rounds forever, how we just have to finish one more admission, one more discharge before generously giving ourselves a break), and that morning would have to be the day that I would summon all forces learned along the way. With unknowing brightness, I hoped that we would make a stop over somewhere.
We did. We actually did. It was when the police (in their routine stop-over for bribes) stopped our driver on an intermittently paved road. There were tall bushes on our right. Some of the passengers went down, headed for and disappeared in the bushes. They reappeared a minute later, business done. I couldn’t do it. Not with a pair of pants on me.
Don’t get me wrong—I have done it in the past when there was no other choice (i.e., mountains).  In fact at one time I did it in an open but remote field (I swear there was no one else around save for a cow or two that were staring at me with their bland eyes). But that was a different story. In this story, there were other people around. There was a real threat of being seen. Had I worn a skirt I would have headed for the bushes too. 
At this point, I still hoped that we would make a real stop over.
We never did.
To imagine the magnitude of how long I kept my bladder in check — it was a whole day’s (Ghanaian) work schedule. A whole Ghana day.  Anyway, this was not even the best part of our trip.  It was the hundred kilometers upon hundred kilometers long bouncy ride on potholes. Orange-colored potholes that bequeathed millions of orange-colored dust particles into the muggy air, into the open windows of our white tro-tro, that ultimately settled on our hair, on our faces and necks, on our arms and legs, on our bags and clothes. The key thing is that they settled.
Dust settled. Knotting our hair, forming a cake of dust foundation pasted further by the oil on our faces.
And remember the seat we had? Perfect chum for this perfect ride. My knees were starting to get so sore it almost rivaled my pre-knee surgery days.  There was no way around it — no matter how I lifted my leg up and curled my feet the impossibly scant space between my legs and the driver’s seat was a fact that could not be changed.  I tried to out-sleep and out-mind these conflicting matters at hand, all of which were seeking immediate attention at the same time. But sleep would not come to me so readily. And when it did, it would come so suddenly and quickly: my head would snap back in a flash and at almost the exact moment that it does, I awaken.
Now, this may seem like a ride to forever but we did make it eventually to Kumasi.
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Second Saga: THE HOTEL.
Sports Hotel was what it was called. Unmistakably blue in appearance, as described so aptly in their website. It was so named with the Sports Stadium which was near the vicinity, in mind. We booked a suite for three people, for two nights (120 cedis/60 dollars a night). I thought that was well-understood over the phone. First thing the receptionist asked was if we were going to book two suites since there were three of us. She said it was hotel policy that only two people could stay in a suite. I said we didn’t want to spend for two rooms. She began to haggle. I asked if we could see the room, thinking that an argument could be better settled once there is proof that an alternative existed. So up we went to see the room. Immediately I found proof of the alternative: a solid couch that could fit all 5’2 of me and a big queen-sized bed.  I said, see this room is big enough for us. She insisted on the hotel policy. I said well, 240 cedis or nothing—your choice. Fine, she said, you can have this room.
I thought that was the end of the Kasoa girls vs Sports Hotel. It turns out, that was the easiest. On the night of our arrival, all we wanted was a good dinner. After struggling with human and vehicle traffic in the city and mistaken restaurant identity, we decided to have it in our hotel. Our guidebook said it had a good restaurant anyway.
I don’t know what standards the author of the guidebook had at the time of his writing, but ‘good’ it was not. Not even close. I ordered one of the simplest food in the menu. Margherita pizza, I thought was fail-safe. L had jollof rice with chicken. U ordered pepperoni pizza without herbs. I added avocado salad and beer to go along with my pizza. Meanwhile our waiter had a look of incomplete understanding. She said she would be able to remember every thing we ordered without writing it down. 5 minutes later she came back, said that there was no pepperoni. Nor avocado. U then said to just replace the pepperoni with ham. I said to just replace the avocado salad with prawn salad. She then expectantly looked at L, who did not have any order changes in mind. L said, what you didn’t get our orders? And we did another round of our orders, this time with pen and paper. 20 minutes became 30 became 40.
My pizza came: a round and thin dough-looking item with tomato sauce and over burned cheese on top. U’s pepperoni-turned-ham pizza came: it was the same as mine. Dismayed, I asked for red pepper and black pepper to spice things up. She gave me two thick sauces, one red and one black. I asked for my salad, which was to be my appetizer. Oh, she said—we ran out of it.  Oh my holy cow. This was not how you reward a 6 hour long potholed ride. The only redeeming factor was the beer.
My pizza with the ‘red and black pepper’ on the side

The story does not end there. We asked for water. She said, do you want small, medium or large. L said medium. I said large. Seconds later she came back, saying I’m sorry we don’t have small or large. This could not be happening.
Come breakfast time we were served toast. We asked for butter. And guess what. I mean, whodoes not have butter in their restaurant?!
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Third Saga: THE MARKET.
Who can resist going to the famed market of Kumasi? Located in the Kejetia area, it is supposed to be the largest open air market in West Africa. Some Ghanaians say the whole of Africa.  It is said to be where traders from across the continent transact business.
So we went. We walked from the Mehia Temple to what we assumed, based on sight, smell and sound, was the market.
There is nothing quite like it. Said to house 10, 000 stalls, it is MASSIVE. Though quite honestly intimidating, it does beckon you to go in and explore. To experience. At first we entered rather reluctantly. But the quick-stepped crowd egged us forward and further on inside the labyrinthine market. And that is exactly how it felt like: a labyrinth. Had we trudged on further inside, we might have seen how exactly the web untangles in what is said to be an orderly manner: dry goods- spices- fabric-clothes-meat-fish. Or something like that. We only reached the part where the dry goods and spices dissected.
Going into the market felt like being swallowed whole. Being in the market, in every sense of the word, engages each of your senses. Again, the septic interplay of human factor, place, odor and sound making my gut churn in unexpected, inexplicable ways. It made me anxious. Especially when some men would start calling me out – ssst! China! Little girl! Obroni! One man at one point blocked my step, then gripped my wrist. I said, ghea! (Stop!). He gripped me harder. I shouted STOP! And wringed my wrist free. My wrist throbbed in heat and I hated him so much at that time.  The way he held me was so malicious. Thankfully that was the last lingering one. The one that followed was equally incredible (I was inside the taxi already and a man reached into the window and touched my arm) but less distressful.
A portion of the MASSIVE market
As the night was fast approaching, we decided to be quick in hailing a taxi, or at least attempted to. I don’t know if we just weren’t saying words correctly, but we have always had to show them our map to give them a sense of where we wanted to go. And always, they still would not know.
On that night, all we wanted was good food. Queen’s Gate seemed to have a respectable reputation, based on our guidebook. What we found was an old rickety Queen’s Gate sign announcing its presence demurely in a dark, run-down building.
Fourth Saga: THE FOOD. ALWAYS THE FOOD.
And so began our eternal luck with food. This upsetting turn of event was what led us to our hotel, and as you already know it didn’t have a happy ending either. It continued through our lunch by Lake Bosumtwe the following day, although looking back I think the tasty French fries was a good omen of things to come. Because where we went for our second dinner totally made up for every misadventure of the past two days. The hotel itself (Golden Tulip) was not very grandiose, but since everything really is relative—it was to our eyes, the most magnificent hotel in the world. And boy did we feast.

Yeeha!
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I do not mean to ignore Lake Bosumtwe, said to be the largest natural body of water in Ghana. It was stupefyingly placid. The road leading there was embraced on either side by rainforest. I loved it! The lake is surrounded by many (22, I think) villages. On a canoe, we attempted to visit a couple but because of our less than mediocre canoeing skills we didn’t even come near one. The guide suggested that we swim in the lake and try to cross to the other side as some have done in the past. We declined. It was not a day to attempt greatness. We saw a couple of fishermen on their wooden planks. These planks are just quite plainly, planks. Fishermen sit on them and with hand paddles they propel themselves forward. Their abs must be solid with the kind of balancing perfection they have to do each time they cast their nets.
Said fisherman in balancing perfection

Wooden planks
___
Our trip back to Accra was infinitely better. For 4 dollars more, we bought ourselves a cushioned seat that reclined, air-condition and comfort. I was so thankful for the improved ride that I was able to ignore the annoyingly boisterous dialogue happening in the DVD movie being played on the screen.
L so happy

Me, so happy too

And yay, we made a proper stop over. See, I learn from my mistakes. This time I went down and gave relief to my bladder. After paying 10p (5 cents), I proceeded to the restroom and lo and behold: 
I could not escape from squatting, could I
____
Truly: 
We live only once and it is for these experiences that we thrive! If traveling were an art, and I believe it is, it would be nothing close to logically ordered designs. 

Eh-heh

October 11, 2012
Kasoa
Eh-heh.
I stand corrected; that is actually how they say ‘uh-huh’ here. Sometimes though they do say ah-hah as I have previously observed. Given my tendency to copy people’s way of speaking and acting after observing them for prolonged periods of time, I have on several occasions stopped myself from saying eh-heh.
I went to work on my own today! Yay to me. I hailed a tro-tro using the hand signal (index and middle finger turned down) that means ‘I’m going to Kasoa Junction.’ W taught me two other hand signals to signify your destination (a particularly important know-how since tro-tros here do not give clues to their terminus): index and middle finger bent to your right (‘I am going to Accra’) and bent to your left (‘I am going to Kasoa’—that is if you’re coming from the side of Accra). I thought these were cool to know. It made me feel more street-savvy.
I did not have a difficult time traveling to and from work, even if it involved a significant amount of walking (snaking, is the more apt term) through crowded areas in the market. Only once did I hear someone call out to me, ‘China!’ as I walked past. I was pretty surprised that no one bothered me. I guess it helped that I walked fast and purposefully (as if I so knew where I was going), dodging approaching bodies as I did and always looking up. It almost, almost felt like walking through the 168 area in Manila again.
They must have told me and I just missed it, but apparently on Thursdays and Fridays the HIV unit does not normally see patients. I was reminded of it when G told me. Since I made the plucky effort to go to the hospital anyway, I asked if I could instead go to one of the consulting rooms and work with the HIV specialist (who also saw general IM and Peds cases). So I walked up to Room 5 and waited a few minutes for Dr W to arrive (she did ward rounds first).
She after all was amiable. I didn’t think so the first time I met her. Then, she hardly looked up from her paper when I was introduced. And she had hardly smiled. But today was different. I saw all sorts of patients with her—ranging from those who had difficult to treat HIV, to those who had HIV and who were feeling sick; from rashes to um, rashes (fine, so there were benign fungal infections but we had a fair share of scabies and folliculitis); from rule out malaria to rule out malaria. We had some run-of-the-mill hypertensions. We also had one lady who looked so surprised after testing positive for pregnancy. Our first patient was an elderly woman whose skin was sloughing off (she had improving SJS from nevirapine) and whose eyes were so red. I felt so bad for her because she was old, has acquired a lifelong disease and was sick from her medicines.
The most nasty wound I saw was of a young man’s (~20? Yup, that shows my age). Apparently he was having someone take off his old tattoo when an unknown chemical was poured on the area—resulting in a caustic burn. What I saw was red, beefy, degranulated, weeping tissue surrounding what looked like an eschar (or maybe it was the tattoo that was still, unfortunately for him, glaringly present). I can take blood, but not a wound like that. Even after more than ten years of being exposed to such, it takes all my will to control my facial muscles to keep a neutral expression. Luckily though, this wound didn’t smell a smudge as bad as a rotting diabetic foot.  I thought the lessons for this man would be: 1) don’t have a tattoo you may later on regret (i.e., a significant other’s name, because in time this other will be insignificant), 2) don’t have a tattoo taken off crudely and 3) live in the States where you can at least sue the person who poured the chemical.
Most of the patients we saw were I assume on the lower SES. Some of them were on NHI (National Health Insurance), which means free consultation and more often than not, free medicines as well. A non-free consultation with a non-specialist costs 10cedis (5 dollars) and 12 cedis (6 dollars) with a specialist. Since not all of the patients we saw had NHI, there were those who paid out of pocket. Although the fees do not sound significant, I can imagine how it must be a gigantic leap for them to even come see a doctor, when they earn an average of less than 2 dollars per day. Imagine: 2 cedis for transportation,12 cedis for consultation and say 20 cedis for medicines (and I’m being very conservative with this, because I saw that a steroid lotion cost 26 cedis). Holy cow, that would be 34 cedis! Already a week’s worth of your salary! And we’re not counting the lab and xray requests yet. It is no wonder then that even here or should I say especially here, people don’t voluntarily go see a doctor until they feel unwell or are dying.
And with this I confess that I have not seen my primary care doctor since 2009 when I was um, acutely ill. One thing you have to know, doctors make the worst patients. I have done worse than not seeing my doctor, like going out of the hospital to have dinner with a friend—name badge on my wrist and all– while I was supposed to have been admitted for a knee surgery the following day. Like hiking soon after a knee surgery and not going for physical therapy until just standing on my legs for 10 minutes really started hurting. Like sneaking something to drink while I was ordered to be NPO as an appendicitis rule out— why should I, when I knew for sure that it wasn’t what I had? Like asking if I could just walk home after having conscious sedation for a breast lumpectomy, because I thought I didn’t have friends or family available to pick me up and I didn’t want to postpone the surgery anymore.
Here in Ghana though, I have been good. I take my multivitamins every single day and pop my anti-malarial every night –on a full stomach, as I have been instructed. What did I say before—living in a different space changes you.
__
Today marks my 1st week here in Ghana. It feels longer than this, and I think it is because my days here lack monotony and predictability. (After all, don’t we lose power and water at unexpected times?) We like knowing what’s going to happen, but it’s the tiny shockers that really build you up from within. I wonder if this is why I gravitate toward the edge—because really, why would anyone not want to know what is beyond?
I had a conversation with F, our country coordinator (who was sleeping on the night I arrived, but everything’s forgiven) one night. We talked about giving our blessings forward. A relative apparently helped fund his education in the university, which in turn opened up opportunities for him. Today he helps fund a girl’s education. It’s the only way I can give back and give thanks, he said.
I gave him a part of my story. I recounted how the sacrifices of my parents and a very generous aunt supported my long education. And how without them, I would not be where I am now, doing things that I love and that make me grow in love. Once while I was swimming in a pool, something I absolutely love doing, I thought about my father with such extreme gratefulness that I thought water seeped into my goggles only to realize that it was my own tears I was blinking. When my brother and I were much younger I remember him insisting that we must learn how to swim. He enumerated several reasons, as he always does, why knowing how to swim mattered. It didn’t soften his heart when I would in panic grab the arms of my much more skilled brother in the pool because I was so scared to swim on my own.  He was tough on this one, my father, the same way he was tough on making sure we polished our school shoes every night (which my brother and I faithfully did, until we learned how to nicely ask our helpers to do it for us). I guess with swimming it was harder to cheat so I just showed up for our swimming lessons, begrudgingly at first until I not only learned how to swim on my own but also realized with some surprise that I actually loved it.
What I grasped in the pool is what I grasp again today—that no one in this world makes it on her own. And that the ‘useless things’ we do, the meandering roads that seem not to make sense, the bizarre strangers we meet in these meandering roads; the loves we have had, and the loves we have had to let go, our injuries and our blisses —- they really do amount to something.

The Other Side

October 10, 2012
Kasoa
Enjoying here, but missing my sister’s birthday (boo)
One of the good things that can come about when you’re living in a different place is that you can re-invent yourself somewhat. Translated to the more specific, I mean that I have been doing things here in Ghana that I normally would not do back home.
Such as, waking up at 545am (uh-huh; which by the way, Ghanaians say ‘ah-hah’) to work out yet another Insanity video. This time it was time for Cardio and Resistance. L asked me what it was about before starting the video. I said I didn’t know but it sounded like a lot of work. And indeed, it really was intense but this time around we finished the video without having to forward it midway. I think the more you do it, that it gets easier. Our helpers didn’t join us this morning, I think partly because it was too early for them and partly because they were both feeling sore. D today kept walking like a woman with a 20-month old baby in her womb. Luckily for her, it should not take a lot for her to build muscles in her arms (they are already on the way to becoming toned) and in her butt (she already has an ass in JLo proportions). I am taking a liking to working out in the morning, although I don’t know how I would be able to keep this up at home when I no longer have 2 girl friends to join me (my girl roomie at home would not be caught dead working out, that I know for sure).
W again went with me to work. Tomorrow I will be on my own, which I now do not find daunting. I think I can navigate through the chaos here, having snaked through throngs of people in crowded streets multiple times now. 
We arrived at the hospital a little past 9, and found G already busy counseling a patient in the very private (not) hallway in the building they call ‘Consulting Room 4’ which houses both the Male and Female/Children’s Recovery Wards, 2 other unnamed rooms and what seems to be the records department. The entire area of the Consulting Room is very small. It would take longer for me to walk from our mailbox to the end of our backyard than to traverse the entire the room.
Later we were called to the office of the Medicare Unit (I don’t know what exactly Medicare means here), which is where HIV/AIDS CT (counseling and testing) occurs—sometimes. This was where we held our HCTs (HIV counseling and testing) yesterday.  Only difference was, the head of the Unit was there today so aside from the room functioning as the HCT room, it was also operating as her office (and her kitchen and dining area as I later on learned when at a little past 12 she started taking out her rice cooker and bowl, put on her apron and began peeling her vegetables; I wanted to rise from my chair and look over her table to see what exactly she was cooking but I thought it was poor form).
I assisted G in some of her clerical work, although I did at one point carry out the First Response Test on one patient (fulfilling) and did some counseling (the patient understood English). It was almost comical how I struggled using the lancet and the pipette. One of the things G had me do was to write up scripts for ART (most of them were on AZT+3TC+NVP, although some who had had reactions to NVP like lipodystrophy and SJS were converted to EFV) and prophylaxis for opportunistic infections (most were on TMP-SMX).  Not being able to sign the prescriptions myself due to not having a license here, it felt odd to be writing the medicines and then handing the scripts over to G to sign. There were times when the patients would have specific complaints, to which G would say you have to go the doctor. It felt again, odd, that the doctor in the room (i.e., I) could not see them on her own.
There were times however when I had to assert myself for the patients’ sakes.  On one occasion G started writing ‘cotrimoxazole 2.5mls’ for an 18-month old boy whose weight we did not know (the weighing scale was only for adults, and from my understanding babies who are receiving only prophylaxis medicines by virtue of their breastfeeding mothers being HIV positive, do not have their own records). I said, why are you giving 2.5mls? She said this is what I see doctors always give to children. But shouldn’t it be weight-based, I suggested. She said yes I get what you’re saying. I asked if she knew the preparation of the medicine. She didn’t know. I looked up cotrimoxazole in my Harriet Lane app, but it only had Bactrim. I knew they were essentially the same apple, but I didn’t want to assume that the preparations of the syrup were the same. So I said, well you know what—if that’s what you see them give then go ahead. I had to swallow hard.
And then one time a woman came and she asked for ART scripts for herself, her husband and her 9-year old daughter.   G asked me to write the scripts and as for the daughter, to just copy the previous doses.  And since I have a hopeless leaning to details, I noticed that we would essentially be under dosing the daughter if we were to just copy the previous doses. Thankfully the folder had dosing guidelines for children, so there was no question about the doses this time around.
I learned today that infants born to HIV positive mothers are followed on regular intervals, to make sure that they remain sero-negative (if at one point they are found to be positive, then they immediately receive treatment). Those who breastfeed from HIV-positive mothers receive prophylaxis until a certain time (if I understood it correctly, up to when they stop breastfeeding).
They had a meeting today with who I assume to be an HIV control officer from the Ministry of Health. He asked questions I have already asked myself, such as—where is the HIV center (there is no physical center), how are cases recorded (pretty good, but on different books and by two different, but inter-connected departments), what are the challenges (lack of a dedicated HIV center, which translates into an absence of privacy for patients, and poor fluidity in the counseling-testing-treatment-follow up-surveillance continuum). He was, quite understandably, bewildered. It was quite an interesting meeting. The head of the unit was starting to get heated up and defensive when questions were arising. G sounded her desperation about trying to get funding for a center, for quite astonishingly, 2 years now without any luck.
I talked to her about it. I asked her what the barriers were. Did they think you did not have enough data? Did they think the presentation was not good? Are they not convinced that HIV is not a simple case of pneumonia, that it needed serious attention? Did they say they did not have enough money? Have you presented a business proposal? Did you give them numbers to crunch on?
She said that they have been promised of a center for 2 years now. Soon, they would always be told. But nothing has been done. Sure, funds are not plentiful. G says that recently money that they thought was going to go to their department went instead to the acquisition of an x-ray machine. I said, well, that’s also important and it would be hard to argue with that.
I asked if she has already drafted a new proposal. She handed be a photocopy of her abridged and hand-written proposal (I am not sure if this is what she actually submitted—god I hope not). The ideas were sound, but like I said if she presented it in this manner (handwritten on one an half page of bond paper) then I would understand why it was not given high priority. I offered my assistance in helping her write up the proposal if she wanted to. She seemed interested. I don’t know if I was chewing more than I could by offering this to her but at that point it seemed the right thing to do.
Working in the non-physician side of the healthcare spectrum is quite the learning experience. I see the difference in the discipline and approach to patient care. I see how our orders are received and carried out. I see the gaps, and I also see our inter-dependence with one another.
___
This afternoon one of our helpers, P, asked me what we were going to cook. I had to laugh out loud that she asked me because she never did until that point. I asked what we had (yam, rice, cabbage, tomatoes). Oh boy. So I went to the kitchen, rummaged through everything. At the end of my kitchen investigation I had gathered up ingredients for what would be vegetable curry without coconut milk (they neither knew what curry nor coconut milk was). They had curry powder, but they used it for a different purpose (as rice mix).  I think I added too much chili because even I could not eat the curry without having to grab a pineapple chunk as a chaser.
Tomorrow I may teach them how to cook garlic rice. I can teach them chicken adobo but I hesitate because how would that serve me? Haha. And anyway, they don’t know what soy sauce is. Not even sure if I could find one in Shoprite, Ghana’s Wal-Mart.
Another highlight of my day was seeing Dingdong Dantes on screen, with an English dubbed-in voice, while picking out local music CDs at a local store. Not that I am his fan, I just thought it was so amusing that a Filipino film could land its way to one shop in Kasoa, Ghana. I just wish they had a better film to show.
Ah-hah.

First Day at Work

October 9, 2012
Kasoa Home Base
We have lost power again. It is so hot I want to undress myself. It should be okay, I am alone in the room and no one else comes here.  I don’t mind losing power at night. Dinners are always more intimate with candlelight. Conversations are easy. And the air is always more still. I looked up at the sky tonight as I was hanging my newly washed clothes. It was beautiful. Dark and dotted with stars that always to me, look ethereal and quieting. All three of us here are readers, so after dinner we always lie down on the sofa and read books— and tonight was no exception. They both had flashlights, and I had my Kindle (I love it). Reading non-medical books is for me a real luxury, and I am savoring every word I read.
This morning was quite fun and unusual. I got all the girls (including our helpers) to work out with me using the Insanity videos I brought along. It was hilarious how we all struggled toward the 3rd round of the 3rd set of crazy and insane exercises (and decided to fast-forward the video to the end). But oh boy did it feel sooo good. I was sweating so much you’d think I ran 10K on a 90-degree weather. It felt like it. I thought with the morning African heat seeping into the living room combined with our sweat, doing hot yoga here might not be so far-fetched an idea after all. We have a reasonably big front yard and I told L that if she sees me running around the perimeter it means I have gotten bored with the videos. Which I doubt, because I also brought P90X with me. I am crazy active this way.
Ok so I have taken off my shirt already. Oh my god I hope we have power soon. I don’t think I can be more naked than naked.
Anyway, today was my first day at work at Ga South Municipal Hospital. We (W and I) reached the vicinity at around 10 am, after a 45-minute tro-tro ride. Then it was a short (5 mins) walk to the hospital itself. The compound was more like a set of one-storey clinic buildings than one big hospital building. I met with the head of the whole hospital who gave me a draft of my schedule for the month. I asked if I could change it according to my needs, she said she did not think it was a problem. Next I met the Medical Superintendent (a doctor too) who also said the same thing. Then I was led to the HIV counselor, whom I will call G.  She was in a small room at the corner in one of the buildings. At that time she was counseling a patient (whom they call here ‘client’) and I thought it was notable that people here do not mind walking into a room even when there’s obviously some business currently being transacted among persons inside it.
The next 4 hours were spent counseling patients who were there for testing (either as a walk-in or as a referral from a physician) and for follow up. Most of them were women, interestingly. I watched G swab the oral mucosa (more specifically, the upper and lower gums) of a patient. Apparently this is the way they confirm a positive ‘First Response’ result. Today however she used it for initial screening because they have run out of the First Response kits (akin to a pregnancy kit). If the kit has a positive (two red lines as opposed to only one red line for a negative result) result, they do a confirmatory HIV antibody test by doing the oral swab or a blood test. Then depending on the result they undergo further testing and treatment or not.
While I was there G was called by another nurse to please run a rapid test on a sick patient in the Male Recovery Ward. I went with her and found a real sick-looking man in his (maybe) 60s lying on his yafunu (stomach). I asked G why he was here for and she said because his chest hurts. I instantly became worried. He looked really ill. A doctor has already seen him and has already requested tests and medicines for him, which his relatives are already in the process of buying in the pharmacy nearby.  I walked away feeling helpless and real uneasy. An hour or so after, I took a peek in the ward and saw that his bed was empty. I hoped he just transferred beds.
Every bed in the Male Recovery Ward today was filled, but not with men. Men occupied two of the six beds. 3 women and 1 child occupied the other beds. The Female and Children Recovery Ward also had I think 6 or 7 beds. All but one was filled. A nurse was trying to insert an IV into a child’s vein and I almost volunteered but I have been without practice for such a long time and I didn’t want to waste precious IV needles. Also there was my fear of having a needle stick injury.
Apparently there are always more women than men who are either admitted to the hospital or being tested and treated for HIV/AIDS. G said it may be because they have more women in Ghana (not unique to Ghana, I thought), and may also be because men are less inclined to seek consult. I said because they are macho. She chuckled at this. She thought so too.
She brought out a list of their ‘Defaulters’ or in our language, those lost to follow up. If the records are accurate then I must say it isn’t too bad. They have 73 recorded defaulters from January to June 2012. Some of them were even wrongly recorded as defaulters because they have followed up. G, who I thought was dedicated and sincerely caring, said that she wanted to get the defaulters back into the loop but she didn’t know how to start and she didn’t have the budget as well. I did the math for her and made the observation that if we calculated it out, 73 defaulters would mean around 12 defaulters per month, which I said was a doable number if we further divide the 12 into 4 weeks. I said you could certainly reach out to 3 patients in a week. She lightened up and agreed that this was indeed more attainable than she thought.
I suggested that she should not have to do everything on her own. Hiring public health or community nurses to do the leg walk would decentralize responsibility, which was especially paramount because she was absolutely needed in the clinic.
She agreed and said that she would include this in the proposal she is in the process of writing up.
The physical infrastructure of the HIV unit leaves much to be desired, but I was rather impressed with how they organize their patient files. Each patient that comes into the HIV unit has one folder and in it contains two big notebooks issues by the Ministry of Health. One notebook was dedicated to HIV/AIDS initial and follow-up care, and the other notebook a record of all other visits with each page basically dedicated for a SOAP format. I thought this was pretty neat. It isn’t EMR, but it was better than loose papers or even none.
G said that one of the biggest barriers to adherence is still the stigma to HIV and AIDS and all the misconceptions on how it is transmitted. She told me of one woman who only told her husband of her HIV after almost one year of treatment for HIV, and after an ultimatum from G (bring your husband or else I will stop giving you medicines). Most people think that you get HIV just by physical proximity, by using the same cup, using the same spoon. And yet, and yet— men don’t use condoms. It breaks my heart.
Tomorrow I will be back. I cannot wait. There is much to learn.  Along the way today G introduced me to different people and introduced me as Dr? I always chime Baua. I thought two syllables would be easy enough to know, but apparently not (after all in the States I am Dr Bau, Dr Bauer, Dr B, and oh yeah—RosBagh).
It seems they also have a difficult time understanding what Med-Peds is. They say so you’re a pediatrician. I say yes but also an internist. A what? I say a doctor for adults too. Oh, so you’re also a physician! I think about correcting the term and clarifying that a pediatrician was also a physician, but decided to agree that yes—you’re right I am a physician and a pediatrician. I think I chose a specialty that is not universally widely understood.
Before I left, G and I came into the uncomfortable topic of religion (a topic that Ghanaians do not mind discussing with you). She asked if I had a Bible and a devotional guide. I said yes (I only recently received the guide from one of my patients in Geisinger). She asked if I read it. Honestly I said no. And that’s when she went on trying to explain to me how reading the Bible is important. Though I am not opposed to reading the Bible (in fact on occasions I have read it and have found solace in it), I do not appreciate people proselytizing me. The way to my heart is by example. Luckily W gave me a call and I stood up and excused myself. I said sorry I need to go W is here, it was real nice working with you today and thank you very much.
I am pretty sure the Lord loves me as I am. And in this I find my peace and solace.