Ghana: Stepwise

This is a trip down memory lane.

This is a trip from Sydney to Accra.

This is the sort of trip that changes who you are.

December 30, 2011 I left my home. The first place I have ever lived that has really felt like home – a safe place to rest, to recuperate, to share my soul with the world, to smile no matter what the day has held. Leaving the house was an exhausted, 6.30am adventure with a zipped-buckled suitcase, three boxes of glasses (plus the one in my suitcase), a carry-on bad and my handbag. When you have so much to bring, it’s easy to feel just a little bit like you must have left something behind.

A hug from my housemate. See you in seven weeks! A taxi ride to the airport, stressful text messages from my travel buddy, a new friend made chatting to the driver.

It will be at least 28 hours until I get out of an airport. I am entering the Twilight Zone.

Bustling streets, arms reaching to grab you, people constantly shouting out to us. “Obruni! Obruni! Buy some food, buy these pants, give me some money, fly me to your country.” Voices and people everywhere and humidity and heat and the air is perfectly still. The air is suffocating, the streets overwhelming. Step off the kerb and quickly rush back. The cars travel on the other side of the road.  Ushered into a tro tro, squeezing into a seat obviously meant for someone half my size. Forced friendship with whomever I’m sitting next to – we better be friends if we’re going to be sitting in each other’s sweat. The world flashes by…

Goodbye, 2011. We’ve had a wonderful time together but I’m ready for 2012.

The road rules here seem a strange metaphor for the inner workings of Ghanian culture. Where Australian driving (for the most part) complies with very specific rules that are sometimes policed through patrol or cameras, Ghanian driving is about getting where you’re going regardless of the vehicles around you, overtaking and then slamming to a halt as you approach a pothole, swerving around it and speeding up again only to stop at a police barricade that is somehow meant to prevent armed bandits from going from one area to the next.

When I was in primary school, we had this chant we would call for those that got to the classroom door first. We had to stand in pairs and those who got their first and could squeeze their tiny feet under the door claimed “zero the hero,” then those that followed were “first the worst,” “second the best” and “third the golden princess.” I found myself remembering these titles when I was in Ghana…it feels like adaptation to the cultural and physical environment is a step-wise process.

Zero the hero: preparation. A time when we thought we would be bringing desperately needed supplies and assistance to people in need. To people who couldn’t afford a trip to the doctor, let alone the pharmaceuticals, medical devices and surgery that may then be required. People whose livelihood, in this agrarian and industrial economy, depends almost entirely on being able to be mobile. Mobility that requires sight. Sight that is required for the children to go to school and get an education, the catalyst for so much positive change in this country and so many like it. Zero the hero, the sense that we will be saving the world a little bit at a time.

First the worst. We arrived and I suddenly wondered what right we had to be there, imposing our Western values upon people who were not demanding our visit. Arriving into a new country is always difficult because understanding a different culture does not come from a textbook or website. The only way to understand completely is to immerse yourself in it. We arrived without much of that background but a wealth of ophthalmology knowledge. We arrived and I was suddenly unsure of my purpose in Ghana. And I felt wrong. I felt dirty for thinking that a 1st year Medical Student could possibly ever save the world, even one bit at a time.  Why hadn’t I donated stacks of money instead to paying teachers in Ghana, to building roads, to installing sewerage pipes, to building mobile phone towers? That money goes a lot further when it’s not spread across paying for me to get safely to Ghana.

Second the best. We couldn’t spend 25 days sulking about how inappropriate it was for us to be in Ghana. It only felt that way to us – and it only felt that way because we didn’t want to be like ‘those people’ who act like Western ideals are somehow better than those possessed by locals. We listened, we learned and we tried to come up with new and fresh ideas for how to improve health outcomes (among other things) here, using resources available. How could we produce ophthalmoscopes that don’t need the hardest-to-find batteries, how could we educate people on good eye health maintenance while we have a captive audience, how can we harness mobile technology to inform those who wouldn’t consider eye health important, how do we improve nutrition, how do we reduce motor vehicle accidents and the pothole population? How do we make Ghana a safer, healthier place to live through change instigated by locals? These thoughts constantly bubbled out of our mouths, onto pieces of paper and into hours-long conversations. We toyed with ideas, we ran them over again and again in our heads until we had something that sounded accessible and then presented them to our local mentor, an optometrist. She was always encouraging. She was always impressed with our ideas. Supportive. And took us down a notch when things were definitely impossible.

Third the golden princess. This stage was contentment – the stage when the culture shock has completely overwhelmed me so I become subservient to it, accept it and move on. Unpartitioned toilet paper, cold showers, spicy foods, language barrier, I accept you. None of these factors are barriers to happiness. To education. To safety. I will be okay. This is me now. Obruni in Ghana. Culture enthusiast. Hot weather natural. Dusty, sweaty and never-quite-clean human being. Writer. Internet un-user. Twi attempter. Compassionater.  This stage is what I need to help locals make change. Small, sustainable but significant change. Hopefully so that they can change their world.

One step after another.

Ghana: arrival

Ghana. What a beautiful place.

My first impressions after 24+ hours in transit from Sydney to Accra, the capital, were of surprise. I was shocked to see the streets set up in a grid from my sky-high view. It shouldn’t be surprising, but I didn’t expect properties to be lined up in a perfectly grid-like arrangement with street lamps at each corner. As it turns out, this must be only on properties near the airport as it is not like this in most of the city.

We landed on solid ground with a bit of the jump. I flinched. I didn’t expect to bounce onto the runaway. We got off the plane through a sheltered staircase (top notch!) and entered the immigration building with its beautiful red archway. The immigration process is never much fun but we made it through and collected our bags and boxes with no problems. We were both a little overwhelmed by most everything at this point, overwhelmed by a need to sleep in anything that looked vaguely like a bed. A man and his friend found their suitcases had arrived missing their brand new laptops. I wondered why anyone would pack brand new laptops into checked luggage. I guess it made sense to them. Dazed, K and I headed through customs. The officials found great pleasure in searching through our boxes of glasses and decided that they might want a few pairs for themselves. We were upset by their actions but half expected it. I guess what really gets me is that they were stealing from their country men, not from us. That just seems remarkably unkind. Especially in a nation that is so friendly.

On high alert, we got into the wide world of Accra, helped by a lovely group of taxi drivers to figure out where we were going. After much discussion, many phone calls and a lot of confusion, we managed to get ourselves to BaseCamp in Kaneshie First Lights. We were so glad to have made it. There were perfect bunk beds, a flushing toilet and running taps of water waiting for us. This is the life.

It’s funny how quickly I become accustomed to a world without all of the products I have at home. It bothered me little that there was no hot water. It bothered me little that I forgot to bring body soap and instead needed to use shampoo. That I had to brush my teeth with the small amount of Sydney water I still had in my bottle. That I was sleeping under a flattened mosquito net because it was too tall to sit upright underneath the fan. I was so impressed by the quality of our accommodation. I think I had set my expectation levels to be somewhere around the accommodation we had in remote NT. Instead, it seemed comparatively high standard.

We slept for all of five hours, thanks to K sleeping for almost all of the flights here. Me, I was still tired but I am used to a lack of sleep! We had our breakfast, a delicious omelette, fresh bread and a milo, before doing some yoga and relaxing for the morning. As it turned out, one of the boys who works at BaseCamp was taking his brother on a tour of Accra on the same day so we tagged along to see the markets, take the tro tro (public transport), sample traditional Ghanaian food and see the beach.

The beach. Wow. To stand on the southern edge of West Africa, knowing that there is little aside from water between you and Antarctica is just mind blowing. I stood in the water, pants rolled up, playing with the sand, sinking my feet j to the ground under me, letter the waves run between my fingers as I stood folded in half. It took a lot of self control to keep myself from jumping in fully clothed, but having my camera, phone and paper money in my pockets was a pretty logical reason to control my limbic system.

We headed back to BaseCamp to relax for the last few hours of 2011. I finished off my year in the longest conversation with one of the staff, J, who wanted to share his world, understand mine and to make friends. What a lovely way to spend the last hours of my year. I learnt so much about Ghana in those hours and a few words of Twi, the local dialect. I feel a kinship with this place.

After all of our adventures, I was exhausted. I struggled into bed and fell asleep instantaneously despite the yelling of the priest at the church next door. Sound restrictions don’t work quite as well here as they do in Australia.

Today, the first of 2012, we relaxed. I hope this is a reflection of being a little more relaxed this year. I have a tendency to burn myself out too much. We read, I napped, I wrote. We arrived at the Telecentre, our next accommodation, to be shocked by how fancy it is. I am still overwhelmed my the marble floors, fridge and telephone in the room. It’s nicer than my place at home! I don’t need this level of fancy! A mattress, running water and electricity are luxuries enough for me. How much does it matter what things look like on the outside?

The Shadowing Experience

Prior to heading off to Ghana, Kellie and I were required to spend some time with ophthalmologists to learn their trade.  I spent my time at the clinic with a number of doctors and nurses, all of whom were incredibly talented, inspiring and wonderful teachers.  Words cannot explain my thanks to these people who assisted me.

I am overwhelmed by the value of sight.  I spent three days in hospital watching people struggle without their vision.  I saw families huddled on the uncomfortable chairs in the clinic, bored, unable to watch the television, unable to read a book, unable to walk to the bathroom on their own, unable to wander freely while waiting because they couldn’t see.  These people were chained and restricted by their eyes, despite having strong bodies.

Many of the patients that I met had experienced good vision at one point.  Several had suffered trauma to an eye and subsequently lost the eye (sometimes completely). They felt embarrassed by their new face, saddened by their lack of vision and completely helpless because they needed someone around to assist with groceries and going places.  Many had left their preferred profession as a result of their sight. Many had left work altogether.

These are smart people. Capable people. Able people.  They’ve been let down by their eyes and our society allows for little wiggle when it comes to vision.  You can work without an arm or a leg, perhaps without your hearing.  Lack of vision makes everything that much harder.  Sadly, Australia is behind on disability equality and more needs to be done in this field.

The struggles that these patients faced moved me.  I am stunned by how much their lives are affected, how much their family must also mould around them.  And I’m thankful that the public health system does so much to help these people.

I am often asked why I am volunteering in Ghana. There are so many reasons.  At the moment, the knowledge that people in Ghana would struggle even more with these sight issues than people who live here – that an agrarian and industrial society hardly caters for the blind, that poor vision arises so much earlier and with longer lasting economic and social effects – inspires me to do what I can.  I am only a very small piece of this puzzle but I hope that together, we can improve sight here and across the world.  It all starts with knowledge. Action – that is the next step.

Why Ghana?

As many of you would have heard in the past few months, thanks to my spamming you with updates and requests for fundraising assistance, I’m volunteering in Ghana in January.  It was been far too easy to get caught up in the planning process of pre-departure preparation, the stress of fundraising and organizing the glasses and trying to find flights and doing all of the learning required (and, and, and). Between studying medicine, working, volunteering and starting up a not for profit, this has been quite the demanding task. It’s been stressful and difficult. It has grated on my nerves and made me a difficult person to be around. I’ve struggled to sleep and struggled to regain ‘my compass’, as Kate would call it.

So what am I really writing about today?

I have found a little bit of myself again.  In amongst all of the things that fill up my calendar, I frequently decide to spend a day or a few at a conference.  This, though seemingly stupid two weeks out from an 80% exam for my entire year, centres me.  Conferences allow me to immerse myself completely in new knowledge, in meeting people and being amazed by their wonder.  They take away my arrogance. They remind me of the intelligence, insight and extraordinary capacity of my peers.  They remind me that I am human. That I still have so much to learn and so much to improve upon. Conferences remind me to interact, smile and talk.

It is with this reflection, this mental cleansing, that I have once again been able to recognize why I am volunteering in Ghana this January.

I have always been one to advocate for services at home and volunteering with those who have very little in Australia.  I still believe this to the core – having nothing doesn’t get better just because you live in a rich country. In fact, the richness of that surrounding you makes your poverty all the more obvious.  The people in their Hugo Boss suits, carrying their smart phones and grabbing coffee at a local cafe almost shove in your face the face that you sleep in a hallway at Central station and suffer the embarrassment of begging for your food.

What I have realized, however, is that advocating for local solutions is not mutually exclusive to advocating for those in developing or under-developed nations. This may seem obvious because it is. The problem is that we live in a society where fitting into a box is a frequent demand from new acquaintances.  It thus becomes difficult to describe my passion for just about everything.

So let me explain in basics.

I believe in human rights.
I believe in human responsibilities.
I believe in respecting others.
I believe in equity and equality.
I believe in doing MY best to make things better for others.
I believe that we can make improvements, even if world peace and other idealogical concepts are so far away that we cannot see them on the horizon.

I first went searching for what resulted in this placement because I wanted to make real change in the world. I know that I will make change in the future – that my involvement with patients as a medical student on clinical practice and as an intern and doctor, the differences may be small or large but they will exist.  I know that if I get into public policy, I will affect change on a state, national or global level. I know that my work with Inspire does something but I can never see it. I don’t want to wait to make change, to tread water or run a hamster wheel waiting for opportunity to come my way.  I wanted to do something that would make an almost instantaneous difference to someone else’s life. And I didn’t want to take away from them- yes, I wanted to learn but I didn’t want to disadvantage them by being there. I wanted to remember my human responsibilities.

I would have liked to do volunteering in Australia. I love helping out my fellow citizen and spend a fair bit of time doing so.  Somehow, I came across this amazing program in my searches, though, and the way in which it provides sustainable solutions to global health problems inspired me.  I saw that they were recommended by AMSA and I had a good word put in by a very close friend. I figured there was little to lose.

Why exactly Ghana and Unite for Sight?

I can promise you that this trip is not because I “get to go overseas” or because it’s Africa and “everyone there needs saving.” I’m sure that people in Africa and Ghana are just like anyone else from any other continent- of a whole range of intelligences and abilities, of different skills and desires. I’m sure there are people in Ghana with great solutions to the social problems that they face, just as there are many people in Australia with those same plans and goals. The reason that I chose to go to Ghana is simple. There is a position to be filled, for as short or as long as you have time, and I have time to fill it. Not only that, but I’m passionate about the method of service delivery. I’m passionate about vision. I can’t promise you that I will work in eye health specifically. I am, however, passionate about vision because I am a visual learner. Because I need to see things to understand. Because I  can’t imagine life without my eyes. I could imagine being deaf. I could imagine not being able to smell. Communicating without sight sounds so devastating that I’m not sure how i would cope.

When I read up on the methods used by Unite for Sight – the fact that they partner with those smart people in their target nations, that they promote local solutions to local problems and develop global understanding and tolerance in the process – inspired me. They saw a problem and a way to be part of the solution. This is not white man fixing another nation. This is not neo-colonial. This is altruistic, empathetic and logical. This is truly sustainable.

Just writing out these thoughts make me feel so passionate (I wish I had another word for this feeling) about what I will be doing in two months. It reminds me of why I signed up for all of the difficulties I am now facing in the fundraising and time management department.

I am excited that in less than two months I will be hoping in a plane to experience possibly the most challenging 20 days of my life. It may not be as stressful as life has been before but I do imagine it will be difficult. I imagine that I will feel the culture shock. I imagine that I will feel sadness at the great inequalities between our countries. I imagine I may miss things I don’t now realize that I appreciate about Australia. I just hope that I can learn, be inspired and find happiness.

This is the beginning of my journey in global health. One day, with skill, determination and desire, I may end up working with MSF or a like institution. This will be the beginnings of that future..

This is my reflection.

Vaccinations

This Wednesday, I booked myself in to the Travel Vaccination Clinic in the city.  I knew I needed to boost my immune system with some antibodies for all of the conditions and diseases we are lucky enough not to face here.

Thursday afternoon.  Arrive at the clinic.

Take the elevator up…is it left or right? Ah! Left.

Open the door.

“Hello? I have an appointment for 4:30″

“Oh, hi.  What’s your name?”

“Brooke. Sachs.  S-a-c-h-s.”

“Oh…you don’t appear to be in the list.  That’s okay, just take a seat and we’ll squeeze you in.”

And so the wait began…the time spent studying feverishly for our up-coming exam.

“Miss Sachs? Come this way.”

The doctor was lovely.  He asked me which vaccinations I’d already completed and I pulled out my trusty NSW Health vaccination record, with thanks to the Health Department requiring extensive paperwork before starting Medicine.  He explained why I needed extra vaccinations.

Yellow Fever: No vaccination, no re-entry to Australia.
Rabies: One bite or scratch from an infected animal, 100% mortality.
Meningococcus ACWY (only C is provided in routine school vaccinations): an acute bacterial disease that can kill within hours. Symptoms are non-specific and diagnosis difficult.
Typhoid: Transmitted through raw or contaminated foods. Causes severe diarrhoea.   You can die of dehydration.
Polio: Causes paralysis, which can involve the diaphragm. Death caused by inability to breathe.
Cholera: Transmitted in the water. Causes severe diarrhoea.

On top of all of that – HIV prophylaxis is recommended.

I sat there, facts running through my head.  I understand the mechanisms of some of these diseases.  I am faced with my own mortality.  I nod slowly in comprehension.  These needles may save my life.

I get three injections this time.  There will be two more visits to complete the courses.  The needles do not hurt themselves but four hours later my arm starts to ache.  My immune system is doing its thing.  My body is creating antibodies against potentially deadly diseases.

I am lucky to have access to these vaccines.  So many people die daily of these conditions – of things that do not exist here.  I may not be able to lift my arm above my head for a for the moment.  A small price to pay for not risking death.

My arm still aches a few days later.  All I can think is how lucky I am that it’s an aching deltoid rather than an elevated intracranial pressure caused by bacterial infection of my brain.  Prevention is better than cure.

A follow up from the Trivia Night

Our big event – the one that had been plaguing us both with stress, anxiety and dreams of bread – had come and gone.  It is both relieving to have put together a great night for our many guests as well being sad that the year is now that much closer to an end.

Friday.  Such a busy day.

Kellie started her morning by investigating the premises to make sure everything was okay.  She primed the projector and the screen.  She got more people excited about attending.  She was shouting from the rooftops that we had an awesome night planned, fabulous prizes and all.

I was sitting in class, quietly tapping away on my laptop trying to organising things…likely ignoring anything the wondrous lecturers were telling me.  The 10am lecture was (thankfully) cancelled – meaning more time to frantically organise things.  Then, sitting happily at lunch trying to relax, I got a stressful text message from Kellie.  One of our sponsors hadn’t gone so well…and we were suddenly without a prize for our winning team.  So off I went, a desperado needing a gift for the smarty-pants who would win the evening.  Luckily, I came across many a kind soul.  The staff at Bedlam Bar entertained me and calmed me down.  The wonderful folk at Gleebooks donated some amazing books at the very last minute to save the day.  Thanks to these guys, I got to de-stress.  Just a little.

Kellie and I went about our evening preparations.  I went home to collect the MASSIVE bags of bread for the barbeque, adventuring to Broadway shops for the delicious sausages, grabbing onions from Ashfield Fruit Market (always cheap!) on the way.  Kellie started putting together the venue…

 

And then people started arriving.  From this point on…whatever happened, happened.

 

And it turned out to be amazing.  The night went really well.  People were happy, the food was great, the company was warm.  The Miss Medicine competition went off with a bang, the singing was beautiful and the dancing entertaining.

It was a night with a difference.

Thank you for coming.

Another day, another set of challenges

Today, while wandering campus to hand out the many coffee vouchers kindly supplied by Ralph’s Cafe, I found myself adventuring to undiscovered and dustier realms of the University…through many confusing corridors and into many mazes I wandered looking for tired, coffee-hungry university students.  Many were found and many were eager to get their hands on scrumptious wakey-fluid.

As I wandered, I felt as if I walked in the footsteps of so many different students who cover this campus.  In a university with so many courses, it is easy to forget that there are faculties other than your own with hundreds of classrooms and professors hiding away in their own climate-controlled environments.

Later in the day I wandered the often-seen King St asking wonderful storeholders for support for our placement.  The kindness and good-nature of our population will never cease to surprise me.  While little success was had, the smiles and well-wishes are just as valuable (though not quite as useful) as any donation.

Though I felt positive about the business cards and requests for official emails, it was the news that Kellie had gotten the donation of a THREE MONTH membership to Sydney Uni Sport and Fitness that really dazzled my evening.  There are so amazing people on this planet.  Thank you.