The Sounds of Silence

After having arrived in Ghana for the second time and while driving towards my old house there was something missing from the so familiar hustle and bustle of the dusty streets of Accra. Only after arriving at the house, and not being welcomed by the sound of the overburdened speakers of our watchman, I realised that it was the music that was missing. Not shortly after that I learned that it was because of the corn season that had started. Apparently music disturbs the growing of the corn... Oh Ghana, how I’ve missed you!

The welcome I got in the neighbourhood I had lived in was unbelievable. From the tailor I had regularly visited who jumped up when she got a glimpse of me passing by in the taxi, and started enthusiastically waving with an enormous smile, to Christine, our neighbour who pulled open the door even before the taxi had come to a full stop to give me a big hug. A stroll down the street resulted in even more excited waves, smiles and “welcome!” or “It has been too long!” from several directions. If there is one thing you can say about Ghana it is definitely that it houses some of the kindest and warmest people I know.

After spending a bit more than a day within these familiar surroundings of Accra (like I never left!), it was time to go towards the far north of Ghana, to the town of Bawku, of which I could hardly imagine what it would be like. Now, while sitting on the porch of the house of the tropical doctor I work and stay with, it is funny to realise how also this new unknown side of Ghana has already come quite familiar too. I wouldn’t be able to picture life here without the random children or goats that wander around the house and the parading roosters and hens that look for a bite to eat among the dust.

The sounds of rural Ghana are quite different again from urban Ghana. When I have breakfast on the porch the fresh morning breeze carries the sounds that are almost similar to the sounds you hear on a sunny afternoon on the beach: children’s voices, twittering of birds, distant screams of animals (donkeys, birds, and goats instead of seagulls...), an engine roaring, and other unidentifiable sounds of human activity. Combined with distant music, the call to prayer of the mosque, or sometimes singing from the nearby Presbyterian church, this is the silence of Ghana.

After breakfast I ride my bike (with basket, yes, I am very excited about that!) to the hospital, which is no more than 3 minutes. After doing the rounds at the children’s ward, I work besides the Dutch doctor at the Out Patient Department (Dutch: Polikliniek). Up till now it hasn’t been too busy, we see around 25 (which can be upto 40-50 on a busy day) children at the OPD each day, so we usually have an hour or two free time (which means looking up and studying al sorts of medical stuff for me...) before we head to the hospital again for another 2 hours of work at the ward from 6pm onwards. The work at the ward happens every day, also in weekends, since otherwise there is just no doctor that looks at the children until Monday, which quite usually results in worrying mismanagement....

It is sometimes estranging to realise how fast I also get used to the lack of treatment or diagnostic tests when treating these children. It has already happened some times that we just stopped looking, because any found disease would be to complex to treat here anyway... Nevertheless, a lot can be done. Children coming in with malaria (very, very common, almost like a normal flu in Holland) can sometimes already go home after one day of treatment, and even a severe malnourished little boy is slowly improving after this week of care in the hospital. Nonetheless things like very sick or premature new-borns or a boy diagnosed with HIV and Tuberculose make me wish that I had so much more to offer here in the hospital.

Life as a doctor here really means living your work. If you don’t do it, nobody does, so you easily come to the point that you spend as much time in the hospital as needed, not depending on the hour or the day. But, how cheesy it may sound, happy smiles of the children that are discharged healthy from the hospital make it all worth it. Although some are just happy to finally be freed from that scary belly-poking white person!

Living in Bawku at this time of year also means the start of the rainy season. When the thick grey clouds slowly role in, life here just stops. Warned by hard dusty wind that picks up a few of the many plastic bags that are scattered around and blows them away like jellyfish in the sky, everybody rushes inside to hide from the tremendous pouring-down of rain that follows.

It also means filling up my basket with gigantic mangoes and pineapple or tasty sun ripened tomatoes and fresh ginger at the once-every-three-days big farmer’s market. Or cycling towards the river that defines the border of Ghana and Burkina Faso, getting waved at and greeted along the way. (Not to mention getting a flat tire on the way and getting it fixed by a man besides the road who seemed to be the local bike repairer surrounded by many curious spectators...)

All together the first week has given me so many impressions already that every night I am extremely tired and that the next five weeks will probably just fly by. I’ll try to keep you all posted along the way...

Ps. Unfortunately not too many pictures yet... I haven’t quite started taking that many!

Pss. After re-reading some of my blogs I noticed quite some random spelling mistakes, sorry for that! I’ll try to re-read things I post from now on, haha!

The landscape of north-eastern Ghana

Happy waving children along my way to the border with Burkina

Flat tire...

Border crossing with Burkina Faso

The porch :) Big house huh? Totally did not expect this...

On the left side the hospital!

Me in action at the Children's Ward

Posing with one of the nurses :)

Mi Koy bra [I go and come]

Within minutes the sky has turned black and it starts to rain. Together with the fact that both mango and passion fruit have just gone out of season, this can only mean one thing: it is time to go home.

After dropping off Evelien at the airport two days ago, I’ve been thinking a lot more about actually being in the Netherlands again. With the neat, structured, and clean Holland in mind it is almost alienating to be here in Accra. The contrast is just so big; life here and life in Holland hardly comparable.

Only less than a week ago I was travelling passed small round mud huts with grass roofs, neatly ordered in circles. One hut for every person of the extended family. You see little children slowly tiptoeing towards a chicken, scaring it with a sudden jump and scream, having the most fun just running around and chasing it afterwards. All stark-naked of course. Grown ups just sit in front of their hut and stare, making you wonder what’s on their mind. It’s probably not what to wear on the next Friday night out or whether the new episode of Grey’s Anatomy is out yet.

The poverty up North is from a whole other spectrum than poverty in the coastal city area. Although Accra has extensive slums (with no sewers, scarcity of water, no electricity, and a fierce mafia ruling system in place), anything you can think of is available for the rich. In the North of Ghana there is just a whole lot of nothing. Chicken, goat, dust, mud, fufu. Period. I might be alienated by thinking of Holland when in Accra, but the people in those huts will not even be able to imagine how people live in their own capital, and I seriously doubt whether that ‘other’ life is even in reach with the most preferable circumstances. Would they dream of a life that is so unknown? Men in the city do definitely dream from marrying a foreigner...

Before coming to Ghana I didn’t know that my boyfriend is very jealous. Actually, I didn’t even know I had a boyfriend! But the eagerness of men here to marry a ‘white lady’ is only tempered by explaining that I have a boyfriend and that he is very jealous indeed. Sometimes they still insist on giving their ‘contact’ (phone number), so if anyone is interested, I have a Kofi from Kumasi who would very much like to marry you. Just saying.

Kumasi is the heart of the Ashanti Kingdom and with it’s royal palace and colonial looking buildings often considered Ghana’s cultural highlight. Although it definitely was very nice to get a guided tour through the small old palace (now turned into a museum with scary real looking statues of deceased kings and any random object they have used, like the first radio in Ghana), what I liked most about Kumasi was its vibrant, chaotic, crowded and enormous market. Apparently it’s the biggest market in West Africa, it sure felt like it!

Evelien and I dived into the sea of people and deliberately got lost in the maze of narrow alleys. We literally were welcomed with open arms and hugged by market women after sharing our five words of Twi with them. Especially introducing ourselves with our Ashanti name, matching the day you are born, immediately gave us a handful of new friends or sisters. Together with the fact that people even asked to be on a picture (“snap me!” and then proudly holding their tomato or dried fish to be sold) it was all just so friendly and warm!

But it was not just Kumasi we visited. In the one week Evelien was here we actually managed to dance some proper Azonto at an outside bar in Accra, go to the beach in Accra, walk with elephants and ‘pumba’s’ in Mole National Park, swim in a pool at the same park with a view of bathing elephants in the pond down the hill, cycle on the red dusty roads to the village of Laranbanga with an old mud and stick mosque, stay at a quiet and peaceful lake (in the crater from a meteorite hit!) called Bosumtwi, spend a night at Cape Coast to see the fort and a live drums and dance performance at the beach side, and to return to Accra for another day. However, the last day in Accra was mostly spent in bed by Eef due to food poisoning... Unfortunately that is also Africa.

As for now I am going to sit on our roof, look over the large variety of roof tops of Accra, listen to the call to prayer from the mosque and enjoy a bit more sunshine before I head off to Holland. But no worries Ghana, mi koy bra!

Mini Pumba :)

Our guide at the walking safari

And so close!

A whole pack of elephants around us

Picture time...

The obligatory picture with an elephant

Laranbanga mud and stick mosque

Beautiful!

Scary Obruni's :)

Dutch as can be :)

Kumasi market roof tops

Hard work

Crowded Kumasi

Lake Bosumtwi

"If you want to picture Ghana, snap me!"

“That’s why they call it ‘labour’”

There is something magical about the birth of a baby. After nine months of getting used to the idea that a little person is growing inside the woman, the time comes that this human parasite is pushed out, in only seconds changing to a breathing and screaming little baby person, growing up to be a be unique individual human being. During my time as an intern at the obstetrics department in a hospital in the Netherlands, this moment was easily so special that it could bring me to tears, especially if the couple showed the some of that amazement, love, and explosive joy towards the new life (and yes, this is not always the case, being in shock is also an option for new parents...).

In the Netherlands the delivery rooms are equipped to make the delivery as personal and special as is possible in the setting of a hospital. In the private delivery rooms lights can be dimmed, there is a comfy chair for the husband, a personal warm shower or a skippy-ball for during the contractions, even a cd-player so that you can bring your own music for it all. The couple is attended by one midwife or nurse (if possible), and making the woman in labour comfortable is one of her/his main objectives. Of course delivery itself is by nature a painful and messy business and there is plenty of room for improvement when it comes to the hospital treatment for sure (and it also might all be different in other hospitals than the one I worked at), but over-all it is not too bad...

[As you can imagine the next part will be to describe the labour ward at the hospital I work at in Ghana, which can hardly be more different from what I described above. The only problem is, how do I do this without making it sound very horrible? If you look at it from your lazy chair in whatever country you are when reading this, it is so out of context that it might seem shocking, inhuman, and sometimes maybe even cruel. Which it is in some way, don’t get me wrong, but it also does make sense when you see the workload here, the shortage in staff, space, and equipment. So please take that in mind when continuing to read the next part...]

Now imagine being in labour and having to wait on a hard wooden bench with several other women in labour. No room for movement; if you try to walk around you get yelled at by the midwifes and immediately pushed back onto the bench. If you finally are examined by a doctor after a couple of hours, you get a slap and a sneer from the midwife if you’d forgotten to take off your underwear before you climb onto the high examination bed, which you first have to cover with your own plastic cover.

Without introduction the doctor starts vaginal examination (contraction or no-contraction). If you touch his arm in a reflex of a pain wave from a contraction combined with the painful examination there is a disgusted “DON’T TOUCH ME!!” shout from the doctor that will definitely keep you from making that mistake again. After the examination you have to go back to the bench, until you are at least 4-5 cm dilated (and you are lucky enough that someone examines you at that stage, otherwise you might be waiting even longer). For those who are not familiar with those terms, that is a whole lot of contractions later, and quite far in the whole labour process. At that stage you finally get a bed (if there is one available). Not a private bed, but a bed in a room with 5 other women, in a room that is smelly, hot, dirty, and in a desperate need of some renovation work. If you don’t walk fast enough towards the delivery room the midwife will very willingly push you in the right direction, or shout. But at least you can lie down now. Or actually, you have to lie down now: going outside a one-meter range of the bed is off-limits.

The husband is not allowed to come inside; he (or any other relative) has to wait downstairs in the hospital courtyard until the midwife shouts his name through the window. If he’s lucky it will be to tell him that he has a healthy baby girl or boy, but it can also be to go and quickly buy medicine or water for the woman in labour. No updates on what is happening at the women’s quarters whatsoever.

There is no help with ‘puffing’ away pain of contractions (there is of course also no such thing as antenatal couples pregnancy gym...), there is no explanation from the midwifes during the process. When the time is there the midwife tells you to push, the baby comes, is quickly shown with legs spread to show the sex to the mother and then taken away to be measured and weighed. As you can imagine there is not much of magical amazement at this point. There is mainly relief that this scary, painful, and lonely process is over. Women just lay there, sweaty, hot, and almost in apathy to their surroundings, until they are ordered to stand up again and walk (!) to another room where they can lay down a little while before they have to go somewhere else.

In this way an average of 30 deliveries per day happen at the hospital, which means in peak season (end of March – July) almost 50 a day. Fifty deliveries on a labour ward with only 13 beds (including 4 in the hallway), and a maximum of 4-6 midwifes on duty (with some times some extra students and if you’re lucky a doctor for the first examination). Since it is a referral hospital almost all of these women have or have had complications during pregnancy or delivery, which gives them an increased risk for a complicated delivery.

Altogether you can imagine that a day working at this labour ward can be quite intense. I especially have a very hard time with he way the women are communicated to (or actually the lack of communication towards the women). Orders are shouted, not so many nice words, no comforting. This is surely partly biased because of my different frame of reference, and the way English is used directly translated from Twi (which is a language without the fuss of polite forms, but just ‘you sit now’, ‘you go!, ‘walk to that place’). So with this in mind it just might sounds harsh to me, but the women might not experience it that way... Let’s hope so.

However, standing beside it all, in the difficult position of the intern at the bottom of the hierarchy, it made me feel so powerless! After the first day I did manage to use the time that the doctor was updating the patient record to introduce myself to the next woman in line and do some small talk with some nice words, but still it stayed frustrating. I can’t wait to work in this kind of setting and finally be able to do things how I would want to do them. Because yes, the workload is crazy and it will be very difficult to stay nice, but I really hope that I will be able to do so at least a little bit before examining a woman’s private parts (sorry for the explicitness...).

Even though you all might wonder at this point why I still would want to work in a setting like this, I actually have arranged that I will be going back to Ghana again at the end of May for another internship. This time it will be an actual clinical internship at the paediatrics department of the small district hospital way up north in Bawku (you can Google-map it to see that it is quite difficult to get much more Northern than that, on the border with Burkina Faso and Togo). Before coming to Ghana I bumped into a Dutch doctor that I knew from my internships in Holland at the embassy in The Hague. He was preparing his documents to start working in Ghana for a longer period of time, so we exchanged contact details. So after coming home in a bit more than 2 weeks, I’ll be leaving again for another 6 weeks at the end of May, but this time not in the urban setting, but in an area where I’m the only white person together with the other doctor... I will try to write updates during that period too. And after that I will stay in Holland for quite some time again. Promise...

For now only one more week of work, mainly at home to work on my data from the research (I got a bit stressed-out at the hospital when I thought about all the stuff I still need to do for my thesis...) and then Evelien is coming to visit for a final week of travelling up north! I couldn’t believe it when she spontaneously told me she wanted to book a flight, and then just did it within the next 48 hours! I just have the best friends!

Oh... and it’s time for another list of fun stuff, because besides working I also experienced some other fun things like:

... climbing the highest mountain in Ghana (not even 900 m high, but when I came to the top I looked like I walked through a fierce Dutch autumn shower... yes, sweaty business, blimey it was hot!!)

... hiking through beautiful butterfly-filled jungle to a quiet waterfall in the Volta Region (followed by a refreshing plunge of course, using the fact that we were the only one there... magical!)

... crossing shimmering Lake Volta by bridge in a tro-tro going back to Accra from the ‘mountains’

... realising that I really know my way around here by helping out some newly moved in roommates

... starting to talk Ghanaian English (‘oh, sorry-oh!’, ‘Ej! Why?’ [a response to anything that might surprise you or you think is not nice], ‘Oohwokay! [the response to anything. Any-thing!] ‘She’s not picking.’[she’s not answering her phone], ‘Flash me!’[please let my phone ring once so I have your number], ‘I’m coming’ [just wait a minute... or longer])

... not being surprised that all the babies here are actually born with very light skin, sometimes it makes you wonder whether the father is Caucasian, but he never is.

... having people recognise me at some places we go to regularly (the gym, our favourite restaurant after going to the gym, the women in our street)

... going through my phone contacts and not thinking it strange that it is full with: ‘Wisdom’, ‘Nice-one’, ‘Iron Man’, ‘Love’, 'Divine', and more...

... not being surprised anymore that a taxi driver happily tells me that he is married but available (or MBA for short).... Ghanaians really have a different view of monogamy!

See you all very soon! But probably I’ll write one more post before that.

xxx

Weighing infants at the postnatal clinic

Scaring away the evil eye with infant eye-liner :)

One of the midwifes, I just love the uniforms!

Waiting for antenatal care

Scary!

That's what I call green!

Fresh jungle streams, I just love water!

Unfortunately a bit cloudy, but still a nice view from Afadjato Mountain

In the jungle, the mighty jungle...

Tagbo Fall... ain't it a beauty?

Karin and I at the Wli Falls