Of Eyeballs, Stretching, and Hamburgers

It has been some time since I posted and there has been much happening. Last week Natalie arrived from Tanzania. She is a medical student from the UK and it has been great to have another obruni to talk and now travel with. We decided to go traveling last weekend. On the spur of the moment we decided to travel to Kumasi on Friday instead of Saturday.

Kumasi is the second largest city in Ghana and the centre of the old Ashanti (one of the major tribes here) kingdom. Thus,

it is a bit of a tourist centre for historical purposes. The distance from Donkorkrom to Kumasi is maybe 250km in terms of actual driving distance. However, the journey took a bit longer than that. Natali

e and I decided to leave Friday afternoon a bit early if possible. When I mentioned this to one of my preceptors you would have thought I'd lit a fire under his backside. They rapidly got us on our way and by 2:30 we were on our way. We began our journey in a very dilapidated Daewoo share taxi. Share taxis go when you fill them up. This little car (technically a 5 seater if you are all 5' tall and weight 110lbs) is designed to carry six in Ghana at least. The seats had nice covers on them which was fortunate as I'm quite confident there wasn't much seat underneath. After getting into the back seat (which is supposed to fit 3 people) Natalie and I decided to buy the empty seats (they were only 2.5 cedi) and carry on our merry way. The driver asked for our money which we gave him and then he went and bough fuel so we could make our journey to the river. He returned with a 20L bucket filled with fuel and a funnel after which he filled up the car and we set off. The roads I have described before - they were marvelous as anticipated and we made good time to the ferry.

At the ferry crossing a little bit wiser than on my arrival we chartered a small boat. I think it might technically be called a pirogue. I'm not 100% sure on this but I believe that is what they called - they are long and skin

ny made out of slabs of wood and plywood. The hulls are made of plywood and have a flat bottom at the back and then a bit of a bow that comes up about 6' if it were sitting on the flat. We boarded our pirogue and I felt instantly at home. The slow seepage in the bottom reminded me of man

y a river trip (however, I was nice and warm so this detracted from the river trip feeling). Then to top off the marvelous feeling of being back at home the outboard motor of questionable provenance lacked a recoil. The ingenious fellows (reminding of a certain paternalistic figure in my life) had rigged up a rope attached to a little piece of wood that could be wrapped around the flywheel (I think, my mechanical knowledge is rather slim...) after 14 or 15 pulls as we drifted in the choppy waters of Lake Volta we were off...only to be hailed by the organizer of our little cruise who had found another passenger. This passenger also happened to have a street motor bike. After much grunting, groaning, a bit of splashing, a heave and a ho the bike was on board as was our new passenger and we zoomed across the lake (after only a few more wraps and pulls on the recoilless motor).

On the other side of the lake we walked up from the little 'port' area to the area where we could get another taxi. On our way once again we zipped up and down the hills, through little towns, across the Kwahu escarpment to Nkawkaw. Unfortunately the tro to Kumasi had only one seat remaining so we had to wait for a second tro to fill up before we could depart in the dark and rain. At this point in the adventure we realized we had failed to secure lodgings for the evening which was now upon us. Let it be kn

own that attempting to secure two rooms via cell phone with questionable connections, a language barrier, and in a tro tro filled with people, the radio blaring, and the driver and mate both shouting at the top of their lungs trying to fill up the vehicle is a bit challenging. However, with some effort and perseverance Natalie succeeded - I managed to successfully evade the difficulties and instead offered moral support.

The journey seemed to be interminable. The Ghanian authorities in their infinite wisdom saw fit to place a multitude of speed bumps of various types on the main motorway between the countries two major urban centres, Kumasi and Accra. While I'm sure that in a soft bureaucratic chair with sufficient coccyx padding this is a superior example of engineering and design from coccyxes less we

ll padded they made a long journey seem to last an eternity. However, in due time and the pouring rain we reached the 'last stop' where the mate informed us it was necessary to depart the tro. Unfortunately for us we had only the vaguest of ideas where we actually were, no landmarks, etc. As the rains descended and the floods came we managed to flag down a taxi and after some deliberations, gesticulations, and commiserations we began the next stage of our journey to our hotel...which turned out to be about 3 blocks from where the tro had dropped us off.

The Hotel de Kingsway is described in the guide books as 'having rather prison like corridors' and a friendly little night doorman who seems to think it is 'the place' to be. I can now attest that both the former and latter are true. After ensuring that we had secured lodging for the evening the next step on our weekend adventure was to secure varying victuals to satiate appetites which had been subsisting upon rice and chicken or rice and fish with the occasional meal of chicken and rice or fish and rice tossed in on the side. Vic Baboo's turned out to be our port in the storm. Conveniently located just across the street from the Hotel de Kingsway, Vic's offers a large variety of western and Non-Ghanian foods. The proprietress is Indian I believe and while one part of my brain insisted the food was decent the part of my brain which has been in Ghana for almost 4 weeks was in heaven.

Natalie and I began with our customary Fanta (for her) and Coke (f0r me). Then we had SALADS...real lettuce with s

hredded carrots and tomato in an 'Italian' dressing. The lettuce was a bit warm and slightly greasy because it had been well washed then dipped in warm salt water in an attempt to remove amoeba, bacteria, and parasites which lead to gargantuan gastrenteric problems or worse. Then we both had pizza. In a failure to appreciate the shrunken states of our stomachs we each ordered a personal pizza. I managed to get through half of mine but that was all I could do and even that much was

an effort. After chatting with the grinning night manager (who would make a great used car salesman) we retired to our beds.

The next morning after deciding that we didn't want to spend 2 nights in a prison we packed our bags, and set out to explore the city a bit. Our first stop was a 'supermarket'. This store certainly had the expected accoutrement's of a supermarket but the execution thereof demonstrated once again that we were not in the Western World. We discovered much to our pleasure a packaged, processed, no refrigeration required Chocolate Filled Croissants - they are quite delicious warmed up just a little bit and remind me of something you'd buy from a convenience store at home. They made an excellent breakfast and we carried on our way to a Methodist Guest House/Hotel where we procured accommodations for our second night. Then we set off again into one of Kumasi's main attraction - its central market. This market is thought to be one of the largest in W

est Africa at somewhere around 12 hectares. It is truly massive and you can buy most things there. One thing that intrigued me was to see the cobblers at work making sandals. They cut out the leather, plastic, and other various components then nail, sew, pound, and glue them together with the result being relatively classy sandals. We also found live chickens in baskets, plastic rugs

, aluminum cookware, fabric, seamstresses, bead stringers, live snails larger than my fist, assorted candy, row upon row of dried, roasted, salted, or fresh fish, and so on and so forth. After wandering for about two hours we decided to rest and then retired to Vic's for another western meal.

Vic provided us with hamburgers and fries (sold separately for almost half the price of the burger) and then we carried on our way to the National Cultural Centre. Here we saw the sticks that the betrothed of the Ashanti Kings were given so that no other man would look at them, the war vests (that supposedly stop bullets), replicas of the stools upon which Ashanti kings sit, and other paraphernalia. We also observed artisans making drums by hollowing out chunks of wood. After observing and then playing some drums both Natalie and I were sufficiently enticed to purchase a drum for ourselves which we have been attempting (rather unsuccessfully) to learn to play a little this past week.

The planned evening meal was to be Chinese food at a new restaurant which turned out to be a mistake. We should have entrusted our final meal in Kumasi to the faithful cooks at Vic Baboo's. The City View Restaurant offered a selection of Chinese fare, including noodles. However, after ordering a noodle dish we were informed there were no noodles and it would be at very minimum 1 hour before noodles could be fetched and then cooked so noodles were out. Natalie compromised by ordering a spring roll. To her horror and disgust upon biting into one of six which arrived on a plate they had been made with a fish based filling. She persevered trying several more but alas they all proved to contain fish. My visions of lightly stir fried broccoli, crisp fried shrimp, and sweet spicy ginger beef were dashed upon the rocks of Ghanian reality. Instead I was confronted by a bowl of glop...chunks of chicken (i.e. take chicken, cut off head, remove feathers, feet, and guts; cut into chunks, cook, place in Clinton's bowl) although there were not that many chunks of chicken surrounded by a brown glop of limp cabbage, the occasional carrot, and stray piece of sweet pepper. I was sadly disappointed and we returned to our rooms somewhat mournfully.

The next morning slept in and then gathered our belongings and headed to duplicate our journey in reverse as we were uncertain of

our ability to secure transit on a Sunday when things slow down a bit in this country. We secured a more comfortable tro which we changed half way to Nkawkaw as the driver stopped and told us to get into a different tro. I enjoyed seeing the countryside in the day and the land around Nkawkaw is particularly beautiful with massive, rugged hills rising up out of the greenery and rolling hills. From Nkawkaw we secured a taxi and as the ferry was departing as we arrived we took passage on 'the pontoon' as the locals call it - although if time had been a concern I'm quite certain that we would have been faster to secure a pirogue. The ferry moves at quite a glacial pace.

In Eshe, the Afram Plains side of Lake Volta we ran into minor transport difficulties. The only available transportation appeared to be a big old Mercedes tro/bus - a picture should appear somewhere. To our untrained and western eyes this vehicle appeared to be stuffed to the very gills with men, women, children and luggage but fortunately for us this was only an optical illusion. There was certainly room for two obrunis with backpacks and drums (which we were now forced to carry with us after the

ir purchase on the previous day). As we rolled out of the town I enjoyed reflecting on what constitutes a vehicular necessity based upon our travels. It would appear that African society is very minimalistic when it comes to transportation - it is not at all about the 'frills' of western vehicles. For example having power steering is very much over rated, even if you have to dodge 562 potholes between Donkorkrom and Eshe; having good brakes is not really needed even if you do swerve left around a pothole instead of right and then come to the edge of a potchasm and which to stop before you plummet to your coccyx's agony below; another thing that is optional is a relatively clear windshield - I'm not talking about dust but rather the 65 cracks which radiate in all directions from various foci of cracking. An effective park break is also unnecessary - that is part of the role of the mate - whenever you stop he simply places a chock under the tires to prevent the bus full of passengers from rolling away. Much cheaper than maintenance costs on breaks! However, there is one essential item which I observed, namely the Fire Extinguisher. As a passenger I must admit that I felt much more comfortable

knowing that there was a fire extinguisher in the vehicle. Also, in the defence of these vehicles I must admit that in general they are lovingly cleaned with regularity (especially on the outside), although the red dust of the Afram plains makes short work of a good scrubbing.

Our bus lacked power steering or good breaks and had a load on the roof (goods not people), and a load inside. I'm estimating there were about 45 people packed cheek to jowl in this bus. I was sitting at the front (fortunately) as it meant my knees could protrude into the space between the mate's seat, the gear shifter, and the driver's seat. I sat on a seat that folded down into the aisle. To my right were two African women, to my left two African men and a boy about 7 or 8. Thus, we were very cozy. As the journey commenced people got on and off but the total number remained constant and even increased to the point where I was sitting in the front with the mate and I had to dismount the bus, so we could lift up the seat anytime anyone wanted off. However, in good time (only about 2 hours) we arrived in Donkorkrom, ready for a week of medicine before our next adventure.

This week things have been busy at the hospital. This is in part because both of the physicians, one of the Gha

nian student doctors, and about 75% of the many patients coming through the door have been sick with malaria. Because they are locals and have some immune exposure to malaria it hasn't been severe (in the case of the doctors) but it means they are tired and don't feel well. Thus the Out Patient Department/Clinic has been especially busy. There is a constant stream of patients wanting to be seen, complaining of a cough, headache, waist pains, fever, general malaise which in this location is essentially the diagnostic criteria for malaria. However, it hasn't been all humdrum malaria. This week I've seen and done a few new things medically.

Yesterday the lovely Gladys, one of the nurses here, and I sutured up a scalp laceration...thus, I did my first stitches in a real patient which was quite exciting. I must admit I was surprised at how tough the skin actually is. Intellectually I have known that the skin is strong but until you are trying to drive a needle through it you don't actually appreciate it. Earlier in the week I had another big first

- I witnessed a normal vaginal delivery of a bouncing little baby girl. I guess I've always appreciated on an intellectual level that labour and delivery was a messy painful process but watching a delivery certainly made the painful, energetic entry of a being into the world real on a much more experiential/emotional level. I must admit that once again I was amazed at the amazing properties of skin (in this case elasticity) and again I was thankful for the contribution of the Y chromosome in my own genetic experience. Finally I got to scrub in on what at home would likely have been plastic surgery.

Last evening a woman presented to the Casualty Department (ER) with over 10 lacerations on her scalp, face, and hand. She had been attacked by her husband who had taken poison following the attack and was dead. She was stable but the wounds were filthy and bleeding a bit. After ensuring she was stabilized it was decided to wait to do the repairs until today when family members could have come in and donated blood so she could be transfused prior to surgery. This morning I scrubbed in for the repair - the next paragraph is somewhat graphic, consider yourself warned.

We began by cleansing the hardened blood from the face and shaving most of the woman's hair. When blood congeals in these people's hair it is virtually impossible to remove so the hair is shaved off. Then we opened one eye which had been swollen shut and realized that the machete blade had actually cut and destroyed one eye. Thus one doctor closed the cut at the bridge of the nose/cheek (about 15-20cm long, cutting into the bone of the nose) and then another laceration above the eye, and multiple lacerations on the skull, and even one ear was cut almost in half. Then the other doctor came and removed the damaged eyeball (with an eyeball removing spoon, scalpel, and scissors if you are wondering). After the eye had been packed and dressed the first doctor began repairing the hand.

Anyone who has been to Body Worlds, or looked at pictures/models of the muscles and tendon's of the hand will have some idea of the complexity of the hand. Consider the multitude of actions we can perform with our hands - play a violin, stroke a loved one's face, write a letter, type a blog post, paint a Madonna, or wield a machete in rage upon another human being. Thus, the slices on the back of the hand were problematic because they had severed at the very least four tendons, at most seven or eight. The wounds could not simply be closed but the tendons had to be repaired if possible so t

he woman would have at least some function in her right hand. This turned out to be relatively easy for most of the tendons although the final tendon was difficult to find and I have no idea how effective the healing of the tendons will be. Likely this woman will be blind in the right eye and permanently disabled in her right hand...but she will live. I have no idea what kind of scars her psyche will bear but I'm sure they will be deep as well.

That was the lion's share of my day.This afternoon I assisted in the ultrasound scan of a woman who is pregnant with her 9th child. Then this evening one of the doctors had to go in to perform a Cesarean section to remove a dead baby from the womb. The mother was pregnant with twins and delivered the first twin at home dead. The second had not yet come so she came to hospital and it was removed. It sounds like the operation was difficult and gruesome so I'm not particularly sorry that I didn't assist in it.

Life is not particularly kind to some people and for the people living in this region life is difficult. They lack access to a multitude of things we take for granted and have no conception I'm sure of many things we could not imagine living without. However, they still smile when you smile at them and the children are exceptionally cute.

I hope this finds you all well, if you've made it to the end of the post you likely deserve an award as it was a bit of an epistle. I hope it wasn't too painful for you.

CL