Health Care

No, this is not a post about the continuing debate over health care reform in the United States (that's still going on, isn't it?). The past few weeks for Cori and me have been an adventure to say the least.

We spent Christmas weekend at beautiful Ada Foah. However, the day after we returned, I awoke with a spiking fever, terrible nausea and diarrhea. An hour later I was in Accra at a private hospital receiving an IV drip and having my blood tested. Turned out I had an acute intestinal infection - probably something I ate in the previous week. I was admitted and spent two nights at the place, first taking antibiotics via the IV, and once I was able to keep things inside my stomach, I was given tablets, and eventually discharged.
Some interesting notes and observations:

• All private health care is cash-before-care. At one point Cori had to hail a taxi to take her around the city looking for an ATM that would work so she could get the money to pay for my blood work. In the meantime I was laying on a treatment table connected to an IV moaning in discomfort.

• Doctors tend not to tell the patients what's going on with their treatment. And patients tend not to ask questions. It took a monumental effort to find out what type of medication I was being treated with, for what exactly, and how long the treatment was expected to take. Vast generalization here: perhaps Americans have a stronger preference to be "in control" in life compared to their Ghanaian counterparts.

• A few times a day a nurse would enter and give me a clear plastic bag with pills inside. I was instructed to take them, but wasn't told what they were. Once I found out that one of the pills was for stomach muscle pain I decided not to take it: I didn't have any pain any longer. When the nurse came back a few hours later she ask why I hadn't taken all my pills. I told her I wasn't having that symptom any longer (it was just a pain pill). On her face she wore the kind of look I would imagine would come from me saying something like "tomato puppy slippers are down yellow." Her reply, "but you must take your pills. Why wouldn't you take them?" Um, side effects, unnecessary consumption of chemicals, cost savings...? I don't have pain! "But those are your pills. You must take them." Eventually she left the room, confused and frustrated. I never took that pill.

• I was in a shared ward - my room had a total of four beds, three of them occupied. We had one bathroom/toilet...across the hall. There was no soap in the bathroom. In fact, I never saw any soap or hand cleanser the entire time I was in the hospital. Just prior to discharge I was "interviewed" by the head nurse who was looking for quality feedback on the hospital. I told her there was no soap in the bathroom. Her explanation: They have a soap dispenser but haven't installed it yet. See, the hospital is planning to remodel the bathroom and they want to wait for that remodel to be completed before installing the dispenser so this one isn't damaged in the construction forcing them to get another. Huh? How about a hand soap pump from the grocery store?

The hospital had strict visiting hours: 6:30-7:30 am, and 5:00-6:30 pm. And while I observed a handful of visitors to other patients asked to leave, Cori was never once hassled even though she would arrived around 7am, and stayed for 12 hours. Some have said I received obruni privileges.
It took me about a week to fully recover, and just as I did, Cori fell ill. I was at the embassy in Accra when I called Cori at home to discover she had a severe headache and chills. Uh oh! Classic malaria symptoms - according to all the books. I called a colleague and asked him to check on her. A half-hour later, Cori was at a local hospital. When I arrived she had a desperate look on her face. Minutes earlier the nurses had hooked her up to an IV, and just as the fluid started to flow Cori's throat closed up - she couldn't breathe. Scrambling to get someone's attention and gasping for air, she finally had the IV removed, her airway opened up, and she vomited. Within minutes she was receiving Malaria treatment even though the lab results wouldn't confirm that fact for another hour. We never did figure out why the IV solution caused the reaction.

By morning Cori's fever had dropped and her headache was mostly gone. But for five more days she stayed in the hospital with severe diarrhea. At some point the doctors started treating her for a GI infection (We weren't sure when because, remember, the doctors tell you very little). On the third day Cori was visited by the hospital owner (most private clinics/hospitals in Ghana are owned by a veteran doctor - I haven't seen any evidence of corporate health care here). He is an OBGYN and quickly diagnosed Cori's abdominal pain as the result of premature contractions (she's only 20 weeks). Talk about fear and concern! Thankfully the right doctor came along at the right time - he prescribed medication that ended the contractions, and spent the time necessary to answer all of our questions, really putting our minds at ease.
Thankfully two subsequent ultrasounds have shown a healthy baby with a strong heartbeat kicking and dancing around in there.

Blood tests indicate that the malaria is gone from Cori's system. Her stomach is about as good as it has been during this pregnancy - which isn't too good, but a lot better than it was during her time in the hospital. Still, we decided that that was enough adventure for our unborn so Cori left Ghana this morning, headed for Wisconsin.

It will be difficult spending the next few months apart. We went through this 4 years ago when I taught in Hungary, and it was rough. But this time it will be different. This time she's been where I am, she's seen Ghana. When I tell stories about people, places and society, she can relate. That will help us feel closer. At least I hope it will.
I plan to return to Wisconsin some time this spring to be with her when she goes into labor. She's due at the end of May. After that I may return to Ghana to finish the school year.

Until then I'll just try to blend in among the Ghanaians.

View my latest photos here

Reflections on our first week in Ghana

The following is excerpted from an email Cori wrote to her family:

I'm emailing from busyinternet, the best internet place in Ghana, and it's right down the road from the school. Mike and I take a taxi because it's so hot, but in normal weather, we could walk here. Our taxi ride cost 2 cedis (see-dees) each way, and cedis are worth about 70 cents, so our total ride costs $1.40. We usually tip 1 cedi each way also, as is customary.

Busyinternet is a huge room with lines and lines of computers, and great internet speed, usually. It costs 2 cedis an hour to use their computers, and 2.50 (2 cedis, 50 pesewas) for an hour on the laptop - they have wireless available. During the week, they also have a cafe that's supposed to serve coffee, smoothies, etc. As it's Sunday and the entire area is very religious, the cafe part is not open today.

I've been keeping a journal of things to mention in my emails, and since it's building up into pages and pages of notes, I'm just going to list some things so that I pass some of them along in a timely fashion.

12/1/09

Arrived in Accra. Met by school teachers. Driven back to TEMASCO in a double cab pickup with our luggage in the back.

Shown our house and asked to sit down to be greeted. Everyone looked at us and kept saying "you are welcome". We didn't know how to respond to that, so we said "thank you" but eventually we understand that they were saying "you are welcome (to our school/country)". We all sat around our living room and looked at each other while they said their official welcomes. Of course they all introduced themselves, and we were lucky if they had European first names, like Jennifer or Christopher. Otherwise we just smiled and tried to repeat their names as best we could - they were patient with us and repeated it back to us if we butchered it too badly. They had prepared breakfast for us - poached eggs with slices of green pepper and tomato, vanilla scones, hot dog-looking things, wheat rolls, tea and coffee. I ate a poached egg and part of a wheat roll but everything smelled funny and I had to work to get it down.

I couldn't wait to take my first shower that night, having traveled for a day and spent the next day in the heat, and promptly discovered the water was off. Apparently, the water pressure sometimes fails and so the water is "off". That's why we have a huge bucket of water in our hallway, for times when the water is off. I hadn't counted on that - I thought only the electricity was supposed to be iffy.

Our fridge wasn't working (It was repaired the following week), but the small freezer section functions like a fridge (it doesn't actually freeze anything but does keep it cold), so the staff had put bottles of water, Coke and Fanta (real glass ones) in there for us to drink.

12/2/09

We took our first shopping trip, to a local grocery store, Evergreen. Alfred, a music teacher drove us there. Just riding in the car with the windows down felt like the coolest experience in the world - I could have stuck my head out like a happy puppy! The grocery store was not very busy but it had many standard American items; we found canned beans, pasta, some toiletries, some laundry soap for hand-washing, etc. I was so hot and hungry that I bought three ice cream bars for Mike, Alfred, and me. As soon as I took them out of the cooler though, they started melting. By the time Mike and I starting eating them in the car, they were big globs of ice cream and chocolate and poor Mike's spilled all over him and the car floor. Alfred wisely kept his for later when he could refreeze it in his freezer at home.

Later, we took a tour of the campus with Joseph, an assistant headmaster. He's a great guy, wonderful smile and very helpful. The campus houses about 1300 students, with a total enrollment of over 1500! The buildings are all two story cement block painted yellow, and the staff housing is all one-story bungalows like ours, or smaller. The campus is large and mostly covered with dried grass or sandy soil due to the dry season which will last through March.

We met the headmistress - it was like meeting the queen. Her office was huge and air-conditioned and the conversation was very formal. We haven't seen her since as she currently lives off campus.

It's hard to eat in the heat, and the Ghanaian food has a unique smell and hard to eat, for me. For example, today I ate rice and beans that Jennifer, one of the teachers, made for us, and that ice cream bar on our shopping trip. Mike is faring a bit better. Jennifer prepared fried chicken for him and he ate it right down.

I did my first load of laundry by hand in the shower. In fact, I just combined taking a shower and washing the clothes to maximize my time under cool running water. We have a clothes line in the hallway for hanging the clothes and most things dry in a day. The towels we bought from REI are awesome - they dry in a few hours at most.

12/3/09

Today was the breaking point for me. I hadn't been able to sleep very well at night and would fall asleep in the middle of the afternoon for hours even though I was sweating just laying there. Plus, I couldn't get enough food in me to give me energy. While I slept in the afternoon, Mike went to the school computer lab, which has 2 old desktop computers and an Ethernet cord for his laptop. They also have somewhat effective a/c in there, but when I visited him later, the body odor from a bunch of sweaty teenagers negated the refreshment of the a/c, so I went back to the house and laid back down on the couch worshiping the ceiling fan.

In the evening, Lucy's sister, Vicki dropped by to meet us. She looks and sounds just like Lucy and it was fun to talk with her. Her husband is a pastor and she is a stay-at-home mom with 4 kids - 2 still live at home. She will bring them to visit us soon.

Jennifer sent over some more food for us in a plastic basket, carried over by a couple students, but I couldn't stand being in the same room as the smell. I hope this goes away because the whole country smells like their food and I can only breathe through my mouth for so long before I look like a large-mouthed fish.

12/4/09

Today Mike and I woke up early and went on a 2 hour "Health Walk" with the students and staff to celebrate a national holiday, Farmer's Day. We were both worried about walking for that long in the heat, but it turned out to be a great day for both of us physically and emotionally. We were like a parade going down the side of the road, winding all through Tema. It was a great way to see the city without looking so conspicuous as "obronis" (oh-brew-nees). We could stare and take pictures and talk to people without drawing too much attention to ourselves. A few small kids spotted Mike and waved wildly at him, shouting "obroni, obroni" and he waved back just like a mayor on a float :) The conditions we saw as we walked along were unbelievable. The sewers are open culverts here, and they have concrete bridges over them every so often so that you can cross them without jumping, though sometimes we had to jump them anyway to cross the road with the group. People were selling all kinds of stuff, from full-size living room furniture sets to fried plantains to bars of Dove soap to Ghanaian clothing to leather dress shoes to candy to wicker baskets to bicycle parts. Everyone looked remarkably healthy and functional considering the heat, the dirt, the smells, the random children running everywhere in bare feet, the goats wandering along the roadside, etc. Our heads were on swivels, we couldn't stop staring from one side to the other. Every time I looked to the right, I would glance to the left and feel like I was mising something important. Mostly, I couldn't believe the absolute poverty of most of the people I saw. It was like the stuff you see on commercials and in books on Africa - all the stereotypes were there. And yet, people moved around like it was the most ordinary day in the world. My outlook on life will NEVER be the same. When we got back, we were told that the two slum areas were on the outskirts of Tema, so what we had seen was clearly ABOVE what COULD be. Really?!?!?!??

If I'm not careful, I could be on a constant soapbox about the need to provide basic healthcare, food, education and clean water for everyone in the world. I have SO MUCH MORE than what I need. And that's living in the TEMASCO staff housing that I have now. I have running water, a bed with a mosquito net, a kitchen with food in it, a toilet, sachets of clean water in my freezer, money to buy a taxi ride to anywhere I need to go, and the education to know what's available to me. I am RICH!

12/5/09

Mike and I took a taxi to Accra for the first time. We ate a real meal at a sports bar which was reputed to have safe, fresh food. I had a taco salad!!!!! I thought I had died and gone to heaven. And I had a bottle of passion fruit juice - Coke and bottled water is getting very old. Mike had chicken strips and french fries. I could have eaten spoonfuls of the ketchup at our table - it tasted so good. Then we took a taxi to the Accra mall, which was a very modern mall similar to our malls - overpriced, loud, crowded, everyone dressed up, etc. We did some shopping at Shoprite, a huge grocery store and at Game, a Walmart-type department store. I fell asleep in the taxi on the way home - too much activity for me.