Writing from Ghana

Hello everyone!

Thank you for all your and encouraging comments. I was so happy to read them today! So I hope you will like the sequel to my first entry!

As I expected, we do outreach every Monday, Wednesday, and Friday. Yesterday, Wednesday, was my first day on the job. After breakfast at about 7:30am, I was picked up by someone from Unite for Sight. The past two days, it has been Dennis, an ophthalmic nurse (pictured below), and Seth, the Unite for Sight volunteer coordinator. Dennis is a jovial man, whose favourite french sentence is "C'est mon secret." (=It's my secret.) The only sentence he apparently still remembers from French class, besides "Bon Appetit!" (Most of west africa is french-speaking, but schools here can choose whether or not they want to teach it.) Unfortunately, one day, when the teacher asked him why Dennis was late for class, he replied, "C'est mon secret," which resulted in a good beating. Dennis has a very interesting story actually. He, his wife, and two children used to live in the UK, but after seeing the Unite for Sight volunteers, he was motivated to return to Ghana with his family to help his people. He has been working with Unite for Sight since May. It is a demanding job; he isn't able to see his children every night because on many days, we don't return from outreach until late at night, after his children have gone to bed. (The streets are small, traffic-jammed, and often unpaved, so even by car, it takes a while to get around. The roads do not look bumpy, but when you are in a car, and your head and upper body are flailing around because of all the pot holes, you realize how important paved roads are!)

Yesterday, we went to Anomabo, a small fishing town 2 hours away from Accra. I learned how to do visual acuity tests, and after an hour or so, I finally stopped mixing up the right and left eye, and found a system so that I wouldn't get dizzy looking back and forth between the eye chart and the patient. We use the chart with the tumbling E, because many of the patients, particularly in these rural villages, do not know how to read. So, I have to look at the direction he E is facing on the chart, and swing my head around to look at the direction the patient was indicating. I finally began looking at two letters at a time, so that I would need to swing my head less! I think after a couple of weeks of outreach, my right arm will also be significantly bigger than the left, because that is the arm I hold up to point at the chart.

In total, we saw 108 patients, 5 of whom were referred to Dr. Clarke, the ophthalmologist who runs the Crystal Eye Clinic (the headquarters for Unite for Sight in Ghana), for surgery. Most of them were elderly, wearing beautiful traditional clothes with bright, colourful, and geometric prints. There were a couple of school girls and boys who came to get their eyes examined as well. I learned to recognize that when I saw some of the patients search around with their eyes, not quite focusing on any object, that they had very mature cataracts. So I would skip the chart, and move on to counting fingers. If they could not count how many fingers I was holding up from 6, 5, 4, 3, 2 , and 1 meters away, then I would take a pen light out and ask them if they could see the light. This means that their retina is still functional. About half of the cases were like this, and many of these older blind patients, were accompanied by a younger family member.

So I continued to do visual acuity tests from 11am to about 2 or 3pm, and then followed Seth, Dennis, a community health volunteer, Naomi, to learn how to register patients, pick out proper eyeglasses, and teach patients how to use the eyedrops. It was then that I realized how much of a drawback it was going to be that I did not know much Twi, one of the three official languages in Ghana. Very few patients speak English, so I must always have a translator assisting me with the visual acuity tests. The translators are volunteers from the community. In Anomabo, one of the volunteers, clad in a school uniform, even requested permission from her teacher to come and help us out. I am lucky to have a friend, Joel, who was able to teach me some basic sentences (which deeply impressed my hosts here. ;) ), but now, I am very motivated to learn more Twi so that I can be more useful here. (I am also curious to know what the radio hosts on 104.3 are talking about. They scatter English phrases here and there, but I am so curious to know everything they are saying! A lot of the talks actually center around American and national politics.

We finished seeing all of the patients around 4pm, after which we were offered lunch by the area coordinator, Segu, who is involved in a lot of NGO efforts in the area, and directs his own micro-financing company. My first bite of Ghanaian food. It was delicious. Fish with spicy tomato sauce over a bed of pink rice with a few beans. (I forgot to ask what this dish was called.) We then made another 2 hour ride back to the hotel, the Telecentre GuestHouse in Achimota, Accra. I was dropped off at 7, but by the time Dennis had gotten home, after dropping off Seth as well, it was 10pm. I did not expect to spend so much time in a vehicle, and for those that know me, it is hard for me to stay awake in moving vehicles (particularly one that sways from side to side because of the road conditions, and when it is pretty warm outside.) So, a lot of my energies are directed towards trying to entertain myself so that I can stay awake! Although so far, my attempts have not been very successful. Hopefully, I will get over jetlag soon.

Today, I shadowed Dr. Clarke at the Crystal Eye Clinic, and nearly fainted from watching the cataract surgeries! After a couple of breaks though, I was doing alright. There are two categories of patients that come to the Crystal Eye Clinic, there are those that are not referred to by Unite for Sight, in other words, just like you would be referred to an ophthalmologist in Canada, the US, or in HK, you would here as wel. The second category of patients here, are those that come from the surrounding villages visited by Unite for Sight through our outreach efforts, and who are referred to Dr. Clarke, the ophthalmologist, through Unite for Sight's ophthalmic nurses, like Dennis. Today, the patients drove neary two hours to receive surgery here, and were accompanied by a community volunteer. I learned that actually, Unite for Sight's local volunteers help to arrange transportation for the patients, but the patients are expected to pay for the transporation themselves. It is not what I expected, but the reasoning behind this is that the patients must help cover some of the costs of the eye care or they would not value it. Unite for Sight provides consultation, eye examinations, and eye surgeries for free, so patients must pay for eye medication (about $2 US a bottle) and transportation (depending on the distance, anywhere between about $5-10 US). Considering that the per capita income in Ghana is around $1,000 (vs. $40,000 in the US), and that these patients are often farmers or fishermen, it is a pretty substantial amount, but in Unite for Sight's opinion, not an unreasonable sum. The same way that Unite for Sight volunteers are expected to fundraise $1,500US each before beginning their volunteer proram abroad, they believe that the patients must work, or at least use their social networks, to help cover the costs of their eyecare.

The atmosphere at the clinic was very upbeat. Dr. Clarke was very happy to answer all of my questions. The nurses helped prepare the patients with local anesthetics so that Dr. Clarke could move from one operating table to the next an perform surgeries back to back. Each surery took about 5-10 minutes. Today, I watched him perform 11 cataract surgeries. So, it was a very light day. The reason why there are fewer patients here than normal is because Unite for Sight did fewer outreaches during the holiday, and so fewer patients have been referred to the clinic for sugery.

Tomorrow will be another outreach day, so I must wake up early! Thank you again for all your encouragement, I hope that you enjoyed this entry. Sorry, I do not have better pictures for you, I have been very focused on learning when I am in the field, so have not had the chance to pull out a camera when I am at work. I promise to some pictures of Unite for Sight in action later.

I hope you are all doing well in your respective countries! Enjoy the snow on my behalf ;) Cannot wait for the winter olympics to begin!

Christine

Photos: KLM flight 0589 to Amsterdam Dennis and me, in front of the Crystal Eye Clinic