Christine's Adventures in Global Health: Cambodia I

Get your ears checked!

2009-07-16T08:04:00.000-07:00

Since I've been working on a report of the Health Equity Fund in Kep Province, my routine here is pretty boring. I'm in the work eat sleep cycle that strongly resembles my final year of college, so any chance that I get to go out into the field is an adventure for me! This week, I followed Kunthy on two health education trips. On the first day, we visited Phnom Leuv village in Pong Teuk commune. It is about a 30 min tuktuk ride away from the Seaside guesthouse (where I am living). The topic was "healthy ears." All Ears is an NGO that conducts ear clinics around the country, they have visited Kep 3 times before, and they are back again (after 3 months) to find new patients and follow-up with more complicated cases.

The second time, we went to Okrasa village in Okrasa commune, but it was rainy and windy like no other. We rode ther on the back of a motorcycle, our ponchos flapping noisily in the wind, and rain hitting my face like pellets. When we got there, the roads were too muddy to ride through, so we had to get off and walk. To my surprise-in this horrid horrid weather where my sandals were getting stuck in the mud, I was slipping and sliding on the dirt path, dodging cow dung every couple of meters, and trying to ignore the sandy slippery feeling on the soles of my feet and thinking about all the bacteria and parasites that I now had lodged in my footwear and on the bottoms of my now drenched pants-there were people out, happily and calmly planting their rice seedlings. They seemed so happy and many of them were not wearing ponchos. You would have thought that it was like any other day.

The old woman who had offered her home up for the health education gathering this morning even stopped her rice planting, and walked the several hundred meters bare foot in the slippery sliding madness to lead us to her house. When we got there however, we realized that nobody had bothered to show up. Number 1 it is difficult to get villagers to gather together during the rainy season, because this is when they do a lot of their rice planting, and many people often only have enough land to secure enough rice for half of the year or less. Number 2 it was raining and very windy - 'nough said.

On our way back, to get the mud off of my shoes, I approached a relatively "clear" looking puddle and washed my sandals in them. As I was doing so, an image of a little boy that I had seen the other day, peeing right next to our favourite restaurant on the cement floor popped into my head. In this rainy environment it is impossible to tell what is urine and what is not...I told Kunthy before I mounted her moto "Somebody has probably peed in that water, but I just had to get that mud off of my feet." To which she replied, "Pee is probably not the only thing in that water..."

Picture Album (Coming Soon!)
Preview:

Water Filter Distribution Photos

2009-07-11T08:23:00.000-07:00

Preview:

Photos Day 1, Day 2 courtesy of Diana Wu.

Water Filter Distribution to Most Vulnerable Families in Kep.

2009-07-10T07:02:00.000-07:00

The last two days, we distributed 250 filters to most vulnerable families in two communes of Kep province, Okrosa (of DomnakchangAeuk district) and Prey Thom (of Kep district). The cool thing was many of the families had been interviewed by Centre for International health (CIH) volunteers in June.

We held two water filter distribution "ceremonies," because one of the district governors refused to go to another district governor's ceremony. (The pagoda's where we held the ceremonies were less than 20 minutes apart...I thought it was a pretty lame excuse.) While Kunthy, our CIH program manager and organizer of the water filter distribution ceremony, rode her motorbike to the pagoda, the 6 of us volunteers took a tuktuk. In about 15 minutes we arrived at a beautifully carved stone arch, that lead us to a large open sandy area, where the pagoda was located. The pagodas in Cambodia are very open, with colourfully painted balconies (red, yellow, blue, pink...) beautiful frescos detailing the life of Buddha lining the top of the walls, and lines hanging from one end to the other, criss-crossing each other, with cute little shapes (flowers and triangles) cut from patterned shirt fabrics of all the colours you can imagine hanging from them in series. Some of them also have a wall where they record major donations and contributions from the community.

We were met with curious stares, and when we walked up the steps to the pagoda, and removed our shoes, a little boy with a buzzcut grabbed some straw mattresses, placed them on the ground and motioned us to sit on them. All of the villagers had arrived already, and were sitting patiently on the tiled floor. At first they look like a sea of darkened faces from the rice planting and the hot Cambodian sun, amid a multicoloured palette of dusty pink, purple, yellow, and grey blouses. Most of them were women, most middle aged or older, and some men. Slowly though, we began to recognize faces. In Prey Thom, we realized that two of them were our dessert ladies, others had charmed us with their hospitality and kindness when we interviewed them regarding safe drinking water in June. Suddenly the faces seemed friendlier, I even noticed one of my interviewees falling asleep during the district governor's talk (they are known to be long-winded...we asked them to speak for 15 minutes, but neither were able to stick to their time limits. They say it may be a Cambodian habit, of zoning out when you are being lectured at, because that is what they used to do during the Khmer Rouge regime.)

After the district governor and commune chief made their speeches, Allison and I with Kuthy's help, made a small presentation on the importance of drinking clean water (you can avoid getting stomach ache, diarrhea, and malnutrition if you remove the bacteria and worms from your water), and how to prepare, use, and maintain the filter in their homes. I was impressed with Kunthy's ability to connect with the audience. While we were up there, I noticed that every single face was turned towards us - not only was the material more interesting, and not only were we standing up and being more animated, I think Kunthy was doing a good job of using real life examples and cracking jokes here and there (e.g. the ceramic pot that filters your water is not a flower pot like you have at home, though it may look like it). She got the audience to participate, and she got them to ask questions when they were confused. From what I had been told by villagers during water filter interviews, it sounded like a lot of villagers missed a lot of information (particularly the woman that went back to drinking dirty pond water after her water filter broke!), and I thought that it was perhaps because of the boringness of the health education meetings. But now that I'd seen what Kunthy does, I think it has more to do with the fact that many of these villagers are illiterate.

In Canada, say if you wanted to know more about diabetes, you can ask your friends, family, relatives for answers. Ultimately though you will end up relying and trusting what you will have read, because you either look online for information, or ask your doctor because you have easy access to him/her. If you don't though, you end up relying on word of mouth for all of your information. You can imagine how confused you can get at the end of the day.

After the education about the water filters, we went to our stations to distribute them. That was another headache all together. Each volunteer was paired up with either a village chief ("mey poom") or village volunteer (each of them are paid $2 for helping out). They did not speak English, so Kunthy quickly taught us a few Khmer words "Ot Mow" for absent, "niak poom" for villager, and the relevant respectful titles. It seemed as though they were not well briefed on the distribution procedures because everyone seemed to be doing it differently. We were to collect 2,000 riel (US$0.50) for each filter (each filter costs US$10, but we ask for a small contribution from each villager to encourage them to value it, take care of it, and not sell it), and make sure that all of them are accounted for (somebody was caught stealing 8 filters last summer.)

Some of the village volunteers though were rushing through the process, calling villagers' names and handing out filters without marking things down, other volunteers were collecting money and stuffing it into their pockets without counting the money, still others collected money from everyone before the ceremony started without noting down who had paid what, and still others did not even ask for the villagers' Most Vulnerable Families List (MVFL) cards before they handed out the filters. It was a reflection of what both groups of volunteers were used to (doing things by memory and trusting villagers rather than keeping detailed records to avoid liability). In the end, out of all of the villagers in category 2 ("very poor" who lived on US$0.25 per member of the family per day), almost all of them were able to pay. For category 1 ("extremely poor" who lived on US$0.13 per member of the family per day) a little more than half were able to pay (sometimes they would give what they had, maybe about a fourth or 2/3 the asking price).

Since many of the villagers who had come to pick up the filter were old, we worried about them having to bring the filters back home. After all it was a pretty fragile and heavy giant ceramic pot inside a sturdy but still breakable plastic bucket and cover. Some villagers carried them home on their bikes, others had their 5 year old daughter carry them home with them, but for many of the elderly, their only option was to carry it themselves. And we're not talking about a simple 5 minute walk around the block, we're talking 30-40 minutes in the blazing hot sun of early afternoon in tropical, having to walk across very narrow rice field paths, over bushes, sometimes between trees, avoiding cow poop and trying not to fall into the ponds. It is HARD, and I have no idea how to describe it in words, or with pictures. You just have to come to Cambodia and try it yourself.

Anyways, that's all the time I have right now to blog, so I will be back with pictures. Stay tuned.

Dog Bite - Happy Canada Day!

2009-07-02T18:26:00.000-07:00

It happened during lunch, and fortunately, it wasn't me. My fellow volunteers, Kathleen and Allison, and I were eating lunch at our regular Khmer place, when we stood up to return to the guesthouse, and it happened. The restaurant's dog was sleeping under the table, and Kathleen accidentally stood up right on its back. The dog squirmed loudly and bit her in the heel. Not a big bite. If you didn't see it happen, you would have mistaken it for a scratch. But we were nervous, knowing that bites from rabid dogs are deadly. The virus spreading through and attacking the body's nervous system.

There is a pre-immunization for rabies, which consists of three shots over a few weeks. It's called a pre-immunization though because even with it, you are not immune to rabies. What it does is it buys you time. Without the pre-immunization you only have 24 hours to get to a hospital and have the first vaccination dose, one of 5 vaccinations you must receive over a period of 28 days, including immunoglobin, which apparently many hospitals in developing countries do not carry. Before coming to Cambodia, our supervisor warned us that if we got bitten by a dog, there was a high chance you would have to be emergency evacuated to Bangkok, in Thailand in order to find the vaccine.

Unfortunately, Kathleen did not receive the pre-immunization. It is a gamble, and usually doctors will not pressure their patients into getting it because it is expensive (about US$300), and the chances of being bitten are not extremely high. And if you receive the pre-immunization, you still have to be shipped to a hospital to receive the post-vaccinations.

So, when Kathleen was bitten, we immediately notified everyone in the program, we called Kunthy, our Kep program manager who was a qualified nurse, midwife, and accountant, and Buntheon who was our Phom Penh program manager and driver. We also notified our supervisor in Canada, as well as the one in Kep, who was replacing her for this week only. There was a hospital in Kampot (about 30 minutes away), and Kunthy was sure that she saw a private clinic that carried the vaccine. but after seeing the hospitals and health centres in Kep province, Kathleen was a little nervous about the cleanliness and sterility of their medical equipment. The other and more reliable option was to go straight to Phnom Penh (about 3 hours away) to the International SOS hospital, that was open 24/7.

While Allison rushed to look up information about the vaccination process post-bite, I hurried to e-mail our supervisor in Canada, and Danielle, a second year medical student that had just arrived from Phnom Penh, helped to reassure Kathleen that she had some time (24 hours), all we had to do was take her somewhere to get a vaccination. Danielle also insisted that she come with Kathleen to get the vaccination, to accompany her, help ask the doctors the right questions, and notify the travel insurance company about the incident. They arranged for the taxi who had just dropped the two girls off from Phnom Penh to wait for them while they packed their things to go to the hospital. Stephanie, who was good friends with Kathleen, also made sure to remind Kathleen about what she should bring (passport, insurance policy, money, clothing, etc.) and comforted her as well. Buntheon and I were dispatched to the Khmer place where Kathleen had been bitten to inquire about the dog, his age, normal temperament, and whether or not people knew if the dog had bitten anyone else before.

Within an hour of the bite, Kathleen was on her way to Phnom Penh with Danielle to accompany her.

Luckily, the hospital did have the vaccine, and Kathleen received the first dose in 5-8 shots from shoulder to foot. She arrived back in Kep within 24 hours vaccinated, and much calmer. The travel insurance company even promised to cover the entire cost of the vaccine. She will have to return to Phnom Penh to receive the remaining 4 doses in 3, 7, 14, and 28 days from Canada Day the day she got bitten. What a way to celebrate!

When I think back on this incident, I admire the way in which our entire team of volunteers and staff helped to make sure that Kathleen was ok. It is amazing to think that within 24 hours, she went to the hospital in Phnom Penh and back and received the right vaccination. It seems like such an amazing feat when I think about the dozens of families that I personally interviewed that I knew would very likely die from rabies, if they were bitten by a rabid dog. If you are living on less than 25 cents per day, there is no way you are going to be able to search the internet for vaccination procedures, or have access to people who have nursing or even medical knowledge, or health insurance. The whole trip to Phnom Penh for Kathleen would have cost a maximum of perhaps US$71 (US$45 taxi, $6 for hotel, $5 get to the hospital and back to the hotel, $5 to come back to Kep on the bus, $10 for food) and then another couple hundred for the vaccine, which she will get re-imbursed. You could also count the opportunity cost of having 2 of our volunteers away from work for 1 day.

As a villager among the most vulnerable families in kep, the situation would probably have run more like this. Most people know that when you get bitten by a dog, you have the potential of dying from rabies. If the family happened to have a neighbour or relative who had gone to the health centre before, then the neighbour or relative may or may not say very positive things about it. As recently as 2001, full-time health centre and hospital health staff were being paid as low as US$15/month. This extremely meager salary contributed to very low staff motivation to deliver quality health care. Often times there would be NO health staff even present, because they would be busy operating from their own private practices, or doing another job. The health centres are often not well equipped, and at best, they would have chlorinated water, and some drugs, but no electricity (which didn't arrive in Kep until 2007). Because of the lack of staff motivation, you probably wouldn't be referred to the hospital.

If by chance you WERE successfully referred to the hospital, in order to pay the admission fee and transportation and food to get there, you would need to either sell your assets (at worst your productive assets/land), or get a loan, for which interest rates are 10-20%. If you are even near-poor (not extremely poor, but poor) you will likely fall into deeper poverty through this process, which is exactly what has happened to a lot of families in Cambodia.

On the other hand, if none of your neighbours or relatives had been admitted to hospital (which is very likely, b/c the cost of getting admitted is on average about US$54 per admission, including treatment - which is WAY above what any of the families on the Most Vulnerable Families List can afford - they have US$0.25 or less to spend per person per day), you would end up consulting a traditional healer or private practitioner, who would A, not have the vaccine, and B, charge you anyway for a different drug because they want to make a profit. And remember if you don't get vaccinated within 24 hours...the virus will spread through your body, and as the doctor at the International SOS hospital explained "you will experience symptoms after a couple of weeks, and you will die."

Luckily with the Most Vulnerable Families List and with the Health Equity Funds (HEFs) being implemented in two thirds of the country, many poor families are able to access more timely heathcare at a reduced cost (all HEFs cover healthcare costs, and some even cover transportation, food, and lodging costs - none cover opportunity costs yet). For the time being, much of the Health Equity Funding are coming from internatinoal Aid agencies, but more research is needed to figure out how on earth we can fundraise sustainably. One province, Takeo, currently has a local NGO, called Buddhism for Health, that is trying to do just that, but collecting donations from the community itself for the Health Equity Fund.

Anyways, I thought I would take the opportunity of the dog bite to explain the issues that I've been reading about and experiencing in Cambodia. Moral of the story: always check that there are no rabid sleeping dogs under your table, and appreciate the public health care system in your country!

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I have uploaded some pictures here about our recent visit to some nuns in Kep.
Preview:

Thanks Daddy, for sending me to school...

2009-06-29T18:10:00.000-07:00

This is a good example of how Cambodians pose for the camera. One is the actual photo The and Thy posed for, and the other one was the candid shot. Can you guess which one is which?

__________

I will be spending the next little while compiling a Literature Review on Health Equity Funds (HEF) in Cambodia. I feel kind of silly being in Cambodia and doing a literature review because I feel like I should be out in the field rather than in the CIH office reading online articles and typing on my computer. At the same time though, the Literature Review is a VERY important part of the report we hope to produce. The reason it is so important is because it puts the Most Vulnerable Families List (MVFL) and HEF in context. How useful is the MVFL as a poverty-reduction strategy? How does it compare to other strategies that currently exist?

Or, in business terms, the point of the Literature Review in this case would be to introduce our product - the MVFL. What is it? Why do we need it? How is it going to improve the awesomeness of our lives? Apparently, many NGOs do not engage in a lot of research (mainly because they are afraid that private donors would not be willing to fund it). More and more NGOs, however, that they really should be investing in program evaluation if they want their programs to improve and make sure that their programs are really reaching their target population.

I am so glad that I majored in Anthropology. I think I would find this work impossibly overwhelming if I didn't have that training from Haverford College. So, even though I have my work cut out for me for the next 6 weeks, I am very happy right now that I have some experience doing Literature Reviews, and hope that this one will come out nicely. :)

2009-06-27T08:56:00.000-07:00

Over the weekend, Sray Tal, one of our translators took us to the home of a 58-year-old woman who had been interviewed for our water safety project. She was living with her 28 year old daughter and two sons, and owned three small rice fields, enough to feed her family for 6 months, and sold some hot palm-fruit and coconut cakes to make a living. She earned about 1000-2000 riel a day (25-50 cents).

But I swear, her cooking, is AMAZING. She cooked some delicious red curry with snails for us, and it was so good, I would have eaten three bowls of it, if it weren't getting so dark near the end of our meal (there is no electricity in that village, so when it gets dark, it gets dark, and that is the end of your day). The cakes she made were also amazingly delicious. I ate 1 before the meal started, and she sent us home with 11 more - of which I ate 3 when I got home...

Eating this meal was more than just about the wonderful hospitality of these families who own next to nothing. It was about seeing that these people have something to offer, a very delicious cuisine! If she were to open a restaurant, I would be eating there everyday. All she was missing was some start-up funds.

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Today, I met up with my travel doctor's friend, Judy. She was a very charming and well-spoken woman with a million-dollar smile, short but lush gray hair, and an amazing energy about her. She and her friend Linda were staying briefly at the Kep Lodge, a 15 minute walk away from where I was staying. She was working as a consultant specializing in organizational change, working with an NGO whose job was to provide policy leadership for hundreds of other education-focused NGOs in the country. She was just terminating an 18-month volunteer work experience with VSO, which is a UK-based NGO that places volunteers with particular skills in NGOs across the globe.

Her friend, Linda, who had come to Cambodia for about a month and a half, was a specialist in gender issues and health and was working with UNICEF to assess its programs and make recommendations. We discussed the issues involved with trying to educate uneducated people about health. Because many of the Most Vulnerable Families are illiterate and have very little education, often times, they will know what germs are, but will not know how germs can make you sick, or why you ALWAYS need to boil/filter your water, not just SOMETIMES. There were a lot of gaps in their knowledge, and if you think about it...it's not that surprising. How many times have you zoned out during a very boring office meeting? or during class at school? If you are illiterate, and do not have any picture books or written materials to review what you've just learned at a "health education meeting at the village chief's house" you are bound to forget things, misunderstand things, and ultimately, be very confused about what it is that you've just learned. So, it is VERY DIFFICULT to do health education in a population that is largely uneducated.

Judy saw the issue from the Education perspective. She noticed that a lot of students did not get the opportunity to go to school not just because of poverty, but because of bad health and illness. One third of deaths of children under the age of 5 are due to water-borne illnesses. Those that make it past the age of five often suffer from respiratory diseases, or malnutrition. Talking to Judy made me realize that we can't just offer people education or health, they have to be supplied in tandem.

Another issue is community mobilization, which we talked about as well. Linda explained that often what happened with community health projects was that they were abandoned after a while, because nobody took responsibility for them. If the water pump broke, sometimes the only 2 people trained in the community by NGOs will have migrated to Thailand or Laos to work. There was no sense of communal ownership of the water pump. So, what UNICEF has been trying to do since 2006 is mobilize communities by supplying them with nothing but information. They do things like visit the feces-covered areas of the community to show the villagers where the flies also hang out besides around their open food. They calculate as a group how much feces the village produces in a year to give a sense of how much bacteria is circulating the community endangering the health of the village's children. And so far, these efforts have been successful at getting the community to think for itself and demand change, rather than passively accept it from a hodge-podge of NGOs.

A huge barrier to political or community participation though for the poor is, simply, poverty. If you are poor, your options are extremely limited. If you barely have enough food to eat, are you going to go out of your way to visit the village chief and make a complaint? And risk not having enough to make it to the next day?

Anyways, it is getting very late, and I should close up. Thank you for reading!

Lost in Translation...very lost...

2009-06-25T08:24:00.000-07:00

Because of the multitude of NGOs that are present in Cambodia, their efforts to improve the lives of Cambodians are making good progress, but the work is extremely uncoordinated. It's as if Cambodia had a thousand different mini-governments running the country...and I got a taste of what it was like this week.

One of our volunteers, Kathleen, who went into the field to do interviews about water safety encountered an angry villager who complained to her saying that an assistant village chief had forced her to pay 10,000 riel (about 2.50 USD - keep in mind that everyone we interview are families that made it on the Most Vulnerable Families List, and therefore have 25 cents or less to spend on each member of the family per day) for a communal water filter that was yet to come.

When Kathleen heard this, she, very responsibly, asked the woman to bring her some information about the water filter or organization that was providing the water filters, and the villager showed her a black and white photocopy of the CIHCambodia pamphlets we have been giving out during our interviews to educate villagers about clean water practices. It appeared as though someone, perhaps pretending to be the assistant village chief, was scamming the villagers into paying 10,000 riel for a filter that never showed up, and was doing it all in CIH's name.

In shock, Kathleen's translator, Mr. Sun, told the woman that she had gotten jipped because she had paid $2.50 for a water filter that she could have gotten for free from CIH (because she is on the Most Vulnerable Families List - although this isn't true. We now make villagers pay a sum of 50 cents "contribution" to avoid giving out "free" things and encourage recipients to take good care of the donated filters).

When our supervisor Rebecca, she was absolutely alarmed and decided to put Kunthy, our Kep Program manager, on the case immediately. We knew that the Red Cross was selling filters for 2.50 USD, but it seemed as though the fact that they collected the money before delivering it made it very easy for any official to come around and say that they were collecting money for filters.

The next day, Kunthy personally went to visit the woman who had made the complaint. After speaking to the woman, she came back to our CIH office, and told us that it had all been one giant misunderstanding. What happened was the woman who had complained had actually sort of been interviewed before by CIH - by me, to be exact. Kunthy showed me the picture of the villager, and I recognized her face immediately. She was the neighbour that had sat down next to my interviewee, and started answering all my questions, even though they were not directed at her.

A few days afterwards, a Red Cross Volunteer (who often happens to be a village chief, or one of the village chief's many assistant community-chiefs, you could say) had come around asking for $2.50 in exchange for a Red Cross water filter at a later date. She had given him the money, and the next day, my fellow volunteer, Kathleen, went to interview her. When Kathleen asked her for some information about the organization who provided the filters, the poor woman got confused between the two organizations (Red Cross and CIH), and her neighbour (the man that I had interviewed the week earlier) showed up with the pamphlet that I had given him.

To make matters worse, Mr. Sun's well-meaning but ill-informed comment about the price of the Red Cross and CIHCambodia water filters caused the woman to demand that the assistant village chief/Red Cross Volunteer give her her money back, which he did. When Kunthy came a few days later to find out what all the fuss was about and to clarify to the woman that the CIHCambodia actually wasn't free, but cost 50 cents, the woman became even more frustrated and upset. "Whatever," she said, "I don't want a water filter anymore!" And apparently scooped a bowl of dirty water from an open ceramic jar and fed it to her young toddler to drink. So, in the end, the one who is harmed most in this entire misunderstanding is the villager, and her family, who now are not only extremely poor and uneducated, but are angry and unwilling to consider the option of using a water filter.

That same day, Kunthy notified the Red Cross Chief about the issue, and she and I went to meet up with him. In a room with a long desk, topped with binders and papers on one end, I met with a solemn looking man in a pink dress shirt who refused to look at me when I spoke to him. It was incredibly distracting, because I wasn't sure whether he was disrespecting me or respecting me, and later learned that often Cambodians will do that because they feel shy or embarassed when they do not understand the foreign language I am speaking. The whole meeting, I felt as though we were in a precarious dancing competition, trying to see who could back down first.

My aim in meeting with him was to try to figure out why some of the villagers were feeling like they were being tricked into paying money for filters they might not receive, and how we could work together on this same issue of safe drinking water. I wasn't questioning him or anything, but the whole format of the meeting, with us facing each other, Kunthy having to translate everything back and forth between us, and the Cambodian body language that was so new to me made it feel like I was in a face off.

I found out that the Red Cross Volunteers were only being paid $4 a day to do Red Cross administrative stuff, like collecting money for water filters (which they do separately from the filter distribution in order to avoid mis-counting money or losing filters because of theft - CIHCambodia had lost about 8 filters the last time it distributed filters and collected $ for them during a ceremony - one of the theives was someone rather important in the community that shall remain unamed). When they broke, it would be up to the villager to notify the Red Cross Volunteer who would come around and try to repair the damaged filters, or re-educate the villager. However, because the Red Cross recently ran out of funding for the water project, they had to stop paying their Red Cross Volunteers, which resulted in worse service, and problems like failing to tell the villagers what the money is being collected for, what the filters are for, how to take care of them, etc.

At the close of the meeting, feeling a need to end with something positive and diplomatic, I thankd the Red Cross Chief for his time and his free bottle of Red Cross water, and expressed my hopes that we would try to share information with each other, if either of us found a better way to educate villagers about safe drinking water. A nice, but rather unproductive, end to an awkward meeting. I would have hoped to come out with more concrete steps as to how we were going to avoid misunderstandings like the one we had experienced with the villager, but there wasn't enough time, I only have 6 more weeks here, and they apparently have dried up their water project funding. But this whole story just goes to show how much can be lost in translation...

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Other updates (on the food front):

- finally tasted the water fromt the water filter - earthy, but still good! (and free!)

- located a bubble tea stand at Kep Beach and am now in danger of becoming one of my supervisor's and fellow volunteer's diabetes research project subjects. Bubble Tea: bubbles, condensed milk, powder, and ice....yum! And for only 37 cents!

- then today, I visited my favourite dessert stand and thought, 1 bubble tea (37 cents) = 3 bowls of sweet green bean with ice (only 13 cents/bowl!) therefore...felt entitled to two bowls of dessert.

Drinking Dirty Water - The incompleteness of health education efforts in Kep province

2009-06-23T09:17:00.000-07:00

Sorry, I only had time to upload a picasa web album with some captions. We have finally finished the data collection for the water safety project with the Most Vulnerable Families List. Onto data entry like mad tomorrow! Fun Fun Fun!

DRINKING DIRTY WATER JUNE 21-23

Clean water - walking the talk

2009-06-20T22:05:00.000-07:00

Here is an album with some photos of Diana and I cleaning the water filter in our office, so that we can use it. (We are very excited for the prospect of clean water that we no longer have to buy in environmentally harmful plastic bottles.)

It also contains some pictures of my favourite Khmer eatery in Kep.

Enjoy!

Khmer Food, and Cleaning the Water Filter

The extent of Cambodia's poverty

2009-06-18T19:46:00.000-07:00

The past two days, I have been back at the guesthouse working on the Most Vulnerable Families List project. Sadly, I do not miss going into the field to administer surveys about water safety. It pains me to see so many families in one day who lack the most basic necessities, and even though I have been a pretty positive person all year, I think that meeting some of the poorest families in Cambodia has forced me to confront reality, and it is not pretty. It is tempting to glorify poverty - to admire the fact that community bonds are stronger here (people have to rely on each other to survive, and when there are few opportunities to make money, it makes for a lot of down-time). Poverty is like a trap that no matter how badly you want to escape it, you cannot.

Yesterday, while a fellow volunteer, Marlene, and her translator Sray Tal were in the field collecting data on water safety behaviour, they came across a mother and her young 5 year old child. The young boy was wimpering and crying because of a large infection that he had on his buttocks. It had been there for about a week, and was apparently a recurrent infection. But because the mother was extremely poor, she could not take the child to the health centre. What parents usually do in this case is try to get a willing neighbour who owns a motorcycle to take the child to the health centre, located usually about 4km away (but can be as far as 10km away). But because everyone is poor, the mother would end up having to pay for it some way or other, and category 1 (extremely poor, vs. Category 2, which are very poor) families on the Most Vulnerable Families List have less than 13 cents US to spend per person per day. A moto ride to the health centre costs on average 1 USD. You can imagine the giant dilemma this mother is facing.

In the end the mother probably consulted a traditional healer who told her to put flowers and herbs directly ont the wound. If they were smart, they would try to at least clean the water first by filtering or boiling, but because many of the families are very poor and uneducated, many of them do not know how to make their water safe to drink and safe to put on open wounds. The water here has E. Coli and dozens of other very harmful bacteria. Marlene and Sray Tal were faced with a huge ethical dilemma, too. Should they just offer a dollar for the family so that they cojuld take the suffering child to the doctor, or should they call the doctor at the referral hospital to send the ambulance (in which case the family would be charged)? On the advice of the supervisor of our program, Rebecca, Marlene and Sray Tal decided to let the family be, on the basis that Marlene and Sray Tal could not be handing out money to all the families they came across that required medical attention - that would be nearly ALL of them.

Another reason why the mother had chosen not to take her child to the hospital was because the child was afraid of the hospital. This is not surprising considering that healthcare at the public hospital and other public health centres here is quite dismal (poorly staffed, poorly equipped, lacking drugs, and no sense of patient care or patient advocacy). Things are changing, gradually, for the better now that the government has a better financing strategy for its public healthcare system.

One of the biggest barriers to care for the poor is, very simply, poverty. When you are poor, you cannot just take your kid to the health centre. You have to take time out of your work day to look for someone who owns a motorcycle to take you there. You have to pay for gas for the motorcyclist. And when you get to the health centre, they may refer you to the referral hospital because they aren't adequately equipped to take care of your problem. Then you have to pay again to get to the referral hospital. And all the money that you spend may be two or three times the amount of money you need to spend on the family for food for one day. You then either have to pay back your debt through labour, or by selling some of your property.

It is so difficult to get out of this cycle of poverty. And the sad thing is that there are many bright young men and women in this country who are trying to get out of it, like the talented translators that we work with to get our research done in Kep province. But unless you win a scholarship or want to work for NGOs the rest of your life, in Kep province, there are very few avenues for you to make a decent amount of money. It is difficult for me to be optimistic when I am reminded of this every day.

There is so much need in the world. We need more people to put their heads together to figure out how we are going to solve this problem of worldwide rural poverty. I hope that my MVFL documentation project will help alleviate some of it by encouraging the government to invest more in the poor, and to encourage more governmental sectors and NGOs to specifically target the poor with their programs and services as a way of improving the quality of life of everyone in the country.

Visiting the poorest families in Kep Province

2009-06-17T18:31:00.000-07:00

I finally had my curiosity satisfied. Yesterday was my first day out in the field, doing water safety research. Marlene and I have been doing data entry for the past week, inputting data that was painfully collected by Rebecca and 4 other students in every corner of Kep province, where the Most Vulnerable Families were located, behind and around public buildings, in the middle of dozens of rice fields, and shrouded among thick tropical vegetation. Finally, yesterday, we got the chance to see the families first hand, step into their homes, and experience a fraction of their poverty. PICTURES

Some of them were right behind the guesthouse I have been staying at for the past 3 weeks. Others were living around the City Hall two doors down the street, more near the Crab Shack I'd walk past every day for lunch. They were everywhere, but so far into the fields that you'd need a well-powered torch light to get you there safely in the night.

One of the major projects CIH is conducting this year is a water safety project. Students who volunteered last summer applied for funding from Earthtones (a concert put on by the University of Toronto's medical school that features local talent, and that fundraises through corporate sponsors and selling concert tickets). They received $8,000 CAN from Earthtones and Rebecca Draisey, our supervisor, received another $10,000 CAN from a very close friend who was very supportive of the project. The money will finance the re-designing the water filtration system at the Kep Referral Hospital, which currently chlorinates its water because the biosand filters they installed last year just don't deliver enough water at the right pressure (a rather important oversight by a well-intentioned but ultimately inadequately experienced engineering student).

The money is also going towards doing a Knowledge, Attitudes, and Practice (KAP) study, where we try to figure out how much the villagers in Kep Province understand about water-borne illnesses and how to prevent them, and whether or not they are actually practising what they know. Going into the field and collecting data is a very long and arduous process that is not very demanding mentally, but is physically taxing. On my first day, my senses were bombarded by the feeling of wetness, heat, the smell of smoke, mould, sea, and dirt that filled my nostrils with every breath, and the chilling sound of dogs barking loudly at my feet. By the end of the day, even though I felt ok, I think I was subconsciously so overwhelmed and "full" that I was not hungry at all by dinner time (and for those of you who know me, this only ever happened once, and that was when I had gastritis).

Contrasting with my sensory overload was the warmth and good cheer of the villagers that surronded me while I interviewed the families. I interviewed old women, middle-aged men, and even a young 18-year-old woman. Everyone greeted me with huge smiles, and before I even thought of sitting, someone would appear as if out of nowhere with a chair, patting it dry or dusting it off with a cloth before I sat. People from the village gather round once they see two strangers awkwardly dressed in neon coloured ponchos with pen and paper in hand talking to someone they know. We are the entertainment for the day, and a curiosity for the young ones who stare at us and smile shyly when we turn to look at them. The adults joke and laugh at each other (or us...it is unclear) around us, either standing, sitting, or leaning against the damp wooden boards of a house. When it is time to leave, we smile and nod with our palms together, "Akun Cheeran," thank you very much, we say to each other, and "Lia Hai," good-bye.

Today, I will be indoors at the guesthouse, working on the MVFL documentation project, with mixed feelings about being here and not being out there in the field.

Cambodia!

2009-06-14T08:01:00.000-07:00

Dear friends,

I apologize for the long delay in publishing a blog about my trip to Cambodia. I really have no good excuse except for the fact that I am really enjoying my time here!

Many of you supported my efforts to reduce preventable blindness in Ghana, and I thought that perhaps you would find the continuation of my journey in global health of interest. I will be here for 8 more weeks, and hope to update my blog weekly.

I have now been in Cambodia for over three weeks now. I spent the first half of it in Phnom Penh, the capital, where we did a lot of sight-seeing, and the rest of it on the Southern Coast of Cambodia, which includes Kep City, the small rural town where my global health activities are based, Kampot, a slightly bigger town just 45 minutes West of Kep, and Sihanoukville, an ex-French vacation spot and popular beach area also on the Southern Coast of Cambodia.

Kep City is a small seaside town 5hrs South West of Phnom Penh. The shore is populated with inexpensive guesthouses ($8/night 2-bed room - $4/night if you share) and up-scale hotels that charge up to $150/night. The cost of living in Cambodia is going exponentially up because the tourism industry is developing quickly and realizing that foreigners are often willing and able to pay a lot more than the asking price. Further inland, there are acres and acres of bright and neatly organized rice fields, spotted with horse-sized white cows, and separated with red dirt roads, and thin snake-like walking paths. With 50% of Cambodia’s population under the age of 18, you see mostly younger people tilling the fields, harvesting the rice, and herding the cows.

FIRST IMPRESSIONS – A city where things are not as they seem.

Many things in Cambodia reminded me of Ghana, the smells, the odours, the stares, the dust, and the daily language lessons. I have never been in a country with such lavish national monuments amidst such abject poverty, and such reverence for a head of state. At every major roundabout in Phnom Penh, there is a gigantic photograph of the King, the head of state of Cambodia, in gold framing. Near the Royal Palace, where I was staying at the Okay Guesthouse, were several very beautiful boulevards with traffic going in opposite directions on either side of a very long, grassy, and tiled park. Nearly every roundabout and boulevard has a large monument or statue. This is what people use to give directions (To get to Kampot, make a left at the white horse...) even though there are street names. It’s similar to Hong Kong, where people know where they are based on landmarks, rather than street intersections, as in North America. The imposing pictures of the King however, mask the person who has the real power in the country, and that is Prime Minister Hun Sen. The ex-Khmer Rouge, pro-Vietnam leader has been in control since the 1980s, and it is because of him that there is no free press or speech in Cambodia. In fact, even though year after year, during “democratic elections,” Cambodians don’t vote for him, he still wins.

Even though Cambodia has many flashy and comprehensive laws (They legalized abortion in 1997 and made child labour illegal in the last decade, and also have made helmet-wearing for bicycle and motorcycle riders mandatory) it is rarely reinforced, and the police who dot the cities and towns will stop you, but easily let you go for a bribe. The best example of this is the traffic. I’ve never seen a place with such chaotic traffic. There are jeeps, cars, motorcycles, tuktuks (carriage-like things attached to the back of motorcycles), bicycle-powered carriages, and bicycles. At most intersections people simply slow down, inch slowly forward in the opposite flow of traffic , and then make the turn. I compare it to what would happen if the road was a pedestrian side walk. There are loose guidelines (like drive on the “right” side of the road), but people don’t really follow it at all. They just do whatever will get them to their destination fastest and safest.

One thing I noticed here was that there were a lot of tourists, backpackers, as well as a lot of NGO workers. Every corner you turn in Phnom Penh there are NGO offices, or organizations that run restaurants that support community organizations like the street kids, or the blind. In fact there are about 1,000 int’l NGOs providing vital services that the government fails to provide. The wealth of NGOs however has given way to neo-colonialism. With so many foreigners making big bucks and living in a country where much of the population is making less than 1USD a day makes for a very well-established expatriate community, who live a very colonial lifestyle here, a life that is often very separate or hypocritical of the job that they hold here in this country. I can see how leading a high-class lifestyle is tempting because many of these workers are making developed world incomes and paying developing world prices for goods and services. On the one hand, you could argue that it creates employment and supports the local economy, but on the other hand, one can’t help but feel that something unethical is going on here. Recently a group of children from an international school in Phnom Penh came to Kep Seaside for a week of vacation and sight-seeing. On Janice’s last day of volunteering with CIH, we walked next door to the “Sailing Club” which is the hotel that charges $150/room/night, where we thought we’d treat ourselves to a special fancy dinner. When we arrived at the entrance, I see three tuktuks drive up to the hotel filled with the international school children and their chaperones. Upon seeing them, we attempted to race to the “Please wait to be seated” area to secure a table, but the kids simply strolled into the restaurant’s main dining room and sat down to what appeared to be a regular meal. Meanwhile, the waiter motioned us to go sit outside on the patio, which was still nice, but not as well-lit. Not only do these kids eat a place where the average meal is at least 3x more expensive, but they take a tuktuk to get to a place literally next door.

Another paradox is that Cambodia actually has a lot of very exciting and culturally and historically important tourist attractions, like the Choeung Ek Killing Fields. The sad thing is that many of them have been sold to Japanese, Vietnamese, or Chinese buyers and investors – which means that every dollar you spend on admissions often goes into another country’s hands and not into the country you are visiting. Choeung Ek, the place where thousands of Cambodians were executed and slaughtered during the Khmer Rouge is Japanese owned. The problem is money talks in Cambodia. Money talks like NO OTHER, and for a country as poor as Cambodia – it is very hard to say no.

Enough Negativity – what do I love most about Cambodia?

The people. Although I am miles away from home, Cambodia has made me feel at home. From the tuktuk driver I met in Phnom Penh, to the staff at Kep Seaside Guesthouse, and the deaf students from Epic Arts in Kampot. I have met some of the most warm-hearted individuals in this country. Never have I met so many people so eager to learn and to share their culture. Everyday, I am aware of the cultural and language exchange, and it is such a wonderful experience to be able to understand the way someone else sees and experiences the world. I have been having language exchange lessons with some of the staff at the Kep Seaside Guesthouse, and they have been some of the most memorable moments I have spent here. My time at Epic Arts was also unforgettable, of all the places I have seen in Southern Cambodia, I saw the most energy and happiness among the deaf students of Epic Arts. They were just exploding with enthusiasm and a desire for interaction!

I have also fallen in love with Cambodian cuisine. The food is tasty, full of spices and herbs, and yet, very little is actually spicy – which suits me perfectly! One of my favourite dishes so far is Amok, which is like curry, mixed with cooked vegetables, and egg, served with rice. We also had some small fried fish. Very delicious, and only 1.50 USD. They serve every kind of tropical fruit (pineapple, dragon fruit, longan, rambutan, fan fruit, coconut, mango, apples, bananas, and asian pears! Mmm...)

Cambodian street-food is also one of the best I’ve tasted in the world. There are sweet fried bananas and fried sweet potatoes. There is “jiahooey” grass jelly, with crushed ice, carnation milk, and sugar syrup, there is “Nem Grouak” which is rice flour balls with green onions, shrimps, yummy sauce and chilly, there are waffles and coconut cakes, the list goes on, and on, and on. I LOVE CAMBODIAN FOOD!

SIGHT-SEEING

In the first two days, Janice, a neuroscience undergrad student at U of T and I explored the tourist spots in Phnom Penh, including the Choeung Ek Killing Fields, the Tuol Sleng Museum (aka S-21, the “security centre,” aka prison), the Phnom Tamao Wildlife Centre, foot massage on the riverfront, and meeting with one of my friend Samantha’s friends who was on a mission trip for almost a year in Phnom Penh.

In Kampot, Janice and I followed some deaf students at the Epic Arts Cafe to see their school and the Epic Arts studio.

In Sihanoukville, the volunteers and I explored the coral reefs at a nearby island by snorkling, and had some delicious Japanese food. I think the pictures here can explain more than I can in words. Please visit my picasaweb album:

Phnom Penh

Kep City

Epic Arts - Kampot

GLOBAL HEALTH PROJECT

As some of you may know, what I will actually be doing there has been sort of been a mystery to everyone including myself. The Centre for International Health definitely encourages initiative-taking and independence by providing relatively little support, compared with Unite for Sight.

The Centre for International Health at U of T is a small office that provides administrative support to students wishing to do some course or degree-related research in global health. Students range from Masters’ students to medical residents, to undergraduate students, or in-between students hungry for global health experience, like myself. Rebecca Draisey, is the director of the Cambodia Program at the Centre for International Health, and spends 6 months out of the year in Cambodia, overseeing the program and negotiating with local officials so that we can carry out our research activities.

It has several programs that have come out the participants’ interests. Students generally conduct their own independent research, but last summer, they collaborated to apply for funding from Earthtones, which is a fundraising concert put on by the U of T Medical School. As a result, Rebecca, the director, is left with a ton of money that can be spent on water sanitation (which includes distributing water filters to villagers, doing safe water education, and establishing a clean water system at the Kep Referral Hospital). My job as a volunteer is to help out with this side project, while focusing on the Most Vulnerable Families List.

The Most Vulnerable Families List can be understood in the context of health care insurance in Cambodia. Currently, the government has 1 referral hospital in each province, and a few health centres for each referral hospital. Whereas in Canada the government collects taxes which go towards supporting a variety of initiatives including paying for the health system, the government in Cambodia collects no taxes, yet pays the staff at the hospitals and health centres. The result is poorly paid health workers – which a few years ago translated into dismal health care. In order to make enough to sustain their families, almost all government health workers and teachers have two jobs. In the past few years the government started implementing a user fee system. So, patients would pay for the care they received at health centres and that money was used to improve the quality of care at the health centre/hospital. The change to a user fee system vastly improved the quality of health care at health centres, but also created a different problem – that of equitable access.

For obvious reasons, the poor were excluded from this system because of their inability to pay. You would show up at a hospital with someone who was about to die and they would simply turn you away because as a health worker in a user-fee system, you get paid more to help people who have money to pay you. So, the government decided to implement a “health equity fund” which would compensate health workers for treating poor patients. The problem was that this process of deciding whether or not somebody was poor was up to the discretion of the person at the door, receiving the poor patient. In Kampot, a neighbouring province, a German NGO called GTZ was called upon by the government to create a system to rectify this problem, but only in Kampot. What they did was they utilized the already existing pagoda community networks (since about 90% of Cambodians are Buddhist, most people belong to a pagoda, aka Buddhist temple) and elected representatives from each village to help administer a questionnaire to figure out who the poorest in that village.

GTZ divided the poorest into two categories: extremely poor, and very poor. The process of determining who is considered extremely poor and very poor is actually a very transparent process, whereby local power-holders or typical decision makers mainly serve as facilitators rather than actual participants, and lists are made available to the village and open for negotiation and taken back for revision a few times before it is made official. The list of extremely poor and very poor families is called the Most Vulnerable Families List, and is used to make ID cards for each of the families on that list. When poor families show up at the doorstep of health centres, heath centre staff can now immediately recognize who they should offer discounted or free services, and know that they will be reimbursed by the government.

This has opened up a lot of other opportunities in Kampot, where a pilot project was run a few years ago, and students belong to families on the MVFL are offered scholarships for school, for example. (Education from primary to high school is free in Cambodia, but uniform, school supplies, and printing costs are not covered).

The problem with this MVFL is that it is only being implemented in certain provinces in Cambodia. The program requires some “seed funding” from int’l NGOs, because the government simply does not have enough or want to cover it. And the problem is that Int’l NGOs won’t come and help unless they see some evidence of local capacity to carry out and sustain the program. NGOs are not looking for need, they are looking for ability. CIH’s job therefore in this MVFL project is to help show that Kep Province has the capacity to carry out such a program. Kep has shown its ability by already completing the identification part of the most vulnerable families and even the card distribution using the pagoda community networks. My job will be to document all the knowledge we have about Kep Province, and what has already been achieved in terms of identifying the Most vulnerable families to encourage the government to find an external funder to implement health equity funding in Kep, and to encourage governmental sectors and other NGOs to utilize the list as a way of targeting their programs and services to accomplish the nation’s goal of reducing poverty.

So far, last week, I followed Kunthy, who is qualified to do nursing, finance, and midwifery and works as the program director in Kep City. She brought us to see some of the families who needed to be interviewed in order confirm eligibility to be on the Most Vulnerable Families List. After reviewing several criteria that included how much land the family owned, how many working members were there in the family, how many children they had, monthly income, etc. We would take a photo of them along with their number (which identified the province, district, commune, and village they belonged to) with their entire family, and create a card that was about half the size of an A4 sized page. This was the card that would need to be reviewed and stamped by the village working group and officials. I was surprised to see that I just could not identify by eye who might be eligible and who was not, and I could tell that Kunthy, too, could not just by eyeballing someone, so this process is very important and identifies immense need.

The next day, we delivered a wheelchair, that I helped transport from Canada to Cambodia, to an 62-year-old lady who lived in small one room brick house in a village about 40km away from Kep city, in Bon Teuk commune, tucked away amidst a display of shimmering rice paddies. Because of sudden high blood pressure, she had fallen down and lost the use of her legs including the ability to speak. She has been bedridden since then, and that was three years ago. She lives with her husband (who was a volunteer in the village working group, and who helped determine who was eligible to be put on the Most Vulnerable Families List), and grandson. I was surprised to find out that even this family did not belong on the MVF list. They’re home was very simply a one room brick house with dusty wooden panels for beds, no other personal belongings in the room to speak of except for a stack of rice bags in the corner of the room, one cow and a cow shed.

Besides, that we spent a whole morning and afternoon cleaning out the CIH office at the Kep Seaside Guesthouse. The place was ridden with dead bugs, dust, mold, and rust that had developed over the 6 months when Rebecca was away. We also sorted through and took inventory of the medical supply donations that we had brought with us from the CIH office. They were to be delivered to the health centres and hospital in the province.

The next week, while some of us did some field research for the water project, which consisted of finding out what happened to the hundred or so ceramic water filters that were distributed last year, Marlene, Kunthy, and I worked on a grant proposal for Earthtones to create an emergency medical transport fund for children and expectant mothers of the most vulnerable families in Kep province. Currently, I am helping to do data entry with the surveys the girls have completed in the field regarding water filters, and will be begin writing the first chapter of the MVFL documentation I hope to complete for CIH over the summer.

Ok, gotta go to bed now, on to my fourth week!

Reflections on Unite for Sight and Ghana

2009-03-26T15:51:00.001-07:00

Map of Ghana:

I returned from Accra last weekend, and am now back in Toronto to give you a full report about the last leg of my trip!

My blog entry today has three sections. The first one contains some of my own estimations of what our Unite for Sight program accomplished in the two months that I was there. The second section is a reflection about my experience as a whole and the perspective it has given me on many things in life. The third section, thanks to Amy, is composed of some answers to her (yet again!) wonderful questions.

Thank you to everyone who supported Unite for Sight on my behalf, and who have encouraged me through this journey. I owe all of what I was able to accomplish in Ghana to your love and generosity. I hope my blog was able to give you some new perspectives on Africa, volunteerism, global health, and life. All in all, my experience with Unite for Sight and volunteering in Ghana was nothing short of amazing, and I encourage anyone you to write to me if you have any questions about what I’ve blogged about! Christine.yeung08@gmail.com

If you would like to make another donation to Unite for Sight, please re-visit my fundraising page at https://maestropay.com/go/uniteforsight/volunteers/ref/7ae1fa7ff02e4bbe897f635669d3700f. Thank you!

I hope you enjoy this final blog entry about my spring trip in Ghana.

yours,

Christine

Pictures from my first overnight outreach in New Edubiase (Adansi South). The woman in the centre of the collage is an old woman who had received free cataract surgery from the Crystal Eye Clinic in Accra. When I checking her visual acuity, she kept telling me how thankful she was to the program, and how when she first came to a Unite for Sight screening, she had to be lead by the hand in order to walk. I didn't think of taking a picture of her until she had ran around the church, so I had to chase her to get this photo. When she saw me she hastily dropped all the things she was carrying in her hands in order to pose for the camera. This shot is actually from a short movie clip I took of her running.

Statistics!

For the last three weeks, we continued to do outreach, and to observe surgeries at the clinic. In my last week in Ghana, I made a second trip to New Edubiase (Adansi South) with the outreach team. Here are some stats about the impact of Unite for Sight in the two months that I was in Accra: (These are my personal estimations.)

2700 – patients were screened (300 patients/week)
360 – patients received Unite for Sight sponsored cataract and pterygium surgeries (40 patients/week)
16 – villages hosted Unite for Sight’s free eye screenings
4 – regions of Ghana (Central, Eastern, Volta, and Ashanti) were visited on outreaches
2 – overnight outreaches in New Edubiase (Adansi South), for one week each
1 – week in an eye camp in Offinso, neark Kumasi, where Unite for Sight sponsored 76 surgeries.

This is us partnering with the Tema Christian Eye Centre. They have an ophthalmic nurse by the name of Moses who screens patients, but they do not have any full-time ophthalmologists. Instead, they invite foreign medical doctors as volunteers to perform surgery. When they do not have any doctors scheduled to come, they will partner with Unite for Sight and the Crystal Eye Clinic so that their patients can still receive eye surgery.

A New Perspective on Life.

My experience in Accra, Ghana, contributed greatly to my personal growth, and I believe it has prepared me well for not only the practice of medicine and public health, but any challenge I will be faced with from now on in my life. The experience of fundraising, collecting glasses, and training for the Unite for Sight volunteer program taught me the power of implementing many small but well-designed initiatives, and the power of preparation. Each Unite for Sight volunteer must collect $1,500 US to sponsor surgeries for people living in extreme poverty, and obtain 300-600 pairs of reading eyeglasses and sunglasses. There was also over 36 hours worth of reading, writing, shadowing, and viewing videos that volunteers needed to complete before their departure. When I stepped back to admire the work that I had done even before I arrived in Accra, I was impressed with the genius of it all. Why not have students eager to make an impact through volunteering in global health take on some of the fundraising and collection responsibilities, and then prepare them through online training for their jobs as volunteers? The initiatives enabled Unite for Sight to sponsor many more surgeries than they could have through their other fundraising sources, and the preparation before I arrived in Accra certainly made a difference in my ability to contribute to the program on the ground. With little orientation I was able to jump right into the work I had to do. In fact, I did not have a formal orientation until the last week that I was there! It is a forgivable mistake only because my training was so thorough and complete even before I reached Accra.

These are pictures from my second time in Krobo Odumasi. That outreach stood out to me because in the same day, I saw two very unfortunate cases: a mother with her blind son, and a young baby with cataracts and her young father.

I realized two very important bi-products from this design were, first of all, increased awareness about preventable blindness in developed countries (you, my wonderful donors, represent three countries, Canada, the US, and Hong Kong), and an improved appreciation for important global health principles such as ethics and professionalism among participating volunteers, and thirdly, financial support for local healthcare professionals which helps to reduce the brain drain of medical professionals away from developing countries. I am noticeably still in awe of the organization because it has enriched the scope of what I believed what students, nurses, physicians, and regular citizens are capable of doing. Having experienced being part of such a well-designed organization, I am inspired to do something similar once I have my medical training and help more people in need.

The Crystal Eye Clinic. Although most of the cataract patients are elderly women and men between the ages of 60 and 75, and pterygium slightly younger, I saw a couple of cases where the patients were very young, like the babies pictured in the top left hand cornner of this collage. The one in front had congenital cataracts, while the one behind her was completely blind.

Another aspect of my experience that helped me grow personally was my interactions with the youth there. I became good friends with many young people like myself; people who not only had dreams for themselves and their family (as I did for me and my family), but had dreams for their communities and their country. Two fourth year undergraduate students I met wanted to become Members of Parliament in their home districts, and another young man I met, having barely graduated from university, even started his own NGO to develop the Upper West region of the country using three pillars: agricultural development, education, and microfinance. It just strikes me as amazing that people who live in such a challenging environment can have such big aspirations. One of my good friends was periodically skipping meals and studying while hungry because his father could not afford to give him more money for the week. He developed stomach ulcers and was admitted to the hospital for the first time while I was in Ghana. Another young girl that I befriended had to work very hard in the morning selling boiled eggs in order to make enough money to pay for the printing costs for her examination paper. The challenges I face in Canada pale in comparison to the ones my friends face in Ghana. Their hard work and commitment inspires me to forge ahead despite my fears and insecurities. My experience in Ghana taught me that as long as you have a vision for the future, an action plan to match it, and a group of committed friends, you can achieve anything.

I see all of these bright and talented men and women who are working hard so that they can excel in the classroom, get far in life, and learn how to build and help their country. Then, I see another young medical student across the Atlantic in the US, Jennifer Staple, who is hard at work directing her grassroots NGO, Unite for Sight, which provides poverty-alleviating, life-changing cataract and pterygium surgeries in and around Accra. Seeing these two examples, I cannot help but think, “Wow. I gotta get out there and do something.”

More outreaches in the Eastern and Volta regions. Somanya, where we saw the most patients I had ever seen in my life, is in the Eastern region. I remember that place well because we saw over 200 patients, and that day, my task was to do visual acuity, but they had placed the E-charts on the wall of the church, two steps away from the urinal. It was hard to focus that day.

Most of my learning and experiences have come from studying science, social violence, and health, so being in Ghana and seeing such a high demand for education really forced me to re-think my values. I always believed that health was most important because without it, you cannot do much, but there are so many people out there, living at less than the optimal level of health, who are still achieving things, getting degrees, working in jobs, and having successful careers that allow them to give more opportunities to their children. I realized that education is such a powerful tool that helps people get out of poverty. I also realized that in Canada and the US, having an equal opportunity at education is such an enormous privilege. I met many young men in their mid-twenties who were still waiting for acceptance from universities. First of all, in Ghana, education is expensive, so if you don’t have enough money to pay for school, you have to make it yourself first, secondly, it is competitive, so you have to earn top grades in high school, or have connections to help you get in. It is therefore a real privilege to be able to be accepted into a school solely based on merit, and for this reason, I hope to donate to my school to create more scholarships for international students. I still think that health is important, because it removes the burden of certain illnesses from families who are living in extreme poverty, but I now see the value in supporting other poverty-alleviating initiatives like improving access to education, skills-development, and micro-financing.

Outreaches in Krobo Odumasi, and the Volta Region. These were all very well organized eye screening locations. Well organized means that when we arrived, there were at least 100 patients waiting to be screened, and that the organizers were able to successfully manage the crowd of patients so that they would flow systematically through the different stations (registration, visual acuity, eye examination, and dispensiary of glasses and medication). They were also some of the most welcoming - food never fails to make me feel welcome. =P

Amy’s Question Corner!

Amy: How do you wash clothes by hand? Do you have board? You said you had a bucket, so I'm thinking you just scrub the material against each other? Do you just get the water from the tap? Or do you have to go to a river?

Christine: Well, it was quite simple really. You don’t have a board, and you don’t need to go to the river. In most guesthouses, you’ll find a backyard where there are clothes lines to hang your clothes. To wash them, you just grab two buckets, and fill them with water from an outdoor tap (kind of like the ones you would find to attach your garden hose in order to water your lawn). Then you use one bucket for washing, and the other for rinsing. You take the clothing, soak it in the water, grab it lengthwise and lather it with a bar of soap (body soap works fine, but they also sell special laundry-washing soaps which are bigger and therefore easier to handle in the soapy water). Then you grab the clothing lengthwise, say half-way through the middle, and...(this gets a little difficult to describe), place it on halfway up the inside of your forearm. Use your other hand to squish the clothing from the middle of your forearm to the palm of your other hand. This is when you hear a very satisfying sound of water and soap coursing through the weaves of your clothing (I’ll attempt an onomatopoeia...Sqrrruishhhhhh!). You keep doing this down the length of the clothing and add water and soap as needed. When you’re done, you fold the clothing lengthwise, and then ring the clothing in such a way that the water drains right into the bucket rather than everywhere, as it does when you ring clothes in Canada...I won’t even try to describe this because I already know I will fail. If you want to learn, I can teach you in person! Then you plunge the clothing into the “rinse” bucket, and ring it again before laying on the clothesline with some clothespins. Ta-da! Clean clothes. It sounds like it would take forever (as it did when I was just learning) but after a while, you can clean your clothes even faster than the washing machine!

Amy: Do you get nervous about eating street vendor foods? When I visited China with my mom last summer, my uncle would never let us eat anything from the street vendors because he was afraid we would get sick. But I bet since you're going to be there long, it's good to build up your tolerance!

This was my final overnight outreach experience in Adansi South. We saw a lot more patients this time around. Some highlights were the impromptu soccer game that Pastore Mike, Sammy, Simone, Dennis, and Bismark played with the primary school students where we were holding an eye screening. The shirted vs. the no shirts.

Christine: If you really want to eat street vendor foods (I encourage you to try it, because it is often the tastiest things you’ll ever eat in your life, am I right?), you should plan to stay in Ghana for longer than 3-4 weeks. That way you’ll have time to overcome the inevitable negative bodily reaction to some of the bacteria in it. I was taking broad spectrum antibiotics throughout my stay, so I got diarrhea for a week, but then I was pretty much fine after that. I would recommend traveling with somebody who is familiar with the food and its risks so that you can learn what is safe to eat and what isn’t. The only thing I found to be risky eating on the street was when I saw a hamburger (in downtown Accra) and bought it. I bit into it once and saw that the meat was not cooked, so I immediately spit it back out. Dennis, one of the nurses at the Crystal Eye Clinic, when he moved back to Ghana along with his two kids, he also had to take some time to adjust to the water and food here. His kids (3 and 5) alone took two months to adjust completely. Of course everybody body is different, and I can only speak of my own experience in Ghana, so please don’t get mad at me if you get really sick after eating some street food in a different country! The nurses I worked with in Accra kept commenting that I had a rather strong stomach (capable of eating anything!), so perhaps I am a bit of an outlier, too. To sum up, I enjoyed Ghanaian street food a lot, but please take what I say with a rather large grain of salt.

Amy: How often do you work? When you're not working, what "social" activities do you do?

In Accra, the volunteers worked 5 days a week, about a quarter to a third of the day is usually spent in transit (driving to the outreaches can take anywhere from 1-4 hours). We had Saturdays and Sundays free (except when we needed to travel to overnight outreaches which took an average of 4-6 hours, in which case you can expect to be traveling the whole day). In terms of social activities, I regret not having found a soccer team to join, although there were a couple that I knew of or saw). I visited the beach (Labadi Beach), the University of Ghana Legon and Islamic University College, Accra Mall (a new American-style mall complete with food court and movie theatre), shopping at the souvenir/craft markets, the National Museum of Ghana (which is in serious need of government support), the Kwame Nkrumah Memorial Park, Kakum National Park near Kumasi, and Elimina Castle at Cape Coast.

My favourite was when I followed a young girl who worked at the guesthouse (her name is Rahina, she is 13 years old but is just as tall as me!) to the local food market. It was the wildest thing because it was like the food markets in Hong Kong (crowded, full of scents and odours, shoppers had their favourite vendors, and it was incredibly confusing for the newcomer not familiar with the layout), except it was outdoors, they sold a lot of goat, the ground was sometimes uneven, there were a lot of babies and children there (some were working, selling goatskin for example), and there was an evangelist walking through the stands, yelling and shouting at the top of his lungs with much fervour. We returned back to the guesthouse with two giant bags of cassava, plantain, an assortment of dried fishes, goat mean, cow stomach and intestines, tomatoes, onions, and of course, my worst enemy, spicy peppers! (Brief digression: In Ghana there is also a shortage of plastic bags, or what they call “rubbers” or even “poly,” so you have to buy them yourself for 5 pesewas, or 5 cents. There are even stands that sell nothing but sturdy plastic bags, the kind of bags we would get for free by virtue of shopping.) Rahina unloaded the foods we had bought, and Margaret, the guesthouse’s cook, prepared all the foods and made it into the best-tasting fufu and light soup I’d ever tasted.

People in Ghana love to pay visits to each other and eat. People will even walk into a stranger’s home, or hang around a particular vendor, just to befriend them. Once, when we were in Offinso (a small town 20 minutes away from Kumasi) and it was a Friday, Dennis, our accompanying ophthalmic nurse from the Crystal Eye Clinic, took us for a walk around town. There was not much to see, but we stopped by a Coca-cola stand to by some things to drink. Next to the stand was small table surrounded by a couple of plastic chairs. On the table was a board game, the name of which I think is “Loot.” The rules are simple, and there are four players (on our board, it was Princess Diana vs. Nelson Mandela vs. The Dailai Lama vs. Ghandi) but it becomes very difficult particularly when your opponents are quick thinkers and fast players. Dennis invited the girl running the stand to play with us, and it turned into the wickedest battle between the two of them. I was playing, too (or was I?), but I clearly couldn’t think fast or deeply enough to make the right moves, so Dennis and Porshia (the girl running the stand, she was 18 years old) would take turns telling me what move I should make. After playing the game, I noticed that she was also selling some shortbread cookie (I love shortbread cookies), and so I told her I’d like to buy one. She decided to give it to me for free, as a gift. I will never forget that cookie.

4. How is access to education for children? Do both girls and boys have an equal opportunity? I read your blog about that gentleman making it through the University and his year of service, and so, are many families pressured to have their children work in the fields, etc in order to make ends meet?

One of the greatest things about Ghana is its relatively high late of literacy. Access to education is good, with government-run schools as well as private schools available for parents to choose from. Still, there were always children that I suspected did not attend school, even though they would often say that they did, because they were either selling things in the street, or playing outside with their friends during school hours. Even though the government schools (primary to senior secondary) are free, you still need to pay for your own uniform, stationary, food, and assignment/examination printing costs. Girls also tend to have a less equal chance at going to school than boys, particularly in the north where it is largely ignored by the government and therefore less developed. Like in many other parts of the world, parents choose to educate their sons rather than or before their daughters. Near Kumasi, where there are a lot of cacao farms, there are also a lot of children who work on their parent’s or relatives’ farms. You could consider this child labour (in fact the first time I visited Adansi, there was a week-long conference being held at the guesthouse about child labour in Ghana), or you can consider it just part of real life. As you mentioned in your question, Amy, children are considered a very big family investment because of poverty. If the parents did not need their children to help out on the farm or at homes in order to make ends meet, then my belief is that they would surely send their children to school. In order to encourage more students to attend school, we need to find strategies to reduce poverty, and one of those ways, I believe is by helping to reduce the burden of their health problems, like preventable blindness.

Sleeping and napping after a hard day's work.

Overcoming Culture Shock

2009-03-03T03:33:00.000-08:00

Unite for Sight does a wonderful job of preparing its volunteers for the trip. I was very impressed with how much information it had about culture shock, and I think it really helped me to overcome it while I was here.

If I could add anything to the wealth of information Unite for Sight provided, it would be this technique which my older sister taught me. One day, while I was tired and exhausted, and finding it hard to put up with the heat and the slow internet connection (I was trying hard to upload some pictures for my blog entry on a Sunday afternon, sweating like never before, radiating heat in the internet cafe room which had neither fan nor air conditioning. The temperature outside was a good 35 degrees celsius, and I was sitting there, staring at the loading bar at the bottom of my screen...), I had decided to write down all of the things that were making me mad. Everything.

I drew one line down the middle of the page, and on the left hand side, I listed all the things that were hitting my nerves. On it included the 20 mosquito bites I had gotten, the fact that I had misplaced some important documents (I had hidden them so well, even from myself!), and an impending sense of failure because I had not gotten the chance to complete the things I intended to while I was here, such as frequently updating my blog. On the right hand side of the page, next to each cause of my misery, I thought about and wrote down things that I could do to fix those problems. After doing this, that day, I chose three tasks out of that list of things that I could do to ameliorate my situation, which I thought would make the biggest impact on my happiness. Then, I made my mind up to accomplish those three things. True enough, I felt much better within a day or two.

When you first arrive in a country, you must take your time to observe others, and learn to do things the way locals do it. But despite the many things you can learn (like how to wash your clothing by hand in an efficient manner), there are many things you can't, like how quickly or slowly your body is able to adapt to 35 degree weather. So you put up with some things, which sometimes makes you put up with other things, and that eventually turns into tolerating a whole lot of things. Before you know it, you are feeling miserable and overwhelmed. The heat, the lack of internet access, and the mosquito bites were all very little things, but together, they were very annoying. To tackle the heat problem, everytime that I felt complaining that it was hot, I would look for the sun, so that I could tan, if there was no sun, I would find the coolest place I could be and think hard about something else. To tackle the internet access problem, I went scouting for different internet cafes until I found this one that I am at right now (that is thankfully air-conditioned and has a fast connection). To tackle the mosquito bite problem, I decided to actually use my mosquito repellent the moment the sun went down. I have had very few bites ever since.

So if you write things down, you see things more clearly, and are able to tackle each of the problems individually. The sooner you realize you're having culture shock the better, because after dealing with it, you are able to enjoy places and moments like this:

Kakum National Park (Canopy and Nature Walk)

The view from Elmina Castle. A fort built by the Portugese at Cape Coast when they arrived in Ghana in the late 15th century. The building was used to trade goods, and eventually slaves in the 18th century by the Dutch and English.

Guinea Fowl! The first time I had ever seen any in my life.

At the Crystal Eye Clinic, I was observing Dr. Clarke do some of his surgeries, when I looked at one of the elderly patients waiting her turn in the theatre, and noticed what she had been holding in her two hands. They are two stress balls that look like eye balls.

Pouding Fufu, which is made of boiled cassava and red plantain. It is normally swallowed whole and eaten with spicy soup and meats. Margaret is the lovely cook on the right. She skillfully folds the fufu and quickly removes her hand before the fufu is smashed with a surprising amount of force by the man holding the staff which he uses to pound the fufu.

Hawkers selling bread, shrimp, pure water, ice cream and plantain chips surround the van while it stops temporarily so that we can grab something to eat.

Labadi Beach (La Pleasure Beach) on Valentine's day.

A young goat in front of a beach at Anomabo, not far from Cape Coast. All the men, even the elderly ones, had very muscular arms because they were fishermen.

Dennis "C'est mon secret" Baah, an ophthalmic nurse pretending to push the 17-seat van at Amudurasi, in Adansi South.

A church, whose tiles look awfully like Toyota logos...

Will post more soon!

Christine

Pictures from Offinso Jan 25-Mar 3, 2009

2009-02-26T12:55:00.001-08:00

St Patrick's Hospital in the town of Maase, in the district of Offinso (25 min from Kumasi). Again, this is the place where we set up what was supposed to be a two-week eye camp, organized by Dr. Gyasi, with the support of the Bawku Presbyterian Hospital and Unite for Sight. Our goal here was to fix as many cases of cataracts and pterygium as possible.

Hospital staff sawing the legs of an operating table to adjust its height. The team of nurses and doctors that set up the eye camp at the St Patrick's Hospital in Offinso had to transport most oftheir equipment (surgical supplies, medication, sterilizing materials, etc.) to the hospital from Bawku (which is at the North-Eastern most tip of Ghana. They had to coordinate in advance to find out what kind of equipment the Offinso hospital already had. Once we arrived though, we had to improvise with or alter what we had to meet the specifications of the eye surgeons. The tin portable on the left is filled with high-tech surgical equipment that is collecting dust. Many of them have been donated to the hospital, but because they are very advanced and need specialists in order to fix them, they have fallen into disrepair. One of the reasons why developing countries continue to use what may be seen as ancient medical techniques is because it those techniques utilize equipment that is, yes, out-dated, but that is often easier to repair and therefore more reliable.

Patients waiting for their visual acuity tests.

Isaac (sitting at the table) recently graduated from University and is doing what they call here in Ghana a "year of service," where they are given a stipend to work somewhere related to the career they wish to pursue. If you have the right connections, you have some measure of choice over your placement. Everyone must do their year of service following graduation. It surprised me how old many of the undergraduates were here. Often students are not able to enter University because they do not have the right connections, did not achieve the necessary grades, or simply do not have enough money to finance their way through public university. Nonetheless, the youth that I have met here are very driven and pragmatic.

Lily, a nurse at St Patrick's Hospital, and Dr. Gyasi, the ophthalmologist who organized the eye camp. They are examining patients who have received cataract and pterygium surgeries the day before. You cannot tell by the picture, but the hallway they are standing in was very hot, despite the wall of bricks on the right that had some holes. Everyday, we would see patients sitting on the benches, lining the entire length of the hallway, waiting to be seen by the doctors.

Here, Dr. Gyasi and George, the ophthalmic nurse from the Offinso Hospital, are examining a patient. Patients are screened in this consultation room, and either prescribed medicine or referred for surgery in the surgical theatre.

Here, Dan, one of the nurses from Bawku, is preparing a patient to enter the surgical theatre. First, he needs to anesthetize the patient by inserting a needle into the eye orbital of the skull, and then he uses a ball and an elastic cloth to apply pressure on the eye. This makes the eye soft and easier to operate on.

Dr. Gyasi (left-most) and Mr. Baba (right-most), with nurses Diana, Dennis, Gladys, and Theresa, and four patients undergoing surgery. While the doctors were operating on one patient, the nurses would be busy off-loading and preparing the patients for surgery. Mr. Baba is not a doctor, but he is a nurse that underwent training to learn how to perform cataract surgeries. The training of nurses to perform surgeries is one of the ways that organizations like the World Health Organization hope to push forward initiatives like Vision 2020, which hopes to eradicate eye diseases like trachoma, river blindness, etc. by the year 2020. Many ophthalmologist associations are against upgrading nurses because they refuse to believe that it will destroy the profession, and that nurses would never be able to do the same quality of surgeries as ophthalmologists. Despite these beliefs, nurses like Mr. Baba have had a tremendous impact on helping to achieve global health goals in eye health. For example, Mr. Baba often trains other ophthalmologists, including Crystal Eye Clinic's Dr. Clarke, and regularly participates in eye camps such as the one we held in Offinso. This is amazing considering that there are only 50 ophthalmologists in Ghana, 25 of which are in Accra, the capital, alone.

After the operation is completed, Dennis, the Unite for Sight ophthalmic nurse, puts some antibiotic ointment on the eye and covers it with gauze and tapes a plastic protector to the eye to let the eye heal. The patient is then escorted by the nurse into another room, where their surgical gown and cap are removed, and where they are given some pain killers to take for several days following the surgery.

Ernest is a nurse at St. Patrick's Hospital who taught me all the Twi I would ever need to know in order to take patient's visual acuity. I became a pro and have been impressing Twi-speaking patients everywhere I've been ever since.

Here he is helping a patient who is heading to the theatre for surgery.

The eye camp team from L to R: Ahmed (driver), Dan (nurse), Diana (nurse), Gladys (ophthalmic nurse), Fred (nurse), me, Dr. Gyasi (ophthalmologist), Ian (volunteer from Vancouver, Canada), Mr. Baba, Joshua (ophthalmic nurse).

An improvised wheelchair at St. Patrick's Hospital.

New Edubiase, ADANSI SOUTH, Feb 15-Feb 21

2009-02-26T12:25:00.000-08:00

On Monday, we saw the most patients I have ever seen in my life. We drove about 2 hours to get from Accra to Somanya. The outreach location was a church, and when we arrived there at 1:00pm, there were already 120 people waiting patiently for us. By the end of the day, we had screened 206 patients, and gotten over 20 referrals for cataract and pterygium surgeries. Our day in Somanya screening patients was quite refreshing after participating in a couple of less well-attended outreach days in New Edubiase, Adansi South, where only about 20-60 patients showed up.

On my 5^th week here in Ghana, a Unite for Sight outreach team consisting of Dennis (ophthalmic nurse), John (driver), Lily (local volunteer), Hana (volunteer from Ottawa, Canada), and me, headed 4 hours north of Accra, in the Asante region, to a district called Adansi South. We stayed at a hotel in New Edubiase, and visited five different villages in the area that week.

Our team noticed that attendance tended to be high at outreach locations where Unite for Sight had solid financial support either from the district or community leaders, and when the screening was held at a public location, like a church, school, or assembly hall, rather than a clinic. I found out, through the experience in New Edubiase, that there are many challenges involved in getting eye care to those living in rural areas in developing countries, and now have a renewed appreciation for “best-practices.”

The purpose of Unite for Sight’s outreaches are to locate patients with severe eye impairments whose vision can be improved significantly with surgery. I say “improved significantly” because unfortunately, despite the wealth of medical knowledge and technology that we have today, in some cases, the chances of improving the patients’ vision through surgery are very low. Some eyes are more difficult to operate on because the anatomy of the eye is slightly different or abnormal, or the nature of the surgery has an inherently low success rate. In other cases, the patient’s retina or optic nerve are so damaged that no surgery can be done to restore sight to that eye. More often than not, however, surgery IS able to change the lives of those who receive them. I have a short video clip of an energetic 80 year old woman who first walked into a Unite for Sight screening being led by her daughter, clutching both of her hands. But today, she is able to walk and run around her village all on her own.

Patients that are found during outreaches are referred to the Crystal Eye Clinic, and are transported there within 2-3 weeks for surgery. The Crystal Eye Clinic is a private clinic whose revenue comes from self-paying patients, and patients whose surgical costs are covered by Unite for Sight. So, if you walk into the clinic on your own, you will be expected to pay for your consultation, surgery, medication, and glasses. However, if you attend one of Unite for Sight’s free eye screening outreaches (i.e. free consultation), and are referred to the Crystal Eye Clinic for surgery by one of the Unite for Sight ophthalmic nurses (Dennis, Robert, or Kartee), your surgery fee will be covered by Unite for Sight, you can obtain free reading eyeglasses/sunglasses (so far, Unite for Sight does not dispense glasses for near-sighted people), so your only costs would be for the medication which Unite for Sight sells at a reduced price, and your transportation to get to the Crystal Eye Clinic. Your generous donations which I collected for Unite for Sight are therefore going towards paying for the surgical supplies, lens implants, and local medical professional’s salaries, which are needed to perform surgeries for patients referred to the clinic through Unite for Sight’s outreaches.

One question that may be on your mind – because it definitely crossed mine – is how do you ensure that the poorest of the poor receive cataract surgeries, and that we are not just offering really cheap eye care to Ghanaians who can in fact afford the surgery? The answer to that is that the places that we go to do outreaches are places where you are quite unlikely to find someone who can. Many of the villages we go to are fishing and farming villages, and since consultation and surgery together costs 150 Ghana Cedis (approx. $150 Canadian), in this village environment, you would tend to be quite visibly well off in order to afford that. This sounds like some hokey way to go about it, relying on experience and instinct to judge whether or not someone is able to pay for something, but after thinking about it I have to admit that we do not know of a more reliable way of going about it. I remember that when I was working at the Serendipity Day Camp at Haverford College, we ran into a very similar problem. The camp was a non-profit camp that wanted to make day camps accessible to low-income families in the neighbourhood of the college. We charged every family a very low fee for their children to attend the camp (about $110 US a week) and allowed certain families to pay less if they could not afford it. The problem is, some parents want to get away with paying less even though they could afford it, and so the director of the camp had to rely on her knowledge of the Ardmore community to know whether or not a parent was “lying.” There is a lot of this guessing and extrapolating going on here, and perhaps it is just the way it is, doing non-profit work in under-resourced areas, or maybe it isn’t. I can’t figure it out.

When we go on outreaches, to find patients for the Crystal Eye Clinic, our outreach teams consist of 1-2 drivers, 1-2 ophthalmic nurses, 1-2 local volunteers, and 1-18 volunteers from abroad, like myself. When we arrive at the outreach sites, we are greeted by community organizers, who range from assembly women/men (people who are elected to serve their community’s education, health, and development needs, and who attend assembly meetings in their district or sub-district), regular citizens, and religious leaders. These people are crucial to ensuring that outreaches are run efficiently, meaning that when our ophthalmic nurses arrive on site, that they are able to screen about 100 patients per nurse (in an 8-hour day, that averages to about 5 minutes per patient).

In order to get this volume of patients to attend the screening being held by Unite for Sight, they need to do several things. First of all, they need to alert the King and district officer about Unite for Sight and the screening they intend to do. Ghana is intriguing in that they have maintained their traditional governmental system in addition to the modern one, which consists of regional ministers, district officers, and assembly women/men. So, whenever Unite for Sight wants to set up a new outreach site, they must meet with both the King and Elders, who are very well respected in that area, as well as the administrators at the district level. Traditionally, you must approach the King with some alcoholic drink (which they store and share with the community during its community celebrations).

Secondly, in order to make sure that the people in the community hear about the eye screening event being held by Unite for Sight, they also need to send letters to and follow up with other religious and community leaders so that they can make the announcement in their congregations.

Thirdly, they use a service that is often used in Ghana to make public announcements. It’s basically a car with a megaphone attached to its roof, and it drives around town, announcing important news and events to the community. This service costs about 60 Ghana Cedis (= $60 Canadian).

That’s not all though! After Unite for Sight has completed its eye screenings, and made its referrals to the Crystal Eye Clinic, the job is only half done! The community organizers are also responsible for communicating with the patient to ensure that he/she is aware of the date they are scheduled to receive surgery, they must coordinate the logistics to make sure that they can transport them to the clinic in Accra, and some of the communities even go the extra mile by following up with the patients after they have received surgery in Accra. They visit their homes to make sure that they follow the directions for the post-op medication that was prescribed for them, and remind patients not to do any strenuous or highly physical activity for a month following surgery, in order to maximize the success rate of the operation. Post-op patients are able to resume regular day-to-day activities within a few days, but they are advised not to engage in any strenuous exercise (like farming) for a month, because high blood pressure is not got for the eye which has been operated on and is trying to recover.

So the work that the community organizers do before and after Unite for Sight does the actual eye screenings is extensive, expensive, and time-consuming. If the community is fortunate enough to have the district’s financial support, then they will be able to cover the costs of these ancillary services. If not, then they are expected to raise the money themselves. The community organizers we met in New Edubiase had this challenge, and as a result decided to collect an optional 1 Ghana Cedi donation from each patient to cover these costs.

A couple of issues remain however. Number 1: false hopes and expectations generated by other medical groups operating in the region. For example, in Sikaman in Adansi, we were met with only 12 patients, because another organization that was supposedly providing free eye care had came several days earlier, and ended up charging the patients for consultation, glasses, and medication. When we arrived there soon after, the people in the community were doubtful, and therefore did not show up.

Number 2: unreliability caused by the lack of resources and insufficient infrastructure. At best, Unite for Sight is able to plan its outreaches one month in advance, however, at a moment’s notice, it can be postponed by a week. For example, last week, one of the nurses were unable to do outreach because he had a medical emergency. Since there are only three Unite for Sight nurses, one of which was in Adansi with me, and the other was out of town, nobody could replace him. Furthermore, because community organizers’ main way of advertising to the community is through public announcements (which cost $$!) or at religious or community meetings which only occur once a week, the message often does not get to everyone on time. So what happened last week was that all the patients showed up, only to be dismissed because Unite for Sight could not send an outreach team there. Even though they were told that the screening would be postponed to the week after, many patients were probably discouraged after traveling so many miles to attend this one outreach that they were either unwilling or perceived that they could not afford to make the trek back to this outreach site again so soon.

Number 3: costliness, due to geographical arrangement of people living in rural areas. Particularly in rural areas, like in Adansi South, people’s homes are spread very far apart. This makes it very challenging for the community organizers to ensure that each patient follows the doctor’s post-op recommendations about avoiding strenuous exercise and appropriately administering medication. In villages surrounding Accra, where people live relatively close to one another, getting in touch with each of them is not as difficult. But in Adansi, one solution I see is implementing a program similar to what Partners in Health has implemented to administer its DOTS programs (complicated treatment programs for patients living with HIV/AIDS that require a community health worker, who lives close to the patient, to monitor the patient and make sure that he/she takes his/her medication on time.) But this too will require considerably more funding and resources.

Ok, I am tired, and must go to bed. Goodnight everyone!

2009-02-20T10:17:00.000-08:00

Hello All,

Today is my 1 month anniversary of being in Ghana. I apologize for not being able to write earlier. The week before, we were doing outreach every day. Two days, we worked in partnership with another organization called the Tema Christian Eye Centre, which was great, because we learned a few tricks on how to improve efficiency just by observing and working with them side by side. For example, Unite for Sight originally dispensed our eyeglasses from the original plastic bags that they were donated in. Finding the write prescription glasses was not only a confusing process, it was quite dusty. After working with the team from Tema, however, we got the idea of looking for small cardboard boxes which could be used to display and organize them. It was through this experience that I really learned just how RESOURCEFUL you have to be when working with an NGO in a developing country. Instead of buying the boxes, we looked for some used ones in the Crystal Eye Clinic.

I am rushing now, because my time in the internet cafe is coming to a close, but I have much more to write later on about how to overcome culture shock, sight-seeing in Ghana, and my week doing overnight outreach in Adansi South and the challenges involved with bringing eyecare to rural areas. So, stay tuned!

Christine

Answers to some of your questions!

2009-02-04T15:20:00.000-08:00

I was about to respond to these questions in the comments section, but I was worried no one would see it, so I am posting them here! Thank you Caroline and Amy for posting your questions. They are very good. If anyone wants to know anything else, too, please leave me a comment, and I will answer them when I can.

1. what's your living space like?

In Accra, I live in a hotel called the Telecentre Guesthouse. It costs about $15 US a night (for a double), and includes breakfast (oatmeal, cereal, toast, eggs, juice, coffee etc.) It is a pretty decent hotel that has an internet cafe (where I am writing this right now) . They can also do your laundry for you, which costs one or two dollars, and they do it by hand. Otherwise, you can borrow two large plastic wash basins and use your own soap to wash your own, and dry it on the lines provided outside. One of the friends I have made here, Osman, taught me a very efficient way to wash clothes by hand. It makes clothes very clean, but is kind of time-consuming...I am not looking forward to the load I have to do very soon-- it is growing.

They have everything you'll ever need at this hotel, it's just that some things are not very reliable. The water will stop on some mornings, but it is usually because there is a large air bubble or something in the pipes, so the front desk is able to fix that problem rather easily. The internet is sometimes very slow, or does not work, but at other times, it works very well (like right now, which is why I am hurrying to get all my blogs posted! =P) It has never rained while I am here in Accra, so I have never experienced having no electricity here yet. When it happened in Offinso (20 min away from Kumasi), the hotel had a generator that was able to supply enough electricity for the building). If you like to drink water, you are in luck because that is the only drink this hotel gives out for free, all the other sodas and beers are about 50 cents CDN. People here drink a lot of soda. When it is chilled, it quenches your thirst and feels so good!

2. What are you eating?

I usually eat oatmeal, toast, eggs, and either juice or Milo for breakfast (I eat a lot, because I really enjoy all of those foods! In Offinso, I am famous for asking, "Does anyone want anymore [blank]?" and if everyone says no, I will push my chair closer to the food, and eventually finish whatever it was that I was asking about. )

I don't usually eat lunch during outreach days, because that is usually the time when many of the patients are coming in, and seeing the rows and rows of patients sitting on church benches, waiting for us to see them makes us not want to stop!

For a time, all I ate for lunch was rice, fried chicken, cabbage salad, because of the diarrhea. Now that I am healed, I have been a little more adventurous. I have begun to really like fufu (pounded cassava and plantain) which you eat with your hands, and are supposed to dunk in stew and swallow whole - instead of chewing. I watched Margaret (the cook extraordinaire at the Telecentre Guesthouse) make fufu from scratch. she chops up the cassava, boils it, and then mashes it in a heavy wooden container on the floor using a heavy wooden staff. The process of making it is so energy-intensive that in order to make enough fufu for a family to eat, you need two people to make it. One to pound the cassava and plantain, and another to fold the pounded mass in the container on the floor. I also had goat meat for the first time two days ago, and it is delicious. I also try to drink as much water as I can even though many people here drink a lot of soda (or "minerals" as they call it). Water definitely quenches my thirst a lot better! Bagged water here is very cheap, you can get about 300 ml for 5 cents.

3. What does Accra look like?

It depends on where you are. Generally, in the city, you find some tall buildings, painted with pastel colours. A lot of the advertisements are painted (instead of printed posters) and cover entire murals, advertising everything from tomato sauce to phone service, to medication and leaders of the two major political parties in Ghana. Lining the street are lots of small booths, I guess you could call them, fashioned out of wooden tables or simple barbecue-like grills. This is where many people sell tantalizing foods like fried plantain, eggs, freshly cut pineapple and oranges, or kebobs.

The farther away you get from the city, the more roundabouts you encounter. You will also see more paved roads. Closer to the towns and cities though, you will run into many that have pot holes that have been there so long that their edges are smooth and they paint a perfect circle on the ground. Riding over them in a car makes me feel like I am in a Star Wars roller coaster. Other roads are not paved at all, and so the surface is very rugged, and if you are driving a car rather than a landcruiser, you must go very slowly. There is also a lot of road construction going on, particularly for large highways that will improve the transportation between big cities. The sewage system is also above ground, so on either sides of the road, there are always ditches that transport water and, often, waste.

The main public transportation within cities or between towns are the tro-tros which are basically vans, which can hold about 20 people. While the driver is paying attention to traffic, another person (usually a young man) will stick his upper body out the window or through the gap made by the side door to call out to patrons. They collect the fare after you have been seated.When you are in a traffic jammed area, this it the best place to get out your change. There are many people balancing heavy loads of plantain chips, bread, oranges, chocolate, fried dough balls, drinks, and other foods on their heads, who weave through the cars stuck in traffic. Sometimes you will see children as young as 10 doing this. They will come around to sell them to you through your car window. It is better than "drive-thru" in Canada and the US - I think it should be called "walk-to-you." You don't even have to drive anywhere; you just have to be on your way to somewhere and the food will come to you.

As you go further North, to Kumasi, the landscape changes, and you see more greenery, and beautiful mountains and clifffs. I wish I had some pictures of these to show you. I will be going to Kumasi again soon, so hopefully I can take a couple for you. The scenes are truly breathtaking.

4. Are there any security concerns?

Theft and other crimes are committed here, but they are very few. I have not found it hard, as a volunteer for Unite for Sight at least, to find someone to go out to walk with me if I ever need to go out. Either I am with another Unite for Sight volunteer or staff member, or friends of staff from the Telecentre Guesthouse. The only dangerous thing to do seems to be to walk outside on the streets when it is very late, so I try to avoid doing so unaccompanied. Otherwise, it is very safe here.

5. Do you have to be cautious with the drinking water, etc?

Yes. I do not drink the tap water here, and only drink bagged or bottled water. I also recently learned that brushing your teeth with the tap water is a big no-no (for temporary visitors to Ghana, anyway - I think I may have just figured out why I have been having such unhappy bowel movements...)

6. Do you have to take military style showers?

Hmm..I don't know what a military shower is. What were the showers like on your mission trips, Amy?

Eye Camp in Offinso

2009-02-01T10:19:00.000-08:00

Hello!

It has been a week since I've written because I left Accra, and have been very busy working in another town since then!

I am currently writing from Offinso, which is a small town about 30 minutes from Kumasi, which is the second biggest city in Ghana. I came here with another Unite for Sight volunteer, Ian, and a Unite for Sight ophthalmic nurse, Dennis, and we are working in partnership with an ophthalmic team from Bawku (which is way up in the north, about 7 hours from Kumasi, very close to the Northern Border of Ghana). The 12 person team was assembled by Dr. Gyasi, who is a fun-loving and knowledgeable ophthalmologist who is the only other person I have met here who wears glasses! He used to work in Bawku with the team he invited to work with us in Offinso, but moved to Accra 3 months ago with his family because his wife found employment there.

The purpose of our trip was to provide eye care to people surrounding Offinso. The team from Bawku and Dr. Gyasi brought over all of the materials needed to perform cataract and pterygium surgeries (the only ones being performed in this eye camp), and they set up an eye camp in the local hospital, St Patrick's Hospital in Maase, in the Offinso district. We were originally supposed to be here for two weeks (the first week is now over), but at the looks of how many patients are coming in, we may need to close the eye camp early, because there are not enough cases. Since Monday, Dr Gyasi, and an ophthalmic nurse who has been trained to do cataract surgeries, Mr. Baba, have been doing about 40-50 surgeries a day, restoring sight to a total of over 200 people, generally aged 60-90, and with vision of Counting Fingers at 3 meters or worse (Counting fingers means that they cannot read any of the letters on the letter chart, which you normally do at the optometrist's office, and you can accurately tell how many fingers someone is holding up when they are at most 3 meters away from you).

I learned that actually, many people here have health insurance, perhaps about 65%. National health insurance costs are determined individually by the 230 districts in Ghana (each district elects a representative in parliament). In Accra, health insurance costs about 20 Ghana cedis, while in the Bawku, it is only 10 cedis (approximately $10 CDN), and this covers all procedures and health visits for the entire year - including your children who are under 18. Unite for Sight is important here because it is covers the cost of those who cannot afford health insurance. In total, we have sponsored 78 surgeries, here in Offinso.

Blindness in developing countries is a significant burden to families. In Canada or the US -someone who is blind could probably fair alright because the resources and manpower are there to take care of them. In Offinso, it is a relative who is usually the main caregiver for the person who is blind. I was testing the visual acuity of one elderly woman who was virtually blind - she could not even see the chair I needed her to sit on in order to take the test - and when I thanked her and told her she could now line up to see the doctor, a young woman came to her side to help her. As she turned around, I saw that she had an infant strapped to her back. She would likely spend the greater part of her day assisting her mother or grandmother to get eye surgery before she could return home, which is probably quite a ways away from the hospital).

Providing free eye surgery to people in need, however, is a tricky matter. The doctors here explained to me that providing completely free eye surgery can get patients "addicted" to getting free surgeries. That is why Unite for Sight actually charges patients fees for the medicine, which they sell at a reduced price. They believe that it is important for patients to put in a decent amount of effort to pay for their eye health or they will not cherish it. Contrary to what I had thought, too, Unite for Sight does not pay for their patients to transport themselves to the hospital. They have volunteers who take care of all the logistics (arranging for a driver and van, and paying for overnight lodging, if the patients have come from far away, so that the doctors can follow up on them the following morning), but the patients must pay to board the van. The cost of a ride depends on the village's distance from the hospital or Eye clinic where they will receive surgery. I'm sure that some of you may disagree with how they do things here, and I myself am not sure where I stand yet. But a significant and ongoing challenge here is trying to figure out how to improve access to and education about eye health, and yet not doing it in a way that will have negative repercussions among the patients we are trying to help.

Since coming to Offinso, I have an increased appreciation for the work that the doctors here in Ghana do. Although this is an eyecamp, and therefore not the regular clinic that Dr. Gyasi runs, we have been working practically non-stop since Monday (Sunday was our only rest-day). Yesterday, we were in the operating theatre until 7:30pm, having eaten nothing since that morning at around 8am. Nonetheless, there is the urgency to keep going when you have patients coming in who need help. I assisted with the surgeries yesterday, by passing instruments to Dr. Gyasi. It was incredibly confusing trying to anticipate what instruments he would need next, but by the end of the day, I had gotten the hang of it. It may seem a scary idea to some of you that I did this, but there were two ophthalmic nurses present in the room to assist me, and because of the nature of cataract surgery - it is not as time-sensitive or as prone to complications as other surgeries like cesarean sections or open-heart for example - I felt comfortable taking up that role.

Other than that, while helping to test the visual acuity of many patients, my Twi has improved - but only to the extent that I can tell you to cover your left and right eye, and to go line up to see the doctor! Another important, yet not very challenging, job that Ian and I must do as Unite for Sight volunteers is keep a record of the patients that we are sponsoring, and making sure that the right people get the right care that your generous donations were intended for.

Unfortunately, I forgot to bring the cord I need to transfer the pictures that I have taken, but I assure you that they are good! And that I will upload them as soon as I return to Accra.

On a side note, it is getting hotter and hotter here in Offinso, and only now has it begun to rain a few times since I have arrived in Ghana. As a result the electricity has been off and on (even in the operating room, usually only for a few seconds, but when it rains heavily - it can last for several minutes - actually right now, I am writing in the dark...cannot see anything around me at all!

Ahh...it has turned back on again.

Until next time, and with more photos,

Christine

Student life in Ghana: school and food

2009-02-01T09:27:00.000-08:00

Last weekend, I had my first chance to see Accra, outside of the Unite for Sight arena. On the Saturday, a friend that I made while in Ghana, Osman, and his cousin, Wendy, took us around their university, where he is currently finishing his final year of a Business and Communications program. The University of Ghana Legon is a very beautiful university with pretty much all the regular departments that you would find in a Canadian University. University education is free in Ghana, if you choose to live in government-built housing, but students do have to pay "facilities" and "academic" fees. I was astonished at how little space the students had in the government-owned housing units. Rooms that were originally made for one person now housed 5 students - 4 in bunk beds, and the senior student, in a single at the back. It is obviously very cramped, but reasonable given that the alternative would be to pay for your own housing in privately-owned units, which are much more expensive.

That day, we also visited a crafts market, and an American-style mall, complete with fast-food restaurants, and giant supermarkets where an orange costs approximately $1 CDN (no kidding). Speaking of food, the cuisine here is delicious! And street food is incredibly inexpensive. For example, I had my first meal at a "chop bar" which serves the basic kinds of Ghanaian cuisine and has some indoor (although not air-conditioned) seating, last Friday. I paid 80 ghana pesewes (approximately 80 cents CDN) for it, and even though I tried very hard to finish it all, I could only eat about 2/3 of it. Generally Ghanaians eat a lot of starch, among them, rice (which has only been eaten in Ghana since the 70s or so, when they began importing it), fufu, and banku. Fufu and Banku look like balls of uncooked dough, but are really made from mashed up roots (like cassava and maize - which are high in fiber), and something else that makes them very sticky. They are generally eaten with a mildly to super-spicy stew like groundnut soup, perhaps mixed with beef or fish. You are supposed to eat it with your hands and swallow it whole instead of chewing it, but I have mastered neither of these things...so I will elaborate on the process in a later entry. Another favourite of mine, so far, are Waakye (pronounced wa-che), which is basically rice and black-eyed peas, and red-red, which is fried plantain with bean stew. The only dissappointing thing about Ghanaian Cuisine is that most people here do not eat dessert after their meals! For breakfast, eggs, bread and jam, oatmeal and cereals are common, and Milo (a kind of powdered chocolate drink) is immensely popular here. Needless to say, I am not going hungry here! In fact, I have to remind myself not to eat so much!

Today, we visited Dr. Gyasi's medical school in Kumasi, called the Kwame Nkrumah University of Science and Technology, and he took us to eat a wonderful meal at a guesthouse on campus. I was surprised to learn from Dr. Gyasi that medical training in Ghana, and in Australia for that matter, are very different than in Canada and the US. In Ghana, like in many developing countries, because of the immense need, every medical specialist can double as a general internist, and provide life-saving surgeries, like cesarian sections and the like, if needed. Their medical training provides them with this experience, by requiring that their residencies cover general, pediatric, and obstetric medicine, before they get further practical training in their chosen specialty. In Canada, you are exposed to the different types of medicine during undergraduate training, but your residency is only in your chosen medical specialty. The reason is because in developing countries, there is such a serious shortage of doctors, that it is often necessary for doctors to know far more than their own specialty. Just in terms of opthalmologists, there are only 50 in the country, 25 of which are in Accra. In Bawku, where our medical team came from, there are now only two. Dr. Gyasi used to be the third. It is just so mind-boggling how few doctors remain in Ghana, and yet Ghana is doing quite well. In fact, Ghana is well on its way to achieving the WHO's Vision 2020 (eradicating cataracts, glaucoma, trachoma, onchocerciasis - i.e. river blindness by the year 2020). So far River blindness has been eliminated, and only a few trachoma cases now exist in the North.

Ok, I think that is enough for today. Yes...I started talking about school, and ended talking about school, and put food in the middle. I could not end with food, or else you would all suspect that I am a greedy person who loves to eat, and only came to Ghana because of the cuisine. Anyways, I will close for the night. I hope you are all doing well, and stay tuned for the rest of my adventures!

Christine

Writing from Ghana

2009-01-22T15:15:00.000-08:00

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

Welcome!

2009-01-17T15:13:00.000-08:00

Hello everyone!

There are 3 more days until I leave for Accra and begin volunteering in Ghana. I will board the plane on Martin Luther King Day, and arrive in Accra during president-elect Obama's inauguration in Washington. I couldn't have picked a more momentous occasion to begin my adventures in global health.

Thanks to many of you (my dear readers!), I raised a total of $5,241 US, all of which has gone directly to providing sight-restoring eye care to patients in Accra and its surrounding communities. I'll also be bringing 350 pairs of reading eyeglasses and sunglasses, that were generously donated by the Canadian Lions Eyeglasses Recycling Center, along with $210 CD worth of surgical supplies from, Dr. Ying Lu, the ophthalmologist I had the privilege of shadowing in Toronto. Thank you to all for your contributions! Because of you, my volunteer trip is so much more meaningful and I will have that much more to offer the people I will be serving in Accra.

So now, with your donations, (hopefully) enough sunscreen and mosquito repellent to last me 60 days, and a blog that is up and ready to go, I am prepared for my first global health adventure.

Thank you to everyone who made this trip possible! I think about your love and support every day, and it makes me want to work even harder.

Until next time!

Christine