post Ghana dip

Back in Holland, and good internet now. It is always alienating to fly in one day from one part of the world to another, totally different. It takes time to land mentally. It is always sad to leave people you got to know and have worked with intensely. Hope to go back sometime! The last few days in Sampa were very interesting again. The management team has been working very hard on their business plan. Monday was a buzzy day in OPD again and the last chance to train ultrasound.  We went to the seamstress to get my new dress, and I got a chance to see the market, which is really big. . the next day we went on outreach in the morning ,visiting some of the neighborhood health centers. The first village we went to was a small village at the board, with no health centre even. Dr Duodu talked to the local chief there and I was shown around. Within 10 minutes we saw two patients with great problems. They even have no money for transport to hospital. We gave them some cash, and they were seen in the afternoon in the clinic. Everywhere it is the same: the rural areas have bad health care. Ghana's health care system is already much better than Ethiopia, but still lot of problems to be solved!
In the afternoon I was asked to join an application session. It was a fantastic experience, totally different from the way we do it. 12 young people were selected from almost 50 applications. This was only for lower, more or less unskilled jobs. Everyone was allowed in for only a few minutes and the questioning was like an interrogatory, sometimes very personal. Most of them wanted to study on after secondary school, even with very good grades, but had not the means to do this. And of course there is a great unemployment in Ghana, they came from far away. So I got to know another aspect of Ghana life.
Yesterday I drove around in Accra for a few hours and saw some highlights.
Altogether it has been a rich experience, and I look back to this trip with great pleasure,
next week Canada, visit our sun and daughter in law- David and Isabelle.
never a dull moment!

remote village 

visiting the health centres

teaching

Nkrumah mausoleum in Accra

pictures, an impression

Seamstress's choice

Sunday church( jehova witness)

Antenatal OPD

waiting outside

and waiting inside the hospital

new maternity and OR

Financial administrator

management team

cashew factory

Omdat de directeur het ook graag wil lezen deze keer in het engels.

-This weekend I am on a trip, visiting Sunyani, the regional capital. This because both the director and the administrator were going here and then there is not much to do for me in the hospital.It is also nice to see a different place again. Although Sunyani is not really an exciting place. Now I have some time to write on my report. Time goes so fast, next Wednesday I am leaving already.

This week I made official visits, to the bank manager, the local head of the national insurance, ( a very nice, agreeable, wise man. Only he cannot help it that insurance is 4 months behind in paying) and to the local Health office. I spoke to the whole team there, doing good work in public health. We made a groups picture and I got a piece of cotton from them, with the sign of their office. We brought it to the seamstress, and next week when we go on tour to the health centers I will wear it. Meanwhile I gathered a lot of information and have to start writing the report.On one of my walks  I also was introduced to one of the members of parliament, living in Sampa. All these visits have been announced beforehand.

 I try to do some teaching in ultrasound. They have a good machine here, but are not yet capable of making ultrasounds. The both doctors did learn some general US, but not obstetrical. And also the midwife is very eager to learn. I guess these two weeks are too short to really learn it. But I tell them the main thing is: find the head, the heartbeat and the placenta. So I saw several patients in antenatal care. It is so much better organized than in Ethiopia. The ladies get a booklet- provided by the government- , which they have to take with them, in it many advise on pregnancy and childcare. I only don’t know if everybody can really read it. Anyway, some pictures and drawings also clarify signs and symptoms. Everybody (pregnant) gets prophylactic Malaria treatment, which is endemic here. There is also a lot of Sickle cell disease; several patients were admitted with a crisis. So anemia is one of the main problems here. When the new building is finished the maternity clinic will open and they expect about 70-100 deliveries a month to start with….. The surgeon can do caesarean section. Sometimes I have the feeling they think to light of it. Anyway more training is necessary.  I am curious to hear in a few months how all will be evolving.  The matron-midwife was very happy to get some protocols from me. The hospital is very busy, daily they see around 200 patients, on Monday, market day, twice as much. It is amazing how they manage to do this in the limited space they have and with the rather small staff available.

And again I try to make a walk everyday. This week I managed to make a walk on my own and visited the cashew factory. Cashew is the main crop here. Very interesting to see the process. Although it is not the season, they are still working there, and the fresh cashews are so nice!  Friendly people everywhere. It feels very safe to walk around here. And what is so nice here: the children don’t chase you like almost everywhere in Africa, asking for pen, money, etc. They are sometimes even scared of me, the first white person they see. Someone explained to me they think I am an albino, and these people are scary. Sometimes they call me  mammi-Bruni, bruni being the name they call white people here.

So now I am sitting on the balcony of the hotel-Tony’s lodge. It is rather fresh outside, need to put on a jacket! People warned me for the heat here, but up till now it is not hot, even cool now! On the background church singing music. I met another PUM guy in this hotel, he is a bakery expert. Funny to hear about his totally different experiences. Yesterday night We had a meal in a nice resraurant . We means-as usual- I am eating and my hosts watching me.

Tomorrow we return to Sampa and I can do my last teachings.  As I havereasobly good intrenet here I wil try to send some pictures, separately.

Sampa, zondagochtend. Donderdagmiddag kwam ik hier aan, na een goede vlucht uit Adam, 1 nacht in Accra en een vertraagde vlucht naar Sunyani. Hier werd ik opgehaald door twee medewerkers van het ziekenhuis, beide Samuel geheten. Ook de locale Pum vertegenwoordiger was er. Na een uitgebreide lunch in een donker hotel, en boodschappen: lakens, bestek, borden en andere huishoudelijke zaken -in twee uur naar Sampa gereden. Het guesthouse waar ik verblijf is nog maar net af. Protserig gebouwd, kale inrichting. In mijn kamer een bed en een ijskast, geen verder meubilair-kast-. Leef uit de koffer dus. De badkamer heeft een soort enorm  jacuzzibad, maar de douche doet het niet. Kortom beetje behelpen. Er is een grote keuken, er wordt gekookt. De common room is hol. TV(met BBC)-plastic tafeltje en stoelen. Hier wonen een paar ziekenhuis medewerkers, ook de directeur Dr IsaacDuodu, een kinderarts. Hij heeft het ziekenhuis hier opgezet, met eigen geld. in drie jaar tijd een aardige kliniek geworden. De plannen zijn groots, daarin moet ik nu adviseren.

Ghana is -uiteraard- heel anders dan Ethiopie. Echt west afrika, en waar ik nu zit heel rural. Sampa is een dorp met een 20 duizend inwoners, maar het district is >100.000 inwoners. Men zegt veel armoede, de mensen die ik in het ziekenhuis zag waren goed gekleed.

Per dag worden zo.n 200 patienten gezien, op maandag marktdag wel 400!     Het is allemmal goed georganiseerd.

Inmiddels heb ik ook alweer aardig wat wandelingetjes gemaakt. Ik word continu begeleid door de twee Samuels, het mag mij aan niets ontbreken. De directeur is naar Sunyani dit weekend, waar zijn vrouw met pasgeboren zoontje woont. Hij gaf de opdracht mij te begeleiden. Dit doen ze strict, ik mag geen moment alleen opstap. Soms wat veel,weinig privacy. Alles wat ik aanwijsof leuk vind willen ze voor me kopen, ik mag niets zelf betalen. Kreeg zelfs zakgeld, wat ik dus niet uit kan geven. Ghanese Gastvrijheid zeggen ze, ik voel me een beetje opgelaten. Tijdens de wandelingen brengen we steeds surprise visits: bij de lokale drukkerij, de matron, de farmacy(interessante discussie over anticonceptie, wat hier niet gratis is zoals in ethiopie. De farmacist presteerde het te zeggen dat het een opening naar vrije sex zou zijn..... Ik benflink voor de vrouwen opgekomen!

De cashcrop hier is Cashewnoten. Helaas niet het seizoen. Er staan hier veel huizen leeg, tijdens het plukseizoenkomen allemaal Indiers en Libanezen alles op kopen tegen veel te lage prijzen bergijp ik. Op dit moment helaas geen noot te krijgen,

Hoewel de meerderheid hier moslim schijnt te zijn ,zijn er ook veel christelijke kerken. Ghana is in principe vooral een christelijk land, met een grote diversiteit aan kerkgenootschappen. Ook een tv zender met een profeet, die ik al in diverse huizen aan heb zien staan.! Ik wilde vandaag wel naar een kerk, laat nu Samuel een jehova getuige  zijn! Dus heb ik net bijna twee uur in een jehova dienst gezeten, op zich een interessante ervaring, maar wel lang. Kerk-leden allemaal prachtig uitgedost. Je ziet hier veel steil haar, blijken allemaal pruiken te zijn. Is kennelijk in.

Dit is offline geschreven, ik probeer het nu te gaan versturene, en misschien apart nog foto’s

 

in between

Yesterday I returned from Ethiopia. This time I was in Attat hospital, only for two weeks. Together with my colleague Jules Schagen van Leeuwen  we stood in for DR Rita, a Medical mission gynecologist, who went on a congress. We had a great time. There was  a lot to do, much more buzzy than Mota! I was glad to be with the two of us. A mean of 3 caesarians a day,, one night I had 4, and the last day we had 6 in the afternoon, working in two operation rooms at once!!
What striked me most this time were the children who were admitted after hyena bites! luckily there were some befriended plastic surgeons and funds to help these kids. It was more then ever this year. Last year they warned me not to walk in the dark outside the hospital, and I thought it was overdone, but now I realize the dangers.
In spite of the overdose of rain we made some nice walks in the surroundings- daytime! We were often invited by the people and offered a coffeeceremony.
It was grat to be in Ethiopiaa again! As I am leaving for Ghana in two days for the next project, I make a short impression with pictures from the past two weeks. Hopefully there will be more internet in Ghana

rounds in the morning

too small to deliver spontaneously!

health officers to be surgeons

one of the walks

fieldtrip in the rain

people live in TUKULS here

nice pictures

waiting for the second twin.