Second weekend

This weekend was the funeral so we had to leave on Friday early to make the 6 hour bus ride. Almost everyone was in the bus and the driver decided that he needed to adjust the park job which resulted in him loosing control down the hill and crashing into the ditch. I always wait until last to get in to make sure we have everyone and that everything is ok, so watching this was pretty crazy.  Luckily everyone was ok and a few of us had to help push the van out back onto the road. We had to wait for another driver but an hour later we were finally on the road. 

1.5 hours into the ride we saw a group of children on the ride of the road and a few cars around.  Apparently a taxi driver going the other way was being reckless trying to pass someone and ran a bus full of school children off the road. We got out to help and tried to use the first aid we could to banage up wounds and I helped to get some of the kids into the taxi. It was pretty shocking how many people stopped to help and taxis that just grabbed kids, bleeding and all to take to the hospital. The driver and two children were in pretty bad shape and rushed first. Everyone was taken away before the police could arrive.  The rest of the trip was less happy and made me really appreciate the fast responses by medical personnel at home

And strict rules of the road.  It was really great to see how many people stopped to help and assist during the time of need. 

We arrived in Kamasi and had a meal. I got to try Fufu which in a vet traditional dish. After half of us went to an old fort converted into a war museum and learned a lot about the independence, military, wars, and African history.  A group of school children were also doing the tour and after wanted to take pictures with the brunies. We felt like we were part of the tour! 

We went back to the hotel to find out that  there wasn't enough water pressure to take a shower so we had to bucket shower. I got to practice for my village week coming up. 

The next day we went to the funeral. It was a very interesting experience as we were the only white people (300-400 people total) in attendance. We had traditional outfits made of the event so we looked like everyone but still turned heads. I sat back the whole time trying to see the customs, traditions, and workings of a funeral ceremony. It lasted about 2 hours and then the group went to the cemetary and we had to go check out of the hotel.  Biggest differences I noticed during the ceremony were:

1. He died 1 month ago. They normally wait to have the burial until later and when the family is ready

2. Everyone goes! He was 77 and people from all over attended showing the family support. Very close knit communities.

3. The ceremony is very family, church, career, and club oriented. They had a speaker from each aspect of his life 

4. The funeral process lasts 3 entire days.  It began Friday, was 4 am to 8 pm sat and then Sunday. 

We headed back to takoradi on Saturday afternoon and arrived after dinner. Spent the night hanging out with people in the house.

Sunday am I went on another run around town and took a few pictures:

A lot of people were at church so the roads were not very busy. 

On the final hill back to our house a few children were outside playing and wanted to run with me. We did a few hills and after started to play with them and hangout. They wanted a picture before I headed inside:

Went to a hotel for the afternoon with the group to relax and go in the beach. Even got a little studying in:

At night we went out to dinner for one of the girls birthday. I spent the entire time watching the World Cup final with the other guy from the house.

HIV clinic day

Today 3 of us went to the HIV clinic today. We spent the morning in the pharmacy learning about the drug combinations, how they dose, and how the structure in the clinic works. We followed a pharmacist around and watched the interactions with patients. Next we went to the consultation room and spoke with a nurse about the basics of HIV and the stigma in Ghana. Also got to watch some of the interactions with patients.  We spent a few hours in the afternoon with the head doctor who is also the regional director of HIV, leading researcher, and Ghana head for STIs. We went to speak with the nutrionist and had all of our questions answered.

It was a really cool experience and not something I would normally get to do on rotation at home. 

Spent the afternoon doing a workout and relaxing until the BBQ with the house.  Had great food and tons of dancing lead by Alhassan who works for Work the World. The dancing was more like African Zumba but pretty fun.

We head out for our 6 hour bus ride to the funeral in Kumasi tomorrow at 7 am. 

Goat, chicken, curry rice, salad, African spicy sauce, and fish spring rolls 

7/9 clinic day

Another great day at the clinic. Today I worked with some of the regular patients . I used an ace wrapping technique for

Foot drop and to improve knee flexion for

The swing phase of gait and taught the patients wife how to do it at home to practice. 

There has been a few very strange cases while I have been here and one was a young girl who fell and after a period of events that don't exactly make sense  now has open wounds on her arm. Today in clinic the wound nurse came with her to change the dressing so I could see what it looked like. It sounds like a cast was placed on her arm and then 4 days later it was removed and a compartment syndrome occurred in her forearm and hand. After that she must have had some kind of skin infection because her fingers are no longer visible and all of her skin is not healing properly.  I have pictures but they are pretty graphic so I will not post them. 

I also got to do an evaluation today which was fun but hard because I had to use their format and terms and translator. It will take a few more to get used to it and feel comfortable.  After clinic 6 of us went to another orphanage. This one has 50 children who live there and 30 who live at home but receive help from the orphanage. I played soccer with most of the boys which was fun but showed how bad I am at the sport. This orphanage is larger then the other and has less support and help compared to the other. The age range of children is 5 to 17 and many of the older children come back and teach/ help out. 

Came back to house to have some Red red (native dish) and then hung out and watched Messi get the win for Argentina. 

Tuesday 7/814

Yesterday afternoon after clinic another student and I went to Kifo orphanage to hangout with the kids. They had 16 children between the ages of 4 and 16 with pretty nice facilities, volunteers, and well behaved children.  We played on the swings, played soccer, and worked on some English with the older boys. I spent a good amount of time throwing the younger boys up in the air and they loved it. It is nice to see a well run private orphanage with nice facilities. I plan to go to the larger once next week to see more babies and how it is ran. 

We returned to the house to find out that there was a possible case of Ebola (you can look up the medical condition online) in Accra. There has been an outbreak in other west Africa countries and an American traveler came to a hospital in Accra with similar signs and symptoms. The house was very worried and the director of Work the World house was in contact with the organization staff in the UK to figure out options if the tests came back positive. Luckily we found out last night that the results were negative and there are still no cases in Ghana. We will stay very cautious and be prepared for a return home if the risk becomes higher. 

Today I was the only student who went I to clinic from the house due to the scare. I had a great time working with a lot of patients. It was very busy so I jumped around from adults to children and back. I worked with many of the difficult or odd cases and also patients who were progressing and needed advanced ther ex ideas. The last case was a young patient born without a right radius and thumb. He had metal plates added to help form and support the wrist. At the end of the day I worked with the director and therapist to begin my CPI because Thursday I will spend the day in the HIV clinic and Friday we head to a funeral in Kumasi for the leader of our program in Ghana , Joe. His father passed away and we will be attending in support and to see a traditional ceremony. 

Tonight we had traditional Fante lessons to hep with speaking to patients in the clinic. 

Here are pictures of the clinic on the hospital grounds. It is a great facility and well maintained. 

New charts for patients

Clinic and the weekend

Did not have any connection to the outside world for a few days.  

On Friday  we woke up to a monsoon. It rained so hard that we almost couldn't get a taxi and once we did the roads were so flooded that we had to take 3 different routes to finally get to the hospital.  The clinic opened late again because everyone had such a hard time making it in. I worked with more patients that have Erbs Palsy. It was great to see some of the same patients to not only work with them again but also to learn more treatment techniques and also teach the therapist some of the techniques we use at home.  I also learned from some of the nursing students at the Work the World house that the birthing process is rushed here and the doctor tends to pull the baby before letting it turn in the pelvis to clear the shoulders causing the increase in cases. The Physio also said that they treat all patients in the area with this condition and that another local hospital has tons of cases. 

I also worked with a few patients that have had CVAs and educated the therapists on shoulder strengthening and stability to decrease the sulcus sign and shoulder instability. They did not have a sound understanding of the anatomy so we sat down to draw the muscles and pointed on the Physio students/ interns bodies where they were and how they worked to stabilize.  Also educated on isometric exercises and the progression of exercises as the patients improved. Today was really rewarding in that I felt that I had a purpose of my trip and also built a stronger bond with the staff. 

I know very little Fante but I have been trying to use it when I'm walking around the hospital, on runs, in the taxi, and with patients.  They have been laughing at me

But all are very shocked and complement me on my effort and can tell that this little attempt is making me fit in more. 

In the afternoon 18 of us (17 girls and myself) began our 4 hour drive on a Tro Tro from takoradi to kokrobite. It was one of the girls birthday so we stayed at a little beach place. We had 5 rooms but one was infested with bugs from the storm and the roof leaked all over the beds so we crammed 18 people in 4 rooms. Being the only guy I did not have to share a bed but I did get the smallest bed so I had a nice sleep in a ball covered in the mosquito net. I told every girl that if they needed anything at night to come wake me up. At 4 am I felt a tapping on my side, opened my eyes and no one was there.  Instead the roof of the hut was leaking on me from another huge rain. I spent the rest of the night using a shirt to catch the water. We spent the next day relaxing, went on a run, swam in the beach, and getting to know everyone. At night we watching live African drums and dance, hung out, and watched the World Cup on a projector.  On Sunday we returned to the house after a long cramped Tro Tro ride and met the new 6 students who arrived. 

Today was another great day in clinic working with more pediatric patients on my own.  Having to get my own flow and using the students to translate, and lots of hand gestures and simple words to get concepts across to family was very fun and challenging. I also worked with a therapist who was treating a patient post a laminectomy with some paralysis.  The chart said 2+/5 strength in bilateral lower extremities which made no sense so I decided to do a mini eval which showed 4-/5 and 4/5 in both legs.  I decided to push her and increase the difficulty of the exercises as she had no pain and had no problem with the current program. She did a great job and actually showed fatigue at the end of the session which made me feel like improvement was made.  I educated the primary therapist on the changes and he said he will use some of the ideas and would like me to keep working with her and he was unsure what someone with a laminectomy could do as he has only heard about it in books. The last patient of the day was 7 months post a stroke. Tried to get creative to make an AFO to help with his foot drop with ace wrap and looking for any ideas that can be made with wood.  I wanted to try to metal strutt idea with his shoes but cannot get any material cheap around here to do that. If anyone has an idea let me know!! 

Live music and dance 

Street side shops

Finally got wifi working at the house

Last night I went on an adventure with the night duty staff to get some authentic Ghana street food. It was awesome!!

Tilapia over an open fire 

Full tilapia covered in all kinds of stuff and a side of kanki ( maize balls and a spicey dipping sauce) 

Clinic day 2

Today was another day in pediatrics. The patient caseload was mainly cerebral palsy. The therapists use standers and adaptive seats that are made out of cardboard. It is really cool and a great idea for these types of clinics. (I will take pictures tomorrow). I worked with the therapists on differnt ways to treat developmental milestones and also learned some ways with them.  Half of the children did great with me. The other half screamed the entire time. I tried to stop the session but in this culture they expect the entire session to happen. After 5 patients I went to observe one of the other therapists treating a 3 year old with torticoilis. I was shocked with how aggressive the stretching and soft tissue work was. The patient had to be held down my his father. I tried to educate the therapist on other techniques I learned while at CHKD but she seemed to be seeing success with her way and so I had to stand back and let her treat her way.  These are the times that are very hard because I want to jump

In and change things but I need to respect their education and culture.

Later I was asked by one of the therapies to take the lead with his patient that had a cervical myopathy and now left wheelchair bound with trace muscle contractions below C8. It was a great experience working with her daughter caregivers and the therapists working on transfers, strengthening, and exercises. In the afternoon I spent most of the time answering the 3 Ghanian Physio students  questions. 

Again another amazing day and looking forward to tomorrow!!! 

Tonight is the house BBQ where we all hangout, learn African dance, and reflect on the trip.  Also great when the supermarket sells bottles of wine for 7 cedi (money here in Ghana which converts to 3 cedi per US dollar)  Always looking for the deals 

National holiday and clinic day 1

Tuesday was Ghana Rebublic Day so we had off. Half of the group spent the morning at the open market getting to know each other and immerse ourselves in the culture. We got to use the little Fante we know to talk to the Taxi driver and shop. In the afternoon we went to the supermarket. After that I went on a 25 minute run along the dirt streets of Ghana. It was awesome to be alone and greeting the stand workers and local walking with baskets on their heads and riding bikes as I ran by.   At night the whole house of 24 went out to a nice dinner. Right before we went one of the Work the World staff returned to the house with my bag which was pretty great news because I've worn the same shorts for 4 days!!! The night was spent sitting outside with the two other guys and night guard watching the USA game. I wore my USA tank top all night and did the I believe chant 26 times but sadly we couldn't pull it out.

Today was the first day of clinic. We took a taxi to the hospital 15 minutes through pot hole filled dirt roads so coffee isn't needed to wake you up. I arrived at the Physio clinic and my head supervisor wasn't there yet... She is on Ghana time (aka show up when you want).  I decided to show myself around and introduce myself to all the staff and patients with the few Fante words I have learned (I botched it pretty bad and always got laughed at but at least I am trying). 

Once she arrived I explained my goals and mission for this placement. I will get to spend 3-4 days in each location ( Pediatrics, gym, manual, examination, ward rounds, and electrical ((heat ice diathermy stim)) ). Today I began in peds with a PT named Diane. She finished her 4 year degree and is now in her intern year where she gets paid but works there until she gets her career placement from the government. Today was Erbs palsy treatment day so I got to work with a few young children. At my last placement in the children's hospital I only saw 1 patient with this condition so seeing this many in one day was very interesting. I worked hand in hand with the therapist learning how she treated and throwing some treatment ideas in as well. After one patient she let me take the lead and I had a blast working with these children.  They stared at me like they had never seen a big white person with a beard before.... I have no idea why. After all of the children where done I went with another therapist to see how the manual treatment was performed. He was working with a patient that had a stroke 2 months ago. The biggest impairment she had today was pain with touch and pressure to her arms hands and feet. The therapist and I worked on ideas for desensitization and proprioception which improved her pain throughout the session. After the session she spoke to the therapist in Fante and began to cry. I asked if she was hurting again and the therapist said "no but that she wasn't sure if she could hug me to show thanks". I have her a huge bear hug and told her that she did the work not me and to keep working hard each visit.  At the end of the day I had a great meeting with the head of the department about my evaluations during the clinical.  Overall... Amazing first day and expect ever other day to be just an awesome. A nice workout with the other American using anything around the house finished the day until dinner. After dinner a doctor from the hospital came to the
house and presented to us on Sickle Cell Disease.

Post day 1 sweat soaked selfie in the room

Food has been amazing as it is cooked by a Ghanian named Mavis. Today's dinner was called red red and I had my usual 3 plates.  These Irish and British people are shocked at how much I eat.