Medicine in Ghana

Over the past week I feel like I have had a crash course in medicine in a developing country. At the beginning of the week, I was so excited to see several field trips scheduled to visit both a western clinic and nonwestern healers.  Most of you know I’m very interested in medical anthropology, and I was very happy to see that Peace Corps is taking a more holistic approach to our learning about health in Ghana. However, as the week went on the juxtaposition of western vs. traditional medicine hit a little too close to home, causing me an unbelievable amount of stress and many late night hours of personal reflection.

The week started out with a visit to a traditional birth attendant.  We had the choice of meeting either a TBA or an herbalist for one morning.  Ideally I would have gone to both, but that wasn’t an option, so I chose TBA.  We went to a compound and were invited to sit on a porch.  A woman with an intricately lined face and wild white hair who stood about four and a half feet tall greeted us, then picked up a palm leaf and started chatting away in twi about the many uses the plant has in midwifery.  She showed us a variety of local plants, nuts, and concoctions she uses when treating pregnant women.  She said she will turn 90 in April and has been a TBA since she was 30.  During her 60 years of being a TBA, she has delivered most of the people who live in Anyinasin.  I found her absolutely fascinating and loved the visit.  I only regret that I didn’t think to bring my camera to the session. After the session, my group met up with the groups who went to the herbalists and we discussed what we saw.  I was disappointed to hear some of my colleagues say things like “It was hard to sit there and listen to the things they believe, like making tea from plants will cure illnesses.”  I was upset because they were being so judgmental and assuming that western medicine is always superior to traditional medicine, and dismissing the possibility that local remedies might actually work.

Two days later we visited the New Tafo Governmental Hospital.  I was with the same people who visited the TBA, and this time we were assigned to talk to the administration staff of the hospital, the health insurance department, to visit the wards and the outpatient clinic.  The hospital is staffed with four doctors (two Ghanaians, two Cubans), 13 midwives and 56 nurses.  The entire hospital has 56 beds divided among three wards: the women’s/pediatric ward, maternity ward, and men’s ward. There is also an operating theatre, which mostly sees gynecological cases and cesarean sections.  They also will do minor surgeries, such as skin ailments. When we visited the TBA, she told us that several women she knows went to the hospital expecting to give birth for free (Ghana has a campaign that all births at hospitals, as well as pre-natal and post-natal care are free) but after giving birth, the women were charged very large sums.  For that reason, she said many women still come to her to give birth and she only charges 20 cedi. After talking to the health insurance coordinator at the hospital, we understood why this happened to the women.  In Ghana, when you find out you are pregnant you must go to a hospital to confirm it, and then they will give you a card that states all medical care relating to the pregnancy is free.  That means all prenatal check ups, anything that happens during the birth, and six months of post-natal care.  Immunizations for children are always free as well.  However, if you show up in labor without any pre-natal care and no card from the hospital they have no choice but to charge you for any fees that occur related to the birth.  For all other health problems, governmental insurance in this region the cost is 16 cedi a year for an adult, children 1-11 are 4 cedi, and anyone over 70 is free. Pretty different from the States! The hospital staff was very gracious and helpful to our group and they let us see just about every part of the hospital, which was cool.  The visit was still a little difficult because the wards were pretty sparse, there was little staff on hand and little technology, and the line in the outpatient department was incredibly long.

That evening I came home, talked with my host parents for a bit and then my mom served my dinner in my room. I usually eat breakfast in my room, but I eat lunch and dinner in the main room with the rest of the family. At the time I didn’t think much of it, and actually appreciated the 30 minutes of quiet time.  I took my evening bucket bath then went back to the kitchen to do my dishes.  Standing in the kitchen was my sister Akua and my brother Kofi.  Kofi was standing in his underwear, his hands on his knees and his head hanging.  I asked what was wrong—Fi is a very active four year old, always running around, laughing and dancing.  Akua told me his stomach was paining him, and I asked if he ate something that made him sick.  She said, “No, do you want to see?” and I confusedly said, “Yes.”  She convinced him to stand upright, and from his ribs to his hips I saw raw flesh.  His skin was simply gone, and exposed was a sub layer of skin whiter than my own. Shocked, I’m pretty sure I cursed and turned away and Fi let out a little cry.  I apologized, asked him to let me see it again, and then ran to my room to grab a book Peace Corps gave us called “Where There Is No Doctor” and read up on burns.  Based on the book’s description, I was pretty sure it was a third degree burn. I went back to the kitchen and asked what happened.  Akua told me a pot of boiling water fell on Kofi. I asked if he had been to the hospital and she said no, they took him to a medicine woman who put egg on the burn.  I was quite worried about him, but I also wanted to say goodbye to one of our trainers who was leaving the following day so I left for about an hour.  When I got home, I found Fi covered in “black man medicine.”  I’ve asked many people many times to tell me what is in black man medicine, and the best answer I have gotten is a mixture of charcoal and clay.  My host mother used it a few weeks ago when she rolled her ankle to ease her pain.  Needless to say, I was less than thrilled to see his burn covered in it.  He also had some symptoms of shock, and I was really worried for his life. I asked his parents if they would take him to the hospital, and they told me maybe the next day.  I got very little sleep that night.

The next day Kofi was very weak, but he was able to stand and walk a little bit. I again asked if they were going to take him to the hospital and my host mother told me she would, but as I left for school she didn’t seem in any hurry to go to the hospital. When I got home that evening, Kofi greeted me at the door with a big smile and a stomach covered in black man medicine.  I tried to hide my disappointment at seeing him like that. I asked why they didn’t take him to the hospital and never got a good answer, just a “maybe tomorrow.” At this point I had an intense inner struggle debating traditional medicine and western medicine.  I was very interested in black man medicine when Yesewa smeared it on her swollen ankle and wanted to learn more about it. But when they put it on an innocent four year old with a severe injury I was less interested and more judgmental of the practice. For the first time, I related to those colleagues I was frustrated with just a few days before who spoke of the superiority of western medicine. Sitting back and watching Kofi suffer through this while unable to do anything to help also contributed to my stress. Again, I got very little sleep.

The following morning a new trainer arrived and she happened to be a registered nurse. I told her what had happened and asked her to come look at Kofi.  She couldn’t see the burn because of the black man medicine, but she said since I couldn’t see muscle when it first happened it probably wasn’t a third degree burn but a second-degree burn.  She also said charcoal actually helps keep wounds clean and it is good to cover second-degree burns.  Clay is actually a good choice because it is so porous it helps the wound breathe and therefore heal better.  I can’t describe how relieved I was to hear all this information.

(Here is a picture of Kofi feeling better)

Last night Akua asked me if I would accompany her to the medicine woman’s house.  The medicine woman has been reapplying the black man medicine daily to Kofi’s burn since the night it happened.  Now that I knew it was not harming him, I again became interested in the traditional healing.  She lives only about five minutes from us.  We walked down a path in the rainforest and reached her compound.  She was sitting in a grassy clearing between buildings.  Kofi knew what was coming and started crying before we even reached her.  The medicine woman looked just like I would imagine an African medicine woman to look like; she had dreadlocked hair and fair skin for a Ghanaian and she wore dark eyeliner on her eyes.  I can’t remember the name of the character, but she very much resembled the voodoo priestess from the Pirates of the Caribbean movie. She also smelled strongly of incense. Watching her remove the old clay was hard because she did it so roughly and with really hot water, which caused Kofi an unimaginable amount of pain.  She did it quickly, which I guess was lucky for him because we left her house less than ten minutes later.

I’m sure I will deal with the question of western vs. traditional medicine for the rest of my time in Ghana, and while I am still upset Kofi had such a horrible thing happen to him, I think the past week is just about the best introduction I could have had to healthcare in Ghana.  Now I can’t wait to find out my project and begin to try to bridge the gap between western and traditional medicine for my community.

On a completely unrelated note,here are some photos from our trip to Boti Falls

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Oddities in Ghana

Aside

Last time I said it feels like I’ve been in Ghana a really long time after being here for two weeks.  Now I’ve been here for just under a month, and part of me wonders where the time went because it doesn’t feel like I’ve been here any time at all, whereas another part of me can’t believe that only 4 weeks ago I was shoveling snow in Colorado because that feels like it was a lifetime ago.

I guess time is starting to fly by because we have more or less settled into a routine.  The first week in Ghana we were just outside Accra, semi-isolated from Ghana and Ghanaians, and the second week here we were trying to adjust to living in a homestay situation.  Now, we are getting much more used to Ghanaian foods and our Ghanaian families.  We have also all been assigned our languages and language classes, which helps with the routine.  Our group of 24 will be heading out to 8 of the 10 regions in two months, and within our group we were divided into 5 different language classes based on our site placements.  Each class has no more than three people in it, so we get really individualized training. We still don’t know our site placement details, but based on the language assignment some people were at least able to deduce what region they will be going to (for example, the guy learning Ewe—yes, there is only one person learning that language—will be going to the Volta region, and the three learning Dagaare will be going to the Upper West region, etc).  I was assigned Twi, so there are still about 6 regions I could end up in.  All I know is I will be in the southern part of Ghana.  Sometimes I get really frustrated that I don’t know my site placement, but for the most part I’m so focused on language classes or daily life that I don’t/can’t dwell on it.  I will know soon enough. . . just over two weeks now until site announcement.

Since my typical day is fairly boring even to me, I won’t bore all of you with the details.  Instead, I will use this post to talk about all the oddities of life in Ghana.

  1. We drink out of bags.  In Ghana, there is no bottled water, only water sachets. These are plastic bags filled with 500ml of purified water. To drink it, you tear off a corner with your teeth and proceed to suck out the water.  It’s super awkward the first few times, but you get used to it. If you buy them on the street, a sachet is about 5 pesewa (a pesewa is the Ghanaian equivalent to a cent, and sorry, I do not know the current conversion rate off hand).  They are really cheap and readily available, which is good, because Ghana is really hot and you need to stay hydrated. I average between 3 and 4 liters of water a day, which makes me pee like a racehorse.
  2. This leads me to discussion point number two, the frequency in which Peace Corps volunteers talk about their bowel movements (no, I did not plan to make bowel movements discussion point number two, it was just a wonderful coincidence).  We shamelessly talk about our bowel movements at least once a day, usually more.  Now that everyone is settling in to Ghana things have regulated, but for a while that was one of our top talking points.  We have coined a term we affectionately call “Peace Corps slurry” to describe what adjusting to Peace Corps Ghana does to the digestive system.
  3. After greeting someone on the street, often for the first time in your life, it’s not unusual for that person to ask you a question like “where are you going?” or “Where do you live?”  In America, this would be really creepy and you would probably wonder what you did to get a brand new stalker, but in Ghana, that is fair game for any conversation, regardless of how well you know the person.
  4. Animals roam everywhere. Not a day goes by when my class (which takes place in a church) is not interrupted by a herd of goats, flock of chickens, or pack of dogs comes into the church and proceeds to make as much noise as possible.  The roosters will often sneak in a side door, walk to the very center of the church and then call out in their loudest, proudest voice so it will echo and every other rooster within half a mile will hear and call back.  There is also a little baby goat that likes to come in the church and climb in the steps and run around for a while, until he realizes his mom is not with him, and then he will freak out and start crying for her on top of his lungs. Then she will start crying out from outside the church back to him. Unfortunately, goats aren’t the brightest animals and the echo in the church confuses them and they have no idea which way to go to find each other again.
  5. This one is just an example of cultural misunderstanding.  The other day my sister asks me, “Don’t you like to bathe with hot water?” and I said, “Well, yes, I do like to bathe with hot water, but I understand that I’m in Africa so I don’t really expect hot showers.”  She just said “Oh. . .” and didn’t say anything more, so after a short pause I asked, “Do you bathe with hot water?” and she says “Yes, I boil water before I bathe.” Really?? I’ve lived with you for three weeks and you’ve let me take cold baths every day, twice a day, and didn’t say anything? So yesterday morning I had my first hot bath and it was like Christmas came early.  Once I get to my site, absolutely no more cold bucket baths for me!

That’s all I can think of for now.  I’m sure there are more things and I will add them in as I remember them.

A few days ago we took a trip to the district assembly office and had really interesting discussions about development with people at the district level and I was going to write a post about development in Africa, but it’s a really heavy topic and is still marinating in my head so I think I will leave that for another post.

Also, I haven’t had my family take a picture of my two yard yet, sorry! I promise I will do that soon and get it posted.