Home Again, Home Again

So I flew home yesterday. The total trip only took 20 hours. Getting out of the Accra, Ghana airport was a series of waiting in lines that never seemed to end. But my luggage and I survived and came home to my beautiful wife. I have some photos posted here. Kags also has some that will be available at a later date.

Ghana

A long weekend

Whew, quite a while since the last post. On Thursday Kags and I headed north to Ho, a town in the Volta region. It was one of the most Western feeling towns we'd been to with street lights, nice bricked side walks and (interestingly enough) the least friendliest people (almost no one said hello, or even Obruni). From there we went North to a monkey sanctuary. The tro-tro actually dropped us off at the junction to the monkey sanctuary. The taxi wanted too much money to take us the last few miles so we prepared to walk, and then (as often happens in Ghana) strangers came to our aid. A pickup truck stopped and let us ride in the flat bed. The ride was great, getting to see lots of scenery and the closest thing to an amusement ride you'd get. They wouldn't even accept money from us.

The monkey sanctuary was great. We got to feed the Mona monkeys who live around the village. The villagers see them as sacred and protect them. Apparently a few years back Christianity had eroded the mysticism surrounding the monkeys and they started getting killed by villagers. Then Peace Corp saved the day by setting up an ecotourist setup and educating the town about how it could help them to preserve the monkeys. We also heard some African stories from an old blind story teller (the village has kind of a commune feel so everyone must contribute to his own abilities). We also ran into a very nice couple who were also visiting the region (he was Ghanaian and she was American) which made for some interesting conversation. While we were there we walked to a small village that had a ton of Kente weavers. The fabric was beautiful and the looms are something to see (pictures to be posted when I get home). Most of the weaving is done outside with the brightly colored thread strung up to 20 feet away. The loom involves hand motions and foot motions to get the thread woven right, and they do different patterns. I got laughed at for trying to take pictures of some of the goats that were head butting and playing.

Then we headed up to HoHo to see the waterfall. It is apparently West Africa's "largest" waterfall and it was very nice to sit and feel the spray. There was a bunch of school kids there on holiday and it added to the experience. The teenagers were swimming and playing in the waterfall pool and were enthusiastic without bothering us. One group of guys insisted that we take their picture and send it to them, but when we finally did they set it up so the waterfall isn't even in the photo.

Then yesterday we headed to the beach for a relaxing day before our flight home. Unfortunately the "beach resort" we picked had a pretty rocky beach that wasn't good for sun bathing or swimming. But we did get to see a great drumming/dancing/singing demonstration put on by a local youth group. They had dances from all over Ghana and the kids were very cute. They all had Kente decorated clothing.

We spent much of the day getting back to the hostel at Korle Bu so we could pack and check out. Now we're heading out to one last dinner at the luxurious Shangrila before flying out. By this time tomorrow I'll be back in the US.

Matt Bleeds in Ghana

So, earlier I alluded to our mountain biking expedition. We rented bikes from a shop outside Aburi Botanical Gardens. Unfortunately the rates were kind of high, and so we decided not to rent a tour guide. The shop assured us that we could follow one of their trails with a "map" which ended up buying a series of 4x6 photos of parts of the trail with directions on the back (e.g. turn left at the tro-tro station). I would have preferred an actual map of the area. Additionally, Kags hasn't done much mountain biking and neither have I, so we started off riding down the main road and pretty much kept to it. After a half hour of gliding downhill we realized it would be a pain to bike back up, so we started our return to the shop. At one point, I saw a side trail that looked very navigable. It wasn't too steep and had a nice wide dirt path, but it very quickly gave way to lots of rubble and became hard to stop. So I fell off my bike, luckily right onto my cushy back pack. The sad thing is that this was probably twenty feet off the main road. I was wearing a helmet and pants (but no pads) and so I was left with some torn pants and a bunch of scrapes on my hands/knee/arm. I used my mad medical skills to clean it with some water from my bottle and then used a little hand sanitizer. After that I alternated between walking the bike and biking up the road back to the shop. At one point, Kags and I got separated and met up back at the shop. Oddly enough he asked everyone he passed if they had seen a white guy with a bike but they all said "No". Maybe I've tanned so much I've started to blend in.

One of the nurses heard that I hurt myself biking and she said, "Now that you've bled on Ghana soil you have to come back."

Congratulations to Us

Kags and I deserve congratulations, today is our last day of medical school ever. Kind of odd to end the year in Ghana since no one really gets that it's our last rotation so it's not a huge deal to them. But yeah for us. We survived four years and will soon be Dr. Matt and Dr. Kags.

It's also left us with just five more days in Ghana. We're going to take a long weekend and spend Thursday through Monday travelling around the Volta region seeing the lake and some small towns.

For Those Travelling to Ghana

Some helpful tips:
1. Bathrooms - Unlike some countries, Ghana doesnt have squat toilets and I haven't really seen any pit toilets (except for the "public shitting grounds" alluded to in one of the guidebooks). Everything seems to have indoor plumbing. However, you also won't find toilet paper, soap, nor paper towels (those are to be provided by the user). And if the water is out, the toilet general doesn't flush, no matter how much plumbing there is.

2. Getting attention. Instead of saying "hey" or "yo" you make a snake like sound. It's similar to "Psssssst" without the P or the t sound. Kind of rude sounding and one of the expats who had been in Ghana for years really offended a Canadian woman on his trip back home.

3. Abruni - this means "white man" and might be considered offensive, if everyone who said it didn't have a big smile. Even the kids love shouting it and they get so excited when you respond to it. Which brings me to

4. Kids - they're everywhere. They seem to be in every doorway of every town. They say hello, smile, stick out their tongue, and love it when you respond. Like, getting an Abruni to smile and say hello is the ultimate victory. Which only makes them more fun. Also, there are some streets in Ghana that feel very ghetto by home standards and might feel dangerous, if there weren't kids everywhere. Oh, and when they are carried strapped to mom's back they're very cute.

5. Transit - There have been numerous posts about tro-tros, but only because they are essential, ubiquitous, and cheap. Although we usually have to ask people where they are going (there's often a lack of signage) we (almost) always find the right one and it usually leaves within a few minutes. With 5 people per row (they even have a seat that folds out to allow someone to sit in the aisle) they can easily hold 30 people. If that's not your style, then take a taxi, but be aware that some taxis are actually "shared" taxis and are like tro-tros on a smaller scale. They cost a little more, but only travel a fixed route and leave when they are full. The other taxis which take you (and only you) to anywhere you want are called "dropping" taxis and cost much more.

6. Water - No drinking fountains anywhere, but everyone sells 500ml bags (or "sachets") of water for about 400 cedis each (4 cents). So while I buy a lot of water, it aint breaking the bank.

7. Backpacks - A ghanaian with a backpack is just not seen. If they have luggage, they balance it on their head. I've seen luggage, a speaker, a coffee table, bowls, a stack of tooth paste (for sale), wooden boxes of pastries, and lumber. I don't know how they do it. I have to say, that given how hot it is, having anything laying against your back or body sounds uncomfortable. The head is definitely the way to go.

8. Trash - There's not really many public trash cans so littering is everywhere. Sometimes, people will unofficially decide that something is a public trash can. Look in the whole in the conrete and find trash, that box left by the side of the road has more trash thrown in by others. I think if a homeless people put out his cap on the street all he'd get would be more trash.

More to come.

The Kindness of Strangers

Kags and I had a great weekend. On Friday we took a Tro-Tro up to Aburi Botanical Gardens. We had a couple bumps initially because our guide book told us to catch the tro-tro at Tema Station, but the cab driver dropped us off there and they told us that they didn't have any tro-tros to Aburi. So we were told to walk to a station about half mile away. Same store, and they told us to go back to Tema. We told them we had just come from that station and so they told us to go to Nkrumah Circle (which is pretty much the transit hub of Accra and would have been very easy to get to from our Hostel if we had known). So once we were on the righttro-tro everything went well. Until the driver went past Aburi. We had told a half dozen people our destination, but apparently the driver didn't here and there was no sign. So when we noticed signs for the next town on the road wespoak up and had to take a cab about ten minutes back the way we came. Since this is Ghana, the cab cost about twice as much as the tro-tro and took us about 1/10th the distance. Also, never trust a cab driver here when they tell you that they know where something is. We said we wanted to go to the Oleander Guesthouse, which he said, sure to. Then when we got to Aburi he tried to take us to a different guesthouse and it was obvious he had no idea where the Oleander one was. So we stayed at the Aburi Botanical Gardens guesthouse and had a nice time. We payed extra for a TV (that was my doing, not Kags') which only worked part of the time because (like the rest of Ghana) Aburi has periodic power outages.

The first night Kags and I wandered around looking for a restaurant that was open during the outage. We eventually stumbled on a roadside grocery stand where the girl working there walked us down the street to a candle lit restaurant (for necessity, not romance) and helped us order food. We offered to buy her dinner, but she refused. It even seemed as if she was going to stay to see that we got our food. Everyone is so nice here. They didn't have Coke, so the guy wentacross the street to buy one for Kags. So, what could have been a terrible, hungry, dark night, ended up being very nice because of the Kindness of Strangers.

Saturday, we went to some waterfalls and then Sunday we explored the park, which was more Arboretum than Botanical Garden. We went mountain biking (more to come later) and took pictures of ourselves inside the random rusted
helicopter in the middle of the garden. Sunday we returned home and
returned to Champs for movie night, where we saw The Freedom
Writers and Death of a President (which, after watching, I felt was in poor taste).

American Idiots

So, last night Kags and I returned to Champs (the American Sportsbar) for Trivia night. Previously we went with some UK and German students, but the UK students went home and we haven't been able to find the German students anywhere (and have no way to contact them). SoKags and I were our own team, American Idiots (thank you Green Day). We failed miserably in the overall game. There was one round where you had to identify as many people as possible on the cover of theBeatles's album Sgt. Pepper's Lonely Hearts Club Band (click on the link to see how many you can do), which year certain famous historical events happened, name the names of drinks based on ingredients (where is my wife when I need her?), and various other things. However, all was not lost. We scored perfectly on the beer round, which consisted of a bunch of riddles (scrambled movie names, trains leaving at 120mph, asking questions of someone who always lies, etc). So we won two pitchers of Star beer. I dutifully finished my pitcher, andKags donated his to another table. Thus, the American Idiots were just smart enough to earn free alcohol.

Oh, to be a med student again

Today was fun, but kind of frustrating. As I've been here I've functioned more like a wandering consultant than a regular med student. This means I don't have to do most of the crappy med student jobs like writing long notes on patients or stating 10 causes of atrial fibrillation. I mainly talk to residents and faculty about patients, asking them about management and then doing physical exams for interesting findings. They know that I understand what's going on, by the type of questions I ask. It's allowed me to be involved with a lot more patients than I would if I were solely responsible for three or four patients (as I would in Michigan). But it also means that I don't have as much autonomy to take a patient and interview them for an hour on my own, because someone else is ultimately handling their care. Additionally, I have to be evaluated at the end of the month (and though I only need to pass), I'm not sure that they'll be able to evaluate me fully.

Today I tried to get a little more involved. During rounds I tried answering some of the questions that the attending was asking the Ghanaian med students, but I was kind of scolded and told to hang out in the back of the group with the house officers/residents. Later on, I tried to pickup a few patients in the ER. I was hoping to get a history and physical and then talk to a resident about it, like I would back home. But every time I found a patient, they had already been seen or claimed by someone else. I could sit down and go through a history and physical exam with them, but why, if someone else has already done it? It seems redundant and silly. I also wanted to try to do some IV's while I'm here, but today was a bust. I finally jumped onto a case and offered to the IV, but after getting set-up (which seems to involve gathering a million random supplies from various carts in the ED) I couldn't find any decent veins on the man's arms. Additionally, he was simultaneously getting interviewed by another med student and having an EKG done by a resident. His family was standing there and he was in the middle of a hot, crowded room; not the best circumstance to try to place an IV. So, when I couldn't find any vessels (and I mean none, if there was one, I would have gone for it) I passed it along to the house officer. I was a little relieved to find that he had trouble finding a vein and when I left, they were still trying to get the IV in, after more than 5 pokes.

Tomorrow is clinic which is a little more ordered and should allow me to pick up patients easier. I can't believe I'm complaining about being treated more like a resident/consultant than a medical student.

Tonight, Kags and I head to Champs for trivia.

Kags Gets Hit By a Car

So as I've previously suggested to others, walking in Ghana should be an Olympic Sport. It is one intense obstacle course out there. Areas of pavement looking like sidewalks appear and disappear at random. Open sewers (basically wide ditches) abound. Tiles and covers for these sewers are cracked or crumble at the slightest touch. And everywhere (even when there are sidewalks and you're not just walking on the side of the road) fast cars, bikes, people carrying big, heavy things on their head, and coconut carts come far too close for comfort to innocent pedestrians such as yours truly. Certain injury and death lie everywhere. I've walked plenty in the big cities and small towns of India and thought that pedestrianism as a way of life was rather perilous there, but it just doesn't stand up to Ghana, mainly because everyone is just going faster here.

Case in point, I was leaving the US Consulate last Friday morning and walking on a small, quiet street without a sidewalk. There were no other people or cars on the street. All of a sudden a car zips alongside me and scrapes off about half of the skin from my left elbow with its sideview mirror. I threw an absolute tantrum, chiefly because there was no good reason for the idiot to be driving so close to me and I was in plain sight. Don't get me wrong, I was thankful that I didn't get hit by anything more substantial on the car, but it is a terrible way to start out any day to get hit by a car.

In happier news the third time proved the charm in terms of getting my residency documents notarized at US Consulate here. The Consulate really put the DMV's of the US to shame in terms of the pinnacle of inefficiency they've reached. But I'll get into my tribulations there at another time.

The random food options here are terrific . And even after 2 weeks I can't get over how cheap it all is. For 50 cents each morning I can get myself a fresh omelette in a grilled sandwich. For 25 cents I can have a coconut artistically sliced up to that I can suck out the water and then eat the meat. I'm really going to miss those coconuts.

Pizza and an Unexpected Visitor

Last night Kags and I went to Mama Mia's and had pizza. It wasn't bad, although it was probably the most expensive meal we've had here. It was a going away celebration for two of the British medical students. Then while walking back we passed a bootleg CD/DVD shop selling notably discounted movies (often up to 9 movies on the same disk). It was questionable that they were playable on American players since many of them didn't have region codes, but I guess 5 dollars for 9 movies is worth a gamble.

Today I worked in clinic this morning and then met up with a visiting faculty member from Michigan. Kags and I have ditched our whitecoats, ties, and undershirts in favor of light, breathable, short sleeve button downs in an effort to keep cool. The faculty member had not done so and looking at him I realized how I must look to the vast majority of Ghanians . . . like a sweaty white guy. Unfortunately he had to head back tonight, but it was nice seeing a familiar face. And it seems that the collaboration between my home school and the medical school here will continue, which is good news.

And, we've past the halfway mark here which is eventful. We've survived in a developing country for two weeks and each day is now a day closer to seeing loved ones. Kags and I hope to have a good time this weekend, travelling to a botanical garden.

Mamma Mia and Daisy Dukes

It's Free Cone Day at Ben and Jerry's and I'm thousands of miles away. Damn it. I tried looking for Ben and Jerry's in the store, but all they have is "Fan-milk" ice cream. I guess it'll have to do.

In other news, Kags has had an incredibly challenging time trying to get some documents notarized for his residency.

I spent much of Sunday night watching TV with my Ghanaian (and many Nigerian) housemates. Apparently Dukes of Hazard does translate internationally as a funny movie, although there appears to be a difference of opinion as to how cute Jessica Simpson is.

Last night we found out that there is a woman who comes to the hostel at 6pm and sells dinners for students. Apparently she comes every day. This would have been helpful to know, as we've been wandering around the neighborhood every night for the last two weeks searching for something to eat. And while it's been fun to explore, sometimes it's nice to eat in. Apparently our fellow medical students from Britain were taking cabs to Osu every night before they found this out. (Visiting medical students could definitely use a guide to Korle-Bu for things like this) We still haven't found a pizza place that delivers, although tonight we'll be going to Mama Mia's, a (mainly ex-pat) pizza place in Osu as a going-away gathering for some of the British medical students who are here.

And, as a testament to how well I'm gelling with my medical coworkers, last week one of the residents said I had a "very positive aura".

Lets All Go to the Movies

Kags and I had a nice day. We slept in, and then took a tro-tro to Nkrumah Circle. At one point on the tro-tro of 30 people, a random man stood up and started preaching something in one of the regional dialects. I asked the girl sitting next to me (who couldn't help but laugh at the speech) and she said he was talking about "youths". Then he started selling his pamphlet, entitled "How to have a successful marriage" or some such name, to people on the tro-tro. The girl who was laughing, bought one.

Then we headed to the National Museum to see some cool artifacts (chief stools/staffs), photos of traditional dance, paintings by local artists, and other stuff. The museum was very hot with poor ventilation, so we didn't stay too long; although it wasn't large enough to necessitate a long visit. Then we walked through town, headed through the market and then walked through Usher Town and James Town. At Usher Town, we visited Fort Usher. The fort is closed to visitors, but if you pay a "fee" to the caretaker he'll give you a tour. It was interesting to see, since the fort was initially built by Dutch and much later used as a prison by the government of Ghana (holding political prisoners including past Presidents during coups), and then most recently used to house some Sudanese refugees. The outer design was similar to other slave forts we've seen, but much of the building had been updated as a prison. There were still many paintings on the prison walls (Jesus, girls in bikini's, etc.) from prison period, and some of the Sudanese had written in Arabic on the walls. Think Shawshank Redemption meets Slave Fortress meets refugee camp. Kags liked the raw feel of it (not as sanitized as the other forts we've visited which were cleaned up for visitors), but I had trouble disentangling the history. I felt like it was mainly a tour of a prison, especially since we didn't see the underground tunnels used to transport slaves and part of the fort was closed off for renovation (for when it will be open to the public, sometime in the next couple decades).

Then we tro-troed it home for dinner and a movie. There's a theater that just opened up near Korle Bu and we went to see Lumumba. We were worried that a Ghanaian theater would get stifling hot, but when we stepped into the theater we found out that we were back outside. The whole thing was a large courtyard, with screen at one end and rows of benches. It was kind of like a sit down drive-in. And with the breeze it was a very enjoyable experience. At around 50 cents for a show, we'll probably head back at some point.

PS You may wonder why all the posting tonight. It's mainly because the power is once again out this evening and thus we have sought working fans in the internet cafe.

A Trip to Vienna

Last night's "clubbing' did not happen. Unfortunately when the time to meet up and head out came, no one was around. Matt and Kags were left to assume that everyone went out for dinner first and then out to the club. This might have been avoided if a phone were available, but sadly we have no phone. One word of advice for those travelling to Ghana, bring a cell phone. Everyone here seems to have one and if you are worried about the roaming charges, you can always buy a Ghanaian cell phone chip to turn your phone into a local phone.

But Matt and Kags decided to head out on their own for a good time. We headed to Nkrumah circle, one of the roundabouts on the road around Accra. I should say that Accra is full of roundabouts, which I find to be horrible, dangerous, scary remnants of British colonialism. I'm pleased the US never fell in love with them. And whenever I see one, I'm always reminded of the scene from National Lampoon's European Vacation ("look kids, Big Ben, Parliament). The street was full of people enjoying the cool breeze with vendors of food and liquor everywhere. It appears Accra must not have an open beverage container law. The main kind of food stand we've found here (outside of the shacks that serve as restaurants known as "chop houses") serves two kinds of kabobs: one is a spiced type of beef hot dog and the other is goat meat (although after enjoying one, a random bystander told Kags he thought it was dog meat). We weren't really up for drinking in the street (I should say there were some tables for people to sit at so it wasn't like everyone was sipping their 40's out of paper bags). We headed into the Vienna Casino for some pool and drinks.

The Casino part of the Vienna Casino consisted of a roulette wheel and some video poker machines, neither of which Kags and I played. And at the pool tables was an interesting mix of Ghanaians and ex-pats (white guys). We sat and people watched for a while, wondering if any of the young Ghanaian women with the middle aged white guys were escorts. At one point in the night, they handed out raffle tickets and then they would randomly select people to spin a big wheel (a la the price is right) for prizes (e.g. 10,000 cedis free credit at the casino). We didn't really get to "win big" though as all of the raffle tickets they picked were letters ("RF") and I had raffle ticket "436". Makes you wonder if it's fixed. All in all, Kags and I had a nice night and didn't even have to go clubbing (with neither of us really likes, but felt the need to be social with others).

Trivia Night

So, last night Kags and I went out with some students from the UK and Germany. They took us to a sports bar, which could have been right out of the US. We had chicken nuggets and Guinness (although there was also the required Star Beer). There was also trivia which we did pretty well at (although we didn't win). Our team was appropriately (and morbidly) named "I see dead people". I was able to use some of my mad movie skills to remember that Ernest Borgnine won best Actor for Marty and Kags was able to answer some trivia about Zoolander. The other sign that this was an ex-pat bar were the prices, charging twice as much for beer as any other place I've visited so far. Although, even in Ghana that means I had to pay about 2$ for a pint. A fun time was had by all. Kags and I were starting to get a little tired of sitting around the hostel, without power, playing cards in the dark. One of the other students even commented about that, saying that we "looked bored, sitting around playing cards while mosquito's buzzed about us". Tonight we'll probably go out with some American students who are going "clubbing". While I'm not normally a clubber, it'll be good to have fun with other visiting students and I've seen Saturday Night at the Roxbury enough to perfect my dancing.

Matt drones on about Ghana healthcare

So, some of you may be wondering if we've actually been to the hospital at all so far (the official reason we are here) and the answer is yes. I don't know about Kags but I've not posted about the hospital for several reasons: it can be hard to give concrete examples about medical care here without giving out personal medical information, it's hard to summarize an entire experience in a few sentences and I fear giving the wrong impression, and also it can be kind of depressing sometimes. The healthcare system in Ghana is very impressive, given what they can do on such limited resources, but those resources pale in comparison to their developed, Western counterparts and so there is always a measure of disappointment in the comparison. After all, Ghana is a developing country:

relatively low standard of living, an undeveloped industrial base, and a moderate to low Human Development Index (HDI) score. In developing countries, there is low per capita income, widespread poverty, and low capital formation.

This hospital in Ghana is pretty much a tertiary care center, meaning that this is not your average community hospital. Like our home hospital in Michigan, a huge portion of it's patients are referred from other clinics/hospitals because they are sicker or more complex than the average patient and this Ghana hospital has more resources than many other hospitals. What kinds of resources? Well, the technology is pretty advanced (including CT, MRI, coronary catheterization, etc) and the size means that it has specialists in virtually every field (note that this means African fields; there aren't any Emergency Medicine doctors here because it's not formally a field here). Even those resources are limited (e.g. the lack of a medical ICU ward). In order to visit the ER at this hospital you must be referred by an outside clinic and there is no mandate to see everyone. If they get too full or for other reasons they can turn people away.

Most of Ghanaian health care is fee-for-service with self pay. Meaning that you pay to see a doctor, then you pay for the EKG the doctor wants done, then you pay for the medication that he prescribes you. If you can't pay for any of these steps, then the system kind of breaks down. In most cases, family will help out (and much of this is much less expensive than the US prices because it's a developing country) but it can still overwhelm patients and there are many tests/studies that don't get done because patients can't afford it. You might see that as terrible, but the question is, if the patient can't pay for it then who should? Many would say the government should, but as a developing country the government doesn't have a huge amount of excess resources, or maybe the hospital, but even hospitals have bills that they have to pay. So, while there is an MRI here, it's usually not the first test ordered. If there's a cheaper alternative to an expensive test then it's preferred. And physicians have learned to do more with less. I've seen doctors here pickup pathology on a plain X-ray that most American MD's would miss (although it's important to realize that most American MDs have access to readily available CT's scanners which pick up even more than the plain X-rays). Clinical exam skills are a lot better because labor is cheap and machines are expensive.

In the end, many hard decisions have to be made here that don't have to be addressed in the US. For example, Ghana doesn't perform kidney transplants. Meaning that if your kidneys fail, you'll likely need dialysis forever. Even in the US, dialysis is usually seen as a bridge to transplant. If there is no transplant, than the treatment might seem futile. And at 100$ per dialysis session, meaning up to 300$ weekly, long term dialysis is no longer a possibility for most people here. Thus someone here with renal failure will die, while in the US thousands each year live with donated kidneys. None of the physicians like watching their patients die, but when resources are scarce, hard decisions have to be made. Luckily, Ghana is making great strides, and as such their life expectancy has increased by about a decade. And also realize that in the end, even the US (one of the wealthiest countries in the world) does not offer universal health care to its citizens. Even in the US, prescriptions go unfilled because they are expensive, tests are not done because no one can pay, and doctors must make hard decisions about limited resources.

Random Observations

So to paraphrase the movie Memento, how does one properly describe a place? Probably only through the hundreds of little details that are part of a place can one truly get a sense of the place. Places like people are complicated like that.

One of the things that has really struck Matt about this place (but is fairly familiar to me having been to India) is the seeming excess of stalls, small grocery stores, and tiny eateries (all of which have almost identical menus by the way). Nowhere that we've yet been in Ghana can one walk for very long before one passes a number of such small businesses. The names of these businesses are also attention-grabbing (to us at least). Ghana is a very overly religious, Christian country so many small-business owners name their establishment after a religious theme or scriptural reference. So one passes "Innocent Blood Barbers', 'The Bread of Life Canteen', and 'Consuming Fire Chop Bar'.

Another little detail is that music is played everywhere. No matter the time of day or the place you are you can almost always hear something playing if you listen closely enough. About half the time it's either Church devotional music or some sort of the local 'Highlife Music' (a fusion of African and Western music that's extremely popular here). The other half of the time however it's Western pop music, but only the most ridiculously trite and insipid variety of it. Walking around one hears (either in the original or covered by a Ghanaian artist) songs by Christina Aguliera, the Backstreet Boys, Celine Dion (I've heard 4 different versions of 'My Heart Will Go On' already), and All4One (the group that gave us 'I Swear').

Finally, people here are very friendly to tourists, and especially to the Obruni (Obruni being the word for 'white man' here. That's obviously Matt, my ethnic identity is a mystery to most Ghanaians who've tried to guess. Though I'm pretty clearly Asian Indian I've been called Chinaman more than anything). Almost everywhere we go people of all ages will start conversations with us, guve us advice or directions, and inform us that Ghana is a great place and we should love it, and that they love it. It's not quite like the hassling tourists get in other parts of the World when the people may have a profit motive. Over here I'm convinced that it's just straight-up friendliness to obvious strangers. I must say it does make it hard to ever be in a bad mood when in the span of 10 minutes, 7 different people have given you a huge smile and a cheery 'How are you?'

Hey, White Boy 2: White Boy Gets Scared

Last night Kags and I were walking around Osu (one of the more touristy parts of Accra) looking for a place to get dinner (after the power went out in our hostel yet again), when we saw a large group of dozens of young Ghanian men angrily yelling at what appeared to be the store front of a Western designer clothing store (e.g. Calvin Klein). The scared white man in me was worried they were about to storm inside the store, and the security guard watching from the street didn't help matters. I walked as far from the group as possible, worried that some anti-Western sentiment might be directed at little ol' me. It was while walking back by the group, that we saw what they were yelling about. Inside the store, was a television playing the satellite broadcast of the soccer game, and Ghanaians (much like most peoples of the world with the exception of my wife and in-laws) take their "foot ball" seriously.

Daytripping

This weekend was Easter weekend, meaning that Friday and Monday were holidays, so Kags and I headed out of town. Unfortunately, Friday was also a holiday for the busses so we left Saturday to go to the coastal town of Elmina. A couple comments on the busses which Greyhound should take note of. The seating was assigned (meaning they didn't oversell the bus), the bus left only a half hour late, and when the bus company realized the air conditioning was broken (which happened on the way there and the way back) they immediately issued a partial refund of the purchase price for the inconvenience.

Elmina itself is is a small fishing villiage with a huge fort (originally Portugese, then Dutch, then British) built for the slave trade. We were worried about getting to the Fort after it closed, but given how much tourists pay to get in they were willing to stay open until we had seen everything. The tour group consisted of Kags and I, along with some Dutch girls and other foreigners (a.k.a. white people). Everyone scattered as soon as the tour was over though, leaving Kags and I to walk home in the rain. One thing Kags and I noticed as we walk through these towns is that occasionally we'll see some obvious foreigners and we'll usually say hello (curious about where they are from and what they are doing in Ghana), but the interaction seems to be one sided. Often we're ignored, and at best we just get a curt response. I don't know if it's because they know we're American (and not that popular with much of the Western world) or if they just don't want to waste time on non-Authentic experiences. Maybe if you travel to Ghana, the last person you want to chat with is a medical student from Michigan. The Ghanaian, on the other hand, are always incredibly friendly and interested where we are from. As I've said, they know I'm foreign, but a British accent sounds just like an American accent so they always have to ask. Kags has been accused of being Spanish and Mexican.

Then we headed over to Cape Coast, a pretty traditional tourist spot that's bigger than Elmina and also has some slave forts. One of the things that struck Kags and I was the beauty of these forts. It's white washed, huge stone walls with Western design and beach front setting (many of the slave ships loaded/unloaded directly from doors in the side of the fort) make it really nice to visit. And the museum aspect with gift shop distances visitors from the history of slavery, rape, death, and misery almost as much as it educates them. It would almost be a nice place for a wedding if the building weren't so . . . evil. And right outside the fort, on the other side of a door marked the "door of no return" which the slaves went through before boarding ships for America, was one of the biggest beach parties I've ever seen. People swimming, playing in the surf, dancing to music and having a great time. All of this (plus the daily life in Cape Coast and Elmina) occurs in the shadow of hundreds of years of terror. I don't really know how to reconcile it all, but it is interesting how the past and the present meld. Ironically, one of the reasons I picked Ghana was the large number of English speakers here, and that is largely a relic of colonial imposition by the British.

Kags and I wandered around town for awhile and then headed back hom Monday. Luckily the water was back on and the electricity was on (until last night when it went off again for 8 hours). Also, on a side note (for those of you interested in the health of this fearless traveller) I succumbed to that most common of travel ailments (TD) and kept myself hydrated and close to bathrooms for a few days. I am pleased to report that I am feeling better, and didn't even have to take the antibiotics that I had packed.

"Hey, White Boy"

Yesterday Kags and I headed to the area of Accra around Usher Town (named for Fort Usher nearby) since it was a hospital holiday on Good Friday. It was Good Friday so much of the stands were closed, but this was also kind of relieving as it made things a bit calmer. There was still a fair amount open and we did end up wandering through the market. Kags bought some scissors. The locals kept calling out to me "hey, white boy" and some of the children have just wanted to touch us or shake hands. At one point a woman grabbed my arms and tried to drag me to her stall, but I was able to shake her off. While we've been here we've been drinking 450ml bags of water which are much cheaper than a bottle of water and seem to be more for locals (tourists tend to drink bottles). We saw and advertisement for bags of liquor which Kags says he wants me to get. Unfortunately we couldn't find them for sale.

We also made it to Fort Usher and the Atlantic Ocean. It was very nice to see, only a couple thousand miles from home. We couldn't get a tour of the Fort yesterday but we might return.

We've been taking taxis around here (usually 2-4 dollars for each trip) but we decided to try a local tro-tro. There seems to be a cab for every person in Ghana and even more tro-tros. It's pretty much a van that functions like a bus, travelling fixed routes in the city. The driver navigates and the driver's mate calls out to people to let them know where it's going. As a foreigner all of the destinations sound like gibberish. But we happened upon a sign indicating that Korle Bu was straight down the road. So when the next tro tro stopped and yelled gibberish, we asked "Korle Bu" and they nodded in affirmation and we got on. We were shoved in with a bunch of other people, but as crowded as it was, it was still comfortable. Then when we recognized the buildings we were passing we got off. The ride only cost 40 cents for both of us. A huge savings. Don't know that I'll ride many more tro-tros though as so many of the streets don't have names (a map of the area pretty much showed a bunch of unlabelled streets) it would be easy to go right past our destination and not recognize it. But as I said above, even if that happened, it's never hard to get a cab.

PS We finally have power and water back again. I was able to watch part of the Jetson's on satellite TV yesterday.

Next up, Kags and I are taking a bus to Almena to see the slave fortresses. We'll try to head out today and catch a bus back tomorrow in time for rounds on Monday.

Beer, Yes we have Beer

So, last night Kags and I found something like a restaurant in Korle Bu. It was pretty much a snack bar where you order food through a window and sit on tables in a bricked in patio. But it was clean, painted attractively, and no part of it was on wheels. Also, I had my first beer here. After asking the waitress what kind of beer they had (and she responding "beer, we have beer") I ended up with a 20oz bottle of Star Beer. Kind of reminded me of Coors or Michelobe. Not great, but it seems Accra's two big beers are Star and (oddly enough) Guinness. So when we went to Frankie's I had a Guinness.

I should clarify that in Kag's post, the guy thought I was mormon because I was wearing a white button down shirt with kackie pants. When in fact Mormon's usually wear white button down with black pants. And though we were travelling in a pair, Kag's was not similarly dressed.

I saw an older Ghanaian woman today wearing a shirt that read "Blonde Bomshell". We also saw a sign advertising "magical" checking accounts to increase money.

Matt and Kags Escape the Boonies

Hello all. So this is my first post here and I would just like to state my objections to the malicious lies and slanders Matthew has perpetrated earlier in this blog. I most certainly do NOT appreciate or get any of his humor.

So today Matt was absolved from his clinical 'duties' (I use duties in the lightest sense of the word) and I was able to skip out at noon. We spent some time planning where it is we wanted to go this weekend and then made our first foray into Accra proper.

Our first stop was the main bus terminal to purchase tickets for the weekend. We regretfully found that most of the buses we wanted were sold out. Also, because I was instructed to show up for rounds on Monday (despite the fact that it's apparent some kind of national holiday for reocvery from Easter excesses) we had to postpone our plans to head to the mountains and pick something nearer. We decided on Elmina, a nearby, allegedly-pleasant coastal town that is home to one of the large slave castles. (That is, one of the castles that slaves were stored before being transported to the New World.)

We then proceeded to an area called Osu which was recommended to us as 'the place to go' by several different people. It consisted (to us at least) of a long, ridiculously loud, traffic-choked road with tons of stores and restaurants. We ate lunch at an expat-haunt, a clean place innocuously named Frankie's where we feasted on burgers. It was more meat than either of us had seen our entire time here. We then walked around for a bit on the street, where we encountered some of the most aggressive entrepeneurs we had yet come across. Young man after young man wanted to drag us into his shop or next to his stand so we could examine his wares. One man literally clasped Matt's hand and walked with us for half a block. Another purveryor of assorted trinkets in Ghana's national colors ( a cheery combination of yellow, red, and green) stopped Matt and asked him if he was a Mormon. I think Matt would make a terrible Mormon.

On the cab rides into and out of Accra we saw much of the city, and I was struck by how much the traffic, noise, pollution, and lack of any kind of urban planning whatsoever reminded me of Bombay. But worse. One will pass lovely government buildings or cathedrals or offices and then a half minute later pass a slum. The sidewalks are nonexistent, sewage collects in open drains, and good God, the noise, the unceasing noise. Our travel books have oodles of abuse that they heap upon poor, unsuspecting Accra, and for now I'd have to say I agree.

Also in our hostel, we are now entering day 3 without power or water. Aaarrggh. Matt and I, the last couple nights, have had to go to sleep at 9 just beause we come back home and there is not really much we can do without light. And the humidity discourages us from partaking in activity.

Things I can't get over, for better or for worse:

1) the balls of goo, banku, or fermented cakes of maize meal that one dips into sauces or soups here. it's like playing with Playdoe, and then having to eat it. The taste is slightly better though

2) selling water in sealed plastic bags, called sachets

3) the spicy food; it's been a pleasant surprise. for some reason I thought African food was supposed to be bland

4) the brusque way people talk; Matt and I both keep thinking we've offended people, based on how they react to us

5) the God-forsaken humidity. One thing I've learned about myself already, if I participate in foreign aid work in the future, as I've long planned and still hope to do, it will have to be in somewhere cooler. Maybe Nepal? Or is there a need for ER Docs on the summit of Mt. Kiliminjaro?

Kags, over and out

Matt finds Hot Dogs

So, more on my travels here. Earlier on I alluded to preparations for bribing the customs officials. I brought fun American toys and a radio that I got at the dollar store. But sadly, at the airport customs I was able to walk right through. This means that Kags and I now have silly putty and super balls to play with.

Wandering around today I found another street/alley with lots of food stalls and stores. Ghanaians love to add religious monikers to things, thus "The Lords Grace Beauty Salon" etc, etc. I got what can only be described as a spice hot dog which was very tasty. Given that much of Ghanaian food consists of starch (rice, maize, etc) mixed with very spice sauce/soup, it was fun to find something like junk food.

We are staying near Korle Bu, the teaching hospital, which is in Accra (the capital), but kind of on the outskirts. So it feels kind of like the boonies. Kags and I are hoping to head down to central Accra tomorrow to buy bus tickets for a weekend getaway. Since it's Easter weekend our duties are pretty much nill on Friday and Monday. Apparently there's a national park up north that has a walkway in the canopy 40 meters up. And since it's mountainous it should me much cooler :)

Kags joins Matt

Yesterday morning Kags, my fellow classmate, joined me in Ghana. It was nice to see a familiar face and someone who gets my jokes. Kags, like me, also got lost wandering the streets when he was walking to our hostel from the hospital. Last night it was too hot to sleep so we chatted for awhile. When it's 85 degrees and 100% humidity and the fan doesn't work because the power is out . . . it's uncomfortable. Actually, the heat isn't bugging me too much, but I am having to drink plenty of water.

I've liked the Gahanaian food I've had so far, but I can never remember the names so I usually just walk up to a vendor and point or ask for a recommendation. Everyone remains very friendly. Mosquitos and flies haven't really been any problem so far, which is nice. I've also seen some people carrying things on their head, which I can understand. It's really too hot for anything like a backpack. Although all the doctors usually wear white coats and many wear ties. I can't imagine that. Yesterday I wore a button down short sleeve with no undershirt and it was tolerable.

Matt Arrives in Ghana

Well, I made it to Ghana safe and sound. My flight on North American Airlines went well. I was one of maybe 6 people who weren't black. And some of my fellow passengers were quit dressed up for the flight. This meant women with vertical hair (feathered up, frowed, and my favorite the stiff stack of curls reminiscent of the candied ribbons on fancy cakes). The headphones that they gave out had to clip on your ears because a band over the head wouldn't have worked.

I got picked up at the airport and settled in to the Hostel. The porters were cleaning my room while I was unpacking which was a little unsettling. I was taken on a bus to the medical school, only to find my contact wasn't in her office yet. So I wandered around. I tried to get money at some ATM's but they were broken. Then wandered into a currency exchange but they were still mopping the floor. Ever feel like you're not wanted? But the people are all very friendly. When I went to buy water, all I had were 10,000 cedi notes (don't get impressed, that's the value of 1 American Dollar) but they couldn't break it and so the woman offered to give me the water for free and have me pay it back later today. Very friendly. I promised to buy water tomorrow and then bought from another stand a kind of overpriced (thus they could break my bills) but wonderfully large (1.5 liter) bottle which I'm halfway through.

What I've learned so far:
1. Not a lot of white people in Ghana
2. It's hot here
3. Even in Accra there are periodic loss of electricity and water so we all have buckets to store water just in case
4. Ghanaians are very friendly

Right now I'm travelling alone, but tune in tomorrow when my fellow med student from home joins me, fashionably late as always.

Rearin' to Go!!

T minus one day. Today I got some funds for travel, went to the dollar store for gifts/bribes/fun stuff, and bought a bunch of pens from Office Max (apparently the children like to get money, candy or pens). I don't exactly know what they'll do with them. And I'm not really huge on bribing officials; I hope I do it right :)

I spent part of the day spraying my clothing and mosquito bed netting with Permethrin which is kind of like DEET except it's incredibly toxic and you can only apply it to clothing, not skin. So I'll probably have kinds with two heads someday, but better that than dying from malaria.

Welcome

Well, this is my travel log for my trip to Ghana. I'm a medical student who's heading to Accra to work at the hospital, Korle-Bu, for a month. Right now I'm packing and making last minute preparations. Malaria pills, check; passport and visa, check; stethoscope, check. Actually, I'm not really packing yet. I don't leave for two days and if I start packing too far ahead of time then I have to leave some stuff (e.g. daily toiletries) out and then when I go to pack the rest later on I forget what I've packed already. I prefer to do all my packing at once. But I have spent the last few weeks collecting what I'll need.