Day Two: Ho, Ghana

I set my alarm for 5:45 to give myself plenty of time to finish packing and get my suitcases down four flights of stairs and out to the parking lot before breakfast at 6:30. Starting at midnight, I woke every half hour in a panic that I’d slept through the alarm.  I finally gave up at 5:00, exhausted from the up and down and clock-checking.  I don’t know if it’s the Malarone for malaria prophylaxis or just my craziness, but it was a bizarre night.

The drive from Accra to Ho took about four hours on narrow rocky roads. We passed through many small communities with plywood houses and roadside stands selling mangos, pineapple, bread and beaded jewelry.  I rode next to Henry, an Op Smile Ghana board member since it’s inception in 2011.  He’s also a member of the Lions’ Club and when Op Smile Ghana formed, the Lions’ Club partnered with them and continues to raise money to support missions.  Henry told me that for the 25 million residents of Ghana, there are just 3500 physicians and 200 dentists.  Medical and dental education are subsidized in Ghana, and students come from all over Africa for the free education.  Most of the young physicians, however, leave the country to practice.  Those who stay generally specialize and practice in the cities.

Another factor contributing  to the shortage has been the EU.  Since English is the official language of Ghana, large numbers of the young doctors go to the UK after graduation.  With England pulling out of the EU, that avenue may close, and with Trump tightening immigration, the other big path out of Ghana may be closing as well.  The Ministry of Health is not counting on the doctors staying and is looking at developing a program to train medical assistants to be the “doctors” for the rural areas of the country.

Sitting behind me on the bus was a lovely woman who is an OR nurse.  I really enjoy her; I’ve worked with her on a couple of past missions.  However, she is one of those non-stop talkers and managed to keep up a monologue for the entire four-hour trip.  In addition, her laugh, which punctuated her monologue every few minutes is a dead ringer for the laugh of Dustin Hoffman’s character, Mrs. Doubtfire. If you don’t remember it, I’m sure you can find it on Demand.
We were booked into a beautiful hotel overlooking Ho, but when we arrived, we found that the President of Ghana and his entourage had arrived that day unannounced and had taken about half the rooms.  Half the team is now at another hotel about 30 minutes away.  I’m one of the lucky ones with a room here; the others will have to move back once the President moves on.
We went to see the hospital today and it’s built in the open-air style that is also common in Latin America.  Tomorrow and Saturday we will screen about 400 patients and then will have to choose only about 125 of them for surgery.   However, by the end of the week, each resident will have done lips and palates from start to finish and at least two or three will be accredited.

April 19, 2017 - first day in Ghana

I’ve arrived in Accra (Ac-CRÁH,) the capital of Ghana, and will stay overnight with several team members before driving on to Ho tomorrow. We’ll leave right after an early breakfast and drive for 3-5 hours, depending on traffic and road conditions, i.e. washouts, rock falls, ruts, herds of goats.  I met up with another Op Smile team member at the Logan airport, and thought I had worked with her before.  I greeted her with a smile and a hug, which she returned, Op Smile style.  She then told me I had never worked with her; in fact, we had never met at all; I was a TOTAL stranger to her. She was obviously enjoying the whole scenario.   I had worked twice with her identical twin sister who also volunteers with Op Smile!  I was truly amazed.  She said that she and her sister go to the big twin convention in Twins-burg, Ohio every year and that last year they came in second in the “most identical” competition.  It made me feel a bit better about mistaking her for her sister.  The flight from Logan to JFK was short and easy, and after a three - hour layover, we boarded the plane for Accra. I had paid a bit more to have some extra leg room, but the man in front of me immediately put his seat back as far as it would go and laid his head in my lap. For the next 13 ½ hours, he snored away, skipping drinks and dinner while I wrestled with my conscience, managing to resist the extremely strong temptation to dump ice water over his head.

Meanwhile, in the row behind me, a 3 year old boy and his grandmother waged an epic battle over a video game toy.  The grandma was in a fury, screaming at the boy, telling him he would never ever be able to get it right, his mother should never have bought it for him and he should just SHUT UP and quit whining.  The boy, from what I could tell, was enjoying playing the game his own way, but the Grandma wanted him to play it “properly."  The only whining I heard was from the Grandma. She periodically raised her hand as though she would strike him, and repeatedly called him a “devil-child.” He, of course, responded to all this abuse by crying more loudly, and she ended the interaction by taking the toy and putting it in the overhead bin until he could “grow up and follow the rules.”  An Op Smile team member was sitting across the aisle from the grandmother and finally couldn’t take any more.  She said, firmly, “don’t you hit him.”  The grandmother didn’t miss a beat responding, “stay out of it.” They went back and forth several times, “don’t you hit him,” “mind your own business,” while the poor little guy kept crying. Finally, he wore himself out and fell asleep.
I was reminded of times in my office, before I retired, when I would see a young child whose parents were having a hard time with normal but difficult behavior.  I never observed this degree of verbal abuse, but there were times when it was clear that the message the child was receiving was that he or she was bad.  It always made me so sad, knowing that the child would likely grow up feeling that he was bad, unlovable, somehow defective. I just wanted to snatch this boy up and cuddle him and disappear the grandmother.  Likely I’d have ended up in a Ghanaian jail. One  of the things I love about Op Smile trips is observing the different cultures and styles of parenting.  I hope the remainder of my time here is filled with positive parent child interactions.

We’re staying at the Coconut Grove Hotel here in Accra.  The First Lady of Accra is here all day for a conference on empowering girls. I haven’t seen her, but there are dignitaries everywhere and many,  many uniformed soldiers carrying multi-weaponry.  The hotel is very fancy, and I have a “suite.” Luckily there is AC as it’s 95 degrees and 66% humidity. This afternoon, three of us shared a taxi to the local craft market.  It turned out to be a bit stressful.  The taxi driver was a young man from the neighborhood where the market is, and he’d only been driving a taxi for about a month.  He was obviously very excited about taking us there and escorting us through it.  He was so busy explaining the market and the bargaining process that he didn’t watch where he was going and got lost.  Suddenly we were in the middle of the town dump, the car surrounded by about 15 young men and boys whose impromptu soccer game we had driven into.  While I sat there imagining, “bad outcomes,” the young driver started joking with the soccer players.  It seems they were his schoolmates and were teasing him about taking tourists to the dump.  He finally got us to the market, a warehouse-type building filled with tiny cubicles and competing artisans. I bought some small paintings of Ghanaian people done by a young man, and I was done.  Getting out of the market, however was nearly impossible.
Artisan: Miss, come look at my……..
Me: “Oh, no thank you. I’m done buying.”
Artisan: “Oh, I know you’re done spending money, just come look to give me luck.”
Me: (after SEVERAL rounds of me firmly stating I’m DONE!!,) “I’ve spent more than I should have. I must buy my food all week. I think I’m going to be very hungry.”
Artisan: “Oh I know you aren’t buying anything else, Catherine, - yes, by now they knew my name – if you just come look at what I have in my space, I’m sure you’ll bring me luck and the next person will buy something from me.”….  then, in the stall, “See this tiny bracelet or ???, only $15 just for you because I know you are done buying things today!"

The final blow came when we arrived back at the hotel.  The driver had given us a reasonable rate for our trip to the market and back, and we had discussed that since I was in the front and had US dollars  preferred by all the locals, I would pay him and the other two women would reimburse me.  However, they both forgot and both paid him as they got out of the car.  Unaware that the young man had already received twice the quoted fare, I handed over the cash for all three of us!!!  He smiled sweetly, took the money and drove off.  I’m trying to consider it my good deed for the day, trying really hard.

This mission is an official teaching mission.  Op Smile is always teaching, but in some countries, like Ghana, where there is a big need and very few qualified, trained surgeons, they put on formal teaching missions to try to quickly build up the number of competent cleft surgeons, nurses, anesthesiologists,  and nurse anesthetists. Of the six operating tables two will be teaching tables and will have five residents each and two plastic surgeons.  Cases will be chosen for their teaching quality at those tables and they will necessarily go slower.  It will affect the total number of cases we can do, but is desperately needed. The population of Ghana is 25 million, and there are only two plastic surgeons in the country who have ever repaired clefts. They were trained by Op Smile last year.  There are ten plastic surgeons total in m Ghana.  By the end of this mission, there will be four qualified, accredited cleft surgeons and by the end of the year, another two. Gradually over the next year, more and more will be trained. Anesthesia residents are also being trained.  I will be training two pediatric residents, and there is a first-time pediatrician from Sweden on the mission.  He’s 70 and a friend got him interested!

This is long enough so I’m going to stop, but I do have one quick story.  One of the surgeons arrived yesterday, and at breakfast this morning at the hotel, a man came up to him and remarked on the Op Smile tee shirt he was wearing.  The surgeon explained what he would be doing in the coming week and the man became tearful.  He said he had a 6 year old daughter with a cleft lip and he didn’t know it could be fixed.  The surgeon told him to get up to Ho on Monday morning early and by the end of the week, his daughter would have a beautiful new smile. The man was at the hotel for a conference, and he jumped up, leaving his breakfast, ran up to pack his things and checked out.  I expect I’ll see him and his daughter on Friday.
I’ve posted some photos of the hotel, the band and some dancers - artistically blurred. On One-drive. The band and dancers were part of the First lady’s celebration.

On My Way to Ghana

On April 18th I'll be flying off to Ghana for my 18th mission with Operation Smile.  The team is big due to an unusually large number of observers and trainees.  There are 92 members, mainly comprised of Ghanaians with with five from Sweden and two to three each from Israel, Egypt, Kenya, Spain, Belgium, Brazil, South Africa and China.  The chief cleft surgeon and Team Leader is from Ghana.  There are six surgical residents and three anesthesia residents on the team.  They will be observing and assisting in the same capacity they would in the OR in their home countries.  There are also four CRNA's (certified registered nurse anesthetist) observers from Ghana on the team, an orthodontist/dentist observer, and four nurse observers. There are also eight trainees in areas such as medical records, Patient Imaging and Biomedical Technician, (keeps all the medical equipment running and "Macgyvers" -  what is needed in less well-wired countries. There is an extra surgeon, anesthesiologist, Biomed and Patient Imager to provide education.  Patient Imaging or photography, is actually very complex.  Each child has "before" photos, intra-operative photos that are very precise and may be used to guide subsequent surgeries.  Immediate and two week post-op photos are also taken.  All of the photos are archived for use in the education of local cleft surgeons.
There are five students who have been active in developing Op Smile student support clubs at their schools and have thus qualified to join a mission. They have a student sponsor who travels with them.  They each try to find a patient close to their age and follow him or her through the surgical process. They also do a project like helping out at an orphanage while they are in the country.  Finally, there are eight guests and their Op Smile sponsor. I think the guests on this mission are from Sweden and likely are sponsors for this trip.  Sometimes the guests are well-known celebrities in their countries and do filming for money-raising back home.  So, subtracting out all the "extras,"the number of team members involved in the actual patient care comes to 41 plus the residents (10) - 51 - as they both learn and help.

I'll be doing photos a little differently this time - I hope better.  It's on OneDrive and I'll email the link. It only has one public domain photo from Wikipedia right now.
   More later