Special Inclusive School

I spent the day at the Special Inclusive School. Isaac, my host, is the headmaster of this special needs school. They had class work today so it allowed me to see how the children interact in a classroom setting. The main lesson of today was on personal hygiene. They discussed the proper steps and what was needed in order to bathe and brush one’s teeth. It was a very simple lesson, but very important considering poor hygiene could mean death here. Cholera and typhoid are two of the common diseases that occur here due to poor water and food conditions.

There were about 12 students at the school today. Unfortunately, the students with more severe physical challenges are not able to make it to school right now since the bus broke down in December. Before the bus broke, about 30 kids attended school daily. From a physical therapy standpoint, I saw very few things that I could help out with. The things I did notice I made sure to tell the instructors about so they could try and modify it.

My little buddy, Wisdom, would benefit from help with adaptive utensils to write and eat with. Wisdom has cerebral palsy. He has a slight gait abnormality, but is very functional with his walking. He has poor hand dexterity. His biggest difficulty is with speech. The teachers have worked with him long enough that they can understand him some of the time. Also, Wisdom nods appropriately so you know he understands you correctly when you ask him a question. I was unable to tell if his difficulties with writing stem from the fact that he cannot grip the pencil or if there is a learning disability affecting him. I think is probably a combination of the two. He lives behind Isaac so I’ve gotten to spend a lot of time with him. He often will not allow anyone to help him, but him and I seem to get along well so I’ve enjoyed spending time with him.

My buddy from Friday was at the school today also. I think I was more of a disturbance to him than helper. He constantly wanted me to come over to him. Whenever I tried to help him with his work, I ended up distracting him and everyone around him. Luckily, the 3 boys sitting around him wanted to show off their work so they did a very good job with their lesson!

I really enjoyed watching these kids learn today. Yes, they are not learning calculus. They will never be the doctors and lawyers of Ghana; however, with patience and proper instruction, they all have a chance to be productive members of society. My second little buddy is always carving a stone. Who knows he may be the next great artist of Ghana with the right guidance. Some of the children like gardening or tending animals. Some may make good carpenters. All of the trades are important; thus, this school is very important. However, the teachers here do not have as strong of a special education background as in the US, so they do not always know how to unleash their talents. Any teachers or therapists with a good special education background would be much appreciated here if anyone wants to volunteer!!

I plan on going back to the school on Thursday. I think I could observe a few more times to see when they are doing labor tasks if there are modifications that they may need.

Tomorrow, I will be back helping at the hospital. I pray it will be less sad then Monday!

Love, Kari

Sad Face :(

At least 4 people died in the hospital today. I was around for 2 of the deaths. My first job out of PT school was at a specialty hospital, so I've seen dead bodies before. However, it is not anything you get use to.

Celestine and I were going to the ward to start seeing patients. The ward is a very large room that holds about 10 hospital beds. We were in the women's ward when I noticed a patient who's breathing was extremely labored. My thought was, "God don't let her suffer." I could tell she was very close to death's door. I did not realize how close. About 3 minutes later, her relative was crying hysterically. The nurse quickly rushed over to her to tell her the loved one was dead. They placed a curtain barrier around that bed. Celestine and I had no choice but to continue our session with the patient we were seeing.

After that, we decided to go see the small boy who had the burns since he was suppose to be back from xray. The door to the room was closed. We walked in without thinking anything of it. I was surprise to not see the mom in the room. Also, the mosquito nets were not down around the bed. I looked at the boy and quickly realized he was not breathing. He had died a few minutes earlier. The mother did not know yet. She had walked to town to buy him breakfast. It made me so sad to think the little boy died alone. I'm sure the mother was devastated not being there to hold the little guy as he passed on.

I was probably too optimistic about the little boy. His burns were no where near as severe as the other little boy; however, ~30% of his body was covered with burns. If he had been in the US, I'm sure he would have had a 90% survival rate. Here in Ghana, they just don't have access to all the monitoring tools to have a minute by minute update of someone in order to treat the issues that arise. I was told the little boy had gas in his stomach. I'm guessing his organs probably shut down from fluid loss with the wounds. There are no IV machines. Also, IV fluids are delivered passively by gravity. A bag is hung up high allowing gravity to pull it down into the body. In the US, the IV machines have ways for you to dose the medicine. The boy was getting saline solution to help maintain his electrolyte balance but it wasn't enough. Obviously, many other medical issues contributed to his death (infrequent wound dressing changes, infection, etc.)

I know I am helping people here. One of the hospital employees spent 10 minutes with me just to thank me for coming to Ghana. However, it is hard to feel like you are accomplishing anything when you see someone die. There is so much that needs to be done to help Ghana and Africa. I know I cannot do it all myself, so I'm trying to focus on the accomplishments. Unfortunately, this morning did not make me feel too good.

After lunch, I confirmed my hospital visits with everyone from the Step FaR conference. I will be going to the 5 hospitals this month to provide hands on follow up help to the therapists. I am trying to focus on these visits since earlier in the day was upsetting to say the least!

Again, I can't say it enough, tell your loved ones you love them! Life is precious no matter where you live in the world!!!

Love, Kari

Laundry Day

I'm really going to write a whole post on doing wash! :) Haha! Just how everyone wants to spend their Saturday.

How I miss a washer and dryer! We took a taxi to Isaac's school. Water has not flowed at the house since the Thursday I got back to Kpando. That's over a week!!! Luckily, Isaac's school has a deep well and a backup Poly tank to store water when the tap doesn't run. It took us about 4 hours to wash all of our clothes. Every item has to be washed by hand. It's not hard, but it just takes a long time! Lifting/Filling/Dumping the buckets of water is hard work. Also, squeezing the excess water out of the clothes is tiring. My hands will be sore tomorrow. You don't really need to lift any weights here in Africa. The daily chores are enough. The problem is they are slowing getting use to modern ammenities. Thus, diseases due to a sedentary lifestyle like we see in the US are becoming more common here.

While I was waiting for my turn to wash my clothes, I decided to lay out in the sun. All of them started laughing at me. Isaac thought it was so funny that he even had to take my picture. At least he understood the importance of me getting my daily dose of Vitamin D! :) They find it so funny when any white person wants to be in the sun. Every African is always trying to avoid the sun.

I'm glad I was their entertainment today: The silly American who does not know how to wash clothes and likes to lay in the sun! Issac also made me carry my clothes on my head like a true African. My neck doesn't hurt so I must have done something right. Maybe if I keep practicing, I will be able to balance stuff without needing my hands. :)

The game is in 1 hour! I'm so excited to cheer on my adopted country, Ghana! Go Black Stars!!! I think I'm starting to like football.

Love, Kari

I've been reunited with my passport!

My passport is back in my possession!!!

Isaac and I had to return to the immigration office in Ho today to retrieve my passport. It is now stamped. I am allowed to stay in Ghana until April 7^th. I think I need to extend my trip by 2 weeks! J My parents would probably not like that so and I can’t afford to change my ticket so I guess I’ll leave on March 21^st as scheduled!

Before we went to Ho, I accompanied Isaac to his school. It was my first time going there with students present. All of the students had special needs of some sort, but if they were going to school in the US, most of them would be in a normal classroom. The severely disabled children do not get a chance to go to the school because there is no way to get them there. The school bus broke down. If you read back in my blog, I mentioned that scary ride! They are in the process of building a dormitory, but of course that requires funding. Even though the school is government run, it gets very little funding from the government. (Hint! Hint! Donations are needed!)

I spent most of my time talking with one of the teachers. Friday is sort of a free day for the children. They are supposed to clean the building and grounds. Then they get to play. Some of the kids are better helpers than others. One of the little boys became my shadow. He didn’t do any of his chores since he was so fascinated by me. He use to not talk, but since attending the school has become a chatterbox. Unfortunately, he hasn’t picked up much English yet so I had no idea what he was saying. Only 7 kids were at school today so it will be interesting to see what it is like next week on a day when they are actually being instructed.

I’m learning that any drive in Ghana is always an adventure. We stopped to visit one of Isaac’s sisters on the way back from Ho. I have yet another home to stay at when I come back to Ghana! J

Tonight, we watched the African cup. Gabon played Morocco. It was such a good game. I think I’m beginning to like football. It is a good substitute for American football right now! I’m excited to watch the game tomorrow!!!

Love, Kari

Ataxia = Drunk Sailor :)

Today was just a good day of therapy! It is still a little slow for my tastes, but I got to be a therapist so that was nice. There is a really interesting stroke patient in the ward. She is very ataxic (poor control of movements). The beds are all too tall so I was pretty nervous having her stand up today. Luckily, she did okay. She managed to walk about 10 feet with max assist from Celestine and I using a wheeled walker. It was like holding onto your very very drunk friend and trying to keep them from falling over. I wish I had a set of parallel bars here. It would allow me to work on her balance a little more without worrying about her falling. I think I will visit the carpenter and see how much it would cost. The gym would really benefit from that.

There is actually another burn patient in the ward. This patient is a middle age man. He was in a boat fire. He has 2^nd degree burns over his back and waist and then 3^rd degree burns over his feet and lower legs. The doctor says he’s being lazy since he won’t get out of bed. I told the doctor that I’d be lazy too if I had burns over my entire body. Yes, the man doesn’t want to walk, but I think it is due to fear and pain! I couldn’t get the man to walk today. He said he was having too much pain. I believe him, but I also tried explaining to him how important is to start moving now before contractures and stiffness sets in. I think I was talking to the wall. Unfortunately, therapy is not a passive treatment like taking a pill. You can only force someone so much to participate. He said he would get up tomorrow. Hopefully, Celestine will be successful!

The little boy with the burns was less scared of me today. I could tell it was painful for him, but we are maintaining his motion!! As long as he does not get an infection, I think he will survive; thus, it is so important that we keep his skin flexible!!! His mother said he wanted to walk today so we tried to stand him. Unfortunately, there was just no good place for me to support him without putting a lot of pressure on his burns and so he wouldn’t stand on his legs. He did sit up in bed for a few minutes though and clapped his hands with me! We asked him to wave bye to us and he shook his head “no”! Haha! Hopefully, that means he is feeling better.

I walked to the orphanage after the hospital today. Mama wasn’t around so I didn’t get to stay and play with the kids. Hopefully, I will be able to start helping there next week. It will really just be a way for me to pass the time since workdays are only 6 hours long here. Luckily, I do not think they have any kids there right now who need PT!

Tomorrow, I have to go back to Ho to pick up my passport. They better have stamped it to extend my visa. I feel so naked without my passport!! I think we are going to a funeral in Grace’s village this weekend. It should be very interesting.

Love, Kari

Rest in Peace Small Boy

Today was a sad day. The little boy who had burns on at least 75% of his body died today. Celestine and I were on our way into the room when we were told the news. The nurse was in the process of wrapping the body in the sheets to carry him to the mortuary. The mother had been ushered out of the room because she was inconsolable. The mother of the other boy was also crying uncontrollably. I'm sure she is very fearful that her little boy will suffer the same fate.

I knew the little boy's prognosis was not good, but it doesn't make death any easier. Life is so fragile, especially in Africa. I understand why religion is such a huge part of their lives here. What else do they have to explain the pain, suffering, and death? I know children in the US also have horrible things happen to them, but it is a daily thing here. I knew situations like this would occur, but it does not make it any easier.

Please tell your loved ones they are loved! Life can change in the blink of an eye!

I will try and have a more uplifting post tomorrow. I just find it hard to change subjects so this is all I will post today.

Love, Kari

Go Black Stars!

No one came to the clinic today. It was so slow. We spent our morning seeing 2 ward patients and going on 2 home visits. Then in the afternoon, I saw the little boys with the burns. I did not realize there were 2 burn patients yesterday. I performed PROM on the same little boy as yesterday and then also on the other little boy next to him.

It was so painful for the first little boy. I would estimate at least half his body is covered in 3^rd degree burns and probably 70% of his body is burned. My heart was breaking as I did his ROM. If he does survive from this, it is so so important that he stays mobile. Scar tissue is not as flexible as skin; thus, we cannot let it get stiff! I could tell the little boy was in and out of consciousness. I hope he did not get nightmares from me. I’m sure he is not use to seeing a white lady. Also, I was a very mean white lady. L

The second little boy’s burns cover about 30% of his body. His prognosis is much better; however, they do not do skin grafts so he will not heal as well as he would if he had US medical care. He had some pain during his ROM, but nowhere near as bad as the first little boy. Both boys’ burns are being treated with silvadene cream so that is good. That is the same topical ointment we use in the US to treat burns. However, the families cannot afford daily dressing changes.

It is so hard for me to treat children. I use to work weekends at the Children’s hospital in Milwaukee my first year out of school. I quickly learned, while I love children, I do not have it in me to treat sick or injured children. Obviously, there are no other therapists here so I have no choice but to try and treat these little boys. I just wish I could be more helpful.

This afternoon/evening, Ghana had its first African Cup game against Botswana! Everyone was so excited for it and talking about the game all day!! Ghana only scored 1 goal, but they won!!! Their captain got a red card so he will have to sit out the next game. That’s not good. Ghanaians are going to turn me into a football fan after all! Go Black Stars! J Ghana had an amazing save. That was the best part of the 90 minute game. Seriously, I’m use to so much more action. Haha! Ghana is one of the favorites to win the whole thing. Let's see if they can pull it off! It would be their first time in 30 years.

Since I’ve been back in Kpando, I’ve been suffering some stomach problems. I’ve been taking it easy to let it recover! I think I will lay off the Ghanaian food for a while and stick to rice, spaghetti, and boiled yams. No Fufu or Bamku until my tummy settles down. I was just starting to like the stuff, too! Boo!

I can’t believe it’s the 3^rd Tuesday of the year! I wonder how the State of the Union address will be this year. I’m glad I have a good excuse not to watch it. Haha! I will be asleep!

Love, Kari

Immigration Office

Finally Blogger isn't giving me an error message anymore! I've missed being able to post everything I've been up to!

Once I got back to Kpando last week, I took it easy on Thursday and Friday. I need to do wash and email some of the people I met on the trip! I have a lot to coordinate over the next 9 weeks so I was able to figure some of that out last week.

Over the weekend I went to the Isaac's home village. Isaac had me accompany him to his village on Friday night. His brother was in town this weekend for a campaign meeting. His brother is running for MP of Kpando state. I think it would be equivalent to the county leader in the US. He has a very large house in Isaac’s village. As we were driving to the village around 9 pm they started saying, “Kari, will you survive, lights out!” At first I didn’t understand what they meant, then I realized that none of the villages we drove past had power. I told them the power can go out in the US too if there is a large storm so I’d survive.

Once we got to the house we used candles and flashlights to find our way. It wasn’t too bad. I think the house had about 5 bedrooms! Its layout was very Ghanaian but it was much larger than most US homes! Their home in Accra, I guess, is even larger!!! Around 1 am, I was rudely awakened by the power coming back on. I guess the light was turned on in the room and so it woke me up! After that I was able to turn on the AC though! That was so nice!!

In the morning, I walked around the village with Isaac’s brother’s personal assistant/campaign manager. He kept making me laugh since he told me he was going to marry me about a hundred times. I told him I needed to get to know him better so I would not accept any proposal at this time. I can’t even count the number of proposals I’ve gotten. The funny thing is I think most of the men are truly serious, because they want a green card. Haha!

For lunch, Isaac’s brother’s wife made bamko with tilapia in a light soup. It was pretty tasty. She served me the head of the fish. I guess that is the best part. She did not realize I was a silly American who cannot stand the look of a dead fish head. Isaac’s brother promptly corrected her and she gave me the body of the fish. I’m getting pretty good at eating it without stabbing fish bones into the roof of my mouth anymore. Isaac’s brother and I talked about the difference between life in Ghana and life in the US while we ate. He said he loves vacationing in the US, but he could never work there. He said people in the US live to work and spend money. They do not enjoy their time beyond that. I can’t disagree with him on that statement.

After lunch, Isaac and I stuck around the village for a few more hours. Isaac had to do his rounds. He has to say hello to everyone otherwise he will hear about it. Also, he has to give quite a few people money since he is better off than them. Isaac showed me the goat we were taking back to Kpando with us. He said he was going to kill it tomorrow. He said he’d make sure I wasn’t around. He knows Americans well enough to know we won’t eat it if we watch it getting killed! Haha! The goats are so tiny here. It looked like a baby to me. It seems too cute to eat!

Issac killed the goat sunday morning. I made sure to stay in the house when that was occurring. I will not be able to eat any goat the rest of my stay if I see one being killed!

Today (monday), I went to Ho to get my visa renewed. Also, I stopped by to visit a man named Nelson. He is a school teacher in Kpando and tudor at the orphanage. He recently had his leg amputated. From what I was told, he broke his leg playing soccer. It did not heal correctly so he had an above knee amputation. I had been told that it was still healing and that he did not have any equipment; however, since the time I heard about him his leg has healed and he has crutches. He is in the process of figuring out how to get a prosthesis. I told him I'd help him with that if his connections fell through. He didn't really need my help, but I gave him a few pointers and provided him with my phone number if he had any questions.

The visa renewal is not finished. I had to pay the money of course and then leave my passport and information there until friday. The visa is only good for 60 days. My 60 day mark is Feb 7th! It's hard to believe I've been here for as long as I have. 

It will be nice to go to the hospital tomorrow. I stopped by briefly this morning to talk to Celestine. I saw one patient with her. It was heart wrenching! A little boy around one and half went too close to a fire when he was cold. He ended up with severe burns over his whole body. I instructed Celestine on how to properly do range of motion (ROM) on him to ensure he does not develop limb contractures. I did not get to see the burns without the dressings on to determine if they were 3rd or 2nd degree. I'm praying that it's not 3rd degree over his body. There are no skin grafts here. Also, they do not have enough wound dressings to change the bandages daily so his risk of infection is so high! What do you do besides pray in this situation? The prognosis is probably not good so I feel horrible causing him so much pain during ROM! I will just make sure the nurses provide him with plenty of pain medication next time!! I will keep you updated on the little guy. :(

On a positive note, my patient who I was seeing before I left Kpando, who had a mild CVA and was dancing during our last session together, keeps making good progress!! I'm excited to see her again. Her family was just going to brush her off as being too old to walk or move again, but we showed them that she can still have quality of life, she just needed to get her strength back!!

Hopefully, I will not have trouble with blogger anymore! I sort of combined 2 posts into 1! My grammar is horrible, but I just want everyone to have something to read!!!

Love, Kari

Slow Slow Internet!

I’m back to the ridiculously slow internet! Boo!

My 3 week journey with Sam and Ken of Step FaR is now over. It was such a wonderful opportunity traveling around with them. I got to see more of Ghana. I met many awesome therapists! Most of all I made new life long friends!! I am so excited to be a part of Step FaR. Ken and Sam have been awesome. I can’t wait to help them with future projects. Sam has become my African big brother. I am going to miss him a lot! Luckily there is email, phone, skype, and facebook to keep in touch!

The Step FaR trip finished yesterday with a conference called “Life Without Barriers.” It was a forum that brought together various professionals in Ghana to talk about how to help people with disabilities. It was a very interesting conference. Many of the speakers had really good ideas or suggestions. Hopefully, some of them will come true. Ghana has a long way to go, but the dialogue is started. They need a way to put words into action. Hopefully, my volunteer work is helping that some! J

After the conference there was a lunch where I had a little time to network and talk with Patsy and Pastor Allan about some ideas I have for future volunteer work in Ghana. They seemed very receptive. I know they are praying about it so I have faith that something good will come from it! I also talked with two people who have organizations to help the disabled. I’m excited to email with them to find out more about their projects to see if Therapists Without Borders or Step FaR can assist them in any way.

Ken and I drove back to Kpando in the afternoon. Millie, Isaac and Grace seemed very happy to seem me. It nice to be back in my African home! J I missed it. I did not miss the water problems though. Although, I’m use to it now so it really isn’t that bad. Millie and I had a nice time catching up. She isn’t leaving for school until next week so we will get to spend some time together!

I have so much to organize over the next 9 weeks! I need to visit 5 hospitals along with a couple of other organizations. Ken and Sam have welcomed me into Step FaR so I really want to help them continue with their goal of better educating Ghanaian therapists. Also, when I’m in Kpando I have to continue my work at Marquat Hospital! While, in my mind my goals have changed, I still need to make sure Celestine is trained as much as possible since things move slowly in Ghana in terms of getting a real PT there. I’m excited for all these projects. It really makes me feel like I’m accomplishing something. In the grand scheme of things we are just scratching the surface, but we all have to start somewhere!!

Love, Kari

Ridge Hospital

Sam and I decided to do a follow up visit to Ridge Hospital, yesterday. Bridget was the PT Ridge sponsored to attend the course last week. Ridge is the Regional Hospital for Greater Accra. It would be the equivalent to a Level 1 Trauma Center in a major city in the US. However, the care you receive at Ridge is much much different than the care you would receive in the US!

We had an impromptu meeting with the PT director at Ridge. He helped explain to us how their department functions. Also, he discussed with us his frustrations of the PT education program in Ghana. He told us that the students are getting absolutely no practical training in school. The school expects the clinical instructors who oversee them at the hospital to give the practical training. This is a huge problem because many of the PTs who graduated 5 years ago did not have well trained instructors so they never learned how to be good therapists. Thus, therapists who are not well trained are expected to train the new graduates. It is not working at all!!!

In the US, about 1/3-1/2 of the curriculum consists of practical training, then on the clinicals you fine tune the skills you practiced on other classmates in lab at school. He said the universities are focusing on theory and not application of knowledge. He said the same problem exists for medicine. First year doctors do not know how to place a line or perform a physical exam since they did not learn any of that in school. I'm sure if you ask them to explain what meningococcal meningitis is they could do it without a problem, but would they be able to diagnosis someone with it is another story! Obviously, this is a much greater problem than I can solve on one trip; however, it is making me think about ways I can help influence the system or current PTs.

After meeting with the director, Sam and I helped out with some patients. I saw 3 interesting patients. I was able to help the therapists understand how to treat the patients a little more effectively from now on!

The first patient I saw was a person who had an incomplete spinal cord injury from an infection in his cervical spine. He was around 20 years old. The doctors had no idea how he got the infection. The director was working with him and so I did not have a ton of suggestions. The director was trained in Cuba and Holland so he actually is very knowledgeable. He said he just doesn't have the time every day to train his 4 interns at the level they need to be at! I did try and emphasize the importance of using a gait belt since they do not seem to use them ever! It would make their jobs so much easier with any patient who is not able to stand independently!

The next patient I saw was a man who was attacked. He suffered a shoulder dislocation. The doctors immobilized him for 5 months! That was way way too long! The doctors essentially created adhesive capsulitis or frozen shoulder from excessive immobilization. They have been trying to restore his range of motion. I learned that they have only been focusing on shoulder flexion. Their thought was that once they restore shoulder flexion then they could work on the other shoulder motions. I tried to nicely explain the poor logic behind that idea. Rarely do we move our shoulder in 1 plane of motion; thus, it is very important to stretch, mobilize in all motions that are missing! I did very aggressive PROM and stretching on the patient. Then I instructed him in AAROM wand exercises that he can perform at home. The intern was impressed with how much increased ROM he had at the end of the session. I explained that really the combination of our movements are needed to regain full ROM and that is why my treatment was more effective than what they had been doing.

I'm having a hard time explaining things without being condescending! I do not want to insult them because they are trying! They are doing the best they can with the limited practical skills they have. I remember learning and struggling to feel comfortable with my skills. I still question myself so I know if someone tears you down, it can destroy the learning process. I want to inspire these therapists to continue learning. I truly think the only bad therapists out there are the ones who quit trying to learn! I guess it can be said for any profession!

The last patient I saw was a lady who had a radical bilateral mastectomy in the fall. She has finished her chemo and radiation treatments. She ended up developing lymphedema in the left UE. The intern had no clue on how to treat this lady. I explained to him that she has lymphedema and how to effectively treat it. This was something I presented last week during the course so I told the student to ask Bridget for all of her notes. Also, Bridget should him how to perform the correct treatment at the next session. The patient had her surgery in Nairobi, Kenya where her daughter is working for the American CDC as a MD. (Since Kenya was under British rule longer than Ghana, their hospitals in the major cities are closer to American or British standards.) The patient actually had printed handouts from the American Cancer Society on lymphedema after breast cancer. Since her children are doctors in the US and she was a nurse, she was very knowledgeable on the subject, but did not know how to explain it to the therapists.

The medical system in Ghana is very patriarchal. As a patient, you do not question what they doctor, nurses, or therapists know. If you do question them, they often times will refuse to treat you. Obviously, this is another problem that I cannot tackle in one trip or by myself!

Anyways, I went on to treat the patient. I did manual lymph drainage (MLD) to her and then wrapped her with compression bandages. I showed the intern and another student how to perform MLD and wrap her arm. Hopefully, my crash course education session will allow them to help the patient with her lymphedema until she settles her affairs in Ghana and can see a lymphedema therapist in the US, when she visits her children.

My whole vision or goal for my trip has radically changed. Originally I thought my purpose of this trip was to train Celestine to be a pseudo-therapist. However, seeing how much help the actual therapists need who have had 4 years of book education makes me realize it is not enough time to train Celestine. Thus, I want to help the patients in Kpando as much as I can when I go back. I will still try and train Celestine, but I'm really going to try and push for the administration at the hospital in Kpando to hire a PT. If the government is soon mandating that PTs are licensed then they will not reimburse the hospital in Kpando if they do not have a real PT in place. Hopefully, that will be enough ammunition to get them to hire one. The next thing I will do, is travel to Ho and Hohoe to do follow up visits with 2 of the therapists from the course. Both towns are close enough to Kpando that I could spend a week with each of them. It would allow me to really help them to think like a therapist. I was impressed with both of these therapists so I think they will catch on fast!!! Lastly, I want to work with the various NGOs I'm affiliated with to help establish effective continuing education courses in the future. I do not know what the future holds for myself in terms of returning to Ghana, but I can help structure the process for future volunteers, that way the therapists of Ghana can learn to be effective!

I feel this trip has so much meaning! I am helping the sick and disabled of Ghana. Also, I feel I am truly  helping shape or inspire the therapists of this country to continue learning in order to provide quality care to their patients! I know there are still many cultural barriers in the way that will keep me from impacting every therapist I meet. However, I really feel a few of the therapists I have interacted with are now better therapists because they had some training from Sam, Ken, and myself!! I think that makes this trip a success! Obviously, I have over 2 more months left so more can be done, but its just nice to know that at the 6 week mark we have accomplished something!

Love, Kari

Birthday Party

I had good intentions yesterday morning. I was going to wake up and go to Church with Sam and his brother. Church in Ghana is such a celebration with singing and dancing so I really wanted to see what a Catholic mass was like here. However, my lingering sore throat got the best of me. I stayed in bed and slept a few extra hours. I think I have a slight cold and all the dust keeps it from going away completely!

After Sam and his brother came home from church, we ate a breakfast of rice balls. The soup was too spicy for me so I did not eat a lot. The meat in the soup was too tough for me to chew, so I passed on that too. I'm quickly learning to eat only fish and chicken. Most of the meat is too tough and chewy for me to tolerate.

Then, we drove to Sam's dad's and stepmom's house for their birthday party. It was fun. It wasn't very elaborate, but I'm learning that any ceremony here must have a chairman and an MC. Also, all ceremonies start and end in prayer. There was of course dancing! Ghanaians love to dance! I took a video of all the little kids dancing the azonto. It is the latest dance craze in Ghana. There are youtube videos of it so check it out!! Also, they had a cake cutting ceremony. I was included in it! They are so welcoming to me. I'm just this random white girl, but I must be included in the most important part of the ceremony. Makes me love this country!!!

I spent most of the evening hanging out with the little kids. As soon as I took one photo of them they wanted me to take more! Then I couldn't get rid of them. Haha! They were trying to teach me tre, the language of the central region. I'm a slow learner when it comes to languages so I don't think I remember anything they told me.

Overall, it was a fun day! Anytime we drive anywhere in Accra it takes at least an hour so I was ready to get back to Sam's brother's house to sleep! My throat is only scratchy this morning! I think I'm feeling better!!!

More cultural differences:

• If you want to get someone's attention, you hiss at them
• You wave your hand side to side to say bye, if you wave your hand by bending your fingers up and down you are signaling someone to come to you (I always wave the second way so now I know why kids always walk up to me after I wave to them. They thought I was signaling them. Oops!)

Love, Kari

Used Car Parts

So if your car breaks down in Ghana, you go to the car parts market! Who knew that an entire market about the radius of 5 city blocks could be devoted to car parts. A lot of Sam's childhood friends work in this market so we went to visit them. I'm amazed at how many people Sam knows! They are all so excited to see him, too! I think I've now met more people in Ghana then I know in the US. Everyone knows everyone here, and everyone wants to be your friend! Sam said he was going to start charging the men 1 cedi to talk to me. Haha! Everywhere we turned, men started following me yelling "Abrunni (white person) I want to be your friend," or "Abrunni, you are nice." I guess not many white girls venture into the used car parts market very often. Usually its the little kids yelling at me, not grown men! Luckily, Sam has become the protective big brother I never had/bodyguard! :) I guess people from all of the neighboring African countries comes to this market in Accra for parts. There were some guys buying parts from one of the french speaking countries. Sam's friend told them he'd teach them english tonight so they could talk to me. He then told them, "You are in good hands, I graduated from secondary school." I think that's the equivalent of 6th grade.

Sam has a lot of interesting stories. He was explaining to me last night that he always loved sports and school. He could play soccer all day, so a 90 minute game was nothing for him. Anyways, most of the good soccer players quit school around 14 to focus on soccer. I guess the really good Ghanaian players on the European teams do not have more than a secondary education, if that! One of Sam's friends was a really good soccer player as a teenager. He didn't end up making it pro and so now he is selling car parts since he never got a great education. Sam loved school and still wanted to learn so he went to school and played sports. The combination of the two are the reason he is where he is today!

Once we were done saying hi to everyone (and it seemed like everyone!) we went for dinner and drinks. Two of Sam's friends joined us. One told me he build me a house and cook for me if I married him. He asked me if I had a boyfriend in Accra, I told him either the answer is no or I have hundreds! Haha! It's very flattering, but as my host Isaac said, American women are too possessive of their men, so I don't think most of these African men would really want to marry me! :)

There are still a lot of cultural things that I find interesting or amusing so I will try and list a few:

• If men turn their backs to you, it's okay for them to urinate on the streets.
• They carry everything but their babies on their heads.
• They carry their babies on their backs. They don't need babysitters here or daycare since their babies are all ways with them strapped to their backs.
• Women breastfeed their babies whenever the baby is hungry. They just sit down and whip out for the baby to feed.
• The traffic laws are just suggestions. They drive in whatever lane is less crowded or better paved, even if oncoming traffic is coming!
• A 40 oz bottle of beer is the normal size!

Of course there are so many more but my mind is drawing a blank right now!

Love, Kari

Dinner Meeting

We drove back to Accra once the course finished, yesterday. We had to make a few stops along the way. We stopped to visit Sam's uncle. Then Rev. Joel (he's been our organizer for this trip, I need to tell you more about him!!!) had us see a good friend. Rev's friend was shot in the thoracic spine about 2 years ago by armed robbers. She is now a paraplegic. Sam and I helped give her some suggestions to get stronger. We are going to try and have a slideboard made for her so she can transfer from bed to wheelchair by herself. She is an incomplete paraplegic so there is a chance with exercise that she may gain some leg strength, but I don't think she will ever have enough strength in her legs to walk again. She has been homebound since the accident. I'm hoping our suggestions will give her a little more independence in her home.

After the stops, we drove into Accra for dinner. We met with Jonathan, the vice president of the Ghanaian Physiotherapy Association (GAP). We talked to him about a lot of our concerns. Also, he helped explain to us the cultural barriers present that makes it hard to overcome some of our concerns. However, there is a lot of good things going on with GAP so I made sure to acknowledge that, too! Ghana has only had a PT program for about 10 years. Before that time, all the therapists had to get their training outside the country. Thus, the program is doing the best it can with limited resources!! They are aware of the issues that Ken, Sam, and I felt are most troubling. They are trying to find ways to overcome them!

Ken and I pleaded with Jonathan to get a PT in place in Kpando. Marquat hospital serves enough patients that it would benefit from a trained PT. Ken is going to try and talk to the administrators there to see if it can be done. Jonathan gave us a recommendation for a therapist to put in place there! There is a taskforce in place, hopefully it will be law in Ghana soon, that all therapists must be licensed. Then, someone like Celestine will not be able to provide PT services since she is not a trained therapist. Thus, I think the sooner an actual PT can be in place in Kpando the better it will be for everyone.

I feel like I have a lot of stuff to accomplish in 2 months once I'm back in Kpando. I want to continue training Celestine so she can be a quasi-therapist until a trained PT is place in Kpando. I need to visit the PTs in Ho and Hohoe to help them implement the information they learned from the course with actual patients. I want to try and help Issac some at the Special Inclusive School, even though my pediatric knowledge is limited. I would like to visit Pastor Allan and Patsy again to see their disability center where they would like to have a clinic and training center someday soon! I need to go to the Cape Coast for a small vacation!!! And, I know there are other little projects/meetings I have to take care of in Kpando!!

I think I will be doing a lot of TroTro traveling. I'm a little nervous, but it will be an adventure!!! Rev. Joel and Sam have told me I have a Ghanaian personality. I guess its since I'm pretty laid back and just go with the flow. I told them, you can't be type A in this country! You'd have a heart attack from all the anxiety!!! Haha!

Love, Kari

Success!!

I think the course was very successful! I really enjoyed interacting with the Physiotherapists of Ghana!! I'm excited to visit the clinics in Ho and Hohoe during the rest of my trip. I definitely learned new stuff from them. Hopefully, they learned some new things from us, too!

It was sort of cool this morning. I lectured on lymphedema treatment on Monday. Today, they called in a patient who has severe lymphedema for the past 8 years. The patient had a radical mastectomy due to breast cancer. We did a session of some Manual Lymph Drainage (light edema massage to stimulate the lymph system) and I wrapped her with compression wraps. I wasn't able to find any short stretch wraps so I had to use a stretchy ace bandage. The lady will hopefully get some swelling relief. Once they buy her short stretch compression wraps, she should get even more relief. There are some concerns with the treatment. There is a possibility that removing the swelling from her arm could cause fluid overload to heart, kidneys, and lungs. Thus, we had to explain this to her very well! Hopefully, her cardiac system is not compromised to allow her to get relief from lymphedema treatment. I most likely will not be able to see this patient again. The therapist treating her has my number to call me, so hopefully we will be able to problem solve if issues arise.

Right now, we are finishing up some lecturing then we will head back to Accra. I am going to spend the weekend with Sam and his family. I'm not quite ready to go back to Kpando, yet! I really want to see the conference Sam and Ken are having on Wednesday. That's my main reason for staying with Sam, but I also am enjoying traveling around and seeing more of Ghana!

I feel so blessed to have this opportunity to impact the physical therapy profession of Ghana! They have such a need for therapy in Ghana. Also, the therapists need more knowledge or more opportunity to apply their knowledge correctly! I think this trip has been the first step in meeting both those goals!! We had 9 participants in the course. I can tell that at least 2 of them really embraced the information!! I think they are learning to think of how to make treatments functional! That really is the most important thing about therapy. It does me no good to give a patient an exercise if it does not allow them to have less difficulty in their daily life. I think the participants started to grasp this concept. I really hope I can find away financially in the future to continue helping with these courses in Ghana and other countries! I love being a therapist because we have so much knowledge to allow a patient to have a higher quality of life. Now, Ghanaian therapists realize the power they have, too! :)

I hope everyone has a safe and fun weekend! I should be back in Accra this weekend so my internet will be better, again!!

Love, Kari

Cheeseburger!!!

I had a great internet connection while at the hospital yesterday and in the evening when we went to dinner with Patsy and Pastor Allan at their hotel in Kofuridua. Then once I was back in my hotel room, I could not connect so I never got my blog posted. I'm not presenting right now so I figure I will write my blog.

The course continues to go well. Yesterday, the topic was strokes. I prepared a 40 slide power point presentation thinking it would take me 45 minutes to present and it took me an hour and a half. I think everyone found it useful. It was a really good review for me!

Then, we changed things up a bit. We saw some actual stroke patients in the clinic so we were able to show how we would go about treating them. The thing I tried to recommend to the therapists here in Ghana is not to be so focused on giving them exercises but breaking down functional tasks into exercises. One patient said he was having difficulty rolling in bed, so we spent the time teaching him how to roll and sit up in bed without help. The concept seems so simple, but I guess if I wasn't taught these things in PT school, I wouldn't think of doing stuff like this for treatments.

After lunch we went to the children's ward. There was a 1 year old in the ward who had malarial meningitis. The prognosis is not good for this child. This child was presenting with excessive extensor tone and abnormal reflexes indicating central nervous system injury. Sam and Ken talked the therapist through treating the child to try and decrease tone. The child had been in this condition for over a month so the joints were so stiff that it was extremely hard to break the tone and spasms. Unfortunately, at this stage there was not much we could do for the child. Most likely, the child will not survive this. If the child does go on to survive, she will have severe mental and physical problems. Pediatrics is not my area of expertise and I find it very hard to treat sick/injured children. They are innocent little beings. Its hard for me to see them suffer, especially when there are no resources available to help the child. I just hope that they are not in pain, and that God takes them to a better place if medicine fails them.

I have to keep things in perspective. I will never be able to help everyone, but I am helping people. I focus on that when I see situations like the little girl is experiencing.

For dinner, we went to the Capitol Hill Hotel where Patsy and Pastor Allan are staying. Since their organization is helping sponsor the course, they wanted to see how it was going. They treated us to dinner. I had a cheeseburger!! I don't mind the food here in Ghana, but it is completely different than any food I've ever had. I definitely miss American food so I've been indulging the past 2 weeks when its been available. The cheeseburger tasted good, but Ghanaian beef tastes nothing like American beef. The cows are too skinny here! Haha!

We have a day and a half left of the conference! I hope Ken and Sam are successful in finding funding so they can continue educating the therapists in Ghana on subsequent trips. If anyone would like to help their cause, please contact me and I will get you in touch with them!

Love, Kari

Day 2 of Continuing Education Course

I didn't really do a lot today. I sat and listened to Sam and Ken present on Neck and Back Injuries/Pain. Also, I finished putting together my stroke presentation for tomorrow. I helped a little with demonstrations in the afternoon so I guess I wasn't totally useless. :)

I'm sort of enjoying all of the reviewing of material trying to put together my slides. This trip has really forced me to review my anatomy and kinesiology a lot to make sure I am not telling the PTs incorrect stuff! Maybe I should do some teaching after all. I think I doubt my abilities too much sometimes.

I'm really impressed with the bunch of therapists we have in the course. They are very inquisitive and have interesting ideas on how to approach certain treatments! I hope this course will help them a little more with applying the book knowledge to treating patients. Therapy is very much an art. Unlike medicine, we cannot give all patients the same treatment for the same problem. Often times patients will have the same exact diagnosis. However, as therapists we will create a completely different treatment plan for once patient compared to another since the patient responds totally different to one exercise then the other patient. Its been really hard for me as a therapist to understand this and develop effective treatments. Without good mentoring in school or when you finish school, these skills may never be established if one does not have a good mentor. I hope we are helping them establish good treatment skills!!!

Two of the therapist at the course are from the Volta region. I am planning on visiting their clinics over the next 2 months to help them problem solve on tougher patients. I hope I will be helpful. They see such complex things here. A lot of the injuries they see are due to how hard labor is for the women here. The babies have difficulty getting through the birth canal and so they end up with Cerebral Palsy or Nerve Injuries. While in the US, cerebral palsy is a common disease, we treat it much sooner and have therapists following the patients as babies. A lot of the nerve injuries like Erb's Palsy are rare in the US because the doctors do C-sections on high risk women. Most of the women here never even see a doctor during delivery. They deliver at home or have a midwife present. Only if there are complications does the doctor get involved. At that point, the damage may already be done. I'm not trying to put down midwifes, but we just have more diagnostic equipment in the US or faster response times to alleviate problems.

That makes me think about a car accident we saw yesterday. I guess a trotro (minivan bus taxi) hit a motorcycle with 2 passengers. The motorcycle was weaving in and out of traffic on a very windy mountain road. The trotro driver said the motorcycle ran into them. The trotro ended up in the ditch and the bike was laying on the side of the road. Ken passed the accident before Sam and I so he stopped to help. The 2 motorcyclists were laying on the side of the road bleeding. No one was helping them. People were just standing around. Ken stopped and tried to stop the bleeding and get a taxi to take them to the hospital. The taxi cab driver was more upset about the blood that would get on his car than the fact that a man was going to die if he didn't get help fast! By the time they got to the hospital, both motorcyclists had died. Had there been 911 or EMTs they people may have survived. Its just such a different mentality here. Traffic accidents are very common. There is no emergency response team and so I guess people do not really think about trying to get them to the hospital.

There is so much basic training that needs to be established here. They've come along ways. Every pregnant woman gets HIV testing. They now know not to reuse needles. So progress is being made. I think seeing what has been accomplished in the past 10-20 years keeps me from getting discouraged. The change does not happen over night, but it can happen!!! I think that makes this trip so exciting and worth it!

Love, Kari

I've been in Africa for over a month!!!

I can't believe a month has already gone by!!!

The past 2 weeks have been so different than the first couple! I have been travelling around with Ken and Sam of Step FaR. Last week, I posted how we were at Tema General Hospital. This week we are at Koforidua General Hospital. This week we have organized a whole continuing education course. I was not prepared at all for this and so I spent most of this past week creating presentations to give to them! Day 1 went really well! I demonstrated a lot of core and abdominal exercises in the morning. We are on GMT (Ghana maybe time), so the course did not start until 10:30 even though it was suppose to start at 9am! We didn't get there until 9 am since our driver also follows GMT! Haha! I am always on time so its such an adjustment for me! The world doesn't end if I'm late, so I'm learning to just let it go. There was 3 times where I tried to get the course started this morning since I was sick of waiting. :)

When I wasn't preparing this weekend, I traveled around with Sam. We stayed at Sam's brother's place in Accra. Traffic is horrible in Accra. A 20 minute drive in the US takes an hour and half since the roads are so bad and there are so many cars! We also went up into the mountains to visit his parents. We were in the coldest part of Ghana. It would probably be a hot summer day for most Midwesterners. Haha! I met Sam's grandma. She was such a feisty sweet lady! She was a teacher and still knows American geography. She could list all the major cities and Great Lakes. I don't think most Americans could do that! I really enjoyed Sam's area that he grew up in. It was in the jungles and hills! Also, it had a nice breeze. If I had a swimming pool and a cold beverage, I could have stayed in that area for forever!!! The towns are neat too! The first white settlers went to that area since its cooler, so I think the villages were probably planned off of European towns. The car ride was a little scary. I'm adjusting to that too, just like GMT time! Haha!

I'm getting spoiled right now. The guest house we are staying at this week has running water with a water heater. Sam's brother had running water. Also, my internet works well in Accra. I think Kpando will be an adjustment all over again. I miss my African family, though.

Funny event of today: We were driving in the town of Koforidua to our hotel at the end of the course, and completely naked Bush Man was walking around. He looked like the men from photos a 100 years ago. No one made a big deal about it. I think he's sort of like the homeless in the US. More often than not, they have untreated medical illness and slip under the cracks.

Then not so funny, 10 feet from him was a lady with a goiter the size of a grapefruit! I'm assuming she has untreated thyroid cancer/disease since most of the spices have iodized salt in them. We take for granted in the US how amazing our medical care is. I've already seen so many things in here that if you lived in the US, would have been medically managed at birth or in childhood. Most Africans do not think malaria is a big deal, but it kills more Africans than AIDS every year, so it is a really big deal!!!

Tomorrow we are presenting on back pain and injuries! I did most of the talking today, so tomorrow I'm just assisting. My throat is very dry so I'm okay with taking a back seat!!

Love, Kari

If you give a mouse a cookie, he will want a glass of milk...."

I spent most of today in a car!! The traffic is so horrible here that it took us over 2 hours to get to the town where we are holding the course next week. Sam said the drive use to only take 45 minutes!!! Luckily, it was a really pretty drive. We drove north of Tema and Accra into the mountains and jungle! When its not so hazy, you can see all the way to the ocean, supposedly.

Ken went back to Kpando with his wife and I stayed behind with Sam. Sam, Reverend Joe, Shariff (Ken's cousin), and myself all drove to Kofidra (I'm spelling that wrong). We went to the hospital where we are holding the course. We met with the lead PT and the medical director. I feel like we can't even step foot in any of the hospitals without first meeting the director and administrator!!! It's sort of like having to go to the village chief! Haha! Also, we checked out the hostel where we will be staying next week. This hospital is actually paying for our lodging!

It has been interesting spending time with Ken and Sam because I've learned a lot about Ghanaian culture through them. Since they are so Americanized, they explain to me the idiosyncrasies. Ghanaians are more than willing to accept foreign aide and almost expect it, yet they are sort of stingy if you ask for a little help. Once someone has money in this country, they do not have the same desire or need to give back. Sam was telling Shariff how I am a Doctor's daughter and here I am in Ghana giving 4 months of my time. Shariff said in Ghana I would just be spending my dad's money trying to show off how rich I am. I told him that I was raised very well, but I do not expect my father to provide for me anymore and that his money is not my money. Shariff found this very interesting and wished more Ghanaians would embrace this idea. Instead many accept the gift you give them and then ask you for something more. It reminds me of the children's book, I think it's called, "If you give a mouse a cookie." Haha! It's funny. I take it with a grain of salt. For the most part the one's in need are so appreciative, but the few bad apples sometimes spoil the bunch.

It has been fun getting to know Sam the past couple of days! He is a very interesting guy!! He is an Olympian. He ran track for Ghana in the 2000 Olympic games. I think he is the first Olympian I have personally met! Through track and being involved with the paraolympics, he got a track and soccer scholarship to the US. His school was in North Dakota. Sam was talking about the customs official he encountered when he got off the plane in the US. He was expecting her to ask him a lot of questions instead she just told him that it would be really cold in North Dakota. Sam told her, "It's okay, I live in the coldest part of Ghana." Little did he know!! Haha! The record low temperature in Ghana is 60 degrees.

Sam had a lot more stories about the cultural shock he experienced! Now he lives in Corpus Christi, Texas with his wife and 2 little girls! Ken lives in Arizona. I guess they both escaped North Dakota as soon as they could. I told them North Dakota is even too cold for myself and I like winter sports!

I hope everyone has a good weekend. I'm not entirely sure what I'm doing. It always ends up being interesting in some unexpected way! :)

Love, Kari

Tema Hospital Day 3

Today, I spent my last day at Tema General Hospital with Kenneth and Samuel of Step FaR. The day went much like yesterday where we spent the morning working side by side with the therapists and then gave them a brief inservice in the afternoon.

I saw interesting patients today, too! I was in the gym area today. I worked with Prince, one of the intern P.T. students. I sort of gravitated towards him since he was young and impressionable. He was a sponge and very eager to learn!! Some of the actual Physical Therapists seem to just throw their workload off on the students in the clinic or therapy technicians. That was a little discouraging. However, Prince was very anxious to apply his book knowledge to patients. He came up with a lot of good ideas, but needed guidance to make them safer or more appropriate for his patients. I kept thinking while I was working with him, he would become an excellent therapist if he just had a good clinical instructor. I'm realizing these therapists have good book knowledge but have never had good mentoring to apply the knowledge to treating patients. The Ghana PT school requires a year long internship before they graduate. In the US, it would be sufficient amount of time to become an entry level therapist; however, the practicing therapists themselves have never really applied their book smarts well and so they do not know how to mentor or train the students. Thus, I think they are in a vicious cycle. Hopefully, Kenneth and Sam's organization will take off and allow more continuing education and mentoring opportunities for Ghanaian therapists.

I'm so glad Village Volunteers, one of the organizations that helped me come to Ghana, had pre-volunteer packets. The information in them about not expecting too much has been very helpful in making me have realistic expectations for my trip!! It could be very easy to become discouraged. I know I can not change the system with this one trip, but I may help change one therapist (maybe Prince)! By changing that one therapist's mindset on how to appropriately treat patients, he may train a few more allowing a turn around in events.

After spending the day at the hospital, I returned to Pastor Allan and Patsy's home. They are the missionary couple that opened their home to me!! It's funny because I specifically chose Therapist without Borders Organization because I did not want to do missionary work, but I can't help but feel blessed to have met this wonderful couple! I'm not sure where I stand with religion at the moment. I have my own beliefs, but I have no desire to force my spiritual beliefs upon other people. It's amazing though how moved you can feel by spending time with a couple who's lives are so influenced by their faith! Whether you agree with missionary work or not, the help and happiness they provide to Ghanaians is amazing!!

I will go into a little more detail about Pastor Allan and Patsy. Allan owned a oil drilling company in Colorado. Patsy and Allan went on many mission trips prior to moving to Ghana. I guess about 17 years ago they decided to sell everything and come to Ghana and do missionary work. They were a very well off couple in the US. They had every material possession imaginable, but still felt like something was missing from their lives. They originally were just doing traditional missionary work trying to convert people; however, somewhere along the way they started working with "Joni and Friends," a faith based Christian organization that provides wheelchair and adaptive equipment to people in need around the world. Allan and Patsy have become a huge advocate for people with disabilities in Ghana along with being missionaries! Also, they help drill holes for water so people in Ghana can have clean water. The money they charge to drill helps maintain their faith missions and equipment acquisition. Allan and Patsy have some crazy stories of things they went through in their 17 years in Africa. They have become very ill with malaria, typhoid fever, parasitic infections! They had guns placed to their heads. That's why I admire their faith! If I went through all of that, I'd be out of Ghana in a heartbeat!!!

I'm learning the desire to volunteer does not end after one trip! I'm really excited to be working with Ken and Sam and meeting Allan and Patsy because I will have more opportunities to continue my volunteering in Ghana in a few years, hopefully!!!

Tomorrow, I am going with Sam to our next training site to set it up for next week. Our plan for next week is to run a week long continuing education course! I did not know I'd being doing public speaking on this trip. I hope they have a microphone since I have such a quiet voice. I'm going to be doing a lot of "winging it." If I would have known back in the US this was the plan, I would have prepared power point presentations and done more research. Oh well, this too will be an adventure!! I feel so powerful in a way. I have a chance to influence the entire P.T. profession in Ghana with the programs we are putting on over the next 2 weeks. GTV (Ghana Television) is coming to one of the conferences!!! Please send your positive thoughts, prayers, and support my way so Ken, Sam, and I can do a good job! About 10% of Ghanaians are disable so they really need quality physical therapy. I want to help with that!!!!

Love, Kari

Tema Hospital Day 2

I went back to the Tema General Hospital today with Kenneth and Samuel of Step FaR Organization. We each split up again with the various therapists and observed treatment sessions. We gave our input when appropriate and often ended up taking over the treatment sessions, even though that was not our goal. The therapist seem to have the knowledge, they just do not have the training or mentoring to treat effectively. Next week, we will be running a continuing education program at another General Hospital, so hopefully we can help them put their book knowledge to use better!

I saw some very interesting cases! A little girl around 4 or 5 years old came into the clinic. She had foot drop, meaning her anterior tibialis muscle is paralyzed at the moment and so she could not bring her foot up into dorsiflexion (towards your head). Her foot just flops down into the pointed position. The little girl had malaria a month ago. She was treated by an injection in her buttocks. Either the malaria medication damaged her nerve or they hit the nerve when they injected her. The therapists were trying to use electrical stimulation to help get the anterior tibialis muscle firing again. That is a very appropriate treatment. I made sure to let them know that. The problem was their electrical stimulation machines are very old with huge electrode pads inside wet sponges that you strap to the arm or leg. Since the little girl was so tiny the electrodes were too large to stimulate just the anterior tibialis muscle; thus, we ended up also stimulating the calf muscle that causes plantar flexion. Plantarflexion is the motion we were trying to avoid. I think for a while we had some dorsiflexion and so I let the therapist know that it was an appropriate treatment to continue for another month. After a month if they do not notice any active dorsiflexion, they need to consider bracing the girl with an ankle foot orthosis (AFO) to allow her to have a more normal walking pattern.

Shortly after treating the little girl, we went to the maternity ward. We saw 2 patients who gave birth a few days ago. Both were complaining of severe pelvic pain and had severe leg weakness. The doctors labeled it as paralysis. The doctors feared their nerves were damaged from giving birth. Kenneth and I after our examination felt they were just in severe pain and may have had damage to their pubic ligaments and tearing in that area from childbirth. Hopefully, with good pain management and gentle strengthening exercises they will return to normal walking. They did not have any sensation issues, bowel or bladder incontinence, or weakness from neurological damage to indicate nerve injury, luckily.

In the afternoon, Kenneth, Samuel, and myself gave a short in-service on safety and patient positioning. It was very basic information, but stuff that will allow the therapist to conduct safer and more efficient treatment sessions. I think they were pretty responsive and some had great questions! While we only have 3 days with the staff at this hospital, I think if they took away just 1 or 2 things, they will hopefully be better therapist.

The Ghana physical therapy program has a long long way to go!!! There are so many barriers that make it hard to treat patients; however, hopefully future volunteers and us will allow some of the roadblocks to come down.

Patsy and Pastor Allen, the missionary couple I’m staying with this week, just made a wonderful pot roast for dinner! It was so nice to have an American meal. I’m really getting spoiled this week!!! I get to take showers with hot running water. My room had air conditioning last night! I shouldn’t get too use to it since I will have over 2 months in Kpando before I have conditions like this again! It’s amazing how much the littlest things make you happy after you’ve gone without them. I feel so blessed that I’m getting the opportunity to go on a trip like this. I get to help people who truly need it, but I’m also learning what is truly important in life.  Please, if you learn anything from my experience, we have such a good life in the US! Do not take it for granted. Tell your family and friends you love them. Do not fret about the small things. Lastly, realize that it’s the people who you love and love you that matter, not your things!!!

I’m staying with a missionary couple, it’s only right that I get a little preachy! Haha!!!

My internet connection is better right now. However, it is still taking too long to upload on blogger. Friend me on facebook and you will be able to see a few photos!

Love, Kari

Tema Hospital

I woke up at 3 am this morning to drive to Tema, Ghana. Tema is just outside the capital city Accra. Kenneth, his family, and I had a 3 hour drive to the General Hospital. We arrived early enough to have a quick breakfast before meeting with the staff at the hospital.

I’m realizing there are many communication problems with the programs. I think it’s probably due to cultural differences and then Ghanaians like technology but they just have not mastered email communication yet!

The P.T. department thought we were going to arrive yesterday, and we were told no one would be at the hospital due to the New Year holiday. Also, they thought we were here just to deliver equipment. We actually have very little donations to provide and instead are donating our time and knowledge.

We got it all straightened out luckily and they are still very happy we are here. We broke off, where each one of us shadowed and Ghanaian therapist. I mainly spent my morning with the therapist that was doing initial evaluations on patients. I sat with him for 2.5 hours. I only saw 1 full evaluation and the start of another eval. People were constantly interrupting him and so the eval took forever. The therapist seemed to have pretty good P.T. knowledge! He was trained at the only Ghanaian P.T. School. He appreciated my insight.

The first person we saw was a lady who had a partial hip replacement 7years ago after a motor vehicle accident. Over time her acetabulum (hip socket joint) wore out from a too large prosthesis being placed at the femur (thigh bone). The revised her surgery and had a total hip replacement. The x-rays showed a much better ball prosthesis for her socket size. I’m assuming they probably only had 1 prosthesis size 7 years ago, and not that it was doctor error. It seems like they rely on a lot of donations so something a lot of times is better than nothing.

The next patient we saw was a stroke patient. She had a recent stroke. The therapist had to leave the room so I went ahead and got started on the evaluation. I then was shortly ushered out of the room for a ward tour. They have 9 wards, but rarely get referrals from the doctors to see patients and so many people just lay in bed all day even though they would be excellent therapy candidates. Tomorrow when we are back at the hospital, we are going to try and do a lot of education to help them make their case better to the doctors. Once the doctors here realize that P.T. helps their patients recover faster, I’m sure they will start to embrace it. However, that takes much time!!

Afterwards we went to lunch that turned into dinner since they were so slow!! I am staying with an American couple that has been in Ghana for the past 17 years doing missionary work. Once I learn more about their organization, I will write more about it tomorrow night. They have outfitted their home like an American home so I am very excited to sleep in it tonight!!! She made us a delicious lemon cake! It was so nice to have American food!!

I do not want to be rude to my hosts so I am going to stop writing now. Tomorrow I will try and elaborate more on the Tema P.T. program and my host family for this week.

Love, Kari

Volta Lake

I am in Eastern Ghana just east of Lake Volta. Lake Volta is one of the largest man made lakes in the world. I have been able to see it while driving, but did not get a chance until yesterday and today to walk the shore. The water is very dirty so unless I want a parasite I cannot swim in it.

Yesterday afternoon, I went with Millie and her cousins to the village of Torkor. Torkor is a fishing village about 5 minutes west of Kpando by car. Since it was New Year’s Day, the village was dead. I guess even the fisherman take New Year’s Day off. The shore was pretty but since it is being dry season the haze was so thick that it was hard to see across the lake. The lake was pretty wide here, but since I couldn’t really see well I’m not sure how wide.

We were walking the shores and a man started yelling at us. We went to talk to him to find out what he wanted. He supposedly said we entered a customs port. There was absolutely no signage or anything to indicate it was a customs area. After talking more with him we found out that we were at a naval headquarters, and that all foreigners are suppose to report there when they go to Lake Volta. He said the government wants to know if a foreigner is on the lake in case they drown. I didn’t bring my passport with me, oops. So he was not very pleased with me. I guess I will make sure to carry my passport with me whenever I leave Kpando. On my longer trips, I have brought it with me, but when I’ve gone on short drives I’ve left in the security of my locked room. 

After talking to Kenneth today, he informed me that the naval officers are now at that port to prosecute human traffickers. CNN recently had an article on boys being sold into slavery and being forced to fish on Lake Volta. I think Oprah may have also had a show about the slavery on Lake Volta. I learned my lesson to be better prepared when I leave the home! I’m glad the Ghanaian government is trying to stop human trafficking.

Today, I went back to see “Aunti” with Kenneth. We wanted to make sure she was getting comfortable with the slideboard transfers. Also, we made a block for her to place her feet on when transferring so they would not get so tangled up in the wheels. She said her family is no longer lifting her into the chair and that she is doing the slideboard transfers!! I will continue to check on her and make sure things are going well.

After the home visit, Kenneth and his wife took me on a scenic drive through the countryside. We stopped at Lake Volta, but at a different village. We were at a little inlet of the lake, so its shores were very pretty here. I didn’t have my camera with me since I didn’t know I was going for a drive when I saw Kenneth. Boo! I need to start carrying my camera everywhere too! 

Now that I know how close Lake Volta is to Kpando, I plan on visiting it again during the wet season so I can see more of it! There should be less of a haze in the air in February after the first rainfall.

Tomorrow, we leave at 4 am to start our training around Ghana at various hospitals. I’ve been anxiously awaiting this!! Ghanaians love their holidays, but I’m afraid I’ve become restless the past couple of days. The plans for the visits with Kenneth are to work along side local therapists and help train them in whatever way we see fit.

This is Kenneth’s first trip with his organization so he is still trying to work out the details. Luckily, I’m a very patient person so it hasn’t been an issue for me that things have been delayed some. Well other than I still find the slowness of life here a lot to handle. I think for most Americans, it would be the thing hardest to adjust to here. I am use to my bucket showers and the toilet issues! Obviously, the poverty is still hard to handle. I don’t think you ever get use to that. I have just realized that despite the poverty, Ghanaians are overall a very happy and optimistic society!!

I’m bringing my computer with me tomorrow but I’m unsure how well the modem will work, so if you do not see a blog for a few days, don’t worry! I will definitely be able to post this weekend, so make sure to check then if you don’t see anything this week!

Love, Kari