"I may not have gone where I intended to go, but I think I've ended up where I needed to be"- Douglas Adams

There is really no adjective or string of words I can jot down that will truly describe this weekend. So, I'll write down what I can, hoping that I can paint a picture of what a joyful time I had at Lake Bosumtwe. 

Several people and websites recommended a place called 'The Green Ranch' on Lake Bosumtwe. This is the only natural lake in Ghana, a crater lake about 45 minutes outside of Kumasi. A French woman named Elodie owned the ranch and had rave reviews from several visitors. I had been in contact with her through email about my upcoming weekend trip, and she sent me an email describing the ranch, meals, and riding choices. She listed the options which were basically per hour of riding in the area. But an option at the end of the email caught my eye. She advertised it to me as a trip for the 'adventurous spirit'. It was a nine hour ride and hike around the entire lake. She warned about the strenuous ride and heat, but did say it was a lovely way to see all of the villages around the lake. So as usual, I bit off probably a little more than I can chew, and decided I was in for the long trek. 

I arrived at the ranch Friday afternoon. Those who had been in contact with me the days leading up to this knew what a state I was in prior to going. I was slowly starting to unravel after two weeks in Kumasi. I sure picked a busy and hectic African city to visit for my first trip alone! The constant honking of cars, traffic, dusty air, and non-stop suitors made me want to lock myself in my tranquil guest house for a few days to decompress. I had been here for exactly 14 days, and I was really beginning to get stir-crazy. I sighed in relief as I stared out the window in the taxi on the ride to the lake. We slowly made our way out of busy city. I felt my shoulders relax back in the seat, and I instantly felt better watching the car take the windy road through the mountains. 

The ranch was beautiful! What the rooms lacked in comfort and AC, the ranch made up for with its perfect location in the hills overlooking the lake. I really could have just stayed at the ranch without riding and been perfectly at peace. But then what kind of story would I have to tell?

I was met by Elodie's Ghanian husband Kojo, and their 1 year old son Simione. Elodie arrived a little later with two guests after an afternoon ride. As soon as I saw her, I knew I was in the right place. She climbed off of her horse and made her way to greet me, a wearing a tye-dyed smock and a beehive of dreadlocks piled on her head.  With her were two British women taking a vacation in Ghana. There was also a young Australian girl, Zoe, who was about 17 and studying to be an equestrian nurse. Zoe's father is working in Ghana, and she came to volunteer at the ranch and gain some experience. We all showered and had dinner together on the large porch overlooking the lake. It was so wonderful to have such good company that evening. They were all such strong women who had done so much traveling in their lives and were so encouraging of my own journey. I was paralyzed in awe listening to them tell their various stories. It was a moment that I knew would be monumental and I would tell later in my life, maybe when recounting my various journeys with new friends.

The next morning we ate breakfast early, and set off on our ride at about 8:30 am. I had no idea what to expect when I climbed up on my horse. Elodie had packed picnic lunch, lots of water, and several machetes to cut down the bush. We climbed up on the horses and set off! And then all of a sudden I was galloping on the horse through the jungle with the sound of African drums playing in the distant villages. All I could think was, "Oh my god, please don't let this be a hallucination from my anti-malarial medications. And if it is real- please don't let me fall off and die before getting to tell someone, ANYONE about this!". It was definitely the most amazing thing I have EVER done, and could quite possibly be the coolest thing I'll ever do. I know life will bring me many joys, but how does it really get better than this? There we were, a French, Australian, and an American woman all riding and spending the day exploring the Ghanian jungle together! It was like a dream!

We rode through the forest and villages surrounding the lake. People came out to watch us ride through in each little village that we visited. The children would smile and excitedly scream 'OBRUNI OBRUNI!!' which means 'white person' and march behind us singing until we had riden back into the forest. Everyone was excited to greet us, and happily shouting "Akwaaba!!" which means 'welcome' in Twi.

We rode down by the lake, letting the horses cool down and stopping for lunch. I was taking a bite of my sandwich and felt like someone was staring over my shoulder. I looked back and there were probably at least 10 children standing about 2 feet from me watching me eat. They stared in awe and I couldn't help but laugh and shout "me pow chow" (means please/I beg of you). I felt like a zoo animal! They backed up maybe 1/2 a foot and giggled as I threw my hands up, laughing as well. I had my own little paparazzi crew!

The lake is very sacred to the local tribes and villages. They believe that the spirits of the dead come to say goodbye to the God Twi here. Because it is so special, no motorized boats or metal boats of any kind are allowed in the water. They are only allowed to use Padua which are wooden planks/boats. It was fascinating to watch the men sit out on the boats, balancing themselves perfectly. They used their hands, cups, or a stick to glide through the water, pulling up their fishing nets, and collecting the fish in baskets. 

I didn't realize that the day included a hike as well :) There were intermittent periods of climbing some steep hills through the mountains.We hopped off our horses, dragging them behind us, as we crawled red-faced and out of breath to where we could get back on. When going down the mountains  I could only pray that the horses didn't slip and fall behind me, dragging me down the mountain in an avalanche with them. But the horses knew the trail well, knowing each step to take up and down the mountain, and we all made it safe and sound!

We returned to the ranch around 6:30, showered, and enjoyed another wonderful night together! Elodie and I shared a beer as I poured my heart out to her on the porch. She listened to all of my fears, frustrations, and worries about my work in Kumasi. I was frustrated with the lack of organization within the program, and the cultural barriers that made communicating sometimes difficult. I want so badly to have made some type of difference when I leave, even a small one. She smiled and nodded and I instantly felt better. I just needed someone to HEAR me, and really understand how difficult it can be in a country that is not your home. To come in as a young woman, trying to teach people who are older and not as accustomed to a young female coming in and instructing them.  Everyone has been so kind and welcoming, but I've never wanted to 'step on anyone's toes' or be disrespectful because it is so important in this culture to respect the elders in the community. But all the while, I see a lot of changes that must be addressed for a patient's well being, and sometimes that means I have to stop someone, and explain that there is a safer, and more effective way to be doing something. And a lot of times it is something that they have been doing a certain way for a long time. It's been hard to balance this need to improve patient outcome, while also respecting a culture that I am still trying to learn and understand. There is a quote by Bono that I LOVE and try to live by that says, "Where you live, should no longer determine how long you live". I believe this to my core, and no matter what road I may take in my career, I want to be always working towards this goal. It's not an easy thing to accomplish, but I really believe that through education and empowerment of nurses to take control of their knowledge and increase their autonomy, we can achieve a better quality and standard of care globally. 

It was a magical weekend! 

At least I knew this wasn't going to be easy

There is a scene from the movie Gone With the Wind where the character Scarlett O'Hara is working in  the military hospital in Atlanta during the Civil War. In the scene she is hot, sweaty, and overwhelmed with death and dying. After witnessing one particularly gruesome amputation, she runs out of the hospital, stating that she has had enough. Today I felt like Scarlett O'Hara in that scene. The excitement of being in an ER in Africa has slightly worn off, I've learned my way around, and I'm starting to see how little resources they have here. Don't get me wrong- this is an amazing experience, and I'm quite sure that it has been a major turning point in where I want to go in my career. But it definitely hit me that while KATH has come a long way, they still have a very long way to go. And I can't sweep in for three weeks from Atlanta and change everything, save everyone's life, and fix the problem. It was a humbling experience.

Last week I hung around the RED unit where the most critical patients are located. The care still needs a lot of improvement, but it is more organized and there are less patients than the ORANGE and YELLOW units. Today I rotated around all three of these areas, helping the nursing students assess the patients, give medications, and question the physicians regarding care. I'm not sure how to describe ORANGE and YELLOW other than large rooms with stretchers crammed in every corner in no apparent organization. It's hot, dirty, and people are really really sick. Labs may or may not have been drawn, medications may or may not have been given, hell- the patient may or may not be alive. My anxiety level was at an all time high. Every chart I opened had several things that were not addressed: High blood sugars, low blood pressures, altered mental statuses, etc. I finally had to take a step back and realize that I am not God. I cannot control the amount of resources this hospital has, and how they allocate them. But I can do my best to work with the nurses so that they can better care of patients in this environment.

I recognized that there is a bit of missing piece when it comes to the nurse's assessment of their patients. The patient is seen initially by a triage nurse, but after that there is no clearly defined assessment tool to continuously re-evaluate the patients' status. The nurses are wonderful about putting in IV lines, starting IV fluids, placing a catheter, putting on oxygen, etc. initially, but they seldom come back and re-assess, put pieces together, and trend vital signs. A lot of this has to do with the number of patients vs. the number of nurses. There are also very little resources. Everything is re-used, oxygen tubing, URINALS, thermometers. A quick spray of some alcohol and it gets passed along! But they have no choice! And they are doing a great job with what they do have. Taking this into consideration, I've started working on some assessment tools for the nurses. Just a few pieces of paper that I hope can be implemented into their charting system, or lack there of, so that they can better detect a patients' decline. More often the not, the patients are in such bad shape when someone finally recognizes it, and there is little that can be done to save them. It may be a futile effort, but I want to at least give it shot!

On a more pleasant note- I've been really enjoying Kumasi. I've had several walking tours with friends I've met here. I'm much more comfortable walking around, and have not been lost once in 4 days :)


How I first felt in Kumasi:

How I felt today:

And now for a few pictures from dinner!

Still quite hot!

Hello all! I am settling into my cottage in Kumasi quite nicely. I'm still adjusting to the time change. The four hour difference isn't horrible, but when 8 am feels more like 4 am, no amount of breakfast could taste as good as sleep feels. It barely takes 2 seconds of my alarm ringing for me to make the decision to enjoy a protein bar for breakfast instead of leaving the comfort of my air conditioned room.   However, tomorrow I will have to wake up to be at the hospital by 9, so I will get to enjoy the hotel's breakfast!

I promised myself that I would brave the Kumasi city streets yesterday. My laptop charger would not fit into one of the 20 adaptors I brought, so I decided it would be a perfect reason to head into town. I approached the front desk of the hotel to ask for directions. There is a very helpful young man who has been at the desk the past two days. He rummaged around, looking for adaptors that the hotel may have had for me to use. Unfortunately, these did not work either, and we decided a new charger would probably be the best. He offered to send someone out to find it for me! I have to admit I'm still taken aback by how helpful everyone is here.  I cringe a bit when anyone here calls me 'madame'. Good God- I am CERTAINLY not a 'madame'! However, I try ignore that uncomfortable twinge and be as appreciative as they are generous. The young man gave me directions into town. I had no idea where to go but I figured I'd at least give it a shot! Thankfully, as I walked along the busy, hot streets another friendly young man stopped me to talk. His name is Ratty, and he is a student and artist in Kumasi. He asked if I would look at his paintings, but I explained tried to explain my situation with the charger and my anxiety about finding a way to use my computer. All of my lectures for the nursing students are on here, and I was going to be lost without having it. Well, Ratty took me under his wing and escorted me into town to a local shop where his friend sells electronics and accessories. It was another busy, dusty street with shops taking up every inch of space. I don't know how anyone finds anything because there is just so much STUFF. His friend was very helpful, and ended up finding me an adaptor that would work. I was so thankful that I didn't have to purchase another expensive charger! They pulled a chair into the maybe 5ftx5ft covered store and let me wait until they made sure the charger fit, charged my laptop, and that the electricity was converting correctly. I was very appreciative as a fried computer would have been about as useful one with no charger. My new friend Ratty walked me back. I said goodbye and thanked him, and promised to come back so he could give me a drum lesson!

I went back to the hotel and enjoyed some delicious chicken kabobs! I wondered if any of them were family to the chickens that frequent the grassy area behind my cottage? At least I know its local and free-range.

After lunch I decided to go for walk and try to take some photos of the town. While snapping a picture I heard some giggling behind me. Four little girls made their way from behind a tree and introduced themselves. They asked if I would play with them, and although I wasn't sure if I really knew how to 'play' anymore, I couldn't say no! The girls ended up being much more interested in my camera. They took pictures of each other and myself for a bit, all giggling as they showed each other the shots they had just taken. But after about 30 minutes the heat began getting to me, and I headed back to the hotel. I looked at the photos when I got back and felt silly for almost crying! How happy I looked! I had forgotten what that eyes closed, noise squished laugh of mine looked like! I was so pleased that I had already found a bit of joy so early in the trip.

Today I ventured to the hospital. Directions were easier to follow this morning, and I think I'm beginning to get an idea of the city's layout. The walk was only about 10 minutes, however the street was much more impoverished than any other I had been down. You must first walk through a large gate where the Army barracks are. A handsome armed guard stood at the gate with a strikingly large machine gun. Well, I'm not positive it was a machine gun. I've only seen about 2 guns in real life. But from war movies and what not I put together that this was some sort of machine gun-ish contraption. I walked through the gate and along buildings with soldiers in their camouflage walking around. How do they stand this heat with all those clothes? The back of my hand is almost permanently attached to my forehead in a sweeping motion, wiping the sweat off of my brow before it stings my eyes. But they stand so composed in their full set of clothes. The hospital is surrounded by a large gate with guards as well. People sit around the gate selling water, fruit. Some are just sitting, leaned up against the hot iron fence. What a walk! It only made me nervous about what I would find inside the 'Accident and Emergency' Department at the Komfo Anoyke Teaching Hospital or KATH.

I am thankful that my contact person urged me to visit the hospital today, before starting tomorrow. I walked inside and immediately forgot all complaints that I once had about my own emergency room. The foyer around the main nurses station had about 20-25 stretchers all over the place in no apparent organized form. I greeted the nurses at the main desk and they showed me where I could find the Charge nurse to introduce myself. He was in the 'triage' room and although nervous to enter and interrupt, the other nurses encouraged me to go ahead in. Inside he was attending to two different patients. There was an older women, very cachectic, lying in one stretcher, and a crying infant in another. There may have been nothing wrong with either of them but I think the newness of all of it threw me off. I wish I could describe how I felt standing there in what we ER nurses call 'controlled chaos'. I wasn't afraid. It was almost more of desperation to give all that I could in these three weeks. Was my lecture strong enough? Was I going to be able to actually contribute to this project? I've only 2 years of experience as an RN under my belt. What if that wasn't enough? I kept the greeting quick, and made my way back to my hotel where I began furiously working on my powerpoint. I've sense spent the day writing and re-writing my lecture, attempting to make it simple but full of as much information as I can squeeze in. Thankfully this first week I will only be in the hospital setting. I can't imagine what I will be able to supervise tomorrow. I'm sure it will take a few days to get adjusted. But I'm glad I'll have the rest of the week to work on my lecture. I can't even begin to think what the next day will hold for me.

It's really really really hot

I've got an hour to kill before I board my flight from Accra to Kumasi, and I squeezed everything I brought into my one large suitcase. I bit the bullet and payed the baggage over weight fees because after lugging around two checked bags and a large carry-on on the first leg of my trip I realized that $25 is well worth my sanity. So now I'm all I'm left with is my purse, a bottle of water, and my laptop. I've always loathed the idea of blogging. I romanticized this idea that I would be sitting outside in the morning or at night by a fire curled up with a journal. Internet blogging is for 'techies' and after a year of ownership I can still barely figure out how to charge my macbook. However, I want to share my trip with friends and family. And I am far to lazy to construct individual emails. So here it goes...

I left Atlanta with a huge pain in my chest Wednesday night. I sat curled up on my couch watching an episode of 'Girls' on HBO with Asher and Ashley. If you haven't seen or heard much about the show it's a fabulously crude and hilariously relatable comedy/drama on HBO about a group of 23-24 year old girls who are best friends in NYC. Far from the ladies of Sex in the City, it gives me a sense of comfort in knowing that my angst-y quarter-life "WHAT THE HELL AM I DOING?" crisis is pretty typical of my generation. The end of the episode we watched Wednesday night had two of the main characters dancing around their bedroom to a song called"Dancing On My Own". It's hard to describe the ending in a way that conjures the same emotions we were feeling that night sitting on the couch about to say goodbye. But after the credits rolled we hugged and cried, and I had to leave my two 'limbs' to head to the airport. 

I didn't allow my mom to come to the airport. I knew how proud she was but I also knew that she was going to be an emotional wreck and I didn't want to get on the plane with that last sight of her.  My dad and I drove alone to the airport, listening to the sweet mix-cd 'my limbs' made for me. I said goodbye to my dad which was terrifying. I was walking through security and immediately I started to wonder why I was doing this alone. Was this a good idea? Could I really take 5 weeks without my best friends and family? But oh well, it was too late! 

The flights were painful. I can never really sleep sitting up with a total stranger's elbow so close to mine. However, I sat by a wonderful Saudi Arabian macro-biologist on the way to Amsterdam. He was in the US at a conference for antibiotic resistance. On the flight from Amsterdam to Accra I sat by an older gentleman, a native Ghanian, who was working in Amsterdam but coming home to visit his two daughters in Kumasi. Both of his daughters are nurses, and we exchanged contact information so that we may all have lunch or dinner once I get settled. There were about twenty 13-15 year old's on the flight to Accra from Great Britain. They were coming to Ghana for some type of service project on their holiday. There was also very beautiful Ghanian woman about my age who sat to the left of me on another row. She spent the ENTIRE 6 1/2 hour plane ride doing her hair and makeup. Seriously.The only break she took was about 45 minutes where she read a few chapters from '50 Shades of Gray'. It's nice to know that some things will be exactly the same as back home! hah!

When I arrived in Accra I started to unravel a bit. I dressed appropriately for the arctic temperatures of the airplane, but as soon as I walked off the plane, the 90-something degree heat had me baking in my clothes. The airport was chaotic, and I quickly realized that yes, I am a 24 year old female alone in another country, on another continent, at night. Too many people were trying to have me let them carry my bag, or pay them an exorbitant amount of money to 'help' me get through customs. Sweaty, exhausted, and frustrated I finally got a cab to my hotel.I know that I my yoga pants, nikes and old sorority t-shirt don't exactly scream worldly. And my small stature and blonde hair don't help my cause.  But part of this trip for me is about independence, and that quick moment of feeling defeated put me in 'defense mode'. But I left the cab driver in good spirits again and stepped into my beautiful hotel to get some much needed sleep.

This morning I woke up with determination. I CAN and WILL maneuver this airport! I took the hotel shuttle back across the street to the hotel and found my way to the check-in line. Thankfully, the staff for 540 Airlines were nothing but helpful. An absolutely beautiful woman helped me figure out my flight, and made sure that I understood where to go and when to board. When you first check-in there is an air conditioned tent where you sit and wait before you can go through security. I suppose the area to wait for the domestic planes is very small, so they have people wait in this area. 

Once I went through security I waited in another holding place before the lovely woman from earlier came out with a megaphone and called us all to board a shuttle which took us to the plane. It was a small plane, but the ride was short (45 minutes). They gave us some very strange ginger cookies and orange Fanta as a snack! Ghana was turning out to be pretty great! The airplane literally lands right in front of the sliding glass doors of the Kumasi airport. I grabbed my extremely heavy 3 bags smashed into 1 and found my ride. 

And now I'm in Kumasi! The city is incredible. The streets are packed with cars. It appears as if there are no real traffic lanes.  Cars are just packed into the street every which way trying to move forward. There are lots of pedestrians, and a constant honking sound coming from irritated drivers having to slow down. I can't tell if half of the buildings are falling down or in the process of being built. It's hot, and the streets are covered in a dust/dirt mixture. But oh my god- the vegetation is beautiful. Everything is so green and lush. The city seems more laid back than my very brief experience with Accra. So far, I think I'm really going to enjoy this place. My hotel is very nice. There are lots of trees and grass, and I can hear birds instead of cars which is a plus. The view from my back window is of a nice grassy area where a clothesline sits with white linen sheets stretched out. There are also lizards everywhere. I'm pretty sure that one crawled across my foot earlier, but I was much too tired to address that possibility. Overall I'm very happy. It was a struggle getting here, but I feel safe and very comfortable now. All anyone said of Ghanians before my trip was how kind and helpful they are. NOW I see what everyone is talking about. What a lovely country that I will be spending the next month getting to know!