"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!