Hello friends and family.

I’ve added a link under the web albums tab with some recent photos.  I am not a photographer.  The quality is not good.

I hope you are all well and happy!

Sincerely,

Kimmie

I ran a marathon yesterday.  Below is my race report.  But first, a few quick updates.

The first annual “Zoggu Malaria Awareness Day” was a success.  Me and some volunteers I recruited from the village went door to door to 151 huts (there are 208 total) to provide basic malaria education (read “don’t wait until your kid has a seizure to bring him/her to the clinic”) and determine whether or not kids under five were sleeping under mosquito nets.  Turns out Zoggu needs more nets.  I’ve submitted a grant application to Peace Corps for funding to buy nets.

Last week I was in Kumasi for a PEPFAR (President’s Emergency Plan For AIDS Relief) conference and I stayed in a fancy hotel with running water (HOT running water) and A/C.  It was an educational week AND I turned my thermostat down to about 17 degrees Celsius (62 degrees Fahrenheit) and took long, hot showers.  I was very happy.

World AIDS Day is December 1^st and I am planning another event with one of the nurses in the village.  We’re trying to pull together a big event that focuses on testing men for HIV.  The Zoggu clinic tests lots of women (namely pregnant women) but men are harder to convince to test.

Overall I am doing well.

And now….the race report.

Kimmie’s Accra Marathon Race Report

So I generally like to organize my race reports mile to mile.  But the Accra marathon didn’t have mile markers.  There were kilometer markers but they were haphazardly placed and often incorrect (we’ll get to the soul crushing impact of an incorrect kilometer marker later).  So…here we go.  Also, a small warning.  There are several references to swear words in this entry.  No actual swear words, but still, I just wanted to warn you.

2:15am:  Wake up in the Peace Corps bunk house in Accra.  It’s a rented room in a guesthouse called the Swiss Rest (affectionately referred to by volunteers as the Sh*t Rest or the Swiss Mess).  Anyway…it’s not all that nice.  A big room with four bunk beds, no a/c or ceiling fans, and running water that is pretty much just a trickle.  We have two cabs picking up the group (there are 8 of us running the full, 4 running the half) at 3:15 am to go to a fancy hotel where the shuttle is picking us up at 4:30.  But in Ghana, time is sometimes kind of a joke (more on this later), hence the 1 hour 45 minute cushion with the cab driver.

3:30am:  Cab picks us up and takes us to the fancy hotel where the shuttle is to arrive.  We meet some Japanese expats who are running the marathon.  One of them is wearing a pink kimono (seriously) with his race bib pinned to it and he has a teddy bear backpack on his back.  It was interesting.

Between 3:30 and 4:45am:  We watched a prostitute walk up to the hotel to solicit work from all the foreigners be shooed away by the hotel security guard.  We also used the bathroom at the fancy hotel pool (flush toilet!!) a few times.

4:45:  The shuttle that fits 9 people comes to pick us up with 5 people already in it.  We then cram the Peace Corps group and the Japanese expats into the remaining space in the shuttle.  Very Ghana, only this shuttle had a/c.

4:45 to 5:25:  Drive to a distant suburb-like township that is 26ish miles outside of Accra.  The start and much of the race course is on the main highway out of town.

5:27:  Urinate behind a bunch of bushes.

5:30:  Watch the designated start time for the race come and go.

5:31:  Wait to start

5:32:  Wait to start

5:33:  Curse the hot African sun that is now rising.  I will be running the entire race in the sun.  Continue to wait.

6-freaking-45:  After getting up 4 and a half hours earlier, all 100 or so runners start the race.  Apparently Coca-cola, one of the major (read “only”) sponsors, hadn’t shown up on time with the water for water stops.

6:50:  Notice that the road I’m running on is not only a major thoroughfare but that it’s not blocked off AT ALL.  Basically the race is on the shoulder of the highway.

6:55:  Notice that it’s very windy.  VERY WINDY.  And this highway is hilly.  I am not pleased.

7:00:  Notice that when 18-wheelers fly by that they (a) increase the wind by a considerable amount and (b) kick up lots and lots of gravel that somehow feels as if it’s being thrown directly in my face.

Around 7:15ish:  Come to the first 3-kilometer marker.  Crap…how many miles are in 3 kilmeters?  Okay…I think it’s almost two.  Meaning I’m running about 9 minute splits.  9 minute splits equals about a 4 hour marathon.  I can speed up as I go and cut that down.

7:30ish:  Laugh at all of the other runners that came out of the start line too fast.  Think to myself, “Ha…I’ll see them later.  Hahaha.”  (You have to see where this is going.)

7:30ish to 8:15ish:  Wonder why I’m not into a good rhythm yet.  Continue to curse the wind and the traffic and the gravel and the lack of road barriers.  But I am still on a 4 hour pace.  Doing okay.  Though feeling a strange pulling/tightening sensation in my right hamstring, the same hamstring that I pulled (perhaps almost tore) during training.  Some thoughts going through my head at this time:  “Why the #@*& are there no road barriers?!  This is actually a marathon?!  Do I stop to let this truck pass as there is no shoulder to run on or do I run off the road in the bush that is up to my knees?  Do I go left or right at that upcoming fork in the road?  Is that dot in distance in front of/behind me a pedestrian or another runner?  Do I speed up/slow down so that I can run with said runner?  Why did I sign up for this?  Did I feel this bad so early on in any of my other marathons?  Why do I live in Africa?  What do I do about all the starving kids in my village?  How the *&^% can I get the people in my village to wash their hands?  WHAT AM I DOING HERE?!  AMERICA, WHY DID I LEAVE YOU?!?!”

8:30ish:  Briefly panic as I realize that I have most likely re-injured my hamstring.  This is probably around mile 12.  Pray that the next 3km marker/water stop will soon reveal itself.  Realize that it’s incredibly annoying to receive cat calls from truckers while running a marathon with a pulled hamstring.  Realize also that the majority of Ghana does not understand why a bunch of people (most of them white) with numbers on their shirts are running on the shoulder of a major highway on a Sunday morning.  I received lots and lots of, “white lady, where are you going?  Why are you running?”  Or, of particular help was, “White lady, you are too slow…your brothers and sisters are yonder.”  Hey, thanks a**hole!

8:40ish:  Traffic is in full swing now.  I’m still running along the “shoulder” (read bush, gravel, sand, curb, etc. etc.) of a major road along the coast of the hub-city of West Africa.  I am also completely solo at this point; no runners in sight in front or behind.  Only 100ish runners equals many different paces and mostly solo, highly dispersed runners.  There are also no spectators (save the people coming out of shops, houses, etc. to ask me why I am running).  I also am conjuring up a very interesting running technique to relieve the pain of my right hamstring.  It’s called try-to-pull/strain/injure-almost-every-other-muscle-group-in-your-legs-to-compensate-for-a-pulled-hamstring.  In retrospect this was stupid.

8:45ish:  Thinking to myself that I should be approaching the halfway point soon.  Concede that this is not my day.  Come to a roundabout in the highway and have no clue which way I am supposed to go.  So…I stop.  I then wait for an opening in the traffic and shuffle to the grassy, circular median in the roundabout.  I look in all four directions and see no other runners.  I think, “Hmmm…would now be a good time to quit?  What if I go the wrong way?!  I’ll be screwed!  But if I quit now, then I can hop into a cab (plenty had been offering me rides as they passed by) and tell the driver the name of the hotel where the finish line is.  But I’d have to DNF (runner-speak for “did not finish”)!  ARGHHH!!!! What should I do?!!”

8:46ish:  Some Ghanaian rent-a-cops notice me stumbling around the roundabout and get my attention.  They direct me to the left.  Apparently they were hired by the marathon to direct the runners.  They were taking a break in their car or something.

8:47ish:  Continue on another busy road, weaving in and out of 18-wheelers that are parked on the shoulder.  Dodge women carrying produce on their heads.  I am basically running through an outdoor market that is split by a paved road down the middle.  And where the f*&^ is the 21km marker?!

8:50ish:  Come across a km marker that says 18km.  WHAT!!!????  I’ve been running for over two hours and I’m not half way yet?  Lose a small amount of my soul.

9ish:  The course now makes its way through a busy neighborhood to a somewhat industrial area of Accra.  It’s now just me, the pavement, and some railcars stacked on top of each other.  It was very lonely.  But, then I spot, in the distance, another runner!  And he’s walking!  I shuffle, shuffle, shuffle to catch up to him.

9:10ish:  Catch up to the runner.  He’s European.  I ask him if he feels like he’s dying.  He says yes!  He, too, is miserable!  I ask is this his first marathon.  He says no!  Yea!!  It’s NOT just me!  This race sucks!

9:12ish:  The European dude continues to walk and I decide to shuffle on.  Soon I am all alone again.

9:20ish:  I come around a sharp curve in the road that is along a ramp to an overpass (thereby blocking my view of what is around the bend).  I immediately run into a sign (no water stop) that says “24 KILOMETERS.”  I decide that I want to die.  I then stop shuffling and begin walking.  The first time I’ve walked in a marathon since my first.  And I was barely halfway through (I later discovered after talking to several of the other runners that the kilometer markers were invariably wrong).  My spirit is squashed.

9:21ish:  The industrial area slowly turns into the coast line.  I am now walking/shuffling along a highway that runs along the beach.  Scenic?  Yes.  Windy?  YES!  Sunny?  YES!  Salty?  YES!  Hot/Humid?  YES! How does salty, humid, sunny wind feel on an already sunburned face?  BAD!

9:30ish:  Sight another runner!  He is walking!  Shuffle for several minutes to catch up.

9:40ish:  Catch up to this runner.  He is Danish.  Immediately upon catching up to him I stop shuffling and begin walking.  Again, with my questions.  Is this your first marathon?  No, it’s my 14^th.  Do you want to die?  Yes.  I regain a miniscule portion of my spirit as I am once again reassured that it is not just me.  I walk with him for about a kilometer and then continue to shuffle.

9:50ish:  I come across a water stop that is out of water.  I am offered some unsweetened guava juice and almost vomit.  I hurl the juice to the ground and curse.

10ish:  The desolate coast ends and I begin to encroach upon a busy, heavily populated area of Accra.  Picture this if you will:  Sunday morning.  Open market place.  Two lane road that is bumper to bumper traffic with tro tros, cabs, private cars, etc.  Everyone is out of their house and on their way to/from church.  The market is hopping.  And I am to run along the “side” (read narrow, dusty, sandy, uneven area of about one foot) of the road past all the shops/ladies-with-things-on-their-heads/motos-weaving-in-and-out-of-traffic/goats/dogs/chickens/etc. for the next 9ish miles.  I can’t put into words what I was thinking.  There are no words.

10ish to 10:30ish:  Walk, shuffle along the “side” of the road.  Try to ignore all of the inquiries, cat calls, shouts, etc. about what I am doing/where I am going/whether or not I am crazy/why I am wearing a number/where is my husband/etc. etc.  My legs seem to have lost nerve enervations from my brain.  I almost trip several times over curbs, stones, grass, and yes chickens and at one point a goat.

10:45ish:  Begin to grow increasingly irritated with a tro tro driver that has slowed down his packed tro tro to harass me about what I am doing/where I am going/whether or not I am crazy/why I am wearing a number/where is my husband.  He has basically stopped traffic by slowing down his tro tro.

10:46ish:  I stop running.

10:46:30ish:  I turn to face the tro tro directly and scream the dirtiest, meanest, most profane curse words that I can think of in a rage-filled shout at the tro tro driver.  People on the side of the road (kids, men, women mostly on their way to/from church) all stop and stare.  The tro tro driver takes the hint and drives away.  I continue to walk/shuffle along the side of the road.

11am:  I sight another runner.  He too is walking!  I shuffle to catch him.

11am to 11:15ish:  Walk with this runner.  He is from the Midwest somewhere.  He, too, has run several marathons.  And he, too, feels bad, bad, bad.  He, however, has to be on a plane to Singapore at 6pm.  I do not!  I somehow am thankful.  He estimates we have about one 5k left in the race.  I wish him luck and continue on.  The sun is high in the sky, the traffic is kicking up dust, and there are people everywhere blocking my path and/or inquiring about what I am doing/where I am going/whether or not I am crazy/why I am wearing a number/where is my husband etc., etc.

11:15ish to 11:25:  Make my way through the busy coastal area to a less populated (but still traffic-heavy) stretch of road.  I am dying.  I am miserable.  I am seriously hoping there are medical professionals (aside from myself) at the finish.  I’m self-diagnosing myself as hyponatremic (low-sodium) which presents itself in all forms of discomfort.  There was no Powerade/Gatorade on the course (this IS Africa, after all) and the four gels I’ve consumed just weren’t enough.  I am covered in sand, salt, and dirt.  I’m sooooo grimy.  My legs…not sure how to describe.  Worse than they’ve ever been.  Particularly my left groin and quad and my right hammy.  I almost fall several times.  I am staggering.

11:30ish:  I come across this Rastafarian next to a car on the side of the road.  He is in a sort-of running outfit (looked kind of like a wet suit, but at this point I am absolutely delirious and cannot distinguish what a normal running outfit would look like from other forms of beach clothing).  I ask him if he knows anything about this marathon.  He says yes, I ran it and finished it a long time ago.  I say where is the finish.  He says it’s not far, I will run there with you.  I say I can’t run, I can only walk.  He says, no, you can run and I will run with you.  I say ok.

11:30 to 11:35ish:  This barefoot Rastafarian begins to run with me along the side of the road which is gravel, sand, rock, etc.  He has his cell phone out and is holding it up.  A Celine Dion song is playing from his phone.  It’s random.  I tell him that I need to walk.  He says no, I have to run.  He says see that signboard (Ghanaian English for billboard) ahead?  The finish is just down a path from that sign.  You will finish on the beach.  I tell him he’s lying.  I am dizzy.  I’m stumbling.  I’ve been running on the equator in the sun for almost five hours.  I have no sodium in my body.  I hate the world.  I would rather be in a coma than running right now.

11:40ish:  We come to aforementioned signboard and turn.  I see stretched out ahead of me a sandy/rocky dirt path and think this guy (oh…I somehow got the words out while I was running with him “what is your name” and he said “prince”), so I ask Prince “are you serious?  I have to run the last 200 meters of this race on sand?”  Prince says it’s okay, I can do it, blah blah blah.  Mind you, I am not running, I am barely shuffling.  I am staggering.  I am pathetic.  My right leg is not working.

11:forty-something.  I stumble across the finish line.  My time was somewhere around 4:55 (no pads, no chips, no digital time boards; just a guy with a stop watch at the finish).  Over an hour and a half slower than my last marathon.  8 of the 10 other volunteers (five of whom were running the full marathon I thought I would cheer on at the finish) were waiting for me.  They were all clapping.  There were several hugs.  There were several we-were-so-worried-about-yous, what-happeneds?, etc. etc.

So I think this is what happened…I (re)pulled my right hamstring and probably should have just DNFed but became somehow incredibly masochistic and carried on.  My pride was left somewhere along the beach, perhaps at the misplaced 24km marker.  My electrolytes were also depleted thereby making my pull/strain/injure-almost-every-other-muscle-group-in-your-legs-to-compensate-for-a-pulled-hamstring technique even less effective than it should have been.  Also, my level of fitness has just taken a nose dive since moving to Africa.  I am generally healthy but have so much less control over my exercise routine than I did in the States.

All this being said, everyone one of my Peace Corps friends finished the race.  4 ran the half, 8 the full.  Only three of us had ever run a marathon before, and I apologized profusely for talking the others into running this one.  I had no idea the race was going to be so miserable!  It was MISERABLE!  But, alas, it’s over.  Immediately after I finished this race I decided I would never run another marathon.  Then I decided that you can’t truly be an experienced marathon runner without a few horror stories.  So now I’ve decided on an Accra Marathon Rematch in 2010.

Also, there were very few women who ran the race.  Probably under twenty.  Maybe under 15.  I came in 10^th (perhaps there were only 10 female runners, who knows).  I won 40 cedis.  I spent it all on ice cream (a HUGE luxury) for everyone who ran the race.  I am a lucky girl.

I will post pictures next time.  For now, you’re imagination will have to suffice.

I miss you all and hope you are all happy and healthy!

Love,

Kimmie

Yes, I’m still alive.  Not sure why I haven’t updated my blog recently. Probably because there’s not a whole lot to report.

Let’s see…First off…the “road” to my village is now a swamp (note the lack of quotation marks around swamp…I am not speaking figuratively here…it’s a muddy path that is now covered in lots and lots of water). Here’s a fun travel-to-my-site story for you all:

I am headed home on my dirt “road” after a morning of rain. There’s a huge pool of water covering part of the road…maybe 20 yards across, flanked by tall, tall grass and about 30 yards long. The cab driver merely eyeballs the pool, and rather than assess the actual depth of the pool, he just decides to try his luck and drive straight through. (See where this is going?). Of course, we just nosedive into the water and stop. Then we start to sink. Seemingly on cue, all six (sixish, I think…the car was the equivalent of a 1980 civic maybe?) of the other passengers open the doors (thereby allowing turbid water to pool into the car up to my knees, but at this point I am cross-legged so I am still somewhat dry) and go to the back of the car to push it out of the muddy pool. I am about to brave the muddy water myself (with my backpack above my head) but the driver tells me to stay put so I can “steer.” I basically hold the wheel (I’m still sitting shotgun, crossed legged, with my pack on my lap) while the other passengers try to heave the car out of the pool. Somehow they free the vehicle and push it to dry-ish land and the driver opens the driver-side door and starts scooping the brown water out with his hands. Then he gets in the driver seat and actually tries to start the car. Ha! Of course, the car doesn’t start. So, what does the driver do? He opens the hood, unhooks a hose in the engine, and then starts sucking the turbid water out of the engine and INTO HIS MOUTH.  Gross. But he spits it out so I guess that somehow makes it okay?  Unfortunately (shocker), this doesn’t help and the car still won’t start. So the driver flags down a farmer on a bicycle, borrows the bike from the farmer, goes to Savelugu (sav-UH-loo-goo, the town from whence we came) and, long story short, the other passengers, myself, the [now] bicycle-less farmer wait for three hours until the driver comes back from Savelugu with a mechanic and, miraculously, they get the car to start again. So very Ghana.

In other travel notes, I traveled to the Southern part of Ghana last week to see the new group of trainees get sworn in as new volunteers. That was fun. And I am officially no longer a newbie! Just so you all have a little more perspective on travel in Ghana…travel to the South entails purchasing a bus ticket to Accra from Tamale for 16 cedis (roughly 16 bucks, or I could pay 22.50 for a bus with A/C…but I’m on a budget and I could eat for days, seriously, off of 6 cedis 50 peswa).  The bus ride to Accra is about 12 to 14 hours long. Luckily, the swearing in ceremony was in a town called Koforidua (koh-for-IDGE-uuu-ah), which is only an eight hour ride from Tamale (but there is no direct line there so you have to purchase a ticket for Accra and get off the bus early). What is noteworthy about all this travel is that, by road, it takes a very long time to get anywhere here. There is an airport in Tamale, however. And (if one can afford the 200 cedis…ha!), the trip from Tamale to Accra is ONE HOUR. So…imagine driving from Austin, Texas to Dallas, Texas and having to set aside 14 hours of your time. Then think about how nice it would be to be able to cover the same distance in one fourteenth of that time. Welcome to my world! But, the swearing in ceremony was nice and I was able to see some friends that I hadn’t seen in a long time.

As far as work is going, well…it’s going okay, I guess. My first big project is coming up next week. I’ve officially deemed the 26th of August, 2009 as (drum roll) “Zoggu Malaria Awareness Day.” Basically, I’m asking (read forcing, begging, pleading…anything but providing financial compensation) all of the village health volunteers, clinic staff, Zoggu water and sanitation committee, and ten Ghanaian medical students to go door to door to all the 230 huts in Zoggu to provide malaria education and to assess the use of (or rather, lack there of) mosquito nets for households with children under five. The chief of my village is going to announce the “malaria day” with his domba drummer (aka the village newsman…he’s a guy that stomps around the village with a drum making announcements…there’s not really an American equivalent), and the Imam (the Muslim minister) is going to make a similar announcement over the PA system that sits on top of the mosque. Tuesday will be “training day” at the clinic.  This is where I tell all the volunteers what to say at each house.  I’ll also pass out paper, pencils (to record how many people use/don’t use nets), and chalk (to mark the houses once the education has been completed). This will, of course, all be done via a translator.  My Dagbani still leaves much to be desired. Pray that the day isn’t a total disaster. And that it doesn’t rain. Rain stops everything here.

Also, a special shout out to my running group who sent me a great care package that included a new pair of running shoes!

Also a new camera, so I have added a few new photo albums as well (http://picasaweb.google.com/kimmieellison/AugustRandom?authkey=Gv1sRgCNrU8uf26rLeZA&feat=directlink, http://picasaweb.google.com/kimmieellison/KimmieS31?authkey=Gv1sRgCJvF4IW9vMn6bQ&feat=directlink). There are captions to explain.  I’ve also put links to these same albums under the “web albums” tab.

Now, I can’t mention one care package without paying tribute to my mother…who has kept me in continuous stock of priceless toiletrees, coffee, cookies, pretty much anything I ask for she sends me. Seriously…I’ve been able to enjoy a cup of coffee every day for a while now and it’s all because of her. She has been, by far, the most devoted care-package sender.  And I love her!! Love you momma!!

The marathon is in just over a month. Seeing as how I’ve slowed down on the blogging, my next post will probably be after the marathon. I’ll include an update on “Zoggu Malaria Day-2009″ in that post as well.

Overall, I am doing fine. Feeling healthy…staying malaria free (although the mosquitoes are BAD right now…so, SO many children are brought to the clinic with bad, BAD malaria)…and I am so thankful for, well simply, my health.  And also for the health of my friends and family back home. My grandma turned 92 last week! I tell people in the village that my mother’s mother is 92 and the usual response is, “Are you sure?” People here rarely get that old. And if they do, their actual age is a total guessing game. No birth records.

Anyhow…miss you all!

xoxoxo, Kimmie

I finished reading a book last week called When a Crocodile Eats the Sun.  It’s a book about Zimbabwe by a guy named Peter Godwin (who is himself from Zimbabwe).  And in this book the author describes experiencing something called “first world panic” when he is trying to procure proper treatment in a Zimbabwean hospital for his father who has just had a heart attack.

As I was reading about his “first world panic,” I was thinking… “I can  TOTALLY relate.”

Here’s a good story about what I like to call “first world frustration” (we’ll get to the panic a little later) from an American trained nurse (me) living as a health volunteer in Ghana.

Last Sunday I’m waiting, in the heat, for the market lorry to take me to Savelugu because it’s market day there and I’m dangerously low on toilet paper (an item unavailable in the thriving metropolis of Zoggu).  Anyhow…I’m sitting next to a young mother (say 17 or 18?) with a fussy 9 month-ish old baby.  Baby is crying, fussy…nothing out of the ordinary for a child of this age.  If you had asked me, I’d say the kid was probably teething.

Anyhow, the baby just can’t be soothed …the baby won’t eat, her clothes are dry/unsoiled (diapers aren’t used here), and no position that she’s held in seems to make her comfortable.  A few minutes later a small girl (about 12) comes by with a small box of pills from the local chemical store (akin to a pharmacy in Mexico where you can easily buy medications that in the States would require a prescription).  The medicine contains a pain reliever somewhat similar to aspirin or ibuprofen (called diclofenac…not commonly used in the States as far as I know) and gives it to the mother.  So…what does this young mother do with the medicine?  She takes a pill, breaks it in half, crushes a half pill between her fingers, mixes it in a soup ladle filled with cloudy water from a “street” (read…dirt road) vendor, and feeds it to her baby.  Here is the conversation that ensued just prior to her actually administering said concoction (note…the following took place in Dagbani…hence my rudimentary grasp of conventional grammar):

Me:  Your baby does not have health today?

Young mother: No, she does not have health.

Me:  When baby does not have health you need go clinic and talk with midwife.  You not know medicine you give baby good.  You not know why baby has no health today.

Young mother:  I don’t have money for clinic (as she is administering cloudy water/diclofenac concoction).

Me:  Please when your baby has no health go to clinic.  Talk with midwife.

Mind you, in my head, I want to say this: “Okay…please stop what you are doing.  What you are about to feed your baby may cause harm.  Unfortunately, and at no fault of your own, you lack the necessary health knowledge to ensure to the best of your ability that your child remains healthy.  I’ll sit back, watch, and continue to feel helpless as I struggle with the tribal language and customs and hope that the medicinal solution you just gave your baby will not (a) cause any sort of organ damage or allergic reaction from the pill you know nothing about or (b) cause any sort of bacterial or parasitic illness as the water you mixed the crushed pill with was obviously not clean.”

And this, ladies and gentlemen, is what I like to refer to as “first world frustration.”  I experience it often.

A note on the health insurance here in Ghana.  I think you pay 8 cedis (roughly $10) for a year of health insurance, meaning consultation and treatment (including medication) at the clinic is free.  If you have no insurance, you pay 2 cedis plus the cost of medication each time you visit the clinic.  Whether or not this young mother even knew the ins-and-outs of her insurance options? I have no clue.  I lack the Dagbani vocabulary to get into a discussion regarding the benefits of health insurance.  I will say, though, 8 cedis, while not an extraordinary amount of money, would provide me with enough food to eat for a week.

Now…another little story on what I call “first world panic.”

I am awoken a few nights ago to knocking on the compound door by a man calling “Ago” (AHH go)…a traditional Twi greeting to announce your arrival in someone’s home.  It’s about 9:30pm, I’ve been asleep for almost an hour (things wind down early here…we’re usually up before 5am to beat the heat).  Anyhow…this gentleman had tried to wake up the midwife but was unsuccessful.  I tried to explain in my broken Dagbani that “midwife tired a lot.  She have four babies at clinic today.”

Anyhow…this gentleman goes on to tell me, in very broken English, that his son is sick and he needs the midwife.  He asks if I can I call her to wake her up?  (Sidenote…the midwife and I are now living in the same compound.  I’ve moved over to the nursing quarters so that the “national malaria eradication” program can use my old compound as an office/storage space for their mosquito spraying equipment. Now I am cohabiting in the same compound with the two community health nurses and the midwife.  It’s nice.)

So now I’m in the courtyard of my compound, dressed in flip flops and two yards of cloth wrapped around me, dialing the midwife’s number on my phone.  I hear the midwife’s phone ringing from where I am standing.   After a few rings the midwife answers and I explain to her that a man is here and his ill son is waiting at the clinic.  She says she on her way.

I walk over to the clinic with the father and the midwife and am slapped in the face with a big dose of “first world panic”.  There is a small boy, about 7 or 8 years of age, rigid as a board, foaming at the mouth, taking shallow, sporadic breaths lying board-like across his grandmother’s lap.  This poor kid was stuck in the middle of a full-on generalized tonic-clonic seizure (medical-speak for “grand mal” seizure).

The midwife takes one look at the child and tells the family in rapid Dagbani, “Go, NOW, to the hospital in Savelugu.  NOW.”

Note – the clinic, while capable of treating many common village illnesses, like uncomplicated malaria and diarrhea (and of course, baby-delivery), has no business caring for a child in this condition.  One of the first things you do in a health-care setting if someone is having a seizure (in the States, mind you, where resources abound) is give the patient some oxygen (via an oxygen tank conveniently located behind the wall with a little gauge you flip to “on” and voile!  Oxygen!).  The only oxygen the clinic has in the air we breathe.  There is no oxygen tank.  No antiseizure meds.  Nada.

After helping the woman tie this small boy onto her back (who was at this point resembling a mannequin frozen in a very awkward, contorted position with frequent twitches…that’s how stiff he was), she then straddles the moto that the boy’s father is driving and off they go.

The fate of this poor little boy?  Unknown.  I wasn’t familiar with him or his family and don’t know if they were from Zoggu or another smaller, surrounding village.  And, I probably will never know, because all too often, children die at home or even at the hospital and it’s just not discussed/reported/even mourned in public.  But, to be honest, I had a very, very bad feeling about him.  Who knows what was causing the seizure…high fever from malaria, meningitis, rabies, tetanus?  Who knows.  None are good.  In fact all of those, when allowed to progress to the point of seizure activity, can very likely end in death.

In my head I’m thinking, “Where am I?  What is the world coming to?  How can an innocent little boy, who probably just prior to entering into seizure-mode felt absolutely dreadful and scared out of his wits and was trusting in the adults around him to take care of him and keep him safe…how can he be stuck here in the middle of nowhere late at night having a seizure like this?  Why didn’t his parents bring him to the clinic earlier when whatever symptoms he had were manageable at the clinic level?  Will his father even really take him to Savelugu?  Or will they go home and just leave the future of this little boy up to fate?  Why!!!! In what universe is this allowed to happen?!?!!”

Now this, this is first world panic.  The injustice of it all brings tears to my eyes and causes me to lose sleep at night.  It knocks the wind right out of me.

So, I could go on about other depressing, unfair, just wrong moments of panic and frustration…but I’m not sure what good that would do.  But let me just say that in my own, very small way, I know I’m trying to help.  And I know that even though what I’m doing seems completely irrelevant in the face of a seizing child, it’s at least something.

Life’s just not fair.  Period.

Okay…moving on.  I had a new Peace Corps Trainee come and stay with me for her “Vision Quest”.  She was an excellent house guest and will undoubtedly make a very good volunteer following her training.  She was a particularly good sport when I came down with a very unpleasant stomach ailment called giardia which pretty much incapacitated me for an 18 hour period of her stay.

Okay…a brief note on giardia.  I’ll spare you all the gory details as I know many of you that read this aren’t nurses or doctors.  But…it’s a stomach bug that you get from eating contaminated food (I’m blaming some street food I ate in Savelugu two days prior), and it will cause you to drop a kilo or two in a relatively short period of time.

Luckily…this giardia is easily identifiable and the Peace Corps medical officer told me exactly what meds to take and my symptoms are pretty much gone now.  Again…next time you are sick with anything stomach related, while at the time you may be miserable, you can always say to yourself, “at least I’m not afflicted with this stomach illness in a setting where I have to leave my house to go to the bathroom.  And leave town to purchase toilet paper.”

That’s all I have to say about that.

Okay folks, that’s it for now.  I’ve included a picture of me fetching water on my head.  The big, concrete, circular thing in the background is a rain-water reservoir (donated by Christian Children’s Fund of Canada).  The skirt I’m wearing is tie-and-dye fabric purchased here in Ghana and made by my favorite tailor in Tamale.  The bucket can hold 20 liters…I’m able to carry it without spilling any if I fill it with about 17 liters AND use my hands.  I also only have to carry it about 50 yards.  The Zoggu women can carry a large metal drum of containing about 30 liters of water, filled to the brim, over half a mile and spill very negligible amounts.  With NO HANDS.  I’m not there yet.

Anyhow…I’m feeling healthy again (the giardia knows who’s boss now, thanks to a five day course of Flagyl), am thankful for the little niche of novelty that I occupy in my rural, West African community. I think of my friends and family back home often.  I am so thankful for all of the positive energy I receive from my loved ones back home (not to mention the emails, letters, care packages, etc.).  I am also thankful for all of the healthy little kids in the village of Zoggu and for the joy they can bring me by just being their healthy little selves.

Oh, one last last thing.  My flight home for Christmas is BOOKED (thanks to my momma for making the reservation and to the US of A for consistent, high-speed internet)!!!  Come mid-December I will be stuffing my face with deep-fried Turkey (Shawn and Val…get the deep fryer ready please) and of course, a huge bowl of queso.

And of course, A HAPPY FATHERS DAY to my wonderful daddy.  I love and miss you!!!

Sincerely,

Kimmie

I haven’t written in a while…that’s because there’s not a whole lot to report from my end. I’m still working on the health education program. I’ve posted a couple of the pictures that I’m using in my presentations (thanks to some educational materials from UNICEF). As my target audience is largely illiterate, all information has to be conveyed verbally and pictorially. And as they say…

 

A picture is often worth a thousand words. This way no one will be confused on the topic at hand. DIARRHEA! But, all joking aside…a few days of bad diarrhea can kill an infant. So, it’s something that has to be discussed. Pictures like this hopefully will help me to get my point across. Here are some other pictures about malaria and not carrying too much on your head when you’re expecting:

Let’s see…what else. There is a new group of Peace Corps Volunteers arriving this month. So I will no longer be a “new-bie”. Amazing that there will be 60 new volunteers going through the exact same oh-my-GOD-what-did-I-get-myself-into-I’d-rather-die-than-ride-a-tro-tro emotions that I went through only eight months ago!

I’ve been asked to do a presentation on HIV pathology for the new group, so I’ll be headed south, back to my old stomping grounds (Kukurantumi!) in July. And, next week, I’ll be hosting a new volunteer for a few days. Each new volunteer-in-training goes on what is called a “Vision Quest” where he/she stays with a volunteer to get the “real-life” idea of what a volunteer does everyday. Should be interesting. She’ll be here for my first-ever Junior High Health Education class, where I introduce Germ Theory to a bunch of teenagers. She’ll also be here for an “antenatal” day at the clinic where she can see exactly how many of the women in my village are with child (believe me, there are plenty.).

Also, I am back on the running-wagon after a painful five weeks off. First I pulled my hamstring by merely stretching it after an hour-long run in sweltering heat. Then, in an attempt to run with the injured hamstring, I pulled a groin muscle (yes…I know I should know better than to try to run with an injury…I’ve learned my lesson). So I just sucked it up and didn’t run, do yoga, or any other real strenuous activity (besides living in the bush) for four long weeks. Then, as I had my return to the running wagon all planned, I got sick, I mean really sick, for the first time since I’ve been in Africa. Yes…I’ve had a few self-limiting cases of very unpleasant gastroenteritis, but this time I was stricken with what I think was bronchitis. Fever, body aches, nasty cough, etc. (thankfully my GI system was unaffected). Thankfully, again, the Peace Corps medical staffers were on the ball and took good care of me, prescribing a very effective little course of Azithromycin. And in a matter of days I was back to normal…actually, I think I was better than normal because when you are sick and then better again, you are just sooo grateful for being healthy. And being grateful makes for a happier constitution, I think.

But let me just say…it is far more better (for lack of a better term) to be sick in the US of A than to be sick in rural West Africa. It was rough there for a few days. But, as mentioned above, I’m feeling particularly energized and am back on the running wagon…have even done a long run since being down and out with the bronchitis (the Accra marathon is less than four months away! Ship of Fools…None of you have signed up yet. You’ll run back to back Saturday-Sunday marathons but won’t hop the pond to run one in Africa?! C’mon!). I am also enjoying the new, GREEN landscape that surrounds me thanks to the rains that are coming a few times a week. I’ve enclosed a picture. Beautiful!

That’s about all for now, folks. I am doing well, feeling good, and am well nourished with American goodies thanks to the care packages that keep on rolling in (I’ve had M&Ms almost every night for months!). That being said, I’ve also devised three or four staple recipes that sustain me throughout the week. They all contain ginger and ground nut paste (Ghanaian for peanut butter…without all the preservatives…quite tasty!) with different variations of vegetables and pasta. I would still give up my first born for a bowl of queso, but I’ve grown accustomed to what food is available here, and am even spoiled by the delicious freshness of the pineapples, bananas, avocados, beans, etc. that are all grown here (fresher, I dare say, than even Whole Paycheck).

So I am strangely feeling very at home here. It’s a little bizarre to me that I no longer see the novelty in things like brushing my teeth outside (which at night gives a great opportunity for star-gazing!). Same goes for cooking, bathing, and relief of bowel and bladder. All these activities call for at least some time outside (thankfully my latrine and bath house are enclosed). The other day my lorry to Zoggu broke down and all of us passengers got out of the car, laid down on the grass, and took naps for a few hours while we waited for the driver to fix the car. Six months ago I would have panicked. Now? Not scary at all. I’m just happy it wasn’t raining. I think about my friends and family daily which always brings a big smile to my face and a happy feeling in my heart. Then I think about what an interesting experience I’m having here and that makes me happy too. Then I think about a big plate of cheese enchiladas with sour cream and chips and queso and pico de gayo and guacamole with a frozen margarita and I want to cry. But…I suppose Maudie’s will still be in business next time I’m home.

Oh…and I figured out how to add decorations to pictures that I take with my webcam. I thought this border made this picture particularly African-ish. It’s me in my room working on this blog entry! The pictures in the background are pictures of YOU!

I hope you all are doing well!

Miss you! -Kimmie

Dear friends and family,

Last time I wrote I described to you Juakin, a little boy that was grossly malnourished. Here’s a photo of him prior to receiving nutrition therapy at the regional nutrition center Karaga, Ghana.

This is Juakin today!

With the help of some intensive nutrition therapy, Juakin almost doubled his weight in only five weeks. He checked in at 4.8 kilograms and now weighs over 7 kilograms. Finally he and his twin sister truly look like they could be twins. Also, he’s now able to pull himself up and stand while holding on to something!! A big milestone for him. Prior to going to the nutrition center he was way behind in his gross motor skills simply because he didn’t have the muscles necessary to support himself. Hopefully he will continue on to be a happy, healthy, fat little boy. I’m just thrilled with his progress.

As for my progress? Well…I’m learning the difficult lesson that it is difficult to get projects rolling in rural Africa. I’ve been here over six months now. I’ve learned from other expats that six months is sort of the magic timeframe when one finally figures out how to live here. So…the culture shock has worn off, thereby giving way to frustrations with regard to my role as a health volunteer. While I am certainly aware of where the health deficits lie here in Zoggu, it is difficult to know where and how to start. My problems lie basically in the fact that (a) I don’t speak Dagbani (at least not well enough to function independently) and (b) there is a general lack of resources where I am. I swear if I had a team of healthcare professionals at my disposal and a full time, female Dagbani translator then I’d be the most effective Peace Corps Volunteer ever! Alas, I have none of the above.

So while I am still hopeful that I can do some good here in my new(ish) home, the realities of my limitations are becoming more and more evident. It’s incredibly frustrating to know what needs to be done yet not know how, exactly, to do it. I sometimes wish I could just parade down Zoggu Main Street (read nameless dirt road…I am truly living, as Bono puts it, “where the streets have no name”) and toss protein bars from the window of an air conditioned vehicle. But…one of my goals is to create something that is sustainable because I won’t be living in Zoggu forever. And a mass influx of protein bars is not sustainable.

So…that’s what’s going on in my neck of the woods. I am in Tamale today (doing my taxes! Fun!!) and have a meeting tomorrow with an NGO that does some work in Zoggu. I am also working with one of the teachers at the Junior Secondary School in Zoggu to establish a health education program for the students there. My ultimate goal is to target women of child-bearing age, but the kinks there lie in the fact that (a) most, if not all, of the women of child-bearing age in Zoggu don’t speak English and (b) it is hard to gather all of them in one place at one time to do any sort of formal teaching as they are busy working themselves to the bone. So…as things stand now…any health education that I am able to provide is piecemeal. But…I have two years. So we’ll see how things go. I have my fingers crossed.

In other news…a few nights ago, when I went to fetch the bucket by which I bathe out of my outdoor bath house, I was surprised to find a black snake hiding in the corner. Kimmie in the States would have shrieked and ran far, far away from the snake. Kimmie in Ghana (aka Wunpini) grabbed a big stick and killed the snake. And the scary thing is is that I wasn’t even that scared. I just reasoned that I could either let the snake go and wonder all night if it was going to make its way into bed with me or send the snake to snake heaven. I chose snake heaven (sorry, Mr. Snake). And all this was done by the light of my head lamp, as this took place at night during lights out. Yes, friends, it has come to that. I am truly that grizzly now. Initially I would say with pride, “Kimmie…you’ve come a long way. You can go three whole days without washing your hair.” Now it’s “Wumpini. Snake. Kill.” See? The six months makes a huge difference. Who knows what’s next.

Also, for your viewing pleasure, I added a new album under the web album tag. It includes a picture of the dead snake. And one of me with a really unattractive heat rash on my face. Neither are too graphic.

Also, official marathon training for the Accra marathon has begun. (It’s September 27th . SOF…Any of you crazy enough to register?!). I can run for about two hours (with absolutely zero gauge on my distance) but I pulled a hamstring yesterday so am having to take this week off.

Really…I have nothing else to report. I try to think of things to write about and I’m like “Heat? Nope…covered that. Starving children? Nope….been done. Poverty? I think I wrote about that a long time ago.” So I hope I’m not boring you.

Thanks to all of you for the letters, cookies (KALLIE!!! Home-made!!!), care packages, etc. They are all truly appreciated and make meal time here much, MUCH more enjoyable. Please know that overall I am doing well, feeling healthy (minus the pulled hamstring), and am thankful for all of my blessings. I hope you are all doing well too!

Sincerely, Kimmie

Things get real in Zoggu

 

Since I last posted a blog entry, things have gotten scarily real here in Zoggu.  Let me tell you the short story of a baby boy named Yakim (pronounced Yah-keem).

 

Yakim is 15 months old and has a twin sister.  He is the youngest of several children and lives in one of the nicer houses in the village (meaning cement walls, zinc roof).  His house is on the main “road” (meaning sandy dirt path about 15 feet across), so I pass by his house every time I travel to and from Zoggu.

 

Yakim had been sick with diarrhea for much of the month of January and part of February.  Sometime in February he visited the clinic and received medicine for his diarrhea from the midwife that runs the clinic.  On a separate occasion his mother brought him to the clinic for a baby weighing day.  He was found to be profoundly underweight.  However, on that particular visit, the diarrhea had abated, and baby Yakim was able to eat small amounts of food.  So, no intervention was offered except to encourage his mother, Meri (pronounced Mary), to encourage him to eat. 

 

Earlier this week I returned from a trip to Daboya (dah BOY ah) where I attended a Peace Corps meeting.  Thankfully, baby Yakim’s house is on the main road, so my lorry passed by his house, as usual, on the way to my house.  Thankfully baby Yakim was outside sitting on the lap of a male relative.  I got just a quick glance at him as the lorry was passing by, but I could see that he was even skinnier than he’d been last I saw him at the clinic.

 

So, I go home, drop my bags off, and go back to Yakim’s house to see if he’d been sick again.  When I arrived at the house I was absolutely shocked at the condition of baby Yakim. 

 

I’d never seen anything like it.  Maybe something akin to his condition I’d seen on a Worldvision commercial late at night.  But to see something like this, live in person, was shocking.  I mean SHOCKING.  Terrifying.  As a nurse I feel that I can hold my own when it comes to blood and guts, suffering, etc., etc.  But this was different.  Here, in front of me, was a helpless child about to starve to death.  Literally.  His head took up about ½ of the surface area of his body.  His body was that tiny.  I could see his little ribs poking out of the skin on his back.  Skin sagged from his legs like something you’d see on an adult who had lost extreme amounts of weight.   And the diameters of his limbs were about the same as that of a roll of quarters.

 

According to Yakim’s mother, he had just stopped eating.  He would barely breast feed (most babies here continue to take breast milk as a supplement food until at least age two).  He would barely eat any other food.  He would barely drink water.  His twin sister, Zakia (zack EYE uh) however, is fat, healthy.  Yakim, at 15 months of age and in his condition, was unable to stand he was so weak.  He could sit up but barely.  Kids his age are usually walking with no problem.  His twin sister is walking with no problem.

 

Yakim’s mother and the other adults that live in the house knew he was in trouble but felt helpless.  They had been to the clinic twice with Yakim and were trying in earnest to follow the instructions they received there (just encourage him to eat), but, obviously, more needed to be done. 

 

I instructed Yakim’s mom to bring him to the clinic first thing in the morning.  I left the house feeling completely helpless and panicked.

 

So, the next day I go to the clinic and, rather than wait for Yakim and Meri to show up there, I decide to take the community health nurse with me to Yakim’s house.  (I hate waiting…my patience has definitely developed since coming to Ghana).

 

We arrive to the house and see Yakim, who looks even tinier (if that’s possible).  The community health nurse agrees with me that something needs to be done, and fast.  And she asks me, “So, what are you going to do?”  SHE asks ME.  A foreigner who doesn’t speak the language, isn’t licensed to practice nursing in this country, and can barely get around (because you have to wait forever to get anywhere) what I am going to do about this baby.  In my head something along the lines of this was going on:  “I don’t freaking know what to do!!  I need help!  I need a hospital!  I need doctors to tell me what to do!  Pediatricians!  Pediatric nurses!  I need AMERICA!  I need high protein foods and NG tubes and IVs and experts on how to fix severely malnourished kids!  How the *%$# am I supposed to know what to do!  I don’t have a license to practice here!  I don’t even live here, really!!  I’m just a volunteer!!”  Back in the States I could enter a hospital room and say with a certain amount of confidence, “My name is Kimmie…I’m going to be taking care of you today,” and mean it.  Here?  Well…the resources that I enjoyed at home are non-existent.  The environment is completely foreign.  It’s difficult to know what to do, how to help, where to start.

 

So we go back to the clinic and I tell the midwife about poor little Yakim and how freaked out I am about his condition.  She suggests telling his mom to send him either to the Tamale Hospital or the Nutrition Center in Karaga (CARE uh guh, a town about three hours from Zoggu…it is the location of a fabulous facility that treats severe malnutrition in children).  And she tells me that all I/we can do is suggest to Yakim’s family what needs to be done to help him, but whether or the advice is heeded is not our business.  I got the overwhelming sense of, “Kimmie, if you worried about every starving kid in Africa and whether or not he/she received the care he/she needed to live…well, then…you’d be up a river.  There’s not enough worrying in the world to cover that problem.” 

 

Basically, I felt like no one was accountable for this kid.  And he’s a KID!  A BABY!  Helpless!  And he’s starving!  STARVING!

 

Yakim’s mother wanted to take care of him, but just didn’t know what to do, where to go, etc., etc.  And let’s face it…she wouldn’t be the first (or the last) to lose a child.  Unfortunately, it’s the norm here. 

 

My colleagues at the clinic seemed concerned, but all they could tell me was, “You’re right, he needs to go somewhere or he will not survive.”  So, the midwife and I agree that the nutrition center at Karaga is a better place for Yakim.  He is still alert, awake, able to sit up…so medical attention is not what this kid needs at this moment.  What he needs is FOOD.  Besides, I’ve known of several instances where I heard the midwife specifically say to someone “You/He/She needs to go to the Tamale hospital,” and that person chose not to go but rather to wait it out in the bush.  Sometimes he/she fared okay, other times not.

 

So…by the grace of God, Karaga, the city with the nutrition center, is also the site of two Peace Corps Volunteers, a married couple from my training group, Kim and Cam.  So I call Kim to find out what steps need to be taken to get a baby set up at the Karaga nutrition center (locally referred to as “Coco Duu”).  She says that the mother and baby just need to show up.  The cost is three cedis (about three bucks) per week and that includes food, water, and a place to sleep.

 

So, I grab a nursing student from the clinic (to serve as a translator) and head back to Yakim’s house.  We arrive and I basically tell the mom (through the nursing student), “Look…Yakim needs help.  There is a nutrition center in Karaga that may be able to help him.  If he does not get help then I don’t know what will happen to him.”  Thankfully I have my sunglasses on because at this point I am so freaked out and frustrated I am about to burst into tears.

 

She says (through the translating nursing student) that, yes, she knows he needs help, but that she doesn’t know if she can afford the three cedis a week. 

 

So, now, I’m getting freaked out that she won’t do anything. 

 

I then tell her, “Okay…if you want me to go with you to Karaga, I will.”  She says okay.  I am relieved but skeptical.  Traveling anywhere in Ghana is not an easy undertaking.  Especially if you are poor, live in a village, and have kids with you.

 

So, I tell her that I will meet her in Tamale the next morning at 11am at the Karaga bus stop.  She says that she has family she can stay with in Tamale tonight so that she will be sure to be there in the morning.  It’s impossible to get to Tamale from Zoggu…a distance of about 50 miles…before noon on any given day by lorry. You have to have either a moto or a bike.

 

So I tell her, “Good.  Get to Tamale TONIGHT so you can make it to the Karaga station by 11am.”  I tell her I will ride my bike out of Zoggu in the morning and meet here at the station at 11am.

 

So…the next morning, I get to the Tamale as planned and am at the Karaga station by 11am (the bus leaves at 1pm).

 

Meri doesn’t show up.  I’m completely deflated.  She didn’t listen.  She doesn’t understand how grave baby Yakim’s condition is.    

 

I decide to head to Karaga anyway to at least see the nutrition center and visit with Kim and Cam, my Peace Corps friends.

 

So, I get to Karaga and Kim and I head to the nutrition center.  We run into one of Kim’s Ghanaian friends on the way, and Kim introduces me, “This is Wunpini.  She is from Zoggu.”  Her friend says, “Oh…there is a new family at Coco Duu [the nutrition center] from Zoggu.  They arrived on the first bus this morning.” 

 

Oh, joy of joys!!!  Yakim made it!  He’s here!!!  He has a chance!!!  Thank you, GOD!!

 

So…I go to the center and see Meri sitting on a pallet on the floor next to Yakim who is asleep.  They misunderstood my instructions and thought that I would meet them in Karaga at 11am.  But, whatever…they’re here now.

 

Yakim weighed in at 4.8 kilos (about 10.5 lbs)…the average weight of a three month old.  Remember…he’s ONE YEAR and three months.  He has a long row to hoe, but at least now he is with experts who are experienced in the treatment of malnourished children.  Many children of his size are at the center for several months before they are strong enough to go home.  But “Coco Duu” is a wonderful place…not only do they provide comprehensive nutrition for mother and baby, the center also offers instruction and classes on what foods to buy, how to cook, and it’s all done with locally available foods.  So, when Meri comes home to Zoggu, I’m hoping that she will be able to share her new knowledge with the other mothers in Zoggu. 

 

In the meantime, please keep Meri and Yakim in your prayers. 

 

Now…for the hard stuff.  

 

What if I hadn’t been on that lorry and hadn’t seen baby Yakim that day?  What would have happened?  Would someone else have convinced his mom that he needed to go somewhere to get help?  Or would he just have continued to eat smaller and smaller amounts of food until one morning he didn’t wake up?  Harsh, I know.  But, people, this happens!  It HAPPENS!!!  ALL THE TIME!  I had seen Yakim at the clinic just weeks prior.  I knew he was in trouble.  But…I figured that someone else would do something.  Perhaps his mother would make sure that he wouldn’t lose any more weight.  Or that the other clinic staff would follow up.  But the problem is is that no one held themselves accountable for the fate of this poor little boy who was unable to account for himself.

 

And what about all the other starving kids out there?  Believe it or not, there are many villages that are more, yes MORE, remote that Zoggu!  And I’m sure there are starving kids there too!  Kids!!  Babies!!  Who is responsible?  Sure, the parents are responsible, but they lack the resources and the education to get the help that their kids need!  Is it their fault that they were born in a remote African village, didn’t attend school, don’t possess the knowledge on what’s healthy/unhealthy, don’t have the resources of a clinic, hospital, or merely available sources of protein?  Who’s accountable for all that?! 

 

And the answer is…well…I have no clue.  But if I have to start claiming responsibility, then that’s fine.  I’m happy to do it.  It’s just so hard to get things done when resources are so scarce!  But we’re talking about the weakest of the weak here. Children.  Babies.  And they need help.  SO MUCH HELP.

 

Below is a link to a short video of Yakim on the day he arrived at Coco Duu. 

 http://picasaweb.google.com/lh/photo/uwiUNDyLbLzAEcV0AsuVxQ?authkey=Gv1sRgCNzk3aeqkueuCg&feat=directlink

 

This is real, people.  And it’s happening EVERYDAY.

 

Think about it.

 

-Kimmie

 

Greetings from the thriving metropolis of Zoggu!

Am doing well here…blown away that it’s already March. But in Ghana, March often brings with it RAIN. Which, does it’s part to decrease the temperature (it was 104 degrees yesterday). In Texas I can recall many, many days of 100+ degree weather. However, I wouldn’t dare think about doing anything outside during the heat of the day in that weather. In Ghana, well, my life is pretty much unrecognizable compared to my life back in the States…so I thought I’d describe to you some of the things I do here to escape almost constant heat exhaustion.

Water (obviously). However, it’s almost impossible to keep up with the amount of fluid I lose from sweating. So I am pretty much in a constant state of mild dehydration. Particularly when I wake up in the morning. I sweat all night while I sleep and, as I am sleeping, I can’t drink any water. So I wake up with a headache and without the urge to urinate. And to those of you who have sent me the Gatorade packets, I love you!

Sleeping outside. The roof of my compound is made of zinc, which is an amazing heat absorber! So my room at night is about five to ten degrees hotter than it is outside. So many volunteers (particularly those without electricity) choose to sleep outside. I did this twice last week as Zoggu was without electricity for four nights (no electricity = no precious, beautiful, wonderful, glorious fan). I tried sleeping in my room under my mosquito net for the first two nights, but decided that sleeping in an incubator of netting in a room that’s about 90 degrees (it cools off at night!) was just not working. So I dragged the old-school steel hospital bed outside (note…this hospital bed does not have wheels as the beds did at my old job), my hepatitis foam mattress (I joke about getting diseases from my mattress as it was covered in stains when I received it…my next big purchase will be a new mattress), the two sets of sheets that I cover the mattress with before I will touch it, and my giant mosquito net outside and slept under the stars. Luckily the rats either didn’t come out those two nights or they were quiet. I sleep with earplugs so the vermin don’t wake me.

Finding good use for a wet blanket. Instead of using a sheet, I use two yards of cotton fabric (commonly referred to as a “two-yard”) to cover myself with at night (when it’s not the hot season). Since my room (or the outside…depending on my electricity status) is so hot, I soak my two yard in water and then cover up with that. So the phrase “wet blanket” is not just a phrase. It actually exists. In Africa.

My spray bottle. I fortunately packed an empty spray bottle with me, thinking that it may come in handy while I was here. I had no idea the brilliance of that foresight. Each morning I put my spray bottle in the small freezer compartment of my fridge and then take it out before bed. Over the course of the evening it melts, and then I spray the icy water in front of my fan and the fan blows the icy water all over my miserable, sweltering, overheated body. It’s quite nice. However the fan is on full blast so the cold spray evaporates quite quickly. The fan also dries the two-yard out pretty quick so I get up usually at least once a night to re-soak it in water.

What do you do in the summer to keep cool when it’s really hot and you want to sleep? Oh yeah…you just make sure you’re A/C is on!

On average I wake up about six times each night. When it’s finally morning I’m relieved that I get to get out of bed! Back home I would hit snooze about five times.

Never before had I realized what a blessing the feeling of just being comfortable is. I’ll go into huts in the community and see children napping on the cement or dirt floor and see a silhouette of sweat outlining their bodies. Heat, EXTREME heat, is just a way of life here. Temperature-wise it’s very similar to an August day in Texas, but the lifestyle here doesn’t offer any respite from the heat. You just sweat all the time. Mind you, I’ve been sweating since I arrived five months ago. It’s only now that the days are consistently 100+ degrees that my Ghanaian friends have begun to sweat.

I initially spent a lot of time being frustrated about the constant lack of simply feeling comfortable here. I mean, literally, the temperature is never okay. Don’t get me wrong, I expected it to be hot, “Africa-hot” even. But just never being able to completely relax due to never being as comfortable as I could get back at home in the U.S. can get quite exhausting.

So, you know what I did? I just accepted the heat. Yeah…it totally sucks to not be able to sit on a couch in an air conditioned room and channel surf on a Sunday afternoon. But, I can’t change the weather (or when there’s no electricity, or the fact that I sometimes have to wait four hours for a tro tro, or the fact that Africa has rats and mice and bats and that I actually cohabitate in my compound with these freaky vermin). And I’ve learned that acceptance can offer a lot of peace. So, I just accepted the fact that it will be impossible for me to be comfortable like I was six months ago (and for 30 years). I have also become so much more aware of how fortunate I was in America. I know I go on about this in almost every blog entry, but it’s hard to ignore the daily, sometimes hourly, in-your-face notion of, “Kimmie…whatever complaining you did in the States was complete bull&%$#!”

Anyway…it’s amazing, after all the time I spent focusing on how uncomfortable the heat was making me, just accepting the heat made me feel so much more comfortable.

Now, onto a more serious topic. I’ve decided what exactly my purpose is here in Zoggu. As I’ve mentioned in previous postings, each Friday is antenatal day at the clinic. And each Friday I help out at the clinic by registering all the pregnant ladies (sometimes up to 60 women). Each time I register a woman I get a chance to look at her pregnancy history. And of the 60ish women I register, I note that almost 1/3 have lost at least one child. Many of them, if their parity is high (meaning they’ve had lots of babies), have lost more than one.

So, for the next two years I’m going to try to decrease the infant and child mortality rates in my tiny little village of Zoggu, in the middle-of-nowhere West Africa.

In the next couple of weeks I’m going to go door-to-door (or hut-to-hut, rather) to interview women of childbearing age to find out what, exactly, is killing the babies aged five years and under. My guess is it’s one of three things: 1)death during or soon after a home birth not attended by a midwife or skilled birth attendant; 2)malaria; 3)diarrhea. Now…what do all three of these things have in common? They are all PREVENTABLE. Preventable, preventable, PREVENTABLE!!!

So, once I figure out what the real problems are, I’m going to hit the schools, hit the clinic, hit the mosque, hit the community and offer free classes on a myriad of topics…general pregnancy education, general hygiene education, nutrition education, malaria prevention, diarrhea prevention, family planning, etc. etc.

And, oh, the challenges that surly lie ahead!! It’s very difficult to initiate change in a community where people have been merely “getting by” for hundreds of years. So I’m sure many of my future postings will be full of frustration after frustration. But, we’re talking about babies here! Children! God’s children! Our children! Your children, my children, everyone’s children! I think about the heartache that must come from losing a child and, well…that’s enough.

So I guess that’s why I’m here. That’s why it’s okay to endure the heat, the rats, the dark nights with no electricity, the waiting forever for a tro, the dirt, the dust, the cracks on the soles of my feet, the lack of Blue Bell ice cream, the lack of Mexican food (oh…queso, I miss you!!), the lack of running water, the lack of a flush toilet, the lack of A/C, the lack of many friends, the lack of my family and getting to hear all the heartwarming and hilarious things that come out of the mouths of my sister’s three kids. Yes, that’s why I’m here.

And…one last thing…my latrine has finally been completed! Meaning I no longer have to trek 120 paces to the latrine behind the clinic. For your viewing pleasure, I’ve included a couple of pictures of the brand-spanking-new facility.

Voile!!

 

 

The packages keep arriving and each time one arrives I glow. It’s like I’ve won the lottery. The oh-how-I-miss-and-love-American-goods-so-freaking-much lottery. I’ve developed a new appreciation for Pepperidge Farms and M&Ms. And US Weekly? Jessica Simpson is getting fat!? Josh Duhamel and Fergie got married?! May seem like completely unimportant information, but brain candy like that is sometimes very valuable.

Anyhow, I am doing well…most days my spirits are good…and everyday I am thankful for the love I have for my friends and family back home!!

Until next time! -Kimmie

Dear friends and family,

 

I’ve added a link to a new photo album under the web albums tab.  There are captions to explain them.  

 

Please note, many of the pictures show malnourished kids that live in my area.  However, while malnutrition is, of course, a big issue here, please don’t think that it’s all doom and gloom.  Many of these kids are happy, healthy (and LOUD) little rascals.

 

I look at these pictures and am reminded that I need to be thankful everyday for my blessings (which includes the experience I am having here).  Life continues to be an adventure.  The hot season has begun in Ghana.  I won’t even go into how hot, exactly, it gets here (I’ve already done that in some emails to some of you).  Just let me say that I now appreciate what it’s like to sleep in a climate controlled environment more than ever.  I miss A/C!!! 

 

I hope you are all doing well.  Thanks to all of you who have been sending emails, letters, care packages!  Please know that I am doing just fine over here and that I miss you all (and the food that you are eating!).

 

xo,

Kimmie

Just warning you…this blog entry gets a little technical. 

 

So…Over the past few weeks I’ve seen several births. Since January 1, I think there have been almost 20 …pretty busy as far as African clinics go.  I thought I’d share my experience with you all…particularly the mothers and the nurses/doctors who read my blog.

 

“Delivery Room”:  ALL births take place on the cement floor in the clinic.  A grey plasticy tarp thingy (but not as flimsy as a traditional blue tarp) is placed on the floor to prevent any major messes.  Inevitably, however, fluids always seep off the sides or through the seams of the grey plastic tarp onto the cement.  The clinic has a Western-style delivery table (with stirrups and all), but the moms-to-be don’t like it because a) they are more comfortable on the floor, as all the lying down they do at home is on a mat on the floor of their hut and b)they are worried that if they have the baby on a table with their feet placed in stirrups that the baby will fall to the ground and be injured.

 

Monitoring the progression of labor:  When a pregnant woman comes to the clinic and says she is in labor, the midwife examines her cervix only ONCE to determine if her cervix is actually dilated.  That’s the only cervical exam the laboring mother receives.  Initially, when I showed up to the clinic and a woman was in labor on the floor, I would ask the midwife, “how dilated is her cervix?”  It took me a couple of births to understand why I never received a straight answer to this (and I knew it wasn’t the language barrier…this midwife speaks perfect English). 

 

Now…for those of you who haven’t been through the ordeal of a vaginal delivery (sorry if that word makes you uncomfortable…get over it) or if you’re not a doctor or a nurse…in the States, if a woman is in labor at a hospital, either the L&D nurse or the OB checks her cervix frequently.  I don’t know exactly how frequently (my L&D rotations feel like they were a zillion years ago) but I’d say maybe every three hours.   Here, there’s not nearly as much of a focus on the cervix.  The Zogu clinic does not enjoy the luxury of unlimited amounts of surgical gloves like I did while working on 3S.  And sterile surgical gloves like the ones used in the States for cervical examinations…ha!  Those don’t even exist here unless you are actually performing surgery (I presume…I’ve never seen a surgery here).  Also…the entire process of birthing here is deemed as less medical.  So, the thinking goes along the lines of “if a woman is meant to have a baby, her cervix will dilate to a circumference large enough so that the baby can pass through…as God intended.”  Therefore, why constantly check the cervix? Surely, it will dilate to an appropriate circumference, as it has on millions of women, since the beginning of time.  Note also, that for the entire clinic (which serves a population of about 8000), there is ONE box of medium sized latex gloves.  ONE BOX.

 

Drugs, etc:  Now…about analgesia/anesthesia (as in pain meds/epidural)…again…ha!  Don’t even think about it!  Also, don’t think about foley catheters, fetal heart monitoring, blood pressure monitoring, temperature taking, lab studies, testing for Strep B, AROM (manually breaking mom’s water…many babies are born inside the amniotic membrane here), antibiotics, air conditioning, or even running water or electricity (many births take place when it’s “lights out” with the use of a lantern!).  Amazingly enough, these things are deemed “optional” when it comes to childbearing.

 

What has made it to the clinic in Zoggu (which was a little surprising to me…considering all that appears to be missing) is PITOCIN!  Pitocin is a drug that causes the uterus to contract, thereby inducing labor, hastening labor, and decreasing the time it takes for the uterus to return to its pre-delivery state.  It is generally thought to be a very helpful little drug in preventing post-partum hemorrhage. 

 

Many laboring women here at the Zogu clinic receive an IV infusion of pitocin during labor.  They also receive usually one, sometimes two or three, injections of pitocin intramuscularly following delivery of the placenta. 

 

A word on IVs for my fellow nurses.  In Zogu, there is no fancy little nylon needle that is threaded into a vein after introducing it into the vein with a metal needle.  There are no IV pumps.  There is just a bag of saline (into which some pitocin has been injected) hung on an IV pole, to which some tubing is connected and a hollow-barrel, metal needle (I’d say about a 20 to 18 gauge) is at the end of the tubing.  There’s no waiting for “flash back” when the needle is introduced…there is just application of a tourniquet (usually some previously discarded plastic IV tubing)…and insertion of the metal, hollow barrel needle into a vein and opening up of the IV tubing (which is reused…along with the bags of saline) to see if the vein has popped or if the small part of the needle that is actually in the laboring mom is, in fact, in her vein.  If it is in the vein, tape is applied, and the woman’s arm is held straight by whoever is there to help the midwife.  If the vein has blown, you start over again with the same needle.  NOTE…ALL needles, once used (even if it’s multiple times…BUT ALWAYS on the same patient) are discarded into a yellow, cardboard “sharps” container (donated by UNICEF, I think).  When the sharps container fills up, we burn it!  There are no pre-filled saline syringes, no chloroprep/alcohol swabs, no tegaderm…nothing like that.  Just the absolute necessities to get a liquid substance into the vein of a human.

 

The actual birthing process:  So…the laboring moms are on the floor with their “IV”.  Most moms that I’ve seen are basically silent during birth.  No crying out…screaming…nothing.  Maybe some whimpering, but that’s it.  The baby is then born (with the help of the midwife), placed on the mom’s belly, and covered in cloth (each mom shows up the clinic with a bag of supplies including several pieces of cloth, a towel, a sponge, and a bar of soap).  The cord is clamped (with one metal hemostat on the placenta side, one traditional plastic clamp on the baby side), cut, and then placenta is delivered.  Baby is swaddled and carried to a bed in the next room, mom is cleaned up (with the use of some of the fabric she brought with her) and, get this, then the mom crawls to the room where her baby is.  There is FAR less sympathy/coddling/what have you with regard to laboring mothers here.  Mom then climbs up into bed with her baby where she rests for a couple of hours.

 

All of the after effects of birth (placenta, soiled cloth…and when I say soiled….I mean SOILED) are placed into a plastic bag and sent home with the family.  Most families ceremonially burn the placenta and other products of birth after returning home.

 

The baby is weighed, measured, bathed, rubbed down with shea nut butter (locally produced) and talcum, re-swaddled, and then carried home (usually on foot or by moto) by a female relative of the mother.  The mother goes home separately on a moto or the back of a bicycle.  All this only hours after the baby has been delivered.

 

So…note any differences from having a baby in Africa from having a baby in the U.S?  Maybe a couple?

 

REAL issues:  This is not how all births transpire here.  Believe me, this is a relatively safe way to deliver a baby.  Many, MANY births still occur at home, unattended, on the hut floor. This is one of the reasons why, as I register women on Fridays for “antenatal day”, that I learn that many, MANY women have lost at least one infant.  It’s not at all uncommon to register a woman as a “G6-P5-3alive-2dead” (meaning that, including her current pregnancy, she’s been pregnant six times, has delivered five babies, three are still living, two are dead).  I’d say out of the 40 or so women we see every Friday, at least 10 have lost a baby.  TEN, at the VERY least.  Infant mortality is not uncommon here.  Mind you, I am in RURAL Africa (commonly referred to as “the bush”)…I doubt it is like this in the hospitals at the larger cities. 

 

Note, also, thanks to Fridays/“Antenatal Days” at the clinic, any pregnancy that is qualified as “high risk” is referred to the hospital in Savelugu (sav uh LOO goo) or Tamale (TOM uh lay) (the district and regional capitols, respectively).  We check blood pressures, the midwife performs palpation to determine the position of the baby, etc.  Hypertension, breech babies, particularly small women (who are deemed less able to deliver without complication), etc. are all referred out.  I surveyed the birthing log at the clinic, and since mid-2007 (that’s how far back the book goes) the clinic has had only successful deliveries, with the exception of one stillborn baby.  Not a bad track record.   

 

Why, you may ask, don’t all the pregnant women just go to one of the neighboring hospitals to deliver their baby?  Well…transportation for one.  Culture for two.  Many of the women who are seen by the midwife at the Zoggu clinic don’t even live in Zoggu.  They live in a smaller (yes, there are villages smaller than Zogu) neighboring village.  Often times the only way they get to Zoggu is on foot.  Their village doesn’t have a lorry that leaves every day like Zoggu does.  And the Zoggu lorry only leaves for Savelugu every two hours during the day, maybe.  And ambulances?  There’s no way an ambulance would be sent anywhere from Tamale or Savelugu for something as simple as a birth.  So, often times a woman’s best (read only) option is the Zoggu clinic.  Safe?  Relatively.  Effective?  Pretty much.  Readily available alternatives?  Nope.  Also…the culture here really downplays childbirth.  For many women, giving birth at home is a rite of passage.  Many of these women have NO (zero, ziltch, nada) form of formal education, so, basically, they just don’t know any better.  It’s a real problem.  (Ever scolded as a child by someone saying, “Where I come from, education is a PRIVELIDGE!!!”  Yeah, well…that phrase has very real foundations.  Painfully real.  I had no idea.)

 

Interesting observations so far:

The first birth I saw took place on the floor of the examination room, as the first-time mom that showed up was crowning as the midwife performed her initial examination.  She was about four weeks early, and the baby weighed only 2.3 kg (5.06 lbs).  This tiny baby was home with mom within a few hours of delivery.

 

The second birth I witnessed, the baby required several minutes of CPR before breathing on her own.  The length of the umbilical cord between the baby and the placenta was unusually short.  My guess is that during delivery, the cord was pulled and therefore pinched closed, depriving the baby of oxygen.  Basically, the baby coded (stopped breathing) as it was delivered.  Had this baby been born at home, on the floor of a hut in rural Africa, I have no doubt that she would have died.  I thank God that the midwife knows infant CPR, performed it, and got the baby to start breathing again.  Again…baby and mother were both back home in a matter of hours.

 

Once, there was a woman who delivered a decent sized baby (3.3 kg…7.26 lbs) with a certain degree of difficulty (she was one of the few women who actually cried out in distress during delivery) and suffered a labial tear during the delivery process.  Following delivery she was stitched up with no local anesthetic, no epidural, no nothing…just a surgical needle (not sterile) and thread.  Only then, did she (justifiably) show any overt signs of pain.  (To the women reading this blog….CAN YOU IMAGINE?!)

 

The record timing between birth to going home was in a delivery I saw on Sunday.  Time of delivery:  1410.   Time mother and baby were on their way out the door:  1445 (just enough time to weigh/measure/clean baby). It was her sixth baby.  

 

 

Like I said…things are very different here!

 

So…with all of the above said…there are pros and cons about seeing deliveries take place with such little medical intervention.  While the description of birth in the Zogu clinic may seem painfully barbaric compared to how things are done back home (especially to my nurse/doctor friends), please note that the midwife that I’m working with does wonders with the limited resources available to her and that if not for her, many, MANY of the children in this area would not have survived their own births. 

 

All of this just makes me appreciate so much what resources are available in the U.S.  And that me and my friends and family (well, me in two years) have access to such wonderful, life-saving technologies.  Breaks my heart for the third world, but that’s why I’m here.

 

And…for the first time ever…HIV testing is now offered at the Zoggu Clinic!  We tested THIRTY-FOUR pregnant women last Friday.  Real headway!!

 

Of far less importance, I’ve jotted down a couple of nuances that I’ve learned to become accustomed to while living here:

 

I cut my own hair.  And it’s GONE.    And really, who cares?  It’s just hair.  I also only wash my hair a couple times a week.  (Bye, bye vanity!!)  No one ever sees my hair, as I keep it covered every day.  Also, washing my hair means using more precious water as I bathe.  So…it’s really a no-brainer.   Shorter hair, less washing, less water, less hassle!

 

Also, my feet are ALWAYS dirty.  I now understand the significance of the story where Jesus washed his disciples’ feet.  Walking around all day in flip flops in a dry, hot, DUSTY environment…makes ones feet disgusting.  I’ve taken to scrubbing them before I bathe, so that way I can get all the preliminary dirt off.  I then scrub them five minutes later while bathing (outside, from a bucket).  Then, after my bath, I switch into some special flip-flops (special, meaning, I NEVER wear this pair outside my compound…therefore they are relatively clean) and immediately apply anti-fungal cream.  Too much information, perhaps, but my feet are so dry and flaky that I’m attributing it to more than just a dry, dusty climate.  I’m pretty sure I’ve acquired an almost permanent case of athlete’s foot…caused by the same fungus that causes ring worm…of which probably half of the village kids are afflicted.

 

And to those of you who have sent me care packages…you have no idea what joy it brings me to open a box of goods from America.  Cookies are particularly enjoyed.  And the M&Ms always serve as an excellent substitute when there are no cookies, or when I need a snack, or when I’m depressed because it’s lights out, or simply because it’s Tuesday, whatever.

 

 

So anyway…I am doing well…many days I’m filled to the brim with gratitude for the blessings I have in my life.  Other days I am in a mild case of panic for hours on end (like after the rats made it into my room, or last week when I had an awful, but thankfully self-limiting case of gastroenteritis).  It’s easy to get depressed when I think of all the suffering that goes on here, and just HOW EASY my life was back in the U.S.  But then I think about why I am here and say to myself, “Kimmie…just suck it up.”

 

Also…a camera is officially in the mail to me (thanks, Momma!).  So, pictures are coming, I promise. 

 

I hope you are all doing well!  Next time you enjoy a cold glass of milk count YOUR blessings!  They are many!!

 

Sincerely,

Kimmie