Tamale to Enchi

February 7, 2010
We just arrived in Enchi today, after 13hours of travel. We left on Sunday morning from Tamale. The bus ride from Tamale to Kumasi is 7hrs. The bus broke down half way, but luckily after 45minutes, and all the male passengers puching the bus to gt it started, it finaly began to move on its own. Thank god for African muscle!! We all had a good laugh when we arrived in Kumasi, because all f us weak white people were sweating buckets on the air conditioned bus while they pushed. In the 40 degree heat, they hardly broke a sweat, and not one complained. We stayed the night in \kumasi at a guest house close to the bus station, the room had a king bed, two twins pushed together, and one single. \i never slept a wink.There was three of us in the bed and \i am not used to the humidity. We had been in Tamale where the weather is hot and dry.

Philomena,Vida's sister met us this morning at the guest house for breakfast. She had arranged for a van to drive us to Enchi. The Vans are 140 cedis if you rent the whole thing, but if you are open to picking people up along the way it is 10dedis a person. We traveled with three men going to enchi and Philomenas brother and his daughter. It was the craziest drive of my life! The roads here are terrible. They, for the most part are paved but there might be 100kms per trip that are dirt, not to mention the giant pot holes. There was about 5 cars on the way that were changing their tires.They don't seem to stop people from driving 100 to 120kms though. The cars all swerve from left to right on the road trying their best to dodge the holes. Sometimes we were driving three tight on the road. It was so scary and I thanked god for gravel and seat belts. About 45minutes from Enchi the little girl sitting nto me vomited all over me and both of my bags. \i couldn't complain though because Kat was sitting infront of the little girl and got it on her face and in her hair.

It took us 5hrs to drive to enchi. Enchi is about 20kms from the IvoryCoast. It is luch and green, a semi tropical climate. The humidity here is very high. Philomena told us about the two motels that she had looked at for us. Oned is a two minute walk to the clinic, but would cost 50cedis a night. We had all thought we would be paying about 7 so we decided to stay in town at the motel that was 30 instead. The one we chose in town didn't have a shower and is right next to a bar and the music is carzy loud. Philomena picked us up to take us for dinner at the Hotel that was closer to the clinic. The manager came and talked to us while we were eating our dinner and told us he would give us the same price if we moved our stuff over.

Philomena told us the clinic consists of mostly prenatal, antenatal and postnatal care as well as family planning. am so excited, it is completely the experience that i wanted. Tomorrow we are going to get started with a tour around the town and then a look at the clinic. She wants to show us the drug dispensary and go over the different experiences that we each want. i am not sure if i am understanding her but it sounds like the clinic practices in general medicine as well.i think maternity care is her specialty though.

Our first night in Enshi we left the motel in search of a place to find a beer. The streets are like the other streets we have seen in Ghana. They are narrow and lined with sewer trenches. The air is always slightly tainted by the smell of raw sewage. its difficult here to tell whether something is a bar or a convinience store or a hair salon. All the buildings look like little shantys. We dicided that one of them was a bar because we saw the beer posters plastered on the walls outside and their was loud music coming from within. The room was no bigger that 8ft by 8ft. We ordered four beer and started drinking them. The roofs are made of tin and the inside of the room was so hot, the owners went outside while we sat inside, to give us a little more space. We asked if we could sit outside too. They moved our table out to the front, inside a small enclosed space. Within minutes there was about 30 kids that had encircled the enclosure. The love our cs posing the minute your cameras and are always posing the minute you pull one out. They do everything you do. If you give a thumbs up, all thirty give a thumbs up, if you raise your hands, they raise their hands. They are all pro dancers right from the age of three. We showed them how to do the sprinkler and some cool underwater moves. They thought it was so funny, and picked it up super fast.

February 8, 2010
Today we began at Philomenas clinic, it is more like a small hospital really. We were supposed to have orientation of the village as well as the clinic, but there was a woman laboring when we arrived. Two of us assisted with the labor and the other tow helped in the clinic.Because of our interest Kat and I were sent with the laboring woman.I was surprised at the things I remembered from my labor and delivery rotation. i am glad to have had that experience now. i did my first check of a cervix as well as cut the cord. it was a straightforward delivery. i think that thow weeks here will hardly be enough time. wit hthe language barriers \i experienced today i think it would take twice as long to learn a system. the nurses i worked with were unable to answer any of my questions. philomena was the only one i could get answers from and it is even difficult to understand her sometimes. after the delivery, we bathed the baby and the mother and then i helped assess pregnant mothers and helped with post natal visitis and family planning. it was difficult because i can't understand what the nurses want me to do, or what the mothers are saying. lucckily everyone is so even tempered.

The clinic is so busy. i have asked philomena is i can take a short video clip one of the days we are there, just to show everyone at home just how busy the clinic is. the people generally come to the clinic and first see the triage nurse, who decides in what order they will see the doctor. The doctor then assesses and writes orders on a small chart that the patient carries with them through the clinic. After seeing the doctor, depending on what kind of orders he ahs written, the patient might go to the lab or to the dispensary or both, then to the casualty room to be bnadaged or receive some type of treatment. if they need to receive a drug by injection they have to visit the dispensary first to pick it up, then come to the casualty room to and have the nurse dispense it. often after receiving treatment the nurse will decide whether or not the person is sick enought ot be assigned a bed in the male or female ward, or in one of the observation rooms.

In the after noon weh we had finished up with all the moms and babes, I went to the casualty room to help out there. The main diagnosis that I saw there was small children with malaria. They had all been to see the doctor, been to the lab, and to the dispensary already and were visiting us in the casualty room to receive their injections or quinine, and antimalarial drug.

in the middle of one of our treatments the doctor came rushing in with a convusling five year old boy. The nurse immediately gave him diazepam rectally. he had a fever of 39.2. i found it challening trying to help, again, because of the language barrier, but also because they do things so much differently here. They are short on supplies so i never know what i should use or what i should save.i immediately went to grab a towel to moisten and sponge the child, but apparently they don't use the towels for those things. The nurse grabbed me a small amount of guaze. We were able to get his temperature down wit the bath as well as giving him tylenol rectally. he was kept for observation, lab work and the treatment of malaria.

February 10, 2010
i have had a cold for the last 4 to 5 days. i always feel slightly on the verge of heat stroke. it is just so damn hot here. The clinics are not airconditioned and it feels 10 degrees higher when you go inside. i feel like i am going to faint half of the time, so i am finding it difficult to learn. i am beginning to feel a bit low. it is just like i thought it would be, a slow downward spiral. it starts slowly with a few small things and then everything just seems so much bigger than it is. i am really beginning to feel what it feels like to be part of a minority. today i wored in the dispensary. the staff were nice but stoic and preffered to speak in their native tongue than in english. i really began to feel like an outsider. i never know what is going on around me and it is beginning to take its toll. the short walk back to the hotel for luch over heats me and i can't cool down when i get back to work. the four of us are constantly sweatiing. it is no wonder they think we are weak. They are constantly telling me to sit and rest and that i look pale. Which, believe it or not, i do. it is way too hot to spend any time in the sun, and their isn't a body of water in sight.

i find the clinis staff funny, every morning when we arrive to do rounds they shake our hads and tell us " you are welcome". it is actually not uncommon to be greeted like that here. this morning though the doctor patrick, shook my hand and said that it was hotter than the rest. he asked me if i had any bug bites. I had to laugh, the care starts at a very basic level here and the staff are in tune with much more than i could have expected. i reassured patrick that i was fine, even though i took the afternoon off. i just needed a break from the heat, and some time alone in my head. i realize now though, how closely the staff keep an eye on us. Several student last year contracted malaria.

February 11, 2010
Today a beautiful thing happened, the skies broke, and it rained...

February 13, 2010
I feel much better, after two days of rain, I know my illness was heat related, what a relief!