I got this letter from Dawn from Crossroads. it’s an update on their project in Ghana.
Two Weeks in Ghana
Many of you know that I have been working, along with a very dedicated committee, on a project to bring palliative care services to Ghana. The project is supported by the Crossroads Hospice Society, where many of us volunteer. Many of the committee are also professionals in active practise with the Community Palliative Care Team with Fraser Health. After in depth research, which included talking with folks who had originated in the countries, lived and or worked there, we chose Ghana. Stop and think-do you ever hear of Ghana in the news? Not often and usually in a positive way. Ghana was a British colony until 1957. The working language of government, professions, etc. is English. The country is stable and democratic. Ghana is widely seen as a positive economic example of what an African country can achieve. For all these reasons and also that we found a potential partner in the Ghana Palliative Care Association, we chose to focus our efforts on assisting the GPCA to bring palliative care to that country. Currently, there are no palliative care services within the health care system. As was the case in Canada 40 years ago, once curative treatment is no longer an option, people are sent home to die. Their family and friends do the best they can but have few resources. There is one nursing education programme that contains a formal curriculum component on PC. There have been several short workshops given by outside groups who come and give a day to several days of basic education and then depart. So far no efforts have been made to set up a sustainable programme of care/education to develop a critical mass of caregivers in PC. This is something we at Crossroads and the GPCA in partnership hope to change.
After almost three years of researching, planning and communicating with each other I and Sharie Ford, as representatives of the Canada Team left Vancouver the end of July, to visit Team Ghana and the country. What a journey of exploration, discovery and common purpose it turned out to be. The two weeks flew by in 12- hour days, meeting new people and old friends in the community, government, health care and education.
It is a very long trip between our countries. We flew British Airways in both directions and were very well cared for. The first half of the trip is circum-polar to Heathrow (London) then almost straight south to Accra, the capital of Ghana. We arrived late at night having to descend via stairs onto the tarmac into a warm, slightly steamy tropical night. We knew we were being met but had to pass through several check- points and pick up luggage before seeing immigration. Once we had our luggage on a cart we experienced a rather chaotic “bumper car” trip that was a precursor warning of driving conditions the rest of our stay. Definitely no-holds barred, take no hostages, every one for themselves! Once out-in one piece!, we found our hostess and felt very welcome indeed. We were whisked off to a nice hotel and settled for the night. Phew!
The next day we had some orientation and then started to work. The pattern was pretty much set of early starts and late finishes with lots of time on the road getting between appointments/meetings. Of the fourteen days we were there one was a “tourist” day towards the end of the stay. The rest were work. Our partners had set up a wide range of visits with officials in government, health care and education at a fairly high level and we had a number of meetings with the GPCA group. Everyone was welcoming, friendly open and enthusiastic about the efforts to set up palliative care. There were a number of substantive offers of concrete help along with verbal support. Only one government official, while supportive of setting up PC, saw doing it another way. The GPCA has decided that they want to set up a model hospice to be a center of care and also a source of education. This will be a 10-15 bed unit/facility. They are currently looking at the offers of space to select the one that best meets their requirements. This is in line with our thinking as it is small, defined and allows for evaluation. It is hoped it will become a hub of PC that will facilitate slow spread of knowledge/expertise.
We were very impressed by the openness, welcome and friendliness that was expressed towards us. There is such commitment to making this small start a success and growing it. The professionals at the GPCA are incredibly hard working and dedicated. The 12- hour days are routine for them. Traffic/travel is incredibly bad with 4-8 hours in the car daily getting around, routine. There are only a few “motorways” and they are always congested and move at a snails pace. We used a lot of that time asking questions about what, how, who and learning how systems work and the culture. Each night Sharie and I spent 1-2 hours minimum, debriefing the day, cross checking information, meaning etc. A very necessary activity when you are operating outside of your usual environment. It was essential to have one observing while the other talked and several pairs of eyes, ears working on all the communication cues. A major benefit for us out of the trip is the understanding we have gained of the context our partners are working in and the resources they have and do not have. While we were there the entire capital city was without power for ¾ hour. Internet access was pretty good the first week but the second week had 3-4 days of very inconsistent Internet access, for very short periods of time. It was Internet Russian roulette!
I was very impressed by what I saw in the hospital. The equipment was not up to date but it was adequate. The units were clean and there were no smells. The exception was the medical emergency but not surprising to have messes and smells there. There is an obvious dearth of resources but we were in Africa. There were many signs of doing the best with what was available. Health care is pay as you go for most people although there is some limited health insurance, both gov’t and private. The government is looking at wider coverage. Communicable disease is largely under control due to immunization programmes. Malaria is still a scourge and of course Ghana has its share of HIV/AIDS. There is growing concern re non-communicable diseases such as cancer
The streets were better in many ways than I expected. Once off the few paved streets it is dirt (red like PEI) and lots of potholes-big ones! Most people have drivers and they are skilled at avoiding the potholes with a very sinuous driving style. Seat belts a necessity! There is lots of garbage but it is largely “dry”(paper, plastic, leaves, branches) not waste products from people and animals with the occasional dead bird/small animal I saw in the Far East. They had just had floods so the open drains probably had been washed cleaner. Not too many smells. We were told it was less hot/humid than usual while we were there. I found the temperature much like the Montreal in Aug./Sept. of my growing up.
Because of the slow moving traffic there is very heavy pollution, which became very unpleasant at times. We were fortunate in that offices and cars were a/c but sometimes that made the contrast worse.
Food as we expected was very different. We had to be meticulous about only using bottled water even for teeth, washing fruit we bought and the utensils we used to peel the fruit. The hotel we stayed at the longest (we had one move), became very good at sautéing the “salad”(mostly cabbage, carrot, onion) in oil for us so we could get some veg. We were also OK eating fruit like papaya and pineapple they were careful preparing. Never ate fruit away from the hotel. The fruit is sooo fresh and sweet-I am spoiled for pineapple forever as what we get does not compare in juiciness and sweetness. They are very big on starchy stuff like cassava, rice and noodles. They make “jellof” rice and noodles with onion and spice-delicious but the quantities are huge. We also tried “fufu” which everyone said “you won’t like that!”. It is like uncooked bread dough that you pluck up in a ball and dip in a sauce before eating. Not a wonderful culinary experience but at least we tried! I had a hard boiled egg and toast each morning as it gave me protein to run on. We often never got lunch so learned to carry energy bars and trail mix we had brought. Chicken was the meat of choice as the beef was very tough and we were not sure about the tilapia. Needless to say rice, chicken and eggs are off the menu for a bit!
Most Ghanaians only eat breakfast and dinner.
Our one tourist day we drove down to the Gold Coast area. This is where the infamous Elmira castle is found with the “door of no return”. It is very affecting to tour the castle. One can almost hear the cries of the people carried away from their villages by slave traders and the clank of chains as they were dragged out to the slave ships to be packed like cordwood. Fifty percent or more died on the ships to the Islands and southern US. And only a remarkable few ever saw Africa again. On a happier note we visited the Rainforest reserve with its ropewalks but chickened out. We also visited a crocodile reserve that also had trees filled with colourful birds making nests like baskets. Fascinating watching the building process going on 2 feet away. On the trip we saw pineapple farms, mango, papaya and coconut groves. Fresh fruit could be purchased, just cut, from roadside stands. We also got a 2- hour run through the Accra Craft Market going to targeted outlets to get the items we wanted. Too bad we did not have time for a more leisurely visit, as there were some wonderful pictures to be had. We took as many of those as we could, so will share later.
There is huge unemployment and underemployment. Anyone with a regular job is very happy to have it. One of the features of the traffic jams is the large number of street vendors that walk the lines of idling cars selling an amazing range of goods. The first two days home I found myself looking for the vendors. We did see some begging but not a lot-there was much more free enterprise.
All in all it was the right thing to do to go over for a visit even though we were a bit uncertain of what we might find. The country has many problems but is dealing with them as best can-the “free” press keeps hot on the politicians! The people are wonderful from top officials to the street vendors. They are friendly, welcoming and very hard working. Canada has built a good reputation in Ghana through the many projects government/NGOs have fronted. We have partners who seem dedicated to the cause. We learned a huge amount. The country is lush and beautiful with gorgeous beaches.
On many fronts the trip was worth the time, effort and cost. We look forward to the project developing so we can return to work next year.
