Northern Ghana...

There are parts of Ghana that have a National Geographic feel with round mud huts, roaming goats, and fields of maize tended by villagers wielding wooden hoes and machetes.

Houses in the Upper West Region

Advertising for Vodofone (Leading Cell Phone Provider)

But the realities of life in northern Ghana don’t fit neatly into the stereotypical “rural Africa” box. Weaving among the donkey carts and bicycles are district chiefs driving to meetings and funerals in their SUVs. A closer look at those same bicycles reveals baskets packed full with cans of petrol, cell phone chargers and bottles of coca-cola. On the roadside, stalls selling Tupperware and neon flipflops jostle for space alongside those selling groundnuts and onions. Soccer jerseys and second-hand little league t-shirts are the dress of choice for teenage boys.

Motorcycle Avoids Hitting Donkey Cart

At first, I struggled to reconcile this seemingly disjoined clash of modern and traditional. However, I am starting to recognize and appreciate the harmony of new and old that is grounded in the practicality of everyday Ghanaian life.

Emma

I'll Meet You at Traffic Light

Roadside in Tamale

Even though Tamale is the largest city in northern Ghana, it’s defined by a small town bustle of bicycles and motorcycles weaving among overstuffed road-side stalls. Tamale is typical of most towns in northern Ghana where you can tell someone to meet you at “traffic light” and you will have no trouble finding each other.

Although quite a bit more confusing, this system of naming meeting spots and businesses extends to the large cities as well. In Accra, it seems as though the biggest, best, or closest thing in its’ category earns that thing as its name. The neighborhood where the Ministry of Health is located is called “Ministries,” the largest traffic roundabout is called “circle” (as in, “I will meet you at circle,” or “drop me at circle, please”) and Accra’s new shopping mall is called…wait for it….”the Accra Shopping Mall.”

Taking a similar approach, locations are typically defined by the nearest significant landmark. In Accra, navigating to our house consists of telling a taxi driver to take us to “one junction before the Papaye” and turn onto the “rough road.” Both Papaye (a chicken and rice fast food joint) and the “rough road” produce surprisingly successful results, which actual street names generally solicit blank stares. In Tamale, our guesthouse is once again defined by it’s relative proximity to a fast food place, and regardless of the region we are traveling through, the Regional Health Ministries become the place just past the [insert bank/hospital/hotel].

Emma

Site Visit at Karaga

Based on an example request list that we provided (with categories for diagnostic equipment, wound care, etc, etc), Dr. Twumasi will develop a request list of supplies and equipment that best reflects the needs of the Northern Region. Since much of the supplies will be distributed to the region’s five new polyclinics, it was important for us to get a better feel for their specific needs, priorities and challenges. Just days before our meetings in Accra, a young doctor from Karaga Polyclinic had sent a list of needed supplies and equipment to the MOH, along with a heartfelt request letter. After hearing more about him in our regional meeting AND learning from a contact that he did an away rotation at the University of Michigan, we knew we had to meet him. A few phone calls later, we had a site visit scheduled and a vehicle arranged and were ready to visit Karaga. Just outside of Tamale, the paved road is replaced by bumpy red dirt, and banks and hotels give way to flat expanses of farmland and thatched-roof family compounds.

Village Along the Road to Karaga

In the tro-tros and pickups passing by, there seem to be an equal number of people sitting on roofs and perched atop bags of rice as there are actually occupying seats. The landscape is dotted with women hanging brightly colored laundry over bushes and uniformed school children clustered around homemade soccer goals. I felt ready to get out into the communities where MedPLUS Connect shipments make the most impact, and eager to meet Dr. Abraham.

Karaga Polyclinic

While completing his internship at the Tamale Teaching Hospital, Dr. Abraham was inspired by a talk on the need for doctors in the health facilities surrounding Tamale. He took a position as the sole doctor in Karaga, a district in Ghana’s Northern Region that previously was without a doctor and is still without a hospital. Since arriving in Karaga this year, Dr. Abraham has petitioned the government and Ghana Health Services for funds and equipment to turn his polyclinic into a fully functioning and comprehensive hospital.

Dr. Abraham in a Poorly-Stocked Exam Room

When Dr. Abraham’s polyclinic lacks the training or medical equipment necessary to care for a patient, the patient is refereed to the regional hospital in Tamale. Even in the comfort of a Ghana Health Services SUV, the trip that we took from Karaga to Tamale was a jarring two hours. For many polyclinics and district hospitals in the Northern Region, the trip is three or four times that distance. Because the Karagra Polyclinic lacks an anesthesia machine—and thus has no option to replace an epidural with general anesthesia if complications arise during a c-section—many high-risk delivery cases, and most general surgery cases, have to be referred. Although we talked for almost four hours, Dr. Abraham’s words about referrals stuck out: “…sometimes when I write a referral, it feels like I am writing a death warrant.”

Emma, Dr. Abraham and Sonya

Dr. Abraham’s frustration is evident as he is forced to reconcile his years of training with the constraints that a lack of funding and medical equipment place on the care he can provide. At the top of Dr. Abraham’s request list is an anesthesia machine. I hope that together with our partners in the U.S., we can get an anesthesia machine into Dr Abraham’s very competent hands.

Emma

Northern Region Meetings

Road Leading from Tamale in the Northern Region

After spending the morning practicing pronouncing his name, we met with Dr. Akwesi Twumasi, the Regional Director of Health Services for the Northern Region. He was excited that the Chief Director of the MOH had suggested that we send three containers to the Northern Region, and we spent the next hour discussing issues of logistics, need, and geography…a huge factor in a large region with limited resources for distribution.

We decided that first container will go directly to the Bole District Hospital and surrounding health centers and clinics. Bole is the district hospital located the farthest distance from Tamale, thus making distribution from a regional shipment difficult. We have plans to meet with the Medical Director at Bole next week to introduce him to the MedPLUS Connect model and begin developing a request list.

The second and third containers will be delivered to Dr. Twumasi who will distribute the contents to the Northern Region’s 5 new polyclinics and several additional district hospitals according to need. The polyclinics are located in districts that currently don’t (but should!) have a hospital—the MOH and Dr. Twumasi both stressed the impact that supplies/equipment could make there.

Emma

A Great Contact Goes a Long Way

At our guesthouse bar, we met with Kofi Gyan, a fantastic new contact from the University of Michigan, who seems to know everyone and everything related to health and healthcare delivery in Ghana. Together, we reviewed the blueprints for the child and maternal nutrition center that we are building in Lawra, and discussed changes in dimensions and layout of specific rooms. After final meetings with the health staff of the Lawra District Hospital and our contractor, we will be ready to break ground!

Our Work Station at the Jungle Bar

Even more important than Kofi’s advice about the physical construction of the center was his advice—taken from years of experience carrying out projects in Ghana—on issues of accountability, payment, and coordination. In hopes of building a larger and more comprehensive center (particularly a large kitchen for preparation of food and maternal education workshops) we are working with Kofi to apply to the international Rotary Club matching program with support from a rotary club in northern Ghans and it’s counterpart in Ann Arbor, Michigan.

Emma

Plans for Our Next 5 Containers!

Hallway in the MOH...Tamale Feels VERY far from Accra

On our first morning in Tamale, I woke up to a phone call from the Chief Director’s assistant saying that the Chief Director of the MOH had signed the invoice and memorandum authorizing MedPLUS Connect to ship 5 more 40 ft containers of medical supplies and equipment! At the moment, I wasn’t sure what I found more exciting: that fact that the document was signed or the fact that someone in the MOH took the initiative to actually call us ☺.

Based on our previous discussions with the MOH in Accra, we together decided that three of the containers will be sent to the Northern Region, with destinations determined by the Regional Director of Health Services. The 4th container will be sent to the Upper East Region and will have a general surgical focus to compliment the 2 containers of beds, equipment, and consumable supplies that are currently on their way from the USA . The destination for the 5th container will be based on the outcome of site visits and meetings conducted over the next three weeks.

Emma

Traveling to Tamale

In efforts to avoid a long bus ride, Sonya and I caught a ride with Kofi, a new contact who was driving from Kumasi to Tamale to drop off a medical student. Along the way, we stopped in Techiman so Kofi could meet “briefly” with a local chief about setting up homestays for an undergrad summer research trip. The meeting followed typical Ghanaian form, with the chief leading us into his living room, turning on the TV in the background, and waiting to ask Kofi who he was and why he had decided to come by until after glasses of Coca-cola, Fanta, and Star Beer had been passed around. Finding a place to stay in Tamale turned out to be a bit of a challenge after realizing that Ghana’s recent change in area codes made every single phone number in our guidebook incorrect. After a bit of resourcefulness, we ended up hitting the budget hotel jackpot with a guesthouse run by the Tamale Institute of Cross Cultural Studies.

Parade Outside Our Guesthouse

The chairs lining the central garden courtyard (complete with a swing!) are occupied by young people volunteering for unite for sight or working for local NGOs and the breezy “jungle bar” serves a surprising normal tasting cheeseburger. Of course, our first night in Tamale wasn’t without a few power outages and visits from an odd collection of lizards, cats, and an oversized slug.

Emma

Akwaaba, Sonya

Last Tuesday I was joined in Ghana by Sonya Narla, MedPLUS Connect’s 2011-2012 Executive Director. It’s been great to have someone to share in the long taxi rides and laugh at the Ghanaian idiosyncrasies that fill our days. But most importantly, I’ve enjoyed having someone to bounce ideas off of, to brainstorm and plan with, and to share in the responsibilities of coordinating and documenting the trip.

The learning curve is steep but I’m confident that Sonya will do a fantastic job in the coming year. Akwaaba, Sonya. Welcome to Ghana.

Emma

A Brief Rewind to Last Week

Now that I’m back in the swing of things in Ghana, I’m focused on the day to day process of scheduling meetings, coordinating the arrival of upcoming shipments, and the general chaos of traffic and heat. This morning, organizing recent photographs reminded me that just six days ago, MedPLUS Connect loaded our largest shipment to date.

The shipment consists of two 40 ft containers (a total of 31,204 lbs), both of which are headed to the Regional Health Directorate of Ghana’s Upper East Region. Under the direction of the Dr. Awoonor-Williams, the Regional Director of Health Services, the contents will be divided among a regional hospital and five district hospitals.

The first container, loaded in the morning, was filled almost completely with 40 hospital beds and mattresses.

Hospital Beds Stacked for Loading

The second container, loaded later that same day, contained an assortment of equipment—including 6 OR lights, 6 oxygen concentrators, 8 infant incubators, and an anesthesia machine—as well as hospital furnishings and 9 pallets of basic consumable supplies.

Infant incubators

Anesthesia Machine Wrapped for the Load

Emma

A Quick Trip to Kumasi

On Sunday, I made the 6-hour bus ride from Accra to Kumasi where I was picked up by a friend at “last stop,” not so conveniently located in the center of a busy intersection just above Kumasi’s largest tro-tro station. Since February, construction on a new divided road has been finished, complete with an impressive row of street lights decorated with the requisite Ghanaian flags. Not surprisingly, the divided road does nothing to reduce congestion since taxis and tro-tros continue to drive both ways on both sides of the divide.

Kejetia - Transport Hub in Kumasi

On Sundays, everything shuts down in Ghana and extended families and friends gather to eat and chat—it was the perfect evening to spend with my host family in Kumasi. I’m not sure what was more adorable, a three-year calling me “auntie Emma” and bringing me sips of her malta, the baby that burst into tears whenever I got too close, or my host brother chasing Emma (my canine namesake) around with a mop when she tried to grab the top off the pot of stew.

Sitting in the cozy living room, removed from the bustle of central Kumasi by an especially bumpy dirt road, I was once again reminded of how interconnected the world is becoming.

Main Street Leading to My Host Family's House

Akwesi was working on a PowerPoint presentation on the role of social media in mobile phone advertising for one of his business courses while Gaby showed me photos of his recent trip to Morocco as the Ghana Projects Abroad representative at a conference on volunteerism. In the background, Ben chatted to his brother Simon (who is in his final year of an engineering degree in China) in a rapid mix of English and Twi, peppered with a few words of Mandarin. All the while, reruns of American talk shows and Jimmy Fallon standup played on the TV.

Emma

Back in Ghana

The strangest thing I’ve encountered in Ghana so far is the feeling that nothing seems strange. Since my most recent trip to Ghana in February, I have driven a rental car through Southern Africa, taken a trip to the British Virgin Islands, and decided where I will be starting medical school this August. But stepping of the airplane in Accra, it felt like just a week had passed.

I spent my first evening in Ghana catching up on sleep and watching TV with my friend’s uncle. I’ve gained a new appreciation of American reality TV after watching “Big Brother Africa.” I made it through 15 excruciatingly slow minutes of two housemates playing chess before realizing that the show is broadcasted on a dedicated channel, in live time, 24-7…

Today was spent dealing with something just as annoying back in the states as it is when traveling…computer problems. The disk I’ve had stuck in my CD drive for the past two years finally decided to put up a fight, making it impossible to use the internet (which I had spent the morning setting up) or access any of my documents. So I did what you do in these situations…head down to the Apple Store, or in case of Ghana’s closest approximation, the iStore. I was immediately put at ease when the technician lectured me about the importance of “running a full backup with time machine” and he managed to remove the disk within minutes. In the midst of apple t-shirts and sleek displays of iPhones I almost forgot I was in Ghana…until the technician not-so-subtlety reminded me that he works for tips ☺.

Slow Traffic

One the bright side, sitting in traffic on the way to and from the iStore gave me plenty of time to make calls to health and government officials, mapping out their various travel schedules in an effort to plan my own route through northern Ghana.

Emma

Shipment Arrives in Nandom, Ghana

Several weeks ago, a container of medical supplies and equipment was unloaded in Nandom, Ghana.

Boxes of Medical Supplies Being Unloaded

Speaking to the Medical Director via skype shortly after the unloading was certainly rewarding! He spoke at length about the impact that the supplies and equipment would make in the Nandom community.

Donated Beds in Adult Ward

Most importantly, he stressed how involved he felt in the process, how closely the donated items fit with his hospital's specific needs, and how excited he was to build a lasting partnership with MedPLUS Connect.

Donated Surgical Instruments Put to Immediate Use

Below is a quote taken from a letter of appreciation sent by Dr. Robert Amesiya.

"We the management and staff of St. Theresa’s Hospital, Nandom acknowledged receipt of shipping container full of valuable items such as slit lamp, patient beds, operation lamp, pharmaceuticals, curtain materials, drip stands, office chairs, lockers, needles and syringes, gloves etc etc.

The items have been very beneficial to the hospital and community as a whole. We hope this collaboration will continue so that the hospital can improve and widen its scope of health care delivery to the communities in this part of Ghana and Africa. Thank You."

Emma

Welcoming Josh Posen as 2011-2012 In Country Director

I am thrilled to welcome Josh Posen to our team as 2011-2012 Ghana In Country Director. Josh will work to advance the mission of MedPLUS Connect through his on-the-ground work in Ghana. Among other things, Josh will conduct site visits at hospitals, oversee local health initiatives, and work to develop a more sustainable structure for in-country leadership.

Josh Posen, 2011-2012 In Country Director

Josh Posen holds a bachelor's degree in Psychology and a certificate in Markets and Management from Duke University. He spent a year working for the host broadcaster of the 2010 Winter Olympics in Vancouver, and also worked as a Research Assistant for the Mobility Clinical Research Unit at St. Michael's Hospital in Toronto, Canada. He recently completed the Goucher College Post-baccalaureate Premedical Program, and anticipates starting medical school in the fall of 2012. He previously volunteered at the Nsutaman Polyclinic in the Ashanti region of Ghana, and is excited to now have a home base in Ghana.

Emma

Celebrating Life

Whenever anyone asks what I like best about traveling and working in Ghana, my answer is always the same--the people. I am fortunate to have met some truly amazing people in Ghana, many of whom have become lasting partners and close friends. In the midst of meetings, dinners, and random encounters, I continue to be amazed at the love, enthusiasm, and happiness that permeates life in Ghana. I think that the New York Times article below captures this spirit as it comments on Ghanaian funerals as a celebration of life. Enjoy!

http://www.nytimes.com/2011/04/12/nyregion/12funerals.html?pagewanted=1&_r=2&hp

Emma

Social Entrepreneurship

I'm sharing the words of Lauren Slive, our fantastic Board President... This weekend, 16 teams comprised of students, researchers, professors, and community members will compete in the UNC Carolina Challenge in Chapel Hill, NC. Winning teams will receive seed money to jump start their ventures. In 2009, MedPLUS Connect won the Social Track of the Carolina Challenge & the People’s Choice Award, and collected $16,000 to expand our non-profit. The Social Track includes ventures that are concerned the “social return on investment and improving the local or world community” (carolinachallenge.org).

MedPLUS Co-Founders with Check for Winning 2009 Carolina Challenge

The tenants of social entrepreneurship have always been, and continue to be, core functions to the MedPLUS Connect mission and model. Moving beyond traditional paradigms of philanthropy and giving, MedPLUS Connect aims to empower local communities, repurpose “waste” into valuable supplies, and work in financial partnership with recipient countries.

MedPLUS Connect partners with hospitals and health centers in Ghana to create a direct link between recovered supplies from the United States and under-resourced health care systems in Ghana to ensure that our shipments of medical supplies are compatible with the needs, resources and technologies of our partner hospitals in Ghana. Our recipient hospitals and governments pay the full cost of supply transporation, warehouse space for recovered supplies, an administrative surcharge, and a value added denomination to enhance existing shipments with necessary electronic components and supplementary supplies, such as solar powered lanterns. MedPLUS also works with local partners to engage in side projects to enhance local provision of health care services.

We encourage you to learn more about social entrepreneurship! To find out more about the Carolina Challenge, please visit: www.carolinachallenge.org

MedPLUS Awarded $15,000 Grant!

MedPLUS just received the exciting news that we have been selected by the trustees of the Dorothea Haus Ross Foundation to receive a $15,000 grant to build a nutrition rehabilitation center in Lawra, a rural community in northwest Ghana. The nutrition rehabilitation center will provide both outreach preventative care and nutrition education to mothers and children, as well as in-patient children’s malnutrition care for children. The mission of the Dorothea Haus Ross Foundation is to support organizations that serve vulnerable children, and their website can be found here: http://www.dhrossfoundation.org/

Children in Lawra, Ghana

Ghana’s national malnutrition rate of 22.1% masks severe regional disparities, with 33% of children in northern regions (such as Lawra) under age five classified as underweight and 48% of children in northern regions under age five classified as stunted.

Poster on Nutrition Outside MOH

Over the past few years, plans for the children’s nutrition rehabilitation center have been developed in partnership with the directors and medical staff of Lawra District Hospital and government officials from the District Assembly of Lawra. It has been heartbreaking to know that our Ghanaian healthcare partners have the skills, local knowledge, and desire to address the needs of malnourished children, but lack access to funding to cover construction expenses. I am ecstatic that these funds will allow us to fulfill our commitment to making the center a reality!

If you are interested in volunteering your time to help with this project, please email medplusconnect@gmail.com

Emma

Exciting News!

I am thrilled to announce that MedPLUS Connect was just awarded a $15,000 grant to construct a nutrition rehabilitation center in northern Ghana!!

Nurtition Poster in Ghanaian Hospital

More news on the grant and the details of the project coming soon!

Emma

Goodbye to Ghana

Looking back at the past few weeks, it’s interesting to see how my daily routine in Ghana has changed. Throughout college, as I led service trips to Ghana for other undergrads, my focus was exposing my travel companions to the genuine “Ghanaian experience”…sweaty tro-tro rides, broken-down buses, trips to the market. In the past 20 days, meeting with hospitals and officials in 4 of Ghana’s regions and traveling through several more, I have found myself increasingly opting for efficiency and professionalism—riding to site visits in government cars, trading shorts for dress pants and a polo, and using a mobile internet modem. In the past, I found myself looking at people riding in USAID SUVs with a certain amount of judgment. Now, as I have made the personal transition from a student volunteer to a director of a nonprofit, I understand that getting the job done (while sticking to our shoestring budget!) is the first priority. I appreciate all of the experiences that I have had, transportation nightmares and all, and know I will continue to have my fair share of Ghanaian adventures.

I’m writing this post from the airport in Accra, waiting at the gate to board my flight to JFK. I cannot believe how fast the past few weeks flew by, but I’m happy with how much I have accomplished and ready to tackle the states-side aspects of preparing our next shipments. Goodbye to Ghana, my now-destroyed black flats (that somehow made it through 3 trips to Ghana and 9 med school interviews), my much-needed sweat rag (slightly smelly but so necessary), eating fish at bus stations (I think I my meal last night broke every rule the travel clinic advises), and the wonderful people that have made this trip so enjoyable!

Emma

Final MOH Meetings and Visit to Korle Bu

Back in Accra, I set up my final meetings with the MOH, this time to present an invoice and memorandum for the two new shipments that I had planned before and during the trip. The MOH signed the documents and gave us the go-ahead for a 40 foot container (approx 16,000 lbs of supplies) to the Jirapa District Hospital located in the Upper West Region, as well as two 40 foot containers (approx 32,000 lbs of supplies) to the Upper East Region. As soon as the MOH transfers the agreed upon funds, we will start the process of selecting a load date and booking transport!

Accompanied by Habib, one of our Board members, I had one last meeting with a great organization called MSSI (Medical and Surgical Simulation Institute) that is based at Korle Bu, Accra’s main teaching hospital. In addition to providing advanced hand-on training to surgeons at the facility, the center also coordinates trainings for physicians and health staff at sites throughout Ghana.

MSSI at Korle Bu

http://www.facs.org/fellows_info/bulletin/2010/jacobs0610.pdf

Especially as we begin plans to obtain/ship x-ray machines, I am beyond excited about this potential partnership! This meeting reminded me that despite having larger facilities and more highly trained specialists, Ghana’s huge urban hospitals also face critical shortages in supplies and equipment. Korle Bu—serving as one of Ghana’s two teaching hospitals and providing care for Accra’s 2 million inhabitants—has 24 operating rooms but just 3 working anesthesia machines.

Emma

Last Days in Wa

Before leaving Wa, I met up once again with the Director of Health Services for the Upper West Region…this time for drinks at my guesthouse, which also functions as a conference area and is a popular meeting spot for local health, development, and government officials. I have learned that while a 10 minute meeting in someone’s office can get the job done, it is the hours I spend “unofficially” chatting with health personnel where relationships are solidified. Aside from the benefit to MedPLUS, I feel so fortunate to have the opportunity to talk to such incredible people who are leaders in Ghana’s health sector! My conversation with Dr. Alexis was no exception. Dr. Alexis was a practicing physician for many years before moving into the public health arena and it was fascinating to hear about his experiences in Ghana and the many countries where he studied and consulted. Moving outside after the restaurant closed for the night, we chatted about our mutual experiences in Beijing, the ethics of life support in Ghana, and what it means to be a physician working with underserved populations. Hand down, one of the best conversations I have ever had!

The bus ride from Wa back down to Accra was another all-day marathon but we managed to miss the worst of traffic and make it to Accra after a quick (?) 12 hours. Although the idea of watching movies on the bus sounds like a nice way to pass the time, the reality of the situation—poorly acted Nigerian movies blasted at full volume, followed by a DVD containing a series of movies that should have been titled “films Steve Martin made but was rightly too embarrassed to show in the United States”—was less than enjoyable. As we reached the outskirts of Accra at just past 4am, it apparently became the appropriate time to switch from Steve Martin’s “excellent” portrayal of a Russian submarine captain and begin blasting rap videos ☺.

On a more serious note, the journey from northern to southern Ghana highlights just how diverse the Ghana is in terms of development (and development challenges).

Emma

Crossing Border Between Ghana and Burkina Faso

Roads Connecting Rural Communities in Northern Ghana

Transport Hub in Kumasi, Ghana's Second Largest City