Congrats to Emma Lawrence!

Congratulations to Co-Founder and Board Member Emma Lawrence, who has just been awarded the Velji Leadership Award for Emerging Leaders in Global Health by the Global Health Education Consortium! This award is presented annually to "a student or resident who has demonstrated outstanding commitment to Global Health through providing organizational leadership." Emma has generously chosen to support MedPLUS Connect with part of her award! Thank you for your hard work and commitment to MedPLUS, Emma!

Board Members Unloading a Shipment in Lawr

Updates from the Board

MedPLUS Connect's Executive Director, In-Country Director, and Board of Directors have been very busy recently! We have some exciting updates to share:

• Thanks to a grant from the Dorthea Haus foundation, support from the Ann Arbor Rotary Club, the Lawra District Assembly, and our wonderful individual donors, we are excited to report that we are very close to our fundraising goal for the Lawra District Malnutrition Center! Board Member Habib Yakubu met with representatives from the Lawra District as well as our contractor to finalize construction and contract plans this past weekend. We hope to break ground soon!
• We have been working closely with Medwish International to prepare upcoming shipments and we hope to send our next 40 foot container of life-saving supplies by the end of October!
• One of our recent shipments just arrived at its destination in Jirapa, Ghana. Dr. Wodah has informed us that he is very happy with the supplies that have been delivered!

Thanks to the MedPLUS Connect staff and volunteers, as well as our generous supporters! This is quite a team effort, and we grateful for this opportunity to collaborate and make a significant impact in Ghana.

Board Members Unloading a Shipment in Lawr

Meet our new Intern: Meera

Meera Patel is a junior at Case Western Reserve University studying Nutritional Biochemistry and Metabolism with a pre-medical concentration. She is the Vice President of USG Diversity and Inclusion Committee, a University Hospital department of Pediatrics research assistant, a member of the Student Turning Point Society, a Dean's Honor Scholar, and a Horizon's mentor. This is her first experience in this type of philanthropic endeavor and she is very excited to be a new addition to the MedPLUS Connect team! Thanks, Meera!

If you are interested in interning or volunteering with MedPLUS Connect, email director(at)medplusconnect.org

Different Technology for Developing Countries

Bicycle Ambulance: an Example of Technology Specific to Conditions of Developing Countries

A recent article published by the BBC discusses the issue of donated medical supplies going to waste in the developing world (full text available at: http://www.bbc.co.uk/news/mobile/health-14902877). For example, voltage regulators, infrared sensor technology and ultrasound scanners may lie around unused if there isn't a local technician to maintain such equipment. To avoid these issues, MedPLUS Connect conducts site visits to recipient hospitals before a shipment is ordered, and after it is received. On these site visits, we ensure that the hospitals' requests are compatible with their current infrastructure. If a hospital receives a piece of equipment they can't use, we make arrangements to have it sent to a facility that can use it.

The issue of technology synchronization raises another very interesting question: should developing countries strive to catch up to the technology of developed countries, or should they seek different technology altogether? The BBC article focuses on the latter. The article states that appropriate technology is not low tech, but different tech. Technology designed specifically for environmental conditions of the developing world can yield tremendous benefit - and it would make sense to invest in this kind of technology. Prototypes of "different technology" that were recently displayed at a conference of the Institution of Mechanical Engineers include a solar-powered hearing aid that overcomes the need for expensive batteries, a stethoscope that can connect to mobile phones allowing doctors to monitor hard-to-reach patients remotely, and a nipple shield for breastfeeding mothers who are HIV positive which blocks the transmission of the virus to their babies. The onus is now on the engineering and development communities to get this sort of technology, specific to local environments, into the field.

Help Build a Nutrition Center in Lawra - Match Our Donation or Sign Up for iGive

Lawra, an impoverished rural community in Ghana with over 23,000 children, faces serious child health and malnutrition challenges. We are building a nutrition rehabilitation center in Lawra to provide preventative care, nutrition education, and in-patient malnutrition care for children. Introducing maternal and child nutrition services can save lives, and your help can make all the difference. Double your impact! MedPLUS Connect Co-founder, 2009-2010 Executive Director, and current Board member Emily Nix will match any donation made up to $750.  We have already received $500 in donations, and need another $250 to take advantage of the $750 total!

Mother Holding Child Patient in Lawra, Ghana

Also, you can join iGive to support MedPLUS Connect every time you shop! Registering on our behalf is free and can make a significant impact – like helping us send life-saving equipment or raise funds for a nutrition and rehabilitation center. Just by shopping at online stores such as BestBuy, Amazon, Staples (and many more), a portion of your purchase is donated to MedPLUS Connect. Follow the link to check it out: http://www.igive.com/medplusconnect

"Busy-ness" As Usual

From working on grant applications and newsletters to day-to--day tasks like organizing our containers and facilitating communication, there is certainly no shortage of work for MedPLUS Connect! We have been busy gathering medical supplies from our U.S. partners as well as coordinating the Ghana-side of things. The shipment we are currently assembling marks my first time overseeing the process - but certainly not the first (or second, or third, or tenth..) for MedPLUS Connect. I definitely rely on the experience of the rest of the team to help guide me! I may be biased, but this container looks amazing. It is a fantastic combination of consumables like gauze and sutures and larger items such as hospital beds! While we are busy assembling future shipments, we are also currently waiting for three containers to clear the port in Tema, Ghana. Due to some congestion in the Tema port (over 30 containers at once!) there has been a slight delay in transporting these containers, but we are hopeful that they will be en route to our recipients soon! Fortunately, one of our many unofficial slogans seems to be "expect the unexpected" and I think we've become pretty good at rolling with the punches. Another example of this is adjusting to the many roles and tasks of Executive Director. I love the diversity - there's a wonderful mix of social media tasks, administrative duties, financial responsibilities, and facilitation between the Board, volunteers, interns, donors, and partners. Playing all these different roles at once has taught me how to learn on the fly. It has also reinforced to me why I love lists and post-it notes so much; staying organized is crucial! How else can we work on our value-added projects, such as the Lawra nutrition center or collection of medical journals and textbooks? Never a dull moment. For more detailed updates of MedPLUS Connect's "busy-ness" as usual, check out the Summer newsletter!

Sonya

The Importance of Teamwork and Commas

Since returning home from Ghana, I've become more comfortable with the daily operations of working for a non-profit organization. Sometimes it is difficult to balance everything, but fortunately we've all had quite a bit of practice in the art of multitasking. What I do find to be challenging, however, is accepting the fact that sometimes you simply will not be able to finish everything on your to-do list -- and realizing that it's okay. I have found that there will always be more to do, another step to take, or a way to make whatever I'm working on "better." I'll stop talking (typing) in the abstract: take, for example, writing my first newsletter for MedPLUS Connect. I had been excitedly working on articles and stories for awhile, writing, editing, fact-checking, formatting, etc. But regardless of the planning and pre-planning, I still managed to spend an embarrassing amount of time agonizing over details like subtitle wording: should I write "and" or "or"? Does this sound better? Is this sentence less confusing? Before I knew it, I had spent the entire day poring over the already-finished newsletter and it didn't look any different. And yet it was totally necessary! I think Oscar Wilde summed it up best when he said, "I have spent most of the day putting in a comma and the rest of the day taking it out." Throughout this whole transition, rest of the MedPLUS team has been so helpful and understanding. When things get stressful I can always count on them for a helping hand, support, feedback,and more. Here's to teamwork - and, of course, to poring over every little "comma"!

Sonya

Help MedPLUS Connect just by doing your online shopping!

Join iGive to support MedPLUS Connect every time you shop online! Registering on our behalf is free and can make a significant impact – like helping us send life-saving equipment or raise funds for a nutrition and rehabilitation center. Just by shopping at online stores such as BestBuy, Amazon, Staples (and many more), a portion of your purchase is donated to MedPLUS Connect. Follow the link to check it out: http://www.igive.com/medplusconnect

Ghana Time

Life in Ghana follows a different timeline. Maybe there's a formula for anticipating how late somebody will be for a meeting, or how delayed a flight will be, but I haven't been able to figure it out yet. When somebody tells me he'll get the job done by Friday, I wonder which Friday he refers to.

Ghana Time can occasionally be frustrating, but at the end of the day, that's how life works in most of the world. Few things in the world are as reliable as an Austrian train schedule or a FedEx delivery window. I've learned to change my expectations when working in Ghana. It's not a matter of lowering expectations, because people in Ghana are responsible and always keep their word on important matters, but I've learned to expect the unexpected, especially when it comes to timelines.

Recently we played a game of "Find the bill of lading at the Ghana Ministry of Health." FedEx delivered the document to the Ministry of Health on time, but it took a while to find its way to our Ministry of Health customs representative, who needed it to clear our container from the port. We knew that the document was somewhere at the Ministry, and that it would eventually find its way to our representative, but we tried to speed up the process to get our container cleared and on the way to its destination hospital at Jirapa, in the Upper West Region. This was a great learning adventure, and despite the administrative issues that we perceived, the Ministry of Health solved the problem as they always do, and as should have been expected, their timeline followed Ghana Time. Some things in this world are a given, like the sun rising every morning and the pattern of ocean tides. Maybe Ghana Time is just another impossible-to-change natural phenomenon.

NY Times Article: Salvaging Medical Cast-Offs to Save Lives

Last week,  New York Times blog author Tina Rosenberg wrote a great article about medical supply recovery organizations that are similar to MedPLUS Connect. Tina wrote about Doc 2Dock, a Brooklyn based recovery organization, and MedShare, which is based in Atlanta. The article explains the great need for supplies in under-resourced areas of the world, as well as why there are surplus supplies in the United States:

Every year, hospitals in America throw away thousands of tons of usable medical supplies and equipment — by some measures 7,000 tons a year, a value of $20 billion. The 2006 model ultrasound machine is sent to a landfill because the 2011 model has arrived. Unopened, sterile packages of supplies are thrown away because they were marked for one patient’s surgery and hospital regulations prohibit their use by another.

Hospitals are not the only ones who donate. MedShare gets 65 percent of its cargo from manufacturers or distributors of medical equipment and supplies. A small puncture in a carton may mean that a box can’t be shipped to a paying customer, even if the supplies are still individually wrapped and sterile.

Yet every year, hospitals in developing countries around the world turn away patients or provide substandard care because they lack even the most basic medical equipment.

Tina also compares supply recovery organizations to food banks, which is a great analogy. For both food and medical supplies, parts of the world have great surplus, while parts of the world are in dire need. The value that MedPLUS Connect and other supply recovery organizations creates is a systemic connection.

However, connecting medical supplies to recipient hospitals presents many challenges. The article explains:

It’s a much bigger challenge to get a mammography machine no longer needed by a hospital in Atlanta to a hospital in Ecuador. You have to collect the equipment, check to make sure it’s in good condition, store it somewhere, pack it into a container and put it on a boat, get it through customs when it arrives and ship it by truck to the hospital.   You also have to make sure the hospital needs a mammography machine, enjoys consistent electricity and has personnel trained to use the machine.

What sets MedPLUS Connect apart from some other organizations is our commitment to making sure that we only send supplies that are needed and specifically requested by our recipient partners. This ensures that our shipments of medical supplies are compatible with the needs, resources and technologies of our partner hospitals in Ghana. The MedPLUS Connect team is dedicated to partnering with local health and government officials to improve the provision of quality health care in the most impoverished and underserved areas of Ghana.

Access the full text article here: http://opinionator.blogs.nytimes.com/2011/08/04/salvaging-medical-cast-offs-to-save-lives/?scp=4&sq=Ghana&st=cse

Reflections: My First Trip to Ghana

Container Loaded in Cleveland, Arrives In Ghana

From cutting open a juicy pineapple with a machete to trucking over miles and miles of red dirt road, there is no doubt that we had quite a few adventures in Ghana. But despite the innumerable memories made, it’s still easy for me to pinpoint my favorites. I’ll never forget listening to devoted doctors explain their serious need for basic medical supplies. Being able to play a part in helping these hospitals receive medical supplies has been meaningful in a pretty indescribable way – which is ironic and unfortunate considering I’m trying to describe it right now! When Dr. Robert was showing us around Nandom District Hospital in the Upper West, he was so proud to show us how they had used donated material to make curtains for the entire hospital. Exam rooms now had privacy curtains; beds had dividers, and more. Another moment that really stood out to me was when we visited Lawra District Hospital and saw white coats donated from University Hospitals – Case Western. Here were the same kind of coats I had seen doctors wearing during my undergraduate shadowing experiences, but all the way in Ghana! It’s incredible to see everything come full circle. The above photo epitomizes this feeling: you can see a shipment being packed at the MedWish International warehouse in Cleveland, Ohio, and the same container being unpacked in Ghana. The photo is actually the one with Dr. Robert's curtain fabric - you can see it on the left!

Lawra and Tumu

Lawra District Hospital

Our site visits to Lawra and Tumu were nothing short of fantastic. My favorite part about visiting Lawra was getting the chance to see the actual grounds for the nutrition center! I also got to see the library created a few years back by Project Heal…the library was complete with Emma’s face on the wall. Our visit to Tumu District Hospital was equally exciting because they seem to be a very good candidate for a shipment this year. Not only is the hospital pretty far removed from the other districts and towns, but it was also extremely crowded. The OPD was packed; the halls were packed; the rooms were packed. After speaking with Dr. Bukari, we were able to get a better idea of the hospital’s needs, which range from hospital beds to an ultrasound machine for OB/GYN use. Though ultrasound machines are sometimes difficult to find, we hope to meet this need for the Tumu District Hospital.

Visiting Nandom

Pediatric Ward at Nandom

Getting caught in the rain in Ghana is like standing under the Niagara Falls. Well, maybe not quite, but it certainly seemed that way when visiting Nandom district hospital in the Upper West Region. At one point Emma and I found ourselves jumping across a small stream that had formed a moat around the health clinic. And by jumping across, I mean jumping into it, sinking into red clay, and almost losing our shoes. But it seems that as foreigners we are just simply not adapted to the Ghanaian rain. As Emma and I walked through the corridors of the hospital, shielding ourselves from the wind and water, Dr. Robert called over his shoulder to us; “Hey!” he said conversationally, “rain is coming down a little, eh?”

During this torrential downpour, we had an amazing tour of the hospital. Emma had been there twice before, but even though it was my first visit I could already see how much Dr. Robert’s patients respect him. He took the time to ask patients how they were feeling; he stopped to greet people in the hallways and walkways, even when the rain crept in sideways under the awning. It was also a great personal experience for me to finally meet Dr. Robert because I had read about his work on the MedPLUS blog (one of Emma’s old posts) long before I became involved with the organization.

Dr. Robert explained to us how new districts were being created – meaning that Nandom was also hoping to turn health centers into hospitals to serve these new districts. Dr. Robert did a fantastic job of distributing extra supplies (which they already had at Nandom) to these in-need health centers of the district. Some of these health centers didn’t even have a single IV pole, surgical scissors, or BP monitors. Because of this, patients don’t come to the health centers, and consequently crowd the hospitals. The district hospital already sees a ton of patients, especially because of the influx from Burkina Faso. Thus supporting these health centers and helping them become self-sustainable would have a great impact on the area.

Sonya

Last Stop in the Northern Region

Because Dr. Josephat was kind enough to drive us from Tamale to Wa, we got the chance to stop in at the Bole District Hospital -- where Dr. Josephat is the medical director and only physician. We were especially excited to visit Bole because it is so far removed from the other districts in the Northern Region. Like most physicians working in rural northern areas, Dr. Josephat lives miles and miles away from his family in order to serve this high-need area. His dedication is both remarkable and inspirational. It was pretty cool to see Dr. Josephat’s plans for expanding the hospital. In just a few days time, they would be using previously abandoned wards to create a separate pediatric unit. A shipment of consumable supplies will help to get the new unit up and running. Over the span of the next year, Dr. Josephat hopes to see even more expansion. People had lost faith in the center and were opting to travel all the way to Wa for medical care, he told us, but the trend was starting to change now that hospital has a regular doctor and staff. Dr. Josephat also had the great idea of having all the different wards in the hospital contribute personally to the request list – that way it would be most representative of the entire hospital’s needs. We are looking forward to sending a direct shipment to Bole this year!

Sonya

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

The Tale of Two Mohammads

Emma on the phone with Mohammad

In order to prep for our Tour-de-Bolgatanga, Emma and I needed to make sure we had everything planned out. We got the list of medical directors and hospitals from the Regional Director; we made sure we had a place to stay once we arrived. But we still needed to find a way to get there. Fortunately, Kofi is like a combination of Wikipedia-Ghana and the holy grail of rolodexes. He. Knows. Everyone. So, of course, Kofi puts us in touch with one of his trusted drivers, Mohammad. That day, Emma calls Mohammad to talk about our driving plans – we decided it would make sense to head west of Bolgatanga, then hit up the eastern districts. Considering that taxi drivers frequently lie about knowing where places are (no, seriously, one time we drove around for an hour before our driver admitted he had no clue what we were talking about), we are really excited after talking to Mohammad. He seemed super on top of everything, from planning out meeting times to our petrol range. Things were looking good.

When we were in Karaga, Emma called Mohammad to finalize some details. After having some trouble reaching him, she tried his second line. I should probably explain that in Ghana its common for people to have multiple cell phones for different reasons. In important meetings, everyone will have all of their cell phones sitting out on the table, subscribed to different services and set to different ringtones. I am not making this up. The way I see it, the more cell phones you have, the more important you are. I have one. You do the math. Anyways, when Emma finally gets hold of Mohammad on his second line, the conversation goes as follows:

Emma: Good morning Mohammad, this is Emma. I’m just calling to talk about meeting tonight, so we can go over our travel plans?

Mohammad: Okay. Where are you?

Emma: Karaga. Can we meet tonight?

Mohammad: Yes. What time are you free?

Emma: 8 PM. Can you meet us at the Jungle Bar?

Mohammad: What’s the Jungle Bar?

Emma: It’s the bar at my guest house.

Mohammad: Okay I’ll meet you there at 8.

Happy we have our plans for the evening meeting solidified and ready to head back to Tamale, Emma and I start saying goodbye to the medical staff at Karaga. But before long, Emma’s phone rings. The screen reads “Mohammad.” So soon? Emma and I exchange a look, hoping that he isn’t calling to cancel the meeting. She picks up the phone and this conversation goes as follows:

Mohammad: Good morning Emma. This is Mohammad. I’m calling about our travel plans. Where are you?

Emma: I’m….I’m in Karaga. I’m still in Karaga.

Mohammad: Can we meet tonight?

Emma: Yes, we are meeting tonight, still. 8 PM at the Jungle Bar. Still.

Mohammad: What’s the Jungle Bar?

Emma: Uh. It’s the bar at my guest house.

Mohammad: Okay I’ll meet you there at 8.

Emma looks confused. I raise an eyebrow and ask Emma what happened. “Nothing,” she answers, “I think Mohammad was confused.” We shake our heads, both hoping Mohammad doesn’t bail on our plans to drive to Bolga the next day.

Cut to the Jungle Bar, 8 PM. As planned, twice. Emma and I meet Mohammad. We pull out a GoogleMap of Ghana’s Upper East Region and begin tracking the paths between district hospitals. Mohammad is extremely helpful, pointing out the distances between each destination and suggesting alternative routes. Emma’s phone rings, and because we want to seem really important and professional, she goes to answer the call. Things. Get. Weird. The screen says “Mohammad.” We both look at Mohammad to see if he is on the phone. He is not. Mohammad looks at his own phone to see if he pocket-dialed us. He did not.

We pick up the phone and ask, “Is this Mohammad?” The voice on the phone says “Yes.” We look at the man in front of us and ask, “Are you Mohammad?” The man in front of us says, “Yes.” Thoughts immediately sprang to mind: who are we sitting here with? Who is on the phone? Will the real Mohammad please stand up? Finally we decide to ask three very important questions:

1) Are you really Mohammad?

2) Are you a driver?

) Do you know Kofi?

The voice on the phone responds, “I am in Wa.”

Even though that didn’t technically answer ANY of our questions, we decide right then and there that the real Mohammad is the one sitting in front of us. Wa is a town nine hours away by bus. It turns out that we had been talking to two Mohammads. Mohammad 1, the driver recommended by Kofi, and Mohammad 2, the middle-aged man that a year ago unsuccessfully tried to woo Emma into marriage by yelling into her hotel room that he loved her.

Fortunately we hung up on Mohammad 2 before he could propose to Emma once again.

The next day we drove to Bolga. With the real Mohammad.

Two Days & Six Hospital Site Visits

After our meeting with Regional Director Awoonor-Williams, we met with the medical director of Bawku District Hospital. He was currently on site for a construction project to erect an eye clinic outside of Bolgatanga. This is what really kicked off our "Super Tour" of the Upper East Region. From this meeting we went on to Bongo, then to the War Memorial Hospital in Navrango. We used Bolgatanga as our base camp for the night, and woke up in the morning to visit the Zebilla Hospital in Bawku West, and then WaleWale Hospital. The first five hospitals are going to be the recipients for the two current shipments. We wanted to go and introduce ourselves to the medical directors so they would have a better idea about what MedPLUS aims to do. Our site visits were awesome. The doctors and nursing staff are truly inspirational in their dedication and desire to improve healthcare for their patients.

Dr. Al-Hassan said it perfectly: it is beyond frustrating to have the medical knowledge but lack the necessary resources and supplies. It was pretty amazing to actually see the sites that will benefit from these current two shipments. We got the chance to see maternity wards, pediatric units, threatres (operating rooms), and more. While some of the hospitals were better-equiped than others, there was clearly an overall need. This example should give you an idea of what I mean: the best case scenario in terms of x-ray was a machine from the 1970s. Not exaggerating.

Meeting with Regional Director Awoonor-Williams in the Upper East Region

Debriefing After our Meeting with Regional Director Awoonor-Williams

Emma and I just got back from our Super Tour of the Upper East - six site visits in just two days. We were especially excited to head to the Upper East Region after a fantastic meeting with Regional Director Awoonor-Williams. Here's a play-by-play. We walked into the air-conditioned office and told the secretary our reason for visiting. As we sat down to wait, the office began filling up with other visitors. These visitors proved to be very interesting and entertaining, to say the least. This is where it gets good. The first lady walked into the office carrying some paperwork, her handbag, and a pillow. Yes, I said pillow. Yes, she brought her own pillow for the couch. Next, a group of about five people walked into the waiting area and were immediately beckoned into the Regional Director's office. Ten minutes later, about seven different people emerge. Five minutes after that, three more people leave. None of them appeared to be the five that had originally entered. Do not be alarmed if you are having trouble keeping up with this. Emma and I still do not know 1) how so many people fit in that room and 2) what happened to the original five. Wait. I saved the best for last. One man was telling a story so interesting that we couldn't help but listen. Here's the shortened version: he left his house to do some traveling for work, and in his absence, the local women from the village had chosen his house to be the centerpoint for the Market. His house was taken over by the Market. As in, he came home and people had staked out part of his porch to sleep on. The best part is that the District Chief couldn't do anything about it. Can't move the Market. Not only did we find ourselves saying "Only in Ghana," during this story but on numerous occasions Emma and I turned to each other with the exact same question: is this real life?

Finally, after our highly entertaining wait, we met with Regional Director Awoonor-Williams. We first explained how Chief Director Anemena suggested sending another shipment - this one with a more surgical focus - to the Upper East. Sincetwo regional shipments are currently on their way to the Upper East, we also got a chance to talk about accountability with respect to distributing the supplies. The idea of regional shipments (instead of direct district shipments) makes sense because many district hospitals benefit from just one shipment. This also allows the Regional Director to distribute the supplies based on the need of each hospital at a given time. But because this is a relatively new idea, we still had a few questions to work through - like how involved are we once the shipment arrives in the region? Or who should we be in contact with to know where the individual supplies ended up? Fortunately Regional Director Awoonor-Williams was more than helpful and together we sorted through these questions.

Once the shipment arrives in the Upper East, the Regional Director will coordinate transport of supplies to the appropriate hospitals. The supplies are distributed according to request lists made by each individual district hospital. That way, for example, if one hospital is in dire need of an oxygen concentration versus another that needs surgical gloves, these respective supplies can end up in the most needed place. Regional Director Awoonor-Williams also suggested sending him the packing lists for the two shipments already en route to Ghana so he could show us his plans for distribution. We couldn't have been happier with the outcome of the meeting and look forward to following up with our shipments to the Upper East Region!

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