November 1999

Day 1 - Day 2 - Day 3 - Day 4 - Day 5 - Day 6 - Day 7 - Day 8

The preparations for a trip to Ghana are significant. I had begun preparing for the trip during the summer of 1999, including an application for a visa and and several immunization shots. These shots prevented diseases such as yellow fever, cholera, hepatitis A, hepatitis B, and typhoid. I even filled a prescription for a malarial preventative (mefloquine).

During the fall, I also began collecting the equipment and supplies that we would deliver to Dr. George Atsina for use at the clinic. We purchased a laptop computer, a printer, and a micro centrifuge, a camera and a microscope were kindly donated.

On Tuesday, November 17, 1999, with the excitement of a great adventure, I climbed onto a jet in Indianapolis to begin the journey to Ghana. As with most modern air travel, this trip began in the wrong direction with a short trip to Dallas where I then boarded a Boeing 767 headed for London. After a short layover in London, I arrived in Amsterdam, Netherlands around 11:00 a.m. on Wednesday. I would spend the day here before flying to Ghana on Thursday the 19th.

Thursday, November 18, 1999

On Thursday morning I took a shuttle bus to the airport where I met Tomoko Kobayashi who would also join me for the trip. Tomoko is a Japanese woman who was a student at Indiana State University in Terre Haute. My family served as Tomoko’s host family during her year in the United States. This would be Tomoko’s first trip to Africa.

The flight from Amsterdam to Accra, Ghana included a stop in Kano, Nigeria. Altogether, the flight from Amsterdam to Accra lasts 8 hours and 45 minutes and so at 7:30 p.m. on the evening of November 19th we arrived at Kotoka International Airport in Accra. Immediately upon exiting the airplane the warm and moist evening air made it clear that we were no longer in Europe or North America. Accra is located about 5 degrees north of the equator, on the prime meridian. Tomoko initially found it hard to breathe.

I had no intention to deceive any customs officials with our small amount of equipment and supplies that where to be donated to the clinic; I had visions of corrupt customs officials demanding high "taxes" for our microscope, etc. It turned out, in fact, that I passed directly through customs with no questions, no forms to fill out, and no random inspections.

After we exited through customs, there was a huge crowd of people just outside the door of the airport. There were dozens of "extremely helpful" porters all waiting to help carry our baggage.

Just beyond the area with the porters, there were hundreds of people who were all waiting behind barricades for the arriving passengers. There was a lot of shouting and waving and it took us about five minutes to locate George, but eventually we did. It was wonderful to be back in Africa and to meet my former classmate once again.

George rented a car; we put the luggage in the trunk, and climbed in for the ride across Accra to the Atsina Charity Medical Clinic, where George and his family live. Kotoka Airport is on the east side of Accra and the clinic is on the west side, but the distance is only about 9 miles. At one point during the trip, Tomoko asked George if there was some special event, like a festival, happening to account for the large number of people on the street. George laughed and told us that this was the normal number of people on the streets of Accra (see picture below).

About an hour after we left the airport, we arrived at the Atsina Charity Medical Clinic. This property, which we rent for approximately $100 per month, consists of a fenced compound, a main house, an out-building, which used to be the "boys quarters" (servants quarters), a small guesthouse, a small shop, and the clinic building.

George and his family live in the main house. The building which was formerly used for servants quarters is now used as a sewing school. George’s wife, Adjoa, teaches a group of apprentice seamstresses in this building. Adjoa also runs the shop at the front of the house. There are many similar shops spread throughout the neighborhoods of Accra. In these shops one can buy drinks, groceries, cleaning supplies, greeting cards, paper, etc. They are a kind of African convenience store. The guest house is really a large guest room with a private toilet and bath. Behind the house is a garden with banana and coconut trees and behind the garden is the clinic building.

When we arrived at the clinic, Adjoa and George’s adopted 11-year-old daughter, Diann, was there waiting for us. Adjoa served us a glass of water as it is a Ghanaian custom to offer water to travelers after a long journey. Later we opened the luggage and I showed George the microscope, micro centrifuge, glucose meter, needles, syringes, sponges, computer, camera, etc. George was a very happy doctor that evening!

Friday, November 19, 1999
I woke up around 6:30 a.m. Adjoa served Tomoko and I a breakfast of onion omelet, bread, butter, orange juice, and coffee. Later we realized that George almost never ate – at least we hardly ever saw him eat. Adjoa served us but she, too, never ate with us. This was a bit strange for us at first, but that is the Ghanaian custom.

By the time we had finished breakfast, George was already seeing patients. He had told all of his patients that we were coming and that the clinic would be closed for a week during our visit. Despite the fact that the clinic was "closed," when people are sick, they still come. Each morning a group of patients were waiting at George’s front gate and he began seeing them immediately.

Following breakfast, I sat in with George on one of his consultations. An elderly woman accompanied by her two sons came in. This woman did not speak English, but the sons could translate. George can speak 11 different languages, but there are about 80 different languages in Ghana, so he can’t speak them all. George began by asking the woman how old she was. After some consultation, the reply was, "the oldest son is 60 years old." It took five or ten minutes of negotiation and everyone settled on an age of 80 for this woman.

George treats all his patients with a tremendous amount of respect. One of the guiding principles of the Atsina Charity Medical Clinic is that poor, sick people deserve the same respect as wealthy, sick people. Another guiding principle is to "listen well." George spends a lot of time with each patient; much more than might seem necessary or efficient in a health-care delivery system in a more developed country.

After a visit of approximately a half hour, George determined that this woman likely had a bladder infection that had spread to her kidneys. It was a problem that had developed over about a six-month period with no medical treatment. He wrote the woman a prescription which the sons thought they might be able to get filled. One of the difficulties of the clinic is that George doesn’t really have a lot of medicine to give away. Typically he will diagnose an illness and write a prescription in hope that the patient can find the money to get the prescription filled. Oftentimes a patient may have some relatives who can help with the purchase of the medicine. George asked the woman to come back in two weeks for a follow-up visit.

After seeing a few patients who had been waiting, Tomoko, George, and I piled into the rental car and drove to the American Embassy where we registered as visitors in Accra. It is not a legal requirement to register, but George thought it might be a good idea to let the embassy know that we were in Accra in case of any "difficulties."

We then drove to the Village of Hope. The Village of Hope is an orphanage for street children of Ghana that is supported through the Church of Christ in the USA. Children who have no family often live on the streets. The kids are placed in these villages which are modeled on the traditional African family with a mother, father, and perhaps a grandmother and auntie. A married couple might live in one of these homes and serve as parents to 16 Ghanaian orphans.

George had heard about the Village of Hope when the pastor in his church announced that a child had died at the Village of Hope. As time wore on, several more children had died at these orphanages. George found that the children had died from treatable illnesses but because the orphanage had no money they lost their lives.

George volunteered to serve as the health-care provider for three Villages of Hope and since he began seeing these children last spring, no more children have died. Normally, George does not have a car so he rides several buses and a taxi or two to the Village and walks the final miles. It takes about a half-day to reach a Village and another half-day to return home. This means that about three days of George’s time, out of every two weeks are taken up by visiting the Villages of Hope.

On this day, we had a rented car so it only took about two hours to reach the Village of Hope. The trip included some "diversions" which took us through some rather nasty looking puddles and streams. When we reached the orphanage, the children were still at school and the mother, father, grandmother and auntie greeted us. We saw an extremely well organized home with tidy, dormitory style sleeping quarters, running water and electricity. The Village of Hope was very close to the coast. One could stand near the house and look out to the sea.

We sat under banana trees taking in the cool ocean breeze on an extremely warm Ghanaian afternoon. Suddenly, a swarm of children in tidy school uniforms came noisily down the drive, excited to see that Dr. Atsina had come to visit. The children stood in a group and one by one they introduced themselves in English. English is the official language of Ghana, but not the native language of most Ghanaians.

Next, after a short consultation, the children announced that they wanted to sing a song for their visitors. It was like a scene from the "Sound of Music" as these sixteen African orphans, dressed in school uniforms, sang a beautiful rendition of "All to Jesus I Surrender." It was such a moving experience that sometimes the memory can bring tears to the eyes of a 42 year old, American, engineering professor. Poverty and sickness exists in Africa, but music and laughter also exist.

As we were preparing to leave, George asked the children whether they remembered what he had promised to bring them on his next trip. You could feel the excitement mount when he asked, but the children were a little bit shy to shout it out. Finally he pulled out a bag of candy, which he gave to the oldest child (a 16 year old girl) and told her to pass out the candy later that evening. She should give one piece to every child and two to every well behaved child.

On the way back to the ACMC in Accra, we drove once again through the Ghanaian countryside, back through the diversions, and dirt roads. We drove with few apparent rules, continuously honking. Sometimes we raced down two lane paved country roads with little or no shoulder and occasional cars passing three abreast at speeds near 80 mph. Cars were bumper to bumper and people were everywhere. At one point we saw an accident that had completely stopped traffic, but we took a detour through a gas station, jockeying for position with the other cars trying to make the same detour. Through a mixture of skill and daring, George somehow managed to get our car through that mess and back on the road to Accra.

We returned to the clinic to a delicious dinner of rice and chicken, with spices that I could not quite identify. We also had fresh pineapple, boiled cabbage and pop. We took a nice walk around the neighborhood after dinner and discussed the future of the Atsina Charity Medical Clinic. I told George that it is such a wonderful story that eventually, we will probably see a book and a screenplay. We joked about James Earl Jones playing Komli-Kofi Atsina in the movie.

Saturday, November 20, 1999
Sometime around 4:00 a.m. I woke up to the sounds of a shouting mob.These noises that sounded like angry shouting in an unidentified language were somewhat disturbing. The noise sounded very nearby, as if it were coming from the street not far from my bedroom window.

When I described the noise at breakfast the following morning, Adjoa told us that it was a worship service at the neighboring Pentecostal Church! … at 4:00 a.m. on a Saturday morning!

Breakfast included a hot cereal called Tom Brown. Tom Brown is a combination of millet and peanuts and is usually eaten with sugar and milk. It was delicious. We also ate hard-boiled eggs, bread with cheese, juice and coffee.

After breakfast, George and I started up the laptop computer and George began learning to use the computer. George is highly educated, and one of the most intelligent men that I have ever met, but he doesn’t have much computer experience. He finished his doctoral dissertation at Iowa State just a few years before personal computers were in common use. The concept of "point and click" was a bit troublesome. Throughout the coming week, however, George would make tremendous progress in his computer skills.

George’s son, Junior, also came home briefly on Saturday morning. He came home to have a shower since there was temporarily no water at the boarding school where he lived about an hour away.

Although the clinic was officially closed, four more patients came on Saturday morning. Two patients had malaria and one had gonorrhea. George prescribed mefloquine for the malaria cases and gave them free samples of chloraquine. Some malaria is chloraquine resistant so it is not very effective, but mefloquine is very expensive and costs about $10 per pill in the USA. I took mefloquine once a week as a prophylaxis (preventative) during our visit, but Tomoko usually took a daily dosage of chloraquine.

Malaria and typhoid are the two most common diseases that George sees.  He sees patients with these maladies nearly every day.  Typhoid is less common, but it may be endemic in the area where George lives.  This means that it may exist within the population of a certain region at a higher rate than one might normally expect. Left untreated, both malaria and typhoid are normally fatal.

Cholera is also deadly; it kills quickly and is highly contagious.  The patient dies from dehydration.  With treatment and re-hydration, patients can recover fairly quickly.

AIDS is a serious problem in Ghana and George normally refers these patients to the Kumasi Teaching Hospital where he received his medical training.  Since there is no routine testing for AIDS, George wouldn't usually see an AIDS patient until that patient has the full-blown disease.  At that point, George can't do much for him.  He has only seen a few AIDS patients this year.

For the young man who was diagnosed with gonorrhea, George ordered a lab test to confirm the diagnosis. This means that this young man will need to go to the main teaching hospital in Accra and pay for a lab test. If the diagnosis is confirmed, George will prescribe a medicine to treat the gonorrhea for which the young man will also need to pay. This case is not an emergency, but left untreated the young man will die over the next few years.

In the afternoon, we went to visit the mausoleum where Kwame Nkrumah is buried. Kwame Nkrumah is considered to be the father of independence in Ghana. He was the first President of Ghana after they received independence from the British in 1957. Ghana was the first African country to be ruled by a black African. It was also the first African country to receive its independence from European colonialism.*** e Nkrumah, click on this link. ***

After leaving the mausoleum, we drove along the ocean. We saw many fishermen and their dugout canoes from which they fished. We also drove to the university at Accra where George taught physiology after he first returned to Ghana.

Dinner on Saturday was a spaghetti-like dish with carrots, beans, and ground beef sauce. We had more boiled cabbage and pineapple. After dinner Tomoko and I took a walk through the streets of Accra around the clinic and bought a couple of drinks for a bit more than $1. The drink of choice in Ghana seems to be Guinness, a malt tonic, non-alcoholic, sweet beverage; it is imported from Europe.

Sunday, November 21, 1999
Sunday breakfast consisted of tomato omelet, bread, cheese, oatmeal, juice and coffee. More patients arrived on Sunday morning. Normally the clinic is closed on Sunday but some patients who tried to come on Saturday, returned on Sunday morning and George "couldn’t" turn them away.

Around 10:00 p.m. we ate a supper of thick chicken vegetable soup and as we talked through the night. George told many stories about his life, a number of which I had not heard previously. Some about his school days, about how he met Adjoa and the places he had worked.

George told these stories beyond midnight and I think we might still be there listening if Adjoa had not insisted that George stop.

Monday, November 22, 1999
On Monday we got up and ate breakfast, as had become our custom. Breakfast on this day would consist of hard-boiled eggs, a corn porridge with a slightly sour flavor, fresh bread, cheese, coffee and juice.

George had several patients waiting on Monday morning. Once again, he had explained that the clinic was closed during this week, but still the patients came and waited patiently. One patient on this morning was a small three-year-old girl brought by her parents from about one hundred kilometers away. They had begun their journey about 5 a.m. that day. The little girl was diagnosed with malnutrition. These are problematic cases for which George can educate the parents, but it is a difficult case to treat if the parents do not have money for a proper diet. Proteins (meat, cheese, and eggs for example) are expensive and many poor people in Ghana suffer from malnutrition.

On our return trip from Cape Coast to Accra, we drove through a huge thunderstorm. The defroster did not work on our rental car and the windows fogged up pretty badly. George rolled down his window to help defog the windows, while Julie wiped the windshield with a rag. Sitting in the back seat with the driver's widow open, was pretty similar to sitting in the shower. Just when I thought I couldn’t get much wetter, rain began pouring in through the leaky sunroof. The roads were also pretty badly flooded in spots, so we were relieved when the rain ceased after about twenty minutes.

Back in Accra, we had African cuisine at dinner on Monday evening. We ate plantains, a spinach and fish casserole in a yellowish sauce, pineapple and orange juice.

Tuesday, November 23, 1999
For breakfast we had "Tom Brown," tomatoes, meatballs (ground beef with onions), bread, butter, jam and coffee.  Perhaps not what many Americans eat for breakfast each morning, but delicious nonetheless.

After breakfast, I took my hand-held GPS outside and turned it on for the first time.  For fans of geography, who might be interested in such trivia, the Atsina Charity Medical Clinic is located at 5 degrees 33 minutes N latitude and 0 degrees 16 minutes W longitude.  That means it is almost directly on the prime meridian (directly south of Greenwich, England) and just a bit north of the equator.  Furthermore, it is located 5,814 miles from Terre Haute, Indiana at a heading of 136 degrees. In the mean time, George was learning some of the basics of using the spreadsheet on his new computer.

We decided to make a trip into Accra to buy souvenirs.  We first checked the exchange rate.  George had brought along enough cedis to purchase all of our souvenirs and then we were able to reimburse him in dollars later.  The rate was about 3400 cedis = 1 dollar.  We first made a trip to the "Multistore" where we bought postcards and a map of Accra.   Then we took a trip to the post office where we bought stamps.  The cost of mailing a postcard to the US from Ghana is 550 cedis or approximately 15 cents.

After leaving the post office we walked to a craft center, a large outdoor complex where vendors sitting under tents sold an assortment of mostly hand-made goods.  You can read further about this market at the following link:

We spent hours bargaining for souvenirs, with George doing most of the bargaining and complaining that he had to pay "tourist" prices since it was obvious to everyone that we were not Ghanaians.  I had the feeling that it might have been easier to make the things we purchased than it was to buy them!

After an afternoon of shopping we returned to the clinic and had a delicious dinner consisting of rice balls in peanut soup with fish and mutton.  We also ate watermelon for dessert.  George had more patients waiting to see him after dinner.  He had two patients in the morning who were follow-ups from an earlier visit.  They were elderly people with pneumonia.

Wednesday, November 24, 1999
Omelets with tomato and onion were on the menu for breakfast on another warm Ghanaian morning.  We also ate bread, cheese, grits and papaya.  Coffee, butter and jam completed the breakfast.  I always enjoyed the breakfasts which Adjoa prepared for us.

On Wednesday morning George had more patients waiting for him.  For example, three of his patients included a woman with bone cancer, a man who is an alcoholic, and a man with TMJ syndrome (temporo-mandibular joint syndrome).

In the afternoon, we took a drive through the Ghanaian countryside and passed through and by a number of villages.  Some of the villages were extremely primitive, with no nearby source of clean water.  The villages usually consisted of a grouping of mud huts with thatched roofs.  Sometime the villages contained buildings with sheet metal roofs.

We revisited the second Village of Hope, which we had already visited once when nobody had been home.  This time we were greeted by a huge crowd of children, along with the mother.  We had a pleasant, but relatively short visit.  Since our visit had been unannounced, I believe George was concerned that we may have surprised the mother who had not had sufficient opportunity to prepare her sixteen children for visitors.  As we were leaving, the mother presented us with a large bunch of plantains that had been grown at the Village of Hope.

After returning to the clinic, our Wednesday dinner was African cuisine once again.  We ate a white-colored potato-like yam, eggplant and fish in a reddish-brown sauce, watermelon and juice.  After dinner George saw several more patients in the evening before we took our routine walk around the neighborhood.

Thursday, November 25, 1999
Thursday would be my final day in Ghana before heading back to the U.S.  We arose to another wonderful breakfast of corn porridge, sausage, bread, watermelon butter and jam.  As usual, George was already seeing patients by the time I got out of bed and had breakfast.  When the last patient had gone, we sat in the cool shade in the waiting area outside of George's office and discussed the future of the Atsina Charity Medical Clinic.  This discussion continued into the afternoon and I was able to put down on paper a general outline of our vision for the clinic.

As the afternoon came to a close, we ate one last meal at the ACMC before George drove Tomoko and me to the airport. For our final meal we ate plantain fritters, chicken and tomato stew over rice, pineapple, ice cream and cokes.  After this wonderful meal was finished, George saw a few more patients and finally had to send away the rest of his patients and ask them to return the following day, so we could leave for the airport.

I flew back to America after spending a day in Amsterdam and after a short visit with my friends. The images of Ghana and of the Atsina Charity Medical Clinic are very strong in my mind.  The images are sometimes wonderful; the singing children at the Village of Hope and George telling stories of his past long into the night.  Sometimes the images are terrible; a young couple who brought their young daughter to the clinic who was slowly dying of malnutrition or the mental images of slaves being warehoused in the Cape Coast castle.  I have memories of a warm and humid equatorial climate coupled with memories of a cold and rainy day in Amsterdam.  I remember some unexciting hours spent reading and relaxing at the clinic and some terribly exciting moments driving on the Ghanaian highways.  I suppose it was more than I could really take in over such a short period of time.  I'm looking forward to going back.


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