No, no, that not good, price, you give me good price.

Journal Entry from Day 12: Sunday May 31

So, I cannot complete my journal entries without discussing our shopping excursions. I was not excited about the whole negotiation process, I have to admit. It did not go well for me in Jamaica and when I have to go through it at the Exmore VA annual yard sale it wears me out. But now, I have to say it's the best system ever for shopping. We're doing it all wrong in the states. I dread going home and not getting to look at the shop keeper and say, oh no, this is too much, I'll give you (insert 50% asking price here). And then hearing, no no that not good price, you give me good price in response. It's great! Of course knowing that I'm getting the foreigner price in the first place add another dimension to the whole process, as does the Ghanaian shopkeeper assumption that because I'm American, I have a limitless amount of cash to spend. We were even able to get some dresses and skirts made for us using some fabric we purchased from a woman in Adoteimon and at the Makola Market. I love shopping abroad, love it, but it's hard to do so in developing countries without thinking with each purchase that the small amount of money you spent on some souvenir, is a large amount of money to any number of residents in that country and would have potentially made an enormous difference in their lives had it been used there instead.

Second, I would be remiss to not discuss the food I have enjoyed while here, because, well, I love eating and I haven't had a single bad meal here! First I have to say that Fanta is fabulous, I never drink orange soda at home, but there's something about Fanta and being abroad that just seems so right, and an Fanta orange on a hot afternoon, when you're about to crash because you've only had a piece of bread and a granola bar to eat all day, is just a life saver. Also, I have had fried plantains with just about every real meal I've had here, I'd say I've had my fill, but I don't think that's possible. And after much failure (I order fufu three times at the hotel and at first I was told, it is finished, which is fine, so the next time we ate there I ordered it and was told it is finished, maybe Tuesday, so on Tuesday I came back and ordered fufu which by the way is a standard item on the menu, and was told it is finished) I finally got some fufu. It was so worth the wait! Made of mashed plantains and cassava, fufu is like a big doughy dumpling that gets served in a soup (I had palm nut soup, yum!), with or without meat, whatever floats your boat. It's SO GOOD. But the best meal ever was the hotdog in a pita. It was an accidental order, I was totally going to order a Ghanaian dish that night but then I saw it on the menu and I just had to have the hotdog in a pita. It's a hotdog, wrapped in something more like a wheat tortilla, stuffed with slaw, pickles, and fries, and ketchup. It sounds gross, and was totally confusing when it arrived on my plate, but it was so great I found myself singing about it the following day. If you're ever in Ghana, you simply have to have the hotdog in a pita at Paloma restaurant! And wash it down with a Fanta Orange, it's the only way to go. On the whole I have to say, dining in Ghana has not been too much of a change-- I've eaten a lot of rice! The hardest thing to get used to is having only one solid meal a day and then having a cliff bar for breakfast and then another cliff bar, granola bar, plaintain chips or bread for lunch. For a while there the two granola bars a day thing was killing me-- if I ever see another granola bar it'll be too soon. I've settled in to the toast and butter and jam for breakfast and plantain chips for lunch and then something most likely served with rice and fried plantains for dinner.

Wow, that's a lot of wheelchairs!

Journal Entry from Day 10: Friday May 29

Today we went to the Accra Rehabilitation Center. On our way we got to stop at the OT Department craft store (the OT Department is associated with the psychiatric department of some health care provider, I'm not sure if it's a hospital or clinic or what). Fun times for us! The department reportedly employs the only OT in Accra. It's interesting that it is associated with a psychiatric facility given that psychosocial needs do not really seem to be addressed or even considered here when disabilities are discussed and given OT's psychosocial roots in the US.

Once at the ARC we got to talk with the site manager at some length about what the ARC does, what he would like to see it do, what challenges he faces and how individuals qualify to enter the ARC. The ARC, first and foremost, is a vocational rehabilitation residential center for males only. Entrance into the facility requires substantial paperwork as well as either money of your own or the sponsorship of another individual. Some of the vocations taught there include, woodworking, shoe making, sewing/tailoring, and basketry. The site manager admits that some of these skills are not marketable or profitable in today's society and would like to incorporate more appropriate trades such as tv/radio repair. The trouble is that the ARC is government funded and the government has opted out providing funding for several months. The facility has not been shut down, no fault has been found with the facility, the government just hasn't felt like sending funds apparently. The site manager is barely able to provide food for the residents much less materials for the existing workshops or training and materials for new ones. We were able to tour the facility and talk to a variety of residents, which was as always enjoyable. The facility itself though is confusing. Most of the workshops were dark-- there was lighting, but it was off-- was this because there was no money to pay utility bills? or had no one bothered to turn the lights on? Also most of the workshops were grungy, disorganized and filled with broken machinery or left over materials. The residents didn't seem to have an particular schedule, some were in the workshops working, others were in the workshops sitting, perhaps watching or maybe just waiting for something, others were attending a seminar on fire safety that was being provided by an outside organization and still others were still getting ready for the day or just wondering around the compound (seemingly without much direction). Some workshops had instructors, others didn't seem to. Was this apparent lack of organization a reflection of my lack of understanding of their system? or was there no system? Were people wandering around and sitting around doing nothing because there was nothing to do given the lack of funding to purchase supplies? or did residents just not know what they were expected to go and what to do when they got there? The whole scenario was just really confusing. It was hard to tell the extent to which the financial situation affected the facility's ability to function and how much of what I saw was just how things were done there. I feel like a more apparent daily structure or schedule and some environmental adaptations might be two easy ways to make some vast improvements in the facility that wouldn't require additional funding.

Yesterday we went to Echoing Hills, which is a boarding school for children with various disabilities. It was a much smaller facility than New Horizon school, having only one open air classroom, it seems many of the children that stay there attend school in the community and only the children with the most severe disabilities remain at the center all day and are educated there. In addition to providing basic education at the facility, some residents participate in meal preparation and other facility chores. It is unclear what kind of plans, if any, exist for these residents as they age. Overall long term plans seem to involve the vocational track-- which consists mostly of crafts, or a basic educational track. What is unclear is what supports individuals with disabilities are supposed to make use of to succeed at their vocation once they master the task or what they are meant to do with their basic education as they get older. Additionally the center has a fairly large and mostly unused clinic space, a lot of outdoor space that would be perfect for the construction of an accessible playground, and a wheelchair distribution center. The wheelchair center receives used wheelchairs that have been donated which it refurbishes and then distributes to various communities a particular points throughout the year. They reportedly do some wheelchair fitting when they distribute the chairs.

Putting the MacGyver Kit to Work

Journal Entry from Day 8: Wednesday May 28

Today was our second day at the New Horizon School. Check out their website for pics of the school and students--http://www.newhorizon-school-gh.com/. The school is a non-governmental organization that calls itself "an educational and vocational center for children and adults with intellectual disabilities. While they are cannot afford to hire formally trained special education teachers, it seems they have been able to find a staff of individuals who do want the best for their students are are genuinely interested in learning what they can do to further increase student interaction, independence and overall functioning. On our first day we got a tour of the school and of the sheltered workshops (which are the vocational section of the facility). We also had the opportunity to spend some time in the classrooms talking to teachers, health care assistants and the students about their days and how we can contribute to their daily experience at the school. Day 1 was really fun. The workshops are great-- the are open air rooms organized like little pods around a central grassy courtyard. In the middle of the courtyard was a huge speaker, from which was playing very peaceful, upbeat gospel music. The students all sat at their work stations engaged in tasks ranging from sewing, stuffing pillows, basketry, doll making, batik making, cardboard furniture making and door mat weaving. Each room had an instructor overseeing everything as well (this is in stark contrast to the Accra Rehabilitation Center we visited later). In the classrooms students were group according to skill level and worked on everything from math and spelling to handwriting and matching. That said, there seems to be a lack of engaging and age appropriate activities, especially for the students assigned to the autism classrooms. In the classroom I sat in I found students seemed hungry for interaction-- wanting to play games together-- but there were no cooperative games made available to them. During activity time everyone was given their own sorting or matching game (few of which were age appropriate and none of which were especially engaging, with the exception of Lego's). So we set up simple turn taking games to encourage both interaction and use of the hands the student's frequently neglected to use.

Last night we made a variety of adapted tools with the MacGyver kits to bring back to the school for the students to use, and hopefully to give the staff and idea of how to adapt every day items to make them more useful for their students. We presented these items during an in service for the staff and did a demonstration of proper transfer techniques during that time as well. They seemed to enjoy our presentation and I hope they are able to continue to use the information and tools/materials we left them. After the in service we went to the classrooms and demonstrated the use of some of the items for staff working in those classrooms. For example, we had specifically made adapted eating utensils for two students with CP in one classroom so we we tried them out to see which ones worked the best (if any at all) for each student and to resize them. We also made several adapted writing tools, a homemade sockaide, a long handled sponge, and adapted scissors. The school also has a phenomenal resource in the form of a volunteer physiotherapist from the Netherlands. Watching her in action was just awe-inspiring. She has been able to create so much and initiate to mane projects at the school that it just amazes me. Her energy and enthusiasm was contagious-- and really set a new standard for me, if I can go into any situation with half her enthusiasm and energy, I think I'll be doing really well. She is working with a project called Appropriate Paper Technology through People Potential. It's really cool-- she's making all kinds of chairs, trays, tables, standing frames, etc. out of layered cardboard glued together with cassava paste and paper and then covered in newspaper and sealed with cassava paste. She's basically making her own triwall and then making all kinds of furniture for the school-- both as tools for the students to use in the classroom but also as merchandise to sell in the craft store. It's really amazing. The website is http://peoplepotential.org.uk/page6.htm.

Overall the past two days have been more successful for me than last Saturday's screening day (I think anyway), I felt like I could answer questions the teachers had and I had suggestions for teachers in the classroom. In my big book of firsts (there have been a lot of those here in Ghana), in working in the classroom with the two students with CP, I got to assist in a feeding session. I accomplished nothing, the student I was working with was absolutely not interested in using a straw and the cup with a handle that we made for her was just not quite right for her. So, not exactly a smashing success, but I got to increase my experience working with children with CP (which wouldn't have been hard to do, since my experience level was at zero when I landed in Accra). The best part was just getting to work with kids-- they're so fun, the say the greatest things. Being surround by children for 4 of the past 5 days makes those first days full of painting in the hot African sun completely worth it.

Proper goniometer use, marriage advice and the best outfit ever

Journal Entry from Day 5: Sunday May 24

Yesterday we did our screenings out at the Sovereign Global Mission school in Adoteimon (the school we'd been painting outside Madina that I mentioned in my previous post). At least 20 kids from the community came out the play (some helped Cameron organize the library while we did the screenings) so we got to play when we weren't doing screenings. Only two children with disabilities came for screenings-- we had been expecting, and even hoping for more, but I think two worked out because we were able to spend a least an hour with each child and his/her family. I assisted Stacey with the first screening and I have to say I wish I had been more useful during the session-- it was like all the things I learned and knew (or thought I knew) just went right out the window when I stood up to do anything (like how to read my goniometer-- how hard is that Susan?!). Our client reportedly began having trouble after he received a shot as a child (a common report among individuals with loss of lower extremity usage here in Ghana). It seems some people get bum polio shots that leave them with varying levels of lower extremity disabilities. One of the employees at our hotel for example reportedly received one such shot, he was able to get around but did so with a limp. Our client used crutches and had some symptoms that resembled those of an individual with CP. He had significant tightness in his legs, as well as weakness. One arm seemed to be affected as well. This was my first experience working with a physical disability case in pediatrics, so I felt like I was mostly winging it and trying to remember what I learned in class, but mostly grateful Stacey was there. Throughout the session I was struck by how pleasant and calm our client was, how easy-going he was. He had just walked, I don't even know how far, but it was apparently fairly far, in the African sun, on crutches that sunk down in to the dirt roads to let us question him, do range of motion and manual muscle tests, do stretches and have him do a variety of exercises and was absolutely gracious in accommodating our requests. He even let us take some pictures. He was so easy. I think of the challenges he must face and the complacency he seems to face them with and I'm absolutely humbled. After his long walk to see us and all his work with us, we thought surely he'll want a ride home, but no, he wanted to walk home, it was his exercise. So he and his mother walked back home. It is inspiring to be around people with that kind of spirit.

Today we went to Eric's church in the Nima neighborhood of Accra. Eric has been our contact here in Ghana-- he has arranged our driver and our contacts at the schools we'll be going to and everything. He is the founder of Sovereign Global Mission (http://www.sovereignglobalmission.org/index.html) as well as the reverend at the church we attended. We went to both their version of Sunday school and the church service-- Sunday school was about marriage and I just have to share the message because it was awesome. Eric was talking about how when people decide today to separate in Ghana, that the wife, she moves back in with her family and they say, go back to your husband, but she won't do it. And the husband, he stays at home alone, the wife leaves him to figure out how badly he needs her. And everybody says, go home to your husband, wife! Take your wife back, husband! But they don't do it. So they give the wife a hot pepper (literally) and put it in her mouth for her to chew. And with that she remembers that marriage, like that hot pepper, has hot intolerable times, but those times, like the spice of the pepper, will cool off eventually. And the husband, he learns, while at home alone, just how much he needs his wife at home. So the wife returns home and the husband welcomes her. And thus ends the separation. So we all must realize the worth of our marriage, for it is of vital importance. Eric really is a great speaker-- I need to find a church with a pastor who speaks like Eric, he can drive a point home!

After church we went to the feeding program for the street children. I wasn't really sure what to expect with this-- I imagined kids in lines (clearly I forgot where I was, lines are a no go in Ghana) holding cups and us distributing rice. It was so nice and organized in my head. I'm not sure if that's how it went because I was at the first aid station with Kate. It's funny, we'd been there for several days, we were familiar with the street light optional, takes 45 minutes to get tea and toast for breakfast, "it is finished" with the Fanta less structured approach to life than say that of the typical westerner's, and yet what did Kate and I do first thing at the first aid station? We said okay, everyone get in a line (statement 1 that was ignored), then we said okay, child 1 you're in charge of this (statement 2 that was ignored), child 2 you're in charge of this (statement 3 that was ignored) and child 3 you're supposed to be in line (statement 4 that was ignored). We just went automatically with our little western system of get in a line, delegate tasks and go, and that did not work (for us, the kids tuned us out and did what they wanted and we had to make adjustments accordingly). So we had to reassess-- lines don't work, but circles do-- before I knew I was in the middle of a circle with band aids and antibacterial cream and the circle was working-- far more chaotically than the line, but oh so Ghanaian.

We were greeted when we arrived for the afternoon by the entire group of children-- with hugs and cries of hello Obruni and little hands just reaching out to grab ours. I've never been so warmly welcomed anywhere in my life-- the just encirlced us and immediately let us in, I couldn't resist opening my heart to these kids after such a welcome! The entire experience was really great. It was just such a tangible reminder that kids are just kids, everywhere, no matter what the circumstances. My favorite memory is of a little girl I saw-- she was a free spirit really--she was never with the group, always running around with one or two other kids just laughing nonstop. She was maybe 3, arrived fully clothed is a tunic, pants, shoes and when I first saw her she was running up and down the veranda of the building we used with another child while the rest of the group sang songs. The next time I saw her she had stripped down-- no shirt, no shoes, no pants. I thought she had blue undies on, but then she came running closer and I realized she had blue beads on around her waist, and that was it. She was running around laughing, happy and she could be with nothing but blue belly beads on! Best outfit ever. I lament that adolescence was not kind enough to me to leave my self esteem in tact enough for me to be able to enjoy such an outfit anymore! Belly beads, we later found out, are simply body decoration, they're only meant to be seen by a select special few. I recently learned that in Mali belly beads are sometimes blessed with magic and meant to bring you good luck.

God is my strength and thru him I can do all things rehabilitation center

Journal Entry from Day 3: Friday May 22

That would be the name of my rehab center if I opened one in Ghana. The system for naming business and even tro tros here in Ghana is the best. ever. At first I only saw a tro tro named God is Love here or one named Jesus Saves there, but then we left downtown Accra and I was introduced to the God is King Automotive Shop, the Clap for Jesus snack stand, the Amen Driving School, the Psalm 23 Stand and the Love and Peace Beauty Salon. I never imagined faith would be so constantly and openly present here in Ghana! Being Christian I found the constant reminder of faith oddly comforting and as well as amusing, but I wonder what affect if any the constant bombardment of Christian messages has on the country's fairly large non-Christian minory (there is a large Muslim population in Ghana as well, they are not so prolific in naming their businesses and tro tros however!), or are these names, just names that no one gives thought to?

We finally finished painting at the Soveign Global Mission school outside of Madina (one of Accra's northeastern suburbs). The school will be initially for the community children, but SGM hopes to add on to the school and be able to add a boarding school for street children there as well. The property has a classroom complex (the building we painted, inside and out!) and a library/living space building. The books we collected via the book drive will help build up the library that SGM has already started there. The neighborhood the school is in is an "up and coming" neighborhood that has been developed in large part by habitat for humanity ghana. At first I thought we had come to a lower income semi-abandoned neighborhood because of all the partially constructed homes and the complete lack of pavement, but later found that the area is solidly middle class and that the construction issue in Ghana is this. People don't take out loans and mortgages, they buy the land and then save up and slowly build their homes as they can afford to-- which could literally take a decade. Also, I quickly caught on the pavement optional trend in Accra, mostly the downtown area has pavement, but in the suburbs, etc. it's optional, like turning on the traffic lights.

Tomorrow is our big day to work with the community children and to do our screenings of children with disabilities who live in the community. I'm a little nervous, given my limited clinical experience with children and given that we are not entirely sure of what to expect. We know we might see some kids with physical disabilities, but no history is really given so we aren't sure of what the source is. We know we might see some kids with behavioral problems-- they've been kicked out of school because none of the teachers no how to work with them. But that's it. I realize now how spoiled I was in my fieldworks-- I knew who I was seeing, what their dx was, what we would be doing, how long the session would last, etc. Not so much tomorrow. I'm excited to meet the children and hopefully we'll be able to make some useful recommendations to the children and their families-- I've done my homework Stacey-- all ready to do the VMI! So, I am ready to follow my fearless leader into screenings tomorrow and hope I can figure out what I'm doing.

It is possible I'm actually in Africa?!

This post marks the beginning of a series that represent my journal entries written while in Ghana. I find I've been putting off this task-- I'm not wholly comfortable putting my thoughts and feelings out there because they are so personal to me-- but at the end of the day this was one of the most profound experiences of my life and I can't go around telling everyone I meet they should absolutely take advantage of any opportunity they have to travel to a place like Ghana and then not be open and honest about my own experience! So here it goes.

Hello! Today is day 4 in Accra, Ghana-- though it seems like I've been here much longer. It seems so long ago that we landed and wandered through the onslaught of people waiting outside the airport to meet their families (or fares) or to carry travelers' bags in hopes of earning a few cedis and into the burning african sun. At first I thought, I can do this, this is just like Chile with the brightly colored flowering trees, wide sidewalks, walled yards, stucco style architecture and street peddlers-- then we travelled outside the area around the airport (which coincidentally was where many of the embassies and government housing seemed to be located) and into the rest of Accra. Our tro tro (tro tros are the vans Ghanaians travel in) creeped through town and we went from a lovely suburban looking area to an area so packed with people and vehicles it seemed like pure chaos. Street vendors now lined the street and weaved in and out of the vehicles which were already packed bumper to bumper on the street. The street vendors' kiosks looked more like shanties forming slum neighborhoods than kiosks forming markets. And oh my lord it was HOT. The African sun burns-- it was like we had started an enourmous bon fire in the middle of the day and decided to sit next to it all day long-- it just roasts your skin.

People are just everywhere, I have never seen so many people just out and about. The first 2 days were totally overwhelming--too much heat, too many people, too much grime, too much sweat, too many odors (exhaust, burning trash, open sewage) and too little sleep. I started to worry that I would never find it in my to actually like it here in Ghana. Give me lack of schedule, give me constantly waiting for everything to get done, but please at least let me feel clean most of the day! I was completely dismayed. Didn't I survive 6 months in South America?! What was wrong with me? I like the heat, I like the change of pace, and I LOVE traveling! Why wasn't I totally in love with Ghana on day 1?! I'm not sure I have an answer for that.

But thankfully by day 3 I was getting sleep, so that helped and by day 4 I was loving my tro tro window seat and the feeling of the African sun on my skin, and all the easy access to the street vendors--it didn't even bother me when a few reached in the window and gave my shoulder a pat, like hi there obruni! I see you! Orbruni is the twi word for us white folk (and twi is the most common language spoken in Ghana). I am also starting to enjoy my frequent cleaning schedule-- the grime is not so horrifying any more and there's even something extremely satisfying about looking down in the tub and seeing dirt-- like yeah, that shower really accomplished something, it wasn't just part of a daily routine that I do becuase not doing it is frowned upon! So, thankfully, 4 days in Ghana is growing on me, I am finding my place here and looking forward to the rest of our stay.

Ma'am this coin says Ghana on it, do you have a dime?

So apparently I had some extra pesowas mixed in with my American change-- and just in case you're wondering, no the little 5 piece Ghanaian coins won't pass for dimes, as the nice lady at KFC let me know. Maybe I'll get my program together better here soon! I have a lot of catching up to do (on this blog and in general) so I'll be in touch over the next few weeks, but here are the pictures I took while in Ghana: http://picasaweb.google.com/sjphipps12/Africa#. Enjoy!