August 6 Wednesday- Heading for Daboase and Elmina Fort

The day starts early with roosters that crow at all hours of the day- We leave at 7am and today we head for the most remote location, Daboase (pronounced Dah-bwah-zee) which is about 4 hours away from Accra and is more north in the Asante region of Ghana. I’ve been told that Sami, our driver, is a bit of a nut driving, but since he is the head driver at the Ministry of Health (and overseas all of the other drivers) I guess he is our best and safest bet. The group has been using him as our driver for the past 6 years and I’ve been told I’m in for a real “treat”…. Uh-oh. We are to pass through some jungle and I should expect a lot of bumpy dirt roads and cold showers.

We get word early on that there are several patients already waiting for us in Daboase. We know that there are a lot of hernias and a small boy who has a cleft lip. We are a little cautious as we hope it is only the lip that is cleft as we do not have the resources (machines etc…) to do a full palate- fingers crossed that the child is only cleft in the lip. I really hope that we can help him- we think kids are mean in the US- think how mean a culture can be when they think that you have a birth defect because of something you did or because you are cursed.

Before we head all the way to Daboase, we are told that a side trip is warranted and we must see Elmina Fort- one of the locations that housed slaves before they came to America. The village we pass through is amazing- a fishing town it is, boats everywhere, men hand pulling in the nets they cast out the evening before, and as before, small, dirty homes stacked one on top of another.

I will spare you all the details of the tour of Elmina fort with the exception that it truly is sad and remarkable what the Portuguese, Dutch, British, and even other Africans did to the people of Africa; the abuses are beyond your worst nightmare. The women’s holding cell STILL had an odor that was overpowering and gagging- I cannot imagine the stench of this room centuries ago. The cell typically held over 300 women who were not able to shower for over 3 months at a time- leaving them to sit in their vomit, feces, menstrual blood, and decay. I did get a really interesting book that chronicles the history of Elmina, the Fort, and the slave trade in the region. Elmina was originally named for the gold in the area (El mina), but later the highest selling commodity were slaves.

<3+hours>

So yes, the roads we traveld are rather bumpy and I think I left an organ or two behind a few miles back- the roads are AWFUL!!! The ones that are paved (only a few) have pot holes that are more like sinkholes! Some of the holes take up an entire lane, leaving drivers to swerve into the other lane (and oncoming traffic) to avoid wrecking the car. Nothing like a forced game of chicken to get the old ticker pumping. After about 30 minutes I stopped looking out of the front window.

As we approach Daboase hospital I get beeped by my boss over the walkie talkie. I am asked whether or not I see the barren tree tops on the side of the road and in the jungle that is just past the road. “Why yes, I do”…. I quickly learn, and to my dismay that it is from BATS! They strip the trees. GOOD GRIEF. Bugs and bats…. Lovely. Apparently we are truly in the jungle and the bugs and bats are rather prevalent here. Oh how I love the fact that I packed 4 cans of OFF – which I have a feeling will be my new best friend during this trip! We did see a Megabug later in the evening which we called a Rhinobug. Not sure what it really was though...

We get into Daboase and get settled and begin seeing patients. We see children with advanced lymphoma (we sent him to Korle Bu for a biopsy and chemo), undescended testes, cardiac arrhythmias, and lipoma- just to name a few. I think there are about 60 people waiting to see us. I'm not quite sure as everytime I go to check there seems to be more and more people waiting. I learn that some people learned ahead of time that we were coming and started walking days ago to come see us. Moving and heartbreaking at the same time.

As we proceed with the examinations and setting up our storage room for the supplies we will need for the surgeries, the power goes off. We are told that it happens often as the power supply is not consistent out in this region. GREAT. This might become a real issue as we begin to operate as we need light- obviously – and a power outage can have catastrophic consequences for a patient who is being operated on when the power goes off. So we decide this is a good time to have lunch (it’s 2:30pm at this point) and we meet Dr. Ahmed’s wife Amtul who is beautiful and sweet- and their 2 children are adorable. We learn that they have dedicated 5 years of their lives to serving this region/hospital- both Dr. Ahmed and Amtul are doctors and run the hospital by themselves with only a handful of extremely dedicated “nurses” and help (most are uneducated except for what they have been taught by the doctors).

As we finish up lunch- which was amazing- we learn that the reason the power is out is because a bamboo tree, somwhere in the jungle, has fallen across the power line and broken it. Luckily they were able to find the break quickly (which sometimes can take days) and they had already begun working on fixing the power line. It is interesting to note that the entire village of Daboase is served by this line so no one had any power. AND BOY DOES IT GET DARK OUT THERE! We did get to experience our first African rain around 3pm- the sound of the rain coming through the leaves and hitting the foliage of the jungle was really soothing. The rain cooled and cleaned everything- it was wonderful.

The power comes on around dinner time (6pm-ish) and we are able to perform some surgeries this evening. We are working 2 beds in the tiny OR which is about the size of 1 OR room in the US. As we are operating we also learn that we have no water!! How crazy is that! First the power, then the water. I have a feeling that we are in for some major challenges this trip. Well, the reason we have no water is because the water and power supply are fed by 1 line and so what they decide to do was to divert the ENTIRE area’s power for the water supply to us so we could have electricity so we could begin operating. This is one of the amazing sacrifices and examples of generosity that we will see on this trip by the people of Ghana.

Still, their generosity is not immune to the powers that be as we still lost power later on in the evening- and while we were operating. After an initial “Oh Crap” comment by just about everyone in the OR, we regrouped and worked in the dark for a while before the generator could kick in. Luckily Victor, our 4th year Resident, had a spelunking light with him and we were able to proceed. It is important to note that we were still without any other equipment that needed electricity so it was a little scary at times, hoping that the case would stay routine and therefore not need the extra equipment. We were more than overjoyed when the operation ended and all was well as our first and most important motto of the trip is ""First, do no harm" or "Primum non nocere". Hoping not to have to repeat that episode EVER, we finished up for the day around 12:40am (Thursday morning) and I think I was asleep before my head hit the pillow – and the fact that we were 3 to a bed in the ladies room- didn’t matter. This was to be the only time we were able to get to bed without a HUGE, late meal served by our gracious hosts.