My friend who is in pharmacy school had an amazing opportunity to go to Ghana this year with Global Brigades to help set up medical clinics and educate people about healthcare. She says she hates writing, but I’ve managed to convince her to let me compile and edit her Facebook posts into a story to share with you. It is written in her voice and only edited for grammar and clarity.
Day 1
I have arrived safely in Ghana. Our lodge was three hours from the nearest airport. The air was wet and slightly scented, like being in a sauna. On the long drive through the countryside, we got our first glimpses of Ghana, covered in green trees with deep red soil. We drove through countless small villages on the way. Every time we stopped at a traffic light, vibrant people would cluster around and try to sell us treats from the overflowing bowls balanced on their heads.
Our lodge is lovely and surprisingly ornate, compared to the small shelters nearby. We are sleeping in rooms of four with bunk beds and private bathrooms with showers. The rooms are air-conditioned and that is heavenly. There is a large common seating area with big windows where we meet to talk and eat the wonderful food they prepare for each meal. Most meals are served buffet style, with a chicken dish, a fish option in rich sauces, grilled veggies, salad, some sort of dessert or bread, and fresh juice made from ginger and pine that tastes like paradise.
Day 2
This morning we enjoyed an English-style breakfast, with eggs, toast, baked beans, coffee and an Ovaltine-style malty chocolate drink. We spent the morning sorting and repackaging the medical supplies we brought. We counted out one month supplies of vitamins into zip-lock bags using plates and butter knives to hold and sort the pills as we worked. Directions for medications are marked with symbols instead of words: a circle for once daily and two circles for twice daily.
We enjoyed a delicious lunch of chicken, fish, salad, and plantains and then headed to one of the villages. We wanted to get to know some of the people we would be seeing and invite them to join us at the clinic the next day.
The whole village was overrun by adorable animals, wandering in and out of the houses and sleeping in pots and on roofs. Baby goats, cats, and chickens stumbled between our legs. We set out in groups of six plus a translator to meet the members of the community.
Everyone was very welcoming. They have a tradition in Ghana of inviting you into their homes and offering you a seat, water, and food in ritual fashion before asking why you’ve come. We were able to ask lots of questions about their lives and culture, as well as their experiences with healthcare.
I brought a Polaroid camera and took pictures of everyone we visited. The children went crazy about it, running around and posing for us. One family played music for us on their radio and invited me to dance with them. I can’t stop smiling about how wonderful and kind everyone was.
We learned that many of them walk an hour in the hot sun everyday to farm. They can’t find buyers for their crops, so they have food but no money. That means they can eat, but can’t buy basic non-food necessities. The little kids asked us for toothbrushes by miming brushing their teeth with their fingers. I’m glad we brought lots of toothbrushes and supplies to share.
They all seemed happy to have us there and excited to visit the clinic the following day. It was hard not to give them everything I had. They were kind, beautiful, proud, and generous. I’m looking forward to spending more time with them.
After dinner, we attended a talk from their local doctor, Dr. Cornelius to hear more about the healthcare challenges he faces in the region and the tools they are using to treat people.
Day 3
On Monday we set up our first clinic in their local hospital. It was a good building but had almost no medicine or supplies. There were only five hospital beds and otherwise it was mostly empty rooms. We set up a small pharmacy by laying out boxes of medicine on the floor.
This particular village has easier access to medical care than most because it is so close to a facility with trained nurses. People in other villages in Ghana often have to travel on foot long distances to find a clinic with nurses and if they need any prescription medicine, they need to go farther still to reach a regional health center. This typically requires hiring a cab and taking a day off of work, which few of them can afford.
They rely heavily on yearly medical brigades to bring medical supplies and care, however there have been several years where no aid arrived due to fear of the zika virus. I’m glad we’re here now.
The first village we went to is one that our program has visited before. It’s helpful to see that some of the positive changes brought in previous visits have stuck with them. During the first encounter with this village everyone was cooking inside, which was causing them to have respiratory disorders. We helped them create community outdoor cooking areas which they are still using.
Hypertension is still a huge problem and many people came to the clinic with systolic blood pressure far over 200. (Note: below 120 is healthy, above 140 is red alert) Global Brigades has helped many people in the village become enrolled in the national Ghanaian health insurance which makes visits and medicine mostly affordable.
It is difficult to convince people to come to the clinic for chronic care if they’re feeling well. We spent a long time trying to help people understand that high blood pressure can lead to stroke, which they’re familiar with and afraid of. Those who have gotten medication in the past have only taken them sporadically, so a lot of time went into education and motivational interviewing to help people engage in maintenance care and preventative care.
We are working to help the villages develop systems for chronic disease management, such as having a monthly day where a doctor visits from the regional center to provide care for people with chronic conditions. If we can get funding toward it, this could become a celebratory day with a meal provided to encourage people to attend. Hopefully some of these changes will help people stay healthier.
These clinics have been incredible to experience. I can’t get over how patient and grateful everyone has been. The villagers are usually lined up long before we arrive and some wait all day to be seen without complaint. When we spoke in their language or used our Ghanaian names the mothers would light up and smile proudly at us. In Ghana your name is based on the day of the week you were born. My name here is Afua, Friday born.
The clinics are set up with a number of stations, starting with intake, triage, physician visits, optometrist visits, pharmacy, and counselling/education. We rotate between these different areas and home visits. My favorite station so far has been optometry. The doctor spent a long time teaching us about how to diagnose eye disorders and conduct exams. So many people came in with poor vision, sometimes unable to see the chart at all and restricted to finger counting at 3 meters or light only. It felt wonderful to give these people medicines and glasses and watch the change on their face as they were able to see clearly for the first time in their lives. It felt like we were peddling miracles.
Day 5
My adventures were mildly paused when I became quite sick for a few days. It seems the food disagreed with me and after eating I had to collapse into bed with painful shivering and fever. Good news about being on a medical brigade is that you’re surrounded by doctors and medicine. After some rest, antibiotics, and restricting myself to just bread, hard boiled eggs, and rice, I’ve made it through and can go back to clinics at last. Looking forward to being back in action and grateful for the wonderful people who took care of me and luxuries I often take for granted like shelter and running water. I feel so lucky to live a life with so many gifts, when so many struggle.
Day 6
We moved to another village called Otuam. Their health facility was much smaller and patients had to wait outside under tents to be seen. I worked with Dr. Cornelius, testing for malaria and checking blood sugar. In Ghana, Malaria is seen more as a nuisance than a life-threatening sickness. It’s similar to the way people in America relate to the flu. The flu occasionally kills people in the US, but most of us expect to get it at some point. Since we were already on malaria prophylaxis (vaccine), I followed their lead and have been mostly skipping insect repellent. Amazingly I haven’t gotten a single bite all week.
Working with the physicians was wonderful. I learned so much about how to diagnose the common diseases and developed a talent for getting blood from kids without making them cry. I was sad to see how many little ones had swollen bellies. I always associate it with undernourishment, but on our clinic intake form everyone indicated that they were able to eat.
Later in the day we went from home to home taking blood pressures and inviting people to the clinic if they needed additional care. Otuam was close to the sea and many of the houses were made out of palm fronds. There was a quality to the place that felt like Neverland, with forts hidden among the trees and laundry and nets hanging like pirate sails. Hungry cats watched as people cleaned fish and radios dangled from branches. The children were curious and wild as ever and I had fun playing and adventuring with them. It was an incredible day.
Day 7
We visited the large regional hospital that patients are referred to if they can’t be treated in the clinics. If they have Ghanaian health insurance many things are covered, but if they didn’t register or can’t afford it they have to pay cash for services. Registering can be challenging and is already closed for this year because the machine that prints cards is broken.
Getting to the hospital is difficult for people in the villages. Even those who can grow enough food to eat well still may not have any money to pay for a taxi. Those who can’t afford a cab may walk for days under hot sun.
This hospital is rare and unique in Ghana. It has a special team to manage chronic conditions like diabetes and hypertension. We spent some time talking to their director and making plans to work together over the next year to bring their amazing work to more communities. We are also going to try to get them additional funding for important equipment they need, such as the ability to test HbA1c levels (a diabetes blood sugar test). We were able to tour the hospital and were overjoyed to find that, unlike the rural village clinics, they kept medical records and charts on their patients. I’m excited to see teams in Ghana working to initiate chronic condition management and hope other hospitals are inspired by their work.
On the way home from the hospital we took some time to relax at one of the local beaches. It was incredibly beautiful, but parts were covered in litter and we were told the water wasn’t clean enough to swim in. It was nice to listen to the sound of the waves and rest in a place with a cool breeze. Such a lovely day.
Reflections
The best part about Ghana has been the people. The adults are generous, wise, proud, beautiful, sad, and kind and the children are playful, curious, clever, and mischievous. Most people wear beautiful colors and there is a tailor in the community who makes custom clothing for everyone.
While we were setting up the clinic there were always little faces peering in the windows at us or running up when our bus arrived. They were eager to play and quick to ask for treats and supplies. One boy gave me big eyes and mimed brushing his teeth. This broke my heart and caused me to skip the normal process of giving adults all the supplies needed for their family at the end of the visit to sneak a toothbrush for this boy. It was a foolish choice. Soon they were swarmed around me begging for toothbrushes. I tried to stop handing them out and had a nurse translate that their mothers would be getting some for them, but they wouldn’t release their hold on the ones in my fingers. I eventually was able to give them to one of the mothers and escape.
I distracted them further by taking pictures of them using a Polaroid camera I brought. They went wild for the pictures, posing and dancing around. Eventually I decided I had used enough of the film and wanted to save some for the other communities. I started playing with them by showing them dance steps, like the Charleston and the salsa basic and spinning them around. They were thrilled and tried to show me their version of head, shoulders, knees, and toes as well as some local kicking games. We also taught each other different clapping games and high fives.
Whenever I had to go inside to help clean up they would follow and call for “sister Afua” after me. I got lots of hugs and happy bounces whenever I would emerge again. At one point we were finishing up at the clinic and it started pouring with rain. Everyone was huddled under the shelter but the kids were being adventurous and darting into the rain. It seemed refreshing after the hot day in the clinic so I followed and played in the rain with them, spinning around and dancing. It was wonderful and by the time I got to the bus my heart was so full it could have burst.
A Dark Past
Our last full day in Ghana was a cultural day, where we visited a local market and enjoyed Ghanian music and dancing. We also visited Cape Coast Castle, a notorious stronghold of slavery and torture.
Cape Coast Castle was a trade fortress that was converted for use to house and break the spirit of slaves before they were loaded onto boats. Our visit began wandering around the open air area and looking at the canons over the sea, then into a museum detailing the history of the castle and its role in the slave trade. When I was about halfway through the museum our guide collected us for a tour of the dungeons where the people who were to be slaves were imprisoned.
To give us a glimpse of the fear they must have felt, he had us initially descend in complete darkness, only turning on lights once we had reached the stone wall on the other side of the male dungeon. He explained that this small underground space held up to a thousand men for months at a time. They were forced into complete darkness where they had to live in their own filth and excrement, packed against their brothers. The floor we were standing on was false, built on top of the human waste that had accumulated there.
To add insult, directly above the slave dungeons where people endlessly suffered was a Christian church. Our guide described the thought process that many slaves went through when they decided to convert to Christianity. To a person experiencing such agony, it would seem like your God had abandoned you or was weak, yet those who followed the Christian faith were clean and happy, prospering above. It must have appeared to many that the Christan god was stronger or better to his worshippers.
The men in these dungeons would never come out the door the entered again. The governor didn’t want the people of the castle to see the slaves, so they were moved, shackled together and driven forth by other slaves, through an underground tunnel to be loaded onto the ships.
The women’s cells were similar to the men’s, except that their door was regularly opened so they could be grabbed and raped at will. Sometimes they were bathed before this occurred, and other times drunk soldiers would not even afford them that decency. Women who resisted were beaten or put into a hotter cell where they were locked without food and water and often died if their spirits weren’t quickly broken. Our guide shut us into the boiling confinement cell for about 30 seconds, which was enough to have some of us panicking.
The last they saw of their country was the Door of No Return: a portal that brought them to the water where they were lowered and packed into the ships as cargo. By the time they emerged through that door, they had been in darkness for many months and thus were blinded by the bright sun, unable to fight. Those who did not die at sea lead painful backbreaking lives in slavery.
Immediately after walking back through the Door of No Return, our guide took us up to the airy hall where slave prices were negotiated and then up to the British governor’s chambers. The governor had a beautiful set of airy rooms with large windows that looked out on the picturesque coastline. The dichotomy was so startling I felt shaken and revolted.
We were left with a plea to remember that slavery is not gone from this world. People are still taken against their will and forced into terrible suffering and servitude. He asked us to see, to take a stand, and to remember.
We have so much work to do, in our country alone, to ensure that people are able to lead fair and decent lives. The horror of the atrocities that we do to each other when we dehumanize our brothers and sisters is echoing around in my heart.
These terrible things happen when we group people together and see them as ‘other’. We do this sometimes because we want power or wealth, other times because we don’t understand them or are afraid of them. As we band together to stand against injustice, I urge you all to avoid the slippery road of dehumanizing those you stand against. Fight them with all of your fury, but don’t follow the dangerous path of talking the humanity away from anyone.
It is ideas that we fight, not people. Fight against the idea that anyone can be treated as less than human. Our trustest goal is to stop that idea from spreading, to take it out of the minds of people, and until that is accomplished to stop those people from acting on this deadly idea through any means necessary. Stand together against the heinous crimes happening in our country. Do not let this terrible sickness enter your minds and hearts. Keep fighting.
You can donate to Global Brigades on their website. I don’t work for them or get any kind of kickbacks or sponsorship, I just like charity.
Tickets to the Tokugawa Gardens can be purchased at the same time you buy your Nagoya Castle ticket (combo ticket ftw) which gets you a slight discount if you are planning to do both, but does not include the art museum at the gardens.
The golden bus drops you off right at the gates to the gardens, and I was able to show my combo ticket to get in with no trouble. The gardens start out with a main square that houses the entrance gate and the museum (which I did not go in that day). There is a large lake to walk around and feed koi fish in. The koi are ginormous. Biggest koi I have ever laid eyes on. I think there are smaller tuna. Some were close to a meter. There were also many colors, mainly the gold color and the calico mix of orange, black and white, but there were also ghostly solid black koi that were invisible even a few cm under the water until they broke the surface. They were like swimming shadows of fish. It was fascinating to watch.
Finally, because I can’t take a vacation without finding the waterfall, I found the waterfall. I am reasonably sure given the size of the park that the river and falls are man-made, but they don’t look like artificial fountains, they look like natural waterways. It’s a specialty of Japanese gardens to cultivate nature in a pleasing manner while still maintaining the natural beauty.
On my way back toward the main gates, I happened to run into the Samurai. Ninjas AND Samurai. It’s like cosplay meets museum, so very Japanese. Much like the ninja, the Samurai pace the palace grounds daily for photo ops and 
Our first famous food sight was Yamachan, a chicken joint that is usually so popular that wait times can be over an hour. Yamachan is famous for chicken wings. Initially, I was very skeptical since I get plenty of chicken in Korea, but when we arrived we were sufficiently early as to be able to get a table. We had to take the smoking section, but it was still clear air when we were seated.
Amid the many things that I found to try while in Nagoya is the “morning service”. Many of the cafes around town have begun to offer a light breakfast (egg and toast or ogura toast) for free (“service” in Japanese) with any order of coffee. Sunday morning my friend and I headed over to Komeda Coffee. This cute little coffee shop is a chain restaurant famous for it’s special morning service of thick, fluffy, buttery toast and red bean paste, also known locally as “ogura toast”. While lots of places in east Asia love sweet red bean paste in pastry (I eat it in Korea all the time), Nagoya got famous for ogura toast by adding… wait for it… margarine! The sweet thick red bean spread with creamy salty margarine creates a unique Nagoya flavor that should definitely be on your “to eat” list. Plus, their coffee is pretty good.
Even in normal restaurants, eel is one of the more expensive dishes. I tend to avoid buying it here in Korea because it’s often not prepared well. Nonetheless, it is one of my all time favorite Japanese foods. The “plain” hitsumabushi still had plenty of flavor. Of course the smokey, fishy unique flavor of the eel itself, but also a lighter version of the sauce it’s cooked with, as well as the vinegar in the rice. It had so much of what I look for in a good meal, I instantly knew the price was well worth it.
The second ¼ of the dish is meant to be served with the dry fixings provided in the little side box. In our case, we were given small slices of spring onions, thinly shredded nori (seaweed), and what very well may have been fresh wasabi. Most wasabi in the world is fake, sadly, it’s just green horseradish. Now, I love horseradish too, so that doesn’t usually bother me. I’ve learned a little about fresh wasabi from watching cooking shows and documentaries, but I’ve never had any. When I looked at this wasabi, I noticed the texture was very different from what I’m used to. Instead of a smooth paste, it had little shredded bits of plant matter.
Round 3 we were instructed to replicate round 2 and then add broth. I don’t really know how to describe the flavor of the broth. It was also a little smoky, a little umami. I suspected there were some dried shitake involved in the flavor as well as some konbu dashi. It was nice, but for my taste it didn’t really add to the flavors the way that the spices alone had. Additionally, it drastically changed the texture of the dish, turning crispy eel and rice into a wetter soup. It was still delicious, and I’m glad that I was able to try all the different styles of eating hitsumabushi, but I was grateful for that final ¼ serving where we were instructed to return to whichever of the first three we had liked best and do it again!
Sakae was my first non-airport sight in Nagoya where I disembarked the airport shuttle bus and met up with my friend. It’s a large and bustling neighborhood in Nagoya with lots of trendy shops and restaurants. While waiting for our dinner restaurant to open, we decided to do a little shopping.
The shops in Yokohama and Tokyo had a huge array of Ghibli goodies and I wanted to go back and see if I could get something unique for my niblings (gender neutral for the children of siblings, I did not make it up but I love this word). I’ve been sending them one Ghibli movie a year along with a few themed toys. Every other family member is drowning them in Disney, so I claimed Miyazaki. So far they’ve gotten Totoro, Kiki, and Ponyo (they are still quite young). My niece especially loves the lace bracelet I got at the shop, but mine is from Mononoke which they are not old enough for yet. I did manage to find a Totoro online, but it was twice as pricey as mine had been, so I figured I’d hit up the shop in Japan and have extra prezzies. Cool Auntie!
The other shop is at a place called Oasis 21 which is ostensibly a bus station, but is really a shopping center. It’s much easier to find and less crowded than Takashimaya. It’s part of the lovely greenbelt in Sakae and it has a great view of the Nagoya TV tower which Nagoya loves to brag about like it’s the Tokyo Tower. It’s a little adorable. The Donguri in Oasis 21 isn’t as decked out in plush petable Totoro characters, however, so if riding the Catbus is on your bucket list, you better go to Nagoya Sta instead. I didn’t really have much time to see the other stores in Oasis 21, but it looked cute. It’s a big oval with an open center and covered shops on two stories around the outer rings.
Gallivantrix 
