Words of Wisdom and Dire Predictions by Jouette

On this trip, I was known for sometimes often making dire predictions which is why my group members suggested that this be one of my blog titles. It really started before we left when Lilly told me about the Ebola outbreak in Guinea, Liberia, and Sierra Leone which are very close to Ghana. I think I might have said, “Well, I guess we are all going to die of Ebola.”

Other conversations in Ghana might have gone like this:
Nava: “My bug bite is really itching.”
Me: “You probably have yellow fever.”

Me: “I really want to play with the kittens, but I’m pretty sure I will get rabies.”
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Me: I just swallowed some of the water when I went under the falls. I hope I don’t get giardia.

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Macy: I ate some of the lettuce.
Me: I think you just got salmonella.

Me: So if one of us would cut our leg off or something, where is the closest hospital?
Stacy: About an hour away, try not to cut your leg off.

Now it’s time for some words of wisdom. Despite all of my predictions, we had an amazing trip with no problems other than a few minor gastrointestinal issues. I felt comfortable everywhere we went, and I loved hearing the phrase “You are welcome” when we entered a shop, restaurant, or a home. I found Ghanaians to be friendly, open, and kind; they were very eager to share their culture with us and to learn about life in the U.S. I would recommend travel to Ghana for anyone especially my classmates and the Grad Is who might be reading this. Go if you can!

To sum up, I want to share some other highlights of the trip that I have not talked about in my previous posts in the hope that I will entice some of you to go next year. One of my favorites was the Tafi Atome Monkey sanctuary. I was expecting that we would walk through several different types of monkeys in caged in habitats like at the zoo. Instead, a guide walks you across the road from the office building to a grove of trees and gives you a banana to hold in your hand with your arm outstretched. Then, four or five monkeys start jumping on you from out of the trees and eating the banana out of your hand. The monkeys then jump back into the trees using your head as a springboard.

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Meghan with a mona monkey.

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Rick and the mona monkey have the exact same expression on their faces.

Hiking to the Wli waterfalls with the kids from the orphanage was also a memorable experience. The kids loved playing in the water even the ones who were hesitant at first, and almost all of them got in the water. Some of them even went under the falls. This was such a relaxing, fun day for us and them.

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We also hiked up to the highest point in Ghana, Mt. Afadjato, which was much more strenuous than the hike to the falls. Our guide did it in flip-flops, and he does it several times a day! The hike was challenging, but seeing the view at the top was worth the effort. You can see Togo from the top! We enjoyed having some of the older boys at the orphanage join us for the hike.

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One of my favorite nights at the orphanage was when the children played the drums and danced and sang songs for us. It was a really special to see such joy on their faces when they danced and sang religious songs to traditional music.

Another highlight of the trip was the food. I was convinced before the trip that I would be eating rice the whole trip, and I blame our professors, Carole and Stacy, for this assumption. I think they really just wanted us to be prepared if rice was the only option at a restaurant. I was pleasantly surprised to find that I really liked Ghanaian food. It was very flavorful and spicy. I even ate some soup with a whole fish in it, eyeball and everything (I didn’t eat the eyeball).

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Light soup, Tilapia, and Banku

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Red red and plantains. My Favorite!

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Cassava Cookies

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Groundnut soup and rice balls

When we returned to Accra, our group visited the Dr. Kwame Nkrumah Memorial Park and museum. He was the first president and prime minister of Ghana after it gained independence from British colonization in 1957. He and his wife are buried in the park, and there is also a large statue of him along with a fountain and many different trees planted by world leaders who have visited Ghana. The museum contained mostly pictures of Dr. Nkrumah and some of his personal effects.

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Meeting with University of Ghana Occupational Therapy Students by Jouette

         When we visited the New Horizon’s School on Thursday, we were also joined by the first occupational therapy class of students in Ghana. The students attend the University of Ghana which is the only university in the country that has an occupational therapy program. The program is a four year undergraduate degree, and the students are in their second year. The class is made up of 19 students, and they are about evenly divided between men and women. They have two occupational therapy professors, and they also take some classes with the physiotherapy (physical therapy) students.

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     The students attended the transfer training for the staff, and they participated in practicing the transfers that we demonstrated. They also met with us in small groups to go over two case studies of students at New Horizons School. The students in our group were very soft-spoken and shy at first, but they became more comfortable talking with us as we discussed the case studies. Since they are only in their second year of the program, they are taking introductory classes like anatomy and physiology. They have not discussed many clinical applications of the information they have learned, so this was a new exercise for them. Another member of our group was the physiotherapist (physical therapist) for New Horizons, and she was able to provide additional information about the children in the case study because she is currently working with them. At the end of our small group discussions, we shared our thoughts with the larger group and got feedback from our professors about our answers to the case study questions.

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     After we completed the case study activity, we had time to talk with the students individually. Many of the students I spoke to told me that they had no knowledge of what occupational therapy was before they started their program. Several students had been placed in the program because they had taken a science track in high school. A few others had been hoping to apply to Medical School, but their grades were not high enough. They thought occupational therapy would be a way to pursue their dream of working in the medical field. I was glad to learn that all of the students I spoke with expressed they are now interested in the OT after starting their classes and learning more about OT. One girl summed it up by saying, “I have developed a passion for occupational therapy.”

     They also talked about how it is difficult to be the pioneers of a new program because their professors are still learning how they want the program to be structured, and the students are concerned about the availability of OT jobs in Ghana. Their professors are having trouble finding fieldwork placements for them because of the limited number of OTs practicing in Ghana.

     The Ghanaian OT students also had many questions for us that we discussed over a lunch that they hosted at the University of Ghana. They wanted to know why each of us had chosen to study OT, and they were interested in the classes and tests we were required to take before applying to our program. They were amazed at our tuition costs compared to theirs. We also discussed the difference between the masters and undergraduate programs and the requirement that OTs have a masters in the U.S.

     It was a great opportunity to share our experiences with the Ghanaian students, and I felt excited to see the development of occupational therapy in Ghana in its beginning stages. It gives me great hope for the future of rehab therapy to see students who are interested in OT and who are carving out their niche in Ghanaian society. I think the success of rehab therapy in Ghana will be a great contributor to ending the stigma attached to disability as people see how individuals with disabilities can contribute to society.

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Our group touring the Allied Health building at the University of Ghana

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VCU and University of Ghana Professors

 

New Horizon’s Special School by Jouette

We had the opportunity on Thursday of our second week in Ghana to tour the New Horizon’s Special School in Accra where the other half of our group has been working for the past several days. New Horizon’s is a day school that provides educational and vocational services for children and adults (4 to 40 years old) with intellectual and physical disabilities. It was founded by, , who had a child with an intellectual disability named Francis. I was most impressed with the vocational facilities for the older children and adults. Some of the crafts that they make are batik fabric, hand woven baskets, kente cloth, and, stools and chairs, and jewelry, and they sell these products in a store at the school.

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The loom used to make kente cloth.

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Kente cloth

 

 

 

 

 

 

 

This school is unique in a society where disability is generally stigmatized. I was impressed with the staff’s understanding and acceptance of disability and with the classroom techniques that the teachers were using to adapt their teaching to best fit the children’s learning style. There are many signs and quotes around the building that promote the dignity of individuals with disabilities. In the classrooms, the children are separated by ability, and teachers were using tools like picture schedules in the rooms. They also have a class for the adults who work in the vocational workshop, so they can continue to maintain basic skills in reading, math, and writing. I was especially interested in this because in the U.S., adults with intellectual disabilities have very few opportunities to take classes to maintain these skills once they graduate from high school.

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During our tour of the school, we also got to see some of the work that the other group had completed at the school. The other group had done some wheelchair repair and adapted the wheelchairs to improve the positioning of the children in their chairs. We got to see one of the wheelchairs they had adapted for one student called Emma and were able to see a picture of his positioning before they added a cushion and built up the foot plates of his chair. They also built up and lengthened the handles of eating utensils and writing utensils for children with poor grip strength. Other projects included sensory bags with different objects to stimulate various senses for children who would benefit from this sensory input.

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Emma in his adapted wheelchair

We also met with the New Horizon’s staff to do some transfer training with them. Many of the staff were not aware of the best ways to transfer the children to prevent injuries to themselves and to the children. Many of the children use wheelchairs and have weaker shoulder muscles, pulling on their arms to transfer them can injure the muscles or pull the joint out and sublux the shoulder. Some of the staff were surprised to learn that they should not pull on the children’s arms. We also discussed the importance of good body mechanics for the staff like bending at the knees, keeping the back straight, and getting as close as possible to the child. The student mentioned previously, Emma, also was a great help with our transfer training for the staff, and he allowed us to do multiple transfers with him from his wheelchair to the floor and to a chair.

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Kate and Rick demonstrating a stand pivot transfer with me.

While I was surprised and impressed with the New Horizon School facilities and staff, I still wonder about the children with disabilities who live in the more rural areas of the country away from the resources available in Accra. I think it will be a challenge for future groups to figure out how to provide occupational therapy services in a meaningful way to this population. In Volta, our group discussed trying to find a way to do some of the same things that the Accra group was able to do at New Horizons for individuals with disabilities in the community. This would mean that future groups would have to find a way to identify these individuals and to travel to their homes with an interpreter. My hope is that in the future this idea will prove feasible for the upcoming groups.

For more information on New Horizons, check out this video and more videos about the school can be found on their website.

The Peggy Good School of Hope International and Our Best Laid Plans by Jouette

On our third and fourth days in Hohoe, we went to the Peggy Good School of Hope International to work on handwriting, health education, and transition planning with the children. The children who live at the orphanage attend the school along with other children in the community whose families pay for them attend. We had many plans laid out for these activities with the children, and some of the activities went according to plan and others not so much.

The education system in Ghana has some marked differences from the system in the U.S. (read Lilly’s post for additional information). Most schools in Ghana include kindergarten through junior high; this is considered a basic education. The Peggy Good School also runs through junior high, and the children then have to go a high school in the area, if they want to continue with their education. They take a national exam at this point called the Basic Education Certificate Examination, and if they pass this exam, they are eligible to attend high school. They also can go to a vocational training program at this time if they do not want to continue with school.

In high school, students must chose a specific track like agricultural, arts, science, business, and vocational. At the end or high school there is another exam that is similar to the SATs in the U.S.  This exam is the West African Senior School Certificate Examination (WASSCE), and the score a student receives determines if and where they can get accepted. If a student wants to change their field of study from high school when they apply to university, it is more difficult for them to be accepted into a university program because they consider all the candidates from the specific field of study before considering applicants from another field.

Some of our group members discussed transitioning from the school and the orphanage into a job or into high school and university with the junior high students. They went over the basics of an interview and how to write an essay for university. They also talked with the students about identifying their strengths and interests and showed them how to tie a tie for an interview. One problem we did not anticipate when planning this activity was the children’s unwillingness to engage in a discussion about their ideas and questions about the transition process. We believe that this may be due to the fact that they do not get asked many opened questions during school. From what we observed, the teachers appeared to ask questions that have a specific answer rather than engaging the class in discussion.

We also ran into this problem when we talked about health education with the younger children. They did well with naming their body parts, and they enjoyed doing the Hokie Pokey and singing “Head and Shoulders, Knees and Toes.” They also were interested in the station about washing hands and sneezing into their elbows. However, the mental health education stations did not go as smoothly. The children were not able to articulate the things that make them sad or anxious or mad. They sort of stared blankly at us when we tried to initiate a discussion about the things they could do when they felt these emotions. We talked to Mamma’s daughter Yvonne about our attempt at discussing feelings and what may have contributed to our lack of success with the discussion. She told us that Ghanaians generally hold these emotions in and are stoic when they are going through difficult times, so the children are not used to talking about feelings.

Another activity that we did with the children was handwriting. We taught them to create letters with curved and straight wooden pieces, and we practiced forming the letters in a handwriting workbook. They seemed to enjoy having their own workbook to practice in and were motivated to practice their letters. In Ghana, much of the lessons are done orally, and rote memorization of facts is a large part of their education. The children do not have the opportunity to do a lot of written practice or read individually from their own book. We also discovered that many of the children did not connect the letter with the sound that it makes, and they had trouble coming up with a word that started with a specific letter. Their literacy level of the younger children was also much lower than I expected. Many of the children around 6 to 9 years old had trouble recognizing sight words and were unable to read the books that we brought with us.

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Overall, I believe the activities we planned were successful, and the portions that did not go well provided us with valuable information for future students who are planning occupational therapy activities. There is also much more to learn about the classroom education at the Peggy Good School to better provide targeted occupational therapy where it is most needed. I believe that more informal discussion with the older students could provide more information on the transition and health education services that they feel are important to them.

 

 

Eugemont Orphanage and Adoption in Ghana by Jouette

     On our second day in Hohoe, we went to the Eugemont Orphanage to meet the children and staff there. The orphanage is home to about 35 children who range in age from 1 year old to 22 years old. The Eugemont Orphanage is supported by the Eugemont Foundation that is described on their website as a non-governmental organization and is registered as a nonprofit organization in Ghana. The funds that the Eugemont Foundation raises go to the running of the orphanage and the Peggy Good School of Hope International that the children attend along with other children from the community. The foundation is run by Eugenia Motogobe (“Mama”) and her family. Mama is a constant presence at the orphanage where turnover in staff is the norm.

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Prosper, Emefa, Angela, Bright and Michael hanging out on the porch.

     The orphanage building was surprisingly small for the number of children who live there. There were several small rooms crammed full of bunk beds that the children sleep in, and there were some small common rooms as well as a small bathroom. The children spend most of their time outside playing or resting in the shade under a thatched covered area. There are also outdoor kitchen and communal bathroom areas close by to the orphanage.

      When we arrived at the orphanage, we were welcomed by the younger children who had stayed at home from school. Some of them were a little shy and stayed at the edges of the group of children gathered around us; others jumped right up into our arms and laps. They all craved attention, whether that involved talking to us or being hugged or held. I loved their unique names, and some of my favorites names were Bright, Prosper, Melody, Bless, Kelvin, Delight, Emefa and Henrietta. Other children had more traditional biblical names like Michael, Daniel, Enoch, Luke, Mary, and Judith. And a few of the children had more “American” names like Samantha, Angela, and Jennifer. They all spoke English very well, and for the most part were easy to understand.

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Henrettia

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Stacey with Prosper and Michael

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Lauren with Baby Jennifer

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Bright a.k.a. Mr. Sassy Pants

                          The children at the orphanage act as a support system to each other, and the older children are involved in the care of the younger children. They do not seem to receive much personal attention from the orphanage staff unless they are very young, and their strongest relationships seem to be with the other children. All of the children are involved in the running of the orphanage, and they are responsible for most of the chores including cooking, cleaning, yard work, and laundry. The relationship between the children appears to be that of a large family unit.

Many of the children at the orphanage have one parent or other extended family still living who are not able or unwilling to care for them. Some of them also have parents who have remarried after a death of a spouse, but these children are not usually reclaimed by these new families. These children are eligible for adoption if their parent signs paperwork giving permission for the adoption, but some of the children have a parent who cannot be tracked down to sign this paperwork. Other children come to the orphanage as a result of abuse or neglect from their families.

It is not common for Ghanaian families to adopt children outside of their extended families, but they do care for children within their own extended families whose parents can no longer care for them. Our van driver shared with us that he has two of his sister’s children living with him. Many families also do not have the means to care for other children beyond their own. Unfortunately, the Ghanaian government has suspended the processing of all adoption cases since 2013 while it is reviewing its adoption procedures. Several of the children at the orphanage have families that have expressed interest in them, but they cannot be adopted at this time. It is also difficult for families from the U.S. to adopt children because the government would prefer to keep the children within their own home country if possible.

For more information about the orphanage and the children check out their blog http://eugemotfoundation.wordpress.com/

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Mary, Angela, Emefa, and Melody

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Macy with the beautiful older girls

 

 

 

 

 

First Impressions of Ghana by Jouette

     After a two long flights and a layover in the London airport, all 18 of us finally arrived in capital city of Accra on Monday, May 19. Amazingly, we collected all 36 of our checked bags after a long wait when the baggage carousel was stopped due to a downpour outside. We also all made it through customs smoothly thanks to no one looking too closely at our yellow fever cards. The process of leaving the airport was a little overwhelming because there was a group of men waiting outside who swarmed us wanting to help us with our luggage for tips, but our contacts met us at the airport and were able to help us manage the men and divide up their tip.

         On the trip to the hotel, I was impressed with the quality of the roads and the buildings and infrastructure in Accra. My impression of the buildings did change in daylight after I was able to see how worn some of the structures looked, but many of the newer buildings were in good condition. I’m not really sure why I was surprised that the roads were so well-paved. I think that we had been warned that the road to Volta would be full of potholes and very bumpy, and I assumed that all of the roads would be in poor condition.

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When we arrived at the hotel, three of us piled into the large bed and tried out our new sleep sacks. I slept like a rock despite the air conditioner that made some very interesting noises that can only be described as gurgling, gasping, and growling. One other group member also described it as sounding like a flapping bat was trapped inside it. The hotel room itself looked a little like a college dorm room with two twin beds pushed together, bedside dressers, a mini fridge, and a wardrobe. The bathroom was a bit temperamental requiring several pumps of the toilet handle to flush and no water pressure. There were large buckets in the shower to fill up with water to make a “shower” possible.

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The following morning, 9 of us loaded up into our “trotro” (12 passenger van) with our fabulous driver, Vincent, and traveled to Hohoe in the Volta region. As we were leaving Accra, I was fascinated with the people walking between the cars stopped in traffic to sell many different items out of big containers on their heads. The items for sale included: plantain chips (my favorite), bike tires, children’s toys, FanIce (another favorite not discovered until later in the trip), bagged water, bananas, and phone cards. At first, we attempted to turn on the air conditioning and keep the windows closed in the van, but we soon discovered that was a mistake as we started to feel sweat dripping down every part of our bodies (not an exaggeration). As soon as we opened the windows, we felt much better as long as the van was moving.

As we left Accra and its suburbs behind, I started to feel that I was in the Ghana that I had envisioned in my mind before we arrived. We went through several villages with some of the typical mud brick houses, and we started seeing goats and chickens everywhere. The road also got progressively worse the farther we travelled, and I might have seen my life flash before my eyes a few times. The driving technique entails weaving in and out of potholes at the fastest speed possible for the condition of the road while another driver is coming straight towards you doing the same thing. From what I could see, it looked like a very complicated game of chicken.

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Along the roadway, there were signs that are large color memorials for individuals who have passed away.  They have the person’s picture and their age of death along with phrases like, “Gone from us too soon.” and “Called to Heaven.” The names of the businesses were also similarly unique. Many of them had religions themes like “God’s Time Chemical Store” and “Surely Goodness and Mercy Beauty Salon”.

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After a 5 ½ hour van ride that included a stop to cross Lake Volta on a ferry, we arrived in Hohoe. I was surprised at how large the village was compared to the image I had I my mind. There were many businesses and several schools and churches, and a few hotels. I was impressed with our hotel as well. The rooms had large king size beds, large bathrooms, and air conditioners that made normal noises. Nava and I lucked out any got the largest room that had a bathroom the size of the hotel room in Accra.

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At dinner, we learned that the hotel is planning on turning the restaurant courtyard area into a nightclub. They had several large T.V. screens set up in the courtyard with pool tables and loud American music playing. Chris Brown, Beyoncé, Rhianna were very popular. Also, the movie Slumdog millionaire was playing on the screen.  It was a very stimulating sensory experience to say the least. After a 2 hour wait for dinner under a fancy disco light above our table, we crawled into bed and prepared to visit the orphanage the following day.

P.S. I did not take all of these pictures. Thanks to everyone I stole pictures from!

 

 

Disability and Stigma in Ghana by Jouette

This post is related to Lilly’s last post and the video that she talks about in her post. Great minds think alike. Instead of finishing my packing, I decided to procrastinate and watch a video that one of our fellow group members, Kate, shared from the International Rehabilitation Forum. The video (watch here) delves into disability awareness and the status of rehabilitation medicine in Ghana. It got me thinking about the Ghanaian attitude surrounding disability that we have discussed quite a bit. Many Ghanaians view disability through the lens of their traditional spiritual beliefs; they believe that disabilities are a spiritual problem, or they are caused by witchcraft or spirit possession. In a society where everyone is expected to contribute to the survival of the family, individuals with disabilities are considered a burden on their families.

In Ghana, individuals with disabilities face stigma daily. Many people refuse to hire them and buy goods from them, and most van drivers refuse to pick them up and take them to work. Children with disabilities are often sent to special schools away from their families because their families are also stigmatized for having a child with a disability. This stigma is one of the largest barriers to work and community participation. The only option for many individuals with disabilities is to move to the urban areas and beg for food and money.

There have been some improvements in government support of disability rights. In 2006, a Disability Rights Bill was passed in Ghana which established a National Council on Persons with Disability and set a goal of providing disability services and equal employment opportunities to persons with disabilities by 2016. This will be a daunting task considering the lack of government funds and poor infrastructure in Ghana.

I also found it interesting to learn from the video that the disability community in Ghana has organized itself into local Disability Councils even in the most remote areas of the country. Many of the individuals in the video traveled long distances on hand bikes to participate in these meetings. The video also showed examples of individuals with disabilities who were successful in finding employment to provide for their families despite the stigma they face. These individuals also appear to have been accepted by their local communities.

I am excited to get the chance to talk to the staff members who work with children with disabilities, and I am curious to see how their views differ from the general societal views on disability. I also hope to get the opportunity to change attitudes about disability by sharing my views about the contributions that individuals with disabilities can make to Ghanaian society.

Countdown to Ghana by Jouette

In 5 days, I will be traveling to Ghana with 12 other students in the Occupational Therapy Program at VCU.  Developmental screenings, health education, after school activities, wheelchair repair, and modification of toys and tools are some of the OT services that we plan to provide to children at schools and orphanages in the capital city of Accra and the Volta region. I will be traveling with half of our group to the Volta region in the eastern part of Ghana, and our work sites include the Eugemont Orphanage, the Volta School for the Deaf, and the Gbi Special School for children with intellectual and physical disabilities.  I am nervous about putting my limited clinical knowledge into practice, but I welcome the opportunity to get more hands on pediatric OT experience with the guidance from our 3 professors traveling with us.

The reactions that I have gotten when I share my news about my trip are overall positive. Most people tell me that it will be a wonderful experience and that they wish they had the opportunity to travel to Africa. Like Sam’s earlier post, some people have been worried about safety, but I try to explain that Ghana is a stable country with little conflict. I did get a phone call from my mother the other day telling me not to get near any one-humped camels in Ghana because apparently they are giving people Middle East respiratory syndrome (MERS). I pretty sure she was trying to be funny but was also slightly serious. I told her that I didn’t think I would see any one-humped or two-humped camels in Ghana.

Our group has been meeting weekly throughout the semester to discuss Ghanaian culture and related issues. I was surprised to learn that the culture is fairly conservative, and we are expected to wear knee-length dresses and cover our shoulders when we are out in public. In general, women are expected to play a submissive role and let a male take the lead if he is present. I’m sure I am going to forget about crossing my legs and only using my right hand to point or hand things to others. I am also excited to learn the special Ghanaian handshake that involves snapping your middle finger against the other person’s finger.

I am not sure how my expectations of Ghana will differ from the reality of the country. I think there will be some things that they use or have access to that will surprise me. I’m sure there will also be many “necessities” from the U.S. that will not be available in Ghana. It has been interesting thinking about how to plan the health education and afterschool activities for the Eugemont Orphanage. Some of the questions we have asked ourselves are: What access do they have to health services? Do they go to the doctor when they are vomiting or have a cut that might need stitches? Are water balloons an appropriate activity or would they be considered wasteful? Our group leaders keep reminding us to have a plan for activities, but be prepared to scrap that plan and come up with a new one if needed. I am excited to challenge my expectations and experience Ghanaian culture first hand!