Packing Tips by Nava

Prior to leaving, one of the hottest topics of conversation was what to pack, what to buy, where do buy it etc. so I figure I’d share what made it into my bag and what got cut. I planned to continue on with travels after our time in Ghana so I packed light in a 40L REI backpack and found I was able to squeeze in everything I needed no problem. This did require doing laundry in the sink a few times but I had no problem drying clothing overnight on a line.

My clothing list included:

  • Bottoms (3 pants, 3 skirts, 1 shorts): 1 pair of linen pants, 1 pair of very light Northface pants, 1 pair of leggings (for travel days), 1 maxi skirt, 1 mid-calf Northface skirt, 1 nicer skirt (for church), and one pair of running shorts (for hiking and waterfalls)
  • Tops (6): 4 cotton target t’s, 2 Hanes cotton t’s (to be ruined and left behind
  • Shoes: One pair of runners and one pair of Teva flip-flops
  • Underwear: 5 pairs and 5 sports bras (much easier to wash and clean that regular bras)
  • 1 Rain jacket
  • 1 Bathing suit

Other things I brought along included:

  • Travel size bathroom stuff (deodorant, toothbrush/paste, REI travel shampoo/conditioner)
  • REI Travel detergent
  • Hand sanitizer
  • Mini medical kit and prescriptions – ibuprofen, antimalarial, anti-diarreals, band aids, neosporine, tums…
  • Sunscreen
  • Copies of insurance/passport/credit cards/tickets/immunization records
  • Passport/yellow fever card
  • Cash to convert at the airport – they had a good rate and if you’re heading to Volta, this is possibly your only opportunity to convert cash)
  • Electrical converter – we only encountered the two round prong kind (I’ve heard this referred to as British but not sure)
  • Travel towel
  • Baby wipes
  • Deet bug spray
  • Day bag
  • Journal & pens – I like small Field Notes, for portability and convenience
  • Kindle & charger
  • Phone & charger
  • Camera, charger, extra storage card
  • Cocoon Sack
  • Water bottle
  • Toilet paper/tissues

And food! I brought 16 bars and two bags of trail mix, chocolate and dried fruit.

All done it looked kinda like this:

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Tips and things I would change if I were doing it again:

  • Pants vs. Skirts: I’m really not a skirt person but found myself wearing skirts a lot because of the airflow they allow. The majority of our trip members shared a uniform of target t-shirts and old navy skirts which seemed to work really well and are very cheap. We also often unintentionally matched which was pretty funny.
  • Never needed any special shoes. Many people chose to bring older running shoes and leave them behind after our hike.
  • Bug spray: The wipes are awesome because they don’t count against your liquid amount and are easy to apply. If you’re going the liquid route, a normal size, normal deet content (like 35%) would have been fine for the bugs we encountered. I would recommend testing it before you go as Macy had a minor allergic reaction to using my bug spray! A few people went for the permethrin (spray for your clothing/sleep sack) but it turned out to not be necessary, at least for the time of year we were there.
  • Baby wipes and tissues came in handy often as you never know what/when/where your next bathroom will be and the wipes were helpful for wiping down your face or hands from the dirt. Hand sanny was nice as well but doesn’t do as much to help with the dirt.
  • Food: I really don’t love bars and luckily in the heat, we all just found that we were not that hungry until the sun went down. That said, there were often times during the day when I could just feel my energy crashing and then the dried fruit and trail mix was my go-to. If you’re going the bar route, I suggest mixing up the brands you’re bringing so that you don’t get burnt out on any one brand.
  • If you are a MasterCard user, we found that many ATMs were not accepting of MasterCard so be prepared with an alternative method or bring cash. Also maybe this will be different in a year?
  • If you’re going to Ghana through VCU OT’s program, ask people who went last year if you can borrow things such as sleep sacs, skirts, sink detergent etc. If you go the target/old navy route, you can really spent very little on what you’re packing.
  • Things I wish I’d brought: AFTER BITE! Only Rick had the foresight to pack this and oh man, did it come in handy. Also more dried fruit. And one old navy skirt
  • Things I wish I’d left at home: 1 pair of pants (traded for the skirt), 2 of the 4 little hand sanitizer (took up too much liquid room and didn’t use ’em)

 

Trip Reflections by Nava

Lauren helping Michael with his letters

Lauren helping Michael with his letters

1) Participating in this trip helped me think a lot about what kind of OT I want to be and what the role of OT (international or domestic practitioner) could or should be. Being back in North America, I am regularly reminded that one does not have to fly across an ocean or drive even 5 miles to find children growing up in difficult situations who need love and services. It only takes turning on the local news or opening up a web browser to come up with many ideas of how we could volunteer right at home to try and decrease the burden carried by our nations children and families. While it might not be as exciting as packing a bag and getting on a jet plane, regularly volunteering at a homeless shelter, shelter for victims of domestic violence, food bank, Ronald McDonald house, centre for immigrant services…these are all things that can be done here to promote occupational justice through use of the skills we have as OTs. They may not be in a different country but even local participation can provide personal growth opportunities like those we had in Ghana such as learning words in new languages, experiencing belief systems that are not your own, and practicing cultural competency. It is also a great way to learn more about our own communities and the parts of them that we may not see or know much about. These options allow for continued involvement which may allow the effect we have to be more long lasting and meaningful for us and for the people we work with. And we may even get to enjoy some sort of air conditioning while we’re at it.

Jo reading to Bright and Henrietta

Jo reading to Bright and Henrietta

2) I’m glad that occupational justice is a concept that is part of our curriculum and that it is regularly impressed upon us how important it is to practice in a client-centred manner. We could have headed in this unknown Ghana and tried to show them everything we know without listening and looking at what it is they need and want but I often heard myself and my trip-mates asking questions about what future trips to Volta could look like and how we could spend our time there in a way that we could actually help. No one had any easy answers but I think this trip was a great opportunity for each of us to really experience how valuable many of those general and obvious feeling concepts we talk about in class are. It can be challenging when you’re excited and have all these ideas of how to ‘fix’ things to remember the context and specific needs of the individual you are working with. This trip helped hit home the importance of these things for our future practice here in North America.

Girls dancing at Eugemont Orphanage

Girls dancing at Eugemont Orphanage

3) I’m really excited about the OT program that is being developed at the University of Ghana and what it hopefully means for the future of OT in Ghana. I hope that VCU is able to maintain a relationship with the program as is develops and grows. It seems like exchanges between our program and theirs could provide some wonderful cross-cultural learning experience and help to create a sustainable method of supporting the growth of OT in Ghana. The opportunity to do problem solving exercises with their students and get to know them over lunch was definitely one of my highlights of my trip. I was really impressed by their ability to explain to me what they feel their education is about and their fears and questions about what and how they will practicing in a few years.

4) Monkeys!

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Tafi Atome Monkey Sanctuary

What to do now? by Nava

After the experiences had in Ghana, it was hard to just leave and move on to the rest of summer. In the Accra airport I shared these feelings with Lily when realized we felt the same way, we figured we should work together and do something. We wanted this ‘something’ to follow-up but our experiences at study abroad students and as OT student trying to deliver services in a rural area. We spoke to our professors and decided to gather a few ideas that we could put forth as poster proposals for the National AOTA (American Occupational Therapy Association) conference next spring. With the due date two weeks away, we brainstormed a list and rounded it down to two topics we feel we can present information on that might interest the AOTA crowd. We will not know if either topic has been accepted until sometime in September but I thought I’d write about them anyway as the process of submitting these proposals has helped me process a lot of what we did and saw over the course of our trip prep and travel. The concepts we submitted are:

1: Compare participant and leader pre-departure goals with post-trip feelings of what was gained from the experience in both Accra and Hohoe through a simple survey of trip participants and by examining blogs.

2: Investigate the issues faced in delivering OT services and carrying out projects in the rural setting. Explore what we understand of why these issues occurred, and possible solutions for future trips. (language/cultural differences, available resources, time, relationships, etc.)

Through the first topic, we hope to look into the different experiences had by each group to compare and contrast the outcomes and how each group feels their experience aligned with the goals of the trip as set out by the course syllabus. When we were all together for our last few days in Accra, it was clear that there were significant differences between the type of work done by each group. The Accra team completed very OT related tasks by working with students and teachers on things like positioning and wheelchair repairs in a school specifically for children with disabilities. They also completed a significant amount of Denver screenings at a school for typically developed children and helped write-up reports for those they had some concerns about. This experience (we expect) was likely very affirming for them in their choice of career and was a great experience for them to put to use the skills they’d learned in the classroom. For those of us in Volta, our time was primarily spent with children from the orphanage. While many of these children may have some psychological trauma in their pasts that contribute to behavioural or emotional concerns, with only two weeks in country, we were not able to focus on those areas. Our time was spent learning and absorbing the culture of rural Ghana life and its challenges. We developed relationships and asked many questions about what and how one could be an effective OT in this setting. From the survey results, we do know that participating in this trip was valuable for all members. We hope to find out more about which aspects were most valuable and most challenging and how they compare to the expectations of our professors to help provide insight for future OT study abroad trips.

Our second prompt touches on a topic that I’ve thought a lot about since our trip. There are many arguments for and against NGOs and ‘outsiders’ providing aid to developing nations. Regardless of what side you find yourself on, many practitioners are doing it. Just like we did, they choose to travel overseas, usually for a short period of time with the goal of delivering services and making a difference. Just as we did, many of them likely experience significant unanticipated  barriers to being able to provide the kind of care they imagined. When looking through literature to prepare this proposal, Lily and I found many articles regarding the systemic and structural barriers for delivering services in rural areas such as limitations to government funding and small numbers of practitioners, but nothing that touched on the face-to-face part of delivery. That’s kind of a lie. We found one article that touched on some of the language and religious concerns and got really excited and then realized it was by Stacey (our trip leader). But still, none of these articles proposed any suggestions for mitigating these barriers when in country or ways to prepare. This is likely because there is obviously no one-size-fits-all solution and the collection of formal research in this small area is likely difficult to acquire funding for. In this poster, Lily and I would like to share the knowledge we acquired through conversations with the Ghanaians we met, the reflections of our trip-mates, and consultation of literature across medical literature. We want to provide suggestions and ideas that we wish we had prior to our departure and hopefully help those interested in participating in this realm of OT seriously consider what they can do to prepare for such an experience.

As I said above, we wont know if we will actually have the opportunity to present either of these till September but regardless, the opportunity to go through the process of submitting was an interesting learning experience that will hopefully come in handy in again in the future.

Trials and Tribulation with Health Education by Nava

The lesson plan I was assigned to work on with Jouette was health education. Before leaving we planned a few different sessions that we hoped to be able to adapt for different age groups in different settings as we had no idea what age groups or in what setting we would be working with kids in before we left. We prepared these short sessions so that they could be grouped together in a variety of combinations with ice breakers and activities. As many others talked about in their posts, we did not anticipate the differences between American and Ghanaian culture in how classes are taught and how students are expected to behave. All of our plans involved student participation and that is where we experienced our biggest hurdles.

The classrooms for 7 and 8 year olds that we spent most of our time in had ample room with desks and chairs for each student and a large blackboard up front. The children mostly behaved according to the expectation that they would sit in their seats and perform rote memorization of the lesson.The lessons we observed consisted of the teacher explaining something and the students repeating it back. We didn’t see any examples of students being asked to provide answers demonstrating comprehension or critical analysis.

Kids at orphanage practicing handwriting

Kids at orphanage practicing handwriting

Jo and I created mini lesson plans on personal hygiene, basic emotions and coping skills, relationships and appropriate physical behaviour, smoking, and healthy eating/food pyramid. Most of it was geared towards the 7-9 year age range with the ability to simplify for younger kids or grade it up for 10-15 crowd. We also put together role playing and information on relationships and consent aimed at more of a teenage audience. We only had the opportunity to execute these lesson plans with the 7 and 8 year olds and decided, after teaching them the hokey pokey, to break them up into three groups. The groups rotated between three stations each lead by a pair of OT students that covered oral hygiene & taking care of your skin, emotion health and coping strategies, and how to stop germs.

After completing all the rotations, catching our breath, we headed back to our hostel on the way, had a little debrief of the experience. At each station, students had been responded with silence to simple open ended and we always eager to repeat a suggestion provided by us ‘teachers’. They appeared to listen and be somewhat engaged when learning about oral hygiene, skin care, and germs but were rather disengaged on the topics of emotions and coping strategies. The children to regularly perform teeth brushing of some sort and wound care but still struggled to tell me about it when prompted. Emotions seemed to be foreign concepts to them. The only responses they were able to provide were that they were sad when they “got beat” – a common parenting practice in Volta. Talking about putting names to feelings and the idea that one would discuss feelings with a confidant only brought blank stares and wiggly feet.

An interesting contrast to this experience was how the children behaved out of school. There was one 13 year old girl we met in the older classroom when some of my group-mates were teaching transitional skills who seems pretty quiet and disengaged. A day or two later when we visited a village to conduct interviews with mothers, she approached our tro tro (van) and chatted with us for probably about 30 minutes. She had so much to say and answered questions about what she wanted for her future, her favourite activities, her family, etc. She bounced around as she asked us tons of questions about our families, our favourite foods and shared her story. This was a drastic contrast to the personality she displayed in school. She was clearly bright, active, and inquisitive. Meeting her outside of the school context provided us with an interesting idea of how students adjust their behaviour and attitudes based on the expectations in the classroom.

Establishing Crucial Relationships and Learning More About Child Development in Ghana by Macy

A lot of our time in Ghana was dedicated to establishing critical relationships for future trips to Ghana.  We had the opportunity to visit a couple schools to form connections including the Volta School for the Deaf and the Autism school in Accra.  The Volta school for the Deaf was impressive because it was like a mini campus.  The children stay there throughout the year for 3 months at a time, and then go home to their families for a couple weeks between sessions.  At this school, they have a vocational area where the students make really cool crafts—we were able to see and buy these crafts at their store in the market called “Our Talking Hands”.  During our visit at the school, the children were out of session so it was difficult to see how we could be most helpful to them.  We talked about possibly focusing on ergonomics in the vocational area or tackling communication barriers between children and their families.  We learned that most children struggle when they go home because their parents do not know sign language and have no way of communicating with them.  It made me wonder why they have to be sent home if both the child and parent are not happy with the situation.  However, since this is a requirement of the school, I think that we could help with this communication barrier.

The Autism school was overwhelming for me.  As a former ABA therapist, I couldn’t help but notice how much these teachers could benefit from ABA training.  I think a major part of our role at this school could be through teacher education.  There was sensory overload from the time we walked in including a loud TV, drumming, and singing very loudly.  The teachers could benefit from an understanding of sensory integration because it was clear that some children had sensory processing difficulties.

We were lucky to have Yvonne (the daughter of mama from the orphanage) help us get in touch with the autism school.  She is a wealth of knowledge and I enjoyed having the opportunity to talk to her.  She and Bless, one of the older guys from the orphanage, have a lot of connections in Ghana, making it important for us to keep good relationships with them for future visits.

I enjoyed learning more about child development in Ghana by administering Denver II screenings and interviewing mothers in the local villages.  Bless was helpful in finding mothers to interview, and also helped with interpreting.  We conducted these interviews to get a better idea of typical child development in Ghana in hopes of eventually creating a screening tool for Ghanaian children.  A few of my observations included: people did not seem to think a child’s age was very important, children do not have access to toys or feeding utensils, and parents will seek medical attention mainly for children who are overheated.  I also thought that the animal identification list should be changed to include more common animals in Ghana (such as goats).

We were only able to administer Denver II screenings on a couple children from the orphanage.  I helped administer the screening on two young girls, but it was difficult to get a true idea of their skills because of the language barrier (they speak Ewe to them).  They were also feeling sick and were not comfortable with us, which might of also skewed our results.  We noticed that they did not move around much and had a flat affect, but this could have been due to the heat and/or their sickness.  Hopefully next year we can continue this research and get more Denver screenings in the Volta region.

Forming relationships is essential when traveling to a foreign country to provide services.  We were lucky to have pre-established relationships to assist us during our trip this time, and hopefully the relationships we formed this year will continue throughout the following years.  This trip was completely life changing and I am so blessed I had this opportunity. Not only did I learn about a completely different culture then my own, but I also realized how much we take for granted on a daily basis.  I feel very fortunate for all that we have here in the US and hope to someday have another opportunity to travel abroad again (maybe to go pick up Prosper :)).

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One of my favorite pictures from the trip 🙂

How We Provided OT Services by Macy

As mentioned in a previous blog, I was assigned to co-lead handwriting and after school activities with the children at the orphanage.  I was most nervous about co-teaching handwriting because of my lack of experience in this area.  We were fortunate to use a curriculum called “handwriting without tears” which provided us with ideas for working with children at all stages of handwriting.  I spent a lot of time reading the teachers manuals, which were really helpful, but the uncertainty of how it would actually work in Ghana made it a bit more complicated.

The first day we spent at the orphanage, we introduced handwriting to the kids.  The lack of structure and table space made it difficult for the kids to pay attention.  However, after having each child take a quick handwriting assessment, we were able to split the kids up into reasonable groups by skill level.  Overall, the kids were decent at writing their letters, but there was a wide range of skill level.  Some of us worked on chalkboards, others with wooden blocks, and a few in workbooks.

The next day we were able to teach handwriting in school which was a little better since each child had a desk, and we had access to the blackboard.  I was really glad to provide each child with their own workbook with the letters in the correct teaching order (based on difficulty level and groupings of letters).  While working with the kids, we noticed that they had difficulty making the connection between letters and their sounds.  They could usually tell you what the letter was, but most could not tell you the name of something that started with the letter.  Based on this observation, it seems like the teachers are more concerned with memorization of the letters alone versus usage of letters in words.  Maybe this could be something to look into in the future, followed by providing feedback to the teachers.  Overall, I thought the handwriting went pretty well.  Most of the kids benefited from learning the correct way of writing letters, which will help them in the future when they learn to write words.  I would have liked to have more time for handwriting so we could of worked on lower-case and cursive letters (for the more advanced kids).  We did leave some materials and the curriculum for the teacher, so hopefully he will take advantage of that information.  Writing is a critical skill that will benefit these children for the rest of their lives and I was happy to take part in the learning process.

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The biggest success for after school activities was making the rainbow loom bracelets.  The kids had never seen them before so they were very interested.   When we brought out the rubber bands, the kids all swarmed around to learn how to make them.  We taught them how to make them on their fingers since they wouldn’t have access to a “loom” (which most kids in the US use to make them).  I was impressed with how quickly they caught on—even the younger ones. They even asked for us to send them more rubber bands so they could sell bracelets at the market!  The friendship bracelets out of string did not interest the kids as much, but some of them really liked it.  They were able to tie the string to their toe to make these—improvising at its finest!

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During our last day, we had the opportunity to meet with the University of Ghana OT students.  I really enjoyed working through case studies and learning more about them and their program.  The students we met are the first OT class and they are in their second year of undergraduate studies.  They haven’t had much exposure to OT yet and have taken mainly general education courses.  They will only need a four-year degree to practice as an OT in Ghana, but we are not sure how it will work since there are only a couple OT’s in Ghana.  However, working through case studies was a cool experience because we were able to help them begin to think like OT’s.  This experience made me realize that I know more than I think.  I think that our pediatric course this past semester helped prepare me for working through the case studies.  It made me feel good that I could help them with their critical reasoning skills and helped me see that I am starting to think more like an OT!

I also enjoyed providing transfer training to the teachers of New Horizon’s and The University of Ghana students.  I was glad we were able to do this because so many people get hurt while trying to transfer others.  I hope we at least helped them understand the safety concerns for both people during transfers to help reduce injury in each person.

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What I learned most during these OT related projects was that most learning usually comes from uncomfortable situations. Before each of these activities, I did not feel competent since I am not yet an OT.  However, I learned so much from each of these experiences, and realized that I knew more than I thought!

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

 

What Was Different in Ghana by Macy

While in Ghana, there were certain parts of the culture and environment that took some getting used to.  People in Ghana are so friendly and almost every person that saw us would tell us “you are welcome”.  I am not used to people being so welcoming and it was a nice change!  The part of Ghana that I had the hardest time with was the heat and humidity.  I had never been so sweaty and dirty in my life, so it was a hard adjustment for me—I even sweat through my “sweat proof” pants!  Another difficult adjustment was waiting such a long time for meals—in the US, we are spoiled and food is prepared quickly, and all food is served at the same time.  In Ghana, everyone gets his or her meals at different times and it could take a couple hours for it to be ready.  Also, there are not nearly as many choices as we have in the US.  While in Ghana, someone asked me what kind of food we have in the US and the only answer I could come up with is “everything!”  It can get overwhelming with the amount of choices we have here, but it is better then having only a few of the same choices at every restaurant. Another part of meals that was different was that most people eat meals with their hands instead of utensils.  Before a meal, the server would bring out a bowl of water and soap to wash your right hand with before eating a meal. Here is a Ghanaian dish called “Banku” that we tried which was actually pretty good (although I was a little freaked out by the fish in the soup), Melodee washing her hands in a bowl, and Prosper eating his lunch with his hands:

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The older boys from the orphanage informed us that some people in Ghana eat cats and dogs—this news was a bit disturbing and steered me away from eating meat the rest of the trip.  They also found it very amusing that people in the US have cats and dogs as pets and take them to the doctor—it is kind of ridiculous if you think about it. It is so common in the US that I never really thought about it that way.  People in Ghana hardly have access to medical professionals and we are taking our pets to a doctor!

Something that I found interesting that I have never really experienced before is sometimes babies were afraid of us—I hadn’t really thought about the fact that some babies there may have never seen a white person before!  This would happen mostly in the villages while we were doing interviews with families.  At the orphanage, most of the kids were used to white people because volunteers visit the orphanage throughout the year.  I also noticed that at the orphanage, the kids clothing and shoes were not gender specific.  The kids were just happy to have something to wear— in the US, this would probably be shamed upon.  But is it really that big of a deal? Here is a picture of one of the outfits Prosper wore while we were there:

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I did not enjoy hand washing my clothes in the sink—I felt that I could not get them clean enough and we did not have a stopper for the sink which made it extra difficult!  I respect the people in Ghana (like the older girls at the orphanage) who hand wash clothes on a daily basis—it is not fun and hard work!

One of the biggest differences I noticed in the children at the orphanage versus children in the US is their independence level.  The kids in Ghana have to learn from a young age to look after themselves versus kids in the US who are “babied” for a good portion of their childhood.  It was hard for me to accept this because I just wanted to make sure the kids were okay! For example, when we took the kids to the waterfall, I was scared about the younger kids running ahead on the trail.  The “US caretaker” in me was thinking I didn’t want them to get lost or taken.  However, I realized quickly that they knew their limits and I had to just let them go!

My favorite difference about Ghana was the true happiness expressed in the people there.  I feel like here in the US we don’t even know what true happiness is because we are always looking for happiness through “things”.  In Ghana, they don’t have much, but seem to be happier with the little they do have.  They seem much more appreciative for what they have and rely on their tremendous faith each day.  I only hope to one day be as spiritually sound as the people in Ghana.  One of the major things I learned on this trip is that less really is more because without all the materialistic things is where to find true happiness.

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.