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.


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!


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.


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.”

Me: I just swallowed some of the water when I went under the falls. I hope I don’t get giardia.



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.


Meghan with a mona monkey.


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


Red red and plantains. My Favorite!


Cassava Cookies


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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The Markets by Becky

We were lucky enough to have some free time during our 2 weeks, and many of us took advantage of some of that free time to look around and shop at the local markets. We went to 2 different markets as well as shopped at the New Horizon school, where items made by students are sold.

We’d heard stories ahead of time about how mobbed the markets can be – lots of people and vendors who follow you around, trying to sell their goods, even after you’ve politely declined. We lucked out at the first market we went to, which was out by Grace Life school and up a mountain that provided us with gorgeous views. We pulled into the parking lot and saw the market was practically deserted, except for the vendors. We hopped out and headed to the nearest seller. It wasn’t nearly as overwhelming as I’d expected, and made for a pleasant first Ghanaian shopping experience. Some of the sellers were working on their crafts, and we met some children who were sanding handcarved giraffes. Everything was beautiful and you could tell the crafters took pride in their work. This market also provided a quiet, low stress environment to practice my haggling skills. In Ghana, when you find something you want to buy, the seller states a price, and then you come back with what you want to pay. The back and forth continues until both buyer and seller agrees on a price. At first I was nervous about the process, but it was actually pretty fun.

A few days later we headed to the Accra market. Talk about overstimulation from the moment you step out of the tro-tro! A crowd met us, all wanting to talk to us and show us their wares. I had to be polite but firm in telling them no, and that we’d reach their shop as we walked around. The vendors at this market were noticeably more aggressive, often following us around from shop to shop, putting items in our hands and trying to get us to return to their goods. The haggling continued at the Accra market, although I was more tired on this day and at times didn’t negotiate as much as I would have otherwise. You definitely need energy to shop at the bustling markets!

One afternoon we also made a stop at the store located at the New Horizon school. Going in, I knew I wanted to buy something to support the school, but I was shocked when I saw what items were offered for sale. There were some beautiful woven baskets, intricate dolls, pretty jewelry, and gorgeous batik fabric. You could tell they were all carefully crafted and high quality items. I fell in love with all of the fabrics, but settled on a pretty red with white pattern that I can’t wait to turn into throw pillow covers. This store, and the fact that the students are taught the skills to make such products, was just one more reason why I loved New Horizon school.

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


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:


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:


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.


The loom used to make kente cloth.


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.



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.


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.

Interviews and the Denver-II by Nava

A few posts here have mentioned the interviews we conducted with Ghanaian mothers as part of Kate’s PhD project and Carole Ivy and Stacey Reynold’s ongoing research. Carole and Stacey are in the process of adapting a developmental assessment used in the US and many other countries, the Denver Developmental Screening Test (Denver-II), to be used in Ghana.

The Denver-II is a screening administered typically by a pediatrician or other early childhood  professional to obtain information regarding a child’s overall performance in four categories: social, language, fine motor skill, and gross motor skill. Children are asked to perform a variety of age appropriate tasks such as stacking blocks, drawing shapes, or answering questions. How they perform is compared to national standard averages to determine if a child is developing as expected in these four areas.

In order to develop a Ghanaian Denver-II, it is necessary to gather information about the expectations timeline for development, what skills are important and expected for Ghanaian children, and how to structure and word screening items to ensure that they are accurately testing what it is you want to test. Gathering as much of this information as we could was a big goal of this trip and we did it primarily through two methods.

  1. The group in Accra completed the American Denver-II on over 50 children to see how they performed according to our norms. This also allowed screening administrators to observe which screening items were more difficult to test due to cultural differences, language barriers, or other factors.
  2. Kate in Accra and myself and others in Hohoe interviewed ~30 mothers by asking them each about 40 questions regarding parenting practices and child development. We recorded these interview and Kate is now reviewing and coding them to pick out important trends and information

All of this information will be complied over the following year and used to create a trial Ghana Denver which can be taken back to Ghana next year to be tested.

I interviewed two women at Eugemont Orphanage, four mothers in their homes, and one woman at our hostel with the help of Bless, our local interpreter, and another student to record. Each time, Bless had found these women a head of time and arranged a time for us to conduct the interview. This was necessary in Hohoe as the level of English varies significantly and thus walking around and soliciting women in the neighborhood can be very difficult (and moderately intrusive). In Accra, Kate used connections through the schools they visited and also wandered the area and approached women. We started each interview by explaining the procedure of recording and the confidentiality of the interviews. We then proceeded to ask questions about how children spend their time, types of play, expectations for chores, money management, potty-training, etc. At the end, we showed the women 15 images of children ages 3mo-5years doing things such as rolling over, running, or feeding themselves and asked the women to tell us at what age they think their children started to do these things.

Completing these interviews was a very interesting and informing experience for me. It was a learning process to figure out how to ask the questions and follow ups in a way that would get at the information I needed. Because of the language barrier and cultural differences, the mothers were not always sure what it was I was asking or how much detail I wanted and often seemed to want to provide a ‘correct’ answer. It was also interesting to go through an interpreter as I often felt as though details in the answers were lost either due to a limit in our interpreter’s vocabulary or judgment calls on his part as to what it was I wanted to hear. In addition to learning from the answers I received, it was also very educational to observe what was going around in the areas where these women lived. We inevitably had a bit of an audience at each home during the interviews. Most of the homes we visited were situated very close to other homes in a compound-like set up and kids or other mothers would gather around to listen and sometimes contribute their thoughts. Being able to meet these women and children in their homes made it easier to see and understand the skills they need to be able to perform in order to contribute to the home. There seems to be many physical requirements that I couldn’t imagine needing to complete everyday in the hot climate. During the interviews I was able to watch older boys crushing cassava root with very large mortar and pestle like tools, girl and boys of a wide age range walk with large buckets of water from the river and older girls preparing washing done at the river to be dried.

All of these are tasks that we, in North America, either complete with the click of a button or a purchase at the store. We can adapt the buttons and tools we use relatively easily for someone with a disability so that they can act independently and contribute to their household. Thinking about working with Ghanaians living in rural areas in a OT context puts a new spin on things. While many areas such as fitting wheelchairs or adapting utensils, might be very similar to how they are done in the states , many other aspects of OT such as role development/adaptation and social skills are a whole new ball game. It seems to me that the most valuable skills for OTs (and probably most professions) working in different areas of the world is cultural competency and patience . As we learned on this trip, there is only so much you can do to prepare but once you’re on the ground, it is so important to ask questions and observe and listen as much as possible to understand how and why things are done the way they are before you suggest adaptations and changes. As we learned, this is not always easy as you don’t always get answers that make sense to you or that tell you what you need to know but eventually things can mostly be pieced together, which is why you need to be patient. Being patient allows you to see more and hear more, which may give you the answers you need without you needing to ask questions.

The Markets by Sam

Saturday we went to Grace Life International to help paint some of the classrooms, and Kate and I went around the community with Ms. Felicia conducting interviews. After finishing at the school we went to a market not too far away on a mountain that Eric had recommended to us because it was less expensive and a lot of the stuff was made there. Many of us had travelled previously and gone to markets where people are very pushy getting you to come in to their shops and buy things, and then you have to haggle with them, so from those previous experiences and what Carole had told us about the Accra Market the year before we were preparing ourselves for some chaos, but we were all very surprised by what we found. The market was very open and quiet, and there weren’t many people there. When we got out of the tro-tro the shop owners were very excited to see us, some came up to greet us and others called from their shops to welcome us. We all buddied up, but being in a group of 3 I jumped around a lot between buddy groups, and I felt okay doing that because there were so few people, it was such an open place, and everyone was very nice. Some of the kids came up and showed us where they were working on sanding and painting the wooden sculptures and masks, you could watch people carving and could see how genuinely handmade the majority of the products were. It was really awesome to see how they made these pieces of wood into these beautifully crafted pieces of art. I enjoyed walking around and just getting to look at everything, and I appreciated that I was able to do that without the shop owners constantly trying to get me to buy things. My main goal was to get a drum that I liked and I was happy to find one that was not too big or too small, I also got a couple of masks, some elephant statues, a giraffe, a bowl, and a painting. Everything was so beautifully made that I wished I had had more money with me because I would have loved to buy more things. I got some drum lessons from one of the guys, and continued to walk around enjoying myself. I think everyone was pleased with what they purchased and we were all very glad that Eric recommended that we go to that market because it was such a nice experience.

Kevin playing the beautiful drum.

Kevin playing the beautiful drum.

The detail on this drum was incredible.

The detail on this drum was incredible.

Monday was a holiday in Ghana, so we did not get to go to New Horizons like we had originally planned, so most of us decided instead to go to the Accra Market to see what it was like and probably to get some more stuff. We knew right when we arrived that this was much more of what we were expecting the market to be like compared to the last one we had gone to. It was not very busy with shoppers, probably because of the holiday, but it was busy with people. From the second we got there everyone started to swarm around us trying to get us to come to their shops and break us off from our groups. I had my shopping buddies for this market and I was definitely going to stick with them. They had a lot of interesting things, but much of their merchandise seemed to be more commercially made than at the last market we had gone to. You could tell just from the atmosphere that this was a much more touristy market, prices were higher, people would haggle less, and they were much more aggressive. Since it was a holiday we hadn’t gotten to go to the bank to exchange money and I didn’t have an ATM card to take any out. I didn’t have many cedis left but I was kind of glad because it made me really think about what I was buying and made it easier to walk away when shop owners were handing me random things that I had briefly looked at and asking how much I would pay for it. It was definitely an experience with all of the people trying to get you to come and look at what they had, which was often almost exactly the same as their neighbors. Somehow we made our way through the really chaotic part of the market to the back. We had been told to be careful and not let people lead us far back in the market because it got a little sketchy, but after we got through the front part the back seemed much calmer. We figured if we stayed together and in the main rows we would be fine and we were happy that we did. The people towards the back of the market were much calmer and quieter and weren’t as pushy. The sculptures and artwork also seemed more hand-made or at least less commercially produced as the things in the front of the market. At one shop I played on the floor with a little girl while Becky and Caitlyn looked at all of the beautiful bowls and coasters. Her mom told me that I could take her for free and we all laughed. We enjoyed walking around this part of the market much more, and since we had time to kill we got to talk to some of the shop owners. Walking back to the tro-tro it was interesting to experience all of the noise and chaos of the front part of the market again.

I found it really interesting how different the two markets that we went to were. One being more rural it is fitting that it is more relaxed, but it surprised me how much cheaper it was than the urban market, especially because it would have been so easy for people to say things were more money than they did and we never would have known. It also surprised me how much the Accra market varied in its way of being from one part to the other. While the back part of the market was still loud and people were still a little pushy it was still much more similar in feeling to the rural market that we had gone to on Saturday than it was like the front of the very same market.

Rope Bridges, Castles, and Waves by Sam

On our day off we decided that we wanted to try and make it to both The Cape Coast Slave Castle and Kakum National Park. Both of these places were a couple of hours away from our hotel, but luckily they were in the same general direction. We weren’t sure if we would make it to both but we figured it was worth a try since it was our one day to adventure. Going to both meant it would have to be an early morning, but we were excited and figured we could sleep on the tro-tro. The drive was fairly uneventful, I was surprised that I was able to fall asleep as I was sitting on the folding seat that we had nicknamed “the Busch Gardens Chair” as it reminded us all of being on a rollercoaster. I do remember that we drove through at least 3 police check points which surprised me, but many of them they just waved us through quickly. At one point we stopped for one of our driver’s friends to get in the tro-tro with us so he could give us directions the rest of the way, and we thought we must have been getting close as we were seeing signs for Cape Coast, but when we kept going we realized that we must have been going to the National Park first.

We arrived at Kakum just before a bunch of school groups did, and after getting our passes we walked around in the visitor center reading about the rainforest and the various animals that lived there. We then had a short hike to get to the canopy walkway with our tour guide telling us about the different things that people could do at the park, when the best time to see the animals is (unfortunately the best time was at night), and the history of the conservation project. We climbed up into a big tree house that was the start of the canopy walk and began our adventure atop the trees. The bridges were rope nets with pieces of wood laying on top of ladders to walk across and attached to these tall trees that stuck out through the forest canopy. Around these trees were platforms where you could stop and enjoy the beautiful views. Our whole group made it across the first bridge, but then we split and went separate ways. To the left was a shorter path with less bridges to cross, to the right was the longer path. I went to the right with Jodi, Kate, Caitlyn, Anna, our bus driver and his friend. While I continually got yelled at for purposefully shaking the bridges, I really enjoyed all of the beautiful views that we got to see being up so high above the trees. Unfortunately, we didn’t get to see any wildlife because of the time that we were there, but it was still an amazing experience. After we crossed all of the bridges we met up with the rest of our group that went the other way and made our way back down to the visitor center and gift shops.

Aikens and I on the bridge

Aikens and I on the bridge

Rope bridges!

Rope bridges!

Beautiful view from the canopy walk

Beautiful view from the canopy walk

Proud of these two for facing their fears (and grateful that they didn't throw me over for shaking it)

Proud of these two for facing their fears (and grateful that they didn’t throw me over for shaking it)

Next we started our journey to Cape Coast Castle. The castle was right along the beach so there were beautiful views and a cool breeze coming off the ocean when we got there. Before our tour started we went to the museum to read about the history of Ghana and the Slave Trade. It was an interesting perspective to learn about because it was a part of the story that we are never really told about in public school in the US. Europeans went to Africa to trade for gold, and built the castles for these purposes after buying the land from the African tribes. The castles changed ownership many times finally coming into the hands of the British. What I found interesting about the history was that the slaves that were kept in the dungeons of the castles before being transported to The Americas were actually sold to the Europeans by the chiefs of the various African tribes. In school it always seemed that the Europeans went into Africa and captured people arbitrarily to then sell as slaves, so it was interesting to learn that the people were actually traded to the Europeans to become slaves for other goods. The conditions of the slave dungeons were terrible, pitch black with hundreds of people crammed into a small area with nowhere to go to the bathroom other than where they stood, and the cool breeze from the ocean was not able to be felt. On top of one of the rooms of the dungeons was the church, and there was a whole in the ground near the entrance to the church where people could check in on their slaves as they went in.

After our tour of the Cape Coast Castle, we went to a restaurant nearby and enjoyed an early dinner overlooking the beach. As we watched the waves crash into the ocean, and all of the kids playing, we all laughed when we saw pigs walking around as well. Many of us were eager to stick our feet in the water after we ate, but when we did so we realized that the pigs that we had seen were eating out of a sewer drain that was, of course, leaking onto the beach and right into the water where we had been walking. We tried not to let this bother us too much, laughed about it, took some pictures, and headed back to the tro-tro to make our way home. It was a great day exploring tourist spots in Ghana, seeing more of the country, and learning a lot about the history and culture of the country that we came to do work in.

View of the Castle from the beach

View of the Castle from the beach

Beach from the restaurant.

Beach from the restaurant.



Becky carrying plantain chips

Becky learning how to carry plantain chips on her head!

We learned how to carry things on our heads

Plantain Chips!


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.


Ghana 7IMG_2351

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.