Day 4 at Korle-Bu Hospital

After breakfast, we left the hotel to Korle Bu Hospital like the past three days.  Students separated into their groups and started working with patients.  Each group saw approprixately 2-3 clients with different types of communication disorders.  Similar to the past few days, we conducted parent interview, assessed the patients, and made recommendations.  Today was less busy because George informed us that people in Ghana prefer to rest on the weekend including Friday.  Hence, there were less patients today.

Three students were assigned to the audiology clinic, where they performed hearing screenings.  Seven students visited the Reconstructive Plastic Surgery & Burn Center, where they read books to children, who had surgery.  These students visited the 5 months old baby, who had his cleft palate repaired on Wednesday.  It was observed that his grandma was feeding the child in an improper posture.  Subsequently, one student recommended and educated the grandma the proper feeding position (i.e., upright position) and food consistency (i.e., thicker liquid).  It was imperative to discuss the anatomy briefly because milk and water were coming out of the child’s nostrils.  It was reported that the child also has an opening in the secondary palate.  Therefore, the student explained how everything is connected.

After placement, we went to the Dean’s Guest House for lunch.  Our clinicial director, Miriam Baigorri, asked us to reflect on the first day and the last day, share what we learned, and what do we want to improve.  Many students thought about the questions while enjoying their lunch.  One student stated, “I learned a lot because I haven’t had a placement.  It’s so different compared to the clinic at home because we’re assigned to work with the same client throughout the semester.”  Another student replied, “I think my clinical judgment has improved significantly within the four days.”  She elaborated by saying how she exhibited difficulty identifying individuals with a disability initially.  Collectively, all students felt they have improved in making clinical judgments, conducting parent interviews, assessing the patients, and providing appropriate recommendations.  

We returned to the hotel around 3pm to pack for our next destination, Kumasi.  We all got together at 5pm to discuss tomorrow’s schedule and to prepare for the Professional Development Retreat.  Most people went to bed early because we have to wake up at 4:30am.  We are looking forward to our placements in Kumasi!!

-Yuk Lan Peng

Third Day at Korle-Bu

Our day started with extra excitement and alertness, anxious to keep up with the schedule for today without any delay. As excited as we were to see the new patients waiting for us at Korle-Bu Hospital, we also had another big event of the day in the back of our minds; it was the meeting with the Minister of Health of Ghana, Hon. Joseph Yieleh Chireh. We were blessed with the amazing opportunity through one of our colleagues, Christin Chambers, who was able to arrange the meeting with the Minister of Health through her fortuitous acquaintance. So all of us were packed and ready for the hospital earlier than usual to make sure that we had time to see all of the patients by noon, for which was when our meeting was scheduled.

When we arrived at the hospital, we were divided up into four groups with our three supervisors and with one group joining the Audiology clinic to participate in the hearing test procedures. It was evident that the student clinicians have increasingly become more confident and effective in treating a variety of patients at the hospital, even through the pressure added by the cameras and reporters from TV-3 channel that had gotten there early before our meeting with the Minister of Health. One of the most memorable patients today was a 19-year-old male who has stuttered his whole life before coming into the Korle-Bu speech and language therapy clinic for the first time today. He demonstrated with a severe stutter during his initial assessment for speaking and reading. However, with the use of the techniques introduced by the student clinicians, such as the easy onset and Melodic Intonation Therapy, the patient was able to produce sentences and read with perfect fluency. During the interview with TV-3 right after he came out of the therapy room, he commented that he “feel[s] a lot more confident now," and that he was "glad that [he] was here."

Our meeting with Ghana's Minister of Health

With another day of adventures and excitements at the hospital behind us, we moved to the place where the meeting with the Minister of Health was held. Veronica Adjei kindly arranged this meeting for us. First, a warm word of Akwaaba (welcome) was given by the Minister of Health as well as a few other board members of the Ministry of Health that were able to join us in our meeting. Then, Dr. Crowley and a few members of our team spoke briefly about our past few years of experiences in Ghana, some of our current goals and accomplishments, and about some future, long-term goals regarding the speech and language services in Ghana, such as the establishment of the Speech and Language Pathologist training programs in Ghana as well as a possible pilot program for providing speech and language services from the United States to patients in Ghana through the use of Skype. The constructive and positive responses from the Ministry of Health throughout the meeting has unveiled a vast amount of opportunities and potential for further development of independence and sustainability for the speech and language services in Ghana.

Sowah Tetefio, Celestine Sappor, Amy Erickson,
 Pres. Victor Asante, Sheila Zotorvie, Dr. Cate Crowley,
and Dr. Emmanuel Kitcher

However, meeting with the Minister of Health was not the last crucial event of the day. Thanks to another colleague of ours, Amy Erickson, our team had been invited to have a meeting with a member of the Rotary International club in Ghana by the pool-side at a four-star hotel. We were able to discuss with them about the current and following collaborative projects regarding the Audiology department at Korle-Bu Hospital as well as the new SLP training program in Ghana.

With all the exciting events and meetings aside, famished students were happy to end the day by shopping for some groceries of our individual preferences at reasonable prices (unlike the drinks and salads at the four-star hotel...) at the Accra Mall. We will surely have enough food and snacks to sustain us through another adventurous day at the hospital!

-Jinyee Kim

Day Two at Korle Bu!

We arrived eager for our second day at Korle Bu hospital (the 3rd largest hospital in Africa, with around 2,000 beds!) having an idea of what we would experience, with heightened confidence and enthusiasm. Upon entering the hospital, we were greeted by the stroke victim that some of the students had evaluated the previous day. He suffered a stroke 2 years ago, leaving him unable to express his thoughts through speech; however, through assessment, the students found his strengths lie in his comprehension and compensatory communicative abilities, using a variety of gestures, pointing, and intonation of vocalizations. Although he was able to get some wants and needs met, he lacked a more productive communication system that would allow him to communicate socially. After our strenuous day of therapy at the hospital, the students, motivated by this man's story, strengths, and deficits, stayed up late constructing a personalized booklet for the purpose of alternative and augmentative communication (AAC). They used many of his interests, such as football (that's soccer for those Americans out there reading this), favorite foods such as fufu (a traditional Ghanaian dish, not a bunny rabbit), and family members, to create various pages for his book.

Although we felt accomplished and excited to share our patient's new book with him, we were apprehensive about whether or not his family would see the value of it as a significant means of communication since we learned in our classes here in Ghana that the Ghanaian culture holds eloquent speech in high esteem. Our fears were put to rest immediately upon witnessing the reactions of the patient and his brother to the page depicting football pictures (i.e. foul, team names, good game/bad game, etc.). Those smiles were truly worth the trip to Africa. Not only was the patient excited to explore these new avenues of communication, but his family began to recognize him as a viable communication partner once again. We recognized even moreso that this would truly be a sustainable system when we suggested that the family add items to the book that they thought would be useful, and his brother without hesitation named several more favorite foods and mentioned that he knew someone who could draw them on the extra pages of the book. One student guided the patient through using this new communicative system and how it can progress over time, and worked with the family to model its use. Another student dispelled the previous notions that the family held that his symtpoms were caused by a disease, by explaining the incident that occured in his brain, and what he can expect in his recovery.

Imagine that this was only our first case of the day! Next we split into three groups with our supervisors to see the remaining patients seeking our help. One group ventured off for a tour of the facility and to meet with other rehab specialists, such as physical therapists and audiologists. In an unexpected yet exciting turn of events, a few of the students were offered the opportunity to view a cleft palate surgery, and quickly scrubbed in. While the students jumped at the chance to see this live surgery after learning about it in our cleft palate class back at TC, our documentary film maker, Skye, agreed in the spirit of filmmaking while the color drained from his face.

Meeting with the Chief Executive of Korle Bu Hospital

When given the option to rest at the hotel after all our hard work or to meet with the Chief of the hospital, we all mustered up the energy and decided, "when in Ghana...!". At the meeting, we applied all the rules we had learned about Ghanaian etiquette. Dr. Crowley scared us enough in our first meeting for us to remember NOT to cross our legs! Fortunately we remembered this tip, among others, such as the way a group is always greeted by counterclockwise handshakes with the right hand. Stay tuned tomorrow for more details on this and what's to come... hint: you may want to ask your cable providers for access to Ghana's TV-3 to see the TC students in action with a surprise guest!

-Alana Krieger

Our First Day of Clinical Work in Ghana!

Ready for our first patient!

The day we have all been waiting for has finally come.  After breakfast at the hotel we briefly discussed our plan for the day before heading on our bus.  We drove only a few minutes to Korle Bu Hospital, where we met Albert Osei Bagyina, who for decades was one of the very few practicing speech language therapist in Ghana. (nb: in the past several years a new Ghanaian SLT qualified in England and is practicing in Ghana, a U.S.-Trained SLP moved to Ghana approximately 6 months ago, and 3 Ghanaians who were sent to England to qualify by the University of Ghana have recently returned to Ghana and are waiting to begin work.) Albert was very welcoming and informative, explaining his role at the hospital and his plan for us while we are here!

We then began to see patients who have come to the hospital to see our therapist team.  Although we broke our big group into 3 smaller groups for the majority of the time, we began by evaluating 2 patients together.  The first, a toddler who arrived with his mother said few words, such as 'yeah' and 'bye' and pointed to objects he wanted without sounds, was assessed as having a language delay.  After discussing his development with members of our team, the mother was given recommendations to expand his speech by modeling 'bi' for 'biscuit' and waiting for him to respond.  The more he does this, as well as other techniques, the more he will connect saying a certain sound, and eventually a word, for a specific item.

The second, a school age boy who has had hearing aids for 2 weeks had problems articulating /s/ /k/ /r/ /z/ and /t/.  The team worked with him by isolating the trouble sound in a word, such as 'seal', by running his finger along his arm while saying the /s/ sound for tactile stimulation.  As the parents were very attuned to his speech abilities, they were able to give detailed information about his school life as well as progress since he has had his hearing aids.

While in 3 smaller groups, there were a variety of cases we were able to assess and evaluate, including individuals with Cerebral Palsy, Aphasia due to a Stroke, Expressive and Receptive language delay as well as many other communication disorders.  This gave us all the unique experience of working with different patients of different ages in the course of just a few hours.  We all came away from our first day of clinical work in Ghana with a sense of accomplishment that we were able to help parents and family members communicate better to their loved one, as well as more ways their loved ones can communicate with them!

After a busy morning at the hospital, our team, along with Albert, enjoyed a wonderful lunch while outdoors, learning more from Albert as well as discussing our plans for tomorrow.

Proverbial Coffin at Artists Alliance

The rest of the day was enjoyed by all, going to the W.E.B. duBois Memorial for Pan African Culture, visiting where the African American leader lived and was buried with his wife.  We then drove to Umanye House where there were many beautiful paintings, beadwork, items of clothing and carvings for sale by a local artist alliance. The most intriguing pieces of art, however, were the coffins, which are called Proverbial Coffins.  These amazing coffins are made into shapes very specific to the deceased lifestyle, or a symbol of their clan or tribe.  Coffins on display at the alliance included a Coke bottle, Nike sneaker and tiger!  It would not be unusual in Ghana for someone to be buried in a Nike sneaker coffin if they were a well known basketball player.  Aside from being functional, the amount craftsmanship and artistry displayed through these coffins is truly unparalleled.

We ended the day by going to a local market where fabric, shoes and food (as well as many other items) were sold before heading back to our hotel for dinner and discussion about the day. Tomorrow is sure to bring more rewarding experiences!

- Shemaiah Villani

Our Cultural Competence Continues...

Sunday, January 2nd

     After waking up ocean side in the huts of Coconut Grove Beach Resort, we enjoyed breakfast to the sounds of the waves of the Atlantic crashing behind us. After breakfast, we gathered our things and packed ourselves back on the bus. George started the ride by exercising our brains with a couple of riddles. Give them a try...''I am greater than God, I am more evil than the devil, and if you eat me you will die.'' and ''Every room has two and every corner has one. What am I?''

     As the answers were revealed, we arrived to St. George's Castle in the town of Elmina, the oldest and largest slave castle in Africa. Similar to yesterday's experience at the Cape Coast Castle, our tour guide, Kofi, led us through the male and female dungeons and the Door of No Return. Built in 1482 by the Portuguese, the castle was captured by the Dutch in 1637, purchased by the British in 1872, and finally taken over by the Ghanaians in 1957. The beautiful backdrop of the ocean was again overshadowed by the horrifying statistics of the castle's history: Throughout the 400 years of slave trade at St. George's, 3 million people were captured, of which two-thirds of them died. Despite all of the appalling information Kofi revealed, we ended our tour with a very appreciative "maydasay'' (thank you).

    Next, we traveled a short distance to a small fishing village in Elmina and were greeted by a local fisherman named Lionus. The overwhelming smell of fish and smoke accompanied the sight of women and children hard at work in their daily routine. While several children loaded and carried long, wooden pallets of fish to be cooked and smoked, women packed the smoked fish for delivery to the market. As Lionus led us though the village describing the process of catching and preparing fish, we were greeted by many young children of the village. We shared our names and high fives with the children and a few students learned the cultural art of balancing a baby on their back with a wrap. The hard, skilled workers fish everyday except Tuesday, which is the day of rest for the workers (and the fish)!!!

     The three and a half hour trip back to Accra left time for George to further engulf our minds with the culture and history of Ghana. He discussed various stages in a Ghanaian's life focusing on the rituals surrounding birth, marriage, and death. Guess which of the following is true: 1) You can go to a stranger's wedding whenever you want (bring a bag of rice of course). 2) It takes anywhere from one month to one year for a Ghanaian to be buried after he/she dies. 3) In the past, the birth of twins was seen as a curse. You guessed it! They are all true! Can you believe it?

     We survived the "bottle neck" (traffic jam of Ghana) with the help of a local woman selling plantain chips in the street. She briefly joined us on the traveling bus, where she sold more plantain chips than she had sold all day! This served as an appealing appetizer before preparing for dinner at Asanka, the local chop bar. The daring ones amongst us ate the traditional Ghanaian dishes of Banku and Fufu with their right hand, as it is disrespectful to eat with the left. As dinner winded down, we gathered in a circle to learn the modern Ghanaian dance, Azonto. Although a few of us had difficulty coordinating our foot tapping with simultaneous hand and hip movements, we all shared laughter and singing until we closed the restaurant.

     This weekend's experiences have provided us with significant insight to Ghanaian culture, which is crucial for our upcoming clinical work. Our  increased knowledge and understanding of the culture will allow us to be more sensitive and competent clinicians when working with our first patients tomorrow. As we anxiously and eagerly await our first day of clinical work, we drift off to sleep with the rhythm of African music in our minds...

-Brenna Zielinski


   

Accra to Cape Coast...an adventure through Southern Ghana

"Afehyia Pa" -- HAPPY NEW YEAR!

Our first day of 2012 began with an early breakfast prepared by the staff at Fort Royale Hotel in Accra. Many of us were comforted by the familiar breakfast staples - cereal, toast, eggs and sausage. However, the subtle differences were charming. For one thing, Ghanaians eat their cereal with warm milk! Although confusing at first, it turns out that this gives cereal an oatmeal-like consistency, making it a much heartier meal. Little did we know, we needed the fuel for the adventures George, our tour guide, had planned for us.

We started our journey westward by heading towards the town of Cape Coast. Since this was going to be a long trip, George took the opportunity to further educate us about Ghana.

Ghana is the size of the U.S. state of Oregon and has a population of 24 millions. It is made up of over 35 tribes that belong to six different ethnic groups. The people of Ghana speak more than 35 different languages (Twi being the most commonly used language). English is also spoken by most Ghanaians. Accra, the capital of Ghana, houses many monuments like the Black Star Square, which was erected to mark Ghanaian independence.

As George took questions from some members of the group, others nodded off for the rest of the ride to Kakum National Park, which was about two hours away from our hotel. When we arrived, we found out that the reason why this park was famous was due to the seven canopy bridges that were situated in the middle of it. One by one, we put our acrophobia to the side, and took the strenuous hike to reach the first bridge. While some of us took the first steps onto the unsteady plank with nerves of steel, others found solace in the reassuring words of friends to inch onto the bridge.
It was over before we knew it! We all walked across the seven canopy bridges--some of us praying for our lives, while others were just walking as if they were taking their daily stroll to campus.
A sense of camaraderie was developing among the group as witnessed by many members stepping up to cheer on those who struggled with taking on this adventure. Collaboration, like that which was seen today, is essential to the success of any team that is working towards a common goal.

After we shook off the excitement of the canopy walk, we took a 20-minute ride to Hans Cottage Hotel for the next part of our adventure. If heights didn't scare you, then crocodiles will! We had arrived at a restaurant that let its patrons take pictures with crocodiles. Step right up. Get your picture taken with one of the most feared creatures that has deadly reflexes. All that was standing between us and this hungry beast was a strong willed Ghanaian business woman with chicken fat on a stick to lure him out of the water. Decisions, decisions. Finally, the brave ones amongst us went over to this young male crocodile and touched his back. The others watched carefully and displayed their own superb reflexes when the young croc made any slight movements.
With a few Ghanaian ice-cream bars in hand, the group eagerly boarded the bus after their first contact with African wildlife in Ghana.

On the way to our next destination, George and his nephew, Nicholas, taught us a Ghanaian church song that is well known throughout the country. Religion is at the core of Ghanaian society. From the edifices of buildings to common conversation topics among the natives, the influence of Christianity is evident everywhere in Ghana. As such, knowledge regarding hymns and other songs can be an essential tool to build rapport with the patients we see in Ghana. George used many strategies to help us learn this song. With frequent modeling, we finally got it! Soon, we will debut it with our patients and see what they think. Wish us luck!

Our final destination lied in the town of Cape Coast, where we toured the Cape Coast Castle. This castle was originally erected in the 1600s by Swedish traders but was later used by the English for the slave trade. With the peaceful sounds of the Atlantic ocean waves in the background, it was difficult to hear about the injustice carried on behind the white walls of this castle. With each succeeding dungeon, the stories brought greater sorrow in the hearts of all that heard them. Our castle tour guide, Sebastian, maintained a calm composure even as he saw the grimaces on our faces.

As he was concluding the tour, Sebastian brought to the Door of No Return. This was the exit that the slaves were forced out of, not towards freedom, but to see large vessels floating by the shoreline. These ships would take them away from the land and the people they loved to North America or Europe, where they would work without rest for the remainder of their lives. We all walked through this door and were amazed to see a vibrant fishing village on the other side, full of joy and cheer. While we adjusted to the sudden change in aura, Sebastian directed our attention to the other side of the door, which was marked as the Door of Return. He explained to us that while the events that took place at the castle where inhumane and troubling, it no longer limited the rights of Africans who left through that door. Their descendants were welcome and encouraged to come to Africa and trace their roots. This gave some members of the group great perspective--from every ending, there is a new beginning. With these thoughts, we bid farewell to Sebastian and went to Coconut Grove Hotel to recharge and have our first class in Ghana.

Posted by: Marilyn Sam

Akwaaba: Greetings from Ghana!

 After months of anticipation, we embarked on our journey to Ghana on December 30th at 9:50 pm from  JFK airport. Before taking off the pilot informed us that we were traveling with Professor John Evans Atta Mills--the current president of Ghana. We all had walked right past this important political figure and did not even notice! This set a positive tone for our trip.
 

We arrived at Kotoka International Airport in Accra, Ghana at approximately 12:55pm on December 31st. Although our flight was 10 hours we seemed to have the most difficulty adjusting to the five hour time difference.  It was here that we met our tour guide George. George greeted us with a warm and heartfelt Akwaaba which means "welcome" or "hello" in Twi--one of 35 languages spoken in Ghana. He also provided us with a small taste of the Ghanian culture and history as we traveled to our hotel in Accra. According to George, the people from Accra are predominantly from the Ga tribe and are known to be especially animated in the facial expressions, gestures, and tone of voice. Although these behaviors may appear rude or offensive to some, George encouraged us to perceive such emphatic behaviors as passionate friendliness rather than aggressiveness.

Traveling through the city gave us the opportunity to observe the Ghanian society from our own point of view. The presence of numerous billboard advertisements, small businesses, and traffic provided clear indications that this society was very modernized. Despite this modernization however, it was also clear that the Ghanians simultaneously retained a strong sense of pride in their culture and customs. The Ghanian flag waved in numerous parts of the city and was depicted in many murals and storefronts. Women were observed carrying heavy loads on their heads, and many Ghanians were seen wearing traditional outfits. Monuments symbolizing Ghanaian independence also held a pervasive presence in the city. While driving through Nkrumah Circle for example, George pointed out the statue of Kwame Nkrumah, one of six  leaders who played a major role in helping Ghana achieve its independence. All six leaders are depicted on the Ghanian currency. Kwame Nkrumah was also a Pan Africanist (i.e. an activist seeking the autonomy and independence of African countries) and he was elected as the first president of Ghana after its independence.

At the Forte Royale hotel we continued to witnessed the Ghanian culture in a social context.  Juliet the general manager of the hotel greeted each of individually in a counterclockwise direction. This ensured that she greeted each of us with her right hand and ensured that the palm of hand rather than the back of her hand lead each handshake. In the Ghanian culture it is considered proper etiquette to each individual in a group setting and it is considered an insult to lead a handshake with the back of your hand.

After a hearty dinner we spent the remainder of our evening visiting three locations. George called the first location "The Spot" which was similar to that of a nightclub. As we danced to Ghanian music we were briefly entertained by street performers whose acrobatic dance moves were of Cirque-de-Soliel caliber. It was amazing watching the youngest performer of the group (who was at most 7 years of age), use one leg to balance on top of another individual's head, with the other leg extended behind his head. We subsequently visited two church services. The streets bustling with many people headed to church to bring in the New Year. This highlighted that religion also plays a major role in the Ghanian culture. The first service was held in what George described as the "national gathering" by a mega-church known as the International Central Gospel Church (ICGC). The national gathering was actually a stadium that could hold up to 45,000 people and appeared to be filled to capacity. We concluded the evening at George's own church where we witnessed a profound and emotional prayer for the New Year. Although much smaller than the church previously described (there were at most 45 people in attendance), the emphatic female pastor of the church lead the congregation in an extended period of worship, prayer, and praise that seemed to intensify as the clock slowly approached midnight. It seemed as though a spiritual rebirth was taking place to usher in the new year. At midnight, we all wished each other a Happy New Year and thought of family and friends at home who were five hours away from celebrating theirs.
 


According to George to be considered Ghanian it is not enough to say that you were born in Ghana. At birth you are given a name that literally traces you to where and when you were born, and who your family is, and the order of your birth among your siblings (i.e. whether you are the first, second,). In essence your name is your address. I found this to be the most profound statement of the day as it brought theme of Ghanian pride full circle.

In the words of the Ghanian people we would like say Afehiya Pa, which is Twi for HAPPPY NEWWW YEAR!!!!


~Valerie Bazile~