Ghana Health Mission

PREPARING FOR THE TRIP

A. Immunizations

GHM team members are responsible for getting all necessary immunizations for travel to Ghana.  All participants should visit a health care provider or travel clinic at least three months before the trip since some vaccines require several weeks to take effect.  The Centers for Disease Control, as March 2009, recommends the following immunizations for travel to Ghana:
            •Yellow fever.  This is mandatory for entry into Ghana and must be documented on an International travel certificate.
            •Hepatitis A or immune globulin (IG).
            •Hepatitis B, if you might be exposed to blood, have sexual contact with the local population, stay longer than 3-6 months, or be exposed through medical treatment. 
            •Meningococcal meningitis, for travel from December through June. 
            •Typhoid, particularly if you are visiting developing countries in this region.
            •As needed, tetanus-diphtheria, MMR, and a one-time booster dose of polio vaccine for adults.

B.  Medication

The CDC recommends one of three medications for malaria prevention:  mefloquine (Larium), doxycycline, or Malarone
            •Participants also find it helpful to bring a sleep aid such as Ambien
            •Many also bring a supply of ciprofloxacin (Cipro) and Immodium for treatment of traveller’s diarrhea
            •If you have a chronic illness, you should talk with your health care provider to plan for your trip; also, please inform GHM of your medical needs at the time you submit your application.
The CDC website at www.cdc.gov/travel/wafrica.htm has information on immunizations and malaria-prevention medication

C.  Visas

A Visa is required to enter the country.  GHM or your group leader will give you information regarding visa applications.

D.  What to pack

Suggested clothing and supplies:
            •2 scrub suits for clinic (one to wear and one to wash);
            •shoes (comfortable and sole cushions, we work on a concrete floor);
            •at least 2 pairs of socks;
            •name pin;
            •stethoscope, [BP cuffs and oto/ophthalmoscopes, if you have them];
            •personal water bottle.

For leisure time:
            •2 comfortable cool clothing outfits and sandals;
            •cool sleeping attire that you would want to be seen in.

See below for clothing restrictions.  Do not over pack!  It is not necessary to bring a lot of clothes because laundry is done daily and often participants have had clothes made. Sometimes team members have shared the purchase and use of some supplies.
We bring as much medication and supplies for the clinic as we can, using our check-in baggage allotment for these supplies. To avoid paying charges for excess baggage, we ask GHM travelers to keep personal luggage to a minimum.

WHILE YOU ARE IN GHANA

A.  Keeping in touch with home

The church does not currently have telephone service.  In an emergency, our host is Reverend Robert Andoh and his cell phone number is: 011-233-244 941 37. However, your group leader may have a Ghanaian phone for family contact, etc. and will provide you with that phone number.
GHM team members can place international calls by purchasing phone cards in Sekondi but the public phone booths have become scarce since the advent of cellular phone service in Ghana. Don’t purchase phone cards from home, often they can’t be used and they are more expensive than buying one in Ghana. Please be aware and advise family that there are times when telephone service is disrupted and a phone call will not be possible, it is not as predictable as at home. There are internet cafes in Takoradi, the neighboring city, and there is usually a group going into Takoradi most afternoons, so it is possible to have access to the internet. However, the speed may not be what you are accustomed to.

B. Money

The currency of Ghana, the cedi, was exchanged at the rate of 9.5 cedis to the dollar in 2008. However, the currency was altered in 2007 so many of the people in Ghana still speak of 9500 cedis to the dollar. It is best when bargaining to have a community health worker with you because it is very easy to get confused in the”heat” of shopping.  Please keep the following points in mind:
            •Do not bring travelers' checks.  They are impossible to exchange!  Don't believe the advertisement…don't bring them.
            •Do not rely exclusively on credit cards.  They are not widely accepted.  They may be accepted in tourist businesses in Accra but only a few shops, restaurants and hotels in Takoradi honor credit cards. But even in businesses where they are accepted, credit card transactions can take a very, very long time to complete.  There is only one ATM machine in Takoradi, and it will dispense a maximum of $30 worth of cedis.   
            •Do bring cash, in denominations of $50 and $100 bills.  You will need cash if you wish to purchase items in the markets in Sekondi-Takoradi and Accra. While in Sekondi, Rev. Andoh makes arrangements to exchange money almost every other day. The large denominations of $50 and $100 bring the best exchange rate.  Cash transactions are simple and efficient and, unlike credit cards, can be completed quickly.

C. What GHM team members spend money on

The fees paid to GHM cover all your living expenses at the church compound in Sekondi, you are responsible for hotel rooms and meals at other locations.  There are opportunities to purchase gifts as well.  Local craftspeople produce wooden sculptures and practical wooden items such as bowls, woven baskets, batik clothes, and items of clothing.  In fact, a small market is usually set up in the compound by the local craft persons during the time of our visit. Still be prepared to bargain. Look at a desired item during the afternoon trips before buying in the compound. However, if there is something that you want but don’t see, Leonard, the leader of the church compound market, will find it for you. Community women are available to make clothes out of fabric purchased locally.  The markets in Sekondi, Takoradi, and especially Accra offer many, many items to purchase.  All of these opportunities require payment in cash only. 
One evening during the first week the team has dinner at a local restaurant, and toward the end of our stay the team goes to a local resort.  In Accra, hotels and restaurants routinely take credit cards.  On these occasions, it may be possible to pay with a credit card, but please remember that credit card transactions take a very, very long time to complete; using cedis is the most efficient way to pay. 
Some examples of items you may purchase: fabric; wooden bowls, wood sculptures, baskets, havng a dress made, hotel rooms (shared occupancy) $50-75 per night per person, hotel dinner ($10), 22 oz beer ($!), bottle of water ($0.50), and taxi ride one way into Takoradi, $1.00/ per person.

D.   Living Conditions

The weather in Ghana is hot and very humid year-round, with a mild reprieve during the rainy season.  During the dry season, from October through April, temperatures stay above 90 degrees and water for bathing is often scarce. Electricity is water-powered, so occasional blackouts occur in times of drought. The rainy season, May through September, is slightly cooler, with nighttime temperatures in the 70s. The pace of life in Ghana is much slower than in the West, and simple things can take more time than visitors sometimes think they should.  Among the many lessons that Ghana teaches is patience.
GHM team members live in church housing, which is clean but sprase.  Two large dormitory rooms, each holding up to a dozen people, have only one bathroom apiece.  The only personal space is the individual's bed.  There is no privacy. Some people find this lack of privacy difficult; some have found that books or music can be helpful in providing some respite from day's activities and provide a “sense of privacy.”
The community is welcoming and appreciative of the hard work displayed by GHM team members, and they are eager to take good care of everyone. Indeed, they provide exceptional care. Laundry, dormitory rooms and bathrooms are washed daily by women in the church community. 

E. Meals and Snacks

Mrs. Augustina Andoh operates a small restaurant on the church premises where she serves the GHM team three meals a day. The food choices are limited but plentiful. Mrs. Andoh and her staff will accommodate all reasonable dietary restrictions if given sufficient notice. 
Many participants bring non-perishable food items that are important to their daily diets either for health reasons, personal preference, or as snacks such as soy items, peanut butter, raisins or nuts. 
Each dormitory has a refrigerator.  Please use it for all food stuffs. Ghana has tiny ants that get into everything if it is not sealed or refrigerated.
Food is expensive by Ghanaian standards, so that we ask that if you are not sure whether you will like a particular dish that you take a small taste first and then return to the buffet table for as much as you want.
 A typical day's menu is: 
            •Breakfast:  tea, pineapple, toast, eggs or cereal (If you do not want an egg every morning, please let your group leader know so that she may give an egg count to Mrs. Andoh in the mornings. Coffee is not a Ghanaian staple, Mrs. Andoh provides single serving packets of Nescafe (which is pretty much the only coffee in Ghana), so if you are a “coffee person”, bring your own instant. You may find it comforting to have herbal teas from home, etc.
            •Dinner: (the main meal of the day): ground nut stew, rice, vegetable in season,
                fruit
            •Supper: spaghetti, salad, ice cream
                Sodas are provided with each meal. If you want a cold drink at other times. We use the honor system to pay for them.
We do recommend that each person bring powered Gatorade with them and personal water bottles. When you are working in a hot clinic replacing just water is not enough; you will need electrolyte replacement also.
Please let GHM know about dietary restrictions before leaving the U.S.

F.  Some reminders about deportment and dress


GHM team members are the guests of the church community and, as good guests, are expected to adhere to the social standards of that community.  The community takes its responsibility for us very seriously; therefore, when you go outside the clinic area it is important to take community members with you.  This is not a reflection on you or your level of maturity, it is an issue of respect. We are their guests and they expect to accompany us everywhere.
Because we are so highly visible to the community at large, team members also become role models, especially to young people. Team members must not drink alcoholic beverages or smoke in the community. They should conduct themselves in a manner that is respectful and mature at all times; this includes language both verbal and nonverbal. This extends to clothing choices.  Here are some guidelines.
For both sexes:
            •Very loose shorts that reach to the knee are acceptable.  Shorter shorts are not acceptable outside the dormitory rooms.  This is true even for those who jog or run; running shorts are not acceptable; team members have used long, loose shorts or lightweight pants for jogging or running.
            •Shirts and shoes must always be worn
            •Avoid tank tops or muscle shirts when outside the dormitory room
            •Scrubs can be used during clinic but should not be worn outside the compound.
For women:
            •Nothing transparent or otherwise revealing
            •Skirts and dresses should be at the knee or below
            •Loose-fitting pants are acceptable but skirts and dresses are clearly preferred (and much cooler) and the traditional attire for local women
            •Bathing suits should be one-piece
            •Non-provocative undies. The washing is hung in the courtyard for all to see.
 
G.  A very, very important note about charity. 

Ghana is a developing country, and Sekondi-Takoradi is a crowded area with much evidence of the economic struggles that Ghanaians face daily.  The housing and living conditions of most of the local population are, by United States standards, substandard.  There is a great need for food, clothing, education, health care, shelter, and other basic necessities of life, and this need can feel overwhelming to a Western visitor. Sometimes, GHM team members will respond to individual requests from local residents for gifts of money. These requests can come while the team is in Ghana or even after returning home if team members have exchanged addresses with community people.
Rev. Andoh has made a strong plea to all GHM team members
to resist the temptation to respond to these requests, no matter
how compelling the individual requests are.
Instead, direct all requests to Rev. Andoh.  With the generous support of past GHM members, he has established funds that provide money for schooling for children and for urgent health care. There is also a separate fund that supports the needs of members of the children's choir of the church. The education and health care funds are available to all in need in the community, regardless of religion or tribal heritage.  Rev. Andoh and his assistants will verify the legitimacy of every request and respond where appropriate. GHM team members can help those in need in Sekondi-Takoradi best by
directing all requests for money made during the visit or after to Rev. Andoh. 
If you wish to leave clothing or shoes, these items are to be given to Mrs. Andoh at the end of the trip and she will dispense them as need-appropriate within the community.
 
H. Clinic Issues

There are a variety of medical problems encountered. Many resemble the problems we see at home such as asthma, upper respiratory infections, urinary tract infections, musculoskeletal problems.  The medical issues in this community are related to nutrition, sanitation, crowding, farming and fishing techniques, sand, sun and heat exposure.  Children often have malnutrition, developmental delays, physical development anomalies, anemia, malaria, skin infections, diarrhea, intestinal parasites, dehydration, upper and lower respiratory infections, asthma, and urinary tract infections.  Adults have symptoms of dehydration (dizziness, headaches, weakness), waist pains (low back pain, arthritis), malaria, typhoid fever, filariasis, intestinal parasites, tuberculosis, skin infections, hypertension, vaginitis, and pelvic inflammatory disease.  You may also see leprosy, guinea worm, and other tropical diseases. 
Regardless of the site, each clinic is administered along the same routine so that providers can see patients efficiently and provide quality care. The number of patients that will be seen is determined by the number of providers available. Patients cannot be admitted to the clinic area unless a designated Community Health Educator has distributed a clinic card indicating that the person can be seen. Thus, the community, not GHM, controls access to clinic health care.
Patients pay a small admission fee, even for Ghanaian standards, that goes into a fund available for urgently needed medical care and administered by Rev. Andoh and the Advisory Board. However, no one is turned away that needs care.
Once admitted, patients are triaged, demographic information, vital signs (including: height, weight and blood pressure) and the three most important presenting complaints are recorded.
Each provider has a separate work space.  In Sekondi, these areas are small stations within a very large room.  There is a small curtained area for examinations that require the patient to disrobe, but the vast majority of patients can be seen at the provider's station.  In other clinic sites, there may be individual rooms some with beds and desks.
Each station or room is maintained with basic supplies for examination) and treatment as well as commonly prescribed medications (e.g., ibuprofen, multivitamins).
 
Each provider and triage personnel is assisted by a Community Health Educator, whose primary job is to provide translation services.  Several have been with GHM for many years and are very experienced in the clinic routine.  
Each clinic has a pharmacy component. Community Health Educators package "routine" medications, such as NSAIDS and vitamins. Some providers, acting as pharmacists, work with Community Health Educators to distribute prescribed medications and medication information for safe, effective self-administration. 
The clinics are staffed with direct care providers (physicians, nurse practitioners, physician assistants, and students as appropriate). Triage, assisting in the pharmacy, and health education are usually performed by undergraduate nursing students. Most clinics have one GHM team member assigned as the onsite leader to ensure that the clinic is running smoothly and to oversee the dispensing of medication.
An average clinic day begins with breakfast at 7:30 AM. Triage begins to admit patients at 8 AM.  Providers remain at the clinic until all patients are seen, usually ending by 1-1:30 PM when the team goes to lunch.  While that may seem like a short day, the intensity of the work makes it a very full and productive time. This schedule also mimics how clinics are run in the area.
Patients often need to return for rechecks. In this case, each patient is given a note indicating name of provider, diagnosis, date of exam, date to return and what the patient is returning for (medication evaluation, dressing change, etc.).  Other times patients need to have referrals made to the hospital for tests, etc. In this case, the provider writes a brief health summary about the patient, their interpretation of what is wrong, and what the patient needs from the hospital or lab. Many providers request feedback from the local provider about what they found and how they treated it. Fees for tests and transport to the lab or x-ray are negotiated by the GHM Advisory Committee member who is in charge in the clinic site for that day.
 
I. Free Time

There is a sufficient amount of free time built into the schedule so that GHM team members can explore the many opportunities Sekondi and Takoradi have to offer.  With the help of community people this free time can be the most memorable part of the trip.
Some of the most rewarding times have been spent sitting and talking with members of the church in the courtyard at the end of their day. Going to the local market is an adventure in itself. Listening to the choir rehearse for the upcoming Sunday service is inspiring. There is not a moment that is not full of potential.
When leaving the church compound, go in small groups (2-4), always with a person from the church community. They know their way around their own city, can provide translation, and can help newcomers understand what they see. The people in the community are anxious for participants to have a meaningful visit and are gracious hosts. They want to learn from us, and they have much to teach. Those who are willing to be open to all the lessons that this experience can offer return home with a new perspective on their professional and personal lives.