Goodbye Africa, for now...

I absolutely will miss Africa and the people I met along the way.

The journey was somewhat of an emotional rollercoaster full of laughter, tears, frustration, anxiety, and pure satisfaction. From my first few nights in Ghana when I had a huge cultural shock and wondered how I would get through the next 9 weeks, to my excitement of traveling to another country in Africa, to the healthcare product demonstrations that I gave to thrilled and extremely thankful obstetricians and midwives, to some lonely nights in my hotel room with weak Internet and limited TV, to the huge smiles and waves from the little children in the villages that were so excited to see an obruni (Ghana)/ mzungu (Uganda) – both mean white person, to the beauty and awe of the Ugandan and Ghanaian countrysides and their wildlife … I experienced a lot!

I am so thankful and blessed to have been given this opportunity. This experience has impacted my life forever.

I think this journey has been much like a marathon (I’m a marathon runner back in the states). There is a lot of preparation and excitement leading up to the big endeavor, spending months thinking about the best course of action. After the marathon/journey starts, there is an initial shock of, “Wow, I’m really doing this!” After the miles/weeks go on, you start to fall into a rhythm. You enjoy some miles, and others are pure mind over matter to get through. As you finish the last mile, though, you start to look back on the full race and feel so proud of your accomplishment, through the ups and downs. When looking back, you think, “Of course I would do that again!”

At times, this marathon was tough for me with my husband thousands of miles and many time zone hours away. However, I’m a better, stronger person because of this experience and I’m so grateful for the opportunity to (hopefully) have made an impact in the lives of African mothers.

See you all back in Ann Arbor very soon!!

Wedding Traditions in Uganda

I guess I missed the boat on not getting married in Uganda…

Today at lunch, Edward, the program officer at the PATH Uganda office, explained the marriage/wedding system here. Men have to pay the woman's family to marry her (a dowry of sorts). There is an elaborate negotiation and "market research" process that takes place to determine how much she is worth. Edward apparently paid 5 cows and 10 goats for his wife plus small gifts for all of the bride's aunts and uncles! This is the "customary wedding". Once the payment is accepted by the family, the two are technically married.

They also have "white weddings" after the customary wedding that are just like American weddings with dinner, dancing and drinking. But, instead of the bride and groom and their families paying for the wedding, the bride and groom bring together all of their friends and family into what they call a "planning committee". The couple receives donations from all of these people to pay for the wedding! Why couldn't I do that for my wedding back in the states??

White Water Rafting on the Nile

Today was one of the most terrifying, exhilarating, exhausting days of my life! I went white water rafting on the Nile. I feel like that short sentence by itself could be the end of this post. It just sounds so surreal, but I’d like to provide a play-by-play of the day and my heart rate roller coaster!

My morning actually started out with a knock on the door, waking me from my way too short sleep. I instantly realized I had slept through my alarm! The man at the door was the bellman that had arranged a taxi for me and was wondering where I was. I had less than 5 minutes to get ready and get to the cab in order to get to the hotel where the shuttle to Jinja was picking me up! Heart rate: 130+

The taxi took me to Humura Hotel where I met up with David Yeh (another WDI intern working in Kampala the next couple weeks) and we were picked up by the Nalubale shuttle (travel company for the rafting) to take us to Jinja. On the shuttle we were joined by a group of people, mostly from Seattle, that David met a week or so ago and headed out for the 2 hour drive to Jinja. I slept most of the drive up. Heart rate: 80

When we arrived, the Nalubale staff had breakfast waiting: coffee, tea, chippati and egg, and bananas. We quickly ate, changed, and lubed up with sunscreen before heading out. The drive to the source of the Nile took about 30 minutes. When we arrived, the view already was just amazing! We got in our boats and went through about 30 minutes of safety briefings/lessons on what commands the guide would use for rowing forward and backward and getting down in the raft to hold on. We also practiced flipping the raft, getting stuck under, and swimming out from under. The only thing I could think: Are we really going to flip over?? Heart rate: 110+

So we are off…we hit the first rapid and although I was nervous and water crashed into the raft, everyone stayed on. OK, this isn’t going to be so bad. Heart rate: steady around 110

Boy was I wrong. After some rowing on calm water, we hit rapid number 2, affectionately called ‘Chop Suey’. Well that’s exactly what we were! After a couple bobbles, an enormous wave (probably a 5 foot wall of water), flowing backward, came roaring at us and that’s the last thing I recall until I realize I am under water. The water had a nasty yellow tint and I couldn’t tell if I was going up, down, or just spinning in circles. For several seconds I panicked and just flailed under water, with no success. Thankfully, my left brain kicked in and remembered that the guide said to “just trust the lifejacket”, so I went completely still and just held onto my jacket and prayed for what seemed like an eternity! I finally started to see some light and then I was at the surface. I think I was underwater for a good 7-10 seconds, so I must have flown from the raft to get so deep. (We ordered the video from the trip, so we’ll see what actually happened from the footage!) Heart rate: 175+

After being rescued by one of the safety crewmen on a kayak, I was back in the boat. After some initial reluctance that the rest of the trip was going to include life threatening moments, I was back to laughing with the group and ready to take on the next rapids. In between the rapids there was about 30 minutes of rowing through very calm water. It was actually quite taxing on my arms, but the view of the water and trees along the side was just breath taking. We saw monkeys in the trees, tons of crazy looking birds, and a massive swarm of bats. Heart rate: 80

We went through 4 rapids in the morning, had a lunch of ham roll-ups, pasta salad, pineapple and carrot cake (which was an amazing break from local African food), and continued with 4 more rapids after lunch.

In the afternoon, we managed to only flip the boat once on the rapids called ‘Hair of a Dog’. Yes, they name them all with wacky names! On the second flip, I was much more prepared. I kept my eyes open this time, so when I hit the water (not submerging as far) I knew where I was and how I got there! Everyone on our boat again was in the water, but since we flipped on the first big wave this time (and there were 2 more after the first one), we all floated/bobbed/swam/drank a ton of Nile water through the second 2 and scattered in different directions. Thankfully, the rescue crew was there again to bring us back to the boat, but this time it probably took about 15 minutes to get us all back together!

Overall, the day was amazing. I was asleep in the car on the way back to Kampala before we even left the parking lot! My heart rate is finally back to a normal resting rate, but I still feel like I’m swaying in the water. I would absolutely do it again and I definitely plan to try out some rapids back in the states!

Elmina and Cape Coast Castles

Last weekend I had the opportunity to go to Cape Coast in the Central Region of Ghana and see two historic castles, Elmina and Cape Coast Castles, there.

The oldest castle, Elmina Castle, was built in the mid 1400s by the Portuguese. This fortification, which served as a trading post, is considered to be the first European building in sub-Saharan Africa. The Portuguese were so successful in trading goods, such as gold and timber (two of Ghana’s core exports to this day), that other European countries were enticed to also build trading posts along the “Gold Coast” of Ghana as well.

The other castle we visited, Cape Coast Castle, was originally built in 1653 by the Swedish to trade gold and timber (two of Ghana’s core exports to this day). About a decade later, the English conquered the fortification.

Both of these castles were later used as hubs for slave trading during the 17^th and 18^th centuries. Although different European countries controlled each, the dungeons, in which the Africans were held, are very similar. The dungeons are underground stone holding cells where up to 1,000 men and women were held. There were separate cells for men and women, but identical in structure. The rooms had one, maybe two, very small windows at the top that served as the only light and fresh air. I was in a group of about 30 people going on a tour of the castle and I felt claustrophobic and hot – I can’t even imagine 1,000 people in there. They must have been shoulder to shoulder!

The Africans were kept in these dungeons for up to 2 weeks with one to two meals a day (just to keep them alive). They were never permitted to leave the dungeon, so they were forced to go to the bathroom on the floor where they sat and slept. The waste built up so much that it turned to about 2 feet of hard “stone” on the floor of the dungeons.

When the ships arrived to collect the Africans and take them to the Americas to be sold as slaves, they would be filed out individually and evaluated to determine if they were healthy enough for the journey. The weak or sick ones were placed in a separate cell and not permitted to board the ship. They were left there to die.

 

Seeing these castles was extremely eye opening and emotional. There were many flower arrangements and other sentiments left in the cells, as descendants of these Africans come back to remember their ancestors. I am glad they keep these castles open and available for people to see so that we can remember the past and those that suffered.

Akwaaba!

Akwaaba means “Welcome” in Twi (one of the local languages in Ghana), and that’s been the theme of my first week here! I couldn’t feel more welcomed and supported here. From the hotel driver that picked me up at the airport last Sunday night, to the manager of my hotel, to my PATH Ghana team, to the new Ghanaian friends I have met so far – everyone just seems so happy and excited that I’m here, and that has really helped with the transition to a new culture and a new country!

I definitely hit the ground running! After two weeks in Seattle (to meet my US-based PATH team and other key stakeholders), I felt very equipped with the information and support I needed to get started right away when I got to Accra. 


This summer I will be developing a supply chain strategy for a medical device that treats women with uncontrollable postpartum hemorrhage, by controlling the bleeding, reversing the shock, and stabilizing the patient for safe transport to a comprehensive obstetric care facility. I will be interviewing stakeholders in the government, medical field, and private logistics network to understand not only the Ghanaian distribution landscape, but more broadly, the West, East, and Central African network. The device's benefits have been limited by its high cost of distribution and large minimum order quantity, so I hope my work will alleviate this barrier and enable broader distribution of the device in order to save more mothers' lives.


I have already met with many government officials (i.e. Ministry of Health, Central Medical Store, Food and Drug Board, Customs Agency) and ob/gyn physicians and midwives to understand the local distribution network, regulations, and informal policies for the introduction of a new medical device in Ghana. The openness and willingness to spend over an hour with me explaining the system has been astounding! I just can’t imagine this same level of availability and immediate trust back in the states!

Boiled peanuts

African Jazz Concert

Although I’ve only been here a week, I’ve taken the opportunity to see a lot of Accra already. I met a few ladies at my hotel, so I tagged along with them to Labadi Beach and to an African Jazz concert this past weekend. I’ve also tried a lot of local dishes and treats, and my favorites so far are the locally grown, boiled peanuts and fried plantains. There's a lot more places to visit and food to try over the next couple months!

                                           

                                                 Labadi Beach