Kristin spent a Friday afternoon sitting in her studio, interviewing Charlie about her summer working in a hospital in Ghana, West Africa.

K:What made you interested in going to Ghana?

C:I was born. Ever since forever I have been drawn to W. Africa. I have always said I would go to the Ivory Coast or Ghana- no idea why. Suddenly it was my senior year of college, and I realized it was time to make a plan to go abroad! I found a program where I could volunteer for a medical internship in a hospital in Ghana to finish up my degree in medical anthropology. So I raised $8000, got a scholarship, and then off I went.

What is medical anthropology exactly?

Anthropology has 4 sub fields: biological, linguistic, cultural and archaeological. I have always had an interest in biological anthropology-which is basically human evolution. In my senior year, cultural anthropology blew my world open too-all the theories on past present and future, observing other cultures, how it all fits together- it was so inspiring!! I felt torn between biological and cultural, and unsure of how to proceed. This is when I became interested in applied medical as it is the perfect synthesis of the two: medicine and disease concepts, nutrition, health care techniques, and how it all engages with religion, gender roles and politics, and so on.

Economics too.

Yeah, that too, everything is so interrelated. I want to uncover the truths about how things work together.

Make a difference in their lives...

Not just in their lives but on the level of their health. You know, what are the boundaries you are dealing with?? The understanding? Sickness, health, taboo versus protocol etc…. there are lots of things to look out for to understand how to help someone. You have to be on your toes and know your shit about who are you dealing with in a medical setting…. How to be human and give effective care that will work for them.

Did you feel like being a white American woman ever got in your way?

No, it all worked to my advantage, which was a shock to me.

Do you think this sense of privileged status comes historically from missionary activity or from a sense that the west has turned its back on Africa, so anyone that still cares is highly appreciated?

Definitely the latter, the west has largely turned its back on Africa so those who do care are fully embraced. The privilege is that I am American, working, volunteering. People would just give me things if they found out I was volunteering in the hospital, like food, crafts, clothes, money. But there are always ulterior reasons; people also wanted to befriend me so that I could vouch for them on visa applications to the USA. Could I bring them home or vouch for them, please? They would ask. A kid would want to be seen holding my hand on the street even, it makes that kid’s year, to feel that love and also for the status within the community.

When they wanted you to do things you weren’t comfortable with, how did you deal?

They are so nice, jovial, accommodating. They would be curious, always giggling at anything I brought to the table that was new, they would laugh. One day I attended a caesarean section; the power went out during it. There was nothing happening, no electricity so no equipment was working, meanwhile, the woman was losing a lot of blood, baby in danger, mother not breathing, respirator not working, power still out… minutes go by... I got very uncomfortable, all the blood on the floor, and people shouting at each other, so I left the room. The next day everyone laughed at me, and called me a coward in a lighthearted way. Even this was so intense for me and not for them. They laughed about everything!

I would have been uncomfortable too. I can only imagine what they are used to dealing with that they could be so lighthearted about that. Did the woman survive?

She survived, I don’t know about the baby.A lot of women come to the hospital from the bush to have a baby. If it is not healthy or has any sort of difficulty or birth defect, they very well may kill the child. Otherwise it is just another mouth to feed, not help, but a burden. A baby may stay in the hospital for a week but sometimes if it is still sick or needs antibiotics when it leaves, it will die. It is just too expensive.

I can’t imagine, really, all children with defects or illness? That is potentially a lot of infanticide.

I saw no children with birth defects while I was there, I don’t know what that tells you. There are no records of those babies most likely. They do not record birth or death certificates for everyone who is born or dies, so there is no way to know. There is no Big Brother, so to speak.

Their medical system is stuck in the fifties. It will only change with a lot of time and money, which isn’t going to happen any time soon. A company can go in and sponsor four hospitals and feel good about itself- but there are more sick people in Africa than there are healthy people to take care of them.

They would say they need money and education. I'd specify: unbiased clean effective education. They are so hard up for just new information, you can’t imagine. They will take literature or publications from anyone, even if it is not true. This is not moving forward. It is instead just needing, wanting, searching for medical current events. They are getting someone’s answer, but not necessarily the right one or an effective one, but they are doing their best, no doubt about that. They need doctors. There were four doctors at the hospital I was at; two were Cuban, one Russian, only one Ghanaian. As soon as Ghana makes a doctor, s/he leaves. Three nurses left for London while I was there. They outsource all of their medical help, which is just what they need more of.

Like this, Cuban doctor, native nurse, American me….

It begins with the nurse translating for the patient from Ewe, their language. Then the nurse would tell me in English and I would tell the doctor in Spanish. (I do not speak much Spanish.) You can imagine how much is lost in translation!! One day there was a little boy with sickle cell screaming in agony, for hours, the doctor finally gets to him and says to the nurse, “give pain medicine- scream bad”.

That’s it. The nurses run the show definitely. The doctor doesn’t speak English, or not enough. Plus the doctor can only be there once a day for a few minutes with each patient. It is just not a lot for the patient.

That is really frightening and sad. Communication is so key to good medical care. On a social scale, does Ghana face the same sort of extreme medical crisis as the rest of Africa with AIDS, malaria, and the like?

Ghana was the first African country to gain its independence; it has a stable government, which makes a big difference for a lot of issues. As the local AIDS outreach program told me, only 3% of its population has tested positive for AIDS, however, there may be more since testing is largely voluntary. Still, malnutrition is a bigger problem there than AIDS. But prostitution is in the big cities, polygamy is part of the culture, STDs are more prevalent than people really want to talk about. There are huge campaigns against AIDS, “use a condom, keep tourism alive.” There is a lot of education about it, and it is not devastating the community.

So what diseases are at issue in Ghana?

Malaria, TB, Polio, septic wounds (where an infection does not go away). I copied down some causes of death from death certificates while I was there… Rudimentary is a compliment for their record keeping!Male ward 1999-on lists: TB, Total organ failure, hemorrhagic shock, retroviral infection, malaria, septicemia, head injury, alcoholic coma, stroke, hypertension crisis, shock, pneumonia, heart failure, typhoid fever, cancer among others, but that is mostly it. Their concepts of cancer are out of this world, I don’t know whom they are talking to, but they thought breast cancer was an STD in the maternity ward!!! I mean, they know it is connected to heredity and has other causes but they also think you can get it from sperm!!

Sperm? Wow, that is some misinformation! I know you got malaria while you were there. What was your experience as a patient?

I was doing work with traditional healers as well as at the hospital, contrasting the two systems. Getting malaria was a golden opportunity to try both. Malaria makes you delirious, you are so fucked up you can’t see straight. One day I was lying on the floor, it was 10 degrees outside but I was wrapped in blankets, freezing, very sick. I went to the local clinic and took the antibiotics. If you have malaria in W. Africa you are lucky, everybody gets it, they know how to treat you for it, you show up and pay about $10 for antibiotics and you are better in a few days, not uncommon at all. It comes and goes, it makes you tired and you should rest but people go to work anyway. It is a disease that they live with.

Aren’t there efforts to try to eradicate malaria? I remember reading something about work on genetically crippling the virus within mosquitoes or something like that.

It certainly is not anywhere near action at this point. Plus standing water is everywhere in Ghana, open sewers, dirt roads with puddles, rice fields- all are big mosquito breeding grounds.

How does traditional medicine treat malaria?

They make a blood tonic, and a tea: you take them both a few times a day. Herbal remedies are at the pharmacies, but at the hospital, it is antibiotics only.

I have a profound respect for traditional healers, more so than biomedical healers. It saddened me to see that the division between traditional and western medicine is as great in Ghana as it is here. In the hospital they scoff at traditional healers and traditional healers are likewise threatened by modern medicine. There is no mutual respect. It is sad to me that Christianity is by and large the root of the division. Missionaries converted the southern half of Ghana and largely eradicated traditional beliefs. Therefore only a glimmer was left but traditional approaches still exist. They exist to make money, to heal people, to capitalize on a traditional mystique, but you know western medicine does that too. You always just have to hunt for the true healers. It was interesting to see how the traditional religious and healing beliefs incorporated Christian beliefs but not so much the other way around.

I mean, the Golden Rule, sure, that is how things should be, but it is the details that get in the way. Loving others is great, but thinking Jesus is the only way to get there limits love. Traditional Ghanaian culture is more shamanistic, the medicine man I worked most closely with did a really good job of researching and studying any religion he heard of, expanding his mind, Buddhism, Islam, Judaism, Hinduism, Rastafarianism, god is good love thy neighbor sort of thing they really agree with. There is a protocol to the medicine that they do and it is a religion but by and large they were curious and open-minded when it came to other religions. The medicine is very ritualized; only certain people can become healers. There are born healers. When you go to see a healer they feel you out, and then heal you spiritually or physically and appease whatever god you have upset in order to get you back in balance, on track.

Most people go to a biomedical doctor first, if that doesn’t work then they go to a traditional healer, even if they don’t believe in the religion.

I was all gung ho about volunteering for this hospital and I was ill prepared to walk into work there every day at 730 to be around sick people all day everyday. The same people or new people, it was so intense. I moved around to different wards and units but I had to seek refuge sometimes where there were fewer people, “I can’t see another open wound right now, no gangrene for just a minute please!”

You are a really strong and more importantly, flexible person. You obviously found ways to help you handle all the suffering so that it did not eat you alive.

Everyone at the hospital was like family in terms of their support, all of that love definitely helped.

That kind of love and support can make a huge difference. Is there a strong sense of family there (biological or chosen)?

There is no such thing as an orphan in W. Africa. Extended families reign supreme. People want to extend themselves: “what can I do for you?” I am a newfound believer in extended families. That is what we are lacking here. We need that! They seemed much richer to me than we are in many ways. Even though when I walk down the street I could tell that they think all Americans have money and are inherently better off than they are. But at the same time, I did not see a lot of poverty in Ghana, grass huts and dirt floors do not make you poor. The people of Ghana are some of the richest people I know. There is not a sense of lack in their culture but rather one of abundance, though not financial.

The idea of the clan or family is very interesting to me. I think family is a good thing. Love and support always help. But tribalism can be a big problem; you know when that sense of family mutates into the next step- us and them, in-group and out-group. Having grown up in a family of mixed religious and ethnic backgrounds, I am very aware of this.

Ghanaians have the best role models for family structures, very healthy. Extended family is part of their society but peace and love are paramount there. Everyone is peaceful and loving. Southern Ghana is Christian, the North is Muslim, and they intermarry. War is considered very bad, peace on earth must be kept, and otherwise what will come of us?! I have a very idealistic but very real sort of example that I lived there.

I agree that acceptance of differences is paramount to peace. I think the key to finding success in most things is to not avoid your weaknesses but to embrace them to grow beyond them.

Yes, that is exactly it. In Ghana they all seem to know that what you don’t like about your neighbor is what you don’t like about yourself.

They think that (and this is in the Christian region of Ghana) George Bush was elected by God the Almighty. He was sent here to do God’s work. Which was to eradicate Hussein, get rid of his government, but now there is this unending war. Therefore he should not be reelected; he made a mess of God’s work because war is bad, especially when it is drawn out like this. He will lose the election and God will prevail in this situation in the end.That kind of thinking stems from the missionaries, I think; an idea that all white Christians know what they are talking about. Christians run in packs, faith is a powerful thing.

You also went to India. What was the contrast?

HUGE, I went from living in a house, having a job and a normal life, to being a tourist, and it came as a real shock. My only thought was “what am I doing here?” I don’t know anything about this place or this culture, why am I here? I don’t think I got anything out of it compared to Ghana where I was prepared to understand the culture.

I think that is the difference between being a traveler and a tourist, you know like taking hallucinogens for a vision quest versus getting fucked up, not that there is anything wrong with either one necessarily, but they are different experiences. One will open you up to more of yourself than the other.

Yeah, I agree. Both are fine, even fun, but different things by nature.

So what comes next from all of this?

Well. I feel like I can do anything now. I want to go back to Ghana in two years. The research I started is hopefully just a prelude for my PhD. I am planning to go to grad school in fall 2005 and then go back for more volunteer work and research. Besides, everyone there wants to meet my ‘husband’ and all that. I have to be careful though, I mean I need to be conscious of not confusing Ghana with this time in my life, I mean I always will associate the two, but the world is going on without me every day all over the world, not excluding Ghana.

I want to get into traditional medicine more next time, learn more, see more, explore it further.