I'm Claire Shanahan

Mabel Owusuaa, Health worker, Huttel Health Centre, Boamadumase

Ghanaian people

I should mention that my introduction to Ghanaian people came long before I arrived in Ghana. It was my first week working at Royal Darwin Hospital (RDH) as a 5^th year medical student, and we were undergoing orientation. Every Tuesday at RDH is RMO (resident medical officer) teaching, and that first Tuesday’s topic was led by a tall, handsome, 30-ish bald African surgical registrar by the name of Dr. Osei-Tuto, or OT for short (first name Lovelace – and I have to say the name couldn’t be any more fitting). I think most of the females  (and some of the males) at RDH were infatuated with OT, and I was one of them.

Not long after meeting OT, I met a similarly bald 30ish African surgical registrar, not quite as tall, and this time sporting glasses, by the name of Dr. Ed Yeboah. Over the subsequent 3 years working at RDH (2 as a medical student, 1 as an intern) I got to know OT and Ed very well, and discovered they were both from Ghana.

How to describe OT and Ed? Firstly, they were extremely passionate about their jobs, and about teaching and training new recruits. Their skill level for their years of experience went unmatched in the hospital. They both loved to joke and entertain, and almost always could be seen sporting a wide grin. Both were happily married and devoted to their small children, strong family men. I never felt uncomfortable in the presence of either, rather I felt as if I had been warmly welcomed with open arms.

I know I talk about Ed and OT as if they are the same person but this is not the case. One thing I will never forget about Ed is his strong connection to the supernatural and his capacity to bullshit you with a straight face (to this day I am unsure if half the stories he told me were things he truly believed or if I am extremely gullible). OT, although he knew that many women were attracted to him, would get very embarrassed at the RMO awards night when he would receive “Most Handsome Doctor” each year without fail.

When I first heard about Foundation Human Nature through my friend Steph, I have to admit I wasn’t keen on coming to West Africa – mainly because it was so far from the things I considered “sights” on this continent. That said, as the clinic resided in Ghana my first thoughts were of Ed and OT, and how if they were any representation of their nation then the people would all be extremely friendly, open, happy, jovial, laidback people. This sounded pretty good to me.

Now that I have been here for a few months I will give you a bit of a rundown on the different types of people I have met, and some similarities common to most Ghanaians, with the few subtle differences. I do not want to be guilty of the sin of generalizing about a people. It is also important to mention that many of the cultures within the entirety of West Africa have similar behavioural traits, but many are completely and totally different yet live very close to one another.

Firstly, I spend the majority of my time with very poor farmers. A breakdown of their weekly routine: if Christian (about 70% of my cohort), Monday to Thursday are spent tending to the farm, 5am until 7pm. Thursdays are harvest day, Friday is market day, Saturday is to resow crops, and Sunday is for church. No day is shorter than 14 hours solid work except Sunday, but don’t think that church days are rest days – they are not. Most of these people will bathe twice a day, which for some means walking up to 2 hours each way to collect water and carry it on their heads. To eat usually requires 3 hours (at least) of intense effort, especially if pounding fufu. This is followed by washing numerous amounts of dishes – and as I have already mentioned getting water is a massive task in itself.

As for the Muslim cohort, there is very little difference in the routine except for the day of rest (Friday), and awakening at 4:30am for prayers every morning – which for some very unusual (and unknown) reason only awakens me on a Wednesday, every Wednesday. At first I thought that maybe they only undertook morning prayer on a Wednesday but everyone laughed at that, and the other obrunis complain about being woken up every morning.

There are, of course, many other Ghanaians – those who work in cities, in offices; professionals; sports players; musicians; just like in any other country. Obviously personality types differ, everyone retains some individuality. This said, no matter which type of Ghanaian I interact with, I am welcomed (literally – they will almost always say akwaaba “you are welcome”) with a broad smile, an invitation to sit, join, chat the day away. I rarely see anyone seriously griping about having to perform a task – the children all know their place, that they are expected to help out, which they do, most of the time, always making a game out of it (jumping up and down on the water pump until Solomon – our lab tech – beats them with a stick, scolding them). When something doesn’t go to plan – which is often – there is usually a frown, a loud “Eh!”, the throwing of the hands up in the sky, and then a click of the tongue followed by laughter. Even in a severe car accident people behave quite relaxed, picking up the pieces, moving on.

This can be a little frustrating at several points:

1. When someone comes into the clinic who has signs of being seriously unwell, things move awfully slowly. No-one really seems to give a toss about any of it, not even when I am trying to carefully explain to the relatives (often the parents of a small child with severe malaria) that they need to get a taxi to the hospital or their child will die. This certainly doesn’t mean that they don’t care – to the contrary, in fact. The love I have seen exhibited for family here, it blows me away. 28 year old men carry their elderly grandfather for treatment, women and men combined love to play with their babies and the babies of others – children are raised by the community, everyone loves and shares with each other. I do not think it would go down well if you tried to suggest you could give a woman’s child a better life – pretty much every child is loved and wanted.
1. Rather, I think that the attitude of the people is simply more relaxed than ours, and mainly due to a supreme acceptance that what will happen will happen – what’s the point in getting stressed over it?
2. This doesn’t mean that things don’t get heated at times – I’ve seen some wicked fights, usually two women fighting over one man. The atmosphere is so electric that everyone is drawn in to observe the spectacle – but it’s usually over just as fast as it began, and before long the two are chatting as if nothing ever went down. Actually, often they are sister wives – polygamy is common here – and I have seen that many sister wives are best friends – their husbands usually being a little more chauvinistic than most, the women commiserate, bonded by their shared situation.

                                               i.     I’ve mentioned that polygamy is common here – I should elaborate. It’s acceptable practice to have several wives, most people who are polygamous have two wives. On further enquiry into the specific situations in each of these relationships it’s often the case that the first wife has had difficulty bearing children, and as such the husband takes on a second wife. The first wife tolerates it, it is an acceptable situation for her husband to impose upon her, along with often not having the right to refuse. As you can imagine, though, in this situation the first wife is often suffering from some level of anxiety. This (in my practice) is usually not because of having to share her husband – although there will be moments of spite – actually, I think many of them enjoy having a buffer when they are pestered for sex. Rather, it is the pure shame at feeling they have failed as a woman. Ghanaian women truly feel that to give birth, multiple times, is something that defines them, that is theirs alone, that is what makes them so special.

                                              ii.     While polygamy is accepted, many monogamous men in the community frown upon the practice, stating that those men who enter such a relationship are “weak” and do not show respect to their wives. Actually, many monogamous men revere their wives as they would (and do) the Virgin Mary, and the women to them also. The man share the domestic duties, even upon returning from 12 hours heavy labour at farm. The women accompany the men to farm once domestic tasks are completed – such strength, I have seen wiry 40Kg women carrying several 4m long logs on top of their head, sometimes for 5-10 kilometres. When I meet these couples, the love is obvious, and the longevity of it after fourteen children amazes me. I guess I have a hard time believing in everlasting love, and it’s nice to be proven wrong.

2. Getting up to go for a morning walk (even at 5:30am) requires stopping an average of 30 times to greet each individual person. Most of the time I love it, I always said I wanted to be a part of such a community, but there are times when I wish I could go walking on my own without any interruptions. I tried to go with my headphones on an music blaring a few times, but I found people appeared to be insulted (which, I was later informed, is the case – the worst thing you can do to a Ghanaian is not greet them).

OK, I know I am often guilty of waffling on, sorry…. I just wanted to say that I really admire the genuine pleasure people seem to have with their lives, it exudes from them like a lovely warm cloud, and I find myself increasingly positive by proxy just being in their company.

A few key Ghanaians in my life:

1. Definitely Mabel – one of the clinic health workers. Mabel is 31 but looks like she is all of 17 years old, she has that kind of teenage innocence about her. Mabel wears a perpetual smile on her face, awakens at 5am, begins cooking stew. She fills the handwashing bucket (that I demanded be made for the bathroom, but that only the obrunis use), going back and forth to the pump. She then sweeps the compound we live in, methodically, rhythmically, patiently, careful not to miss a spot (often cleaning out my kitchen and arranging my shoes), then carries the bin to the garbage pit, empties it and washes it out. She hums whilst bruching her teeth, cooks her rice, puts the food aside for later (breakfast is usually eaten at around 10:30/11am). She irons her clothes for work (the communal iron attached to the wall near my room, outside), bathes, then arrives at work before anyone else. Mabel works tirelessly, always shows initiative, but never fails to greet each newcomer by name with a smile or a hug or an “Eh!” Often she is required to check vitals, give medication, see any new patient, several times after hours, waking her – but always with this incredible positivity. I just love her, and feel extremely guilty when I take out my “jut-woke-up” grumpiness on her – she makes me want to be a better person cliché alert.
2. Mary, or Maabena – Efriye’s 18-month-old second-born daughter (now I speak English like a Ghanaian). I think she is so beautiful, and such a personality. She is so independent though, and she hates obrunis – so despite my multiple advances to become her friend she still screams when I pick her up. In my defense, she also seems to scream when anyone tries to get her to do anything she didn’t choose to do of her own volition.
3. Baba, the night watchman. A muslim man, about 90 years old, tiny at 38Kg, who arrives every afternoon around 4pm, and stays overnight at the clinic until the cleaner arrives at 6am, waking up with any patients who arrive overnight, and dutifully collecting whoever is on duty. Just the other day Baba interrupted my twice-weekly tutoring session with Efriye to tell me how much he appreciated how I always took the time to greet him with a smile in the street. His approach was so honest, so heartfelt that I was on the verge of tears.

One more point, a little out of context, but I want to write it before I forget it – children here are not “put to bed” they just fall asleep when they are tired. If the mothers are working, they strap the children to their backs, and carry on with their work. I have never understood “bedtime”, and I like the Ghanaian method.

Ghana - on food and malaria

Food in Ghana

Food is something that takes up most of my thinking time (what’s new?). On a Friday it is possible to buy rice, beans, cornflour, fresh bread, locally grown plantain, yam, cassava, garlic, onion, tomatoes, cabbage, small yellow eggplants, okra, chillies, kontomere (cocoa yam leaf – similar to spinach), ginger, avocado (at 5c each and soooooo delicious – I eat an avocado every day), freshly smoked fish, lettuce, many herbs, salt, pepper, stock cubes, curry powder and leafy greens. Also, you have a multitude of choices of freshly cooked meals, ranging from 20c to $1 in price: rice, beans and tomato stew; banku (ground fermented maize dried in sticky balls) with groundnut soup (peanut paste with tomatoes and ginger); local porridge (blended maize with sugar and lime) served with deep fried mashed maizeballs; omelette sandwiches; and then there are all the delights retained within the glass boxes or tin bowls delicately perched without support on the women’s heads. Riceballs, “doughnuts”, pasties, plaintain chips; finally, there is the FanIce man – rides around on a bike with a cooler at the front honking a honka-honka horn (the type clowns have), and will be delighted to serve you frozen sweet milk sachets (vanilla, strawberry yoghurt, or chocolate) or frozen juice (orange). Given that there is little electricity, we take every opportunity we have to eat Fan Ice. This is all washed down by purchasing a 5c bag of pure water, frozen and then sold from the bowls on the heads of the women. All of these things are also sold on the roadside and at trotro stations, women and young children clambering to sell you the goods every time a tro slows down or stops, at any point on a journey. So you don’t really have to plan ahead for food or drink, but you must have some small change as you risk losing big notes if the tro takes off suddenly during a purchase. To purchase fruit we walk to the roadside at Dua Pompo, where women sell oranges (Dua Pompo is known as the place of the oranges), and other fruit when in season – mangoes, pineapples, papaya, banana. If we want vegetables at any other time we must walk up the road a little to the ladies who sell on the highway – but this veg is significantly more expensive than at our local market as they are selling to businessmen traveling between Accra and Kumasi; and the local market caters to very poor locals. Right now we are extremely lucky, the mangoes are in season and I live 50m from 3 massive mango trees, sweet, juicy mangoes falling from the tree daily. When I arrived it was orange harvest, so we had as many oranges as we could possibly eat.

Food is a major drama – storage without electricity means you have to plan your meals carefully – I try to purchase all fruit and veg raw, because it ripens very quickly and it must last until the following Friday. You need to buy small quantities as everything is sold in sizes for whole families (a “bunch” of plaintain – around 30 – costs 50c so at times I have had people give me the five I request, with a strange look). You have to cook the things that go off first, which usually means you eat well at the beginning of the week and not so well at the end. Also, we usually take off on Friday afternoons, which means that the food will sit untouched in our hot “kitchen” – a gas tank with burner directly on top and a small table with a few utensils in a sand + concrete stove of a room – for the weekend, where we run the risk of returning to a room full of off food. But I am becoming more skilled at purchasing and preparing correctly as time goes on. You also need to cook only enough to eat that night or the next morning because after that you cannot eat it.

Cooking requires patience – for those of you who have spent any time whatsoever with me you will know that I have rarely got any at all. Firstly, you must wash the food. Easier said than done – you get the bucket, go to the borehole, collect water, return to the kitchen. I’m about ready to give up at this stage. You then wash the food, then chop it, and place it in a clean container. Really patient people will cook things separately, using multiple pots and pans etc etc to make really nice dishes. Me, I put everything in together – rice, vegetables, oil, with lots and lots of water as our burner setting sets to “very very high”, “very high” or off – and then leave it until it is some form of stew/soup/risotto. I don’t tend to cook with meat, I don’t trust the storage of it. To make sure you have “clean” water to do this with you will have had to separate the water you cleaned the veg with into another container. By this time you have sweat five bucketloads, and will need to gather 2 more buckets of water – one to wash the dishes afterward, and one to have a shower. This is another reason why I cook/eat out of as few dishes as possible – if I can stretch out the number of dishes I use I don’t have to do dishwashing every day. All dishes have to be rinsed before they are used as the dishwater is pretty gross at the end and often they get very dusty, in a mere few hours.  This whole process can take all afternoon.

I was so frustrated with clinic life initially, with very few patients, cooking being a massive chore but no locally prepared food had much in the way of vegetables and far too much salt and oil. It was too much, especially in the relentless heat, to cook, clean dishes, carry buckets of water, work, walk, wash clothes by hand, and I found that most of the food I bought would go off. I was at breaking point when Debbie arrived, and she, not a fan of cooking, was only to happy to take over the role of water collection, and washing dishes. She also had some great ideas about what types of things we could cook.

Now my staple diet goes a little something like this: porridge (from oats) with locally extracted honey (stored in a glass Coke bottle), freshly brewed coffee (strained through fabric), freshly squeezed orange juice mixed with a little water, and papaya for breakfast; this usually lasts me until late afternoon when I prepare the rice/soup/stew, and maybe we will have a mango at some point during the day. If we cooked too much for dinner one night we tend to eat it the next morning. The best thing I have cooked so far was this kontomere and banana curry, that tasted a million times better the second day than it did the first.

Local dishes in Ghana include (but are not limited to):

-      Banku with okra stew or groundnut soup or palmnut soup

-      Fufu (pounded cassava/yam – a delight to watch the women prepare) with groundnut soup or palmnut soup

-      Kenke (similar to banku but dried longer and wrapped in banana leaf – it has more of a mashed potato texture) with stew

-      Rice/beans/spaghetti  with stew

-      Redred: fried plaintain with beans cooked in palmoil – very oily but delicious

-      Ampesi (my favourite): boiled sweet yam and raw plantain served with stew

-      Jollof rice: rice cooked in spices, quite delicious, often eaten on it’s own

Snacks

-      Women on the street often sell fried yam chips, served with a little home-made chilli sauce, something I like to purchase if I’m hungry between breakfast and dinner

-      Boiled eggs, also served with a little chilli

-      Many people will be seen chewing sugar cane

-      There are plants cut into sticks that people use to clean their teeth and gums every day and night, whilst also brushing teeth – teeth here are not as bad as many of the other places I have been, with many adults still retaining all their teeth with few cavities.

-      Any of the things I mentioned before that are sold from women’s heads

Each region has it’s own locally grown food (Ghana is a country made up of farmers), along with different customs, which changes the variety of food you can purchase on the street. Larger towns (significantly larger than Boamadumase) allow for the purchase of the “treat” of fried rice, cooked from a small hut on the roadside, served with a small piece of fried chicken, some chilli paste, mayonnaise and tomato sauce, along with a dollop of “salad” – a bit of onion and parsley.

My first trip away from Boamadumase was to travel to Agogo for orientation week. Actually, I lie – I went to Kumasi for a few hours with David on my third day in Ghana to exchange money and to purchase some essential items – but I really didn’t pay much attention, not realizing that it was the biggest place I would be in for a long while. For some reason, when reading over the introduction to my placement I had thought that Agogo was a bigger place than Kumasi, and was planning to make friends with the staff there, big plans of going away for weekends in “the big city”, having brunch at cafes, etc etc. Unfortunately, you would be lucky to find anything that resembles a Western café, anywhere in Ghana. It is a very rare occurence indeed. Even the Western restaurants in Accra and Kumasi would barely pass for food in many other countries.

So how does a foodie like me cope? I am surprised at how well I am adapting to the fairly bland diet here. I now love banku, I enjoy all the fresh fruit. It all sounds very healthy however all the crops are sprayed with an insane amount of pesticide (which farmers do from a plastic tank attached to their back, using little to no protection for themselves whilst doing so). Groundnut soup is delicious. Ampesi with tomato and fish stew or egg stew is also wonderful. But to be honest, none of it even really hits the mark for a truly delightful meal. So instead, I eat the “heavy” foods so I don’t eat as often – for example, if I eat banku I am completely satisfied until the same time the following day. That said, many locals will eat the same banku then eat twice more that day – but they are mainly farmers who work extremely hard from dawn til dusk, every day from when they are 7 years old until they die – and many die well into their eighties due to such hard work.

We recently traveled to Togo and Benin, both previously French-occupied, and delighted in the foods available there. This is how I managed to score freshly ground coffee – although I will run out at some point and as such may just have to “hop” on over the border again. More about that later…..

As you can see, I am a little obsessed with food.

Drink, other than water, is another interesting experience. There are lots of options.

-      Beer, often lukewarm, rarely ice-cold, purchased from a “spot” (local drinking hole) at somewhere between 60c (local price in small communities) and $1.50 (local price in towns/cities) for 1.5L. You can buy Star, Club and Stout

-      Guinness – so interesting that all the “black” countries I’ve been to make a killing from Guinness, so much so that everywhere, even the smallest spot, sells it

-      Sachets of 50mL of spirit: gin, whiskey, irish whiskey, coffee liqueur, and many others, sold for 25c each then mixed with coke/sprite/etc (coffee liqueur mixed with coke tastes just like a black Russian, irish whiskey mixed with Fan Ice is incredible)

-      Apeteche: locally brewed spirit, about 80% proof, and extremely cheap – poor people’s drink of choice, similar to Aborigines in Australian communities who would drink the methylated spirit before it began to be dyed purple to discourage this behavior. It is really interesting to visit a local “distillery” in the ground.

-      Palm wine – very common in remote communities, made from the husk of a palm tree

-      Non-alcoholic drinks include all your usual soft drinks plus alvaro (fruit soda), malta (malt-based soft drink), FanDango (sweet artificial orange drink), soy milk, and milo is very popular here. Tea and coffee are lipton and nescafe, there is no variation whatsoever on this in Ghana. Of course, it is extremely easy to make fresh fruit juice, but you will only find the Obrunis (white people) doing so.

The grand finale: when in Ghana, do not forget that it is commonplace to cut open a fruit or vegetable and find yourself staring down the gullet of a fat, juicy maggot. Said fruit/vegetable often has little/no outward appearance of containing such an inhabitant, and often catches you out as you have already sliced half of said fruit/vegetable into your pot, effectively ruining your meal (your appetite along with it). Maggot 1: Claire 0.

Malaria

I really need to start talking about what I have learnt the most about, and what I work with the most – Malaria.

Brief overview of the illness: malaria is an illness that was first described centuries ago when the world was being mapped out by various travelers mal aire literally meaning “bad air”. The usual course described by patients is 2-3 days of fever with drenching sweats that comes and goes, usually once a day during that time. Other symptoms are very non-specific and varied, so it can be difficult to pinpoint the diagnosis of malaria, especially in the presence of another focal infection (such as pneumonia, etc).

Malaria is caused by the parasite plasmodium, with four subtypes – plasmodium falciparum, plasmodium vivax, plasmodium malariae, and plasmodium ovale. I will mainly focus on plasmodium falciparum as it is the cause of 99% of malaria cases in Ghana. Plasmodium falciparum is also the number one cause of severe/cerebral malaria (malaria that kills, quickly) – something I am becoming all too familiar with.

The lifecycle of plasmodium is split between humans and the female Anopheles mosquito. I will not go into much detail on this, just remember that plasmodium does not infect the mosquito, it just resides and multiplies within it. It only infects humans.

The incubation period (time between plasmodium injection into human blood by mosquito inoculation and presence of symptoms) of falciparum is between 9-14 days. So, you get bitten by the female Anopheles, then somewhere between 9 and 14 days you begin to experience symptoms. This is the time it takes for the parasite to multiply within the liver, then it infects red blood cells, which begin to stick together and then rupture – it is this process that causes the major killing effects of malaria: blood loss causing severe anaemia; chemical release causing profuse vomiting and diarrhea, along with severe dehydration; loss of blood sugar; all off which affect brain function causing seizures and ultimately, death.

Luckily, if you live in a malaria-prone region (such as here in Sub-Saharan Africa) for your entire life, you will be infected multiple times and as such build up a great level of immunity to the illness. Many adults I have seen with malaria have very few symptoms and can overcome the illness without medication. However, in order for this to happen you must first develop that immunity, and chances are if you live in this region from birth you will be infected at least twice a year for your entire life – you better hope that you have the capacity to overcome it those first few times when you have no immunity.

For this reason, the disease is particularly dangerous in children under 5 years old, pregnant women, the immunocompromised (AIDs/HIV/TB patients; malnourished patients, etc), and those who did not grow up in malaria-endemic areas (such as me!). The rule of thumb is that anyone with fever/or a history of fever in the three days preceding needs to have a blood film to check for the presence of malaria parasites. If they have signs of severe malaria, the test can wait until after commencement of antimalarial treatment as things can go downhill very quickly, and you must also order haemoglobin and blood sugar levels to ensure those are treated adequately also.

I had a few issues grasping the process of detection and treatment of malaria at first, mainly because it goes against pretty much everything I have learnt in Australia for the evaluation and management of fever. Firstly, parents of children with fever in the absence of a focus in Australia are simply given a pamphlet on “Fever” printed from the Royal Children’s Hospital online treatment guidelines and sent home (actually, practitioners often get frustrated that parents come in at all). Here, parents are strongly encouraged to bring their children at the first sign of fever, and in the absence of facilities to test blood, all children with fever must be treated for malaria, with or without signs of other infection (if there are signs of other infection usual practice is to treat both conditions). Many children appear the same as Aussie children, the only difference being in our management of them. Adults with malaria, on the other hand, often appear simply like they have a mild viral infection. The decision to treat such patients is taken on a case-by-case basis.

When I first arrived at the clinic, I read through the record of daily patient attendance and diagnoses, and found that the overwhelming majority of patients were being diagnosed with malaria, many not receiving blood film even though we have a the lab facilities available 24/7. Whilst I was willing to accept that malaria is a major problem in Ghana I could not believe that people didn’t succumb to the vast array of other common medical conditions that the rest of the world do, and I set about changing this practice. I would demand blood film for every patient of whom the senior nurse suspected malaria. The results were surprising. Often, people who had a classic history for malaria would test negative, then those in whom malaria was only an afterthought often tested positive. Moral of the story: the test is cheap, and resource-friendly so it is worth doing with even the slightest hint of suspicion given the disease burden. Drug resistance is a major issue also, so in the absence of signs of severe malaria it is a no-no to treat without lab diagnosis.

Female anopheles tend to bite in the evening, so prevention strategies involve the following: remaining under a treated mosquito net/indoors with screened and treated windows/doors at night, wearing long sleeved shirts/trousers, use of mosquito repellant and coils, and taking malaria prophylaxis (daily medication to help prevent contracting severe malaria). Mosquitoes lay larvae in stagnant water so it is also important to ensure that no open containers are allowed to sit and collect rain. That said, there will always be some level of stagnant water around in the wet season so there are going to be more mosquitoes around at this time of year.

The reality is that locals use very few to none of the above methods, and as we get further into the rainy season we are experiencing more and more severe cases of malaria, especially in young children.

One case that comes to mind is a small child I saw on outreach clinic who was profusely vomiting (a sign of severe malaria, but also a sign of gastroenteritis – tummy bug – also highly prevalent in this region due to poorly prepared food/unclean hands/water), but was also pale so I was sure she had malaria. I thought she looked well enough to undergo testing before treatment but was prepared to commence immediately after that. However, her test was negative and her haemoglobin was adequate. This was surprising to me, so I commenced her on treatment for gastro, but she continued to worsen so I tested again. Lo and behold she had a very high parasite count and her haemoglobin had significantly dropped – she would need a blood transfusion. Moral of that particular story, if you have a high index of suspicion, treat anyway – death is worse than the risk of drug resistance. I certainly learnt my lesson.

Now, I have been here for 3 months and I find that even I can get quite lax with my malaria prevention as I start to become settled in my life here. It’s like I was initially expecting to succumb to malaria immediately, but now that I haven’t I am becoming blasé. To that effect, there was recently an extremely sad event. The following events may not have taken place quite as I describe, this is just what I have heard from the wall of Chinese whispers in the country. One of the Peace Corps volunteers, an African-American who was due to finish her 2 year term in June this year and return to the USA to undergo post-graduate studies at Emery (having completed undergraduate at Brown), an all-round well-loved girl who had volunteered in a number of developing nations, and seemed to be preparing to dedicate her life to similar work, a girl full of vibrance, life and passion – succumbed to cerebral malaria. Apparently, she had recently headed up a troup of students in learning and performing a strenuous dance from one of Beyonce’s film clips at a Peace Corps event, then, exhausted after the show, traveled back to her remote village, collapsing in what she thought was just a case of being run down. In the meantime, World Malaria Day events were due to commence, and in Ghana a large surf comp was being held to commemorate the day. Danielle decided to remain in bed, and even though she experienced fever on and off she did not attend a clinic. By the time another of the volunteers pushed her to seek medical help her disease was too far gone and she died. This has rocked the Peace Corps community, along with Ghana in general, and even though I never met Danielle, I find myself absolutely shocked at her death. This is not because I believe that the life of a Westerner is more important than that of a Ghanaian, far from it – it is more that I am starting to become blasé about protection and it is scary to realize just how quickly this disease can present and take over – even if you have been here for two years. It has really reminded me that we must be vigilant at all times.

The question that was asked many times was “why didn’t she get tested as soon as she developed a fever, like we are advised to?” Debbie was quick to point out to me that although we all know what we should do under such circumstances, and this was especially the case with Danielle as she would apparently teach with gusto the ins and outs of malaria to the locals in her constituency, it is another case altogether to extract yourself from your sickbed to go and get tested when all you want to do is pass out – moving is the hardest thing in the world, especially in this heat. It’s an extremely sad story, and from all the information I have heard from other parties, she will be sorely missed.

So that is malaria! In a nutshell.

Time for a little more about Ghana

I have been really slack of late. I keep meaning to do stuff but procrastination worms it’s way in and I find instead that I spend most of my time watching “It’s Always Sunny in Philadelphia”; “Arrested Development” or any of the multitude of TV shows and movies I brought out with me on my new 2TB hard drive (bought for me courtesy of the South Australian Local Health Network’s Professional Development funds at the end of last year). That said, I really enjoyed Moonrise Kingdom.

So, that will be my first point. Procrastination in Ghana. On an average clinic day in Boamadumase, I wake up to my alarm at around 5:30am (an hour and a half after the mosque prayers, half an hour before the roosters begin to crow), get up, get into my rather battered, holey, dirty sports gear plus second-hand sold-as-new $6 shoes bought in Kumasi (the second largest city/town in Ghana – I say this as even Accra, the capital, does not have any outward appearance of a city i.e skyscrapers, highways, shopping malls, etc), and head off for an early morning walk in the only time of day cool enough to do so, and when the mosquitoes decide they will remain in hiding. I return around 6:45am, when, until my yoga mat decided to fall apart, I would do 12 rounds of salutation to the sun. I would then collect my purple bucket, traipse the 30 odd metres (30 Odd Foot of Grunt) to the borehole and pump water for my bucket shower. I have learnt how to place the bucket on my head like the local women, although with new braids (woven in plaits into my hair with purple hair of a consistency reminiscent of Barbie’s own platinum locks) it tends to hurt somewhat. I carry the water back to the staff housing, often spilling some on myself along the way, but as I become more proficient in the activity this too is improving. Sometimes I have to be careful about how tight I tie my sarong as if it is too tight the sarong will lift almost to my waist when I raise my arms above my head – exposure! I use a cup to spoon the water from my cup onto my body, it only takes about 1/5 of a bucket to cover myself with enough water to lather up a good soap, for which I use a small length of netting purchased at the Friday market day in Boama; and then another ¼ of a bucket to rinse. Showering done, I dry off, cover myself with my sarong, and empty the remaining water into the makeshift reservoir I had the clinic staff build in order to wash our hands (it’s a bucket with a lid, filled with water, placed on a table, a hole cut at the bottom and a tap with clay placed there; a small tray below it with a plastic tub to catch the water). Debbie (another volunteer doctor) and I have a three part system – the water from the borehole is used for washing the body/clothes/dishes, or for cooking; anything leftover is poured into the handwashing bucket, then the dirty water in the tub/or from dishwashing/clothes washing goes into the toilet cistern to flush when we do number 2s – if it’s yellow, let it mellow, if it’s brown, flush it down. I then return to my room, dress, then head to our kitchen, one of four in the complex, and sit on the small table next to the gas bottle/stove – literally a gas burner directly on top of the gas tank – sounds a bit risky right? I boil some water for tea (and now, coffee!) and porridge, to which I respectively add fresh ginger and honey. I like to relax a little before work so usually watch an episode of whichever show I have been into lately, whilst eating my breakfast, and then head across to the clinic to start my day at 8:30am. Initially, when I arrived, there were little to no patients attending on a daily basis, but this has changed quite dramatically in the 11 weeks I have been here. No matter whether patients come or not, the 6.5 hour day is more exhausting than any I have encountered in Australia, largely due to the frequent power cuts, extreme heat, translating, and heavy diet (starch based). At 3pm, when it is time to come “home” – around 50m behind the clinic, the borehole situated between the two – I am ready for a nap, and as it is the hottest time of the day. I swelter in my mud-walled hut that retains all the heat of the sun, waiting for the sun to go down so I can have some cool. Other activities performed are done in order of necessity – cooking dinner, washing clothes/dishes, all of which are extremely time consuming and done by hand. At night I retire early under my mosquito net, again with another delight from my hard drive.

The staff accommodation is split into three – there is the head nurse Ma Vic’s house (the oldest building), where she lives with 3 of her children, one grandchild and a nephew; a complex split into two separate areas, one occupied by Efriye, the other by Ma Grace (see previous blog for various roles of the mentioned employees); and the complex I live in, along with Debbie, Zulu, Hawa, and Mabel. David, Vittus, Abdul, the cleaner and gardener all live within Boamadumase community proper, about 5 minutes walk from the clinic. The complex I live in is a work in progress that was commenced in 2008. As I have previously mentioned, it is built from sand mixed in with concrete, and has a corrugated iron roof. It is a U shape with courtyard that faces the setting sun. Going clockwise around the building is empty bedroom, Mabel’s bedroom, Hawa’s bedroom, 90 degree bend, empty kitchen/storeroom, empty kitchen/storeroom, Hawa’s kitchen, volunteer’s kitchen, Mabel’s kitchen, Zulu’s kitchen, shower, shower, toilet/shower, empty storeroom/shower-to-be, empty storeroom/shower-to-be, 90 degree bend, Zulu’s bedroom, Debbie’s bedroom, my bedroom. The clinic lies at the northern side, which places me on southern side, and there is nothing but farmland outside my room. When I arrived the courtyard was dirt, which would turn to mud in the rain. Since I have been here, the courtyard has been filled in with the same sand/concrete mix, a wall built to stop chickens and village children entering. This is useful but annoying at times as you have to travel to only one point of entrance/exit to collect/dispose of water when the shower/kitchen/toilet are at the furthest distance from this – this can be frustrating after you have just washed some ingredients etc etc. There are two washing lines hung across the two arms of the building. There is no roof over the courtyard. Plans for the future of the building include building a number of large rainwater tanks above the complex to provide running water to the showers/toilet when they are full.

On the weekends, Debbie and I usually take off to some other destination, both to explore more of Ghana and to get away from the monotony of small village life for a while. We leave the clinic directly after work on a Friday, catching public transport trotro (minivan filled to the hilt) from the marketplace, returning either Sunday or Monday evening, depending on the distance to/from our holiday spot. Travel is both terrifying and exhausting, even to areas relatively close, as the roads are terrible, drivers are infuriatingly unskilled and exhibit multiple risky road behaviours, the whole experience is uncomfortable due to overcrowding, multiple stops, and heat. That said, it’s an incredible experience and I am learning a great deal, especially when I see the way Ghaniains react to such circumstances – of course they disprove, but the relaxed manner in which they behave contrasts so dramatically to the vast overreaction of Westerners to the same stimuli, and if I believe (as I do) that stress can result in many different issues, I think we can take a lesson from this. By the time the weekend is over and we arrive back at the clinic, we are relieved to be somewhere without roads and traffic, peace and quiet amongst the roosters and goats.

Outside of clinic life, I have visited Agogo (orientation week at the hospital there), Kumasi, Konongo, Ejisu, Juaben, Lake Bosumtwi (gorgeous, yet still too hot in the water to really be refreshing), Bobiri Butterfly Sanctuary (close to Boama and one of the only truly relaxing destinations), Butre/Busua (a wonderful beach getaway on the West coast but as it took eight hours – in a reliable 4 wheel drive with no stops – to get to will not be heading back any time soon), Akosombo/Lake Volta (again, stunningly beautiful but the most horrendous journey so a one-time trip), and Accra. If I have not elaborated on the place it is because it is not worth mentioning.  During these trips I have managed to have the following wonderful, zany and sometimes inspirational experiences:

-      Meeting Peace Corps Ghana volunteer Steve Burgoon at Lake Bosumtwi, and mentioning that the only other two PC volunteers I had ever met were Corey Benov and Andrew Guarino, who I met last year whilst they were on their one-year vacation from Mongolia to the Philippines – only to discover that Steve and Corey grew up living next door to one another! For those of you that don’t know, the Peace Corps is a United States initiative that sends volunteers out on 2 year placements to developing nations in order to help out with sustainable projects such as building public latrines, education, etc – similar to mission work without a religious base.

-      Sticking my thumb out on the side of the road in Akosombo to try and hitch a lift to the dam there, only to be picked up by the head engineer of the Dam who gave myself and good Ghana mate Jocie a private tour of the entire facility, only too happy to help out the Obrunis!

-      Attending the world-cup qualifier of Ghana vs Sudan, in Kumasi, and witnessing the patriotism exhibited by Ghaniains in full-force – the equivalent of a four separate marching bands staying in place in the stands, playing throughout the entirety of the game; body painted individuals in the national colours of red, yellow, black and green; and the crowd going wild as Ghana scores 4 goals, obliterating the Sudanese at nil.

-      Being invited to the Paramour Chief’s palace in Juaben (highest level below the King) for the once-in-40 day celebration in offering to the Gods – a very high honour, even if the majority of people at the ceremony appeared to be asleep, and I was suffering from Dehli belly but petrified to ask to use the crapper in the presence of royalty!

So, these days of procrastination, I have found myself jotting down memorable things in my notebook (when I can be bothered), so that when I finally write my blog I don’t forget important points – and here they are.

Firstly, electricity – or lack thereof.  There is no efficient source of power in Ghana, the current power is routed from the Akosombo Dam, 1028 MW of power to a country of 23 million people, which gets split between the people who need it; and at the same time, sold internationally for profit. The reality of this is up to the whim of the power companies to decide who gets power when – in Boamadumase, there may be power consistently for 24 hours, or off for 3 days straight, or on for an hour then off, or on for five minutes then off for an hour then on for five minutes again. In other words, completely unpredictable. Some of the staff have refrigerators in the vain hope that they will be able to keep food cold – I have used them at times but not since I opened the fridge to find the avocado (still whole) that I had placed inside 4 hours prior was completely covered in mould. It also means you should carry your head torch with you at all times, especially given the multiple potholes in the dirt road and the open drains I have fallen into on occasion.

Secondly, water – the water from the borehole is meant to be safe for drinking but as we are provided as much as we need free of charge by the clinic – which arrives in 500mL plastic sachets – I do not bother. I do use it for cooking. The few occasions I have let the water I pumped sit for an hour or so, you can see a thin film of oil develop at the top. There are several boreholes in Boamadumase, and most of the small surrounding communities have their own borehole, some have a well, but the ones with neither (who also most definitely don’t have any electricity whatsoever) have to walk up to 4 hours to the nearest water source, then walk back, often carrying the water on their head (and I feel proud when I carry it a measly 30 metres). Needless to say that for those living in these areas, most of whom are often farmers, fudoobuddas (my fellow B3ers, or really anyone who ever watched “Kath and Kim” will understand that reference) don’t exist.

OK, my computer battery is about to die and I have to take advantage of internet while I have it so that will have to be all for now!!! xoxoxo

Ghana - part 1

I arrived in Accra two hours late after a “technical fault” delayed us in Cairo. I had spent the previous night considering my options on how to arrive at the airport by 5am (considering Cairo traffic), and Mohamed suggested the extremely overpriced (but safe) option of pre-hired London cab. So at the bright and early hour of 4am I climbed aboard, hugging my hosts goodbye. The order and luxury of the cab seemed completely out of place in chaotic Cairo.

Yet again, there was no morning traffic and I arrived in 20 minutes, waited around until check-in opened, then had to figure out how to withdraw then exchange sufficient Egyptian pounds to English pounds, to then exchange again once I arrived in Ghana. I had been informed by previous volunteers that ATMs are unreliable and it is better to bring cash with.

I did all this rushing around only to sit at the gate for an hour, board then disembark the plane, wait 2 more hours then finally board again, and eventually we were off!

The plane was packed full of Ghanaians and I finally got a good overview of what my new neighbours would be like. Most people on board were extremely friendly, even helping me contact David (clinic coordinator, to meet me at the airport), when I knew I would be late. There were a few who kept taking photos of me on the plane, but by this point I’m pretty used to having that happen.

Arriving in Accra, I quickly passed through customs waving my Yellow Fever vaccination form, and easily spotted a weary-looking David with his sign displaying my name (I’ve always wanted to be collected by a stranger waiting with my name on a sign at the airport, this was the first time – can’t say it’s that exciting). We then caught a taxi through the city to the VIP bus station. On the way, I took in my surroundings. The temperature very hot and humid, the road bitumen with many potholes, with a great deal of tropical rainforest trees on the roadside. The roads full of women selling wares from baskets/glass boxes/buckets expertly balanced on their heads, their bodies adorned with exquisite tailored dresses of multi-coloured fabrics of all patterns, children in pristine school uniforms, crisp white shirts, on their way home from school, and various other passersby. We hadn’t gone far and all of a sudden there was a crash from behind – a very nice BMW had hit us! There was a small dispute but pretty quickly it was settled with no real drama, we bought some apples from a lady on the road, and were quickly on our way.

As my flight had been quite late, we decided not to exchange money/purchase goods that day, rather to head directly to the clinic as it would be quite late when we arrived. The VIP bus was very comfortable, with plenty of leg-room, air-conditioning, and sufficient luggage storage. The only real downfall was the seemingly endless Nigerian church soapies – basically your regular soapie on an extremely low-budget, with every minute oozing out judgement from every corner – blasted at a thousand decibels. You know when the volume is so high that the speakers are blown? Well, that about describes Ghana – whenever and wherever there is a speaker, this is the volume setting. Thank God for power cuts.

Anywho, back to the soapie – whilst I hated the 6 hour and 4-part special on Church in the Community, the locals seemed to find it very entertaining, like the latest Hollywood blockbuster. I was to discover that the soapie was actually a television example of real-life judgement passed down every day. This is a very religious country!! People are very involved with the church, church and life seem to be synonymous. But more on this later.

At around 8pm, in complete darkness, we arrived in Dua Pompo (village on the main Accra-Kumasi road), 3Km from Boamadumase, my new home for the next 6 months. The road is in various stages of construction – interesting, considering it is THE major highway in the country. That said, I have been told by many others that Ghanaian roads are the best in West Africa – to travel this area would be an experience, one I am not sure I will be keen on doing. Everyone’s got their limits, right?

We got off of the bus then spent about half an hour waiting for a share taxi to take us on the 5-minute trip down the dirt road to Boama. When one finally arrived, I stood only to forget that all the roads are sidelined by 1m deep/50cm wide open drains (they serve as the sewerage system also), and promptly fell right into one. I landed on my knee and as they are made from concrete I was very lucky not to hurt myself (other than grazing the knee).

So, we piled 6 passengers into the dilapidated sedan with completely shot suspension, bumped our way along the dusty road in the humidity of the night, swerving to avoid potholes here and there. When we arrived, I could see a large number of locals roaming the streets, lively music playing from phones and personal radios, but I couldn’t see very much. David led me by the hand (to avoid further incidents) through the uneven clay road to the clinic. I caught a brief glimpse of the clinic in the dark before being delivered to my room, in a compound of 6 rooms, 5 kitchens, 3 bathrooms, still under construction, behind the clinic.

My room is about 5x5m, with a Queen sized bed, hard mattress, wooden bedhead, mosquito net, desk, chair, and drum! There are two windows, the walls are made of sand and concrete which heats up in the sun – making the room much hotter than the outside. There is a ceiling fan and a light, both of which work well when the power is on, which it wasn’t when I arrived, as I am sure you have gathered already from the multiple comments I have made about pitch darkness. It was extremely hot in the room but I was exhausted so I set about getting ready for bed. Needless to say sleeping without air movement in 38 degree heat and 90% humidity is not a pleasant (or easy) experience!

Thus was my introduction to Boamadumase life.

I started work at the clinic, only to find that, well, there wasn’t really any work to do. My great expectations of patients lined up out the door, given that this was the GREAT AFRICA of my dreams, where people are desperate for healthcare that isn’t there, where every day people die of starvation in the street, where HIV is rife and education is low. Whilst many of these things are very true for Africa as a whole, Ghana is far more developed than most African nations, and as such things are not so dire. There are also many things that hinder the delivery of healthcare within Ghana.

Boamadumase clinic – or the Huttel Health Centre – was founded by a German couple over 15 years ago when they visited the region and found it in need of improved health services. It consists of a maternity section, outpatient department, men’s ward, women’s ward, office, pharmacy, injection room, dressing room, and lab.  Foundation Human Nature, a charity founded by several Western (English) doctors took over the health service several years ago when, due to failing health, Mr. and Mrs. Huttel were no longer able to efficiently manage the centre.

The centre employs a head nurse, Ma Vic, nurse assistants Mabel, Vittus and Howa, midwife Ma Grace, midwife assistant Efriye, laboratory technician Solomon (Zulu), and clinic manager David. There are also night watchman Abdul, a gardener and a cleaner for the clinic.

I was given preparatory information regarding life at the clinic, although the information was from 2008, so it was somewhat out of date. It stated that clinic attendance was between 10-15 outpatients daily Monday through Thursday; with 20-25 patients on market day Friday. It also reported that there are also after hours patients who attend for emergency care, and that there was an ambulance available to transport patients to a tertiary facility. There are 2-5 antenatal consultations daily with 1-2 births per week, all handled by the midwife.

In reality, in my first week there were an average of 2-3 patients attending the outpatient department daily, even on market days. The maternity side ran as reported, though.

It has taken quite a bit of investigating to understand exactly why this is the case with the clinic. I am not sure if it’s something that is going to change, either, which means at times I am unsure of my role here.

Issues identified to date:

1.     There was a period of >12 months between the last volunteer and myself. Whilst this in itself was what attracted me to this job – to see a self-sustaining clinic in action, in reality what it meant was that without regular supervision the clinic had fallen drastically behind. It is not that the staff are not skilled. One of the people who run the organisation was very good at describing the situation to me: in a Western health facility, even if you have no formal professional development, you are constantly supervised and critiqued by your peers.

a.     For example, a patient arrives with particular signs, a nurse in triage examines them, admits them, then another nurse examines them. You as the doctor then examine them along with the information already recorded by each of the nurses respectively. You formulate a differential diagnosis and suggest tests and medication. The nurses are of varying levels of experience and when they give the medication the dose must be checked by another nurse. If the dose is wrong, or the medication inappropriate, they will contact you or a senior doctor about it. Senior doctors on the roster will supervise your behaviour sporadically and if your diagnoses are way off they will inform you. Senior staff will also critique the actions of other senior staff, there is no such thing as “top of the pile”.

b.     There is no such process here in remote Ghana – the most senior staff member is the head nurse, and unfortunately for her and the community, her treatment goes unchecked most of the time. If I were in the same situation I know my knowledge would fade, and I would begin to become dangerously lax in diagnosing and adequately treating patients. This is the situation I have walked in to.

2.     Perception and acceptance of Western medicine is still not great within the African subculture – very understandable given everything that has happened historically in this country, and I cannot say after all my experiences that I am sure that Western medicine is all it’s cracked up to be.

a.     People use a variety of traditional medicines, often causing more harm than good – I saw a girl whilst I was working in Agogo who attempted to abort her pregnancy by inserting prescribed herbs into her vagina – she arrived with a ruptured uterus, in hypovolaemic shock, was lucky to survive.

b.     People prefer not to know about illness they cannot feel – if they feel normal/well, they will not present to the doctor. Again, it is difficult to fault their logic but we are discovering a large amount of undetected chronic disease when we attend outreach clinic.

c.     People believe that if they are referred to a tertiary facility it will be because they are going to die, and are very reluctant to go.

3.     People have very little money – health insurance is 12 cedis ($6 AUD) for the first year and 4 cedis ($4 AUD) for each subsequent year, which covers the majority of treatment, but this is more than most people can afford.

There are a great deal of other issues but I prefer to look at things from the positive – this was difficult initially but as time passes and I become more accustomed to life in the village things that initially annoyed me are now becoming regular and acceptable.

I think I will leave it there for now, a great deal more has happened than this but you’re probably over it by now! Chapter 2 coming soon. Suffice to say that after much turmoil I can now appreciate the experience for what it is and I find myself falling in love with this place “kakra kakra” slowly slowly…..

Men smoking shisha, playing games and drinking sweet tea, a regular sight in Cairo

Egypt

I arrived in Cairo at 6 in the A.M and my first task was to obtain a visa and clear customs. I didn’t have any Egyptian pounds, or in fact, any cash of any currency. The two ATMs in arrivals were broken and the visa counters did not take credit card. Thus I pled my case to the customs officials who very kindly advised me to leave my passport with security, head downstairs to the arrival hall and withdraw some money from the ATM, then return and purchase my visa. Everyone was extremely friendly, helpful and nice towards me. Getting my visa and clearing customs was a breeze, as was leaving the airport to the taxi rank – one or two taxi drivers hassled me in arrivals but this is nothing compared to what I have previously encountered.

However, on arriving at the taxi rank I had a dozen different drivers contending for my business, each offering the fare to the bus station for 100 Egyptian pounds ($15 AUD). I had it on good authority that the fare should be somewhere between 40-70 and to demand that the drivers use the meter. It took a while to find a driver willing to do so but I stuck to my guns and eventually was successful. The driver spoke very little English so I had to improvise somewhat. Eventually he understood my request and off we went. No sooner had we exited the taxi car park only to encounter a long traffic jam and as such the driver started backing down the ramp that we had driven up at breakneck speed…. I was petrified!! The driver saw my look of shock and simply laughed, then continued backing down. To his credit, we ended up in a laneway all to ourselves and sped past the long traffic jam, an accident on the road holding them up (gee, I wonder how that happened?).

As usual, I was trying to get back into “traveller mode” and not fall so easily into the tourist traps of getting ripped off. I don’t have a problem with locals who are very low-income earning hoping to get a bit more money from the foreigners who seem to be rolling around in it, but demanding a certain amount and then refusing to turn on a taxi metre etc etc can be very frustrating. Especially if you can see another client paying a completely different fare. I would like to tip someone living in such circumstances, but when they automatically assume I’ll pay whatever they state I find it difficult to locate my compassionate centre.

That said, there needs to be a balance. If I were to get frustrated and complain every single time I am ripped off as a tourist, well, let’s just say I’d constantly be wearing a frown. My advice after constant travel is to expect to be ripped off, then decide just how much fighting is worth it for you, and just how far the extra money can go for the person ripping you off. In their shoes, you’re the lucky rich foreigner who gets to travel while they work every day. Most of the people doing the ripping off have never been on a holiday, anywhere.

OK, so I’m getting back into travellers mode, and although the Wikitravel Cairo guide tells me to be adamant to not pay the airport toll (should be the cabbie’s expense) I relent when he asks as the amount is $5 EGP, around 75c. Not worth the fight, especially since I am alone in a male-dominant society in the early hours of the morning with a strange cab driver who could drop me just about anywhere. After an uneventful journey through the quiet streets of Cairo (ha!) I arrived at the Go Bus station, and started to enquire about fares to Sharm El Sheikh, to meet up with my bestie’s mother-in-law in the popular Brit holiday destination.

I found a fare for about $12 AUD and after a long (and cold) wait in the basement of the bus depot, we started off on the “supposedly” six-hour journey. My travel guide mentioned that the trip was meant to cover spectacular landscape. Not sure who wrote that. The journey was sand, sand, and sand, with a great deal of sand. I spent most of it either sleeping or watching “Chuck” on my laptop. We arrived at 730pm, the journey taking a total of about 9 hours, and my entire travel time since leaving Kuala Lumpur being around 30 hours. But, I’ve been through much worse than that, so can’t complain.

Delightful Deb was awaiting me at Delta Sharm, a safe complex of apartments in a village with several pools, supermarkets, restaurants, beauty salons, and travel agents in Sharm El Sheikh. She grabbed my backpack, which concerned me greatly because although it is quite small for a hefty person like me, Deb is all of five-foot-nothing and I thought it might tip her over! But like her son, she is extremely fit and strong, so size certainly doesn’t matter! After a week’s stay with her I’m sure she could carry a great deal more than that. She led the way through the maze of units to her apartment, in which to my surprise she had relinquished her bedroom to me for the week!

Now, Deb could probably talk the ears off of a bull, which is hilarious because I’m pretty sure that’s how most people describe me.  We sat up for a long while talking about everything and anything before I felt quite rude retiring to her bedroom while she sat up. That said, I re-he-hee-ally enjoyed the sleep I got from her wonderful queen sized bed.

The following day Deb took to showing me around town. The first place she showed me was the local marketplace, the Brazilian coffee shop in particular as it was highly rated for doing a good Americano. Deb doesn’t drink alcohol, smoke or eat meat but she loves a good cup of coffee! I explored the trinkets of the market, and was able to bargain with the local shop owners to get a good price on some charms for my bracelet.

For those of you who don’t know, my folks gave me a silver chain-link charm bracelet with 4 charms as a “pre-sixteenth” celebration prior to my departure for Chile on student exchange in 2001 (as I celebrated my 16^th birthday in Chile). The charms were chastity, charity and hope (I lost hope on the first day – no jokes!); a sweet sixteen charm; Australia map charm; and St. Christopher, patron saint of travel. Neither my folks nor I are religious but we are superstitious and I was grateful for my own St. Christopher. Now this bracelet had not left it’s place on my right wrist since it was gifted to me, until sometime in late December last year when I noticed, all of a sudden, it was no longer present. I was a little panicky and attempted to find it anywhere possible, but I couldn’t.

I took this as a sort of bad omen, and had to make a decision – purchase a new bracelet and St. Christopher charm in the hope that it would do the same (as I have never had a truly devastating experience whilst travelling and I don’t want to tempt fate), or go without it. I decided to purchase a new bracelet. Besides, I had a number of charms that I had purchased on my multiple travels that I had yet to attach, so I collected them all together to make a new bracelet.

So, after this great purchase, we set about the next item on my list – dental check-up. I often get my teeth checked abroad as I find it is much cheaper and the quality of dentistry is as good if not better than in Australia, so long as you have a good recommendation of a dentist by a local. On my year’s travel in 2011, I had chipped a tooth in Vietnam, which was fixed by a Kiwi dentist in Hong Kong, and then at the end of the year in Chile I went to an extremely expensive dentist recommended by my host family, who informed me that I needed 6 fillings. I decided to get a second opinion and in the Philippines in May last year a local dentist checked me out and told me I had perfect dentition. The conflicting opinions confused me so in Egypt I was a little apprehensive. However, Deb steered me to her dentist, who does not charge for a consult only for procedures. He took one look at my teeth and again let me know they were in mint condition. I requested a cleaning service and he told me my teeth were perfectly clean and there was no need. I walked out rather chuffed, having spent no money and gotten a bit of a confidence boost.

Over the next week Deb and I spent a lot of time gasbagging, and I managed to go quad biking and camel riding in the desert, then decided to get my advanced dive certification in the Red Sea.

Sharma El Sheikh scenery is spectacular, especially the coastline. That said, the whole place has a kind of fake feel about it, similar to Dubai, Las Vegas, and many other such towns that survive around holiday tourism. Getting your advanced diver certification is relatively cheap and made in good time, so that’s one reason for going, along with having relatively few other divers in your vicinity – there is something really special about being almost completely alone with the underwater world of life in spectacular reefs like Ras Mohammed.

This said, I am not sure I would recommend Sharm El Sheikh as a destination of choice – but this is based on my love for cultural travel and anthropology – there is not much local culture to study in Sharm. If you are European, however, and desire a relatively cheap beach side holiday, this is your place – there are many budget airlines that fly from European cities direct to Sharm for very little.

Sharm is also known for being close to St. Catherine’s – however with recent politics in Egypt this was closed for the foreseeable future.

That said, I really only went to Sharm in the first place to visit (and meet) Deb. I had only purchased the ticket to Egypt because it was the cheapest way to get to Ghana, after which Kae (my bestie) told me her mother in law was there. And I am very grateful for the time spent with her, as always I had a wonderful experience with her as my host. She is living permanently on Delta Sharm, managing holiday apartments for Westerners living outside of Egypt. She has been there for a year, with the view of permanency, depending on tourism of course. Poor Deb (as is the case for all Western women) has to constantly fight off the attention of amorous Egyptian males, which I learnt quickly. My diving instructor decided that he loved me (the day he met me) and spent the entire one-on-one experience trying to woo me. Been there, done that! Not so interested this time around.

I purchased a ticket on the bus back to Cairo, having already arranged to stay with a couch surfing couple who lived in the worker’s district of Shobra. When I was in Malaysia I began the couch search for Cairo, giving approximate dates for my stay. There’s a new feature on couchsurfing that enables you to give out a “blast” to all local Csers in the area about when you’re coming, what you’re doing, so they can offer to host you. I elected to do so (maybe a mistake?) and received over a hundred messages (all from Egyptian males, largely named Mohamed, all very keen to host me. I could not even begin to read through each of them! Luckily, the couple I had contacted agreed to host me, and I did not have to. I did, however, arrange to meet up with Hema, one of the males who had good reviews on his profile and had offered to take me on a guided tour of the Giza pyramids, as he lived so close he had a rooftop view!

Mohamed and Shereen, newlyweds, had provided me with very precise directions to their home, and after catching the women’s only subway carriage, surrounded by glamorous designer hijabs, I arrived at the station, and was greeted by Shereen and her couchsurfer/new housemate from Italy, Ylenia. We weaved our way through the throngs of locals escaping into the outside air, seemingly thousands of people purchasing goods from multiple market stands in the street, fresh fruit, vegetables, woven baskets a metre high filled with spices of every variety. In stark contrast to relatively liberal Sharm, it was clear that even modern women in Cairo cover most of their body at all times, in a combination of jeans, enclosed shoes, long-sleeved flitted shirts covering their bottoms and finally, the hijab. The elderly women tended to dress in full-length black loose robes, and many of them stared at me as I passed.

We arrived within minutes at the apartment, and although the exterior was quite grotty and the stairway unkempt, upon entering I realized the place was bigger than a house! I was very surprised as, while it’s common for young couples in Australia to be able to afford to live alone in a house, this is certainly not the case in the developing world, and Mohamed and Shereen did not strike me as loaded. Shereen soon explained to me that the apartment had been rented by their family since before she was born, and at the time the rent was 5 Egyptian pounds per month (a lot of money at the time). Her family had worked hard to pay the rent. However, apparently in old Egyptian law there is a clause that states the amount of rent cannot be changed until the existing tenants move out or are deceased. As such, Shereen and Mohamed are paying 5 Egyptian pounds per month to live in a mansion apartment very close to down town!!

I immediately felt at home, with Mohamed in the kitchen cooking up dinner, and Shereen showing me to my room, providing towels and proffering me a shower prior to putting up my feet. I gratefully accepted.

That night, we sat up late discussing all things, travel, politics, life in our various countries. Ylenia had come to Cairo to study Arabic for three months, and during her week couchsurfing with Mohamed and Shereen, she had been apartment searching but had not found a suitable place, and as such was so frustrated that Mohamed and Shereen suggested she rent their spare room. Shereen, who had just released a travel novel on Paris, works for an international company close to the airport, which is only 20Km by car but with Cairene traffic can take 2 hours for the journey each way. Mohamed works downtown, only a couple of stops on the subway, but given the current political situation in Cairo he was not situated well as he was next to the Minister of Interior.

It was interesting to be exposed to the politics of the Egyptian revolution from the point of view of a local. That said, opinions were many and various. Mohamed and Shereen were strongly for the revolution, believing that united the people could change the situation in the country. They were attending each of the protests as they occurred (usually on a Friday). Often there would be tear gas released into the crowd to disperse them, and occasionally people were shot. Hema, who took me on the tour of the pyramids, was staunchly against it, stating that the government are due for re-election in 4 months so why sacrifice lives when you can simply vote the current regime out?

That week, the four of us went to visit Shereen and Mohamed’s friends in the outskirts of Cairo. It took us 45 minutes to leave the suburb of Shobra – and most of this was on the one main street stuck in horrendous traffic! After that, it took another hour and a half to reach our destination. I felt like we had driven to another city, yet Shereen informed us that most young couples were choosing to live in these “new” suburbs for affordability – although it meant a commute of almost 5 hours daily. The area was full of new luxurious apartment complexes, very similar to Delfin homes for you Aussies out there – except without the picturesque parks that are incorporated in Delfin projects. However, this particular suburb must have been relatively recently developed as although there were many hundreds of buildings, some ten stories tall, the suburb was a ghost town. The young couple we were visiting, also newlyweds, had this bizarre brand new apartment that looked like it came from the pages of a magazine, with all the latest designer furniture and appliances (including Mad Hatter-esque purple plush dining chairs), when right outside the world was a pile of construction materials, the roads were dirt, and the rest of the building was a shell.

There were about 20 people at the housewarming, and the food that was served could have fed 50! I am a huge fan of the local dishes, which are mainly Lebanese in origin, but at this function the dishes were not so much to my liking – large amounts of heavy pasta and not much salad, followed by about ten different cakes to choose from, and the food just kept coming. Soft drink consumption is also very common, with Ylenia and I being the only two drinking water at the function. We also partook in shisha, flavoured cappuccino, peach, and apple.

It is customary for Egyptians to remain living at home with their parents until marriage, with some choosing to move into the family home with their spouse and in-laws. Sex before marriage is strictly prohibited; homosexuality is prohibited and can cite violence if publicly displayed. Alcohol intake is very uncommon amongst Egyptian nationals, but cigarette and shisha smoking are very common in large quantities.

At the party I learned what a group of 30-year-old professionals do when they let their hair down in Egypt. As alcohol was off the table, instead of drinking games, sober adaptations of the same were common. All the people gathered in a circle, raising their ten fingers up in the air, and played “I have never”. This time, instead of drinking, people had to lower a finger each time they had done something. Pretty soon I cottoned on to the fact that the unmarried Egyptian girls were using the game to shame the foreigners into revealing their sacrilegious ways, in an extremely judgemental way. The girls appeared to be proud of their very sheltered lives, and at one point it was hilarious when the male host (also Mohamed) loudly stated “Gosh you girls have not done anything fun in your lives!” and I laughed loudly.

It is fairly obvious that there is a large amount of ignorance through propaganda spread to the nation – for example, evolution is not taught in school. Yet again, I think that the key to reduction of prejudice is education. Whilst in one of the women’s carriages with Shereen and Ylenia one day we got to talking about the advantages and disadvantages of the segregation of sexes. Shereen mentioned that she was largely in favour of it but that she becomes disgusted when the women breastfeed in public. I began to point out the pros of such a practice but it was evident that it is not widely accepted in this culture.

I slowly learned proper shisha etiquette – whilst all my experiences until this time had been in Western nations where people tend to share a single shisha between a group of people – you are actually meant to have your own shisha to yourself. It can take several hours for you to smoke the entire amount of tobacco. Also, if you constantly suck on the pipe eventually the concentration of smoke delivered is so high you will cough uncontrollably – you counteract this by alternating sucking with blowing into the pipe – a ratio of 3 intake to one blow usually clears the pipe sufficiently. Also, whilst the new flavoured shisha is very popular amongst the youth, and that now it is socially appropriate for women to smoke shisha, up until recently it was only men who smoked, and they only smoke very strong thick tar tobacco. There are still very many “men’s only” cafes all over Cairo, and Egypt in general – this is not a strict rule, women are not forbidden, but the looks you receive by even entering are quite formidable. Here men will wile the hours away smoking their respective shisha, playing ……, and drinking strong sweet black tea. You’ll find that most men have their “local”, where they have stored their own personal shisha pipe and can rock up at any time. The old shisha pipes are handmade out of brass or silver, stunningly extravagant with velvet pipes, and wooden mouthpieces. The new, modern pipes are mass-produced in Turkish or Chinese factories, and come with multiple disposable plastic hoses and mouthpieces – so as to prevent spread of infection. It makes the whole process of smoking have a much less authentic feel about it – I enjoyed smoking with Hema in his local, from his age-old pipe, instead of smoking at the new trendy modern cafes.

Shereen and Mohamed took Ylenia and I on many different adventures through Cairo – the old Islamic sector, including many old and beautiful Christian churches (Christianity makes up 30% of all religion in Egypt); the market; Tahrir square; and the up-and-coming expat district of Z…… They were very gracious hosts, providing wonderful food, with tea and pastries; Egypt guidebooks and maps; even showing us the take-off of “Gagnam Style” – “Hoppa Egyptian style” (hilarious).

OK, I think I have rattled on quite enough. I will list off a few of the other things I experienced in Egypt:

-      Meat makes up about 70% of the portion of food on any plate. The food is also heavily laden with oil, salt and sugar. That said, there are many delicious vegetarian dishes available, such as hommous, baba ganoush, delicious greek salads, tahini, beetroot, and many more – but these are never considered the bulk of a meal, rather a side dish/starter with Lebanese bread. I used to make a whole meal of sides and be fully stuffed!

-      Although there is a large amount of prejudice against Westerner’s with their unacceptable public behaviour and dress, the culture is largely dissipating within Egypt, with very few of the younger population actually practicing their religion in any form. Modernism/globalisation is a common theme in my travels.

-      Furniture re-upholstery is a booming business

-      The air is so dry you constantly feel like you have a frog in your throat

-      Cairo by Max Rodenbeck is an excellent guide to the city if you want a little of everything

-      Salmon Rushdie is censored

-      Ancient relic upkeep is not a priority, to the point that it’s possible that the key features in this country may not be around for future generations – not that the locals care, as many do not know or care about the history of their country, preferring to exist for today – and who am I to question this practice?

-      Petrol is about 15c per litre. Yes, you heard me right.

-      Businesses open around midday, closing at midnight

-      If you find yourself in a car accident, don’t be surprised if a fight ensues – and a very large one.

-      A multitude of horns can be heard throughout the cities, and Shereen taught me that there are different phrases that can be beeped out from one car to another.

-      It is not uncommon to see horse-drawn carts carrying various loads on the road interspersed with traffic.

-      Pollution is evident everywhere – dirt and rubbish on the roads, stained buildings, smog, etc.

-      Most people will change their shoes for thongs and socks once indoors

-      Must read Naguib Mahfouz and Ahdaf Souez – two Egyptian authors with brilliant novels.

-      Egypt has a tipping culture – usually leave a few Egyptian pounds on any bill.

OK, finally done! Even if it is 5 weeks late. I want to come back, learn more Arabic, and travel more of the country in a road trip with others, through to Jordan and Israel.

Now to write about my Ghanaian experiences so far….

Kuala Lumpur

Malaysia

Having spent a glorious week vegging out at home with the parentals, eating market food, getting rained on in monsoonal downpours, and sorting out all my remaining worldly possessions (some of which I had not seen since I was 15 years old), my mother and I boarded a flight to Kuala Lumpur via Singapore.

FYI I had searched on my trusty travel website momondo.com to find the cheapest travel deal to Accra, Ghana. I found that with a multicity booking from Kuala Lumpur via Cairo was the cheapest, so I booked it with a stopover (and holiday) in both Malaysia and Egypt. There are no direct flights from Darwin to Kuala Lumpur so I waited for the Jetstar sale flights to Singapore then booked a Tiger Airways flight to KL – these only cost $6 and leave several times a day!

We arrived in KL at around 11pm, weary. We had checked hotels on Trip Advisor and eventually booked the Nan Yeang Hotel in Chinatown. I must have completely switched off my travel brain because when I checked the pictures of the rooms online I actually believed that was what the room looked like! I had neglected to remember that in developing nations, especially Asian nations, the hotels tend to use fake photos to make their hotel rooms appear much nicer than they actually are. That said, the price was very reasonable, the location desirable and we had all we needed – bed, air-conditioning, en-suite, and the bonus of a balcony.

The taxi from the airport was a harrowing ride even for the much-experienced me as it appeared the driver was only using the parking lights, his fuel gauge was on empty and he was driving 110km/h in the rain…

Mum and I settled down to sleep, then awoke the next day to go for breakfast, bright and early at 8am, only to find pretty much nothing open. We wandered around for a while, eventually stumbling across (quite by mistake) a hidden cafeteria serving all sorts of food, including laksa, a Malay delight. Darwin markets also serve laksa, so I have known this dish for a long time. We purchased local coffee – mum “hot black”, me “cold white”, and found it to be the same thick sweet coffee as Vietnam. The rest of the day we spent exploring Chinatown, getting lost in the streets, and finally taking the LRT (metro) to the Petronas “Twin” Towers. Once the tallest building in the world, its bottom floor is now an air-conditioned shopping mall.

During the five days we spent together we managed to explore the Golden Triangle, Bukit Bintang, Chinatown, Central Market, the botanic gardens (including the bird park); fitting in many massages, professional hair wash and dry, and glorious food sampling along the way. We decided to do a cooking course and did this through LaZat cookery school on Mum’s last day in town.

When it was time for Mum to leave, I could tell that she was apprehensive about my travel to Africa. I think (I’m not her but I will hazard an educated guess) that she was not so concerned that I would be in danger, after having witnessed the number of times I had travelled alone before – she knows that whilst I take risks they are calculated and I don’t do anything particularly stupid. I think she was more concerned that this time I would really be completely isolated, not the easy travel destinations I had frequented in the past.

So we had a slightly teary goodbye, then I headed to meet the couchsurfer I had arranged to stay with – Eric. Eric is a very interesting 65-year-old Chinese-Malay man who is married with three children, whom he lives with outside KL. He also has two apartments closer to KL city in which he is starting up a system entitled WORK-LIVE-TRAVEL-PLAY-REST. Each of his apartments is fully furnished, 3 bedroom, 2 bathroom, air-conditioned, with full amenities, office set-up, internet and entertainment system plus massage chair, and a pool in the secure complex. Eric plans to sell 90% of both properties to 9 other people over a period of time (say, ten years), in which each of these people will have full access to each site in order to live, work, travel, play and rest. Each is also entitled to have couchsurfers come and stay, and rent rooms out to holiday-goers.

Interesting concept. Eric’s theory is that if we could all share less space then we would all be contributing to less waste in terms of mass construction, energy use, etc, whilst also maximising income potential by reducing costs to the individual. In addition, ten likely complete strangers would be forced to get to know one another in effect increasing their sense of community.

This is still an idea in theory that Eric has yet to put into action – he is going to commence marketing to sell each of the 10% portions of each apartment, and if successful, will “expand his empire” so to speak. Eric told us that his children think he’s mad, and his wife largely ignores his activities, happy so long as she can continue to live her life in the way she is accustomed to. Eric has a background in real estate.

Eric picked me up from KL Sentral, right on time. We drove out to one of the two apartments, and met up with Yun, a Korean couchsurfer. That afternoon, in the space of a few hours, Eric managed to show Yun and I everything that it had taken my mother and I 5 days to accomplish!! Needless to say, I was exhausted by the end of it.

The next day Yun and I went to the Batu caves, north of KL. This was a pleasant day out, if you can forget about the overwhelming heat and streets strewn with rubbish after a recent Hindu festival at the temple at Batu caves. There were about 12 million and ten monkeys in the temple, very cheeky indeed, stealing all and any food from the tourists at the site.

That night we went to the Reggae Bar in Chinatown (another place I had been to with my mother for a cheeky mojito), and met up with the local CSers in town for their weekly meeting. About 30 people showed up, and Eric brought a new CSer for the flat, from Estonia. We stayed until about 1030pm (it was really only getting started by the time we left). We attempted to go to the local market on the outskirts of town (every Wednesday evening 5pm-12pm) however we could not locate a park and as such decided to leave.

The next day I was to fly to Cairo in the evening, so I did my washing in the morning, then relaxed for lunch with Eric, Yun, and two new Chinese couchsurfers having arrived that morning (mother and daughter) - the Estonian CSer had already caught a plane that morning. I then got my hair washed and dried one last time, and got yet another foot massage before heading to the airport. This time I caught the KLIA Express, a 28-minute journey in air-conditioned comfort. Check-in was uneventful, as was transit in Bangkok however there was a slight delay.

Highlights of Malaysia:

-      I loved the Singapore-esque feel of Kuala Lumpur, whilst still retaining some of the busy and dirty elements that I am so accustomed to in Asia.

-      The food: laksa, roti, curry, fried noodles, nasi lemak, nasi campur, Indian delights, gado gado -  a mixture of Chinese, Thai, Indonesian, and Indian – if you could throw in Greek and Mexican I think I’d never leave!

-      The LRT (metro) and KLIA Express were very good.

Some things you should know:

-      If, like me, you have been to other South-East Asian countries in the area, you might be a bit surprised by the cost of things in KL.

o   The cooking course cost 230 ringgit per person, around $77 AUD; and did not have any major difference to any cooking course I have done before in Asia – actually I think the best one I did was the $15 cooking course on the banks of the river in Hoi An, Vietnam

o   Massages cost 50 ringgit, around $17 AUD

-      The water in Kuala Lumpur is drinkable, or at least, I drank it on the advice of expatriates living there, and never got sick.

That’s about it for Kuala Lumpur – great for a short stopover, but I don’t know if I would plan to go there otherwise, or if I will be in a great hurry to return. I would, however, like to see the remainder of Malaysia which still remains uncharted territory for me.