final thoughts

Travelling always reminds me that there is more than one way to think about things.  If someone thinks differently than you, it’s important to consider how their own culture and experiences influenced their values and beliefs. At home, we tend to befriend people who are like us.  But travelling forces you to think outside your norm.  Traveling always helps me learn a little bit more about myself and why I do and think the way I do.

I think that everyone would be a better person if they experienced a different culture and learned that their way of thinking is not the only way.  Despite what CNN tells us, the U.S. is not the center of the universe.  There are a lot of important and interesting things happening all over the world – you just have to turn off the tv and get out and see for yourself!

A picture's worth a thousand words...

more pics from Grace Life International School:

Random dinner pics:

At the Gulf of Guinea:

Random, random pics:

Making Connections

During our trip, we were fortunate to be able to

VCU and U Ghana students working on a case study

meet the University of Ghana's first ever class of OT students!  The University's OT program was started just a few years ago by two foreign-trained occupational therapists.  Their first class has 19 students!  We first met up with the students at the New Horizon School where they participated in the transfer training we conducted.  The students from U Ghana and the VCU students who had just returned to Accra from the Volta region then met in small groups to discuss case studies of New Horizon students the Accra-based VCU group had worked with during the previous days at the school.

Visiting the U Ghana OT Department

Afterwards we all treked back to the School of Allied Health Sciences at the University of Ghana for lunch.  It was interesting talking to the students and hearing about their experiences.  They had many of the same concerns (complaints?) as OT students at VCU did: too much theory, not enough practical knowledge, etc.  I'm glad to know it's not just my class :)

U Ghana lecture hall

We took a tour of their facilities, and while small, it was impressive.  Their lab was fully equipped with adaptive equipment and even had a real working hospital bed (at VCU we have to use an air mattress on a table).  Their lecture rooms were also reminiscent of the ones at VCU: uncomfortable desks and no natural light  :)   They even had air conditioning!

In addition to actually working with the kids, an important part of this trip was making connections.  In order for this service learning program to be sustained, we need partners in Ghana to help us identify need and coordinate sites to visit.  During our time in Accra we strengthened our connections with both the Grace School and the New Horizon's School.  We are already talking about and starting to plan for what the next group will be doing for the schools next summer.  This new connection with U Ghana will be important. Since there are no OTs in Ghana yet (except the two professors), the kids at New Horizon are not getting regular OT services.  We are able to come in and do some immediate interventions, but there are many things we can't do because we don't have anyone to follow up (for example, splinting/orthoses). Perhaps the U Ghana OT program can begin to work with the school too and we can coordinate interventions so that when we leave they can continue with the plan.  The connection may also provide new teaching and/or mentoring opportunities for VCU's OT doctoral students: in addition to working with kids, the summer program could also include a chance to teach a seminar at U Ghana. So many ways for this program to grow!  While I am not sure I will be able to go on the trip again next summer, I hope that I will at least be able to help do some planning and prepare the next group for their adventure!

VCU and U Ghana OT students!

Monkeys and elephants and hippos....or not

The trip to Ghana wasn't all work.  On our trek south to visit the Slave Castle in Cape Coast, we also made our way to the Kakum National Forest.  Kakum is a 145 sq miles of protected tropical rain forest.  At the park we did the canopy walk where we walked across bridges suspended from the tree tops  almost 100 feet (30 meters) up!  The walkway connected seven tree tops and was over 1,000 feet long!

I don't know about you, but when I thought of Africa, I thought of jungles and wild animals and safaris...you know, The Jungle Book and The Lion King.  Sadly my Disney fantasy of Africa was crushed.  Ghana is not the place to see lots of animals (though the group that went to the more rural Volta region got to go to a monkey sanctuary!).  There are supposedly forest elephants in Kakum but we didn't see any.  I don't even remember seeing any birds!  The park ranger explained that many of the animals in the forest are nocturnal.  The park offers an overnight visit in a tree house with a guided nocturnal tour.  If I ever go back I'm definitely going to do that!

But despite my disappointment at not seeing any cool animals, it was still pretty amazing walking through the trees.  If you're afraid of heights, this is not the activity for you!  The walkway was constructed of a metal frame with wooden planks over it...in some parts the planks were broken or there was clear sign of repair work - not the most reassuring thing to see when you're so far from the ground.  

All in all, it was a nice day away from the hustle and bustle of Accra, nice to get some fresh (ok, it was insanely hot and humid and it felt like I was breathing underwater and it was not refreshing at all, but I'm assuming the air was fresher there than in the city).  Interestingly,  most of the other people at the park were school groups. Even in Ghana, learning about the environment and the natural world is important.

Everything relates back to football

Cape Coast, Ghana

I just finished watching the last World Cup match of the evening - Japan vs. Ivory Coast - and I was reminded of the field trip we took to Cape Coast (about 2 hours from Accra) to visit the Slave Castle there. During the game, Predrag mentioned that he was surprised that so many Ivorians made it to Brazil for the World Cup.  I thought about it for a moment, and I wondered if the fans had actually come from the Ivory Coast or if they were Brazilians of Ivorian or West African decent cheering on the team?  During the tour of the Slave Castle, I learned that 1/3 of the slaves from West Africa were shipped to Brazil. Thus even today, a large portion of the Brazilian population is of West African decent.

Cape Coast Slave Castle

Cape Coast Slave Castle

The Cape Coast Castle was built in 1653 as a Swedish outpost for the timber and gold trade.  Over the years, the castle changed hands many times: Denmark, Netherlands, and England all had possession of the castle at some time or another.  Eventually, the castle became used as a holding place for slaves before shipment to the New World or Europe.

dungeon entrance

dungeon where hundreds of slaves were held

The last stop before being shipped off

 It was very eerie walking through the cells and dungeons.  The guide pointed out deep indention in the rock floors where the slaves' chains dragged. The cells didn't have toilets or sanitation, the guide explained that when the castle was in use, the floors were covered in excrement.  At one point we were in the cell used for punishment and the guide turned off the light so we could get a better sense of what the slaves experienced. It was terrifying.  He told us that slaves died within 24 hours of going into the cell, that it was cheaper for them to suffocate in a hot, airless, cramped room, than to waste a bullet shooting them.

We're all aware of the history of slavery in the U.S.  It was really interesting to learn about it from an African perspective.  While I went into the castle almost with a feeling of guilt that my ancestors could treat people that way, I learned that EVERYONE was involved in the slave trade. Africans themselves were selling prisoners of their tribal wars.  The castle museum explained it very simply that slavery was accepted practice throughout the world at that time - the slave trade was a lucrative business and everyone wanted in on it.  I'm not sure if that made me feel better or worse - that most people thought it was ok to treat others so inhumanely, but it at least gave me something to think about, another way to view the situation. It was a powerful experience.

Taking the tour, walking down the stairs to the dungeon, I realized that many people with physical disabilities would not be able to experience this important site in history.  The castle is completely inaccessible to wheelchairs and the uneven surfaces would make it nearly impossible for someone with difficulty walking. It is so easy to take for granted the laws in the U.S. that require accessibility for all people.  It is not until you experience a totally inaccessible place that your realize how fortunate we are here.  Occupation, doing things that you find meaningful, is what makes us human, it is a requirement for life.  But travelling around Ghana, I learned how limited the occupations are for people with disabilities.  There are those few gems like the New Horizon School that advocate the abilities of all people, but overall, the country is still a long ways away from being disability-friendly.  But I don't know how to change it.... even making the roads and sidewalks easier for those in wheelchairs to navigate is an impossibly daunting task...it would require a complete (and expensive) overhaul of the road infrastructure....

But then I think about the slave dungeons and see how far the world has come.  I bet some slave owners couldn't envision the economy working without slavery, yet slavery was eventually outlawed and the economy adapted.  Perhaps I am being shortsighted with my pessimism of Ghana, I hope I am and I hope Ghana can find a way to accept people with disabilities and adapt their country to allow people with disabilities to live lives full of occupation  :)

But to end on a happy note:  The girls in Ghana loved to do model-like poses when you took their pictures, so I thought I would do the same:

the beach outside the Slave Castle

The streets of Accra

relaxing at the hotel before
heading to church

The director of the Grace School is also a pastor at a Baptist Church in Accra.  He invited us to his church on Sunday and to accompany his wife to her youth ministry and feeding program for a community of "street children."                                                                                                                                             Church in Ghana is an event.  It was fun to see the women decked out in their beautiful and colorful dresses. In honor of the occasion I even blow-dried my hair (the only time in Ghana I bothered to do so!)  I have been to Baptist services before and I have been to gospel services before, but this was something different.  The service was both in Twi and translated into English (I'm not sure if it was on our behalf or if they always do it in both languages).  Church was a participatory event - there was no just sitting and listening, people were up, moving around, speaking their faith out loud, singing.  You could tell that the people were really "feeling" it.  While there were some familiar aspects of the service: there was a sermon, the choir sang, offering was collected- it was really different than other services I've been to.  There was no benediction or lord's prayer, and rather than passing around an offering dish, everyone walked up to the front to drop their offerings and there were two rounds of offering.  My favorite thing about the church were the people who were assigned to walk up and down the aisles and make sure no one fell asleep :)  In a hot room made hotter by lots of people (there was no air conditioning), I definitely felt myself getting drowsy just from the heat.

the feeding program

After the (2 hour) service, we drove to a nearby area that is home to some of Accra's poorest of the poor. The pastor's wife goes there every Sunday to teach bible study to the kids and give them with a meal.  We went to provide shoes to the kids - we were lucky to have a huge suitcase filled with donated shoes for this occasion.  The kids were happy to see us.  The bible study took place under a sort of pavilion to keep out of the sun.  Kids sat on cardboard and old blankets while the teachers read them bible stories and quizzed them on what they had learned the previous week.  After the bible study, food was served.  

I have pretty strong views on religion and I respect other people's beliefs, but I've always had a difficult time with proselytizing, which is basically what was going on here.  From what I could tell, the kids attended in order to get food.  I'm not sure they really understood what was being taught to them.  However, the experience was a good reminder for me that my role as an OT is not to impose my views or beliefs on the client.  Client-centered practice is a big thing in the OT world.  It means we assess and intervene within the context of the client, we take their lead on what is important to them and work WITH them, not ON them. So while I may not have agreed with the bible-study part of the feeding program, I understood that it was not my role to change that and that I needed to work within the context of the children's lives...and this was their context.  That being said, I observed the bible-study, even participated a bit in some of their songs.  But what I enjoyed most was being able to interact with the children afterwards.  They loved the attention we gave them, they loved having their pictures take.  Half of our group played with the kids and kept them entertained while the other half worked on fitting them with shoes.  

The kids loved their new shoes - many of the boys even got soccer cleats (soccer is HUGE in Ghana).  We noticed that some of the kids immediately took of their new shoes and put their old shoes back on.  Come to find out, they wanted to keep their new shoes clean so they could wear them to school.  Initially I thought that these were kids living alone on the street, but after speaking with some of them, I realized that they actually lived with their families.  In Ghana, many people come to Accra from rural parts of the country looking for work.  Many families then find themselves essentially homeless and they take shelter in communities like the one we were in.  Despite the circumstances, the kids seemed pretty happy.  It was nice to be able to do something for these kids.  

Did someone say jigsaw?

The school's logo

My favorite part of the trip occurred during the second week when we worked at New Horizon Special School.  The school was founded in the '70s by Salome Francois who had a daughter with special needs and no school would take her.  Mrs. Francois is in her 80's today and still active in the school - she is by any standards a very progressive and amazing lady. The school provides education for kids with disabilities and a sheltered vocational training center for adults with disabilities - and this is in a country that stigmatizes disability!  I was so impressed with this school and their mission!  More info about the school can be found here:  http://www.newhorizon-school-gh.com/about.html

fixing an armrest

We were at the school for two and a half days and focused on adapting equipment and seating/positioning.  This was our time to bring out our inner MacGyver's and let our creativity flow.  We packed kits with all kinds of tools and supplies in anticipation of our work at New Horizon, including foam, 3-in-1 oil, velcro, and lots of duct tape (I would love to know what TSA thought when those bags went through security!).  The school identified some needs that they saw and we also went through each classroom and identified other areas where we thought we could help. We were fortunate to have an OT who specializes in feeding on our team so she led feeding assessments and advised on feeding strategies and equipment, and adapted utensils to make them easier to grasp.

We cleaned up and repaired most of the school's wheelchairs: fixed breaks and fixed and adjusted foot and arm rests.  We didn't know this at the time, but the school was getting ready to ship their wheelchairs out to pay for repairs so they were enormously grateful that the expense was no longer necessary.  Next year the plan is to provide wheelchair repair kits to the school along with some basic training so they will be able to maintain them and make adjustments themselves.  It's all about sustainability:  we can come out and do it for them once a year, but it's even better if they learn to do it themselves!

cutting board for wheelchair seat

It appeared that most of the kids had donated/hand-me-down wheelchairs.For kids who just used them for transport (ie moving long distances but they can walk and aren't in their chairs all the time), the fit of the chair isn't as important as it is for kids that rely on their chairs for daily activities.  We found a few kids who were way too small for the chairs they were using.  Their positioning was incorrect and it affected their ability to engage in daily activities such as eating and writing.  For these kids, we got out the big guns...or more precisely the jig saw.  We cut boards and built new seats with foam and duct tape to elevate them in their wheelchairs, provide better cushioning (to prevent pressure sores), and allow for more trunk stability and better positioning.  It was pretty amazing what we accomplished in such a short amount of time.

my favorite student at New Horizon
with his new pimped-out chair.  Check out
the flashy footrests!

In my classes last year, we talked a lot about the importance of good positioning but it was't until I was able to see bad positioning at New Horizon that I truly understood not only what it looks like, but its importance for daily occupation.  So much of what we did on this trip solidified what we learned in class.  At New Horizon in particular, we were forced to think outside the box, a skill that is important to be a good OT.  We didn't have a textbook to tell us what to do, we assessed what the problem was, looked at what supplies we had available and figured out a way to improve the situation with what we had.  This type of thinking will come in handy in any practice as we (or the client) will not have unlimited funds to purchase the fanciest innovations and interventions.  In many situations we will have to adapt with what we already have.  This experience will serve me well for the rest of OT-school and for my career as an OT.

In addition to adapting equipment, we also conducted a training session for the school's staff on performing correct transfers (ie moving someone to/from a wheelchair to another seat or floor). The staff has do transfers on a daily basis, even multiple times a

Transfer training

day and it is really easy to hurt your back if you don't do it correctly.  The staff was really receptive to the training and even recorded it for future use.  This was yet another situation of learning about transfers in school but not actually understanding the relevance and importance until I experienced in a real setting. I really really really loved my time at New Horizon.  The kids were wonderful, the teachers were wonderful. I learned a lot, they learned a lot. Our services were well received and I feel that our advice will be taken and interventions continued even when we are gone. yay!  I love OT!

One of many inspirational posters throughout the school

Thank you card from the students and staff