5 straight days of diarrhea and weakness earned me two nights in the hospital.
After self-diagnosing malaria and taking the 3-day drug course, I was left without malaria, but feeling totally weak, starving, nauseous, with stomach pains and seemingly constant diarrhea. I went to the hospital and described my symptoms, and the doctor suggested that everything was a result of the malaria medication’s side-effects. He prescribed some vitamin B and glucose powder for energy, and sent me home.
Obtaining the proper drugs is an adventure. You go to a chemical store, show them the script, and pray they’ve got it. You yourself can’t even read the script (which has proven true for the 5 scripts I’ve gotten so far), so you’re basically at their mercy… you take and buy whatever they hand to you. That is, provided they hand something to you. Finding vitamin B required a visit to the hospital dispensary plus two more chemical shops in a nearby larger town. Finding glucose powder required a trip to an additional chemical shop which was open at its owner’s convenience.
Still weak the next day, I tried convincing myself that if I wanted to get better enough that I should just start acting like everything was fine, and go about my day like normal. I went to the beach, went for a few quick swims, and said hello to some friends. This delusion proved successful until lunchtime when I had to think about food again. My stomach felt like there was a monster inside, tearing at the walls, and daring me to try eating something. I tried bread. Diarrhea again. The place I’m staying has a small chemical shop downstairs, so my caretakers provided me with something like Immodium to stop the diarrhea. Immodium is great for the first 4 hours or so, but it turns out to actually harm you in the long run – it destroys the good bacteria in your intestines which reabsorb liquids, thus causing more diarrhea. But, at this point I was ready to try anything, so I took it and laid down to rest. 15 minutes later I was dry heaving, and knew it was time for the hospital. I took a large shot of glucose drink to make sure I’d be able to make it there, sent a child to bring a brother, and we were off to the hospital again.
The family I’m staying with (it’s a home-stay) has proved very helpful during this time. They cook for me and help me navigate local places and culture. It’s a lot different than staying at a hotel or a guesthouse. Its not just a place to sleep and eat, it’s also like a temporary family. They provided people to help carry me to the hospital and brought food to the hospital for me for two days (the hospital doesn’t have a kitchen), and made sure that I was generally taken care of. It was really the best possible situation other than being with my real family. If I was staying at a guesthouse or a hotel, there wouldn’t be these kind of family-like “services”, and I’d be left at the hospital hungry and confused.
Upon stumbling out of the taxi at the hospital, and wandering over to the check-in, I did the requisite weight, BP, and temperature checks. I described my symptoms to the nurse. She told me that my face was thin and she could see the dehydration just by looking at my eyes. “Have you seen yourself in a mirror recently?” she said. “I’m afraid of the mirror these days,” I replied. She told me that it was time to be admitted to the hospital ward and get some IVs going. I was delighted to hear that someone had a plan for my recovery.
Buildings in Ghana aren’t like buildings in the States, primarily because of the climate. In Ghana (at least along the coast here, around 4.5 degrees North latitude), it’s warm all the time. They don’t need heat. And if some of the rich want to use air conditioning, they only need it during the heat of the day. So buildings aren’t insulated, and walls are made mostly of concrete and painted. The climate also affects the way larger buildings are laid out. In the States, a hospital is a big building with many floors, everything under one roof. Here, hospitals are more “open air” buildings. There are rooms or a block of rooms under one roof, but you walk outside to go between the each room. There’s usually a canopy above the “sidewalk” for walking between the rooms. And walking from one group of rooms to another, you follow a canopy-covered path. So going between reception, the doctor’s offices, the main ward, the operating theatre, and maternity, you’re protected from the noon sun and a light rain.
Arriving at the ward, I handed my sickness description card to a nurse (from the previous nurse), and sat and waited. About 10 minutes later my bed was prepared and I had an IV started. Three minutes after that, I was feeling great. The stomach problems disappeared and I could feel my blood warming up.
I should say that until this point, I was really disoriented at the time, and my friend/brother (the son of the mother of the homestay) was really doing all the work. He stayed focused and told me “sit here” and “let’s go over here” and what to do. Without him, it would have been a really difficult time.
The nurses were really friendly (and cute) and the doctor was friendly too. It didn’t strike me as strange until the next day that everybody working there was very young. Some enquiries revealed that the oldest person in the ward was 25. The head nurse, around 40, left some short hours after I arrived, and didn’t return until the work week began again.
Dixcove hospital was one of two hospitals in the area, it turned out. Since it was closer (10 minutes taxi ride as opposed to an hour of “tro-tro”* hopping), I went there. The other hospital, I was to find out later, was comparitively much more expensive, but had many more resources and could provide “better” treatment.
[* A tro-tro is a privately driven minivan, usually in poor to decrepit shape, which follows a popular fixed route and stops to let people on and off. They’re cheap, convenient, ubiquitous, and not too unsafe (any vehicle in traffic faces the same problems here)]
As the darkness descended, the clouds let loose and we enjoyed a torrential downpour for about 15 minutes. This cooled the air to a fine temperature. One side-effect of being far in the bush however is that electricity is often on precarious grounds, and rain and wind are all that’s needed to upset the balance. The lights went off around 7 pm. A child cried. A nurse came in soon after with a kerosene hurricane lamp and searched for places to leave it. She settled on hooking it to a bed-end, leaning against a foam mattress. “Good move,” I thought. As she brought in the second lamp, she proudly proclaimed what I like to think of as the hospital’s motto: “Dixcove Hospital: This is What We Have!”
Let’s have a summary of the situation. I was in a room with 14 beds, 4 of which were occupied, but one guy died from head trauma, so he was moved to the morgue. Another guy got into a fight and got cut with a knife between his eyes, along his nose, on his upper lip, and across one side of his neck. He seemed to be recovering well though. There was also a boy of 12 or so who was recovering from “I don’t know” as he said. And there’s me, dehydrated and supposedly recovering from malaria. (Did I ever really have it, or was it just food-poisoning?) There’s no electricity, but there is a large generator, but no fuel (“its not an emergency” – true enough). Remember about the open-air construction – although all the doors and windows have screens on them, mosquitos still sneak in. No mosquito nets on the beds. Seems strange really – they tell you to sleep under a treated mosquito net, and then when you go to the hospital, they don’t use them. Also, there’s no running water. Nowhere near the place actually, but most hotels and guesthouses use a water pump into a well. (“This is what we have…”) This means that showers and toilet facilities are of the traditional nature – a bucket and a room for a shower, and a hole in the ground for your toilet.
The first night passed by in 2 hour blocks. I only remember hearing one mosquito the whole night. When I woke up the fourth time, I had finished a second IV and felt pretty good, except for my stomach. When my family arrived with breakfast, the tea went down easy, but it was all I could do to force a couple slices of toast down.
As the day went on, I became bored and decided to walk around. Now on my third IV, and still attached to the IV pole, I picked up the pole and walked towards the TV room. The nurses, doctor, and standers-by were quite taken aback by this – they weren’t used to people walking around with their IV pole. I explained that I wanted some exercise, and that the IV poles in the States have wheels to make this easier, and that it was fine. I got a tacit approval, and continued on to the TV. The looks I got were quite funny on the way. “What is that white man doing out of bed with that IV pole?” they were thinking. Some people even tried to stop me, threatening to tell a nurse or doctor. “Let them try!” I thought.
My “family” brought lunch and dinner, and each successive meal went down easier. My stomach was becoming familiar with digestion again. Shortly before dinner however, I noticed that my left hand (the one near the IV) was becoming swollen. I asked them to take out the IV, as my veins were soft and the IV was likely to have slipped out after the past 24 hours. “This is Africa. We don’t have another needle… this is what we have.” So I asked them to just take it out altogether, and I could start on some ORS (oral rehydration salts – basically electrolytes). This also made mobility easier.
The second night passed without incident, and I awoke the next morning feeling pretty good. Breakfast was still a little shaky, but the doctor discharged me, and I paid the bill:
Two nights in the hospital: 52,100 Ghanaian Cedis
3 IV bags: 30,200 Ghanaian Cedis
1 nausea injection: 9,600 Ghanaian Cedis
1 worm tablet: 3,000 Ghanaian Cedis
2 oral rehydration salts: 3,000 Ghanaian Cedis
Total: 97,900 Ghanaian Cedis = US$10.62 (not bad)
Three days later my stomach is feeling perfect again, and I’m back to work on the computer. Thinking back on that hospital, with its friendly people and cheerful motto, I realize that despite the limited resources, the people there really do make due with what they have, and patients do get better. Not only that, but where in the States can you stay at a hospital for two nights and pay US$11, whether you have health insurance or not? Granted, for more serious issues, like the guy with the construction accident – a corrugated iron sheet fell from above and cut into his brain, who was to be airlifted out to the country’s capital Accra – this hospital just wouldn’t do. But though unnerving at times (I’m older than everyone there, and they ran out of IV needles, and the power went out), I’d choose to go back there if I had the same problem. They handled my sickness with professionalism, concern, and friendliness, and most importantly provided quality health care.
Something is also to be said for these homestay kind of arrangements that are not to be found in the States. Without an adopted family, I’d have been pretty screwed. Three times a day they walked hot food on a 20 minute walk to me, let me knew they cared, and that things were going to get better. One person even stayed with me for most of the time in the hospital to make sure I got along OK. It seems to me that in the States, since we are always so busy, our culture has put more importance on working and money. The “family” services I enjoyed here in Ghana are just that – “services” in the States, and we pay dearly (much more than US$5/day) for that. Which one is better? Neither, they’re just different. I’m just glad I was taken care of!
My idea was to spend some time on the beach, doing nothing more than enjoying the beach and doing some programming. I arrived and checked-in to Elizabeth’s Homestay, a place I had been to about 1 month before, and was given a warm welcome back.
Elizabeth’s is set up like a compound – there is a central courtyard around which many rooms for family members (most of which are full), and in the one building that has two levels, there are some extra rooms for guests to stay in. Downstairs, there is a small chemical shop (Ghanaian English for “pharmacy”). It is situated in the middle of a small village called Busua, and its about 200 yards from the beach.
As a guest at Elizabeth’s, you’re automatically a member of the family – a feature which worked out very well when I fell sick with malaria/food poisoning (see the post entitled “This is what we have.”), and which you can’t get at a guesthouse or hotel. The operation side of things is smooth. You wake up, walk out onto the 2nd floor veranda, order your pancakes and fresh fruit or omelette sandwich. 
You’re on your own for lunch, but for dinner they’ll prepare any kind of local dish, or even foreign dishes according to your specs (provided the ingredients are available). Fresh lobsters can be obtained at a relatively expensive price of US$6/pound (you wouldn’t come to Ghana just to eat lobster, would you?), and Elizabeth or her family members will boil it up for you.
Busua Beach is on the brink of becoming a tourist town, but it doesn’t have many tourists. Many hotels are there, and you can stay in any amount of luxury (or lack thereof) you want – prices go from US$4 for a room with a bed to US$80 for a room with everything you could possibly ask for). 
You can rent surf boards (a project recently set up by a returned Peace Corps volunteer from Bolivia) and kayaks, lie on the beach and soak up the rays, or swim out the 45 minutes (my pace) to the island (be careful of the sea urchins!). If the beach can’t hold your attention for more than a couple days, you can also spend your time interacting with the locals. 
There’s a junior seconary school (grades 7 – 10) you could get involved with (maybe after school activities?), seemingly regular football matches in the “park” or on the beach, and few local artists and artisans producing paintings, carvings, and postcards. Or, you can walk 20 minutes over the hill to Dixcove and check out one of Ghana’s slave castles (sadly currently being converted into a hotel).
As the beach never could keep me entertained for too long, I swam in the mornings, got breakfast, and got to work doing some programming. A lovely French couple who own the Busua Inn let me work on their terrace which overlooked the beach. That was wonderful, until I got malaria/food-poisoning.