Ghana

Letter from Dr. Gieser:

Dear Friends,

Once again a small patch on the globe has dominated our thoughts for a couple weeks. Marge and I have been immersed in the culture of Ghana, a country the size of the British Isles, located under the hump of Africa near the equator. Kwame Nkrumah led a peaceful revolution against the British that brought independence in 1957. He started his rule as a spirited and creative visionary but was thrown out in a military coup in 1966 after turning the country into a Marxist police state and driving the economy into bankruptcy. A try at civilian rule was followed by another military coup which was followed by another try at democracy, which was again followed by another military coup. This group of generals was so corrupt that a junior grade officer, Lt. Jerry John Rawlings, led a revolt that resulted in the execution of eight officers by a firing squad on a prominent hill on the outskirts of Accra, the capital. Rawlings actually called for elections (ran successfully) and was elected to be President for two terms over a period of ten years. An election in which Rawlings did not run occurred just before our arrival. He is a respected ex-president, living in Ghana. This is almost unheard of in Africa.

We stayed in the home of Jude Hama, a Ghanian, that we adopted while he was a student at Wheaton College. We ran together each Sunday morning at 7:00 a.m. for the two years that he was in town.

I taught at the Korle Bu Teaching Hospital, the major teaching hospital, of the Ghana Medical College and at the Emmanuel Eye Hospital started by an American ophthalmologist, but now run by Ghanian doctors. There are no retinal specialists between Cairo and South Africa. An indication of the status of healthcare is the statistic that only 50% live to their 50th birthday. One of the delights of the trip was working with Dr. Steven Akafo, a bright, eager man in his 40s who does some scleral buckles for repair of retinal detachments and may well become Africa’s first vitreoretinal specialist. We hope to get him to Wheaton to learn about our standards of care, complex vitrectomies, patient flow, and office design.

One quickly judges the status of retina care by the location and state of the indirect ophthalmoscope. At the teaching hospital there was one dirty scope with one functioning ocular located next to a chair that did not recline. The vice-president of Ghana’s wife came to the Emmanuel Eye Hospital with bilateral floaters from bilateral posterior vitreous detachments. As I was cleaning the oculars on the one indirect ophthalmoscope, one ocular fell on the floor. I examined the vice-president’s wife with one eye. I do not think she had a retinal hole. They have eight indirect ophthalmoscopes at the teaching hospital but cannot use them because the light bulbs are not part of the budget. I have not seen a reclining chair in the Third World. The patients are usually examined in a kitchen chair.

Eight of the fifteen ophthalmologists in this country of 17 million have completed a complete residency. Unfortunately much of their precious time is not spent in direct patient care. The great completed controlled eye studies that are the basis of our care are unknown to these local ophthalmologists. I left summaries of the completed studies.

The care of glaucoma is simplistic. The care is regulated only by the tension and not by the appearance of the optic nerve or visual fields. I saw one patient that had had bilateral filtering procedures followed by a placement of a valve in one eye that had normal optic nerves.

Marge’s creative engine sputters when the air temperature approaches her body temperature. She spent most of her time reading or capturing the colorful activities of the area on film. Kodak loves her. She should publish a book on children of the world.

You tend to worry about dangerous germs or armed bandits when thinking of traveling in developing countries. The real dangers are road hazards. The scariest moments of this trip were on a three-hour trip, in darkness along the border of Togo, on a road with borders that were as irregular as a bread knife. We were following a large truck and noted a smoking rear tire. As we started to pass the truck, there was a loud bang as the tire exploded, sending a large piece of rubber flying in front of our windshield.

We visited Cape Coast, a city founded by the Portuguese in 1450. A large stone castle guards the shore that is best known for being a center of the slave trade. Stories are still told of the brutality and death that occurred in the windowless dungeons on the ground level. This trade of human flesh died out after the British banned the slave trade in 1806. The genocide in Rwanda where 800,000 people were killed in 1998 in central Africa and the barbaric activity of a pack of rebels in Sierre Leonne, 200 miles to the west, where limbs of women and children were hacked off, reminds us of an evil flame that reoccurs throughout history.

Friday and Saturday are funeral days in Ghana. Dozens of hearses pull up to the main morgue in Accra on Friday afternoon to take the recently deceased to their home village, which may be 100 or 200 miles away. A common site in rural Ghana if you are traveling on a Friday or Saturday is a group of people in black or red on the way to a funeral ceremony. We attended a funeral of a 90+ year old man who was the father of a prominent pastor, in a village that was located one hour by care off the paved roads. About 250 people dressed in their best finery sat under tents in the tropical sun to honor this simple, kind farmer who had led an honest life. Those presiding were dressed in suits. I was surviving in a short-sleeved shirt with a bottle of water nearby. A choir in robes was accompanied by a band that included two on percussion, an electric keyboard, a guitar and a trumpet. We left before the feast that the village had prepared for guests.

Jude Hama took us to the highest peak in Ghana and insisted on racing to the top. I was really impressed as he blasted past me at the start, like a rocket. He sat for a moment at the top under a large rusty cross set in cement and then staggered down the hill about 20 yards and collapsed. He was coughing, breathing hard, and complaining of chest pain. I was wondering how I was going to carry him down the hill. Fortunately, he recovered. He blamed his collapse on a recent bout of malaria.

The high point of our visit to Cape Coast was actually a high point. A national park is located about 20 km from the coast. It is known for two things: 600 species of butterflies and a 360 meter cat walk located up to 100 meters above the forest carpet. Cables are stretched between seven tall tress that form a circle. You walk on something that looks like a narrow aluminum ladder with a strip of plywood down its center. Nylon netting keeps the unbalanced from flying to the ground. You feel like a monkey sitting at the top of a tree viewing the tropical forest far below.

I eat about a bushel basket of food a week. Due to our careful hosts and God’s grace, I ate a couple baskets of food in Ghana and never got sick. We rarely taste fruit as it is created in America. Pineapples, papayas and oranges directly off the tree are as sweet as candy. Drinking from a freshly cracked coconut when you are thirsty is a truly tropical experience.

Jude’s wife prepared great meals. Breakfast included hot cereals that include something like oatmeal, a dish of toasted ground corn with peanuts, and another dish using fermented cornmeal. Fufu is a dish made from pounded cassava root and white yams. A thick, white, sticky paste is served in a loaf that is then placed in a sauce of tomatoes and onions. Smoked fish and chicken are added. What a feast!

Ghana may be the nicest country we have visited. The people are genuinely kind and helpful. In spite of almost 20 years of political stability, the economic progress has been painfully slow. Obviously the legal environment has not given enough security for investment from international businessmen, although the potential for sales is high in most sectors.

We look forward to the day when investment dollars compete for markets in Ghana, the life expectancy equals the retirement age, and we match the Ghanians in joy and hospitality.

Cordially,

Richard G. Gieser, MD