7 August, 11:10pm GMT – Anyinasuso, Ashanti Region

We finally had our first outreach with Charity Eye Clinic. We were ready early, so we had time to sit around and watch some local TV shows. We've seen people watching news, sports, Ghanaian CSPAN, and evangelical channels so far, and in the mornings Good Morning Ghana or Ghana's Got Talent is usually playing (I don't know the real names of the shows, but they are equivalent to their American counterparts). The clinic's van that arrived to pick us up has a DVD player and TV, so we watched Rihanna music videos the whole way there and a Ghanaian soap opera in Twiglish on the way back. On the way, we met the nurses: Everest (who mans the registration station) and Eric (who mans the eye exam station), who sang along to all the songs. We had a good turnout of 74 people at this outreach. Dr. Kate opened with a prayer (most of these outreaches are in churches), then we introduced ourselves and got applause from the community when Kate explained what we had gone through to get there to help them. Ricarda and Lianna get to start their research today, so Kate introduced them separately to explain the survey process to the patients. Today is my 20th birthday, and Kate got the whole crowd to sing me happy birthday. It was really sweet.

During the clinic, Shreya, Eric, and I ran the visual acuity station. After registration, we measure each patients' distance vision for each eye by working our way down a directional E chart. If they can't see even the top E, you can wave your hand in front of their face and ask if they can see it. If they can't see your hand, you can shine a light in their eye and ask if they see that. If they can see the hand motion, you hold a number of fingers in front of their eye and ask how many, then change finger counts as you move backwards one meter at a time. Their vision is recorded by the most they are able to see. The worst vision is NLP (no light perception) if they can't see the light, then LP (light perception) if they can. Next worst is HM (hand motion), followed by CF (count fingers) at a certain distance (ranging from 0.5 to 5 m). If the patient can read the chart, you can record them at the vision indicated on the chart at the line at which they can easily indicate the direction of all the Es (these are in meters: 6/60, 6/36, 6/24, 6/18, 6/12, 6/9, 6/6, and 6/5). For instance, if you can only see how many fingers I'm holding up at 3 meters with your right eye, and but can read down to the fourth line on the chart with your left eye, we would record you as VAR CF 3m, VAL 6/18. 6/6 vision is equivalent to 20/20 vision (I have 6/5 in both eyes, which is equivalent to 20/15).

On the way back, we bought fried yams from a hawker for lunch. Hawkers are street vendors who walk along the road with their wares in baskets on their heads. Hawking is technically illegal, but, like having 5 people in a taxi, this rule is generally ignored. It seems like a lot of people have about a meal or two a day from street vendors and hawkers. For somewhere between 50p and GHC2, you can buy plantain chips, sweet bread, dough balls (which taste like donuts), fried yams (which taste like large fries) in hot sauce, bagged water, soda, biscuits, fruits, and other snack foods. Hawkers also sell everything from posters to shampoo to alphabet magnets (each one specializes in one or two wares), so it's kind of like having a drive-thru Target around you any time you're in the city.

Today was certainly a birthday I won't forget, even if it didn't turn out as expected. On the way home, we hit a goat running across the road, which went flying into a ditch and promptly stood up as if nothing had happened. Goats, chickens, and dogs wander about seemingly without owners much like squirrels do in the US. We visited the Vodaphone store in Kumasi, where apparently everyone goes to get their internet, and bought a portable wireless hotspot. There, we met George, who doubled our data limit and gave me free calls to all Vodaphone numbers for my birthday. Alas, the hotspot does not get signal in our hotel, and now George won't stop texting me to ask what I'm up to. We had made big plans to head into town for the night, but getting back to the hotel to change took too long, so instead we're eating leftovers and playing card games in the dining room. Still a good birthday.