31 July, 3:30pm EST - Dulles, Virginia

I've just arrived at my gate in Dulles airport. I've got 32 lbs of donated reading glasses (645 of them, to be exact) plus 10 lbs of food in my suitcases, so hopefully they'll arrive unscathed. I've spent my day here watching Olympic men's foil semifinals, eating Jelly Belly jelly beans, and planning a trip to Amsterdam for my layover there. The traffic was nonexistant, and I enjoyed a long conversation with the shuttle driver about how volunteering abroad changes your perspective on how privileged you really are, and about how high schools should teach a class on how to get a job and manage your savings. I got to skip the long line for KLM/Air France because I checked in online, the TSA agent gave me a fist bump for going to Amsterdam, and now I'm enjoying my last slice of NY style pizza while listening to Billy Joel play over the PA system. So far, so good.

Upon hearing that I decided to take this trip, most people assume that I must be interested in ophthalmology as a career. In fact, I’m probably the only person on this trip who isn't planning on or already attending med school. I had originally intended to study abroad this summer, taking HIV/AIDS and public health courses for six weeks at the Danish Institute for Study Abroad (DIS) in Copenhagen. I applied to and was accepted to the program when a listserv email popped up in my inbox announcing that Unite for Sight was accepting volunteers. Here was yet another opportunity to study preventative medicine abroad, but in a starkly different culture and in a way that helped someone more than myself. I had looked into the “Alternative Breaks” programs at the University of Maryland before, but they seemed more like a chaperoned learning vacation than an opportunity to get your hands dirty and help out. Unite for Sight instead required all the training to be done at home, then threw the volunteers out into the field to learn about the culture by doing. I had only taken one volunteer trip before: to Biloxi, Mississippi in 2008 to reconstruct houses demolished by Hurricane Katrina. Since then, I'd been itching to volunteer again in a way that will really make an impact. I started scouring the net, shopping around for a volunteer trip that was as intensive, intellectually stimulating, and productive, yet somehow Unite for Sight, the program that had fallen into my lap, won out. I applied, was accepted, and turned down my offer from DIS over the next week.

I also have some family history in helping the blind. My great-grandmother Lillian Fletcher had congenital cataracts, taught at Perkins School for the Blind, and was the personal tutor of Edith Thomas, a blind deaf-mute who was the best friend of Helen Keller. She and Anne Sullivan were coworkers who both face the seemingly insurmountable task of teaching a blind deaf-mute to speak while also being blind. However, only Anne and Helen went on to be famous, as Edith Thomas died at a young age due to her parents' poverty. You can read her story here. After Edith Thomas died, Lillian had her cataracts removed by an experimental new surgery, which restored her eyesight in one eye. She then took a boat to Hawaii to become governess.

Lillian Fletcher and Edith Thomas

Lillian Fletcher teaching a blind girl.

First, a bit of background about the program I'm about to join. Unite for Sight's mission is to eliminate preventable blindness. Since 80% of all blindness is preventable or curable, this means that 36 million people worldwide are needlessly blind. Unite for Sight reaches this goal by sponsoring each surgery, including post-operative care; paying the salaries of outreach staff; purchasing supplies as needed by the clinics; and sending volunteers with eyeglasses to each country to help with outreach clinics. I will be joining the ranks of nearly 8,000 volunteers trained since the program started in 2006, who have helped provide care to over 1 million patients and raised funds to sponsor surgeries for 45,000 of them. Ghana has a low density of ophthalmologists per patient, so each ophthalmological surgeon in Ghana needs to perform 1066 sight-restoring surgeries every year to reach the WHO's 2020 vision goal. Surgeons who are funded by Unite for Sight have their work streamlined by volunteers, so they perform 2500 surgeries per year on average.

Unite for Sight has programs abroad in Ghana, India, and Honduras. I chose Ghana to expand my cultural horizons the most. I plan on vacationing in India someday, and I hope to visit Latin America to volunteer later on, but I had never imagined I would travel to Africa. The food, the language, the climate, and the customs were completely foreign to me, so what better place to visit when traveling alone for the first time? I’d always felt that the my college, major, and roommate were easy and comfortable choices, so I chose this trip as the first time to dive head-first into the unknown.

While I’m there, I will be helping local doctors see more patients at outreach clinics by helping to run stations at the clinic which don’t require a medical license. The goal of these clinics is to reach more patients than was possible without volunteers, yet to still entrust diagnosis and treatment only to medical professionals. Ghana has about one ophthalmologist for every two million people, so the volunteers help each ophthalmologist reach thousands of patients each month rather than the few hundred that could make it to their clinic. Each outreach visit is made by a clinic, not just the volunteers, so that patients will have regular (they aim for monthly) visits from a local doctor and nurses that speak their language. Hopefully, this will teach patients to trust this doctor for their eye care, not their local traditional medicine man.

Before I begin, I would be remiss if I forgot to thank everyone who made this happen. In order to get here, I completed dozens of hours of training about eye health, cultural sensitivity, global health practices, and Ghanaian culture provided by Unite for Sight. I shadowed an ophthalmologist, Dr. Iliff, for two days. He was considerate, insightful, eager to help me learn, and shadowing his surgeries and clinic consultations was an unforgettable experience. I had to fundraise $1800 to pay for 36 cataract surgeries, which I did with help from my sister, who helped me put her beautiful floral photography on notecards to sell; Pilgrim Church, whose members were more than happy to donate and included me in their announcements; and my family, who put up with all my prep work and helped me reach my funding goal. Finally, I paid for my ticket and supplies from a grant from my late grandfather for travel abroad.

Thank you, donors. Thank you, Dr. Iliff. Thank you, family. And thank you, Granddad. To Ghana!

1 August, 10:00am GMT +2 - Amsterdam

My flight landed at the Amsterdam Schiphol airport a few hours ago. I spent the flight trying to sleep, which a melatonin pill and a window seat made possible, but 6:00pm-1:40am EST is not my normal sleep cycle and was interrupted by meals at 8:00pm and 12:00am EST. Over dinner, my seat mate struck up a conversation with me because we both ordered the vegetarian option (which means you get your food first AND it's really good) and it's rare that either of us sits next to another vegetarian. She was a cheery South African woman in her late forties who had moved to Falls Church, married an American man, and was now flying to the Netherlands to watch her nephew perform in an opera.

When my flight arrived, I searched to no avail to find an arrivals gate listing, which was neither online nor on the computer screens. I was supposed to meet Lianna, another volunteer, at her gate when her flight from Portland, OR arrived at 8:30am, so I wandered around the airport a bit and settled at a lounge where I could email her. Wifi is free for two 30-minute sessions in AMS airport, which was just enough for me to find her but not enough for me to post my blog entry. I had planned to take the train into town to take a canal tour and walk around the area enjoying the sights (the red light district, the Anne Frank house, the Van Gogh museum...) and local food, but my exhaustion from the red-eye and the fact that boarding for KLM flights from Amsterdam takes 1.5 hours lead me to bide my time in the airport. I will definitely come back here to see the city, but I'll spend the night instead.

This is by far the best airport I've been in for a long layover (and this 7.5 hour layover is the longest I've ever had). At the moment, I'm watching Micheal Phelps win silver in the men's 200m butterfly (live coverage, finally) with a giant cappuccino  There is a wide selection of fast and slow food, a museum, a library, a playground, a hotel where you can rent a room by the hour or pay for just a shower, perhaps a dozen spas, and cozy lounges for charging your laptop or taking a nap. We met one gentleman who had missed his flight back to Minneapolis because a diplomat had passed through security and they had shut down the security lines for an hour, so he spent the night here, and, honestly, I'm jealous. I could LIVE here. I spent an hour walking up and down terminals exploring and didn't cover 1/3rd of the airport. Also, they were selling dozens of elephant figurines at the museum shop. This place gets me.

.....

I will be posting this blog a bit differently than normal blogs. When I arrived in Ghana, I realized that there would never be constant internet, so posting daily or even weekly was not an option. You'll notice I've switched to past tense, as I'm writing this after I returned from Ghana. I wrote most of this narrative in Ghana, but, as I wrote, I realized that I wanted to include small lessons about Ghanaian culture in each post. I wanted to include as complete a picture of each aspect as I could each day, rather than recording the small tidbit I learned each day. So, I will be henceforth telling a story in present tense, but in each entry I will elaborate on a piece of Ghanaian culture from my story, including all the information I learned about it over the course of the trip. I will be writing it as if I had already learned and experienced every example I include, but sometimes these examples will not have happened yet. I will also be including pictures from each day, but when touching on a cultural aspect, I may include pictures of that piece from across the entire trip. The writing and most of the pictures are my own, but I have used about 150 photos from other volunteers (credit goes to Lianna, Ricarda, Roxane, and Shreya) when they captured something I missed. I've posted these in chronological order so you could read the entries like a book, rather than in the reverse order which blogspot insists upon. The pictures will often tell additional stories to the ones I tell in writing, so check them out if you want to see everything. I've titled each entry with the time I originally wrote the narrative and where I spent most of the day, which I narrow down to the village and region name for outreaches or the suburb and major city name for other days. On driving days, I put our destination city.

So here it is: dozens of pages of notes, two thousand photos, and 21 days of memories boiled down to about 15,000 words and 450 photos. I don't pretend to have learned everything about Ghana in the three weeks I lived and worked there, but through this, I hope to show you Ghana as I experienced it. This is Ghana as I know it.

1 August, 11:00pm GMT - New Achimota, Accra

We've arrived at the Telecentre Bed & Breakfast in Accra. We have A/C, hot water, an electric kettle, and wifi, which is relatively upscale, all for $23/night. This is the first hotel all volunteers come to and the home base of North Western Eye Clinic and Crystal Eye Clinic volunteers. There are three other clinics working with Unite for Sight which are located outside Accra, so their volunteers stay elsewhere. My group (Roxane, Brian, Shreya, Lianna, and myself) will be spending the night here, then going on an overnight outreach to the Eastern Region with North Western Eye Clinic.

Arriving at the Accra airport would have been frightening had I not had four other volunteers on my flight to travel through passport control, customs, and baggage claim with. Before our flight, Lianna, Ricarda, and I met up for Dutch pancakes and smoothies which we got to eat in a booth shaped like a teacup. We met with Roxane and Shreya at the gate. On the flight, the Vietamese man on my right who sounded just like Mr. Pham (my 10th grade computer science teacher) lectured me on how I should "become the doctor". The Dutch couple on my left were visiting friends they had made in Accra when the woman volunteered there for 5 months. While I couldn't get seats next to the other volunteers, everyone spent the flight watching movies and sleeping anyway, so I'll get the next three weeks to get to know them better.

Passport control at Accra airport was surprisingly strict, including fingerprinting and separate officers checking for yellow cards (a form that proves you've been vaccinated against yellow fever, which is required for entry into and exit from Ghana). Baggage claim and customs were a free-for-all with mobs rather than lines; the culture here is that you either assert yourself or get left behind. We pushed our way through crowds trying to carry our bags for us to find Ernest and Jerome, two Crystal Eye Clinic nurses who shuttle all new volunteers to and from the airport. We've arrived!

2 August, 11:30pm GMT - Nankese, Eastern Region

I've been assigned on this trip to work with North Western Eye Clinic, which serves the Eastern & Central regions and has only been a Unite for Sight partner since 2010, and Charity Eye Clinic, which serves and Ashanti and Brong Ahafo regions and has been a partner since 2008. Today, we are on outreach to Nankese in the Eastern Region with North Western Eye Clinic, staffed by nurse Frank, driver Seth, and ophthalmologist Dr. Kye. Over breakfast, we met the other volunteers in Telecentre who are working with Crystal Eye Center: Brandon, Emily, Sarah, Hussein, Carrie, Diane, and Jeremy. From there, we visited street vendors to exchange money and buy phone credits and water.

The currency here is Ghana Cedi (symbol GHC, pronounced see-dee), which exchange for GHC2.02 per USD as of 7 August 2012, so prices in cedis are about double the value in dollars. Their cents are called pesewas (symbol p, pronounced pehs-wahs). The currency was converted on 1 July 2007 from old Ghana cedies to new Ghana cedis, where 1 new cedi is worth 10,000 old cedis. Still, some people will say their price is 90,000 when they mean GHC9; oddly enough, prices that include pesewas, such as GHC1.5, are always told as "1 cedi 50 pesewas" and never "1 50".

Everyone here carries vodaphone, glo, airtel, or mtn phones, and all four providers distribute crates, carts, and umbrellas to street vendors, so their logos are everywhere. Our phones are pay-as-you-go; minutes are sold as GHC2 - GHC10 scratch-off cards that you can find anywhere and will give you about 5 minutes of talk (even internationally) per GHC, so it's about 10 cents a minute. The volunteer who used the phone before me signed up for a GHC2/month program that doubles every credit I add, so I get to make calls for 5 cents/minute.

As for water, everyone here drinks 500mL bagged water, which comes in packs of 30 for GHC1.5, or 5 cents/liter. We were skeptical at first, but it's surprisingly easy to dump them into empty water bottles (which are GHC1.5 for 1.5L) or to drink them straight once you get the hang of ripping the plastic open with your teeth.

The van was scheduled to arrive at 8am, but we soon discovered "8am pickup" here means "the driver will arrive at some point between 8 and 10am, but expect you to be ready to go regardless". Welcome to GMT: Ghanaian Mean Time. We arrived at the first outreach site to discover that everyone was at the funeral of the local chief, so the outreach was cancelled. Instead, we walked for an hour along the main road of the village and stopped to watch a football game. After driving and wandering around for almost 5 hours, we finally got lunch, which for most of us was banku (fermented dough in a spicy soup) at Chris's Cafe. When we arrived at the hotel, the driver told us he would take us to dinner at 6pm, so we took a walk in the village nearby until then. An hour later, Brian discovered there was a terrace on the roof, so we had drinks there until Frank came up at 8pm to tell us the driver had fallen asleep, so there would be no dinner. We stayed up with Frank until around midnight instead.

Meals here don't seem to be a regularly-scheduled sit-down affair like in the US. Breakfast is often skipped because every hotel serves the same white bread, thin omelette, and nothing else; lunch is normally either non-existant or consists of snacks bought from street vendors; dinner is eaten if we can successfully get out into town, and many places only serve three dishes: jollof rice, banku, and fufu. Thankfully, I brought enough chips, crackers, protein bars, and dried fruit to cover lunch and some breakfasts for three weeks, and it looks like I'll need it.

We are staying at Nananom Hotel, which is dirty and cramped and has no hot water, A/C, functional toilets, towels, or any appliance besides two lights per room. I shared a full size bed with Lianna, and since we both have Sans Bug tents that take up a 6.5 x 3ft bed, we had to put them sideways in order to fit, which was extra fun for Lianna, who's 5'7". The bathroom was a challenge all on its own, since you had to walk through the shower to reach the rest of the bathroom, and the entire bathroom was about 2.5ft wide. Fortunately, our rooms were just GHC10 per person, and we spent most of our time on the terrace or in the village anyway.

3 August, 6:00pm GMT - Osu, Accra

Today was our first real outreach. We spent the morning sorting donated reading glasses by prescription, then headed to a church to set up our clinic. It looked as if word had spread to avoid the clinic (perhaps someone had had a bad experience the last time the clinic visited here), for as we drove around the village announcing the outreach visit, the villagers just stared and didn't follow us. The village coordinator, a local responsible for raising awareness for the event and arranging the facilities, couldn't give us a straight answer for why this was. In the end, we saw 46 patients, which was a mediocre but not terrible turnout.

On each outreach, there is normally a preliminary health talk to explain the purpose of the outreach, common eye diseases and their symptoms and causes, potential treatments, and how to use glasses and eye drops. This is followed by patients rotating through five stations: registration, where their explain their symptoms; visual acuity, where we measure distance vision; exam, where an ophthalmologist measures near vision and examines the lens and retina for problems; research, where any volunteers doing research ask patients survey questions with their consent; and distribution, where we give out glasses and medication, schedule surgeries, and type up the final diagnosis and treatment in a spreadsheet to send back to Unite for Sight. At this outreach, there was no talk, so the patients didn't understand what they were receiving treatment for nor how to administer eye drops. Somehow also, nearly every single patient was diagnosed with refractive error, even if their problem was actually vitamin deficiency or allergies. Nearly everyone was prescribed reading glasses and either eye drops or vitamins, but most only took the eyeglasses since there were GHC1 whereas all medication was GHC7. These are nominal fees charged to give the treatment some value so that patients will treat it with care, use it properly, and not feel as if they are receiving a handout; all the proceeds go towards paying for gas and the salary of the staff so that these outreaches can continue to happen and become somewhat self-sustaining. At the end of the outreach, there was no record of how many glasses or drops had been distributed nor of the amount of money collected, which was worrisome.

The outreach was dominated by older patients, mostly male. There were no children, and Lianna's research, which looks at caretaker's perception of eye health care for their children, revealed that this outreach had mostly grandmothers rather than mothers, and that they for the most part saw no reason to take their children in for eye exams. Of the few women we saw, most of them looked very upset by the experience, and nearly all of them had to leave to get money for their treatment. None of us spoke the language yet, and we received minimal translation help from the staff. I'm not surprised that they were distressed by being treated by foreigners speaking a language they didn't know examining and treating them for problems they didn't understand. Overall, I felt this overnight outreach was pretty ineffective, but hopefully the others will be better organized.

On the plus side, after we returned to the Telecentre, the veteran volunteers who have been here nearly all summer took us out for dinner. They are Brandon, Carrie, Sara, Hussain, and Diana, and they are all leaving before we get back from Kumasi, which is really too bad because they are an awesome crew. Ghanaian culture has shaped them so that everything comes naturally, and so that our clean clothes and our US-made snacks seem foreign and unnatural. I imagine we'll feel the same way after two more weeks here.