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Jessica Davis and Amanda Binkey are sixth-year Pharm. D. candidates at Ohio Northern University who have traveled to the city of Accra, Ghana, to complete an elective international Advanced Practice Pharmacy Experiential (APPE) rotation for September 2012.
While on this rotation, they will be staying with Daniel and Cynthia Amaning and their family. Daniel is a pharmacist who owns several independent pharmacies called "FamilyCare Pharmacy" throughout Ghana. He is also on the pharmacy council of Ghana.
Cynthia is also a pharmacist and she teaches at the Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana.
During their stay with the Amanings, not only will they be learning about healthcare and the practice of pharmacy in Ghana, but they will also be learning about the culture including a variety of foods, local dialects, and general lifestyles. They will be posting blogs as regularly as they have electricity and would welcome any questions at firstname.lastname@example.org and/or email@example.com.
September 27: Goodbye Ghana
As we prepare to board our separate planes bound for the U.S. (Amanda) and Rome (Jessica), we’re left sitting here thinking about our experience. Both of us agree that we’re extremely thankful to have had the opportunity to not just visit another country while we’re in pharmacy school, but to actually get to live and work in one. Each of us are looking forward to returning to consistent electricity, hot running water, perforated and soft toilet paper (except when Cynthia goes to buy some especially for us), and our American food covered in cheese, sugar or salt. We miss American television, normal grocery shopping, fast food that doesn’t come from someone’s head or roadside shop and ice (specifically iced coffee). However, with all the stuff we miss now, we both have a feeling we’re going to miss more about Ghana once we leave.
Man carrying plantain leaves on his head
Children carrying fufu making equipment
This marvelous country is filled with the most unique culture we’ve ever experienced. I know we’re going to miss the liveliness (Accra is a lot busier than Ada ever will be), the colors, the sounds (especially hilife music), the dancing (azonto!), the smells (not the sewage, but the fresh trees and fruits), the lifestyle (Jessica’s adjusted to the laid back atmosphere, even if Amanda’s still not completely used to it), and most importantly we’re going to miss the people. Daniel and Cynthia have been extremely gracious hosts; taking the extra time to make sure we’ve felt at home in their home and giving us the ability to experience anything and everything we could. The rest of their family will also be missed as they’ve become like our family. Hang out time in the kitchen back home will never be the same with a group of people hanging around to watch us make mashed potatoes or scrambled eggs.
Jessica with Michael and Martin
Bright being a wonderful driver, like always
We’ve also made friends outside of the family. It’s honestly going to be strange not seeing Bright every day to every couple of days. He’s become just as much our preceptor as Cynthia and Daniel have. And of late we’ve also made friends outside of the pharmacy realm, whom we know we’re going to miss being able to hang out with. However, we’re not just going to miss the people we’ve met, but we’re going to miss the people in general. Ghana is a community-based, caring and extremely extended-family-involving lifestyle. Like we’ve mentioned before, everyone cares for everyone else and the sense of camaraderie runs deep.
Amanda showing some kids a picture she took of them
Sunset from the hill above Daniel’s house
We know this interesting place has a long way to go to catch up to the infrastructure and standards of the United States and we’re thankful for getting to see it at this stage in development. Just because a place doesn’t have the best technology or roads doesn’t mean that it is to be ignored. Ghana is beautiful and has much to offer the rest of the world.
Thank you for going on this journey with us,
Auntie Amanda and Auntie Jessica
The two of us at Elmina Castle holding “A Comprehensive Course in Twi (Asante),” which we bought in the bookstore there. We will use it to practice for the next time we visit!
September 25: Here elephant, elephant, elephant!
Ghana is home to many different tourist attractions and we’ve been taking full advantage of them! A week ago we traveled to Cape Coast to visit Sanford Clinic. This clinic was built by Sanford Health, which is based out of North Dakota, and is providing health care to a community in desperate need. When we arrived at the clinic we were welcomed by the clinic’s director, Harry, who showed us around the facilities. Unlike everywhere else that we’ve visited, this clinic is completely paperless and runs on a computer system. The patient is registered, sent to the physician or triage center, then sent for labs, and then sent to the pharmacy to pick up their prescriptions without wasting one single tree or producing any trash. This has major implications in Ghana for both healthcare and research. The system holds valuable, reliable patient population information for researchers to observe trends and collect data. This clinic also provides an area for future ONU students to spend time during their international rotations.
From left to right: Bright, Jessica, Amanda, Daniel, and Harry standing in the Sanford Clinic. The pharmacy is down one floor and to the right.
The main hallway at Sanford Clinic
While we were in Cape Coast, we made sure to visit two castles that were along the ocean and had previously been used as slave trading posts. Elmina Castle was built by the Dutch to serve as a trading post for spices, gold and other African valuables, but was later taken and operated by the Portuguese at the time of the slave trade. It is one of the oldest slave trading points in Africa and now serves as a constant reminder of the mistakes that were once made by humanity.
Looking into the courtyard of Elmina Castle
There were many shocking areas inside these terrible walls, including an area where the governor came out onto a balcony to select a woman who must visit him with the consequence of rebellion being death. The women were kept in an area underneath the governor’s quarters in pitch black, poorly ventilated giant cells. Sometimes the only days they would see the light is when they were brought out for selection by the governor.
Two jail cells located at Elmina Castle. The one on the left was for African captives that misbehaved and the one on the right was for the misbehaving Portuguese.
Another area that we both found to be stunningly inhumane was the area where unruly prisoners were housed. The skull above the door is appropriate because once the slaves entered the cell, they never came back alive. A group of slaves were put into this dark cell that lacked ventilation and kept there until the last one died. The bodies were then thrown into the ocean. The other cell served as a temporary holding area for Portuguese prisoners. As you can see, that cell is well ventilated and has a window, which is visible in the picture of the African cell (these two cells are located right beside each other and the only airflow to the African cell comes through the Portuguese cell). In addition, the African cell’s door was made of solid wood, while the other door was made of iron bars that allowed for airflow and the entrance of light.
Courtyard of Cape Coast Castle
We next traveled to Cape Coast Castle, which was very similar to Elmina Castle. Cape Coast Castle was built by the British and was the only castle built on the coast in Africa to be used specifically for the trade of human beings. At both castles, there is a door called “the door of no return” where captives were pushed out of the castle and onto boats waiting to sail across the ocean to the Americas or pacific islands. However, at Cape Coast castle, they also have “the door of return” in an attempt to welcome Africans from all over the world back to Africa. Two Africans that had been taken from their homeland, enslaved and ultimately died abroad as slaves were exhumed recently. They sailed back to Africa, passed through the opposite side of the door of no return, and were re-buried nearby the castle. This symbolically invites all African slave descendants back to their homeland. Also of note, the Obama’s visited Cape Coast Castle in 2009 during a goodwill tour of Ghana.
Door of Return at Cape Coast Castle
View of the harbor next to Cape Coast Castle, right outside of the Door of Return. The slaves literally stepped straight from the castle onto the waiting slave ships.
After leaving the castles, we headed up the coast to Kakum National Forest to experience the canopy walk. This consisted of walking up into the forest and then across a series of hanging rope bridges that were suspended above the lower canopy of the forest. Jessica thought this was amazing and had no problem walking across the bridges while not holding on and taking pictures. Amanda had a panic attack. (Jessica filmed it but Amanda probably wouldn’t appreciate that going up here) For future reference: if you are afraid of heights and swinging rope bridges, skip the canopy tour.
Amanda clutches the ropes as she pulls herself out to the highest tree on the tour
A couple of the suspended canopy bridges taken from the “safety” of a tree
After taking on the daring adventure of Kakum, we decided while in Ghana we really needed to see elephants. So we signed up for a trip: An Expedition to Mole with a tour group called Adventure Junkies (look them up because the guys who run this company are awesome! adventurejunkies.com.gh). Mole National Park is an animal sanctuary in the Northern Region of Ghana, which is home to all types of animals including warthogs, baboons, lizards, monkeys, snakes, alligators, kob, lions, panthers and elephants.
We left with the tour group (a group of Ghanaians, the two of us and one man from the UK) at midnight on September 20th in a bus headed towards the Northern Region. Everyone told us we were crazy for wanting to go because of how bad the roads were outside of Accra, but we were pretty desperate to see elephants in their natural habitat so we went for it (with Bright, our babysitter for the weekend). We ended up arriving in Mole after a few stops at about 6:00 p.m. the following day.
Jessica standing in front of Kintampo waterfall #3 which was one stop during the Expedition to Mole (right before she tried to get brave, walk further in on the rocks, and fell into the water. Sadly, that misadventure was not recorded.)
Amanda and Jessica with their little followers in front of Larabonga Mosque on the way to Mole. This mosque was the first one in West Africa and was reported by our guide to have had its foundation magically appear overnight. Religion is very important in this region, and all of the citizens in Larabonga are still Muslim. This mosque was discovered/built in the early 1400s and since then the town has gained 7 other mosques. However, this town only has 1 school, which was built in 1992.
After 18 hours of driving, we arrived at Mole just in time to see the sunset over the savannah. It was a beautiful and absolutely breathtaking site. After a few hours of getting to know each other, everyone in the group headed to our hotel rooms, which (along with the entire motel) were located inside the reserve. The next morning was even better when we loaded on top of jeeps and headed out in search of the elephants we all so desperately wanted to see. We had one major issue with actually finding the animals that weren’t willing to come out near the roads or near the hotel, though. We didn’t realize that it was the rainy season in the Northern Region and so the usually brown and dry savannah was green and lush. This meant that the elephants would be spread out equally over the entire greater than 4000 square kilometer area instead of being confined to the regions containing lakes.
Sunset over the savannah
Riding on top of the jeep! It broke down halfway through our safari and forced us to walk up a giant hill and walk through a river to get back to the hotel. We were pretty happy with the opportunity to get to go on a guided walking safari, though, so it was alright with the two of us.
Surprisingly, the baboons preferred to be near buildings in the park. We stopped the jeep to get out and see how closely we could walk up to one/get better pictures (remember, the group’s name was Adventure Junkies). This is our fellow non-Ghanaian in the group approaching them.
A Kob and a Green Monkey (yes we know it’s not actually green)
Baboon family crossing!
Pumba! Hanging out by the hotel munching some grass. Hakuna Matata
So in the end, we never saw our precious elephant but we saw many baboons, monkeys, warthogs, antelope, kob and birds. The trip was amazing and it was awesome to get to know some Ghanaians outside the world of pharmacy.
Ghana has many gems in the way of tourist opportunities and the people here are beginning to take advantage of their homeland’s natural beauty. Between the beaches, many wildlife reserves and diverse cultures, Ghana has the potential to one day be a leading tourist attraction. We look forward to seeing growth for the country in tourism as it would be a significant economy boost and bring much deserved attention to this beautiful, peaceful country.
So check out Adventure Junkies and start planning your own African safari!,
Auntie Amanda and Auntie Jessica
September 20: Hundreds of pharmacists + dozens of vendors + CE + one week= PHARMACY CONVENTION
Pharmacy conventions in the US are something like family reunions for pharmacists that happen to take place every few months. Turns out, the concept is universal! Daniel told us we would be spending three days in Cape Coast for the Annual General Meeting (AGM) of the Pharmaceutical Society of Ghana (PSG). We were excited to network and meet other students and pharmacists from across Ghana.
All pharmacists rise for the opening ceremony of the AGM.
The week was to start off with the annual outreach in a village near Cape Coast. (the meeting was held at the University of Cape Coast) We arrived in the village about half an hour before the outreach was supposed to start. The venue was already jammed packed with people from the village and the surrounding area. The local children were brought by their teachers to the clinic, so there were dozens of them running around in school uniforms. We were immediately swarmed. They all wanted to touch an obroni (white person)!
Amanda is greeted by local school children at the PSG AGM clinic. Hi five’s all around!
We have neglected to mention this term yet, although we hear it every day. The vast majority of people here are Ghanaian, so anyone who is different (i.e. Caucasian) sticks out. After three weeks of practice with this “obroni swarming” behavior, we were very capable to disentangle ourselves from the school children and meet some of the other pharmacists working at the event. We quickly helped finish stocking the pharmacy tables with boxes of medicines that had been donated by various pharmaceutical companies and organizations and changed into shirts donated for the event.
The clinic was divided into two sides- pediatric and adult. The adults had their vitals checked first, then saw a doctor and then went with prescriptions to the adult medication table. The children went straight to the doctor and then the pediatric medication table. The idea was for the volunteers to switch stations every hour or so to prevent boredom and fatigue. Jessica and I positioned ourselves at one of the two pediatric pharmacy tables and ended up staying there all day. It was easier to keep doing what we knew how to do then try to learn another station when there were patients waiting. We knew we wouldn’t be much help counseling, as patients in the more remote villages are rarely fluent in English. However, the prescriptions or disease states were written in English and the pharmacists spoke English, so we could help them get medications ready to dispense. Jessica made this her primary role at the clinic, while Amanda became the “go-for” girl, if you will. We helped run our table with the most efficiency we could; we kept it stocked with each medication or found alternative medications when things started to run out.
From left, sitting at the table: Emmanuel (Ghanaian pharmacist), Jessica, and Amanda get the line of patients started through the pediatric pharmacy table. Jessica’s starting to fill the prescriptions as Amanda reconstitutes antibiotics. (without a graduated cylinder)
We spent eight hours at the clinic, with only one 15-minute lunch break. We saw so many patients that we simply had to turn some away at the end of the day — we were literally out of everything, including paracetamol (the form of acetaminophen used here). But when we were finished, we were happy to have helped so many people and to have represented the pharmacy community well. Many of the recurrent diseases here (i.e. diarrhea, malaria, worm and fungal infections) could be greatly reduced by consistent pharmacist intervention and counseling. Jessica and I were impressed with how the pharmacists at our table were able to counsel the mothers of children or the children themselves (many of them came from school, so parents were not with them). Some Ghanaians may have cultural or traditional beliefs about medicines and disease that could make their acceptance of treatment challenging, but the pharmacists worked through it and made them understand how important and helpful the drugs were.
Barbara, a Ghanaian pharmacist, counsels a mother about malaria treatment for her baby and children. Barbara was a great help to us throughout the day with translating, and a great Azonto teacher later that night! (if you don’t know what Azonto is, I suggest you youtube it)
Tuesday evening was meant to be a relaxing night after a hard day at the clinic. So for pharmacists this translates into cocktail party! We went back to our hotel, freshened up, threw on some heels and headed to the regional representative of Cape Coast’s house. It is apparently customary for the regional representative of the region the convention is held in to host at least one party for the pharmacists. We met many people, took many pictures, and sampled many Ghanaian hors devours, including goat skewers, fish quiche and gizzard ‘nuggets.’ Like any proper Ghanaian gathering there was ample food, drink and loud music. The representative’s front lawn was soon turned into and azonto dance floor, with pharmacist’s young and old showing off their moves!
Jessica and Amanda at the cocktail party
Wednesday morning we arrived on the university campus in time to register before the opening ceremonies. We assumed Daniel had registered us as students, as we would be registered in the US. Turns out pharmacy students don’t often attend conventions here. They basically have to sneak in. Luckily for us, we know the right people and received a convention goody bag like the registered attendees, but were still troubled that students were not regularly expected to be involved. We watched the opening ceremonies, complete with traditionally dressed Ghanaians and more dancing and music. The day then progressed with scheduled presentations about pharmacy legislature, studies and current issues. We also explored the campus, visited the vendor booths and ate a traditional Ghanaian lunch. By Ghanaian lunch, we mean everything from jollof rice to fresh fried tilapia to mass fufu and banku production was set up on the lawn for the pharmacist’s enjoyment. Wednesday evening we convinced one of Cynthia’s old students to take us to see the beach at Cape Coast and ate some delicious seafood (the picture from the last post of lobster was dinner that night… yummy!)
The catering company brought made hundreds of orders of fufu with soup to order.
Fresh fried tilapia served with banku (sour dough ball), and tradition Ghanaian sauces, tomato on the left and shito on the right
While we didn’t accept samples of prescription and over the counter drugs like the other pharmacists, we did try some Rita Cereal Milk! It’s like a milkshake in a can that doesn’t have to be refrigerated!
Drummers for the opening ceremony. So much kente!
A view of a row of vendors at the convention!
After a hard day of networking, Jessica enjoys Oasis Beach in Cape Coast.
Thursday was another day of convention-ing. We met more people, passed out more business cards and explained a few more times why American students were at a convention. By this time we had made friends with quite a few of the pharmacists and were able to network well. (You would be proud, Dean Sprague!) The sessions that day were continuing education classes for the pharmacists, so of course we snuck in to see what they would talk about. We went to the hospital section, thinking that would be the most controversial because of the current strike. Government paid hospital pharmacists have been on strike in Ghana since the Monday after we got to the country (September 3rd). The issues brought to attention included pharmacist intervention documentation, accurate patient profiling, doctor-pharmacist interactions and clinical pharmacist roles. At one point in the discussion, a joke was made about how impossible it would be to look at 300 patient profiles in a day! Jessica and I couldn’t help but chuckle a little and agreed that if we only saw 300 patient profiles in a day in US pharmacy retail, we would be lucky. Obviously, hospitals are different than retail, but the concept of giving every patient the same attention and clinical approach should apply no matter what. Pharmacist interventions are not always documented here. In the states, a law suit would soon ensue if a pharmacist forgot to note a dose or drug change. As interns in the US, we speak to many doctors every day, over the phone or in person. There is ample open communication for the most part. Here, the system is more old-fashioned, and open acceptance of pharmacy input is not always smiled upon. The pharmacists are striking in the hopes that they will be badly missed and get the pay increase they desire. But the hospitals have been running for weeks without them; maybe not with the best patient outcomes or most efficient process, but they have been running. If your presence doesn’t make an impact, your absence won’t make a difference. The hospital discussion seemed to be more of a revival than an actual learning session. It was a call for pharmacists to get out there and make themselves needed.
After an eye-opening and mind-boggling convention experience, Daniel had yet another surprise for the three hour drive back to Accra Thursday night. We had the pleasure of taking home Mrs. Ruth. She was the first B.Pharm woman pharmacy graduate in Ghana, and the first woman pharmacist at Kole Bu Teaching Hospital, and the founder of LAPAG (Lady Pharmacist’s Association of Ghana). If that wasn’t enough, she was also the mother of six boys. The woman is a living legend and should be an inspiration to all women. After the typical round of formal Ghanaian introductions, she gave us leave to pick her brain for the next three hours. And oh boy, did we ever! We asked her for the best advice she could give us at the beginning of our careers. She said to always keep your passion for the profession. As long as you are passionate about what you do, people will notice your work, appreciate it and take your advice in the future. She was impressed with how much we had accomplished thus far, and how young we were. She said two of her sons were still unmarried, if we were available. We kindly declined and thanked her for the offer. Hints of marriage proposals are becoming an almost daily occurrence, so it wasn’t that out of the usual for us. It was by far the most entertaining three hours we have spent in the car the whole month!
All you pharmacists and interns back in the States, take some advice from Ghana, and renew your pharmacy passion!
Auntie Amanda and Auntie Jessica
September 19: The most awkward moment of our lives
Everything here qualifies as a new experience to us, but a couple things we’ve done stand out from the rest. The first being when Daniel took us to a funeral a couple weeks ago. When someone passes away here in Ghana, the family honors the person by throwing a funeral followed by a celebration. This entire process usually takes place over a week. On Saturday, the body is carried, sometimes long distances, to where it will be buried while family and friends walk behind the casket.
The front of a funeral procession here in Ghana. The casket is being carried on the heads of the deceased person’s relatives; not a car. Yes they walk right through traffic.
Here you can see the entire group of people walking down the road behind that casket, paying their respects to the one who passed away.
Once the person is laid to rest, the attendees of the funeral return to the location where the body was previously kept and begin to celebrate the life of their loved one. This is the part of the funeral that Amanda and I were privileged enough to be able to attend. After driving out of Accra and up into the mountains for a couple hours we finally arrived in the region where Daniel grew up. After asking about 10 different people on the side of the road for directions (we definitely missed our smart phones and Garmin at this point) we finally spotted a few attendees of the funeral walking down the street and were able to get reliable directions from them. You can tell who is attending a funeral, because the burial process followed by a party is always held on a Saturday and the attendees are expected to wear only red and black, unless you’re a grandchild of the person who passed away, then you should wear white and black. On Sunday, the funeral is continued when guests show up in white and black with the grandchildren wearing red and black. The grandchildren are differentiated from the other people at the funeral so it’s easier to identify them as they serve the guests water and help to greet attendees.
A group of people on the side of the road who are dressed for a funeral.
So anyway, when we arrived at the funeral, we drove past it and went down the road a little ways so that Daniel could put on his cloth. This is a more traditional garment which is worn by men and demands respect by others in the community. Tribal leaders and elders will always be found in this type of garment, while others will wear this garment for special occasions.
Two men wearing their traditional woven kente as they walk to the funeral. If you wear a color other than black to a funeral (besides the above-mentioned exceptions) it is considered improper dress.
After the wardrobe change, we headed back to the funeral. Behind a house there were a series of two tents set up like a T that were wrapped around a building that looked like a shelter house. We entered under the first tent and Daniel began to shake everyone’s hands. As we walked beside him, we began to realize we were getting dirty looks and then someone pointed out to us that we were being rude by not greeting everyone who was already paying their respects under this first tent. So we walked back to the beginning of the tent and shook everyone’s hands, trying to figure out what it is we were supposed to be saying to them to greet them and say “sorry for your lost”, as we are accustomed to saying. After we got done butchering the only greetings that we knew (some “akwaaba” and “akiye”), we joined Daniel at the end of the tent. He pointed out that the shelter house that was against the next tent had a tribal chief and members of the royal family sitting in it. It was at this point that we realized the deceased was of the royal family in the area. Minor detail with major implications for funeral etiquette!
As we waited for permission from the chief to enter the next area of the funeral, the hosts of our current tent brought us chairs (front and center so we could be seen by all). Before we knew it the extremely loud music was turned off and someone was speaking in a local dialect over the loudspeaker. Then Daniel was walking straight for the chief and we weren’t quite sure if we were supposed to follow behind him or wait for him to come back. It didn’t take much time for other people to realize we didn’t want to move and we were soon ushered out of our tent and pushed towards the chief. Jessica was the first to shake his hand and not knowing the custom or wanting to be rude, she was afraid to look him in the eye. It’s better to be awkward than offensive, we guessed. Amanda followed along and did a normal American handshake (which was apparently a lot more acceptable than the timid one they had received before). By the 3rd handshake, we were stopped and shown by a member of the royal family how to shake hands properly and what to say. But to be honest, we were both so nervous that even if they spoke English, we probably wouldn’t remember what they said.
After that ball of awkwardness, we headed back across everyone to shake the mourner hands’ in the second tent before returning back to the safety of our chairs. We were then offered water by our hosts and watched some dancing. A man walked up and apparently asked permission to dance from the chief, which was allowed. So he began to dance and the royals acknowledged this by holding their arms out with two fingers extended in his direction. Soon a couple others joined in and this was followed by more appreciation. We were surprised by how happy everyone was. Daniel explained that deceased had been buried, the crying was done in the morning, and now it was time to celebrate the life of the deceased and take their mind off of their grief.
As we watched the dancing, Daniel apparently went to make a donation on his and our behalf to help support the cost of the funeral. After the song had finished, the music cut out and someone started saying something in another language about wanting dollars from us, which everyone thought was hilarious. Then before we knew it, most everybody at the funeral was lined up to shake our hands and we each received a handkerchief in return for our contribution.</p><p>It was at this point that we noticed that there was someone filming us as we sat there and shook everyone’s hands and talked to each other. We figured it would be really rude to take pictures there (hence why this part of the blog doesn’t have any pictures), but apparently it was very important to them that they get video evidence of our presence as it showed the deceased as someone who demanded great respect.
Not too long after the last round of hand shaking the tribal leaders left and we all stood as they walked by to show respect. We followed suit and headed home a few minutes later. As we went to our car we realized how normal the leaders are in this modern society as they laughed and joked with other people on the side of the road and tried to hail taxis. We’re very thankful we were able to experience this part of Ghanaian culture, even though it was definitely the most embarrassing and awkward moment of our lives.
We leave you with a picture of one of our $10 dinners in Cape Coast last night. Imagine us eating this on a beach next to the ocean, and start planning your own trip to Ghana!
Until next time,
Auntie Amanda and Auntie Jessica
September 17: Pharmacy Phun!
Just like in American, Ghana has many different types of pharmacies: Supermarket, corner store, department store, etc… For this blog, we thought pictorial representation would be the best way to communicate how pharmacies in Ghana look. Scroll down and enjoy!
Frimata Supermarket and Pharmacy consists of two separate stores side by side. The supermarket takes up three of four windows along this strip mall and the pharmacy takes up the fourth, which is not included in this photograph. The shops are not connected on the inside of the building, but it gives patients the ease of picking up groceries (if they don’t want to buy them from the street or market) and getting a prescription, just like in the US.
Frimata Pharmacy is, as you can see, very compact. They do not carry a large amount of goods when it comes to both over the counter and prescription medications. The prescription medicines are housed behind the wall that says “Dispensary," which is very cramped and lacking in variety. Seen in this picture are Bright (a pharmacist at FamilyCare pharmacy), Amanda and a Frimata employee.
The Medipoint Pharmacy reminded us of a typical American style CVS, Rite Aid or Walgreens. The inside of the pharmacy is centered around prescription and over the counter medications, beauty products and personal care items. It is customary here for the pharmacist or other employee to get things off the shelf for the patient and put the item in a bag or envelope before giving it to the patient. Ghanian hospitality is always a must!
Bright and Amanda look over the inventory of Medipoint Pharmacy.
Pills and Tabs Pharmacy is a bit of a super-power in the Accra area. This is one of many stores, and, as the newest addition (notice the construction is still ongoing), it is obviously the largest. This pharmacy would probably be considered a “chain” in the US, and be part of a corporation. However, most pharmacies here are still owned by a single person, usually a pharmacist.
The inside of Pills and Tabs was very busy, which was expected because of its large size. The pharmacist seen here (the man in the short sleeve white coat) was trained in the US, and so was able to explain to us about the vast differences in pharmacy between Africa and western countries. He said he enjoys having more freedom to practice in Ghana, but finds Ghanaian’s opinion of pharmacists and medications difficult. For example, not many women in Ghana are on contraceptives. They simply come to the pharmacy for the “morning after” pill (i.e. Ghana’s version of Plan B) when they think they need it. Some of these women may be too shy to ask the pharmacists any questions about the medication and so they may end up taking it wrong (we’ve even been told that some women believe they must take one Plan B before intercourse and one pill after intercourse to prevent the pregnancy). This is obviously not the best option for the patient, so the pharmacist at Pills and Tabs tries to educate as many female patients about contraception as possible. However, education about this subject can be difficult because it is considered cultural boundary to discuss these topics. There is no sexual education in Ghana unless the principal or dean of a school deems it fit. The people here are generally shy and reserved to begin with, let alone in controversial and personal subjects such as sexual education. Many Ghanians, especially the uneducated ones, are left to figure out these things alone, which leads to more unplanned pregnancies and the spread of STDs.
Ernest Chemists, Limited is the largest pharmaceutical company that includes free standing pharmacies in Ghana. This was another new store, about half a mile down the road from Pills and Tabs. Retail competition seems to be the same everywhere! Think of it as being the same as having a CVS across from a Walgreens in the US.
A pharmacist at Ernest (the man in the striped shirt) and several technicians put away an order of prescription medications. Ernest Chemists is primarily a drug manufacturer; they sell products to other pharmacies and hospitals. They also run retail pharmacies that are mostly stocked with their products. Most things in Ghana are this way —locally produced, dispersed, sold and used. We are still always shocked by the turn-over rate of merchandise here. Just about all products in the country (drugs, food, etc) have a “manufactured” date above the expiration date. The manufactured date is rarely more than four months out from the day it is sold.
We greatly enjoyed our time touring different types of pharmacies around Accra. Because of the size of the city, there was a great variety. Bright seemed to know at least one person in every pharmacy we went to. Just like at home, the pharmacy community here is a family. Sure there is competition, but in the end competitors are always willing to help each other out and work for a common good.
Until next time,
Auntie Amanda and Auntie Jessica
September 15: Shopping!...Not as easy as it sounds.
Most tourists enjoy bringing back souvenirs from their travels. Ghana has no lack of souvenirs. Everywhere we look, there are things to buy being held up for our inspection, food being waved in front of our faces and people asking us if we need anything specially made. Buying hand-crafted items of any kind in America is a huge deal, and we usually pay dearly for it. Here, it is an expected part of shopping. When we told Cynthia that we would like to buy dresses like the Ghanaian women wear, she told us she would take us to her dressmaker and have them made. First, we had to go to the market to pick out our fabric.
Accra Central Market, where we went to find our fabric for our dresses!
It was difficult for us to picture what the dress would look like when it was finished, so Cynthia told us to pick fabric that we liked and the dressmaker would come up with a design to match the fabric.
An estimated 85 percent of Ghanian citizens are employed in what is called the “private sector”. .. i.e. they manage their own “business." This could be anything from making clothing to selling plantain chips on the street, to being a carpenter or a taxi driver or miner (yes, they literally have a mine in their backyard). The unemployment rate here, although reported at 11 percent by some sources, seems to be nonexistent. Everyone makes the most of the resources they have available and the services they can provide. Every street corner is an opportunity to set up shop and sell anything from phone cards, to puppies, to meat pies.
An outside furniture store! This carpenter specializes in wicker. What if it rains? Night time? They carry ALL of the products back inside! Every night and every time it rains…
A line of produce sellers along the road to Cape Coast, Ghana.
No free corner? Just use your head! Literally, that is. Gideon informed us that all Ghanians learn to carry things on their heads; it’s just something that you do from a very young age. This makes for an excellent way to hold goods and food and have your hands free for other things, like collecting money or knocking on car windows. A common practice here is to sell things to the people sitting in cars in traffic. To get through a red light in Accra can take anywhere from 2 minutes to 45 minutes (yes, we timed one at 45 minutes)! Because of the wait, sometimes people do their shopping while waiting for the light to change. We have decided that this is also a much more convenient way to shop. Also, it is much faster to buy what we have taken to calling “head food” from the mobile vendors than to actually stop and get lunch while out (we call it head food because people sell food from containers on their heads). There are no fast food restaurants, so Cynthia called this their version of fast food. In fact, stopping to get a tuna “sandwich” for lunch usually takes over an hour.
Vendors sell their wares (food, dust rags, shoes, etc) from baskets or trays balanced on their heads. And yes, they walk between the cars when traffic stops; they do occasionally get hit. It’s hard to get pictures of them because looking at them means you want to buy what they have and they all run to the car!
These women are selling plantain chips and peanuts to cars parked next to us in traffic
So, back to our dresses! We took our fabric to Cynthia’s dressmaker, Mayaa Fashion Designs, where they started off by taking our measurements. They took at least two dozen measurements! And then the dressmakers asked what we wanted our dresses to look like. We had some ideas, but couldn’t quite get the concept that they could make anything we wanted. When we curiously asked them if they could put pockets on our dresses, they seemed shocked that we’d doubt their abilities so to say. The dressmaker charged us 45 Ghana Cedis (about $25) and instructed us to come back in a week to pick them up. Simple as that! Cynthia doesn’t even have to tell them what type of dress or outfit she wants anymore, because they know her style there. She just takes in the cloth and they make her something they know she will love. That method seems much easier than hunting through multiple stores for the right dress, like what we do in the US!
Jessica poses with one of the dressmakers are Mayaa Fashion Designs with her finished dress!
Amanda poses with another dressmaker at a different dress shop who sold her a handmade skirt. Notice the handmade flip flops in the background. You can have them made to match your dress!
Until next time, happy shopping!
Auntie Amanda and Auntie Jessica
September 12: No prescription? No problem!
Pharmacy practice in Ghana varies greatly from that in the US. As most people know, in the US a prescription is needed to obtain any drug classified as a “prescription drug” by the FDA. However, in Ghana, there is a clause in their health care law that states pharmacists may dispense medication without a prescription for “common disease states." Naturally Jessica and I wanted to know what fit under the heading of “common disease states.” The answer? Whatever the pharmacist interprets it to be. Pharmacists here are definitely utilized for their triage capabilities and are primary health care resources for many people.
From left: Jessica, Cynthia Amaning-Danquah (Ghana rotation preceptor), and Amanda inside FamilyCare Pharmacy in Madina, Accra
As in the US, a pharmacist is required to be in the pharmacy to dispense prescription medication. However, the law is not heavily enforced like in the US and many of the people here are not educated enough to know the difference between a technician and a pharmacist. Pharmacists usually are in the shops during the day. Dispensing technicians (DT’s) or Medical Counter Assisstants (MCA’s) are available during the day and in the evenings when the pharmacist may not be there. DT’s go to polytechnic for 3 years to receive a diploma, while an MCA goes through a six month training program (3 months classroom, 3 months practical). DT’s are certified to dispense drugs and recommend medications for common ailments like cough or malaria, while MCA’s are more like cashiers who assist the pharmacist or technicians. Some patients will only want to talk to the pharmacist, which the DT’s and MCA’s always honor. For these patients, the pharmacist is always available by phone, or the patient will come back when the pharmacist will next be in the store.
Daniel enters one of his FamilyCare Pharmacy stores. There are two other such stores in Accra and also one in Kumasi.
Specifically to FamilyCare Pharmacy (owned by Daniel and Cynthia Amaning-Danquah) where we spend most of our time, there are two MCAs, one pharmacist and occasional interns on staff. The pharmacist of the Madina FamilyCare, Bright, has a Pharm.D. degree from University of Buffalo, New York, and has come back to Ghana to work in his home country. He has been a great resource for us, as he knows what pharmacy practice is like in the US and takes care in explaining the differences. For example, on the second day we spent at the pharmacy, he took us the US embassy, leaving the MCA in charge and by herself on a Monday. Anyone in the states who works at a pharmacy wouldn’t dream of leaving a single person to handle a Monday; let alone not a pharmacist. We were pretty shocked by this. We learned later that the afternoon is actually the slowest time to be in the pharmacy and the busiest hours are between 5-10 at night, after people earn money for the day from their shops or side jobs.
An MCA at FamilyCare serving a patient who has a prescription! Notice the register drawer is open; it is never closed due to frequent power outages.
Most patients that visit the pharmacy do not have enough money to buy a large quantity of the medicine they need. They may only have 1 or 2 cedis (about $0.50-$1) to their name and so they can only afford to buy a week or day supply of their medication. For this reason, almost every medication stored in the pharmacy comes in a unit dose box, which is sold by the strip. (A sheet of unit dose pills varying usually from 5-10 pills.) This makes medication dispensing very easy; almost zero counting is involved. The quantity the patient needs is placed in a white envelope with the instructions on how to take the medication written on it.
Since the electricity here is not stable, computer systems are not reliable so even the cash register in the pharmacy does not run on electricity. Using technologies found in modern American pharmacies would be extremely impractical and worthless. However, the lack of computerization essentially eliminates the creation of a virtual patient profile; unless you’ve worked in the pharmacy for a long period of time, you may not even know the patient’s name that you’re dispensing medications for. It is almost impossible to know all the medications someone is taking as they may visit multiple pharmacies to purchase different medications, which means it’s impossible to evaluate drug-drug interactions.
Some of the prescription stock at FamilyCare, almost all in unit dose packages.
Compliance is also an issue, as people will decrease doses or just stop taking a medication until they can afford it. There is no way to even track refills, as the prescriptions are not filed in any sort of easy retrievable manner. There is no way of knowing when the patient was told to start or stop a medication. This is one of the largest areas that pharmacists here are of help. Jessica and I have counseled several patients at FamilyCare who were given a prescription for an antibiotic, but not told when to stop taking it, if at all.
As in the US, patient’s opinions of pharmacies and pharmacy practitioners change based on education level, background, and/or exposure to healthcare. In the wealthier areas of Accra, patients always expect to have a pharmacist available to talk to, as they would in the US. In less developed areas, however, patients may not know the difference between an MCA, technician, or pharmacist, and therefore also don’t know the level of care that they are missing out on. This is a problem that the pharmacy council here would like to fix. They want to focus on providing patients with quality clinical information through pharmacists. But the problem is not getting the pharmacists on board, it’s figuring out a way to show the value of pharmacists to the entire nation…
But that’s another soap box for a later date!
Until next time,
Auntie Amanda and Auntie Jessica
That’s what we said when we accidentally walked into a room in which Grandpa was still sleeping. Apparently it is acceptable to wake someone up, as long as you greet them appropriately.
The house in which we’re staying is typical —for Ghana, that is. This means that on average there are 10-12 family members, friends and students all staying under one roof. It’s a bustling, busy household. So far, we have met these following members of the household:
Daniel and Cynthia Amaning – They own the house and run the household. They have been our interpreters, preceptors and basically host parents as we learn the lifestyle of Ghana and attempt to learn one of the many local dialects, Twi.
David, Michael and Martin- The three Amaning children (listed in order of age) have also been helping us learn the language here. They are always willing to play any games we can teach them (right now they love playing War and Go Fish) or to devour a huge plate of jollof (a cooked rice dish with tomato sauce and fried chicken).
From left: Jessica, David, Michael, Martin, Amanda on the front porch. Possible future polar bears!
Grandma and Grandpa- The inspiration for the title of this blog post, Grandma and Grandpa are Daniel’s parents and have recently moved into the household. Grandma barely speaks English, but assumes we understand everything she says to us in Twi. She is an experienced fufu-maker (fufu is a dough-like ball made from mashed up boiled plantains that can be eaten with soup), among other things, and she finds our American antics very entertaining. Grandpa is a retired mathematician who has become an excellent resource for translating. Although his is quiet by nature, we quickly found out he is fluent in English.
Grandma (left) and Ruth (right) begin to prepare fufu for dinner!
Ruth and Serwaa- Ruth is the housekeeper who tries to make it her mission to wait on us hand and foot. Ghanaian hospitality is serious business, and she’s very persistent with being at our service! After a week of living here, and much trepidation from Ruth, we were finally allowed to prepare lunch for ourselves (but not wash our own dishes, of course). Serwaa is almost always with Ruth, and is Daniel’s niece, which by Ghanaian families means that she can also be considered Daniel’s daughter. More on the family titles to come.
Serwaa prepares banku for dinner. Banku is made from mixing
sour dough and regular dough together over hot coals. It can be eaten with
lots of foods, but usually rice and fish.
Charles- We like to call Charles the concierge of the Amaning household. He is actually Daniel’s older brother, but has moved from his family (who live in Kumasi) to stay in Accra for a while to help take care of Grandpa and the kids while Daniel and Cynthia have a busy season with their work. Charles usually drives us wherever we need to go. He is very passionate about music and wants us to know the meaning of every song on the radio. He’s a windows-down, bass-up kind of guy.
Edwin and Gideon- Both are people that we met for the first time today (this place is like Grand Central Station). Edwin just arrived from Kumasi, and he is Daniel’s brother and Serwaa’s biological father. Gideon is another pharmacy intern who was a student at KNUST and is working at FamilyCare Pharmacy, also (that is the pharmacy chain the Amaning’s own that we work in). In Ghana, you graduate from pharmacy school before you begin your year-long internship, which is opposite what happens in the US.
Left: Amanda trying to make fufu with Grandma, as Ruth watches. Right: Jessica attempts to prepare banku in a dress!
There will certainly be more people filing through the house during the rest of our time here. The Ghanaian family unit is not just composed of the “nuclear family”, as Cynthia refers to the American family style, but instead it is anyone who is biologically, socially or economically related to you. This could mean neighbors, relatives, co-workers or acquaintances. Females older than your generation are called “auntie,” and males are always “uncle.” Since Jessica and I are together so much, we are “sisters.” Serwaa is Daniel’s niece, but she introduces herself as Daniel’s daughter. Cynthia explained to us that when a woman marries here, she not only marries her husband, but essentially the whole family. It is for this reason that Cynthia’s brother-in-law, Charles, can also be considered her husband. Confused yet? Don’t worry, we are too and we live here! No worries though, because (as a common song here says) there is always an uncle around to take care of you!
Until next time,
Auntie Amanda and Auntie Jessica
My name is Amanda Binkey and I am here in Accra with Jessica Davis for the month of September on an international pharmacy rotation. We arrived yesterday after an 11 hour flight from JFK airport in New York. Our total travel time from Columbus to NY to Accra was about 20 hours. This is Accra, Ghana from the plane!
After getting through customs and picking up our baggage (which looked like it had a much worse trip than us!), we met Daniel in the airport lobby. This is a picture of us in the truck (not looking so hot) headed to his house (where we will live for the month) from the airport! It took us about 45 minutes to get through the traffic, peddlers, bikes, stop lights (which were enforced by the military), and dirt roads.
After settling in to our room, we were left to recover from our trip. But when we found out the housekeeper, Ruth, was going to the market to buy groceries, we asked if we could go too! This is a picture of the Mallam Market as we walked in.
As you can see, we were the center of attention! Or at least our cameras were. The people seen here are wearing kente cloth (the brightly patterned material) that was developed in Ghana. When the women found out we didn’t actually want to buy anything (we were just following Ruth), they tried to barter our jewelry for vegetables. We declined their offers for produce and took more pictures instead. Note: we will no longer be wearing jewelry to the market.
Hope to update everyone again soon! We send a special hello to our families and friends keeping up with us during our adventure!