By far the most important book I read to prepare for the trip is:

“Africa is not a country” by Dipo Falonyin. I would like to recommend it to you. Anyone who is interested in this continent and its history.

We haven’t fully worked through that yet.

In the introduction there is a quote from the writer Chimamanda Ngozi Adichie:

“If all I knew about Africa was from popular images, I too would think that Africa was a place of beautiful landscapes, beautiful animals and incomprehensible people, fighting senseless wars, dying of poverty and AIDS, unable to speak for themselves.”

What follows is an impressive report about the emergence of African states, about missionaries, colonial rulers, slave and gold traders.

About the Berlin Conference of 1884/85, about Bismarck’s magnificently flawed map of Africa on which borders were drawn with arbitrary, dead-straight lines, along mountains that didn’t even exist, by rivers that kept changing course, across established structures. The kingdom of Ghana was located over 850 km northwest of the state I am currently in. Far away from today’s state borders with Togo, Cote D’Ivoire and Burkina Faso, drawn with rulers. Ivory, Slave Gold Coast, more of that later.

After independence, they proudly adopted the name of the former kingdom of Ghana.

The most important thing in this book is to expose the superficiality, the shameful ignorance with which the colonialists invaded this continent and divided it among themselves. Ignorance of the rich history of the peoples and their cultural heritage. The book is shocking in its account of the disastrous effects of the major aid campaigns for Africa (Live Aid), which cement the image of the needy, immature African.

So: be present, be aware, notice the prejudices and images and let them go, don’t hold on to them. Get to know and experience what it’s like here, what the people are like, Ruth, Derick, Peter, Abdul, Jude, Vida, Gabby. Zen helps with this attitude, because letting go of thoughts, judgements and ideas has at least already been practised. Akwaaba, Ghana,

Dipo Faloyin says:

“For too long, “Africa” has been treated as a buzzword for poverty, strife, corruption, civil wars, and large expanses of arid red soil where nothing but misery grows. Or it is presented as one big safari park, where lions and tigers roam around our homes and Africans spend their days grouped in warrior tribes, barely clothed, spears palmed, hunting game, and jumping up and down with ritualistic rhythm to pass the time before another aid package gets delivered. Poverty or safari, with nothing in between.

Various international charities have convinced them that to be young in Africa is to be surrounded by flies and filled with contaminated drinking water. That to be African is a daily exercise in barely escaping the clutches of a rotating cast of free-roaming warlords in dirty fatique, hanging off the back of 4 x 4 Jeeps that whiz along dirty jungle paths.

In reality, Africa is a rich mosaic of experiences, of diverse communities and histories, and not a single monolith of predetermined destinations. We sound different, we laugh differently, craft the mundane in uniquely mundane ways, and our moral compasses do not always point in the same direction.”

They sound different, laugh differently, do their things differently and, not only morally, are not always heading in the same direction.

Enough quotes, it’s best to read it for yourself. It is a wonderfully written book, ironic, funny and serious, full of surprising aspects.

Today I’m visiting the young internist in charge of the hypertension consultation. One by one, the hypertensive patients enter the tiny room, their blood pressure is measured and their current medication is taken. Some have small cardboard cards with the names of the drugs and the dosages. Almost two out of three patients cannot read or write. Illiterates. The first patient had to have one of her hypertension medications changed because of a side effect of coughing, but she didn’t get the change at the pharmacy or didn’t understand it, so she kept taking the old medication and now complains of coughing.

There are only two interns in internal medicine at the moment, and no specialist since October.

They work in pairs to cover the clinic, treating patients with high blood pressure, diabetes and HIV. They alternate between two weeks of outpatient care and two weeks of ward duty. Every six days they take part in the hospital’s emergency service, where they are responsible for all disciplines. There is little sleep, up to 48 hours on duty at weekends. It’s a tough school!

The power goes out during surgery and the emergency generator does not start. It is dark in the small consulting room. The young doctor is relaxed, that’s all, and she wants to become a specialist in internal medicine and learn something. If she or her colleague leave, there will be no more doctors working in internal medicine. So they stay. Years of training.

A new head doctor could come in March – we are praying for it.

Diabetes and hypertension care is well structured and there are national initiatives for these groups of patients. HIV patients are well cared for, and antiviral drugs are available to everyone free of charge. A health system with strengths to learn from.

https://www.afro.who.int/countries/ghana/news/ghana-offensive-against-diabetes

The endoscopy continues. Now I sing along. We had the most joy when I sang along to the songs with German lyrics: “Silent night, holy night. All is calm, all is bright” “Silent night, holy night”, I sing along, “Everything sleeps, lonely wakes”. I like the “Holy infant, so tender and mild” much better than our “Holder Knab‘ with curly hair”.

Such hair! Her skin is a deep dark brown, a truly impressive skin tone. But it is only in contrast to the black hair that one realises that the skin is not „black“ at all. When I look at my sleeping patients, I am always amazed at their beauty. Maybe it’s the Ghana virus.

Daily life has found its rhythm this week. It starts with the palliative course, a short break and then the endoscopies. During the endoscopies I am now assisted by an anaesthetist, a jolly, slightly overweight gentleman in his best years, who fills the room. „Why I’m waiting, Why I’m waiting?,“ he sings loudly, encouraging Ruth and Vida to hurry up. „No pressure, no pressure!“

I prepared very seriously for the palliative care course and was nervous at first, like I used to be before an oral exam. I have Peter by my side, the nurse who is doing his palliative care training in Accra and wants to set up and run the palliative care unit. My main concern is the discussion, questions into the microphone, Ghana – English, that’s where I get confused, especially when they repeat their question. Now I can give the microphone to Peter, he’s doing great. The atmosphere is attentive, they are following along. Thirty-eight young people with good hearts were in the room.

When it comes to communication, when it comes to giving „bad news“, when it comes to the essentials, when it comes to supporting the dying and their families, my audience is totally focused.

„Speak from the heart, listen with the heart. In other words, essentially. Don’t judge, listen, just be present“.

It’s about the WHO definition and the history of palliative care. I introduce you to Cicely Mary Saunders. Mama Cicely, who started palliative care in the UK. We continue with principles and attitudes.

I give a warning: the introduction of palliative care has side effects on the whole hospital. People, patients, relatives and friends, but also staff, become the focus of serious attention; symptoms become an issue, and we are really good at that: symptoms!

Communication is the focus of the second day, after which there is time for „dying and death“. Everyone has some experience of this. The hospital mortality rate is over 10%.

The theme of the third day is: Symptoms! We spend most of the time talking about pain.

Peter asked me to pay particular attention to the visual pain scale (1-10), which is used to measure the effectiveness of pain therapy over time. 1 means no pain, 10 means you can’t stand it any more. How nice that this simple instrument will soon be used everywhere in the Holy Family Hospital, including surgery, internal medicine and gynaecology.

Finally, there are two care topics: nutrition and hydration at the end of life and „oral care“.

Peter and I are happy and can’t stop shaking hands, loud applause and a small but touching speech of thanks. I’m really happy and so is Peter, I think it helps palliative care and his status in the hospital. There’s something going on.

I am trying to establish a long-term partnership with palliative care in Nuremberg. This would be a great opportunity for an exciting intercultural exchange at eye level. In palliative medicine, the principle is: high person – low technology. At last, no insurmountable technological obstacle! „High person“ exists in Nkawkaw, and not just numerically.

In the evening, preparations for our cleanup on the hospital grounds get underway. Abdul connected us. The project coordinator from “Technology without Borders” Ghana and the regional directors from the provincial capital Koforidua have registered. It’s getting crowded in my guesthouse. Gabby wants to cook us a Ghanaian feast. The reverent buys the beer.

But first, something more on the topic: the night .

It’s dark, you lie down. The fan is humming, rhythmic music outside and monotonous, piercing alternating singing. It is very warm. You quickly realize: you definitely can’t sleep. So relax, turn back and forth and at some point, you don’t notice, you fall asleep. Because of tiredness. At 4:00 a.m., you won’t believe this, the muezzin in the mosque starts calling. This takes a while. At 4:30 a.m. the rooster follows and then life begins. Full power. You toss and turn, sweat, fall asleep again and then the time stretches until the alarm goes off and you find peace again. Sometimes fatigue stays with you all day long.

Tomorrow is the big cleanup preparation day, T-shirts made from Tamale are on the way, certificates have to be printed, garbage containers ordered, gloves and garbage bags. Everyone is excited. We go to Malcome to shop for prices, I advocate footballs, everything else is open. Plastic everywhere, a senseless individual action given the masses of plastic in every corner, maybe something can be done with consciousness. So many people have registered, lots of young people. They want something to change.