Preparing To Volunteer in Preparing To Volunteer in Tamale, GhanaTamale, Ghana

Nick Greene, B.S.Nick Greene, B.S.April 14April 14thth, 2007, 2007

Unite For Sight Fourth Annual International Health Conference 20Unite For Sight Fourth Annual International Health Conference 200707

Vaccinations/PreVaccinations/Pre--cautionscautions

West African region An anti-malarial net in the background. Average cost is about $15-20 US. Most Hiking/Outdoor (REI.com) stores have them for sale.

This is your enemy. Use insect repellents that contain DEET (N, N-diethylmethyltoluamide).

PrePre--Departure PackingDeparture Packing

Bring whatever items you need from home including Bring whatever items you need from home including medications, clothing and toiletries. medications, clothing and toiletries. Please refer to Unite For SightPlease refer to Unite For Sight’’s inventory travel list for s inventory travel list for recommended items.recommended items.

The idea is to not bring too much, but not too little.The idea is to not bring too much, but not too little. Think Think of it this way, if you bring tons and tons of clothes for every of it this way, if you bring tons and tons of clothes for every occasion, then youoccasion, then you’’ll be doing plenty of laundry.ll be doing plenty of laundry. ItIt’’s advised s advised to bring 1.5to bring 1.5--2 weeks of clothing.2 weeks of clothing. Once one wears a weeks Once one wears a weeks worth of clothes, they can spend the weekend washing to worth of clothes, they can spend the weekend washing to prepare for next week. prepare for next week.

PrePre--Departure Packing (cont.)Departure Packing (cont.)

ELECTRONICS:ELECTRONICS:FlashlightFlashlightDigital cameraDigital cameraUniversal adaptorUniversal adaptor

ENTERTAINMENT:ENTERTAINMENT:BooksBooksJournalJournalMp3 playerMp3 player

RECOMMENDED ITEMS:RECOMMENDED ITEMS:Water: sachet, bottled. Sodas are OK.Water: sachet, bottled. Sodas are OK.Food (nonFood (non--perishables are best):perishables are best):

Gatorade powder/drink mixGatorade powder/drink mixGranola barsGranola bars

MicrotowelMicrotowelquick drying, can be bought at REI and quick drying, can be bought at REI and other outdoor stores)other outdoor stores)

mosquito net mosquito net water purifier water purifier sunblocksunblock (30 to 45 (30 to 45 spfspf))fisherman hat fisherman hat PermethrinPermethrin (at least 20% DEET treated)(at least 20% DEET treated)bug repellentbug repellentbaby wipesbaby wipeshand sanitizerhand sanitizerMini first aid kitMini first aid kitAntibacterial (Antibacterial (purellpurell))

ELECTRONICS:ELECTRONICS:FlashlightFlashlightDigital cameraDigital cameraUniversal adaptorUniversal adaptor

ENTERTAINMENT:ENTERTAINMENT:BooksBooksJournalJournalMp3 playerMp3 playerMagazinesMagazinesTextbooks (MCAT, class)Textbooks (MCAT, class)Cards/Dominos/Board gamesCards/Dominos/Board games

Dress Code (is there one?)Dress Code (is there one?)

There is no dress code as a volunteer.There is no dress code as a volunteer. However, some things to consider:However, some things to consider:City people wear jeans, tCity people wear jeans, t--shirts, and shorts to accommodate to the hot weather.shirts, and shorts to accommodate to the hot weather.Village people wear the same, but youVillage people wear the same, but you’’ll often see those dressed as Muslims in ll often see those dressed as Muslims in their garb.their garb.

MEN: MEN: Tops: tTops: t--shirts, button up short sleeved, and polo shirts are the best washirts, button up short sleeved, and polo shirts are the best way to dress.y to dress.Bottoms:Bottoms: Shorts, loose and light pants (not Jeans, unless you want to), kShorts, loose and light pants (not Jeans, unless you want to), khakis, hakis, running pants are good ideas, too.running pants are good ideas, too.Footwear: Thick soled sandals, running shoes, trainers, and hikiFootwear: Thick soled sandals, running shoes, trainers, and hiking boots are good ng boots are good footwear.footwear. There are some roads that are very bumpy.There are some roads that are very bumpy. Some paved roads are Some paved roads are rocky, so you can imagine what flip flops will feel like if you rocky, so you can imagine what flip flops will feel like if you were to walk for were to walk for miles in them.miles in them.

WOMEN: WOMEN: Tops/Bottoms: light shorts/pants and dresses (below the knee preTops/Bottoms: light shorts/pants and dresses (below the knee preferred), tferred), t--shirts, shirts, button up shirts, etc. are good in terms of weather conditions.button up shirts, etc. are good in terms of weather conditions. Again, the key is to Again, the key is to dress light, as you will be sweating profusely outside.dress light, as you will be sweating profusely outside. Make sure to wear hats, put Make sure to wear hats, put on plenty of sun block, and wear sunglasses, if possible.on plenty of sun block, and wear sunglasses, if possible.

Arrival in GhanaArrival in GhanaYou will be arriving at the You will be arriving at the KotokoKotoko International Airport International Airport which is located about which is located about 2020 minutes away from minutes away from the the TelecentreTelecentre..Make sure that you have confirmed your arrival date and Make sure that you have confirmed your arrival date and time with your UFS Coordinator before your trip.time with your UFS Coordinator before your trip.You will be picked up after going through customs and You will be picked up after going through customs and immigration.immigration. Some Ghanaians at the airport will try and Some Ghanaians at the airport will try and help you with your bags.help you with your bags. Do Do NOTNOT allow them to help.allow them to help.Politely decline. They expect a tip from you.Politely decline. They expect a tip from you.Banks:Banks:

Standard CharteredStandard Chartered and and BarclaysBarclays. . They are usually the only banks that can exchange They are usually the only banks that can exchange travelertraveler’’s checks (most Ghanaian banks will not s checks (most Ghanaian banks will not accept traveleraccept traveler’’s checks). s checks).

TelecentreTelecentre::You will be brought to the You will be brought to the TelecentreTelecentre Guest house in Guest house in Accra, where you will be able to rest and attend the Accra, where you will be able to rest and attend the UFS Ghana orientation.UFS Ghana orientation. You will also receive a cell You will also receive a cell phone.phone. Food is usually served at the orientation and Food is usually served at the orientation and you are checked into the guest house for rest before you are checked into the guest house for rest before traveling to Tamale.traveling to Tamale.

““AkwaabaAkwaaba!!”” (means (means ““Welcome!Welcome!””))

One of my first pictures taken when arriving at the Kotoko Airport in Accra, Ghana.A Ghanaian mentioned to me that the Kotoko Airport used to be a military base airport, named after a well known General before Ghana gained its independence.

Arrival in TamaleArrival in TamaleYou will go to Tamale with Dr. You will go to Tamale with Dr. WanyeWanye, Unite For Sight, Unite For Sight’’s Northern s Northern regional Ophthalmologist.regional Ophthalmologist.99--10 hour trip (starting early 10 hour trip (starting early morning)morning)Vehicle: truck/minivanVehicle: truck/minivanRoad conditions: paved, dirtRoad conditions: paved, dirtStops will be made periodically for Stops will be made periodically for food and rest.food and rest.Be ready for a long and bumpy ride!Be ready for a long and bumpy ride!

Living ArrangementsLiving ArrangementsDr. Dr. WanyeWanye will arrange your accommodations at the volunteer house near dowill arrange your accommodations at the volunteer house near downtown wntown Tamale.Tamale.Guest house:Guest house:

Equipped with a kitchen, dining room, living room, garage, fourEquipped with a kitchen, dining room, living room, garage, four bedrooms, two bedrooms, two toilets, and two showers.toilets, and two showers.

Local stores and shops:Local stores and shops: internet cafinternet caféé, pharmacy, gas station, and general goods., pharmacy, gas station, and general goods.Be careful about buying food from vendors.Be careful about buying food from vendors. It is not known where or how the food is It is not known where or how the food is prepared, so it could possibly make you sick.prepared, so it could possibly make you sick.Internet CafInternet Caféé::

Rate: 6000Rate: 6000--8000 cedi/hour, which is about $0.608000 cedi/hour, which is about $0.60--0.80/hour0.80/hour. . LaundryLaundry::

Hand wash (DITY!)Hand wash (DITY!)Washing suppliesWashing supplies (wash basin, detergent, clothes pins) are widely available at t(wash basin, detergent, clothes pins) are widely available at the he market in town.market in town.

Food:Food:A caterer will be arranged to cook breakfast, lunch, and dinner A caterer will be arranged to cook breakfast, lunch, and dinner at a rate of about at a rate of about $3$3--4/meal.4/meal.Choices? Breakfast. Lunch. Dinner.Choices? Breakfast. Lunch. Dinner.

HouseHouse

The FoodThe Food

The ChildrenThe Children

“Once one comes, they all come!”

The Children (cont.)The Children (cont.)

Children from local villages and primary secondary schools.

Tamale Teaching HospitalTamale Teaching Hospital

Aerial View of TTH. Hospital where University of Developmental Studies Medical Students study. Includes Emergency, Maternity, Pediatrics, Surgery, Lab, Radiology, ENT, etc.

TTH Eye ClinicTTH Eye Clinic

A Day in SurgeryA Day in Surgery

A Day in SurgeryA Day in Surgery

Dr. Wanye at the Operating Theatre at Tamale Teaching Hospital

Dr. Clarke at Crystal Eye Clinic in Accra

PostPost--Op Cataract PatientsOp Cataract Patients

VolunteeringVolunteeringThe Tamale Teaching Hospital eye clinic is The Tamale Teaching Hospital eye clinic is supported by Swiss Red Cross.supported by Swiss Red Cross.Swiss Red Cross Staff:Swiss Red Cross Staff:

Two main Red Cross coordinators Two main Red Cross coordinators arrange outreach screenings in arrange outreach screenings in neighboring villages.neighboring villages.Coordinate the days of screening and Coordinate the days of screening and plan when outreach for each village.plan when outreach for each village.The Swiss Red Cross will send Red The Swiss Red Cross will send Red Cross volunteers, who will accompany Cross volunteers, who will accompany you to those villages.you to those villages.

Ghana Health Service Staff:Ghana Health Service Staff:Ophthalmic nurses, an Ophthalmic nurses, an optometrist, nurse trainees, and a optometrist, nurse trainees, and a small clinical staff in small clinical staff in administration, finances, and administration, finances, and maintenance.maintenance.Tamale Teaching hospital drivers Tamale Teaching hospital drivers who will escort the UFS outreach who will escort the UFS outreach team to villages and hospitals in team to villages and hospitals in the Northern region.the Northern region.

Weekdays: outreach team will travel in two Weekdays: outreach team will travel in two trucks to villages and schools 1trucks to villages and schools 1--15 miles 15 miles from Tamale.from Tamale.Hours: Screening is from 9am to 2pmHours: Screening is from 9am to 2pm. .

VolunteeringVolunteering2 Teams (Group A and B): 2 Teams (Group A and B):

Group A: visits school and screens Group A: visits school and screens children (primary, secondary)children (primary, secondary)Group B: visits nearby village and screens Group B: visits nearby village and screens infants, children, adults, and eldersinfants, children, adults, and eldersmobile unit, transporting all equipment mobile unit, transporting all equipment (glasses, charts, etc) to each location(glasses, charts, etc) to each location..

Team Members:Team Members:Consists of 1Consists of 1--2 ophthalmic nurses, 12 ophthalmic nurses, 1--2 2 ophthalmic nurse trainees (occasionally), ophthalmic nurse trainees (occasionally), the UFS volunteers, a Ghana Red Cross the UFS volunteers, a Ghana Red Cross volunteer (occasionally), and the Tamale volunteer (occasionally), and the Tamale Teaching hospital driver.Teaching hospital driver.

Team duties:Team duties:At each eye care siteAt each eye care site,, comprehensive eye comprehensive eye exams exams ((case historycase history,, visual acuityvisual acuity,, ocular ocular health and refraction if necessaryhealth and refraction if necessary)) are are provided to each patientprovided to each patient.. Reading andReading and//or or distance glasses are also distributed to distance glasses are also distributed to patients as neededpatients as needed.. Referrals are made for Referrals are made for patients needing more extensive care patients needing more extensive care ((cataractscataracts,, etcetc.)..).

Supplies:Supplies:Ophthalmoscope/pen light, refraction kit, Ophthalmoscope/pen light, refraction kit, sunglasses, eyeglasses, Esunglasses, eyeglasses, E--charts, charts, SnellenSnellencharts, blank sheets of papers, 20 ft long charts, blank sheets of papers, 20 ft long rope, and pens.rope, and pens.

Visual Acuity StationVisual Acuity StationMaterials needed: Materials needed:

pen light, epen light, e--chart, chart, snellensnellen chart, chairs, chart, chairs, occluderoccluder, 3x5 note cards, 3x5 note cards

EE--Chart/Chart/SnellenSnellen chart:chart:Look for a chair, wall, tree, or any other object Look for a chair, wall, tree, or any other object that can hang or hold the Charts.that can hang or hold the Charts. Another way Another way to efficiently see all your patients is to set up to efficiently see all your patients is to set up multiple charts with a volunteer conducting multiple charts with a volunteer conducting visual acuity tests at each chart.visual acuity tests at each chart. Translation:Translation:

2 Stations:2 Stations:Eye screening (You)Eye screening (You)Eye Exams (Ophthalmic nurses)Eye Exams (Ophthalmic nurses)

Translator may become necessary as some Translator may become necessary as some villagers speak their own dialects other than villagers speak their own dialects other than TwiTwi or or DagbaniDagbani.. For each patient, obtain this For each patient, obtain this information on a 3 x 5 sheet of paper:information on a 3 x 5 sheet of paper:Direct each patient to the ophthalmic nurse or Direct each patient to the ophthalmic nurse or optometrist, who will do the eye exam (and optometrist, who will do the eye exam (and refraction).refraction).

Date:

Village Name:

Name:

Age:

Sex:

VR: VL:

Dx:

Eye Examination StationEye Examination Station

The ophthalmic nurse or optometrist is trained to do a thorough The ophthalmic nurse or optometrist is trained to do a thorough eye exam.eye exam.They should find a dark location.They should find a dark location. Usually a classroom or village hut will do.Usually a classroom or village hut will do.The eyes should be checked for any significant abnormalities seeThe eyes should be checked for any significant abnormalities seen on the n on the surface.surface.Areas of importance: checking the lids, the eye orbital region, Areas of importance: checking the lids, the eye orbital region, inside the lids, inside the lids, especially the eyelashes for especially the eyelashes for endotropionendotropion (inner curling of the lashes inward (inner curling of the lashes inward indicating possible indicating possible TrachomatousTrachomatous TrachiasisTrachiasis) and the surface of the eye ) and the surface of the eye (conjunctiva, iris, and pupil).(conjunctiva, iris, and pupil).Refraction:Refraction: the optometrist dispenses the eyeglasses.the optometrist dispenses the eyeglasses. Bring eyeglasses in 0.5 Bring eyeglasses in 0.5 increments (for example, +1.0, +1.5, +2.0, etc.) in prescriptionincrements (for example, +1.0, +1.5, +2.0, etc.) in prescription size.size.The optometristThe optometrist or head ophthalmic nurse in the team should be able to or head ophthalmic nurse in the team should be able to teach everyone to set this up and take an accurate visual acuityteach everyone to set this up and take an accurate visual acuity. Ocular health . Ocular health and refraction generally take place at this stage; each optometrand refraction generally take place at this stage; each optometrist will probably ist will probably have a certain way of setting things up to his/her liking. have a certain way of setting things up to his/her liking. Triage: Triage:

Schools: teachers and staff should be seen first. Schools: teachers and staff should be seen first. Villages: priority of older age and urgency of problem (someone Villages: priority of older age and urgency of problem (someone with an object in with an object in their eye or someone in extreme discomfort).their eye or someone in extreme discomfort).

Outreach Eye Screening/ExamsOutreach Eye Screening/Exams

Outreach Eye Screening/ExamsOutreach Eye Screening/Exams

ActivitiesActivitiesTamale:Tamale:

VRA has a public swimming pool VRA has a public swimming pool located near located near NorripNorrip village areavillage areaInternet Cafes are found Internet Cafes are found throughout the downtown areathroughout the downtown areaA used bookstore is located on a A used bookstore is located on a side road between the downtown side road between the downtown area and area and NorripNorrip villagevillage

Accra:Accra:University of GhanaUniversity of GhanaDowntownDowntownMarket place (great for souvenirs)Market place (great for souvenirs)

Useful Phrases in TamaleUseful Phrases in Tamale

English Dagbani

Des pah Good morning

An te ray Good afternoon

Ah noo lah Good evening

Nah Tu ma Pom! Thank you very much!

Ka ooh lah How are you?

Nah… I’m fine.

Questions?Questions?