Victoria Falls and Rafting the Zambezi

I know this is quite late because I have already been home for some time, but I still want to take the opportunity to write about the rest of my trip.

After my amazing experience in Chobe National Park, I wasn’t sure that anything on the rest of this trip could compare. Victoria Falls provided a different flavor than other parts of the trip.  It was the first and only visit to Zimbabwe during the trip.  Our first day in Zimbabwe began with the border crossing into Zimbabwe from Botswana.  This border crossing took a bit longer than previous crossings because all of us were required to purchase visas in order to gain entrance into Zimbabwe.  The processing of visas for 24 people takes some time, so we were probably there about an hour and a half, which was pretty quick considering how many of us there were.

After successfully crossing the border, we made it to Victoria Falls National Park shortly before noon.  It is difficult to describe Victoria Falls and do it justice.  It was truly a beautiful sight and absolutely huge!  You couldn’t see the entire falls from one viewpoint.  It had at least 15 viewpoints along the falls, and you really had to visit most of them to see the falls in its entirety.  The main falls was probably my favorite, as it was just an immense wall of roaring water.  Though it was winter and therefore low water season in Zimbabwe, the main falls still had a lot of water going over it.  There were some viewpoints where it was difficult to take pictures because of all of the mist.  I got completely soaked just because of the water off of the falls.  I can’t imagine what it is like during the high water season.  However, there were some gaps throughout the falls where there was less or no water flowing over the falls.  However, I found that some of the prettier parts of the falls were those with less water coming over them.  We ate our lunch on some rocks that overlooked the falls.  It was a very beautiful place to see.

The second day at Victoria Falls was a free day to enjoy one of the many activities available in the town.  Victoria Falls is known as a place for adventure seekers.  It offers everything from bungee jumping to helicopter flights over the falls.  The previous day we went into the adventure center to learn about the activities offered and book them if desired.  I was hesitant at first to do any of these activities, but I really had my eye on white water rafting.  I have always wanted to go white water rafting, but I was hesitant because the Zambezi River has category five rapids, which are one of the highest levels that commercial rafting trips will traverse.  There was a category six rapid on this river, but all of the rafting companies walk around it because it is dangerous.  For an inexperienced rafter such as myself, the category five rapids can be quite daunting.  However, six other people from my tour group were doing it, so I was convinced to join the fun.  However, I did not tell my mom about it until after the rafting trip was finished, because she did not want me to do it and would have constantly worried about it.

On the morning of rafting I was extremely excited, but also very nervous.  Though safety was a priority from the company, and we wore both helmets and lifejackets, my mind tended to go to worst case scenarios of falling out of the boat, or hitting a rock, etc.  In reality, the water is high enough that hitting a rock would be really rare.  There were only really a couple of rapids where I could see exposed rock in the rapid, and we skipped both of those.

The rafting trip began with a walk down to the bottom of the gorge.  This did very little to ease my nerves, as we pretty much walked down steps with see-through grating straight down the gorge to the river.  One of the pictures shows some of my friends walking down the steps.  Once we reached the bottom we were loaded onto the raft.  My raft consisted of seven people from my tour group, including myself, plus the rafting guide.  Some of the rafts had a guide who had two oars and therefore controlled more of the power and steering of the raft.  We were not in one of those rafts so we did all of the hard core paddling with directions shouted by our guide when we needed to turn, etc.

We made it through the first couple of rapids with relative ease.  They ranged from categories 2-3.  However, I got quite a bit of an adrenaline rush from the first couple of rapids because they were the first ones I had ever encountered.  After those rapids I started to feel a bit more comfortable.  Then the big ones started to come.  I won’t talk about every single rapid because it would take way too long, and honestly, some were more memorable than others.  However, you can look at the map for all of the names of the rapids, because even some of the less memorable ones had really fun names.  The first rapid of note was rapid #4, known as Morning Glory.  This one was a category 4 and our first taste of a big rapid.  I don’t remember much about this one except for that as we were cheering when we made it through without flipping over, one person in our raft said that she had hurt her ankle.  She had turned it over in the boat while getting down into the raft during the rough part of the rapid.  It is hard to describe what really happened because it was kind of a weird accident, but we found out later that she had broken a bone in her leg near the ankle.  Keep in mind that this was on rapid #4 and she made it all the way through rapid #10 before going back up the gorge with the people on the half day rafting tour while we continued on.  I don’t think I could have done that!

The next rapid was one of the scariest and our first category 5 rapid, known as Stairway to Heaven.   The name is pretty fitting, considering it is pretty much your raft heaving itself over a flight of stairs!  I would describe it as dropping over a miniature waterfall and then getting pummeled by water at the bottom.  It was incredibly scary, but extremely exhilarating!  Our rafting guide said that we had about a 50:50 shot of flipping our raft over, and we didn’t flip over, so we had a big celebration after that rapid.

We walked around two rapids in the first half of the trip.  One was Gulliver’s Travels, which has some exposed rocks.  We almost accidently went through that one because we weren’t paddling hard enough towards the shore, and momentarily got sort of caught between a couple of rocks.  However, we were able to get ourselves out of it.  After that incident we were sure to put a lot of extra effort into our paddling.  Some rafting companies would take their rafts through Gulliver’s Travels, and almost every one flipped over as we watched them go through as we walked along the shore.  I’m glad that we didn’t try to run that one.  The other one we walked around was a category 6 rapid known as Commercial Suicide because going through it would be “bad for business” as our guide told us.  All of the rafting companies had clients walk around that one.

There are also a couple of rapids in the second half of the trip I would like to talk about.  We were told that the second half of the trip was not nearly as bad as the first half in terms of difficulty and potential for flipping over the raft.  I would say that was generally true, but the guide probably should have saved that talk for after the particular sequence that I am going to describe, rapids 12 and 13.

Rapid 12 actually consists of three rapids, which are together known as the Ugly Sisters.  These three rapids are one right after the other and then are immediately followed by rapid number 13, known as The Mother.  So basically, we went through four rapids in a row with little to no break between rapids.  Up until this point we would have a long stretch of calm water between rapids, so this was a new challenge for us.  We made it through the first ugly sister, a category 3, with few problems.  It was a fun rapid and nobody fell down into the boat on it and we paddled through it quite well.  The problems started with the second ugly sister, which was supposedly a category 2 rapid.  As we went through the rapid a huge wave of water lifted the left side of the boat up, almost flipping the boat over!  As the boat was lifted up I fell off of my seat on the left side of the boat and flew across the boat slamming into its right side and bouncing off of it back into the boat.  It was a good thing I had the other side of the boat to stop me or I would have flown right out of the boat.  One of the girls on the right side of the boat fell out and into the water.  Luckily she stayed next to the boat so the guide was able to pull her right back in.  Afterwards we asked how that was a category two rapid and he said it was maybe more like a two and a half.  The third ugly sister was a category 1 and we got through it easily.  You know it’s an easy rapid when the guide doesn’t even give you instructions on what direction to swim in if you fall out of the raft.  I think it was expected that we wouldn’t fall out.

Immediately after the Ugly Sisters came the most exciting, frightening, and difficult rapid of the afternoon, The Mother.  I think that the video I have attached here is of our run down the last ugly sister and this rapid, but I am not positive.  Just as a warning there are a few choice swear words in this video, because that reaction tends to happen when you head towards massive waves of water.  My friend Elis from the tour had a waterproof camera on the trip, so he was able to provide some great pictures and video.  It is hard to tell what exactly is going on in the video, but here is what I remember about this rapid.  As we approached the Mother, our guide was yelling us to keep paddling forward.  We were pretty determined to do this until we saw the beginning of the rapid and started going down it.  You can hear a few of us scream in the background of the video.  At this point most of us were just kind of like, nope, paddling isn’t going to happen, and ducked down into the boat and held on for dear life.  I was definitely one of those people.  As we crashed into the water, the force bumped me onto my back.  Then, as I sat up, we approached a wave of water which pushed the boat up to nearly a vertical angle!  I thought for sure we were going to flip over, but Elis’s quick thinking to put all of his weight at the front of the boat saved us from flipping.  I’m pretty sure this corresponds to the point in the video where everything turns chaotic.  After that rapid we were all completely wound up and relieved that we had made it through at the same time.  This sequence of rapids was without a doubt the highlight of the rafting trip for me.

One more rapid of note was the Washing Machine.  We were told to paddle right as hard as possible so that we would go to the side of the Washing Machine instead of inside it.  We were extra motivated because he said if you go through the spin cycle of the Washing Machine there was no chance of getting through the rapid without falling out of the boat.  And yes, the Washing Machine looked exactly how it sounds like it would look.  Luckily, we were motivated and strong enough to avoid the center of this rapid and made it through safely.

After our adventure through rapids 1-19, we had to walk up to the top of the gorge.  This was probably the worst part of the trip because you had basically paddled constantly for almost five hours straight with very little drinking water and then had to walk straight up a cliff.  Let’s just say my adrenaline kind of wore off half way up the cliff and the second half was a bit of a struggle.  However, lunch and cold drinks were waiting at the top, so we were rewarded at the end of the hike.

Rafting the Zambezi is definitely an experience I’ll never forget.  It definitely was not a relaxing day.  We all had to work very hard for several hours to keep our boat upright and moving.  In the end, we were a successful raft because we worked as a team.  I think it helped that we were all friends who had been on tour together.  Our raft didn’t flip over once, and we only had one person fall out of the boat, which was a pretty big accomplishment.  It was one of the most exciting and scary things I have ever done.  I am so glad that I took advantage of the opportunity.

All photo and video credits go to Elis, who was awesome enough to take some pictures and videos of the experience with his waterproof camera!

The girls of the group before rafting. 

Walking on the shore around rapid #9

Walking down the scary steps to the river!

Proof that I was actually in the raft!

A view from the raft

  I don’t think I would necessarily recommend these particular rapids for beginners such as myself, and I think that rafting this river truly was a once in a lifetime experience.  I probably will not raft this river again and I kind of think I want to stick to category 4 and below from now on.  It would probably make my mom less nervous.  However, I am looking forward to trying out more whitewater rafting on different rivers in the future, and who knows; maybe I will decide to try some category 5 rapids again in the future!

Also, here is a link with a cartoon map of the rapids with all of their fun names! https://www.afrizim.com/Image/maps/zimbabwe/victoria-falls/Batoka_Gorge.jpg

Chobe National Park

Chobe National Park is nestled in the north of Botswana on the Chobe River which divides the border between Botswana and Namibia. The only thing I really knew about Chobe National Park prior to going there is that it was apparently well known for having elephants. I went into the day at Chobe with the expectation of maybe seeing a few elephants and maybe a few other animals. Let's just say that my expectations were blown away.

Our group's first activity was a game drive in the park in an open 4x4 vehicle. The roads inside Chobe National Park are all sand and dirt, so even the ride in the car itself was fun. It kind of felt like the Indiana Jones ride at Disneyland as you rocked back and forth in the vehicle. It was a good thing the truck stopped for us to take pictures because it was nearly impossible to take pictures while it was moving.

I soon forgot about the rocking of the truck as a group of elephants crossed the road right in front of our truck! I was surprised and excited to see them so close to the truck. They passed so close to the truck I could hear their footsteps! It was as if they didn't even care we were there. I learned later that the elephants don't see vehicles as a threat, but can see humans as a threat so if we were to talk loudly in the vehicle they might have felt more disturbed. Once they passed in front of the truck, they headed for the river where they started drinking and playing in the water. This was the first of many elephant sightings. I think we saw at least 50 elephants over the course of the day, but I sort of lost count after a while. It was at this point that I knew this was going to be an amazing place.

The truck headed down to the river's edge where there were animals as far as the eye could see. Hundreds of impala were grazing on the grass around the water. There were hippos lounging on shore. I also saw many types of birds. One of my favorites was the African spoonbill, which was using its spoon shaped bill to search for small fish in the water. I also saw my first giraffes, which was very exciting. There was a group of them grazing near the river. They were eating grass and had to spread there legs out and lean over in order to even reach the grass because they are so tall. It was very funny to watch.

As we headed away from the shore we saw the Tsessebe, a shy species of antelope. Unlike the elephants, giraffes, and impala, the tsessebes are nervous around the cars so they started to run when the car was approaching. They were incredibly agile and fast. They sort of bounced as they ran. I was able to get a video of them and it was very cool to watch. There are so many other things I could talk about, but the last thing I want to mention is that at the end of the drive we were able to see the Sable antelope, which was incredibly exciting because they are rare and not often seen. They were behind some trees, but we still got a pretty good look at them. My friend Gabby was really hoping to see one so she was very excited to see a whole group of them!

After the game drive we headed to the river for a sunset river cruise. The cruise went very close to an island in the middle of the river, where the animals like to hang out due to availability of food and close proximity to water. I was able to et some great pictures of a couple of male elephants that the boat got close to. We also saw a baby hippo with its mom grazing on the island. This was really cool because before most of the hippos I had seen were either in the water or laying down on the ground or in the mud. We also saw a crocodile that opened and closed its mouth for us, which was awesome to see.

As the sun was setting I was able to get a few good sunset pictures from the boat. My favorite is one where a local person in a canoe was rowing by and I was able to catch the sunset with him in the foreground.

After we got off of the boat and headed back to camp I didn't want to leave Chobe. It was a beautiful setting and I couldn't have imagined prior to that day that I would ever see so many elephants in one place. Prior to this trip I thought it would be cool to see elephants, but they weren't one of my favorite animals. Seeing the elephants in Chobe up close and watching them play and interact quickly changed my mind and they are now one of my favorites! For example the elephant's trunk is basically like a hand. I was able to see up close that it could be used to pick up almost anything, from the tiniest leaves and branches off of trees, to the dirt on the ground to throw over themselves to cool off. Chobe National Park succeeded in becoming my favorite part of the trip up to this point and I wish I would have had more than one day there!

Okavango Oasis

Okavango Oasis

My tour began with two long driving days through Namibia and Botswana. I actually joined into a group partway through the tour along with my new roommate, Gabby, who is from England. The rest of the bus has been on tour for two weeks already, so they all know each other really well. They will all finish in Victoria falls however, while Gabby and I continue to Kruger National Park in South Africa.

The entire group was very welcoming and they are a fun group. Most are from the Netherlands and Germany, but we also have one person from New Zealand, one from Belgium, and a couple from Sweden. There is a bit of German and Dutch being spoken at times, but most of the people on tour speak great English and really welcomed Gabby and I to the family. We have a whole range of ages in our group, with 19 as the youngest and 67 as the oldest. Everyone gets along really well despite the age differences and there are a lot of young women around my age who I hang out with a lot.

The first major stop for the tour was the Okavango Delta. We departed on the first morning from a camp on the western side of the delta and headed Southeast through the delta by speedboat for two hours to our camp for the next two nights in the delta. The speedboat ride was full of twists and turns and it felt amazing to feel the wind in my face despite the early hour. We stopped a couple of times along the way to look at crocodiles along the shore. The boat went really close to them and one of the crocodiles actually snapped at the other boat in our group and scared some people onboard.

When we arrived on shore, we took open trucks to get to our campsite for the next two nights. On the way we were pleasantly surprised to see some elephants next to the road! These were my first elephants so I was very excited! The camp itself was fantastic. The tents had cots in them, so it felt like a real bed compared to the mats we sleep on in the regular tents. We also didn't have to set them up and take them down, which was nice. The bar area overlooked the reeds of the delta.

On the first afternoon we took a mokoro ride through the small channels of the delta. A mokoro is a canoe which holds two people plus a poler. The poler is a person who stands in the canoe and uses a long wooden pole to propel it through the channels. On the mokoro ride we were able to see many of the birds of the delta. My personal favorite was a tiny blue kingfisher, which was beautiful, but difficult to get a picture of. I think I got one or two good ones. We then traveled to a deep pool where we were able to see hippos. There were about 8 in the pool and they would just pop their heads out of the water. We only saw them from a far distance because if the mokoros get too close to the hippos, they become aggressive and you do not want a hippo bumping against your small canoe. The hippo would win that battle hands down. On the way back to camp we were able to see the sunset over the delta from the mokoros, which was a great way to end the day.

After getting back we were able to enjoy one of Mama Soli's amazing homemade dinners. On this night it was grilled hake (a type of fish) with salad, potatoes, and butternut soup. She made her own tartar sauce for the fish which was delicious. It was one of my favorite meals.

We were warned when we arrive that elephants often walk through the camp at night and were told to stay in our tents if we heard them. That night as I lay in my tent I heard elephants and they sounded close. When I got up to go to the bathroom during the night I kept hearing things rustling in the bushes. I couldn't get back to my tent fast enough! Camping definitely takes on a different tone when you could potentially literally run into an elephant in the middle of the night.

On the second day we took the mokoros to an island where we were able to do a bush walk. On the bush walk we saw elephants, zebras, warthogs, and antelope. We even got a bit too close to a breeding herd of elephants, which tends to be more aggressive because they have babies. Luckily our guide noticed them before they noticed us so we were able to quickly walk away to a safe distance. It was very cool to see the zebras. We could get fairly close to them because they hang out around the cows that roam freely in Botswana. Since the cows don't see humans as a threat, the zebras tend to stay in place grazing when humans are around too. The zebras apparently hang out around the cows because they can outrun them when predators come. It was a bit strange to see zebras and cows next to each other, but then again, seeing elephants along the highway has become the norm for me, so I'm not surprised by much anymore.

Later in the afternoon we got to try our hand at poling the mokoro. I didn't flip the boat over doing it, which was quite an accomplishment because it is surprising hard to balance and propel the canoe forward while standing up. We went back to camp for a dinner of stew made with kudu meat and then headed to bed because the next morning was an early morning.

Though the delta was an extremely exciting experience, it ended on a bit of a sour note. Our speed boat broke down on the way back so we were stuck in the water for almost two hours before another boat rescued us and took us on the additional hour and a half of the boat ride. My face got badly burnt and a bit of it was even blistering the next day. I think this was due to the sun sensitivity side effect of my antimalarial medication. I certainly learned my lesson about putting on sunscreen even if you are leaving somewhere at sunrise because you never know what might happen.

Though we were a couple of hours behind on our long drive after the delta, the day ended on a positive note, as we saw a cheetah cross the road right in front of our truck! I was half asleep when this happened so I could only scramble around to get a bad picture with my phone before it disappeared, but I saw it really well! It was a 72 hour period that started with my first elephant sighting and ended with a cheetah sighting, so I would consider it a big success!

Off to Namibia!

Off to Namibia

Excited for the start of my tour, but sad to see Ghana go, I headed to the airport via taxi early in the morning before sunrise. Little did I know that this was going to be a stressful day of traveling.

When I got to the airport I found out that my flight had been delayed for an hour. In the end we were delayed an hour and a half and finally took off for Johannesburg, my first stop before connecting to Windhoek, Namibia. As my flight landed in Johannesburg things started to get crazy. I had about an hour before my flight was scheduled to depart. I rushed to find that I had to go through a passport checkpoint despite this being a connecting flight. It was madness as hundreds of people were trying to get through the line to catch their connecting flights. Finally, at the urging of an airport employee, I pushed through the crowds of people to a specific line where I got through, though not without some dirty looks. The head of a group of about forty high schoolers voiced her anger because they had a flight leaving soon as well. I was given specific instructions so I didn't feel too bad, plus one of me was much more likely to be left behind than the forty of them on one flight.

Once I got through that checkpoint I then had to go through security to get to the departure terminal. When I got through security it was about 7:10. My flight was scheduled to leave at 7:30 and the gate was supposed to close at 7:10. Not knowing what else to do I started sprinting towards my flight gate. Easier said than done considering that I had the misfortune of my connecting flight on the opposite end of a huge terminal. As I ran by a sign that said it was an 8 minute walk to my gate, a voice came over the intercom saying they had an urgent announcement for anyone on my flight to Windhoek that hadn't boarded because they were about to close the gate. I ran faster yelling to workers that gave me strange looks as I ran by that I was on the flight to Windhoek, hoping that someone would call and tell the gate that I was coming as fast as I could. When I finally reached the gate I breathed a sigh of relief as I was allowed to board. I scrambled to my seat, flustered from the entire affair, huffing and puffing for a good five minutes both from the running and the anxiety of almost missing my flight, but I made it so I was relieved.

About 10 minutes later five more people walked onto the plane with no sign of exertion on their faces. They obviously had not made the same sprint I had. Oh well. I guess I got some exercise.

As I relaxed into my short two hour flight to Windhoek, I began to get excited about my tour that was going to leave in about 36 hours. I thought that I had it made once I made my flight to Namibia.

However as soon as I got through immigration in Windhoek, I found that neither of my checked bags had made it to Windhoek. This meant that I had to stand in line for over an hour to fill out a missing baggage form so that they could search for my luggage. When all of that was over, I got a ride to my hotel, which luckily came into the airport looking for me and didn't just leave without me. I checked into the hotel at about 11:00 at night. The hotel said they only had me booked for the next night though I had booked for two nights, but luckily there was a room available, so I was finally able to collapse on a bed.

There is a happy end to this tale, however. Though most things went wrong that could have, I found that I was able to handle it a lot better than I thought I would. Additionally as soon as I got to my room, I took my first hot shower in a month. I didn't have hot water at all in Ghana, so that shower really washed away the worries and stress of that day. Then I slept for about 10 hours because I had a free day before my next adventure began.

Hospital Inpatient Pharmacy

For about a week and a half I had the opportunity to work in the inpatient pharmacy at Tema General Hospital. In contrast to the outpatient pharmacy, which was big and open, the inpatient pharmacy was tiny and cramped. It was smaller than the studio apartment I used to live in in Corvallis. The entire pharmacy consisted of two large desks with chairs crammed around them and a few cabinets stocked with medications. At any one time there were 10-12 people trying to work in the pharmacy,so it could get very crowded and hot in there.

The process of filling a prescription was different here than in the outpatient pharmacy. One major difference is that instead of getting written prescriptions, we were given patient charts. This hospital still uses paper charts, so the nurses or patients would bring the charts by when they needed medications. Things generally didn't pick up in the pharmacy until after 10, when the doctors finished their rounds. Then we would start getting stacks of charts from nurses for patients either needing medications or needing their medication bills calculated before being discharged.

If a patient needed medications, the chart would be evaluated by a pharmacist who would key the medications into the computer system. The pharmacist or intern must go to the plan section in the chart to determine which and how many medications are necessary. They are starting to transfer to a computer system, so they enter the patient's medications and directions into the computer system before filling the prescription. Once the drugs are keyed into the computer system, the drug names are written into the back of the chart along with the number of tablets or units to be given. This is later used in discharging which I will explain later. Then the charts are given to another worker who pulls the drugs off of the shelf and gives them to a nurse or a family member of a patient to take to the patient's room.

Now I will explain the discharging process, which is the area that I primarily worked in, so I can explain it in more detail. Before patients are discharged from the hospital, their hospital bill must be calculated. This billing process usually includes services billed to the national health insurance and services that are paid in cash. The inpatient pharmacy here is responsible for writing in all of the charges for medications that patients get at the hospital. When a nurse brought in charts for discharge, I would take the chart, and turn to the back section, which consisted of essentially a cost sheet. This is where all of the medications and quantities that the  patient had while at the hospital are listed. I would then do a quick skim of the rest of the chart to make sure all of the medications given were written down on the cost sheet. At this point I would also assess if there were any discharge medications to be given and calculate the number of tablets that would need to be provided to the patient. I would add those medications to the list in the back of the chart. Then I would go through the process of calculating the drug bill. If the patient had the National Health Insurance, there would usually be a separate insurance sheet that would have the patient's information and diagnoses in it. If the patient's diagnoses were not on the form already, I would look through the chart to find them and write them down. I would then fill out the medications section of the claims form where I would write down the name, quantity, price, and date that the medication was administered to the patient. I had to look up all of the prices in a pricing book, which usually listed prices on a per tablet or per vial basis. The pricing book would also say if the particular drug was covered by the national health insurance or if it needed to be paid for with cash. The prices for the cash prescriptions were written in on the cost sheet in the chart. Once I had prices all of the drugs figured out, I would add the totals for both cash and insurance. Then I would tell another student keeping the record book the insurance and cash charges along with the folder number and ward. This book is their handwritten record of all pharmacy charges since they do not have a complete electronic system available at this time. Finally I would hand the chart to another student or pharmacist to fill the prescriptions if there were discharge medications, or back to the nurse if there weren't any prescriptions to fill. Then patients would take their folder to the billing and claims office after discharge so that the medication bills could be paid.

This process proved to be difficult at first because they gave me about a three minute introduction to the entire process. However, I was able to adapt pretty quickly  and a pharmacist in another section of the hospital was even surprised that I had figured out their system so quickly, so I was pretty proud of myself. Luckily certain medications were repeated a lot so I had quite a few of the prices memorized by the end of the week. It was a lot quicker if I didn't have to look up all of the prices for every single patient.

Though at times I felt like a worker at an insurance claims office or an accountant during this process, doing these discharges was a great pharmacy experience for me. I spent quite a bit of time reading through and assessing patient charts. When discharge medications were required, I was really able to flex my pharmacy muscles since I needed to assess these prescriptions before they were filled. I got to see profiles of patients from many different wards with many disease states. I became familiar with treatment regimens for different conditions, which I think will be beneficial once I start my hospital rotations back in Oregon. I learned a little bit about how billing works in a hospital, which is great even though I know it is different in the United States. I also learned how to quickly work and adapt to a busy and pressured work environment because speed was definitely emphasized and the work was nonstop.

I also realized from this experience how grateful I am for all of the technological advances we have back home. Doing almost everything without a computer made me realize how much I rely on them. Doing things by hand takes a lot of time and concentration. When you read a handwritten chart, there is a greater potential for error if the handwriting is not very legible. I have a new appreciation for the difficulties that hospitals must go through in providing patient care while having to do nearly everything by hand. The people are extremely hardworking and I respect them immensely for being able to do this everyday.

The inpatient pharmacy was a tough week, but the people who I worked with definitely made the experience so much better, even in a sometimes stressful environment. I especially want to thank my pharmacists, Auntie Sylvia and Auntie Janice, who pushed me to really be involved in the process and were always supportive. The experienced female pharmacists and technicians are all called "Auntie" as a term of respect. Additionally I want to thank all of my new student friends who worked with me. Harris and George always managed to make me laugh with their questions and jokes. Lillian was always supportive and the first to say good morning to me and ask me how I was doing. Priscilla was my partner in crime for the week, always sticking by my side, and Samantha, the non-newbie of the group showed me the ropes so that I could really participate in the pharmacy.

The inpatient pharmacy is where I began to really feel like a part of the pharmacy team. Everyone played an integral role in providing patient care, and if all of the pieces hadn't fit together, we would have fallen apart under the pressure. With new students constantly rotating through the pharmacy, it would be easy for the pharmacy to get overwhelmed and fall behind. However, this was not the case when I was there and I was able to have one of my most rewarding experiences yet in Ghana!

Hospital Outpatient Pharmacy

I have decided to split my hospital experience based on the different parts of the hospital I have been to, starting with the outpatient pharmacy, where I spent a week and a half. First I will describe the hospital to you a bit more. Tema General Hospital is unique even amongst hospitals in Ghana. Each ward of the hospital is a separate one story building. For example, the male ward, female ward, surgical ward, children's ward, emergency room, and labor and delivery are all separate buildings. There are partially covered paths leading between buildings, but they are open to the outside air. This means that for example a patient going from surgery back to their general hospital room would be transported via these outdoor paved paths. These paths are paved and clean, but one can see the potential for contamination of wounds, etc. that may occur when transporting a patient outdoors, so healthcare providers need to be vigilant in transport. Unfortunately, I can't really illustrate this hospital layout by taking pictures due to privacy concerns of patients during transport between buildings. Additionally,  this separation of buildings makes it difficult to quickly get medications to the different wards from the inpatient pharmacy. Usually either family members of patients or nursing students come to pick up and transport the medications.

The outpatient pharmacy, like all of the other sections of the hospital, is its own building. It is located near the entrance of the hospital and is a small distance away from all of the other wards. This makes sense because patients going to the outpatient pharmacy are either coming from the nearby outpatient clinic or from the outside community to fill prescriptions. Additionally the outpatient pharmacy services the emergency department prescriptions since the ER is closer to the outpatient than the inpatient pharmacy and needs prescriptions to be filled quickly.

The process of filling a prescription at this outpatient pharmacy is as follows. The patient will bring a prescription to the first window, where it will be taken and reviewed by a pharmacist or fourth year pharmacy student for appropriateness. Then a technician or student will key the drugs to be purchased into their computer system to figure out the pricing and insurance billing if the patient has the national health insurance. The patient then goes to another window to pay for the drugs if insurance does not completely cover them. Next, the prescription and attached receipt come to the dispensing station. Usually pharmacy students are here and take the prescription, go pull the drug off of the shelf, and fill the prescription. This process requires writing a handwritten label with instructions for use of the medication because the pharmacy does not have printed labels. The prescription goes up to another window where there is a final check and the prescription is given to the patient after counseling is performed.

I worked primarily in the dispensing section, meaning I was reading the handwritten prescriptions, pulling medications off of the shelves and making labels. This was more difficult than I imagined it could be, mostly because of doctors' handwriting. Much of the time the writing was barely legible, so I had to be careful that I was getting the correct medication in the correct amount. Additionally the doctors don't write the number of tablets they want. They only write the instructions, so you have to calculate how many tablets to dispense. What made the dispensing process difficult at times was the fact that their abbreviations were different than the ones I am used to at home, and I didn't really figure all of them out until a few days in. Here are some examples.

1. Three times a day, instead of the normal tid, is usually abbreviated tds.
2. Once per day is usually dly instead of qd.
3. Their abbreviation for both eyes is BE, right eye is RE, and left eye is LE. We use OU, OD, and OS for those abbreviations respectfully. We don't use the previous abbreviations because the "E" could be interpreted as eye or ear, so we use completely different ones for both. When I asked a student about this, he didn't have a clear answer for me. He basically said that people would know if it was supposed to be in their ear and the doctor would probably write out ears if it was an ear drop. Anyway this confused me when I first saw it.
4. When they write for length of treatment they don't just write the number of days. For example a five day treatment would be written as 5/7 or 14/7 would mean a 14 day treatment. It is also sometimes written in terms of weeks (1/52 would mean one week, the same as 7/7 would mean one week). It can be written in terms of months, so that 1/12 would mean one month, 3/12 three months, etc. They aren't always consistent with  which way they write it either. For example, I see both 30/7 and 1/12 quite frequently for a month long supply.


The combination of these changes plus the less than stellar handwriting made it difficult to adjust to filling prescriptions. Additionally, there is a pressure to fill prescriptions extremely quickly in this setting. This is not to say that I don't sometimes feel this pressure in the United States, but the environment here puts a larger emphasis on getting things done quickly rather than slowing down and possibly being more accurate. They want accuracy, but I found that the speed at which they worked to fill prescriptions lent itself to a higher possibility of letting mistakes get through. I am so used to the number of double checks implemented in the American pharmacy culture, that this approach took me by surprise. I ended up moving at a pace that I felt comfortable filling the prescriptions accurately at, and they didn't seem to have a problem with that. In fact, by my last couple of days in the outpatient pharmacy, I really seemed to get the hang of things, as one of the technicians complemented me on how hard I was working.

Additionally, I am sensing that there will soon be a shift in the practice of pharmacy in Ghana. The director of pharmacy for the hospital came and had a long talk with the students about what distinguished a pharmacist from just anybody filling a prescription. He said that just sitting there and filling prescriptions as quickly as possible wasn't a good way to practice pharmacy. He said that when filling the prescriptions we should be assessing the appropriateness of the medication, the dosing, and thinking of questions to ask the patient during counseling. I found that the director's attitude reflected more accurately the picture of pharmacy that I have learned at school. It was great to hear that this brand of pharmacy practice is being taught, though it may not be fully practiced yet.

If anyone has any questions about the outpatient pharmacy, feel free to comment and ask! I will probably post on my inpatient experience in a few days.

Cape Coast Adventure

My day started on Thursday before dawn. I was told by Edem to be ready at 4AM for an early start since we would be traveling a few hours away. I should have learned that Edem time is not the same as my time. We ended up not leaving until 5:30.

We finally departed and caught a tro-tro to Accra where we then caught another tro-tro to Cape Coast, a journey of about 3 hours. As we made our way along the road to Cape Coast we passed through several villages, each with their own unique architecture and people. One of the towns blocked off a full side of the road at different places throughout with stones or logs so that cars would have to drive around them and only one could get through at a time. I never figured out why this particular place did this, but it made it difficult for vehicles to get through town. When we finally made it to Cape Coast we immediately boarded a taxi to take us to Kakum National Park, which is about 30 minutes inland.

The road to Kakum is without a doubt one of the worst paved roads I have been on. While the ride to Cape Coast was smooth for the most part, the road to Kakum was riddled with potholes. The cab constantly slammed on its brakes and weaved towards the other side of the road to narrowly avoid potholes. However much of the time it could not be helped and we had to go over pot holes. When we reached Kakum National Park, I knew the ride would be worth it.

Before embarking on our treetop tour through the famous canopy walkway, we stopped for food. This was when I got my first introduction to Fufu, a Ghanaian dish which is essentially balls of cassava dough served in a broth with antelope meat. You just kind of dig in with your hands, so it is quite difficult to eat. Edem made fun of me because I kept chewing on the fufu and apparently you are just supposed to swallow the dough without chewing. I was glad to have the experience of trying it and the antelope, but it was not my favorite meal in Ghana so far.

Once we finished eating we went to what I had most been looking forward to, the canopy walkway. We took a short hike uphill to the beginning of the canopy bridges. As we approached I could hear the laughter of school children on their field trip in the distance. When we got to the walkway the noise died down as the children had finished their walk and were headed back.

When we got to the beginning of the first bridge my heart began to beat a bit faster as I approached the edge. I am not very afraid of heights in general, but this was a bridge up at least 60 feet in the air with only support between two trees! As I climbed onto this bridge make of mostly rope and wood, it began to shake. However after the first several steps I began to become accustomed to the sensation of moving up in the air and began to take in my surroundings. It was green as far as the eye could see. I looked down and couldn't even see the forest floor because the foliage was so dense! I have been around forests for all of my life, so I have seen a lot of trees. However, there was something different about this rainforest. Maybe it was the lighter color of the leaves in contrast to the dark pines I am used to. Maybe it was the vantage point of being up so high. Maybe it was the sounds of the birds, insects, and other creatures unknown that I could hear in the distance. It was probably a combination of all three. All I know is that I rarely stop and take time to just enjoy being surrounded by nature. This rainforest was one of those cases where I just stopped and observed in awe. It didn't scare me to stop in the middle of one of the hanging bridges. When it started to rain it was a welcome familiar face from home rather than a nuisance. I probably could have stood there for hours if I didn't have to leave to let the next group onto the bridges.

Even though I had felt tired this morning from waking up so early I felt energized and refreshed leaving the rainforest of Kakum. We took the bumpy road back to Cape Coast and headed towards Elmina Castle.

The two castle experiences, Elmina and the Cape Coast Castle, were definitely more sobering compared to awe of Kakum. These were formerly forts that held slaves before they were transported to the Americas by ships and are now preserved as memorials and historical sites. The tour guides told us of the history and living conditions of slaves as they took us into the dungeons where they were kept with no space, little light, and little ventilation. I think it was an important site for me to see and the guides did an excellent job of explaining the history while  acknowledging and preserving the memory of those who died there. It is an experience I will not forget.

After a long and exhausting day we took a bus back to Accra and finally arrived home in Tema at almost midnight. It was my favorite non-pharmacy day in Ghana so far, with Kakum being the most amazing thing I have seen!

The Community Pharmacy

Community pharmacy is much different in Ghana than in the United States. I already touched on some of these in my initial post, but there are so many things to talk about. I may have to split this up into a couple of posts because there is so much information. I'll make a disclaimer now that this information is based on what I have observed and may not be completely standard everywhere in Ghana.  This is going to be observational and so it may not always be completely accurate. My ability to do research here is limited, but feel free to ask any questions and I will try to answer them to the best of my ability. I am hoping to be able to do more research once I get back to the states. Hopefully at least some of my pharmacy friends might find this interesting or informative.

1. A typical interaction in a pharmacy.

I thought I would start by talking about a typical interaction between a patient and pharmacist because it is a core part of what we do. I would guess that 90-95% of patients come into this particular pharmacy without a prescription. Sometimes they will have a text about what they want or an empty box that they want refilled, but most of the time they just verbally tell the pharmacist what they want. The pharmacist or technician then goes and gets the medication and tells the patient the price. The patient then pays and the pharmacist will write a handwritten label of how to take the medication and then verbally tell the patient how to take it. Normally for refills on chronic medications such as blood pressure medications they do not write a label or check a prescription.

Most medications can be given without a prescription with a few exceptions. For antibiotics it is up to the discretion and expertise of the pharmacist. For pain killers like tramadol the pharmacist generally asks for who or what it is for before giving it out. However the counsel is usually limited to how to take the medication. Side effects are not commonly talked about. A typical interaction lasts less than 5-7 minutes total in my experience from the patient walking in the door until they leave with the medication, which is a huge contrast to the United States.

Additionally this particular pharmacy is cash only so they don't deal with insurance companies. Some customers ask for written receipts that they can give to their employer for reimbursement for medications, but there is no formal insurance billing at this location. Patients with Ghana's national health insurance usually fill their prescriptions at a state sponsored hospital's outpatient pharmacy.

There is also more downtime in this pharmacy than in the United States. We don't process many prescriptions or deal with insurance which cuts out a lot of time. We also don't have patients calling in for prescriptions to be filled and the pharmacy does not have all of the checks and verifications that we do in the United States. Activity basically ebbs and flows with the patients coming into the pharmacy and I would guess we don't sell to many more than 50 people in an entire day, at least on Saturdays when I am in the pharmacy all day. It is busier on weekdays, but I am only there part of the day on those days so I do not have a good sense of the total traffic.

2. Record keeping in the pharmacy

Now this is specific to my location so I do not know if this is standard to all pharmacies. This pharmacy does not keep a record of the prescriptions it receives. In most cases the prescription is given back to the patient once they have purchased the medication and is marked off with a pen so they can't fill it again. They do not have a record of patients and all of the medications they are taking, which makes it difficult to assess drug interactions or misuse of medications. One thing the pharmacy does in cases of acute illness is take the name and number of the patient down so that they can call and check up on the patient in a few days to see how they are doing. This is done quite often with antibiotic treatments. I have talked to one of my pharmacists who finds that having a record of a patients' medication list might be a useful way to help mediate this problem. He is very interested in how pharmacy works in the United States and has talked with me extensively about topics such as MTM and antibiotic resistance. Hopefully some of my knowledge might help the pharmacists here with their practice of pharmacy just like their knowledge is helping me.

3. Rapid Malaria Testing

While I am in Ghana I am taking a medication to prevent malaria. The locals however do not do this malaria prophylaxis, with the exception of some pregnant women (Could you imagine everyone in the country taking antimalarials for their entire lives?)and malaria is very common. For this reason, one really nice service that the  community pharmacy I work in offers is rapid testing for malaria. Then, if the test comes back positive, the pharmacist can provide the patient with the malaria treatment right there in the pharmacy, cutting out the doctor's visit and need for a prescription.

The particular test that is used in this pharmacy tests for HRP-II (histidine rich protein II) in blood. This protein is expressed only by the P. falciparum species of malaria, but this is the most common malaria type in the country. You essentially add a buffer to the blood sample on the test strip. A positive test equals two lines and a negative test equals one line on the strip. The blood is taken from the thumb or finger, in a similar way to blood glucose testing.

If the result is positive, the patient has the option to purchase the treatment. The most common treatment I have seen for adults is Coartem 80/480, which is a combination of  artemether 80 mg and lumefantrine 480 mg. It acts as a schizontocide, destroying the parasite that causes malaria. It is taken twice per day for 3 days. There are other regimens available and the doses change for pediatric patients.

4. Drug Packaging

Now people may look at this title and think: Why is she writing about drug packaging? While it might not be all that fascinating, it was interesting for me to find that almost all of the tablet medications are in boxes with blister packs. As pharmacists in the U.S. know, most of our medications come in bottles and then we count the correct amount for the prescription. The community pharmacy in Ghana doesn't even own a counting tray! I commented on this upon my arrival and I did not get a clear explanation, but I do have a few ideas listed below.

1. The boxed medications are what the pharmacy is able to order.
2. Many patients come into the pharmacy to buy less than a months worth of tablets so it is more convenient to just grab a strip out of a box. Additionally they often change their mind on how much they want based on the price, and having it in a bottle could mean the pharmacist would need to constantly re-count tablets.
3. It is quicker to retrieve the correct number of tablets from the box. Patients expect to get in and out of the pharmacy quickly so timing is key.
4. The climate here makes the blister packs of tablets more suitable. It is hot and humid here and most places do not have air conditioning (though the pharmacy does) so having medications in bottles could lead to unwanted moisture damage to tablets.

Anyway, I found this to be kind of interesting though it may not be having a huge implication on what I am doing in the pharmacy.

5. The dangers of so many OTC's

I mentioned in my first general post that a lot of medications are over the counter here or given without a prescription by the pharmacist based on their assessment. I thought I would end this post with a story that indicates why this process can sometimes be problematic.

I'll start by saying that people come in for NSAIDs (Nonsteroidal anti-inflammatory drugs) like ibuprofen all of the time. NSAIDs that are prescription in the U.S., such as diclofenac, are essentially OTC here in all strengths. The drugs are all kept behind the counter, but if someone asks for diclofenac, it is often given without questioning.

However, I noticed that the pharmacists tended to ask more questions when it came to a particular NSAID, indomethacin. The pharmacist would ask what the patient was taking the medication for, and the response would be that they didn't know. Customers couldn't give a direct answer about who it was for either. Finally upon coaxing we found out in some cases that they planned to use the indomethacin to kill rats. Apparently it is common for people to come into the pharmacy seeking indomethacin for this reason because it is cheaper than rat poison. They apparently open the capsules and sprinkle the powder on meat or bread to attract the rats so they eat it. The problem is that not all pharmacists may be as diligent about asking questions and people could walk out with indomethacin both using it for the wrong reason and potentially preventing patients who need it from accessing it. This would be more likely if a technician, who generally doesn't ask as many questions of the patient, ran the encounter.

Now some of my pharmacy-minded people may ask why only indomethacin? If it kills the rats shouldn't another drug from the same class do the trick? The best explanation my pharmacist gave me is that indomethacin was one of the first and most popular drugs in Ghana used for pain and inflammation. He said it is likely someone discovered that it in particular can kill rats and the tradition of its use continued. The public doesn't have the knowledge of medications to know that something else could potentially work.

Anyway I will leave you with this thought. The ability for patients to access medications without a prescription can be extremely beneficial in populations that cannot easily access doctors. However, there is always the danger of medication misuse and caution should be taken when providing patients with medications, especially those with a large potential for misuse and those with severe side effects.





http://www.standardia.com/en/home/product/Rapid_Diagnostic_Test/Malaria_Ag_Pf-HRP2.html

Welcome to Accra!

On Thursday I had the opportunity to visit some tourist sites in Accra, the capital of Ghana, with Edem, my host. We boarded a crowded tro-tro in the early afternoon that took us straight to the city. We walked past a market on our way to our first stop. You could see every color of the rainbow from the different fabrics on display and the smell of grilled fish was prominent.

My first stop was the Kwame Nkrumah memorial and museum which is in honor of Nkrumah, the first president of Ghana. The memorial itself was impressive and the museum taught me a lot about the history of the man. I learned that he was not only President of Ghana, but later was president of Guinea. He is the only person I have heard of who has been president of two separate countries at different times. The grounds were also very nice and had peacocks and chickens roaming through them. It was peaceful and quiet inside the gates which was a nice change from the hustle and bustle of the city outside.

Our next stop was Jamestown, which is part of the Greater Accra area. We stopped at a lighthouse there which provided a spectacular view of the coastline and city from the top. There was a fishing village in view from the lighthouse and I could see all of the fishing boats out on the water. One of my favorite pictures I took was a view of the city that included a dirt soccer field where kids were playing. The top of the lighthouse also provided an amazing breeze which I was thankful for seeing that I haven't quite become accustomed to the hot and humid weather yet.

Next we went to the independence square which is a landmark that marks Ghana's independence from the British. A parade is held there every year on their Independence Day and the president sits in a special box in the stands.

Finally we took a side trip to another part of greater Accra called Osu. A fun side note is that everyone here comes in and reads my OSU white coat as Osu and think I am somehow associated with that place. It is a great conversation starter, so thank you Oregon State! While we were there we got fresh sugar cane juice with lime. The best way that I can describe it is that it tastes sort of like limeade only it is much sweeter and less tart. We then headed back home to Tema and our day was complete. It was great to learn a bit more about Ghana's history and experience its capital city.

My First Week in Ghana

Introduction 

I thought it might be nice to keep people updated about my trip this summer to Africa which includes  internship in Ghana as well as a vacation I am taking to a few countries in Southern Africa afterwards. I have never written a blog before, so I apologize if this isn't that great, but I thought it might be a good way to keep people updated. I also apologize for any weird formatting issues. I am doing this mostly on my phone so I don't know how it will look. This first post is just going to be dedicated to different things that I have had to adjust to in my first week in Ghana.

Here is just a brief background about what I am doing in Ghana. I am part of a student exchange program through the International Pharmaceutical Students' Federation (IPSF). As a part of this program I am interning at a community pharmacy called Top Pill Pharmacy and a hospital called Tema General Hospital, both located in Tema, Ghana, which is just outside of the capital city of Accra. I will be working at least 50 hours per week, so my ability to update may be limited. I also get two days off per week to explore different parts of the country. The following is just a quick overview about things that I have had to adjust to being in a new country.

1. The Pharmacy

Pharmacy is way different in Ghana compared to the United States. I am planning on doing at least one or two more detailed posts focused on pharmacy in the next couple of weeks, but here are a few first impressions:

1. Pharmacists can prescribe antibiotics: if a patient comes into the community pharmacy with symptoms that the pharmacist finds consistent with a bacterial infection, then they can give the patient antibiotics for the infection. However I have found that when a person comes in asking for a specific antibiotic, pharmacists will give it to them as long as they say who or what it is for. They are essentially over the counter but at a pharmacist's discretion.

2. All prescriptions are on paper: There do not appear to be any electronic or phoned in prescriptions. Additionally all hospital patient charts are on paper. I have had to deal with reading some bad handwriting so far. However there is some electronic inventory and hospitals are working towards an electronic system. The community pharmacy has a computer system to look up products and their price.

3. A lot more medications are over the counter: I will go into more detail in a different post, but some examples that may surprise pharmacists in the U.S. are diclofenac and tramadol, which are both OTC. They are kept behind the counter so you must ask a pharmacist or technician for them, but they are supplied to the patient as an OTC product.

4. Pharmacists cannot give vaccinations in Ghana: this kind of surprised me considering it seemed like pharmacists did so much clinical work in the community. However this was one major thing that I can do that pharmacists in Ghana cannot! Community pharmacies will sell tetanus vaccine if given a prescription, but the patient must then take the vaccine to the hospital to receive the injection.

There are so many more things, but I will address them later!

2. Transportation

Getting to and from work every day is also quite different. I take a combination of a  tro-tro which is essentially the Ghanian bus system, and cabs to get around. Now I say the tro-tro is like a bus, but actually they are vans that squeeze 15-20 people in them depending on their size. They are a very cheap, costing 1-2 cedis ( 25 cents-50 cents U.S.) per ride. They have a driver and a person in the back who collects fares, directs the driver when to stop, and signals potential riders. There are no discernible markings that designate routes but rather hand signals that dictate the route. If the fare collector has a finger pointed to the right, they go in that direction at the big roundabout. A finger pointed straight up in the air is straight, which is the route that I take. A finger moving up and down and pointed straight up goes all the way to Accra. Those are the only ones I know. I literally can only get to work because somebody showed me exactly what to do.  They also drive on the same side of the road as we do.

3. Food and Water

All of the water that I drink here is either bottled or comes in little plastic bags, called sachets. The sachet water is also purified and comes in 500mL bags. You bite the corner off of the bag and drink out of the corner. I still look a bit clumsy drinking from the sachet bags so I generally pour them in a water bottle for ease of transport and drinking.

My diet here is much different than back home. Mostly I have been eating street food that my pharmacist has been showing me, so I think I am being at least somewhat adventurous. The meals usually have a base of rice with some sort of meat or fish and sometimes coleslaw. The local dishes I have tried so far include jollof rice, Ghanian fried rice with chicken, Ghanian noodles, Red fish, grilled tilapia, Banku, fried plantains, kebabs, and local fresh fruit. They use much different spices than I am used to. I also miss vegetables, because though some dishes might have a little bit of a vegetable thrown in, I haven't seen many salads or cooked vegetable side dishes so far. The street meals are pretty cheap at 6-10 cedis ($1.50-$2.50 USD) and usually have enough food for me to eat two meals. Their portions are huge! Packaged food isn't quite as inexpensive but is not really expensive for the most part. The difference in food is taking some getting used to, but I think I am slowly adapting.

4. Language

English is the official language of Ghana, meaning it is the language used in drug labels, prescriptions, patient charts, road signs, etc. However it is not the most widely spoken. Most speak the local language, Twi, most of the time, including the workers in the pharmacy. They usually only speak English when talking to me. Most people understand or know a bit of English, but prefer to speak Twi. I am learning a little bit and know some basic greetings, but most people switch to English when speaking to me.

5. Street vendors

There are people on the street who sell all kinds of things, ranging from food to toilet paper to soccer balls to clothing. The locals call them hawkers. They even walk between cars during rush hour traffic, selling snacks and drinks to people in cars stalled in the traffic. This is definitely a different experience that I was not used to before coming to Ghana.

Sorry about the long marathon post. Hopefully my others will be much shorter. I hope you have enjoyed learning a bit about my experience in Ghana so far!