Dinner

 Vanilla gelato with homemade blueberry sauce, homemade  chocolate sauce, homemade whipped cream

This was part of a grand meal I made for Wife's birthday this weekend. We had shrimp cocktail, beef tenderloin and mashed potatoes and the dessert. This was a classic Julia Child style meal where making the three sauces (the beef stock reduction for the tenderloin, the berry sauce and the chocolate sauce) plus the whipped cream took more time by a factor of 7 than the whole rest of the meal. 

Unfortunately, as is so often the case with our aged digestive tracks, by the time we were done with the main meal , we had no room for dessert.

So this is what we had for dinner. We loved it but decided this is maybe a once a year thing to do!

 

 

 

Theodora Africa Update - Yes, I Did More Go To The Hospital

 Actually, I went to Ghana for reasons other than the full immersion experience into the Ghanaian Hospital system. The actual reason was to conclude our search for a full-time local manager.

Since the first of the year and especially after the client survey, it has become apparent that lack of day-to-day, onsite, local management was inhibiting our Participants development and therefore the projects development. Working with a number of our volunteers, we established the position expectation for this role and the criteria for screening candidates. We publicized this in Ghana and got over 100 applications in two weeks time.

Two of our volunteers,  then screened the applications bringing the number to 12. I now became involved. We shed another 4. The remaining 8 were interviewed by the two volunteers. We selected 3 finalists. I conducted two virtual interviews with each of the 3. We were faced with a problem that our desired compensation range was far below the market's expectation. We were faced with a situation where after all this effort, might not have an acceptable candidate. 

However, our number one choice showed a real desire to find a way to bridge the gap between her requirements and our capabilities. She suggested that we hire her on a part-time basis for three months at a a fraction of her compensation expectation so we could mutually prove to ourselves this was a good match. I was quite pleased to have this option and we accepted. 

She will be starting this Monday. I am on my way back home. I will be back in Ghana in 7 weeks. I am keeping my fingers crossed that this will be the element needed to take our quality, and productivity to the level necessary that we can safely expand.

But Wait! If You Act Now There's More!

Thought we were done with the Ghanaian hospital system? Well, there was one more thing we had to do once our Participant was released and I had an inkling it might be a reprise of our prior frustrations. 

 I had stopped our story because we were just so glad to have her out of the hospital. But checking out was not a simple process. You had to get a person from the Ward to go get your bill. Then you had to pay your bill. But no, we put a deposit down and the bill was for less than the deposit. The folks at Bill Pay said they had no record of the deposit. Go back to the Ward and get the deposit receipts. Done. Go back to Bill Pay. Nope. Go to Billing itself. They run a bunch of statements. Stamp them all and say we don't get copies. Plus we can't get the refund on Saturday. We have to come on Monday when the full staff is in and they can process it. But they do give us something and tell us to go back to the Ward so we can finally get our Participant out.

Monday comes and my driver, Frimpong, and I are back at the hospital. I had this feeling (cue the ominous music) that we were not just going to waltz in and get the refund. I mean how complicated could it be. They give us the statement that shows we paid in more than we owed, we go to the Bill Pay and we get our money back. 

Not quite.

The first part went as thought. BUT, then we were told we had to bring the papers to the Ward to have it verified. Done? No. You have to go to a different office and have all the papers copied (just a window in the wall to the office with a crowd of people around it all needing copies). Then you go back to the Ward. Each time you go to the Ward, I should mention, you have to find this one particular person, who I might say doesn't particularly like to be found (honestly, I think he has a crap load of stuff he is in charge of). But having Frimpong made it easier. 

Now having gotten our Ward certified set of papers, we go to the Bill Pay office and get our money.

Right?

Wrong.

We have to find some hospital-wide finance office way, way in the back of the facility. This requires wandering around, asking numerous people and finally finding the office. Frimpong by now has determined that I am pretty much a worthless Obroni (White Guy). He plops me down in a chair and waits until it is his turn. Shows all the papers. Papers are in order.

We get our money.

No.

We are told that the money won't be ready until 2 hours from now. I have to get to my business meetings. Frimpong says he will come back. When he picks me up in the evening, he tells me he had to wait another THREE HOURS before they finally made the pay out. 

In fairness I know plenty of horror stories of people dealing with our own American medical and medical insurance system. I am not sure this is so much worse. It is just very different.

 

Hospitalization Update

 We got our young Participant out today. She's tired (right, hospitals are the worst places to rest). But she seems to have recovered fine so we are all very happy. And for you Americans, you know that wages in Ghana are about a 10th of what a similar position would pay in the U.S. The same is true for many costs. Four days in the hospital, all tests done etc, medications, all those incidentals I discussed...$400.

de-I in Wonderland - A Ghana Hospital System Adventure

 One thing I DID NOT plan to do this trip was learn how to navigate the Ghanaian Hospital system. But learn to navigate it I did.

One of our Participants had been complaining of a pain in her right side. It was preventing her from lying on her side when she slept. By Tuesday morning the pain was acute and she was barely able to move. It's hard for a middle class or higher strata person in a developed country to conceptualize the what those in less developed countries who are not in the upper strata deal with medical issues. Our Participants, people who have fallen through the rather wide cracks of society here, have little to do with doctors or hospitals. 

This Participant does my local scheduling so we were scheduled to meet the first thing that morning and go to the office. She shows up at the apartment just about ready to collapse. Of course she doesn't know a thing about her own hospital system. First thing I do is go online and search for hospitals and emergency rooms. The search comes up dry. I find hospitals but none even mention having an emergency room. 

I call one my local board member who has been most closely working with our team. She tells me to call 112, the Ghana equivalent of 911. There is no answer, despite numerous tries. She tells me the hospitals that are close by. I look them up and call. No answer. By this time my Participant is in severe pain. My driver shows up. Another contact I reached out to tells me the closest hospital to me is the 37 Military Hospital and it has an emergency room. They didn't even show up on my search! I find out later they are considered one of the best in the city.

We arrive. Of course the emergency room looks nothing like anything I've seen. Even finding a reception person is a task. My colleague shows up to help me (she is a godsend). We are told we need a 'card' that registers our Participant. We are given vague directions of where to get said card. It takes waiting in three different lines to get the 'card'. Back to the emergency room. Wait. In the heat. No air conditioning. No chairs for any but patients. 

Finally, our young woman is seen. They tell us to get an ultrasound. This requires us to walk outside to another building. It takes an hour to navigate who to see, how to get in the queue, how to pay for said ultrasound (I will find you have to pay for each and every item you get for the process as you go along), then finally get the test done. We are told to come back in an hour and pick up the results. It is the patient's family or representative that has the responsibility to get the results back to the medical staff. Finally our young woman is entered into the emergency ward.

Now we are asked to by pharmaceuticals for our patient. Off we go again (some other Participants have shown up now to help with the process) to the Pharmacy to get the needed drugs. Again the three step process of checking in, paying, then getting what is needed. Blood work is needed. We carry the vials of blood to the lab where again we wander around trying to figure out where to drop things off only to find there is a check-in, pay, then drop off process...in this case all at different places. At each there is a crowd of people and no specific line. So you have to exert yourself. 

We finally get the ultrasound. We started this all by arriving at the hospital at 8am. It is now early afternoon. We are told they want to watch and observe our Participant. We come back in the early evening. They need us to buy more pharmaceuticals. At least we know what to do now. They want to observe her longer. We are told that at 5:30 to 6:30am the next day, they will either release her or have her enter the hospital proper. It is around 7:30pm and my driver is taking me back to my apartment. We get a call from one of our other women who was helping us. They want another blood test done. And because the hospital lab is closed we need to drive it to a 24 hour lab. And we have to pick it up and bring it back to the hospital. 

We get to the lab. They are noncommittal about when it will be ready. My driver ends up going back three times and it is only finally ready at 3pm the next day. Now they have admitted our Participant into the hospital proper. With us getting the final blood work, they have confirmed a diagnosis - acute pancreatitis. This is nothing to sneeze at. We are fortunate to have been able to get her taken care of. The care now is in line with what one would find in the the U.S. as far as the medical treatment. Except that the patient's family/representatives have to take care of all the non-medical needs. 

As of this writing, she is still in the hospital but improving visibly. She reports she feels much better but is weary of the hospital. The treatment for this condition is no food or external fluids, only intravenous. So she is hungry. We are hopeful that she will be released tomorrow, Friday. Keeping my fingers crossed.

Has been very stressful.

Knocking It Out Of The Park - A Ghana Travel Adventure

 Newly vaccinated and ready to travel party. 

Once I got my first shot, I rescheduled a badly needed trip to Ghana to drive Theodora Africa Project forward. 

Travel in this Covid world has all kinds of requirements that add complexity. First there are many countries you can't get into period. Second, there are countries that won't let you change planes (which limits your options for getting places). Third, there are a multitude of testing requirements. As I wrote back in October of 2020 when last I went. 

Ghana, relatively speaking, is one of the better places to go. They 1) let visitors arrive, 2) Have a system that has kept travel borne variations at a minimum, and 3) have a significantly lower reported incidence of infection (I say reported because in a country like Ghana I am sure that a lot of people who get Covid and just think they are sick from something else). They are one of the few countries in the world that have invested in and have operational a system for testing you using the PCR testing system upon arrival and getting you results in under an hour. So you arrive and exit the airport with a clean bill of health. 

Having said that, there is still a bunch of hoops you need to jump through to get there, all of which require both paperwork and money. 

1.  The pre-flight Covid test. You must get this 72 hours and have a negative result before you depart. You must have the proof in writing and show it when you check in or you will not be allowed on the plane. If you are me and you are taking two separate reservations to get to your destination, you have to time your test to be sure it is exactly 72 hours or less before you take off. After you take this test you have a required worry time until you actually get the test results back.
2. Prepayment of your Ghana arrival Covid test. This is also required. You must show proof of payment or you cannot board the plane to Ghana.
3. Filing your Ghana arrival Health Declaration information. This you do online - for fee of course - so you don't have to deal with entering the information awkwardly on small kiosk when you arrive. Of course when you do this, the site tells you your information will come in two to three business days. But you are leaving the next day. But for an extra fee, you can get it expedited so you get it in 24 hours. I pay the extra fee. The confirmation comes in 10 minutes. Hmmm how do you spell scam? I think it is Ghana Health Declaration Online.
   

 Having prepared all this ahead of time, I do the two airline dance to get to Ghana. This is because (as I am sure I have written before) it costs way less to book a flight to Ghana from a U.S. hub city than to book it directly from Albuquerque. We are talking about many thousand dollars of savings for business class fares. I can save 40% to 50% booking my flight out of Chicago versus Albuquerque, save $3 to $4 thousand and book a flight to Chicago separately for $500. But then you have to worry about your first flights not having any problems. In our case, there are none this trip.

On the connecting flight on my second airline from Chicago to New York, they only look at my Covid test. They don't even check the time, just the date. I don't know why I worry so much about having it exactly right. When I get to New York, now they really check all your documents, including the prepaid Covid test and your visa. I have all my papers in order.

Our flight leaves at Midnight East Coast time. We are scheduled to get into Ghana at around 2pm Ghana time. But we come in much earlier, almost 45 minutes early. I am one of the first off the plane. At each check point, I show my pristine paperwork and am sent ahead. After my Covid test, I go through immigration without a pause. Then there are the bags already off the plane! Crazy. That never happens in Ghana. My Covid test result comes within 15 minutes of that. I meet up with my driver, Frimpong and we are off to my apartment. We get to the apartment at about the time I was supposed to land!

Of course nothing is ready and we end up cooling our heels until the manager shows up. But that is a different story.