This weekend I went to Elmina, the site of the 1st West African Slave Trade Fort.Elmina was originally a fishing and salt-producing village, (pictured: the boats ready for sea!)
until the mid 15th century when the Portuguese arrived in search of gold. The Portuguese named the town after the gold mines they found there, which soon became “El Mina.” Gold is common in the area and formed an important part of the trade industry.
St. George's castle was originally built as a Franciscan church, and is one of the oldest European structures outside of Europe. (pictured: St. George's viewed from the road)
<---original Franciscan Church
Courtyard built around the Church---->
The castle was later renovated and served as a slave fort for over 200 years under the Portuguese, Dutch, and finally the British. Slaves from all over West Africa were led in shackles to Elmina, where they were sorted and kept in dungeons for up to 3 months before the ships arrived. Millions of people were traded as slaves to the Americas in return for alcohol, guns, fabrics, and Bibles.
<----doorway into women's dungeon
"Cell of No Return" where rowdy slaves were left to die-->
CapeCoast, 10km west of Elmina, is a town with a similar history. It was ruled at different times by the Portuguese, Dutch, Germans, and British before it was finally closed at the end of the slave trade in the mid-nineteenth century.
Cape Coast's Castle Courtyard:
Me in the Courtyard!:
View from the castlefront:
Standing in the slave dungeons where literally thousands of Africans died en route to the Americas was definitely a profound tourist experience. Thankfully, the towns seemed to have done a wonderful job of recovering from their atrocious pasts. Elmina has even returned to its fishing roots. The traditional African lifestyle bustling right in the shadows of the slave fort is quite an interesting contrast, and stands as a reminder of the past as well as hope for a peaceful future.
On the walk home from clinic today, a pickup truck passed me with a BABOON sitting in the flatbed. Just hangin out. Wow. Working in Africa is awesome sometimes!
On a more clinical note, today was the weekly Retro Clinic at the Korle-Bu Children’s Health Block. While I’d like to say that Wednesdays are the day everyone whips out their bellbottoms and tye-dyed tshirts, unfortunately Retro in this case refers to HIV (a “retrovirus”).
For those of you who are interested (which I assume you are if you’re reading this blog), the following passage from my Handbook on Pediatric AIDS in Africa is very informative:
“At least 90% of the 2.1 million HIV+ children (<15 yrs. old) worldwide live in sub-Saharan Africa. The high infection rate of children in Africa results directly from (1) the high HIV infection rate in women of childbearing age and (2) the efficiency of Maternal to Child Transmission (MCT). It’s currently estimated that in developing countries 1,600 children are infected daily by their HIV+ mothers.”
Accordingly, the Retro Clinic at Korle-Bu works closely with the Prevention-of-Mother-To-Child-Transmission (PMCT) counselors at the Maternity Ward. They recommend HIV screening of all pregnant women, which the counselor told me has been very successful at screening almost all the patients. Now the task is to recruit more pregnant patients to Korle-Bu!
Once an HIV+ pregnant patient is identified, she is (1) counseled on the pros/cons of Cesarean Sections, breastfeeding, and safe sexual practices, (2) offered antiretroviral medications in the perinatal window to prevent transmission to her child, and (3) recommended for followup at the Adult Retro Clinic. The counselor told me that this has been a very effective program with mothers who are fully compliant. Unfortunately, some pregnant patients forgo these treatment options because they are afraid of the social stigma associated with C-sections and nonbreastfeeding, or they are simply in denial. I saw one woman in counseling who was diagnosed with HIV several years ago, pregnant with her second child, and had never been treated at all. That was a difficult session to witness....
The Retro Clinic at the Children's Block is (sadly) a hoppin place. Almost 50 patients are seen every week in the span of roughly 4 hours. I'm sure I won't have trouble recruiting my study patients here, and as expected, there is lots to learn about medicine in resource-limited settings from an afternoon at the clinic:
Some things that have disturbed me at the Retro Clinic:
-There are 3 exam rooms, to which the doors are never closed. So everyone in the waiting room can see the patients’ interviews and exams.
-Two doctors see two patients at a time, in the same room.
-The nurse overseeing PMTCT (Prevention of Mother-To-Child Transmission) counseling advises her HIV+ patients to avoid breastfeeding if possible. My pediatric mentor, on the other hand, advises all patients to breastfeed, because malnutrition is a formidable foe here in Ghana. These mixed messages must cause confusion. Pair this confusion with the strong cultural pressure to breastfeed, and most HIV+mothers here are breastfeeding. Like the ones I saw in clinic today….
Some things that impress me at the Retro Clinic:
-The same nurse works the front desk every week. I think this consistency is great, because the nurse must have a level of proficiency in her work, and she may even get to know the patients. Familiar faces can be very comforting.
-The charts include a standard WHO progress booklet, in which the WHO staging system, clinical details, and a full history are included. This helps to coordinate care between the labs, physicians, and nurses. It will also hopefully help me in data collection!
Obviously some of these problems cross cultural barriers, and others are dealt with both in the US and in developing countries. Nonetheless, they are difficult each time I learn about them or encounter them firsthand.....
Just to clear the air regarding my feelings toward Germany, I’m quite pleased to announce that I’ve found a wonderful new traveling companion in Kirsten, a visiting medical student from Berlin. Not only were we both born in the year of the Pig, but we also both have the same Ghanaian name: Akosua, meaning “Sunday-born.” Today, we navigated Accra by tro-tro (in the city traffic they can’t speed aha!) and visited both LabadiBeach (“La Beach” to the locals) and Kaneshie Market. In the words of my favorite Kazakh, Great Success!
La Beach is typically entered through the Labadi Beach Hotel. However, my half-marathoning experience showed me an alternate entrance. Here's the site of the Marathon finish, as well as my new secret entrance. No entrance fee for us, mwahahaha!
Views to the left and right:
Unfortunately, some locals got a little frisky on us. Some guy actually got in Kirsten's face and started pulling on her bag (I had walked away quickly. Maybe I'm not the best companion in a scrap?) so we took our cue to leave and headed off to the market.....
Getting measured for dresses!
Posing with some kids who were amazed by our cameras...
Kaneshie was just amazing. It's known for its variety of foodstuffs, and although I couldn't get any pictures, I saw goat skins for sale, cow legs, GIANT snails (still alive), crabs (also still alive, but for a small fee the vendor would rip their heads off!), and well, anything else you can possibly imagine...
ter renovated and served as a slave fort for over 200 years under the Portuguese, Dutch, and finally the British. Slaves from all over West Africa were led in shackles to Elmina, where they were sorted and kept in dungeons for up to 3 months before the ships arrived. Millions of people were traded as slaves to the Americas in return for alcohol, guns, fabrics, and Bibles.
