Before I get to the circumcision, which I am in no hurry to transfer from my memory to words, I would like to spend some time describing some details I've forgotten in previous posts.
Garbage and human waste clog the open gutters systems – a perfect breeding ground for mosquitos, which, dare I say, is one of the reasons why malaria is so prevalent here. And bag water. Let me just say, if you thought we – Americans – with our plastic, BPA saturated, one-use water bottles are something to shake your finger at, you haven't seen bag water. Let me explain: In Ghana, water comes in plastic pouches that are about as big as your hand and hold a half liter of water. There is no twist top. You bite down on a corner, get a firm grip on the soft plastic and rip the bag open. Caution must be observed because to much force usually means getting the front of your shirt soaked – I speak from experience. The water inside has been filtered, or at least that is what I've been told and so that's what I choose to believe. A sucking and squeezing motion is recommended to obtain maximum drinking efficiency, but again, one must be cautious not to suck or squeeze to hard. Time? I take a few minutes to finish a bag, but I've seen women in the market finish a whole bag in 3 seconds. When you're done, simply toss it on the ground, or out a window. They must be biodegradable...
I must apologize to Anna, our roommate, because in four entries I have yet to mention her even once. Luckily, she doesn't read my blog so for the time being I'm safe. If I had to describe Anna in one word it would be: German. Apart from describing where Anna comes from and her cultural background, which I will get to shortly, being German in the Volta Region of Ghana is an especially important characteristic. During colonial rule the Germans controlled the territory east of Lake Volta, which today is part of Ghana, and Togo, calling it Togoland. Even though the Germans, except for Anna, are long gone, they have been preserved in the history classes and folklore of the locals. And, like any good folk tale, very little truth can be massaged out of the stories we hear. For example:
Myth #1: Germans only drink beer, never water, just beer.
This myth, by far my favorite, was started during WWII. Ghanians believe that during the war the Allies poisoned all German water sources and thus beer was the only safe option to stay hydrated. Anna doesn't help to dispel this myth because she loves beer and drinks it often. I have seen her drink water though, so the myth is false. But I'm sure that if we measured it out her beer to water ratio must be close to even.
Myth #2: All Germans speak Ewe(local language).
The Germans are responsible for bringing the alphabet that was used to derive the Ewe language to the Volta Region. For some reason, Ghanaians believe that the Germans teach Ewe at there universities. Ana has assured me that this is false, never even hearing of the language before coming to Ghana. However, she does little to dispel the myth. In three months she has learned enough of the language to have full, meaningful conversations with people. I'm not sure if this can be attributed to the fact that she is multilingual and can pick up new languages quickly, or, the more locally accepted explanation that Ewe is part of her being. Either way, I'm sure she felt more pressure than any one of us to learn the language, especially after being told her people played a crucial part in inventing it...
Anna has a great sense of humor and so Josh and I are constantly teasing her. We've developed a punchline that we like to work in to most situation: “How German of you...” It is very useful. When Anna orders a beer, or when she speaks Ewe, or when she lifts a heavy object, we just chalk it up to her showcasing her cultural predispositions. In fact, Anna has taken to calling herself out when she believes she's acting out a stereotype.
All joking aside, Anna is wonderful. She is currently studying to become a social worker and as part of her degree she is serving in Ghana for six months. Anna has been here for three already, evident by her dark brown skin and flip-flop tan line, and had immersed herself completely in the culture. She has probably forgotten more Ewe than I've learned, everyone in town knows her and she has received no less than three marriage proposals. Anna speaks English with an unexpectedly soft accent, but with perfect grammar and clarity, which she attributes to time spent in Australia. Her strong physical features match her strong personality. She is very kind, always allowing the children to use her phone to “call their family members,” but she isn't scared to stand up to anyone when she senses dishonesty. Most of all, she is constantly smiling and laughing – at herself, the kids and probably, more times than not, at the Americans.
Now the main attraction: THE SURGERY
A few days into our stay in Kpando we were invited to a local private hospital, St. Patrick, to observe a surgery. Doctor gave us some background on the case: A young man had perifimosis, or an infection of the foreskin on an uncircumcised male, and had very bad swelling. The surgery would consist of relieving the swelling then performing a circumcision.
The morning of the surgery we woke up early, ate a full breakfast and waited for Papa to pick us up. We arrived at the hospital in the early morning and taken on a full tour. The compound consists of three buildings: Administrative, Maternity Ward and General Ward. Doctors sees patients out of his office in the Administrative block, which also houses the Accounts Office. The Maternity Wars is a small building with maybe five or six private rooms, and an office for the Midwife. The General Ward is split up into a few rooms: Female Ward, Mens Ward, Operating Theater and Pharmacy. The Female Ward is the largest room, with about 20 beds.
The line at St. Patrick's begins to form early in the morning, on the benches and chairs on the outdoor patio. First, patients are registered then sent to triage area where temperature and blood pressure are taken. Those with emergent complaints or worrisome symptoms are admitted to the wards, while the rest are seen as out-patients by a physician. The doctor usually sees anywhere from 75 to 150 patients per day. Non-emergent cases are typically related to hypertention or diabetes, while those patients who are normally admitted suffer from Malaria. The wards are chaotic. Family members are expected to provide patients with food as well as to pick-up any medications or IV drips the doctor orders from the Pharmacy, so there are always two or three people sitting on one iron bed. The nurses are all dressed in color coded uniforms circa WWII – one piece white or blue dress. The ward is clean, but could use a fresh coat of paint.
We waited, and rounded, and waited, and sat in on out-patient consultations, and waited some more. Finally, about four hours later than we expected, we dawned surgical masks, put on white rain boots and entered the Operating Theater. The patient lay on the operating table, infected area exposed, and the technician stood above him with a scalpel, ready to begin. When I came closer to the table I realized the man was still awake. I pointed this out, looking around for an anesthesiologist. The tech laughed. She informed me that this procedure would be done with just local anesthetic.
And so she began. She started by making many small incisions into the swollen area , which was a bit smaller than a tennis ball but larger than a golf ball. With every slice of the scalpel I looked up at the man's face, waiting for a scream or at least a look of extreme discomfort. He was a champ. The local seemed to be working.
About a half-hour into the procedure the tech made her final incisions. It was then, when she cut into the fluid filled area, that the man jumped. The sudden movement, followed by a painful groan, made Josh jump into me, almost knocking me over. Luckily, the tech and nurse both kept there composure because I would have hated to see what would have happened if her hand made any sudden movements. From that moment on the man felt everything. Every puncture, every clamp and every suture. It's beyond safe to say that Josh and I felt his pain. Every time he groaned we groaned and every time he squirmed we squirmed. And every time the nurse would just chuckle and tell him to suck it up...
With the swelling relieved the tech moved on to the circumcision. I will spare you the play by play, but I have to mention one part in particular: At one point the skin was pulled up clamped and then the tech just cut it, in half. Josh and I both looked at one another, wide-eyed, because we thought the tech had mistakenly cut it in half! After she unclamped the skin we realized all was well. Sigh...
Thirty more minutes, and about twenty painful stitches later – he felt every single one – it was finished. Poor man. He had been cut where no man ever wants be cut and he felt every last stitch of it. The most amazing part of the whole procedure came in the end – the man put on his clothes and walked out of the room.
Josh and I said our thank-you's and started our long walk home, in silence. Every few minutes we would both look at one another, the unspoken words echoing in our minds. Lesson learned. Don't get an infection down there.
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