real community education!

"your friend has not even come into my office to greet me. why? Hmpf."

it was sophie's second day at work, and nobody had informed her of the importance of greeting in the Ghanaian culture. she had gone into Maame Vic's office to work with her for the day, leaving Ma stewing behind her desk, feeling unappreciated.

"Ma, she's new. she doesn't know that she is supposed to say hello to everyone." i said.

"but i was even wondering about her and worrying about her. did you see? i asked you what she ate this morning? see how i care? and she doesn't even come to say hello and ask me how i am."

"but from where we are, people just go to work and sit behind their desks. they don't visit every department and ask how everyone is doing, so she doesn't understand!" i tried explaining again.

"yes but i even had gladys bring her tea. and we are in Ghana, don't you see? so you have to greet."

"you're right. so why don't i go and tell her. i'm sure she'd want to know." i said.

"yes you should do that."

i got up and began to walk away.

"but Kaisy!" Ma whispered loudly. she bent down low to her desk, her chin was sweeping across the top of the plastic tablecloth. "you shouldn't tell her i sent you and don't let her know of what i was saying. just inform her but don't mention me."

just as she was saying this, the screen door opened and Sophie walked in.

"good morning!" she was cheerful and energetic.

"good morning" Ma said, chuckling softly.

she cut right to the chase.

"in just a short while i'm going to be doing a little workshop over outside Victoria's office. we'll just be reviewing how to do a proper injection. i wanted to invite you, if you're interested?"

Ma nodded.

Sophia looked at me.

"we'll come." i said.

"alright then, we are just about to start so..." she motioned for us to follow. Ma scooted her chair back and removed herself from her spot. we walked across to Maame Vic's office.

3 white wooden benches had been arranged in a triangle shape, with a chalkboard on the outside. Secetry, Kingsley, Efreeyeh, Vera, Ma and i all sat down with Sophie.

"alright" she started "today we are going to learn about injections."

i had made a poor choice. i sat next to kingsley, whom i adore, but who also happens to douse himself in cheap cologne religiously. its as if he has been dipped in a huge vat in some knock off perfume factory, emerging extremely potent. my cheeks were already starting to sweat and my head was getting cloudy, but i wanted to learn how to do a shot so i wasn't moving.

Vera and efreeyeh had teamed up on the bench across from me. they were already nudging elbows and laughing at me.

Sophie was an excellent teacher, involving everyone, and going through an interactive step by step of the correct way to perform an injection. vera had brought in a piece of foam, with a butt drawn on it.

"now" sophie said "does anyone know the region where you are supposed inject in?" holding the foam up, one cheek drawn bigger than the other in thick red marker.

we all did.

"that's right, divide the bum into four parts, and it is the upper outside that you want to go for, does anybody know why?"

nobody did.

she explained it to us, and i was thankful for her education and desire to teach.

she took out an ampule of medicine.

"here is a trick i never knew" she said as she popped the glass in half, creating a perfect break. "the glass has been designed with a weak spot in it. if you look closely there is a dot. break the glass in the opposite direction of the dot and it will work perfectly."

i shot efreeyeh a look. any time she had filled a needle full of ergometrine she had held the bottom of the ampule and smashed the top open, leaving the floor scattered in little glass shards. i considered this dangerous, mostly because women in the ward pace barefoot, and the glass is never swept up. i didn't know their was an alternative.

"you see, so you just break it like that, and it works just fine! i've been practicing for 7 years now and not once have i cut myself. then, go like this" she flipped the liquid filled container upside down and not one drop fell out "...MAGIC! i can't explain it but trust it. pretty neat huh?"

we were all amazed.

"now, who wants to attempt an injection?"

i forced myself to say i wanted to. "i've never given a shot before" i admitted. everyone laughed. i was a little nervous. i wasn't receiving much confidence from my girls, Ma was just staring at me blankly, i had my back to Kingsley and Secetry seemed just as inexperienced as i.

"alright" Sophie said, handing me the needle.

vera yelled out "be bold kacie! bring the boldness from california! ahhhaahha"

my hands shook and the entire ordeal was awkward. i didn't like it at all. i stabbed the foam with a little too much force, glad that it wasn't human.

Ma sighed through my lack of experience. secetry winced. "oh kessy, you are forceful, ei!" his body shuddered.

my fingers weren't swift and fluid, i became incredibly self-conscious. the fact that i had commentators didn't help much either.

"i don't know how to do it!"

i didn't want to be under their scruntity for my first attempt. i'd prefer to try secretly in my room for weeks until i got it perfect. then i'd show up at work and perform it seamlessly, quietly walking around, sneaking up on my coworkers and sticking needles into their flesh. "haha! see how experienced i am now!"

Sophie had to get up and help Maame Vic in the office with a patient. "by the time i'm back you all should try it at least once." then she left.

Ma stood up and walked back to her office. i handed the needle to Kingsley, who was just as unfamiliar with it as i, and he injected the inside part of the buttocks. i instantly felt better, except his mistakes seemed to be less funny to everyone. no one laughed.

"this bench is the learning bench!" i declared, trying to ease my discomfort.

the needle made it's way around to each person by the time sophie returned. then she took the needle back and held it up. "okay! now that we are finished, what should we do with this needle?"

if she wanted to know what they HAD been doing with contaminated needles she probably wouldn't have liked the answer. there was no method of discarding them, they just got tossed into bins and then thrown out somewhere behind the clinic.

"what do you do with a contaminated needle?" she asked again.

no one said a thing. then efreeyeh offered a very general answer. "throw them away?."

"yeeessss" sophie said "but how? just like this?"

we all looked at each other. i piped up. "that's how we've been throwing them away."

"just exposed like this?" she asked.

"yes."

i thought of the big blue plastic bucket in the labor ward, with membranes, feces, urine, cloth, the case's placenta, and needles floating around in it. i never felt comfortable handing the bucket over to a family member and instructing them to sift through the matter and wash their sister's cloths, but Ma informed that was 'their way'.

the manner in which we had been dealing with needles was unacceptable, for obvious reasons. the next 15 minutes were spent brainstorming as a team how we could change this hazard.

we devised a simple method of discarding them safely and then burning them.

the teaching session came to a close.

it was informational and very basic. all these things needed to be taught. these changes needed to be made. community education/outreach is a buzz word, which works it up into something it is not. it is not some grand intimidating hierarchical notion. its accessible.

it is grassroots.

it is a few people, sitting around on wooden benches, learning from each other, sticking needles into foam bottoms, even if their hands shake. it's one less person possibly becoming infected with HIV, because of a morning well spent.

it's the little things, and i was glad sofie was there to remind me of that.