***

Ma had left for the day, and i was told Maame Vic had gone to Kumasi. it was saturday, and i dropped by the health center to check if there were any cases.

the past few days had been busy, mothers were coming in and having babies, and i was learning more and more. the head of the foundation, Dr. Ed Gold, emailed me in response to my complaint that no one was sending for me on weekends and at night.

'you must remember that it is the antenatal aspect that is the most important part of our services.' then he gave me a list of things to check and make sure were being attended to during those visits.

i was glad that he wrote that, it gave me perspective. but the antenatal check-ups with Ma weren't explained very well. most of my questions went unanswered, or i got laughed at. i really scrambled for information and had to be persistent in my questioning.

efreeyeh walked out from the maternity ward and raised her eyebrows. "we have a case, inside." she said. "will you deliver her?"

i wasn't sure if that was the best idea. wasn't there any body more qualified than me around?

"where is vera?" i asked.

"she's in there."

"than let's go."

she turned around and walked back in with me.

"when did she come in?" i asked.

vera replied "this morning. vic said she will deliver at 2. so 4 hours. will you stay to deliver the baby?"

i gave her a long serious look. i wanted to know if the request was a serious one. i assessed the situation.

there was efreeyeh, vera, and me- and a very pregnant woman sweating and snapping her fingers every time she felt pain. snapping fingers seems to be the way to deal with extreme pain in the village. i've noticed it a lot.

i had never seen vera in the delivery room but she struck me as the most competent. that was until she listened for the fetal heart rate. she put the fetascope up to the patients stomach in the wrong direction, and in the place the baby's butt would be.

"the other way." i said.

"oh." she turned it around.

"and listen here" i suggested.

"oh." she laughed.

i wanted to make fun of her only because of the needle incident, to make her feel inexperienced and foolish too. i realized that was not a nice thing to do. so i only laughed at her a little.

"you're laughing at me?" she said, running over to me and swatting my arm.

"efreeyeh, how many babies have you delivered?" i asked, dodging vera's attack.

"two."

"have you already given her a vaginal examination?" i asked.

"yes, she is four cm. vic said she will deliver at 2."

this whole prediction thing was bothering me. they kept walking out of the ward while the woman was sprawled out on the delivery table, in a state that could well produce a child. they were too confidant of vic's guess, and i let them know it. it was the only thing they were resting their faith in, because underneath vic's words 'she will deliver at 2' i felt a swirl of questions and uncertainties arising from us all.

i remember being about 10 years old when family from all over came to stay at our house. cousins, aunts, uncles, they were everywhere. the adults decided they needed a night out and hired a local teenager to babysit all of us. the "nanny" faked confidence in front of my parents and crumbled shortly after they left. my littlest cousin started wailing uncontrollably, meanwhile the other ones got a tangled up ball of string wrapped around our entire house, through every room, knocking down breakables and keeping me running all around. i have a distinct memory of watching the string tugging at a green sea shell shaped ceramic lamp balancing high on a ledge. 2 teen boys had stopped by and only added to the mayhem. dinner burned, diapers were dirty, and where had my brother gone? the feeling was that of slight excitement, because after all- the parents were out! but mostly underneath the thrill was a sense of dread . i was only 10 and i felt responsible for it all.

i could feel that same situation arising, just in a different fashion. this time i was hoping efreeyeh wouldn't take the role of babysitter, but would pull through. i was praying for her ability to shine through. i didn't know how to handle complications so i asked God for a smooth delivery.

"sister akua is going to do the delivery." efreeyeh said.

i had watched Ma's hands time and time again, paying special attention to each maneuver. i was ready if no one else was.

"i'll do it." i said.

we both had gloves on our left hands, they were bloodied from an examination. we heard the screen door open and efreeyeh whipped hers off and yelled at me to do the same. "vic is coming, if she sees the glove she will beat you! throw it away! don't let her see!"

i didn't move.

"akua, she'll insult us, take it off!"

i had a hard time imagining Vic getting angry at us. plus, wasn't she in kumasi?

"akua!"

"efreeyeh! you said Vic was in Kumasi!"

she started laughing, like she was ashamed.

the woman began to heavy moan. the sound was familiar to me now. the baby was coming.

"is Vic here or is she in Kumasi?"

vera walked in the room.

"vera" i asked "where is Vic?"

"she's traveling."

"is she gone?" i needed her to be more clear, but she was intent on being vague. i didn't want to do the delivery if somebody much more qualified was available.

the string was tangling around the house.

the woman started letting out heavy grunts.

"go get Vic." i said.

"she'll come at 2."

it was 1:55.

the baby's head was close to emerging, so i stood in the position that Ma takes when she does the delivery. it also felt the most comfortable for me.

Vera was at the foot of the bed, and Efreeyeh was standing across from me. we were all huddled around with our hands up close. i wanted to gently massage the perineum and stretch it just a small bit to help make room for the child but each time i put my hands up to the woman's vagina Vera moved them out of the way.

"akua don't." she said. then her and Efreeyeh spoke quickly in Twi. i wanted them to back off, let me work my magic, unleash it. but instead of that, the woman let out a great roar, Vera ran around to where i was at, pushed me out of the way, and caught the baby.

i stood there wondering what had just happened.

the baby was crying loudly, thank God, but a strong flow of blood gushed everywhere. more than i had seen before.

i saw the string tangle around the lamp, it was balancing on the edge of the mantel, where were the parents?

"akua ko fa bra!!" efreeyeh was thinking quickly, but i didn't know what she wanted me to go and get.

"in english!" i said.

"the drugs, get the drugs"

i was hoping i wouldn't have to do the injection. even after my lesson it was going to take a longer time than necessary for me to figure out how to get the drug into dispenser. i sensed time was precious.

i went to Vera and took the baby out of her arms. i knew what to do with him. i'd let the two of them take care of the woman. i handed her the ergometrine.

efreeyeh was dripping in sweat, and so was i. the third stage had brought on a slight panic amidst us all. again, i wished i had more education.

blood was everywhere, i put the baby on the table and vera came and started to dress him. there wasn't any form to any of our actions. i went to see what efreeyeh was doing. the cord had been clamped too far down, it should have been done closer to the woman's body. just as i began to distress a little more, Vic walked in.

i looked at the clock. it was 2:01.

she went straight to the base of the bed and looked at what was going on.

"there is a knot in the cord here, do you see? you should always loosen a knot if you see one, it could potentially harm the baby by keeping the blood flow from getting to him. but in this case it seems to have worked out well, you should have clamped the cord up here, see? and she is bleeding too much. have you already injected her?"

efreeyeh explained the situation and everything seemed to have been done correctly.

"has she delivered the placenta?" she asked.

we said no.

efreeyeh and i gathered around her like a mother hen and her chicks, while she walked us through the next few steps of delivery, and then yelled at us for not calling her in earlier.

"did you weigh the baby?" i asked vera. she was wrapping him up in a blanket.

"no" she said. she undressed him and put him on the scale.

everything felt a little off. it helped me to see Ma's experience and grace in a different light. being excellent at something, i thought, is making a difficult task look effortless. Ma was excellent at delivery. i wanted her to come back. she had a lot of control.

the baby and mother ended up leaving the clinic healthy and in tact.

when i showed up to work on Monday morning, Ma threw up her arms. "HEELLOO!!" she said. "so you got a case this weekend!?"

"yesss."

"and was it nice?"

i squinted my eyes, trying to think up a response.

"nice?"

"yes, did you deliver her?"

"no i didn't. vera pushed me out of the way."

was i really tattling?

"she did! aahhhhhhhaahahaaha. so vera delivered her?"

efreeyeh was sitting there quiet and submissive.

"and efreeyeh." i said.

"and did they do it nicely?"

i wasn't jiving with her context of the word "nice", so i didn't say anything. the silence became too awkward and my shrug didn't release Ma's inquisitive eyes so i said "okay okay, just put it this way, i've only ever watched a master." i gave her a little smile. "how can you follow up a master."

it wasn't even 9 a.m. and i had already tattled and now i was kissing up. it felt like childhood all over again.

"well any way, you are all learning. but next time, you will do it." Ma told me.

i looked over at efreeyeh. "you weren't all that bad." i said, and we all laughed. "okay" i said "next time, i'm ready."

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.

akwaaba

the volunteer arrived, and it wasn't a German man.

in the twi language, there is no differentiation between the pronouns "he" and "she", the same word is used for both. this has caused a many slightly confusing conversations, because a twi speaker using english interchanges the two quite freely, without a second thought. english being my first language i get held up on this little detail quite easily.

some examples...

"kacie? your sister, is he beautiful? would he marry me? ask him?"

or

"my father went to the market. she won't stay long because she is sick with malaria and wants to come home and rest. he is buying a cloth for her wife. he is sewing a dress."

i've learned to let go of my control over pronouns and let the miscommunication settle itself. so when the car pulled up at the clinic, with 2 foreign volunteers, i wasn't surprised to learn that neither of them were german, and it was the woman who was the doctor and had planned to stay and work.

i laughed. "welcome any way." i said "i was told you were a german man!"

"oh no! why, are you disappointed?" she asked.

"not at all." i was glad to have another female around. and i didn't mind her boyfriend, he had some pretty strong feminine energy.

"i'm kacie." i shook his hand, it was so pale.

"i'm andrew." he said "and that is sophie." she had been bombarded by all the other people that wanted to meet her too.

"so are you both here? or whats going on?" i was a bit confused. "and who is the doctor?" i just wanted to make sure.

"sophie is the doctor. i'm volunteering at Agogo Hospital so i'm just visiting for a bit. came to see the place and help sophie settle in."

it had been quite some time since i had made conversation with a white man. it jostled me.

"so where are you from?" i asked.

"i am from britain."

"and sofie?"

"she's swiss, but lives in london."

"you both look young." sophie walked back over. "how old are you?" i asked.

"i'm 30 years old." she said, giving me a little sly look, as if she'd been told she looked younger than her age many times before.

andrews face was welcoming. his eyes were alert and spoke more than his mouth. he reminded me of a very good therapist. their accents were nice to listen to and their choice of words kept my ears constantly interested.

i liked sofie right when i met her. i observed her interacting. she seemed confidant, but not overly. she laughed a lot and was flexible. the two arrived as a couple but operated as individuals. i let out a sigh of relief.

"andrew? do you reckon we should leave our bags here or take them back to the house? i've got heaps of supplies that i don't want to carry back here. i'd much rather just leave them. but..." she went off calculating just what she should do.

"have you been to the house yet?" i asked.

"no, not yet. we've just come straight from Agogo." he said.

this should be interesting, i thought.

"let's just go to the house and drop our bags there. then we can sort through them and bring whatever back." she decided.

"what do you have?" i asked.

"loads and loads of books mostly." she said.

Secetry walked up. "the car is waiting. will you go with them to show them the place?"

"yes" i answered. but in a way i felt silly. i wasn't sure if they wanted me tagging along. oh well, i'll be overly hospitable, it's the ghanaian way. if it bothers them they'll just have to get used to it.

the van chugged down the road. it felt luxurious to be riding in a 16 seater with only a few of us. i stretched my legs.

a few minutes later, after many waves out the car window to the locals staring at the strange trio, we pulled up at our gate.

"is this it?" sofie asked.

"yup!" i said.

andrew started letting out little gasps that were half laugh half shock.

"it's quite out of place, don't you think?" he said.

he hadn't even stepped inside the courtyard yet and he already could tell.

we walked through the gate and auntie, chief, and sakola were tending to a big pile of maize spread out on a blue tarp. they looked up at us.

"maaha (good afternoon)" i said.

auntie gave a little nod and chief kept working. sakola walked over and introduced himself. he asked them a few questions in twi, which went unanswered and unnoticed. "they don't speak twi yet" i told him. so he tried in english and they all had a good laugh.

"this area is quite large, isn't it?" andrew said looking at me. i smirked. "what would be the reason for building such a massive front yard?"

sofie had already made her way onto the front porch and was peering through the tinted windows into the first room. i was wondering what they thought of the carcass flagpole, but decided it'd be too early to ask.

i hadn't really noticed that our house had columns. 4 of them, large and foreign, rested in intervals attached to the porch.

we waited for sakola to bring the key, while admiring the design of the porch.

he eventually yelled up to us.

"i'm waiting for the key!" i said.

he told me the door wasn't locked. i pushed on it hard and it opened. then he yelled at me for being foolish in front of my new friends.

sofie practically ran down the hallway while andrew and i lagged behind and talked about the property. when she turned the corner into our living room she yelled

"this is the biggest flat i've ever lived in! i could do my yoga in here!"

i immediately felt unoriginal, mostly because that was my first thought too when i saw the room. i had a strange awareness in that moment. for months i had been made to believe i was something extremely original, bordering freakish, an anomaly. sofie was shattering my false belief.

she was exploring the house like a ballet dancer, moving gracefully from one room to the next quite intrigued with it all. andrew followed her closely and i just hung back, waiting. i heard them asking each other where the bathroom was, noting the electricity hook-ups, and excited about how 'nice' the house was.

they walked out from sophies room.

i answered some of their questions, but wasn't sure what to leave for them to figure out on their own. there is so much beauty in self-discovery.

"the toilet is outside, behind the house where the papaya trees are." i said. "don't sit on it. go like this." i showed her how to go to the bathroom, which felt a little funny because i didn't know her or andrew and i was improv-ing private matters, but it was a useful tip that took me weeks to figure out.

she gave a long slow nod, "ahhhhh okay."

her mind was quick, i could already tell. both she and andrew wondered about everything; how things were built, how they operated. they focused on details i would never think to ask. i felt very different in that regard.

"the house doesn't have electricity and we fetch our water from the well. you just carry it in and then you can bathe in your bathroom. but don't pour water down the sink, it's not hooked up properly." i advised. i figured that one out a month after spitting toothpaste down a pipe that goes underneath the house.

andrew had a perplexed look on his face. "this place is really strange." he said. "it's almost as if it is half completed. who lives here?"

"yes, how many rooms are there?" sophie asked.

"there are 5 rooms and i'm not really sure who lives here. definitely sakola. he's the guy you met outside."

"safola?"

"sakola."

"sakola? okay, sakola. sakola. who else?"

"there is a boy named chief who stays in that room around the corner. and the rest of the rooms well, just pretend we live in a hostel, that might make it a little easier. half hostel, half church. okay?" i would have told them about collins and nanakwame but i wasn't sure they would be coming here. i'd wait.

they looked up and around, at the walls and ceiling, over at the cushion less couches pushed against the walls, not to be used. they laughed at the situation.

"whats going on with that?" andrew asked, pointing at the sofa.

"um, i don't really know except they are supposed to stay like that. i haven't seen anyone sit on them."

he pointed at a door in the living room with big wood boards nailed across it. "and that?"

"oh, i guess i've never noticed that. the room on the other side is sort of like a closed in porch, we keep our pet rat in there. but he's lost. if we go out to the porch we can get in that way. i'll show you, c'mon."

he and i walked around to the front. i noticed his posture, it wasn't straight and powerful like the men i had seen here. he was curved, and slumped. i thought about something someone had said on my first trip to africa, when i was in kenya.

"it's not good to carry your babies tied to your back the way they do here, they'll grow up to have weak backs." she was from america.

i thought of the millions of african people i had seen and how strong and perfectly able they are. then i looked at Andrew. we made our way to the porch and i saw my reflection. i tried my hardest to stand up straight, shoulders back. it was uncomfortable.

"okay, that maize, that they're working with over there used to be in here." we walked into the outdoor/indoor room connected to the porch. "over here is where we dump our scraps to plumpen up our little buddy. but we think he's gone down beneath the ground, so Sakola sticks yam chunks into this hole right here."

if we kept feeding the bushmeat like this he would become too big to come back out through the hole he crawled in. then he'd just die and rot in there and stink everything up.

andrew was observing and carefully assessing the household situation. "so the rat lives under there?"

"yes. and we are going to eat it."

"eat it?"

"uh huh, you'll have to come to the dinner whenever it happens."

"ah hu huh ha, alright."

we walked back outside and chatted some more.

"this living arrangement is much better than i had expected. we were told we were going out into the middle of the bush. i thought sophie was going to be sleeping..." he moved his hand close to the ground.

"...in a mud hut!" i said.

"YES!!!"

we laughed.

she almost had to but i didn't mention that.

the rest of the day was spent touring the surroundings, introducing the two to the folks in the village, and translating a bit. i had learned more twi than i had given myself credit for. i also knew more about the village people, their personal lives and connections, than i realized. we eventually made our way back to the clinic, where sophie saw her first patient.

i sat in the office and talked with andrew about boamadumase.

sophie walked back in after having been gone for quite some time.

"well!" she exclaimed "i've just seen my first patient! a young boy whose teacher hit him on the head with a board eraser."

"was the wound bad?" i asked.

"ah yes, it was quite deep."

she gave andrew a look that was full of life.

they were in africa. it was her first time here and everything was fresh. she had committed to throwing herself into life at huttel health center.

"so i assume corporal punishment is accepted here." she said.

being around her reminded me of home. she was driven and motivated and wanting to work hard. i liked that. it also seemed out of place. the village moves slow.
i couldn't imagine her napping at noontime.

i was sure that africa was going to soften her and slow her down just a little, but we'd just have to wait and see.