Memories from Tamale, A Life-Changing Experience

By Samuel Kitara
College of Wooster Student
Global Impact Fellow

You cannot completely describe certain situations and feelings with just a few words, but even when you attempt to, you don’t really feel like you have done justice; they are better left raw, whole and indescribable. Such is the nature of thoughts that run through my mind as I try to explain my experience with Unite For Sight. I immediately realize that I cannot unravel, let alone synthesize, them all in a matter of seconds, and yet, I can’t resist the temptation to try to describe them. I spent six weeks of the summer working as a Global Impact Fellow in Tamale, Northern Ghana, where I volunteered at outreach programs and clinics across twenty-three different villages, four hospitals and at least five districts. This experience was so immersive and insightful that it spanned from tackling the eye health of local communities to delving deep into the heart of the local culture and its influence on health care provision.

On arrival at Accra-Kotoka International Airport, I looked out for Jerome, a volunteer coordinator from Crystal Eye Clinic, which is one of Unite For Sight’s partner clinics. I had been told he would be holding a Unite For Sight placard and looking out for me and one of the other volunteers. Incidentally, I bypassed him and walked out of the main waiting area to an airport staff support officer who helped me make a call to him. When we finally met, he was surprised. He confessed to me that he actually watched me pass by, but that he expected the volunteer to be a white person, not black. I laughed it off and we started up some small talk as we headed to a taxi. But this first encounter once again provoked questions I had all too often pondered before my trip to Ghana; “How would the village community perceive me, a black man?  Would I also be treated as foreigner like the other Caucasian volunteers? Would they expect me to understand the local language? How would I respond to this?” And yes, it wasn’t long before I confronted these same questions at work. On one village outreach to Nakpatwa village, after greeting an old man named Iddrissu in Dagbani, he responded with a thirty second non-stop sentence, from which I understood nothing except for the reply to my greeting. I simply stared at him, shaking my head sideways; at that time, I didn’t even know how to say “I don’t understand” in the local dialect. I called upon Ali, our volunteer coordinator to help me with the translation. After listening to the old man, Ali told me that Idrissu is surprised that I could not speak Dagbani. Idrissu said that I am a black man with a scar on my cheek so I must be a typical Dagomba man (coincidentally, I actually do have a scar on my right cheek, although I don’t remember how I got it). 

Abdulai is a sixty-five year old native of Nyankpala village; he is just one of many natives who know little to nothing about eye care. He is completely blind in the left eye and gradually going blind in the right eye too, although he can still see a little. The ophthalmic nurse Al-Hassan diagnosed him with a mature cataract. Since he will need surgery, I have to place him on the booking list and educate him about the benefits. However, Abdulai tells me that he already knows the benefits but still declines a cataract surgery appointment because he has heard that the healing process takes over 3 days, and yet he needs to provide for his family during that time. He says he cannot let his family go hungry when one of his eyes can see. I felt helpless and disappointed. It was difficult to understand his position.

I put aside the experience with Abdulai, hoping that he was just an isolated case, but later realized this was typical and there were not many smooth sails in the nature of the work I would be doing over the next month. This was different from the perfect ideas and solutions I had read about; this was the real world, a world that confronted me with real problems which demanded dynamic practical solutions. It was not the world of reading text books and writing exams. These were problems that preyed on my emotions, yet challenged my professional work ethic. 

Mahamais one of the over 25 patients who attended the previous screening and turned up for the surgery appointment. He is an elderly man with mature bilateral cataracts, so he has been almost completely blind for over six months.  As I apply drops to dilate the patients’ eyes before sending them to the ophthalmic nurse for local anesthesia, I come to Mahama, and wondered where he had gathered his newfound confidence in modern surgery. He seems very excited and is eagerly waiting for his turn.  I flashed a pen light into his eyes and something seemed strange about his cataract lens, so I called the ophthalmic nurse. He immediately tells me that Mahama has had his eyes couched and instructs to me to remove his name from the surgery list. As I soon discover, Mahama is just one of 9 patients who has couched his eyes. Couching is a traditional medical procedure used to treat cataracts among the Dagomba people. Unsterilized needles are used to push the cataract backwards into the vitreous humor. The herbalist performs this procedure without using hand gloves. Bacteria and other foreign bodies are introduced inside the eye and the eye’s anatomy is interfered with. This lowers the chances of successful cataract surgery, so often times, these patients cannot be operated on. Patients pay as much as three hundred Ghana Cedis (local currency), in cash and kind, to receive couching from traditional medicine practitioners. They drain their meager savings and give away livestock to meet the expenses of a dangerous procedure from an unqualified herbalist, and yet for the same amount, they can receive two or three surgeries at an eye clinic from a professional ophthalmologist.

In Savelugu hospital, we were lucky to have all of the patients return for post-surgery treatment; this is by far the most fulfilling part of my work with UFS. There were specific patients that I was interested in seeing on that day. One of them is Sanatu. Admittedly, she means the most to me today. Sanatu is the deaf, mute and partially blind lady from Pong-Tamale whose visual acuity screening I had failed to successfully perform because we could not have any meaningful verbal communication. I had been very surprised and happy when she came for surgery (I felt a certain personal responsibility for her eye health and I would have been very disappointed if she hadn’t come).  I watched with keen interest and optimism as the medicated band aids were taken off from her eyes. Even though she could not speak or hear what we were saying, you couldn’t mistake the wide ear-to-ear banana smile on her face and the glimmer in eyes for anything else, but pure joy. Although she may not have any large social standing in her village, and may not verbally be able to communicate to people about her life experience, I felt a great sense of accomplishment. I hoped that this was in some way, no matter how small, a life changing experience for her.

Often times we feel obliged to be sympathetic rather than empathetic to people whom we expect to feel hopeless and helpless. Such was the profound insight I gained when I met four year old Ibrahim who had congenital bilateral cataracts.

Ibrahim is a jolly kid; he smiles at me as he sucks his pinky finger and points at his face.  As I look into his eyes with Mr. Ali’s pen light, he is seated on his mother’s lap and excitedly staring at the light. He is probably unbothered and unaware of the implications of his medical condition. His mother says that he cannot play with his friends because he cannot see, so he has to be escorted everywhere. He also cannot attend school for this reason. Ibrahim will need surgery. The situation seems hopeless and discouraging, however, I feel encouraged and uplifted by the radiance of this little boy and the determination of his mother. She believes that he has a chance to see, so she takes the initiative to bring him to the eye clinic. This has taught me that the digital representations I see on websites and the paper work in books don’t wholly describe the rigor and breadth of the challenges encountered. Make no mistake; it’s just as exciting as it is sometimes tough; you need to physically and emotionally be immersed into the experience to fully understand.

At the end of my fellowship, one of the best personal every day lessons that I will take with me is the value of exercising patience and showing genuine interest when trying to learn from people. It is often easy and even tempting to underestimate the wealth of knowledge and wise counsel that the local workers and patients have to offer, maybe because of their appearance, social standing or any other first impressions and pre-conceived notions that you have about them. In Tamale, more than half of what I have learned has come from sources I least expected. I have realized that in order to promote any kind of change to a given locality, it’s very important to develop an understanding and respect for the local way of life. It’s important that one develops the humility to try to look at local practices from the local perspective and try to understand the premises that guide them to do certain things. 

All of the patient names in this narrative have been changed to maintain the confidentiality of the patients.