A Ghanaian Healthcare Adventure

Michael safely transported me to the ISOS Clinic, a facility that provides primary healthcare to Newmont employees and their family.

I was met there by Dave and Dr. T, resident physician. After my meltdown with my husband, I sat down and answered a series of questions. Dr. T then had me get up onto the bed where she examined my wrist and leg.

 

My arm was swelling quite badly by this point, and it was very painful. The doctor did the usual tests on my knee (this is not my first knee injury). Based on her examination, she didn’t think I had torn my ACL. She felt the joint was pretty stable and wasn’t displaying the classic signs of an ACL rupture.

She then gave me a sling with which to wear to help hold my arm still and gave me a brace for my knee. Unfortunately, she only had two knee braces – large and small. The large was enormous, and the other, although too small, would work in the short-term. She had me move to a different room where she proceeded to give me a shot of pain medication (yea!). She was very careful administering the medicine as she said patients can react much differently. I quickly felt the medicine and the relief was fast. Unfortunately, it only lasted about 5 minutes, and then I was back to hurting pretty badly.

The IOSO Clinic is small, with very few employees. Dr. T served as both doctor and nurse. She arranged for transport to Lister Hospital where my wrist would be x-rayed and an orthopedic surgeon had been called. The ride to the hospital remains pretty much a blur to me, but I don’t think it was too far from the clinic. I was more concerned with keeping my arm as still as I could, while we drove over the always rough Accra roads.

I was about to find out how valuable Dr. T was going to be in this healthcare journey. Lister Hospital is fairly new, having been built in 2004. The waiting room was quiet when we arrived, with only a few other people waiting.

Dr. T had me sit down, got me the paperwork I needed, and went down the hallway to get the process moving along. As soon as I completed the necessary forms, I was taken to the x-ray room. Now, I’m guessing most of you have had an x-ray at one point or another in your life. This room was about as big as a walk-in closet. The walls were not filthy dirty, but I wouldn’t call them clean and sterile either.

Dr. T asked the x-ray technician if she should begin removing the brace and sling, but he didn’t want to discuss it with her. As Dave said, “He just wanted to be in charge.” We’re not even sure he realized she was a doctor. Dr. T and Dave finally went outside and he helped me to remove the brace and sling. Usually, when a patient gets an x-ray, they are covered (in part) with a lead apron, reducing the exposure to radiation. But, even more so, I would expect the technician to be wearing an apron – neither of us did. The room was so little he was basically standing right next to me when he took the x-rays.

I was then taken into a second room where there were two nurses sitting at a desk.

One of the nurses took my vitals and asked me a few questions. The most disconcerting thing was the way in which she “cleaned” the thermometer. She pulled out a tube that was filled with cotton balls. She took one of them and wiped off the thermometer. This was done without soaking the cotton ball with any kind of disinfectant. I was in a lot of pain and wasn’t thinking clearly, but I knew that I was NOT going to let her place that thermometer anywhere near my mouth. As it were, she put it under my armpit. I couldn’t help but wonder how many underarms that thermometer had been without a proper sterilization.

Next, I got into a wheelchair and was planted in the hallway in front of a door. Dave finally moved me out of the way as workers were running into me. I was then wheeled into a different part of the hospital.

We had to go up a ramp, which was outside, but covered. I was taken to a private hospital room, and was tended to by 2-3 nurses (I was getting personal attention, for sure). The smile was all for show. I was not what you would call happy.

The one nurse made a point of showing me how to turn the TV off and on, but I had no interest. She returned a few minutes later, and when she saw I had not turned the TV on, did so for me.

Dr. T had called a local orthopedic doctor to meet us at the hospital before we left the ISOS Clinic. Dr. Ocloo (oh-clue) was located at Korle Bu (core-lee-boo) Hospital and because of traffic would take anywhere from 1-2 hours. It wasn’t long before he came in, however, and affirmed that I had fractured my radius bone. Just this morning we heard about Louisville's Kevin Ware. He is the basketball player who suffered a compound fracture in yesterday's Elite 8 game against Duke. We didn't see the actual injury, as our TV did a WAWA thing, but we did hear about it. I am feeling more and more like a big wuss, and I can only imagine the pain that poor man is going through.

But, enough about him....back to me and my wrist fracture. Dr. Ocloo said that he would cast it the next morning at Korle Bu. A Lister doctor was in the room at the time and told him that they would be happy to cast it that night. Dr. Ocloo turned to him and told him that they didn’t have the proper materials. The doctor assured him they did, but Dr. Ocloo didn’t want to discuss it further.

Dr. T had evidently been corresponding with ISOS doctors in Paris (ISOS headquarters), and based on the x-rays she had sent coupled with the recent diagnosis of medial epicondylitis in my elbow, they recommended the cast be placed above my elbow. They also suggested the cast be in place for six weeks. Dr. Ocloo strongly disagreed with the Paris doctor’s recommendation saying that he would not cast the arm above the elbow as that would be cruel. He also said that the arm only needed to be in the cast for five weeks.

He then went on to examine my knee, moving it this way and that. He told me, “There is nothing wrong with your knee,” to which Dr. T said, “Do you think we should get an MRI just to be sure?” “No,” he answered. He told me that I could stay in the hospital overnight to which I emphatically said, “NO! I want to go home.” We were then wheeled back to the entrance in which we had arrived and Michael took us home. I think it was about 8 p.m. when we arrived home.

It had been a very long day for all of us, but mostly me. I had woken at 6 a.m. MST on Monday, March 11th. I stayed with my brother in Brighton, Colorado, and he dropped me off at the airport that morning. From Denver I had a direct flight to JFK in New York City, where I had a lengthy six hour layover. I was flying economy comfort overseas, and while I get a whopping four additional inches of legroom, sleeping is still not easy. I can usually get 4-5 hours of sleep, but for some reason had a more difficult time on this trip and estimate getting more like three hours of sleep. The last leg of the trip from JFK to Accra is approximately 10 hours in duration, so when I got home, all I wanted to see were the insides of my eyelids. As is typical for us, we only take short naps upon arrival, otherwise getting to sleep that night is difficult.  

As you can imagine, I was exhausted by just traveling. Add on the entire emotional and painful last few hours, I was hoping to get some good sleep. I took a pain pill and got into bed a bit later, but really couldn’t get comfortable all night long. If my arm didn’t hurt, my knee did. If my knee didn’t hurt, my shoulder did from being in a sling. Every time I felt myself dozing off, I relived the accident. I got up several times, and went out onto my recliner, hoping to pass some time by surfing the Internet or playing solitaire. It was one of the longest nights of my life.

The next morning Dave encouraged me to take a shower, even though I had no energy or ambition to do so. I was emotionally and physically spent. He reminded me that once I had my cast on, taking a shower would be a lot more difficult. As usual, he was right. Have you ever taken a shower with just one arm? If not, I challenge you to try it just once. It’s not as easy as you might think, especially when you have a bum knee and are nervous about falling and further injuring your as yet uncasted fractured arm.

Dave was a huge help in getting me in and out of the shower, drying me off, and in helping me put my clothes on (including my bra….try that one with one arm). However, he was sorely lacking in the “let me help you dry your hair” task. He tried, I’ll give him that.

Dr. T called Dave that morning and told him that the ambulance would be by to pick me up at 9:30 a.m. Dave assured her we did not need an ambulance and that Michael could get us to the hospital. Dr. T insisted, and would not take no for an answer. Right on time (VERY unusual for anyone or anything in Ghana), the ambulance arrived. In fact, they had to wait for me to finish getting ready. As I was climbing into the ambulance I was saying, “I can NOT believe I am getting into an ambulance.”

As I mentioned before, we found ourselves very grateful for Dr. T and her advice. What we didn’t know was that Korle Bu Hospital was located in downtown Accra. We were not only going to the heart of the city (the worst traffic ever), but we were also going in the morning, during hours long rush hour traffic. The ambulance driver turned on his lights and sirens. Dave got in the car with Michael and followed behind. We arrived at Korle Bu in a matter of about 20 minutes, opposed to what may have taken 1 ½ - 2 hours.

When I got into the ambulance, I laid down on the gurney, but was not strapped in. As we were weaving in and out of traffic, the gurney slid back and forth slightly. I knew that if he took a sharp corner, I would likely go tumbling. I sort of hooked my right foot under a bar to keep me from moving too much. Also, since I was lying flat on my back, I had no idea where we were going and what was going on outside. I’ll let Dave provide an account of the ride to the hospital.

Riding through traffic in Accra is normally an exercise in patience and frustration.  Not this time; it was time for Nascar; Accra style.  Usually, cars mosey along in the regular travel lanes with others moving around you into any available open area looking for any flat spot to fill hoping to get into the flow until traffic becomes completely jammed and comes to a grinding halt.  Occasionally, a military or police car will plow through everyone honking his horn and flashing his lights.  If he has a siren, he’ll use that too.  Everyone squishes up against the side ditch or car next to them to make a small opening for the “emergency” vehicle to pass and move quickly to wherever they are going (pastry shop or dropping kids at school most likely).  Ghanaians are very calm about this imposition and only get angry when the military car has a trailing vehicle that’s just taking advantage of having a guy with a siren in front of him.  I often kid Michael that he should flash his lights and honk his horn when the traffic is particularly bad; now was his big chance and he was clearly relishing the idea!  Putting Beth in an ambulance turned out to be a good idea; trying to keep up in a trailing car…not so much.  This was a nail-biting experience with lots of honking and near collisions as we bobbed and weaved through traffic behind the ambulance.  I never realized how quickly traffic closes in behind these emergency vehicles; especially when everyone assumes you are “taking advantage” and tries to cut you off.  We got lots of angry honks and finger pointing trying to keep up.  At one point, a police car started chasing us with his lights and sirens blaring.  Fortunately, he got cut off and we lost him in Accra Central traffic.  Smokey and the Bandit got nothin’ on us.

Ha Ha! I completely forgot Dave telling me about being chased by the police car! There were a lot of quick stops and starts.

The ambulance, like most vehicles on the roads here, had a standard transmission. So, as you can imagine, the stops and starts were that much more pronounced. I could see the tops of trees, and sometimes the blue skies. Mostly I noticed the mosquitoes flying around me.

When we arrived at Korle Bu Hospital, Dr. T told me to wait in the ambulance while she went inside to find the doctor. She wasn’t gone but a few minutes, at which time I exited the ambulance. Korle Bu Hospital is a public hospital and is located in Accra Central. There were lots of people milling around outside in the heat. As we entered the hospital, the first thing I noticed was the lack of air conditioning. Next, I couldn’t help but lay my eyes on all of the injured. There must have been 10-15 gurneys haphazardly scattered in the room. I don’t know if this was the waiting room, or what. Mostly, it appeared to be men on the gurneys. One guy looked as if he had been in a fight. His face was swollen and blood was everywhere. One patient, in particular, sticks out in my mind. He was lying on the gurney with his right calf all bandaged up. He had about ten 4” pins sticking straight out of the top of his leg, and the underneath part of his leg was soaked in blood. None of these guys were really moving, and many were sticking out in the walkway, so we had to walk around them. I would not consider this hospital sterile and clean, by any means. Dave told me that he wouldn’t have let me do anything but cast my arm here.

As Dr. T guided us through the hospital, we must have passed 100 people sitting in chairs, or standing in line waiting to be seen. I felt two things: 1) a tremendous amount of guilt for moving ahead of all of these people who had likely been waiting for hours; and 2) a tremendous amount of relief for being able to be seen quickly.

The area in which Dr. Ocloo was located was air conditioned, and it was full of young children and their mothers. He apologized and explained that it was “Baby Wednesday.” I saw several babies with casts on their arms and legs. There were three “bays,” and as soon as we walked in, Dr. Ocloo had his staff remove a mother and her baby from the middle bay and escorted me inside. Again, I felt much guilt and relief.

A number of hospital workers descended on me, all under Dr. Ocloo’s direction. They quickly (and roughly) cast my arm (boring old white one). As I was lying flat on my back on that gurney, all I could think was, “I can NOT believe I am here.”

 

This is the back part of the room. I didn't even notice it, but my trusty photographer did!

It was very painful, and tears were leaking out of my eyes. However, once they were done I felt instantly better as the arm was now stable and protected.

He had someone check a calendar and said that the cast would come off five weeks from that day. Dr. T asked Dr. Ocloo if he would be x-raying the arm to ensure that it had not moved in the hours since the last x-ray, and he refused….twice.

We walked out the same way we came in, and again guilt and relief were about all I could think about. As we were getting into the ambulance, Dr. T told us that she wanted to get an x-ray regardless, so she said we would be going to the Diagnostic Center, which is in East Legon, completely on the other side of Accra. The good news was we were still in the ambulance, so off we went. This time Dave drove with me. That's Michael behind us trying to keep up!

When we walked into the Diagnostic Center, it was full of people waiting….again. Dr. Tatyana did her “thing” and I was quickly taken back for an x-ray. The center is much cleaner than Korle Bu, and the x-ray was completed efficiently.

Next, Dr. T wanted me to have an MRI, against Dr. Ocloo’s recommendation. We waited for about an hour, and it was a long hour for me. I began to feel nauseas and hot. I was also SO tired, I could barely keep my eyes open. Finally, I was taken into the MRI room, where I expected to immediately change and begin the scan. However, there was already a lady lying in the MRI machine getting scanned. Dave, Dr. T, and I sat in the room with the MRI technicians and basically waited for them to finish. At one point, the two technicians got up and completely left the room, for about 10-15 minutes. In the meantime, the machine continued to make noises and the lady remained in the machine.  You can see the lady in the background in the MRI machine.

The technicians returned, got the lady out of the room, and told me it was my turn. The thing I was most grateful for at this point was simply a place to lie down. I didn’t care if it was noisy or uncomfortable, I just wanted to close my eyes, which I did for the next 25-30 minutes.

We got back into the ambulance and made our way back home (another quick trip through Accra traffic). As soon as we got home all I wanted to do was sit on my recliner, take a pain pill, and maybe sleep a bit. That night I slept at least eight hours, and would have probably slept longer except Dr. T called. She told me she had gotten the radiologist’s report on my knee. According to him, I had a torn ACL, MCL, meniscus, muscle, and significant fluid on my knee.

Dr. T recommended I travel to Paris to follow up on both my arm and knee. I told her I would have to discuss the issue with Dave, and that I would get back to her (he had gone to work). She told me, in no uncertain terms, “You are the patient. You must take control and make a decision.” I was taken aback, but then said, “I am mentally and physically exhausted and I am in no way capable of making a rational decision by myself. I will discuss this with Dave and get back to you.” I think she got the picture.

Dave and I were really not so much concerned with my arm as we were with my knee. Both Dr. T and Dr. Ocloo did not observe any obvious problems with my knee when conducting their examinations.  I partially tore my ACL about eight years ago while playing basketball, but had chosen not to have surgery. Rather, I rehabbed the knee through exercise. When I hurt my knee the first time, it was a much different experience than this injury. The first time I heard a pop, and when I was lying on the basketball court, my knee just burned. As I tried to walk to the sidelines, I had the sensation that my knee was going to fall off of my leg. When I fell off the ladder I heard more of a crack, not a pop. I watched my knee move to the left and then to the right. There was pain, but no burning sensation. It didn’t swell excessively, I was able to bend my knee almost completely, and the knee didn’t feel like it was going to fall off my leg. I could tell that something was not right with my knee, but I was not convinced it was my ACL.

We had a decision to make. Stay in Ghana and hope everything would be ok, or travel to Paris to get a second opinion. I always thought that going to Paris would be romantic….not painful.

Careful What You Wish For!

Sometime between our April 2012 Seychelles trip and our May 2012 Laguna Beach trip, I injured my left elbow. I can narrow it down to those two events as I don’t remember it hurting while golfing in the Seychelles, but distinctly remember it bothering me at the Aliso Golf Resort.

After several months of the pain, I did some research online and was convinced I had what is commonly referred to as “golfer’s elbow.” My symptoms aligned exactly with what I was reading: pain in the tendons connecting my forearm to the elbow. The pain was centered on the bony bump on the inside of my elbow and sometimes radiated into my forearm.  

Why? Well, that also made sense after my research. Golfer’s elbow is usually caused by overusing the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons. Since moving to Ghana I have golfed more than ever as the local weather accommodates the sport nicely. In addition, I have probably spent a record number of hours in the gym trying to pass the time.

I also read up on cures – the number one being rest. As hard as it was to do, I didn’t golf for two months. It started feeling better, but as soon as I picked up a golf club, the pain returned. I also read an article that suggested I needed to strengthen my forearm muscles. Did that, but it only hurt. Mostly I just kept working through the pain.

The pain was sometimes so bad that I couldn’t lift a pan from the stove, or shut the car door with my left arm. In January I decided enough was enough and made an appointment with an orthopedic surgeon in Loveland, Colorado in February as Dave and I would be back in the states.

As I expected, after getting an x-ray, Dr. Chamberlin informed me that I had classic symptoms of medial epicondylitis, better known as golfer’s elbow. After hearing that I lived in Ghana he realized a more aggressive course of action (i.e., surgery) was not going to be my first option. He decided to go the conservative route and recommended placing a cast on my arm for 4-6 weeks so as to immobilize the joint. I cringed just thinking about it, but felt a bit better when he told me it would be a removable cast. He strongly suggested a round of physical therapy after 4-6 weeks, and I was frantically wondering how that would work in Ghana. We scheduled a second appointment for late May when I would be back in Colorado for my niece’s high school graduation.

Dr. Chamberlin’s nurse then took me to the “casting room.” There were two other people in the room that day (among several others) that made an impression. The first was a 14-15 year old kid who had a broken arm. He had been playing in a high school baseball game, was at the plate and got hit by a pitch. Brought back vivid memories of the day when Benjamin broke his arm playing football. I was hysterical; he was calm, asking me why I was hysterical.

The second patient was an older man who had evidently had his toes cut off. Seriously, the guy was lying on the table with his right leg straight out. I was looking straight at the bottom of his foot….there was not one toe left. When his doctor left, the nurse proceeded to take out the stitches, some 100 of them I heard her say.

Right about now I was feeling a bit like a baby. All I was getting was a removable cast as a result of having so much free time on my hands.

At any rate, the nurse started to cast my arm. This was a regular plaster cast, similar to the two I had gotten when I was a child (one on both arms). After the plaster dried, the nurse cut off the cast and then fashioned it in such a way that with a bit of effort I could remove the cast.

For the next week I faithfully wore the cast 24 hours a day, except when I showered. My friend Tanya would have been impressed as I even wore it while doing plyometric exercises. I continued to go to the gym and just did exercises that didn’t involve my arm. It was something I could live with for the next few weeks. I desperately wanted my elbow to feel good again.

On Monday, March 11^th, I began my 20+ hour trip back to Ghana. People were kind and helped me with my bags often. So many people asked me what had happened, and I constantly found myself saying, “I wish I had a better story to tell….”

On the long overnight flight to Accra I finally relented and took off the cast after trying for two hours to get comfortable with it on. After an uneventful flight (something I always pray for) I arrived home and the first thing I did was crawl into my comfortable bed for a short nap.

At 2 p.m. I woke up, took my cast off and jumped into the shower, removing my cast. After getting ready I started to unpack the three bags I had hauled back. I was tired, but felt better after the rest and a shower.

While I was getting ready I heard a loud noise outside of the bedroom and had assumed it was Doris, our housekeeper. Well, when I opened the bedroom door I saw what had made all the racket. The door to the attic was wide open. Now…if this is the first blog of mine you have read, you can’t imagine my horror, and I recommend you go and read about Steve McQueen and his friends.  For the rest of you, I'm sure you know what was going through my mind. Rats! Larvae! Cockroaches! Small children!



Now that I've taken a picture of the door, I can see how filthy it is, what with people opening and closing it.
I can assure you I have no intentions of getting on a ladder and cleaning it!



My reaction, of course, was to shut the door as quickly as possible to insure NO animals, insects, or other disgusting creatures ventured into my home. I went downstairs and got the ladder, set it up under the door, climbed onto it, and quickly shut the door. It flew right back open. After several attempts at jamming the door shut, I realized I was going to need some help. I have experience with the door as the pest guy has been to my house numerous times. I knew that the guards have an allen wrench which is used to open and close the door. So, down to the guard station I went. They could not find the wrench, after looking multiple places. He suggested I contact ATS (our maintenance provider).

It was late in the afternoon, and I knew that if I initiated a call to get ATS to my house, it likely wouldn’t happen. As I walked back to the house, I was devising a plan in my head. I would call Dave and have him (or someone who works for him) call ATS. I just couldn’t imagine the attic being wide open all night long, and was anxious to get it resolved.

I went back into the house, up the stairs, dialed Dave (never thinking he would answer) and climbed onto the ladder. Looking back at my cell phone log, I initiated the call at 3:27, a mere 4 hours after I had landed. Yes, I was on the ladder, phone in my right hand, flip flops on my feet, using my left arm to again attempt to close the door. Unexpectedly, Dave answered the phone and the door seemed to shut. As I began to tell Dave the problem, the door swung open, startling me. I slipped and fell backwards and to the left. When I hit the ground, I heard a crack in my left arm and then watched my left knee twist first to the left and then to the right. It was as if it all happened in slow motion.

As my sister calls it, "the scene of the crime." The door is just above the table and the cross.

The cell phone had fallen out of my hand, and for a second I was just stunned. I picked up the phone, which was lying to the right of me and heard Dave said, “What are you doing?” I told him I had fallen off the ladder while trying to shut the attic door. I was lying flat on my back staring up into Steve McQueen’s world. I looked at my arm and knew immediately that it was broken and started to cry. Dave said something like, “Maybe you just twisted it,” but I assured him it was broken. It had an obvious deformity to it, and was not the first broken arm I’d had or seen. I was blubbering about how a rat was going to fall on me. Dave told me to forget about the attic and to focus on the important thing….me!

If I didn’t know it before, I certainly do now. Dave epitomizes the phrase “grace under pressure.” While I lay on the ground crying uncontrollably, he was already formulating a plan of action. He hung up and by 3:34 p.m. he had arranged Michael to come pick me up and transport me to the Newmont Clinic, had our friend Julie calling the clinic to let the doctor know I was on my way, and was searching for a ride so he could meet me.

As I gingerly stood up and carefully held my left arm to my chest, I moved towards the stairs. I contemplated walking down them, but with not knowing what was wrong with my knee I chose to move down the stairs on my butt, ensuring I wouldn’t fall and further hurt myself.

I had visions of falling down the stairs and breaking my other arm!

As I sat in the living room waiting for Michael, I thought about the fact that I hadn’t eaten a bite of food since I had eaten at Burger King in the JFK airport the previous night. I was desperate for something to take away the excruciating pain, and knew that soon after I got to the clinic I would be receiving pain medication. Evidence exists that I was thinking clearly at some level, as I then hobbled into the kitchen and got myself a soda and a granola bar. After all, you are never supposed to take narcotics on an empty stomach.

I sat back down and decided it would probably take Michael 30 minutes to get to the house. I needed something to distract me, so I called my sister. She answered tentatively and I just started bawling. It’s a wonder she could figure out what the hell I was saying! I felt like we only talked for about 2 minutes, but in looking at my cell phone log, she successfully kept me distracted for more than 17 minutes. It would have been longer but then it occurred to me that I don’t have call waiting (Ghana, people, Ghana) and that Dave was probably trying to call. Just minutes later Michael pulled up and I made my way to the car. Dave called just as I got into car, worried that I hadn’t answered my phone.

Ghana traffic is terrible, so I almost always plan my excursions around the pattern. I rarely ever go towards Dave’s office after 3 p.m. otherwise it will take me an hour to arrive, rather than 20 minutes. Unfortunately, I didn’t have the option. We would be going with the afternoon traffic, and it wasn’t good. I was sure it would take me an hour to get to the clinic.

Looking back, I have to laugh. Michael was so quiet the whole way. I told him I had broken my arm and he would just stare at me and then at my arm with his eyes huge. He didn’t say two words to me the whole way to the clinic. Fortunately, the traffic thinned out after a bit and I arrived at the clinic in about 30 minutes.

I had not seen Dave since March 1^st….12 days. I walked in, saw him, and just started crying (again). He gathered me into his arms and assured me everything was going to be ok.

I was about to embark on more than a week long health care journey. Be careful what you wish for!

To be continued.....

Shark Cage Diving in Gansbaii Bay

My friend, Lina, and her husband visited Cape Town in October of 2012 and gave me lots of great suggestions about things to see and do; one of which was shark cage diving. When I mentioned it to Dave, he just looked at me like I was crazy. Lina assured me it wasn’t scary, but rather it was an awesome experience. I began looking into the possibility online and discovered that there were many tour companies in the Cape Town area from which to choose. After thoroughly researching the review of the various operators, I selected Great White Shark Tours.

The tour begins in Gansbaii Bay, which was about a 2 ½ hour drive east of Cape Town. We drove through some really beautiful country, particularly a gorgeous summit that overlooked False Bay. As was becoming typical of our driving excursions, Dave had to take my word that the views were stunning, as his eyes had to remain on the road.

We were one of the first to arrive, and were treated to breakfast (or was it intended to serve as our last meal?). After a brief safety message, we were each given a big orange raincoat. While they may not have been fashionable, I was quite happy to have mine, considering the wind and cool air.

Some shark facts -

·        The female sharks are typically larger than the males.

·        The average adult shark is between 13-17 feet and weigh between 1,500 - 2,400 pounds.

·        Since the great white shark has no known natural enemies, it dwells at the top of the food chain. Because of this, the great whit is regarded as an apex predator.

·        Great whites have rows of as many as 3,000 serrated teeth which sit behind the main teeth. Trust me….there are lots!

There were about 20-25 of us, and we soon boarded the Apex Predator (didn’t know the significance of the name until I did a bit of research) for our adventure out into the bay.

We cruised across the inlet for about 20-30 minutes, and when we stopped I was surprised to see how close we were from the shore. There were three other boats anchored in fairly close proximity to us, and our captain said he had been in contact with one of them, who said they had been anchored for two hours before they saw their first shark. He told us that, on average, it takes about 20 minutes in which to lure the sharks.

Attracting the sharks is a pretty simple process. One guy is standing on a rather small and narrow ledge at the back of the boat. He has a large 30 gallon drum of “chum,” which is basically bits of tuna and other fish. He continually mashes and stirs the ingredients with a large stick. His actions are such that the chum spills out over the drum and lands in the water, thus attracting the sharks. From time to time he fills up a smaller bucket with water and pours it into the drum. This guy has the worst job, in my opinion. Not only must it stink to high heaven, but he must constantly stir the chum, which was at least two hours.

Another guy has a long rope with a large piece of tuna tied to the end. He stands either right above or to the right of the cage. He casts the rope out into the ocean as if fishing. He slowly drags it back towards the cage before throwing it out again.

At this point, no one is in the cage. He also has a second rope with a styrofoam cutout of a seal. One passenger asked the captain if that seal really attracts sharks, and he said, “sometimes.” He told us that seals only make up about 10% of a shark’s diet, but that sometimes the color attracts them.

While the chum guy and fisherman did their jobs, the captain was responsible for watching out for a shark. He told us that it wouldn’t be like the movie, “Jaws,” where you see the dorsal fin moving stealthily through the water, but rather the water would cast a big shadow. Sure to his word, about 20 minutes later, the captain yelled, “Shark!”

The fisherman cast the tuna out and enticed the shark to come closer to the boat, which he did. So close, in fact, that he bit one of the floaties on the cage. After the shark had circled around three or four times, the captain encouraged the first eight people to get ready to enter the cage. Since we were sitting on the roof of the boat, those on the first floor would go first. We had a great vantage point from which to watch the initial action. At this point, I was a bit anxious. The sharks were SO close, and bigger than I ever expected.

After all eight of the divers were in the cage, the top was secured and the fisherman tossed out the tuna, pulling it back towards the cage….and the divers! The cage is secured to the side of the boat and sits about two feet above the water line. When you are in the cage, you grab the bar above you, keeping your head above the water. The fisherman tracks the movement of the shark and announces where to look. So, if the shark is coming up on the left, he will yell, “Shark on your left. Down! Down! Down!” You hold your breath and go under. As you go down, there is a bar immediately in front of you to which you grasp. Not to worry….the bar is a good 6 inches from the outside of the cage. There is also a bar down by your feet. We were told to place our feet under the bar, but I could never get the hang of that and always had my feet on top of the bar.

After the second group came out, it was our turn. We tugged, pulled, heaved, and wrenched on our full body wetsuits. The suits even covered our heads. We were also given boots, and finally a mask. This operation was a well-oiled machine; very organized and efficient.

When we saw the first shark, I wasn’t sure why they didn’t just get a group into the cage immediately so that as soon as a shark came close, they would get the first up-close look. Once I got into the water, I figured out why. The water was bitter cold! We were told it was about 53 degrees. As much as I enjoy scuba diving there is NO way I would ever go scuba diving in this kind of water. Literally, within minutes my fingers were stiff. We were told that before a group got in the water, they want to make sure the shark intends to hang around.

Before Dave and I were in the water a minute, the fisherman was yelling, “Shark on your right! Down! Down! Down!” I took a deep breath and went under. The visibility was quite poor, but before I knew it, I came face to face with my first great white shark. I held my breath as long as I could, marveling at the very experience, and wanting to etch it into my mind forever.

Dave was immediately to the left of me. We were told to go down as the shark was coming straight for us, so under the water we went. He was not kidding. The shark swam directly towards Dave, opened his mouth, and took a couple of bites of the cage. His mouth was so wide open that I could have counted his teeth. He then turned towards his left and swam alongside the cage. It would have been easy to simply reach my hand out and touch him….that’s how close he was to me. During our safety briefing we were told that under no circumstances were we to touch the shark. If we were seen sticking our fingers, hands, feet, or any other part of our body out of the cage, we would immediately be removed from the cage and returned to shore. Shark cage diving is an industry in this area, and they will not allow anyone to jeopardize their livelihood.

We spent about 20 minutes in the cage, during which time we were able to see the shark multiple times. I remember having a difficult time getting out of the cage to the boat. Not only was I cold, but I had about 5 added kilos attached to my waist. As I tried to pull myself up onto the boat, I briefly wondered if I was going to meet the shark face to face….without a cage. Everyone had the opportunity to get back into the water a second time, but I was just too cold. I couldn’t feel most of my fingers and was afraid I wouldn’t be able to hang on to the bars if I went back in.

Dave braved the frigid waters to go down one more time.

I returned to the top of the boat and took more pictures and videos. It was just as incredible watching them approach the boat from that vantage point.

While I was taking pictures, I introduced myself to the woman sitting next to me. Her husband had also decided to go back down a second time. She told me they were both physicians and were in their last year of their residency programs in Chicago. Her husband was specializing in infectious diseases and thought it would be a good learning experience to visit Africa and learn about some of their diseases up close. They were planning on spending about two weeks travelling around South Africa. Most of the others were from Europe or South Africa. Dave and I were obviously the oldest in the entire group.

We saw four different sharks that day, one of which was about 13-14 feet long (nearly as long as the cage), as well as a “baby” shark. He was probably around 6 feet long, and was pretty reluctant to come very close to the cage, as opposed to the larger sharks that seemed to have no fear. We were surprised at how long the sharks stayed around the boat and kept coming back time and time again. Time went so quickly, but we estimate that we hung out with the sharks for 2-3 hours. There were lots and lots of birds getting their fill of the tuna and chum. I could also see big schools of fish following the tuna bits. We were the last shark cage diving group in the bay to leave.

After seeing the great white sharks up close and personal, there is no way I would ever get in the water anywhere near this bay or even Cape Town. Neither Dave nor I thought the water was as salty as say the Pacific or Caribbean oceans. Lina had warned me that she and Matt smelled so bad when they got out of the water because of the chum in the water, but we didn’t even notice!

After my initial apprehension, once I got in the cage I found I wasn’t scared in the least by the sharks. I felt completely protected and safe inside the cage. In fact, I looked forward to them coming towards the cage each and every time. But, there will be NO swimming in those waters by me….ever! While I may not be scared of them in the cage, I have a great deal of respect for them in the open waters.

Robben Island and Apartheid

After a lazy morning at Abbey Manor and a very interesting haircut Dave received at the V&A Waterfront (I’m not going to embarrass him in a blog, so I’ll let him explain the experience in person for those brave enough to ask), we took a ferry to Robben Island.

Robben Island is a small island located just off the coast of Cape Town, and is Dutch for “seal island,” although I never saw one seal. It has gained notoriety as it is the place at which Nelson Mandela was imprisoned for 18 of the 27 years he served.

I was anticipating a thorough history of Apartheid in South Africa, but was very much disappointed. Our tour guide spent the first half of the visit either making a joke or acting like a prison guard. We had very little time to explore, and he virtually told us nothing about Apartheid. On our tour to two of the local vineyards later in the week, our tour guide provided us with much more history, which peaked my interest that much more.

I believe it is very important to begin this blog by declaring that prior to moving to Ghana, I was pretty much ignorant about Apartheid. I knew about Nelson Mandela, and I knew about Apartheid, but certainly didn’t know of any of the details. So, what I write is either what I have heard first hand, or what I have interpreted through reading about Apartheid.  It is in no way meant to be all encompassing, exact, or gospel. Also, the history covers years and years, and all points can’t possibly be covered in this short, personal blog. Our vineyard tour guide said it perfectly - this was his interpretation of Apartheid and the history and should we ask someone else, it’s likely we’d get a much different perspective. So, with that being said, this is MY interpretation.

I think, for me, what makes Apartheid worse than what blacks experienced in the U.S., is that at one point they did have rights, and then in 1949 the new leaders (National Party) decided that South Africa was no longer one nation, but rather one that was comprised of four distinct races: white, black, coloured (mix descent), and Indians (as in India). There was further distinction; i.e., English and Afrikaans speaking people. Actual laws were enacted outlining racial classifications and what a person could or could not do based on their race. It’s my understanding that the hierarchy was white, Indians, coloured, and then black. Everyone had to carry an identity card with them, and were often required to present it when questioned by authorities. In addition, the U.S. passed the Civil Rights Act in 1964, while Apartheid was not abolished until 1994….not so long ago.

Prior to Apartheid, many people of different races lived side by side. In 1950 the Group Areas Act of 1950 was enacted which put a halt to the diversity and regulated where a person could live according to his/her race. People were forced to resettle into designated “group areas,” based on their race. In particular, we learned about District Six, which was located in downtown Cape Town. The government began a forced removal of more than 60,000 during the 1970s, most of whom were coloured Muslims. Their homes were completely demolished - and everything that was in them. They were relocated to a sandy and unwelcome area about 25 kilometers away. The government claimed the area was downtrodden, full of crime, people lived in slum conditions, and ultimately dangerous. Others, however, believed the government wanted the land for development due to its close proximity to Table Mountain and the harbor.

Marriage between a man and woman of different races was illegal. Even sexual relations between two people of different races was considered immoral and a criminal offense. Whites and blacks had much different educational systems; the one for blacks was designed to prepare the children for a life of physical labor. Similar to the U.S., blacks were not afforded the same access to restaurants, bathrooms, and stores. Segregation appears to have been comparable to that which occurred in the U.S.

It should be noted than many countries opposed Apartheid, and in particular, those countries that formed the United Nations. Trade embargoes were sanctioned, and ultimately South Africa was on the verge of bankruptcy, which led to the fall of Apartheid. It is also important to note than white people only comprised something like 15-20% of the population.

The end of Apartheid took several years and began with a series of negotiations from 1990-1993, and was eventually ended in 1994.

Nelson Mandela was the most famous anti-Apartheid activists, but based on everything I’ve seen and read, his role was one of peace. He was a prominent lawyer who was repeatedly arrested for his political activities. In 1961 he was arrested and convicted of “sabotage and conspiracy to overthrow the government,” in other words…treason. He was sentenced to life in prison. He spent 18 years on Robben Island. The last several years he was confined to Pollsmoor Prison. He was released on February 11, 1990. He was elected as the President of South Africa in 1994 , which was the first year in which multi-racial elections occurred. Everyone I’ve talked to has nothing but great regard for this man - black, coloured, and whites alike. They all believe that if only everyone was like Mandela, the country would be all that it could be. When he was released from prison - and remember, it was after 27 years of being confined - he did not speak of revenge or paybacks, but rather about peace, forgiveness, and working together to move forward as one South Africa.

Back to Robben Island. The ferry ride took us about 30 minutes on very rough waters. When we arrived, we were quickly rushed to the busses. It appeared as if they were trying to treat us like prisoners, but it felt more rude than anything. Like I said before, our tour guide did not provide us much detail about Apartheid itself. We drove around the island a bit, which is now inhabited by people who work on the island - mainly those who maintain the grounds and prison.

Here we took a 5 minute stop (no more than 5 minutes, he said) as this is the closest point of the Robben in relation to Cape Town. That is Table Mountain beside us. Another windy day in Cape Town!

If a prisoner escaped, he would have to swim to the coast. If I remember correctly, only one prisoner ever escaped and evidently drowned trying the swim. We drove by the lime quarry, which is where some of the prisoners had to work….8 hours a day/5 days a week. Now, I’m not saying what they did wasn’t difficult, but to be honest, it’s nothing compared to the Jews and what they had to endure in concentration camps.

We arrived at the actual prison, where we were herded off the bus and led to the entrance. We were met by this man (didn’t get his name) who also served time (5 years) on Robben Island for his political activities.

He provided us with the history of the island and what they experienced on a day to day basis. One lady (she was black and did not speak English; I suspect she was South African and was speaking a tribal language). While the guide did not repeat the question, based on his answer I think she asked, “Was the prison always this clean?” Seriously, the prison was spotless. The floors were polished. There was no chipping paint. There was a fairly cool breeze wending its way through the hallways. He said, “Oh no….it was much, much cleaner.” He was actually embarrassed by the landscape outside because he said they took such pride in their temporary home while confined.

Robben Island imprisoned many men, most of whom were formally educated. These were doctors, lawyers, university professors, businessmen….men who were trying to force a change for their people. Mandela was one of the obvious leaders at the prison, and was always preaching about furthering one’s education, which many of the prisoners took to heart. What happened to these people was not right, but I’m convinced that it could have been much, much worse, in terms of how they were treated and the conditions in which they lived. They appeared to remain peaceful men with an agenda to make a difference.

So, what has happened to the country since the fall of Apartheid? Well, it depends on who you ask. Our vineyard tour guide is coloured. He maintains that while many things have improved for blacks and coloureds, there are still many, many problems.

Well, the best thing that has come from Apartheid is that as far as the law is concerned everyone is equal, just as it should be. As you drive across the country, you see what we consider “slums,” and they call “shanties” (as in shanty towns). Here is an example....not one I actually saw, but they basically all look alike.

Some of these areas go as far as the eye can see. I’ve seen several of them right here in Accra. The difference in South Africa is that there is an actual plan for removing these shanties and to provide those living there a better place. Little by little, the government goes in and razes an area of the shanties. They then build adequate infrastructure (water, electricity, etc.), and subsequently homes (probably about the size of a small apartment). The smaller homes go for about 40,000 rand (local currency), which is equivalent to about $4,500. Buyers easily qualify for low interest 15 or 30 year loans. Very affordable. There are also larger homes that are sold for around 90,000 rand…again, affordable.

There appear to be some downsides….and these were related both by the tour guide and one of our South African friends, who is white. South Africa is experiencing a tremendous amount of corruption, much more so than prior to Apartheid. Below is a recent press released in Johannesberg:

“Not one Eastern Cape municipality has obtained a clean audit, according to a report on Monday. The Dispatch Online reported provincial Auditor-General Singa Nggwala as stating that municipalities in the province had regressed further in their 2011-2012 audit outcomes since the 2010-2011 financial year. Nine municipalities had unqualified audits but with findings. There were 19 councils with a qualified opinion, 11 remained unchanged, and 5 improved from disclaimers and adverse opinions. Local government MEC Mlibo Qoboshiyane said he was disturbed by the regression and by the fact that once again none of the four municipalities had clean audits. He said he would work with all mayors to address the situation but where there was no alternative, he would use the powers bestowed on him by the constitution and other laws of the land.”

Basically what this means is that officials in all of the municipalities are likely stealing money from their own people. Are you kidding me? You worked SO hard to earn your right to be treated like an equal, and yet you are corrupt? Why? Our friend told us that there are so often irregularities in any financial transactions that have to do with the government.

Remember, 80% of the population in South Africa is black. Now that Apartheid has been abolished and equal rights prevail, the whites are in the minority. I recently heard from a South African friend that there has been a huge exodus from the country by white people because of the lack of opportunities, particularly for their children in terms of a promising career or in starting a business. In reality, there is reverse discrimination, which the U.S. has experienced.

Our tour guide also educated us about HIV/AIDS in South Africa. Did you know that an estimated 5.6 million South Africans are living with HIV and AIDS. This is the largest number of people in any country worldwide!  When we asked how that could be possible in a first world country, our guide gave us a few reasons.

First, an estimated 4 in every 5 people with HIV/AIDS are women between the ages of 20-24. He told us this story about local tribal beliefs (although that was debunked by our white South African friend). I suspect the truth lies somewhere in the middle. The locals (I’m talking the townships around the Cape Town area) believe that before a woman can marry, she must “prove” to her husband-to-be that she is fertile. As a result, many young girls (around the age of 13) have sex with the intention of getting pregnant. In this way, they have living proof that they are fertile. Obviously, they are engaging in random and unprotected sex. I asked him what happened to all of those children, and he said that they are then raised by the young woman’s mother and there was little to no connection to the child. It appears to be a vicious cycle.

Second, there were many people in high levels that didn’t believe that all immune deficiency related diseases could be attributed to one single virus - HIV. Even though international drug companies were offering free or cheap anti-retroviral drugs to the county, the Health Ministry was not on board. Not until November 2003 did the government approve a plan to provide anti-retroviral drugs. Even worse, in 2006 the then Health Minister, Manto Tshabalala-Msmang, “advocated a diet of garlic, olive oil and lemon to cure the disease.” WHAT??  The Health Minister was a woman and was serving under President Mbeki, and even though she was the subject of international criticism she retained her job until Mbeki left office.

So, now they have a new President - Jacob Zuma. Trust me….if you think you can’t stand one more day of Barrack Obama….read up on President Zuma! Alleged rape, racketeering, corruption, abuse of power, bribery, and fraud. The man never received any kind of formal schooling. He allegedly raped a 31 year old woman, the daughter of a deceased friend of his who was HIV positive. He admitted in 2006 that he did not use a condom when he had what he referred to as consensual sex (as opposed to rape), even though he knew she was HIV positive. He stated IN COURT that he took a shower afterwards to “cut the risk of contracting HIV.” Here is the scary thing….this “man” has been elected President of South Africa for THREE terms! In addition, Zuma practices polygamy. He has six wives and more than 20 children.

On a positive note, there has been a significant increase in HIV/AIDS education, and like anything, it will take time. Our tour guide said while the percentage of HIV/AIDS cases had not decreased significantly it had also not increased, so he was looking at the glass as half full!

Anyway, I could go on and on and on. South Africa is such an interesting country with its many nations of people. I know that I gave much time to HIV and corruption, but it’s because it’s what stuck out in my mind. Here the people had an opportunity to really improve their lives, and yet overall it doesn’t necessarily appear that it has. I’m sure we can point to a number of reasons, one of which is education, or lack of quality education. Education in the shanties continue to be an issue, where some classrooms have 80-100 students. Yes, you read that right…80-100 students. There is no way any effective education is occurring in that type of environment.

I think that just like with any downtrodden culture, it will take generations for real change to occur.

Above all, South Africans love their country, be them black, white, or coloured. I don’t know how many times we heard “One South Africa.” They have so much opportunity for continuing to grow and progress, but those in power must be stopped. Many times I asked myself, “I wonder what Nelson Mandela thinks about how his country is doing today? What does he really think about Jacob Zuma?” This is a man who was and continues to be all about working together, but above all….forgiveness; a powerful commitment.