On the morning of my first teaching session, I reported to Emma Baxey at the Education/Induction Centre in Pantang Hospital. Emma had previously reviewed the content of my ‘Suicide Prevention and Management’ session and felt it to be entirely appropriate for the staff at the Hospital. In Matron’s request for teaching input there had been a specific mention that I focus on Suicide Prevention and Management and on Risk Assessment and Management. I wasn’t sure if there had been some incident(s) at the hospital that had prompted such a focus but certainly amongst management and senior staff, there was a heightened awareness of risk. I had raised the issue of a potential overlap between these two topics but staff still felt it important that they be covered even if there was some repetition.

Emma proved to be an excellent guide and took me down to the Conference Centre within the Administration Building where my teaching was to be delivered. This was a reasonably large room with a set of tables arranged in a U shaped pattern. A working projector was now available and nursing staff from the many wards around the hospital were beginning to arrive.

Conference Centre and Teaching Area before start of class with the curtains open and prior to use of projector (1).

Conference Centre and Teaching Area before start of class with the curtains open and prior to use of projector (2).

In terms of the session on Suicide Prevention and Management I decided as a STORM (Skills Based Training on Risk Management) Trainer to use a very modified version of this material partly to make adjustments for cultural differences in Ghana and West Africa and partly to accommodate the very shortened time span (Approx. 3 hours) allocated to each teaching session. Unfortunately nurses were released from the wards to attend the classes but this curtailed the time allowed and necessitated a lengthy teaching session without any breaks - something which would be unthinkable in nurse education in Scotland.

When the nurses arrived they presented as a very mixed group with young staff nurses in green and the more experienced older staff in white. All seemed keen and enthusiastic about the input and appeared to enjoy the prospect of some unexpected in-service training. The projector itself was a little temperamental but proved adequate to the task and while the supply of Flip Chart paper was limited, careful use of each sheet, back and front, allowed a sufficient supply for our needs.

The Class Group from my perspective.

Me emphasising a particular point during the session.

While teaching the various nursing groups over my period in Pantang I generally found them a little shy at the beginning and somewhat startled to be asked questions. I usually opened with an examination of key aspects of the therapeutic relationship and this allowed the exploration of such concepts as empathy, rapport and confidentiality. However as the session progressed, groups generally became more participative and less concerned about getting the answers wrong. I was impressed with the theoretical knowledge of several of the staff - their real deficit however seemed to be in the area of Practice Skills. Their three year training programme seems quite theoretical and divorced from what happens on the wards. During training, teaching staff rarely visit the practice areas and apparently less attention is given to this aspect of their programme. This perhaps accounts for the appeal of and the demand for skills based material in nursing. Susie,(Easton), Dr Dzadey, the Medical Director of the Hospital and several of the Medical Assistants in Psychiatry (MAPs) also came along and again found the session very valuable for their own practice. What was heartening perhaps at the end of each class was the number of staff who sought my email address in order to get copies of the resources and to explore the possibility of development in some other aspect of their practice.                                                                                                                                                                                                                                                                                                                                                                                            Me emphasising another point!                                                                                                                                                                             Integral to the Suicide Prevention and Management programme is the use of role-play which I have to say the Ghanaian classes entered into with gusto and enthusiasm. Indeed helping the students develop a loose script around a local scenario proved to be quite revealing and despite the cultural divide it was amazing to discover the amount of nursing parallels and scenario similarities evident around the distressing and challenging topic of suicide. 



Rebecca and Kofi using an effective role-play to demonstrate a point.

Susie (Easton) the psychiatrist from London invited me to come along to witness the management of care in the Psychiatric Out-Patients’ Department (OPD). I gladly accepted the invitation feeling that this experience would help to inform my subsequent nurse teaching at Pantang Hospital. The OPD is housed on the first floor of the Administration Building and is generally very busy and crowded with tens of patients, sometimes accompanied by relatives and children, waiting patiently to be seen. Here ‘patience’ is the operative word since the wait is sometimes a long one. What is most noticeable perhaps is the calmness and composure with which people wait. Waiting is a common occupation in Africa and so people accept it with equanimity. Every morning I entered the building, those waiting in OPD greeted me politely and courteously – Some might have travelled long distances but still they accepted their lot largely without complaint.

Out-Patients’ Waiting Area, Pantang Mental Hospital.

Crowded nature of the OPD on a busy day - 1

Crowded nature of the OPD on a busy day - 2.

Initially I sat in with Susie and observed a number of consultations. Many of the patients speak their native language and have no English and so this necessitates a rather cumbersome three way conversation with the nurse (Yvonne) acting as a translator of the patient’s symptoms and problems. Susie was very kind and caring towards those patients she saw and was diligent in trying to get to the crux of the matter. She was also keen to demonstrate and model the effective documentation of the consultation as this can be crucially important in subsequent appointments. One of the issues that emerged is the cost involved to the patient and their family in conducting any investigations such as an Electroencephalogram (EEG). Here, with the impoverished situation of many of the patients, there’s a balance to be struck between over-investigating and asking for what is reasonable and necessary. A further issue arising was that many of the patients were being brought back for follow-up appointments and often had to travel long distances for a further review at a fairly early date after their last appointment. Sometimes the frequency and level of review seemed a little excessive.

Consultation Room – Out-Patients’ Departmen

(Photo courtesy of Greg Neate)

After being with Susie for a period, she suggested that I might like to join one of the Medical Assistants in Psychiatry (MAPs) in order to see how they conducted their consultations. I joined George Kunyangna, a MAP and Sheila Larweh, the nurse assisting him. Sheila is four years qualified as a Registered Mental Nurse and George was in Pantang on placement from the Kintampo Mental Health Degree Programme in central Ghana which he is presently completing. Like all MAPs he is already a qualified Mental Health Nurse with several years experience. He was also very kind and caring towards his patients and was very helpful towards me ensuring that the consultation was conducted in English although he spoke the local language. Many of the patients were very deferential towards all of the staff including me and although the consultation is free, some brought gifts of vegetables or palm oil as a way of offering thanks for the help given. Apparently it would be rude to refuse these offerings.

MAP George Kunyangna taking a break between seeing patients.

RMN Sheila Larweh assisting George with the OPD Consultation.

In terms of presentation, Psychosis and Schizophrenia loomed largest in the client group but so also did Substance Abuse and strangely, Epilepsy. I say strangely because of course in Ireland and the UK, Epilepsy is primarily regarded as a neurological condition sometimes but infrequently coloured by psychiatric complications. However here the condition is surrounded by so much stigma and superstition that it invariably ends up as a psychiatric illness. Antipsychotic medication seemed to be used quite a lot and sometimes combinations of Chlorpromazine and Haloperidol were applied. The more recently developed Atypical Antipsychotics, particularly Olanzapine, were also used although these seemed to be less available largely due to their increased cost. Sometimes George did suggest counselling and a referral to the single psychologist within the Hospital. This was infrequently availed of largely due to the long waiting list.

I found some of the consultations heartbreakingly sad. What was particularly touching was the stress and strain sometimes evident on the faces of family members as they tried to cope on meagre resources with the mental illness of a loved one - A young woman carer carrying her baby on her back and arriving with her elderly mother who seemed to be suffering from Parkinson’s Disease. This elderly lady was extremely deferential and submissive in pleading for help while her daughter looked strained and broken from the stress of it all. George appeared limited in what he could do but offered some medication to try to relieve some of the symptoms. There was another case of a young man arriving drunk at the OPD and accompanied by his brothers who seemed tired of the whole rigmarole of admission, detoxification and then a return to drinking. You might say that a case like this would have many parallels at home. However what frequently complicates the whole picture is the grinding and unrelenting poverty – poverty we can’t even begin to imagine - that lies beneath many of the presentations.

 Physical ailments are also explored at the OPD and frequently episodes of Malaria colour the presentation of the mental illness. What emerged as well which was slightly shocking to me was that episodes of Malaria had not responded to treatment because of fake and fraudulent medication. This of course is an on-going issue for the wider population in Ghana but it surprised me to think that sham medication could happen even in medication supplied by the hospital.

Happily the area of physical ailments is addressed within the hospital with the presence of a Physical OPD. I was told that this became necessary because of patients frequently arriving in Pantang having been referred from other centres because staff thought them to be mentally ill. Unfortunately so much stigma and prejudice surrounds mental illness that even the slightest pattern of psychiatric symptoms whether it be in a patient with a brain tumour, meningitis or the delirium accompanying a severe Respiratory Tract - Urinary Tract Infection will sometimes result in the transfer of that patient to the mental health setting of Pantang. The Physical OPD then serves as a screening mechanism for such conditions and sometimes returns the patient from whence they’ve come.

                                                                                                                                                                                                                                                                                                      Another consultation involving the MAP, the Nurse and the Patient.                                                                                                                                                                                                                                                                                                         

The unit of currency in Ghana is the Cedi (pronounced ‘seedy’). The currency was re-denominated in 2007 and Pesewas (cent like divisions of the Cedi) were restored after many years of being obsolete. Older locals are still adjusting to the re-denomination and sometimes talk in terms of the old money. I found the Ghanaian money very easy to understand and the ready reckoner in my head converts 1 Cedi to 50 pence or two Cedis to a pound. My bank in Scotland recommended bringing dollars into the country as you can’t buy Cedis abroad. However this was probably bad advice as the strength of the pound sterling in late 2011 would have been better than dollars. I converted my first $500 in the Prudential Bank in Adenta and got 750 Cedis in return. This proved to be a very long process with an enormous amount of paperwork and subsequently I was advised to use Foreign Exchange outlets. These are fairly common in Central Accra and usually give a better rate particularly in the case of notes of large denominations.

Commonly Used Ghanaian Notes together with Various Pesewas Coins.

My other way of sourcing money was to use a Debit Visa Card – Be warned machines that facilitate Mastercard are hard to find. The Visa Card proved to be very effective in lots of Bank Machines in central Accra. There was even a Visa Bank Machine 500 yards down the road from the entrance to Pantang Mental Hospital although this was perhaps unusual so far out from the centre of the city. However I found it very convenient and frequently asked my Taxi Driver to pull over while I withdrew some money. Expect to pay 5-7 Cedis for a two to three mile ride in a Taxi and perhaps 20 Cedis for the ride from Pantang to the Central Mall in Accra – a distance of about 17/18 miles. A meal and a drink in an average Ghanaian restaurant should set you back around 15 Cedis and a little more than that if you want something more upmarket. My usual lunch at the market stalls near the entrance in Pantang - Roasted Plantain and Peanuts with a bottle of Coke or Water - generally cost me around 3/4 Cedis. I always paid in cash and would be reluctant to hand my Visa Debit Card over in any of the restaurants or shop outlets. Stories abound about fraudelent behaviour linked to debit or credit cards. Outside of Accra there seems to be a much poorer chance of using a Visa Card although I did see some ATM Machines and International Banks (eg. Barclays) in Tamale. Obviously cash is essential in a place like Yendi.

Re-denomination of the Cedi in 2007

It’s Monday 12th September and as promised Emma Baxey, a senior staff nurse working in the Education/Induction area is taking me on a guided tour of Pantang Mental Hospital. She prefaced the tour with a slide show on the development and evolution of the hospital. This has previously been described in an earlier Blog but suffice to say that Pantang itself is one of only three psychiatric hospitals in all of Ghana (Pop. 23 million) and is situated in the Ga District near to Pantang Village, from which it gets its name. The hospital is 1.5 kilometres off the main Accra-Aburi trunk road and about 26 kilometres from the centre of Accra. It stands in a rural setting of 365 acres and has its own farm. However problems with poor fencing of the land area has lead to constant encroachment from the many newly arrived people in Accra who set up temporary dwellings on the perimeter of the site. There is also a problem with the recent opening, without any consultation, of a Land Fill Dump which is situated fairly near the Hospital and gives rise to unpleasent smells and a build up of litter.

Administration Building 

Entrance to the Hospital

The Hospital was commissioned in 1975 but was only partially completed as a Regional Psychiatric Centre with a bed capacity of 500. However the bed occupancy frequently exceeds this number and the Hospital receives psychiatric patients from all over Ghana and also from neighbouring countries such as Nigeria,Togo, Ivory Coast, Benin and Burkino Faso. There are over twenty operational departments. The site itself is somewhat marred by the number of unfinished wards all around the place many of which are occupied by squatters and other poor people from the surrounding area.

The Hospital Driveway which is badly rutted and potholed.

An overview of the Hospital Site which gives a sense of its rural setting - Three Staff Accommodation Blocks are visible in the foreground.

There are ten wards within the hospital (7 male and 3 female) each with a capacity of 50 patients. A covered walkway gives access to all of the wards which are separate single storey buildings most of which are fronted with a pad-locked gate. The buildings themselves are rather grim and dark inside - partly to reduce the heat - and fairly poorly furnished. The staff do their best in such difficult circumstances and with such large numbers of patients. However there is a tendency amongst nursing staff to spend much of their time at the Nurses’ Station documenting care rather than spending it as quality time with the patients.

Covered Walkway Leading to the Wards

The Covered Walkway at Ground Level.

An example of one of the Ward Buildings

One thing that struck me while touring the Hospital with Emma was how calm the individual units were. There was little of the agitation or distress one might expect in the Admission Wards. However I was later to learn in class that aggression was not uncommon within the hospital and on occasion staff suffered injuries. Consequently seclusion was sometimes used as a way of managing this problem. Seclusion is only very rarely used in Scotland and then under very strict conditions.

Another major issue which contributes to overcrowding within the Hospital is family and carers failing to return and accept their relative home. Stigma is so great and causes such embarrassment that carers may use the hospital as a dumping ground. Frequently false addresses are given and so staff cannot trace relatives when the patient is ready to go home. This was recently highlighted in the news here when Hospital Authorities announced that a particular patient had died and then confronted the family with a live patient when they turned up for the funeral. The ‘dumping ground’ phenomenon undoubtedly increases the need for beds and contributes significantly to overcrowding. Emma mentioned that many of the patients we met could now go home but unfortunately had nowhere to go. Additionally resettlement services for people leaving hospital are very underdeveloped and so staff are entirely dependent on relatives accepting their role as carers for these patients.

Of course stigma is also an issue for the staff. Within nursing in Ghana the mental health division is very much seen as an inferior discipline and while these kinds of attitudes are still harboured at home in Scotland and Ireland they are much more explicit here. This is partly informed by a belief amongst some people that mental illness is contagious and so by nursing the mentally ill you are exposing yourself to the risk of Mental Illness.

The entrance to Ward 10 under the covered walkway and the garden area         outside.

A visit to the Activities Centre and the Occupational Therapy department showed some fairly basic facilities and a range of ongoing activities including Artwork, Woodwork, Sewing and Needlework, Pottery and Basket Weaving. Unfortunately all of these were poorly attended perhaps partly because it was a late Monday morning and partly due to the age old problem of motivating patients to attend Activities and OT. Gardening was another activity that takes place in the area of ground attached to the ward and in some wards patients and staff were involved in growing some vegetables and thus reducing the cost of food. This is a live issue within the Hospital since Food and Care are free to almost all of the the patients apart from two VIP Wards where the conditions are a little better and patients are expected to pay. Some of the patients also work on the farm which further contributes to the self sufficiency of the Hospital but not enough to prevent it from falling into a significant deficit in relation to ongoing costs. The mention of a Hospital Farm takes me back to my own training in Tipperary where the Hospital Farm supplied vegetables, fruit and meat for the staff/patients and also served as a therapeutic tool for some of the client group. Now a similar situation pertains at Pantang and a small group of patients regularly contribute to the work of the farm.

OT Department showing a garden area outside.

Gardening area outside one of the wards.

Within the Hospital itself significant strides have been made in relation to the Laboratory. Very basic modes of testing have now been replaced with slightly more advanced techniques and this is evident when one compares the old with the new in the supplied Laboratory pictures. 

Picture of the Old Laboratory.

Picture of the Old Laboratory

Picture of the New Laboratory.

Picture of the New Laboratory.

The final building visited was the Physical Out Patients’ Department (OPD).This area offers a very important screening service within the Hospital. Unfortunately because of the high level of stigma surrounding Mental Illness, many patients who present with psychiatric symptoms are invariably referred to a psychiatric hospital like Pantang. Little effort is made to discover if their mental symptoms are secondary to a physical illness such as meningitis or the delirium that may surround a case of pneumonia or cerebral malaria. The Physical OPD screens for such problems and identifies their presence prior to admission to Pantang and refers them on to a General Hospital setting.

The guided tour delivered by Emma made me more aware of the size and scale of the Hospital but unfortunately the many empty and half finished buildings and the dilapidated state of many of the functioning buildings also seemed to be a betrayal of Kwame Nkromah’s original vision - a major psychiatric and neurological centre for all of West Africa. Hopefully someday in one way or another his original vision will be realised. 

The nice lady in the John Lewis store in Edinburgh was definite when I sought advice on head-gear and protection from the sun in Africa. A Panama Hat was best she said, much better than any of the American Baseball caps since it protected your head, the back of your neck and your ears.

“But what about the neo-colonial connotations” I said. She remained silent on this point. Being Irish I thought it best not to pursue the matter.

I’m fair skinned and burn easily. Indeed I’m so sensitive that I can burn on a sunny winter’s day in November so head-gear was an important issue for me. I decided to take her advice, risk some negative responses and purchase the Panama Hat. It cost £37 by the way.

My Panama Hat

Strangely the Panama Hat is a traditional brimmed hat of Ecuadorian origin that is made from the plaited leaves of the toquilla straw plant. It was latterly  popularised by President Theodore Roosevelt in the thirties and was of course worn a lot by British people in Africa. It is considered the prince of straw hats and was glorified during the 19th and early 20th centuries when its reputation was established by figures such as Edward VII and Napoleon III. It became especially popular in tropical climates because of its light colour, light weight and breathability. It is also preferred for travelling purposes because its design allows it to return to its original shape after being folded in a suitcase.

Since arriving in Ghana and wearing my ‘Panama’ on a daily basis, I have had no negative experiences whatsoever. In fact quite the reverse - I’ve had ‘cross the street’ compliments particularly on the decorative banding on the hat. So the neo-colonial fears that I had were unfounded.

Me and My Panama Hat.

Here I am wearing my Panama hat - It’s funny how you notice likeness. My dad always wore a hat and now that I’ve taken to wearing one for Africa I can see some striking resemblance particularly around the eyes and nose.

On Thursday morning 8^th September, Nancy (Aidoo), my guide on the ground in Accra came along to meet me at 9.30am. Winnie (Oware) had given her the task of orientating me to the local area and to the transport system and she proved to be a wonderfully kind and hospitable guide. She decided to map my daily journey by taking me on a trip by Tro Tro to Pantang Hospital. Tro Tros are privately owned and usually 12 seater minibuses which are generally packed to capacity and frequently in a very poor state of repair. Their body-work indicates that they’ve been in many scrapes and bumps and consequently their drivers are totally fearless in nudging into a very tight stream of traffic. Indeed in the very competitive world of Accran traffic, even the guys in the blacked out jeeps are fearful of tangling with Tro Tro drivers.

Winnie (Oware) on the left and Nancy (Aidoo) on the right.

A Typical Tro Tro with the Mate Canvassing for Custom.

The driver is accompanied by a conductor commonly known as the ‘mate’ who hangs out the window and canvasses for passengers as well as taking the fare. Most of the ones that I’ve ever got on were invariably full or almost full and so one has to cope with the movement of the vehicle while making a pathway to a vacant seat. Nancy proved very efficient at dealing with the Mate and paying the fare. Fares were minimal with a one mile ride costing around 30 Pesewas (there are 100 Pesewas in a Cedi – pronounced ‘seedy’ – and a Cedi is roughly equivalent to 50 pence). We also had a laugh about where to stand in order to catch one of these vehicles. There are no visible bus stops but the Tro Tros still have designated places for stopping and one picks these up by instinct and intuition fairly quickly. In any event if you miss a Tro Tro, they are so numerous that several others will come along in rapid succession to pick you up.

 What I really liked about them was the incredible patience and endurance of the passengers and their constant friendliness and good humour. You are thrown into such close quarters with people that one has little option but to make conversation and this is something which Ghanaians enter into with enthusiasm. I remember one episode where I misjudged the height of the door and banged my head because I was wearing my Panama Hat. Almost everybody in the bus who saw the incident winced visibly at my pain and there was great concern for my welfare – I’m not so sure that there would be the same level of concern evident amongst fellow passengers at home.

The Crowded Interior of a Tro Tro.

Our first ride took us to a Tro Tro station near the Adenta Barrier where we disembarked and simply had to lose our inhibitions and enquire from the many drivers sitting in their vehicles which one was next going to Pantang. No such detail is posted anywhere on the vehicle. Nancy was excellent at this and not at all phased by the task. On this trip we were joined by a young mother who was carrying her baby on her back in the Ghanaian style and this lead to another moment of connection with the beautiful little girl and her equally beautiful mother.

A Crowded and Busy Tro Tro Station

 Boarding a Tro Tro – Generally a Very Polite Affair.

When we got to Pantang Nancy took me up the driveway and into the reception area of the hospital. She pointed out the various departments and showed me where to come the next day. The entry area itself has a car-park which is surrounded by stalls and small temporary shops frequently housed in recycled shipping containers.  I didn’t know it at the time but this was an area that I was going to become very familiar with prior to my leaving Pantang. It was here I would get my midday snack of Roasted Plantain and Peanuts combined with a much needed cooled bottle of Coke or Sprite.

Small Village of Stalls at the Entrance of Pantang Mental Hospital 1

Small Village of Stalls at the Entrance of Pantang Mental Hospital 2

When making our return to the Guest House, we decided to take a Taxi and again Nancy showed me the ropes around this task. It’s important to negotiate prior to getting into the Taxi particularly if you’re an Obroni –a white man – since prices are sometimes increased for white people as they’re seen to have money.  In general however I found Accran Taxi men (and they are all men) to be very fair, reasonable and friendly – their driving is another matter entirely and one which is deserving of a  separate Blog entry. Short trips will generally cost 4-5 Cedis and such a trip got us safely back to the Guest House where we started our journey earlier in the day. However now, with the help of Nancy, I was much more fully equipped to tackle the many and complex aspects of Accran life and more specifically the demands of the Accran transport system.

Following my arrival in Adenta, Accra, one of my first tasks was to visit Pantang Mental Hospital, the location of my first month’s placement in Ghana. Taking my lead from Nancy’s guidance the previous day, I successfully stopped and negotiated a reasonable fare with one of the many passing taximen. Our journey took us even further (2 or 3 miles) out of the city on what appeared to be a country road and away from the centre of Accra. In making the journey I was reminded of how many of our own Mental Hospitals had been built in reasonably remote places away from the centre of public and commercial life. As in Scotland and Ireland these institutions have now been swallowed up by the growing urbanisation of the towns and cities that they serve and of course the situation is no different in Accra.

The hospital itself was opened in the 1970’s as the third psychiatric hospital in Ghana and was originally conceived of as a major medical centre for psychiatry, neurology and neurosurgery serving all of West Africa. However the demise of Ghana’s first great president, Dr Kwame Nkrumah in 1966, lead to the plans for the medical centre being scaled down. Today the hospital’s size remains impressive with a central three storey Administration Building surrounded by a large collection of 1970’s type buildings serving as wards and scattered around an extensive rural setting. There are also accommodation blocks and a range of bungalows for staff to reside in. 

Administration Block - Pantang Mental Hospital.

When I arrived I was warmly greeted with an ‘akwaaba’(welcome) from Gloria at Reception. She took me upstairs where I waited for my appointment with Matron, a Ghanaian lady called Margaret Patterson. Matron was a very pleasant and caring woman who made me welcome and spoke about the circumstances that had brought me to Ghana. Her uniform was interesting in that she wore a gleaming white dress with a belt and heavy buckle that reminded me of time spent during the mid-eighties doing agency nursing at the Royal Masonic Hospital in London. Here again the uniform tended to be fairly formal and traditional as well as serving as a reminder of the early links between nursing and the military. 

Signage outside the Hospital.

Matron then went on to give me an overview of the hospital and of the various services provided. Nurses form the major cohort of staff but there are also some basic psychological and social work services available. Psychiatrists are very thin on the ground and this role is frequently filled by a category of personnel called Medical Assistants in Psychiatry or MAPs for short. She explained how resources at the hospital were an on-going issue and although there were two VIP Wards where patients paid, the fact that care and food was free to all of the other inpatients made the financial running of the hospital a challenging task. Interestingly she mentioned that one source of income was the presence of a Mortuary in the hospital grounds. Ghanaian people apparently, tend to spend a lot of money on the funeral of a loved one and so many store the body in the Mortuary until they have sufficient funds to pay for the funeral. This in turn helps to generate a much needed income for the hospital.

Further Signage at the Hospital.

We then went onto speak about the schedule of work which Matron hoped I might be able to offer to all of the nursing staff at the hospital. She was particularly keen for input on Suicide Prevention and Management together with material on Risk Assessment and Management. Her idea was that content on both of these topics might be rolled out amongst all of the nursing staff at the hospital during my time at Pantang. I readily agreed to these arrangements and suggested that supplementary content might also be given on contemporary developments in Mental Health Nursing in Scotland such as the ‘Recovery Model’ and ‘Person Centred Care’. I also informed her that I was happy to share with key personnel at the hospital many of the electronic resources I was carrying on all of the common Mental Health Disorders and their treatment. Another area we explored was conducting a review of the present set of Nursing Protocols at the hospital and facilitating their enhancement and development.

Consequently I was coming away from our meeting with a substantial body of work but content in the knowledge that if I could deliver on our arrangements, then I really would have made a substantial contribution to the Nursing Staff at the hospital. Prior to leaving Matron introduced me to Emma Baxey. Emma is a Senior Staff Nurse who is presently completing a Distance Learning Degree in Clinical Psychology and has been working in the Education / Induction Centre at the hospital over the past few years. Emma agreed to meet with me on Monday to allow a fuller orientation to Pantang and a complete tour of all the wards and departments within the hospital.

Staff Accommodation Block within the Grounds of the Hospital.

(Photo courtesy of Greg Neate)

Wednesday 7th September, 2011. My departure day has come…..I rose at 6.30am. I had packed my luggage the day before carefully selecting what to take and what to leave behind – a difficult task when one is travelling for eight weeks. I had one eye on the weather in Ghana and the other on my needs for the project in hand. I wanted to bring some books and resources to pass on to the nursing staff in Ghana and also decided to opt for lots of T-Shirts/Short Sleeved Shirts and light trousers all made from cotton. Mind you David McKeegan at the Travel Clinic in Edinburgh had advised long sleeved shirts, full length trousers and no sandals to minimise the risk of Mosquito bites or indeed bites from any other insects or snakes. I took on board most of his advice but passed on long sleeved shirts. My opinion was that going very casual in Africa was the best option for a fair-skinned Irishman like me.

I was also conscious in terms of my packing that Fr Joseph, my travelling companion, had asked to share some of my luggage in order to bring a set of football strips he had been given back to his parish in Yendi. In some ways this request was beneficial because it forced me to be ruthless in deciding what to pack and what to discard – something I always struggle with. A friend from Broxburn, Raymond McDonnell, kindly took me and my luggage to the airport where I met up with Fr Joseph and set about checking in.

 At this point I had my first blip when I discovered that the £500 in sterling I was carrying to help pay my accommodation in Accra was all in Scottish notes. Joseph immediately advised me that these notes would not be acceptable in Ghana and that Bank of England notes were required. I immediately tried several of the foreign exchanges but without success and it was only in duty-free that we found a kind lady who was happy to swap notes for most of my amount. Joseph then used his charm in one of the departure retail outlets to swap the remaining Scottish notes for the equivalent amount in English. This is the sort of story that has a ring of ‘strange but true’ to it – I shall know better next time.

Scottish and English Sterling Notes.

Our flight from Edinburgh to Heathrow and later onwards to Accra was largely uneventful although transfer in London was a little fraught due to a lengthy delay in the skies over London. When I arrived in the Departure Lounge in Heathrow I was immediately conscious of being one of the few white people in a very large group of black people. It struck me that this would be my situation for the next several weeks. It was a strange feeling and made me think of what it must be like for travellers of non-white ethnicity when they come to our almost all white setting in Ireland or in Scotland. This experience of course is sometimes made worse when they suffer racial prejudice and abuse, something which I’ve never experienced in my time in Ghana – in fact quite the reverse…..I’ve been greeted with warmth and hospitality.

The flight from Heathrow to Accra takes around seven hours and was very enjoyable and pleasant throughout. When we arrived and stepped off the plane I was immediately hit with that wall of heat and humidity which just about takes your breath away. The usual comparison is that ‘it’s like a hairdryer blowing in your face’ and so it is – even worse than that!  After disembarking I had a lengthy wait in Arrivals where my passport and Visa were checked. However I must say it was all very pleasant and there was none of the nastiness and intimidation that I’ve experienced at other airports.

The arrivals area in Accra Airport. The ubiquitous ‘Akwaaba’ means ‘Welcome’.

When we got outside Joseph was met by his two sisters who live in Accra and I was met by Winnie Oware, Challenges Worldwide liaison person on the ground in Accra. Joseph and myself said our goodbyes but arranged to meet again before he left Accra for Yendi in the north. Winnie and I headed for my first experience of an Accran Taxi! These are mostly old and battered motor cars many of them recycled from Japan but with particular markings – two orange wings back and front -  that identify them as Taxis. Some of the road-surfaces are truly horrendous with potholes one could bury a dog in and frequently tarmacadam turning into dirt road and then back again without any warning.

An example of an Accran Taxi - one of the better ones.

Anyway our Taxi man got us safely to our destination at the Lodge Guest House in Adenta, Accra. This would be my accommodation for the next month. When we arrived Winnie introduced me to Johnson, the owner of the Guest House and a very pleasant man who was eager to see that I was happy with the arrangements. She also introduced me to Nancy Aidoo, who was going to help orientate me to Accra, Adenta and to travelling to Pantang Mental Hospital itself. Everybody was enormously reassuring and tried to make me welcome in my new environment. I had finally arrived in Accra, the capitol of Ghana at the heart of West Africa!

 The position of Accra and Ghana in West Africa.

Dr Kwame Nkrumah - 21st September, 2011.

Today is the anniversary of the birthday of Dr Kwame Nkrumah (1909 – 1972) who was an inspirational and influential 20th century advocate of Pan-Africanism, and the leader of Ghana and its predecessor state, the Gold Coast, from 1952 to 1966. I just wanted to mark this special day for Ghana with a couple of quotations from the great man himself…….

“The best way of learning to be an independent sovereign state is to be an independent sovereign state.”

“Africa is a paradox which illustrates and highlights neo-colonialism. Her earth is rich, yet the products that come from above and below the soil continue to enrich, not Africans predominantly, but groups and individuals who operate to Africa’s impoverishment.”

“Freedom is not something that one people can bestow on another as a gift. They claim it as their own and none can keep it from them.”

The photograph shows Dr. Nkrumah making the cover of Time Magazine.