On arrival at Accra airport, we are met by Naa Agyeman-Dua of World Vision and then driven to the Erata Hotel in the city.
Simon has changed the VAO funds into the local currency, cedis. 184,000 to 1 pound sterling. At the hotel we each take charge of a large wad of bank notes. There is brief get together in the outdoor bar. I know Simon from a previous VAO project in Malawi but have not previously met the other three women. They are all on a first time project. Kolette comes from Ireland, Noreen lives in Dorset and Claire, the youngest member, lives in Cardiff.
We are tired from travelling and must make an early start tomorrow.

Sunday:
Breakfast is a slow affair and there is hip-hop on the sound system. We are anxious to be on our way. First we go to the offices of World Vision, where the boxes of spectacles are waiting. These have been donated by people in the UK, cleaned and sorted by VAO trained prisoners in English prisons. They are packed in large boxes of eight smaller boxes which each contain around 40 pairs of spectacles.
I am however dismayed to find that only half of my order has arrived. World Vision staff have also brought out several boxes of spectacles left over from previous Ghana projects. The problem is that we are not sure exactly what is in these boxes and assume that they will be the less desirable styles of frames. There’s no alternative, we cannot risk not having enough of the right powers and so several of the older boxes are loaded onto our vehicles along with my new supply. We have 2 large air- conditioned 4 wheel drive Toyotas at our disposal. The delay and sorting out the boxes has already left us hot and damp. Naa gathers us all together to prayer for safe passage and then we are on our way.

The roads out of Accra are congested but once out of the city they are not at all busy. We make a couple of stops to buy fruit and vegetables from stalls on the roadside. At one point we are delayed over half an hour by road works and the traders, mainly women and children parade past balancing large trays of produce on their heads. Popular with other car passengers seems to be, giant snails wrapped in banana leaves.
At last we stop for lunch at the Royal Basin Hotel in Kumasi.. Getting out of the car is like walking into an oven. They serve us a lovely fish curry along with chicken, rice, chips and vegetables. The swimming pool looks inviting but there is no time to linger.

We pass through many towns and villages. The landscape is green, sometimes hilly or mountainous with lots of forests. The earth is red. On the plane flying over I had watched ‘Blood Diamond’ and Leo Di Caprio’s character says the earth in Africa is red because of all the blood spilt over it. Everything seems peaceful here.
The next stop, several long hours later, is the Marian hotel in Tamale. Dinner here, fish in sauce for me, chicken for the others. We really don’t want to get back into the cars again but an early clinic is scheduled for tomorrow.
Finally after 13 hours we arrive in Walewale and the Magrabi guest House. It seems that there are less rooms available than expected. We are shown some rooms in the main house and another several hundred yards away. There is some confusion initially in understanding what’s on offer but eventually we settle for four rooms in the main house. Noreen and Kolette are sharing one very large bed in a room with air con. Claire and I each have a room without aircon and Simon has a smaller room without air con and without an adjoining bathroom. We are to discover later that the showers and toilets rarely function due to electricity / pump failures. Water is supplied in buckets. Likewise air con and overhead fans don’t work, however the first night we are oblivious to this and exhausted from our travelling.

Monday:
Breakfast at 7pm because today our clinic is being held very close by in the Walewale Community hall / church. The optoms set up in two, only half built adjacent rooms and I am in the main hall with my boxes. I unpack and remember to stack the boxes out on top of the larger crates in order to avoid backache problems from having to bend over too far to search for powers and sizes. Today before we can really get going there is a welcoming ceremony for us. Various dignitaries have been invited and Simon introduces the team to the crowd of over 100 people already gathered in the hall. The finale is a music and dance demonstration where a group of around 20 musicians and dancers of all ages gyrate around the room, many with bells on their ankles. The main singer sounds just like Ali Farka Toure –great. Old ladies in the crowd join in and the group seem reluctant to leave as I am, to see them go



Tuesday:
A second day in the hall in Walewale. Over the two days here, the optoms test about 350 people. I dispense over 300 pairs of spectacles. The people are from many different walks of life, most speak English and many of them are concerned that they should have fashionable frames. I do my best for them and most people are delighted. There are large speakers in the room and the atmosphere is lively and noisy. The music is rousing gospel and keeps me moving (sometimes dancing around my boxes). One of our helpers is a young man called Emanuel; I admire his black and red printed t- shirt and thinking that Youssef & Haroon might also like it, ask him to get two of them for me from the shop. Later he comes back saying that they no longer have that style in stock but he can take me to the boutique in down town Walewale, to choose from others. Unfortunately there isn’t time to go shopping with Emanuel because the clinic goes on till late. Travelling back to the guesthouse, I wonder which of the roadside tin shacks is ‘the boutique’.
In the evening we have dinner cooked by two women from World Vision, Blandina and Vero. They know that I don’t eat meat and make sure there is an alternative for me. Red red is a bean and tomato mixture with pilchards; stir-fried vegetables rice or chips. A popular meat in Ghana, guinea fowl is also served.
After dinner we collect all the prescription slips together and record the statistics of the sight tests: prescriptions; diseases; cataracts; infections etc. Those patients who are able to are asked to make a small donation towards their glasses. Usually equivalent to the cost of a can of drink. This gives value to the item but nobody is turned away through lack of funds. There is a mountain of cedis to count. Even at 11pm it’s still very hot and humid. We prefer to sit outside, as there is no fan or air con in the house. We surround ourselves with burning mosquito coils, are covered up and any exposed skin, soaked in deet. Even keeping a light on is difficult because it attracts the insects to us. Particularly unsavoury are the giant flying cockroaches.
The torch I bought, new for the trip has proven to be faulty. I’m lucky that Simon has leant me his spare. Must remember on any future project to pack a spare torch. Here without a light it is completely black.



Wednesday:
Today the power comes back on at 6am but I am already awake because some of the staff are having an argument outside my bedroom window. Suddenly the mosquito plug is lit up and the overhead fan begins to push its way through the heavy humid air.
Breakfast is porridge and a boiled egg. No bread, we miss the sweet doughy slices usually served.
The car collects us later than arranged, something to do with transporting other people. We have quite an entourage now. Working along side the team are Mr Moses a local ophthalmic nurse and his two assistant nurses (who we later come to refer to as his ‘heavies’). Mr Moses makes lists of the patients being referred for cataract surgery or glaucoma treatment. He also administers antibiotic drops to patients with infections and itchy eyes. He seems to be well known in the area. The nurses screen the patients arriving and record their uncorrected visual acuities prior to them going for sight tests with the optoms.
The others in our party are Naa and Fati and our drivers all from World Vision. Fati is project manager for this Northern area of Ghana. She is a lovely friendly young woman who always sounds cheerful and positive.
Today we are going further a field to Kpasenkpe. The journey takes about one hour and we are travelling along a ribbon of red dirt road, flanked by lush green vegetation, scattered with dun coloured mud huts. Many of the huts are arranged in a circular pattern with a central courtyard area.
The villagers are waiting for us when we arrive at the village clinic. The rooms are small and hot. All four optoms decide to test in one slightly larger room and I set up my boxes on the opposite side of the waiting area. The open brickwork offers some relief in the form of through air. Most of the people here do not speak English and the teachers from the local school come to work as translators for us. The patients are mainly farmers and traders. There is a side entrance to the building near my dispensing area. A small boy walks in carrying a long stick, horizontally. At the other end of the stick also holding on, shuffles an old man. He is unable to see and I hope that we will be able to help him.
The men are trying to start up a generator to provide electricity but after about an hour of crouching round it and trailing wires around the building, they load it into a truck and drive away with it. We work hard all morning without fans and see lots of patients. Many of the men wear a wonderful smock type coat, either wool, heavy cotton, stripped or patterned materials. Somehow the threadbare condition of some of these garments seems to add to their charm.

At lunchtime Blandina brings out our lunch from the guesthouse and we sit in the shade of the local nurse’s house. It is all very quiet and peaceful. Soon however Naa appears and is anxious to get us back to work. More people are arriving at the clinic and we only have today scheduled in this village. First though we need lavatory facilities. Simon disappears into the bushes but us women are driven off to the pastor’s house. We are given seats in a large courtyard while the toilet is cleaned before our use. We are then presented with tissues and a bucket of water to wash before all being driven back to the clinic.
We work until darkness falls but have managed to see all of the people waiting.
Back to Walewale and Brother Phillip’s lively gospel cassette plays in the car. Someone has brought it along from the church hall.
Dinner is meat soup, greens with eggs, yams and hot chilli sauce. Just as we sit down to eat the power cuts off.



Thursday:
During the night there was a storm. And now the air feels slightly lighter.
Our clinic is in Janga in the village Church. The room is swept out and I use the drum set to block of the side entrance. It’s important to keep the flow of patients moving in the same direction. Today we have electricity and fans. There are wires all over the floor so I do a risk assessment and tape them down with the duck tape. This tape always has so many uses on these projects. We explore the toilet facilities, across the field, two areas screened off by a mud walls. Very simple, two bricks to stand on and that’s it.
The clinic progresses well, as with the previous two days, we will test over 200 people today and supply about 150 pairs of specs. In these very rural areas there are more eye injuries and sometimes it is just too late to help because the cornea has ulcerated and the sight already lost.
The chief of the village wants to have his eyes tested but we are told that tradition prevents him from coming to the building because it is in view of the previous chief’s house. Simon and I go with Naa and Fati to his palace. This turns out to be a mud hut complex and the chief is seated on a chair in a small hut otherwise bare of furniture.
There is however an interesting mask hanging in the centre and something else
that looks like a long haired scalp hanging on the wall. Chief Saaka Sumani has 17 wives. Everyone bows to him and shows him great respect. He is chief of 25 different communities in this area.


Back at the church I pack away the boxes of spectacles, while the others take down the black plastic coverings that they use to black out the windows and hence provide the low light levels needed for the retinoscopy and opthalmoscopy.

The Magrabe guesthouse fridge has been taken over by our supply of bottled water and local beer.
Tomorrow is the end of the week, we are going to be back at Walewale for a final clinic there and then we have some free time. Having consulted the guidebook we have decided to try to get to the Mole National park. Our hosts don’t seem so keen on the idea, it’s a long drive southwest, to Mole and on Monday we have to be in the ‘Overseas Area’, further north. This name is intriguing.



Friday:
Claire has not been feeling well for a couple of days but has continued to work.
Noreen has also now come down with the same gastric problems. Drivers need to be on hand at all times to transport them if necessary, quickly back to the guest house. It is suggested that they take some time off and rest but both decline and insist that they want to travel for a weekend break.
It’s been agreed and the rooms have been booked at the Mole Motel on the edge of the National Park. In Walewale church hall we work through without a lunch break. 200 tests and about the same number of dispensings, however we are able to finish a little earlier and everybody who comes along is seen. A last meal at the guesthouse, and our equipment and spectacles, stored safely away in a nearby office, we set off as dusk falls. The route is back to Tamale and then a turning towards the west. From here onwards it’s a bumpy, bumpy road and by now complete darkness has taken over.
The car radio is tuned to Rasta Radio. Tamale was very busy, driving conditions difficult as other cars veer around the roads without any kind of recognisable signalling and the pedestrian population vie for possession of the streets. One man we pass is relocating his shop, pulling it along on a tiny two-wheel trailer.
We reach the Motel about 11pm. Only the night watchman is on duty. He is not very helpful. It seems that none air conditioned rooms have been booked and not enough of them.
Simon is feeling unwell as a result of the long bumpy road and has disappeared to be on his own to recover. He was the least keen to come here, saying that because the park was so little advertised and difficult to reach, there would probably be not much to see. His idea for the weekend had been to go to a nice hotel in the nearest town or perhaps cross over the border into Burkina Faso and get another stamp in his passport. (Along with his train spotting activities Simon does have some slightly anorak inclinations). After some unfruitful negotiation a manager is called and we are shown the rooms available. Simple but very acceptable. We are all sharing twin rooms, Naa and Fati, the two drivers, Kollettte and Noreen and Claire and myself. In his absence, we allocate Simon the larger superior room all to himself, just to compensate for the hot little ‘storeroom’ he has been in all week at the Magrabi.
We erect our mosey nets, using hooks and string. I spent most of last week sleeping with mine like a kind of shroud but seem to have made a better job of it now. For some inexplicable reason we are not supposed to use the aircon tonight but I am quite happy with the large overhead fan. We go to visit Simon, on route Claire and I are attacked by a large swarm of giant moths and there is much screeching and squealing. Simon has now recovered and has already turned his room into a large fridge. Great for storing the beer.


Saturday:
No need to get up early but I’m awake at 7am and disturb Clair when I inadvertently sit on the edge of my mosey net and detach it from the wall. I try to console her by making peppermint tea in my travel kettle. Outside we have a small porch, I go out and admire the view, miles and miles of green savanna stretches ahead. Suddenly I am jerked back by the sound of Claire’s voice coming from the bathroom “Susan, Susan there is an elephant outside the window!” Sure enough when we step out of the rear door of the room there are two elephants feeding on bushes, only about 50 yards away. Much excitement as people come out of their rooms to take photos.
Simon had said that the only elephants that we were likely to see here would be polystyrene ones carefully placed by the wardens.”Huh this will show him,” says Claire posing for a photo in front of an elephant.
We spend a lovely weekend at Mole. There is a viewing platform from which you can look down on a large watering hole and across the savanna. The park covers 4,840 square km and was established in 1958 (a year after Ghana’s independence).
Some villagers were removed forcibly from the area and there is still some ill feeling around how that was done. The area to this day is tsetse fly infested which means it was never a popular area for human habitation.
On Saturday afternoon, we go on a safari drive, taking along one of the park wardens. We enjoy it very much and are happy to finish our trip at the nearby park workers village, which elephants have also decided to visit at this time.






Sunday:
The Mole Park has several hundred elephants and buffalo There are significant populations of hippo, warthog and several antelope species. Waterbuck, bushbuck, roan, hartebeast, duiker. Baboon and several species of monkey, mongoose, and the odd sighting of leopard and lion. All of this along with 300 bird species.
As our guidebook states, the service at the Mole Motel is not always up to standard and the accommodation only satisfactory. The park is certainly not easily accessible. We think that there is a great opportunity here for any entrepreneur with the money and the energy needed to show the way and develop this into a world-renowned safari holiday accommodation.
On the other hand we are enjoying the low-key atmosphere and good value for money.
We are up in time for a two-hour walking safari starting at 6.30am. Around 7.15am we are seated in a hide overlooking a large lake from which crocodile periodically rise to the surface to satisfy our binoculared eyes.
Back at the motel we sit near the pool for breakfast. We have already learnt to be wary of the monkeys who do not hesitate to leap on your table and help themselves to whatever they fancy. Half of our pineapple is soon carried off by a rather aggressive chap. Kollette is going to the nearby church with Naa and Fatima and the rest of us move over to Simon’s room to catch up on recording statistics from the end of last week.
Simon has enjoyed his time here at Mole but has passed on the Safari trips. He has been enjoying his air con and has a bath permanently filled with cool water. I guess he is emulating the behaviour of the animals visible from his balcony. When it’s really hot, they wade into the lake to enjoy the cool water.

.

We are on the road by midday. We have along journey ahead of us. We stop at Larabanga to look at the mud and brick mosque, said to date from somewhere between 1420 and 1650 (exact date disputed). We are surrounded by a large group of young boys and children as we get out of the cars. They are all very chatty and a sweet little girl is holding tightly onto my hand. Some discussion is taking place on the other side of the crowd with Naa, others of our group and some of the older boys. Then, we are all getting back into the cars and driving off. Naa says they were asking for too much money to show us the mosque and she concluded that we should not pay so much because it’s not our history anyway. Hmmmm. I am disappointed.
By the time we reach Walewale to collect our equipment and specs, its already dark.
While the drivers and World Vision people load it all onto the vehicles, the team retire to sit outside the local hostelry. A man comes over to our table and introduces himself as a chief from the area to which we are travelling. He has heard very good reports of the service we are giving but regrets that he has to stay in Walewale because he has been summoned to a chiefs’ gathering. Unusually he has previously had his eyes tested and has a prescription. He hopes to give it to Fati and for us to leave some reading glasses for him. We suggest that he may get back to the area before we leave at the end of the week but we will arrange some glasses for him anyway. After a while and several repetitions of the same story, it seems unlikely that the planned chief’s meeting will be a brief affair (that is if your man is anything to go by). He still keeps repeating the story; there must be some accepted way to end a conversation that we are not aware of. Everything we say seems to set him off again. Then Clair explains that we are all leaving very soon, including Fati. This works and he rushes off immediately to get his prescription from his lodging house in order to give it to Fati.

Sunday Night.
The journey from Walewale to Yagaba is once again a very bumpy ride. It takes three long hours and it is almost midnight when we arrived. We are staying at a World Vision training centre. This new centre is not yet completed but there are several small blocks of accommodation and service rooms positioned around a large grassy area. It seems very isolated. There is no running water but there is solar energy for lighting.
We are using a block of four rooms, each with en-suite (none flushing wc and space to wash from a bucket). At the far end of each room there is a small kitchen, which has not yet been fitted out. The door to mine is locked but on exploring the room off Claire’s bedroom we find it is full of rubbish. Something rustles in a box and we quickly shut the door. Kolette and Noreen have agreed to share again. Kolette has a phobia of spiders and Noreen can ‘deal’ with spiders. Each room has two single beds, the only saving grace is that each bed has a length of wood standing upright from each corner over which is hung a large mosey net. At least I will be able to sit up in bed but I feel despondent, it all seems very uninviting, its hot and humid and I’m very tired. Lying on the bed, sweating profusely, I long for cool air or a fan.
I am awoken by Kolette knocking loudly on my window, “Can I sleep in your room?’
“Of course, What’s the matter?” I jump out of bed to open the door.
“There’s a rodent in our room and Noreen has taken fright and gone to sleep in Simon’s room”. We clear away my clothes from the spare bed so that she can use it. We’re just settled when the storm starts. Thunder crashing all around us, lightening and torrential rain pouring through the window onto Kolette. I am aware of her closing the window slats as best she can and pulling the curtains across and then I’m asleep. I always sleep well in storms.


Monday:
Not surprisingly Kolette is feeling ill and exhausted. Noreen and Simon have spent much of the night watching the storm rage away and Claire had also been disturbed by something scuttling about in her room. We ask our hosts to have the rubbish cleared from the kitchens adjoining our rooms, in the hope that this will flush out the culprits. That evening we are to be told that no rodents were found although I have since found droppings in the cupboard drawers in my room. It is also suggested that we should place a bucket of water over the drainage in the bathroom as well as on top of the closed toilet seat Simon is offering to turn his room into a dormitory but this hardly seems necessary. Anyway I’m actually feeling much better and have discovered a large mat rolled up in my room. It’s the kind of mat that the local people use either for sitting on or sleeping. It makes a very good Yoga mat and for the first time since arriving in Ghana, I am able to do a proper morning practice. I have also discovered lots of holes in the mosquito net and have used up most of my supply of plasters, patching them up.

Vero and Blandina who travelled here ahead of us serve breakfast. Vero has her baby Katsia with her and the entire staff share looking after her. Simon is having a blitz on hygiene and has insisted that all our fruit and vegetables are rinsed in water with iodine drops added. He wipes all our cutlery and dishes with antiseptic wipes and we are all dispensed antiseptic gel on our hands before eating. All of this is to prevent any further gastric problems, which so far I seem to have escaped the worst of it.


The clinic today is at Loagri only a mile or so away. The people seem very poor and again the local teachers are translating. A large group of children hang around the clinic all day. There is no electricity in the clinic building and the nurse has left the area, leaving nobody to provide any kind of medical care for the local people. I think they may have difficulty attracting a replacement. The three small rooms that we are working in are dark and gloomy.
A farmer arrives with a splinter of wood in his eye. This accident happened two days ago. He is laid down on a bench and the splinter is removed. Antibiotics are administered, the eye is patched and he goes on his way. If the team were not here this would have gone untreated and no doubt he would have lost the sight in that eye.
This is not the only time that we are able to make a real difference to the outcome of an accident. The farmers and the children are very susceptible to eye injuries and over the two weeks, we also see lots of people for whom it is too late for treatment and the sight has already been lost.
There is a young man sitting on the floor outside my dispensing room. He smells strongly of urine and moves his hands to his eyes to indicate that he wants glasses.
I ask one of the ophthalmic nurses to screen him for a sight test but he says the young man is “not with us” (has a mental disability) and could not respond to the sight test. Never the less, I try to get him to stand in the queue but to no avail. I find a pair of sunspecs and put them on him. He is grinning from ear to ear as he wanders off with his new specs, case and cleaning cloth. The onlookers seem happy for him too.
Later on I go off in search of toilet facilities. I’m directed to the pastor’s house and a small hut in the compound. Toilet paper is ceremoniously taken into the hut before I’m allowed to enter. Once inside, I’m confronted by a strange a sarcophagus shaped object, I’m not sure whether to stand on it, sit on it or straddle it.
Driving back to the WV camp, we pass water logged fields and along the dirt road, a man on a bicycle. We have tested and supplied spectacles to this man today. He had missed us at the Walewale clinic but had ridden all day, arriving at Loagri about 4pm, now he must ride back to Walewale.
After dinner, the bullfrogs are out in force. We sit outside our rooms, trying to record statistics by torchlight because it’s too hot in the rooms. The bullfrog symphony is deafeningly loud making even conversation difficult. The rest of the evening is spent gazing up at the wonderful canopy of encrusting the black velvet sky. I sleep well.


We are in West Mamprusi District “ Overseas Area”. It is named Overseas because you have to cross two rivers to get there. West Mamprusi is one of eighteen districts in Northern Ghana.
It is one of the least developed areas and it’s capital is Walewale. The total area of the district is 5,013 square Kilometres and the population is around 120,000.
The Mamprusi are the dominant ethnic group and they co-exist peacefully with other minor ethnic groups such as Kasenas, Grunshies, Bimobas, Fulanis, Moshies, Kantosi, Sisaalas, Koma and Ewes. The Ewes are mainly fishermen settled along the White Volta and the Fulanis are migrant herdsmen.
The people are predominantly Muslims, about 76% of the population. Christians, 15%
and 5% traditionalists.
Water supply from village pumps is only available to about 50% of the population and only the capital and a few communities are connected to the national electricity grid.
None of the communities in the Overseas area have access to electricity.
The district has one hospital and eight health clinics. Most communities have no easy access to health facilities.
Many communities do not have a school and more than half the children of school age are not able to attend school. The total teaching staff is around 550 and of these less than half are trained.
The infrastructure of the whole district is inadequate but in the Overseas area it is virtually non-existent. The flat land and unabridged streams make the area prone to flooding.



Tuesday:
Fati is driving us to Kubore today. On the road we encounter goats, sheep and the beautiful African cattle. Pale coloured cows with humps on their backs and smooth almost luminous hides. (Think I may have read too many of the ‘Number 1 Lady Detective’ books). Along the way she tells us the story of the sheep, the goat and the dog.
“A sheep, a goat and a dog all travel on a bus. The goat pays the right fare, the dog pays too much and the sheep doesn’t pay. This is why on the road the goat doesn’t move for the traffic because it wants to get on a bus. The sheep runs away because it feels guilty that it did not pay and the dogs chases after vehicles because it wants its change”.
Today I am not feeling well and as soon as we arrive at Kubore I need to find a lavatory. The local nurse takes us to a compound where there is a small room with a tiny drainage hole and a bucket of water. On request of alternative facilities, I am shown to a little hut further away. Here there is a deep pit (long drop) over which to squat. It is very smelly and there is a swarm of mosquitoes hovering above. Needs must but unfortunately I have not used the Deet on every part of my body and for this I am to suffer later.
The walls in the clinic are dirty and cracked. Off one of the rooms in which the optoms work there is a broken wc and no dividing door. There is a lot of clutter and undisposed of sharps. Yesterday my dispensing room was very dark and I am insisting on using the lighter, clearer room. Simon recognises some desporation in my voice and lets me have my way. The whole building is very hot and so there is a concerted attempt to get a generator working to operate our fans. It takes half the morning to get it functioning and then just before lunch one of the fans breaks down.



News of our domiciliary service seems to have spread. This afternoon, we have had a request from another chief to visit him at home.
The chiefs are held in very high regard and it is not for us to question this or try to introduce equal opportunity procedures. So we set off to visit Chief Sumani Tampuri. This man is well educated and once had an important job, however on measuring his existing distance glasses we find that they have plano (no power lenses) in them. We don’t tell him this but when Simon tests his eyes he is found to need +1.50 in each eye. His reading prescription is +3.75. He is measured for his glasses, his son is also checked and a grandson with a red eye is prescribed for.
Later we will send 2 pairs of spectacles for the chief. Everyone claps the chief and he is happy. So happy in fact that he gives us a sheep as a thank you gift.


Back at the clinic a man has arrived having had a snake spit in his eye. We have heard reports of this happening to many of the patients. He is very worried because he only has vision in that eye, the other eye being already blind. Noreen is assisting Moses with an examination. They wash out the eye check the cornea for injury, of which there is none. After administering antibiotics and reassuring the man, he goes away greatly relieved.

After dinner, back at the camp we spend a relaxed evening listening to Claire’s ipod collection and drinking Kolette’s port. The sheep is safely grazing in the field.
Many of the people we see have cataracts. Severe cataract (cloudy lens in the eye) will cause blindness but a simple operation where the lens is replaced with an artificial one will solve the problem. People here in Ghana seem to develop cataracts earlier in life than people in the west. This may be partly genetic but is also related to high UV radiation from sunlight. This means that good UV protection from sunglasses can be invaluable in helping to prevent cataracts.
Many people who have had cataract operations in the past did not have artificial lenses implanted and so they need very high plus powered spectacles in order to see clearly.
Often these spectacles were not available to them and so they may be no better off. Vision Aid projects always bring a plentiful supply of high plus powered spectacles with them.
These days most operations carried out, include implant lenses although sometimes the standards of competency are not as in the UK and spectacles are still needed.
The optoms are referring those patients who need cataract operations to Mr Moses who will try to arrange for them to be seen by the ophthalmic surgeon based at the Tamale Hospital. Because people are ill educated, they do not understand that their blindness is treatable with a simple operation. In fact sometimes we find in areas like this they do not understand the function of spectacles in correcting sight problems.
They are sometimes under the impression that ‘eye drops’ will cure their long or short sightedness.

The team also see signs of onchocerciasis (oncho or river blindness in the eyes of some patients. This is caused by a parasitic worm that breeds under the skin and travels through the body, eventually reaching the eyes where it causes complete blindness. The worms also cause very severe itching as they breed under the skin. The parasitic worm is carried by a small black fly that breeds in rivers. These days the flies are no longer born with the parasite but people still carry the disease and if bitten by the fly it is passed on to others. Treatment is a tablet, Mectizan which stops the worm breeding and this can be given to all of the population as a prophylactic however once inside the body the worms can live for up to 11 years. Gradually this horrible disease is being eradicated but many people still suffer the consequences of it.
Another common complaint from a large proportion of the people that we see, is, sore itchy eyes. Often there is no obvious cause for this other than the climate and dusty and smoky (wood burning fires used for cooking) atmospheres. We advise people to
Wash their eyes with clean /boiled water with perhaps a little salt dissolved in it. To use clean cloths and to wipe the eyes with these water soaked pads every day.
The advice is given so frequently that the translators start to repeat the instructions to people even without us initiating it.

There is such a lack of education here where generations have had neither any formal education nor hardly any contact with the outside world via television or even radio,
The people see their family members and neighbours loosing their sight either suddenly or gradually. They do not comprehend the different causes of either eye discomfort or lack of visual acuity. As a result they are scared and may resort to consulting local witch doctors who can often cause more damage with their actions.


Wednesday:
We do not have running water in our rooms and have to carry our water in buckets, from a large water tank a few yards away. This is possible because local women bring water to our tank from their village pump. They come in crocodile formation in the morning carrying large buckets on their heads. Most of them are chewing on miswak sticks. This is the root of the Peelu tree and has been found to have a positive effect on the suppression of tooth decay and gum disease. The water in poured into the tank for the camps use. They return to their village with our empty drinking water bottles which they use to store palm oil and other fluids.
This morning Naa has heated some bowls of water and carried them one by one over to our rooms. A very kind gesture and it is so nice to be able to wash myself and my hair in warm water.

Today we are scheduled to visit Yizesi. It is further away and there is no proper roadway leading to it. The dirt road has already been flooded and we are warned that even if we manage to get through to the village, were it to rain while we are there, it could mean us being stranded for weeks! However we are told, the people there have not had any previous eye care and they are expecting us. We agree to go but feel decidedly nervous at the prospect of being marooned in a village with only mud hut accommodation and very little communication with the outside world.
Our driver today is KoJo. His expert driving skills are truly put to the test on this rough potholed and waterlogged track. When we arrive at Yizesi, I am struck by the picturesque beauty of the area. The huts arranged in small groups and the surrounding areas, lovely soft green grass and beyond that small fields of vegetables and fruit trees. There are clumps of white flowers growing throughout the village and winding pathways crisscross from one compound to another. Livestock graze, small dark pigs and dappled goats. There are shelters built from branches and under these sit relaxing and chatting the men of the village or sometimes a woman nursing a baby.
The only brick built building in the whole village is the clinic where we are working today.
For a change the clinic building is well kept. Ill equip for anything medical to be carried out but at least the walls have been painted and it is relatively clean and tidy.
Simon is not at all well today and asks me to take over room allocation and setting up the clinic. There is no need to worry because by now everyone on the team understands what is required and gets on with it. Tables are moved, E charts pinned up and the boxes unpacked. The E chart consists of the letter E written the right way, facing left, up and down. The letters decrease in size down the chart. From a distance, patients have to indicate to which side the open side of the characters are facing if they are unable to read. This gives an indication whether or not there is a sight problem and following on from this the optoms can perform retinoscopy and opthalmoscopy for a better diagnosis. Noreen in particular presents me with very accurate prescriptions giving details of astigmatism. I can work then to give the best possible lens correction for that patient. Time however is often limited and often an optom will test over 60 patients a day on a VAO project.

The clinic is underway. Hardly anyone speaks any English. I have learnt how to ask people if they can see. ‘ Enyara?’ as I place the reading chart in their hands or point out into the distance. Although all I’m checking for is the ability to focus near, using a reading chart is not always such a good idea because the patients often cannot read. In this case, I indicate for them to look at their hands to check if the near vision is clear. This can also cause some confusion as they mistake it for some kind of gesture that I’m asking them to make. The translators bark out instructions and the people look shy and submissive. Uhm or uhm is the reply, which seems to indicate both yes and no and I have difficulty recognising the subtle difference. I look to the translator for clarification.
The languages spoken can vary from one village to another but I have learnt that here the local greeting is ‘ naaaa’. I try it out but get no response. Then I realise that the naaaa must be really drawn out and accompanied by a low bow. It works wonders, big smiles, clapping of hands and a far more relaxed and valuable spectacle fitting is achieved.
I ask my translator why the people here are sometimes so shy and seem unhappy. He replies that they worry about their eyesight and are concerned that they have problems that will lead to blindness. I am humbled.
At lunchtime we take only a tea and biscuit break and then I go for a walk in the village with my camera. I pass a woman on one of the pathways, bowing forwards I greet her with naaaa to which she replies and then gestures for me to go to her house. I follow her into a small compound where there are various family members including grandmother and several children. My friend asks me to put in the eye drops that she has been prescribed earlier that morning. We all exchange smiles, photos are posed for and then I wave them goodbye and return to work.

We want to see everyone who wants an eye check but we need to be back on the road soon in case it rains again. So many of the people here have had eye injuries or infections that could have been treated successfully had they had someone to go to at the time. Now it is too late and it is always sad and difficult to tell the patients that there is nothing we can do for them.
On the other hand there are wonderful results for some people. Having a pair of specs can mean the difference between being able to see to do a particular job or not and this in turn effects several other people whose survival may be dependant upon that one person.


Thankfully we manage to get back to Yogaba, as there hasn’t been any more rain to further disrupt the road. Simon is still not feeling well although he insisted on testing eyes all day. We send him off to bed to rest because tonight we are giving a party for the WV staff and some local people.

Simon arranged for the purchase of goat, to be slaughtered for the meal along with our gifted sheep. This slaughtering was carried out this morning just a few yards away from our breakfast table. (Meat eaters in England are often so squeamish. They seem to think that meat grows in plastic film in a chill cabinet). At least up until a few minutes earlier, those animals were grazing happily in the field.
Now over in the kitchen meat is being roasted on a large grill. Below the grill there is a fire that sits underneath the floor of the room. A young boy is cleaning the skull of one of the animals under the watchful eye of one of the men. I think this is for the soup. The skins have been stretched out in the sun to dry. Nothing is going to be wasted.
Later that night the dinner is served under a large canopy in the centre of the camp.
There is a long table and a small wall and seating around the edge. It all looks ideal.
The Ghanaians seem less enthusiastic about eating out here but go along with our wishes.
First it is beers all round for those who drink and the ipod is set up. By the time we eat it is dark and any form of light bring the bugs in droves. Now we see why this may not have been such a good idea. It’s still over 30 degrees and very humid. We can hardly see what we are eating.
I have a separate vegetarian dish while the others all tuck into the meat. Apparently it all tastes good including the soup, which is served from a very large pot. Simon and Noreen are serving second helpings of the soup, delving deep into the bowl, they discover exactly what has gone into it, intestines, skulls, organs etc.
After dinner Blandina sings a gospel song, she has a very beautiful voice. The team are asked to sing an English song but the best that can be done is a chorus of ‘On Ilkley Moor Ba Tat’ conducted by Simon.

After the meal, Fati gives a speech thanking the VAO team for all our hard work and we are presented with gifts. The gifts are local robes and of course we all put them on immediately for a photo call.
The party continues, Simon is one of the first to leave, something to do with the soup and still not feeling too well. Eventually the bugs drive us all back to our rooms.

Thursday
It’s the last day at Yogaba and we are all too aware of the very long journey that we have to make back to Aacra. Today we are holding a clinic in the WV offices right
here in the camp. The office that I am in has a large bookcase and there on a shelf is a large can of Raid (insect killer), if only I’d known about this earlier in the week.
Today as well as seeing the patients, I’m sorting out the boxes of spectacles. Some of them are going to the hospital in Tamale and will be allocated to patients by Moses and the ophthalmologist there. The remainder will return with us to Accra and be used by the next VAO team in Ghana. Many of the patients today are teachers as is my translator today, Dansu. I have brought with me to Ghana, lots of pens, pencils and rubbers and these have been handed out to teachers or children attending our clinics.
Today I find that I still have lots to distribute and they are well received. There is also a great demand for the sunspecs and I have found a box of very stylish wrap around frames that are very popular with the young men. They are said to be very useful for those who have motorcycles because they stop the bugs flying into their eyes. I advise
them not to use these dark tints at night!


We are able to set off on our long journey after lunch, everything is packed away. We have said our goodbyes to the cooks and nursing staff. Moses has given us a long list of equipment that he needs for his work and we are all settled into our car.
A young man arrives on a bicycle. He is a teacher and wants to have his eyes tested. I wind down the window and he explains that he could not get away from his school any earlier. We are sorry but ever thing is packed away in the other vehicle. He repeats his story and we reply as before. He tells us again, we seem to be in one of those loop conversations once again. Eventually we get him to explain his eye problems. He says he has sore, itchy eyes. His eyes do not look infected and so we are able to give the instructions for everyday bathing the eyes in clean /salt water. He is very happy with this advice and we promise to test his eyes next time we are here, although he says that he does not have any problem seeing near or far.
No one is looking forward to the long drive; the first part is the worst because the road is not tarmaced. It is already dark when we reach Tamale and the Bigiza Court Guest House where we are staying. Later in the evening having chosen a restaurant from the guidebook, we set out on foot to find a taxi. On the way to the main road we meet Sami, one of our drivers with Naa and so we all decide to visit the restaurant together. We sit outside in a large garden and eat Indian food.

Friday:
The next morning we set off at 7.30am, there is heavy traffic, lots of motorcycles and bicycles on the roads. School children in apricot coloured shirts and brown shorts cling to the backs of their parents as their motorcycles weave in and out of the traffic.
Karim has asked me to buy him a jalibeya (cotton robe) and Sami has agreed to take us to the market to look for this and wooden carvings for Noreen and Claire. In the craft market we do not find the jalibeya but we do find the glass beads as worn by the women in Yizesi and Claire buys a very stunning hat. While we are in the market, Fati calls Naa’s mobile to say hello and check that we are all ok. I tell her that we will all miss her. Sami and I then make a speedy visit to the large central market where I find a nice blue jalibeya for Karim and a beige one for Haroon with matching trousers. They are made in China but what isn’t these days. Before we are out of the town, there is one more stop for the drivers to buy yams and then we are on our way.

The journey seems endless. We stop for lunch at a fast food restaurant selling Chinese food. The meal takes about an hour to arrive. Sitting in the open air, the flies vie for our meals once they’ve been served.
Back in the cars we continue on our way to Accra. Sami is playing a Mama Rams tape, he translates the words. It’s lovely happy music with moralistic and upbeat words. The team don’t want to stay at the Erata Hotel again; we want to see the ocean.
Manage to book by phone, rooms at Nshonaa – Dutch Hotel but it’s almost 9pm when we arrive. The traffic has been very congested coming through Accra and the few kilometres beyond to the coast. Now walking into the lobby, it’s like stepping into Heaven. Cool air, beautiful décor and the knowledge that upstairs there are rooms with clean sheets and towels and proper showers with running hot and cold. Our rooms overlook the swimming pool and then on to the ocean. The waves sparkle and glisten in silvery moonlight, their gentle crashing sounds rise up from the beach.



Saturday:
As soon as I wake, I go down to swim in the pool, I’m the only one there but after a while Noreen comes down to join me. The sun is up but its not yet so hot near to the coast. After breakfast we have a meeting / debriefing scheduled with Eugene Asante, the WV Programmes Director. We meet him in the hotel lobby with Naa. He is wearing a crisp cotton sky blue kaftan and a serious expression. We report to him information regarding the clinics and the services that we have been able to provide. We tell him that there is enough demand for spectacles in Walewale to warrant a whole week of clinics in that place alone. The need for cataract surgery is great and how in the villages, local health workers should be used to educate before our arrival. They should explain to the population, what are the causes of sight problems and which conditions can be helped by medications, operations and spectacle corrections.
He thanks us for our work and choosing to come to Ghana where the need is so great.

Now we are free, so we climb into the car with Sami driving and head towards the Accra Craft Market. The traffic is heavy and although it is not far away, the journey takes an hour. Driving along the coast road we are able to take in the hustle and bustle of city life. In the craft market, the traders are anxious to sell but the bargaining is a long drawn out process. I buy more strings of beads to give to friends and daughters of friends. A red leather box for Youssef and a carved wooden Afro comb for Haroon.

Everyone is happy with his purchases and we return to the hotel for a final meal in Ghana and to prepare to leave for the airport, in order to board our overnight flight back to England. We say our goodbyes to Naa and the drivers; Sami has kindly given me the Mama Rams tape. We will miss them and the other WV people in the North. We promise to keep in touch and hope to return to Ghana in the future.




Post Script:
The team worked for nine days carrying out sight tests and providing spectacles for people in the Northern region of Ghana.
All together around 1,400 people were given eye examinations. Many more were screened but thankfully found not to need correction or treatment. Around 1,200 pairs of spectacles were dispensed.
Some of the areas that we visited were not highly populated but there was a complete absence of any eye care provision therefore making our service invaluable. The people in the villages were very poor and due to a lack of education were not even familiar with the concept of using spectacles to help them in their everyday life. Many of these people were farmers and lived off the land. They were commonly found to have suffered eye injuries from branches or foreign bodies. Eye infection and irritations were prevalent. Malnutrition was giving rise to sight problems and over exposure to sunlight UV radiation was causing a high incidence of cataract.

The team worked hard, often under very difficult conditions including temperatures of over 40 degrees. Gastric problems affected us all but the mood remained buoyant most of the time and we supported each other whenever necessary. Simon was a great team leader and took full responsibility for the accounts (all those zeros) as well as taking charge of our activities without being bossy. Having Saturday to relax at the National Park was very much appreciated and recharged us for the second week. Naa and Fati and the other World Vision employees took good care of us and went out of their way to keep us happy.
We all felt that the long distance travelled to the North by road was too tiring and on any future project planned in that area either the travelling should be broken with clinics being arranged along the route or the team should take an internal flight direct to the area, once having arrived in Accra.