Questions after reading:

• How do they prevent accidents in Ghana if the laws aren't enforced and people can drive drunk?

• What happens to tourists or visitors that don't obey these cultural trends specific to Ghana?

• While we are on this trip will we be invited to someone's house like the reading said? How do we politely say no to the invite?

Summary of Chapter 2 Values and Attitudes:

• This chapter focuses on the values of Ghanaians, highlighting the importance of human relationships, which are considered the most valuable possessions. Family plays a crucial role in Ghanaian society, and it is seen as abnormal for couples to remain childless, as having children is highly valued. Religion also holds importance in daily life, and all most all Ghanaians regularly attend church. God is central to their lives and is the reason that Ghanians adhere to their moral codes. Ghanaians are often perceived as hardworking, selfless, and generous, with sharing being a common trait in most people in Ghana. It is expected that Ghanians and visitors are friendly and put other's above themselves, especially elders as they are highly respected in Ghana. Money earned by Ghanians is expected to be shared with the extended family and not used poorly.

Questions for Panelists:

• How do we know how many clothes to bring?

• What kind of dress clothes did you bring and what kind of casual wear did you bring?

• What was your favorite part of the trip?

Find and reflect on a quote from the book compare it to your own experiences or perceptions of the U.S. health care system. How does Dr. Emanuel’s portrayal of the U.S health care system compare with what you’ve seen or experienced firsthand?

“Since 2003, Medicare has paid based on the average wholesale price of the drug plus 6% for an administrative fee. This payment formula incentivizes the use of more expensive drugs when there are clinically equivalent options because the 6% fee is higher on expensive drugs. Research indicates that physicians respond to this incentive and use more expensive drugs to generate higher payments.” This quote is on pg. 46 of the book. This quote of the book really irritates me and signifies my opinion that healthcare is a business too. I feel like healthcare and physicians in healthcare are more of a business thing than people realize, and Dr. Emanuel expresses that it is getting to be more about business as well. So many people just trust what doctors say and take any medication that they recommend. However, this quote supports my opinion that sometimes physicians truly just prescribe things due to the money. I feel like my opinion on this topic of the United States healthcare system really aligns with Dr. Emanuel’s. The subtopic of this section is Regulation of Physician Prescriptions, and with what was said in the book I concluded that Dr. Emanuel thinks there needs to be more regulation on what they are prescribing, and I totally agree. Cancer chemotherapies is a drug that is not sold through the pharmacy, but rather through physicians. I believe that there really is a better cure to cancer, but it is not being released due to all the money in chemo treatment. The United States is in so much national debt and Medicaid is part of that reason. Physicians prescribing higher costing drugs just increases the cost that Medicaid pays. Dr. Emanuel believes that this buy-and-bill system that we have in the US needs to be changed, and I could not agree more.

2. Personal Connection:

Pick a quote (or report or data) that you found particularly surprising. Explain why this quote stood out to you. Compare it with your own views and experiences with health care. Then dig deeper into the topic with two additional resources reflecting on what you learned.

The data that stood out to me was “Drug prices in the US are 56% higher than in European countries and constitute the single-largest cost category, explaining higher US health care costs compared to European countries,“ which I found on page 51 on the book. This quote stood out to me because 50 percent is a lot and the fact that our healthcare is 56% higher than European countries in crazy to me.  I also didn’t realize that prescription drugs alone caused that big of gap between the countries. I knew that healthcare was more expensive in the United States but I didn’t realize the extent of that and especially just the difference in prescription drug costs.

I found a couple articles that dig deeper into this topic. The first one is a RAND’s 2021 study, “International Prescription Drug Price Comparisons,” and this article found that there was a major gap between United States prices and prices in other countries for brand-name originator drugs, but not so much for unbranded generic drugs. For branded drugs RAND’s 2021 study found that, “U.S. prices were 422 percent of prices of non-U.S. countries.” This means that the price of branded drugs is nearly four times more expensive in the United States. For the generic drugs though, it was actually found that they are generally cheaper in the United States. Overall, with data from all different types of drugs, the prices in the United States are higher than other countries.

Mulcahy AW, Schwam D, Lovejoy SL. International Prescription Drug Price Comparisons: Estimates Using 2022 Data. Rand Health Q. 2024 Jun 3;11(3):5. PMID: 38855386; PMCID: PMC11147645.

With the second source I decided to dig deeper into what causes the difference in drug costs between the United States and other countries. The GoodRx article, “Why are Prescription Drugs more Expensive in the U.S. than in Other Countries,” explains a few different reasons why the drug prices differ so much, and the one reason that stuck out to me was because of the lack of government regulation in the United States. One thing stated in this article is that countries in the EU directly deal with pharmaceutical companies which regulates the price of prescription drugs. The United States does not do this, and the drug makers set their own price for their medications. I also learned that the lack of research for other drugs also causes the prices of medications to raise in the United States.

Why are prescription drugs more expensive in the U.S. than in other countries? - goodrx. (n.d.-b). https://www.goodrx.com/drugs/savings/why-are-prescription-drugs-more-expensive-in-the-us-than-in-other-countries 

In the “Who’s the Best” chapter various metrics are used. In your view, are these metrics the right metrics to evaluate a health care system’s effectiveness? What additional factors would you include or exclude in your own assessment and why?

The seven topics that each country’s healthcare systems were analyzed by in this book were history, coverage, financing, payment, delivery, pharmaceutical regulation, and workforce. Some of the key metrics used to evaluate a health care system’s effectiveness are the availably of healthcare to all citizens, the affordability of healthcare, access to healthcare services and physicians, wait time at hospitals or clinics, drug prices, and quality of care. One additional factor that I would make its own metric when evaluating a health care system’s effectiveness is the availability of mental health professionals and services. In the book, excellent mental health care is a dimension under delivery, however I feel like mental health issues are increasing and it should be evaluated independently. Mental health goes along with suicide rates, so measuring the suicide rates in a country could also be a way to evaluate the healthcare system. Mental health is very important, and a strong healthcare system should have options available for those in need. I wouldn’t exclude any of these metrics in my own assessment, as they all serve and important role in evaluating a health care system.

Pick a Metric:

In the “Who’s the Best” chapter various metrics are used. In your view which metric is the most important? Why is this metric superior? Reflect how your background and personal experiences have shaped your perspective on which metric is the most important.

I think the most important metric to focus on when trying to decide who has the best healthcare is the quality of care. Accessibility and affordability are both very important factors in the healthcare system, but I believe the quality of care is what truly defines the strength of a healthcare system. I would choose the hospital that I would get the best care over the cheapest any day. I feel like it is important to be affordable for everyone, but if I can get better care at a more expensive place then I would choose that as I value a person’s life as priceless. A personal experience that shaped this perspective is when my grandma passed away from cancer when I was in fifth grade. We tried to get her to go to the Mayo Clinic in Rochester instead of her doctor in Sioux City because it was known for its high-quality care. However, she wouldn’t do it because it was five hours away and would be more expensive. She ended up doing chemo, suffering for two full years, and eventually passing away. I think that she could have potentially beat cancer or had a better end to life if she would have gone and got the better care with higher quality doctors instead of worrying about money. I believe that life is way more important the money, and the quality of care could determine whether you live or die.

One major weakness in the U.S. healthcare system is the high cost of prescription drugs and healthcare in general. One way to address this issue could be by implementing a policy that limits the medications physicians prescribe. In the United States, physicians have a lot of freedom to choose what drug they want to prescribe, and this can lead to physicians prescribing more expensive drugs than they need to. Many times, there are more cost-effective drugs that work the same, but aren’t prescribed. This increases healthcare costs, increases the amount Medicare must pay, while also increasing the debt that our country is in. To reduce this issue and limit the prescription drugs physicians can prescribe the healthcare system could adopt a nationwide drug list of approved, cost-effective medications with proven clinical value. Physicians would be expected to prescribe from this list whenever medically appropriate. The focus on the list of medications wouldn’t be just the cheapest drugs, but medications that will provide the best results at the best price. The main goal is to balance the cost and the effectiveness of the drug. By promoting the use of lower-priced, medically equivalent alternatives rather than name brand drugs, the system could greatly decrease the overall drug spending. The main challenge that would come from implementing this would be resistance from physicians, who may feel their authority as a doctor is being restricted. Building trust with the medical community through shared decision-making and evidence-based guidelines would be very important to properly enforce this policy. Along with physicians, patients may also cause a challenge to this as some patients may prefer brand-name drugs over generics. In these situations, patients could still choose more expensive options if they are willing to pay the difference out of pocket, but public insurers like Medicaid should cover the more cost-effective alternatives when it is appropriate.

The second major weakness in the United States Healthcare system is the complexity of the system, especially with insurance and the many different deductible and co-pay levels. This is a major issue and makes it super tough to transfer between clinics and hospitals and know what you are going to have to pay when you arrive at an appointment. One way we could make the healthcare system simpler is by standardizing the number of insurance options. The government could mandate a specialized set of three insurance plans that include low-cost basic plans, a mid-range plan and a high cost, high coverage plan. Having these standardized three plans, different coverages would still be available, but it wouldn’t be so complex for customers and providers. The more variety of plans and tiers we have the more complex and confusing it is. Having standardized tiers would simplify insurance options, reduce confusion, and make the system more efficient. However, one challenge with standardizing insurance plans could be that private insurance companies might not be able to compete or retain enough customers. Often insurance companies benefit from offering certain perks within their plan and the variety among the plans makes them out compete other companies. Having to change those plans and standardizing the insurance plans could cause a struggle for different insurance companies to remain in business.

The third major weakness and challenge in the United States healthcare system is physician burnout. This is a challenge in many healthcare systems as being a physician is a mentally draining job that is very demanding. To reduce this problem, more staff needs to be hired including, both more physicians and medical technicians.  To do this, I would propose an increased wage for technicians and a loan forgiveness program for physicians. Technicians often receive too low of wages even though they are essential to clinical operations. Raising the pay of technicians would make the job more attractive and bring more people into the job. This would allow technicians to take the routine tasks off the physician’s workload, allowing them to put their focus on complex decision making and patient care. To increase the number of physicians, we need the schooling process to not be such a burden on someone’s life. Many people can’t afford medical school, so offering a loan forgiveness program for physicians would attract many more people to become physicians. Having more physicians within a clinic, would facilitate teamwork, strengthen communication, and allow each physician to have more vacation time to relax and recharge. This would make the burnout of physicians less and the quality of care in the U.S. Healthcare system better. The major challenge that comes with paying more and offering loan forgiveness is the financial cost to the government, potentially leading to higher taxes. In order to implement these policies a lot of thought would have to go into it to ensure we are doing more good than bad for our country.

The second aspect I will address is the cost and regulation of medications in both countries. The United Kingdom has a lot of steps in the process of determining prices for their drugs and prices are stable. From page 106 from the book, Which Country Has the World’s Best Health Care, “In the UK, the regulation of manufacturing, marketing, and pricing of pharmaceuticals is all decided at the national level.” Another interesting thing to note from the book is that all medications prescribed in the NHS hospitals are free to patients. Oppositely in Ghana there is not as many steps to follow when it comes to pricing and pricing of medications vary depending on foreign exchange rate. According to page 37 of the article, Healthcare Provision in Ghana, “Medicine prices are not regulated in Ghana. As 70% of all medicines are imported into the country, their prices are susceptible to foreign exchange rate fluctuations.” However, even though the prices depend on exchange rates, so they aren’t technically regulated Ghana does have an Essential Medicines Lists (EML) that provides a little regulation. The EML is a list of generic medicines that are efficient and cost efficient. With that being said, the UK has a lot more regulations and set authority for their medications and cost of them than Ghana does, but Ghana is still trying to have some with the EML.

The third thing I want to address is coverage in both the UK and Ghana. In the United Kingdom they use NHS services and health care is free for everybody in the country. Not even does NHS just cover residents of the UK, but there is also some coverage for nonresidents as well. From page 90 from the book, Which Country Has the World’s Best Health Care, “Nonresidents can receive emergency care and primary care for free, but they must pay for any subsequent care.” Coverage for free for the whole country is very rare, and many countries do not have that. The NHS covers 100% of the population and some also have voluntary health insurance too. Having health insurance coverage across the whole country is something Ghana does not have. According to page 30 of the article, Healthcare Provision in Ghana, “Approximately 70% of the population have health insurance coverage, women having a high coverage than men, 72.6% and 64.5% respectively.” They do have options in Ghana like the NHIS that is available to everyone and provides coverage for almost all conditions but is not used by everyone. The article also stated that percents show that some areas pay out of pocket more often, showing that health insurance might not be available in all areas. Comparing the two, it is noticeable that the UK has a lot more coverage for their residents and health insurance is a lot more common there.

The comparisons between these two reveal that coverage and access to care are two big strengths of the healthcare system in the United Kingdom. I would say that these are the biggest two, but also the way they regulate their cost of medicine and the detailed steps along with it is also a plus. The healthcare system being the way it is in the UK shows that the country focuses on accessibility and fairness for everyone in the country. The biggest strength for Ghana that I saw when doing these comparisons, it the use of the EML to boost the use of cost-effective medications. This is one thing that I even think the United States needs to look further into. I found that Ghana has little access to care and physicians, which is probably their biggest challenge along with the coverage issues. Ghana’s focus right now is to keep expanding and making improvements to their healthcare system.

The first thing we did after leaving the airport was get on the bus, which was super nice, and then we took the bus to a hotel to eat breakfast. The breakfast had a lot of different options, but I felt most comfortable with the simple omelet and pineapple so that is what I had. I did try other things as well but didn’t love anything else. After breakfast, we headed to the beach which I loved. The ocean felt amazing on my feet, and it was a very pretty view. One thing I did notice is that there is a lot more trash that floats up on the shore here compared to back home. The best part of the beach was probably the guy coming up with a horse and letting a student ride it. It was super cool to see a random horse just come up on the beach as that is something you don’t see in the U.S. often.

After the beach we started our 5-hour drive to Kumasi, and this is when we got to see a lot of the streets of Ghana and the interactions of people in this country. It was eye opening to see the number of vendors on the street and the amount of people who walk around all over even in the middle of streets. Many people have baskets of items on their head and walk around selling things out of their basket. I even saw one guy carrying a kennel of chickens on his head, which was very interesting to see. While driving the saddest thing I witnessed was when a barefooted little kid came up to our bus and started signaling for food. These are just things that we don’t commonly see in America, so it was gut wrenching. The amount of trash on the streets of Ghana and the number of unfished areas was also something that stood out to me.

After finally arriving in Kumasi, we met with KNUST International Affairs Office and got checked in to where we will be staying for the next two weeks. The International Affairs Office welcomed us with open arms and gave us girls scarves and the guy’s ties. They explained a little about KNUST and the shadowing that will occur tomorrow, which made me super excited. Checking into our rooms went well, and the place we are staying is a lot different than I was expecting. I am not sure what I was even expecting, but the rooms are bigger and nicer for sure. The final thing we did today was eat dinner and talk about the day tomorrow. A full fish was served for dinner tonight and was surprisingly good. One thing that I discovered today was that I love the pineapple they have here, and it is even better than what is served in the states. Overall, I think this trip is off to a great start and I am excited for the days to come.

The first day of shadowing was very interesting and a lot of fun. When we first arrived at the KNUST hospital we met with the head of the hospital and then were given a tour of the whole facility, and the different specialties present on the campus. I was placed in the operation room with two other girls for today’s shadowing. We got to sit in and watch a hemicolectomy on a 60-year-old male. The guy had a terminal ileum tumor, so we got to watch them cut out a big chunk of the intestine and sew the internal organs up. They were going to let us look at the intestine and find the tumor, but we ended up having to leave before the procedure was over. Being in the operating room was a very interesting experience. I have never been in an operating room in the states, so I can’t compare them, but I will point out a few of the things I noticed. The first thing I noticed was that there was a lot of people going in and out of the procedure at one time and many nurses just watching the procedure not really doing much. At one point we probably had 15 people in the room at one time, which seems like too much. The second thing I noticed is that there were many nurses or med aids that were just watching the procedure and some were also on their phones watching reels at a high volume. I found this very distracting as most of the time the operating room was quiet besides the noise of the phone. The third and final thing I saw today that shocked me was a nurse came and dumped boiling water from a kettle into a bowl in the operating room for a bottle of sterile water to sit in. I just felt like this was very unusual and there is definitely a different way that this is done in the United States. I found it super hard to stand in the same spot in the operating room for two full hours, which is something I have never thought about, and I don’t know how surgeons do it all day. Overall, I had a great first experience of shadowing.

After we shadowed and ate lunch, we went to the Manhyia Palace Museum and learned a lot about the Asante civilization. I found this museum to be interesting and to learn a little about how royalty in different countries works is super cool. I learned that there are a king and queen of Ghana and they come from the royal family. The royal family runs solely on the queen’s bloodline and only her kids are considered a part of the royal family. The king is usually a brother or kid of the queens, not a spouse. Kings hold all the power of everything, but the queens are the heart and soul of the family and run everything. We got to see many sculptures of past king and queens and a lot of gold. The last thing I will touch on is that before there were cars everyone walked everywhere, except the king and queen. The king was carried in a carrier by four men on their shoulders, and the queen is carried by four men on their heads since the queen is the head of the place. I was intrigued by everything we saw at the museum today.

The final thing we did today was shop and bargain for items at street vendors. I found this process exciting and fun, but also stressful. So many people come up to you and try to get you to buy from them. At first it was hard to bargain and say no to people, but it comes to a point where you have to and it eventually got a little easier. I bought three bracelets, a necklace, a painting, and a wood sculpture. I got a few of my items for cheaper than they asked, but probably could’ve got them even cheaper if I had more experience bargaining. I did think that there were a lot of cool things they were selling though.

Today was a lot of fun and had a great impact on me. It is very eye opening to be in the hospital setting for the first time and see the different levels of technology they have compared to the United States. I noticed that Ghanaians talk super quiet, and all understand each other even through masks, which makes me wonder how and why they talk so much quieter. I could barely hear the nurses talk in the operating room so that was an adjustment I had to get used to. I had to gain some will power today by learning to say no while we were shopping and even just stepping out of my box and being with new people during the day shadowing. I can already tell that this trip is going to make me a better person and I am gaining skills that will be great for my future!

Social Norms are just like unwritten rules that people from the same area all follow. They are usually specific to a specific town, community, or even state, but social norms are just the way people interact with others and the way people do certain things. For example, in a small town like mine it is a social norm to wave at everybody you drive by in town and to go to community sporting events even if you don’t have a kid playing. These events are more specific to a small town as lots of times people who live in Sioux Falls won’t just go to a random sporting event.

Social Contracts are agreements that you have with a small or big group of people about a variety of different things. One very common example of a social contract in the United States specifically is the HIPPA Contract. This is a very strict contract that you must sign when getting employed in mainly medical fields but also some business fields. Signing this contract means you will not share any information about the patients you see with other people. This ensures patient privacy and allows you to be worry free when going to see a doctor in a small town. Without this contract people may be afraid to see doctors because they don’t want other people to find out about a disease they have.

Social Mores are the rules in a society involving right and wrong, which usually stem from moral beliefs of the society. Different cultures have different social mores, and they truly reflect the moral values of each culture and society. One major social more in South Dakota especially is standing for the U.S. flag and showing a lot of respect for veterans. South Dakota is big on supporting our country and the people who fight for our country, so it is considered wrong not to do so. You don’t go to many places in South Dakota that don’t have a military discount and that truly shows our values.

Have you ever felt the pains of hunger? If so when and how did you satiate that hunger, if not, why not? What would you do to provide for yourself or your family and loved ones? What did you experience in the past few days that can help you understand hunger differently?

I have never felt the true pain of hunger, but there have been times that I remember being more hungry than usual. I don’t remember the specific times of when I felt this way, which shows that it must not have been that significant. I feel like I haven’t truly felt the pain of hunger because I have a lot of family around me that has always been able to provide for me. I have never had to worry about not having enough money for food or anything like that. I have been blessed with the life I have lived so far and even if my parents weren’t around, my grandparents were always right there for anything I needed and put food on the table. I have always had food available no matter where I have been. If I were lacking on resources, I would do everything in my power to provide for myself and my loved ones. I would work two to three jobs if I had to, and I would reach out to my community for help. I have a lot of nice things at home and if it ever came down to it, I would sell everything I own even my favorite things, for my family to have what they need. The experience that I had today with the kids outside of the Kente Centre changed my perspective on hunger and my outlook on life. There were about 15 kids outside the Centre today and when I was interacting with them at least 3 or 4 asked me for both food and money. I mean these kids that asked me were probably 10 years old, so seeing that they are affected from hunger at such a young age is just heartbreaking. This experience made me realize how blessed and fortunate we all are to even just have food to eat every day. I could not imagine a life as a young child having to ask strangers for food and money. I will no longer complain about the small things in life, because I have now seen first-hand the bigger problems but that other people are facing. I now know that I am never hungry and will never face the pain of hunger that others face.

After shadowing, we went to the Bonwire Kente Weaving Centre, and got to see a lot of unique kente that I had never seen before. We also got to see many different people making kente, and I even got to try out the making process of kente. It was a lot of fun, and I am very glad I took on that opportunity. I ended up buying a piece of kente that looked just like the one I was weaving on, so that is awesome to me. The most fun part of the day came when we walked out of the Kente Centre to a lot of kids standing there. They were all so happy and wanted to talk to us, which just brightened my day. I truly loved interacting with them and enjoyed every second I got to be with them. A couple of kids did ask me for food and money though, and that was very heart wrenching. It is so sad that even young children feel the burden of not having any money or food.

We then visited the cultural center, learning the history of kente, and got to see a lot of the past to present kente.

There are many things that seemed weird and crazy when we first got to the country, however the longer you are here the more you start to understand what is truly going on. The one big thing that I thought was super weird when we first got a tour of the hospital, was the little privacy in the men and female wards. Right away you can investigate a room and see the eight beds with just a curtain, and most of the time not even shut. This took me by such surprise because in America everything is so private, and nobody can know your business. However, after being in the male ward and having a long talk with a nurse I found that there are other options for patients to go to as well. There is a VIP Hospital that patients with more money go, and they have their own private rooms. So yes, there is little privacy for people who can’t afford it, but also, I have learned that Ghanaians are very family oriented and don’t necessarily care about privacy. Privacy doesn’t seem to be an issue, and if it is there is always an option for privacy if you can afford it. Initially I was in awe and thought that was so crazy for everyone to be so close, but that view has changed a little. I still think patients should have a little more room than they do in the wards, but being in Ghana has showed me that it is a very friendly and close together area. They are always right next to each other constantly, so I am sure being that close in the hospital doesn’t bother them as much as it would bother us.

The insights I have recently had about privacy and the closeness of the community were just solidified at the central market. At first, the walk to the market and the market itself was very chaotic, loud, and stressful. However, I then thought about it deeper and realized that this environment just shows us how these people interact and live their everyday life. Having to think deeper about things throughout the past couple days really made me look deeper into this and appreciate what was happening around me. On the streets and at the market a lot is going on and many people are surrounding you and others. There is no gap between people and there are continuous clumps and lines of individuals. This experience at the market explains the evolution of my thought on hospital setting as privacy does not seem to be a thing in Ghana. Understanding what Ghanaians interactions actually mean and not being scared of them helps you embrace the full experience and understand their culture.

After shadowing, we went to a cultural center that had a gift shop. I bought my sister a wood animal to bring back because she has always loved elephants. We then went to watch African Dancing, which was super intriguing and a lot of fun. After we watched three dances of theirs, we all went up on the stage and joined them. Seeing them dance and learning how to dance the same way was a huge leap into learning their culture and their values. This was something I would have never expected us to do, and I really did not want to do it when they first offered. However, I am very glad I did, and it was good to get pushed out of my box to learn something as incredible as this.

We then made our way to the Central Market, which was a whole other experience in itself. We parked the bus a half mile away from the market and had to walk the streets of Ghana to get to the market. Walking through the streets, there were lots of people, vendors, and traffic around us. Many people were yelling at us while we were walking, trying to get us to stop at their shop, and there were even people on the median of the road. People gave us lots of looks as we were the only white people around and for some moments during our walk things were a little scary. Once we finally arrived at the market we walked around and experienced more culture of Ghana and how people interact. We saw the old market that burned down a couple years ago and we also got to stand on an edge of the second floor that overlooked the busy streets of Ghana. Looking over the edge and seeing a street full of people with trash all around was a lot. It was rather cool to see, but also disturbing as you saw many poor people. On the way back to the bus, the walk was the same as the walk there besides one even that stood out to me. A little three year old girl, looked up to me and said “Obroni”, meaning a white person, which just signifies the unique presence of white people.

After the market, we went to dinner at Ike’s Café & Grill. Before we went in to eat, we saw to monkeys and got to see fish. Dinner was more American than previous meals and I also ordered my first alcoholic drink in Ghana. It was a good day!

After shadowing, we went back to our rooms, ate lunch, and started our drive to Cape Coast. We got about an hour or two into the trip when we stopped at a Rest Stop, for what I thought was just a normal bathroom break. However, when we got back on the bus Greg informed us that the bus was having technical problems and needed to be fixed, which required us to get back off the bus. When I heard this news, I was disappointed that we were delaying the trip longer. It was hot, so I was not sure what we were going to do the whole time we were waiting for the mechanic to fix the bus. However, we made the best of it and found a nice spot in the shade and played a few games of cards. We played two games of uno, and I didn’t win either one. I am very competitive, so this was very irritating, and I was ready to play another game and get the win. They then brought up the idea of playing a game of spoons, and my eyes lit up. My family has always played spoons together, so it is one of my favorite games and I was ready to bring out my competitiveness and win the game. We started the game with six people, and after many hard-fought games I was in the championship game. I was so excited, but then Greg told us the bus was ready and it was time to go. I thought we wouldn’t get to finish the game, but we decided to do so anyway and the championship was just who could find the last water bottle first. The intensity was built up and it was time to go. We both raced off to find this water bottle, looking at the same spot to start and then she went further, and I turned around. This was when I spotted the water bottle and brought it back to the table, winning the spoons game. I was pumped and got to get in the bus in a great mood. We then continued our way to cape coast, arriving about 3 or 4 hours later. When we arrived, I was pleasantly surprised to see where we were staying, and it was very beautiful. I am super excited for this weekend and made the most out of our travel day!

We then headed to the Slave Trade Castle, which was a lot different than I was expecting. The building was super old, but still standing perfectly. It was located right on the coast, so you could look out and see a beautiful view of the ocean. The Slave Trade Castle had a lot of history, and it was super cool to see the different areas. They really gave us the true experience by locking us in the same rooms that people were locked in and killed. We also got to go in both the female and male slave dungeons which was super sad to think about. I am not usually big into history, but this Slave Trade Castle was very unique and interesting to learn about.

After that we headed over to Coconut Grove Beach Resort where we ate lunch and were supposed to swim in the ocean. However, the weather was not ideal, and the wind caused the ocean to be very wavey and dangerous. The resort was very beautiful and there was a pool as well. We decided to go down to the beach to just walk along in it when we started to get further and further in the water. This is when we all decided that we were going to get our swimsuits on and at least get in a little way. The waves were super fun to mess around in and we ended up getting most of our bodies drenched. After spending some time in the ocean, we headed over to the pool and played some fun pool games. Even though the weather wasn’t great, we ended up making the best of it and enjoying ourselves anyway. It was a fun day; I just wish I could’ve got a tan!

To end the night, we headed over to watch a live band. We arrived at like 7:15, thinking that the band started at 7, however we were informed that the band actually didn’t start until 9. Getting this news was a little disappointing, but we were going to just hang around and have a couple drinks. We started chatting and having a drink, and then the band started setting up. It was only like 8 when this occurred, so I was shocked and hopeful we would get to see the band. Then suddenly, the drums and trumpet started, and the show was starting early just for us. I was so happy we got to see some live action. We all headed to the dance floor and Joanie got us moving! We danced and hung out on the dance floor for the next hour having the time of our life. It was such a fun day and ending the night with a dance on the dance floor was such a great addition to the already amazing day!

Looking out the window from a place of comfort while seeing many people not in the same comfort as I provided me with a great sense of both a blessed feeling and a feeling of guilt. Seeing the life, they are living while I’m on an 18 day “vacation” essentially fills me with a lot of sorrow and questions. We come into this developing country and get to stay in all the nicest places, ride in a fancy bus, and get 3 meals catered to us a day, truly not experiencing the full effect of what most people in this country truly feel. Everywhere you go there are street vendors run by families just trying to make enough money to survive and feed their family, suffering from the heat while they do it. There are children running everywhere with no adults in sight and that what hurts my heart the most. Coming into this country getting better care than the people in the country is a weird feeling. We are privileged enough to get this type of care, but knowing there are so many people struggling right aside you everywhere you go is something I’ve never felt quite like I have on this trip.

Walking into the Elmina Castle filled my body with a whole new sense of discomfort. As tourists, walking into this castle right on the coast, you see a beautiful view of the ocean which would usually provide you with peace. However, seeing this view from a place where millions of people suffered and died makes the view a little different. Thinking about people seeing this beautiful ocean as a sight of death is hard to wrap my head around. I’ve always thought of any type of body of water as a place of joy and wonderful memories, so thinking that this ocean was a sight of fear is just heartbreaking to me. We all got to view the dungeons and canyons in this Elmina Castle as learning experience not fearful of losing our life. Even just looking at these things and learning about what these slaves went through brought a lot of discomfort, I could not imagine what the slaves felt when they first were brought to this place knowing they would be lucky to come out alive. We entered the door that people entered to die, with the promise of getting let out and there was still a feeling of discomfort. The past of this castle was brutal, with many people getting their whole lives stripped from them. Every day, I get to live freely and pick what I want to do or where I want to go. These people had no say in anything they did, had chains tied to them, and suffered staring at the stone walls of the castle in the heat. I’ve never experienced anything even close to the pain they went through and never will in my lifetime. It is a privilege to walk freely every day and this moment in the Castle signified that for me. Trauma doesn’t just disappear, many descendants of the enslaved still experience lots of discomfort and trauma from this. What happened in this castle is not something you can just move past; it is real and needs to be talked about so people like us can learn about it. I am grateful to be able to understand just a brief piece of the pain that these enslaved went through. We left the castle and moved on with our day like nothing happened, but the people that had their ancestors affected probably didn’t leave and just move on with their day. That feeling would stick and be hard to get over even more than it already was if I had a close one affected.

Now to compare a developing country vs a developed country. I have always read about developing countries, but honestly, I had no idea what the true difference was until arriving in Ghana. After seeing the streets, buildings, and fields I can see the differences. Developing countries are constantly changing and trying to improve, while small things change in the developed countries, but for the most part they are stable. For example, in 2017 when they brought a group to Ghana they had to do their journals on paper still. Now just 8 years later we have enough technology and resources to use the internet and post our journals on Padlet. That just shows the vast changes in developing countries. Also, looking around in a developing country like Ghana you see many unfinished roads and buildings, filled with a lot of trash. As the country develops more and more, I would bet the roads will be finished and we will see lots of progress in the buildings as well. People living in developing countries tend to face many more hardships, with less education, healthcare, and opportunities in general. Everything grows in developing countries, so many people struggle but have hope for things to get better. Differently, in developed countries you start your life with the stability in all aspects of education and healthcare. Things change but you don’t experience as huge of changes as people do in their lifetime in a developing country. After being in Ghana, it would be very hard to live in a developing country and lots of pain would come with it.

When we arrived back, we ate lunch and then began working on our presentation for when we go to the school tomorrow. I did not think that this would take so long, but it ended up being a very long process. We divided up into our small groups, then divided into pairs to do slides. We practiced presenting in front of our small group and then all came together as one big group to practice. Before going over everything in the big group, we did get to eat KFC and pizza so that put us all in a great mood. The “American” food tasted delicious and even though we had just ate a few hours prior we acted like we hadn’t ate in days! I did notice that the KFC chicken here was a little spicier than in the United States. We then started the presentations in front of everyone, critiquing each other, and meeting two other girls from Michigan. It took a long time, but hopefully it well prepared us for what is to come tomorrow and actually presenting our information to children. I am very tired and ready for bed now!

The second learning outcome is for student to be able to communicate with providers and support the delivery of healthcare services as appropriate to their training and established ethical guidelines. I think I have substantially exceeded this learning outcome as I came into this trip super shy and am only halfway through and feel way more confident. In the US I was kind of scared to ask questions and they spoke the same language as me, so I would have never thought I would be able to ask questions here. Coming into this trip, I was very uncomfortable with different languages and trying to understand them, but now only nine days into the trip I have confidence and ask providers many questions to learn about the way things are done here in Ghana. The first day I went into the clinic and saw the way they did some things it was instant judgement. Now, digging deeper into it and learning more I have concluded that this is just the way they were taught and the way they are supposed to do things. A big shock was when I was in the eye clinic and saw they only do a vision test and refraction, with no other tests to check for diseases. I saw the low vision center that had more tests just like in America, but patients only go there when their best eye is worse than 20/60 with glasses. This was mind blowing and I couldn’t understand how this was allowed, as by that point the disease you have is probably already too far gone and may cause blindness. Looking into it deeper many people can’t afford to come into the clinic in general and miss work, so you are not going to waste time checking for things that may not be wrong when the patients may not even come for more serious things. The lifestyle is just so much different, and Ghana is more about treating people instead of preventing due to the lifestyle. I also first thought it was weird that physicians answered phone calls when people were in the room, but that must have been what they were taught, and they are most likely just communicating with others to make sure their patients get the care they need. Privacy is the other big thing that I found super weird in the hospitals, but as you’re in Ghana you realize that there is no privacy anywhere. People are always together, and family have such a big role in each other’s lives that privacy rules are vacant compared to the United States privacy rules.

2. Now onto the time spent in the schools today, which was one of the best things we have done so far. This had such a huge impact on me that I can’t even put it all into words. Seeing these 10-year-olds, sit with a notebook, listening to us speak for 50 minutes was absolutely incredible. They were so engaged and loved every second of it. Feeling heard and valued is something you wouldn’t always get from 10-year-olds, but they sure made it happen. Seeing how eager they were to learn and how excited they were when new stuff popped up on the screen was so much fun. I feel like we had just as much impact on them as they had on us. This moment solidified that this trip was right for me, and the healthcare is right for me as that is a teaching career as well. Education is the base of everything in life including health, community, government, economy, and happiness. First off, having a high level of education and learning about all different aspects of life increases the health of individuals. People know what’s good for you and bad, therefore leading to better health. It plays a role in both economy and government because education provides people with the information to work hard and get jobs, increasing income and reducing poverty. Along with that it impacts the government by providing more educated leaders that can make evidence- based decisions which then in hand also helps the economy. Community is impacted by education in a similar way by more educated people being in a community and working together to be one. Most of the time the educated individuals are the ones who are willing to work hard and therefore volunteer which is great for a community. Lastly, happiness kind of comes with all of these as education brings better economy, community, government, and health leading to more happiness.

The second learning outcome is for student to be able to communicate with providers and support the delivery of healthcare services as appropriate to their training and established ethical guidelines. I think I have substantially exceeded this learning outcome as I came into this trip super shy and am only halfway through and feel way more confident. In the US I was kind of scared to ask questions and they spoke the same language as me, so I would have never thought I would be able to ask questions here. Coming into this trip, I was very uncomfortable with different languages and trying to understand them, but now only nine days into the trip I have confidence and ask providers many questions to learn about the way things are done here in Ghana. The first day I went into the clinic and saw the way they did some things it was instant judgement. Now, digging deeper into it and learning more I have concluded that this is just the way they were taught and the way they are supposed to do things. A big shock was when I was in the eye clinic and saw they only do a vision test and refraction, with no other tests to check for diseases. I saw the low vision center that had more tests just like in America, but patients only go there when their best eye is worse than 20/60 with glasses. This was mind blowing and I couldn’t understand how this was allowed, as by that point the disease you have is probably already too far gone and may cause blindness. Looking into it deeper many people can’t afford to come into the clinic in general and miss work, so you are not going to waste time checking for things that may not be wrong when the patients may not even come for more serious things. The lifestyle is just so much different, and Ghana is more about treating people instead of preventing due to the lifestyle. I also first thought it was weird that physicians answered phone calls when people were in the room, but that must have been what they were taught, and they are most likely just communicating with others to make sure their patients get the care they need. Privacy is the other big thing that I found super weird in the hospitals, but as you’re in Ghana you realize that there is no privacy anywhere. People are always together, and family have such a big role in each other’s lives that privacy rules are vacant compared to the United States privacy rules.

2. Now onto the time spent in the schools today, which was one of the best things we have done so far. This had such a huge impact on me that I can’t even put it all into words. Seeing these 10-year-olds, sit with a notebook, listening to us speak for 50 minutes was absolutely incredible. They were so engaged and loved every second of it. Feeling heard and valued is something you wouldn’t always get from 10-year-olds, but they sure made it happen. Seeing how eager they were to learn and how excited they were when new stuff popped up on the screen was so much fun. I feel like we had just as much impact on them as they had on us. This moment solidified that this trip was right for me, and the healthcare is right for me as that is a teaching career as well. Education is the base of everything in life including health, community, government, economy, and happiness. First off, having a high level of education and learning about all different aspects of life increases the health of individuals. People know what’s good for you and bad, therefore leading to better health. It plays a role in both economy and government because education provides people with the information to work hard and get jobs, increasing income and reducing poverty. Along with that it impacts the government by providing more educated leaders that can make evidence- based decisions which then in hand also helps the economy. Community is impacted by education in a similar way by more educated people being in a community and working together to be one. Most of the time the educated individuals are the ones who are willing to work hard and therefore volunteer which is great for a community. Lastly, happiness kind of comes with all of these as education brings better economy, community, government, and health leading to more happiness.

The second learning outcome is for student to be able to communicate with providers and support the delivery of healthcare services as appropriate to their training and established ethical guidelines. I think I have substantially exceeded this learning outcome as I came into this trip super shy and am only halfway through and feel way more confident. In the US I was kind of scared to ask questions and they spoke the same language as me, so I would have never thought I would be able to ask questions here. Coming into this trip, I was very uncomfortable with different languages and trying to understand them, but now only nine days into the trip I have confidence and ask providers many questions to learn about the way things are done here in Ghana. The first day I went into the clinic and saw the way they did some things it was instant judgement. Now, digging deeper into it and learning more I have concluded that this is just the way they were taught and the way they are supposed to do things. A big shock was when I was in the eye clinic and saw they only do a vision test and refraction, with no other tests to check for diseases. I saw the low vision center that had more tests just like in America, but patients only go there when their best eye is worse than 20/60 with glasses. This was mind blowing and I couldn’t understand how this was allowed, as by that point the disease you have is probably already too far gone and may cause blindness. Looking into it deeper many people can’t afford to come into the clinic in general and miss work, so you are not going to waste time checking for things that may not be wrong when the patients may not even come for more serious things. The lifestyle is just so much different, and Ghana is more about treating people instead of preventing due to the lifestyle. I also first thought it was weird that physicians answered phone calls when people were in the room, but that must have been what they were taught, and they are most likely just communicating with others to make sure their patients get the care they need. Privacy is the other big thing that I found super weird in the hospitals, but as you’re in Ghana you realize that there is no privacy anywhere. People are always together, and family have such a big role in each other’s lives that privacy rules are vacant compared to the United States privacy rules.

2. Now onto the time spent in the schools today, which was one of the best things we have done so far. This had such a huge impact on me that I can’t even put it all into words. Seeing these 10-year-olds, sit with a notebook, listening to us speak for 50 minutes was absolutely incredible. They were so engaged and loved every second of it. Feeling heard and valued is something you wouldn’t always get from 10-year-olds, but they sure made it happen. Seeing how eager they were to learn and how excited they were when new stuff popped up on the screen was so much fun. I feel like we had just as much impact on them as they had on us. This moment solidified that this trip was right for me, and the healthcare is right for me as that is a teaching career as well. Education is the base of everything in life including health, community, government, economy, and happiness. First off, having a high level of education and learning about all different aspects of life increases the health of individuals. People know what’s good for you and bad, therefore leading to better health. It plays a role in both economy and government because education provides people with the information to work hard and get jobs, increasing income and reducing poverty. Along with that it impacts the government by providing more educated leaders that can make evidence- based decisions which then in hand also helps the economy. Community is impacted by education in a similar way by more educated people being in a community and working together to be one. Most of the time the educated individuals are the ones who are willing to work hard and therefore volunteer which is great for a community. Lastly, happiness kind of comes with all of these as education brings better economy, community, government, and health leading to more happiness.

At 10, I headed over to the emergency room hoping to see some action. However, it was a slow day in there too. I did learn that in the ER there is a yellow, orange and red room that patients are placed in depending on the condition they are in. Red is for the most critical patients and there is only one bed. This is usually where people go right away when they are brought in by ambulance. I thought it was cool because I saw the same patient in the ER yellow room as I saw in consult 3 on Friday. He was very restless and looked like he was in a lot of pain. They think he has bladder cancer and that is causing one leg to get super swollen. There was also a patient in bed 2 that was in critical condition and only had a hemoglobin level of 3. With this we learned that the normal hemoglobin level is 12, so 3 is very low. They weren’t sure what she had, but I asked the nurse and she thought it could be bone cancer. It was a slow day of shadowing, but I still learned a lot. I am still in awe of the patients all being so close together in both areas though! 

We then went to present to the KNUST school district about the United States and that was an unreal experience. When we showed up, the girls were dancing all in sync to a song and they were very talented. We then all got situated inside and we began the presentation with the National Anthem. Chills filled my body as the whole room was standing with their hand over their heart honoring America in a different country. We then were honored enough to hear all the children sing the song that Ghana sings to represent them and it was super cool. While we were presenting the kids were so awesome and so intrigued in what we were saying it made it so easy to talk to them. We asked them many questions about our history and country in general, and I was shocked to see them answer most of our questions correctly before we even talked about it. Feeling so valued and heard was something that you don’t always feel when talking to children this age, but they were beyond great listeners. Seeing the excitement on their face when they saw us and found out they got to learn about the United States is something that I will never forget. I was nervous to present, but seeing the children have so much fun with it made all the nerves go away. They didn’t know or care if we messed up, they just loved the opportunity they got. After the presentation was over, we got to hand the children stickers and interact with them. I talked with a group of 4^th graders that actually didn’t get to listen to our presentation, so they had a lot of questions. The children that I talked to were mostly intrigued by how long and blonde my hair was. They don’t see blondes very often, and they all had short hair, so this was interesting to them. I had so much fun teaching them all about the different hair and eye colors we have in the United States. Teaching these children and seeing their interest in my life gave me a purpose and made me realize I am doing life right. I am so grateful for this opportunity to come to Ghana and make a difference on the children. This was such a great experience and I hope I had just as much impact on their lives as they did on mine.

After our hearts were filled with complete joy from the kiddos, we headed back over to the cultural center to do a little more shopping. I found a few more souvenirs to bring home to my friends and family, so the day ended perfectly. I cannot express the amount of joy and gratitude the day filled me with and I can’t say enough about the experience at the school!

After labor and deliver I headed to the pharmacy, where I got a very hands-on experience compared to the other places I have been. I got to learn about a few different drugs and found it remarkably interesting that ibuprofen is prescription here. This shocked me as ibuprofen is available in many gas stations and stores in the US. She did say that you can get ibuprofen and things like it over the counter but only at pharmacies, with no stores selling it. I had read about a generic medicines list that Ghana had so I asked a few questions about that. The pharmacist I was with explained that most of the time medicines are prescribed from that list, but patients can choose to have a name brand drug if they can afford it. She also talked about NHIS, which is the insurance that covers most of Ghanaian people if they pay the required amount each year. I learned NHIS covers most generic medicines so if you have this the medicines are free. After learning all of this, I then moved on to the more hands-on experience and got to start looking up patients, getting their prescriptions ready, and calling their name and dispensing their prescriptions to them. It was challenging to pronounce some of the names, but I loved getting involved and learning about the pharmaceuticals. I noticed that the computer system is a lot less complex than it is in America, so it was easy to learn how to run it. I have nothing but wonderful things to say about the pharmacy department in Ghana, as it was one of my favorite units I was in. I am sad that this was our last time shadowing here, but it has been a substantial experience, and I have learned more than I could ever imagined. 

We then went to the e learning center and got a tour of two buildings. The first room we entered had a bunch of computers and they said they hold 20,000 online exams in there a week. That is a crazy amount and honestly could not imagine how many people must come in and out of there. I was overly impressed with how nice this center was and how much technology they had. They had many rooms with different technology in each that teachers could use to record online lectures and even edit them. We do not even have a place like this on the SDSU campus, so seeing Ghana have it was inspiring. I learned that SDSU gave this university VR headsets so they could get this program started. We got to see them using it and they even let us try out some of them. One virtual reality was a surgery, so you can learn how to be a surgeon on someone before being in the operating room. I thought this was amazing and a great practice for students in that field! 

This afternoon, we had the privilege to meet with the vice chancellor and that was a unique, but super cool experience. We had to go through two metal detectors before we could enter the meeting room and that made a weird feeling go through my body. I was thinking in my head who is this person we are meeting and why is she so important? I knew she was the vice chancellor, but I did not know the significance of this until I attended the meeting and the museum. Turns out the king must appoint the vice chancellor, so she is a pretty big deal. It was so cool to be in the presence of someone that holds such a crucial role as she does. We sat all professional at a table and stood when she came in, honoring her as much as we could. The meeting was very professional and the exchange relationship of our two universities was addressed. Both parties involved love the exchange we have agreed on and I do not see this relationship ending any time soon. The vice chancellor was so happy we were there and wanted to make sure we were treated right in the hospitals and getting tasty food! It was cool to see how invested a high up person like her was in us. Every instance in Ghana has been great so far, and this is just another example.

To end the night, we went to dinner off campus. We were supposed to eat with the Vice Chancellor, but she got busy so the rest of her staff just joined us instead. None of us had any idea where we were going, but when the bus finally came to a stopping point, we were in awe. Our bus was stopped in front of this gated, super fancy hotel that was absolutely stunning. We could not believe this was where we were eating and as we walked inside the disbelief became more. This place was gorgeous and felt too nice for us! Walking through the hotel and out the back we saw a beautiful pool, bar, and play-set with palm trees in the background. This view was the perfect picture and it even made my Snapchat story! We were planning on eating outside right by the pool, but there were a few too many bugs so we were directed to move inside. Things just got better when it was time to eat and we saw all the desserts and food options. This meal was phenomenal with many new things that I had never tried before. I ate so much I think I gained 10 pounds, but I figured I wouldn’t have an experience like this again. After filling our stomachs with lots of delicious food, we went out by the pool and had a long photo session, capturing many fun moments. This night was the perfect night to reset and prepare for the next half of our trip. I had so much fun, and the rain just added to it!

The second facility we visited was a sub district Health Centre. This health centre was a lot bigger than the CHPS compound, with more services available. You could tell that this was a more complex facility and served more people. At this clinic they did have a physician's assistant but not an actual physician. The physician assistant is allowed to see a patient, treat the patient and prescribe medications needed. I found this to be interesting as in the US doctors must oversee everything the physician assistants do. At this facility they do child health, provide immunizations, and do family planning. We got to see the maternal and child health record book they use, so that was cool to see. 

The third and final facility we got to tour was the district rural hospital, which had a lot of the same services as KNUST. This facility was a lot bigger than the other two and offered more amenities like an emergency room, pharmacy, an outpatient department, and a lab. I found the lab to be most interesting in this facility since I did not get to be in the lab at KNUST. They were explaining all the diverse types of things they can find in the blood, and they said that one and a half hours is the average time it takes to get blood results back. 

It was super interesting to compare the three distinct levels of rural hospitals, also considering the comparison to KNUST. I did not fully understand the distinct levels of care in Ghana until seeing these different facilities. 

After touring these different facilities, it was finally time to go eat lunch. We were running about an hour behind schedule, so we were all getting hungry. We started our drive to a resort on the lake where we were going to eat. This drive was longer than expected, but that was not the main problem. The problem was the roads we were driving on and the number of bumps we hit. Once we finally arrived at the lake, we thought we were close to our destination, but the bus just kept driving and driving. After about 40 minutes of driving on these awful roads, the resort was in sight which was a blessing because I was just starting to feel sick. This was the first time the whole trip I had started to get motion sickness, and it was because we were in a tiny van instead of a big bus. Also, the roads were just way worse than what we had gone on before. Eating lunch made me feel better, thankfully the food was good, and then I ate two ginger candies and took Dramamine before the ride back. 

The ride back was longer and even worse. Bouncing off the seats for an hour straight was enough for me and I was beyond ready to get out of this van when we arrived at the washroom. Thankfully, I did not feel as sick on the way back because of the medicine, but I was still super tired of bouncing. I was extremely glad when we finally arrived at the post office shops, so we could have an hour break from the van! 

We shopped around for a bit with a lot more confidence this time than the first time we were here. It was fun to see the progress we had all made with bargaining and telling the sellers no. I did buy a few bracelets and some souvenirs for my friends, but I think it was all at a fair price. I was in the middle of trying to buy a bracelet, when all a sudden the vendors started cleaning up and shortly after it started pouring. I did not end up buying that bracelet because he wanted too much money and I was getting rained on. Unfortunately, the rain caused our time at these shops to be cut short, and we headed to the mall a little early. 

Pulling up to the mall, I was pleasantly surprised to see it look like a mall in the United States. There were many different stores, restaurants, and just little snack stations. We went straight to the grocery store, with intentions to buy snacks for our 10-hour drive to Mole National Park tomorrow. I did not get any snacks because I still have a lot that I brought from home, but I still had fun looking around. We went to a few other stores as well, and I did find a necklace earring set for my boyfriend’s mom! After shopping, a group of us decided to eat at a pizza place for dinner. Genuinely nice conversations were had, and I was glad we got to see a new part of Ghana today! 

Once we finally got out of there, we headed to the place we are staying tonight. It is called Zaina Lodge, and when we pulled up everyone was beyond impressed. You could tell this place was so much nicer than the motel right when we arrived so that brought out lots of excitement. When we got inside, we got to view the pool and the view and we also got introduced to the spa options. I was excited about this and knew I had to get a massage. The pool was awesome and it overlooked a pond which elephants came to throughout the day.

The workers then led us all to our rooms, and we got to check out the place we were sleeping. Walking into our room, we were in utter awe as it had an outdoor shower and a super big bed to sleep in. Checking into a new place is always fun, but this place was extra fun because it is so different than something you would stay in back home. Our rooms are made of tents and all have an outdoor patio with a great view. Once we got all settled in, Cassie and I headed straight towards the front desk to sign up for a massage. 

We got our massage right away and it was so relaxing. It was in a place just like our rooms, but with a curtain in between the beds. It was an interesting setup and I definitely wouldn’t feel comfortable if the other person was random, but it was just fine for us two. The massage was 45 minutes and my body needed it! It was a great start to the day by the pool. After our massage we changed into swim suits and spent the rest of the day at the pool. We had a few drinks, and got to see a few elephants come up to the pond. We were all supposed to go on a safari at 3:30, but only a certain number of people could go so some of us offered to go tomorrow morning instead. While the other group was on the safari, 3 elephants came to the waterfall in the front of the lodge and were super close to us. It was awesome to see them so close. It was a great day in the sun, and very relaxing. 

We then headed back to the room to get ready for dinner and the night safari. We were just about to walk out the door to head to dinner when all the sudden the clouds got dark and our power started to go off and on. Before we knew it, it was pouring! We tried walking outside with umbrellas to make it to dinner, but the wind snapped my umbrella and it was raining too much we had to turn around. We were shocked that it had got so bad out, and were kind of at lost for what to do. About an hour later, we gained some confidence and called the front desk to get an escort to dinner. We arrived when everyone was already done eating, but hey at least we made it and we could get something to eat. Shortly after we arrived, they announced that because of the rain we could not do our night safari. This made me super sad,  but I am just hoping we can at least go on the one tomorrow morning. 

We were all bummed about the night safari but decided to book our adventures for London while we had down time. We figured out our group and got a combo package for the London Eye and a Thames River Cruise. This got our group a little more excited for the days to come and brought the mood up. To end the night, we sat around and played a few card games, while watching the sky light up from the lightning. It could not have been a more peaceful day, and it was a great break from the busy days. 

Once we were all ready to go we continued the safari, and went through many different puddles of water, while trying to just stay on the road. It was a fun experience, and felt like we were out mudding instead of doing a safari. It eventually stopped raining so much and we put the roof back up for the last bit of the safari. I was super tired and just about to fall asleep when someone yelled “elephant” on the way back to the lodge. I suddenly looked up and saw a baby elephant and its mom right next to us. They ended up going behind us and crossing the road, which was an unreal experience. The safari was full of action, as we saw many animals and had some fun in the rain! I would 100% recommend a safari to anyone who has not done one. 

After the safari, we ate breakfast, packed our bags, and hit the road. The rest of the day was just travel. We stopped for a bathroom break like 4 times during the trip, and it still got to be a very long ride. Just as we got to Kumasi and into town we tried turning and couldn’t quite make the turn. There was a car parked close to the curve with no driver in it, so we came to a stop for about 10 minutes. We were all over the ride and were just about ready to get out and start walking when finally they figured it out and the bus driver was able to maneuver his way out. By the time we got back to the hotel it was roughly 8:30 and we were hungry. We headed down to eat dinner and then went and packed our bags for London. The travel starts again tomorrow at 9am so rest is needed! 

When seeing the different incomes of occupations in Ghana compared to the US and having this sense of cognitive dissonance, a few things do go through my mind that seem to justify it. First off, yes the incomes are less, but look at the price differences of everything in the US compared to Ghana. Everything is so much cheaper in Ghana, so the lower income gets them a lot further than it would in the US. Another thing, is that just because I had actions that didn’t align with my moral values this one time, doesn’t mean that my values change or it’s an every day occurrence. I am essentially on a once in a life time experience, so I am trying to do as much as I can and trying not to worry about the cost so much.  Casual spending as much as some people make in a year, isn’t what I typically do, but sometimes it does happen. All of this isn’t enough to justify my actions and the global inequality seen, but does play a role in my mindset. 

This dissonance will stay with me when I get home. I won’t just spend money without thinking about it anymore. I will always be thinking about how much I spend and how it compares to people in other places. I will have a great realization on the privilege I have and be grateful I can live life the way I can. I want this dissonance to stay with me, in the way of giving back and being mindful with money. Anytime I see a donation or opportunity to give back I want to remember this dissonance and take action. I want this dissonance to guide my everyday life, by being thankful for the life I have and making all my life decisions reflecting on this experience of dissonance. Thinking deeper into the life we have and the guilt encountered on this trip will truly help me be a better person and give my life to others! 

Bonus points: You can flush a toilet by dumping a few gallons of water into the toilet quickly. The pressure makes the toilet flush on its own, without having to have a working toilet! 

The amount I have learned and grown on this trip is beyond measurable. I have learned more about myself and others on this trip than I could have ever imagined. First off, with just the eye-opening experience of the life that these people in Ghana live. Driving down the streets, you just see vendor after vendor, person after person, just trying to make it through life. These people are out in the heat every single day just to try and make enough money to provide for their family. At home we have the audacity to complain about water not being hot enough, or the food not being good, when in reality we are lucky to have what we have. People in Ghana would die to have the lives we have, and you do not truly realize the extent of that until you see it firsthand. 

The number of potholes in the roads and the number of unfinished buildings is also crazy. I have learned that we are fortunate to have smooth roads, as driving over one bump after another gets old quickly and slows down traffic a ton. Having paved smooth roads is not something you would appreciate, until experiencing a place like Ghana with many unfinished roads. We complain about traffic in the United States when we have nothing to complain about compared to Ghana. Swerving left and right, slowing down, and speeding up again continuously for hours to avoid the rough bumps is not something we experience in the parts of America we live in.

My adaptability and patience are the biggest skills that have grown on this trip. So many things have changed, and you would never know when something was going to happen or when you will be stuck in traffic. Ghanaian time is a real thing, so many times we were just waiting for a bus or for dinner. With these common occasions, my ability to adapt and my patience had to grow. If I would have been my stick to a plan self with truly little patience this entire trip, it would have gotten extraordinarily long, and I would have been very miserable the whole time. Being ok with a change of plans and not getting super angry from standing around, shows that I have grown in these skills just these two short weeks. 

The biggest thing I learned about myself on this trip is that I love children and have a very helping heart. Anytime I saw children I would drawn to them and always wanted to make a connection with them some way. Interacting with the kids was definitely my favorite thing on the trip and it also helped me grow. The children aspect of this experience is another example of how there is bigger problems in the world than the ones we often complain about. These children are roaming the streets, some half naked, by themselves, asking for food and money whenever they see a stranger like us. That is not something you see in America often and is something that pulls the heart strings. Children are feeling the effects of the Ghanaian people not having money to provide food and that is so sad to wrap my head around. We should not be complaining about trivial things like not having air conditioning for an hour, when there are kids starving in other countries. In another aspect, interacting with children built my strength as a person, to say no even when I really wanted to help. There were so many children you cannot give them all something, so sometimes it is hard, but you must stay strong and not give in. If I would have given one kid something it could have caused a bigger issue and fight, so it is best to just avoid the issue. Even though I could not help the children, I still loved making the connection with them and teaching them a little about the US.

Once again, I have grown in so many ways and learned beyond what I ever thought was capable on this short of a trip. I genuinely loved my experience in Ghana, and it is so cool to see how friendly everyone is even when most are struggling more then we could ever imagine. I will never forget the people I met and the connections I made on this trip, truly so grateful!

After a fun-filled late first night in London, I woke up bright and early to head to breakfast with a group of girls. We had the opportunity to sleep in if we wanted, but we wanted to make the most of our short time in London. We ate breakfast at a cute cafe and it was absolutely amazing. I had Eggs Benedict and the eggs were poached and so delicious. After breakfast we decided to head to a strip mall and check out a few stores. The first stores we went to were just for basic clothes you would wear everyday, but I wasn’t too interested because I was looking for more souvenir like items. We searched the map for a souvenir shop and it ended up being a decent distance away, so we broke out our navigation skills and hit the train. When we arrived at the souvenir shop, we knew we chose the right spot and were all very happy. I ended up finding a sweatshirt for myself, a fridge magnet, and a few shot glasses. This shop had so much cool stuff in it, I probably could’ve been in there for an hour, but we were on a time crunch.

We had to be at a museum by 11:20, and we accidentally left the souvenir shop a little too late. After hurrying our way through the streets of London, watching the time go by, we thought we had finally made it. However, that was not the case and we came to a locked gate. Google maps redirected us about two different times, and took us around the whole building before we finally arrived. Thankfully, nobody was mad and it turned out to be alright. This museum was super cool and we got to learn about many different medical supplies from the past. We then ate lunch and headed to the Anesthesia Heritage Center where we learned about the history of anesthesia. I actually found this information to be super interesting, but my 3 hours of sleep the night before was kicking in. I felt so bad, but as the speaker was talking I kept dosing off and then popping back awake. Once I could finally stand up, and look around this place I didn’t struggle so much. The coolest part about this experience at this place was getting the opportunity to put a tube down a dummies throat. After, we all headed back to the hostel and met by the bar for a speaker to talk to us about the NHS. He was a very good speaker and knew how to keep us all engaged. I learned about what the NHS does and how it works. Finally, to end the night we ate dinner at a fancy restaurant and were fed a 3 course meal. This was the most perfect way to end our experience in London and our whole trip in general.

London involved a lot of walking, but it was cool to first hand experience the streets and people in London. I am ready to be home, but at the same time so sad that this trip is over. Truthfully, so thankful for this experience and the relationships built on this trip.

A big thing I have grown on from traveling across the world is my ability to communicate with others. Language causes a barrier and you have to learn different ways to understand people and communicate with them. Not only did we have to learn how to communicate with different languages, but we also had to have great communication between each one of us to get the full experience and take it all in. No one could just go off alone in Ghana, so communication was huge to make sure everyone stayed safe. Along with my growth in communication, my confidence also grew. Before this trip, I was shy and tried to avoid communicating with people I could not understand very well. I also did not like asking questions, so I really grew in this way as asking questions was big part of this experience. By the end of the trip, I asked questions and engaged in many interactions with people. I also walked through the markets more confidently, saying no and walking away without giving in. 

Not only did my communication and confidence grow, but traveling also grew my patience and adaptability. Traveling across the world is a lot, being very tiring and long. Essentially once the flights are booked everything is out of your control, so you really just have to go with the flow. On this trip, we rode in a bus more than 55 hours in just 2 and a half weeks. That 55 hours does not even include the amount of time we spent waiting for a bus to arrive or for dinner to be ready. With that, patience and the ability to adapt to schedule changes is essential. These two skills had to grow on this trip or my life would have been miserable. Even in London, I could tell my patience had grown because we spent like an hour waiting for our tour guide and I was just chilling, not worked up. 

There is so much more to the world than our little place in South Dakota. Seeing new places and the lives of others really puts a new perspective on the life you live yourself, and I think everyone should explore the world. You don’t truly know yourself or what you like until you do things out of your comfort zone and find your true self. Sitting in the corner in one place your entire life  makes your views and opinions so simple and non diverse. You don’t realize the privilege we have as United States citizens and the life we live. The things we complain about seem valid to us, until you see the way bigger problems other people and places face. I learned that I really have nothing to complain about in life and I truly don’t think this realization would have hit if I would not have seen a different part of the word. New things are scary, but they will change your life more than you ever thought was possible.