Everything That Has a Name Exists

In the middle of an interview with a 65-year-old Muslim man at Pentecost Hospital (Alpha Medical Centre), he mentioned the phrase, “Everything that has a name exists”. This was not the first time I heard this cryptic statement. In fact, in an interview the day before, a Christian man at the same hospital told me the phrase. I am still trying to decipher what these men actually meant by this statement in the context of my interview questions, and I have asked others the significance of this phrase as well. Interestingly enough, the phrase tends to embody my research findings as a whole thus far. Everything that has a name exists…and it seems people like to talk about it all. What I have been reminded of in the past week is that life, illness, and research is insanely messy. I try to plan for each new day—how many patients I wish to see, how many doctors I hope to interview, and the number of hours I hope to observe patient-doctor consultations. Newsflash: it never works out how I planned. The clinic is a dynamic, incredible, and interesting place. One thing that it is not is predictable. To date I have witnessed feuding families over the death of an overdue 10-month pregnant woman, a nurse turned pastor who was praying and preaching in the main lobby, drug reps interrupting patient consultations to sell their latest meds, and chickens randomly running through the breezeway of the clinic. If there is one thing that I am sure of at this point is that people, like the medical institution in which I work, are incredibly complex and each have something distinctive and unique to say. It turns out that about half the people at the hospital are unable to communicate fluently in English. My Ghanaian friend Kobby came to the rescue and has been assisting me as an interpreter so that my research pool does not consist only of the more educated and younger Ghanaian population that knows English best. My interviews are tending to be shorter but more productive because I am getting better and asking the questions in a way that makes most sense. Although the interviews are shortening, I am constantly trying to be careful that I consider nobody’s words as less than others but completely hear each person’s story, for the life behind each person is no less important than the next. By encouraging each person equally, I as the researcher can be best assured that I am fully representing all that I can about Ghanaian spirituality and illness—the ultimate job I am here to do.

Baruch, the child of an interviewee who I became attached to.

Baruch and I at the clinic! I spoke with his mother who brought him to the hospital.
He became attached to me and quickly became "me adanfo" (my friend).

When I am not conducting research at the clinic, I have been entertaining a friend who has come to visit. Diana has just finished her first year of medical school at Duke University and has joined me here in Ghana for two weeks. I have set her up to shadow with a physician at a local hospital. They put her in the pediatric ward. One thing she has learned while in Ghana is that she will not be a pediatrician. I keep telling her that knowing what she does not want to be is just as important as knowing what she does enjoy. ;) Tomorrow, we are taking a long weekend adventure to Cape Coast and Kumasi, two major cities in Ghana with various historical sites and outdoor activities. It is incredible to share my life here with someone else from Duke. I have a feeling that my experiences of Ghana will not vanish with my coming home but will live on in my conversations with Diana for years to come. 

Diana and I enjoying our evening at the beach in Accra.

As I sit here and think about the various responses that I have gotten in my 40 interviews to date, I am reminded that there is so much more for me to learn. I honestly do not know that I will ever be done. I am always going to have more questions, more surprises, and tips that point me to even more inquiries. From the variety of responses I am hearing in Ghana, I am worried that I will end without figuring out everything that I want to know. Somehow, I will have to be okay with that—perhaps it will keep bringing me back to Ghana. After all, Ghana is the land where “Everything that has a name exists”…I hope to keep shedding more and more light on such existence.

Religion is...

An ode to religion as it relates to my experiences and research in Ghana:

Ubiquitous:

I cannot walk ten feet in this country without some sort of reminder that someone, somewhere believes in life after death, a benevolent God, or in basic religious tenants to live by. Spirituality has pervaded almost every advertisement, public transportation vehicle, store shop title, media outlet, and conversation in Ghana. My favorite examples of storefronts may just be “The Blood of Jesus Nail Salon” or “Have Mercy O Lord Beauty Salon.”  Even the newspapers depict this reality in that the bestselling issues are those with some sort of religious scandal on the front—perhaps a famous television Christian pastor has been adulterous, or maybe a Muslim imam has been worshiping at a traditional shrine. The religious demographics of Ghana have been somewhat debated, but most sources say that about 60% are Christian, 25% Muslim and 15% Traditional African Religious beliefs (with very few citizens claiming to be non-believers).  When conducting this research, I have become very aware that these numbers really are as unreliable as various sources claim them to be. Upon interviewing Ghanaians, a vast majority of them often claim to participate in the ceremonies of multiple religious groups—most often being their traditional or ancestral tribal beliefs along with their Christian or Muslim faith. This makes my job as a researcher a lot harder, but all the more interesting and exciting.

A way of life:

Today I was having a conversation with a Ghanaian man who I met last summer, and one of the first things that he asked me was to have a conversation with him about what I have learned about the worlds’ religions—how they differ, how they came into existence, and why they matter today. And so we sat and talked for a while until we shared what we have found to be important about the religions of the world, and how they work. I could not help but to think that the resulting long and fruitful conversation would have never happened in America—where we’re ‘too busy’ or often disinterested in talking about such philosophical and never-ending topics in detail. Thus, religion here is a way of life. It is what you talk about, but more importantly it is what you live. In almost all of my interviews thus far, everyone from Muslim scholars to various protestant religions to some traditional believers all seem to agree on one major thing: that we must live a life that depicts our spiritual beliefs. Talking is not enough, but walking the walk is a necessary part of religious expression and authenticity. As one Muslim put it, “your belief is not sufficient, you must practice what you believe in order to be healed” (Personal Interview).

An identity:

When I started this research last summer, I had no idea how to deal with the ultimate question that all researchers face. Do I allow myself to reveal personal biases that will reveal to my subjects who I am and what I believe as the researcher, or do I obey what I thought was the golden rule of the research—to strive to be an objective observer, to minimize biases, and to allow the informant to reveal his beliefs without invading with my own? I realized very quickly that Ghanaians are not going to let me get away with that “Golden Rule”. Ghanaian interviewees are constantly trying to gauge if I can personally relate, if I can completely understand their devotion to their spiritual beliefs. The answer is, as I tell them, I can. My identity as a Christian is a tremendously important aspect of my life, both here in Ghana and at home. It seems that making this known to my research subjects not only helps my research, but also validates me as a researcher on the topic in their eyes. I am able to sympathetically nod to a patient who is trying to explain to me that she prays when she is sick, and similarly I can understand a reference by a Muslim imam explaining that a “genie” is analogous to what Christians consider angels. Through my ability to relate to and understand the sort of beliefs that my subjects bring up, I encourage them to go deeper with what they are trying to say and avoid becoming bogged down by semantics or technical religious jargon. You know, there is part of me that is terrified to be writing this…perhaps all the researchers reading this are completely turned off by my overly biased research methods.  However, if we are to be honest with ourselves, no research is ever completely unbiased. Yes, it is commendable to design research projects to minimize all the ways that the findings could result from the bias of the researcher, but it is not always that simple. Perhaps not revealing my religious background could be a form of research bias, causing the patients to only tell me what they think an objective, nonreligious researcher would understand. If anything, this research project has taught me that sometimes my identity does not have to remain hidden behind my research. Instead, in the right contexts, my beliefs can help to encourage a truthful and powerful story from my informants that would otherwise remain unheard. This type of inquiry calls for a researcher who is flexible in her methods, who is ready for what each unique informant has to offer and to request of her. It is clear to me that the interactions I have with my informants both mold me as a researcher as well as shape the way I interpret my findings. Religion is an identity of this research, of the researcher, and of the informants—I have come full circle.

That which connects us:

Just a few days ago, I spoke with a beautiful and brilliant 18-year-old girl named Grace. Before our interview got going, she told me that she was about to take her SAT and that she wanted to go to an American college. I asked her which one, and naturally she said Harvard. I encouraged her to consider Duke as a top choice, as well. :) Grace spoke to me about how her Christian faith has helped her to deal with her chronic back pain. She kept telling me how my questions helped her to process exactly what she believed about how her prayers have been helping her get through her severe back pain both now that she’s come to seek medical care as well as before. Before she shared her insights, Grace wanted to know my religious beliefs. After she realized that my religious background aligned with hers, she began to open up more than I could have asked for. There’s a sort of trust inherent in knowing that the person you are talking with can understand your religious worldview and is not there to mock any sort of beliefs that are shared. Similar instances happened with a doctor that I interviewed about her Islamic beliefs as it relates to her practice of medicine. These situations remind me of a quote from an interview that I had with Dr. Raymond Barfield, a pediatric oncologist at Duke Medicine and a professor at Duke Divinity School on how he used his knowledge of religious beliefs in the care of a patient suffering from end-stage cancer:

It was the language of her life. So it made all the sense in the world to use [it]. It would be a shame to use this language for all the rest of her life and then to suddenly stop. You know, it actually is a language that is far more powerful for someone who frames the world in terms of faith like that than any language I could come up with looking at a palliative care communication manual about how to talk to people about hard things (Barfield, Personal Interview).

It is only when I was able to speak with Grace in the “language” with which she sees the world that I was able to obtain honest answers to my questions and a personal connection that I believe will last for a long time to come. On her way out of the hospital, she was determined to present me with a gift: a book on religion that she had been reading and thought would be good for me to read, as well. Later that day she looked up my number on the research information card that I gave her and called me just to inform me that “God is good, and [her] back will be fine”.

Inescapable:

Everyone has a religious worldview. Something that I have learned from scientists like Dr. Raymond Barfield at Duke or Dr. John Lennox of Oxford University is that even if one professes to have no God to answer to, this in itself is a religious worldview. In the US, it seems that it is often thought that one is either “religious” or they are not, but the fact is that we all are. We live in a world that is completely uncertain of the future but that relies on a personal faith that describes that unknown, theist or not. It has never been more clear to me that this question of the life hereafter constantly pervades the minds of the people here in Ghana that I have grown to know and love. In hearing stories after stories of patients facing a variety of debilitating diseases, it has become easy to reason that this is a question that no one can avoid. One way or another we all are going to leave this world, so we can either choose to answer the question now or forget about it only to have it be thrust upon us in our last days. While I have seen the latter happen often in the US, it is apparent that most Ghanaians practice the former, assuring that their personal spirituality is something of a very present reality and not something for a sickly distant future.

Nyame Adom & Gaining Access

When I walk down Ghanaian streets, I stick out like a sore thumb. I have never been so aware of my own presence until I first came to Ghana where my anonymity vanishes. At times it is bothersome—especially when I simply want to enjoy the sites and events around me while everyone is urging me to notice the difference of myself. However, I have quickly come to embrace this reality. It certainly helps me make friends. Countless Ghanaians ask me, “How are you doing, white girl?” in the Akan language of Twi. When I surprise them with saying “Nyame Adom” (meaning: I am doing fine “by God’s grace”) and continue in an impromptu conversation in their native language, they first are amused and then seemingly impressed. I will be the first to admit that I am nowhere near fluent, but the few phrases that I can use here and there have given me a connection to people that I’m afraid most foreigners are not aware of. I am incredibly grateful that most of the people in the city know English, the country’s official language that unites all peoples from different Ghanaian tribes under a single speech.

Unfortunately, my knowledge of the native language has not gotten me complete access to my research site yet. Yesterday, I had a meeting with the directors of the Alpha Medical Centre, a small hospital located in a modest section of Accra called Medina. The meeting was quite intimidating at first, since it seemed that I could lose the main field site of my research with one wrong statement in the presentation that I gave. Thankfully, the presentation went well, and the administrators seemed to think my research is highly relevant and important to their clinic. I thought that was it—that the oral permission of the hospital administrators would suffice and that I could start to interview patients. However, after two days later, many calls and emails to US advisors, and multiple trips to rare Ghanaian printing stations, I have obtained the necessary paperwork for me to proceed at the Alpha Medical Centre. They tell me that I will start tomorrow. I am extremely excited and a bit nervous to actually be conducting the research that I have been planning for and talking about for months. While I am sad for the days that were lost, the entire process was a learning experience and quite an adventure—two things that I am quite fond of.

In order to avoid feeling like today was a complete research day gone to waste, I set up a meeting with Gori, a Muslim scholar that I interviewed last summer about the ways in which Islamic beliefs affect the way Ghanaian Muslims view their health and make decisions when ill. I wanted to ask him a few follow-up questions about his faith and about his interactions with biomedical doctors in the community. He is an incredibly friendly man, and he was excited and passionate to tell me about everything that I wanted to know. The most interesting thing that he mentioned this time was about the interactions between physicians and spiritual leaders in the hospital setting. It seems that some doctors and most hospital administrations are adverse to the idea of community spiritual leaders coming in to pray for religious patients. However, this is not due to anything against religious practices in general. Instead, it is due to the fact that some spiritual leaders bring patients special holy water or herbal concoctions that they intend to use to help heal the patients of their illness. Because the contents and side effects of these spiritual medicines are unknown and often used without consulting the physician, doctors often are highly suspicious of spiritual leaders in biomedical settings. This can often create an environment that is hard for any spiritual leader to come in to pray for patients, unless, like Gori, you have a special relationship with doctors who have similar spiritual beliefs. Gori and his fellow Muslim leaders often have personal relationships with Muslim doctors who encourage them to come to pray for patients, often undermining the wishes of the overarching hospital administrations. This complex dynamic between spiritual leaders, religious patients, and medical professionals is exactly what I hope to somehow shed some light on in the coming days of my research. Fingers crossed, it all starts tomorrow.

Humble Reunions

 There's just something about Ghana that will always keep bringing me back. Today that "something" became a lot less of a mysterious inexplicable feeling and much more of a concrete reality. It's the people. Since arriving in Ghana just two days ago, I have been settling into my home stay, meeting up with old friends, and preparing for my research which starts tomorrow. My first few days reacquainting with old friends and having deeply humbling experiences with new ones has given me a perspective that I have been lacking in the past few months back in the states--fostering a sense of gratefulness and humility toward all that life has to offer. 

The most prominent quality of Ghanaian culture is its hospitality. A foreigner could not step foot in this country without feeling completely welcomed. Upon my arrival, I was overjoyed to be invited back into my Ghanaian home by my host family. They have treated me incredibly well and are an amazing testimony to the phrase that is engraved upon the entrance to their home: “In God We Trust”.

One of the most meaningful conversations that I have already had in Ghana is meeting my new, younger Ghanaian host sister. Her English name is Bridget, but both she and I are very fond of her Ghanaian name: Melenya.* Just last night we spoke for about three hours in bed about Ghana, our goals and dreams, and about life in our respective countries. Despite the misfortunes of her life, Melenya embodies a sense of gratitude, but more importantly, joy. Her optimism is infectious and her curiosity is a pleasure to encourage. Her attitude towards life and her giggly and unassuming demeanor reminds me of the kind of perspective that I want to have when interacting with everyone I meet. She reminded me that it is not enough to just claim that I “don’t want to judge a book by it’s cover.” It means meeting people and not just giving them a chance to make a good impression on me but to actively bring out the best in them and to help to cultivate what they view as their best attributes, not what I think such attributes should be. I look forward to many humbling moments with Ms. Malenya in the future—our girls nights may just become a tradition.

A similar meeting with a little girl that continues to blow me away was a reunion with Giftie. I met the sweet girl when I made the mistake of putting African braids in my hair last summer while in Ghana. Needless to say, the braids did not last long, and Giftie and her hairdresser mother had the task of taking them out. Upon meeting Giftie, I was astounded by her intellect. She was an avid story teller and would not stop asking me questions. In fact, her asking an abundance of questions reminded me quite a bit of myself. I quickly became good friends with this girl, visiting her every other day and taking silly pictures and recording videos for her to enjoy. Upon leaving Ghana last summer, I vowed to call her on Sundays and to become her pen pal (See Picture).

Today was a big day for Giftie and me. I decided long ago that I was going to surprise her with my return to Ghana. The reunion was an incredible one. Her mother brought me into their house, and I found Giftie watching Tom and Jerry on her television set. She jumped up, started tearing up, and leaped into my arms while exclaiming “Auntie Jessie’s back”! She then ran into her room and showed me all of the things she has been collecting to give me. She gave me letter after letter with stories and drawings on them. (See picture). She even completely filled up the coloring book that I gave her last year with detailed drawings and colored pictures on every page. Her dedication was so high that she even colored to the point of using up ALL of the crayons that I gave her, rendering them useless stubs. This girl is one of the most brilliant girls that I have met—with proper education she could go so far. I am excited to watch her grow and to continue our friendship. The last thing she said to me made me emotional as I was leaving her home this evening: “Auntie Jessie, you have made me the happiest girl in Ghana—no you have made me the happiest girl in the world.” As I was walking out of the house and clutching the hundreds of pages of work that Giftie has dedicated her free time to give to me, I looked back to Giftie and realized that she has made me feel the exact same way.

*Melenya wants me to tell you all that she is very excited that I told her I would be writing about her in my computer blog :)