Hepatitis B Screening and Vaccination Day

Thursday, June 12. Day 1 of the Hepatitis B screening and vaccination program at Nyanyano DA Government School. 

7:30 AM: I arrive on foot at Sweet Mother, a reputable food stall in Kasoa, to purchase lunch for the staff of the day. The one time I had been given lunch during a workday I was served rice, stew, and a hard boiled egg. I ordered six of these. "Eggs are finished" I was told. Chicken was the next least questionable option. "No no," said the woman (Sweet Mother?) "Chicken is finished." At 7:30 in the morning? Okay. "Cow meat!" she says, swirling a chunky vat of steaming brown. "Or fish." I glanced at the pile of dried fish stinking in a pile on the counter and dry heaved a little. The Ghanaian Hep B staff might have enjoyed cow meat or fish, but I was the one who had to sit with the smelly food in a taxi in traffic. I ordered rice, stew, and beans and hoped it would be an acceptable Ghanaian lunch.

8:15: Arrive at Nyanyano DA Government School with Claire, who started the project with me, and two new volunteers from our NGO who we have appointed to take over our project duties when we leave Ghana.

We greeted the headmaster and waited for our team to arrive. Mr. Tahir is the administrator of Justab Private Hospital and head of Alpha Al-Akeem, the organization that we are collaborating with to provide discounted screening services and vaccines. Tahir was to bring two nurses and a lab technician with him that day.

From the moment we set foot on the campus, we were swarmed with children. Teachers made minimal efforts to hold them back. We could barely walk to the headmaster's office through the crowd of jumping and screaming boys and girls. I felt like Beyonce.

8:25: Receive a phone call from Tahir saying that he is at the Station, just down the road from the school and will be there in a moment.

8:30: The program is set to start.

8:40: Call Tahir. Learn that the car his staff was traveling in had gotten stuck in mud. He had left to go rescue them.
9:00: Waiting.

9:10: Parents arrive for the optional pre-program parent education session

9:30: Waiting.

9:40: Panic. I confess angrily to Claire my frustration. She and I had been working day and night to execute this project. We raised over $3200 in one month. It felt like people didn't respect our efforts enough to be there on time. Rationally I knew the mud situation was completely unprecedented, but this wasn't the first time we had been left hanging like this and the feeling of disappointment in the moment was all too familiar.

9:40: Tahir arrives! We usher him into the classroom where parents have gathered. Tahir speaks in a combination of Twi and Fanti, two of the local dialects. We Obrunis sit cramped into the small old-fashioned desks and watch as he animatedly speaks then answers questions. 

I was thrilled that 10-15 parents had showed up. Based on what I have seen of the family dynamic and importance of work in Ghana, I had doubted any parents would give up work time to come to school to be educated about their child's health. The talk ended and the parents all rose to shake each of the Obrunis' hands, thanking us profusely. We thanked them for coming and began to set up the classroom, children crowded five deep around the doors and windows to watch us.

The screening began. We led in groups of ten children from class 4A. One at a time, they went to the front of the room and had a sample of blood drawn by the male nurse Atoo. Claire gave them all pep talks beforehand, warning them that the needle might pinch for a moment but that they had to be strong! The little boys were troopers, holding the cotton balls on their veins and flexing to proudly as they were led to another section of desks to wait for their results. A few girls cried, and we tried to go sit next to them and hold their hands if they looked nervous walking up to the nurse drawing the blood. 

(Photo credit Claire Boone)

(Photo credit Claire Boone)

The lab technician Nuzrat added the blood sample to a buffer and received results within a few minutes. We expected nearly all of the children to test negatively. The vaccine would be administered right there by the other male nurse King to the children with negative results. 

Unexpectedly, the second sample taken was reactive with the buffer solution, indicating a positive Hepatitis B screen. So was the fifth. By the time we had screened 25 children, we had five positive samples.

We continued with the pattern of taking ten children at a time, but our efforts to keep order were futile. There was not much technical work for the Obrunis to do so we focused on herding the children outside away from the screening classroom. 

Because of our limited funding we were only going to work with children in grade 4 that day. Our goal is to continue fundraising and promoting the project so that we can provide screening and vaccines for grades 5 and 6, and possibly the whole school some day. 

The day wore on, and around 2:00 the team broke for lunch. As I led Tahir, the nurses, and the lab tech to to the headmasters' office where the food from Sweet Mother was, I explained that I wasn't sure if they ate meat so I hoped rice and beans was an OK lunch. They didn't respond. I kept watch on the classroom while they ate. Afterwards, I asked if the food had been okay. I don't think they were impressed, and they made no effort to counter my assumption. Ouch.

After the food fail, we carried on for another few hours. By the end of it all, we had obtained the following results:

99 students screened
2 teachers screened
25 students absent
1 student opted out
91 vaccines administered
8 students tested positive

8 out of 99 our our sample group tested positive.Tahir was almost beside himself, he was so upset about the results. He had expected maybe one or two children to test positive. Eight, he said, was much too high. Especially for children. Our sample was almost precisely representative of Ghana's HBV morbidity rate of 8%.

The next step is to have a laboratory test the viral load of the positive samples. This test will tell how far the virus has progressed. If the viral load is within a certain limit in the acute stage, there is a chance the virus can be cleared from the body. But if the viral load is too high, then it has progressed too far to be cured and treatment will focus on symptom management and prevention of disease progression.

(Photo credit Claire Boone)

(Photo credit Claire Boone)

Of course, the parents of the positive children must be informed of the results.  We scheduled a date next week for Tahir and Claire to meet the teachers and parents. On that date they will also screen and vaccinate the children who were absent on Thursday.

Leaving Ghana will be bittersweet, but I will continue to work on this project from the States. I fly back to the US on Tuesday already, after spending 9 weeks in this country! I am excited to continue to move forward with this project though. 

Each vaccine requires three injections, so the follow-up for the group given vaccines on Thursday will be in one month. The third booster injection will be administered in September. As I mentioned before, we already have two volunteers who recently arrived in Ghana and will be here through August. They will take over the project when Claire and I leave (Claire is gone two weeks after me), and they will hand it off to incoming Public Health volunteers as they arrive. Claire and I will type up guidelines with all of the details  the successors need to know, and we will continue to manage the project remotely.

(Photo credit Claire Boone)

I'm not sure what I expected out of this volunteer opportunity. I think I envisioned myself doing background busywork for an already-established project. I never thought I would be designing and co-managing two screening projects (our tuberculosis screening was held two weeks ago, see previous blog posts). I am eternally grateful for being matched with Claire, a powerhouse of determination with the organization skills required to execute all that we did. I could not have asked for a more perfect partner-in-crime.

I had admittedly set the bar relatively average - not high, but not low - for the amount of a difference I could actually make during my internship. But our collaboration blew up the bar. I am really proud of what we accomplished and learned not to underestimate what I can accomplish by ignoring that silly bar and demanding results instead of hoping for them.

The One About Food

The Ghana Diet is pretty opposite of what I eat in the States. At home, I try (*key word) to eat mostly a balance of vegetables and proteins such as chicken or fish, tofu, dairy or eggs. (Of course, there are the inevitable junk food binges from time to time, and I won't pretend like I ever say no to chocolate chip cookies.) In Ghana, the diet is based on white rice, white bread, and potatoes. Plus sugar. And oil. There arent many protein options that are trustworthy in my opinion (its mainly questionable meat). Coming here for 10 weeks, I was in for a change.

Many Ghanaians eat heavy meals for breakfast, lunch, and/or dinner. I am usually on the go though and have smaller meals throughout the day, then a bigger one in the evening. 

Breakfast 

Breakfast for me here is either cereal and milk or fruit; the latter is sold on every road for crazy cheap. You can buy a huge mango, a papaya, or a pineapple for one cede (38 cents US) and the vendor will peel and cut it into a to-go bag for you right there. There are also bananas, plantains, apples, pears, oranges, watermelon... You name it. Yum. 

When my wonderful Grandma Eunice heard I was pining for some items from the US, she sent the best care package ever. After three weeks of uncertainty that it would make it overseas, the package finally arrived full of protein powder, Trader Joe's trail mix, and Starbucks instant coffee, among other treats that I usually tie into breakfast. Thank you Grandma!!!

Lunch 

Many restaurants, called "chop bars," offer meals of soups and stews for lunch. I usually opt for combinations of the snacks you can buy from street vendors though instead of big sit-down lunches. 

By around 11:00 vendors are in full force, carrying huge containers on their heads peddling a variety of foods. If I see something I haven't seen before, I generally buy it just to try once even if it looks undesirable. Most foods aren't more than one cede so if they're terrible, it's not a huge financial loss. The most common roadside foods include:

- Meat pies. Triangular pastries about the size of an open hand. Taste like Pillsbury biscuits. Apparently the meat is inside, but the one time I tried one I found only a tiny brown dot of sauce in the middle of the doughy biscuit. I guess that was meat? This was a one-time purchase.

- Egg pies. Similar to a meat pie, but with a hard boiled egg in the middle. I feel like sidewalk boiled eggs are a bad idea so this one I have not yet tried.

Egg pie vendor

- The "other" (awesome) egg pies: Face-sized pockets filled with a mixture of scrambled eggs and onions, deep fried. For some reason when I see the eggs cooked in front of me, even if in a vat of boiling oil, they seem more legitimate than hard boiled eggs that could have been cooked days ago. These egg pies are delicious but a definite heart attack waiting to happen.

- Corn: Either roasted on open coals or boiled in the husks. I hated both versions when I first tried them, as the roasted kind is very chewy and the boiled kind has no flavor. What good is corn on the cob without butter and salt, or chili and lime? But the roasted version grew on me, and the vendors will dunk it in salt water per request. The salt water is pretty unhygeinic if you think about it; I'm probably asking for a parasite. But I choose my battles here.

- Plantains: My obsession. Roasted over open coals like the corn, and you can buy little packets of groundnuts (peanuts) to eat with them. You break open the hot plantains length-wise and kind of jam the nuts in, and voila! Ghanaian version of banana and chunky peanut butter. The plantains alone are awesome as well. I usually have one each day as a between-meals snack.

- Variations on deep fried dough: Doughnuts. Nugget-shaped chips. Flat chips. Squiggly chips. The only ovens here are in conventional bakeries so most things are deep fried as an alternative to baked. Not particularly tasty, but also not bad.

- Groundnut candy: Peanut brittle. I sort of convinced myself its a healthy option. Nuts are good for you, right? 

- Ginger dough balls: These are chunks of ginger, groundnut paste, and sugar rolled into balls with the consistency of cookie dough. They are extremely strongly ginger-spiced. I love ginger and I can still only handle a little of this at a time. 

- Weird coconutty brittle cookies: I think they're meringue. No one else really likes these but I love them. I can only find them maybe once a week or so and have been known to chase the vendor from across busy intersections to stock up while I can.

Dinner 

Most big meals here consist of some form of starch (either banku, fuufuu, or kenke - to be explained) and a stew. Until Ghana, I pictured stew as potatoes, carrots, peas and beef in a heavy brown gravy. Ghanaian stews however are mostly tomato- and oil-based, with some onions and spices usually added. Okra stew is okra, tomato, and oil. Cabbage stew is cabbage, tomato, and oil. Egg stew is egg, tomato, and oil. You get the picture. 

Banku is fermented cassava and maize pounded into a dough and served in piping hot tennis ball-sized portions wrapped in plastic. Plain, it tastes like raw sourdough bread dough (or how I would imagine that to taste). I strangely really love banku, though most people merely tolerate it as a vehicle for whatever stew or dish it accompanies. 

Fuufuu is similar to banku, minus the sour taste. It is made from pounded cassava and plantain. When I tried it it was stickier than banku, which is really saying something because banku is a mess to try to eat.

Kenke is a little stiffer and is made from pounded maize, then wrapped in plantain leaves and steamed. It's grainier than banku or fuufuu and reminds me of the outside of an enchilada.

As you can imagine from the descriptions above, meals are heavy. And messy: Utensils are not usually utilized by Ghanaians. People eat with their hands, usually by using the starch (any of the three above, or perhaps boiled yams or if you're feeling really messy, rice) to scoop up portions of the accompanying stew or other dish. Its fun to try to eat this way, until you remember there is no running water anywhere and your hands are likely filthy despite the constant dousings of Purell. I opt for utensils, which are usually available for the Obrunis.


Tilapia and Banku 

This delicacy deserves its own in-depth explanation. 

Earlier I mentioned that I'm kind of a pseudo-vegetarian in Ghana, based on the questionable meats. My decision to go meatless was confirmed the day I went for a curious stroll through the market and unknowingly wandered into the butcher section. Huge slabs of raw cow, goat, chicken, and I-don't-even-want-to-know-what else were strewn across tables and market stalls, sizzling in the African sun and surrounded by vulturous flies. I decided at that point that I'd be ok sacrificing protein for two months. The chicken feet and giant snails roasting on sidewalk grills, along with the dried and deep-fried fetid fish being sold out of baskets on women's heads, also removed any desire I might have once had for meat.

Unfortunately, my cautious diet got boring quickly. One evening I worked late and decided to get dinner out in town instead of eating what was prepared at home that night. I passed a woman grilling fresh fish over a giant metal barrel filled with glowing coals. I was starving, and protein-deprived, and decided that since I had been sick to my stomach off and on regardless of what I ate for the past few weeks, I might as well give it a try. When in Africa...?

I was served a half of a giant tilapia marinated in magic and smothered in freshly chopped tomato, onion, and avocado, along with a tennis ball- sized packet of burning hot white Play-Doh wrapped in cellophane. 

The elderly lady who served me showed me how to pinch off chunks of the banku (not Play-Doh) and use it to pinch off bits of the fish and toppings. It. Was. Sensational. My mouth reveled in masochism as the homemade pepe (hot sauce) simultaneously sizzled my taste buds and demanded I consume more. 

Thank goodness the meal was served in the dark street, because there was no ladylike way to approach it. All too soon, I found myself staring down at a pile of fish bones. I felt like one of those cartoon cats that gobbles up a big fish and pulls the full skeleton out of its stomach. 

The next week, I brought back some of the other volunteers. We had a giant Obruni tilapia party to celebrate the birthday of one of the other volunteers. The elderly lady (Vic, I learned her name was) welcomed me with a hug and the broken "I have been waiting for you!" Her daughter and sous-chef Portia now hollers out to me in the street every day, asking if I'll be back for fish soon. Tilapia and banku is now a weekly tradition.

And, dear readers, I end this post with the following epic meal:

My lovely roommate Sara and I returned from a very late evening last weekend, starving. We raided the mostly-bare fridge and the care packages we had both recently received. It wasn't until after we'd chowed down that we realized the strangeness of all that was on the table, from both before our food frenzy and after. 

I spy with my little eye:

-Crackers (empty)

-Leftover cold spaghetti noodles

-Rat poison

-Mouse traps

-Chardonnay

-Nutella

-A mosquito coil

-Stale white bread

-Two mobile phones 

-Skittles

-Loose Ghanaian change

-Pepper spray

-Red Vines

... The wine had served us each a glass (by glass I mean mug) hours before. This was not an alcohol-fueled late-night meal. Just a desperate Ghanaian one.

Bon appetit!

CHF Public Health Ambassador Volunteer Opportunity

Finally got our volunteer opportunity posted on Idealist.org. For a chance to help out the Hepatits B Screening and Vaccination project I have been working on in a non-financial way, please check out: 

http://www.idealist.org/view/volop/wpTgsZx6KsCp/

Email me directly or at our program email, CHF.publichealth@gmail.com for more information. Thank you!

Ramblings.

In the past 8 weeks, I have collected countless observations that I have deemed somewhat unclassifiable for the sake of a blog post. They don't adhere to a theme or document a certain event. But to keep them from being forgotten in the depths of the iPad's memory, I figured I'd lay them out in a catch-all post.

I like lists. Who has time to read paragraphs anyways?

Things I miss from the US:

- Ice: It does not exist in Africa. And if it does, it's gone before you can sip the drink you drop it into.

- Ellenos Greek Yogurt: If you live in Seattle, go to Pike's Place Market and spend the $6 for a pint. Yes, I'm a yogurt snob, and you will be too once you've tried it. Dairy is essentially non-existent in Africa, minus shelf stable milk and cheese-product. (But those don't count. If it is safe at room temp, then I don't count it as dairy.) Ellenos is the food I'm most excited to get home to.

- Pedestrian right-of-way: Cars don't stop for pedestrians. Two other volunteers were in a taxi recently that struck a pregnant woman on the street because she didn't cross fast enough. Ghanaian drivers are not messing around.

- Parks: Kasoa is characterized by one long, filthy, dusty road. The sidewalks on either side are clouded with gas fumes and bustling street vendors (diesel-infused corn on the cob, anyone?). Trees are only present once you get back into dirt roads, and even then they are few and far between. I can't wait to be barefoot on grass or sand when I get back to Seattle. Gasworks, Greenlake, Golden Gardens: get excited.

- Baking. If you live within a 10 mile radius of me or do something even mildly niceish in the first few months when I'm home, expect some banana bread or a plate of cookies. Can't wait to get back to my favorite pastime.

Things I'll miss when I leave Ghana:

- Softball-sized avocados for 50 pesewa (14 cents US) each: Forget your $4, Whole Foods. I'm working on a strategy to smuggle a supply through Customs.

- Not wearing makeup. Ever.

- Going days without seeing my reflection: This is awesome, though it's always a shocker to catch a random reflective window when I'm not expecting it. I tend to not recognize myself, and usually look around for the disheveled, sunburned, wild-haired Obruni before realizing its me.

- Kids playing with a wheel on a stick. I don't know why this is so funny to me but I love it.

- The music. YouTube "Shatta Wale" and get excited about Ghanain dance music. Everyone here dances, all the time. There is always music playing and even better, no noise complaints. 



Situations: A few things have happened that have stuck with me in my time here. Again, they don't fit a pattern or belong in any other blog post. A few of my favorite random exchanges: 


Too Big

In my fist week in Ghana, before leaving for a 5-day trip to the coast:

Me: Is traveling safe? I'm afraid of being kidnapped.
Eric (NGO director): HAHAHAHAHAHA!
He falls over sideways, laughing for a solid 60 seconds.
Me: What? I don't get it .
Eric, wiping his eyes: You're too big to be kidnapped in Ghana!

(It's true: I rarely see anyone, man or woman, over about 5'9". I've got a good two inches on the average Ghanaian. Safe!)


The Name Game

Everyone in Ghana is given a nickname based on the day of the week on which they were born. There is a male and a female name for each day of the week. On my first day working at the clinic, the nurses asked which day I was born on. I had no idea, and was totally caught off-guard. Apparently that's something everyone knows here, and I wanted to fit in, so I quickly spat out "Tuesday!" My Ghanaian name became Abena, which a lot of the nurses and people I pass in town still call me (people here have a hard time saying "Emily" so when anyone asks my name, I usually say Abena). I fact-checked later that day, and learned that November 2, 1989 was actually a Thursday. My Ghanaian name should be Ama. Whoops. My little secret. 


Why aren't you running?

I run a few mornings each week before work. The humidity is debilitating even at 6:00 am, so my efforts are usually limited to about 30 minutes. One morning was especially muggy and hot and I slowed to a walk as I neared home. People always stare as I pass and sometimes call out, as I must look absolutely ridiculous to them. You don't see a lot of joggers in Africa.

On this particular morning a little girl yelled out. "Obruni! Obruni! Are you exercising?" I smiled and waved and continued walking. Children are usually content with small acknowledgement, but not this one. "Run, Obruni! Why aren't you running?"

I was taken aback, and ridiculously, my pride took a hit. I thought bitterly, "Well, little girl, because I just ran 3 miles and it's 90 degrees, so lay off!" She kept at it though, following me. "Run, Obruni, run! Exercise!"

I didn't know how to respond, other than to start running. She ran behind me, waving a stick, yelling "Run! Faster, Obruni, run!" until I turned up the dirt path to my house. Confused and exhausted, I collapsed onto a step, ashamed to have just fallen bully victim to a bossy African 8-year-old .  


How we really feel about your paintings

Vendors in Africa are overwhelming. Most of the touristy areas have tons of vendors selling basically all the same things: the same beaded bracelets, the same carved bowls, the same paintings in the same styles. All claiming to be original and hand-made, of course. They're nice to look at, but if you let your gaze linger on an item for more than a second, the seller is all over you like white on rice, shoving said items in your face and yelling about the good price.

My volunteer friend Claire was on a solo excursion in Osu, an artsy neighborhood in the capitol city Accra. A vendor not only called out to her, but started following her down the street with a painting of his, begging her to come into his stall and see his work. She tried to politely shrug him off but to no avail. After he had followed her for a few blocks, she turned to him and said, "You know what? I actually hate paintings."
Confused, the seller stopped. "You hate paintings?"
Claire: "Yes. I hate them. A lot."
The vendor considered. "Well what about bowls? I have bowls too."
Claire: "I hate bowls too. In fact, I really hate bowls."

While the man bewilderingly tried to piece together how someone could hate both paintings and bowls, Claire slipped away into the crowd. From now on, we all hate paintings. Works like a charm.


People: They don't each deserve a post, but at least a shout-out.

Koffe: The creeper Rasta who I've seen on 4 different occasions on three different beaches in Ghana. He looks like a mini Lil' Wayne, and is either slow on the uptake or embraces the Rasta tradition of marijuana all the time (definitely the latter). He never lets me walk away, always complaining I don't want to be his friend (I don't) and begging for my phone number (not happening). I first met Koffe in Busua Beach, which is a 6-hour trip away from where I live in Kasoa. The very next weekend he was at Kokobitre, the beach nearest Kasoa. Three weeks later, I heard the familiar "Emily!" in his slurred Ghanaian on a beach in Cape Coast, another 4 hours away from Kasoa. Once again at Kokobitre again a few weeks later... This guy seriously creeps me out. He's too stoned to be harmless and I'm a solid 8 inches taller than him, but still. I don't get it.

Pacques: Pacques is 2 and lives on the dirt road on the way to my house. He runs to me every single day, without fail, as I walk home. For weeks he yelled "Obruni! Obruni!" while I corrected him "Emily, Emily. Not Obruni." The first time he yelled "Emily" was the proudest moment ever. One day last week, he jumped out of the bucket he was being bathed in, suds and all, and flew at me while his mom and siblings cracked up on the porch. I always grab him and carry him back up the road with me while he wears my sunglasses and pokes at my white skin. I love this child. He has two older sisters, Vanessa and Monique, and cousins that live with him named Precious and Rhoda. Many of the children here are overwhelming with their yelling and taunting of the Obruni, but these are among the few that are great.

Clinton and Maria: Two more children who live near me. About 10 and 8 years old, respectively. They run a shop that sells crackers and laundry soap and little convenience items, and I don't think they go to school, since they are there all day. Every once in awhile the mother will be there too, but the kids mostly run the shop. Some days when I walk home they're dancing or playing games and I'll stop to play with them. The funniest thing in the world, apparently, is when I join their dance parties. "Dance, Emily, dance!" I don't have to be told twice... it's worth it to shake it a little and make a fool out of myself to see them rolling on the ground crying laughing at me. Always a mood lifter!

Joyce: An Obruni who moved to Ghana in the seventies and now lives as a local on Kokobitre Beach. Originally from Oakland, CA, Joyce traveled to Ghana to work with a project to save traditional Ghanaian music.  She has been here over 40 years now, and must be in her late sixties or early seventies. She walks around the beach in her bikini, selling handmade jewelery to tourists to support the music she came to save.

Abiba and Amalia: The two sisters who run the fruit stand near our office. I don't know which is which, and call them both by both names, and they both answer to both. I'm pretty sure they think all the white people are the same person too, so it all works out. They see me coming each day and begin peeling a papaya ("paw paw") for me, picking out a less-than-ripe one the way they know I like it.

Felicia: Runs a beauty shop next to Abiba and Amalia. She's super sassy and loves calling out to me while she has clients to show that she's friends with the white girl. She taught me to say "Nyame bwa, ochina" as I leave for the night, which translates to "If God permits, I'll see you tomorrow." It's always hilarious when I say it, even though it's been a daily routine for 8 weeks now.

Charles and Rosamund: The mother-son duo at the Forex money exchange in Kasoa. Charles is at least 6'5", skinny as a rail, and ambiguously aged anywhere between roughly 17 and 25. Rosamund is cheerful and motherly and constantly nags me to date her son. I don't give a straight "no" because I don't want her to cheat me on the exchange rate (she handles the transfer of US dollars to Ghana cedes). It's kind of weird. But they're both sweet, and the Forex is air-conditioned, so I don't mind making frequent trips to change my money there.

There have been plenty more noteworthy people and countless memorable events, but these are the ones that sprang to mind and seemed least likely to put you to sleep during this post. To be continued as more occur!

Nailed it!!!

Yesterday was the opening day of our tuberculosis screening. In short: successssssssss!

 

First, the exciting stuff because I don’t want it lost at the end of this post. I’ll rehash the project background afterwards.

 

Claire and I showed up in Nyanyano, where the screening was held, at 8am. We were going to hold a “dehba,” an event where the community gathers in one area to hear about a specific topic, whether it be health-related, community-related, politics-related, etc. Ours was going to be an educational session about tuberculosis.

 

After the dehba, we would screen the attendees. We had gathered 6 volunteers who speak Fanti (the local dialect) and they were seated at individual tables where they gave a questionnaire to each person who arrived. The questionnaire determined whether or not the person was a TB suspect. If, based on a points system, they were determined to be suspect, they would be directed to the nurses and a sputum sample would be collected. An hour later they would produce another sample, then be free to leave.

 

The dehba would start at 9am. We had rented chairs and canopies and started setting up in a vacant lot at “Last Stop,” the well-known last taxi stop on the main road in the town. Earlier that morning and for two days prior, a truck with a public address system had travelled the community announcing the dehba.

At 8:45 oldest woman I have ever seen hobbled up with a cane and plopped into the very first chair, front and center. I handed her a flyer on TB that was translated into all the local Ghanaian dialects, but I’m fairly positive she couldn’t read any. She gave me a toothless smile and nodded her thanks.

 

More people began to gather at 9. Unfortunately, the volunteer who was supposed to give the educational speech about tuberculosis didn’t arrive. We called and waited and finally decided to delegate the speech to one of the nurses helping with the event, Mary. She did an awesome job and people were very attentive. They were eager to be tested though, so the screening began shortly thereafter.

 

 The initial turnout was fairly low. The sky was gray and clouds threatened to spill. However, people began to gather as the morning went on and soon we were slammed. I was filling out sputum sample labels like a machine for a solid hour or two and didn't even notice a cameraman from TV Africa showed up. There was a reporter snapping photos as the crowd grew. 

Soon the rain hit though. Unfortunately it dumped and dumped like it never does in Ghana... Literally the only time it has rained like this in my 7 weeks here. 

We had an unfortunate loss to follow up based on the need for people to produce  two sputum samples one hour apart. Twenty of the people we obtained a first sample from left and did not return to produce the second. But we had canopies for people to sit under and the majority waited the hour between sample collections.

All in all, it was a major success. We screened 86 people and of those, 53 were considered "suspect" and provided sputum samples to be tested for TB. And this was only day one! We will return to Nyanyano next Monday, Tuesday, and Thursday and will hopefully be able to reach the people who did not provide second samples. 

I literally got chills at one point when I realized that odds are, none of these people would ever go to a government clinic and would therefore never be tested if not for our work. Claire and I planned this project from scratch and I'm so proud of our efforts! And we are eternally grateful for the help of the awesome people who were willing to lend their assistance. This is definitely the coolest thing I've ever been a part of. I can't wait to see how next week pans out.

CHF volunteer Marissa, me, Gifty, Claire, Nurse Eunice. Soaked from rain, not sweat (for once).

Claire and I recording with Gifty

 

And now, the recap for you fair-weathered blog followers: My other Public Health half Claire and I started this project from the ground up. The NGO we volunteer for, Cheerful Hearts Foundation, was asked by Ghana Health Services to research the level of tuberculosis knowledge of people living in the Central Region of Ghana. Before I arrived in Ghana, Claire played a key role in composing a survey that would be administered through interviews with members of five local communities.

 

We began the interviews right about the time I showed up. The first community was a fishing village called Nyanyano. We completed 200 surveys.

 

A little TB background: The government of Ghana recently announced measures to take a serious stand against tuberculosis. All screening and treatment at government-run clinics have been made completely free. Tuberculosis is often fatal if left untreated, but can be prevented with a vaccine and treated with prescribed medication. 

So given the seriousness of the disease, one would think negating the financial burden would incite people to be screened. Unfortunately, our survey told us otherwise.  We discovered that 78.5% of people interviewed do not go to the doctor for regular checkups: 46% had no identifiable reason, 22% claim to never get sick, and 13% were unaware the screening is free and thought it would be too expensive to go to the doctor.

 

After interviewing in Nyanyano, we were supposed to move onto the next community. But Claire and I wanted to do something for the people we had just spent weeks surveying. The aforementioned numbers bothered us, and we didn't want to leave them as just statistics. We wanted to change them, and so started researching how to bring a screening to the community.

 

We met Eunice, an administrator at the Nyanyano Health Clinic. She introduced us to her team of nurses and a community volunteer who all work specifically with TB. Nurse Eunice (different than Administrator Eunice), Gifty, Mary, and Esther joined our efforts.

 

The Nyanyano Health Clinic doesn’t have the appropriate lab facilities to screen for TB, so we contacted clinics in nearby towns. Claire and I approached administrators at the Kasoa Polyclinic and at St. Gregory’s Hospital, located in the nearby Liberian Refugee Camp. Both seemed intimidated by our requests for assistance, so we looked into other lab options.

 

We were introduced by chance to Dr. Samuel Kudzawu, a local man who studied at and now works at the Korle Bu teaching hospital in Accra. He lost his sister to TB and both his father and brother had the disease, and he made it his life work to research and treat TB in Ghana. He and his assistant Tony run an independent lab in the Liberian Refugee Camp and were thrilled to take on all of our samples to test.

We held several meetings with all the key players over 2-3 weeks. The costs of the screening were minimal - roughly 200 cedes ($75 US) thanks to the government assistance in providing materials for screening and treatment. Finally it all came together yesterday and I couldn't be more thrilled. Our efforts paid off! 

Stand by for final numbers, TBA after our full screening. Thank you for all the prayers and support! 

I will punt...

...the internet in Ghana.

I have been trying to publish a new post for a week now about last weekend. However, the world wide interweb is proving to be a little biased on the "worldwide" front and doesn't work so well in Ghana. I'm about ready to lose it here.

I didn't forget about you, readers, if you exist.

Stand by for more efforts tomorrow maybe.

Boti Falls: A Visual

Last Sunday two other volunteers and I made the day trip to Boti Falls, a park in the Eastern Region of Ghana, to complete a hike boasting a deformed palm tree, a balancing rock formation, and some beautiful waterfalls.

We arrived at the entrance to the park around 11AM, where we paid a small entrance fee and picked up a guide to lead us on the trail. After pulling up our socks in defense of possible fire ants (oh wait, that was just me) and applying cancerous amounts of DEET to ward off mosquitos, we hit the Sunday-empty trail.

The experience is much better described visually:

Do I remind you of someone? Channeling my inner Jake Botts (for those of you blessed to know my fashion-forward brother): high socks, a cut off tank, Wayfarers, and a Jansport backpack. 

Natural cave formation in the rocks

"Umbrella Rock" - our fearless guide Isaac leading the way

Legend has it that women who sit on the rock at the base of this natural three-headed palm tree will have twins when they become pregnant.

... I was the only one to test the theory. Stand by for results.

En route from the twin tree to the falls. We passed through a beautiful meadow... It smelled so outdoorsy and wonderful after weeks of constant sewage aroma in Kasoa.

First view of the falls

Isaac left us on our own after making sure we could make it back to the base of the trail. We wasted no time getting in the water.

Best day trip to date! I was so thrilled to see a region that had more nature to offer than our urban home base of Kasoa. A Sunday well spent.

Keepin On Keepin On

Work has not only picked up, but taken off at a full sprint over the past two weeks or so. I continue to spend Monday and Wednesday mornings in the Reproductive and Child Health unit of the government clinic, assisting with vaccine administration to adorable Ghanaian babies.

Outside of the clinic, I am still conducting interviews about tuberculosis with the two other Public Health volunteers. We aim to conduct 200 surveys in each of five nearby communities, and will then compose a report of our findings. The Ghana Health Service requested the assistance of Cheerful Hearts Foundation to gain perspective of the local knowledge about tuberculosis. Our final report will be a response to this request.

In addition to the research we gather for this report, we also give tuberculosis talks at local schools. The week I arrived in Ghana was the beginning of a national two-week school vacation, so I did not begin these school talks until more recently. I enjoy the talks because the children in Ghana speak English more comfortably than the adults, and they are receptive to and understanding of the information we present to them. The adults we interact with for the interviews are often more difficult to converse with due to the language barrier.

Tuberculosis school talk 

Even with these given tasks, my Public Health partner-in-crime Claire and I were getting antsy with lack of activity. We usually finished with our workdays around 1:00PM, and then were left with too many hours of muggy daylight to whittle away at by checking our Facebooks and Instagrams over the unreliable and painfully slow Internet connection available in our cramped office.

I have mentioned briefly the goal we created to create a free health screening for the community we conducted our first interviews in, Nyanyano. What started as a small thought seedling has blown up incredibly in the past few weeks and we are now up to our ears planning to hold not one but two separate screenings in the next month.

We initially wanted to hold a free tuberculosis screening since this is the disease that most of our work focuses on. However, our director Eric heard that we wanted to hold a community screening and insisted that we consider Hepatitis B, as it is currently a more prevalent and less treated threat in Ghana.

Claire and I researched both diseases and their respective vaccination processes and costs. We met with Mr. Tahir, the administrator of a local private hospital who has worked with Eric in the past on screening projects. Mr. Tahir, like Eric, was insistent that we focus on Hepatitis B. He offered to help with the screening by providing nurses and lab technicians as well as discounted vaccines and corresponding necessary materials.

We calculated the cost per person and targeted a demographic. Children are especially vulnerable to Hepatitis B. Due to close proximity to others in schools combined with lack of knowledge about personal hygiene, they play a key role in transmitting the virus from person to person. We chose a demographic of children attending a government school in Nyanyano, a fishing village about 20 minutes from where we live in Kasoa. The children at the government school are the poorest of the poor. We chose to target 400 students in grades 4, 5, and 6.

 Year 4 children at the Nyanyano D.A. Government School

A vaccine series consists of three separate shots given a month apart each and costs 50 Ghanaian cedes (roughly $18 US). Ghanaians work primarily with small amounts of money and are stingy with anything over 10 cedes or so. Everything is bartered and people are meticulous about being exact with transactions. Though $18 US seems like a small price to pay for a potentially life-saving immunization, most Ghanaians are highly unlikely to ever shell out an amount that large for one thing.

Claire and I went to the Nyanyano District Assembly Government School and met with the assistant headmistress, who welcomed our proposal. We returned the next week to meet with the headmaster and secured dates for the immunizations. We calculated a monetary goal and created an informational website at GlobalGiving.org (link below). We are in the hard-core stages of fundraising and have quite a lofty goal, but are determined to utilize all resources to reach it in a month.

http://www.globalgiving.org/projects/hepatitis-b-vaccination-for-ghanaian-children/ 

If that doesn’t seem like a full plate already… I mentioned we had decided to plan two screenings. The other is for tuberculosis. I felt like since our work here focuses on TB, I really wanted to follow through with that disease and provide a screening for the people we have interviewed for our Ghana Health Service research. The government pays for screening, vaccinations for children under age 15, and treatment for anyone with TB. People do not utilize the services however, mostly because of the inconvenience of commuting to a government clinic.

Claire and I came up with an idea to charter tro-tros (busses) to take patients from the community to the labs where they can be tested for tuberculosis. We met with Eunice, the amazing, no-nonsense, power businesswoman administrator at the Nyanyano government clinic. That clinic does not have a lab, so we need to collaborate with two other local clinics with the appropriate facilities.

So we paid visits to Dr. Senya at the Liberian Refugee Camp’s hospital and the administrator Sarcodei at Kasoa Polyclinic. We created formal proposals for all the key players and have been taxi-ing all over Central Ghana meeting with one, many, or all of them each day.

There are many conflicting opinions about details such as the form of screening we should use (skin testing vs. sputum collection) and whether we should transport the patients themselves or just their samples, which we can collect on-site. Everyone seems to have different input but no one has the time to all meet at once so Claire and I are definitely being challenged to keep it all straight.

We met again with Eunice yesterday, who is planning a debah (“day-bah”) (don’t spell check me there) on May 29. The debah is a community event during which the screening will be introduced and the locals will be educated about tuberculosis. Eunice has a team of two Ghanaian TB outreach members and one Ghanaian volunteer who will execute this debah (the language barrier will make it hard for Claire and I to head it up). We are funding the canopy and chair rentals however and are praying our fundraising efforts pan out.

The planning process is exhausting but I know it will be worth it.

Even with all this craziness during the week I make sure to get some adventure in on the weekends (priorities!). I’ll try to crank out another entry soon detailing the waterfall hike I took on Sunday. In the meantime I’d love it if you can check out our Global Giving page or “like” my post on my Facebook so it attracts more traffic. Prayers and emails/blog comments are always welcome too! I love to hear from anyone who’s following. 


Emily

Cape Coast

Last weekend I traveled to Cape Coast, one of the more popular tourist destinations in Ghana. Cape Coast is home to the Cape Coast Castle and slave forts, Kakum National Park, and University of Cape Coast, among other attractions. The University hosts exchange programs with students in Europe and the US, so the town offers a slightly more varied cultural demographic than where I live in Kasoa, but Ghanaians still make up the overwhelming majority of the population.

I arrived late Saturday night and met up with some volunteers from my program who had made the trek earlier in the morning and had visited all the attractions that day. We had a large communal bungalow booked for 15 cede each per night (around $7 USD). The room was modest and lined with bunk beds fitted with mosquito nets, but outside was a beautifully landscaped courtyard that housed several huts with flush toilets (a luxury!), open-air shower huts, hammocks, shaded lawn chairs, and a full outdoor restaurant and bar.

The "real" shower was amazing after a month of bathing out of a bucket.

The pack of Obrunis and I went out that night for a drink at an amazing hidden upper-level bar on stilts overlooking the crashing ocean. I was half-convinced the place would collapse onto the sand and rocks below, and even more so when we were joined by one of our Ghanaian foundation directors and his friend who had traveled to meet up with our group and an impromptu Ghanaian dance party commenced. Thankfully the creaky stilts held up, and we made our way back to the bungalow in the early hours of the morning.

After too few hours of sleep, the group groggily arose and some of us made our way to a great breakfast cafe where I ordered a pancake, one of my favorite Ghanaian discoveries. The pancakes here are eggy and thin like crepes, and I ordered mine served with avocado and sugar like I had had it served in Busua Beach on my first weekend in the country. One girl went on a limb and ordered a chocolate pancake, which turned out to be a crepe smothered in Hershey's syrup. Nice.

I broke off at this point from the group, excited to spend a day by myself taking in the sights at my own pace. Kakua National Park sounded amazing but was a fair distance from where we were staying. Also I'm irrationally terrified of alligators and therefore was not overly enthusiastic about the possibility of running into one at the nature reserve. I chose to spend my time at the Cape Coast Castle and slave forts instead and broaden my historical knowledge. It was also located quite conveniently about a two-minute walk from our breakfast spot. I paid a small entrance fee and joined a tour that was just beginning with a group of about 8 visitors.

Built 349 years ago, the massive whitewashed structure overlooks the ocean and boasts menacing cannons and countless turrets. Contrasted against the bluest sky and turquoise ocean, the landmark is a beautiful and famous hallmark of Ghana's Gold Coast. Unfortunately, the beauty is dimmed considerably by that which is unseen from the outside. The castle houses several dungeons where Ghanaian slaves were held in the most brutal, unthinkable conditions before being shipped trans-Atlantic by the English conquerors in the eighteenth century.

Courtyard of the Cape Coast Castle. My back is to the ocean, and I entered through the archway under the stairs directly ahead of me. The dungeons are located below this open-air area. The rooms here housed governors and military personnel back in the day. The ones on the left are now a museum, and the others are preserved for public viewing.

The tour, given most excellently by a man named Isaac, was incredible. He led us into dim cells carved out of the stone foundation and explained that over 200 men would be packed into each chamber at a time for up to three months. Those who survived would be shoved out of the "door of no return" onto slave ships where they were stacked like books on a shelf in cramped vessels. If they survived these barbaric voyages, they would be sold into slavery in the Americas. 

In one such chamber, Isaac pointed to a mark on the wall about thigh-high and explained that that was the level to which the chamber was filled with human excrement due to inadequate drainage systems. In another cell that had been used for solitary confinement for those who had fought their captivity, he pointed out the scratches in the stone floor from the shackles and chains used to restrain such men. The women were treated slightly better but were not immune. One chamber about the size of my bathroom in Seattle (which is tiny) was said to hold 8 women at a time for refusing the sexual advances of their European captors. 

I literally had chills that kept erupting into goosebumps up and down my arms despite the 90-degree heat. I was both haunted and enraptured by the tragic history that took place right where I stood hundreds of years ago. I saw a plaque presented by Barack and Michelle Obama, who visited the castle in 2009 with the belief that Michelle's great great grandfather had spent time in the dungeons below. Another plaque hung in apologetic remembrance of those who suffered there.

This portion of my trip was very different from anything else I've done and was incredibly sobering. In reflection, I really enjoyed being able to experience firsthand such an impressive memorial commemorating an unthinkably dark time in African history. I realize how lucky I am to be living in the era that I am, where persecution to this degree is not a factor. I am not naive to the reality that there is still incredible suffering in the world even if it is not portrayed as publicly as it was when these slave dungeons were active. It takes an experience like this one to remind me that using a latrine cannot be classified as torture, and to be grateful for the life I was given and the opportunities I have to experience snapshots of those of others.

My bus story is better than your bus story.

Ask a person who regularly utilizes public transportation, and he or she will likely have a crazy story or two about a memorable experience that took place on a plane, train, or automobile. Remember when our commuter ferry was given an impromptu acrobatic demonstration by a pod of performing porpoises?  How about the traveling brigade of mimes on that flight from Salt Lake, or the time you ended up sharing a cab with a Dumbledore- doppelgänger who rambled the whole way about the "kids these days"? Right. Well, I’ve got one for the books. Raise your hand if you’ve ever first-hand witnessed a bus exorcism.

Thought so.

On Saturday afternoon at 4:00PM I boarded a tro-tro (crowded African minibus, for you first time readers) with the intent of meeting several other volunteers from my organization in the beach town of Cape Coast. They had spent the day there, and I was very eager to join them for the evening and remainder of the weekend. One problem with tro-tros is that they will not leave the station until full. An hour and twenty five minutes later, we finally were on the road. Clearly Cape Coast was not a popular destination that afternoon. Frustrated but satisfied to be finally en route, I pulled out Pat Conroy’s The Prince of Tides and settled in as comfortably as I could to read peacefully on this 2.5-hour journey.

Within thirty seconds of departure I was startled by a man in the front row who, kneeling on his seat and facing the back of the bus, suddenly began yelling at top volume. The man wore a gaudy purple tunic adorned with silver piping. He was about thirty and at first glance attractive, if you discounted the crazy fire in his eyes and irate froth that was already starting to manifest around his goateed mouth.

I looked around, bewildered, as the other passengers patiently sat at attention. The man threw out a singsong “Hell—oo” to which they replied in unison, “Hi.” And again, like an elementary teacher ensuring attention from a group of children. “Hell—oo.” “Hi.” Suddenly he barked out a command, and the passengers shuffled. I became uncomfortably aware that I was the lone Obruni on the tro-tro, and was situated quite conspicuously smack in the middle seat of the middle row. The shuffling stopped as the passengers procured Bibles from their backpacks and purses. Suddenly the man in purple broke into hymnal song, and was enthusiastically joined by the entire tro-tro. Minus the blonde in the middle who didn’t speak Twi.

I should preface that I am a Christian, and absolutely am not mocking the message that the man was supporting. I was just completely caught off guard by what I was about to encounter, and could not in a million years envision a similar situation on Seattle’s 40 Route that I took from Ballard to South Lake Union all winter. The fact that such a display of religion was so aggressively presented in a public setting seemed crazy to me. It was incredibly invasive, yet so brightly received by the audience. Talk about culture shock.

A few hands-in-the-air, swaying-side-to-side minutes later the singing stopped and the real show began. The preacher began to dramatically dictate from the Bible he held, gesticulating riotously and shouting the words with enough Twi fervor to distract from any light reading I had planned on accomplishing. He leaned into the face of the man in front of him, screaming inches from his face like a drill sergeant. He palmed the head of a preteen boy to his right and looked maniacally into the boy’s eyes, shaking his free fist toward the heavens then back to the boy. I realized that if he outstretched his arm just a bit further, my own head was within palming distance. At this point I decided to duck down and focus on my novel as best as I could.

This proved to be wildly unsuccessful. I read page 141 about seven times over and over again without absorbing a single word, as the preacher became more and more agitated and I could literally feel the force of his words rattling my skull. I was absolutely incredulous that this spectacle was not only tolerated but accepted and responded to by my fellow passengers as well as the driver and the “mate” (the man who handles money and keeps track of stops) of the tro-tro. Every few minutes the “Hell—oo” “Hi” routine was repeated. There were several “HALLELUJAH!”s directed to individuals who answered on cue with chirping “Amen!”s. I felt him aiming his words at me as he switched to English, shaking with passion as he hurled scripture in the direction of the one person not responding to his tirade. I kept my head down, fighting the inappropriate urges to:

a) Request that he employ his “inside voice”

b) Look up and engage in a stare-off that would undoubtedly open doors for him to save my heathen American soul

c) Laugh

As a young girl proudly knelt on her own seat to read a passage from the Bible while the preacher nodded approvingly and interrupted periodically with his own two cents, I whispered to the boy next to me, asking for a piece of paper. I held open his Bible for him while he tore the requested scrap from an exercise notebook procured from a ragged once-pink backpack. For the next several minutes I took notes on the situation, suddenly itching to document the other-worldly peculiarity of the scenario.

As I wrote, a sudden hush fell upon the tro-tro. A women to my left bowed her head and silenced her toddler. I peeked up as the preacher laid his hands on the shoulders of the mate. He suddenly screamed, in English, an astonishing commandment for the demons unseen to free this captured man from the forces of the Evil One. The passengers held their hands up and murmured words of support. The mate raised his head to an outbreak of applause.

The preacher shouted out in Twi again, and everyone shuffled once more, this time procuring cell phones. He barked out his phone number in English as the passengers frantically poked at their phones, saving him as a contact. "I want to be your friend! As a commandment of the Lord I will be your friend!" shouted the preacher. As lovely as a Saturday chat over tea with this gem sounded, I declined the invitation of friendship and left my own phone in my purse.

And suddenly, after 48 minutes (of course I was counting!) the debacle stopped as abruptly as it had started. The preacher turned around and flopped into proper sitting position in the front row. Two girls behind me played Carrie Underwood’s “Jesus Take the Wheel” from a cell phone and sang along with enthusiasm that, in the US, would only be appropriate for the shower or driving alone late at night. I looked around in disbelief at the Ghanaians who all acted as if this had been a normal commute. When the preacher's cell phone rang and he took the call with a mild-mannered “Peter, hello,” I couldn’t help but bury a muffled laugh into my arm. In response I received a disciplinary stare from the child who had lent me the notebook paper.

The next two hours were entirely uneventful, and without another peep from Purple. This experience topped the charts of strange Ghanaian experiences. I’m proud to now hold the rights to arguably the best public transportation story out there.