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.

9 to 5 ...ish

When I arrived in Ghana, it became clear fairly quickly that I would have to be very self-sufficient in order to maintain a significant workload. I wasn't handed a work manual or assigned specific tasks; I would have to be proactive in creating work for myself based on the needs I saw and within the scope of my abilities. 

Luckily, my co-volunteer working in Public Health is also a go-getter. She and I have been quite successful in tackling projects as we see fit. 

We spoke last Monday with our  director Eric about our desire to have more work. He was able to connect with someone who asked if Claire and I could visit the Regional Maritime University and give a presentation about breast, cervical, and prostate cancers to a group of students who would be presenting the information to children in schools.

We were to present Friday (3 days later).  On topics with which we had no detailed experience. With very limited Internet access (only available at the office, and during a week peppered with power outages). Roadblocks aside, we were up for the challenge.

We spent the week cramming intensely, researching during the days and saving informational .pdf files to our computers and reading them at home at night. We created a PowerPoint presentation and several interactive activities to break up the monotony of an 80-slide presentation detailing the causes, effects, treatments, and prevention of each of the aforementioned types of cancer.

On Friday we boarded a tro-tro in Kasoa, and three transfers and an excruciatingly sweaty 2 hours later we arrived at the university on the far side of Accra, in a city called Nungua. 

We called our contact there, Derrick, who met us in a courtyard and said he didn't think we were coming (we weren't sure why, as we had confirmed twice). The room he had booked for us had been rebooked. But Derrick pulled some quick strings and secured us a makeshift presentation hall in a lounge room, where there were several students laying on couches watching Beyonce music videos.

Claire set up her laptop, and the students gathered. Our talk went smoothly. I was concerned there would be a lack of interest or lack of understanding (we had no prior idea of the students' level of background knowledge on cancer). But the ten or so men and two women were overall attentive, and actually asked very insightful questions and were enthusiastic about the activities we incorporated.

 Claire and I with the students at the Regional Maritime University

At the end of the talk, one young man presented us with two cans of Malta (a Ghanaian drink resembling nonalcoholic Guinness beer) and a formal thank you: "On behalf of my fellow students and our program we thank you kindly for visiting and educating us. We wish you safe travels back to Kasoa and best of luck in your time in Ghana."

Claire and I took a taxi to the tro tro station, convinced a confused shopkeeper to trade one cold Coke for our two cans of warm gross Malta, and began a 3.5 hour tro-tro death crawl through traffic back to Kasoa. 

With the cancer talk out of the way, we were able to refocus on some of our original tasks. Our internships here are based on researching tuberculosis for the Ghana Health Service. We conduct interviews in nearby towns to determine the present knowledge of tuberculosis. The government has recently started subsidizing screening and treatment for TB, but most people aren't even aware of the disease let alone that the treatment is free.

We also give informational talks about TB in schools to children around the community. We recently created two new games to involve the children interactively, and painted a giant "TB Tree" that the children can pin "leaves" with terms written on them to as a fun way to learn the definitions of tuberculosis-related lingo.

The making of the "TB tree," which students will be able to pin leaves onto matching terms with their categories. For example, "covering your mouth" will be correctly matched with the branch labeled "prevention."

Our next big project involves setting up free screenings for both Tuberculosis and Hepatitis A and B in the community. We initially wanted to keep our focus on TB, since our research here is about that disease. However, Eric was adamant that Hepatitis A and B are bigger threats in the community, so we decided to tackle all three. 


We are only in the beginning stages now, researching the resources we will need and how much it will cost. We have a meeting scheduled this afternoon with a director of a local private hospital who has coordinated screenings in our town in the past. I am only here for another 5 1/2 weeks though, so this goal will definitely be a lofty one! But we're excited to take it on.

Work is becoming more and more of a familiar pattern, and I'm excited to have these projects to focus on. Stay tuned for the updates!

Anti-malarial Entertainment

There are two main options for anti-malarial medication. Doxycycline is relatively inexpensive, but has the unfortunate side effect of making one extremely sensitive to the sun. Malarone (just auto-corrected to "macaroni" ... yum, I wish) is significantly more expensive but instead of the sunburn potential, only threatens a much more vague possible "weird dream" side effect. 

My health insurance covered three months of Malarone for free, and my blue eyes already make me an unfortunate definite losing contender against the African sun. I opted for the macaroni. I mean Malarone. 

Strong medications have never had a huge effect on me. The Percocet prescribed for my wisdom teeth extraction left me still crying in pain for several days following the procedure. I've been known to spend nights wide awake after desperately taking Ambien for my insomnia. I took a Xanax as I boarded my flight from New York to Istabul en route to Ghana, but still cried secretly in a panic, convinced the whale of a plane would definitely not get from one continent to the next without plunging into the Atlantic.

(I realize I've just made a very good case for myself as some kind of prescription drug junkie. I promise this is not the case.)

Anyways, the point is that I didn't think the weird dreams from the Malarone would be an issue for me. 

I don't know what constitutes a "weird" dream, as my dreams are usually not realistic in the first place. But I have lots of dreams here starring people I haven't seen in years. Ive noticed that many of the male cameos have really big beards, when in real life I've never seen them with facial hair. Last night I vivdly dreamt I sat on the floor of Safeway's bakery section eating chocolate chips with two volleyball teammates I haven't actually seen since college.

The dreams are just the tip of the iceberg. A little background about my sleeping. I have, on a few occasions, contributed to full conversations at night that I have no recollection of the following morning. More often though, I bolt upright with a startled gasp that scares anyone in the room or nearby. My roommate in Seattle tells me some mornings, "I heard you freak out again last night" to which I bewilderdly shrug, generally having no recollection. 

My mom (sorry mom! For the blog's sake!) also wakes with these night terrors, but to a more intense degree. I remember tiptoeing into my parents bedroom after having a nightmare as a child, whispering "Mom?" and her sitting up and screaming bloody murder, startled out of her sleep, and scarring me for life. My grandpa apparently did the same thing. So these night terrors sort of already run in my family, but are rare for me, usually happening once every few months.

Until Malarone.

In Ghana I pull the terrified gasp at least once every night, according to my now-immune roommate. Sometimes I wake myself up, sometimes I don't. 

One night last week I awoke on my feet, absolutely convinced the house was burning down. The air outside smelled differently than normal due to a recent rain, and my sleep stupor translated the smell to that of smoke. I sleep with an eye mask on to block out the floodlight outside my window, and when I ripped it off and had momentary blurry vision, I thought it was smoke in the room. My roommate Sarah spent five minutes trying to convince me there was no fire, until I finally just nodded in submission, crawled back into bed, and promptly fell asleep for the remainder of the night. 

At least I'm protected against malaria?

That's all I've got. No life lesson in this post. But it was too amusingly self-deprecating to not enlighten you with. Enjoy.

On the Daily

Nearly three weeks in. Where did that time go?! The past week was a blur. "Ghana time" or "Africa time" colloquially refers here to a very lax schedule and complete disregard of promptness (I've learned to expect +/- at least thirty minutes for any scheduled meeting or activity), but I've found it can have the dual definition of time sneaky enough to race by unnoticed.

I feel like it was just a few days ago that I was afraid of the lizards in my bedroom and was amazed to see women carrying huge items on their heads or goats and chickens crowding the roads. These things and so many more have become second nature to me here.

I've thus far devoted my minimal blog efforts to the exciting things happening here and have yet to simply set the scene of my day to day life in Ghana. So, from the beginning...

While planning my trip, I decided that I wanted to stay with a host family rather than a home or hostel with more volunteers. I wanted to experience the Ghanaian lifestyle and understand daily living firsthand. I was told by the Cheerful Hearts Foundation coordinator that I would be staying with an older woman who runs a school and has a teenage granddaughter. 

When I arrived in Ghana, I was brought to the home and introduced to a girl who seemed about my age. It turns out that my arranged hostess decided to travel in the fall. Once in Europe, she opted not to return. Her granddaughter, Leah, stepped into the role of hostess. Leah is nineteen and takes care of my roommate Sarah and I. She does the cooking and cleaning and helps with her grandmother's school, which is actually located at our house. At 19 I could barely keep track of myself, let alone two other people and a household and a school! Props to Leah.

Our house is located in an area in Kasoa called Blue Top Estates. "Estate," however, is decidedly an exaggeration. There are three units in the house: one for Sarah and I, one for Leah, and one occupied by a couple named Gloria and Frances and their exuberant and permanently naked toddler son Henry. We have a well from which our bathing water is drawn each morning and night. Cooking water also comes from the well, so I'm extra cautious about boiling it before consuming any to avoid parasites.

The kitchen is a tin-roof addition to the house with a steel-grated door, cement floor and walls, and lack of electricity. A propane tank and camp stove sit on a wooden bench under a barred window and a pile of various pots and pans is stacked against a wall. We chop vegetables and do other food prep outside on the well. The refrigerator is in mine and Sarah's entryway. There are no shelves so it can only hold what can be stacked on the floor of it or piled into the door shelves. 

The kitchen is just to the left of this scene. The entrance straight ahead leads to our rooms. The photo is taken from the well.

 

Sarah and I share a bedroom equipped with two twin beds and one small book case. Correction: one twin bed and one hospital bed, and one small bookcase. I've learned to sleep in a partially-upright position (the hand crank that adjusts the angle is broken), and sometimes I'll wake up a few inches further from the wall than when I fell asleep due to my nighttime movement rolling me away (the brakes on the wheels are apparently also broken). Sarah and I sleep backwards on the beds, with our feet at the wall and our heads in the middle of the room, in order to be more directly cooled by the ceiling fan. 

And finally, saving the best for last. The lovely ladies' room. The latrine is located outside and around the corner of the kitchen in the courtyard. That conveniently places it directly outside our bedroom window. I'll keep the aesthetic details to a minimum, except to say that one is never alone out there and can always expect the company of several cockroaches. 
 
I've transformed the complimentary sleep mask I received from Turkish Airlines into a gas mask suitable for my latrine trips. I've actually managed to minimize these trips quite well by locating the few other restrooms on my day-to-day paths and befriending the people who grant permission to use them.

Overall the house is definitely not modern, but I can adapt for the most part. The worst is when the power fails though, especially at night. This means the fans don't work, and when it's 90 degrees with 80% humidity, sleep is absolutely impossible. Unfortunately power outages are pretty frequent. 

The Cheerful Hearts Foundation office is located about a quarter mile down a dirt road. There are a few residences along this road that are typically bedroom-sized metal edifices with cement foundations and porches where the families congregate. The adults will call out "Good morning/afternoon/evening" (never "hi" or " hello" - it feels very proper) or "Ete sayn" (how are you?) to which we respond "eyeh", or "fine." The children will run after us yelling "Obruni! Obruni! Obruni!" then "Obruni bye bye!" as we pass. 

One of the roads leading from my neighborhood to Kasoa

"Downtown" Kasoa is another 15 minutes from the office. The clinic where I work on Mondays and Wednesdays, as well as the bank, an Internet cafe, the market, and taxi and tro-tro (bus) stations are all on the bustling, dusty paved road that constitutes the hub of the city.

The other volunteers live in the director's giant house another 20 minute walk away in an area called Peacetown. There were 3 people when I arrived, 5 as of now, and 4 more scheduled to arrive this week. The house is equipped with running water, a flush toilet (what!!! It was 2 weeks before I saw one of those in Africa), a television, couches, and a kitchen that doesn't require going outside to access. Basically a palace. 

During my first weeks here I requested to be moved to the volunteer house because the cost is the same regardless of where you stay, and the reasons I had wanted a home stay were not really fulfilled (to live with a family and gain an understanding of the workings of a family unit). However, as summer break in the Western world approaches, more and more volunteers are signed up to arrive and pack the volunteer house. I have decided to stay put in my not-so-luxurious but more private location and to brave out the less than ideal amenities while I am here.

I have my whole life to watch movies or be surrounded by other Americans... I'm learning to appreciate the quiet and simpler life in my African home. I have so far read more books in the past three weeks than I probably have in the past year combined:

• The Paris Wife by Paula McClain
• Eat and Run by Scott Jurek
• Orange is the New Black by Piper Kerman
• Zeitoun by Dave Eggers

And I'm halfway through:

•  The Book Thief by Markus Zusak
• The Prince of Tides by Pat Conroy

On a typical morning I get up between 6 and 6:30. Monday and Wednesday I rinse off with a quick bucket shower, have a mug of Bran Flakes and shelf-stable milk or a banana with groundnut spread (basically peanut butter), and make the thirty minute walk into Kasoa for work at the clinic starting at 7:30. Other days I don't have to be at work until 8:30, so I'll usually go for a run through the dirt roads in the nearby neighborhoods.

These runs are always entertaining; the Ghanaians think I'm insane and will holler out, "Obruni! Are you for the excercise!?" or "Obruni! You like the jog?" There is one Ghanaian who also runs and I see him every morning and stop to say hello. Tony runs in long pants and a knit cap and always has a very complete warm up consisting of jumping jacks and showy stretches in the middle of the road. I asked him if he is training for anything, and he said "No, but the exercise is good for the cholesterol!" (YAY! Health-educated!!) I also asked about the knit cap and if he gets hot while running. He said "Oh yes, yes but it's for the sun on my head." Love this man. One person aware of health issues like high cholesterol and overexposure to sun is better than zero.

We usually finish with work between noon and one. Sometimes Claire, the other Public Health project worker and I will find lunch in Kasoa and then head to the office to use the internet and do some of the research side of our work. I generally arrive back at our house around 4 or 5, and we aim to eat dinner at 6:30. 

 A typical dinner in Ghana consists of rice or some form of yams, cassava, or cornmeal and some kind of oily stew. My roommate Sarah and I are trying to teach Leah to incorporate vegetables (rare in Ghana) and other nutritious aspects. This was a collard green stew served with rice, black eyed peas, avocado, and a little tomato stew leftover from the previous night.

The days are slow. I am often antsy with an unfortunate combination of boredom and lack of desire to do anything based on the exruciating heat and humidity. This is where the reading comes into play. After dinner there's usually more reading, another bucket shower, and I'm in bed by 9 or 10:00. 

Weekends are a different story. So far I have traveled to Busua Beach (see previous posts) and have made shorter visits to the capital Accra, the nearby touristy Kokrobite Beach, and another beach town called Winneba. We sometimes make trips to ShopRite, the American-esque grocery store about 40 minutes away, just to have air conditioning and the familiarity of supermarket shopping. This is where we find items like cereal, milk, and anything else we can't purchase from a stall on the side of the road.

All said, Africa is most decidedly not America. But I'm learning to adjust, and am starting to feel more at home here than I did in my first and second petrified weeks. There are times when I wish I could just spend a day in America to recuperate then head back here to finish out my time, but unfortunately that's not an option. So I can make do.