Kumasi, Kakum, and Cape Coast

Early Saturday morning, Amanda and I set out for Kumasi. We left the house sometime between 5 and 5:30, waking Douglas only with the intent of making sure he had the keys after we walked out, but he insisted on accompanying us to the tro tro station. We had planned to take a tro tro into Accra and catch a larger bus there for the longer journey to Kumasi, but when we got to the station there was a tro tro heading straight for Kumasi, so we boarded that instead, but I wish we hadn’t. It was very cramped, so that by the time we arrived, I was hurting everywhere, and the driver was more than a little reckless – I thought we were going to die more times than I can count on both hands. But we arrived in one piece and made our way to the hotel we had picked out.

After dropping some of our things in our room, we headed out to explore Kumasi. We had three planned destinations – the cultural center, the Asantehene’s palace, and the Ghanaian version of the sword in the stone – legend has it that if it is ever removed, the state will fall apart. We made our way through the cultural center – highlights below – and then found a place for lunch. We were headed to the Asantehene’s palace but had to pass through the infamous (and very hectic) market, and Amanda got fed up, so we got in a taxi and went back to the hotel. I spent some time reading by the pool, got a plate of spaghetti from the hotel restaurant, and was asleep by 9pm!

The drums were amazing!

Drum making in progress

Some cool masks and other wood carvings...

Because I fell asleep so early I woke up astonishingly early, too, at 4:30am, before my alarm. We left the hotel around 6 and caught a tro tro to Cape Coast, and were directed by the driver to a taxi who would take us to Kakum. We agreed on 70 cedi for the trip, but didn’t quite have enough, so we went to the bank to get more money, and as we were pulling away from the bank, the driver hit another taxi! He hit an open door, then yelled at the person who had the door open (even though it was his fault), damaging the driver side door in the process to the point that it wouldn’t close. He knew he had lost us for himself, but he called a man he described as his senior brother, who then served as our personal driver for the rest of the afternoon, to Kakum, Hans Cottage, Cape Coast Castle, and back to the station.

On the road to Kakum

At Kakum National Park we did the canopy walk. After a steep hike up to the platform we stepped onto the walkways constructed from cables, ropes, wood planks, and a few bolts to hold it all together. One of the women in our group, a Ghanaian, was petrified of heights and took a few tentative steps onto the walkway and came back. She managed to cross the first bridge (there were 7 total) but couldn’t handle more and started crying, too scared to go on or go back. We passed her and made our way around the semicircle, and by the time we got back, she had disappeared.

Amanda on the canopy walk. Let's go!

Fearless Amanda!

Beautiful view of the rainforest, out over the canopy

No pictures of me on the walkway (yet) but I survived it!

After Kakum we stopped briefly at Hans Cottage Botel, a hotel that has a restaurant and a lake with over 50 crocodiles! We took a few pictures, watched some of them getting fed (from a safe distance!) and moved on to our next destination, the castle.

Oh, hello, Mr. Crocodile... please stay on that side of the barrier!

Glad I'm not in the water...

We joined a tour that had just started and saw the men’s and women’s dungeons, what’s left of the tunnel they went through to the ships, the hall where auctions were held, the officers’ quarters, and the door of no return. After the chilling reminder of some of the worst years of human history, we returned to the station and boarded a bus back to Kasoa.

Entering the dungeon

View from the top

Ahh, home, sweet, home. It’s good to be back.  

Outreach Education!

During my first week at my placement in Kasoa, I was working at the hospital for maybe 4 hours/day, helping with preventative care, which is only given to infants and small children and consists of registration, weighing, immunizations and vitamin A supplements, and on a volunteer basis, family planning (or different forms of birth control) and voluntary counseling and testing for HIV (VCT). The same department at the hospital also handles outreach, which includes education in the community and trips to the field to do the same preventative work for children that we do at the hospital, and during my second week I got involved with some of that.

On Monday and Tuesday I went out into local communities to talk with them about malaria and cholera, which mostly ended up with me listening and failing to understand while the others from the hospital talked about the diseases in Twi, the local language. I’m starting to learn a few key phrases, but I think it will still be a while before I can talk about malaria or cholera. I did speak in English a few times on Monday, and one time what I said was translated into Twi, and the second time I was speaking to a group of schoolchildren who could understand my English fairly well. However, I apparently left a lot out… I need some more practice talking about these issues in a way that is relevant to the local population.

Talking to Walantu village women who are smoking fish

Wednesday I was back at the hospital and tallying for each child that came in for weighing – whether they were new or had previously attended, and below one year, between 1 and 2, or over 2 years. There were none over two years, and few above age one. It was a hectic day, but still, most of the visitors had cleared out by noon. The hours officially continue until I think 3pm, but I have never stayed that late because there is nothing for me to really do at that point.

It was fortunate that they were all gone by then, despite the craziness earlier in the day, because that afternoon I went to Maranatha Preparatory School to give a talk to 7^th and 8^th grade students about malaria. I’d made a powerpoint for my own reference, then written out my notes, gone over them a bit with Eric… but never practiced the actual talk. So I arrived somewhat apprehensive about speaking to an unfamiliar type of audience, particularly since I knew very little about the background they would have on the topic, but feeling confident at least that I knew what I would talk about.

Writing some key concepts on the board

Answering a student question

The talk went reasonably well, especially since it was my first one, but there’s definitely room for improvement. I think the students learned a little bit from me, although I don’t know how much of what they repeated at the end was from what I told them or their own prior knowledge – they definitely threw in things I hadn’t talked about. Eric recorded the whole talk and I will be reviewing it before my next one, so I can figure out where I can make changes and get through to the students more effectively.

I also talked with Raul and Eric about additional work that I can do – the hospital is always finished by noon or 1, and even when I am there I don’t feel like I’m contributing very much, so I’m going to begin designing a full health education curriculum that I can use in different schools in the area and that can also be used by future volunteers. I’ve downloaded articles and reports from the ministry of health about previous health campaigns and the most significant diseases in the country and the general plan for reducing morbidity. I also downloaded articles about health education ideology and methods and I will try to set up my new curriculum based on these. To start, I’m focusing on malaria, TB, HIV, and cholera, but it may be later expanded.

There’s also a huge opportunity now with the school education work to do some data collection – try to assess what they know prior to the talk, what they have learned after the talk, and what they retain 1, 3, 6 months later (timeframe TBD). I’ll set this up in conjunction with Eric and Raul and have to get it approved by Yale before I can begin, but I think this can actually produce some interesting results, and give an assessment of how much people know in general.

Thursday I went to Adom, another small village near the hospital, to do outreach weighings and immunizations. We had about 10 children in the 2.5 hours we were there, much less than the same amount of time at the hospital. One of the children had some sort of skin infection/rash that looked like it could have potentially been measles, but the child was to young to receive the immunization, and received no additional care or referral about the rash. I also thought it was interesting that although one mother came with both a young child (less than one year) and one who was maybe about 2 years (still within the age that they should have gotten monthly weighings), only the younger child was weighed, and the nurse that I was with made no comment about the other child not being weighed.

Friday, today, is African Union day, and so Amanda and I have decided to take advantage of the holiday and take the day off from work. But I’m still trying to get a bit of work done; I’ll be looking over some of the documents I mentioned earlier and trying to develop new talks.

This weekend we are off to Kumasi for a day, then to Cape Coast and Elmina castles and Kakum National Park to see some wildlife and walk across the canopy bridge!

Beginning to adjust

Nothing here is as straightforward as in the US.

Getting to work either requires waiting for Eric to drive me, or soon, walking for 20-30 mins through the parts of Kasoa where the poorest live, to shouts of “Obruni” while dodging rocks that threaten to trip me, piles of trash, and rivulets of questionable liquids. Returning likewise is a question of waiting for a ride, which sometimes may be as much as 3 hours.

Looking toward my path to work from the Cheerful Hearts Foundation office (off to the left)

Ordering food usually does not happen off of a menu but instead happens by seeing what is available and requesting it or pointing to it. Or by going with the nurses from work and letting them order for me.

I live about an hour outside of Accra by tro tro, which is a delightful shared taxi van. People squeeze in and out for a very small fee (yesterday’s trip into Accra was only C1.20, or ~$0.65), and it’s hot and sweaty and full of a rich variety of odors. It’s important to tell the “mate”, who handles the money, when you want to get off, and know where that stop is.

Today I finally bit the bullet and did laundry. I’ve been spoiled all of my life. I have never appreciated my washing machine as much as I do today; I will never look at my pile of dirty laundry the same way again. When it means washing by hand in water that I don’t even want to wash my face with, my definition of “dirty” changes completely. However, there were some things that actually were dirty and HAD to be washed. Unfortunately, when I first decided it was necessary, I had no “washing powder”! So, while out yesterday, I picked some up at a gas station convenience store. Whew. And so it begins.

Washing my clothes by hand!

Hanging to dry

Amanda, a fellow volunteer, and I had to be taught by Douglas, who is a local that is also staying with our official host, Eric, how to wash our clothes. He filled buckets for us and added the appropriate amount of washing powder, and under his advice we threw our clothes in and left them to soak for about 15 minutes. Then we went back in to scrub, scrub, scrub. The process is fairly obvious after that – rinse, wring out, hang to dry, but wow, I had no idea how much work it was! Love love love the washing machine. Miss it so much.

Yesterday Amanda and I met up with Adam, a classmate of mine from Yale, one of his friends from Michigan, and several other current Michigan students. We met at Labadi Beach Hotel for lunch, and it was a wonderful escape at a heavenly oasis of air conditioning and Western food. Ahh. 

The beautiful pool at Labadi beach hotel

View of the beach from the hotel

We tried to go to the National Museum after, but it was closing 20 minutes later, so we didn’t go in. Unfortunately, the malaria exhibit they have is leaving on Monday, so I may miss it :(. We then went back to Circle, the main tro tro stop coming from outside of Accra, and walked around for a while. During our lunch, a big storm had come through, and we had seen the rain and wind and briefly the power went out, but it wasn’t until we got to Circle that we saw the real damage. A large tree had come down, huge signs had blown over, and some of the makeshift shelters that covered many of the small stalls selling various goods had collapsed. Adam and the other Michigan students left us, and Amanda and I went to the Holiday Inn to again savor air conditioning for a while, while we waited for Eric to pick us up after dropping another person at the airport. Though we didn’t get back until late, I was glad for the ride and the chance to avoid another tro tro. 

But it's not all bad. The sunsets can be quite pretty :)

Wednesday's Child

I see you looking at me. I know you're out there, but I get no comments. Not a ton of page views, but I'm not famous... yet. Eric, the cofounder of Cheerful Hearts Foundation, is trying to change that, though. He wants to start a new campaign for health and sanitation to go on TV - and says he expects me to be interviewed. Yes, Jennifer Du Mond will get her 15 minutes... on Africa TV.

Back to our regularly scheduled programming.

First, a poem:


Monday's child is fair of face
Tuesday's child is full of grace,
Wednesday's child is full of woe,
Thursday's child has far to go,
Friday's child is loving and giving,
Saturday's child works hard for a living,
But the child who is born on the Sabbath Day
Is bonny and blithe and good and gay.



At the hospital they alternately call me Jen, Akua (sp? sounds more like Akwiyah, but that’s not what the internet tells me), or Obruni. Sometimes a combination – I’ve also gotten Akua Obruni. Jen is obvious and Obruni simply means “white person” – I’ve been encouraged by at least one person to respond by saying “obibini”, which means “black person”. Akua is the reason for the poem – it’s a Twi name that means I was born on Wednesday, in other words, “Wednesday’s child”.

At the hospital the nurses are very friendly, sometimes too much. I’m never left alone for a moment, even when I say I want to go explore for food on my own. That just leads to “what do you want?” and someone accompanying me to get whatever I say sounds okay… even though I really did just want to wander around. They’re especially concerned about me getting enough to eat. They all want to feed me. It’s the first time I’ve consistently had people telling me I don’t eat enough. I’ve had some problems with a probable esophageal ulcer the last 6 months or so, and the nurses have seen me taking meds for it, and they told me the reason I have the ulcer is because I don’t eat. And if I don’t eat enough, they think they don’t like Ghanaian food. There are a few things I’m not terribly fond of (fufu is kind of weird, it’s just sticky dough), but for the most part I really enjoy the flavors. My Clif bars they call sweets and don’t think they’re enough to eat, and they aren’t convinced yet that I can handle the sachets of water like everyone else, and instead buy bottles for me. It’s just the first week, though, I’m sure we’ll figure things out.

This first week so far I’ve spent two days in the infant/young child area. I spent the first day just helping with baby weighings, which involves a bag with leg holes and a hanging scale, some very complacent babies and some that are very unhappy to be suspended in this way. On day 2 I did a bit more, starting with tallying for neo-natal immunizations (BCG and, if they come in the first two weeks, polio) and then going to registration. I spent more time asking questions on my second day, frustrated by how little I had learned on my first day. At the immunization station, I noted that although they are only supposed to give polio to infants that show up in the first two weeks since birth (the reasons for this are unclear to me), occasionally the infant was given polio vaccine anyway – but the nurse administering it did not want me to tally that for the epi records or note it in the child’s health records, which seems like a huge flaw in the system that will introduce gross inaccuracies about vaccine stores and records. I didn’t stay there long.

When I moved to the registration area I learned more about the general vaccine schedule. BCG is given as soon as possible after birth. I want to look into this more – with any vaccine there is concern that maternal antibodies present for the first 6 months after birth can reduce the ability of the child to develop their own antibodies, and a live attenuated vaccine (like BCG) carries disease development risk in those with compromised or underdeveloped immune systems. Polio is given within the first two weeks IF the child attends a clinic within that time, otherwise they start on a 3-dose regimen at 6 weeks (or as soon as possible thereafter), and then at 10 and 14 (or on successive visits). No other doses are potentially skipped. A pentavalent diphtheria-tetanus-pertussis-Hep B-Haemophilus influenzae B vaccine is given on the same dosing schedule as polio. I also want to check this, I think I remember hearing that this 5-in-one vaccine combo, instead of the 3-in-1 used in the US, plus separate Hib and Hep B, is less effective… but I’m sure it makes up for it in cost, and thus is preferred. Vitamin A supplementation is given starting at 6 months, and is given every 6 months after that until age 5. Measles and Yellow Fever vaccines are given at 9 months (when the immune system is fully developed). Pneumoccocal and rotavirus vaccines are given at any time if available – today the clinic ran out of stores of both, and I didn’t encounter a single record that already had a note that the child had received a dose of vaccine. These are also given in three doses. Children are supposed to come in once a month for weighing until 5 years, but few do. Weight for age is marked on a chart, and most children fall below the line indicating a “z-score” of 0 – meaning they are not necessarily malnourished, but certainly underweight for whatever the standard is. There is no indicator for height.

The books that all of this is recorded in is kept by the parents and is full of other important health messages, although I wonder how many parents actually read it, and if there is a huge lost opportunity to share health messages at these monthly visits. Part of the issue is that many do not speak English especially well, and many of the health messages are in English. And if they do speak it, they may not be able to read it (although those who do learn theoretically do so in school, where they are taught to read and write it as well as speak, and all instruction is in English).

Next week I start outreach education. There was some initial confusion about what my skills/plans were, but it should be sorted out now.

Wanted to post pics with this but haven't quite managed to get them! Hopefully tomorrow...

Week 1 - Accra and Odumase

Akwaaba.

I have only heard this once during my first few days, but all Ghanaian behavior certainly reflects the meaning of this Twi term, Welcome!

The flight was long, but survivable. I tried something a little different for jet lag, choosing to re-schedule my first meal on the plane for breakfast in my new time zone. I think it mostly worked, but the days have been so busy that I've been exhausted at the end of each day anyway.

Arrival went smoothly. Passport control was in some ways more intense than anywhere else I've gone (they took my picture and scanned my fingertips) and in some ways more lax (they didn't actually ask any questions). I collected my bags quickly, then waited probably for another 30 minutes until my mother managed to get hers. Only a few people were pulled aside for examination of bags, and fortunately, we weren't those people.

We met our guide, Joseph, and proceeded to the hotel. Ahh, to decompress. As with Vietnam, the pace here is a bit different from the US standard -  I told Joseph that I wanted to get a phone around 2:30pm, and between waiting for our driver to return and having lunch and then just some unexplained sitting around, we finally left at about 4:45. But the trip was successful, and I managed to get cash as well.

For dinner we were joined by two local ex-pats and more members of our delegation. We sampled some local food, and it was quite tasty - I hope the rest of it is this good! But, after a long 2 days of travel and a week prior to that with minimal sleep, I was exhausted.

On day two we met the Paramount Queen Mother of the Krobo people, the King of the Krobo, and had an extended audience with Manye Esther, the deputy to the Paramount Queen Mother, who is largely responsible for running the Every Child is Our Child program that our church is contributing aid money to. We had lunch with the Queen Mothers, saw performances from the kids the program is supporting, and visited a few of the homes of the children, then headed back to the hotel.



The kids singing for us


A few girls performing a traditional dance


The mother of two of the students supported by the program, herself disabled, receiving food gifts

We went back to the Krobo region the next day to meet with the school district officials and see the schools that the kids are attending. They were all laid out a bit differently, but had many things in common. Each asked for a library, and some pointed out the foundations that had been built for a library. They also wanted computers - three had been donated by a family on a previous trip, but only one school had electricity to charge the battery, and one computer had completely died. And the one school that had a useable computer said it wasn't enough to teach practical ICT (integrated computing and technology? something like that) to the 400+ students who are currently trying to learn it through drawings on a blackboard. Most buildings were run down, with little money available to support repairs, although our team leader, Bruce Knotts, could see that some improvements had been made since his last visit. We left them with gifts of pens and pencils, paper, books, soccer balls and frisbees, and a jar of candies. The kids and teachers were all very friendly, and many asked when we would come back, and if we could take them with us. I'm hoping to go back later this summer, with photos from my first trip, and maybe I will be able to spend some time with the kids then and really get to know some of them.



The foundation and some of the bricks for the unfinished library that will cost ~$15-20k to complete


A typical classroom, with the weekly schedule on the blackboard in the background


My sister and I with a group of kids at one of the schools

After visiting the schools we went to the local hospital to discuss the health coverage of the kids in our program and to find out if they are getting the yearly physicals they are supposed to be getting under our watch. The hospital mentioned several key difficulties - bed nets, although distributed free of charge, are often not used because it's much hotter to sleep under them; there has been a recent outbreak of Cholera; HIV is highest in this region compared to the rest of Ghana; and malnutrition, although low for Ghana, is still too high. Both the hospital and the schools had posters up about health and wellness, which I really liked. Far later in the day than planned on our schedule, we returned to our hotel in Accra.



One of the posters in the schools. Although a little simplified (vegetables are not ACTUALLY medicine), it gets the message across to eat more vegetables, which I liked a lot


An important message about sanitation and food handling!

On day four, called "dignitary day" by the group as a whole and "Jen day" by my family, I joined three other team members - Bruce, our leader, Peter Morales, the President of the Unitarian Universalist Association (UUA), and David Overton, who has been involved with the project since its inception and is on the board of an organization called Mercy Ships - to meet with the Peace Corps office here in Ghana. We discussed with them the value of having a peace corps volunteer stationed in Odumase, the major city near our project, and they told us about the work that they do here in Ghana. I took lots of notes and got a lot of great ideas for side projects during the rest of my time here. After the Peace Corps office we went to the embassy and met the Ambassador, who talked with us for several hours. More great notes. We expected to have lunch after meeting with the ambassador, but because he gave us so much of his time, we didn't have a chance before heading over to UNICEF, where we got a comprehensive breakdown of the health and education status of the children of Ghana. While most of us were at the meeting, Katrina, the trip coordinator, stopped at the supermarket to pick up snacks for us, so after the UNICEF meeting, we had some food before our next meeting with the Ghana AIDS Commission.

The Ghana AIDS Commission was probably my favorite meeting, whether because it was all about a subject I'm familiar with or because I'd just had snack and was fully awake or because I'd had practice from the other meetings, but I was finally able to ask pertinent questions in that meeting. A couple of the most striking things for me were that HIV testing is not mandatory for pregnant women, it is "opt-out", and only 4% of males and 7.8% of females know their HIV status. ARVs are not supported under the government health insurance, which makes them inaccessible to many of the country's poorest. It is no wonder, then, that most people choose to not get tested, when they can do nothing about it.

We finished out the day with about half of our group going to the family home of a former Peace Corps Volunteer who stayed in Ghana and now has a family here. They cooked dinner for us, chatted with us, and as with all of the other people that I met, they have offered any help they can give for the rest of my time here.

I was supposed to join the rest of the group for a trip to the former slave castles on Friday, but I caught a stomach bug which has kept me in bed now for nearly 48 hours. I can tell I'm on the mend, but not quite ready for the outside world. I may try to at least leave the hotel room (but not the hotel) in the next hour or so.

Tomorrow my family heads back to the US and I'm off to Kasoa where I'll be living for the next 10 weeks! And on Monday, I start my placement. I can't wait!!

Ghana bound

I've given the blog a makeover for my next adventure. New links, new pictures, and even a new title.

When I last left off, two months ago, I'd just been told that I hadn't gotten the Downs Fellowship for the project I'd been developing in Vietnam. Ghana was a bit of a pipe dream. Oh how things change.

In the last two months I've confirmed that I still want to do the project I designed for the highlands of Vietnam, but that it needs to be set to the side for a bit (perhaps for a PhD project). So I started looking at other possibilities. Through one of the second year students and one of the professors at Yale, I heard about a program called the Yale-Ecuador HIV Clinic Initiative (YEHCI), which is a joint project between Yale and a group in Ecuador to promote HIV education and prevention. I briefly considered it, but in the meantime, another wonderful opportunity presented itself.

At the beginning of November I got an email from my parents talking briefly about a trip to Ghana that was organized through the Unitarian Universalist church. It included visits with a group called the Queen Mothers, who provide support for kids who have been orphaned by HIV/AIDS; the United States Ambassador to Ghana; and representatives from UNICEF, the Ghana AIDS Commission and other officials. They asked me if I wanted to go. At that time I was still planning to go to Vietnam and concerned about getting back for my friends' wedding at the beginning of August, so at first I was hesitant. But after looking at the calendar for about 10 seconds I decided that no matter what, I would make it work.

So when my project in Vietnam didn't turn out quite as I'd hoped, I started considering Ghana as a viable option. I emailed the current (about to graduate!) second years who had been there the previous summer to ask about the projects they'd done, who they'd worked with, if they knew of any new projects. At the same time I emailed people about YEHCI and also emailed Raul Roman, the co-founder of UBELONG, about a separate project that UBELONG had set up that was public health related, in Quito, Ecuador.

The second years who had been in Ghana provided some great recommendations, and I tried to follow up on a few of them. I also considered trying to set something up with the people that I knew I'd be meeting on the trip with my family. I talked to YEHCI, and thought about potential projects I could do with them. But the most promising lead I got was through UBELONG. Raul responded to me and said that their project in Ecuador was full, but wonderfully coincidentally, they had a new project that was about to open up in Ghana.

My initial conversations with Raul about that project were a little vague, but the more we talked, the more I liked the sound of it. I decided to pursue the UBELONG project in Ghana - grassroots public health education - above all other leads. I applied for funding with this in mind, and unfortunately didn't get funded, but pushed forward anyway with help from my family.

I've got my shots, my visa, my health insurance, my tickets, my accommodations... I'm just about ready. Yesterday I finally got everything approved. It's all definitely happening! I leave New Haven on Saturday. I still have to pack my stuff for the trip, my stuff for the week after in Washington, D.C. (when I'll be going to the International AIDS Conference!), my stuff for Sarah and Zach's wedding (so excited for them!), and anything that I want to take with me to California after that. I won't be back to New Haven until mid-late August. I also have a bunch of stuff I have to pack up from my room so that it's ready to be sublet for the summer, plus finish up finals and squeeze in a couple of days of work. Phew.

I'm planning to keep up this blog for all of my health-related activities this summer. This includes the first week in Ghana with my family, the internship, and then my first week back at the International AIDS Conference. Unlike last year, I will be bringing my computer with me this summer, so keeping up with things should be easier.