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.

Summer dreams, ripped at the seams...

I didn't get the Downs Fellowship. I'm less heartbroken than I thought I would be. I certainly wish I'd gotten it, but maybe this is for the best? The logistics of the summer were starting to get kinda crazy. If I don't go to Vietnam, they might be calmer.

That doesn't mean that I'm giving up, per se. I have a meeting on Monday with the chair of the committee that decided funding to talk about why they decided not to fund me and to determine if the project is still worth pursuing. As I mentioned before, there are other funding sources. But if their reasons are related to significant design flaws, then it may be time to cut my losses and embrace it as a learning experience.

I'm thinking about looking for internship opportunities in Ghana, since I will be there for the first week of the summer with my family anyway. Or possibly other places in West Africa as well. That way instead of flying all over the world in my teeny 12 week window (10 of which I need to spend actually doing the internship), I can just go to one place. Several students went to Ghana last year, so I'm going to talk to them and see who they might be able to connect me with.

In happier news, spring break is almost here! One presentation and finishing up a take-home midterm and I'm done (aside from internship hunting). I can't wait to go home to sunny CA, where the lows are the highs that I get here, and given the change in my expectations, 65 is going to feel downright balmy.

Cheers.

Submitted.

Tonight was the due date for the final draft of my Downs Fellowship grant proposal. It's in. It's done. There are still a couple other funding sources I'm planning to apply to, but this is a HUGE step. And it feels soooooooo good to be done.

I had my consultations with the committee members. They brought up some significant points of concerns, but they were all things I'd thought about before. I had a Skype meeting with a few people from Family Health International (the organization I'm partnered with in Vietnam), and a long meeting with a researcher who works on injection drug use/HIV here at Yale about my questionnaire that I'm using as my primary research tool, and made some significant changes.

Then, today, while filling in various citations, I freaked myself out a bit. The project I want to do is little in some ways... and insanely huge in others. There are several people who I think I should contact about this research to get their insight... but they're UN officials! Basically, the work I want to do is something that only a few people are interested in, and for a while I was feeling less nervous because it felt like something that I thought was important but generally it would be okay if it kinda sputtered out and didn't produce any statistically significantly results. But that's seemingly less and less true. It's great in some ways - this could open a lot of doors for me as a researcher - but also incredibly daunting.

But I feel really good about where it's going. I might be totally heart broken if I don't get this particular grant, but at least I'm looking into other sources of funding, too. I REALLY want to make this project happen, go back to Vietnam, get to know the Hmong in the Northern highlands, and start to make a name for myself as a researcher.

One incredibly wonderful and important step in this process was that I recently heard back from a Canadian researcher who's done work with the Hmong in the area, but focused on cultural and geographical questions. I had emailed her back in December but hadn't heard anything and had just written that off as a lost connection. I was hoping to get advice about cultural sensitivity and Hmong translation from her, but since I hadn't heard anything, I was starting to look into other potential means of getting that information.

And then, about a week ago, I woke up to an email from her. I'd been doubtful that the project was actually going to work out, and her email gave me renewed hope. It's amazing how timing works perfectly sometimes. She gave me a list of suggestions about how to find a translator, things to think about, offered to contact her friends (Hmong people that she has worked with in the past and who have acted as translators for her), and to send me a chapter she wrote for a yet-unpublished book about the Hmong culture in the area. If this work happens and I get to publish it, she's definitely getting at least an acknowledgement. I'll be forever indebted to her.

So now I have to adapt the proposal to fit the next grant source, and wait on information about the INTERVIEWS for the Downs Fellowship (oh yes, it's an intense process), and before spring break rolls around I'll have an answer. I'll try not to have a heart attack from anxiety in the meantime.

Wish me luck!

Jen