NHRC/WMH

The Navrongo Health Research Center, where I’m staying, is actually a pretty big deal in the world of Ghanaian healthcare. One of the first projects- and I guess you can say the project that put Navrongo on the map- was a community health project which sent nurses to actually live in the rural communities that have no way of reaching healthcare. Today, the Navrongo Project is the basis of the Ghanaian healthcare system, although implementing the community health scheme has proved slower than originally anticipated. Since the 1980’s, NHRC has moved from sociodemographic research to more clinical trials, notably a malaria vaccine trial. Thursday evening, NHRC hosted a little reception for a visiting doctor from Denmark who has been coordinating the malaria vaccine efforts. He started working on the vaccine in a laboratory back in 1978, and has made this his life’s work. The vaccine started human trials back in 2001, just for safety, but the efficacy trials are being conducted right now in Ghana, Burkina Faso, Gambia, and a few other countries and are ending this year. [Side note, mostly for my mother-- really interesting note was that there were no animal trials because there’s no animal equivalent for malaria. I guess I knew this, but had never really thought about how it would complicate a clinical trial. Apparently they tested it for safety on a bunch of European volunteers before bringing it to Africa.] The doctor seemed fairly confident that the vaccine was working, although he told us privately that he plans to retire in 2012 regardless of the outcome. In all, it was a nice evening that I think I really needed to remind me why I wanted to come here in the first place.

We hope to finish our IRB (Institutional Review Board) proposals for our research projects this weekend, which means we should be spending more time at the hospital in the coming weeks. The hospital has proved pretty hit-or-miss. There isn’t a volunteer system like in the US, so we mostly shadow the staff there. Sometimes this means watching nurses inject quinine into 50 IV bags, but in cases like seeing that birth, sometimes things get really interesting. Last week, we happened to show up as the main doctor was doing rounds, and he asked if we wanted to watch a surgery. YES PLEASE. A nurse at the operating theater found us some scrubs to borrow, and after a little photoshoot in the locker room, we got to watch two hernia repairs. Because of lack of resources, most surgeries are done only under local anesthesia, with ketamine (which I always thought of as a date-rape drug...) given to relax the patient. Again, the doctor was great about letting us know what was going on. It actually worked to our advantage that the patient was awake-- the doctor kept asking him to cough so that he could point out [ERIN KILBRIDE STOP READING NOW] the intestines bulging through the abdominal wall.

Cristina Yang and Meredith Grey, obvi

The War Memorial Hospital is a far cry from the hospitals we’re all familiar with back home. It’s composed of several wards (one-story concrete dormitories) connected by covered sidewalks outside. The grass between wards is used for everything from drying laundry to... peeing. And there isn’t really a waiting room, so people bring mats and sleep on the sidewalks. This is particularly true of the Maternal and Child Health Ward, whose sidewalk is always lined with pregnant women, babies, and grandmothers waiting for their daughters to give birth. And most strange, at least to us, are the goats that just wander around the hospital grounds like they own the place. In the Outpatient Department, goats literally run circles around sick patients waiting to be seen by a doctor. I mentioned how strange we find all of the goats to a Ghanaian, and she just laughed at me and asked “Doesn’t Georgetown have goats? Or cows?” If only, I can’t even imagine the possibilities there.

LITERALLY my favorite goat in all of Ghana. This is taken at the hospital. 

God Bless the Irish

Well, after two weeks, internet is back! Water is out again, but we'll take what we can get. Likewise, we’ve all sort of fallen into shameful resignation, as we’ve just begun to see how good our situation actually is.

Last weekend, woefully lost in Bolga (the nearest city), we stumbled across an American girl gleaming like the Holy Grail in the middle of the chaos that is market day. Turns out her name is Melissa, too, and she’s in the Peace Corps stationed nearby in a village only accessible on market days. We met up for dinner with her and some other Peace Corps volunteers in the Upper East region (where Navrongo is) the following Friday, and the four of us from Georgetown left feeling very silly. Only one of them has power, none have running water, there isn’t any plumbing, one latrine is missing a door, there’s no air conditioning, they cook over coal braziers, they don’t have refrigerators, and, to top it off, Melissa has been sleeping on a mat on the floor for the past three weeks. We obviously held our tongues about not having internet, and otherwise we had a great time. Melissa (not me, the other one) is kind of all you picture about the Peace Corps. Very hippie, she dropped out of college to move to India and then Thailand, and her post-Corps plan is to either meditate in India for two years or bicycle across North Africa and become a street performer in Europe. That’s right, because she’s a fire baton twirler. However, not everyone was that crazy intense, and several of the rest of us reminisced for a long time about how much we miss cheese. All in all, it was a lovely Friday night out, and we weaseled an invite to the Peace Corps Halloween party.

Saturday we spent with Mary, an Irish school teacher who adopted a Ghanaian girl named Natifa three years ago, and has been living in Navrongo ever since. She’s been an absolute godsend, and has helped with everything from getting around market to finding drivers to take us clubbing in Bolga. Partially because of her experience with Natifa, she helped start a charity called Friends of African Babies, which supports the Mother of Mercy Babies Home which we visited today. The home is run by three semi-retired nuns who take in babies who are unwanted by their families. Mary explained that no one is really an orphan here, because extended family is so extensive and important, but when a mother dies in childbirth, or if the child has a physical deformity, they’re often unwanted. These babies, plus an older sister or grandmother as a caretaker, come to the home where they are raised and taken care of for up to three years. The Home facilitates family visits, and the child is eventually restored to its family and checked up on by the nuns to ensure successful reintegration. Mary has invited us to a board meeting of FAB, so we have a lot to look forward to there.

Creepy classroom, complete with nun.

Dr. Williams has finally returned from Accra, which partially helps in terms of our research. We’re all working on our Institutional Review Board submissions right now, but haven't gotten anything done since the internet left us weeks ago. We have two weeks to pull it all together, then off for a week in Accra and Cape Coast, and then a weekend in Ouagadougou!

Survival, in several ways

Well... Ghana, like any other country, likes its tourist traps. In order to get to see the crocodiles, we had to pay a 7 Cedi entrance fee (each), a 4 Cedi fowl fee, and a 2 Cedi camera fee. After this, a tour guide and a little boy led us around the lake and through a marsh on the far side, “where the big ones are.” We were pretty jumpy at first, cause there were several crocs just hanging out in the shallow water near where we were. However, after watching the little boy wade knee deep into the pond and hit one of them with a stick (it was too small, we told him we wanted a nice big crocodile to impress everyone back home), we manned up. Despite looking like a ferocious dinosaur, he was quite a tame monster, and didn’t so much as blink for our entire photo shoot. Oh, until they fed him. The tour guide grabbed my by the hand and put me back on the crocodile (apparently I was “good” with him), and then the boy threw our fowl towards the croc’s mouth... and I sat on his back while he chomped on the poor (formerly) living bird. Disturbing.

Normally, there are little outdoor shops near NHRC that sell essentials like eggs, bread, and cookies, but actual market day is a huge affair. After a short morning meeting with the head of the Navrongo Demographic Survey, we set out for town on our bikes. This was a little terrifying, as we had to deal with the normal crazy drivers, plus motorcycles, plus avoiding rampant children and several stampeding herds of goats. Market is definitely an experience-- once you step off the main road with all the cell phones and pirated dvds, you might as well be in a different century. The little bazaar we found is this narrow, twisting path of huts that opens up into a clearing occupied by little old women and their vegetables. A girl at NHRC has been trying to teach us a few words in Kasem, the local language, but my efforts with the old ladies at market seem to indicate that I need work.

In other news, we are going on 72 hours of no water. Times are desperate. Let’s pretend for a second that I’m ok with not showering for a few days (I am not ok with this), this also means that we exhausted our reserves of drinking water sometime yesterday, and the outside pump gave out this morning, leaving us without water to wash dishes or flush the toilet. Yum. We biked half a mile this morning to buy bottled water, and are rationing it carefully, because that’s probably all we’ll have until the center reopens tomorrow. Our neighbor, Dr. Issac, said it’s only going to get worse in the dry season. And the plumber doesn’t answer his phone on weekends.

Doing Work

To our great pleasure, water was restored late Sunday, ushering in a new week of smelling clean and feeling good. We met with Dr. Williams Monday morning, and found that all of the promises of things happening “Tomorrow, tomorrow!” were actually going to happen. Firstly, we have begun to shadow the different projects going on at the center. Right now, I’m working with a research study called Malaria in Pregnancy. In Ghana, malaria treatment is a regular part of all antenatal care, but this universal approach has the capability to encourage drug resistance in the malaria parasite. MIP is investigating scaling back malaria treatment by only treating women with diagnosed cases. Tuesday, I got to follow some field workers out to a rural health center a couple towns over. I mean REALLY rural, it made Navrongo look absolutely bumping in comparison. Also, the provider-patient dynamics were fascinating: everything at the health center moved so slow, but everyone joked around together and didn’t seem in a hurry. One of the nurses simultaneously breastfed her own infant while interviewing a patient. Weird, to be sure, but interesting. She’d could lose her job if she worked in the US.

We also were formally introduced to the staff of the War Memorial Hospital, which is next door to the NHRC, and began working there today. We’re volunteering in the Maternity ward, which covers everything from contraceptive counseling to antenatal care to delivery to postnatal care. AND comprehensive abortion care. It’s right there on their sign. Forget losing a job, the place would be burned down in the US. When we reached the hospital today, the head nurse (Gertrude) pointed us to the delivery ward and told us to go watch a delivery. And I know that’s not everyone’s thing, but that’s kind of exactly why I wanted to come here, because I wanted the clinical exposure like that. The midwives and nurses are all really welcoming, and happy to bring us into the patients’ rooms. The birth we saw was fairly complicated, and the doctor was called in after awhile. He was really fantastic, clearly used to dealing with students because he explained what was going on physiologically and what his options were medically. I’ll spare you the grosser details, but it was a really great experience, and I’m pleased to note that I’m not squeamish whatsoever.

We’ve also begun our research, navigating around the questionable internet connection,  and have started planning weekend trips in earnest. NHRC is like a ghost town on weekends. A ghost town with no running water and no one to fix it. SO we’re heading out to Paga for a day trip, which should prove exciting. Paga is the place with the crocodiles, so it’s bound to be eventful!

First Days in Navrongo

This morning, we met with Thompson, the administrative head of the NHRC. He took us around to introduce us to all of the staff here and some of the projects going on. Right now, the biggest projects are clinical trials for a meningitis vaccine and a malaria vaccine (which has been going on for 25 years, and final results will be out while we’re here!). Although not many of the names stuck, and “Melissa” seems like it’s not going to work in Ghana, the staff were all very nice, and the phrase “You are most welcome” characterized our morning. Over the next few weeks, we will be rotating around the different projects, so we’ll actually be able to get to know the people we met today and learn more about the research that they’re conducting.

The internet (including ethernet) was totally out today, so our fingers are crossed for tomorrow. In the meantime, we spent much of the afternoon reading and napping. We did, however, manage to make it into town today! We had two goals in mind: 1) buy bread, because we’re starving and 2) find dinner, for the same reason. After finding bread, we ran into three adorable girls (10, 12, and 13) selling vegetables from baskets. They all spoke a little English, although the youngest mostly giggled, so we asked them if they could help us find the market. At their family’s stand at the market, we picked up some tomatoes and oil, so it looks like we’ll be able to subsist this weekend! On the way home, a little boy named Rudolph offered us a ride on his bike, and then decided to walk with us. He seemed quite taken with Ceci, and stayed with us while we ate dinner. This, as it turns out, was a good thing, because we didn’t know how to eat banku (a big ball of corn dough-- you tear off pieces), or the proper way to eat chicken/guinea fowl/whoreallyknows (hold it with your left and pull off meat with your right). He introduced us to his mother, who sells oranges close by, and then walked us home. Poor little thing, he seemed quite upset when we told him we’d have to leave and see him tomorrow. But we had Bear Beer (disgusting), popcorn, and movie plans.

On Friday, our big excursion was out to see the Navrongo Cathedral, which is pretty much the only thing that comes up if you google Navrongo. While we were walking, a man stopped his motorcycle alongside and offered to lead us to the church. I’m glad he did, because no one is allowed inside without permission from the pastor/priest/guy. We didn’t get much time to poke around the church, or the museum outside, because the afternoon rains were pretty imminent, and we ended up thanking both our new friend and the priest and running all the way home. It’s the end of the rainy season here, which means heavy afternoon showers, cooler weather, and malaria. Though it’s nice to know the mosquitos are going to die down during our time here, it’s only going to get hotter.

Internet update: utter disaster. Also no running water.

Trip to Navrongo

We landed in Tamale, a city in the Northern region of Ghana, around 6:40 am and were picked up by two pickup trucks from the Navrongo Health Research Center, where we’ll be staying and working. Flying in over Tamale was a weird experience. Unlike every airport I’ve ever been to (including Accra), you don’t fly in over sprawling city and suburb lights. Around Tamale, there’s nothing but trees and plants, and it didn’t even look like there was a runway until we got off the plane. The city of Tamale itself, located about a mile down the road, isn’t... what I imagine a city to look like, even less so than Accra. The “downtown” was mostly shacks on either side of a highway (apparently the only road in northern Ghana, although I could be mistaken). Weirdly, several shacks were Chinese restaurants.

Despite arriving in Tamale around 7 am, there were people EVERYWHERE. Turns out we actually had spectacular timing, as today happens to be the end of Ramadan and everyone was just getting out of Mosque. This made for fantastic people watching, as everyone was in their best clothes (including the kids, who were adorable). On the road from Tamale to Navrongo, about two hours at absolutely breakneck speed, we passed a ton of small villages and towns, all of which seemed to have a tiny clay mosque at their center. The villages are made up of family compounds, composed of a circle of clay and thatch one-room houses encircled by a common wall. I kept trying to get pictures, but the driver was seriously speeding. Granted, it was an empty road besides the occasional stray goat or motorcycle, but still.

I woke up as we entered Navrongo (up ungodly early this morning, so I deserved this nap), and we passed Church and some houses before reaching the War Memorial Hospital and the Health Research Center. We had breakfast and met with Dr. Williams, who is our host and academic advisor for the semester. We’re going to spend the next few weeks getting acquainted with the NHRC staff and projects, as well as exploring Navrongo, so there will be a lot more to share with you guys soon. We also had the opportunity to get settled in our apartments, which are next door to each other, and unpack. The apartments are... livable. Kinda worn down, kinda a lot of bugs in the corners... Honestly it reminds me of Henle, although that could be because our toilet paper is tied to the wall with rope. I also want to give thanks to Mrs. Bufe, who provided me with lovely pictures of my favorite people back at Georgetown, lovingly (not creepily), hanging from my bed.

OH. And the wireless is broken... and they can’t find a part for it anywhere in Ghana right now. So internet is going to be pretty limited for awhile, hopefully not long!