Mole and Birthday!

This past weekend, we visited Mole National Park, a two hour drive outside Tamale on some of the worst roads we’ve seen. At one point during the drive, the road narrowed to a three foot wide isthmus and our cab was forced to back up and choose the shoulder of the road instead. At another point, I was rudely awoken from my nap (we left at 6 am, I deserved the nap) when the cab nearly stalled out in a sand pit that, for some reason, took up most of the road. At any rate, we arrived in Mole miraculously intact and thoroughly in need of some time at the pool. The pool overlooked a jungle transitioning to savanna, with two large watering holes. Watering holes frequented by ELEPHANTS. We watched them all afternoon doing elephant things, like ambling around and taking showers using their trunks. Several hours into our elephant reverie, however, a band of baboons came tearing through the pool area, swiping Lyubov’s apple from our table and freaking out pretty much everyone. Baboons, and warthogs we later discovered, pretty much roam free around the hotel site. Accordingly, we chose to eat dinner inside.

The next morning, we joined a 7 am walking safari into the park. Led by an guide armed with a rifle, it was actually a pretty intense hike, at times requiring us to walk across logs to cross a stream or scamper up a hill because a charging elephant is right behind you. Seriously, but we’ll come to that later. Having already seen the baboons and warthogs more up close than we ever intended to, the real point of the safari was to find an elephant. We/the guide tracked down a group of three hidden in the trees, and encouraged us to go as close as we wanted. They shied off when a large group of Ghanaian school children came rustling through the trees, and our guide explained that they’re actually quite shy. They would much rather flight than fight, and there’s never been an attack at the park. The only time they do attack, he went on, is when they’re injured or when a baby is involved. Even then, the warning signs are clear: ear flapping and trumpeting. Good thing he told us, too, because not ten minutes later we were creeping close to another elephant we’d come across, all down on one knee for the best possible angle. And then we saw the ear flapping. And then the guard had his rifle up, and there was yelling, and we were running up an embankment, and then an elephant came charging out of  the underbrush. There were some tense words exchanged with our guide, who brushed the whole thing off with a very casual “Oh, that one is injured.” BUT WE’RE FINE, MOM. We’re great. And it’s a fabulous story.

WAYYYYYY TOO CLOSE

Monday was my 22nd birthday, which makes me feel old just to type. With our research falling apart around us, most of the day was spent fighting back tears and reading emails aloud with emphatic outrage. In the midst of this though, Mary, Ceci, and Lyubov really did throw me a nice birthday. I had a crown and a lovely pizza dinner in Bolga, and the night really took everyone’s minds off of how badly our projects are going. We spent a long time singing along to Mary’s 4th of July playlist, and especially with Thanksgiving coming up, I think we really all just want to go home.

Monkeys and Waterfalls!

We were back in Tamale on Friday, where we met up with Kathryn, who graduated from Georgetown last year. She’s now in Tamale working with a clean water NGO, and offered to let us stay with her for the weekend. It was lovely, she had 4 extra (clean) beds and a kitten, which is really all we ever wanted. On Saturday, a cab driver named Small Boy showed up at the house at 5 am, and we were off for a full day of monkeys and waterfalls. [Sidenote: When Small Boy gets a girlfriend, he’s going to change his name to Big Boy. I couldn’t write this entry without including that tidbit.]

We rolled into the Boabeng-Fiema Monkey Sanctuary around 9:30, having spent fully half of the driving time navigating the 30 km dirt road into the jungle. It was more of a dried up riverbed than a road, and would have been entirely impassable during the rainy season. It’s a shame the road is so bad, too, because the Sanctuary is really well kept and makes for a lovely tourist destination once you get there. Like the crocodile pond at Paga, the Sanctuary was first protected for spiritual, not tourism or conservation, reasons. The legend goes that the chief was walking through the jungle and found a bunch of monkeys playing around a coffin, which he took and brought to the local fetish priest. The priest told him he could give the coffin back to the monkeys and they would go away, or if he liked the monkeys he could keep the coffin and they’d stay near the village forever. Weird, I guess, but whatever. Point is the monkeys have been really closely intertwined with the villagers ever since. Supposedly, the monkeys will always seek out one of the fetish priests before they die, so that they can be buried in the monkey cemetery. The fetish priests are buried there, as well. Historically, one fetish priest was always a virgin woman, but that rule has become pretty lax recently “because a virgin is too hard to find nowadays,” according to our tour guide. Who was a German schoolteacher. Anyway, the Sanctuary has two types of monkeys: black and white colobus and mona monkeys. The colobus are a little more shy and stay in the taller trees, but the monas are really friendly and will come really close. They like to raid the villages for food, and will steal shiny things from tourists if you’re not careful. They came right up to us, like within two feet at times. 

After the monkeys, we packed into the cab and Small Boy took us to the Kintampo Waterfalls. They’re the second largest in Ghana, but the biggest are too far away for us to reasonably travel to so we settled. The waterfall was packed. It was a Saturday, and there’s a Muslim holiday this week on top of it, so entire busses of students emptied out into the park. It seems like a great place to go on weekends, there were lots of gazebos for picnics and a guy grilling meatsticks (kabobs... we just call them meatsticks). Plus, when we headed down the trail to the largest waterfall, there were huge speakers set up by the waterside blasting Ghana’s greatest hits. Very few girls actually went in the water, but Mary and I didn’t let that stop us. Some of the guys even helped us climb up behind the waterfall, which I really appreciated because I was going nowhere but face-first into a rock without their help. It was pretty high up, and Mary and I didn’t know how we were going to get down safely... until someone pushed us and we slid down the slippery rocks into a gaggle of kids at the end. It was so much fun, but we didn’t spend too long in the water. Ghana’s freshwater is notoriously swimming with parasites, and we’re almost definitely infected with schistosomiasis now. It’s nothing a thorough deworming back in the States can’t fix, though, and it was so worth it.

With the Muslim holiday tomorrow, we’re not going to be able to resubmit to IRB until Tuesday at the earliest. Troublesome, because we’re quickly running out of time to get everything done. Oh, and the water is out.

Halloween in Tamale

We worked our Peace Corps contacts and landed an invite to their annual Halloween party in Tamale, the largest city in the northern part of Ghana. Tamale is about two hours south of Navrongo, so it was well worth the effort on our part to travel down for the party. We also were excited to have our first tro-tro experience.

Tros aren’t exactly public transportation, since they’re not state-regulated and you barter a price, but they’re not exactly private either, as they run between established and extensive tro stations. I guess tros are analogous to busses... only in the type of disrepair you only see in junk yards in the States. They’re the size of your typical 12-person Georgetown vans, although the interior is ripped out and refitted to fit over 30 people (we counted 35, but some of those were babies). It’s not uncommon to see tros were the doors need to be tied shut with rope, or where doors are missing entirely. And it’s almost a given that there will be animals. The roof of our tro to Tamale was packed with chickens, who squawked most unhappily when we hit a bumpy patch in the road. However, we only paid 5 cedi for the entire trip, which is a pretty good deal.

Tamale, the “NGO Capital of Ghana,” is rumored to be the fastest-growing city in all of West Africa. There are a lot of foreigners and investment, but this also means that the crime rate has gotten really bad, especially targeted attacks against foreigners. However, it’s a fun city and we had a great time. Besides meeting up with the Peace Corps kids, we met another of Ceci’s cousins who attends medical school there. She took us out for great Chinese food, and showed us around the city a little before we left on Sunday, and we were disappointed to have so little time to explore. Never fear, though, we’re headed back this weekend and will hopefully get to see more this time around!

In Tamale, we also had our first brush with Ghanaian homophobia when Mary and I were, somehow, accused of being lesbians. Despite its reputation as a progressive African nation, Ghanaians in general are very conservatively religious, either Muslim or Christian. Nationwide, homosexuality is illegal and completely unrecognized. “That doesn’t happen in Ghana” is a frequent explanation. The subject has become particularly sensitive in this past year, as several prominent politicians (especially in the North, away from the Western influence of Accra) have called for gays to be rounded up and arrested and have asked neighbors to “report” on suspected homosexual behavior. There’s been huge backlash to Britain’s statement that it will cut off aid to countries who do not recognize gay rights: Ghana’s president just this past week publicly vowed to never legalize homosexuality in Ghana. Unofficially, Peace Corps members are working to support the underground gay rights movement, but it’s clear that Ghana is really far away from equal rights.

All in all, it was a really fun weekend away from Navrongo. Because of all the crime, I didn’t bring my camera (this seems to imply that I value my iPhone over my life, and I’m not really sure what to say to that), so I don’t have pictures. However, if you picture me in whiskers standing in front of a mosque, that just about sums it up.

Hospital update: Was called in at 6 this morning to observe a C-section. Gross and fascinating. Not posting details to preserve Kilbride's fragile sanity.

Back on the Navrongo Grind

Back in the office Monday, we were surprised to learn that, as regards our IRB submissions, “sometimes the expedited review takes even longer than the normal review.” Despite how counterintuitive that sounds, we received conditional approval and on Thursday, we met with the IRB coordinator to go over our comments so that we can resubmit. All four of us were rather disappointed in the meeting. We’d hoped for a rigorous scientific and cultural review... and the only notes we received were to reformat our citations and include our nationality and marital status... Wait, WHAT? So for now, I’m having my consent forms translated into Kasem and Nankam and editing my proposal to include something like this:

Principal Investigator: Melissa Ogden, single white female, enjoys long bus rides through the jungle. Looking for someone to talk about kids pooping.

Ceci and I have started spending more time at the hospital, going in on Tuesdays to watch surgeries and on Wednesdays to go on rounds. We also left our phone numbers with the operating theater staff so they can call us in case of an emergency surgery or C-section, though nothing has happened yet. The entire hospital is staffed by only three doctors, but they’re always willing to explain cases and eager to answer any questions. Dr. Zach even started quizzing us on anatomical markers and making us calculate drug dosages. I was pretty proud when some of the cases, like an infant with Scalded Baby Syndrome, were conditions I recognized from class. I really enjoyed my time at the hospital, and feel like it’s going to be something to look forward to every week.

Tomorrow we’re heading into Tamale to celebrate Halloween with the Peace Corps, but this itself was kind of a lame update, so I’m linking my favorite Ghanaian song here in an attempt to make it big in the US by the time I get back. According to Eye Man, it's not actually Ghanaian, but it's still a big hit here. And it's fabulous.

Ouagadougou

Our Ghanaian visas are only good for 60 days at a time, meaning at some point we need to leave the country and re-enter in order to legally remain in the country. Thankfully, Navrongo is only one town away from the Burkina Faso border. Unlike Ghana, which is one of the fastest-developing countries in sub-Saharan Africa, Burkina Faso ranks second to last on the Human Development Index. It’s much poorer, and significantly less stable. Earlier this year, in fact, members of the military revolted and fired off guns in the streets of the capital, Ouagadougou, and parts of the North remain “forbidden” to Americans (an Embassy worker actually used that word when talking to us). Apparently there’s some al-Qaeda-related-things up there, but I’m just upset it complicates my plans to go camel riding in the Sahara desert. Anyway, following a quick stop in Navrongo in which we learned that no one had even read our IRB proposals yet, we headed up to Burkina for the weekend to stay with Ceci’s aunt in Ouaga.

In retrospect, we should have suspected that any journey beginning with the phrase “Let’s just cross the border and hope for the best” was bound to have a few difficulties, but that’s just what we did. NHRC dropped us off at Ghanaian border control at 2 pm, which I will consider the start time for our supposed 2 hour drive to Ouaga. While waiting for our paperwork to get processed, we watched the news of Gaddafi’s death on a TV in the waiting room. With seven African soldiers all armed with AK-47s. It was pretty surreal. Border control told us we had to walk across the border, which isn’t so much a line as it is a half mile demilitarized-zone. We weren’t even sure we were IN Burkina already... until we reached a burned-out mud hut with a sign proclaiming Burkina Customs. Inside, we met Wongo, a friendly Burkinabe National Police Officer who proposed to Ceci and then negotiated our passage to Ouaga with a cab driver. We didn’t know this would be an issue half a mile down the road, when our cabdriver got in a heated argument with the taxi union about his rights to drive us (apparently, we were supposed to pick up a taxi at the station, and this guy had cheated by getting us at the border). Wongo was called and the matter was settled, but not before we’d spent an hour and a half on the side of the road. After a somewhat dramatic departure from the taxi stand, we pulled over to the side of the road to get gas... out of an old wine bottle...? It was like filling up a car in a zombie apocalypse movie, he siphoned it out using a hose and spit gasoline out onto the road and everything. We finally got moving again, only to get a flat tire. There really is no end to our bad travel luck in Africa thus far. Anyway, Wongo was very helpful, calling once on the road to make sure we weren’t being trafficked and again when we got to Ouaga to talk to the guard at the house and make sure we arrived safely.

Burkinabe gas station

Ouaga is a very strange city, and very different from Accra. In general, it was actually cleaner and well-paved, leading us to question the picture of Burkina I described earlier. We hypothesize that Accra just developed too fast with too little planning, but I don’t actually know enough about either city to say for sure. Ouaga also has a distinct French flair, complete with bakers in chef hats selling baguettes and French desserts. We stayed in a predominantly American neighborhood located close to the Embassy, filled with private drivers and security guards and better housing than our so-called 5 star resort in Elmina. Ceci’s aunt Pam invited us to an Embassy Halloween party on Friday night, and insisted we dress up. Having not brought costumes overseas with us, Ceci and I split one of Pam’s “government sheets” and put together some pretty sweet togas. Which we were wearing when we met the deputy ambassador later that night and he wanted to hear about our research. Picture to come!

We returned to Navrongo this afternoon, calling first to let Wongo know to expect us at the border. As per Pam’s instructions, Ceci executed our first (of many?) African bribe and gifted him a bottle of wine as a present for looking out for us during our trip. With any luck, we’ll finally have our proposals back this week, but in the meantime I’ve got plenty of med school apps to keep me busy!

Accra

Thursday morning we headed into Accra, partially because no trip to Ghana is complete without exploring the capital, but mostly to break up the barbaric bus trip back to Navrongo that loomed over us. With a week’s vacation already weighing on our wallets, we checked into another 8$/night hotel, this one complete with padlock on the front door and a knee-high hose spigot to shower. However, food was delicious and inexpensive, and the view from the porch was amazing, looking out over a bay full of fishing boats. After settling into our chicken-coop of a room, we hailed a cab to the Accra Mall, which is basically a little slice of New Jersey in the middle of Africa. Like hillbillies in WalMart for the first time, we admired simple wonders like movie popcorn and posed for group pictures in the middle of the grocery store. Intending to celebrate Lyubov’s 21st birthday that night, we picked up a cake and a “Happy 21st Birthday!” banner and headed over to Ryan’s Irish Pub, where we easily convinced the entire bar to sing for her.

Well worth $8.

On Friday, we attended a barbecue at the American Embassy, a sprawling, intimidating fortress located in the Accra suburbs. The Marines who work at the Embassy host a barbecue every week for the families of Embassy workers, and we had received an invitation through some of the Peace Corps we met in Cape Coast. However, to get in, we had to hand over all electronics (sadly, including cameras) to the guards, walk through a metal detector, and be accompanied by a Marine at all times. I set off the metal detector no less than 3 times with not a clue how, and it was only at the firm insistence of TJ, our host, that the guards let me pass. We had a great time at the Embassy, enjoying our sloppy joes and AMERICAN FOOTBALL that the Marines magically get on tv, as well as being introduced to the ambassador as he picked up a hamburger. Besides the Marines, who were amazing hosts to us the entire weekend, we met a bunch of fascinating people who work at the Embassy, all of whom were really eager to help us out while in Accra. It seems like the American community in Accra is very close, and it was nice to be a part of it for the weekend.

Ceci’s dad went to boarding school in Accra, and so on Saturday we had lunch with her aunt and several of her dad’s school friends. Having gotten an American perspective of Accra the day before, it was really interesting to sit down with Ghanaians and hear their thoughts. I think we were all really intrigued by Dr. Alex, who has only recently moved back to Ghana after several decades in Ireland. He talked about Ghana’s capacity for development, saying that Ireland was still using outdoor latrines, too, in the 1970’s. However, he lamented the seeming lack of political and personal motivation to work on the infrastructure problems, like open sewers and poor roads, that have irked the four of us since we landed in Accra in August. Overall, my experiences in Ghana thus far have convinced me that I’m not meant to work internationally, which isn’t all that surprising to me, as I’ve been leaning towards working in the US increasingly over the last year. The more I see of Ghana, the more I’m convinced it needs civil engineers and garbagemen more than it needs doctors. Many Ghanaians apparently feel the same way, and Ghanaian health professionals in particular leave the country in droves every year. The brain drain is felt particularly strongly in areas like Navrongo, which are so cut off from the rest of the country that the geographical isolation alone is a deterrent for many young doctors.

We intended to leave Accra on Sunday, but the STC bus company wasn’t on the same page, forcing us to spend another day in the glittering wonderland that is the Accra Mall.  Part of this was spent grocery shopping, stocking up on things we can’t get in Navrongo like peanut butter and vinegar (not intended for use together, though), but the majority was spent in anticipation of going to the movies that evening. The other International Health girls, who live just a two hours outside Accra, had come into the city to see us, and all of the IHealthies had agreed that we needed to see Contagion together before parting ways. In one of the dorkiest movie experiences of my life, the 7 of us sat in a row and marveled open-mouthed at the badassery of the World Health Organization and epidemiologists that could rival Jason Bourne. But it was awesome, and public health is really cool. Really.

...and candy, too...

Our lovely vacation came to a close on Monday, as we boarded another (albeit more comfortable) bus to Bolga. We made good time, actually, and joined a gaggle of old women in bartering further passage onto Navrongo. At midnight, we linked arms and walked home almost a mile in the dark, calmly skirting around packs of wild dogs and trying to convince ourselves that rabies can’t be that serious, anyway.

VACATION: Cape Coast/Elmina

IRB submitted, we departed NHRC 6 am on Thursday, abuzz with excitement and hope. 30 hours later, when we finally reached our hotel in Cape Coast, I cried a little while eating a cheeseburger. The time in between was harrowing and hopefully something I’ll forget as I age. Mostly it was my own fault- I thought I could avoid African bathrooms by not drinking any water for 20 hours, but this just sort of made me hallucinate. This problem that was complicated by the fact that, when hitting a pot hole jolted me out of my malaria-medicine-nightmares, we were crawling along a one-lane dirt road in the jungle in the pouring rain in the middle of the night. And the fact that Irish Mary warned us never, under ANY circumstances, to take a night bus, because they’re frequently attacked by highway bandits. At any rate, we made it there safe and sound and bandit-free, although we estimate that the journey would have only taken 5 or 6 hours on I-95.

So worth it, though.

After a solid meal/nap/shower in Cape Coast, though, we were ready to enjoy our vacation. Cape Coast is a really interesting beach town about three hours west of Accra. It’s arguably the most touristy destination in Ghana, and even Obama has been here! He came in 2009 with his family (Michelle traces her African heritage back to the Cape Coast area), and the town has never forgot it. A big Obama billboard greets you on the highway, and his face shows up on the sides of shops and stalls everywhere. Culturally, Cape Coast is all over the map. Armed with bikinis and sundresses, we were a little concerned when we had to walk through a Muslim market filled with burqas and veils to get to our hotel. Inside the walls, however, the sounds of Muslim prayer on loudspeaker mixed quite hilariously with the American and Ghanaian clubbing music (including one of our favorites, “I Need an African Man.”) Most of the guests were European backpackers or Peace Corps, although the hotel club and beach were frequented by the many Cape Coast Rastafarians. Rastafarianism is basically Afro-centric Christianity, which I only add now because I didn’t know that before and it puts a lot of conversations I had in context. Most of them work as artists or musicians, which actually works well in Cape Coast because tourists are willing to pay for the Rastas’ African artwork. This was an actual conversation that occurred:

Eye Man: The Moon is very happy tonight.

Melissa: How can you tell?

Eye Man: The wind is happy, so the Moon is happy. We call the Moon Eye Woman because she is in the sky with her children, the Stars. The sun is Eye Man.

My new best friend!

Eye Man is probably my favorite person in all of Ghana. He owns a small shop in town where he paints, but he also plays the drums and raps on the side. His hope is to work his way to Accra selling paintings so that he can record some of his music in the city. His real name is Emmanuel, and he is hands down the happiest person I have met in my entire life.

Cape Coast is also home to the Slave Castle, probably the most famous tourist attraction in all of Ghana. Because so many different countries fought over the Gold Coast (the old name for Ghana), the castle changed hands pretty frequently. However, during the height of the slave trade in the 18th and 19th centuries, the British were in control. Slaves were trafficked to the coast from inland areas, like Navrongo, and were held in overcrowded, pitch black dungeons with no ventilation or waste drainage for up to 2 months waiting for slave ships to arrive. The castle is frequented by descendants of the African diaspora from the Caribbean and the Americas, many of whom leave flowers or wreaths at a traditional African alter erected inside the final dungeon in the 19th century. Set against the ocean and palm trees, the whitewashed castle was absolutely gorgeous, but a really sobering experience compared to how much fun we were having in Cape Coast.

Slave castles like the one in Cape Coast are a frequent sight along the coast of West Africa, and there’s an even bigger one just a few miles down the coast at Elmina. We were forced to evacuate to Elmina after a scarring bed bug encounter at our $8/night hotel in Cape Coast. It wasn’t so bad, though, because our new hotel was pretty amazing (with a pool!!) and it was nice to see another town. Despite the close proximity, Elmina had a totally different character than Cape Coast. It was much less touristy, with fewer restaurant and hotel options, and much more of a fishing town. It was also one of the poorest areas of Ghana that I’ve seen so far, with houses made of nothing but palm fronds and mud. We were in Elmina just long enough to celebrate Lyubov’s birthday before heading out to Accra.

All work and no play means it's time for VACATION

We’ve spent the last week mostly in our office, trying to pull together our IRB submissions. Basically, IRB means getting ethical and institutional approval on our project design. In the past few years, NHRC has waived IRB approval for Georgetown students because we’re here for such a short time and our projects are really basic, anyway. In fact, Georgetown advised us NOT to try to get approval because it will take too long. However, you can’t get published in a journal if you don’t have IRB approval, so all four of us decided to go through the extra work this year. In my head, my groundbreaking research is going to get published in The Lancet and the WHO is going to be begging me to come on as a consultant after graduation, so IRB is obviously really important to me. Reality, on the other hand, is obviously not very important.

My project is called “Barriers to the Use of Oral Rehydration Therapy for the Treatment of Diarrhea in Children Under 5 in the Kassena-Nankana East and Kassena-Nankana West Districts of Northern Ghana,” and before you ask, yes, I did make it that long to sound really official and intense. Paul thinks it’s gross and is welcome to stop reading at this point. In Ghana, like in pretty much every developing country, diarrhea is one of the leading causes of death among children (others being malaria, pneumonia, and neonatal causes). First of all, there’s a lot more cases because of lack of things like indoor plumbing and running water. But more importantly, diarrhea occurs in children that are already malnourished, and usually chronically ill from malaria, meaning that the dehydration caused by diarrhea can have complications as severe as coma or death. Since the 1970’s, Oral Rehydration Therapy has been used to cheaply and effectively treat dehydration due to diarrhea. It’s basically a sugar-salt solution, kind of like Gatorade. During the 1980’s, use was really high in mothers of young children. However, today use hovers around 30% despite nearly 85% of mothers identifying ORT as the correct treatment for diarrhea. SO. That’s what I’m looking at in my research-- why mothers don’t use ORT even when they know they should. I actually really like the topic. This is a big problem here, so I feel like my research is actually contributing new and useful information, rather than investigating something that’s already been done.

Pending approval, we actually start our projects next week when we get back from vacation in Cape Coast. Until that point, I have nothing but the sun, the beach, and the quest for a cheeseburger to keep me busy. There’s also rumors of a mall and movie theater in Accra. But I’m going to be a bit MIA, so wanted to give you a heads up that I haven’t died, I hope. Before I go, here is a picture of Natifah (Mary’s daughter) and her friends performing for us at lunch last weekend. It basically could have been 2001 in San Antonio with my brothers, cousins, and I performing, and made me giggle quite a bit. They even dressed poor Robert (front right) up like a girl, and he threw a fit just like Dylan used to. Older sisters are mean, Dyl, that’s consistent pretty much everywhere.

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!

Accra

So, turns out by “two days,” Calvin really meant “one day then we’re leaving at 4 am the next day.” But we did have one day, I guess. I’m going to try to paint a picture of Ghana for you, but I really don’t think it’s going to do it much justice. In general terms, it’s a combination of Disney World’s Animal Kingdom, central Texas, and everything that possibly comes to mind when someone says the word “Africa.”

The first thing you see when you walk out of our hotel is a wooden plank sidewalk, with periodic gaping holes that reveal the open sewers beneath. There’s also a massive highway-- it’s hard to say how many lanes, because no one seems to really care. People and cars just kind of go the way they want. To walk to the bank, you run across the highway and follow one of the sidewalks pass street vendors selling everything. LITERALLY everything. There’s food, there’s clothes, there’s phones, there’s motorcycles, there’s leather sofas. There’s also a fair number of goats milling around, and we even saw some chickens today pecking around old parked cars.

On our way home, Ceci pointed out that, besides one or two billboards, you can’t really tell what year it is here. Sure, people are walking around with iPhones and Blackberries, but all of the cars (including tro-tros, which you’ll hear more about soon, I’m sure) look like they’re from the 90’s, or before. Most of the stores look like lean-tos, or kind of huts, but even the actual buildings all have a faded, dusty appearance. I would say probably about half of the people are dressed in Western clothes, but we also saw a ton of women in traditional African clothing with huge baskets balanced on their heads. They would weave in and out of stalled traffic selling everything from Mentos to bags of water.  OH. And there are men with AK47s (or some other big gun, not really an expert here) outside of all of the banks. I guess this is supposed to make me feel safe, but it backfired. On the other end of the comfort spectrum, Beyonce is apparently a national hero. She’s on the radio everywhere, and this really does make me feel safe.

We’re leaving the hotel at 4 am to travel up to Navrongo, so I should be able to tell you more about where I’m living tomorrow!

Akwaaba!

True to my word, I fell asleep as soon as I was seated on the plane, sleeping through a two hour delay on the runway and eight hours of the flight, leaving me with a comfortable amount of time to enjoy breakfast before touching down in Accra. Once we were through customs, we were greeted with this sign, which makes me more than a little concerned about the rest of the trip:

Having left DC late at night, it was disconcerting to leave the airport and see that, once again, it was night. The sun sets weirdly early here, so by dinnertime it’s pitch black outside. I haven’t had a chance to see much of Accra, since we went straight from the airport to the hotel, but I can tell you that there were lots of goats casually at bus stops and a graffiti reinterpretation of the cover of Bill Clinton’s “My Life.” Tomorrow we’re getting up early to go get our phones and exchange money and things, but I’m also hoping to spend the afternoon sightseeing.

I’m only in Accra for two days, and then we have another full day of travel to reach Navrongo, which is a little town near the border of Burkina Faso. Then we’ll have some time to unpack and relax before meeting our host, Dr. Williams, and getting started.

I’ll try really hard to keep this thing updated. Eric, feel free to badger me if I don’t.