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.