pictures!

Finally some pictures in no particular order...

A man cutting the grass outside our apartment...he's using a large blade

We live near the Centre's kitchen so there are vultures everywhere

April and I outside our block of apartments (ours is at the very end, Ashley's is the first door)

Read the sign. Perseverance Spot is in the back (it's the closest restaurant-ish)

Negotiating a taxi fare--please look at what the windshield says

The three of us at the Tono Dam

Inside market (the mostly non-food area)

Us with a local soccer team

Navrongo

Helping women fingerprint (instead of signing) informed consent sheetP

another picture-less post

Hello, hello! For the first time in a while I actually have some things to tell everyone about. When last I posted I said that April and I were headed off to the HIV/AIDS clinic with Dr. Williams. The clinic is at the regional hospital in Bolga and doctor visits occur on Fridays--the reason that Dr. Williams goes then. While Ghana doesn't have a terrible HIV/AIDS problem, the numbers are increasing and the health care system is working as quickly as possible to address the issue. After arriving at the clinic April and I sat with 2 different health workers who were taking basic data on the patients. The nurse I was sitting with was taking vitals (blood pressure, temperature, weight) and I got to help with the weighing. At one point the thermometer slipped from under a woman's arm and fell to the ground where it broke. There was no replacement and for the rest of the day, there was no temperature put on any of the charts--it really made me realize what limited resources the health system here has. After weighing people for a while, I got to go sit in the consultation room with Dr. Williams (April sat with another worker also in the consultation room). Perhaps the most interesting thing about sitting there was watching as Dr. Williams prescribed the drugs. Because of limited funding and resources, the drugs that they have to give at the clinic are first line HIV/AIDS drugs. This means that it is very, very important for patients to stick to their drug regimens so that resistance to the drugs does not develop. When patients didn't seem as though they would comply or hadn't attended adherence counseling (something they must do in order to get drugs) Dr. Williams was almost harsh with them. At first I was taken aback but then I realized that if they are not very upfront with the patients, they will have problems with adherence and if resistance develops there will be no drugs to offer patients. Despite having a sore bum after sitting on benches all day I am really glad I went but it was tough to sit in a room full of people who are walking around with a disease that is a death sentence, especially when those people where pediatric cases.

Friday night was a lazy night which was nice after a tiring day. Saturday April and I woke up to Ashley yelling through our window telling us to get up and open the door. We did as she said and found out she had received a phone call saying that 2 of our friends from Ouaga were on their way to visit for the weekend which we weren't expecting at all. They made it here despite some visa troubles and we had a fun weekend--even if we weren't prepared for visitors it was still really nice to have them. After they left on Sunday, we were invited to the home of one of the workers here, Armstrong. His wife, Mercy, had made us red-red (the plantains with bean stew) because Armstrong knew that is one of our favorite things to eat. Not only was the food delicious but we got to play with Michael, Mercy and Armstrong's 7 month old son who is adorable. It never ceases to amaze me how kind and welcoming the people are here.

This week has been on the busier side. Dr. Williams is out of town for the week so April and I have been meeting with CD, another one of our supervisors, to get our projects set up. It was the first time we had met with him one-on-one and prior to the meeting he scared us a little (don't know why). But after talking to him we realized that he is not scary and is incredibly helpful. My project has changed many times since last I posted and until I have a final one set up I won't tell you what it is. We did, however, get to meet our field workers this morning who will be collecting our data. Both April and I are working in the realm of maternal and child health so we have female workers who speak both of the local languages. As an added bonus they are former fieldworkers from the Centre so they have interviewing/surveying experience which is great. I think we will be training them either tomorrow or Friday depending on how our meeting with CD goes today.

Well that is all to report for now--it's April's 21st birthday today so we are going to go out to dinner tonight which should be fun. Other than that we have no big plans for the weekend--we may go to the pottery making place about 20 km from here in Sirigu or we may go to Tongo and see the rock formations/go hiking there. But we shall see since our weekends don't always go as we plan. Hope everyone is doing well and enjoying the fall weather (while we continue to roast here!)!

long time, no post

I apologize for not having posted anything in a (long) while, but not a whole lot has been going on here. The past couple of weeks have been taken up by paper writing and research topic finding. In terms of Georgetown and our grades there we have 3 things that we have to do: weekly journals that we have to submit to one of our professors, a health systems paper, and our big research project. We finished the health systems papers last week--they were 20 pagers on an aspect of the health care system here in Ghana. I looked at the introduction of the sector-wide approach to financing in Ghana and the impact it has had on the health system, particularly on a district level. Because we haven't been doing anything heavily academic here (not that we haven't been learning a whole lot), it was hard to get in the paper writing mindset. On top of that I was sick with something or other for 5 or 6 days which made the writing that much more annoying. But the paper is done and I am more than glad to have it out of the way. I also just turned in my proposal for my big research project for the semester. If it is approved than I will be looking to see if there is a relationship between child nutritional status and the nutritional knowledge of mothers, especially as relates to the level of formal education obtained by the mother. I had come up with a number of ideas for projects and the one I really wanted to do couldn't be done because I had no way of finding the proper sample population to survey. So after throwing around a number of other ideas which weren't things I was super happy about doing, I came up with this topic so we shall see how it goes...

Aside from the boring academic side there isn't too much to report. Two weeks ago (at least I think that's when it was) Francis dropped off the clothes that we had made. I have a cute skirt and matching top, so now I can dress like an African. All of us were so pleased with the outcomes that we plan on buying a lot more fabric and having many more clothes made! Francis also introduced to Kate, a student at the university up the road. She seems really fun and is someone I hope we get to hang out with more. Last Saturday we went to Bolga (the "big" town 30 km from here) with Francis to go to the craft center there which was a lot of fun. That same night we went with a different group back to Bolga to attend a hip life concert that was celebrating the end of Ramadan. It was a lot of fun, but a late night which is something we are not used to. This week we participated in a giant dance party in the streets up by the university; its SRC week which is when the other two campuses of the university come to the Navrongo campus for a week of fun. There have been activities all week (we only went to the dance party) but from what I understand there is some sort of parade/carnival today that we might be going to.

Despite all the adventures mentioned above, most of our days are pretty slow. We are in the routine of getting up early-ish (although it is late by Ghana standards) and doing work until lunch time. Then we head to Parliament (the canteen here) and grab some food (usually some form of rice and chicken) before working for the rest of the afternoon. April and I have been the ones to go into market recently (it tends to overwhelm Ashley) which has been fine minus the heat. Monday was a particularly great market day because we bought our first rolls of toilet paper since being here that are white and have individual squares (generally the rolls are gray). Granted it's no where near US standards of TP but hey, I found it exciting. The weather here is getting hotter by the day (upper 90s) and I can't wait for the end of November when the nights will be "cold" at about 75 degrees (the start of flu season here). It's hard to believe that October is almost over--I still can't believe how quickly time is flying here. Well that's all I have time for now, April and I are going with Dr. Williams to his ARV (HIV drugs) clinic in Bolga for the day to see the work he does there. I will try to post some more pictures later on today. Hope everyone is doing well, and once again sorry for not posting sooner!

october, october

from top to bottom: our first dinner in Ouaga (on the left from front to back are Emma, Aki, and Gunnstein, Emma and Aki's apartment mate); the view from inside the tro-tro (although it doesn't quide capture the number of people who were in it); the beautiful swimming pool we went to

Greetings from Ghana! Sorry it has taken me so long to post, but we away over the weekend and then the beginning of this week seems to have flown by. The big adventure since my last post was a trip up to Ouagadougou in Burkina Faso to visit two other Georgetown students there, Emma and Aki. We finished our rotations with the various projects last Thursday and decided that we could use the free Friday as a travel day. After asking around the Centre, we determined that it shouldn't be too hard to make it to Ouaga, all we had to do was take a cab to the border and from there take a taxi or bus from the other side straight to Ouaga.

Welllll it wasn't quite that easy. Getting to the border and making it across was no big deal, especially since we were still in English speaking territory. On the other side of the border, however, things started getting interesting. We realized that there were neither buses or taxis to be found and so, we ended up in a tro-tro. For those of you who don't know what a tro-tro is, its a 12 or so seater van that usually ends up holding 20 or so people inside with a whole lot of belongings (and sometimes more people) on the roof. The big problem with tro-tros lies in the fact that they don't leave until they are full which unfortunately meant an almost 3 hour wait in the heat. Our tro-tro finally filled up and we were on our way, but we stopped every 30 min. or so to let people off or pick up more. Thus what could have been a 1.5 or 2 hour ride via car turned into a very squished 3 hour trip. Before we even got out of the tro-tro in Ouaga, all three of us were totally overwhelmed by the fact that we were in a big city (in fact, we got excited when we saw a stop light). Once we got to the bus station, a Burkinabe who had been in the tro-tro and thankfully spoke English helped us get a taxi and set a fare (Burkina is French speaking and of the three of us here only Ashley is able to speak a little of the language). Many hours after we were supposed to arrive, we finally got to Emma and Aki's apartment (just as they were going in search of us).

It was quite the luxurious weekend. There was much eating of non-African food (we had pizza and ice cream the first night) which was a nice change since that's all you can get here in Navrongo, and we even got to go swimming at a hotel. Having a break from Navrongo was nice, but at the end of the weekend I was homesick for Ghana, something I never in a million years expected to feel (don't worry Mom and Dad, I promise I will come home). Our trip back was much easier, with only an hours wait for the tro-tro and much less stopping along the way. Needless to say it was an exhausting and fun weekend but it was wonderful to get back to Navrongo.

Other than that there is not much else to report. We have spent the past couple of days finalizing topics for our first paper we have due and beginning to think about our final research projects. My first paper will be looking at the sector-wide approach to health care financing and its implication on district health funds; for the big project I have only decided that I will be doing something with adolescent sexual and reproductive health, but I am unsure of which direction I will be taking. The rains here seem to be over (which I'm a little bummed about) and it is getting hotter and hotter--I'm not quite sure how I will be able to survive the temperature change when I come back to the US. That's all there is to report for now, hope everyone is doing well!

September is almost over??

I said last time around that I would try and be better about updating but clearly that did not happen. So here is a quick update of what the last week has been filled with...

After finishing my rounds with ASRH, I moved over to working with some of the malaria projects that are funded by the NIH. Thursday April and I went to a focus group of mothers that was aimed at gauging acceptance of a rapid malaria test (RDT) that they are attempting to introduce in the community. We couldn't understand what was going on because the discussion was conducted in the local language but I was able to help women "sign" (thumb prints) their consent forms (most of the women were illiterate). It's interesting to see the way these groups work--usually there are a few women who are most outspoken and who, in addition to giving their opinions, prod the other women to speak up. There was much laughter and from what we could gauge it seemed the women were very receptive of the idea of the RDT. Friday there weren't any field visits going on so April and I had the day off. It was market day so once Ashley returned from her field visit we made our way into town to stock up on food and water for the week. We have finally figured out a route to take through the inner market to get to the plantains and oranges which is great because getting lost in there is more than overwhelming.

Friday night we didn't do much of anything which was nice. Saturday we got up and Francis drove us around to show us where the schools in the area are so we can pick one to volunteer at (something we have been talking about since arriving). After checking out the schools Francis drove us over to see the Tono Dam (about 20 minutes away) which was an amazing site. It is a gigantic lake surrounded by amazing scenery and the area was so quiet and peaceful. Once we get our bikes fixed (now there are 2 with flat tires), Ashley, April, and I plan on biking out there to have a picnic. Saturday afternoon we went over to the apartment of one of the Centre's employees to watch a movie (Ghanaians seem to LOVE watching movies). After the movie was over we headed to the local University campus to watch part of a talent show that was going on and which involved much dancing and rapping. It was a fun evening and it was nice to be out with some locals--if there is one thing people around here have stressed, it is the importance of seeing what local life is like. Sunday we didn't do too much and spent much of the evening with on again off again electricity thanks to storms (we have been having a lot of electricity outages lately and they are not all weather related...).

Yesterday I switched offices again and went out into the field with the Rotateq trial team. Rotateq is a vaccine that reduces the occurrence of diarrhea in children (esp. infants) and while it has been licensed in the US, South America, and Europe, trials are still going on in Africa and Asia. We drove to a clinic where, after picking up all the mothers and babies, the vaccine was administered (there are 3 doses given over a 2 month period). It was a day long even starting very, very early, and continuing until late afternoon. I was under the impression that administering a vaccine would be a quick and easy thing but somewhere between informed consent, the taking of vital signs, and physical check-ups (to ensure they are healthy enough to receive the vaccine) time seemed to fly by until the whole day had passed (I was told that often the days are even longer than the one I experienced). I really enjoyed having the opportunity to see a vaccine trial in progress and to learn more about the inner workings of these trials. Today I wasn't up to much of anything--we had a meeting with our supervisors to discuss what we want to do for our papers and projects while we are here. I haven't made any final decisions yet so I have a lot of thinking to do in the next few days.

This weekend we are planning on travelling to Ouagadougou to visit Aki and Emma (two other Georgetown students). Hopefully everything will work out--we have asked the girls who were here last year for advice about getting there and it doesn't seem all that difficult which is good. Other than that life here has been going smoothly and I find it hard to believe that September is almost over--I never thought that my time here would slip by so quickly. Well that's all for now and I apologize for not putting up any pictures this time around--the internet does not want to cooperate...

some crocodile fun...

from top to bottom: Ashley, me, and April with Nave; me sitting on Nave; all three of us on the watchtower rock at the slave camp; out for Ashley's birthday (Francis is in the yellow, Daniel's behind him)

So another week (and then some) has passed since I last posted on my adventures (I promise I will try to get better at posting more often!). I think we are mostly settled in now and we are definitely getting more and more comfortable with our surroundings. These past days have been pretty busy and I am glad for the mid-day break I have right now. Well here goes an update of what I have been doing...

After finishing up with IPT-i/Urban Malaria I moved to work for three days with NDSS (Navrongo Demographic Surveillance System). The NDSS gathers census-like data on the entire population of the Kassena-Nankana District where the NHRC is located. Much of the work done here relies on data collected by NDSS as it can be used to find study populations for the various research projects. In other words if, for example, a study was to be conducted on malaria and pregnant women, the project team would turn to the NDSS to determine who amongst the local population is pregnant and can thus be considered as a subject. My first day with NDSS I went out with WM (staff at the center go by what they call code names) and Francis to the eastern region. We stopped at various field workers’ homes to collect their data from the day’s interviews. Because everything here is so rural the field workers live in the communities they are responsible for gathering data from and so senior staff from the Centre must check to make sure the workers are completing their work. Thursday (my second day with NDSS) I went out with Daniel (another NDSS worker) and WM to the west where we went to check up on a field worker while he was conducting interviews. In order to find where in the community the worker is the team stops at the worker’s house and checks forms they leave outside to see which houses will be visited that day. Once there is a general idea the team then goes to the area of the community and asks around to see which compound the worker is in. While this worked for finding the first field worker of the day, it didn’t work for finding the second so much of the morning was filled with driving and asking without being able to locate the person. It was a little bit frustrating but I got the impression this happens often and I was content enough to sit back and enjoy the amazing scenery (the west is hillier than around here). Friday I went out with WM and Francis in the morning to collect field worker data and in the afternoon I got to sit in on a field supervisor meeting.

Friday was also Ashley’s birthday so that night after some much needed showers (we had been without running water for 2 days because the water tank servicing our apartments had burst) we headed out to dinner with Francis and Daniel. It was a nice celebration at an outdoor restaurant with an amazing view of the stars and plenty of bugs to eat us up. Saturday we decided to travel to Paga, a town about 10 km north of here. After hiring a taxi (the first of many adventures) we headed off to our first stop, the Zenga Crocodile Pond. There are two crocodile ponds in Paga and according to all the locals the animals never harm humans—they believe that they are totems and that the spirits of ancestors reside in the crocodiles. When we got to the pond we were told that we would need to purchase chickens to lure the crocs from the water. After our purchase we headed down to the water (where people were doing laundry) and using two of the birds the guys running the site managed to get two crocs out of the water (which didn’t phase the women doing laundry at all). But after feeding them the birds they decided that these crocs weren’t big enough to take pictures with (they looked plenty big to me) and we headed off to look for Nave, the oldest (at 89 yrs) and biggest croc in the pond. We found him in a little side pond after using the last bird to lure him out. The guys then proceeded to show us various poses for pictures including squatting over the croc, holding its tail, and sitting on him. Needless to say it was a little bit terrifying but Nave didn’t seem to mind the poking and prodding and calmly posed for pictures with us. Ashley, April, and I thoroughly enjoyed ourselves although none of our parents were too pleased to hear that we had been sitting on playing with crocodiles.

After the croc pond we headed over to the Pikworo Slave Camp, which had served as a stopover/rest area for slaves being brought from Burkina Faso and Mali before being taken down to the coast. The area was a stony hillside where our tour guide showed us places like the dining area (where food was served in holes bored into the stone), mass graves, the lookout tower, etc. It was very interesting but also sad to see. When we finished up at Pikworo we headed back to Navrongo where it was market day. We braved market to stock up on food for the week and then managed to get stuck in a rainstorm on the walk home. Our cooking is getting better although we eat a lot of rice and noodles and fried plantains. We are slowly but surely finding foods we like including the amazing bread that you can buy fresh on the side of the road (it’s called sugar bread and April and I are capable of devouring a loaf between the two of us in a matter of hours). Sunday Francis invited us to attend services at his church (non-denominational Christian) where he was scheduled to preach. Francis picked us up and we got there at 9:30 (services started at 9:00 but the church wasn’t full until around 10:00). There was a ton of singing and dancing and then Francis gave a really great sermon. When all was said and done the service had lasted over 2 hours. Sunday afternoon we were lazy and April and I took a bike ride which had a few mishaps (including a flat tire) but it was nice to get a little bit of exercise.

Monday I switched over to working at the Adolescent Sexual and Reproductive Health Project. My first day there I went to a meeting at the Ghana Educational Services office in town where they were discussing teacher training for the ASRH curriculum that is taught in schools. Yesterday I got to go about 40 km south to Naaga, a very rural community that is one of the ASRH intervention sites where we facilitated a beekeepers meeting. One of the parts of the ASRH project is a livelihood component. The idea is that by providing certain people in a community with a means of income ASRH can then use these groups as a way to get messages across to the beekeepers who are then supposed to spread information on ASRH throughout the community. Well that’s all for now—I have to go check in to see if there is a group headed out to the field. Hope everyone is well!

One Week Mark

So I have officially been in Ghana for one week but it seems like I have been here for ages already--I can't decide if this is good or bad. These first days have been a whirlwind of activity. We got into Accra late on Monday night and spent Tuesday getting phones, exchanging money, and getting to see some of the city. It's not so much a nuclear city as it is a very spread out urban hub. We (April, Ashley, and I) were taken around by Isaac, who used to work at the Navrongo Health Research Center (NHRC) but has since moved to Accra to become the NHRC liaison there. It was during this outing that we had our first true Ghanaian meal which consisted of goat and tilapia in a very spicy stew served with fufu which is a dough like substance that is generally made from cassava. That same evening we were told by Dr. Liese (a Georgetown professor) to stock up on the "European" food in the buffet at the hotel because it would be the last we would see for a long time.

Early Wednesday we flew up to Tamale, a 1 hour flight, and then had a 2 hour drive from there to Navrongo. Despite being squished into the backseat of a pickup (a very common mode of transportation here) we managed to take tons of pictures of things we have since realized will be surrounding us for the next three months. Everyone in Ghana has been so welcoming, and that includes the staff here at the NHRC. Before we even stepped foot into our apartments we were greeted by various people all offering helping hands and words of advice (i.e. always close the door quickly unless you want wall geckos everywhere). We have two separate apartments--Ashley is at one end of the 3 apartment block, April and I at the other. They are spacious living spaces--living room, kitchen, bathroom, and bedroom (complete with bed nets!). After unpacking, briefly meeting one of our supervisors, and getting our internet set up, we had a quick bite to eat in the guest house here with a Ghanaian soap opera playing incredibly loudly in the background.

Dr. Liese said good-bye the next morning and we have been on our own since. Later Thursday afternoon Rosemary took us to market (market is every 3 days) where we bought some yams (which we attempted to cook later...it was disastrous), some tomatoes, amazing bread, spices, rice, and even pasta. She gave us a good introduction to the market although none of us are ready to brave it on our own yet. Friday was our first set of field visits. Dr. Williams (one of the supervisors) sent each of us to a different project and we were told to tag along with the teams. I was with urban malaria/IPT-i (another malaria program). That first day I went to Bolgatanga, the next biggest city, about 30km away with 3 of the workers here. We visited a number of compounds, first checking to make sure the Community Based Agents (CBAs) were doing their jobs of testing/treating malaria and then to a few compounds where children had been treated to see how things had gone. It was, needless to say, a little overwhelming.

Over the weekend Dr. Williams took us to Bolga where we did some grocery shopping and wandered around after which we ate lunch at a local restaurant. That evening, Francis, who works with the Navrongo Demographic Surveillance System (NDSS), showed us around town a bit, pointing out where we can get toilet paper, the cheapest bagged water, etc. and he also drove us by the Catholic cathedral which is beautiful (entirely made of mud and 100 years old). Sunday was a lazy day. Yesterday (Monday) I was back in Bolga doing visits similar to the first day--this time I was slightly more comfortable with things. Today I went to Paga (home of the Paga crocodile ponds and last town before Burkina Faso) with one of the field workers. She was interviewing a young mother about her experience with IPT-i (which refers to 3 doses of anti-malarials given in the 1st year of life and shown to reduce occurrence of malaria during the first years of life). The worker then showed me the crocodile ponds (I think we are headed there for the true tourist experience on Saturday) and took me to the border to show me what that was like.

Despite things being so very different here, I have to say that there hasn't been any huge culture shock--more culture confusion. When a Ghanaian is welcoming you to their home or country or whatever, they say "you are welcome" which the first few times confused us immensely because they were saying you're welcome and we hadn't said thanks. Other things we have learned: African yams are not at all like "yams" in America, cold showers can feel great when taken after a particularly hot day and not all stove tops light themselves, to name a few. Overall, the experience so far has been great and I can't wait to see what the next weeks bring (hopefully an end to our perpetually upset tummies!!).