Yebehyia

I’m writing this as I eat jollof at a restaurant in Accra. Six weeks went by so fast.

My last week in Kumasi was spent helping the research study TransMAL. In the mornings, I would head out bright and early to Emena Hospital, private hospital in the outskirts of Kumasi. We would set up shop in front of the hospital, where we unfolded chairs, set up tables, sorted equipment, and greeted participants as they arrived. I helped the study by obtaining and recording hemoglobin levels in the field (severely afflicted malaria patients generally have anemia) and processing samples for DNA extraction in the lab. During the evening I would head to the surrounding communities to meet the participants for the next day. If I had a penny for every time someone called me oboruni…

The great thing about this study is that it isn’t just collecting and analyzing data to assess a hypothesis—it also acts as an advocate for the community. By providing frequent examinations of the participants and paying for any low-level medical care, TransMAL helps ensure the health of the participants. The majority of the participants are those likely to be afflicted with schistosomiasis, and therefore have less disposable income for frequent check-ups and clinical care. This study is an example of public health research working for the future and the present. Good stuff.

After many goodbyes and a disappointing Euro Final (why France? why?) I headed to Accra by way of my old friend, the VIP bus. Instead of watching someone get sick, I was the one providing the show this time around. One bad burger and an hour later, my pale and sweaty self jumped off the bus in the outskirts of Accra and begged the boy carrying my luggage to take me through a village to my holy grail, the restroom. Hardly a place of rest, I squatted over a hole and did my business. With everything back in order, I rode a taxi in town. Finally I arrived at the Labadi Beach Hotel. Believe me when I say there is nothing like going from a shack with holes in the ground to a five star beachside hotel in the matter of an hour...

At the hotel, I am attending a symposium for the first day, and then heading to the airport this evening. I am so humbled and grateful that Kumasi made some room for me to be a part of a proud and unique Ashanti culture, even if for a month and some change. I will remember this trip forever, and hope there are more to follow in the future.

Medaase Ghana. Yebehyia. 

My Ghanaian Grandma

Sorry for the intermission! The internet here can be unreliable. But I'm back!

When I last left, I was going to go to a match the next day. Kofi and I went early to get good seats. Baba Yara Stadium, the main stadium of Kumasi and FC Asante Kotoko, is painted in Ghanaian colors, and from the VIP seating you can see the complete flag. That night, I saw Dwight Yorke, Alex Song, Emile Heskey, Edgar Davids, and Sol Campbell*. I thought I missed my chance to see a real live Heskey goal in my youth, and lo and behold he slots one in during the first half. 

This World XI played Asante Kotoko, the local team with a riotous fan base. They were quite a force during the game, and won 4-1. The only disappointing part of the day was not seeing John Mahama. While we were waiting for seats, we saw a coach bus pull in. 40 bodybuilders came out in a single file line (I honestly don't know how they fit through the bus doors) and loitered in the parking lot. I thought it was a good omen at the time, but alas Mahama has evaded me. This isn't over Mr. President.

For the past two weeks, I've been volunteering for the Ghana Health Service and the Sickle Cell Foundation of Ghana. The Foundation works in conjunction with the GHS to provide free newborn screening for sickle cell disease, and acts as a source of valuable information for caregivers. Sickle cell disease (SCD) is a lifelong condition, which affects every part of the body. Early on in a sufferer's life, if left untreated, SCD can damage the spleen. This results in a severely immuno-compromised state that leaves a child open to attack from opportunistic infections. 

Therefore, SCD sufferers are prescribed prophylactic penicillin. Although this protects the child, SCD will continue to damage the body, and requires careful and continual examination by a medical professional. In spite of these issues, treatment of SCD has advanced to the point where it can be managed throughout a person's life. However, these advancements have been quicker than changes in the social and cultural stigma of SCD (more on that later).

First, I headed to Suntreso Gov't Hospital, where I trained and observed Wilhemina, a charge nurse and screener for SCD. She performs a simple heel prick to every infant born in the hospital and collects the blood and information. After a day of this, I tried my hand at it. At first, it was difficult to get perfectly round red spots on the collection sheet. This is very important to avoid false positives/negatives after the lab sends back results. By the end of the day, I was pricking like a champ: I was so good, my last baby slept through it.

Wilhemina was a great teacher and we talked about her relatives in Ghana and the United States. When I told her my age, she told me she was old enough to be my grandmother. Little did I know this would come handy later...

After I wrapped up my last day at Suntreso, I headed out the door and right into a marriage proposal. A nurse was asking me to marry her and her friends surrounded me like a pack of lions. In Ghanaian culture, family has a lot of say when it comes to marriage. I saw my grandmother and told the pack that she would be the one to choose my wife. Luckily for me, she said none of them were good enough and got me out of there. Who knew my Ghanaian grandma would save my life?

Next up, I headed back to KATH to learn about the next process of screening: results and counseling. This part is difficult and at times, emotionally draining. Many believe that SCD is a death sentence, and that their child will be dead before 20. This leads many families to forego paying the cost of educating their children with SCD, leaving them illiterate when they do make it to adulthood. Educating families requires a collaborative effort from the healthcare system to dispel these misconceptions. 

The first day I learned about the program, how to navigate the database, how to ship results to the lab, and how to counsel parents with supervision. When a mother would walk in with her records, I would search for her child in the database and wait for the result to pop up. If the child was FA (F refers to fetal hemoglobin and is ubiquitous among the newborn, A is normal hemoglobin), then all was good. If the mother spoke English well I would inform her that everything was alright and she would continue about her day.

However, there were times the result would be FS. It's hard to imagine how two letters on a screen can change a family forever. A genetic counselor and I would sit down with the parents, and the counselor would walk the parents through everything. Correct information at this stage is crucial: not only can it protect the child, but it also protects the mother. We work to show how inheritance works and how each of them contributed a trait to their child. If we forego this, mothers are often blamed for the child's status. After a thorough explanation, I would fill out some paperwork to refer them to the sickle cell clinic. This experience taught me how important it is to connect with people, and to remain a bastion of stability and trust in an incredibly tumultuous time.

Today, I went to Bantama, an area near Kumasi, in order to find an unreachable mother with a son diagnosed with SCD. After 2 hours of walking and searching, talking to many different people and eventually finding her workplace, the community nurse and I admitted defeat--for the day. We resolved to come back later in the week. Although some slip through the cracks, it's incredibly important that SCD is caught early.

Tomorrow, I will head out bright and early to area hospitals to help out with a field research study called TransMAL. The goal of this study is to analyze the vulnerability of the population infected with schistosomiasis to malaria, and how co-infection affects the body. Schisto is a neglected tropical disease: although it affects tens of thousands of lives, not much research is done to help this population. This study is meant to shed light on how schisto sufferers can be better managed by the healthcare system in Ghana and other countries where it is endemic. 

I will update soon. So long, friends. 

*Judas--COYS

My Name is Kwame

I forgot to mention, many people here call me Kwame now, since I was born on a Saturday. You can find your Ghanaian name using the link below:

http://mefirighana.com/ghanaian-names-what-does-yours-mean/


This past Saturday, I went to dinner with Kofi, Maxwell (a lab researcher) and Kofi's girlfriend, Gloria. Guess what.....it was fufu!! Making fufu is a long process, starting with the soup, which is boiled and kept on low heat while the next part of the fufu is made. It's hard to describe, this part is almost like bread. It is made from Kasava, Kokoya, and plantains, which are mashed together using a large stick and a giant crucible, where the three ingredients are mashed into a dough. Although I can't upload video for now, I will when I return to the states so you can see me try my hand at it....

The dinner was delicious, followed by a lengthy political discussion..the Ghana elections are this November, and President Mahama of the NDC party will be running again (much to Gloria's chagrin). Just as she was telling me how incompetent he was, the power went out. In Ghana, an overtaxed electrical grid frequently results in power outages, (called dumsor in Ghana). After more political talk, I headed home. Since KNUST (the university I am staying at) adds checkpoints at night, I, thinking a checkpoint was an exit, got out of the taxi when it became clear I had no idea where I was going.

Lucky for me, Ghanaian goodwill kicked in and the security guard jumped in the taxi to take me to KCCR. If I had walked, I would have had five or six guard dogs to contend with. The security guard at KCCR made sure to tell me to bring a big stick next time I try the foray on my own...

On Sunday, I woke up early to see the Akwasidae festival. It is a festival the Ashantis celebrate every six weeks, and an opportunity to see Asantehene, or the Ashanti king. After a tour of the museum, I entered the courtyard, where chairs were set up to view the area where distinguished persons, local chiefs, and the Asantehene himself would sit. Soon, the music and dancing started. The dancing is unique: each movement is a word, and the dance communicates with the music. To some who understand their language, the dance is a conversation with drums and trumpets, exalting the Asantehene and the Ashanti kingdom.

The chiefs arrived with decorative clothing, massive retinues, and lots and lots of gold (Ghana used to be called the Gold Coast). They also brought presents for the king, traditionally Schnapps or an animal sacrifice (a large white mountain goat was present). Finally, the Asantehene arrived. It was impossible to hear oneself over the climax of a crescendo of voices ad instruments upon his arrival. His majesty was approached by all the chiefs, as well as the former president of Ghana, John Kufuor. It struck me then how easy it was to attend this festival full of VIPs: no security, no tickets, no nothing. Just come in and sit down. I know if I got to see Bill Clinton 10 yards away from me and the British Queen, I would be strip searched for sure. There is a completely different mindset in Ghana, that's for sure.

Yesterday, I went back to KATH. Kofi, Ezekiel (a lab researcher at KCCR) and I were able to enroll several patients into ORDIS, the study examining young sickle cell sufferers over time. After running their samples in the lab, I returned to the consulting rooms, where I was able to help conduct malaria tests on children suspected of having the illness. It's never fun to cause pain (especially when the patient can't speak English) even if it is a pinprick. Despite this, the test is very accurate and can save these children from a ton of headache (pun intended). After, we returned to the lab at KCCR to run more tests on the patient samples, and then called it a day.

Today was very similar to yesterday, except I was able to take vital signs on children that were new to the study in order to complete their enrollment. We enrolled two more patients, and their samples were run by Ezekiel and I at the KCCR lab. I do feel like I'm starting to get used to the culture here, and the behaviors people expect. There is a chance that assumption will be completely destroyed come tomorrow however, when I go see a match between Asante Kotoko (the local football team) and World XI (a collection of old and current Ghanaian internationals) to promote peace during the upcoming elections. There are rumors President Mahama will play for a few minutes, so if I see him I will be sure to let you know. Until next time..

KATH

For the past couple days, I've been getting acquainted with the hospital I will be working at, the Komfo Anokye Teaching Hospital. For those of you interested, Komfo Anokye was a High Priest that facilitated the start of the Asante (Ashanti) people. I was able to enter the Sword Room, where Komfo Anokye drove a sword into the ground and proclaimed the warring tribes of Ghana as one, the Asante. The powerful unity of the Asante is expressed through the immovability of the sword, which has never been removed, though many have tried (even Muhammad Ali!).

I went into the hospital and met the research assistant I would be working with, Kofi. On Thursdays, KATH has an outpatient clinic. I learned about the layout of the the consulting areas, where I will be screening and enrolling patients for the ORDISS study. This study examines those suffering from sickle cell anemia, and the toll it takes on their body over time by analyzing their blood and serum. Sickle cell is huge problem in Ghana, and carries a severe stigma. Many believe that sickle-cell sufferers will die before 18, therefore many parents refuse to pay to educate children suffering from this disease. I sat in a Sickle Cell Association of Ghana, where sufferers can meet each other and learn about the misconceptions surrounding the disease. It was amazing to see the relief and hope these meetings provide for their members.

After the hospital, I walked around the business district of Kumasi, Adum, with Kofi. I bought a new small phone, and a SIM card. Together they were $18..not too shabby. Adum is sprawling, and full of shops and restaurants. There are very few supermarkets: most of the shopping is done with street vendors. I didn't get to try my hand at bargaining very much but I'm sure I will soon. Jet lag was still hitting me very hard, so as soon as I got back to KCCR around 5 PM I was out....until 3 AM.

The next day, I went back to the hospital. Because there is no driver today, I went there via taxi and tro-tro (with a friend so I knew where I was going). A tro-tro is a modified van, fitted with extra seats. It is often old and rickety, but a lot of fun to ride. The driver's mate sits next to the door, and stands at every stop, hanging out the window/door to let everyone know the destination and the amount of open seats. After asking to get off ("Missi wo 'destination'") I walked to the hospital through Adum. I saw an ambulance pull in and I had to wait and see how the EMTs/paramedics did their business. It's actually very similar to the way it's done in the States, though I was surprised when the paramedic let 8 family members into the back....

 On Friday, the pediatric HIV clinic opens. Children of all ages wait for hours (very often five to six hours) to see a pediatrician. Although it was hard to see all the kids stricken with this terrible disease, it was comforting to see how hard everyone at KATH works to make sure these kids are eventually seen, counseled, and taken care of. On Fridays, I will help screen and enroll patients in a study called Sankofa. This is a HIV disclosure study. Essentially, the vast majority of these children were infected because the mother had HIV as well. As you can imagine, with the societal stigma associated with HIV, it is difficult for the mother to know when/how to tell the child about their HIV status. This study is assessing whether counseling of the caregivers can make disclosure an easier process, while analyzing the underlying reasons why parents find it so difficult to tell their child they have HIV.

After touring the clinic and working on some data entry for Sankofa, I went to the medical school nearby to have lunch. I ate a delicious dish called fufu with goat soup. I also had Sobolo on the side, a sparkling hibiscus drink. In Ghana, it is traditional to eat soup with your hands, and that's exactly what I did (don't worry I have Pepto-Bismol ready and waiting). I pulled the maize apart like bread and ate the soup. Before and after, you wash your hands at the table using your personal water bowl and soap. After lunch, I drove around Kumasi with Kofi, and then headed back. Tomorrow, I will have dinner at his place...and I think its going to be fufu! I'll let you know soon...

First Few Days..

It's June 2nd, and I'm set to see the hospital in Kumasi for the first time this morning. The trip here had some snags but I made it!

I took the Megabus to New York (for only $7!!) and found enroute my British Airways flight had been cancelled. Apparently the day before their JFK computer system crashed and they were forced to issue handwritten boarding passes. Either way, they found me a new flight and issued me a nice non-paper phone boarding pass. With the flight set to depart an hour and fifteen before the original flight, and the bus late an hour to Manhattan, my hopes of getting a slice in the Big Apple were crushed.

Instead, I was running like a banshee down 7th to get to one of two trains that would get me to JFK. Somehow, an hour and a half after I arrived an Manhattan I was sitting in my seat enroute to Heathrow. Compared to US airlines, British Airways was a godsend--but I guess that isn't saying much...

Breakfast and Dinner, 30 movies to pick from and even more TV shows, and complimentary beverages ranging from OJ to mimosas. Not bad. I landed in London in the morning, and had only four hours to spend. I did get to see a Ben and Jerry's vending machine (!!!) and immediately regretted not changing my dollars to pounds.

As soon as I sat in my seat to Accra, I woke up as we landed. The plane opened its doors and I stopped out onto the tarmac. My first thought was HOT. It was 95 degrees with 100% humidity. I entered the airport which first scanned me with a thermal device (to see if I had Ebola) and then an attendant asked for my yellow fever vaccination papers (to make sure I didn't get yellow fever during my stay).

After I got my luggage, I changed my dollars to cedis and stepped out of the airport. There must have  been at least 200 people outside, all asking if I needed a taxi, hotel, phone, cedis, or a tour guide. I went to my shuttle and arrived to my hotel where I would spend the night, the Airport View Hotel. The next morning, I took a taxi to the VIP bus station, where I would take a 4 hour ride to Kumasi.

Two minutes after I bought my ticket, I was on the bus to Kumasi. I saw many villages on the way there. Some were stricken with heartbreaking poverty, but most were developing or developed. One thing they all had in common were goats. So many goats. 

On the way there, a young girl traveling on her own threw up. It was amazing to watch complete strangers immediately come to her aid, with water, towels to clean up, and fresh clothes. It's clear Ghanaian culture is something special, with a true sense of community I hope I can acquire during my stay here. 

I took a taxi to KCCR, a research center I am working for in Kumasi. My first assignment was to introduce myself to everyone, and it was great to hear about the research projects being conducted around the country on subjects such as malaria, elephantiasis, onchocerciasis, schistomaniasis, and much more. Today, I will learn more about how I will help the hospital, KATH, and the work I will be involved in at KCCR. I will update soon. Until then, see you on the flip side.