30 July - 4 August - The Final Stretch!

This will probably be my last post from Ghana! I leave on Thursday for the U.S.A.!

This past week has been full of last minute analysis, presentation preparation, and report writing. I finally got word from the man who was supposed to help me get data. Although the information he provided was not exactly as complete as I would have liked, I appreciated the fact that he finally go back to me!

After an underwhelming response from this guy, I was worried I didn't have enough/correct data to complete my project. I had a momentary freak-out, during which I felt guilty/frustrated/upset...just in general felt like a failure. I couldn't believe I had been in Ghana for so long and would have nothing to show for it. I knew I was the only one to blame, for not being assertive or proactive or smart enough to figure everything out. I allowed myself to wallow in this state for about 2 minutes, then bucked up, sat down and looked at the data that I had and realized I was much closer than I originally realized. By the end of the next work day, after several hours of reviewing reports and papers, I had all the information I needed to at least complete a model for presentation here.

Hours and hours, days and days later (including my first and only weekend that included doing work), I have run my model nearly complete. I have a presentation. I have a (nearly finished) report. Is everything perfect? Nope. But I have a couple more days to review and edit my work and get it as close to perfect as I can. Worst case scenario, I leave Ghana with a few loose ends, go home, and wraps up those loose ends to make an amazing finished product!

23-29 July - Roadblock

It was bound to happen sometime, and I have finally encountered some challenges with my study. I'm almost relieved because everything felt just too easy and I was beginning to feel that I must be doing something wrong.

I am struggling to get a few values I need for my model (transmission rates, costs of treatment, etc.). These mysterious values are proving elusive. After not being able to obtain them from records at the hospitals, I visited the Ghana Health Service office to try their resources. They redirected me to the National AIDS Control Programme headquarters in Accra, whose office I have emailed and my advisor has made several calls, but to no avail.

Nevertheless, I'm not too worried. I will persist a little longer and resort to my multitude of back-up plans if necessary.

I am a huge fan of the Olympics was very grateful to be able to watch the opening ceremonies on Friday night. Ghana is broadcasting the Olympics on GTV. GTV experienced a brief power outage during the opening ceremonies, and subsequently broadcast most of the ceremony's remainder in only green and red, but it was still good to watch! GTV also advertises that they have "full coverage of all of the Olympic events, every detail, LIVE from London"....which is very far from the truth. They show the Olympics for only about 4 hours each day and only show soccer, boxing, and basketball. My original plan for the weekend of sitting in my hotel room, eyes glued to a TV set was not able to happen.

16-22 July - Data Analysis; Reading in Ghana

This week marked the initiation of data analysis. Not surprisingly, data analysis is one of my favorite things. I just love working with numbers, figuring out problems, and interpreting SAS output. Nevertheless....data analysis is not exciting. Nor is it interesting, at least for now. I've determined a few statistically significant relationships, but nothing too groundbreaking...except, however, that a low CD4 count is apparently related to a higher birth rate. Hmm. We'll see.

One huge perk of data analysis is that I get to work from Dr. Agyarko-Poku's office at the foundation of the Asante King (Otumfuo Osei Tutu II). This comes with working at a desk, in air-conditioning (compared to working at the very edge of a desk in a crowded, poorly-ventilated hospital records office). I must say, analysis is much easier when I don't have to worry about sweat dripping on my computer.

View from the foundation office

Life in Ghana has become incredibly solitary. All of the other international volunteers that I knew in the area have left.  Ghanaians seem to enjoy socializing at three points: at work, at funerals/weddings (Saturdays & Sundays), and at church. "Hanging out" on a weeknight really doesn't happen. I was supposed to attend a funeral yesterday, but the driver never came to pick me up. Thus, I am often left to my own devices. One can only watch so many movies in a day and I have spent increasingly significant amounts of time reading. Since arriving in Ghana a little over 10 weeks ago, I have (nearly) finished 6 books:

-In Defense of Food (Michael Pollan) - Fully recommend! This "eater's manifesto" explores exactly why the foods we eat are so unhealthy, from portion size to types of food eaten to food processing. A really enjoyable read, and one that has actually changed how I eat (or...will change how I eat once I get back to the US...not a ton of control over meals here).

-How We Decide (Jonah Lehrer) - Very fascinating book about how humans make decisions, including how we sometimes make poor decisions because we are too informed and how past experiences help make us better decision makers.

-The Man Who Ate Everything (Jeffrey Steingarten) - Pretty decent book from Vogue's food critic. The book starts out very strongly, with Steingarten's experience overcoming dislike of several foods including kimchi and anchovies. The remainder of the book is filled with short stories that describe Steingarten's experiences exploring the world of food...but they become increasingly dense and stiff.

-Shakespeare's Kitchen (Lore Segal) - Described as a "loosely connected collection of short stories" on Amazon, this book feels more like a novel that takes place over a long period of time, with chunks missing in between chapters. Shakespeare's Kitchen revolves around a young woman who has immigrated to the US from Austria as she struggles to make connections while working for a literary think tank. Not that great.

-My Father's Tears (John Updike) - Beautiful portrait of America, presented in (actual) short stories. I really enjoyed Updike's writing - challenging enough, but not inaccessible. I particularly enjoyed his story about 9/11 told from four points of view.

-Inside the Outbreaks (Mark Pendergrast) - Finally, I decide to read a public health book while at my Master of Public Health internship! This book tells of many adventures of the CDC's elite task force, the Epidemic Intelligence Service (EIS). Told through many (many) short recollections of outbreaks and investigations, Pendergrast diligently covers the history of the EIS. It's a little hard to read, given each recollection is a ~5 paragraph case study.


Still on my list for the summer:

-My Own Country - A Doctor's Story, Abraham Verghese

-The American Plague - The Untold Story of Yellow Fever, The Epidemic that Shaped Our History, Molly Caldwell Crosby

-In the Garden of Beasts, Erik Larson

9-15 July - Ghana: For Better or Worse

Big research new of the week: chart review is finished! After several weeks, I'm finally done scouring charts for hours on end each weekday. Moreover, the data from all 818 charts has been entered into Excel. Whew. A little more data collection at the Ghana Health Service Regional Offices, then time to get down to analyzing!

My final 50 charts at Kumasi South Hospital.

This weekend, my friend and classmate, Jen, visited from her internship in Kasoa. We had a great time exploring Kumasi's Kejetia Market and the National Cultural Center. We also attempted to visit the Okomfo Anokye Sword at the Komfo Anokye Hospital, but viewing was closed. Oh well.

Jen loves Ghana and plans to find a job and move here after finished her MPH at Yale next May. I, on the other hand, do not love Ghana. I definitely like it and have enjoyed (and will continue to enjoy) being here this summer, but have failed to be wholly enamored with the country. Although I do my best to appreciate all that Ghana has to offer, I really dislike some things about Ghana. Here are some of them:

I dislike...
-Trash everywhere
-Cab drivers who tell me they know where my destination is, drive for 10 minutes, then ask me if I know where they should be going
-That no one can understand me, despite English being the official language; not ever knowing what people are saying around me
-Dirt & dust everywhere
-Total lack of variety in food
-Automatically having attention drawn to me because I am so clearly out of place

Of course, I also like many things about Ghana.

I like...
-General lack of stress
-How incredibly safe I feel
-How helpful and friendly everyone is
-Bargaining for souvenirs (I really love it)
-The general motivation of Ghanaians to want better things for their country, despite not always knowing how best to achieve those things
-Riding in cars here....it's oddly soothing, considering the condition of the roads/driving style

2-8 July

Research continues to progress consistently and although I enjoy it, the work is rather dull to discuss.

My work-week was pleasantly disrupted by a few afternoons spent at Kwame Nkrumah University of Science & Technology (KNUST), where I sat in on a few classes with their MPH students. To be honest, I was not looking forward to these classes. I had many negative expectations…the lectures would be too advanced or too basic, the English that lectures are supposed to be taught would evolve quickly into Twi, the lectures would be flat-out boring, the room would be uncomfortable, etc. However, my fears were for naught; the classes were extremely enjoyable.

The classes covered HIV transmission, surveillance, and therapy guidelines and were taught by my advisor, Dr. Agyarko-Poku, as well as the Dean of KNUST’s medical school, endearingly called “Prof” by students and fellow faculty members alike. The students in the class were older than the YSPH cohort and were all very engaged in the class discussions. I found it fascinating that the classes seemed to explicitly focus on public health “in developing countries.” Although this makes practical sense, it was just odd to hear all these Ghanaians saying things like “because we’re a developing country, we must create this type of surveillance program.” It also hit me in the middle of a class that the students must have a totally different out-of-classroom experience than students in the Western world…course material is not available online, papers are all written by hand, yet all over the world, other students like me do almost all of our out-of-classroom learning sitting in front of a computer. I learned quite a bit from the classes and plan to incorporate a few aspects of the therapy discussion into my research.

This weekend was my first full weekend not leaving the city! It’s odd to think I’ve been here for a month, but haven’t really gotten to know Kumasi that well. I spent Thursday, Friday, and Saturday nights with Unite For Sight volunteers now stationed in Kumasi – Abbie, Nick, and David. I had volunteered with Abbie during her first/my last week in Accra, but met Nick and David here. We got some really filling Indian food on Thursday, and then went to a few bars on Friday and Saturday night. On Saturday I also attended my first Ghanaian wedding! Similar to my church service experiences, it was interesting, but not overwhelmingly culturally different. The wedding service took place in a church and was almost exactly the same as an American service except it lasted about 2 and a half hours (in typical Ghanaian fashion). A fair amount of time was spent “blessing the couple”, which reminded me more of an exorcism than a blessing…lots of ministers shouting while they stood around the couple. The reception was almost exactly like an American reception, although I don’t have much to compare as I left the reception pretty early in search of a cab to take me home for a surprisingly necessary nap.

Experiencing a Ghanaian wedding really makes me notice Ghanaian culture, especially of those living in big cities like Accra or Kumasi. Ghana has such an interesting patchwork culture, with different traditions and customs coming from the various native ethnic groups, as well as the many European visitors/colonists over its existence. Yet, Ghana has only independence for 55 years. It feels as though Ghana is in its awkward teenage years of cultural development. The country wants so badly to be one of the cool, popular “developed countries” that it is willing to sacrifice its rich background to assimilate. This is exemplified in events like weddings, where tradition has been taken over by tacky Western decorations and music once filled with heritage is replaced by blaring Christian soft rock. Fufu, a totally appealing (to Ghanaians…not me) and critical Ghanaian dish that requires someone, usually a woman, to pound the dough with a large stick, is now mass-produced and sold in boxes, completely consumer-izing one of Ghana’s few traditional foods. These are formative years...will Ghana be able to hold onto and embrace its fascinating culture…or will it get sucked into the Western world with little to show for the many challenging years its citizens endured to gain independence?

With my co-worker, Helena, at the wedding reception

26 June-2 July - Data Collection + Republic Day Weekend

There isn't much to report from this past week...basically just me in hospital records offices, going through charts.

The weekend was very fun! It was Ghana's Republic Day on Sunday, so everyone had work off on Monday. I used the long weekend to visit my friend Jen, a fellow YSPH student in Kasoa. Jen is working with the Cheerful Hearts Foundation. I stayed at her house, which she usually shares with several other volunteers who were out of town over the weekend. It was really neat to see how experiences in Ghana compare. Living in a house with Ghanaian hosts, Jen definitely gets a better understanding of "living in Ghana", compared to my life in a hotel, which is much more of a "life in Ghana for foreigners who are only here temporarily." 

The trip to Kasoa is not incredibly hard, but it is very long. I left the hotel at 6:45 on Saturday morning and didn't arrive at Jen's place until about 6 PM that night (partially due to many detours taken on the road because of accidents). Sunday morning brought a real treat, as Jen made pancakes for me, her, and her hosts. Yum.

We walked around Kasoa briefly on Sunday, then went to Big Milly's beach resort to relax and spent a night hearing the waves crash against the shore. There were so many obronis at the resort!

I spent a fair amount of Monday traveling back to Kumasi, but was able to arrive to the hotel around 3 PM and get ready for a shortened work week!

22-26 June - Weekend in Michigan + recovery day

This weekend involved several things that my weekends this summer have yet to include: more hours traveling than not traveling, being in a room with people that I have known for longer than a month, and not having to worry about a bathroom lacking toilet paper.

I began my departure from Kumasi to Marysville early Friday morning. 6 hours of bus rides, 3 hours of catching up with Unite For Sight volunteers, 13 hours on a plane, 3 hours of taxi/car rides, and several stretches of waiting later, I was finally home for a glorious 34 hours in the States (about 28 hours of which were in Marysville/Port Huron).  The wedding was amazing, but I realized afterward just how tired I was throughout the ceremony and reception. I was cruising on autopilot for most of the event. My apologies to anyone reading this with whom I conversed, especially those who endured a conversation of nothing but me talking about Ghana. Aside from being extremely tired, I also was totally not adjusted to socializing with so many native English speakers. This was especially apparent when anyone asked me, "How are you?" My response was always "I am fine, thank you. How are you?"...because that is the most well understood response in Ghana. As my good friend and YSPH classmate, Raj, accurately predicted during a Skype conversation just prior to me leaving, it just felt like a dream, and now I've woken up, back in Kumasi.

Congratulations, Kathryn & John!

I still can't tell how I feel about including this visit home in my "Ghana experience." I am obviously happy I was able to make it home for the wedding, but going home feels like cheating. I had laundry done in a washing machine and dryer, I bought a ton of granola bars, I dropped off a load of souvenirs that I've already purchased. Most people working abroad for long periods of time don't get to go home, and being here only 3 months with a break included just feels weird. I also got really upset about returning to Ghana when I was back at the airport on Sunday night. I was trying to figure out a way to a) have an excuse to stay in the US, b) have a way to tell everyone involved in my project that I was going to stay, and c) get the things I had left there back home. This was all in vain, as I boarded the plane anyway and did a reverse trip back to Kumasi, arriving very late on the 25th (note: the bus route between Accra & Kumasi has uncomfortably cold air conditioning...definitely wearing pants and a jacket next time!). Once I got back to the hotel and got unpacked, all the frustration/anger/generally negative feelings I had about returning were virtually gone. Maybe it was the after-effects of the sleeping pill leaving me in euphoria, maybe I realized I didn't really have much of a choice,...but probably I remembered that I actually do enjoy living here. I can't imagine permanently moving to Ghana, or any other developing country, but there are far worse things than living here for another 6 weeks! In any case, I won't let a dumb thing like a bad attitude ruin such an incredible opportunity. Cheers, Ghana, let's have an amazing time together.

Side note: My brother, sister, and I must have the most understanding and supportive parents in the entire world. Not only did my parents pay for my trip home, they also managed to say hello and goodbye to all of their children within a few days. All three of us left on Sunday...Chris back to DC, me back to Ghana, and Kathryn off to Jamaica for her honeymoon with John. Thanks Mom & Dad!