Patience is a Virtue

Our last few hours in Accra were strangely enough spent at the Accra Mall. Kofi was trying to juggle a morning of shuffling MHIRT students around, and Keesha and I needed to do a big grocery shopping trip to stock up on essentials before heading to Akwatia—thus, Kofi dropped us at the mall, whose main feature is a ShopRite grocery store. In addition to the grocery store, the mall contained a handful of small very expensive clothing realtors with an African twist—at places like “Woodlin” one can pick out their own fabric and have an outfit from the mannequins made. The other shops included a few Nike-like shoe stores, fine china and silver shops, cell phone networks, a video arcade, and a food plaza. I could do without the rest of it, but much to my excitement there happened to be a coffee place—the closest they could come to real coffee was espresso with cream, but I was stoked nonetheless-- Definitely a step up from the Nescafe packets I’ve been rationing! We also purchased a wireless internet USB through the phone company, in hopes of having occasional internet access in Akwatia for work and play. (Unfortunately, it only sort of works sometimes, as the signal is weak or non-existent here… but it’s better than nothing! (Sorry Mom and Dad for missing all of your calls… weak internet through the phone company also means weak cell signal!)) Kofi told us he’d be back in an hour and a half, but amazingly, we’re learning how things work around here, and weren’t surprised when we showed up four hours later. It gave Keesha and I more than enough time to fill a grocery cart at ShopRite and further indulge in an American summer treat we’d been jonesing for and had not yet found: ice cream cones! It wasn’t Washtenaw Dairy, but it definitely hit the spot. 

Well stocked with toilet paper and tummies filled, Kofi returned and we headed out to Akwatia—North through the San Francisco-esque house-spotted hills of Greater Accra, then veering Northwest through villages and rolling hills that look similar to the green mountains images rendered in Chinese artwork. I chatted most of the way with Kofi, curious about his eclectic background. I learned that he was born and raised in Ghanaian—one of six children, to his father’s first of three wives. Polygamy is practiced in Ghana, but as Kofi explained “the economy just isn’t good enough anymore to support multiple wives” so it’s become less commonplace. Raised catholic like most Ghanaians, Kofi went through primary school and on to a Franciscan Ministry secondary school. The first nine years of schooling (through middle school) are compulsory and free here; secondary school is optional and tuition based. He made friends with a visiting scholar, and ended up using those connections to find free housing in Boston for university, leading him to campaign within the church for funding to attend Boston College. He had always been drawn to animals and badly wanted to be a veterinarian—a rare occupation in Ghana. He ended up transferring to Pennsylvania from Boston College, and later attended Penn State for a DVM specializing in large animals. After four years of practice in Africa and some time working as a veterinarian for USAID, through a fluke he attended a maternal mortality conference in place of his boss. The speaker captivated him with a speech that equated the current maternal mortality rate with a large airplane full of pregnant women crashing every four minutes—99% of those deaths occur in the developing world. That conference changed his life. He went to Korle Bu to review the Ghanaian statistics and was shocked—thought about medical school, and was encouraged to do an MPH instead. Thus, he arrived at the University of Michigan, where he completed his MPH and met Tim Johnson, who in 1986 had started an OB/GYN residency program in Ghana, in an attempt to stop the brain drain and keep more trained OB/GYNs in Ghana. Dr. Johnson was in need of a study manager, and the rest is history. Kofi has spent his time ever since jetting back and forth from Ghana to the United States, and has been absolutely essentially in exponentially expanding the collaboration between Ghana and Michigan. There’s talk of breaking ground on a ‘Michigan Center’ as a home base for research and visitors in downtown Accra on land donated by the University of Ghana. In the time we’ve been here Kofi’s been back to Michigan, spent a week at the ACOG conference in California, came back to Ghana, and is now in Uganda! Utter craziness, but very handy guy to know in Ghana—we’re definitely lucky to have him!

Most of the trip I was fairly engulfed in learning about Kofi’s background, and asking random questions about Ghanaian culture—like why do so many people have straight line scars across their cheeks? (answer: tribal marking traditionally- different slashes for different tribes, and on younger generations because an anti-seizure medication to seizing babies is given through the cheek!) Or, what food are people making on their front porches pounding tall wooden bats into wooden buckets (think the action and strength of post-hole digging)? (answer: Fufu- they are pounding cassava and plantans together into a dough called fufu which is then dipped into stews). A few miles from Akwatia, we saw a scene that needed no explanation. On one side of the road, a tro tro tipped over, on the otherside a busted up taxi cab jutting into the overgrowth on the roadside. A whole pile of people where standing around, having piled out of the tro tro. The accident had obviously happened just minutes before. As far as we could tell no one appeared seriously injured, but the scene was a sobering testament to the dangers of driving in the developing world.

Just before dusk we secured the keys to our apartment, and settled in for our first night. The doctor who lives in the flat next door invited us over to watch a big ‘football’ match. After settling in, and when the cheering through the wall was sufficiently loud, we wandered over, hoping to make friends. We found a group of eight or so Ghanaian men, and three German high school exchange students (who unfortunately left the next day!) utterly engrossed in the game. The room was a hilarious mix of English, Twi, and German—lots of yelling and emphatic fist pumping, while Keesha and I just did our best to figure out which team was which  We didn’t really get to talk with anyone amidst the intense football watching, but we’re one step closer! Actually, we have made some very friendly and lively friends since moving in… they’re fun, energetic, and always up for a party! They happen to be 4 and 5 years old… but hey, ya gotta start somewhere right? Hehe. These two little kids, brother and sister: Kevin and Obi, live on the top of our three story apartment building. Keesha and I met them yesterday on the back stoop and they’ve latched on. Throughout yesterday afternoon, and again this evening, we’ll hear low knocks on the backdoor and excited voices yelling, Obbbrunie! Hey miss Obrunie!! Yesterday they picked us flowers, and had far too much fun with the digital recorder and microphone we are using to record interviews. I think the only English song they know is “We Wanna Wish You a Merry Christmas”… but they are definitely not afraid to sing it!

Almost as exciting as the small children, was our first official day of pseudo work! Yeah! We took the hospital bus that comes at 7 AM into work this morning, where we spent our first morning in the antenatal clinic. The clinic already had a good twenty women waiting at 7:15 when we arrived. Women sat on rows of benches under the shelter of the open air clinic. A handful of nurses and ward assistants trickled in to set up the clinic for the day—they set up a large table with a nutrition and bp station, and sorted the women into sections of benches for antenatal and post-natal 2 week check-ups. All of the post-natal mom’s were easy to spot both from their baby in toe, and because they wear traditional white gowns to symbolize the strength and success of their recent birth. By the time they were sorted out the benches were filled with forty or fifty women waiting for their check up. As Doris, a midwife and our translator, explained, the day always starts with a prayer. All the women stood and sang and clapped to a joyous song, to praise God, and bless the start of the day. After singing a more solemn prayer is said, and then the women take their seats for a talk. They were addressed by Janet, who appears to be a head midwives at the clinic, and had also led the singing and prayer. Doris explained that Janet, addressing the whole crowd of women, was talking about the importance of antenatal care, what lab tests are done, what the midwives are checking for during the exam, that abnormalities are referred to the doctors, the importance of coming to the hospital first rather than a spiritualist in a village, and then the list of what women need to bring with them for delivery (including a plastic pad, a razor, and pads). When all this was done, the actual clinic started.

Our goal today was to pilot test the survey—trying out the questions with a few women, making sure our recorders were working correctly, and giving the translators a chance to practice translating back and forth. We did two practice interviews, which went far more quickly than we anticipated. Not wanting to drain our resources for the actual study (by interviewing too many of the local women in their third trimester for practice), we wrapped it up after two, and were out of the clinic by 9:30 AM! Keesha and I are really itching to actually get started on the study, now that we’re here (with nothing else to do!) and everything is in working order. Unfortunately, we’re still jumping through University hoops. Although our study is IRB (Institutional Review Board) approved at the University of Ghana, the University of Michigan is still hemming and hawing about a few requested changes. Last week we found out they wanted the consent form translated into written Twi. I wasn’t that surprised, but also had no idea what a feat translation would be. It seems that everyone speaks Twi, but no one writes it—not our mentor, or either translator. It sounding more and more like the translation and final approval from the University won’t come until next week. Dr. Adanu had planned to come out to Akwatia today to check in and bring us the final copy of the forms, but we just found out that instead he is coming tomorrow, and will not have the forms with him, as they aren’t translated yet. Trying to be patient! We knew things moved slowly here and that this experience would be an exercise in patience, but it’s easier said than done! Keesha keeps joking that it’s a good thing my leg is broken or she might not be able to keep me tied down. I just hate sitting around like a bump on a log—especially here where I really want to be able to do something remotely useful! Oy! One day at a time I suppose.

After our short morning of work, Doris took us to the local market. Mondays and Thursdays are ‘market days’ when the fruit is fresh. The market is only a mile or two from the hospital. The Akwatia market was much much less intense than those in Accra. The vendors are set up in a cluster near the roadside, in makeshift stick stalls, in loosely defined rows, filling a space comparable to Kerrytown Market in Ann Arbor. Doris greeted many of the vendors who are well known to her, and helped us exercise our limited Twi vocabulary. We found a frying pan and knife, much needed additions to our mini-kitchen set up. Doris also helped us pick out the items needed to parse together a Ghanaian dish—tomato and fish stew with boiled plantans. Realizing that we were clueless when it comes to Ghanaian cooking, she accompanied us back to the apartment for a cooking lesson. It didn’t turn out to be anything fancy, but it definitely tasted like Ghana. She sautéed some onions in the frying pan, then added tomato paste, water, pepper, salt, some little packets of spice with pictures of fish on them, and chunky tuna-like fish canned in tomato sauce. When that was simmering she boiled raw plantans in another pot until they were golden brown and then added cold water to stop them from cooking. And wala! Tomato fish stew? We thank her profusely for her lesson. Apparently the next lesson is ground-nut stew. Sounds fairly similar except instead of tomato paste you add ground nut paste (essentially unsalted peanut butter… which we’ve adopted as peanut butter). Far more familiar to our taste buds, was the pasta with an attempt at cheese sauce (without cheese…) that Keesha fabricated for dinner.

In case the elaborate recount of our cooking doesn’t give it away, besides entertaining small children, we’ve been fairly starved for excitement. We’ll see what comes of Dr. Adanu’s visit tomorrow—if it sounds like prospects of being able to actually start work are bleak for the rest of the week, we may try to bust out of town and do some exploring for a few days. Until then, I’m channeling patience and learning to sit still and smell the roses, or banana trees.