On Coartem: 24 pills in 3 days

From the WHO website, “Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.” Common symptoms include fever, headache, and vomiting. Additional symptoms may include muscle aches and fatigue. I was easy to diagnose as I displayed all of the typical and moderately typical symptoms. Also, I had taken my malaria prophylaxis 2 days late. Why did I forget? Well, unfortunately one of the side effects of the malaria prophylaxis is forgetfulness… go figure. The symptoms usually appear about 2 weeks following the bite of a mosquito. Again from the WHO, “If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.” My symptoms started Monday the 8^th of November in the evening. By 0130 early Tuesday morning I was pretty certain I had malaria. I called the PC physician to describe my symptoms and was diagnosed in less than 4 minutes. I prepared slides with some of my blood to have examined at a later date in a lab, and then took my first 4 pills of Coartem. “Coartem is a highly effective and well-tolerated malaria treatment, providing cure rates of up to 97%, even in areas of multi-drug resistance.” (Wikipedia)

I had a fever up to 103.4 at its max. The fever stayed around 101.4 for 3 days against my attempts to control it with Tylenol and ibuprofen. Aside from that I was quite nauseous and developed a viral infection. I have learned that it is normal to develop viral infections while having malaria. Malaria suppresses your immune system so you’re more susceptible to additional illness. My throat is still sore and tonsils are still enlarged, but visibly improving. I’m no longer nauseous, but am back to having no appetite. The lack of appetite is likely from the malaria prophylaxis; I hope to get on something else soon.

So, day one of malaria was supposed to be a girl’s night J. I didn’t feel that malaria could stop that, so I had 2 PCVs that live near me over for the night. Kris was gone at PCV training for the week, so I felt like I needed some company. We cooked a minestrone soup and ate pineapple and salsa on tortillas! We also walked a bit around the community. I probably exerted myself a little too much, so decided to make it a one-day affair. The next 2 days I spent in bed, trying to stay hydrated and resting in between villagers stopping by to make sure I was still okay. Their concern was appreciated. I’ve now finished the treatment and am just waiting to feel better. I no longer have a fever (yay!) but feel as though it may take awhile until I feel back to 100%.

Lesson learned? Yes. Malaria is not something I’d like to try again. Luckily for me I had access to the best medication within seconds of diagnosis. I already sleep under an insecticidal treated mosquito net, don’t go outside once it’s dark and I wear long sleeves and pants as much as possible. I’m lucky, I really am.

“In 2008, there were 247 million cases of malaria and nearly one million deaths –

the majority (85%) were in children under five years of age. In Africa a child dies

every 45 seconds of Malaria, the disease accounts for 20% of all childhood

deaths. An African child has on average between 1.6 and 5.4 episodes of malaria

fever each year.” (WHO)

I guess this is one of the reasons I am here. There isn’t a malaria vaccine, but there are many ways to prevent malaria. I know at some point in my time spent here I will educate about mosquito nets. Their use alone has shown to decrease mortality by 20%! I will also educate about what causes malaria. Many people in my village have told me that malaria comes from working in the sun. In addition I will educate about the signs and symptoms of malaria. If more children took medication soon after displaying the symptoms of malaria they would be fine, just like me.

I know a lot of people were praying for me this week (thank you). I won’t give all of the credit of my feeling better to the Coartem, I know that the prayers played a large role. Kris comes back from training tomorrow evening. I know he wishes he would have been able to be home with me this week, but I managed all right. He’s brining back a lot of packages from home that have been sitting in Accra for far too long. I miss you all but am realizing more and more that I am needed here, so look forward to another 21 months of updates from Ghana!

Hanging out in bed, the backdrop is my lovely avocado green mosquito net!

Just another day...

What to do on day ~61 at site? I’m taking a stay-cation, which here translates as shutting the main door and all the windows as to appear not here. I’ll be inside drying and making powder out of thousands of moringa leaves and watching Mission Impossible one, two, and three. It is now 3 days later, I’ve watched MI1 and am sad to report that most of my moringa leaves managed to mold. Deep breath. It will grow again (and soon).

Yesterday I traveled to the district capital, Nkwanta, which is only about 30km from our village of Jumbo. I woke up, saw Kris off to school, ate some breakfast and went outside to pick our bunny, Luna, some grass. I was already mostly dressed and ready to begin my journey to Nkwanta, so I was casually dressed in Jeans and a nicer t-shirt. I walked passed the borehole and greeted the small girls pumping and fetching water. I found a nice spot of healthy looking wide grass (Luna’s favorite) and began pulling. Not 3 minutes into the process I felt a sharp pain on the inside of my right foot. Mostly normal, there are a million things here that bite… mosquitoes, flies, bees, other flying insects and oh yeah, ants. I carelessly had stepped directly onto the path of some driver ants. I don’t particularly like ants. I also don’t fear them, like I do spiders, but one step in the path of some driver ants is enough to give you nightmares. They can sting, but they don’t have to because they’d rather rely on their powerful cutting jaws. Here’s an excerpt from Wikipedia, “Such is the strength of the ant's jaws, in East Africa they are used as natural, emergency sutures. Various East African indigenous tribal peoples, e.g. Maasai moran), when they suffer a gash in the bush, will use the soldiers to stitch the wound, by getting the ants to bite on both sides of the gash, then breaking off the body. This seal can hold for days at a time, and if necessary, the procedure repeated - allowing sufficient time for natural healing to commence.” So I was being attacked by natural, emergency sutures; too bad I wasn’t injured. I think the girls at the borehole already knew the English S swearword, but maybe hadn’t heard it used quite so many times by a white lady hopping around with tall grass in one hand and the other hand trying to pull up her pant legs to swat at something (maybe that’s why they don’t wear pants here?). It didn’t take them long to realize my predicament, so they came over to assist me. I was now surrounded by ants and six Ghanaian girls pulling at my pants and slapping my legs and feet. Eventually I had to make a run for it; the ants were too fast, and my jeans were too confining for me to catch the ones making their way above my knees. I made it into the house and depantsed myself. Luckily there were only about ten of them left at this point, mandible deep into my legs. Some of the others had been confused by the blue jean material and decided to sink into that instead.

I wrapped a two-yard of cloth around my waist and chucked my jeans outside. Someone came to greet me at that moment (typical). The person’s uncle had died (kinda puts getting bit by ants in perspective). He had come to see how my health was, and to let me know that there would be a funeral for the next few days. I gave him my condolences and told him I would try to attend the funeral. I managed to leave the house shortly after, finally starting my journey to Nkwanta. I waited to hitch a ride on a vehicle for a few hours, hoping to get lucky. It was not to be. I then walked to the police checkpoint, where one of the officers was very kind and rode his moto to the station, bought a ticket, and told the lorry driver to save a seat for me. Soon I was on the road, and finally arrived in Nkwanta around 12:30pm. 30km in 1.5 hours… did I mention our roads are really, really bad? I went to the market and bought some things I can’t get in Kpassa (cabbage, carrots, cucumber, honey bread and wheat bread). It started to rain, which is normal for this time of year and seemingly typical for when I have to walk a significant distance. I was about 1.5 miles into my walk when it really started pouring, so I took refuge under someone’s roof overhang. The residents noticed me and told me to come in out of the rain, they gave up their only un-broken chair for me to sit (this is known as the white person treatment – I experience it often).

After sitting for about 40 minutes I decided the rain was just going to have its way and get me wet. I was already about an hour late from I had informed the District Health Team I would arrive. I finally arrived, moderately soaked, but welcomed warmly. My business was to discuss progress in preparing a main building and nurse’s residence for a small clinic in Jumbo. I had been recently promised funding from the District Assembly (general funding pool not specific to health, agriculture, etc.), so I had some good news to share.

After the meeting I walked the 2 miles back to the lorry station, bought the last ticket on the lorry back to Kpassa and took my seat… in the back row wedged between two Ghanaians on one side and two on the other. By no means do average Ghanaians travel in luxury. Personal space is foreign, as is common sense like leaving the last seat in the very back of the vehicle, which to access requires that an entire aisle of people in “jump seats” get up and exit, let you in, then file back in. Luckily for me I was sharing this coveted back seat with a student from the University of Ghana, in Accra. He is from Kpassa, and is going for his degree in Psychology. So, in-between being launched by craters the driver was not taking care to avoid, we discussed Sigmund Freud, Piaget and Miller. It was one of those pleasant, “I never thought I’d be…” moments. I can’t recall a more enjoyable trip from Kpasa to Nkwanta.

The student’s story was impressive. This 20-something-year-old’s parents are farmers. They have 11 children. All of them have gone or are going to at least secondary school (high school), with many going on to teaching college or even university. Unheard of! I had found the exception to the norm here (at least in my neck of the woods): illiterate farmers keeping their kids illiterate by having them help at farm. We discussed the problems Ghana has and that we thought education would help the most with those problems. He told me that even for a poor farming family it was possible to send all of their children to school, they just had to make it a priority. Even though (per typical) I arrived back in Jumbo bruised at the knees and migraine fogged, I felt refreshed. Sometimes when you’re working in development your efforts can seem futile. Progress is slow if you can see any at all, and desperate situations somehow manage to get even worse. Meeting a young person from my greater community who is pursuing higher education in Ghana is a breath of fresh air. I had been given enough motivation to keep trying, even if at times it seems as though I’m beating my head against a wall. Somehow I will help the people in my village understand that it has the resources it needs to succeed. Maybe those resources should be in a classroom instead of fetching water and assisting some careless foreigner who stepped in the path of some driver ants.

The latest

My day planner tells me September is over. I’m not sure I believe it, but when I accessed the internet (which is never wrong), it agrees. It feels like it was August only days ago. But I have at least one hypothesis for explaining this seeming contradiction. For one, the weather is not changing. Back home in Wisconsin, the weather is turning cooler, the leaves are turning, and there is football. Here, the heat remains, the rains come almost every day (average of 0.5 to 1 inch per day), and our garden here is in its juvenile stage (cucumber blossoms, sweet corn thigh-high, tomato and green beans knee-high). There are no cool evenings where we have to think about how cold it is and whether to throw on a sweater or (gasp!) turn on the heat just a little.

Another reason that September flew by is due to “waiting” for school to start through most of the month. There is a nationwide census in Ghana right now, and out of the various government service sectors the education service chose the short straw, and so teachers are the ones that have to conduct the census. But wait, what about school and teaching classes? Turns out actual education is fairly low on the priority list. So at my school, a junior high, we were supposed to start September 13th. But they delayed one week and one day to September 21st so that teachers could attend a workshop to learn how to do the census, which will take place during the next two weeks or so (I’ve gotten as many answers as the number of times I’ve asked this question). September 21st is a government holiday, so we finally started on the 22nd. The first two days there were no classes, just weeding and sweeping the school grounds (with minimal supervision from teachers, due to the ongoing census). On Friday Sept 24th, I taught my first class. The other math teacher is MIA because he was in a minor motorcycle accident (he’s ok, just needs to rest and keep his road rash clean so it doesn’t get infected), so while I only prepared a lesson plan for Form 1 (7th grade), I had to teach Form 2 and Form 3 on the fly. It was the same story this week – two to four teachers attending, with students getting only two classes a day, (compared to five or six). I was looking forward to the school term as a good source of structure for my daily life here, but I’ve been having to create my own amongst the chaos. So while I was dealing with these recent events, September has escaped.

As for the earlier portion of September, we have kept ourselves busy by becoming full-time chefs. For any of you that are worried that we are not eating well, behold Figure 1 through Figure 4:

Bean burgers with fresh tomato slice, lettuce, HEINZ KETCHUP, and mayonnaise (with a side of seasoned yam fries)

Close-up of bean burger (seasoned with Weber burger seasoning – thanks Mom & Dad!)

Chicken thigh and leg (from rooster gifted by a chief and freshly butchered by yours truly), with tomato sauce and mashed yam (both made by Tricia)

Tuna and avocado pie (courtesy of Tricia), with biscuit topping

Additional dishes we have made include spaghetti sauce from scratch (with corned beef added), guacamole and homemade tortilla chips, potato salad (made with yam instead), peanut sauce over yam, chicken and rice soup and various other hodgepodge sauces served with noodles, rice or yam.  

We’ve also  made some desserts, including cornbread, banana crisp, and M&M cookie bars.  And for afternoon refreshment we have made plenty of limeaid (lime trees are everywhere).

We have discovered some unlikely sources for some of the foods we have been craving since arriving in Ghana.  One of these is meat.  Meat is butchered and sold much differently here.  Where you go depends on what type of meat you want.  There are “cold stores” (small shops with a chest refrigerator) in town that sell chicken and fish (mostly smoked, not fresh), albeit for a steep price (out of reach for most Ghanaians in this area except on special occasions).  You can also get plenty of smoked fish in the market (fear not - they don’t charge extra for the diseases left by flies).  Though we have heard about it, we have not yet found a source for fresh fish. Stay tuned.  Or, if you are welcomed into the community like we were, by being given two live roosters, you can butcher chicken yourself.  This can be the more sanitary option, as you know how it has been butchered and that the carcass hasn’t been sitting outside for hours.  For goat meat, the easiest source is your neighbor, when they are butchering one.  It’s not very sanitary…but we don’t really like goat meat anyway.  There is also some bush meat (grass cutter, rabbit, etc.), but it is being depleted rapidly, and some of the hunting methods are wasteful (i.e. burning bush to force animals out and then shoot them), so we won’t be eating any of it.  In fact, we will probably do a rabbit project where we sell babies from our rabbit and teach people to raise domestic rabbits.  We have also seen domestic turkeys and pigs running around our village – we hope to get more information on that (turkey for Thanksgiving???). Then there’s beef.  There is plenty of it in northern Volta, but you don’t go to the cold store to get it.  You instead go directly to a butcher shop.  Keep in mind that none of said butcher shops are protected from flies.  Sometimes they even take a hock and hang it outside so that people know the butcher has it.  So not sanitary at all.  Did I mention I have bought beef once so far from a butcher?  The trick is to go there very early in the morning, just as they are doing the slaughtering.  Then you point to an area on the carcass where you want meat from.  In my case I pointed to the tenderloin/sirloin area (couldn’t tell which).  The way I found out the price was by saying I wanted 4 cedi of meat, and then later finding out that I was given about 2 pounds.  So the price isn’t bad.  I don’t think they butcher the cows until they are old (read: chewy), so the best thing to do with the meat is grind it.  Unfortunately the meat grinder I bought is missing some pieces, so I’m going back to the store in Hohoe to hopefully get them.  So instead I cubed the beef and sautéed it, and combined it with brown gravy and mashed yam.  It was delicious.

Another exciting source is for milk.  Yes, that’s right, milk.  Fresh from the source – so fresh, in fact, it’s still warm from being inside the cow’s udder.  There is a tribe of nomadic people in the area called the Fulani that have a settlement nearby.  Apparently the previous volunteer at our site had been buying milk from them, because one day they stopped by with a warm bowl of milk.  We could tell they were different, from the elaborate and beautiful clothing and facial tattoos, and from the fact that they did not speak a lick of English, Twi, Konkomba, or any other language we knew.  They are apparently originally from Nigeria and have migrated here with their bovine in search of better land (i.e. land where rain falls more consistently).  So through hand gestures and other non-verbal, we were able to negotiate a price for 5 cups of milk.  Since then they have been delivering milk about twice a week.  We do pasteurize it, just to make sure it is safe.  It’s an amazing feeling to drink a cold glass of milk in the hot afternoon, or even spread a bit of real butter (not the 2-year shelf-life margarine) on some bread (shake a cup of milk in a jar for 20 minutes and you’ve got about one tablespoon).  One fascinating aspect of the Fulanis is their appearance.  Literally straight out of a National Geographic magazine.  We hope to get some decent pictures soon, because attempting to put it into words is more than I am capable of.

And, just in case we don’t cover all of the essential nutrients, we are taking a multi-vitamin every day. Tricia’s taking a calcium supplement; no need for the combo calcium + vitamin D, there’s sun to be had.

One more shout out to fall, and those enjoying it; we miss it terribly. But we may not miss what follows fall nearly as much.

Fat guy in a little coat - the Ghanaian version

Ok, this will be a brief post, but I just have to share this story.  I biked into Kpasa this afternoon to buy some things from the "evening market" which sets up every day except Sunday and includes the basics (produce, grains, etc.).  After I had bought everything on the list, I stopped by another, smaller market at the bottom of the hill, also known as the "yam market," just to check it out (you never know when you might see an avocado...even though I haven't found one in Kpasa yet).  I was walking my bike through the market fairly briskly (I had hot dinner - "chop" - in the basket so I knew not to dawdle) when a man I had just passed by exclaimed, "White man...in the yam market."  Like most Ghanaians that call out to me using terms like "white man, fada, obroni," I ignored him.  But I immediately thought of the movie Tommy Boy, and the "fat guy in a little coat" scene.  The Ghanaian even said it slowly, almost melodically, like in the film.  So I thought to myself, "I guess this is the Ghanaian version."  I had to chuckle.

On the subject of Ghanaians yelling at me as I walk/bike/ride by (this is a blog post in and of itself, but I'll let it tag along), in Kpasa it is starting to change.  When you are white in Ghana, it is like you are a light and Ghanaians are moths.  But unlike moths, they are not quiet.  I'm not sure what it is, but they feel compelled to say something.  Anything.  In any language.  Usually English, but not always relevant.  For example, in Kpasa this afternoon I heard, "obroni" about 8 times, mostly from children (they haven't learned concepts such as politeness and sensitivity just yet...).  I also hear, "white man" a lot, in case I can't do the translation from Twi to English myself.  Or, in Likpakpaln, the local dialect of Konkomba, their word for white man is "fada."  Why "fada?"  Because the first white people to be seen by Konkomba were missionaries.  Not that they think I'm a missionary, it's just that they don't have a word in their language to distinguish "Peace Corps Volunteer" from "pastor." So when I took the LPI (language test) during training, I had to say, "N ye PCV la" - that's "I am a PCV."  In addition, sometimes they are quick-tongued enough to blurt out something else.  I have heard, "white man, where are you going?" many times when traveling on tro-tros.  Not that I have time to respond with the speed of the vehicle.  Seriously, sometimes I can hear the Doppler effect in their voice as I pass by.  Sometimes I ponder, "what will they do even if I do tell them where I am going?"  That's why I think it is less calculating and more compulsion.  They just have to say something.

I should say that in Kpasa this behavior is slowly changing.  More and more, as I introduce myself, and as rumor spreads, people are addressing me as "teacher" and "Kofi," and are saying more welcoming things like "you are welcome here."  Even one student that remembered me from my brief site visit in July approached me on the main road and declared that he would come over to my house the next day to formally introduce himself.  The children are still incessant in their catcalls, "obroni" or "fada," repeatedly, even after I acknowledge them.  But the adults are starting to recognize me as part of their community (plus some even tell the kids to stop bothering me).  I am trying to keep my responses subdued - there's no sense in getting upset about it or yelling back, or even acknowledging it.  Plus, for some reason it is really easy for me to ignore.  Especially in the market, when I am on a mission to find avocado, good tomatoes, or fresh wagashi (cheese made by the Fulani nomads that is fried in oil - not the same as cheese curds, but still good!).  It's not even derogatory, "obroni" or "fada;" it's only a word they use to describe me, because they do not know me.  Soon it will be "Kofi" or "teacher," though with the kids it will remain incessant and might make me wish I could go back to being called "obroni/fada" to feel more anonymous. 

Ok, not so short a blog post, but I thought it would be useful to describe this aspect of Ghana and my corner here in northern Volta.  It is true that here I am no longer anonymous - I cannot blend in and be a local.  But over the next two years I will be getting close, if only in my community.  And because integration is hardest at the beginning and gets easier each day, I am confident that it won't be a major problem for me.

Better'er Homes and Gardens

Painting the rooms! (bedroom) ----------(living room)

Moringa Trees --------------Zucchini


"Knee High" :) ------------Super Protected Green Beans!

The house is coming along, we now have lights in the bedroom which will make putting in my contacts a breeze in the mornings when it’s not quite light out. Two of the three rooms are fully re-painted, including some spiffy white ceilings. We have some patching up to do from the electrical work that was completed yesterday; turns out most of the wall will crumble if you try to puncture a small hole through it. Hopefully when the carpenter and mason come to fix the crumbling front door, the mason will have some extra concrete and a big heart to help us patch up a few spots, either in the walls or the floors. We have a dining room table now that almost fits our chairs under it, the dimensions are off by about 1/8” so, we have to squeeze the plastic chair arms together to wedge it under the table and out of the way (we’re hoping the carpenter will be kind and shave a little off with his plane when he comes by to assist with the door). The kitchen has been left mostly untouched, but will soon succumb to the same burnt peach walls and white ceiling that we’ve painted the other rooms. We’re just trying to figure out patch a large gap between the kitchen ceiling and one wall. Once it’s all sealed, the painting can commence. We’re also planning on having two closet things made (to house clothing) which will go in the bedroom, as well as a couple of nightstands, a coffee table, and a couch to finish up the living room. I also think we’ll add another large bookshelf or two (though I think Peace Corps should pay for this because all of the books on the shelves will be Peace Corps books). All of these additional furniture items may take some time to acquire, but soon we’ll be set up for visitors J. We’ve also purchased enough linoleum/carpet to put in the bedroom over the concrete floors, so soon I’ll have very fake, but real looking wood floors! Kris reversed the latrine door hinges last week, so now the door swings out rather than in, and I have a little more room to… adjust myself. The door still needs some mending though, to make it up to my health watsan standards (light floods the latrine even with the door closed, so flies can unfortunately find their way in and out, though we’ve been really lucky so far with very few flies). The bathing room door fell or shall I say rotted off its hinges the other day, so now that’s just propped open with a rock. You can’t quite see the person bathing from the courtyard wall, so it still maintains a decent level of privacy. Our 65 gallon rain barrel was looking bleak yesterday. Luckily we received yet another round of torrential rain last night. The rain came in such a fashion that it came in through the not quite sealed windows to the southish end of our home. At least now we now know precisely the lowest area of each uneven room. Kris will probably try to fix those leaky windows too.

Kris has been testing out his green thumb with fervor. So far he’s replanted some green beans and more sweet corn in addition to the initial planting when we got here in late August. He’s devised some sort of chicken proofing over the beans, I’m sure we’ll get plenty of Ghanaian interest and commentary related to the newest strange thing we’ve done. Everything with exception of some of the herbs I’ve planted and cantaloupe and watermelon has made a showing through the rocky dirt. The sweet corn is about knee high, and it’s been in the ground 20 days! Amazing! My zucchini is probably doing about second best, and I love zucchini; I hope it bears fruit for us! Sometime soon I will need to prune back the moringa trees and dry the leaves to make into all sorts of useful stuff. I will write a blog entry on moringa once I’m more knowledgeable on the subject. If you’re really curious, here’s some good websites to peruse:

http://www.moringa.com/

http://www.treesforlife.org/our-work/our-initiatives/moringa

Until next time… Miss you all, love you too!

Here's a link to some additional photos!

http://www.facebook.com/album.php?aid=2031757&id=185900425&l=51b8678127

Go Badgers! ("watching" on ESPNs Gamecast)