48 Hours of Maddness!

(Written Nov. 9th)

Today, I’m doing as little as possible. I will still check in on my Moringa gardens, call the district to remind them to complete some clinic work, read with Rebecca, a middle school girl who’s leg is causing her to miss school, and meet with the village chief. Besides these minor items, it’s a heavy dose of R & R for me. To explain why, let me run through the past 2 days:

(Some background: The Ghanaian government is paving the main road through the eastern corridor, which includes our area of the Volta Region. The work has been split among 3 construction crews. The crew on our section of the road, running from the district capital north to the Oti river (about 60 km) are a group of Chinese engineers that are doing work in Ghana. Jumbo #1 happens to be right about middle of their section, so they've picked Jumbo as the site for their heavy machinery and materials yard. They are currently erecting a concrete block wall that will encircle the enormous yard. Eventually buildings will go up, maybe a well for water, etc. They're hiring local Ghanaians to do the heavy labor and other advisory positions.)

Lot for Heavy Machinery...

Two days ago my counterpart Joseph, the Ghanaian I work with most closely in the village, accepted the position of watchman at the equipment yard. This would require him to be at the yard from 7am to 6pm, 7 days a week, holidays included, to field any issues or problems between the contractors and the local community. The job pays 80 cedis per month (about $54USD).

Huge Wall

Now, I should mention that Joseph is probably one of few reasons I've been successful in this village. After 14 months working beside him, becoming his friend, mentoring him in matters of health and otherwise, he was just going to quit. I was completely devastated. I wanted to quit myself.

After discussing my devastation with him one on one that evening (after his first day on the job), we talked again yesterday morning, during which he told me that he changed his mind. He admitted that after talking with me, his wife, the chief, his peers, and elders, he had made the wrong decision and “couldn't be happy with it.” As counterpart and health volunteer, he's doing a thankless job, as the positions are unpaid and have minimal perks. But he understands that even if he doesn't receive money, he can still see some rewards (doing good for his community, the opportunity to be mentored by a Peace Corps volunteer, the cultural exchange between Ghanaian and American) and that, in his words, "God will reward him." In sum, the crisis was averted, but that brief period of uncertainty was extremely trying and stressful.

So yesterday, after receiving this good news, I felt like I had fresh chance at my service in Ghana. I realized that I had taken it’s comfort and ease for granted and resolved to correct this behavior. By mid-morning some community extension workers came to the village. They were doing a survey of pregnant/young mother’s knowledge of vitamin A, Iron, and folic acid supplements and iodated salt. I took the opportunity to ask them how they could better inform the women in the community about those 3 essential nutrients.

Their visit was followed by a visit from a nearby nurse. I had called her the day before when I was in the middle of my debacle with Joseph, so she decided to come and console me in person. I told her the good news that Joseph had relented; we also discussed future plans for the clinic in Jumbo and health initiatives in the area.

After this, I sent an email to USAID. They had featured a nutrition project of mine as a success story. I told them I was honored to have Jumbo featured, but I also took the opportunity to ask for more. My work with nutrition in the village has been successful, but it’s not enough. When children reach a severe degree of malnutrition, they need more than a hospital that will treat them and release. They need rehabilitation, which can be provided more effectively by a Nutrition Rehabilitation Center. There is no such facility in the entire Volta region. So, I asked USAID to consider funding a center in the north Volta.

After exercising my fingers, I decided to walk around the village and exercise my legs. It was market day, a day on which most people do not work heavily. The conversations went something like this:

Tricia: Aa nwihn (Good afternoon)
Villager: Lafeah beh (I’m fine/healthy)
V: Aa nwihn (Good afternoon)
T: Lafeah beh (I’m fine)
V: Ngeen beh? (How’s the day?)
T: Lafeah beh (It’s fine)
T: Beah poah? (How are your children?)
V: Lafeah beh (They’re fine)
T: Acha poah? (How’s your husband?)
V: Lafeah beh (He’s fine)
T: Lituln poah? (How’s work?)
V: Lafeah beh (It’s fine)
T: Kisaak poah? (How’s your farm?)
V: Lafeah beh (It’s fine)
V: Acha poah? (How’s your husband?)
T: Lafeah beh (He’s fine)
V: Lituln poah? (How’s work?)
V: Lafeah beh (It’s fine)
**Laughter, because they are not working**
V: A cha la? (Where are you going?)
T: N cha do. (I’m going here—completely nonspecific, but widely accepted)
**Confused look on villager’s face, it’s market day, she should be going to market**
V: A cha kinyan? (You’re going to market?) A cha Kpassa? (You’re going to Kpassa—market town)
T: Nn nn. N chuun, n cha Jumbo do. (No, I’m walking. I’m going to Jumbo, here.)
V: A cha Agou?
**At this point they’re straining to understand me, still confused I’m not going to market**
T: Nn nn. N chuun, n cha Jumbo do. (No, I’m walking. I’m going to Jumbo, here.)
V: Aa ha! (villager understands me now) **speaking very quickly repeating exactly what I said to all within earshot**
T: N cha nsan (I’m going to the road—asking permission to leave)
V: Yo! Umbor cheen si (Okay, that’s fine, God Bless you.)
T: Cani lituln (Thank you all!)

This is really fun for me, and the villagers appreciate it very much. I am thankful they’re willing to listen hard to me to try and understand, rather than be lazy and call their son or daughter that speaks English. During training I was taught a different dialect, so sometimes it’s a struggle. One of the people I went to greet was a man working with Moringa garden #2. He wasn’t around, so I continued down the main road. I had the same conversation with at least four groups of people in the span of a hundred meters. At one point the villagers were so happy with my language that they insisted I have some of their Ghanaian beer, called “Pito,” “on the house.” My next destination was garden #1. Along the way I was stopped again by the mother of a toddler that has severe astigmatism in one of his eyes. I stopped to instruct them on how to make an eye patch to try and fix the “lazy eye.” For this, I received a giant bowl of tomatoes. There’s no way I can eat them all, but it’s rude to turn down a gift, so I accepted.

I continued on to garden #1, and greeted the house owner near it, and those resting under the mango tree. My friend Rebecca was also sitting under the tree. She speaks fair English. She was also holding a baby, so I immediately borrowed him for my baby fix and sat under the mango tree for a short time speaking as much of the language as I could. I understood when they asked me in Likpalnpaln “why don’t you have a child?” I couldn’t answer well in the language, so Rebecca became my impromptu translator. This was a prime situation for me to encourage better family planning. Men of child producing age asking me why I don’t have children. I told them, because I practice “family planning.” It was translated and they laughed (it’s still a very new/unheard of concept). The particular child I was holding is the mother’s seventh. I told them that I wasn’t ready for children. First, I explained that I wanted to be able to support all of my children, before they are born. Second, I explained how to do “family planning,” through the use of condoms, pills, or an injection. I’m sure I didn’t make believers of them, but the seed was planted. As I walk through the village many of the mothers ask me to take their child to the US, both for a better opportunity and to relieve the pressure on the mother). This is their startling but practical solution to the problem – I hope they see my advice as a better solution.

Carrying a baby to visit Garden #1

The sun was getting intense as it neared 1 pm, so I walked home, greeting along the way, trying to insist that I had not just come back from market. I sat down to rest, and after 5 minutes Rebecca was at my house! I greeted her and asked her why she had come. Her family had sent her because she wasn’t doing anything else. (Read: “Go to the white lady’s house, she’ll probably have something for you to do.”) I seized the moment, and asked if she wanted to read one of the books I had bought in preparation for a library. Thus, yesterday marked the unofficial opening of the library! Rebecca was the first patron. She swept out the room, and we washed our hands and sat on a prayer mat and read. We also went over the alphabet and made letter sounds. She did well with some help and a lot of encouragement.

With Rebecca and her "brother"

I was able to rest in the house alone for another 10 minutes before calling one of the Chinese contractors we’d met a few days prior. He’s a nice guy, and is intrigued by our presence in the area. I asked to meet with him in Jumbo to ask a favor. Two days ago, I noticed pickup trucks going to and from the Jumbo river collecting barrels of water for the construction. I knew I’d need some water soon for mason work on the clinic. I figured, why not ask if they can use their nice truck and bring me some water, instead of putting even more pressure on the one working borehole in the village. He said, “no problem.” I was floored. We then walked over to my humble clinic site. After looking at it for a second, sizing up the work to be done he said, “Okay, so you’re going to need some sand too, so we’ll just drop some off here, and if you need some gravel, no problem.” He continued (as my mouth was gaping open), “You know, cement is 15GHC a bag, I can get you some for 14GHC a bag.”

He then asked where Kris was. I said in town, at market (it was already past 4pm). He was surprised, and said, “let’s go pick him up; I have some business in the town anyway.” I called Kris, told him to stay put and we met him in town. Kris still had things to buy in the market, so I accompanied the contractor on his “business.” We ended up talking for the next 1-2 hours while trying to find a source for sand, picking up grateful market women along the road on their long walk home from market to the more rural villages. We talked about Peace Corps for a long time, about sustainable development and the programs I was doing. I’m almost certain he still doesn’t quite understand why I would do such a thing, but it was not for lack of trying to explain. We also discussed less serious topics like American TV shows (his favorites are Friends, Prison Break, and Desperate Housewives).

By the time I returned home, it was well past dark (6pm). I continued my work for the day, by making phone calls. I like to “bother” people in the district as much as possible, so they complete their work on time/don’t forget about Jumbo. Once my phone calls were finished, Kris made me eat an egg sandwich, and I watched the Badgers VS UNLV game (thanks Uncle Phil!).

Those 48 hours were not normal for me; it was an extremely busy two days, physically and emotionally. Such is my life, full of surprises. Each day brings new challenges, successes, relationships and experiences. As the motto says, “Peace Corps is the toughest job you’ll ever love.”

Recognize

Check out this blog post on USAID's website. It will sound familiar, as it is describing Tricia's PD Hearth program from June 2011. The funding came from USAID, and now they are sharing the project on their website as a success story.

The Ghana Travel Experience

Travel in Ghana is, much like in other developing countries, an experience very different from travel in the US. We have alluded to this in the past when talking about Ghana, but have never attempted to describe it. After one year of regularly experiencing travel like this, and after a trip back to the US that reminded us how organized, efficient, and pleasant travel can be, what follows is our account of “the travel experience.”

The experience begins fairly innocently. You are to travel to a nearby town to visit a friend. So you go to the transport station, find the vehicle going to the town you want, and buy a ticket. No problem. So you set out to find the “station.” With no signs or other obvious indications of where the station is, the best strategy is to ask a Ghanaian. They respond by asking you, “Which station.” What? There’s more than one? Ok, I want the station that will have a vehicle that will take me to my destination town. Oh, that’s station A. It’s just up the street… But immediately another Ghanaian interjects by advising you instead go to station B. It’s much easier to navigate, they say. But Ghanaian A insists that at this time of day you will not get a vehicle from station B to your destination. This is where the power of statistics is your friend. Immediately ask a number of other Ghanaians until you have a consensus. Ok, most people say station A. How do I get there? It’s just up the street and then right and down the hill. After a few wrong turns (it was actually a right and then a left, then down the hill) you reach station A.

As you approach, if you are any skin color other than black, you are immediately surrounded by Ghanaians, all asking you questions at the same time. Obroni, how are you? Can I carry your bag (and then ask you for money later)? And the most common: Where are you going? Some of these interested folks are actually the vehicle drivers or mates (basically an assistant), but the majority are just sitting around waiting for something to happen. You now have to choose between politely answering all of their questions and losing an hour of your daylight in a place where night travel is significantly more dangerous, or in ignoring them all, except one, whom you ask where the vehicle to your destination is now parked. I suggest the latter. Oh, it’s over there (*points*). You can see the wooden sign with the town name painted on, resting on top of the vehicle.

But wait, what’s this? There are two signs! One is resting on a minibus with four rows of seats (four to a row), looking like a car bomb had recently gone off near it recently. The paint is faded, windows are missing, there are holes in the floor, and in big letters across the windshield it says “ENEMIES ARE NOT GOD.” No kidding. You look inside and see it looks empty. As for the second vehicle, it is a Mercedes-Benz bus, longer, much taller, and slightly wider. Also, much worse-looking. Six rows, five to a row. You avoid the sharp metal edges as you climb up to see how many people have boarded. It looks about half-full. This brings you to major decision #3: Which vehicle do you take? You decide that while the minibus (called a “tro-tro” or just “tro”) has fewer passengers, the overall number remaining (vehicles don’t leave until they are full) is less. Congratulations, you just engaged your brain in thinking critically. Unfortunately you are probably the only one in the station doing so at that moment. You go to the wooden shack functioning as the ticket counter and buy a ticket for the tro. You walk over to it to claim your seat (first come, first served) by placing your bag on it and try to figure out how to kill some time.

One hour later, and five cedi poorer from buying stuff for sale in the station, most of which you do not need, the last ticket for the tro is purchased. The car is full up, the ticket man says. The driver appears from out of nowhere and yells at any passenger that hasn’t yet boarded, which is all but three (the tro seats 18 including the two in front next to the driver). Chaos ensues, as passengers simultaneously are boarding the tro to find their seat, deboarding to urinate or buy some food, and leaving the station completely to find the other passengers, who have wandered off as they were waiting. Ten minutes later, most passengers are in their seats and ready to go. One passenger is arguing with another about whose bag was placed on the seat first (if the argument is co-ed, the man wins and the woman is forced into the less desirable seat). You also notice that the seat next to you is empty, save for a small bag. Who is sitting there, you ask. Just then a very large woman saunters up to the tro with three large bags. That’s who. The other three people in the row, have to deboard and wait for the woman to find her seat. When you board after her and try to sit, you realize that she is taking up her seat plus no less than 50% of yours. Also, one of her bags is on the floor, cramping your leg room.

Thirty minutes after the last ticket is sold, the tro leaves the station. You feel relieved and send a notification text to your friend. “Car has finally left!? :( “ As the text is sent the tro lurches right and veers into a fuel station. Seriously? The driver leaves the engine running and tells the attendant to put in thirty cedis worth of fuel. After taking the money, the attendant obliges. A few minutes later you hit the road again, this time for good.

Now, not all roads in Ghana are what one would call “good.” In fact, most of them are in the broad category of “un-good.” However, there are different degrees of “un-good.” There are paved roads pockmarked with potholes. There are unpaved roads that are well-drained and escape major erosion from rains. My personal favorite, and the standard in the northern Volta, is unpaved and ravaged from rain. It’s actually not even a road by most standards. It is soil and rocks, mounded up into the shape of a road, with a ditch carved on each side. These roads are subject to the worst of potholes, and every rainy season they are washed out completely in some places.

The journey you are taking begins on the first type, paved with potholes, and halfway changes to unpaved and ravaged. Great, you think, at least for the first hour it will be pleasant.

Wrong. The driver proceeds to floor it between every series of potholes, swerving recklessly all over the road to avoid them in addition to other tros, motorcycles, supply trucks, even fuel tankers. Depending on the standard accepted by the passengers, they occasionally beseech the driver to slow down, be more cautious, and in general show that he values their lives even marginally. Notice I didn’t say “he or she”; all drivers are men, most are young, and they drive like they have everything to prove.

Having experienced the relative organization and efficiency and safety of travel in the US, at this point the events start to build up and you start to become frustrated. You focus this frustration on the driver. Doesn’t he realize the danger he is placing everyone in? Doesn’t he understand that to get there a few minutes later is acceptable if it means avoiding a head-on collision at high speed, not to mention the other vehicles on the road? Your anger builds with each swerve, each pothole he attempts to miss but fails, each time the wheels catch air and your head strikes the bare metal roof, until it reaches the level of rage. At this point you silently demand an ultimatum: If this driver hits a big pothole one more time, I am going to lose it. Within seconds, you hit a pothole so big that your head hits the roof, something loose on the floor below you strikes your legs, and the bag in your lap flies up and into the seat in front of you. This is the climax of the trip, emotionally speaking, as you are faced with the decision of losing your mind or finding some other way to cope. Whether it is prayer, meditation, or simply willing yourself to reclaim some degree of calm, it works. You come down from your mountain of rage. The emotional and physical abuse starts to feel less sharp and jarring and more dull and continuous. The road has not changed, it is still punishing you, but your perception of it changes. Is it a higher level of consciousness? It's possible. Once you break through this threshold, for the first time since boarding you actually thing you are going to make it.

Then you hear a loud pop and the tro veers across the road and toward the ditch. Flat tire. The driver manages, without the aid of power steering, to keep the vehicle on all four wheels as it grinds to a halt. The driver, knowing exactly what the problem is, doesn’t even glance at the tire as he walks around to open the sliding door (only the outside latch works) and let the passengers out. Some immediately walk to the ditch, arrange their pants/skirts, and urinate. Others collect their bags and search for the nearest shade. All indications are that it is going to be a while. But you have already crossed the aforementioned emotional threshold, so anger is not an option. Instead you conjure up a hypothetical situation even worse than the one you are in now, and use it to console yourself. A wry smile even appears on your face as you exit the tro and walk over to the shade of a mango tree.

Even more ironic humor is experienced as you watch the driver attempt to repair the flat. He first has to remove all luggage from the rear cargo area to access the spare. This is no small feat, as the area was so crammed with bags at the station that the door would not shut, and had to be tied with rope between the frame underneath and the precariously weak rear window wiper arm. Once the bags are out, the tire is removed and inspected. It is hard to believe, but the tire tread is even worse than on the flat. It’s practically bald. The driver sets to work removing the flat and installing the spare. As he lowers the vehicle’s weight onto the spare (not including the weight of passengers and cargo) it becomes clear that the spare was not fully inflated. A collective groan emanates from the passengers and they start to accost the driver for failing to plan ahead. After enduring a good five minutes of well-deserved verbal tongue-lashing, the driver announces that he is going to drive back to the previous town on the barely inflated spare, fill it, and come back to pick up the passengers and luggage. As another verbal tongue-lashing ensues, the driver hops in, executes the worst Y-turn ever, and drives off.

Thirty minutes later he returns with a fully inflated spare. Luggage is loaded, passengers board, and the driver takes off with even more gusto than before, but not until that Benz bus, the other choice at the station, passes us. You realize that the reckless driving you experienced before was the norm, and that since the driver was running “late” he may not be able to get back to his base town (the one you left from) that day. He is still in the denial stage of this newly-realized grief, as he mashes down the gas pedal not only on good stretches of the road but through the potholed sections as well.

Fifteen minutes later, the bottom of the road drops out as you make the transition to unpaved road. The driver does not appear to notice this, however, and continues to drive with reckless abandon. He passes the Benz bus, but it passes us back when the driver has to slow down for a monster washout. We pass the Benz bus again, this time for good. But in your enlightened state you barely notice as you speed toward your destination. The thought crosses your mind that the spare tire has already been used, leaving no backup in case of a second flat, but it immediately is whisked away by an irresistible feeling of peace. You search for humor or even casual interest in what you observe through glimpses out the right window (the left window is completely blocked by the woman and her bags). You laugh out loud when you see a toddler throw a small rock at the tro as it passes by, and again when you see a man crash his bicycle down into the ditch to avoid the tro as it passes by.

You are surprised when you look at your watch again and an hour has passed. The tro wheels lock up and you slide to a stop. You are in some small village, but this is surely not your destination. The driver opens the sliding door – this time with greater difficulty – and a young woman, in a very nice dress and embroidered cloth scarf, exits the tro and emphatically greets a woman standing just off the road. Her face, clothes and luggage are all a faded, orange-ish, dust-covered version of what they were when she boarded at the station.

Another thirty minutes pass and you finally see your destination town in the distance. As you descend the hill the tro stops, seemingly every few hundred yards, as people request to be let off. This minor annoyance is overshadowed by the exhilarating realization that you are almost there. Your legs ache and begin to cramp, and you wonder if they have forgotten how to stand and support your weight. You pull into the station in your destination town and, in too much of a rush to park, the driver jumps out to open the door. Passengers pile out and immediately start to slap themselves with handkerchiefs to beat out the dust. They repeat the ritual with their luggage as they retrieve it. All around them people are calling out names of nearby towns and ushering people into other vehicles. How could anyone want to go through this again? But then you realize that you will have to do it yourself, albeit in a few days, when you are scheduled to return back. You cringe and try not to think about it as you call your friend and walk out of the station.

Atta

------------------------------------(Atta's Father Bitumba)

September 4^th, 2011, it was going toward twilight; I was sitting under a shady palm in the Bichabob clan. I was told the day before that a young girl had died. I had told the family I wanted to visit them and learn about the now-deceased girl. The family agreed and was very appreciative of my curiosity. To compare, I noted, “My grandpa turned 94 years of age just 2 days ago,” I said to Joseph (my translator). “Oh! Then he’s too old,” he said excitedly with laughter in his voice (he meant that as a good thing). I began with my questions. “So, please, how old was the girl that died? Was she in her 20s?” “Oh no, she was 19 or 20 maybe…they say they have the date written,” they told me. Good, I thought, as I wanted to give the most accurate representation of this deceased girl as possible. The father of the deceased girl returned with a book – a bible, believe it or not, reminding me of the old family bible my mom has in their house next to the recliner. It was filled with dates, names, and accounts of births. “Atta, is the girl’s name,” they said. Upon searching the front pages of their family’s bible, I found no such name. “How about Tawia? Was she Atta’s sister? Was Atta older than Tawia?” I offered. “Tawia is her sister, but she’s younger, they think Atta was 2 years older,” they replied. Okay, so Tawia was born in July of 1988, we’ll give Atta a birth year of 1986. This meant she was about 25 years old. My age.

-------------------------------------------(Family Bible)

Atta was born in 1986 to her mother Yaa and father Bitumba. Yaa and Bitumba are both farmers, farming yam and cassava. Neither of them has gone to school, and they’re not sure of their age (they actually ask me to tell them how old they are). I told them they were “old,” to which the whole of family around our meeting place responded with laughter and acceptance. Bitumba has 9 children and 2 wives; all are living with the recent exception of Atta. He doesn’t have any hobbies, he just farms. Yaa has given birth to 6 children, she tells me all are still living except for Atta, which I doubt as they tend not to include children who pass before they reach the age of 5. In Konkomba if a mother gives birth to a child, and that child dies, her next child will be named Jagri, meaning that the deceased child has come back again. There are a lot of Jagri’s in this village.

---------------------------------------------(Atta's mother, Yaa)

Yaa is confined to the compound because she “has become blind.” Atta has 6 living siblings, and one daughter named Umborinye. Umborinye means “God Knows” in Konkomba (the local language); she looks no older than 5 years. Atta was married to a man named Tamanja, he only officially was married to her, but I was told he had 2 wives. The other one was just for “friendship,” not official. Tamanja will take care of Umborinye now that Atta died. Atta farmed yams and cassava at her father’s farm, attended church in the village, and attended school up to 4^th grade before dropping out.

-----------------------------------------(Atta's Daughter, Umborinye)

“She was sick a long time” was the answer I got in response to the question whether or not her death was sudden. When I asked them to describe the sickness, Bitumba talked for a long time in Konkomba. When he was finished Joseph said, “She had epilepsy.” “That wasn’t all he said, Joseph! Translate it all for me!” I said. “Okay, well, one certain day she met a man, he gave her money and told her to buy food with it. She bought food and brought it home. She was preparing it in the courtyard by the fire when she collapsed in front of the whole family. They all saw it. She was shaking and throwing her limbs around; she had a lot of saliva around her mouth. When her eyes finally opened and she stopped shaking they asked her what had happened, she didn’t know.” I pressed, “So do they think that man who gave her money to buy food caused her sickness?” “They haven’t seen the man before or again, and neither did she,” he replied (implying that they did indeed think the man had something to do with her sickness). When I asked how long ago her first attack happened, no one could remember, just saying, “a long time, and she’s been falling monthly.” On the 2^nd of September, in the evening time “just like now,” (the time period of the interview) she had a similar attack. The whole family saw it again. This time, her eyes never opened again.

“So then what?” I asked. “We never bury a person during the day, the sun is too hot. So, since it happened in the evening and the coffin wasn’t ready, we had to wait until the next evening to bury her.” Dying young here isn’t good. If you’re old and you die, that is natural and normal. If you die when you are old, you will receive the honor of an immediate funeral 3 days after you die, then you will be “buried in your house” or near your home/within the village. If you were very old and respected you will have a “final funeral” later on when the family can raise enough money to have a big celebration with lots of eating, drinking, and dancing. If you die when you’re young, it’s unnatural and often suspect of something evil. In this case you will be buried in the “kichee” or cemetery, in the bush, far away from the village. Your family will mourn for 3 days, then return to normal daily life. If a child dies, there’s even less observance given. The child is buried, again far away from the village in the bush, and only close family is privy to the fact that a child is gone. Not many people notice and the most visibly affected person is the older sibling on who’s back that child spent most of their days.

--------------------------------------(Child carrying younger sibling)

As a person raised in a 1^st world country, one of my first instincts is to find out exactly why a person died. This situation was no different. Epilepsy is surprisingly common in this village. No one in Atta’s family has a history of it thankfully. If there’s medicine available to the average Ghanaian, I don’t know of it. I asked the family to share with me anything else about her, but unfortunately the lasting impression they have of her, is her post-epileptic behavior. “She’d been very stubborn, you ask her to do something, she won’t mind you.” “Once you have epilepsy you won’t have good mind again.” I can only imagine the amount of brain damage resulting from untreated monthly seizures on concrete floor for “a long time.” So it was likely she died from an untreated seizure.

I considered my curiosity satisfied. But this is a significant difference between my culture back in the states and the culture here. People don’t ask why someone died here, it’s not important to them, it isn’t realized as a potential learning point to prevent a similar death. Death is immediately accepted, no questions asked.

I remember when leaving my job at the UW Hospital I had a premonition of being frustrated with the lack of resources in Ghana for treatable illnesses, this has come true. Save for malaria, dengue and yellow fever, dysentery, malnutrition and the many other 3^rd world diseases and conditions we have in Ghana, we have 1^st world chronic illnesses as well, without access to 1^st world resources. As a result, people die here—more than would otherwise. I didn’t write this to make you feel guilty or for sympathy. I wrote it to expand your knowledge of the world, to show how things are in different areas and cultures and how people cope with their situations.

At the end of my time sitting with Atta’s family, I asked them if they were sad she was gone. They responded tearfully that of course they were sad. To an outsider, their way of coping with death may appear cold and callus, but it’s their tradition. It’s not lack of caring or feeling sad, it’s simply how they do things.

-------------------(Umborinye and her cousins in the compound where Atta lived)

Malnutrition and other things Tricia combats (no, Tricia isn't malnurished, but her village children are)

--------------Naomi (an orphan) and I at the PD Hearth Program

Malnutrition. Definition: lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat. A few months ago, I took three influential people from Jumbo to a workshop about the Positive Deviant (or “PD”) Hearth program. The program focuses on finding basic nutrition in the locally available foods and using it to make children healthier. The positive deviant portion of the program seeks out mothers who are doing a good job nourishing their children. This is my favorite part of the program! The PD mother gets to share with women how they are raising well-nourished children and caring for their children using the same resources available to everyone in the community. How do we find these PD mothers? We have a massive baby weighing! 145 children, all 5 years of age and under, came to the weighing; I was happy with the turnout. With the master Excel skills of Kris, I was able to plot out all of the children on a weight vs. age chart. With some basic math skills, we were then able to calculate the percentage of children in our village who are a healthy weight! Drum roll please… 6%. That leaves 60% low weight, 27% underweight and 7% severely underweight.

What can be done about this? There are several strategies that can be brought forth during the course of the program. The first: family planning! With couples averaging 7 children (and multiple-wife households around 10-15 children), there needs to be a lot of food to go around. Second: education (especially girls and women)! If children are educated, they grow into educated adults who make informed decisions (i.e. how many children do we want and when), and are more knowledgeable about resources available to them (i.e. food that is most nutrient rich). Third: Moringa trees! Also called, “the Miracle Tree,” a single serving of fresh Moringa leaves contains 4 times more calcium than milk, 7 times more vitamin C than oranges, 4 times more potassium than bananas, 4 times more Vitamin A than carrots, and 2 times more protein than yogurt. Unfortunately, goats really like Moringa too; they must sense its nutritional worth and try to bridge their own nutritional gap (nobody feeds them). Finally: have the white lady give money so that you can buy candy and soda and a TV! Okay, maybe that last one isn’t something I think would help.

Here’s what I already do to combat malnutrition in my village. I attend Jumbo’s monthly baby weighings. If I show up, more mothers tend to bring their children (white power—the good kind). At the weighings, I plot each child’s weight on their weight vs. age chart. If the child falls into the severely underweight class I write their name down. I then make a house call to see the child’s home environment. Are there 20 naked children running around eating anything off the ground, moving or otherwise? I talk to the parents and explain why I’m invading their home, and they bring me a chair (white power again). I ask for the child who’s name is in my book, and they bring me the child so I can give them a good look. Numbers aren’t everything, sometimes the child appears mostly healthy, maybe skinny, but maybe just small-framed. Sometimes the child has brown brittle hair, wrinkly skin falling off their bodies and distant uninterested eyes. I describe the last feature as listless, one of the more concerning signs of malnutrition (in my opinion). At this point, the child has either attached itself to my leg or is crying from all the attention. I then talk with the parents about what they farm… not if they farm, unnecessary question in this village. From the list of foods they farm, I point out the ones that that particular child should eat more of, and what they could use less of. We discuss what the child likes to eat and their usual scenario of eating, i.e. shared bowl with 6 bigger siblings, only likes the starchy foods, eats a little then complains of stomach pain… I give them some ideas of how they can get the child to a healthier nutritional status and encourage them to keep trying. I then move to the next house. Generally, I write down about 10 names from each baby weighing, I don’t write down repeats (once I’ve talked to them I only check in with them when they heed my advice and come to the next month’s baby weighing, or if I’m particularly concerned I just star the name and revisit as necessary). I also try to write down at least 1 well-nourished child from each weighing and visit them too, to give them a verbal high five.

In addition, I recently submitted a grant to help pay for bamboo I want to use for fencing. Each clan (there are 12 in Jumbo) would create a fence with the bamboo, near their homes instead of at farm. After the fence is complete, I plan to have them each plant 30-40 Moringa trees in the garden. I’ve already mentioned the benefits of Moringa. If I am successful and the women start using Moringa in their stews and soups, Jumbo will produce massive kids that could give obese American children a run for their money… well, maybe not, these kids do a little more physical activity than American children. In any case, they will be healthier, and parents would have no excuse not to use it, as it is costing them almost no money.

Also, pretty much from day one I have been working to get a small clinic in the village. We’ve completed the work required of the village for getting the clinic and nurse in Jumbo. Very soon I’ll have a nurse to collaborate with on the matter of malnutrition, and I can’t wait! Along with helping reduce malnutrition rates, we’ll have more women utilize family planning methods available at the clinic, and reduce the severe cases and deaths related to malaria and other easily treatable diseases.

May 28th I finished my first PD Hearth Program. Most villages do the program about two times to capture the most malnourished children; unfortunately, I’ll need to do it at least 5 times to reach the most severely underweight children in Jumbo. The program is a nutrition-focused cooking program, lasts for 12 mornings and enrolls 12-15 children (this group included 12 mothers). Each morning mothers of the children selected are shown a nutritious meal to cook, using protein rich food such as ground soya beans, peanuts, fish and Moringa. Then they cook it and feed it to their children. The left-over food is sent home and fed to the child throughout the day.

Our 1st PD with a girl 4 days older than him

Fufu and palmnut soup!

A busy day @ the clinic, baby weighing + PD Hearth Program

Another morning of nutritious food @ Hearth

This first two-week program went well, especially for it being my first try! Most of the women came on most days (I have some ideas for improving attendance in the future). The kids ALL ate the food, and liked it too! Not one child in the group lost weight. Rather, three maintained their weight from the first day and the rest all gained some weight! The child who gained the most weight gained 7.6% of his body weight!! (You try that in 12 days!) In 2 weeks we’ll weigh these children again to check if the mothers are still doing what they’ve learned in the programs while at home.

This is Nakoja, he gained 7.6% of his body weight & was out “biggest gainer”

Tomorrow I’ll start with a second group, this time with 13 children and their mothers. The PD (positive deviant) for the group is a 3.5 year-old girl born into a farming family. As farming is the most common occupation for people living in Jumbo, I was excited to hear how this ordinary (read: very poor) family was able to keep this young girl so well nourished. Their secret? Moringa leaves in her food at least once a day! I’ve been trying to push moringa at any opportunity (baby weighings, community meetings, nonchalant conversation). If I would have been smarter, I would have “planted” this type of mother into conversation much earlier. Regardless, I was given a real-world example of what moringa can do for a child’s nutritional status. The other women in the program are now very excited about moringa, so I told them all to go home and nag their husbands about working a small plot of land so they can use my funding for bamboo to have a moringa garden of their own!This is Jagri, she's the PD for our 2nd group, a very healthy little girl!!

In other news, Kris and I are getting excited about our vacation to the US in less than 2 months! Cheeseburgers…mmm… The rains have arrived, so it’s now cooler, but also more humid, muddy and, well, wet! We no longer have to rely on fetching and pumping our water; we instead collect rainwater from the roof. We are also preparing for a youth camp in June. We are also getting ready host some brand new (less than 7 days in country) Peace Corps Trainees (PCTs). One or two of these PCTs will venture on their own from Accra to our village to see what life is like for a PCV in Ghana. I can’t wait to share insight and advice with the PCTs to help them transition to their new life in Ghana as a Peace Corps Volunteer. Sometime in June I’m co-leading a project that is loosely based on “Take Our Daughter to Work Day.” We’ll take some girls from my village to a bigger town to see women with occupations other than farming. Its intent is to provide girls with positive role models, encourage them to stay in school and to strive for their dreams. We’re also getting ready to say goodbye to PCVs who finish their service starting in July. I guess this will officially make us the “old group.” We’re at the one year mark in our service and can hardly believe how fast the time has gone. A year from now we’ll be busy planning our reentry to life in the U.S. We miss you all, thanks for all your continued prayers, thoughts and support!