A tale from my experience in rural Ghana

It is 5.30AM. Already showered and with my things packed in my travel bag, I rummage through my clothes to see if I can find something for breakfast. I have an apple and a protein bar, so I thank my past “me” for having thought about packing enough non-perishable food for these days. Hopefully we will find a street vendor selling boiled eggs or a couple of coconuts before noon.

After hearing my colleague Becca argue on the phone with a male nurse with whom we had made an appointment the day before, but who no longer wants to come with us because the Covid-19 vaccination campaign pays him more per diems (cash per day worked) than us (our project pays monthly), I take an angry bite of my apple followed by a grunt. Three calls later, the local health department identifies another nurse who can accompany us today. Today it is particularly important that we arrive to the target communities before 8.30am, it’s only 6.15am and we are already behind schedule.

Before taking off, we split into two teams, Becca goes to one community, and I go to another. In my car there are three of us: the driver whom I address as “brotherrrr” (brother, sister…. are terms used colloquially to address people your age, instead you would call uncle or aunty someone older than you to show respect), because I still did not get his name after asking him 3 times, and I am too embarrassed to ask again, Eric, a master student who oversees our social science research and interviews people in the communities to learn more about stigma and other social issues related to neglected tropical diseases (our area of research), and me. We drive for about 45 minutes to get to the health center where we must pick up two other nurses, Mary and Linda. Once there, a girl who is studying to become a community health worker asks me if she can join us. Sure she can! After discussing the plan for the day, I am ready to get back in the car, but I see that the three ladies have sat in the shade and started having breakfast. They prepare chocolate milk and cookies and invite me to join in, but I politely decline. I look at the time on my cell phone, it’s almost 7AM, we really have to go!

My first reaction is to feel frustration, since we had all agreed to leave at 7AM the day before. But I’ve been in this situation many (many) times before, and after a few deep breaths I remind myself that my perspective on this project is very different from theirs: to me, this is a 3 million € grant that we need to account for; for them is yet another foreign public health program with its own agenda and timeline, that does not necessarily have to fit their agenda and timeline, or more importantly, is not even among their public health priorities. We are talking about a skin disease, not Malaria, HIV, TB and definitely not Covid-19. No pandemic is going to arise from this anytime soon.

But still, I need to get things moving; this is literally our job, “to get shit done”: we have to seep, jump, push through and figure out solutions for any logistical, bureaucratic or cultural barrier we encounter. Is not precisely the brainy, neat, and delicate academic job people think you have when you say you are a researcher in the medical field.

Anyway, it’s fine, I’ve been doing this for almost a decade so I usually find my way around things… But no one warned me in college I would also have to find solutions in the scenario of a global pandemic. With Covid-19 restrictions we are already so behind: we were not allowed to travel to Ghana when planned, and finally getting here was an absolute nightmare. This, added to extra-slow international shipments, sick personnel, schools closing earlier to reduce exposure, the ongoing vaccination campaign which means less relevant public health interventions have been put on hold and that everyone is busy with, let’s be honest, more important matters than this project, plus case-finding has been much slower than expected… we need to reach an “N” of 600 people before spring, and we have barely reached 100. I take another deep breath to expel the stress from my body. Be gone!

I try to text Becca, but there is no cell coverage. I secretly pray she is having a better start than me and that she is already on her way to visit the patients.

While the nurses finish their breakfast, I go into the clinic to pick up the box of material that we left prepared a few days before. It is a plastic box of about 70 litres with all the necessary material: lancets, rapid tests, cotton, etc. … As I lift the fairly heavy box, I hear a creak behind me, and when I turn, I see a goat with its head stuck in a bag of medical waste. Mary walks in the clinic as she explains: “The lock of the door is broken, so it comes in constantly”. I get it, the place is swarming with tiny adorable goats with parkour-ninja abilities that could break into any place. I pat the goat away, and I chase it as it comes out of the clinic reluctantly, with absolutely no rush and chewing on what looks like a piece of paper. I look around the clinic that only has 3 rooms and do a mental review of all the material that we must take with us in case I forget something.

Finally, we get into the car, a ramshackle 4×4 that the Noguchi Memorial Institute for Medical Research (NMIMR), with which we collaborate, has lent us. Noguchi is as modern as you can imagine, situated on the university campus of Accra, with incredibly modern laboratories and biomedical research areas, all donated by the government of Japan and the JICA (Japan International Cooperation Agency). The centre is named Noguchi in honor of the Japanese researcher Hideyo Noguchi, who worked in Ghana in the 1930s searching for a cure for yellow fever. Sadly, Noguchi died ironically of yellow fever, and the Japanese government decided to donate this incredible centre to continue the fight against infectious diseases. Unfortunately, I cannot sing the same praises of the car they have left us: it does not have air conditioning and the person sitting in the middle has to do without a seat belt. The engine makes cat-like noises, and I am sure it will leave us stranded in the middle of the jungle sooner or later. It is not exactly comfortable (or safe), but at least we have a car! We drive for almost two hours on winding roads made of a mixture of pitted asphalt, mud and rocks that leave us all reeling when we get out of the car.

At last, after almost two hours or torture, we reach the village where the houses of five patients that we have to visit are located. We are doing a “household survey”. In short it means that we visit houses where children with yaws live and collect blood samples from their relatives in order to assess the prevalence of latent yaws, and also ask them a series of questions about habits, infrastructure, and beliefs to learn more about risk factors related to the disease. The goal today is for Mary and Linda to understand and master the procedures so that they can perform them without me in a few days, and that they can later teach them to other workers. We go off road to reach the first house; I am surprised to see a large, isolated cement house (they are usually made of clay) painted in light blue, with a large terrace to which all rooms in the house overlook. The kitchen is located on the other side of the esplanade: a huge, polished stone for making bonfires surrounded by saucepans and metal pots drying in the sun. Since we arrived so “late” (meaning past 8.30am), all the school-age children are already in school, and most of the adults have gone to work. The only people left in the house are the mother of the boy with yaws, his two older sisters with their two babies and the grandfather, who happens to be a traditional healer. Eric smiles at this fact, as healers are not easy to find, and they give us key information about traditional treatments and the stigma of the disease. The healer looks sick, and I ask Mary what’s wrong with him. “He has malaria.”