Back in action

I know it’s been almost a week since I wrote a post. I wish I could say that Julia and I have been busy having a blast traveling and the like but, sadly, I cannot. We spent the better part of the last week housebound, well actually bedbound, sleeping off some food poisoning. I didn’t eat for two or three days and went on Cipro from the getgo. At first I was sure it was food poisoning. Then I was thinking that it might be malaria after I had a mid-level fever for a couple days that didn’t subside with the Cipro. Then I got a rapid diagnostic test for malaria at a pharmacy to be sure. It was negative, but there was a chance my Malarone was cutting the malaria symptoms and parasite load so nobody could be sure. Then I stopped Cipro, had a giant meal, and came to the conclusion the most of the symptoms that I was having (including the headache) were probably the result of starvation rather than any sickness.  Now I’m getting my energy back and more restless than tired after spending a week in the house.

Not much happened the last few weeks. Two of our team of six went home this week to the States because one of them wasn’t feeling well. And then there were four. As a result, we cut one of our sites for the study so that we would have enough resources. Hopefully we will be able to do one site really well.

We are still waiting for Ghana IRB approval…things take a long time in Africa.

Perhaps now is as good a time as any to explain what we’re studying: we’re doing a randomized controlled trial with a control group and three intervention groups. There are two stages. The first stage looks at the impact of incentives to reveal existing mosquito nets. The second stage looks at leakage of nets over time and the impact of using community health volunteers to hang up a net.

During the first stage we will have community health volunteers conduct a door-to-door registration of compounds in the community. They will ask for information on existing bednets, sleeping spaces, malaria incidence, etc. The total popolation is randomly broken up into two groups – one group is offered a bar of soap for every good net they declare when asked during registration, the other group is receives no offer of soap but is asked the same question. We will look to see if more nets are declared in the group that is offered soap.

The second stage is a little more complicated and looks to address leakage of nets that occurs after a point distribution as well as the impact of doing a door-to-door hang-up campaign after a point distribution. There will be a point distribution of nets based on the information received in the registration followed by door-to-door hang up of the received nets. There are four groups to which compounds are randomly assigned. Group one receives the nets and then has no hang-up; this is the control. Group two receives the nets and then has a community health volunteer show up on day 3 to hangup the nets. Group two is the same but the volunteer comes on day 7, group three on day 14. Then after one month, a survey is conducted to see how many nets that were given away are hanging, among other things. We are looking to see if there is a difference between the groups.

The issues we are studying were chosen after many meetings with administrators in the Ghana government, USAID, and NGOs working on bednet distribution. We are attempting to provide these actors with information to improve future distributions of nets…that is, if we get IRB approval!

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A day in Accra…with a point and shoot

We started the day talking to Joyce and took a couple of snapshots with her. More on these later.

Then we went to Osu to look for some fabric for Julia to make a dress and for some pillows. We tried a big shop and didn’t see anything we liked so we stepped into a fabric stand outside, where two girls were playing mankala. We bought two types of kente print, 6 yards total, for 4 cedi a yard. Of course, Jules tried on some of the pre-made dresses to the delight of the shopkeepers. One of the girls complained that her skin is too dark. I informed her that she is crazy and that, if anything, the beautiful, colorful fabrics looked much better on her black skin than on Julia’s white skin. I hope Julia wasn’t too insulted.

Then we stopped into a supermarket/home goods store for some groceries. Food is super expensive in Accra. Even though we try to buy as much as possible from stands (as much as possible without getting too sick), the costs are high. We came across some cribs with built-in mosquito netting. Awesome!

We made a trip out to University of Ghana, Legon and looked in the very impressive bookstore. Dad, I know you’re jealous. There was a neat chalkboard outside marking all the new arrivals. Julia picked up a little red book of a lecture given by a professor at University of Ghana on foreign development aid. Is it a Trojan horse? I’ll let you know after I read the lecture.

Finally, we stopped at the mall and decided to have prints made of the photos with Joyce. She’s going on vacation soon and we wanted to give her a gift. We stopped at Pizza Inn for some lunch.

Obama Biscuits – no explanation needed.

Today it was hot. So hot that the tar in the street is melting. Not the bubbling melting I used to see in Maryland when playing on the street at my grandparents either. This is more like a mini river of melted tar, flowing downhill and pooling. It’s hot.

Oh yea. Hi. I’m Mat.

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I got a new camera!

You might remember that my camera died after being exposed to sewage runoff in an open drain in Accra about a month ago. Today, I received its replacement! A Canon SD940IS digital point and shoot.

I wanted a camera with HD video and a longer zoom. This guy has a 2.7″ screen, HD video, and a 4x optical zoom. I haven’t taken it out yet but will update with photo ASAP.

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Obruni tro tro

Just came across this video of a news segment on an anthropology student who worked as a tro-tro mate (the person who calls out the tro-tro route and collects fares) on a popular route in Accra. Julia and I have taken this route from Medina to Station 37 a couple times now…never seen an obruni mate though.

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Meeting a chief

So the bednet project is moving along. We have submitted Ghana IRB and are awaiting its approval before we can proceed. There are still a number of ends to tie up with our local NGO partners before we can proceed anyway, so we are taking advantage of this lull in the action to do so.

Yesterday, Julia and I went to a meeting at the National Malaria Control Programme (NMCP) to observe and contribute to their discussion on Ghana’a upcoming bed net distributions. They are aiming to achieve universal coverage of the entire population by 2011. It was a great opportunity for us to contribute some of the things we’ve learned from our trips to the field over the last few weeks. We helped to shed light on the policy for distributing nets to households  – suggesting that it be based on the number of sleeping spaces, rather than the number of people or number of rooms. We also chimed in when helpful regarding the potential ways of dealing with nets that are already in place when a universal coverage campaign rolls through a community. It was also a facinating cultural experience. You might draw a parallel between this meeting and a meeting in the US of high-level managers at DHHS who are overseeing a national vaccination program, or something like that. The room was filled with public health professionals and project managers who are part of the Ghana Ministry of Health and/or the Ghana Health Service as well as the leaders of the implementation partners for various components of the program…and Julia and me. Unlike how I imagine a government meeting like this would be run in the States, this meeting had a lot of push and pull, joking and jibing, and good natured fun while remaining professional and productive in a very African way (not to generalize too much). I loved it.

And then for something completely different today, Julia and I were in the field working with a potential partner in the Greater Accra region. We found ourselves at the extreme other end of the malaria bed net implementation program spectrum. While yesterday we were discussing guidelines for the distribution of nets to be applied throughout the country, today we were in the field in a community of around 3,000 people, talking with a local NGO about implementing a point distribution in one village. As obruni, cultural etiquette mandates that we receive permission from the chief of the village before conducting preliminary data collection. Today we wanted to count the number of compounds in the village to see if we could cover the entire population with nets and were brought to the community chief to seek his blessing. The chiefs are also a vital part of communicating with the community. The chiefs in rural Ghana often make announcements using a drum or gong. In our situation, it is vital that the chief communicate to the local population that he wishes their cooperation with our study and that he supports our efforts. This helps get over the natural skepticism that comes with a bunch of white people giving away nets in a rural African village.

The chief seemed very stately as one might have expected. He was well-dressed in colorful clothing and large, wood sandals that were heavily lacquered jet black but he did not wear any headdress or ostentatious decorative jewelery. A man of around 60 years, he spoke with a deep voice in a deliberate fashion. While all the Ghanaians in our party showed clear respect for the chief, they were not full out deferential, as I expected them to be. They spoke directly to him, not through an “interpreter,” and occasionally cut him off to explain things. This may be because in this area, near Abokobi, the chiefs are not hereditary, but are selected by a collection of local Christian leaders. I also found it interesting that protestants introduced chiefdom to the villages to encourage greater cultural ties between leadership and the population some time ago. The chief was very welcoming to us and approved our intervention in his community, if we would like to proceed. He also asked that I say hello to his daughter, who is now working somewhere in Maryland as a teacher. That’s the second person I’ve met who has a relative in Maryland. I miss my Old Line State.

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The fourth of July in Ghana

there were none of these:

but there was a lot of other coolness. We signed up for the Marine fourth of july party at the U.S. embassy in Accra and spent all afternoon there from 12pm until 5:30pm. We spent a good part of the time chilling and chatting with 20-something ex-pats either here for the summer or for a couple years. Let’s see if I can remember this just for a little flavor of the kind of people here. I spoke to: a teacher from Tampa volunteering to teach Ghanaian teachers, a senior from Harvard researching Cuban doctors in Ghana for her thesis, an intern from SFS at MCC, an intern at USAID, a political, econ, and public diplomacy officer, a couple who used to work at Chemonics (and was giving me the lowdown), a couple marines, someone who works at the Clinton Foundation, and probably many more I’m forgetting. It was a good group and I’m learning a little more about all the orgs in the development field. There were burgers, hotdogs, fries, an inflatable moonbounce WITH slide, and classic music ranging from “Girls just want to have fun” to “I’ve got friends in low places” playing in the background.

As the party was dying down, we played a couple spirited games of volleyball with some of the embassy crowd. There’s a basketball court and sand volleyball pitch on the embassy grounds. Oh yeah…and a pool that is about 85 degrees.  =) They live well here.

It was a very nice way to spend the fourth. We’ve been looking to meet more of the young crowd in Accra and hope to spend more time with them in the coming weeks. I’m at least hoping to start playing volleyball every week. There was definitely a feel of college to the whole thing at least with the 20-something crowd. This side of the embassy life was definitely not coming through in our discussions with ex-pat families. Good times.

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Europe and its racial and religious problems

In 2005, I spent a summer working on an archaeological dig in Tuscany near Siena – perhaps one of the best summers of my life…the food, the weather, the cigarettes, OK definitely not the cigarettes. I went to the Palio that year and almost was beaten up by an angry mob for violating their contrada space only to be saved by a carabinieri who was friendly with a girl in our group.

Anyway, this year a Muslim artist was commissioned to design the Palio and there was much debate over whether this is appropriate in such a Catholic society. This reminded me of a recent article on Foreign Policy that examines the racial tensions in France through this year’s World Cup scandal. Racial and religious tension in Europe seems to be a popular theme these days.

In a Sacred Italian Race, Some Bristle at the Prize

SIENA, Italy — No horse race is more sacred in Italy than the Palio, which traces its lineage back 700 years. This year, however, the hotly contested chase has taken an unexpectedly ecumenical — and disputed — twist.

For the first time, a Muslim painter was asked to design the Palio, or banner, that the winner takes home at the end of the race, which is conducted two days every year around Siena’s distinctive shell-shaped square.

Not everyone was pleased with the choice, though that was not evident Friday evening, when residents of the winning district, or contrada, as Siena’s 17 neighborhoods within the city walls are known, jumped over fencing that lined the square to grab the Palio, crying and shouting with joy.

http://www.nytimes.com/2010/07/04/world/europe/04palio.html?_r=1&ref=global-home

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