Data Collection Hazards: Fountains of Labor Waters

Yesterday was my lucky day. I had been waiting impatiently to witness births here at the hospital, but had yet to really have a chance beyond glimpses from afar when the woman gave birth on the floor, or peeking into the labor ward when trying to get ahold of the elusive delivery book. But yesterday, the nurse-midwife in charge had me copy the data from the book at the nurse's desk right in front of the two birthing tables (usually they give me the books and I take them to the waiting room where the women in first stage labor are waiting to reach second stage- this is where the "floor births" take place).

As it was Monday, we were having to collect data on every delivery from Friday, Saturday and Sunday, which ended up amounting to 117. Needless to say, I spent a good 3+ hours in that delivery room copying the delivery information onto my data sheet (which is then taken back to our work room where we upload it into our computer databases).

And during this time, I witnessed 8 births. Births in the labor ward - I can assure you - are nothing like ones back home (although truthfully I've never witnessed one in the States). Besides the occasional "floor deliveries" in the first stage labor waiting room, the labor ward boasts of 8 beds with mostly naked women in various stages of 2nd stage labor, some naked, others half clothed. Some screaming, some moaning, and some snapping their fingers (a sign of pain). Meanwhile, doctors, nurses, med students, and occasional research teams such as mine are wandering through. Although there are curtains hanging from the ceiling in front of each bed, they have remained tied up. When a woman must relieve herself, she does so in her "hot bucket", a small plastic pail with lid that the women must provide themselves to urinate and defecate in. They simply get off the bed and squat over the pail between the beds.

In the adjoining room is the delivery room with its two labor tables and newborn assessment area in the corner. Across from these is the nurse desk where they write down the delivery information in the patient files and record them in the delivery book. It is also the resting place for the nurse-assistants, nurse-midwives, and any other helpers or researchers such as myself - all approximately 3 feet from the table where the laboring woman is lying with her legs spread.

The deliveries were fascinating: the women are not given any drugs - no epidurals or easy ways out like we have - and yet most women remain incredibly in control, although there is of course a number of women who make plenty of noise. Part of the reason they are often so quiet is that it is a Ghanaian belief that a woman should be quiet during birth to prove her maternal strength. And part of it is that the nurses often yell and sometimes even hit women who choose to scream or cry out.

From my sitting point three feet from expanding vaginas I was able to watch (amid writing names, dates, times) the nurse-midwife as she aided the baby's head to first emerge, then checked with her finger to make sure the cord was not wrapped around the baby's neck, then watch carefully for the shoulders to rotate before pushing the head down and freeing the shoulder as the rest of the grey body quickly followed.

Birth number four was interesting from the beginning. The young woman was put in the stirrups, and after abour 5 minutes her contraction slowed, and then seemed to cease altogether. Now normally, the woman is in and out of the stirrups in 10 minutes by the time they get her in there (because there are only two delivery tables they can't afford to put women in them until they are literally delivering, because there are so many more waiting). But this young woman (about my age) had been on the table for about ten minutes making no sounds. I was hardly surprised, therefore, when the nurses gave her an IV drip with oxytocin, which is a drug used to induce uterine contractions to progress the labor development.

The nurses, nurse assistants, nursing students, janitors, and myself were all looking on intrigued, asking about the treatment and how long it would take to kick in etc. Within two minutes, the woman began groaning and fidgeting, and I suddenly saw her stomach contract down as if the baby was about to burst out....when suddenly her waters broke, shooting a HUGE projectile stream three feet out, and directly onto three of the nursing students's laps. I was mostly spared - it only got on my shoes. We were all pretty shocked, as none of us had realized her waters hadn't yet broken.

But this was only the beginning. As the time between contractions became closer, it was apparent that the baby's head was not going to fit through the small vaginal opening. The nurse-midwife made the decision for an episiotomy, and using a small razor blade, told the woman to push and cut the perineum little by little with each push so that the woman would not feel the cuts through the other pain.

The baby's head soon followed, and was delivered shortly after. It didn't take long for the placenta to follow. The nurse took the pail where the blood had dripped into and poured it into a large measuring cup - 800 ml of blood, she nnounced. This is quite a lot, given that most women we record average 150-250 ml of blood loss. Anything over 600 ml is a potential case for a blood transfusion.

I then watched a different nurse suture her episiotomy closed, and as aweful as a comparison it was, I could only think about how similar the technique seemed to the stitches I received from my skiing accident a few years back...

I thought I might have had to interview this woman today if she ended up indeed having a blood transfusion, but luckily she never showed up today on our list of complications. I was greatful for the opportunity to see how hard the nurse-midwives work to safely deliver babies as easily as possible for the laboring mothers. I was in total awe of this young woman's strength and courage - of every woman's - to sacrifice her body in order to bring a new being into this world. And I was relieved for having a lap free of her labor waters.

Soccer Insanity: Mosh Pits, Pick-Pockets and GOOOOOALS!!!

So I have been greatly anticipating today's Ghana versus Libya Word Cup qualifying match here in Kumasi. It has been apparent from the moment I landed on Ghanaian soil that people here live and breathe soccer ("football"). And after this evening's match, I think I can say that the football fans here are more passionate about the game than the players themselves.

This weekend, the four other students here on my program (two who are doing research on sickle cell genes in Accra and two doing research in Aburi on native herbs that have been used for centuries in obstetrics here to induce uterine contractions during labor or slow post-partum hemorrhage) have come to Kumasi to visit. We arrived at the football stadium two hours before the game began, and had some late lunch. Kofi, our Ghanaian liaison here (without who we'd still be sleeping in the cement jail cell) warned us we'd better get inside before all the seats were gone.

We made our way around the stadium to the side we had tickets for. When we approached the entrance - two turn styles about 8 feet apart going thorough a huge concrete wall - we were met with utter football fan chaos: about 150 crazy fans fighting in a massive mosh pit to get through the turn styles. I mean, there was absolutely NO line whatsoever, just a sea of sweaty fans screaming, pushing and cajoling each other. When someone would finally get up the turn style, they would try and get their friends up there too, and people were elbowing each other even when they got to the turn style, using any body parts the could to push people back.

As we joined the craze, we noticed a young man getting yelled at and slapped in the face by a couple of other young men. I was able to get the gist of the argument, which was that the guy had been pickpocketing and had been caught. I yelled to the other seven girls to hold tightly onto their purses and not to keep anything in their pockets. As we slowly got shoved, pushed and elbowed towards the turn style, I started having fun with it- what else could I do? I pushed back, stuck my butt out so the guy trying to push past me got stuck, jabbed a couple of men in the ribs, felt myself get actually lifted up off the ground and moved forward by the surge of the crowd. The other girls weren't finding as much sport in it as I was: their hair was being pulled, their necklaces torn off, groped (it pays in such circumstances to be tall as I am...) - one of the girls actually started punching the guys around her. A football fan and I caught each other's eye and he saw my wry smile and the other girls getting upset and yelled to me "football is everything to us fans, welcome to Ghanaian football!"

I managed to make it to the turn style before most of the girls by perfecting the skills of knowing when to push back and when to let myself be carried by the crowd. I was laughing and high-fiving the girls who made it through before me, and shook hands with the football fan I'd spoken with on "the other side." The whole thing took about 15 of the sweatiest, exhilarating minutes of my life, and I found it hilarious. Until I realized I'd forgotten to take my own advice and had left my phone in my front pocket. Gone. I'd even felt hands in my pocket in the mass of limbs, but had thought to myself that I had nothing in them.

But the rush of it all made it impossible for me to be upset - especially because I knew to be thankful that it wasn't my wallet, passport or credit cards (like in Barcelona). The last time I'd had my phone stolen was in Kingston, when I had been in a similarly crowded scenario in the back of a route taxi.


We all finally made it in and found seats. The game was amazing: thousands of excited fans, the Black Stars of Ghana scoring three magnificent goals against Libya, and an incredible sunset as a backdrop.

Football here truly is a sport for all - for the players on the field, and the fans jostling to get a chance to watch. Todays' experience reminds me of the absolute passion of the fans I experienced in S. Korea during the World Cup. It is such a shame that those of us who grew up playing and adoring soccer in the States never got to experience soccer with such nationalistic religiosity. It's worth a cell phone any day.

Nurse-Midwives: A Hazardous Occupation

Before I begin, I wanted to say that internet connection here in Ghana is very intermittent, and has been a frustrating experience in terms of trying to check my email or write this blog. So please be patient, and between posts, you can always write me!

Incentives, Pay and Brain Drain in the Health Care System.

During my data collection rounds the other day, I happened to take a break in the nurse’s lounge with my translator Auntie Lydia and the head nurse for the labor ward, Auntie Mercy (we call everyone here auntie, uncle, sister etc). Auntie Lydia is one of our two translators, and is currently on leave from the labor ward here as a nurse-midwife. Auntie Mary, our other translator, just recently retired from her position here as head nurse-midwife of the antenatal ward. However, both of them have been working here on and off to help with the shortage of nurse midwives. As we sat, Auntie Lydia and I listened to Auntie Mercy tell of her difficulties in desperately trying to hire two more full-time midwives for the delivery ward.

Currently, Komfo Anokye Teaching Hospital (KATH, where we work) is experiencing extreme shortages of staff, most notably among the nurse-midwives, who contribute far more throughout the maternal wards than the doctors. Many of the nurse-midwives have been taking double shifts to assist their coworkers when short of staff.

Many of the newly-trained nurse-midwives being trained here leave immediately for district hospitals because the work load is lighter and the work incentives are better (KATH is famous for overworking and underpaying its staff). Lydia and Mercy talk about this new generation of nurses as being more concerned about making money and less about caring for their fellow Ghanaian sisters than the older generation of nurse-midwives. Lydia and Mercy refer to these younger nurses as the “computer generation” – one trained for money and new technology, and less for quality patient care. They explain that the older generation of nurse-midwives are very close friends, and so are willing to work double shifts to help each other when they are overburdened.

In the past, nurse-midwives (okay, I’m shortening them to NM, this is getting tiring) were trained solely in the maternity ward. Today, NM-in-training spend three years doing rounds that include other departments in the hospital, including oncology, pediatrics, and even psychology. Mercy and Lydia think it is beneficial to have a more well-rounded NM, unfortunately it also means having to wait longer for potential new workers.

Where as KATH doesn’t provide any work incentives such as reimbursement for the cost of transportation or providing free meals, district hospitals usually do – accounting for the majority of new NMs wanting to work there. While both are government run, District hospitals have much more financial discretion because they employ so few workers, and are therefore able to provide meals and money for transportation, as well as a yearly bonus. For instance, according to Mercy, last year one of the nearby district hospitals gave each worker a bonus of 35 cedi, while here at KATH each received just 8 cedi (one cedi is approx. $1.01).

Brain drain to other African countries, especially South Africa, is extensive. However, with the recent riots in S. Africa over international workers and the deaths of 7 Ghanaians and the burning and pillaging of many of their shops, Mercy and Lydia, are hopeful their Ghanaian workers will return. They note that Ghana is a stable, peaceful country relative to other African countries, and they can’t understand why their fellow Ghanaians leave to work elsewhere- even if the pay is better. They believe that Ghanaians can plan out and budget their earnings and should live according to their means and not what fancy accessories they see others having.

“Occupational Hazards”: Putting oneself in danger to help others.

As Kumasi expands, many nurses are living farther away from KATH – some as much as 40 km away. And for these women, many of them must walk 1-2 km from their homes to the nearest tro-tro stop (Ghana’s form of public transportation - small mini vans that pack in 20 people). If they work in the morning at 7am, they must leave up to 3 hours ahead of time, and add an hour if it is raining.

These long distances and the transportation hubs involved put these women at a much greater risk of being attacked, and such dangers are considered “occupational hazards” by Lydia and Mercy. The attacks usually involve robbing for phones (which use SIM cards and so are easy to immediately sell off) and money, but have become increasingly violent to include rape and murder. Two days ago, the TV reported on a pregnant nurse-midwife who was returning home at night from her shift at the main teaching hospital in Accra when she was attacked with a machete while waiting for the tro-tro, killing her and her unborn child.

Mercy and Lydia argue that in the old days, it was the district hospitals in and near the mining towns that were the most dangerous to work at. Now, they assert that all hospitals are somewhat dangerous to work at, including KATH. They believe this change began in 1983 when the Nigerian government decided they were too many foreign workers, and deported them all (including 10 million Ghanaians of every profession) back to their home countries. This massive influx of returning Ghanaians fostered high unemployment, housing crunches, and massive burdens on the health care system, all of which led to an increase in violent crime.

Since 2001, KATH has been transporting a number of its staff on new hospital-owned buses. This has reduced the chance of these workers being attacked. However, there are not enough of these buses for all of the staff, and they do not run during the night, when many of the doctors and nurse midwives begin or end their shifts. Mercy and Lydia argue that providing more buses for transport along with providing accommodation close to the hospital for doctors, nurses and their families would greatly reduce attacks and would increase the retention of workers, ultimately reducing brain drain.

Ghanaian Soccer Fans: Testosterone and Stinky Pits

Soccer - or "football" as it is called in every other place in the world besides the States - is the national pastime here in Ghana. On our first full day here in Kumasi, we were walking to find a bank to exchange money. Everyone on the street had their radios turned to a station with a man talking so fast I thought it was an auctioneer. All of a sudden, the entire city erupted in a roar of victory, completely stunning me and the rest of the researchers. Kumasi had just beaten Accra- their arch enemies - in the Ghana premier league championships. We soon found out the game had been here in Kumasi, for shortly after as we driving back to our hostel we encountered thousands of fans running wildly in the streets, waving their shirts frantically, honking horns, and jumping up and down as they poured out of the stadium. This was my first introduction to the extent to which Ghanaians live and breathe football.

My second introduction occurred last night. It turns out that Ghanaians are nearly as passionate about the European leagues as they are about their Ghanaian ones. The talk of Ghana the past couple of days has centered around last night's match between Manchester United and Chelsea as they faced off in Moscow for the Champions League final. Since we arrived here, we have met and made friends with a number of medical students who will be coming to the University of Michigan this fall to do 6 weeks of rounds at our hospital. The guys made us promise to join them for the match at the medical school hostel, located close to our own hostel.

Now, in the States, I picture the TV viewing of championship matches as a time for eating drinking, and swearing at the TV. You know - chips and salsa, beer, pretzels, cheese, popcorn, swearing at the TV...unfortunately we found out that in Ghana they replace food and drink with sweat and B.O., although they still retain the foul language. We arrived to find ourselves in a small, stuffy dark room with approximately 60 guys and no women save us. The air was the most awful smell of testosterone, sweat (it is soo hot here, and I'm guessing few if any of the guys managed a shower between hospital rounds and the game...eeew!) and hoooribble B.O. We were packed into the room, and I thought I'd pass out from the lack of fresh air - thank god I didn't have any food I was hoping to eat!

I was cheering for Chelsea, but they were playing lousy and Man U wasn't looking much better. When each team scored, guys would jump up, tear off their shirts, run around the perimeter of the room and then jump over all the couches and chairs where everyone was sitting, screaming and pounding their chests and body-checking the guys cheering for the opposing team. By the time the game finished its double OT and went into shoot-out, I pretty much didn't care anymore who won or lost- I just wanted to shower! And of course, just as the first round of shootouts ended and Chelsea stepped up to take the first sudden death kick, one of the excited fans kicked out the electricity cord and the TV went off - by the time it came back on, Chelsea had missed and Man U were the victors.

The Man U fans screamed as they ran out of the room, the scent of testosterone trailing behind them and into the street. Meanwhile, I couldn't even count on both hands the number of Chelsea fans I saw crying, including our med school friends.

Needless to say, I don't think us girls will choose to watch the next big game at their hostel, our own has a much bigger screen and an OUTDOOR LOUNGE WITH PLENTY OF FRESH AIR. Oh, and beer, too.

The game reminded me of being in Seoul at the town hall square with 60,ooo other S. Korea fans watching the World Cup, only of course it was outside, and their was food drinks, and yes - plenty of swearing.

Musings on what this research is really all about.

One of the most difficult aspects of working here at the Komfo Anokye Teaching Hospital is witnessing the horrible conditions under which the doctors and nurses must work to ensure the health of laboring women and their infants, and the squalid conditions under which women give birth. It is not seeing a woman give birth on the floor of the ward, or the lack of sanitary instruments, or even hearing of the woman who died the previous night after she delivered a still born baby. Rather, what makes bearing witness to such events so trying for me is learning to deal with seeing such daily happenings, without becoming numb to their significance in the broader global context of countries that have versus countries that desperately need. As my directer of this research Dr. Anderson pointedly remarked before he headed back to the States this past weekend, "Don't forget the significance and implications of what you see here. When you see two women to a bed, or hold the maternal death registry in your hands and feel its weight, don't ever forget that it should not be this way - that this is unacceptable." And yet, how does one allow oneself to feel so indignant at what one sees, when day after day one witnesses it and it becomes "normal." It is an intense exercise in emotional and intellectual compatibility.

Today was a glimpse for me of what lies in store for me as I work here. This week we are piloting our research, practicing collecting data and interviewing patients before we officially begin next Monday. When we made our way down the stairs from the 5th floor labor ward for the "VIP" women to the first floor where the delivery ward and "dark room" (the room housing all post-delivery complications) are, we were greeted with a loud, rather chaotic scene. On the tiny landing between the stairs, the elevator and the entrance to the delivery ward were about 20 men and women milling about. The elevator door was open - but there was no elevator. Men were shouting loudly up and down the shaft, below the elevator was stuck due to power failure with a laboring patient inside. Meanwhile, just inside the doors to the delivery room, people were peering through the windows to the floor. Inside is a very small waiting room where women who have begun labor but are not yet fully enough dilated to be brought to the delivery table wait. And as we arrived and walked up to see what they were looking at, I saw a woman lying, slumped against the doors, giving birth on the cement floor. It was over in seconds, there were two nurses there, one of which quickly cut the umbilical cord and carried the baby to the delivery room. The other one attended the new mother, and pulled her to her feet about 2 minutes later to walk to the recovery room. The woman was naked, covered in blood, and watched by over ten pairs of eyes through the door. We waited around a few minutes to see if we'd be able to get inside the doors to find our data books, but upon seeing the large amount of blood on the floor left to be cleaned up, we decided it was time for lunch.

Later today I told one of my medical resident friends what we had seen, and he laughed gravely and said that it was very common for women to give birth on that floor, and that the elevator ride was never a sure thing.

Last night, a woman died after giving birth. Two students here from University of Michigan to observe the wards saw three infants pass away today, all from asphyxiation - a cause of death that would never happen in the States where every newborn has access to assisted breathing machines.

As I left the hospital this afternoon, I noted the 30+ women sitting and lying under the tree in front of the main hospital entrance. these are the women who have no friends or relatives in Kumasi with who to stay with as they wait for their family members to be seen for their various illnesses.

Witnessing today's events and knowing that they are in no way unusual makes me evermore sure that my research matters. The death of these women and newborns will not be forgotten - through our careful recordings of their delivery, determination, and sometimes death, our research will contribute to the reduction of obstetric complications in this and other hospitals in Ghana.

As my sister Kelsyn graduates from college today, the world her oyster and the sky the limit, I can't help but reflect on the privilege American's have in growing up where we do, the opportunities we take for granted, and the relative ease with which we are able to secure clean water, safe shelter, education and medical care. One of the most important things about traveling is being able to witness what the majority of this world's population lacks, and to be humbled by the strength, resiliency and determination with which people in developing countries summon each day.

And it is because of my privilege as an American - as a middle-class white woman - that I feel compelled to travel around the world, learning from others and finding out how I might assist them in overcoming barriers to living their lives in dignity. This is what brought me to Kumasi, Ghana, West Africa.

Kelsyn, I am so proud of you for graduating today, and I know your time in South Korea will humble you as well, and that you too will find a way to use your English teaching to touch the lives of your students.

Hospital Hel(l)thcare and Detective Drew's Data

The past two days my research team and I have been familiarizing ourselves at the Komfo Anoke Teaching Hospital here in Kumasi where we will be conducting our research the next ten weeks. The maternity wards where we will be spending our time are grossly different from those in the States or other developed countries. Our hospital delivers 40-50 babies each day, and the antenatal (before they give birth) and postnatal (after they give birth) wards are overflowing to the point that they often have two women per bed - the overflow rest on sheet-less mats on the floor. There is absolutely no privacy for these women, as people such as ourselves walk through the aisle and the hustle and bustle of the nurses and medical teams ebbs and flows some how despite the ever-diminishing floor space. This is how it is, unless you have the privilege of affording the "VIP" labor ward that offers curtains, actually clean sheets, and a private delivery room.
In the delivery room, up to 10 women in their first stage of labor (before their cervix has dilated enough to begin delivery) wait in a tiny room with a bench, using buckets to relieve themselves as they wait to reach full dilation, at which point they will be transferred to one of eight side-by-side delivery beds where they will give birth without the assistance of any medication or drugs. As is cultural custom, they are urged by the nurses to refrain from making noise or screaming during delivery.
This is one of the top two hospitals in Ghana. Yet it remains understaffed, understocked with essential life-saving medical supplies, overburdened, and overcrowded. These are just a few of the reasons why my research task is so difficult and important: trying to locate all of the necessary information about each woman who comes in to deliver, and conduct interviews with those who have severe or life-threatening complications during delivery, is an exercise in detective work when patient records regularly go missing, women are transferred without notice to different wards, and the nurses are too overburdened to fully record all of the important information for each patient.
For instance, each of the three delivery wards (the regular, overcrowded one, the VIP one, and the surgical one) have an A&D book- Admission and Dispatch - that tracks each woman while she is there. They each have a delivery book as well that records information about the actual birth. There are also the individual patient records. And finally, the anesthesiologist in the surgery ward has his or her own book. Now, imagine a woman who is admitted to the regular ward and is having labor contractions. She is registered in the A&D book for that ward. One day later, it becomes apparent that she has pregnancy-induced diabetes and needs special care. So she is transferred to the "black room" - the ward for pregnant women with complications. So she is signed out of the first book and into the new ward's book. Then her family manages to come up with some quick cash to get her into the VIP ward for the best care. Now she has been signed out of the second ward, and has been admitted to the new VIP ward and is in it's book. But then the doctors detect fetal distress and decide they need to perform an emergency c-section right away. So she goes down to the surgical ward (called the theater) and is recorded in that book, and has the emergency c-section and is recorded in the anesthesiologist's book, before being returned to the VIP ward with her new baby. So now, she has been admitted into three wards, discharged from two, and her delivery was officially recorded in the third (surgical ward). She is additionally in the anesthesiologists book, and has her own personal chart.
So the next day, when I come in and see there was a woman who had a complication and I go to try to find her, I must track her through each ward and book to find all of the information. This is especially complicated because not all of the proper information was recorded in each of the books. Rather, each of the books captures some of her information, and it is possible that even when combined they fail to capture the full picture of what happened, so I need to find her chart, only it has gone missing....and once I find all of that information, I still need to interview her. Now you begin to get the picture of what we are up against.....
There are many additional logistics to be covered before we can begin our research - most importantly the fact that we are still awaiting the final approval of the IRB ( the Institutional Review Board that must clear us for our research). It also includes securing interpreters for the interviews and finding an appropriate place that ensures privacy during the interview, practicing the interviews and the data entry, and meeting all of the appropriate contacts, nurses and doctors we will be working with.

PHEW! Needless to say the last couple of days have been intriguing, exciting and exhausting. I'm incredibly excited to begin the research, to continue picking up the local language (Twi), to learn how to get around using the tro-tros (the mini-vans that act as public transportation) and to finally have a place to stay. Our first place in Kumasi on Sunday night consisted of four cement walls, two bunk beds, and THAT"S IT - unless of course you count the bed bugs...two of the students who were less-than-thrilled opted to sleep on chairs for the night (LOL). So last night and tonight we are "living in luxury" at a very nice guest house our research director has been staying at while we wait for our next place to stay to be ready. We will move tomorrow to the medical students' guest house located right behind the hospital. But after two weeks we will move one more time to the newer quarters of the med student lodging where most of the international medical students are housed (it is currently full as school does not get out until the end of this month).


Such is the current state of affairs here in Kumasi, Ghana.
Detective Drew, signing off.

It's Ghanarific: Sweaty bills and mysterious rice baggies

WOOT! I have arrived. Accra - the capital of Ghana - is a sprawling, lush, bustling city during the rainy season. I have spent the past two nights at a hostel at the University of Ghana, and the days exploring the campus and touring Accra. The weather here brings back memories of Jamaica during it's rainy season - hot hot, humid humid, hot - with occasional heavy showers (though it hasn't actually rained yet). We're talking over 100 degrees Fahrenheit each day and 80-90% humidity. But I actually don't mind (except for my secret money belt fanny pack which holds in some rather unpleasant heat and moisture in my groinal area, making me feel quite sorry for the poor Ghanaian who must take my warm, moist Cedi (Ghanaian money)).

I head up to Kumasi today on a bus with the other U of M students. Besides the four of us who will be conducting research regarding maternal obstetric complications in the hospital, we have been joined by another U of M group of students (undergrads) who are also studying maternal mortality on a four week program and who will be staying with host families. So it has been interesting touring Ghana with such a big group. And by interesting I mean uncomfortable. I have found - through my study abroad program in Jamaica and to a lesser extent in Korea - that it is always better to be a traveler or tourist by myself or with one other person. Groups of obvious tourist/travelers, especially in countries where there are few white people, are such an eye sore, and draw so much (often unwanted) attention, making me feel quite uncomfortable. I much prefer to be on my own, where I can interact with locals better.

However, despite my previous experience being on my own in other countries, I must always start out a newbie, getting a feel for the culture and learning how to go about simple tasks such as getting lunch. For instance, yesterday when we were dropped off on the main busy street to find ourselves lunch and look around, I was DETERMINED not to eat at Papaye, the "Burger King/ McDonald's"-esque fast food chain that all the other students made a beeline for. For I, having traveled around the world and being oh-so-knowledgeable, was going to order street food like the locals and the ex-pats who live here. So I found a popular street stall (always go for a popular one so you know that it at least sits well with the locals) and attempted to order the one dish I knew called Jolof rice (rice cooked in a tomato-based soup). Of course, they were out, and I ended up with a plastic baggy full of plain rice with a mysterious brown sauce. I had no idea if I was supposed to eat it with my hands or if there were utensils around, because all of the locals ordered and took their baggies with them. So I paid and walked away, pretending I knew exactly what I had just gotten and how I should properly consume it (turns out they eat it with their hand, which I'm glad I didn't given how filthy mine were).....and made a beeline for Papaye, for an expensive but delicious grilled fish and Jolof rice...WITH utensils, thank you very much.

And so it goes as I slowly get a feel for my new surroundings, adapting to the heat and constant sweat, and the new food and ways to consume it. West Africa is vibrant and alive, and I am excited to go to Kumasi where I will spend the remainder of my time (besides weekend excursions), exploring the largest open air market in West Africa, the food (I had Bunku last night- a large ball of play dough-like mashed cassava that you pinch off with your hand and dip in sauce- not so great) the countryside, the people, the language (Twi is the main spoken language after English in the Ashanti region where I'll be staying) and the culture.

Akwaaba - Welcome- to Ghana

What exactly is Drew Doing in Ghana?

Maternal death represents the greatest disparity between developed and developing countries. Almost all maternal deaths (95%) occur in Africa and Asia. In her lifetime, a woman in sub-Saharan Africa faces a 1 in 16 risk of dying during pregnancy or childbirth as compared to a 1 in 2800 risk in countries such as the U.S. In Ghana, an estimated 56% of mothers give birth without the assistance of a skilled birth attendant and 214 women die for every 100,000 women who give birth – compared to 8 per 100,000 in developed countries such as the U.S. Additionally, the life time risk of a woman dying while pregnant or giving birth is 1 in 35 in Ghana.

Okay, enough with the grad school statistics, but they are important in giving an idea of why I am going to Ghana and the importance of this research.

I’m going to Ghana. Woot! I’ve been trying to get to Africa for what feels like my whole life. And I couldn’t be more excited to be going to Ghana to research my passion – global reproductive health. I’ll be spending ten weeks collecting data at Komfo Anokye Teaching Hospital in Kumasi – the second largest city in Ghana – with four other students from the University of Michigan. This is my summer internship for my master's degree in public health.

We will be recording all of the women who come to the hospital to give birth. But what we are really interested in is the women who come in with serious labor complications. We will conduct interviews with these women to try and identify what may have led to the seriousness of the complications. For instance, some women who live outside of Kumasi may have had to walk 10-20 kilometers to reach our hospital after they went into labor. Our goal is to collect enough interviews to create a picture of the main risk factors that lead to labor complications at this hospital, so that a prevention program can be created to reduce the number of maternal deaths and disability associated with pregnancy and labor in Ghana.

After my ten weeks in Ghana, I will fly to Cairo for a ten day traveling adventure. I had wanted to go visit Tanzania or Kenya, but it is incredibly expensive to fly even within Africa. But I got a great deal on a flight to Egypt, and am thrilled to see the Pyramids, the Sphinx, and float down the Nile. As of now, I'm traveling by myself- anyone care to join me from July 25th to August 5th?

Africa, I've waited a long time to see you. Ready or not, here I come!