International Conference on TB

Ok So I am going to indulge my Public Health portion of me on this post. Sorry if this post is a bit fragmented in my thoughts... I am trying to beat the cybercafe clock.

So; after some sneaking around and lots of determination I was able to attend the 17é Annual Conference on Tuberculosis and Respiratory Diseases that was offered by the African Union on TB (Jen I would like to dedicate this post to you); Here is a link to the sponsoring website (http://www.theunion.org/news/more-than-530-delegates-attend-17th-africa-region-conference.html) The conference was attended by over 530 people; many leading researchers from across Africa and WHO AFRO, His Excellency Blaise Compaoré, President of Faso, and the Chairmanship of Seydou Bouda, Minister of Health, ( photo of me and the MOH). I made some great contacts and made friends with a great group of handsome Ethiopian researchers (photo). I even met the team of researchers that I will be working with for my dissertation research from Orange Free State South Africa.



The issues surrounding TB are very dynamic and the implications of Multidrug resistant TB (MDR) and extremely drug-resistant tuberculosis (XDR) could really devastate countries. It was originally believed that the resistance was more of an issue in Eastern Europe but every country in Africa with the ability to diagnose MDR has found it. There are relatively very few effective drugs to treat and cure TB right and with mass migration of people for economic and political reasons this is a problem the continent has to deal with on the whole.. not just each country.

The health systems play an enormous role in causing drug resistance; lack of appropriate access to testing, treatment and diagnosis within health systems are causing ineffective disease management with many patients not returning for treatment, coupled by difficulties in monitoring and evaluation.

Imagine if a patient falls sick with TB; they would first have to access a care provider (this could mean a long, expensive journey). Often times the patient would wait hours in a crowded hospital waiting room where TB could easily spread; The clinic would have to possess the ability to see if the patient has TB, MDR TB, or XDR TB and prescribe the appropriate drug regimen and take the needed precautions. Assuming the medicine is both economically and logistically accessible to the patient he or she could then begin treatment. After a certain amount of time the patient would need to return again to see if they are responding to treatment; If they are not responding the 2nd line drugs must be available to treat the patient. The staff must be present to counsel the patient in the importance of being compliant. Many factors need to come together to successfully control the spread of TB in Africa.

HIV co-infection adds another dimension to the problem with the need for integrated management and diagnosis. I see strengthening the health systems as an ideal (yet not quick) solution to some of these issues. I have yet to understand the perfect balance between decentralization of the health system and strengthening of the periphery but I think I am not alone.

The role of community is also important to combat the stigma around TB. In some communities TB is viewed as a sexually transmitted disease and people do not want to come forward with it.

Overall the conference was a great platform to showcase some of the successes and challenges from TB programs across Africa and to emphasize the need for increased monitoring and evaluation, diagnostic capabilities, commitment from the international and national levels, access to medication and ,of course, strengthening of health systems.

First Days In Ouaga

Upon arriving Henris family were so nice and opened up their home for me. His 4 year old nephew Razak is a doll. His sister took me around town on her motorcylce and showed me some of the beatiful crafts of the area. The bronze work, batik and sculpture are very impressive. While visiting the artisinal center I noticed they were making bags for the 17th annual conference for the African Union against Tuberculosis and Respiratory diseases. I thought it would be a great opportunity to attend.

That afternoon the rains came very hard while we were at the center and we were trapped for a few hours under the monsoonlike rains. Luckily, we were next door to a vendor of instruments and I received a few hours of training on an instrument called the kambè lè ngonni. Its a pentatonic string instrument similar to a banjo with a bass feel to it. Super nice.

On the way to Burkina Faso

My internet access has been a bit limited so I will try to back step a bit; I left Accra for the 16 hour bus ride to Tamale in the northern region of Ghana. Before I left I made a guestbook for Japhets guesthouse and presented it to him as a gift. It is meant for people who come to visit his NGO to write their experiences and share them with future visitors. He loved it and I headed off on my journey north.


The landscape changed dramatically and I had a good first hand experience on the buses not running on a schedule; Everyone has an opinion on the best way to get to Ouguadougou. While I waited for the evening to arrive I went to the cultural center and was able to catch some dancers from the northern Ghana region practicing for an event. It was incredible to see the clothes, colours and stories with the dances.

Then I tried to make my way to Burkina Faso. First one I tried was to catch the night bus that will make an unofficial stop in Tamale and see if there is space; After spending a few hours attempting that and not suceeding I decided to get a hotel for the night and try again to take a few buses across the border. After trying at a few hostels it seemed they were all full. My taxi driver took pity on me and offered me his sofa in the modest one room home with no running water or electricity; I arrived and his wife offered me some fufu and I crashed.

In the morning when dawn had just errupted I headed down the rural road to find the bus stop. I arrived and took the next bus to Bolgatanga on the border of Ghana and Burkina Faso (previously called Upper Volta). I took a bush taxi from there to the border where I walked across. It was a long dusty road with vendors lining each side and I began to hear French spilling off the peoples tongues. It was a little surreal walking across the border because I wasnt really sure where it was.

Once I arrived, I caught the first bus for a 3 hour ride to Ougua. The people on the bus found me very interesting and tried very hard to communicate with me in the regional language. They even pulled out a Bollywood movie (I am starting to love the Universality of Bollywood). I phoned Henris sister and arrived in the hot sun of Ouguadougou;

L&A Memorial School

Yesterday we did a tour of the school that Japhet's organization has been building. The school is a tribute to the memory of his parents and this will eventually be pilot site for integrating a health clinic into the school. Currently there is a shortage of funding so the building is half complete.

There are about 400 students from nusery school to 8th grade. The school is ranking very well in Accra. I was talking to some of the teachers about the school system in Ghana. The public school system is in tact but does not offer a decent quality of education. For a student to have hope for a bright future and a college education, the private schools really prepare them better which seems to be the same globally.

I met up with Jean who is the french teacher there and he is giving me lessons to brush up on my French before I head north to Burkina. I also had a chance to practice with some of his eager students (2 boys pictured). My Ghanaian sister Lilian is also pictured looking out from the school room door.

We also had another chance to visit with the Mayor of Accra (He, Japhet and Lilian pictured). He delivered an inspiring message to the students from the Bronx to use this experience to carry forth good things in their lifes and let the world know about Ghana. I have to say--I was hesitant at first to travel with these 18 to 20 year old students. They were each honors students who were able to come on this trip based on Merit and desire. It was interesting to witness them processing some of the realities of Africa and comparing it to their world. I think a wonderful experience for them.

Cape Coast GHANA

Hello All,
Two days ago, we did a quick little day trip to Cape Coast which is 2-3 hours west of Accra on the southern Coast of Ghana. Its a nice town with more of a coastal feel to it. The first stop was Kakum National Park. It is one of the few remaining rain forests in Western Africa. The mist of the rainforest reminded me of home and was a welcome shift from the dry heat. A group of foreign enigeers teamed up with some Ghanian engineers to make a group of rope bridges that traverse the canopies of the forest. They are seven plank and rope bridges that are only large enough for one person to go single file. Walking above the forest was a wonderful experience and seeing the tops of lush trees, wandering butterflies and soaring birds instantly calmed me and left me serene and peaceful for most of the day. The educational center was a great way to emphasize how the destruction of the rainforests are damaging the ecosystem.

After a brief stop at a crocodile farm where I fell in love with the frenzy of the nesting rituals of the Ghanian Yellow Bird, we headed off to Elmina Castle where the slaves were held before being sent off to the New World. It was a large castle and fort built in the 1600's that many Europeans had tried to gain control of(the Danes, Swedes, Dutch,Brits, Portuguese) . It finally was acquired by the British and used for the slave trade.

The origins of the slave trade are interesting. Apparently when the Ghanaian Kings were warring the winning king of the battle acquired the remaining soldiers of the losing side. These were the first slaves sent to the coast and traded for weapons and supplies. Once the demand increased and it was apparent that this was a lucrative opportunity, African middle man began capturing people and marching them to the coast (yes literally capturing them like animals) and they would arrive at this castle. There were two major slave trade movements--one was transatlantic and one trans-saharian. The trans atlantic movement of people had an immense impact on the population and some say the development of Africa.



Once here, they were shaven, bathed and oiled and prepared for sale. There were two types of slaves-domestic and manual labor force. They were separated by gender and kept in 2 dungeons that were dark with a recessed perimeter for the feces and urine to collect. There was a small window (more like a hole) at the top of the chamber where food and water were thrown in. The water was so little and would fall on their heads that some people would suck it off the hair of the others. They were moved from chamber to chamber as they were being prepared for sale and shipment. The sick ones would remain in the dungeon while the stronger ones were moved forth.

The last door they would pass through is called "The door of no return". I walked through that door and felt an immense amount of sadness. To think that once passed through this passage, they were sent to a land that they did not know and left behind all their people, customs and beliefs.

On the journey, if a woman was discovered to be pregnant or if food was scarce on the ship, they would throw a few slaves overboard to the sharks. It was common that sharks would follow the ship most of its journey since they knew food could easily be found.

As I continue to discover more about the slave trade, I am overcome with grief and unable to imagine how people could treat our fellow brothers and sisters like animals on a mass scale. There are two thoughts on the impact of slavery on the development of Africa. In total it is estimated that in the 4 and a half centuries of trans-Atlantic slave trade some 6 million Africans were transported away from Africa. How could a continent be able to prosper with that much of the strong, healthy and able population removed. From a genetic point of view, what does that do to the remaining population of non-healthy people and how does this correlate to some of the diseases we see? Another point of view--asks if the continent is having difficult developing now, how would it have done with the added population (implying that it would have been worse off than it is today which I don't personally agree with).

I am interested in comparing the slave trade impact in Ghana with the other large coastal port of Dakar when I get there. I hope sharing these facts and stories with you will help us all be aware of the consequences and inhumanity of slavery on a more personal level. I have included a few pics of the ominous clouds over the castle (I thought very appropriate).

Obuasi Ghana

A few days ago, I took a long bumpy bus ride from Accra north to Obuasi where the Ashanti Gold Mine is located. Ghana is famous for its gold and the Ashanti Gold Mine was an interesting example of a private sector initiative to control malaria.

Essentially, for the terms of a merger with Ashanti Gold and Angloashanti Gold (South African component) they promised to commit to reducing malaria in the local community. In 2005 they had a baseline of 6000 plus cases per month and daily a worker was falling sick. It is more of an investment in human resources and as they claim a legacy to the locals.

Its an integrated program with a large amount of monitoring and evaluation including 20, 000 houses sprayed twice a year. With 3 million dollars of initial infrastructure development in 40 districts, it has proven to be pretty successful. They began with a concerted effort of educating the people and taking to various community leaders. Its a sensitive issues since the workers really need to enter every corner of a person's home.

They were looking to reduce the incidence and life expectancy of the mosquito and also collected mosquitoes to understand exactly which ones are being targeted and which ones are becoming resistant to some the spraying. Based on this, they decide what kind of Mosaic group of pesticides to use next.



Overall, it seems like a good effort taken from the Private sector to fill some gaps where the public sector can not. The major con of this program is that only those living within the camps of the minors are benefiting from this. The rest of the communities and the outskirts of the mining community are still facing immense issues with Malaria.

After meeting with the Epidemiologists and Malaria team members, I took a tour of the gold mine which was pretty interesting--I suited up with a headlamp, smock, rubber boots and oxygen tank and headed down 420 meters into a cold,damp, drafty shaft. It reminded me of the Scooby Doo episodes I watched as a kid where ghosts were being chased through the railways and carts of a gold mine. They have lots of safety measures in place that ensure the safest working environment for the miners but it still seemed like a horrible job.

I asked around a little about the profits generated for the mine and how much compensation was given to those tribes who originally owned the land. This is one of the only mines that was originally mined by the locals...of course no one had any comments on the distribution of the wealth generated by this and the mining tour guides were really evading my questions--seeing that I was going underground with them, I decided to not probe too much.

Overall a very fun and interesting experience! After the mine tour I met with the mayor of Obuasi.

We then headed off to a village to hang mosquito nets and also to meet some children at a local school. The children were asking so many questions and all of them wanted to touch my hair.

Accra Ghana--Here we go!

I'm officially on a continent I know very little about. From what I have seen so far the people are as warm as the sun. On the plane, I met a retired man who has a Health and Eduacation Foundation based in New York that works to improve the lives of children in Ghana.We had a great dinner together (he is pictured in the photo)



This man worked for JP Morgan Chase for many many years and retired when Septemeber 11th took away his office. He decided to use his contacts to build a school in Accra and quickly realized that lack of an institution for school was the least of these children's problems. They were not attending school regularly because of being ill frequently or having to stay behind at home to care for a sick family member. He decided to open a clinic inside the school for the families and the children to see how that improved attendance. Sure enough, it did. You can read more about the organization at the website (Click here) and feel free to donate to the cause...it's legitimate and a great organization!

Although there is a government health scheme here where any family can purchase a card for about 10 USD a year, many people still do not enroll in the health care because of the money and time to go to large health care centers in the city. When Ghana gained its independence 50 years ago, the first president wanted to show off his power and desire to help the people. So, he built large palacial health centers in the city that are inaccessible for some. Moreover, the population has changed in the past 50 years--both the demographics and the urban/rural spread.

He recognized Malaria as being the greatest preventable reason for students to miss school. Although many families had mosquito nets, many did not use them. Mainly, the mosquito nets provided by the local NGO's are box shaped and do not cover those who sleep on mats on the floor. Also, the directions are in English, French and Chinese but nothing to assist the illiterate woman who uses one of the 14 tribal dialects. Also, the color white represents death (as in many cultures) so many people feel a ghost is hanging over them.

He has organized a group of CUNY Global Health Students to go into some villages and help educate the people to tie up the nets properly etc. He has asked that I join on this trip. There are some 14 students that live in Harlem and most of them are children of immigrants from all over the world. Sounds like fun and also we would get to go visit the gold mines and see the mining company's set up for Malaria prevention.

So far, Accra is similar to India (I can't believe how many Indian clothes are for sale in the markets)....there is a thirst here that I can't pinpoint. The soil is so orange, you feel so close to the sun and there is a constant feel of dust.

Ok more to come! Here is a pic of my little bag I am doing this two month trip with and some of my initial photos.