Another day in paradise

On Monday, I finally visited Nela’s “jungle”.  Nela is my GSK colleague who has been working on the Tropical Laboratory Initiative, described very well in this Millennium Villages Project blog post.  While she lives with me in Kumasi on the weekends, she spends her weeks out in the Bonsaaso cluster, a grouping of 30,000 people across a bunch of small villages located a couple hours by car from Kumasi. 

Due to some issues regarding paperwork for visa extensions, we got a late start on Monday morning, leaving Kumasi around 9:30 or 10.  [Editor’s note: if you ever have the good fortune to spend an extended time in Ghana for work, the visa extension process will probably drive you insane.  Let me put it this way—leaving the country to extend the visa may be expensive but it’s so much simpler than this process.  Nela had to get a new letter from the health service just because the back of her letter had writing on it.  There’s a process for the government workers to follow, and writing on the back of a letter interrupts that process.] But leaving late is not really a problem, since most of the people employed by MVP live in Kumasi on the weekends, including all the Ghanaians.  After dropping things off at Nela’s jungle hotel, we arrived at the MVP office around 11 po find almost no one there.  They make up for the late start to the day by having a multi-hour meeting every Monday starting at 5 pm.  At the office, we picked up an MVP person who needed a ride to the cluster.  Before heading to the lab in Tontokrom, we made a stop at Ghana Health Service for Nela’s replacement letter and picked up another rider: a community health worker who was going to be working somewhere in the cluster.

During the uneventful drive, I was reminded of the driver Owusu’s fondness for 80s music—not the happy, bouncy sort, but the more thoughtful kind, like the Phil Collins hit with the same title as this post.  Somehow “Another Day in Paradise” fits very well with driving through the impoverished communities serviced by this project.  For some reason there weren’t nearly as many people out in the villages as on a normal day.  Part of it may have been the lack of children going to school.  Due to the teachers’ strike, most of the schools were boarded up with fewer children than normal playing in the school yards.

We arrived at Nela’s lab in Tontokrom, where we dropped off the community health worker and the MVP employee.  Nela showed me around the small but organized lab and introduced me to Eric, the lab technician.  In the short time I was there, I developed a very good impression of Eric.  He and Nela were discussing a problem with how the cleaning woman was not really cleaning the lab very well.  His response was that he had sent for a duster and would clean the countertops himself until they got things sorted out with the cleaning woman.  Here was a lab technician who was willing to do what it takes to keep the lab clean, even if it means doing the cleaning himself, a job that would be considered beneath him by local standards.  After seeing the lab, we made a quick visit to the clinic across the dirt road.  This clinic had been housed in the lab building but their work had increased enough that they had to move to a larger building.

We left the lab to head off to see one of the local gold mines that employs many of the local men.  Owusu knew someone at the mine and was able to arrange a tour of the mine by the owner himself.  The miners here were working in the blazing sun, shoveling piles of dirt onto the sluice that ran water over the dirt to find the tiny specs of gold underneath.  Some dim recollection helped me remember the term “panning for gold”.  This mine was almost identical to the classic gold mining in the US west in the Gold Rush.  While we were there, a couple of trucks pulled up and dumped piles of dirt in front of the miners for them to keep shoveling.

Watching the gold miners, I began thinking about their place in the global economy.  Gold is crucial to so many things, as a hedge against economic problems to a key component in much technology and industrial manufacturing to serving as a symbol of love when fashioned into a wedding ring like the one I’m wearing.  And yet, I’ve never given much thought to the harsh, dangerous work required to pan tiny bits of gold from the ground. 

Leaving the gold mine, we stopped by one of the larger clinics in the cluster.  I had the great fortune to meet Rita, a nurse who had worked with Abenaa and asked me to send

Abenaa her good wishes.  Rita and all the other people at the clinics obviously love Nela and will be very sad when she goes.  I can’t blame them. 

We headed back to the health service office for Nela’s letter.  On our way out of town, we stopped by the office again to find the lab manager, Francis, and Nela’s local MVP manager, Eric.  I had a wonderful conversation with Eric about my work with MCI and the unique focus of the program on training the teachers, rather than just the students.  Our stay at the office was all too short.  We dropped Nela off at the hotel and started the journey back to Kumasi.

Seeing the lab was both encouraging and scary, as it made me begin to wonder about the sustainability of such a project.  Nela is fortunate enough that the TLI has a wonderful new technician and a great laboratory manager to run the lab, but what about the samples?  Will the midwives still send samples to the lab when Nela isn’t visiting with her huge smile and happy attitude to encourage them?  How often will anyone visit the midwives at their clinics when they don’t have access to reliable transportation?

My project invokes many of the same worries.  Ghana Education Service will be assigning one of the ICT teachers to the role of S2S (School-to-School) coordinator to keep the schools on task for this program, but (s)he won’t have a car and driver paid for by company money or a corporate laptop for organizing files or a corporate expense account to cover Internet and mobile phone credits.  All these things have made my job easier while I’ve been here but they are not sustainable when it is GES footing the bill.

In addition to the financial constraints, there’s the key difference between how visitors and residents are treated by other residents.  In a conversation yesterday, the point was made that visitors are treated with more kindness and assistance that someone who lives here.  Almost every school I visit has treated me like royalty, bringing me food and drinks and being concerned about me anytime I visit.  But the person who takes over the S2S coordinator role will be a Kumasi local.  I’m hoping that the fact that this person will still be a visitor to the school will go a long ways towards these extra courtesies, but I’m not sure if it will.

I have even started to wonder about the advisability of having a volunteer from overseas involved in this project in the first place.  But then I think about the teachers that have been helped by this program.  Even if their computer labs decay away to nothing, some of them will continue to know how to use the Internet to find fascinating topics to teach, to send email to colleagues far away, to share their thoughts on teaching with someone across the Atlantic Ocean.  After a great deal of thought and soul-searching, I still come down on the side of thinking that it was a good thing to kick this project off with a full-time Pulse volunteer.

I would guess that the TLI will be much the same.  Even if not all of the clinics continue to send samples for testing, some of them will.  And those clinics will have patients who will be helped from a more accurate diagnosis in a faster time.  Tying it back to the reason that I’m here, GSK has the same sort of concept: focus on the patient.  While these programs may not be the same that they were when we were directly involved, there will still be individuals who have greatly benefited from the work.  In the end, that’s all that really matters.