Kate LeMasters '15
Washington and Lee University
West Africa AIDS Foundation
In the wee hours of the morning I'm awoken by roosters crowing far before dawn, women sweeping their patios of endless red dirt, and laundry being done outside before the heat of the day. By the time my alarm goes off at 5:30, most of the neighborhood is bustling before the sun rises and my fellow Shepherd intern, Alex, is getting ready for her commute to downtown Accra that should take about 20 minutes, but takes up to 2 hours with traffic. I start my morning run along the dirt roads of East Legon, the label of our neighborhood in Accra and the closest thing to an address that I have encountered. Along my route I see the man who runs in a ski vest, women roasting corn on the side of the road, children in their vibrant school uniforms, and the never-ending pile of burning trash that is used as a substitute for a landfill.
When I return to Mummy's house--I don't even know her real name, she insists we call her Mummy--she sends me off to have a "blessed, blessed day Auntie Kate." Now begins the trek to work. After about 5 weeks, I've finally mastered it. I begin by taking a 30-minute walk to Okponglo Junction, an intersection on the main road into and out of Accra. I do my best to avoid falling in the open, 3-foot deep drainage systems on the side of the road; I've been successful so far. Little children yell "Obruni, Obruni!" meaning, "white person, white person!" and I wave as they giggle and applaud each other for their courage. Taxis constantly honk, thinking that the only Obruni in sight must be lost. When I tell them I am going to the Tro-Tro, they are caught by surprise. The Tro-Tro is the public transportation system in Ghana, if you can call it that. It is a van from the 60's or 70's that violates just about every vehicle standard in the books. It seats 12 people, but usually crams about 15 and has a 'mate' hanging out the side and repeatedly screaming the final destination. There is no schedule, no map, no set rate, and no English spoken. I take the Medina Tro-Tro to Atomic Junction and then the Haatso Tro-Tro to the bus stop or Total Filling Station and then turn right at the big dirt road. Try being told that on your first day of work.
I arrive at the West Africa AIDS Foundation and read the 'schedule of events' that is the white board. I never know when I'll find my name next to a trip that only says the town of destination. Only en route have I realized that the bus ride over pot-hole filled roads would be 13 hours, that I would give a presentation in a tuberculosis training for peer educators, or that I would speak to 500 high-school aged girls on reproductive health. The developing world comes with a work culture that has no agenda for business trips and no adherence to meeting times. For now, the sporadic, weeklong trips to the northern and western regions of Ghana have seemed to cease, so it's back to life at the office.
Today, my name is not on the board. At first I'm disappointed that there are no big adventures planned, but I'm quickly reminded that a day at the office is never too typical. I quickly check in with the chairman, Eddie, the most energy-filled NGO supervisor that I've ever met, who tells me of all the upcoming meetings, the billion projects he has formulated in his head, and the incredible meat pies that he had last night. I go into the Projects Room and am all too excited when the AC and internet are both working. It's going to be a good day. I look over my concept paper for a grant proposal I've been working on. The proposal calls for USAID to expand HIV services for pregnant women to the community level in multiple districts in Ghana through a public-private partnership with Ghana Health Service. Currently, most funds are given to regional hospitals for state-of-the-art technology for antenatal care, while community level clinics don't have a midwife or registered nurse, much less an ambulance for emergencies. Working at an NGO with offices in four regions of Ghana and with the mission to combat the spread of HIV/AIDS leaves big shoes to fill for an ill-equipped intern. I am in no way accredited to write grants, meet with the Ghana AIDS Commission, or present my grant proposal to municipal health directors. But I've come to realize that my preconceived notions of my capabilities are far less important than the requirements of an agency working towards the elimination of the global HIV/AIDS epidemic.
I take my updated grant proposal to Dr. Naa, the CEO of WAAF, medical director of the on-site clinic IHCC, and the only medical doctor in the whole operation. She is superwoman. While I wait for her to finish seeing patients at the clinic, I hear the cries of an 8-year-old boy with a fungal infection covering his body. He is at stage 3 of HIV and is refusing all food and drink. No doctor, nurse, family member or other child can change his mind. Dr. Naa emerges, obviously discouraged by his state, but hopeful that the grant proposals and projects that she is about to check over will find a large-scale solution to the drastic delays in treatment that result in 8-year-olds with stage 3 HIV, the stage of AIDS diagnosis. A situation that could be prevented by increased HIV treatment for pregnant women and infants.
Next emerges Esther, an HIV positive woman wearing colorful traditional garments and scarves. She is one of the leaders of the Almond Tree Project, an income generation and microfinance group started at WAAF for HIV positive women. Most microfinance institutions won't lend to HIV positive groups because they believe they will be too sick to repay their loan, they may die before their deadline, and the MFI's simply stigmatize against those living with HIV as unworthy clients. I listen to Esther's story of Almond Tree; it gave her hope when she was hopeless and friends when she was abandoned. Finding out her status years ago was devastating. The discrimination in Ghana towards people living with HIV is startling. She and other women at the clinic started to meet under an almond tree as a support group and they began to teach each other how to sew, bake, and make beads. Funders have seen their unbreakable support for one another and we are currently working on expanding their work through skills training, more funding and showrooms for their work.
Ah, lunchtime. I make my way back up the 'big dirt road' to the marketplace and am bombarded by endless stands of waakye (a mix of just about every food possible), roasted plantains, fish heads, fried yams, and fresh fruit. I make my way to the mango stand on the end, where the young girl smiles at me, reassured by my daily return to her stand, and quickly prepares mangoes for the other interns and me.
Returning to the office, it's time to work on my project. In a developing country, it's all too easy to allow too much down time at work, take two-hour lunch breaks for groundnut soup with goat and say "oh, I'll do it tomorrow." For better or worse, I need to be busy. I set up a meeting with the clinical staff to ask what question they want answered. I know this is incredibly broad. However, I know from previous conversations that IHCC and WAAF have many unanswered and pressing questions that they need answered to better serve their patients. For now, they want to know what factors determine disclosure of HIV status to one's partner. The fear, worry and anxiety of sharing this information is often simply too much. It often leads to abandonment, violence and false accusations of infidelity and promiscuity. This is not an easy topic to cover or interview patients on, but Dr. Naa's smiling face reassures me, and I know this is a topic we must address. I prepare myself to interview patients and listen to heart-breaking stories of the fear and violence that the nurses have told me about. In a country that is considered a success for Africa and often overlooked by international organizations for support, the status of HIV/AIDS and the nuanced issues surrounding it in Ghana are hardly a success. Stigma prevents disclosure, fear prevents testing and corruption resulted in a $10 million refund to the Global Fund last year for AIDS, malaria, and tuberculosis control programs from Ghana.
I take the long dirt road back to the Tro-Tro stop, this time on the look out for a car yelling "Accra, crrraa, crrraa, crrraa" and desperately hope that I can understand them this time. I carefully get on and off the Tro-Tro, remembering that I've already ripped 3 skirts during this process on the rusted steps. It's the rainy season in Ghana, but usually that just means extraordinarily high humidity and a soaked-through shirt when I take off my backpack. I hear Mummy making dinner in the kitchen and her children, grandchildren and countless other household members ask about our day. I still don't know who all lives in this pink-walled house in East Legon.
It's about 6:00 and I'm ready to call it a day. Alex and I share our daily stories of work and Tro-Tro hassles over dinner after we take off our matching Birkenstocks. We often discuss the option of leaving the house, but never make it past the mental block of navigating the Tro-Tro system and haggling the taxi drivers for a decent rate that isn't an "Obruni price." Today we are planning a trip for the weekend to the Volta Region. Alex laughs as I look through a guidebook and I quickly remember that planning much of anything here is a joke in itself; word of mouth and a flexible schedule are the keys to travel. At this point we watch an episode of LOST and I crawl into bed to read, excited to start my tenth book of the trip. After a few chapters I can't stay awake, knowing that the now-familiar sound of the sweeping of porches will wake me soon enough.