I am an SHS graduate preparing for my tertiary level education, which will begin in 2013. I attended Eguafo-Abrem Senior High School (2008-2012). I am 22 years, born into a family of five (5) with me being the first child. Being the first son my younger ones look up to me, so I always try to do what may be good to imitate. I always wanted to make a difference in my society. ICHA was made known to us by Mr. Brains and I was in the school science club as the president. When I realized the objectives/goals of ICHA, I knew this was my breakthrough to make a difference in society. Cardiovascular issues have not been the major talk of town and we are unaware that it is the centre of attraction of all the killer diseases. With ICHA I knew I could touch a life.

Working with ICHA in school, I was able to talk my peers, colleagues, friends and family about cardio-health. On outreach, we were able to talk to two communities (Eguafo and Agona-Abrem) in our locality through radio talk shows. We also went to Elmina for sketch and drama presentations at a seminar organized by ICHA. We were able to go to a science festival in one of the renowned schools in Eastern Region, Koforidua Secondary Technical School.

Anything that creates awareness of social issues that need to be changed positively to improve upon human survival is important. Therefore I know the project of ICHA is important to us individuals, society and Ghana as a whole. My dream for ICHA is for ICHA to spread their wings all over Ghana in some few years to come and Africa as a whole. I also pray that ICHA gets supports in making this dream true.

I am in a peaceful and harmonious society that is somewhat ignorant to certain health issues. I say ‘somewhat’ because those who know don’t pay attention to them and others attribute certain cases as superstitions. In my area cardiovascular diseases creates terrible pain when you know that you could have prevented such diseases. It devours joy and replaces it with sorrow. It can even create financial conflict.

ICHA has helped me and all those around me. I am now more conscious of how to live a healthy life and ICHA has given me the right tool to touch lives all around me. With the ICHA school club project, we the next generation will be more aware of cardiovascular issues and as we share this information with relatives, friends and society, it will spread in the years to come. If this continues we will be proud with ourselves for making a change in the world.

Imagine living in the midst of much different knowledge, you get to learn a new thing each day. In Ghana, living with people of diverse culture is amazing because you got to know so many things that eventually help you to co-habitat in peace and harmony because there is the key of understanding to unlock any disagreement. You are always loved. I’m not saying there is no hatred in Ghana, but the love outweighs it and you never feel alone. One thing that make it hard to live in Ghana is it economic instability, as prices of goods go high at any time without responsive change in income. Others challenges are the level of technological advancement and negligence of health issues.

Beside hardship, Ghana is fan. We have interesting sceneries and tourist attractions. I am proud of Ghana, especially our history, cultural, heritage and how, despite its diversity, democracy exists with no problem from any of the tribes. A program like the ICHA school club is going to make Ghanaians have a long healthier and happier life which will go a long way to reduce cost of living and increase standard of living.                      

LIFE IS BETTER IF YOU KNOW HOW TO LIVE IT RIGHT                          

The morning sun was up and so was the internet connection we had been waiting for. We had Jason's phone call to the network provider on the previous day to thank for it! After some minor tweaking of the phone settings, the mPACT BP tool worked smoothly. Never before in my life had I though I would be so elated to see the message "sending data to ICHA"! Today our task was to visit the four clinics in the KEEA district and ensure that the health workers were able to use the tool well. We also planned to take this chance to update the tool to the smart program that could communicate with the server.

My first stop was the Elmina Urban Health clinic. Clement walked with me, pointing out the various features and facilities, while patiently answering the questions I had for him. What I noticed immediately was the sheer numbers of people waiting to see a prescriber. This was not surprising as the Elmina clinic is the largest in the KEEA district. Also, this scene is familiar in most Indian clinics. What was unusual was that only 2 or 3 health workers were at hand at any given time to see the 100+ patients. I met one of the health workers who had attended the orientation for the mPACT program the day before. He showed me proudly that he had his phone out and ready to enter BP data. I was happy to note the enthusiasm in his voice. I briefly interviewed the triage staff who mentioned that they measured the blood pressure, temperature and weight of all patients. It was a little disappointing to note that they were not calculating BMIs as they had been taught before. The lab staff members at the clinic were very friendly. They showed me their diagnostic equipment including two glucometers which were not working because their batteries had died. New batteries that were shipped to them from the United States had been lost in transit. When I inquired about how they measured the blood glucose of their patients, they calmly mentioned that they borrowed a working battery from a guy who worked elsewhere. They said they picked it up from him every morning, used it during the day and returned it in the evening on their way home.

Next, Abby, Jason, Clement and I took a taxi to the other clinics. It turned out that the only health worker at Kissi had been called to the regional office at Cape coast, so we directed the taxi driver to take us to the clinic in Komenda instead. Again, there was only one health worker staffing this clinic. The Komenda clinic was much smaller than the Elmina clinic and there were fewer patients waiting in comparison. We updated the phone and asked the health worker some quick follow up questions before we left. Last on our trip was Agona. The town and the clinic are located in a very rural setting, several kilometers off the trans-African highway.Most of the drive was through a narrow unevenly paved road. The entrance to the clinic was very beautiful. Even though the building itself was very plain, there was a garden with blooming flowers that instantly cheered up the surroundings. The Agona clinic was much bigger than the Komenda clinic, but still smaller than the Elmina one. There we met another health worker who was a part of the mPACT pilot group. We were really impressed with this particular health worker's commitment to prevent and treat cardiovascular disease in his community. He had already compiled a database of his regular patients who were being treated for hypertension and hoped to use the phone program as a tool to guide their treatment. This meeting was undoubtedly the high point of my volunteer experience in Ghana.

The technical team confirmed that the program was online and they were starting to see a constant trickle of data. Thats all we hoped for at this point. With our mission for the day accomplished, we rode the taxi back to the comfort of the Dawson's lodge.

-The Mobile Health Team

Sitting by the Volta River in Sogakope, watching the heat lightning and trying not to think too hard about the mosquitos. Grateful the sun has gone down, grateful for the breeze, grateful and more than a little awestruck that we get to do the work we do. 

I arrived in Sogakope yesterday, in a tightly packed van  – half people/half rice/half market miscellany (if you counted 150% full, that's because it was) – and, within hours, was taken in by the community's hospitality and disbelief that ICHA has been working in Ghana for 1.5 years and has not yet come to Sogakope. So today was spent trying to remedy this, to evaluate launch of a new pilot program, to build the necessary foundation and troubleshoot potential barriers, so we can kick off asap. Ghanaians like swift action. If you have a good idea, let's go. For today's purposes, that meant a lot of driving, not nearly enough water, and a lot of meetings – with secondary school head masters, the director of Sogakope District Hospital, the public health coordinator at Ghana Education Services, teachers, a director at Ghana Health Services, just to name a few – all enthusiastic and all repeating (after hearing what we're about): "Ah, you are welcome. It is good you are here." 

It's interesting to see in practice the things you learn in theory. A keystone to a strong community program – in Ghana and probably any other community – is understanding who the community respects and establishing relationships with the local leaders. If they agree with your mission, they will introduce you to the folks you need to know, explain your purpose and onward you go. Each community has its own systems (Sogakope is so different than Elmina!), but the basic principles are the same. 

So, it seems, are some of the basic principles of Ghanaian culture. Inasmuch as someone from Eastern Region might tell you that people from Volta are different ("transparent and very loyal," for example), the enthusiasm for knowledge and its incredibly swift absorption, the commitment to health and community betterment, the excitement about programs like ICHA's is the same here as it was in Elmina. So, people don't know about heart health – "many don't even know that the food they eat impacts their body" (this is a direct quote from a teacher I spoke with today). 

But people here want to know and they embrace you (literally) for coming and bringing this information. (And you get tears in your eyes, because you're just a catalyst for information that everyone has a right to without having to ask for it.) And you know that the information you are working with your new partners to spread will have a tangible impact on people's lives – not just thousands but hundreds of thousands. So how could you not want to just keep coming back to Ghana until you are entirely sure that every community that wants it has the basic information about health that we take for granted? And how do you sleep at night knowing that people die because nobody told them? And how do you go back to practicing law when you see how simple it is to make friends and make change?

I should end this here. But I want to impart (and know I can't) the overwhelmingly engaging power of this culture. The respect I have for the people I have met here. The profound sense of dismay at Ghana's poverty and the simple unfairness of it all, that most people have very little, that daily life is really – deeply – hard, that people die too young in this place. And that, through our alliances, we really have the opportunity to make things better.

-Nikka

Hi everyone!

It’s been a little over a week now since we left a chilly, rainy San Francisco and arrived in the overwhelming humidity of Ghana, and it’s truly been an eye-opening experience. The people, the culture, the politics, the lifestyle.

We spent the first few days in Accra with members of the Google Africa team, and met a dozen or so university students – each very excited to be chosen by Google to be on-campus ambassadors. Some of the students were from University of Cape Coast, which is very close to Elmina and we hope to be in touch with them again during this trip, to discuss a bit about ICHA curriculum materials as well.   

In just a week, I feel like we’ve met some amazing people, and while one of our objectives here is to teach about the importance of diet and exercise on cardiovascular health, we are learning a ton as well.  People we have interacted with have all surprised me with their level of education, enthusiasm, curiosity for why we’re there, and memory (they remember you, and are really on top of the work we’re doing with them).

My own expectations and standards are changing as well – I definitely don’t snack as much as I do back home! Mostly because it’s extremely hot, and I’m constantly drinking water. The living quarters we are in are truly luxury – and this means little things like having a fresh coat of paint, a fan, a desk, running water. The level of “making do” is just so impressive – old televisions pile up along the streets. In a different context, I would see these as antiques to be recycled. But here, TVs are luxuries. They really utilize everything until exhausted – things like pens, plates, anything really. Thinking about ways in which to make our messages stand the test of time involve things as simple as lamination, as this goes a LONG way.

Yesterday Francois and I treated ourselves to an afternoon by what must be the most luxuriest place in Elmina – the Elmina Beach Resort. We paid 7GHC to access the pool, and there were definitely fewer foreigners there than Ghanaians (and note that none of them go into the ocean, but will pay to be at this pool!). One night at this hotel is minimum $180USD. In contrast, the place we stayed during our first night here was 20GHC, or about or $13USD. Interesting to me that no matter where you travel in the world, and despite my own preconceptions of the level of poverty here in Ghana, there still exists a distinct income gap. 

Two more weeks left, and I’m looking forward to making my way more into the community to interact with more people, not just in the schools and clinic. Also really looking forward to soaking in more of the history here as well. Tonight is Ghana vs. UK soccer game – it will be a big day!

Tina

It was orientation day! I was prepared to introduce the health workers in the KEEA district of Ghana to the new Mobile Phone Assisted Cardiovascular Teaching (mPACT) BP tool. The mHealth team of ICHA had spent several months designing, creating and testing the program that would eventually allow the Ghanain health workers to enter patient blood pressure data in a mobile phone and receive smart prompts about treatment guidelines. We hoped that these guidelines would make treating hypertension a breeze! However, not everything had been a smooth sail so far. Since arriving in Ghana, we discovered that the phones we had tailored our program to were out of stock in all the stores we checked in. Luckily, we found a similar phone that was within our budget. Once the phone was loaded with a SIM card and activated, I anxiously downloaded the BP tool. The download and one test data entry was successful but the program stopped communicating with our server soon after. The phones still refused to connect to the internet reliably on the morning of the outreach. By this time, the technology team in the US had been up most of the night, reading forums and trying to figure out what was wrong. Finally, Jason called the network provider only to learn that the company was experiencing outages in the Elmina area that would be fixed in 24 hours! We didn't know whether to be happy or sad! Patchy internet meant that the phones would not be able to receive the smart prompt for treatment guidelines. Instead, each time the health workers submitted the data, they would see an error message! However, it also meant that once the internet was up and running, our program would work again!

The technology team had been resourceful and prepared for a scenario like this. They had a version of the program that did not rely on the internet for providing the smart prompt. Although we would still not receive any data from the phones using this version of the program, at least the health workers would see treatment guidelines instead of an error message when they submitted data using the phone. At this point, we still had a couple of hours till the outreach was set to begin so we tried to download this "dumb" version of the program in the 30 sec intervals that the internet worked.

The health workers started trickling in at 1 pm. Polite welcomes and smiles were exchanged. Then it was time. I worked my way through the materials we had planned to cover, telling the health workers the objective of our program, why they should use it and how they should use it. Thankfully, the health workers had no problem learning the program. Individual questions about data entry were easily managed by Jason and Abby while the rest of the class followed along with me. The health workers were really excited about the prompts for treatment guidelines. As we ran though several example scenarios of the data, there was almost a competition as each health worker tried to be the first to report what guidelines were displayed! As we prompted for questions, we were surprised by the large number of relevant questions and great suggestions we received. Finally, we wound up the orientation and sent the health workers home with their new BP tool. Once the network was up again, we would download the smart program and start receiving data from the phones, but that would be tomorrow. Today, we had launched ICHA's first mHealth program in Ghana. It was time to celebrate.

The Mobile Health Team

I wish I came to Ghana with a blank slate. I wish I could say that I’m truly unbiased and open-minded. Unfortunately, that’s not entirely true! The reality is that no matter what you think, you’ll probably end-up with ideas about Africa in your head you’ve gathered from books, TV and other medias. You’d have this friend of yours that spent a week on some safari tour and brought pictures of exotic looking animals. You’d have heard about the weather so hot and humid you couldn’t hide from it.

I’m not sure what I expected from my first time in Ghana, but whatever it was, what I found is better.

The first thing that blew my mind is the people. After a week meeting with students and teachers from several schools, I’m really impressed by their warmth and friendliness. You’re welcomed with sincere smiles. Laughter is a very important part of the culture and they will laugh with you and tease you all the same. They also seem really happy to see you again when you come back. It’s just a pleasure to meet people.

Another thing that got me thinking is how they do business. Organizing things with people is fun. They are very action oriented and will make it happen on the spot. I experienced this on multiple occasions. Wanna print a large number of flyers for an event? They’ll call their friend that has a printing machine and negotiate costs. You’ll have the copies ready the next day. Anytime you want to know something they are not sure about, they’ll get someone who can help right away or pick up the phone right there.

All in all, my first week went extremely fast and was a blast. I’m looking forward to meeting more people in the coming weeks!

Francois

Dear team – 

A year and a half ago, I wrote my first open letter to ICHA. We were launching our initial program in Ghana (training roughly 40 health workers at the Elmina Urban Health Centre) and conducting community assessment and reconnaissance for our second (what was to became the secondary school classroom curriculum and clubs initiative). That letter was a congratulations to our volunteers (many of whom are still with us today!) whose passion had made ICHA happen, and confirmation that the work we are doing is important and – if we do it right – will have an impact beyond what we can even imagine. 

It's only a year and a half later and in forty-eight hours we will be launching our fourth program – a mobile technology pilot that applies basic, readily-available technology to solve a complex challenge in a creative and efficient way. 

Also during the weeks ahead we will be meeting with community leaders and conducting teacher and student focus groups to further develop our secondary school classroom curriculum, providing students essential information about health and nutrition and empowering these students to educate their families and communities. 

We will be assessing the impact of our clinical program, evaluating opportunities to create capacity for cardiovascular disease prevention and working with nurses to ensure that the patients who come to the clinic – one in three of whom is hypertensive – have access to basic information and treatment to prevent disease. 

We will be working with student-run ICHA heart health clubs to sponsor a community-wide event to conduct blood pressure screenings and promote cardiovascular health awareness. 

We will be meeting with the WHO, Family Health International, Doctors for a Right to Health, and ministerial officers and directors in health and education to evaluate potential partnerships and strategies to expand the reach of these programs to communities throughout Ghana. 

And that's just a taste.

We – you, oh amazing ICHA'ers – put these programs together in record time, in your spare time, committing evenings and weekends and lunch breaks to meetings and research, hunting down resources and consulting experts to ensure our programs are the best they can be – not to mention developing organizational systems and strategies to turn our ICHA into a full-blown sustainable non-profit.

Thanks to you, this means we can operate major programs on a minor (barely breathing) budget. And this means we get to do things no other organization can – like develop and implement creative, evidence-based cardiovascular health programs in poor communities when funders still refuse to acknowledge that these diseases are one of the most devastating global health challenges of our generation. You guys are amazing and this outreach is going to be huge. 

Congratulations, everyone.

I'm on the plane and getting excited.

Till soon,

Nikka

As I sit here in a Charlottesville coffee shop, furiously pecking away at my streams of consciousness, proper words to describe my experience elude me.  I learned long ago that only through travel do we realize how truly provincial we all really are.  The beauty of travel, particularly to a destination that challenges your own paradigm of the world, is that the memory stays with you far longer than any trinket, souvenir or written description ever will.

The trip started quietly enough.  With the assistance of pharmacotherapy, my last memory was that of a bad airline movie and a stale meal.  I awoke with a thump in a new continent.  The first couple of days were spent getting to know my colleagues: a medicine resident from India who recently crossed the intern year finish line, a sharp-minded first-year medical student collecting data for a research project, and a seasoned and wise veteran from...well...Michigan, I suppose, though recent Locums stops include Alaska, Hawaii, and Vietnam.  The four of us would be spending the next two weeks teaching local health care providers - mostly nurses - some of the basic tenets of managing chronic diseases.  Main topics included hypertension, diabetes, obesity, smoking cessation, proper diet, and exercise.  Each of us was to lead sessions on these specific topics, but oftentimes conversations became appropriately tangential.

On my first day of leading the session, I was to talk on - among other things - choosing healthy food options.  Having recently returned from a month of medical work on Lake Atitlan, Guatemala, I fumbled for a proper comparison.  Here the obesity rates in the towns surrounding the lake seemed to directly correlate to the level of tourist infiltration; and, I had noticed, the tourist business appeared to correlate with the number of foil wrappers strewn about the streets of dust.  Foil wrappers that were very recently filled with foods high in saturated fats - Fritos, Doritos, potato chips, Cheesy Poofs.  In my awkward proclamation that "most foods which come in foil wrappers will contribute to clogged arteries and other poor outcomes," I was met with a roomful of blank stares.  The nutritionist raised her hand and - without hesitation - asked how the foil in the wrapper could possibly cause the food to be unhealthy.

I was once again humbly reminded that the student often is observing an object, or subject, from a completely different perspective than the teacher.  As an American who lives within a stone's throw of a gaudy supermarket, and as a recently graduated Family Medicine resident with little to less time to think about what's healthy, I had programmed myself to try - and oftentimes fail miserably - to avoid the foil wrapper food group and aim for something more conducive to healthy living.  Here in Ghana, however, that luxury of choice is not so evident.  Often, in a country like Ghana, the cheapest and most readily available foods can be found in the foil wrapper food group. Here, where fruits, vegetables and fish appear abundant, they are oftentimes too expensive for the family to eat on a regular basis. Yams and mangoes are common in the area, as are a whole host of exotic and edible fish.  And it turns out that fish, for instance, is found on a majority of the plates in Elmina on any given afternoon.  But foil wrapper foods are cheap, tasty and readily available.  And fish are fried in soy oil.

The same concept holds true, of course, in the States.  No difference, really.  The populations most likely to consistently go for the foil foods, or the fast foods, for sake of argument, are those who don't have the money or the knowledge to choose the healthier alternative. A Big Mac is a delicious alternative for most to a rice cake with a dollop of peanut butter.

The difference lies in the fact that there is a MAJOR push here and in other developed nations for healthy lifestyles; an emphasis on foods low in saturated fats and carbohydrates, and rich in protein and fiber,  among a spate of other relevant and long-overdue changes in the way we live our lives.  Our health care systems cannot possibly continue emphasizing the "treatment" aspect of medicine, and grossly underestimating the importance of the preventative side of medicine. A recent article in the New Yorker by Atul Gawande speaks to this point.  To wit: "Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit."

To avoid the proverbial worm can, I shall digress no further but to say that prevention is a critical aspect of medicine that has sorely been missing in the United States, though I am encouraged by a recent emphasis on Evidence-based Medicine (for example: Is surgery really no better than conservative measures for a herniated disk?  Does riboflavin really work to prevent migraines?) and the importance of patient responsibility.  A mentor of mine described it as this:  the doctor and the patient are in a rowboat, each with an oar.  If the patient stops rowing, the boat goes in circles.  The patient's "oar" in this case is healthy living, healthy diet, exercise, alcohol moderation, smoking avoidance and cessation.  And so it goes....

The same holds true in developing countries, including Ghana. Countries that were specializing in damage control with such devastating diseases as AIDS and polio, are now starting to actually tread water.  The infectious disease aspect of health care in developing countries is no doubt going to continue haunting us for time eternal.  But, in Ghana as in most other developing countries, overall survival rates are increasing.  Ghana's life expectancy in 1960 was 46 years old.  Today it is 60 years.  Still appalling statistics, given so many people still die a young death from wholly avoidable diseases.  Chronic disease is now becoming more of an issue in these countries.

This is where ICHA comes in.  In my estimation, ICHA has done a masterful job at looking into the future and seeing the need for teaching local health care workers - the real teachers - about the importance of healthy living now the.  The simple but powerful message that good food is good for you.  That exercise is good for you.  That preventative medicine should be practiced in every country regardless of the GDP, or the number of foil wrappers strewn on a dusty street.

I could write of so many other experiences during my short stay in Ghana.  Perhaps I'll save the story of getting my pants pulled down in the front of a thousand Ghanians celebrating the last day of Bakatue, a festival to usher in a new fishing and farming season in the Elmina traditional area.  Or the nurse who offered to give me a pineapple enema to cure my viral-induced myalgas.

Then again, perhaps some experiences are better left in memory and not on paper.

I felt that the class also ended with a general positive feeling of what had been learned and achieved. We decided to go over the post-test after all had taken it in an effort to solidify knowledge and address any outstanding questions. We went around the room as each person explained the answer to a question. This spirit of group-teaching had been echoed throughout the course – in which people would each take on teaching what they knew about a topic to open the discussion and teaching – rather than creating a lecture instructor-student dynamic. Healthcare workers continually seemed to seek us out to ask questions about the materials. For me, as a medical student who has not had the opportunity to do much teaching yet, I found great pleasure in explaining what my new, limited knowledge of medicine could add.  The course also served as a platform to start off with making health lifestyle changes amongst ourselves – talking about the healthcare worker’s own daily lives and partaking together in an exercise walk. 

What it shows is a population of all ages experiencing a burden of the infectious diseases that we all imagine of a tropical, developing country.  However, I have been struck by the large number of high blood pressure readings I have seen in my own cursory glances at the data. It has not been uncommon to see a patient diagnosed with malaria and hypertension at the same time. This speaks to the “double burden” of communicable and non-communicable diseases that countries like Ghana experience. Hopefully, this data on hypertension will help shed like on the silent processes of chronic cardiovascular disease that lie below the surface of people’s daily lives.  One healthworker anecdotally estimated 5 new cases of hypertension/day in a clinic that sees an average of 150 patients per day.

What our time thus far in Elmina has also revealed has been a great generosity of locals inside and outside of the clinic.  The healthworkers that attend the 2-week ICHA training in Cardiovascular Disease greet us each day, and they are far from shy. Rather, they are engaged and can fiercely offer their opinions and questions on matters of diet, exercise, and pathophysiology.  Learning this new material challenges the statusquo of their roles as nurses, nutritionists and medical assistants in the community. Yet, I am struck by their willingness to take in new information and new workload – and balance a new priority of cardiovascular disease. One healthworker explained at the first session that it was difficult to find someone to cover for her as she attended our training sessions, but that she knew it was important for her knowledge and “for the betterment of her patients.”  To me, the best part of the training sessions – which have truly been facilitated as discussions rather than lectures by the 3 doctors on our team – has been the moments of honest sharing – where discussion yields pearls of knowledge about this local context which could never be written into our training manual or be understood by us as foreigners. For example, we learned that many people do not eat fruits or vegetables, or overcook them when they do, because they are worried about pesticides and chemicals from run-off and poor water quality.  I think that one of ICHA's invaluable strengths lies in the fact that it can help to facilitate dialogue on the realities of cardiovascular disease, and in doing so better understand local perceptions that will influence the success of prevention and treatment of cardiovascular disease. 

Fish is obviously a great source of protein and full of nutrients that protect your heart. And they’ve got lots of it here, as Elmina is a coastal city and a major fishing hub! However, the most common way you will see fish in the market is salted and smoked, for preservation. The smoked fish is fine, but it’s the salted fish that is a concern for risk of heart disease. It is often cooked into a stew and salt is also added, making the entire dish very high in salt. We are suggesting to cook the salted fish first in water, to get some of the salt out before using it in a meal, or if cooked into a stew, don’t also add salt.

Fruits and vegetables abound here. I see bananas, mango, pineapple, oranges and watermelon everywhere – and I eat them as often as I can! Vegetables of all sorts are also in ample supply. But, like most places, it’s more expensive depending on the season and probably doesn’t go as far, when trying to feed a lot of people.  We suggest to eat as much fruits and vegetables as often as possible – whichever ones are a favorite, or the most common and most affordable. They’re all good for you!

From speaking to people and paying attention to the signs on the street, the most popular dishes are:

Fufu and some sort of soup or stew (light soup, ground nut soup, fish stew)

Fufu is ground cassava and plantains. It requires a strenuous process to prepare – using a large stone bowl over a fire and essentially kneading (pounding with full force) the ingredients with a long, heavy wooden gavel, standing over the bowl. The soups vary – light soup is made with water, tomatoes and vegetables. Ground nut soup (ground nut is peanut) – the nuts are cooked over a fire in a stone bowl mixed with sand to heat them. When cooked, the nut is oily and pasty – a lot like peanut sauce in thai dishes. Fish stew can be prepared many ways. However, a common way to preserve fish here is by salting it. Once it’s ready to be cooked, it is added to broth (oil, water, tomatoes, etc.) and the salt flavors the soup. Smoked fish is also common here, which will also be used in soups giving a different flavor. All of the soups are often made with palm oil, which is most commonly a sweet red oil; though the palm nut can produce three different kinds of oils (black, white and red).

Banku and okro stew

Banku is maize, soaked in water for three days, giving it a sourdough taste. It is then cooked with plantains and eaten as a dough. Okro stew is made with okro and palm oil. Personally, I have not acquired the taste to enjoy okro in stew form. I’m not sure if I will take that opportunity now. The consistency is just too slimy for me. The consistency makes it difficult to eat too, as you eat the dish with your hands. You are supposed to twist the stew around your fingers. But because it’s slimy, I don’t have the skills to get much of it from the dish to my mouth. It’s a favorite here though!

Jolof rice and chicken

Jolof rice is white rice, cooked with tomatoes, tomato paste, spices and water or oil. The chicken comes fried or grilled. Rice, prepared in many ways, is popular here – especially a favorite of the kids.

Kenkey

Kenkey is made of maize and plantains. It is harder than a lot of the other starchy meals, like fufu and banku, which are doughy. It is closer to the consistency of a starchy biscuit.

Red-red and fried plantains

This is my favorite! Red-red is beans that are cooked in palm oil with tomatoes and onions, served with fried plantains. Very tasty!

I have tried all of these dishes except the light soup, which sounds like it may be the healthiest and most popular – I don’t know why I haven’t had it! I wasn’t aware of it when I was here in October. It’s on the agenda!

Most of these dishes are made with palm oil, and usually a lot of it. Both salt and palm oil are used in excess in most Ghanaian dishes. This is something that we are focusing on, as we talk about ways to eat more consciously of your heart health. We are certainly not saying, “no more palm oil, no more salt!”, as the traditional food here is certainly a big part of their culture, and we’re not trying to change that. Our message is “moderation, moderation, moderation”! Use less palm oil, less salt, less sweets. Often stews and soups are cooked in palm oil and is also added on top. It’s this kind of cooking preparation that we’re giving attention to.

Vince and I are waiting for the day a fish taco stand appears on the street – they’ve got all the ingredients! Until then, I’ll continue to enjoy trying all these new tastes (and consistencies)!!

Foregoing the excess packaging and attendant disposal requirements of individually wrapped band-aids, after a blood draw, patients are given a swab of unwoven cotton torn from a forearm-length bolt.  Before their blood is even drawn, a piece of IV tubing suffices for a tourniquet.  The plastic tubing offers an unintentional integrated safety mechanism.  It snaps if pulled too tightly.  For blood samples that must dessicate before or after staining, louvered windows, placed to catch the scant from a clinic courtyard, can be tilted to become a perfect drying shelf.  For those serum tests, like typhoid, that must be rocked and checked for agglutination, a ceramic floor tile is an excellent tool.  Its white surface provides a contrast with serum or whole blood, and its adsorbent surface assures neat mixing of serum particles.  Economically placed, up to 35 samples can fit on a single tile. 

In our home hospitals and clinics, with their myriad specialized gadgets, it’s easy to forget that things need not be purpose-made to be useful.  Indeed, pressing everyday articles into sophisticated uses reflects and cultivates a versatility of mind that is priceless in any setting.

Our visiting team has been treated to high fat, high salt snacks washed down with Coca-Cola after presentations of Preventing Heart Disease and Diabetes Mellitus 2.  The irony isn't lost on us, nor is this counter-productive situation unique to Ghana--just look at the foods served at Western medical conferences, and the American Academy of Family Physicians decision to 'partner' with Coca-Cola to produce patient education materials on healthy beverage selection.  The point is, often, patient education and community health improvement begins with the messengers.

Doctor, heal thyself! applies to both the Ghanian nurse covering her salad in dressing and the American doctor snacking on cream puffs at a Cardiovascular Disease conference.  Addressing health care workers' choices are excellent starting points for changing the choices and health outcomes of a community.

For someone who spends the majority of his professional time in patient consultations, I was very impressed with how the laboratory (typically, a faceless entity to Western doctors) contributes so much to patient care and community building.  With early use of inexpensive point of care testing, lab personnel are ably to quickly and accurately diagnose malaria; enabling rapid treatment and decreasing unnecessary antibiotic use and subsequent malaria resistance.  Malaria is a (likely, the) leading diagnosis at the Elmina Urban Health Centre, and simplifying the care process saves patients much time, enabling them to return to their daily activities and freeing the health care team to see other patients, a reverberation that decreases their waiting time too.

Little changes can make big differences.  Those changes are happening now at the Elmina Urban Health Centre.

This workshop started well before the outreach.  Much of it could not be possible without the coordination, assistance, and vision of Wilfred, the public relation officer at KEEA district, and his staff.  The material (which was well received) came from many hours and revisions by a dedicated team within ICHA.  And our three talented speakers sacrificed time from their busy schedule to come together and deliver a united message about 1) the importance of understanding heart disease; 2) how to prevent heart disease; and 3) why teachers are at the frontline of spreading this knowledge.  For all of this, ICHA is immensely appreciative for everyone's efforts.

What has amazed me though, is the level of commitment, interest, and dedication from the teachers throughout the outreach.  At times, I feel that we are all on the same page; what the teachers want are the same as ICHA's wishes.  The three public secondary schools - Komenda, Edinaman, and Eguafo-Abrem - all welcomed us on to their facilities for a number of events.  But it was the teachers that sat through and gave us feedback on our surveys, provided us insight on how to reach out to the students and enable them as ambassadors, and made the workshop a success with their presence and participation in discussion.

The teachers have not shown hesitation to express their opinions and ideas.  They tell us when students might not understand this or suggest a better way to engage the class.  But through and through, they tell us how necessary our program and organization is.  The teachers are hungry for more - more material, more visuals, more activities, and more time with ICHA.  And we think this is partially because they know their students are equally as hungry and enthusiastic for more.

So this Heart Health Workshop marked another milestone for ICHA.  We have trained the teachers.  They will share the information with students.  And hopefully the message continues to spread, leading us to new ideas.  A few great minds will turn into many - and this is how the community can keep Elmina safe from heart disease now and in years to come.