Friday, July 4, 2014

Research, Education, and Outreach: Ghana, June 2014 (June 9th - June 14th)

June 9th, 2014

The project I am working on is called ReBUild which stands for Research and Education in Buruli Ulcer, Inundations, and Land Disturbance. It is a multidisciplinary collaboration between Penn State and the University of Mining and Technology in Tarkwa, Ghana. The project is trying to tackle the very perplexing issue of a relatively under-researched disease called Buruli Ulcer.

Buruli ulcer is like something out of a horror film. First described in 1867 but named for its first recorded outbreak in a small region of Uganda in the 1960’s, it has since become somewhat of a localized epidemic, especially in West Africa. The disease itself is caused by a bacterium called Mycobacterium ulceranus which is related to the infectious agents that also cause tuberculosis and leprosy. The bacterium (MU for short) infects an individual through a still-unknown process; once infected the individual begins to show preliminary symptoms before the ulcer forms. The bacteria then begins to slowly eat away at the skin and sub-cutaneous fat of the body, opening up potentially huge swaths of flesh to the environment. These ulcers can spread laterally across great sections of the body and they can also begin to cause secondary infections of the muscle tissue and bone.

Buruli ulcer, like TB and leprosy, is completely treatable with antibiotics if caught early. Unfortunately, as a lack of understanding, education and resources are what typify this disease, it often goes untreated, especially among children. All too often, rampant BU infections surge out of control and end in massive deformities, muscular atrophy, debilitating loss of limbs, and even death.

The terrible nature of the disease is only compounded by the fact that it really should not even exist in the first place. The little that is known about the nature of BU is that the bacterium that causes it is waterborne. As a result, outbreaks and endemic communities seem to emerge in concert with land-use change and especially certain kinds of land-disturbance that increase exposure of stagnant water bodies. By default, “land-use” is greatly dictated by economic disparities, both on a global scale and within local communities. Such problems have only been accelerated in the past few decades by the additional impacts of climate change in West Africa resulting in more intense and more unpredictable rainfall events.

So what exists today is an under-treated, under-researched disease with potentially debilitating impacts on thousands of lives that is driven primarily by forces beyond the control of those who suffer from it.

The aim of the 5-year long ReBUild project is to identify a more clear mode of transmission, adding to the knowledge and prevention of this disease, while at the same time directly supporting local communities in regards to education, professional development, health care, and outreach. My role in all of this is that of the research assistant, a position that entails data management, analysis, communication, and working with a team on raw data collection from the field. So far, this has proven as exhausting and challenging as it is fulfilling and enjoyable. I have had the amazing opportunity to work with local people, to hear their stories, to work alongside them in a number of ways, and to absorb this beautiful country along the way.

June 10th, 2014

Diaso is the end of the world. It seems fairly self-evident even to the casual observer but when Petra, our project leader who has worked with development in over 80 countries over the course of 25 years, looks me straight in the eye and tells me so, I believe her. It’s not that Diaso is so far removed or somehow so remote—the best way to describe it would be like the drop-off at the continental shelf where the ocean goes from a few hundred to several thousand meters deep within the course of a few kilometers distance. Few people who don't belong in Diaso ever go to Diaso, and very little other than illegal gold comes out of it. Accra might as well just be another planet instead of the capital of the same country.

The more seasoned member of our research team tell me that the road has been improved dramatically since they first started visiting 5 years ago. The hotel we stay in, generously named “The Peace Hotel”—the only lodging in town—is a dive, although this as well, I am informed, has gotten better in the past few years. There are a precious few places to buy food in town, although beer proves somewhat easier to find.

Diaso is a haphazard collection of dilapidated buildings whose disorganization creates a labyrinth of side-streets and narrow alleys. Each day they are alternatively filled by children and chickens and women collecting water and goats and stray dogs. When it rains, water snakes through these causeways and carries the garbage and loose soil downhill towards the river. Some of the oldest houses stand out not because of their prominence, but because of their relative elevation. Once constructed at ground-level, the earth around them has worn away in the intermittent years leaving behind tiny wooden houses precariously balanced on top of meter high pedestals of compacted earth. The effect is curious and somewhat charming and it lends strange dynamic to an otherwise sleepy town that has risen from the surrounding forests with seemingly little intention.

June 12th, 2014

Today on our way back we stopped at a small clinic in the town of Nkotumso that specializes in treating BU patients. It was a small, unassuming facility, certainly not anywhere near the standards we are used to in the states. There were lots of people, women and men, but also lots of young children. Some had small spots and open sores indicative of the relatively early stage of a Buruli Ulcer infection; others had much more extensive infections, covering entire forearms, hands, lower legs, or thighs,  requiring constant dressing and re-dressing. But despite the alarming appearance of these massive ulcers, they are mostly painless to the patients: the MU bacteria that causes the Buruli Ulcer secretes a necotizing agent that also completely numbs the area. So the dejected looks on the faces of the victims comes more from grim prospects and social stigma than from actual physical pain.

In the communities, we had seen a number of people with BU scars, the hideous results of having large-scale untreated infections; those that manage to survive the ulcer are left with widespread scaring and debilitated or amputated limbs. But seeing young children with active infections was affecting on a whole different level. This is a disease that should not even exist. And yet, it continues to spread as land degradation and climate change drive the conditions that make BU an epidemic in certain communities in West Africa.

Today was a very sobering day.

June 14th, 2014

The tidal waters along the coast are brown and dull against the sky, constantly fed by the alluvial streams that rush towards the ocean as the result of heavy tropical rains. Further out, beyond the breakers, where the fishermen gather in their slender wooden boats with their home-spun nets, the water is pale and gray. It blends with the horizon with the help of a persistent haze that hangs along the beaches and over the waves in the early morning. The moon has not yet set and it sits directly opposite the sun in the sky. They glare at each other over the small outcrop that is Accra until eventually the moon is overtaken by rolling clouds.

On the beach, a man and his dog lead their small herd of goats past heaps of litter and shipping detritus. The animals look for food among the garbage and, as goats always do, they seem to find a few things worth picking at. It is an unimpressive coastline, at least in the most populated areas. This is not a place for many tourists—those beaches are farther away and well-guarded from the dirt and rubble of the poor urban population—but it is not altogether un-beautiful.

Wherever people live, they leave a trace. One of the main traces of poverty, more often than not, tends to be trash. In the developed world we have the luxury having our own waste removed from our sight and from our mind, but we are no less wasteful. There is something more honest—albeit unintentional—about living in the midst of the traces you leave behind. I do not envy the poor, but I care for them and feel very deeply for them; I do not idealize or glorify their condition, but by seeing poverty for what it is and understanding that even the poorest among us has so much to contribute to the world, I think we can begin to level the playing field--at least in a philosophical or cultural sense. The economic, geo-political realm of things takes a different kind of action entirely.

Still, I feel as if this is where I belong. At the crossroads. Creating spaces in which the voiceless have a voice and communicating the reality of the world to those who are otherwise unaware. This brief experience in Ghana has been amazing, but like my years spent in South America and the other time I have spent abroad, this is only the beginning. It’s been so good to sink my toes into African soil once again.

Until next time.

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