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by Danielle Tsougarakis, Bioengineering ’20; Jason Grosz, Bioengineering ’19; Ethan Zhao, Bioengineering ’19; and Kate Panzer, Bioengineering ’18

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

The first thing we did today was visit the Komfo Anokye sword, which is a sword buried in the ground that represents the power and stability of the Ashante Kingdom. Rumor has it that, if the sword is removed from the ground, the Ashante Kingdom will collapse. To this date, no one has been able to remove the sword from the ground, and it is a tourist site frequented by famous visitors, including Muhammad Ali.

After seeing the Komfo Anokye sword, we visited a pediatric tuberculosis clinic at Komfo Anokye Teaching Hospital (KATH), the major hospital in Kumasi, which is well equipped with medical infrastructure. Upon entering the clinic, we were immediately struck by the appearance of the waiting area and check-up room. The check-up room was small and consisted of a wooden desk and plastic chairs. The windows and doors remained open to the outside and waiting area such that any passers-by could listen to the check-up. The clinic was not very busy while we were there, but the doctor said that that was atypical; typically, he is completely booked and has to rush from appointment to appointment.

The first patient was a five-year-old child who was referred from another doctor for persistent coughing, weight loss, fever, and vomiting. These are all classic symptoms of tuberculosis, so the doctor ordered a smear microscopy diagnostic on the patient’s sputum and a digital X-ray. If the sputum sample is viable, it will also be sent for molecular diagnostics with the GeneXpert. One thing that we found surprising was that the cost to the patient for the diagnostics and the check-up was $0 — it is all funded by the government and NGOs.

The second patient was also a five-year-old child currently being treated with anti-tuberculosis medication and anti-retroviral therapy for HIV. His symptoms included wheezing, coughing, and an extremely rapid heartbeat. Given the patient’s history of HIV, the doctor suspected acute pneumonia and/or drug-resistant tuberculosis and admitted him to the emergency room for observation and treatment. One thing that we found surprising was that infant patients in the emergency room usually share beds with up to seven other infant patients. This makes hospital-borne infections extremely common and dangerous. We also found it interesting that only the mother was allowed to accompany the child to the emergency room, but the father was given the final say for all important medical decisions.

After the clinic visit, we went to a nearby rural high school, where we planned to tutor the students in science and math. Upon arrival, we were told which subject we would be teaching just before we were essentially thrown into the classrooms without much preparation. This tutoring session was held after the usual class period, but the students were eager to stay, learn, and interact with us. The school was split into two forms similar to the British school system, with the underclassmen in Form 1 and the upperclassmen in Form 2.

The high school has about 900 students, split into eight classrooms with sides that open to the warm Ghanaian air. The rooms hold classes of varying sizes from 25 to 50 students, with ages between 13 and 18 years. Some of the subjects taught in the different classrooms include physiology (the cardiovascular system), math (algebraic expressions, change of subject, quadratic equations, etc.), and language arts (article and essay writing). Each room was filled with goofy, lively students who would occasionally break out in giggles and applause to encourage their classmates who volunteered to come to the board.

We all had a blast interacting with the students, attempting different teaching techniques on the spot and brainstorming ways to get the students excited about the class topics. Despite the initial nerves of not knowing what we would be teaching until just before entering the classrooms, we look back at this experience with excitement, and we are looking forward to returning to the classrooms to tutor on Friday.

by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science ’20; Kathryn Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; Dave Pontoriero, Biotechnology MS ’18

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Our team woke up and hit the floor with some Zumba. Following this exercise, we went to the campus cafeteria for breakfast. The food consisted of rolls with jam, sausages, omelets, and coffee, tea, or Milo (Australian chocolate milk).

Our first academic activity of the trip was after breakfast! We made it back to the house for a lecture from Dr. Anthony Enimil, a local pediatrician. During his initial lecture, he spoke about Ghanaian culture and how it related to our group, both as tourists and and as medical professionals. Dr. Enimil said that misconceptions mostly stemmed from tourists who think they are above Ghanaians. Ghanaians are multilingual, intelligent, and very proud of their culture. This pride is particularly prevalent in Kumasi and the Ashanti region, which is considered the cultural capital of Ghana. The question and answer period was particularly interesting, considering that we have spent a semester learning about tuberculosis without necessarily having any ability to learn specifics about the situation in Ghana. One fact that we found remarkable was that the WHO estimate of tuberculosis prevalence was found to be only one-quarter of the actual prevalence in Ghana.

The next portion of the day was critically important, if somewhat futile: a tour to get us oriented around campus. The KNUST campus is, according to a casual guestimation poll of the Ghana Nine (the nine Penn students on the trip), approximately five times bigger than the Penn campus. To make matters worse, large parts of the campus are, to our untrained eyes, identical stretches of unkempt jungle. We ended our tour with fufu for lunch at a chop bar, a casual Ghanaian restaurant that apparently serves the purpose as Wawa: keeping the Ghanaian students happily fed for cheap. We knew the food was spicier when our right hands (used in Ghana as utensils) tingled for a solid hour post-exposure. However, the fufu we ate was legitimate and delicious, and there were no complaints from the Ghana Nine about the food, particularly when we had a lovely post-meal Icy Cup (a tangy yogurt smoothie). It distantly reminded most of us of yogurt.

Our second academic activity of the day was a continuation of the lecture led by Dr. Enimil. This time we got into the nitty-gritty details of the tools that are used to diagnose TB. Even with the progress made with technological advances, a recurring issue is stigma. TB is curable, but the perception of it as a “disease of death” has made it highly stigmatized. Much work needs to be done to reach some of the benchmarks set. For example, the hope is to eliminate the disease burden by 2035. To do this, Ghanaians must continue strengthening diagnostic methods. We discussed the microscopic culture molecular examination, chest radiographic findings, and sputum sample usage with the Gene Xpert. After another very stimulating question and answer session, the Ghana Nine took a 90-minute break, filled with naps and a competitive game of cards.

We then enjoyed a delicious dinner that consisted of salted fish, plantains and (white) yams (collectively called ampesi), palaver sauce, and avocado. After dinner, the whole group took a walk to the shopping mall on campus to get an ice cream treat to cool us off. We ended the night reflecting on our day, speed friending, and discussing all the new information we learned about TB in Ghana to prepare for our visit to the clinics.

by Kaila Helm, Biological Basis of Behavior ’20; Kathleen Givan, Bioengineering and Political Science ’20; Kathryn Cocherl, Bioengineering ’20; Hope McMahon, Chemical and Biomolecular Engineering ’18; and Dave Pontoriero, Biotechnology MS ’18

David Issadore, a faculty member in the Department of Bioengineering at the University of Pennsylvania teaches an engineering course ENGR566 – Appropriate Point of Care Diagnostics. As part of this course, he and Miriam Wattenberger from CBE, have taken nine Penn students, most of them majoring in Bioengineering, to Kumasi, Ghana, to study the diagnosis of pediatric tuberculosis. While in Ghana, these students are blogging daily on their experiences.

Our day started early: at 6 A.M. We were startled to see an aerobic fitness class outside our hotel room door. Participants were sweating and dancing with smiling faces to high-energy rhythmic music — a definite contrast to the decidedly low-energy sleeping state we were hoping to enjoy further.

Breakfast was a lovely, carbohydrate-heavy smorgasbord of avocado, pancakes, and flower-shaped chicken sausages. We then boarded our bus for our trip to Kumasi. Along the way, we noticed the changing landscape as we headed out to the rural area. On the bus, Ethan played his ukulele. Due to construction, the traffic sides switch slightly at random. This could be hair-raising at times: suddenly, the bus would simply divert to the side of the road where, mere moments before, the traffic was streaming along merrily in the opposite direction.

We also stopped at a rest area, and we tried guinea fowl, goat, and banana milk. As we continued, we saw more goats and churches and fewer vendors on the side of the street. It was also interesting to see more and more mosques as we passed in to the more Muslim northern/central area. We arrived at the exceedingly spacious KNUST campus, lush and green, and also, not the bus (we were very ready to be off after four hours of driving!). We set up our rooms and prepared for the rest of the night.

The afternoon was hot and lazy, filled with unpacking and chatting about the wild experiences that we’d already had. A definitive highlight was a run that some students took on campus. The group was lucky enough to see the computer lab and a Ghanaian wedding and to meet up with some Ghanaian friends who helped with the program last year. After a shower and perhaps a quick nap for the lucky ones among us, we were ready for the next stage of the evening: the welcome party.

At the welcome party, we met the Ghanaian students who will be with us during our time here. We then watched a performance by drummers and traditional Ghanaian dancers. They pulled us in their circle and taught us some of their dance moves. We met some of the KCCR staff members who told us more about the work we will be starting this week. We ended the night in the lounge, reflecting on our day and getting to know each other better.