APOC Ghana: Day 12

By Summer Kollie, Health & Societies ’19; Amber Figueroa, Biology ’21; and Bosede Ajiboye, Psychology ‘19

Ghana 2018
(left to right) Penn students Amber Figueroa, Bosede Ajiboye, and Summer Kollie watch a nurse at KATH demonstrate how she teases Kangaroo Mother Care to new mothers.
Ghana 2018
A photo of the Kangaroo Mother Care ward as well as public service posters explaining their benefits.

Today, we made a visit to the premature infants and Kangaroo Mother Care (KMC) wing of Komfo Anokye Teaching Hospital (KATH). Our visit was very informative. The overall goal for premature babies was for mothers to engage in KMC. When talking to the doctor in the premature clinic, she mentioned that, on average, a baby would stay in the clinic, where there are incubators and CPAP machines, for about one week before being referred to the KMC ward. In some cases, babies who have more severe cases might stay for a month or longer. The goal of the premature clinic was to stabilize the baby. An infant was stable when they no longer needed supplied oxygen and IV fluids, they had no more difficulties in breathing, and they were able to take food, as in breastmilk, through their mouths. After the baby was stable, then they were moved to the maternal ward, where the mother could administer KMC.

Kangaroo Mother Care (KMC) is an efficient way to take care of premature infants without using an incubator. With skin-to-skin contact, the baby is placed on the mother’s chest between her breast. Then, two to three blankets are wrapped securely around the baby to keep them warm.

At the KMC ward, a nurse demonstrated on herself how a mother would tie her infant onto her chest. Th nursey emphasize for mothers to be able to perform the process of tying the blanket on their own. In this ward, KMC is administered 24/7. The only time a mother gets a break is if she needs to use the bathroom or to buy food. Fathers and other relatives only assist in this process for short periods when the mother needs a break or when the mother has more than one baby, as in twins or triplets, and cannot physically carry more than one on her chest.

APOC Ghana 2018: Day 10

By Adam Yablonski, Health & Societies ‘21

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Penn students Rebecca Zappala (left) and Amber Figueroa (right) teach math to grade 2 students at Kokoben (Photo credit: Eliza Culp)

Another early start to the day and another breakfast later, we were on our way to the KNUST Counseling Center. Our aim was to inquire further into another of the four fields our groups are interested in, today’s visit being geared towards mental health in Ghana (and more specifically, the mental health of university students at KNUST). Our plan for the afternoon was to return to the Kokoben Academy for our final set of lessons for the students there.

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Penn student Xuanjie (Lucas) Gong teaches English to a grade 4 class at Kokoben
(Photo credit: Eliza Culp)

Upon arriving at KNUST however, we hit an unexpected roadblock (figuratively, that is). There was an unforeseen situation (the details of which remain undisclosed) that resulted in the unavailability of our contact in the facility. Luckily, we are no strangers to scheduling changes. We were able to call an audible, and simply ended up switching the order of our activities for the day – we drove instead first to Kokoben. Once again, the kids were eager to learn anything we would teach, but they seemed most interested in American culture. They inquired about our holidays, demographics, geography, food, and even our government. We ourselves were able to learn from them as well – both introspectively at our own culture as one of immigrants, but also simpler lessons, like the first ten numbers in Twi! Since today marked out final trip to the school, many of us bought candy beforehand to gift to the students. We had to exercise caution however, Ghanaian children are almost as voracious as their American counterparts and will not hesitate to swarm any candy-giving figure in proximity (no matter how tall you are, I found). Though fun, our trip was marked by melancholy; we had to say goodbye to the very real connections that we had formed in just a few short days. The service aspect of APOC will not end though, as we will be teaching at another school in the coming days.

After skipping lunch due to its lateness and our crunch for time, we returned to the University Counseling Center to discuss the state of mental health among the students there. They have low funding and just 10 staff members, and they see 900 new cases each year. We learned about what the Center does, which includes therapy, outreach, and training programs. Since poverty and hunger are unfortunately not rare problems among students at KNUST, the Center will also provide basic food items to students during exam times, and provide free health screenings of all kinds.

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Penn and KNUST students listen to a member of the University Counseling Center

In speaking with a faculty member there, we uncovered some rather stark cultural differences that surround the issue of mental illness in this country. Firstly, there are no explicit diagnoses made at the Counseling Center, at least not as we would think of them. Instead, patients come in and simply speak with counselors there. The counselor will listen and perhaps will be able to diagnose something, be it GAD, MDD, or another condition. There is a disconnect though – because of Ghanaian society’s attitude towards mental illness, counselors are unlikely to even tell their patients of their condition, for fear that they will not return to counseling. As a result, emphasis is usually placed on what are perceived to be the causes of these conditions – the most commonly cited are relationship and family issues, financial issues, and academic stress (oftentimes, combinations will manifest). Counselors focus on these stressors with patients, rather than the disorders themselves. This stigmatization of mental illness is widespread, structural, and systemic, and will be a real challenge for our mental health group moving forward.


APOC Ghana 2018: Days 7-9

By Summer Kollie, Health & Societies ’19; Amber Figueroa, Biology ’21; and Bosede Ajiboye, Psychology ‘19

Ghana 2018
The team posing under a cocoa tree in front of the Center for National Culture, which did not allow photos inside. Left to right: Penn students Sheldon Amoo-Mitchual, Muti Agyekum*, Rebecca Zappala, Kwabena Asoka Sarpong, Yasmina Al Ghadban, Amber Figueroa, Summer Kollie, Sandy Tang, and Ethan Zhao (* second-year KNUST medical students)


We spent Friday morning learning more and experiencing Ghanaian history and culture. This was after we got the bad news that the scheduled programming to visit the urban high-risk maternal clinic was canceled. Even though we were disappointed because we wanted to learn more about high risk pregnancy in urban areas, we were luckily able to re-plan our day by going to the Center for National Culture Kumasi, a small museum containing objects significant to Ashanti history.

While there, we learned about the history of the kings and warriors of Ashanti culture. We learned about the golden stool and how it fell from the sky. We also visited the shops of several Ghanaian artisans and got the chance to patronize their work. We bought various jewelry, paintings, fabric, bowls, bandanas, and food.

We also had the chance to see a basket weaver weave an elaborate basket from scratch. It took him about 30 minutes to do so while we got an educational talk about the process while he was doing it.

On Friday night, we went to a bar and grill with music, where we ate dinner and danced with the other restaurant-goers. 

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A basket weaver constructing a basket from rods of straw


We spent Saturday morning at the market exploring and getting a taste of the rush of the market. We went to a big market, which had many sections and was bustling. The Ghanaian students helped us to navigate and barter with the sellers. We bought a lot of pretty fabric, like kente cloth. We also bought Ankara fabric, whichis used to make colorful wax-printed clothes that are common in Ghana, in preparation for the tailor, who will come in the following week to measure us and sew nice outfits for us.

On Saturday afternoon, we went home, slept, and later hand washed our laundry. We got a taste of what it was like to do laundry the way the locals do it, without washing machines. It took hard work and elbow grease, but it was fun.

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Penn student Adam Yablonski navigates his way through the Anakara fabric at the market


On Sunday morning, we moved into our new home which is more secluded. We went from having no air conditioning at the last location to having wonderful and cooling AC, along with private bathrooms. In this location, we are able to vibe with new people and get to know the neighborhood and culture more.

We spent Sunday afternoon resting after we enjoyed a delicious homemade lunch. On Sunday evening, we went out to a nice bar called Bar-Nas, where we enjoyed music and traditional Ghanaian dishes.

APOC Ghana 2018: Day 6

By Sandy Tang, Bioengineering ’19; Eliza Culp, Fine Arts ’20; and Jessica Fan, Biotechnology MS ‘18

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Penn students Rebecca Zappala, Xuanjie (Lucas) Gong, and Eliza Culp observe and interview patients at the Afrancho Health Center

After a delicious breakfast, we headed out to Afrancho Health Center, a rural health center about an hour away that specializes in maternal ante-natal care. There we talked with the head nurse about their internal processes and the general work flow of the center, as well as general practices for maternal healthcare. She showed us several examples of blank paperwork used to register expecting mothers and their medical history, which was very helpful to our understanding of their process. From our conversation, we learned to identify and categorize pregnancies as high risk based on conditions such as anemia, hypertension and preeclampsia, hepatitis, teenage pregnancy, and timing of pregnancy.

The Afrancho Health Center sees all women once a month during pregnancy and weekly during the last month before delivery. Sonograms are done at each visit. Diagnostic tests are also run when the women initially come in to screen for risk factors and conditions. The center also provides educational materials on nutrition, safe delivery practices, and other important information. In addition to speaking with the head nurse, the center kindly arranged for us to speak to patients with their consent to gain a better understanding of each of the high-risk factors identified by the center. Afterwards, we got a glimpse of their delivery rooms, as well as the laboratory spaces where they are able to run several diagnostic tests for the center. They are able to provide these services, but they need more staff, an ambulance system, a reliable power source, bigger facilities, and lab machinery.

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Penn students Adam Yablonski and Shihan Dong teach a grade 9 class at Kokoben geography and Chinese.

After lunch on the road, we arrived at the Kokoben Municipal Assembly school. We continued to assist with their classroom lessons, including English grammar, math, and physics, and we also introduced some new topics, such as Chinese and art. The kids were wonderful and very active participants. We look forward to working with them again on Monday.

We also look forward to re-visiting the health center in two weeks to follow up on some cases.

APOC Ghana 2018: Day 5

By Yasmina Al Ghadban, Bioengineering ’20; and Rebecca Zappala, Bioengineering ‘21

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From left to right: KNUST second-year medical student Muti Agyekum, Penn students Sheldon Amoo-Mitchual, Amber Figueroa, Rebecca Zappala, and Ethan Zhao.

This morning, after a breakfast of eggs, sausage, and toast, we headed to the Maternal and Child Welfare Center (at the Komfo Anokye teaching hospital) to visit the malnutrition ward. We learned about two types of severe acute malnutrition: marasmus, which is characterized by severe wasting due to starvation and a lack of both protein and energy nutrients; and kwashiorkor, which is characterized by swelling of the belly, cheeks, and limbs due to a lack of protein in the diet. We also learned about the process of treatment starting from diagnosis by measuring the mid-upper arm circumference (MUAC), as well as the weight. After the specific case of malnutrition has been diagnosed, healthcare providers look for underlying conditions, such as infection, anemia, HIV, or malaria, by running lab tests. For treatment, depending on the severity of the case and the age of the child, they administer F75 or F100, which are different kinds of ready-to-use therapeutic agents. After learning about the third case that we will be working on, we went to the nutrition center where families are sent for outpatient care and follow-up. This is also the first point of contact between the family and the healthcare system; if the case is severe, the patient is referred to the malnutrition ward that we first visited. At first, we had questions about how the follow-up process works. We discovered that mothers are supposed to come back weekly to collect more food and check the weight and MUAC of their children to track their progress. In cases in which mothers do not come back for their follow-up, they are called and sometimes even visited at their homes by nurses.

Although we had visited this same ward yesterday, it is still so hard to look at the children there. The clinic seems to be doing everything they can; however, it is difficult to ignore that there is a clear lack of resources, funds, and accessibility. For example, the malnutrition center had to move from being a 2-room clinic to a 1-room clinic due to a lack of funds. This resulted in having the waiting area, the food distribution, and the assessment of the child in the same confined space, which then limits the number of patients they can care for at once.

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Penn student Ethan Zhao teaches a grade 8 class at Kokoben Municipal Assembly School about the importance of a balanced diet and its components.

Later in the afternoon, after a drive through the market and a stop to get coconuts, we headed to Kokoben Municipal Assembly school (kindergarten through grade 9) for service. We were divided into pairs, which each taught a class about something the grade was currently working on or wanted to learn. The experiences ranged from singing with 5-year-olds and struggling to communicate in English, as most children only know Twi, to teaching about heart diseases and the circulatory system. There was a lot of shock at first since it was not easy to stand in front of 40 students and teach an unprepared lesson. Overall, the kids seemed very excited and fascinated by our presence. Although we were glad we were able to spend some time with them and share an (infinitely) small part of knowledge, we were shocked by their fascination and overwhelming joy to see us.

As on our fourth day in Ghana, we feel like we have learned so much — both about the healthcare system and the culture, and we look forward to continuing to learn and grow tomorrow.

APOC Ghana 2018: Day 4

By Xuanjie (Lucas) Gong, Biotechnology MS ’19; Shihan Dong, Biotechnology MS ’19; and Princess Aghayere, Health & Societies ‘19

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MUAC tape

Today, we all went to the Maternal and Child Health Hospital in Rural Kumasi. The main purpose of the visit was to observe malnutrition cases in children and to interact with doctors and nurses who treat children suffering from malnutrition.

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While visiting the clinic, the nutrition group asked the questions that we prepared yesterday. It turns out that the situations here match up with our research. Doctors and nurses use WHO standards to determine the nutrition status of the kids. Also, they use MUAC tape to determine the severe acute malnutrition. Children who have MUAC less than 11.5 cm will be sorted into a severe acute malnutrition group.

As for solutions or treatments, they do know about and have RUTF (Ready-to-Use Therapeutic Food). We also learned that they have therapeutic milk, F-75 and F-100, to treat malnourished children in different phases. They have F-75 to use at the starting phase of treatment. If F-75 helps to stabilize the children, they move onto F-100, and they use diluted F-100 for children under 6 months.

We had 2 cases that we mainly focused on. The first case was of a 3-year-old girl who suffered from Kwashiorkor, Marasmus, and Marasmic Kwashiorkor. All 3 diseases are signs of severe acute malnutrition. She had been there for 3 weeks for treatment, and her condition was not improving. The doctors attributed her declining condition to poverty and the mother’s psychiatric problems. The patient’s mother has already lost two children to the same condition. The doctors describe the girl’s status as unstable because she often vomits and isn’t gaining weight. The second patient is a child exposed to HIV as a result of her mother being positive for the disease. Because she is only 3 months old, blood cannot be drawn, and testing cannot be done to ensure her HIV status.

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F-75 therapeutic milk

In the evening, we went to a church to give a presentation to local women with little to no education. We started by asking them what they eat everyday, and luckily we received a lot of responses. From their responses, we could clearly see that their diet lacked components of vegetables and fruits. Then, we delivered a brief speech containing basic nutrition knowledge, mainly based on the six essential nutrients. We explained the function of these nutrients and some local sources to obtain them. Surprisingly, one of the female audience members said that this was her first time hearing about vitamins and minerals.

During the question and answer segment of our presentation, some women asked about the different types of sources for minerals and vitamins. In particular, one woman asked about the foods that she could eat to help with her hypertension. To our surprise, another women asked whether her intake of fruits was excessive. This question made us think about people’s awareness of obesity and other diseases related to overeating. At the end of the presentation, the audience was happy about what we presented today and looked forward to learning more on our next visit.

APOC Ghana 2018: Day 3

By Xuanjie (Lucas) Gong, Biotechnology MS ’19; Shihan Dong, Biotechnology MS ’19; and Princess Aghayere, Health & Societies ‘19

This morning, we had our official kickoff in the morning. It was a great meeting with Dr. Ellis, the Dean of School of Public Health. In the afternoon, professors from different schools delivered three lectures about the state of mental health, maternal and child nutrition, and health systems in Ghana.

Ghana 2018The mental health lecture, given by Dr. Emma Adjaottor, was impressive and surprising. We are so lucky that we met one of the psychiatric physicians among a hundred across the country. The doctor frankly introduced mental health development in Ghana. Though they have lagged behind, they have made a lot of progress, with the number of psychiatrists in Ghana  recently increasing from single digits to the double digits. Dr. Adjattor emphasized that the epidemiology of mental health in Ghana is nearly identical to the rest of the world, particularly in terms of incidence and prevalence, even though it is severely under-reported. The doctor explained that, although the epidemiology is the same, the terms used to describe these issues are often different, relying on more local ideas, such as spirits and witchcraft.

The maternal and child nutrition lecture, given by Dr. Samuel Newton, was even more astonishing. Kangaroo mother care (KMC), in which a prematurely born infant is given constant skin-to-skin contact with the mother, is undergoing study in Ghana, and it has shown promising outcomes. Even with limited studies, KMC has been found to greatly increase the likelihood of survival even when using “surrogates,” such as grandmothers and even fathers. The professor also introduced another study that found that the application of oxytocin during the third stage of labor in mothers at risk of postpartum hemorrhage (PPH) greatly decreased the likelihood of PPH.

Finally, Professor Ellis Owusu-Dabo gave an extensive lecture covering the health systems of Ghana, which are logically and hierarchically managed, with administrations at the national, local, district, sub-district, and community levels. We also learned about the insurance program in Ghana. For formally employed workers, national insurance participation is mandatory, as it is funded by a mandatory tax on their income, like in many socialist countries. However, insurance coverage is a more complicated matter in Ghana, in which a very large proportion of the population is not formally employed and instead earn its living through trading and cash-paying jobs. For these people, other than the free public health services provided by the government such as malaria, tuberculosis, and HIV care, they must pay out of pocket for many other services.

Tomorrow will be the very first clinic visit, where we can observe children suffering from severe acute malnutrition. So the three of us in the nutrition group, Princess, Shihan, and Xuanjie, gathered together after dinner to discuss what we would ask the doctors and nurses during the visit. We agreed that, at first, we should ask whether we can take pictures to record. As for nutrition, we will ask how healthcare workers there define malnutrition.

To our knowledge, malnutrition standards are normally based on BMI, which is a composition of weight, height, and age-related data. We want to know whether Ghanaian healthcare professions use the same standards here, as well as how the local standards differ from the established WHO standards. Furthermore, we will ask for access to their local data sets. In addition to the results of malnutrition, we also want to know what the major causes of malnutrition are. We assumed that the principal cause is poverty, and based on this assumption, we want to ask them whether there are any welfare systems or NGOs helping to resolve the problem. We hope to find out what the clinics’ initial steps are to resolve malnutrition. Our last question involves how macronutrients are measured.

Tomorrow evening, we will give an open presentation in a local church to female market workers. We first planned to deliver the presentation in a discussion form, but considering the language barrier and other factors, we decided to give a speech, but we will ask simple questions. We thought that the scope of our research was not appropriate for local life in Ghana because much of the research was done in the U.S.; thus, it was necessary to get the input of local people. By asking them questions about what they eat on a daily basis, we want to make our research as appropriate as possible. In relation to our presentation, we will briefly introduce what nutrition is and explain the 6 essential nutrients through definitions and explanation. For example, when introducing carbohydrates, we will refer to fufu or banku, which are local main dishes basically consisting of starch. Also, we came up with an educational idea for the future. If we have a projector, we could possibly show some dishes to let the audience choose which is more nutritious, to provide general idea of a nutritious diet.

APOC Ghana 2018: Day 2

By Sandy Tang, Bioengineering ’19; Eliza Culp, Fine Arts ’20; and Jessica Fan, Biotechnology MS ‘18

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The mouthwatering jollof and fried tilapia we ordered at the swimming pool

This morning, we had a chance to sleep in a bit and recover from our busy travel day. We had a delicious breakfast that consisted of porridge with sugar cubes, sausage, hard boiled eggs, a locally specialized donut made of beans, watermelon, butter bread, and a variety of hot drinks: yum. After our breakfast, a group of us went on a walk around campus, and another group went to a church service at First Love Church.

The church service started with praise worship, followed by numerous student performances. There was a dance group, a drama group, a praise group, and a traditional Twi praise group, and the congregation members were bursting with energy. The pastor then gave her sermon and afterward greeted the congregation. We made a few friends who happened to be students at the university we are staying at: KNUST.

For the other group, we explored KNUST’s expansive campus. We started to wander, and only when we noticed excessive nature did we realize we were no longer on campus. Once back on track, we saw some lizards, baby goats, and plenty of flora and returned to the residential area of campus. We accidentally entered a boy’s dorm but caught a glimpse of what it would be like to be a student at KNUST. Inside the dorm, a pastor was giving a fiery sermon, and many students were hand washing laundry in the courtyard. After leaving the dorms a few of us bought some amazing meat pies, for only 1 Cedi (about a quarter)!

Around 1 p.m., we all got into our bathing suits to head to the pool! The ride was short, and we were excited to have some relief from the heat. We ordered some food before entering the water; there was a choice of jollof or fried rice with either fish or chicken. After ordering our food, we applied sunscreen and dove into the water. There were many other people in the pool already, so we made some friends with the swimmers our age, many of whom were instructors. Shortly after being in the water, Genevieve and Estabelle, two young girls, joined us in the pool, and we played with them and carried them around in the pool. It was such a great time.

We stayed until the pool closed at 6 p.m. and then dried off and took the bus back home. A few of us bought sweet treats from the little shop in our graduate student hostel, Tek Credit. Then, dinner was brought to us by Nana Yaa: a meal of yams, spinach fish stew, rice, fried fish, beef and water melon. We had a brief Twi lesson from Nana Yaa on basic greetings. Our night ended with a quick debrief from Dr. Wattenbarger about our upcoming week.

Excited for the days that lie ahead!

APOC Ghana 2018: Day 1

By Ethan Zhao, Bioengineering ’19 and Sheldon Amoo-Mitchual, Biological Basis of Behavior ‘20

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The APOC team! From left to right, then bottom to top: Dr. Ocek Eke, Dr. Miriam Wattenbarger, Summer Kollie, Princess Aghayere, Eliza Culp, Bosede Ajiboye, Jessica Fan, Amber Figueroa, Xuanjie (Lucas) Gong, Sandy Tang, Ethan Zhao, Sheldon Amoo-Mitchual, Shihan Dong, Adam Yablonski, Yasmina Al Ghadban

Like last year, a group of Penn Engineering undergrads enrolled in ENGR566 – Appropriate Point of Care Diagnostics, a large number of them Bioengineering majors, have gone to Ghana to get some hand-on experience. They’re blogging their experiences daily.

Today we touched down in Accra bright and early at 8 a.m. We went through immigration and baggage claim without a hitch, and we met up with Nana Ya Awua-Boateng, a PhD student at the Kwame Nkrumah University of Science and Technology (KNUST), who helped us with arrangements as a translator. We loaded up the bus with luggage (both inside and out) and set off for the 5-hour bus ride to Kumasi. Along the way, we slept (a lot), given that we touched down at the equivalent of 4 a.m. EDT. We stopped in the middle for lunch and our first taste of Ghanaian jollof rice and grilled tilapia, which were incredible.

Afterward, we finished our journey to Kumasi and arrived at KNUST, where we unpacked our belongings in the hostel. We also met Salim, a medical student, and Nana Ya’s children, Nana and Genevieve. Soon after, we all took a quick trip down to Big Chinese Restaurant (its literal name) to taste Ghana’s version of Chinese food. We then went back to campus, where we finally went to bed after a long day’s journey.

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Loading up the bus for our drive to Kumasi at the Accra airport! The bus was so full we had to strap luggage to the to the roof of the bus.