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Feb. 19, 2000 -    I returned to Accra this last weekend to meet with a CDC supervisor from the US, the WHO Representative and to share notes with my two other colleagues on the Ghana Stop team. This was a very profitable time of exchanging ideas as to how we could be more effective in sensitizing and promoting the need to identify AFP cases. It was a nice change, but I'm pleased to be back in my little hometown of Kumasi to continue my work.

It was especially nice to meet with the Rotarians here again. They are small in number, but big in heart and commitment. They have the Golden Stool of the King as the logo on their banner and during the exchange I received one.

One of the simplest things we could do to help the children in Ghana would be to provide nets for the children's wards and to give nets to the children who were hospitalized with malaria to keep them from coming back. A few hospitals already have nets for the children and the pregnant women. One unfortunate problem is that typhoid often has similar clinical symptoms like malaria. Parents and Outreach HealthCare Workers will often keep giving a child chloroquine thinking that malaria is the problem. After a week of not getting better they then bring the child to a larger clinic. Only a few can do the Wider test for typhoid, so even the larger clinics my just change malaria medication, thinking that the malaria is resistant to chloroquine. This little boy is the victim of such an error and the typhoid developed a perforation in his bowel, requiring abdominal surgery. As you can see, after weeks of treatment failure ending in surgery he is now skin and bones. Fortunately, he now has a chance of survival. Typhoid is very prevalent here as it was when I worked in Nigeria, where I had no lab facilities to differentiate between that and malaria.

If you ever wonder what palm oil was made out of, you don't need to wonder any longer. Here is a picture of bunches of palm nuts that boys were piling up at the side of a road to be picked up by a truck and taken to the factory where they will be processed and used for cooking oil, as well as for soap.

The Palm nuts grow in the center of the tree, as pictured above. Another of their economic plants is the cocoa tree. When the pod is broken the seeds are covered with a sweet white substance, but it's the seeds that are of financial interest. They are dried on tables for a week or longer and then put in bags to be sent to the city.

This child was examined for possible AFP. She is 9 years old, had a bad siege of malaria and was given a shot of Chloroquine for it. Shortly afterwards she complained that she couldn't walk and had pain down her left leg. She came back to the hospital 3 weeks later, after the traditional healer was unable to help. I don't think it's polio, although many cases of polio develop after a shot in the butt, since the nerves seem to be more receptive to the viruses after being irritated with a toxic substance. Goiter are still very common, in spite of the advance of iodine in the diets. I am embracing a wonderful dedicated women who will be spending 5 years in a distant and isolated village to care for the poorest of the poor. The clinic was just built and we used our vehicle to bring in some sponge mattresses and supplies for her. She is showing me her "Placenta Pit,"   which is a more civilized way to discard the placentas (rather than throwing them to the dogsor down the hole in the outhouse.)

Yes, you are seeing a Rotary Emblem on a shirt. This was given to this gentleman who volunteered during the polio immunization in his village in 1998, and he cherishes it, wears it only on occasion of NIDs or immunization activities. The volunteers also act as surveillance eyes, ears and mouths. Every village has a "Community Based Surveillance Volunteer," who will walk up to 6 hours to the nearest Sub-district Clinic to report any suspected case of a child with AFP, measles, yellow fever, meningitis or anything that they recognize as needing to be reported. They will then receive something less than a dollar for their travel expense and the clinic will try to mobilize some form of transportation (usually a motorcycle) and investigate the child's illness and provide treatment, if possible. The above village does not even have a bicycle. It's just amazing to see the evidence of Rotary's contribution in such remote villages. I'm sometimes overwhelmed when I realize all the difficulties that had to be overcome to provide the hope of polio eradication in the world. What's even more astonishing is how many of the children of the world have benefited by the increasing routine immunization programs that are spin-offs of the polio eradication initiative. Even though many of the African countries have not yet quite attained a strong 80% coverage of routine immunizations (Ghana seems to be in the high 60% or low 70%) it is amazing to think that not many years ago the average coverage for the children in the developing countries was only 20 - 30 %. "We've come a long ways."

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