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The movement and health of children in Nima

31 Jan

As many of you know, I’m in the middle of conducting my dissertation fieldwork in Accra, Ghana. The topic is about how children perceive environmental health hazards, and one of my study sites is the neighborhoods of Nima/Maamobi. I’m using a hodgepodge of methods including surveys, photo identification activities, focus groups, and giving the kids GPS and cameras to run around with. I’m finding out all kinds of interesting things, but as you can imagine, the most fun part is seeing where the kids have gone with their GPS and all the awesome photos they are taking.

The first thing you notice when looking at these GPS tracks, is that these kids MOVE. You don’t see fat kids in Nima and there is a reason: while most have a relatively large daily caloric intake, these kids are constantly on the move, some clocking in over 30 kilometers of walking within a two day period, most between 10 and 20 kilometers. The image below is a composite of tracks from the 13 and 14 year old children, each color representing a different child. Most of the kids have a fairly large ‘roaming’ range, but they do stay pretty localized to the Nima and Maamobi neighborhoods. All of these tracks are walking tracks, with the exception of the deep red track, which involves some trotro driving.

One of the girl’s tracks was particularly interesting – after school and on weekends she heads to the Nima market area and sells water (below). The track demonstrates her weaving through the streets, with a heavy focus around a tree (upper middle) and street intersections. Water girls and boys are abundant in Accra, you’ll find them on every street corner selling the sachets that are now a main source of drinking water for most households (right).

The point of seeing where kids are going is to better understand where and how much they are interacting with their immediate environments. Clearly, the neighborhood environment for children in Nima and Maamobi plays a big role in their life, as they seem to be constantly out and about roaming, playing, working, running errands, or going to school. So then my integral question is, does it matter for their health? The pictures children have been taking speak to an environment that cannot make it easy to stay healthy. The images below are similar to what constitutes around 70% of the images the children take – rubbish and clogged gutters were the main issues represented in the photos. They are very aware of the degradation and potential dangers of their surroundings. Their understanding of why such surroundings are bad for them is a bit more fuzzy, but that is a whole other matter.

So how do children deal with living here? How is it possible that they aren’t constantly sick? The collected images also displayed a range of health-related behaviors that are effectively acting as a buffer to the living conditions (below), however these images are few and far between the negative health aspects of the local environment. I don’t really know what to make of the fact that children chose to photograph the negative aspects of the environment overwhelmingly more than positive aspects or good health behaviors.

Overall this is just a tiny sample of the data I’ve been collecting and experiences I’ve been having. The children have been a blast to work with, and its been great fun to show them some new technologies and hear what they have to share about their community. Below are some of the contributors :)

Women and reproductive rights - Part 1

20 Dec

This is a relatively long two part posting… so tuck in for a nice read :)

A recent Demographic and Health Survey report for 20 countries throughout Asia, the Middle East, Africa, and Latin America states that on average, 34% of all pregnancies result in an unintended live birth or an induced abortion. In other words, 1/3 of pregnancies in this representative sample of low and middle income countries are unplanned and unwanted. Furthermore, one in three unintended births is a result of contraceptive failure, while more than half of induced abortions are a result of contraceptive failure. Its a two stage problem: there is serious unmet need for contraceptives, and for those who do have access, there is unmet need for counseling and better education on how to use contraceptives. There is also a completely different side of the reproductive rights coin – many women who want to have children cannot. Is it not a right to be able to have children when you want them as well?

For any woman who has been to the doctor or had a discussion with her partner about family planning, contraceptive use, and reproductive issues – she knows that one size does not fit all, and often multiple approaches and trials are needed before the right form of treatment can be found. This is the heart of the problem for women’s reproductive issues – they are singular and individualistic making intervention and education difficult.

In the past week I’ve had the privileged of shadowing field workers from the Willows Foundation and Planned Parenthood Association of Ghana. They are taking the individuality of reproductive rights to heart, and their work revolves around going to women’s houses, and sitting down one on one to discuss a woman’s concerns, questions, issues, and plans together. The field workers – men and women trained to discuss reproductive manners – are all individuals within the local community. I wanted to write about this experience and share a gimps into these non-profits and specific women that are genuinely making a difference.

Part 1: Emma
I’m supposed to meet Emma, a field worker for Willows, at 8:00am on Saturday morning near Hot Coffee – an area of Nima. Nima is a slum, but an old, well established slum. Most houses are durable, with electricity and some sort of water source. My cab driver has no idea where Hot Coffee is, and as we inch through the traffic for 20 minutes, I finally realize that he is looking for a shop called Hot Coffee. Frustrated, I get out of the cab and call Emma. Handing the phone to a random passerby, I ask them to explain where I am, and after a lot of hand-waving, I’m directed up the street to ‘Gutta’. ‘Gutta’ is literally a giant gutter that holds Nima’s sewage as it flows to the ocean (the map below shows a part of Nima, with the giant gutter cutting through horizontally).

View Larger Map
I get to Gutta, and call Emma again. We are trying to find each other but in the throng of people, cars, and chaos it is still difficult. She asks me what I look like and I laugh – I’m a giant white woman in a sea of black people, I shouldn’t be that hard to find. Finally a woman strides up to me. Emma is about 5’5, wearing an orange and yellow printed fabric dress at the knee. She is lovely, but also very serious, quickly taking my hand to greet me, turning, and immediately diving into the pathways between compounds that make up Nima’s housing. The paths are perilous with rocks, trash, and tiny gutters flowing with things you don’t want to step in. She is difficult to follow as she speeds to her first client, already an hour late because of me. I’m not too worried though – Ghanaian time is flexible, and lateness of up to two hours is acceptable.

Emma has no problem locating her first client of the day, which is honestly baffling to me as all of the compounds look exactly the same. The last time she was here was a couple months ago, which makes it all the more amazing. As we enter the compound, we are greeted, and curious eyes follow us as Emma inquires about her client. ‘You are welcome.’ A huge mango tree grows in the middle of the compound – one of the few pieces of vegetation that has not been chopped down as it has continuous economic value. Client 1 is a quiet woman, even smaller than Emma, wearing wrapped fabric around her waist and a ratty t shirt with a faded sports team logo. Her eyes are huge, and she could be beautiful if she didn’t look so tired. Emma pulls out the client’s card, and begins to go through her list of questions, mostly in Twi, a little in English. When was your last period, are you currently sexually active, are you currently using contraceptives… at this point Emma stops as the woman begins quietly explaining something. Emma looks at her sympathetically, and pats her on the shoulder. The woman’s husband exits the room, greets us, and leaves – he is obviously not disturbed that Emma is talking to his wife. The discussion is wrapped up, and Emma makes some small notes on the clients card. As we leave I ask Emma what was said. The woman has been married for almost four years, and she has not been able to get pregnant. Emma has been working with her to convince both her and her husband to go to the local clinic for infertility treatments, and the husband has finally agreed. They are soon to go for their first appointment, and the woman has concerns.

Client 2’s compound is a very different atmosphere. Clothes are hanging everywhere in the courtyard, freshly washed. Three teenagers are helping a bunch of younger children dress, all of them are laughing and playfully hitting each other. As we pull up some stools and sit with Client 2, she is dressing her 3 year old daughter who is demanding 10 pesowas for a toffee. Client 2 is a very kind looking woman, her body and hair are covered in traditional Muslim clothing. She is eager to discuss matters with Emma, while at the same time handling her daughter who is trying to throw shoes out of a bucket at anybody nearby. She has three children: a 9 year old boy, a 5 year old daughter, and a 3 year old daughter. She shares with Emma that she is currently pregnant – an unplanned and unwanted pregnancy. Emma goes over with her how to use the morning after pill, even though its too late for that now. She explains and gives her a booklet on IUDs, birth control implants, and the pill. The young girl manages to steal 20 pesowas out of Client 2’s pockets and runs off, returning a minute later with a toffee and 10 pesowas in change. The mother is not angry, but she gives us a pained look, sighs, and in English says, ‘one more’.

Client 3 lives in the same compound as Client 2. She has two children already, and does not want anymore. But her husband does not want to allow her to do family planning or use contraceptives. Her and her husband are currently using condoms, but the woman wants something more permanent. This is a situation I have wondered about, what will Emma say to this? Emma has no qualms whatsoever. She assures her that its a decision the woman can make on her own if she wants to, she emphasizes the idea that the woman doesn’t have to tell her husband about this, she repeats over and over ‘its your right’. I’m surprised, but also impressed. The client is obviously conflicted, and Emma does not push her, rather talks her through a number of contraceptive methods. The woman does not respond enthusiastically to any, until Emma gets to the shot – a method that is 1 cedi per shot (about .60 cents) and lasts about three months. The woman lights up, she seems to think a three month period is a nice amount of time, its not too permanent, and the pricing is reasonable. Emma asks her when she will go to the clinic for the shot, and the woman becomes uncertain again. Emma then quizzes her about using the morning after pill, and once Emma is satisfied that her client knows how to use it, we leave. I ask Emma if she thinks the woman will go get the shot, and she sighs and admits that it probably won’t happen.

We visit clients until about 11, when I have to leave for another appointment. We meet a woman who has two children, is 35, and her periods stopped after her second born. She wants more children but the doctors don’t know whats wrong. Another woman is concerned about a lump in her breast – Emma feels it and urges the woman to visit the clinic immediately. Another client is 25, has never had a period, but is having regular sex with a boyfriend. Emma encourages her to visit the clinic to assess why she has not menstruated, and also explains the perils of unprotected sex. The girl does not look convinced. One woman has six children – and does not want more. She proudly tells Emma how to use the morning after pill, something that Emma has been working with her to learn to use. We also visit a woman with two boys, pregnant with her third child. With the help of Emma’s visits, the woman and her husband have decided to get an IUD after the birth of the third child. They are hoping for a girl.

Emma walks me back to Gutta, and after I catch a tro-tro I see her dive back in between the houses to continue visiting clients. Emma is patient with her clients, but also straight and to the point. She does not look down on their decisions, rather gently encourages and informs them, continuously repeating information with each visit. She is kind. Emma is not paid for what she is doing – its a volunteer effort on her part. But she diligently visits clients most days. Willows Foundation and PPAG have about 30 field workers meeting with more than 3,000 clients in the Nima/Maamobi neighborhoods. They have registered over 16,000 woman, and over the coming years hope to visit them all. Their efforts are not going un-rewarded, but change is very slow – so far just over 600 women have started using some form of family planning as a result of the program. Many woman who are visited do not immediately alter their behavior. It often takes multiple visits on a field worker’s part, spread out over a year or more, to see some kind of change. Emma notes that the most difficult aspect of her work is misinformation. One woman may try a method that doesn’t work for her, and then she doesn’t want to try anything again, while at the same time telling her story to her friends and kin. This kind of social networking can be a challenge and a blessing. Emma is basically working to break down and reform these strings of information, so that when women do share their experiences with other women, they can be more informative and positive. Change is happening: when I asked Emma if she thinks the program is working, she simply says ‘yes’.

Climate change and malnutrition (aka I'm back!)

02 Nov

I’m not making excuses or anything for this ridiculously long absence from the blog – but I got married (wedding was amazing!), and then had to deal with the aftermath of things I put off, and then I had my written exams (I passed – yay!) and had to deal with that aftermath…etc etc. The point is I’m back!

One of the things I’ve been doing is working on a paper that got published in Applied Geography on Climate change and malnutrition in Mali. You can download the paper here as well as the interview about it that appeared in Nature Climate Change.

This project has brought up ideas, issues, and even some conflicts for me – particularly having to do with conducting research on topics that are incredibly hard to conceptualize, and furthermore link. You can’t really go to a place and see all that climate change represents and deals with. Its such a grand concept that functions on a grand scale, and it even requires grand models to represent and understand it! Climate change, while obviously happening and effecting people already, draws much of its power from the abstract. A huge part of it deals in the realm of ‘what if’ and ‘in the future’. Furthermore climate change itself doesn’t really do anything – climate change is a driver that acts through particular systems to influence people and places, often with detached and numerous consequences. Global warming resulting in ice melting resulting in habitat loss, increasing water levels, etc. Climate change resulting in less rain resulting in fewer crops, economic difficulties, rising food prices, etc. I have such difficulty wrapping my mind around climate change – to me its the ultimate butterfly causing the ultimate hurricane.

Then there is child malnutrition – which in terms of numbers is also a grand issue – but in terms of reality comes down to such a simple single thing: a child doesn’t get enough to eat. I’ve had experiences with child malnutrition, seen the direct consequences of not having enough food. And I feel that understanding it in terms of numbers, a model, variables, does not do the problem justice. It seems to remove the human aspect of the problem that was the reason we care about it in the first place by reducing malnutrition to a set of variables. To me, a child suffering is a different type of hurricane. One that results in a vicious cycle and culminates in a suppressed economy. But where we are trying to understand the system that climate change works in and influences, child malnutrition is very much still a cause and effect issue.

So how do we study these grand concepts, and furthermore, how do we link them together, place them into larger systems, and stay sane? The article above is one stab, but we can do better. I’m proud of it, because it offers a specific place – a strip of land that is currently undergoing change, and that will be dealing with the shock of climate change sooner than the rest of Mali. It puts a local dimension into climate change research that for me personally, helps me wrap my head around what climate change is resulting in. Yet, there is so much missing. Of course we can always add more variables, but will that help to understand the problems? Maybe a little. I’m not entirely even sure how to research these kinds of problems together (beyond just adding more variables), but I’ve been thinking about it. I’ll keep you posted with what I come up with :).

Dream Spaces

28 Apr

I have been remembering a lot of my dreams lately, which is probably just a sign of poor sleep, however they have been making me think a lot about space within dreams. This is all rather abstract, so bear with me. In writing this post I find that it is very difficult to describe in words some of these thoughts.

In my dreams, space is very meaningful. In my waking world, it is more of a nuisance that I must deal with constantly. When I walk from point A to point B, I must plan a navigational route that conquers the absolute distance between the two points. When I want a glass of water I must calculate where my hand should reach to acquire the cup into my hand, and then bring the cup to my mouth. Space is there whether I like it or not, and I must find ways to deal with it. In my dreams though, space is negotiable. I’m not only talking about distance, such as when at one moment I am in a museum and in the next on a railroad, and in the next somewhere completely different. In dreams I can go from point to point without traversing distance, particularly if that is the function of the dream (to be in differently places seemingly at once). Beyond distance though, one can argue that while space is always present in dreams, the physics surrounding it are optional – for example when I am talking to somebody or interacting with an object space is present, however proximity, orientation, rotation, adjacency, etc. are negotiable through the dream. For me, this negotiation of my subconscious with space imbues space with much more significant meaning than in my waking world.

In my dreams, space becomes symbolic. If space is not there to carry some sort of function – for example I must traverse a path to get somewhere, I am running away from something, or something I need/want is beyond my reach – then space can be mutated (as in appearing in one place and then immediately another). So what does this mean about how I perceive and interact with space, both in my dreams and my daily life? There must be some connection here. So I, who has a good sense of direction, perhaps make better use of space in my dreams. What about people who have worse concepts of space in their waking lives? How do they negotiate space in their dreams? And then there is the question of places, landmarks, paths, etc. Is how I interpret these things in waking life reflective of how I would interpret them in dreams and vice versa?

In a way, dreams are the purest forms of cognitive maps. They are snapshots of our subconscious’s view of reality…a processing mechanism to translate what we see in our waking life into categories, codes, connections, and sequences. So what does it mean that I have particular dream places? When my dream occurs in a school, it is always the same dream school. When things happen in a family house, it is often the same dream house. The school and house can expand, mold, or change to suit a particular dream’s purpose. For example I recently have been having many wedding related dreams. In one we had a guest list of 2,000 for a 4 night affair – the family house expanded to include an estate like property complete with stables, pool, tennis courts, a stage, and a chapel. Yet the inherent qualities of the dream family home where still there. The brick, the wood trim, the garage – basic characteristics that did not change that clued me into knowing that this was the same house that pops up in other dreams. One example that I find particularly fascinating, is my dream European city. I have a distinct mental map of this city, and while new things are added from dream to dream, there is a basic structure, layout, and landmarks of the city that I know and can distinctly remember between dreams. Sometimes streets are longer, sometimes squares are much larger. Sometimes certain things are missing. Yet my image of this place is clear. There is a sketch of my dream European city below with some description – I am a very poor artist, just as a warning.

How is space present in your dreams? Do you use it, bend it to your dream will? Or are you as confined by it as you are in your waking life? Do you have particular dream places – landmarks? Or is each place new? I would love to hear about some of your spatial dream experiences!

My dream European town. The main square, changes in certain features, but there is a landmark giant cathedral tower that is always there. One street connects to the more industrial part of town, while the other street goes to historical buildings. There is an excellent patisserie there. I remember one dream where I yelled at my brother for going to the supermarket for croissants, when they were so much better at the patisserie. There is a hostel near there that I sometimes stay at, and for some reason I usually bring my dog, Buttermilk, and they agree to keep her there. Down the street is the transit station, which is often where new areas of the city develop from– I get on a bus/trolly/train, and find myself in a ‘new’ part of town. Now that is some symbolism for you. There is also ALWAYS a train that goes to some distant Eastern European city. I have gone on this train many times and usually find myself in different Eastern European cities of imagination. There is a bus that takes a loop that ends up at a sports complex (or at least my subconscious has never taken me further), and goes past my grandmother’s apartment house. The apartment house has very similar features as her waking place of residence, but there are always strange differences.