Two days after I returned from Ghana, the Ghana Standards Authority (GSA) finally sent me the selenium concentrations of selected Ghana foods run by spectrometry and I could now begin my data analysis. Interestingly, I thereafter became the cause of my own delay—in my attempt to calculate the total selenium intake of the population of pregnant women my research team surveyed, I unknowingly went about a long path to analyze the data. As I see it, it was part of the learning process. Furthermore, the purpose of my practicum research was to carry out a feasibility study to make recommendations for a pilot study to be carried out in the future. This structure freed my mind to accept every part of the process as not a success or failure, but instead a lesson for improvement.
Seeing all of the moving parts of my project come together left me desiring to continue this work into the career path that I choose as a physician. Studying the relationship between micronutrients and pregnancy is a path where there is a lot of room to grow and discover. Policy changes and clinical counseling recommendations can come from this kind of research. Potentially, I can turn this foundational work into a career-long pursuit that helps to improve the lives of women not only in Ghana but also around the globe.
I am grateful to each mentor, preceptor and advisor who helped me complete this project. I could not have done it without their support. I look forward to seeing what my future holds in this field!
My star research team and me (front row, in white coat)
As a 3rd year medical student, I began brainstorming with one of my mentors how I could integrate my interests in women’s health and global health together. By the start of my 4th year, and just a few months before I began my MPH degree, I knew I wanted to study the relationship between dietary selenium deficiency in pregnant women in Ghana. It has been my habit to find every academic excuse to do work in this country, as a first generation Ghanaian-American. In 2014, it was a nutrition internship at Noguchi Memorial Institute for Medical Research (NMIMR) the summer after my sophomore year in college. In 2019, it was a 4 week internship with Ubora Institute, a Ghanaian owned healthcare quality improvement (QI) organization. Interestingly, my project for this internship became a mixture of both past experiences– studying the process of administering dietary recall surveys (QI and nutrition) to pregnant women of Korle Bu Teaching Hospital (KBTH), the primary public tertiary hospital in the southern region of Ghana.
My previous experiences in Ghana taught me that in order to be effective in reaching my goals, I need to start early and communicate often with people on the ground. Delays were a common part of my experience both times. At NMIMR it was unavailability of nitrogen gas for beta-carotene analysis. At Ubora Institute, it was the Ministry of Health that delayed in giving me approval to interview government health care workers to assess the successes and failures of a completed maternal mortality intervention. This time around, I was determined to hit the ground running with my practicum and begin work as soon as possible to prevent these delays from occurring again.
Training session before data collection
I figured that I would receive approval from the KBTH Ethics Committee within a few weeks of submitting my application, which I did in mid-January, then could submit my UNC IRB soon after. Despite the fact that my UNC IRB approval came before my KBTH approval, the latter finally came on May 10th, the day before data collection (note the ~4 month delay).
My research assistants preparing food samples in the lab
My first two weeks in Ghana were everything I could have imagined and more. Every single research assistant (RA), mentor and supervisor were as enthused about my work as I was. RAs and I did nutrition lab work together, running food samples of endemic Ghanaian foods to determine their selenium content. They subsequently eagerly showed up to do the training for data collection at KBTH. Data collection was beyond successful– we took advantage of the high clinic volume and completed more surveys than anticipated each day.
My RA interviewing a patient during data collection. Verbal consent received
The final two weeks, during which I scheduled to complete my data analysis and report writing, I waited 1.5 weeks for data from the Ghana Standards Authority (GSA) needed to complete my data analysis.
Despite my attempts to control delay, each experience I have had has taught me something new about working in the Ghana context. Giving up working in Ghana is not an option for me– this country holds much of my heart. I am actively working towards a career as a public health physician that will incorporate service in Ghana annually. With perseverance, an open mind to continue adapting, and a lot of heart, I will overcome delays, and as I expect, I will leave a big mark here.
