Western Africa: Ghana
This section will explore details relevant to the Western Africa Experiential Learning Program, inclusive of Ghana. Please visit the links below to access country specific information, which will be updated regularly.
Know before you go. Review the country overview to learn about the current social, political and economic trends as well as the relevant historical highlights.
Accommodations While Abroad
Fellows will be staying at the Time Tells Hotel in Akatsi, Ghana while traveling through Ghana. Unlike the U.S., many businesses and homes in hotels often do not have a physical address. Please visit this pages for additional updates regarding confirmed accommodations.
Health Guidelines: Ghana
The following Health Guidelines and Requirements are based on the current recommendations from the U.S. Centers for Disease Control and Prevention. It is important that students, parents, and physicians review these guidelines together to ensure a healthy and successful Program summer. We suggest taking this document with you to your physical examination. Ultimately, you (in consultation with your physician) should decide which immunizations and precautions are appropriate for your child. However, certain immunizations are required for entry into Ghana. Your child’s group leader will also review these guidelines during orientation to make sure students understand their role in staying healthy.
For your protection, we require that all students have up-to-date routine inoculations including: Tetanus, diphtheria, pertussis; MMR (measles, mumps, and rubella), and a negative TB skin test or chest x-ray.
In the case of Ghana, the Yellow Fever vaccine is the only immunizations required for entry into the country from the U.S. or into the U.S. from in-transit locations. The Program requires that all Fellows receive a Typhoid Fever immunization (either orally or by injection) as well as secure a Malaria prescription, the cost of which is determined by your primary insurance provider. Please discuss the relative merit of each with your primary care physician.
Additionally, several are strongly recommended to protect your own health, or may even be required if you are visiting other countries just before or after your visit:
• Hepatitis A: Hepatitis A vaccine, which provides long-term immunity, is recommended. It needs to be given at least 3 weeks prior to departure, with a booster at 6 months to one year.
• Influenza: Influenza vaccine should be considered for any individual wishing to decrease risk of influenza or non-specific respiratory illness-especially those who are at high risk for complications from influenza including those with asthma, COPD, diabetes, chronic cardiovascular disease and immunocompromised conditions.
• Rabies: Follow carefully the special instructions in the section on Rabies.
• Meningitis (Meningoccal disease): Recommended if you plan to visit parts of Ghana located in the meningitis belt during the dry season (December–June), when the disease is most common.
Please plan ahead since some immunizations require more than one dose for effectiveness. For your own comfort and protection, do not leave shots to the last minute!
Remember these are recommendations from the Centers for Disease Control and only those immunization specified are required by the Program. The decision to immunize is up to the student, parents and doctor.
To protect your health, you need certain pre-departure immunizations followed by reasonable health precautions while in the country. The following Health Guidelines and Requirements are based on years of experience and the current recommendations from the U.S. Centers for Disease Control and Prevention. It is designed to inform you of health concerns that may be present in Ghana especially as you venture to smaller cities off the usual tourist track, or spend time in small villages and rural areas for extended periods. Although no information sheet can address every conceivable contingency, the following Health Guidelines and Requirements are an attempt to provide you with a standard, which if followed, should optimize good health during your stay abroad.
You may find that local customs and practice, as well as varying U.S. physicians’ approaches, at times conflict with these guidelines. It is essential that you review these Health Guidelines and Requirements with your physician, particularly in order to discuss individual issues such as pre- existing medical problems and allergies to particular drugs. Any further questions or concerns should be directed to the U.S. Centers for Disease Control and Prevention (CDC) or to your own physician.
The Program may venture off the usual tourist track. Pay careful attention to health and safety guidelines.
Prevention of Insect-Borne Illness
Malaria: Malaria is present in parts of Western Africa and prophylaxis is recommended. The CDC guidelines suggest that prevention of malaria is possible if you follow personal protective measures carefully as described below and take one of the following antimalarial drugs (listed alphabetically) as directed by your healthcare provider: Atovaquone/proguanil (Malarone), Doxycycline, or Mefloquine. The selection should be discussed with your physician or health care provider. If, in spite of adherence to these preventive measures, you develop symptoms of malaria, prompt medical attention lessens the severity of the illness.
Consider the following when selecting an insect repellant, in particular for protection against ticks and mosquitoes, select products with one of the following active ingredients can also help prevent bites. Higher percentages of active ingredient provide longer protection:
- DEET (20% or more)
- Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
- Oil of lemon eucalyptus (OLE) or PMD
The following insect precautions should be followed, especially after dark, to prevent mosquito bites that may transmit malaria:
• Wear long-sleeved shirts and long pants.
• Use mosquito netting over bedding.
• Use insect repellents on bedding and netting. (e.g. permethrin – commonly known as Permanone).
• Use insect repellents on skin and clothing. DEET-containing products, e.g., Off, Off Deep Woods, Jungle Juice, Muskol. These products may be used on skin in concentration up to 30–40% and on clothing in higher concentration. Permethrin (Permanone) may also be used on clothing.
Prevention of Food and Water-Borne Illness
Diarrhea-producing infections: “Traveler’s diarrhea” is the most common form of diarrhea in Ghana. This is a self-limited diarrhea lasting from a few to several days, characterized by watery, non-bloody bowel movements. Traveler’s diarrhea usually requires no treatment other than fluid replacement including ORS (World Health Organization’s Oral Rehydration Solution which comes in package form) or other home-made solutions such as: 1 teaspoon salt, 1/2 teaspoon baking soda, and 2–3 tablespoons sugar or honey in 1 liter of clean water; another option is carbonated soda diluted by one half. Fluid replacement for more severe diarrhea could require up to 3–4 liters initially over 2–6 hours, followed by 8–12 ounces for each subsequent loose stool. Antidiarrheals such as Imodium or Lomotil may be used short-term in some circumstances. Pepto Bismol in large amounts and certain antibiotics (doxycycline, sulfa- TMP, ciprofloxacin) can prevent or attenuate the infection. Antibiotics are indicated for more severe cases of traveler’s diarrhea. More protracted and disabling diarrheal illnesses may be due to giardiasis and amoebic dysentery (caused by parasites) and bacillary dysentery (caused by bacteria), including cholera and typhoid. These infections (as well as “traveler’s diarrhea”) are caused by contaminated food and water. Therefore, the best way to avoid such infections is to respect certain dos and don’ts:
DO WASH your hands scrupulously with non-contaminated water and soap before eating and snacking.
• Bottled or canned beverages (water, soda, soft drinks, beer, wine) from a trusted source (ensure caps are sealed).
• Water that has been boiled for 5 minutes at sea level (longer at higher altitudes).
• Carbonated mineral water (to increase the likelihood that the bottle was opened by you and not filled at the tap).
• Tap water, even in ice or in mixed drinks (alcohol does not kill the disease-causing organisms); don’t risk using it for brushing your teeth either.
• Tap water in larger cities is often safe, but the water in rural areas is probably not, so be sure to check with a reliable source before using, and if in any doubt, take all the recommended precautions.
• Commercial iodide or tinctured liquid iodine to treat water, only if boiling water is not possible and bottled water (from a trusted source) is not available. Chlorine in various forms is less reliable than iodine. If not outdated, these provide substantial protection when added to tap water.
• Cooked vegetables and fruits with thick covering (citrus, bananas, and melons); these should first be washed with soap and rinsed in boiled water before cutting with your own clean dry knife; also, thoroughly wash your hands before touching food. Other vegetables and unpeeled fruits can be eaten if soaked for 30 minutes in iodine solution the color of weak tea.
• Meat or fish that is thoroughly cooked (pork and lamb should be very well done)
• Pasteurized dairy products from large commercial dairies.
• Raw vegetables including salads; rinsing them in water will not clean them unless extraordinary measures are taken, not usual in most restaurants.
• Fruits that do not have a thick, disposable outside covering.
• Rare or raw meat or fish or shellfish.
• Dairy products from small, independent vendors without pasteurizing facilities, including food of any kind that has been left out in the sun, especially custards, creams, and mayonnaise.
• Raw (un-pasteurized) milk or milk products. Tuberculosis and brucellosis, both serious diseases are transmitted in this way, so the consumption of un-pasteurized milk and milk products should be strictly avoided.
Residents of our host country may be quite sensitive to the implications that their food and water are not safe for consumption. Due to acquired immunity over generations of exposure, our hosts may not be at risk of becoming ill from consumption of local food and water. There may be times when refusing an offer of a drink with ice, or avoiding the salad, will be considered rude. Even the most careful travelers may have to consider compromise on these occasions, or in instances where alternative food and beverages are not available. You must decide for yourself, but excuses, thought out in advance, are often handy. Discuss these alternatives with your Group Leader(s).
Hepatitis A: Hepatitis A is a highly contagious virus that causes liver inflammation. It is most commonly spread through contaminated food and water. Most Americans have not previously been exposed to the hepatitis A virus and are at risk of contracting the disease during travel to areas where the disease is more prevalent. A very effective vaccine is available and should be administered 2–3 weeks prior to travel.
DO NOT SWIM OR WADE IN FRESH WATER.
• Schistosomiasis, a parasitic infection that can be spread in fresh water, is found in Namibia. Avoid swimming in fresh, un-chlorinated water, such as lakes, ponds, or rivers.
•Heat bathing water to 50°C (122°F) for 5 minutes (if using untreated water that comes directly from a freshwater source such as canals, lakes, rivers, streams or springs). This will destroy the parasites. Iodine treatment alone will not guarantee that water is safe and free of all parasites.
• Filter untreated water with a tightly woven cloth or with paper filters. This may also be effective in removing the parasites from untreated bathing water. If these measures are not feasible, allow untreated bathing water to stand for 3 days, since the parasites live only 48 hours.
• Properly chlorinated water that is piped into homes, chlorinated pools and salt water are generally safe from infectious diseases.
• If accidental exposure to suspected water occurs, immediate and vigorous towel drying or rapid application of rubbing alcohol to exposed areas may reduce the risk of infection.
If you suspect that you are infected, contact a doctor or hospital immediately and obtain urine and stool tests. If you do test positive, Praziquantel is the treatment of choice.
Typhoid Fever: Typhoid is an infection caused by a particular species of the salmonella bacterium. It is spread by contaminated food and water. Symptoms include fever, severe toxicity, rash, and in about half the cases, bloody diarrhea. Untreated, there is a 30% mortality rate. Vaccines are 60–70 % effective in prevention. One vaccine involves a single injection, with immunity lasting 2 years. A second one is administered orally every other day for 4 doses, and lasts 5 years. Antibiotic resistance has been developing, but treatment of the disease with certain well-known antibiotics is usually effective. As with all diarrheal illnesses, careful dietary discretion continues to be the main line of defense.
Hepatitis B: Hepatitis B is a serious and often chronic viral infection of the liver. Since this type of hepatitis is most often acquired from contact with infected blood, or sexual contact (as with HIV), or from skin-to-skin contact of mutual open cuts and sores, appropriate precautions to avoid these types of exposure are necessary. This includes avoiding tattooing, ear/body piercing, and cuddling children with sores and draining insect bites. A series of three immunizing injections is recommended. This series should be initiated as early as possible so that at least two doses are taken prior to departure. This will provide partial protection. The third shot should be taken five months after the second dose, and may be given after returning home to achieve full, long-lasting immunity. An accelerated schedule can also be used as an alternative.
AIDS and Blood Supplies: AIDS is a concern worldwide. AIDS is an acquired immune deficiency that can result in life- threatening infections. The HIV virus is transmitted by way of bodily fluids from an infected person. Abstinence is the surest way to prevent contracting the disease via sexual transmission. It is the student's responsibility to protect him /herself from acquiring the disease through sexual transmission. Condoms are generally available abroad but may not be of good quality. Students anticipating even the possibility of sexual activity are strongly urged to bring their own condom supply. Other potential routes of infected blood transmission such as tattooing, body piercing and needle sharing must be strictly avoided. With regard to blood transfusions, the local US Embassy may identify hospitals where ʻʻsafeʼʼ blood is available. In a life-threatening situation, the risks versus benefits of an emergency blood transfusion must be examined carefully and a decision made based on the best information at hand.
Rabies: Rabies is a viral disease almost always caused by animal bites (especially dogs). It occurs in mainland Ghana and, therefore, you should take measures to prevent it. Given the serious danger posed by rabies as a uniformly fatal disease, follow these important guidelines:
• Consider pre-exposure immunization (if available).
• Avoid bites from all animals and especially avoid handling or feeding puppies, kittens, monkeys or other animals. They can have rabies before it is obvious• If you have been bitten or have had direct contact with the saliva of a suspected rabid animal, immediately wash the affected area with a soap solution and running water thoroughly to neutralize and to rinse out the virus. Then proceed immediately for post-exposure treatment, the sooner the better; depending on the location of the bite, you may have little time.
• If at all possible, the animal should be captured and kept under cautious surveillance until the diagnosis and therapy are completed. If capture is not possible, a clear description of the animal and the circumstance of contact should be carefully recorded.
Tuberculosis: Tuberculosis (TB) is a bacterial disease spread by airborne droplets from a person with untreated pulmonary TB or by ingestion of TB-contaminated unpasteurized milk products. Transmission is more likely in conditions of crowding and poverty. A TB skin test can indicate prior exposure to tuberculosis and is required prior to travel (unless already known to be positive). A repeat test is recommended after returning to the US even if the pre-departure test was negative.
Sun Exposure: The Program recommends the use of sunglasses, wide-brimmed hats, sunscreen lotions and lip protection to reduce problems related to sun exposure.
Take good care of yourself!