Sicknesses of the Heart and Mind

 A NYT piece on the Affordable Care Act indicates that people who have gained health care coverage are experiencing improved mental health because they no longer worry about how to access health care. One interviewee, who now has consistent care to manage diabetes stated that, “The heavy thing that was pressing on me is gone.”  I focus my research energies on the heavy things that press on people here in the Upper West Ghana. It turns out I’m not immune from my own heavy things either as I continue to cope with being a stranger becoming no less strange in a strange land.  

Medical anthropologists approach health in a holistic way. I study how emotional strife originates, navigates into the mind, and settles in the body. I investigate how illness, as medical anthropologists Nancy Scheper-Hughes and Margaret Lock (1987) assert, is a form of communication by which nature, culture and society speak simultaneously. Such an approach looks for how proximate biological symptoms have ultimate factors of causality that are social. 

Here in the Upper West region of Ghana, where farming is becoming an increasingly challenging livelihood, and access to other viable income earning opportunities are constrained, emotional strife is not difficult to uncover. No matter where you are in the world, managing a household on marginal incomes is stressful.  It involves daily decisions about how to meet immediate needs like food and health care while not neglecting future needs.  A common scenario in this region is the struggle to farm to feed children while also ensuring that their increasingly expensive school fees are paid.  The higher the educational attainment, the more likely they are to obtain a salaried job and the more likely they are to be able to take care of ageing parents constrained to farming.

People operating under these circumstances talk about “thinking too much”, a local idiom that describes a brain overwhelmed with the need to solve various economic problems. People who identify as doing too much thinking talk about how the activities of the brain result in poor sleep, body pains and dizziness.  Some people identify these symptoms as congregating in an illness locally known as worry sickness.   Thinking too much can also, and quite deleteriously, travel to the heart.  When worry settles in the heart, a more debilitating illness, which translates as heart sickness, can result.  This illness of the heart somewhat resembles hypertension and somewhat resembles severe anxiety disorders. Regardless of its clinical categorization, it greatly limits the amount of work that people can perform, thus reducing their income and feeding back into a cycle of thinking too much.

Not surprisingly, prevention of the onset of worry sickness and heart sickness is companionship.  Both men and women identify socialization as the primary way to put too much thinking at bay. Both men and women actively seek out their peers to discuss their worries and ways to mitigate them. 

It’s also not surprising that the most well-adjusted sounding anthropologists are those who have moved to their field site with a significant other or a family unit. 

Fieldwork is not hard because I don’t have indoor plumbing. Fieldwork is mother trucking hard because it is always emotionally overwhelming.  Without someone who is also simultaneously experiencing and understanding that emotional hurricane, it’s hard to keep these heavy things from pressing too hard on me.

I think I just took 5 days of Ciprofloxacin to cure homesickness.  When I get homesick, my heart feels like it’s sinking into my lower abdomen and I embody the “heavy heart” idiom common in the US.  And I’m beginning to suspect that this weighty melancholy instigates other physical symptoms.  Since starting fieldwork I’ve had phases where I become intensely nauseous. It’s a sickness that is not comparable to the “well I shouldn’t have eaten that” illnesses I have previously experienced here.  I think these phases of nausea have psychological rather than organic origins.  I think these phases are a way that my body is rebelling against my social circumstances.  The waves of nausea may be my body’s way of saying “Why the hell are you even here???”

If only emotional ailments could be treated with something like Gripe Water

Cipro won’t cure my heart sickness. So to keep my social protest stomach at bay, I’m trying to play with as many roaming puppies and babies as possible without looking too loony. I keep working my way through the WTF canon and am cultivating quite a fictional friendship with Marc Maron.  I’m also packing in as many evenings with my adoptive family as possible.  Even though we can’t share laughs over references to Arrested Development, we can drink beer together and share laughs over the universal funniness of flatulence. Sinking comfortably into the backdrop of a busy, loud and welcoming house (farty or not) is a pretty good social medicine for keeping those heavy things from always pressing too hard on me. 

Somebody Still Loves You Barack Obama

When my nationality is inquired about,  usually within seconds of my response, "Obama!!" is gleefully shouted.  For a country that loves to hate its own politicians, it is pretty infatuated with my own president.  This love emerges without consideration of who Barack Obama is as president. 

It's kind of refreshing to be away from the disillusioned disappointment of Obama's supporters and vitriolic hatred of his haters. Here Obama is more of an ethereal figure--a man who doesn't have to stand for what he does,  but is admired simply for his eloquent movement  into a realm of power and prestige.  

Here he joins the ranks of rappers with admirable haircuts. 

And his message of hope and change is not used to amplify grand policies such as national health care, but rather it is all that is needed (alongside a toothbrush) to encourage healthy teeth and gums. 

Here, he even has his own cheer leading squad. 

 And boys deck out in the "Obama Tuxedo"

Where a jersey is best accompanied by embroidered jeans

So, regardless that back in the USA where Obama is greying crazily fast and looking dour and mournful as he tries to salvage the pre-presidential legacy that gave him the opportunity to gain a presidential legacy, here he is a man that is likeable enough that he sells cheap, yet comforting biscuits called Obama Biscuits.   It's a lot easier to digest this Obama. 

Searching for Saalong

At the risk of sounding like a line Meryl Streep probably delivered in Out of Africa, “Thank God the rains are coming.” I am thankful for the rains because the temperature drops and the dust is contained.  The world looks and smells refreshed and I can sleep without sweating and thereby come a little bit closer to looking and smelling refreshed.  The rains are also bringing out critters.  The other night I woke up to the sound of 2 furry spiders galloping across my room.  In the ongoing tournament for MVFP (most valuable fieldwork possessions), in the current bracket, furry spiders initiate the triumph of mosquito net over Kindle.

There’s obviously a lot of relevance to the start of the rains to my research on food and farming as well. Though farming is still about a month or two away, the rains are bringing new green growth in the wild.  Tiny shoots are springing up out of the still very dry earth.  Some of these tiny new green things are edible.   Last Saturday I was invited to accompany some teenage girl on one of their recent foraging expeditions for such a green edible called saalong.  

I’m hyper self conscious when it comes to foraging for things because as a child I failed in every single morel mushroom outing I ever had.  During the springtime morel season, I’d board the school bus and my bus driver would boastfully hold up the giant bread bag of morels he had gathered in the morning.  Those dumb mushrooms evaded me in every angry march through the woods. 

I got a little flustered, therefore, to see that saalong is not even close to looking substantial in girth.  It’s teeny and grows as close to the ground as it possibly can.  If I couldn’t find a mushroom how was I going to find this tiny plant, a tiny plant that I suspect might actually be classified as an herb? Well it took about 5 tries, but I did eventually and correctly identify saalong.  Much to the amusement of my young female friends, I threw my arms up in the air in celebration, feeling vindicated for every little elfin mushroom that has ever escaped me.  I never determined any kind of pattern for where saalong might be found and noticed that the girls were very careful to pluck only the leafy growth so as to leave the roots intact. We paraded around the bush for about 3 hours.  By the end of the expedition I’d say that each girl had about 1 cup of saalong to take back home, an amount substantial enough to do what it is valued for—making soup slippery.

Saalong that I found

How close to the ground you have to be to pick saalong

About 90 minutes in to collecting saalong, this was the amount procured.  I got great delight that one of my companions was collecting her saalong in an old bread bag-it was this that made me remember all of my bitter and happy morel mushroom memories.

Saalong is helping to drive home the point that food security is not just about having food, but having food that is prepared in a way that is most appreciated and enjoyed.  Commonly used products from the savanna forest (including leaves, seeds, and fruits) contribute to how food tastes and, perhaps even more importantly, how it feels.  Yes, how it feels.  There is a very strong preference for foods that are “slippery.”  Slippery is the less caustic way to describe the sliminess I often ascribe to okra. Though I’ve yet to dig deeper into the matter, I’m guessing that a slippery texture is important for soups because slippery soup covers the staple porridge quite well.  Slippery soup really isn’t my cup of tea, but it is the cup of tea for people here.  If they didn’t value this aspect of their food culture, no one would spend 3 hours searching for it under the glare of the savanna sun.

Even though I’ve never been able to supply my own morel needs, I’ve eaten my fair share of them and appreciate their fleeting buttery presence. Perhaps one of my earliest food memories is sitting in a tavern eating deep fried morels and knowing that because they came from the woods and not from the grocery store, they were afforded a degree of admiration for the time (and obviously talent) they took to find. So even though saalong and it's slipperiness isn’t my cup of tea, I understand why it’s important and not to be neglected in talking about food security in the Upper West and why it and other foraged for foods need to get on the radar of the designers and planners of food and nutrition interventions. 

Attempting to capture the slipperiness of the saalong as it is used in soup.

Making Sense of Mangos

Fruiting trees are pretty rampant in the savanna.  However, compared to the fruit producing forests of the south, where pineapple farms are aplenty, the fruits of the north serve different purposes.  Some fruits are valued for their flavor and some for their seeds, but few for their flesh. 

Fruit stand in Accra

Pineapple farm in the outskirts of Accra

As a lover of fleshy fruit, I’m having some difficulties adjusting to the fruits at my disposal.  February was dominated by cashew fruit. Cashews produce a beautiful fruit that is also quite tasty.  However, cashew fruit did not a fruit hankering quench.  Mangos, however, hit the mark.  Mango trees, though not indigenous, have been around a long time and are a very common tree. They provide great shade and great fruit.  And they just came into season.

Cashew fruit sitting on top of the cashew nut

Chiraa-a fruit I can only describe as being kind of like a pomegranate if a pomegranate only had 1 big seed inside that was not very juicy. 

Mangos are the reward for enduring the hot and dry season.  I like to think that every day the temperature climbs past 105 is a day that makes mangos extra sweet. Not surprisingly, mangos are valued as a food source. In my most recent round of surveying households on their food security status, it’s apparent that many households are already running out of their stored food from October’s harvest.  Many are employing meal cutting strategies to make the food last a bit longer before they are dependent upon purchasing food.  As such, mangos are valuable hunger quenchers and vitamin boosters. 

Surprisingly, I'm also learning a lot about social relations and dynamics with the mango boom. Ownership of mango trees is difficult to parse out.  The very large trees around the borehole seem to provide communal mangos.  After school, these mango trees become battlegrounds.  Previously I would have described mangos as something that one foraged for.  Now I’m convinced that mangos are indeed prey that require sleuth and strategy similar to hunting.  Long sticks are employed as weapons to knock them out of the trees.  Children also climb into trees to get the finest pickings.  

Mangos fit much better in bike baskets than watermelons

Two weeks ago a young boy fell out of a mango tree and pretty severely injured (probably broke) his arm.   In visiting with the boy and his parents I learned that they were not going to take him to the local hospital even though they had health insurance to cover the hospital fees. Instead they were going to rely on local medical practices to for bone setting and healing.  In inquiring a bit more about this decision making process, I learned that the local hospital is not able to take care of broken bones. Rather, they refer patients to distant hospitals that require expensive transportation fees that are above and beyond what people in this community can afford.  Even with relying on more affordable care options, these parents were pretty stressed with the situation as even localized care requires fees or in kind that can be pressing for households with minimal income. 

Smaller trees, where the fruit dangle not meters above your head but tantilizingly in front of your face, are claimed as owned. These trees are often adorned with items such as a turtle shell or ram horn to make potential thieves think twice about crossing the spiritual forces guarding the fruit. Just as mangos are good food sources, they're also good money sources.  When you don't have a surplus maize crop to sell, a surplus mango crop can provide an income boost. 

Mango trees growing inside courtyards makes ownership easy to decipher

Last week a young girl of about 10 was out in the bush collecting mangos.  When she saw someone approaching her, she assumed it was the owner and went into panic mode.  She dropped her toddler sister in fear and ran off.  In a country where spirits are protecting against thievery and where and theft is punished with vigilante justice, panic mode is the only mode for being caught in the act. Unfortunately, when she got home she wasn't able to relay where she had left her sister, thus initiating the localized form of the Amber Alert. All men in the community came together to form organized search parties to cover the expanse of the bush.  Luckily the child was found. When she was returned to her parents, everyone in the community went to the family's house to receive her.  I guess sometimes it does take a village. 

I value being witness to such effects of mango season because I'm reminded of how social undercurrents reverberate to both create and solve problems. Mango season is important for its nutritive contributions, but  negotiating the risks involved in accessing those mangos requires understanding more about social relations and social dynamics. This is, ultimately, the lesson that the world of philanthropic development continues to learn.  Just because a mango tree exists does not mean everyone will have equal access to mangos. Just because health insurance is activated and a local hospital exists does not mean that the provision of basic service will be available.   And that is why nearly every anthropologist's conclusion is "but it's more complicated than that."