I’m in the taxi again, [heading] for teeming, lively, colorful Nima—the Nima that intrigues me, the Nima that suffers, the Nima with a sense of belonging, the Nima of feeling, the Nima of endless goats and sheep intermingling with people, cattle, open sewers . . . . It’s the Nima where our group works with the citizens, for the citizens, right now doing health research, right now asking the Nimans what they think their major health problems are, and asking what they want.
--- excerpt from Jonathan Mayer’s email journal from Nima, Ghana

	Children in Nima, in the Ghanaian city of Accra.Photo by Julia Lowe.

It started innocently enough. Jonathan Mayer had come to Ghana to work on a research project funded by the Norwegian government. During his stay, two well-known researchers from a prominent Ghanaian research institute invited him to collaborate on another study, this one focusing on parasitic diseases. They took him to the proposed project site—Nima, a desperately poor neighborhood in Ghana’s largest city, Accra—and Mayer’s life changed forever.

“After my first walk-through of the area, I knew that I could not return to do ‘objective’ research without contributing to the community,” recalls Mayer, UW professor of geography, epidemiology, and medicine. “I was so taken aback by the lack of public health infrastructure that I wanted to do something more ambitious than research on parasitic diseases. I wanted to assemble a group that could help develop some ongoing health programs there.”
Nima’s challenges would overwhelm even the most staunch Pollyanna. It has no central water supply. Open sewers line the neighborhood’s dirt roads. Literacy is low. There is one full-time physician for 150,000 people.

Mayer made several return trips to Nima, eventually recruiting colleagues from several institutions in the U.S. and Norway to visit with him and his Ghanaian colleagues in July 2005. He also invited UW graduate student Courtney Donovan and undergraduate Julia Lowe, an international studies major.

The group first contacted community leaders—ranging from Ghana’s minister of health to 18 tribal chiefs in Nima—to ensure that they were welcome. Then they spent days walking through Nima, talking with citizens about local health issues.

Jonathan Mayer talks with women about their health concerns. Photo by Julia Lowe.

“The people were blown away by the idea that foreigners were interested in what is considered the poorest area of Accra,” says Mayer. “They feel totally neglected, shunned by their own society.”

With the information they gathered, the team was mobilized to move forward with the project. Next they obtained census data for Nima, constructed a formal survey for Nima households, sought funding, and researched the requirements for creating a non-governmental organization (NGO) in Nima. (Their non-profit is now officially incorporated in the State of Washington.)

The team returned to Nima in July 2006, visiting about 40 households to test several versions of their survey. Their goal was to develop a single survey that can be administered on a much larger scale with additional funding. “We now have a survey in which every answer will help us do something valuable for the community,” says Lowe, who recalls comparing notes with her colleagues and revising the survey each evening.

	Julia Lowe ('06) shows children photos of themselves on her camera.Photo by Jonathan Mayer.

Questions range from the number of people living in the home, to the source of the household’s water, to bathroom facilities (or lack thereof). Specific health questions include the incidence of tuberculosis and malaria and how such illnesses have been diagnosed and treated. The researchers also took blood pressure readings.

“Blood pressure measurement frequently reveals hypertension, and we believe those measures are crucial,” says Mayer. Blood pressure tests are also a way to give back to the community. “So few people can afford any treatment at all,” explains Mayer. “This is something that we can provide. We had people lining up for blood pressure checks.”

That did have its drawbacks. People sometimes viewed the research team as doctors, which they are not (although Mayer has considerable expertise in tropical medicine and infectious diseases). They looked to the team for answers, which no one, regardless of medical degree, would have been able to provide. “We don’t have the answers,” says Lowe. “We’re just trying to ask the right questions.”

Mayer admits that he is “just short of obsessed” with this project. Now others—including Julia Lowe—share his obsession.

Lowe recalls spending long days visiting Nima’s residents this summer, with five-minute conversations resulting in four-hour visits when families wanted to feed their guests and chat. “At the end of each day I would be exhausted, collapse into bed, and then not be able to sleep because I was so focused on what I’d seen,” says Lowe. “The deeper my understanding of the problem, the more it would wear on me on an emotional level. I felt a sense of urgency. This community deserves so much more.”

Open sewers line the streets of Nima. Photo by Jonathan Mayer.

Once funding is in place—in the next few months, Mayer believes—the team will establish a full-time presence in Ghana and train Ghanaians to administer the survey. They hope to reach approximately 5,000 households in Nima, to identify the region’s most pressing problems and target the best use of resources. The goal, says Mayer, is not for the team to decide how to address Nima’s problems, but rather to help the community take the lead.

“The survey is the first small step on a very long road of community building to catalyze change,” says Mayer. “We have to find out where we are, in terms of health issues in Nima, before we can start going anywhere else. But our long-term goal is for the people of Nima to do their own health education and lobby for their own clinics. ”

Mayer already has identified the best person to staff the NGO in Ghana: Julia Lowe. “She has graduated, she’s knowledgeable, extremely organized, mature, and she wants to live there,” says Mayer. “It’s a perfect fit.” Lowe is thrilled with the prospect. “It’s been hard to be there and just be a visitor,” she says. “I think I’ll be a more effective worker when I have a life there and the Ghanaians know I have a life there.”

Mayer will remain in Seattle, but he will continue to visit Nima several times each year. It would be hard to keep him away.

“Nima has changed my life,” Mayer says. “When I’m there, I feel an emotional connection with the people rather than a removed clinical connection. I spend a lot of time worrying about them. It’s very exhausting work—the heat, the humidity, the uneven terrain that makes me look carefully to avoid falling into an open sewer. But I’m always excited to be there, jumping into the work. To see my vision develop and become a reality —it’s going to be fantastic.”